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March 18, 2026 Get Citation Alerts Download PDF Add Note

People v. Stroh CA1/4

California Court of Appeal

• Citations: None known
• Docket Number: A173906

• Precedential Status: Non-Precedential

• Opinion

• Authorities (4)

• Cited By (0)

• Summaries (0)

• Similar Cases (10.4K)

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Combined Opinion

Filed 3/18/26 P. v. Stroh CA1/4

NOT TO BE PUBLISHED IN OFFICIAL REPORTS
California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for
publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication or
ordered published for purposes of rule 8.1115.

IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA

FIRST APPELLATE DISTRICT

DIVISION FOUR

THE PEOPLE,
Plaintiff and Respondent, A173906
v. (Alameda County
THOMAS STROH, Super. Ct. No. 21MH0147451)
Defendant and Appellant.

Thomas Stroh appeals from the trial court’s grant of the People’s
petition for an order pursuant to Penal Code section 1370 to compel his
involuntary treatment with antipsychotic medication. He contends the order
is not supported by substantial evidence. We disagree and will affirm.
I. BACKGROUND
In December 2021, the Alameda County District Attorney filed a felony
complaint charging Stroh with unlawfully driving or taking a vehicle (Veh.
Code, § 10851, subd. (a)) and assault with force likely to produce great bodily
injury (Pen. Code, § 245, subd. (a)(4)).

1
On March 19, 2025, defense counsel declared a doubt as to Stroh’s
competency to stand trial.1 The court suspended proceedings and ordered a
psychiatric evaluation of his competency. On May 2, 2025, the court found
him incompetent to stand trial and subsequently ordered him committed to
the Department of State Hospitals (DSH) for up to two years.
On June 27, 2025, DSH filed a petition in Alameda County Superior
Court for an order pursuant to Penal Code section 1370 (section 1370) to
compel Stroh’s involuntary treatment with antipsychotic medication
(petition). The DSH attached two exhibits to its petition: a June 23, 2025,
13-page certification report prepared pursuant to section 1370, subdivision
(a)(2)(C) by Dr. Sarah J. Polfliet, which extensively reviews Stroh’s mental
disorder, symptoms, and behaviors, including a history of delusions and
violence, his denial of his mental disorder and need for medication, and his
need for medication; and a June 26, 2025 administrative law judge’s order
that Stroh could be involuntarily administered antipsychotic medication until
July 14, 2025, later extended to July 17, 2025.
On July 17, 2025, the trial court held a hearing on DSH’s petition. The
only evidence presented at the hearing was the testimony of Dr. Richard
Cross. Dr. Cross was a DSH staff psychiatrist working in the section 1370
restoration competency hearing unit who, since June 17, 2025—the date
Stroh was transferred to his unit from Alameda County—was the

1 The three-and-a-half year gap between the filing of the complaint and

of defense counsel’s declaration is perhaps explained by evidence presented at
the hearing that we will soon discuss that Stroh had another case in San
Mateo County for which he was hospitalized as incompetent to stand trial
from August 15, 2023 to September 5, 2024. At the end of that commitment
he was found unlikely to regain competency. Apparently, that case was
dismissed and Stroh was then transferred to Alameda County for this case.

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psychiatrist in charge of Stroh’s case. He testified as an expert in the
psychiatric treatment of mental illness.
On direct examination, Dr. Cross testified that Stroh’s current
psychiatric diagnosis was schizoaffective disorder bipolar type. According to
Dr. Cross, Stroh’s symptoms “are most notable for paranoid and possibly
delusional belief systems. . . . He has been very paranoid. And when the
symptoms get worse, he’s had a history of acting out violently in defense of
his system of beliefs.” Stroh “is frequently in distress and fearful of the staff.
In previous instances, he has been aggressive towards staff members. He has
told us that the doctor who testified in a previous hearing perjured
themselves and needs to be prosecuted for perjury.” Dr. Cross further
reported that “we haven’t seen any overtly violent behavior since [Stroh’s]
admission here in the current episode that might be due to partial response
to the probably inadequate amount of medication that he wasn’t receiving
under these current circumstances. We are grateful for that. But we are
worried about the risks going forward.”
Asked if Stroh was aware of his psychiatric condition, Dr. Cross said
that Stroh had “stated many times that he does not have a mental health
problem and is quite fearful of various medications. We are not able to
discuss what appears to be his treatment history with medications . . . and he
hasn’t been cooperative with our recommendations.” Stroh had told Dr.
Cross “several times” that he did not have a mental illness.
Dr. Cross opined that Stroh did not have the capacity to make decisions
about the administration of antipsychotic medication. Stroh was “unable to
describe . . . a recognition of the condition and what treatment options are
available and the pros and cons of each one, including the risks of no

3
treatment.” Further, “[w]ithout treatment, his risk of disruptive or
aggressive or violent behavior is quite elevated.”
Dr. Cross further testified that untreated patients such as Stroh could
engage in “[a]dditional episodes of behavior that could result in new criminal
proceedings, injuries, inability to meet one’s basic needs in the community,
an inability to remain at liberty in the community without new encounters
with the police, episodes of seclusion or restraints in treatment settings.”
Also, Dr. Cross, noting that Stroh had not been treated since the previous
December, opined that the longer a person such as Stroh goes untreated, the
lower the chances for a good outcome with treatment. Nonetheless, Dr. Cross
said, Stroh “has a condition that we would expect would respond quite well to
the treatment we’re proposing.”
Dr. Cross indicated that Stroh was resisting taking the presently
prescribed medication, which consisted of two antipsychotic medications,
quetiapine and Haldol, and a traditional medicine stabilizer, lithium. There
were “several instances” where Stroh had to receive the “[involuntary
medication] backup under the temporary involuntary medication order. He
“typically sa[id] that a prior medication caused a side effect syndrome,” but
Dr. Cross was not able to discuss the details with him or compare Stroh’s
stated concern with his treatment records. Stroh preferred a particular
medication that did not satisfactorily resolve his symptoms and he would not
take any of the other medications that were needed to effectively treat him.
Dr. Cross believed that Stroh would not take medication required for his
treatment without an involuntary medication order.
On cross-examination, Dr. Cross was asked if there were “any
symptoms or apparent conditions that you can specifically describe or
worsening in [Stroh’s] current commitment.” He responded, “The falsely held

4
paranoid beliefs could get reinforced with more experience that confirms
what he believes, which is that he is being mistreated by the treatment team,
and the treatment team is not interested in helping him. This could further
degrade his ability to form trusting treatment relationships with providers in
the future.” He also testified that Stroh’s “condition has been improved
because he’s been at our very high level of care: Supervision and guidance,
prompting for taking care of his basic needs, et cetera. I think if we were at
liberty in the communities, his condition would be decidedly worse. So the
treatment that he does receive on an involuntary basis, namely commitment
to the state hospital, has helped him to improve. The skill of our staff ha[s]
avoided any violent episodes so far. But I’m concerned that . . . we are still at
risk from that.”
On redirect, Dr. Cross testified that Stroh, despite showing “some
improvement” while in DSH care, still required involuntary medication
backups, was entirely uncooperative with medications as a critical element of
his overall care, and was still experiencing persistent paranoia and
delusional thoughts related to staff.
At the conclusion of the hearing, defense counsel argued there was not
sufficient evidence of a probability of serious harm to Stroh’s physical or
mental health and, therefore, the court should deny the petition. The court
then granted the petition, ordering involuntary medication of Stroh for up to
one year. It stated, “Having considered all of the evidence and argument in
this case, the Court finds by clear and convincing evidence that Mr. Stroh
lacks the capacity to make decisions regarding antipsychotic medication; and
if his mental disorder is not treated, serious harm to his physical or mental
health is the probable result.”
Stroh filed a timely notice of appeal.

5
II. DISCUSSION
Stroh’s sole argument on appeal is that Dr. Cross’s testimony is
insufficient to support the court’s order. The People respond that Dr. Cross’s
testimony constitutes substantial evidence and, moreover, Dr. Polfliet’s
certification report, attached to the petition, buttresses the testimony. Stroh
contends we cannot consider Dr. Polfliet’s report because, although the
People attached it as an exhibit to the petition, no one introduced it into
evidence or referred to it at the hearing.
We conclude Dr. Cross’s testimony constitutes substantial evidence
adequate to support the trial court’s order. We have no need to and do not
further discuss Dr. Polfliet’s certification report or the parties’ debate over
our authority to consider it as part of our evidentiary review.
A. Legal Standards
As our colleagues in Division Two of this court recently wrote, “ ‘[A]n
individual has a “significant” constitutionally protected “liberty interest” in
“avoiding the unwanted administration of antipsychotic drugs.” ’ (Sell v.
United States (2003) 539 U.S. 166, 178 (Sell), quoting Washington v. Harper
(1990) 494 U.S. 210, 221 (Harper).) The right is protected by the Fourteenth
Amendment (Sell, supra, 539 U.S. at p. 178) and by the California
Constitution and common law. (In re Qawi (2004) 32 Cal.4th 1, 14.)
“This right, however, is a qualified one. . . . [T]he government is
permitted to administer antipsychotic drugs involuntarily ‘to a mentally ill
defendant facing serious criminal charges in order to render that defendant
competent to stand trial, but only if the treatment is medically appropriate, is
substantially unlikely to have side effects that may undermine the fairness of
the trial, and, taking account of less intrusive alternatives, is necessary
significantly to further important governmental trial-related interests.’ (Sell,
supra, 539 U.S. at p. 179.)

6
“In 2004, the California Legislature amended section 1370 to meet the
constitutional standards set forth in Sell and added subdivisions (a)(2)(B) and
(a)(2)(C), which govern the administration of antipsychotic medication to
defendants found incompetent to stand trial (IST defendants).” (People v.
Lewis (2025) 111 Cal.App.5th 1078, 1089–1090.)
Section 1370 allows a trial court to authorize involuntary
administration of antipsychotic medication to a defendant who is found
incompetent to stand trial in any of three circumstances. (§ 1370, subd.
(a)(2)(B)(i)(I)–(III).) The trial court below made its finding under the first of
these provisions. That provision states that such an order is authorized if,
based upon the opinion of a qualified psychiatrist or psychologist, “the
defendant lacks the capacity to make decisions regarding antipsychotic
medication, the defendant’s mental disorder requires medical treatment with
antipsychotic medication, and, if the defendant’s mental disorder is not
treated with antipsychotic medication, it is probable that serious harm to the
physical or mental health of the defendant will result.” (§ 1370, subd.
(a)(2)(B)(i)(I); see People v. Lameed (2016) 247 Cal.App.4th 381, 396
(Lameed).)
“Probability of serious harm to the physical or mental health of the
defendant requires evidence that the defendant is presently suffering adverse
effects to their physical or mental health, or the defendant has previously
suffered these effects as a result of a mental disorder and their condition is
substantially deteriorating. The fact that a defendant has a diagnosis of a
mental disorder does not alone establish probability of serious harm to the
physical or mental health of the defendant.” (§ 1370, subd. (a)(2)(B)(i)(I); see
Lameed, supra, 247 Cal.App.4th at p. 396.)

7
Stroh argues that the trial court was required to find clear and
convincing evidence in support of the issuance of an involuntary medication
order. He does not cite, and we have not found, a case deciding the burden of
proof required under section 1370, but Lanterman-Petris-Short Act
conservatorship cases have applied the clear and convincing evidence
standard in evaluating a conservatee’s competence to give informed consent
to medical treatment. (E.g., Conservatorship of S.A. (2020) 57 Cal.App.5th
48, 55–56.) The People do not address the issue. Faced with similar
circumstances, the court in one of the cases cited by Stroh assumed without
deciding that the burden of proof below was clear and convincing evidence.
(See People v. Garcia (2024) 99 Cal.App.5th 1048, 1054, fn. 2.) We shall
make the same assumption without deciding the issue.
On appeal, we must affirm a trial court’s order authorizing an
involuntary medication order if it is supported by substantial evidence.
(Lameed, supra, 247 Cal.App.4th at p. 397.) Our Supreme Court has
instructed that, in reviewing whether evidence sufficiently supports a clear
and convincing evidence finding, “the question before the appellate court is
whether the record as a whole contains substantial evidence from which a
reasonable fact finder could have found it highly probable that the fact was
true.” (Conservatorship of O.B. (2020) 9 Cal.5th 989, 995–996.) The O.B.
court further instructed, “Consistent with well-established principles
governing review for sufficiency of the evidence, in making this assessment
the appellate court must view the record in the light most favorable to the
prevailing party below and give due deference to how the trier of fact may
have evaluated the credibility of witnesses, resolved conflicts in the evidence,
and drawn reasonable inferences from the evidence.” (Id. at p. 996.)

8
B. Analysis
Stroh does dispute that Dr. Cross’s testimony provides substantial
evidence sufficient to meet the first two prongs of the governing subdivision
of section 1370, subdivision (a)(2)(B)(i)(I), i.e., that he lacks capacity to make
decisions regarding antipsychotic medication and that his mental disorder
requires medical treatment with antipsychotic medication. His challenge
rests entirely on the contention that there is insufficient evidence of the third
prong, that if his mental disorder is not treated with antipsychotic
medication, it is probable that serious harm to his physical or mental health
will result. More specifically, he argues that Dr. Cross’s testimony does not
meet the “probability of serious harm” standard stated in the subdivision
because that testimony shows neither that he was “presently” suffering
adverse effects to his physical or mental health nor that he had previously
suffered those effects as a result of his mental disorder and was in a
substantially deteriorating condition.
We disagree. Dr. Cross testified on direct examination that Stroh was
presently suffering from paranoid and possibly delusional belief systems. He
was “frequently” in distress and fearful of staff. He had a history of violently
acting in defense of those systems when his symptoms became worse, and in
the past had been aggressive towards staff members. Dr. Cross further
indicated (albeit in somewhat garbled syntax) that Stroh had not acted
violently since his current admission in part because, despite his denial of his
mental disorder and resistance to medication, he was involuntarily receiving
prescribed medication pursuant to the temporary involuntary medication
order.2

2 Dr. Cross added on cross-examination that Stroh’s paranoid beliefs

could be reinforced if he continued to believe his treatment team was

9
Further, Dr. Cross said on direct examination, without medication,
Stroh’s mental health could dramatically deteriorate to the point that he
engaged in additional episodes of behavior that could result in new criminal
proceedings and injuries. If his “serious mental illness” went untreated,
“biochemically there could be harm to the brain.” Also, the longer Stroh went
untreated, the lower the chances that treatment of him would result in a good
outcome. In Dr. Cross’s opinion, “[w]ithout treatment, [Stroh’s] risk of
disruptive or aggressive or violent behavior is quite elevated.” A fair
inference from this observation—which we may and will draw—is that there
is a probability Stroh’s demonstrated propensity to be aggressive and even
violent will worsen if he is off his medication, and at the very least there is a
probability of harm to his own brain if he goes untreated for a lengthy period.
This testimony more than satisfies the standard we are to apply here.
That is, Dr. Cross’s testimony—which Stroh did not and does not dispute
factually—constitutes substantial evidence from which a reasonable fact
finder could have found it highly probable that at the time of the hearing,
Stroh was both suffering adverse effects to his mental health as a result of
his mental disorder, had previously suffered those effects, and—but for
involuntary medication—was in a deteriorated condition that would continue
to deteriorate, thereby creating a “quite elevated” risk that he would engage
in further violent episodes and have encounters with police. This is
substantial evidence establishing the probability of serious harm to his
physical and mental health if the court did not grant the People’s petition.
Stroh, while he acknowledges much of Dr. Cross’s testimony that we
have just recounted, largely ignores it in his analysis. Instead, he leans into

mistreating him. According to Dr. Cross, that “could further degrade his
ability to form trusting treatment relationships with providers in the future.”

10
those parts of Dr. Cross’s cross-examination answers to questions about
Stroh’s worsening conditions in which the doctor indicated that Stroh was
improving and had not acted out violently, because of the high level of care he
was receiving at DSH.
There are two problems with Stroh’s argument. First, as we have
discussed, Dr. Cross indicated on direct examination that Stroh’s present
condition was aided by the involuntary medication he was then receiving as
part of his care; and indeed, as of the hearing, the record indicates DSH had
been temporarily authorized to administer involuntary medication to him for
a considerable period of time—about three weeks. Given that testimony, a
reasonable fact finder could conclude that Dr. Cross’s testimony on cross-
examination about Stroh’s improving condition, although he did not again
refer to this medication, included the positive effects of it on Stroh. This
supports the People’s petition, not Stroh’s opposition to it.
Second, even adopting for the sake of argument Stroh’s
characterization of Dr. Cross’s cross-examination answers, Stroh nonetheless
is asking that we give greater weight to those answers than to Dr. Cross’s
testimony on direct examination. That would be improper for us to do under
the substantial evidence standard of review we are to apply here. Again, we
“must view the record in the light most favorable to the prevailing party
below and give due deference to how the trier of fact may have evaluated the
credibility of witnesses, resolved conflicts in the evidence, and drawn
reasonable inferences from the evidence.” (Conservatorship of O.B., supra, 9
Cal.5th at p. 996.) As we have discussed, Dr. Cross’s testimony contains the
necessary substantial evidence here.
Stroh also argues, again by leaning into his counsel’s cross-
examination, that Dr. Cross’s opinion that Stroh would suffer more in the

11
future was merely a generic opinion that would apply to all defendants who
suffered from a mental disorder, which is not sufficient proof of his future
deterioration. Dr. Cross’s testimony belies this argument. Again, among
other things, he stated that “[w]ithout treatment, [Stroh’s] risk of disruptive
or aggressive or violent behavior is quite elevated.”
In sum, Stroh’s arguments about the insufficiency of Dr. Cross’s
testimony lack merit.
III. DISPOSITION
The order appealed from is affirmed.
STREETER, Acting P. J.

WE CONCUR:

GOLDMAN, J.
MOORMAN, J.*

• Judge of the Mendocino Superior Court, assigned by the Chief Justice

pursuant to article VI, section 6 of the California Constitution.

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