IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
STATE OF WASHINGTON, ) No. 68469-8-1 5>
CO
Respondent, ) DIVISION ONE -
ON
v.
CO
AT., ) UNPUBLISHED en -~,
Appellant. ) FILED: September 16. 2013
Cox, J. - AT. challenges his involuntary 90-day commitment under RCW
71.05.280. He contends that there was insufficient evidence to support the
conclusion that he was "gravely disabled." We disagree and affirm.
In January 2012, Seattle Police brought AT. to Psychiatric Emergency
Services at Harborview Medical Center after he was found running naked in cold
weather. AT. was committed for involuntary treatment for 14 days. This was
A.T.'s third hospitalization since December 2011.
The State then filed a petition to commit AT. for an additional 90 days of
involuntary treatment. The petition alleged that AT. was "gravely disabled" due
to a mental disorder.
At the trial, the State presented testimony from Harborview psychiatrist,
Dr. Sharon Romm, and from Harborview Social Worker, Christine Winther.
These two expert witnesses testified to their interactions with AT., their
observations of A.T.'s behavior, and detailed information contained in A.T.'s
No. 68469-8-1
charts. Both experts expressed the opinion that A.T. was not ready for a less
restrictive setting.
A.T. testified that if he were to leave the hospital, he would go to his
mother's house. AT. also believed that he would be able to obtain employment.
The court entered findings of fact and conclusions of law. It found the
testimony of both expert witnesses to be credible and incorporated their
testimony into its findings. The court concluded that AT. was gravely disabled
and entered an order committing him for an additional 90 days.
AT. appeals.
SUFFICIENCY OF THE EVIDENCE
AT. argues that the trial court's findings of fact are not supported by
substantial evidence, and these findings do not support its conclusion that A.T.
was "gravely disabled." We disagree.
A person is "gravely disabled" if "as a result of a mental disorder," he or
she either:
(a) Is in danger of serious physical harm resulting from a
failure to provide for his or her essential human needs of health or
safety; or (b) manifests severe deterioration in routine functioning
evidenced by repeated and escalating loss of cognitive or volitional
control over his or her actions and is not receiving such care as is
essential for his or her health or safety.[1]
1 RCW 71.05.020(17).
No. 68469-8-1
Under either definition, the potential for harm must be "'great enough to
justify such a massive curtailment of liberty.'"2 Under subsection (a), the
standard on which the trial court exclusively relied in this case, the danger of
serious physical harm need not be evidenced by recent, overt acts.3 Instead, it
"usually arises from passive behavior - Le., the failure or inability to provide for
one's essential needs."4 A person's "essential needs" may include food, clothing,
shelter, and medical treatment.5 Finally, the State must present "recent, tangible
evidence of failure or inability to provide for such essential human needs . . .
which presents a high probability of serious physical harm within the near future
unless adequate treatment is afforded."6
Generally, where a trial court has weighed the evidence, appellate review
is limited to determining whether substantial evidence supports the trial court's
findings and, if so, whether the findings support the trial court's conclusions of
law and judgment.7 Substantial evidence is evidence that is "sufficient to
persuade a rational, fair-minded person ofthe truth ofthe finding."8
2 In re Detention of LaBelle. 107Wn.2d 196, 204, 728 P.2d 138(1986)
(internal quotation marks omitted) (quoting In re Harris, 98 Wn.2d 276, 283, 654
P.2d 109 (1982)).
3 Id at 204.
4Jg\
5|o\ at 205.
6|o\ at 204-05.
7Id at 209.
8 In re Estate of Jones. 152Wn.2d 1,8, 93 P.3d 147(2004).
No. 68469-8-1
For a 90-day involuntary commitment, the State must prove that the
individual is "gravely disabled" by clear, cogent and convincing evidence.9 This
standard of proof means that the ultimate fact in issue must be shown by
evidence to be "highly probable."10
Here, there is substantial evidence to support the findings that the trial
court could reasonably have found to be clear, cogent and convincing.
Moreover, these findings support the conclusion that A.T. was "gravely disabled."
A.T. challenges Finding 3 of the Supplemental Findings. Finding 3
identified A.T.'s passive behavior by failures in personal care, specifically in
personal hygiene and mental health care, and also indicated the harm that could
result.
3. [AT.] is unable to care for his personal hygiene because, as a
result of his mental disorder, he has repeatedly refused to bathe
himself and change his clothing, despite his pants being saturated
with urine and feces while in the hospital. [AT.] is also reluctant to
take his medications, and without adequate medication, [AT.] will
decompensate immediately, which could lead him to be out in the
cold weather naked as he was prior to this hospitalization.1111
Finding 4 stated that A.T. was in danger of serious physical harm resulting
from these failures. It also provided the court's conclusion that AT. was "gravely
disabled."12
9 LaBelle. 107 Wn.2d at 209.
10lcL
11 Clerk's Papers at 39-40.
12 This conclusion of law was erroneously labeled as a finding of fact. Jn
re Detention of M.K., 168 Wn. App. 621, 623 n.3, 279 P.3d 897 (2012) (trial
court's determination of "grave disability" is a conclusion, not a finding).
No. 68469-8-1
4. As a result of a mental disorder, there is a substantial risk that
[AT.] is in danger of serious physical harm resulting from a failure
to provide for his essential human needs of health and safety.
Therefore, the respondent is gravely disabled and requires further
inpatient treatment in a more restrictive hospital setting to
effectuate appropriate compensation.(13]
A.T. does not contest that he suffers from a mental disorder. He contests other
points in the court's findings.
The finding that AT. had poor personal hygiene is supported by
substantial evidence. For example, A.T.'s chart notes from his stay at
Harborview showed that AT. repeatedly refused to change his clothing, despite
the fact that his pants were soaked with urine. A.T. was "fearful of washing
himself, afraid of getting hurt or getting germs." As a result, AT. repeatedly
refused to bathe or shower, despite evidence that he risked infection by not
washing his body or hands after he used the bathroom.
The finding that A.T. was reluctant to take medications, and without
adequate medication he will decompensate immediately, is also supported by
substantial evidence. Both experts testified that A.T. was often non-compliant
with medications and that he had to be monitored very closely. Further, Winther
testified that A.T. "very quickly deteriorates in a very short period of time" and
pointed out this was A.T.'s third hospitalization since December.
The dispositive issue is whether there is substantial evidence to support
the finding that as a result of a mental disorder, AT. is in danger of serious
13 Clerk's Papers at 40.
No. 68469-8-1
physical harm resulting from a failure to provide for his essential human needs of
health and safety. We conclude that there is.
The trial court made two references to potential physical harm to AT. in
Finding 3, but this evidence was improperly considered as substantive evidence
by the court.
First, Finding 3 states that A.T.'s pants were "saturated in feces." The
State concedes that this fact was not supported by the record. Second, Finding
3 states that A.T.'s decompensation "could lead to him out in the cold weather
naked as he was prior to this hospitalization." The State also concedes that this
hearsay evidence was improperly considered as substantive evidence.
Consequently, we do not consider this evidence to support the finding of danger
of serious physical harm.
But even disregarding these facts, there is substantial evidence to support
this finding.
Dr. Romm testified that A.T.'s psychiatric diagnosis was schizophrenia, a
mental impairment. She agreed with the conclusion that A.T. was "in danger of
serious physical harm from a failure or inability to provide for his essential needs
of health and safety, such as adequate nutrition, medical care, clothing, and
bodily safety." Both experts recommended that AT. remain in a hospital where
he could be very closely monitored.
Moreover, as described above, the experts' testimony revealed that AT. is
unable and unwilling to care for his personal hygienic needs despite risk of
No. 68469-8-1
infection. AT. is noncompliant with medication and medical advice, he quickly
deteriorates when off his medication, and his behavior is erratic and impulsive.
In sum, there was substantial evidence to support the trial court's findings.
Moreover, these findings of fact support the conclusion that A.T. was "gravely
disabled" under RCW71.05.020(17)(a).
AT. argues that his "various idiosyncrasies" do not rise to the level of
grave disability under the first definition, because his poor hygiene habits do not
put him in danger of serious physical harm. However, as discussed above,
A.T.'s habits, specifically his refusal to wash his hands and body, and his
repeated refusal to change his urine-soaked clothing, do put him at risk of
serious physical harm. They put AT. at risk of infection. Further, RCW
71.05.020(17)(a) does not require that the risk of serious physical harm be
imminent.14 Thus, this argument is not persuasive.
We affirm the order of commitment.
£rf,J
WE CONCUR:
C3\^N^^
14 LaBelle. 107 Wn.2d at 202.