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2815 SEP 21 m 9: |
IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
In re the Detention of: No. 72509-2-1
C.L, DIVISION ONE
Appellant.
UNPUBLISHED
FILED: September 21.2015
Cox, J. - "Substantial evidence is 'evidence in sufficient quantum to
persuade a fair-minded person of the truth of the declared premise.'"1 C.L.
appeals the order committing him to involuntary treatment, arguing that
insufficient evidence supports the court's findings that he was "gravely disabled"
and that treatment in a less restrictive setting was not in his best interest. Here,
the State presented testimony demonstrating that C.L. could not provide for his
essential needs of health or safety and could not adhere to treatment outside an
inpatient psychiatric facility. Thus, substantial evidence supports the trial court's
findings. And those findings support its conclusions of law. We affirm.
In July 2014, C.L. was admitted into a hospital after a less restrictive order
had expired earlier that month. In August 2014, the State petitioned for C.L.'s
initial detention, and he was detained. Thereafter, the State petitioned for 14
days of involuntary treatment, and the court entered an agreed order. Before the
1 InreDet. of A.S.. 91 Wn. App. 146, 162, 955 P.2d 836 (1998) (quoting Holland
v. Boeing Co.. 90Wn.2d 384, 390, 583 P.2d 621 (1978)).
No. 72509-2-1/2
14 day period ended, the State petitioned for 90 days of more restrictive
involuntary treatment. The petition alleged that C.L. was "gravely disabled" due
to a mental disorder. At trial, the State presented testimony from mental health
counselor Alexandra Hughes. Hughes testified to her interviews with C.L. and
notes contained in his medical chart.
The court found that C.L. was gravely disabled and that treatment in a less
restrictive setting was not in his best interest. The court entered an order
committing C.L. for an additional 90 days. The court later entered supplemental
findings of fact and conclusions of law.
C.L. appeals.
SUFFICIENCY OF EVIDENCE
C.L. argues that insufficient evidence supports the court's findings. We
disagree.
"[T]he State must prove its case by clear, cogent and convincing
evidence" in order to commit a person to 90 days of involuntary treatment.2
"[W]here the trial court has weighed the evidence, appellate review is limited to
determining whether substantial evidence supports the findings and, if so,
whether the findings in turn support the trial court's conclusions of law and
judgment."3 If the State's burden of proof is by "clear, cogent and convincing
evidence, the evidence must be more substantial than in the ordinary civil case"
2 In re Pet, of LaBelle. 107 Wn.2d 196, 209, 728 P.2d 138 (1986); accord RCW
71.05.310.
3 LaBelle. 107 Wn.2d at 209.
No. 72509-2-1/3
where the burden of proof is "by a preponderance of the evidence."4 The trial
court's findings "must be supported by substantial evidence in light of the 'highly
probable' test."5 "Substantial evidence is 'evidence in sufficient quantum to
persuade a fair-minded person of the truth of the declared premise.'"6 "[W]e will
not disturb the trial court's findings ... if [it is] supported by substantial evidence
which the . .. court could reasonably have found to be clear, cogent and
convincing."7
Here, the State demonstrated that C.L. could not provide for his essential
needs of health or safety and could not adhere to treatment outside an inpatient
psychiatric facility. Thus, substantial evidence supported the trial court's findings.
Gravely Disabled
C.L. first argues that insufficient evidence supports the court's finding that
he was gravely disabled. We disagree.
A person can be committed for involuntary treatment if that person is
gravely disabled.8 Gravely disabled "means a condition in which a person, as a
result of a mental disorder, . . . [i]s in danger of serious physical harm resulting
4lo\
5]d (quoting In re Pawling. 101 Wn.2d 392, 399, 679 P.2d 916 (1984)).
6 AJL, 91 Wn. App. at 162 (quoting Holland. 90 Wn.2d at 390).
7 LaBelle. 107 Wn.2d at 209.
8 RCW 71.05.280(4).
No. 72509-2-1/4
from a failure to provide for his or her essential human needs of health or
safety."9
The State must show "a substantial risk of danger of serious physical
harm."10 Specifically, "the State must present recent, tangible evidence of failure
or inability to provide for such essential human needs as food, clothing, shelter,
and medical treatment which presents a high probability of serious physical harm
within the near future unless adequate treatment is afforded."11 This risk of harm
does not have to be "evidenced by recent, overt acts."12
The State is not required to show that the "danger of serious harm" is
imminent.13 Requiring imminence "could result in the premature release of
mentally ill patients who are still unable to provide for their essential health and
safety needs outside the . . . hospital setting but who, because of their treatment
there, are no longer in 'imminent' danger of serious physical harm."14
Further, "uncertainty of living arrangements or lack of financial resources
will not alone justify continued confinement in a mental hospital."15 A person can
be gravely disabled if evidence indicates that person's "deteriorated condition"
9 RCW 71.05.020(17)(a).
10 LaBelle. 107 Wn.2d at 204.
11 id at 204-05.
12 Id at 204.
13_ld at 203.
14 ]d
15 Id. at 210.
No. 72509-2-1/5
renders him "unable to make a rational choice with respect to his ability to care
for his essential needs."16
Here, Hughes testified that C.L. was gravely disabled due to his mental
disorder. Specifically, she stated that C.L. had "fixed delusions, poor insight,
poor impulse control, [and] inappropriate boundaries with others. He . . . [was]
not able to maintain his activities of daily living independently."17
Hughes also read several notes from C.L.'s medical chart into the record.
A psychiatric evaluation note described C.L.'s behavior after the less restrictive
order expired. This note stated that C.L. stopped taking his medication, became
increasingly aggressive towards other residents where he lived, and believed the
FBI and CIA were looking for him. The note also stated that C.L. punched
another resident and threatened other residents and staff.
Hughes also read into the record a note written at the end of the 14 day
commitment period. This note stated that C.L. was "unable to carry out
directions," made "paranoid statements," and was "aggressive and verbally
abusive" towards other patients.18 It also stated that C.L.'s appearance was
"unkept," that his activities of daily living "need[ed] prompting," and that he was
"not oriented to the situation."19 The next day's note stated that C.L. was "still
16 id
17 Report of Proceedings (August 25, 2014) at 9.
18 Id at 14.
19 Id.
No. 72509-2-1/6
positive for significant psychotic behavior."20
Importantly, Hughes stated that C.L. had not been organized enough to
participate in his own discharge planning. She read another note into the record
stating that C.L. did not have housing or an outpatient provider for his discharge
and "will not survive at a shelter or on the street. He would probably end up in
jail because he is not prepared for that much independence."21 Hughes also
stated that C.L. had not made any plan without "delusional content."22
Hughes further testified that she did not believe C.L. "could meet his basic
needs for safety" if he were to leave the hospital because "he would not know
where to go to get his basic needs met."23 C.L.'s mother is his social security
protective payee, and Hughes believed C.L.'s mother and family were not in
Western Washington or Seattle. Hughes stated C.L. was homeless and she did
not believe he knew how to access his money or housing by himself. She also
did not believe C.L. could relocate to Wenatchee by himself to "access any sort
of services."24
Hughes's testimony demonstrated a substantial risk of danger that C.L.
was unable to provide for his essential needs of food, clothing, shelter, and
medical treatment on his own because he continually expressed psychotic
behavior and poor impulse control up to three days before trial. Thus, this
20
1^ at 15.
21
id at 17.
22
Id, at 21.
23
]d
24
Id.
No. 72509-2-1/7
testimony constitutes substantial evidence to support the trial court's finding that
C.L. was gravely disabled.
C.L. argues that he was not gravely disabled. He does not contest that he
has a mental condition. Rather, he cites two other reasons. They are
unpersuasive.
C.L. first argues that he was not gravely disabled because his behavior in
the hospital improved. The State satisfied its burden of proof because it was
required only to show "a substantial risk of danger of serious physical harm."25
Additionally, the State was not required to show that the "danger of serious harm"
was imminent.26 Although the testimony demonstrated that C.L. had generally
been "medication-compliant" and his behavior improved in the hospital, the State
showed a substantial risk of danger with evidence that C.L. would still be unable
to provide for his essential needs outside the hospital.27 Specifically, Hughes's
testimony illustrated the aggressive and psychotic behaviorthat led to C.L.'s
detainment after the less restrictive order expired.
Hughes also observed "currentthreatening behaviors" and had "little to
no[]" confidence that C.L. knew where to obtain medication, food, orshelter.28
More importantly, Hughes did not know if C.L. could continue his medication
compliance "outside ... an impatient setting" and noted the difference between
25 LaBelle. 107 Wn.2d at 203-04 (emphasis added).
26 id at 203.
27 Report of Proceedings (August 25, 2014) at 26-31.
28 id at 22, 25.
No. 72509-2-1/8
meeting one's basic needs in a structured inpatient setting versus being outside
the hospital.29
Second, C.L. argues that the State's focus on his potential difficulty
returning to Wenatchee or inability to access a shelter in Western Washington
does not demonstrate that he was gravely disabled. He specifically argues that
the State's claim that he "would be homeless if released" was insufficient to
involuntarily detain him. This understates the full scope of the evidence.
C.L.'s psychotic behavior "rendered him unable to make a rational choice
with respect to his ability to care for his essential needs."30 The testimony
showed that C.L. would not know where to go to access a shelter in Western
Washington on his own. Similarly, C.L. did not know how to return to Wenatchee
to access his money, housing, or services. This testimony constitutes substantial
evidence of C.L.'s inability to provide for his essential needs. Being homeless if
released was not the focus of the State's argument.
Additionally, C.L.'s argument is not supported by the case he cited. C.L.
argues that "[i]nvoluntary commitment of an individual is a significant deprivation
of liberty that may not be imposed simply because the State believes the
individual will be better off in a hospital than on the street."31 C.L. then cites In re
Detention of Harris32 to support his argument. But the issues in that case were
29 id at 22, 35.
30 LaBelle. 107 Wn.2d at 210.
31 Brief of Appellant at 9.
32 98 Wn.2d 276, 278, 654 P.2d 109 (1982).
8
No. 72509-2-1/9
whether dangerousness could "serve as the basis for depriving an individual of
his liberty" and whether "the summons procedures of RCW 71.05.150(1)
violate[d] constitutional safeguards of procedural due process."33 Thus, that case
is not analogous to this case. Accordingly, C.L.'s argument is unpersuasive.
Treatment in Less Restrictive Setting
C.L. argues that insufficient evidence supports the trial court's finding that
treatment in a less restrictive setting was not in his best interest. We disagree.
A person may be committed for 90 days of involuntary treatment if the
State shows that "the best interests of the person or others will not be served by
a less restrictive treatment which is an alternative to detention."34 RCW 71.05
does not create a statutory right to less restrictive treatment.35 Further, a person
is not entitled to treatment in a less restrictive setting when continued treatment
is "amply supported by professional judgment."36 A court "'may take into account
the availability of treatment options or.. . the resources necessary to supply . . .
these options'" when determining if there are acceptable treatment alternatives.37
Here, the State presented substantial evidence that treatment in a less
restrictive setting was not in C.L.'s best interest. Specifically, Hughes testified
33 Harris. 98 Wn.2d at 280, 285.
34 RCW 71.05.320(1); accord In re Pet, of T.A.H.-L. 123 Wn. App. 172, 184,97
P.3d 767 (2004).
35 In re Pet, of J.S.. 124 Wn.2d 689, 701, 880 P.2d 976 (1994).
36 id
37 ]d at 700 (quoting Jackson v. Fort Stanton Hosp. &Training Sen., 964 F.2d
980, 992 (10th Cir. 1992)).
No. 72509-2-1/10
that C.L. could not survive in shelters, based on her review of C.L.'s progress
notes and interactions with him. One progress note characterized C.L. as
"agitated, threatening, [and] hyperverbal."38 The note also described his thought
process as "grandiose, tangential, [and]. .. delusional."39 C.L.'s risk assessment
that day was "[significant for psychotic behavior."40
Other notes stated that C.L. complained that he was in the hospital for the
wrong reasons and continually presented "with poor insight."41 The next day's
note described C.L.'s thought process as delusional and his behavior as
"anxious, isolative, and withdrawn."42 The note also stated C.L. was "not oriented
to place."43
Hughes further testified that C.L. "has shown ... no insight into his current
condition" and she recommended "inpatient psychiatric care."44 C.L. would not
"be able to adhere to treatment outside of an inpatient psychiatric facility" or have
"the capability to care for himself outside of a structured residential setting."45
38 Report of Proceedings (August 25, 2014) at 18.
40 id
41 id
42]dat19.
43 id
44 id at 22-23.
45 Id. at 23.
10
No. 72509-2-1/11
Hughes also noted that C.L.'s shouting of delusional statements in court
demonstrated his "poor impulse control."46
Hughes's testimony showed that C.L. continually expressed psychotic
behavior and had no insight into his mental disorder up to three days before trial.
Most importantly, her testimony showed that C.L. would not be able to maintain
treatment outside the hospital. Thus, the State presented substantial evidence to
support the trial court's finding that treatment in a less restrictive setting was not
in C.L.'s best interest.
C.L. argues that the trial court could not "find the State met its burden
based only on a lack of available resources."47 Specifically, C.L. argues that the
court "improperly focused on the resources available" to him and that the State
"could not meet its burden simply by suggesting no services were available" to
him.48 C.L. cites In re Detention of T.A.H.-L.49 to support his argument that "the
appropriate inquiry when considering a less restrictive option is not whether there
is a specific resource available to the individual but instead whether the person
presents a danger of serious physical harm in a less structured environment."50
This argument is unpersuasive.
As previously stated, the court may determine if treatment is acceptable
by looking at "'the availability of treatment options or. . . the resources necessary
46 id at 35.
47 Brief of Appellant at 12.
48 id at 11-12.
49123 Wn. App. 172, 187, 97 P.3d 767 (2004).
50 Brief of Appellant at 10.
11
No. 72509-2-1/12
to supply . . . these options.'"51 Here, the court acknowledged C.L.'s ability to live
outside a hospital when he had access to "structured supportive housing" and
"mental health services" in Wenatchee.52 But the court's finding that treatment in
a less restrictive setting "would not be appropriate" for C.L. was supported by
evidence of C.L.'s inability to locate and obtain his essential needs on his own
and the unavailability of structured housing and mental health services in
Seattle.53
C.L. also cites In re Detention of J.S.54 to support his argument that
requiring him "to engage in the services on 'the other side of the mountains' or
participate in comparable services in [W]estern Washington pursuant to a less
restrictive order was appropriate regardless of whether the court was aware of a
specific facility that would currently accept him."55 This argument is
unpersuasive.
C.L. is correct that the trial court's ability to order less restrictive treatment
is not restricted when no such treatment is available.56 Treatment in a less
restrictive setting "can be ordered even when ... no facility has agreed to
51 JJL, 124 Wn.2d at 700 (quoting Jackson. 964 F.2d at 992).
52 Clerk's Papers at 37.
53 id
54 124 Wn.2d 689, 699, 880 P.2d 976 (1994).
55 Brief of Appellant at 12.
56 J.S.. 124Wn.2dat698.
12
No. 72509-2-1/13
assume the responsibility."57 But as previously stated, RCW 71.05 does not
create a statutory right to less restrictive treatment.58 Thus, the court is not
required to "create a facility specifically designed for.. . [a person's] unique
needs."59
In sum, C.L.'s arguments are unpersuasive.
We affirm the 90-day involuntary commitment order.
CcrkJ.
WE CONCUR:
I/,' ^ y;A
57 In re Pet, of RAW., 104 Wn. App. 215, 222, 15 P.3d 705 (2001).
58 J.S., 124Wn.2dat701.
59 T.A.H.-L. 123 Wn. App. at 187.
13