IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
In the Matter of the Detention of No. 72634-0-1
H.L.
DIVISION ONE
STATE OF WASHINGTON,
c:;r- CO r
Respondent, ~• <-
UNPUBLISHED OPINION ~T\ —
CD
v.
VD -"; ~;
H.L,
2? "-;
Appellant. ) FILED: November 9,2015 V? C J '-•
4T- Ci~-
o
Schindler, J. — H.L. appeals a 90-day involuntary commitment order. H.L.
contends insufficient evidence supports finding she was "gravely disabled" under RCW
71.05.020(17)(a). We disagree, and affirm.
On September 25, 2014, a designated mental health professional, Navos
Inpatient Services clinical psychologist Dr. Julia Singer, filed a petition to commit H.L.
for up to 14 days of treatment. The petition alleged H.L. posed "a likelihood of serious
harm to others," and H.L. was gravely disabled as a result of a mental disorder and "in
danger of serious physical harm, resulting from a failure to provide for. . . her essential
human needs of health or safety." H.L. did not dispute the allegations in the petition.
On September 26, the superior court entered an agreed 14-day involuntary commitment
order for treatment at Navos.
No. 72634-0-1/2
On October 6, Dr. Singer filed a 90-day petition to commit H.L. for additional
treatment. The petition alleged that H.L. "was taken into custody as a result of conduct
in which . . . she attempted or inflicted physical harm upon the person of another or.. .
herself.. . and continues to present, as a result of a mental disorder, a likelihood of
serious harm," and that H.L. was "gravely disabled." The petition states, in pertinent
part:
[H.L.] has a mental disorder with paranoia, delusional thinking, mood
lability, agitation, auditory hallucinations, and impaired judgment and
impulse control. She has a history of hospitalizations, as well as a history
of assaultive behavior. She reportedly went missing several months ago
and ended up psychiatrically hospitalized for six months in Paris. Upon
her return to Seattle she went to the [emergency room] seeking help, but
became angry and threw her purse at the social worker without warning.
She threatened to slap her mother, whom she has assaulted in the past.
She stated she could not go to her apartment because of the ghosts there.
She was too impaired to formulate a plan for meeting her basic needs
safely.
In the hospital she is gradually stabilizing but her thinking remains
delusional and tangential. She continues to report auditory hallucinations
and is observed responding to internal stimuli. She is unwilling to return to
her apartment due to her continued belief that the ghosts are related to the
apartment rather than to her illness. Although she is medication
compliant, her judgment and insight remain impaired. If she were
released prematurely she would be at risk of discontinuing her
medications and deteriorating further, endangering others and remaining
unable to care safely for her basic needs in the community. [90-day more
restrictive involuntary treatment] is currently recommended, until she is
sufficiently stabilized to engage in court-ordered outpatient treatment.
The superior court held a bench trial on the 90-day involuntary treatment petition
beginning at 1:30 p.m. on October 22. Throughout the entire trial, H.L. interrupted
numerous times by "yelling and screaming."
No. 72634-0-1/3
At the beginning of the trial, the State moved to amend the petition to allege H.L.
threatened, inflicted, or attempted to inflict physical harm to others and herself after
commitment for evaluation and treatment. H.L. did not object to amending the petition.
Dr. Singer testified that H.L. suffered from paranoid schizophrenia and exhibited
"[d]elusional thinking" and "auditory hallucinations." Dr. Singer stated H.L. "is labile to
the point of agitation. Her thought process is tangential. Recently she has been voicing
depression and suicidal ideation." Dr. Singer stated that although H.L. was initially
"calm" and cooperative," "[r]ecently she has been significantly worse" and "all over the
map . .. with plans for how she will care for herself."
Dr. Singer testified regarding H.L.'s behavior while hospitalized at Navos. On
October 16, Navos staff placed H.L. in seclusion after observing H.L kissing a male
patient. On October 17, H.L "threw a tray at staff." The psychiatric progress notes from
October 19 indicated that H.L. refused all morning medications and "hugged and kissed
[a male patient] without any evident context."
Dr. Singer testified that on October 20, H.L. repeatedly yelled that she was going
to kill herself. A short time later, Dr. Singer observed H.L. "screaming" at the American
Medical Response (AMR) drivers and threatening to kill them.
During a meeting with social services on October 21, H.L. yelled that she wished
her mom would die. When the social service worker explained that H.L. would be
unable to obtain housing if she continued to yell when stressed, H.L. said that she
"wanted to die, that she did not want this life." H.L. stated that she wanted to kill herself
and did not want medications. H.L. yelled and banged on a chair so loudly that Navos
staff responded out of concern for the safety of the staff member.
No. 72634-0-1/4
Dr. Singer testified the morning of October 22, H.L. was "verbally abusive" and
threw her shower supplies at Navos staff. When the staff attempted to direct H.L. to her
room, she punched a staff member in the chest and left arm.
Dr. Singer testified H.L was recently psychiatrically hospitalized for six months in
Paris, France. While hospitalized in France, H.L. received a prescription for
Olanzapine. After the United States Embassy transported H.L. back to the United
States, she "immediately ended up back in the hospital."
Dr. Singer testified that due to her mental impairment, H.L. was unable to
develop a consistent and coherent plan for taking care of herself outside of the hospital
setting. Dr. Singer told the court that H.L. had an apartment but refused to live there.
Dr. Singer stated that the alternatives H.L. suggested regarding where she would live if
released from the hospital "vary minute by minute" and there seemed to be a "high
likelihood" she would "tak[e] off, once again, when she is really not able to care for
herself, even here with supports."
Dr. Singer testified that as a result of her mental disorder, H.L. presented a
"substantial risk of physical harm to others," was "in danger of serious physical harm
from a failure or inability to provide for her essential needs of health and safety," and
was "gravely disabled." Dr. Singer stated that her conclusion was based in part on
H.L.'s inability to present a coherent and consistent plan regarding where she would live
after leaving the hospital. Dr. Singer also believed H.L.'s "sexually aggressive behavior"
could lead to H.L. being sexually assaulted if she left the Navos facility.
H.L. testified that her prescribed medication made her feel physically ill,
emotional, and depressed.
No. 72634-0-1/5
At the conclusion of the testimony, the State withdrew the allegations related to
precommitment acts creating a risk of harm.
The court found Dr. Singer credible and that the Navos medical records
supported her testimony. The court found that H.L. suffered from a mental impairment,
paranoid schizophrenia. The court found by clear, cogent, and convincing evidence that
H.L. continued to present a likelihood of serious harm to herself and others1 and that
H.L. was gravely disabled under RCW 71.05.020(17)(a).
The court also finds that she is gravely disabled. She remains
highly delusional, psychotic, angry, and hostile. She continues to scream
and yell when met with restraints or limits or stressful situations. Because
of her mental impairment, she is unable to develop a coherent plan for
taking care of herself outside of a hospital setting. She is unable to find
housing on her own, refuses to return to her apartment because she
believes it's inhabited by ghosts.
. . . She has fled the country once, leading to her hospitalization in
France . . . and being prescribed . . . Olanzapine. She is verbalizing a
plan to leave the country again ... if discharged. . . . But she has
demonstrated that she is unable to care for herself if she were released.
.. . She has no other housing at the moment, and at times insists she will
not go to a shelter — ... at other times she says she will go to a shelter.
The court agrees with Dr. Singer's opinion that she currently is too
symptomatic to be able to find adequate shelter on her own without
substantial assistance through her treatment provider.
The court entered an order remanding H.L. into the custody of Navos for
"a further period of intensive treatment not to exceed 90 days from the date of
judgment."
1 The court ruled:
The court also finds that as a result of this mental impairment, she does currently
present a substantial risk of harm to herself and to others, based on the following
findings: She is currently highly impulsive and has been in seclusion at Navos very
recently because of her uncontrolled behavior. She is throwing items at staff at Navos.
She physically struck a staff member this morning. She has gotten agitated extremely
easily. She has repeatedly threatened to harm herself, her mother, and the AMR
crewmembers. She remains highly labile, yelling and screaming throughout even the
court proceedings. This is sufficient to establish that she presents currently a risk of
harm to herself and to others.
No. 72634-0-1/6
H.L. appeals the 90-day commitment order. H.L. contends insufficient evidence
supports the finding that she was "gravely disabled" under RCW 71.05.020(17)(a).
Preliminarily, the State asserts the appeal is moot. We disagree. "An individual's
release from detention does not render an appeal moot where collateral consequences
flow from the determination authorizing such detention." In re Pet, of M.K., 168 Wn.
App. 621, 626, 279 P.3d 897 (2012). Under chapter 71.05 RCW, the superior court
considers the history of recent prior civil commitments. See RCW 71.05.012
("consideration of prior mental history is particularly relevant in determining whether the
person would receive, if released, such care as is essential for his or her health or
safety"); RCW 71.05.212(1 )(d) ("Whenever a designated mental health professional. ..
is conducting an evaluation under this chapter, consideration shall include all
reasonably available . . . records regarding . .. [p]rior commitments under this
chapter."); RCW 71.05.245 ("(1) In making a determination of whether a person is
gravely disabled, presents a likelihood of serious harm, or is in need of assisted
outpatient mental health treatment. . . , the court must consider the symptoms and
behavior of the respondent in light of all available evidence concerning the respondent's
historical behavior. ... (3) In making a determination of whether there is a likelihood of
serious harm . . . , the court shall give great weight to any evidence before the court
regarding whether the person has: . . . (b) a recent history of one or more
commitments.").
Because the appeal is not moot, we address the merits of the appeal. The State
alleged H.L. was gravely disabled under RCW 71.05.020(17)(a). RCW
71.05.020(17)(a) provides that an individual is "gravely disabled" when, as a result of a
No. 72634-0-1/7
mental disorder, the individual "[i]s in danger of serious physical harm resulting from a
failure to provide for his or her essential human needs of health or safety."
To meet the burden of establishing an individual is gravely disabled under RCW
71.05.020(17)(a), 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." In re Pet, of LaBelle. 107 Wn.2d 196, 204-05, 728 P.2d 138 (1986). The
State must also show the failure or inability to provide for essential needs presents "a
high probability of serious physical harm within the near future unless adequate
treatment is afforded." LaBelle, 107 Wn.2d at 204-05.
"[W]e will not disturb the trial court's findings of 'grave disability' if supported by
substantial evidence which the lower court could reasonably have found to be clear,
cogent and convincing." LaBelle, 107 Wn.2d at 209. Substantial evidence is the
quantum of evidence sufficient to persuade a rational fair-minded person the premise is
true. InreDetof H.N.. 188 Wn. App. 744, 355 P.3d 294, 303 (2015).
H.L. contends the court based the finding of grave disability, in part, on her lack
of housing and ignored the evidence showing she was willing to work with her treatment
team to find housing, stay with a friend, or live in a shelter. We disagree.
The record shows sufficient evidence supports finding that H.L. was gravely
disabled under RCW 71.05.020(17)(a). The court found that H.L. was gravely disabled
based on the undisputed evidence that H.L. remained delusional, psychotic, angry, and
hostile. As a result of her mental disorder, the court found H.L. was unable to develop a
consistent and coherent plan for taking care of herself outside of the hospital setting and
No. 72634-0-1/8
was too symptomatic to find adequate shelter on her own. The record supports this
finding.
Dr. Singer testified that H.L. provided varying explanations of where she would
live after her hospitalization. Dr. Singer stated that H.L. had an apartment but was "a
hundred percent consistent" in refusing to live in the apartment because she "saw
ghosts and heard voices there." In September, H.L. expressed interest in mental health
housing. On October 9, H.L. stated that she "could go stay with her mother's friend until
she could get another apartment." On October 20, H.L. said that she planned to "live
with her father on Delridge Way" but the telephone numbers she provided Dr. Singer did
not belong to her father. Later on October 20, H.L. told Dr. Singer that rather than
finding housing, she "was going to go on a vacation" to Canada. On October 21 when
asked by a social worker where she would live after leaving Navos, H.L. stated she
"would just be homeless" but insisted that she would not live in a shelter.
Dr. Singer noted that because H.L. refused to return to her apartment, she had
"no other alternative" source of housing. Dr. Singer testified that the alternatives H.L.
offered "seem to be made up" and "vary minute by minute." The fact that H.L. had "no
clear shelter plans and [a] propensity for fleeing the country" was "very concerning."
According to Dr. Singer, H.L. was "just clutching at ideas" and had "no reality basis on
what it would mean to go out in the current weather and find her way to a place to stay
warm and dry tonight, let alone down the road."
The evidence supports the court's determination that H.L. "has no other housing
at the moment" and "is too symptomatic to be able to find adequate shelter on her own."
The evidence supports the determination that H.L. was in danger of serious physical
8
No. 72634-0-1/9
harm resulting from a failure to provide for her essential human needs and was gravely
disabled under RCW71.05.020(17)(a).
We affirm.
Vrfifl^,
WE CONCUR
£