IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
DIVISION ONE
In the Matter of the Detention of ) No. 73818-6-1
BARRY ALAN SORRELS, UNPUBLISHED OPINION
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Appellant. FILED: August 1,2016
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Verellen, C.J. — B.S. appeals a 90-day involuntary commitment order. He
contends substantial evidence does not support the court's finding that he suffered
from a grave disability. But the State presented recent, tangible evidence of B.S.'s
inability to provide for his essential needs, with a high probability of serious physical
harm within the near future unless adequate treatment was provided. We conclude
substantial evidence supports the trial court's findings and those findings in turn
support its conclusion. We therefore affirm.
FACTS
After being voluntarily hospitalized at Harborview Medical Center from May 1,
2015 through May 22, 2015, B.S. was discharged to an adult family home. He was
readmitted to Harborview on May 23, 2015.
No. 73818-6-1/2
On May 27, 2015, the State petitioned for B.S. to be committed for 14 days of
involuntary treatment, and the court entered an agreed order.1 The State then
petitioned for 90 days of more restrictive involuntary treatment. The petition alleged
B.S. was "gravely disabled" due to a mental disorder.2
The State presented testimony from Harborview Medical Center psychiatrist
Dr. Kokil Chopra and Harborview social worker Ashely Molenda at the commitment
hearing.
Dr. Chopra treated B.S. since his voluntary admission to Harborview. She
performed a mental status exam of B.S. daily and reviewed nursing and other staff's
overnight reports. Based on Dr. Chopra's evaluation, B.S. had mental, emotional,
and organic impairments. He was diagnosed with major depressive disorder and
cognitive disorder "not otherwise specified."3 In addition, he had a history of chronic
heroin use. Dr. Chopra stated these impairments had a substantial adverse effect on
his cognitive and emotional function.
Dr. Chopra testified that upon B.S.'s May 23 readmission, he appeared
"altered" mentally, declined to answer staff's questions, and repeatedly stated, "It's all
the same," or "It doesn't matter," and "I do not want to do this anymore."4 As for
B.S.'s functioning since readmission, nursing reports indicated B.S. required a lot of
assistance with his activities of daily living such as bathing and toileting. B.S. also
1A designated mental health professional previously petitioned for B.S.'s initial
detention.
2 Clerk's Papers (CP) at 24.
3 Report of Proceedings (RP) (June 15, 2015) at 10.
4 Id. at 18.
No. 73818-6-1/3
had balance problems. Staff reported he fell off a shower chair while bathing. And
before his readmission, bystanders observed B.S. stumbling on the street. B.S. was
supposed to use a walker, but sometimes walked on his own.
B.S. also had significant memory issues. Dr. Chopra testified that the week
before the 90-day commitment hearing, B.S. did not remember her, even though she
worked with him every weekday. She stated a lot of the time, he could not connect
where he was or the day of the week and was unable to recall events occurring both
before and after his previous discharge. B.S. also insisted he would return to his
apartment if released, but B.S. did not have an apartment or the means to obtain
one.
Dr. Chopra also testified B.S. suffered from other medical concerns, namely
heart problems, which required a number of medications. Dr. Chopra doubted B.S.
would be able to manage his medications or comply with medical appointments if
released. In addition, toxicology testing indicated B.S. had used cocaine and opioids
during his brief May 22 to May 23 release to an adult family home.
In Dr. Chopra's opinion, B.S. was gravely disabled as a result of a mental
disorder; specifically, he was in danger of serious physical harm from a failure to
provide for his essential needs of health and safety. She recommended B.S. remain
at Harborview until they could find an adult family home or assisted living facility to
provide him with the 24-hour supervision he needed to help manage his medications,
cook his meals, and help him with his activities of daily living. Dr. Chopra testified
B.S. was incapable of outpatient management given his memory impairments, and
therefore, a less restrictive alternative placement was not appropriate.
No. 73818-6-1/4
Molenda testified that B.S. disagreed with Harborview about the proper
placement for him. She stated his mental disorder interfered with the hospital's ability
to develop a safe discharge plan for him because he lacked "insight into his illness
and how it affect[ed] his ability to be safe in the community."5 Molenda testified B.S.
planned to go to his own apartment and stay in an independent setting after being
discharged. But Molenda concluded B.S. was incapable of living on his own. She
was concerned about his ability to attend necessary appointments, obtain medical
care, and feed himself.
The court concluded B.S. was gravely disabled. The court found it significant
that, after being released from the hospital for only one day, B.S. returned in an
"altered" mental state, indicating he was suffering from depression and unable to take
care of his daily needs.6 The court therefore entered an order committing B.S. for an
additional 90 days.
B.S. appeals.
ANALYSIS
As a preliminary matter, although the 90-day commitment order at issue has
since expired, B.S. contends, and the State concedes, that his appeal is not moot
because an involuntary commitment order may have collateral consequences on
future commitment determinations.7 Under the circumstances, we exercise our
discretion to decide the appeal on the merits.
5jd. at 41.
6Id, at 52.
7See InreDet.ofM.K.. 168 Wn. App. 621, 625-30, 279 P.3d 897 (2012).
No. 73818-6-1/5
B.S. argues the trial court's findings of fact are not supported by substantial
evidence, and these findings do not support its conclusion that B.S. was gravely
disabled. We disagree.
A person can be committed for involuntary treatment if that person is gravely
disabled.8 Gravely disabled means a person, as a result of a mental disorder, "is in
danger of serious physical harm resulting 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 need not be evidenced by recent, overt acts.12 Instead, it "usually
arises from passive behavior—i.e., the failure or inability to provide for one's essential
needs."13
Where the trial court has weighed the evidence, our review is generally limited
to determining whether substantial evidence supports the trial court's findings of fact
and ifthose findings in turn support the court's conclusion.14 Substantial evidence is
8 RCW 71.05.280(4).
9 RCW 71.05.020(17).
10 In re Pet, of LaBelle. 107 Wn.2d 196, 203-04, 728 P.2d 138 (1986).
11 Jd at 204-05.
12 Id at 204.
13 id
14 Id. at 209.
No. 73818-6-1/6
'evidence in sufficient quantum to persuade a fair-minded person of the truth of the
declared premise.'"15
For a 90-day involuntary commitment, the State must prove the individual is
"gravely disabled" by clear, cogent and convincing evidence.16 This standard of proof
means the ultimate fact in issue must be shown by evidence to be "highly
probable."17
Here, it is undisputed that B.S. suffered from serious, long-standing mental
disorders at the time of his commitment. The State provided substantial evidence
that B.S. was gravely disabled by those disorders. The State's witnesses testified
that B.S.'s mental disorders significantly interfered with his self-care and the
hospital's ability to develop a safe discharge plan for him. The fact that B.S. was
readmitted to the hospital in an altered mental state after being discharged for just
one day demonstrated that he lacked insight into his illness and how it affected his
ability to be safe. B.S. also had significant memory issues and suffered from other
medical concerns requiring multiple medications. If B.S. did not receive treatment in
an inpatient setting, the State's witnesses' concluded he would be unable to take
care of himself, decompensate "mentally, as well as physically," and be at risk for
another stroke, heart problems, and other medical issues.18 There is thus substantial
15 lnreDet.ofA.S.. 91 Wn. App. 146, 162, 955 P.2d 836 (1998) (quoting
Holland v. Boeing Co.. 90 Wn.2d 384, 390, 583 P.2d 621 (1978)).
16 LaBelle. 107 Wn.2d at 209.
17 jd
18 RP (June 15, 2015) at 20-21.
No. 73818-6-1/7
evidence that B.S. was in danger of serious physical harm due to a failure or inability
to provide for his essential human needs.
B.S. claims any mental disorder he suffered from did not prevent him from
meeting his essential needs because he was able to participate in self-care at
Harborview and previously managed his own needs despite being homeless for 10
years. But the State was required only to show "a substantial risk of danger of
serious physical harm."19 Additionally, the State was not required to show the
"danger of serious harm" was imminent.20 Although Dr. Chopra testified B.S. was
participating in self-care and meeting nutritional needs at Harborview, she clarified
"participating in self-care need is different from [being] able to completely meet their
own need. So he was participating, which means he's been cooperative in all the
self-care ... assistance that he gets."21 Dr. Chopra further testified:
The fact that he's meeting his nutritional goals is because he's in
a structured setting right now. So things are monitored. If he stops
eating, ... the nurses will go to his room. . . . They'll prompt [him].
. . . [T]he medications are provided. ... I don't see [B.S.] taking
that initiative to take his own medications. . .. [W]hat he's doing right
now is because of this structured setting. And even now, ... we are
noticing a lot of deficits and impairments. So without a structured
setting, he's bound to fail.[22]
19 LaBelle, 107 Wn.2d at 204 (emphasis added).
20 Id at 203.
21 RP (June 15, 2015) at 32.
22 Id. at 35-36.
No. 73818-6-1/8
Therefore, although B.S. was able to participate in self-care in the hospital, the State
established B.S. would be unable to provide for his essential needs outside a
structured setting.
Furthermore, while B.S. had been homeless in the past, a homeless existence
would present a grave risk of harm. Given his current medical issues, memory
deficits, and inability to provide for his daily needs, only an inpatient facility can
provide the supervision and assistance B.S. needs. Therefore, B.S.'s arguments are
unpersuasive.
We affirm the 90-day involuntary commitment order.
WE CONCUR:
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