In re A.O.-A.

1

In the Matter of the Detention of A.O.-A. Appellant.

No. 57773-9-II

Court of Appeals of Washington, Division 2

January 17, 2024

UNPUBLISHED OPINION

CRUSER, A.C.J.

AO-A was involuntarily committed based on a civil conversion following the dismissal of his charges of two counts of rape of a child in the first degree. AO-A appeals the trial court's order extending his involuntary commitment for an additional 180 days of mental health treatment. AO-A argues that the State failed to prove that he was gravely disabled. We affirm the trial court's commitment order because the finding that AO-A was gravely disabled was supported by clear, cogent, and convincing evidence.

FACTS

I. Background

AO-A is 48 years old. In 2008, he was charged with two counts of rape of a child in the first degree for incidents that occurred in 1999 and 2002, when AO-A allegedly molested his cousin's minor daughter. His case went to trial and he was found guilty by a jury, but the sentencing judge ultimately overturned his conviction after finding that AO-A had been incompetent to stand trial. He was first evaluated in 2010 at which point he was diagnosed with borderline intellectual functioning, but the evaluator did not note any psychotic symptoms. His charges were dismissed and he remained in the King County Jail for nearly a decade before being civilly committed to Western State Hospital (WSH) in 2020. Between 2010 and 2020, AO-A underwent six competency evaluations. He was found to be incompetent in 2010, competent in 2012 and 2019, and then incompetent again during two evaluations in 2020. No opinion was offered from the physician who conducted the second evaluation, which was in 2011. It was not until the evaluation in 2020 that AO-A was diagnosed with a psychosis-related disorder. Specifically, he was diagnosed with "Unspecified Schizophrenia Spectrum and Other Psychotic Disorder." Clerk's Papers (CP) at 54.

II. Petition to Extend Involuntary Treatment

In September 2022, doctors from WSH petitioned the superior court for an additional 180 days of involuntary treatment for AO-A. The doctors, Peter Bingcang, MD, and Rosario Archer, PhD, alleged in their petition that AO-A remained gravely disabled but opined that he was ready for a less restrictive alternative (LRA) placement once an appropriate placement became available.

III. Hearing

A. Dr. Archer's Testimony

Dr. Archer, an evaluator for the Commitment Center at WSH, was the first witness to testify at the commitment hearing. Her testimony was based on the mental status examination (MSE) she conducted, interactions with AO-A's health providers and treatment team, a review of AO-A's medical records, as well as the multiple occasions on which she observed AO-A during her visits to the WSH ward where he resides. She conducted the MSE in Spanish, AO-A's native language, because when he initially approached her, he spoke in Spanish and indicated that he felt fully comfortable speaking in Spanish. Dr. Archer conducted the MSE in-person, which she opined was important in that it provided her the opportunity to observe his body language and the small physical movements he made throughout the evaluation.

Dr. Archer opined that AO-A has "a mental health disorder labeled as unspecified schizophrenia spectrum disorder or other psychotic disorder." Id. at 245. She testified that during the evaluation, AO-A "displayed delusional ideation, [and] auditory and visual hallucination." Id. AO-A told Dr. Archer that he could hear spirits speaking to him from the corner of the room. He spoke of his belief that the sun was guiding him in his life and directing his departure from WSH. Dr. Archer testified that AO-A's hospital record notes that he repeated similar beliefs regarding spirits, God, and demons during his interactions with other WSH staff.

During the evaluation, AO-A frequently interrupted Dr. Archer and presented "unstable mood, demanding behavior," and agitation. Id. at 246. AO-A demanded that Dr. Archer open the doors to the hospital to release him. Dr. Archer testified that AO-A repeatedly interrupted her, exhibited an unregulated mood, as well as a disorganized and confused thought process. She unsuccessfully tried to redirect AO-A when he became agitated and went off track. AO-A told Dr. Archer that he was the victim of a plot who had been kidnapped against his will and WSH staff were infringing upon his liberty. Additionally, AO-A stated that he did not have a mental illness and refused psychotropic medications. Regarding AO-A's cognitive and volitional control, Dr. Archer explained that AO-A has not exhibited any aggressive behavior at WSH, but opined that his cognitive control is impaired as evidenced by his irrational thoughts, agitation, and demanding behavior.

Dr. Archer opined that AO-A would not be able to meet his basic health and safety needs if he were to be released from WSH at the time of the hearing. She testified that he would not be able to attend to the needs of his diagnosis because he did not demonstrate an awareness of his disorder, and therefore was unable to make rational decisions regarding treatment. Dr. Archer said AO-A's judgment was impaired and provided an example where she asked him "What goes through your mind when I tell you there's no use to cry over spilled milk?" His response was "I would clean the milk on the floor. I like to clean here in the ward."^[1] Id. at 251.

While AO-A attended to his hygiene and appearance, he was reportedly uncooperative with a social worker in preparing potential discharge plans. Dr. Archer was concerned that AO-A did not allow the social worker to contact his sisters who he planned to stay with upon release and explained that AO-A would not be deemed ready for release until he participated more actively in discharge planning. Additionally, Dr. Archer expressed concern that if AO-A was released from WSH, he may neglect his needs and could decompensate, especially given the ways in which his delusional thinking may prevent him from seeking help and making rational decisions. In support of her opinion that AO-A would not function successfully in the community at that time, Dr. Archer explained that AO-A participates minimally in group therapy, he is disruptive when he does participate and acts hostile and argumentative, he is difficult to redirect, and he refuses to take psychotropic medications. Moreover, Dr. Archer testified that AO-A appears to be unaware of his disorder, and unaware that his behaviors are inappropriate and disruptive.

In conclusion, Dr. Archer's opinion was that AO-A needed to remain at WSH until an appropriate LRA was identified for him in order to ensure that his basic health and safety needs would be met.

B. Dr. Stanfill's Testimony

Defense counsel called Dr. Michael Stanfill to testify. Dr. Stanfill holds a doctorate in clinical psychology. He previously worked as the psychiatric services director for the King County jail system, and as a part-time forensic evaluator for the Special Commitment Center. Dr. Stanfill conducted two evaluations of AO-A, one a month prior to the hearing in question, and another roughly a year before that, when Dr. Stanfill evaluated AO-A for a previous civil commitment petition. In preparation of those evaluations, Dr. Stanfill reviewed the previous competency evaluations of AO-A within the past decade. He spoke with AO-A in English and via Zoom.

During his first evaluation of AO-A, Dr. Stanfill administered two psychological measures aimed to assess risk of recidivism in sex offenses. The measures are known as Static-99 and STABLE-2007. He found that AO-A "was in the low risk range, low risk categorization of potential sexual reoffense." Id. at 276.

Dr. Stanfill agreed with both the initial borderline intellectual functioning diagnosis, and with the diagnosis of unspecified schizophrenia or other psychotic disorder. He also confirmed that according to the record, AO-A refuses to take antipsychotic medications at WSH. AO-A did not tell Dr. Stanfill that he would seek treatment in the community if released. Dr. Stanfill explained that throughout AO-A's competency evaluations he has "consistently presented with some amount of what has been conceptualized and deemed by numerous evaluators and clinician[s] as delusions, often with a religious preoccupation." Id. at 278.

Dr. Stanfill noted a "complete lack of aggression" in AO-A's hospital records. Id. at 285. Dr. Stanfill opined that AO-A exhibited cognitive control over his actions and provided an example where AO-A demonstrated that control in a potentially agitating and exacerbating situation. In that situation, AO-A's roommate at WSH repeatedly used AO-A's toothbrush and spit on his clothes. AO-A was able to maintain cognitive control over his actions and handle the situation appropriately by first asking his roommate to stop, and when that did not work, going to staff and asking them to intervene. According to Dr. Stanfill, there is "no evidence of any concerns in [AO-A's] ability to meet his essential human needs both before his incarceration, during, or his time while at Western." Id. at 283-84.

C. AO-A's Testimony

AO-A testified briefly at the hearing. He testified that if he were to be released from WSH, he would go stay at his sister's house and begin looking for a job. He testified that prior to his commitment, he always held a job and has various skillsets. He also testified that he would not seek mental health treatment upon release. He did not believe that he suffered from a mental illness and testified, "I have no problems. I've never had any problems." Id. at 305.

D. Court's Ruling

In the findings of fact and conclusions of law, the court found that AO-A continued to be gravely...