In re Det. of E.C.

In the Matter of the Detention of: E.C.,

STATE OF WASHINGTON, Respondent, v. E.C., Appellant.

No. 54608-6-II

Court of Appeals of Washington, Division 2

August 3, 2021

UNPUBLISHED OPINION

SUTTON, J.

EC appeals from an order for involuntary administration of an antipsychotic medication, olanzapine, under RCW 71.05.217(1)(j)(i).^[1] EC argues that substantial evidence does not support the findings that (1) there was a compelling interest in allowing him to be involuntarily medicated because he was likely to be detained substantially longer, at increased public expense, without such treatment, (2) treatment with olanzapine was necessary and effective, and (3) alternative treatments were less effective. He further argues that with respect to the finding that the treatment was necessary and effective, the superior court failed to make specific findings as required under RCW 71.05.217(1)(j)(ii). And he asks that we "clarify the level of evidence that is required to support an order for involuntary treatment with [antipsychotic] medication." Br. of Appellant at 1, 13. These arguments fail. Accordingly we affirm.^[2]

FACTS

I. PETITION FOR INVOLUNTARY TREATMENT

On July 11, 2019, the criminal court signed an order dismissing several criminal charges against EC after finding he was incompetent to stand trial. The criminal court then committed EC to Western State Hospital for an evaluation and possible civil commitment.

In late July, EC's treatment providers petitioned for 180 days of involuntary treatment based on EC being gravely disabled and the fact that there was a substantial likelihood that he would repeat his criminal acts. In the declaration supporting the petition, ^[3] EC's treatment providers stated that EC had one prior admission to Western State Hospital from August 2011 to August 2012, four additional hospitalizations in the community between 2010 and 2011, "three outpatient crisis contacts" with a mental health facility in May 2019, and "several" emergency room visits for "'mental health crises[es]'" in January 2019. Clerk's Papers (CP) at 7. EC's treatment providers noted that EC was "unable to participate meaningfully in treatment due to his severe and persistent symptomology and intense focus on delusional themes." CP at 13. In early October, following a jury trial, the superior court granted the petition and entered an order detaining EC at Western State Hospital for up to 180 days pending arrangements to place him in a less restrictive alternative placement.

Just over a month later, but almost four months after the criminal court referred EC for evaluation, Dr. Xiaping Xie filed a petition for involuntary treatment with antipsychotic medication, specifically "Olanzapine or Fluphenazine/Fluphenazine Decanoate, or Risperidone/Risperadal Consta." CP at 19-20. In the petition, which Dr. Xie signed under penalty of perjury, Dr Xie alleged that EC did "not believe he needs psychiatric medication." CP at 20. Dr. Xie further stated that EC had "recently threatened, attempted or caused serious harm to others"^[4] and that treatment with antipsychotic medication would "reduce the likelihood that [EC] will cause serious harm to others." CP at 21.

Dr. Xie asserted that "[f]ailure to treat [EC] with antipsychotic medication may result in the likelihood of serious harm or substantial (further) deterioration" and that there were no "[p]ossible alternative treatments." CP at 21-22. Dr. Xie noted that EC had refused to take any psychiatric medications since his admission in July and that he had "not shown any sign of self-remitting since then." CP at 21. The doctor also asserted that EC would "likely be detained for a substantially longer period of time, at increased public expense, without such treatment." CP at 21.

II. HEARING ON PETITION FOR INVOLUNTARY TREATMENT

A superior court commissioner pro tem considered the petition. Dr. Xie and EC were the only witnesses.

A. DR. XIE'S TESTIMONY

EC's psychiatrist, Dr. Xie, testified that he had reviewed EC's records; had spoken with EC's treatment team; and had attempted, unsuccessfully, to discuss the medication with EC. Dr. Xie stated that EC had been diagnosed with schizoaffective disorder, bipolar type. The doctor further testified that EC was psychotic, "frequently" made "grandiose [and] persecutory" "delusional statements," and exhibited "mood instability," and that EC's prognosis was "poor" if he was not treated with antipsychotic medication. Verbatim Report of Proceedings (VRP) (Dec. 2, 2019) at 15, 21.

When Petitioner's counsel asked Dr. Xie if "there [was] a likelihood of serious harm to himself or others [i]f anti-psychotic medication is not administered," Dr. Xie responded, "Yes. He is dangerous to others." VRP (Dec. 2, 2019) at 21. Dr. Xie then stated that on November 12, EC had "hit the ward secretary" in the face and the secretary had been on sick leave since then. VRP (Dec. 2, 2019) at 21-22. EC's counsel objected to this testimony based on hearsay; the commissioner admitted this testimony under ER 703.^[5]

Based on EC's history, Dr. Xie opined that the administration of antipsychotic medications would be effective. Dr. Xie stated that EC's records showed that during a prior hospitalization between 2011 and 2012, EC had received the antipsychotic medication haloperidol and that he responded to this medication. EC's counsel objected based on hearsay to Dr. Xie's testimony about EC's prior admission in 2011 and his prior treatment. The court admitted the testimony under ER 703.

Dr. Xie then testified that he was seeking to involuntarily administer olanzapine, "a second generation anti-psychotic" that EC had not taken before. VRP (Dec. 2, 2019) at 19, 30. The doctor noted that EC had been prescribed olanzapine upon his admission, but he had refused to take it. Dr. Xie further testified that with "strong encouragement," EC had previously been treated successfully with another antipsychotic drug, haloperidol. ^[6] VRP (Dec. 2, 2019) at 19. The testimony about the haloperidol was admitted under ER 703.

Dr. Xie described the main potential adverse side effects of antipsychotics, including olanzapine, as "[extrapyramidal (EPS)] symptoms, like shaking hands and unsteady gait;" dizziness; drowsiness; and "metabolic syndrome." VRP (Dec. 2, 2019) at 18, 26. Metabolic syndrome could include such issues as increased "[b]lood sugar levels and lipid profile," and weight gain. VRP (Dec. 2, 2019) at 26. Dr. Xie stated that the rarer side effects included fever, delirium, and death.

Dr. Xie testified that EC's existing health problems included "hypertension, hyperlipidemia, [and] COPD" and that EC was currently prescribed medication for hypertension and hyperlipidemia. VRP (Dec. 2, 2019) at 28. The doctor had investigated the potential interaction between olanzapine and EC's other medical conditions and stated that the possible interactions could be managed by "adjust[ing] the dosage to avoid or minimize the side effects" and starting EC "on very low doses" to avoid complications. VRP (Dec. 2, 2019) at 29. Dr. Xie admitted that the drug had the potential of worsening EC's existing hypertension, but he assured the court that starting with a lower dosage could avoid the risk of metabolic syndrome. In regard to the risks of administering the drug, Dr. Xie stated, "All the medication we have right now have a benefit and a risk, so we decide the medication based on the benefit ratio." VRP (Dec. 2, 2019) at 29-30. He opined that "for now [he thought] the anti-psychotic medication will benefit [EC] . . . despite the side effects," given that EC currently "pos[ed] a risk to others and consequentially also to himself." VRP (Dec. 2, 2019) at 31.

Dr. Xie further opined that EC had a "poor" prognosis if he were not medicated. VRP (Dec. 2, 2019) at 21. The doctor stated that EC "will continue to present with mood instability, agitation" and that he would "continue to be delusional" and to "frequently make delusional statements." VRP (Dec. 2, 2019) at 21. The doctor testified that if EC did not take the medication, "[i]t will prolong his stay [at Western State Hospital] significantly." VRP (Dec. 2, 2019) at 23. Dr. Xie also testified that they had "tried non-pharmacological treatment like counseling, group therapy," but it was "ineffective." VRP (Dec. 2, 2019) at 23.

B. EC'S TESTIMONY

EC testified that he did not want to take anti-psychotic medication and that he never had taken them in his life. After briefly asserting that he objected to being medicated under the "First Amendment" and "Fourth Amendment," EC then started talking about other unrelated matters. VRP (Dec. 2, 2019) at 36-37.

C. COMMISSIONER'S DECISION AND DENIAL OF MOTION FOR REVISION

The superior court commissioner entered written findings of fact and conclusions of law. In the written decision, the commissioner found that EC had refused treatment with antipsychotic medications because he "denie[d] mental illness or need for medications." CP at 26. The commissioner further found that "[t]he Petitioner has a compelling interest in administering antipsychotic medication to [EC] for the following reasons: . . . [EC] will likely be detained for a substantially longer period of time, at increased public expense, without such treatment." CP at 26.

The commissioner further found that the antipsychotic mediation was "a necessary and effective course of treatment for [EC], as evidence by [EC's] prognosis with and without this treatment and the lack of effective alternative courses of treatment." CP at 27. Additionally, the commissioner found that "[t]he alternatives are less effective than medication for the following reasons: . . . [t]hey are more likely to prolong the length of commitment for involuntary...