In re A.P.

1

In the Matter of the Detention of: A.P., Appellant.

No. 86015-1-I

Court of Appeals of Washington, Division 1

September 30, 2024

UNPUBLISHED OPINION

FELDMAN, J.

A.P appeals a 14-day commitment order under the Involuntary Treatment Act (ITA), ch. 71.05 RCW. A.P. asserts (a) the trial court erroneously concluded that she could be detained under the ITA for up to 14 days of involuntary mental health treatment and (b) RCW 71.05.240(6), which prohibits her from possessing firearms until a court restores that right under RCW 9.41.047, violates her equal protection rights by treating her differently than someone who agreed to voluntary mental health treatment. We disagree with both arguments and affirm.

I

On October 23, 2023, A.P. was initially detained for up to 120 hours of psychiatric evaluation and treatment at Valley Medical Center (Valley) after she flew from Chicago to Seattle and was found rolling around on the ground outside Boeing Field in Renton complaining that her ex-boyfriend and brother were trying to kill her. While A.P. denied any suicidal ideation, she acknowledged that she had been thinking about jumping off the roof of her seven-story apartment building to escape from her brother who she believed was stalking and seeking to harm her. Later the same day, she was transferred to Fairfax Behavioral Hospital (Fairfax). Fairfax determined that A.P. required further evaluation and treatment beyond the initial 120-hour involuntary hold, and so it filed a petition for an additional 14 days of involuntary treatment based on grave disability under prongs (a) and (b) of RCW 71.05.020(25) which are quoted and discussed below.

Pursuant to RCW 71.05.240, a King County Superior Court commissioner held a probable cause hearing on October 30, 2023. Three witnesses testified at the hearing: (1) A.P.'s father who testified regarding A.P.'s history of paranoid and suicidal behavior and that A.P. was "definitely manic" when he last spoke with her earlier that month; (2) Patrick Swann, a Mental Health Counselor at Fairfax, who testified that he had evaluated A.P., that A.P. has a working diagnosis of bipolar disorder with psychosis, and that A.P. presented a danger to herself and others in the absence of continued in-patient treatment; and (3) A.P., who denied having any suicidal thoughts in the past month and testified she would not harm herself and would provide for her essential human needs, including her medical needs, if permitted to return to her apartment. The court also heard closing argument from both parties.

Following closing arguments, the court granted Fairfax's petition. In its oral ruling, the court meticulously described the evidence supporting its ruling. And while the court expressly acknowledged A.P.'s testimony, it stated it was "not persuaded by [her] testimony." Instead, the court was largely persuaded by the testimony of A.P.'s father, who it noted was "a credible witness." Lastly, the court also ruled, "as a result of being involuntarily hospitalized, [A.P.] does lose her constitutional right to possess a firearm. And that right can only be reinstated with a court order." The court subsequently entered a written ruling that both supplemented and incorporated its oral findings and conclusions. This timely appeal followed.

II

A. Involuntary Mental Health Treatment

A.P. asserts that the trial court erroneously concluded that she could be detained under the ITA for up to 14 days of involuntary mental health treatment. We disagree.

RCW 71.05.240(4)(a) states in relevant part as follows:

[I]f the court finds by a preponderance of the evidence that a person detained for behavioral health treatment, as the result of a behavioral health disorder, . . . is gravely disabled, and, after considering less restrictive alternatives to involuntary detention and treatment, finds that no such alternatives are in the best interests of such person or others, the court shall order that such person be detained for involuntary treatment not to exceed 14 days in a facility licensed or certified to provide treatment by the department or under RCW 71.05.745.

As this statutory provision requires, the trial court here found that A.P. was "gravely disabled" and could therefore be detained under the ITA for up to 14 days of involuntary treatment.

On review, we must determine "whether substantial evidence supports the [trial court's] findings and, if so, whether the findings in turn support the trial court's conclusions of law and judgment." In re Det. of LaBelle, 107 Wn.2d 196, 209, 728 P.2d 138 (1986).

"Substantial evidence is the quantum of evidence sufficient to persuade a fair-minded person" that the premise is true. In re Det. of H.N., 188 Wn.App. 744, 762, 355 P.3d 294 (2015). This is a deferential standard of review: "we consider the evidence in the light most favorable to the Petitioner[]," which in this case is Fairfax. In re Det. of A.M., 17 Wn.App. 2d 321, 330, 487 P.3d 531 (2021) (citing In re Det. of B.M., 7 Wn.App. 2d 70, 85, 432 P.3d 459 (2019)).

The trial court found that A.P. was "gravely disabled" under both prong (a) and prong (b) of RCW 71.05.020(25). Starting with prong (a), RCW 71.05.020(25)(a) defines "gravely disabled" as "a condition in which a person, as a result of a behavioral health disorder . . . [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 establish grave disability under this statutory provision, the petitioner must prove both "recent, tangible evidence of failure or inability to provide for . . . essential human needs" and that "the failure to meet these needs placed [the person] 'in danger of serious physical harm.'" A.M., 17 Wn.App. 2d at 334 (quoting LaBelle, 107 Wn.2d at 204-05; former RCW 71.05.020(22)(a) (2018)). Essential human needs, in turn, include "food, clothing, shelter, and medical treatment." LaBelle, 107 Wn.2d at 204-05.

Substantial evidence supports the trial court's finding that A.P. was "gravely disabled" under RCW 71.05.020(25)(a). The trial court meticulously catalogued the behaviors that support this finding, which includes inconsistent sleep, pacing at night, failing to consistently take prescribed medication, removing her clothes in public, defecating in the shower, ripping up her mattress, wrapping a shower curtain around her neck, rubbing a banana all over herself, and attempting to enter other patients' rooms. Based on this evidence, a fair-minded person could find, as the trial court did, that A.P. was gravely disabled under RCW 71.05.020(25)(a) because she was exhibiting active symptoms of a behavioral health disorder and was consequently unable to provide for her essential human needs.

Turning to prong (b), RCW 71.05.020(25)(b) defines "gravely disabled" as "a condition in which a person, as a result of a behavioral health disorder . . . manifests severe deterioration in routine functioning evidenced by repeated and escalating loss of cognitive or volitional control over his or her actions and is not receiving such care as is essential for his or her health or safety." Here again, the trial court meticulously catalogued the relevant evidence regarding this determination, which includes A.P.'s repeated and escalating loss of cognitive and volitional control over her actions such that she would not receive essential medical care outside a hospital setting. As the trial court found, the record includes evidence that A.P. was hyperactive and paranoid, was making nonsensical statements, and believed her father was selling her to pedophiles, was trying to kill her, and was selling drugs as a member of a cartel. Based on this evidence, a fair-minded person could find, as the trial court did, that A.P. was gravely disabled under RCW 71.05.020(25)(b) because, in the absence of involuntary mental health treatment, she will continue to exhibit active symptoms of a behavioral health disorder.

Against this weight of evidence, A.P. claims that Fairfax failed to establish she was gravely disabled under prong (a) of RCW 71.05.020(25) because there is no evidence of "a recent overt act of self-harm." While Washington law requires a "recent overt act," there is no requirement that it be an act of self-harm. Instead, we have recognized, "'This act may be one which has caused harm or creates a reasonable apprehension of dangerousness.'" In re Det. of T.C., 11 Wn.App. 2d 51, 57, 450 P.3d 1230 (2019) (quoting In re Det. of Harris, 98 Wn.2d 276, 284-85, 654 P.2d 109 (1982)). The ITA defines "recent" as a "period of time not exceeding three years prior to the current hearing." RCW 71.05.245(3). The evidence satisfies this requirement in two respects. First, when A.P. completed the Columbia Suicide Risk Assessment while at Valley, she indicated she had suicidal ideation within the past month, including thoughts of "wanting to die" and "want[ing] it to be over." Second, also while at Valley, A.P. pulled down a shower curtain and wrapped it around her neck, which required immediate intervention by Valley medical staff. Viewed in the light most favorable to Fairfax, this evidence satisfies the recent overt act requirement.

A.P next argues that Fairfax failed to establish she was gravely disabled under prong (b) of RCW 71.05.020(25) because she "recognized she had a bipolar diagnosis" when asked about this issue at the probable cause hearing and "indicated she will take her medication, continue regular outpatient care, and rely on her support system in times of crisis." But A.P.'s father testified that A.P. is fine until she starts smoking cannabis, which A.P. indicated she does "once in a while." The record also shows that A.P. failed to coordinate any outpatient services prior to...