In re Det. of Black , 422 P.3d 881 ( 2018 )


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  •       IN CLERKS OFFICE                             This opinion was filed for record
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    SUSAN L. CARLSON
    SUPREME COURT CLERK
    IN THE SUPREME COURT OF THE STATE OF WASHINGTON
    In the Matter of the Detention of           No. 94494-6
    Mark A. Black.
    STATE OF WASHINGTON,
    Respondent,
    V.
    En Banc
    MARK A. BLACK,
    Petitioner.         Filed:    Allfi fl 7 ?niB
    YU,J.— To commit an individual as a sexually violent predator(SVP)
    pursuant to chapter 71.09 ROW,the State must prove beyond a reasonable doubt
    that the individual "has been convicted of or charged with a crime of sexual
    violence and [he or she] suffers from a mental abnormality or personality disorder
    which makes the person likely to engage in predatory acts of sexual violence if not
    confined in a secure facility." RCW 71.09.020(18). This case concerns the
    admissibility of expert testimony about whether the subject individual suffers from
    a mental abnormality.
    In re Det. ofBlack, No. 94494-6
    The trial court held a Frye^ hearing and excluded expert testimony regarding
    "hebephilia" on the basis that such a diagnosis is not generally accepted by the
    relevant scientific community. The parties do not challenge that portion ofthe
    court's decision. However, petitioner Mark Black argues that the court committed
    reversible error by allowing expert testimony on a diagnosis of"paraphilia not
    otherwise specified(NOS), persistent sexual interest in pubescent aged females,
    non-exclusive."
    The Court of Appeals affirmed Black's civil commitment in an unpublished
    opinion. In re Det. ofBlack, No. 71292-6-1, slip op. at 10(Wash. Ct. App. Mar.
    27, 2017)(unpublished), http://www.courts.wa.gov/opinions/pdf/712926.pdf,
    review granted, 
    189 Wn.2d 1015
    , 
    404 P.3d 480
    (Wash. Oct. 5, 2017). It concluded
    that regardless of whether paraphilia NOS was improperly admitted, there was
    sufficient evidence to find Black had a mental abnormality and a personality
    disorder based on two other diagnoses that Black did not challenge on appeal. 
    Id.
    We affirm the Court of Appeals on different grounds and hold that the trial court
    did not err as a matter oflaw when it admitted expert testimony on paraphilia
    NOS, nor did it abuse its discretion when it allowed an expert to describe Black's
    specific paraphilic focus as "persistent sexual interest in pubescent aged females."
    Frye v. United States, 
    54 App. D.C. 46
    ,
    293 F. 1013
     (1923).
    In re Det. ofBlack, No. 94494-6
    FACTUAL AND PROCEDURAL BACKGROUND
    In 2011,the State filed a petition to civilly commit 40-year-old Mark Black
    as an SVP prior to his scheduled release from prison. In support of its petition, the
    State included the evaluation of Dr. Dale Arnold, who diagnosed Black with sexual
    sadism; paraphilia NOS,persistent sexual interest in pubescent aged females,
    nonexclusive; and personality disorder NOS with antisocial and narcissistic
    characteristics.
    Prior to trial. Black moved to exclude evidence of hebephilia and paraphilia
    NOS, persistent sexual interest in pubescent aged females, arguing that hebephilia
    is inadmissible pursuant to Frye. Black was not diagnosed with hebephilia, but he
    argued that Dr. Arnold's paraphilia NOS diagnosis was just another name for
    hebephilia and was therefore also inadmissible. According to testimony at the
    Frye hearing by Black's expert. Dr. Karen Franklin, hebephilia "[i]n general . . .
    has something to do with sexual attraction or sexual activity or both with . . .
    adolescents." Report ofProceedings(RP)(Sept. 13, 2013)at 35. Dr. Franklin
    testified that "[tjhere's nothing abnormal or pathological about a certain level of
    attraction" between an adult and an adolescent. Id. at 93.
    The trial court excluded evidence of hebephilia from being presented at trial
    because it "is not favored in the relevant scientific community." Id. at 149.
    However,the trial court allowed expert testimony from Dr. Arnold on the basis
    In reDet. ofBlack, No. 94494-6
    that paraphilia NOS is generally accepted in the psychological community and that
    Dr. Arnold used commonly accepted methodology to diagnose Black.
    At trial, the jury was instructed that to determine Black is an SVP it must
    find that the State proved the following elements beyond a reasonable doubt:
    (1)     That Mr. Black has been convicted of a crime of sexual
    violence;
    (2) That Mr. Black suffers from a mental abnormality or
    personality disorder which causes serious difficulty in controlling his
    sexually violent behavior; and
    (3) That this mental abnormality or personality disorder
    makes Mr. Black likely to engage in predatory acts of sexual violence
    unless confined to a secure facility.
    Clerk's Papers(CP)at 1385. The jury was further instructed that its verdict needed
    to be unanimous, but that it "need not be unanimous as to whether a mental
    abnormality or personality disorder has been proven beyond a reasonable doubt so
    long as each juror finds that at least one ofthese alternative means has been proved
    beyond a reasonable doubt." Id.
    Dr. Arnold testified that each element was satisfied in Black's case. First, he
    testified that Black had been convicted oftwo counts of child molestation in the
    second degree and one count of attempted child molestation in the second degree,
    which are all crimes of sexual violence.^
    ^ The jury heard testimony about these ineidents. Black's former stepdaughter testified
    that he had sexual intercourse with her when she was 13. 4 Verbatim Report ofProceedings
    In re Det. ofBlack, No. 94494-6
    Second, Dr. Arnold testified that Black suffers from two mental
    abnormalities (sexual sadism and paraphilia NOS, persistent sexual attraction to
    pubescent aged females, nonexclusive) and a personality disorder (personality
    disorder NOS), each of which independently causes him serious difficulty
    controlling his sexually violent behavior. Third, Dr. Arnold concluded that in his
    opinion. Black "is more likely than not to engage in predatory acts of sexual
    violence if not confined." 5 Verbatim Report ofProceedings(VRP)(Oct. 28,
    2013) at 480.
    Black presented his own expert witness, Dr. Joseph Plaud, who testified that
    Black does not suffer from a mental abnormality or personality disorder at this
    time. Dr. Plaud further testified that the paraphilia NOS diagnosis was
    inappropriate because "it doesn't represent fundamentally disordered sexual
    arousal. Men are attracted to pubescence." 9 VRP(Nov. 4, 2013) at 946. When
    asked whether an adult male's attraction to a pubescent aged female could ever be
    deviant, he testified that it might be illegal but "it doesn't happen as a result of
    underlying sexual deviance." Id. at 947.
    The jury unanimously determined Black met the criteria for an SVP,and the
    court ordered his civil commitment.
    (VRP)(Oct. 24, 2013) at 220-22. The friend of a former girlfriend's daughter testified that when
    she was 12, he fondled her breasts and rubbed his crotch against hers. 8 VRP (Oct. 31, 2013) at
    859-60.
    In re Det. ofBlack, No. 94494-6
    ISSUE
    Whether expert testimony on paraphilia NOS, persistent sexual interest in
    pubescent aged females was improperly admitted at trial?
    ANALYSIS
    This case does not ask us to determine whether evidence of hebephilia can
    be offered as evidence of a mental abnormality in accordance with Frye. The trial
    court excluded any evidence of hebephilia following a Frye hearing, and the State
    has not appealed that decision. Instead, we consider whether the trial court
    improperly admitted expert testimony on paraphilia NOS,persistent sexual interest
    in pubescent aged females as evidence of Black's rnental abnormality.
    Our review of the trial court's Frye determination regarding paraphilia NOS
    is de novo. In re Det. ofHalgren, 
    156 Wn.2d 795
    , 802-03, 
    132 P.3d 714
    (2006).
    Our review of the scope of testimony that the trial court actually allowed is for an
    abuse of discretion. 
    Id. at 802
    .
    A.     Black's paraphilia NOS diagnosis
    Paraphilic disorders are characterized by
    recurrent, intense sexually arousing fantasies, sexual urges, or behaviors
    generally involving 1) nonhuman objects, 2)the suffering or humiliation of
    oneself or one's partner, or 3)children or other nonconsenting persons that
    occur over a period of at least 6 months ...[and] cause clinically significant
    distress or impairment in social, occupational, or other important areas of
    functioning.
    In re Det. ofBlack, No. 94494-6
    Am.Psychiatric Ass'n,Diagnostic and Statistical Manual of Mental
    Disorders: DSM-IV-TR 566 (4th rev. ed. 2000). Both the former DSM-IV-TR
    and the current American Psychiatric Association, Diagnostic and Statistical
    Manual ofMental Disorders (5th ed. 2013)(DSM-5)emphasize that paraphilic
    sexual urges are not considered a disorder unless they are also persistent over an
    extended period oftime and cause significant distress or impairment. DSM-IV-TR
    at 568; DSM-5 at 686.^
    While certain paraphilic disorders, such as voyeurism and fetishism, are
    specifically enumerated, others, such as necrophilia and zoophilia, are not.
    Paraphilia NOS is a diagnosis reserved for those individuals whose paraphilic
    focus does not fall within the descriptions of any ofthe eight enumerated
    paraphilias. It is followed by a description ofthe individual's paraphilia, which, as
    defined in the DSM-5,is "any intense and persistent sexual interest other than
    sexual interest in genital stimulation or preparatory fondling with phenotypically
    normal, physically mature, consenting human partners." DSM-5 at 685. The
    DSM-5 also allows for a diagnosis of unspecified paraphilic disorder, where the
    clinician cannot or does not wish to specifically identify the individual's paraphilic
    focus. Id. at 705.
    ^ Although Dr. Arnold diagnosed Black in accordance with the DSM-IV-TR, he testified
    at trial that his three diagnoses would be unchanged using the DSM-5. 5 VRP (Oct. 28, 2013) at
    384.
    In re Det. ofBlack, No. 94494-6
    Dr. Arnold diagnosed Black with paraphilia NOS and described his
    paraphilic focus as pubescent aged females. He reached this conclusion after
    reviewing approximately 4,000 pages of records, administering a psychological
    test to Black, and interviewing him in 2008 and 2011. He described in his
    evaluation that Black "enjoyed 'grooming' young girls because he found the
    attention from them exciting." CP at 407. He was sexually aroused by their
    budding breasts and also emotionally attracted to them because they were easy to
    manipulate.
    What makes Black's interest rise to the level of paraphilic disorder, thus
    evincing a mental abnormality, is not specifically his sexual focus on pubescent
    girls, but that he has demonstrated an inability to control his behavior to such an
    extent that he has committed repeated sexual offenses against multiple children
    who were legally incapable of giving consent. As Dr. Arnold concluded in his
    evaluation,"despite prior sanctions for virtually identical grooming and sexually
    exploitive behavior,[Black] was unable to resist the opportunity to reoffend." Id.
    at 426.
    B.     Paraphilia NOS is generally accepted within the psychological community
    As a threshold matter of law, the trial court correctly ruled that paraphilia
    NOS is generally accepted as a diagnosis. It is recognized in recent editions ofthe
    DSM,which is "a standard reference for clinical practice in the mental health
    In re Det. ofBlack, No. 94494-6
    field." DSM-5 at xli. Paraphilia NOS has also been a basis for numerous SVP
    determinations, and this case does not present any reason to question that
    precedent. See, e.g.. In re Det. ofStout, 
    159 Wn.2d 357
    , 363, 
    150 P.3d 86
    (2007)
    (paraphilia NOS,nonconsent); Halgren, 
    156 Wn.2d at 800
     (paraphilia NOS,
    nonconsent); In re Det. ofCoe, 
    175 Wn.2d 482
    , 489, 
    286 P.3d 29
    (2012)
    (Paraphilia NOS,urophilia, and coprophilia).
    Indeed, Black conceded in his briefing that he was not "seek[ing] to
    challenge . . . generally" the diagnosis of paraphilia NOS, only the specific
    diagnosis of paraphilia NOS,persistent sexual interest in pubescent aged females.
    CP at 344; Pet'r's Suppl. Br. at 15. He contends that because sexual interest in
    pubescent females is not abnormal, it cannot be the basis of a paraphilic disorder
    evincing a mental abnormality.
    The presence of a paraphilic disorder, however, does not turn on whether an
    individual's sexual focus is abnormal, but on the consequences of that individual's
    paraphilia in his or her specific circumstances. DSM-5 at 685-86. The DSM
    makes clear that the eight enumerated paraphilias are a nonexhaustive list because
    "almost any [paraphilia] could, by virtue of its negative consequences for the
    individual or for others, rise to the level of a paraphilic disorder.'"* Id. at 685.
    "* We also note that we have never required that a specific diagnosis be in the DSM before
    it can be offered as evidence of an individual's mental abnormality. In re Pers. Restraint of
    Young, 
    122 Wn.2d 1
    , 
    857 Wn.2d 989
    (1993). For example, in Young, we noted that "'[t]he fact
    In re Det. ofBlack, No. 94494-6
    Therefore, if a person meets the clinical definition of paraphilia, the question of
    whether he or she has a paraphilic disorder evincing a mental abnormality depends
    entirely on the consequences of his or her paraphilic preferences.
    Black meets the clinical definition of having a paraphilia because persistent
    sexual interest in pubescent girls is properly specified as a distinct paraphilia in
    appropriate cases. The DSM defines three broad categories of paraphilic foci, one
    ^ of which is "children or other nonconsenting persons." DSM-IV-TR at 566. The
    term "children" is not defined, but it is not limited to prepubescent children (as
    pedophilia is), and it is undisputed that the child victims of Black's sexual violence
    were incapable of consenting as a matter of law.
    While it may be true that an adult's attraction to adolescents is not
    necessarily a "mental abnormality" in itself. Black's persistent sexual attraction to
    pubescent aged females, generally ages 11 to 14, is disordered and evidence of a
    mental abnormality because of its negative consequences. As a result of his
    paraphilic focus, he has committed multiple acts of criminal sexual violence
    against children, served time in prison for those crimes, been ostracized from his
    family, and ruined other relationships. Accordingly, the trial court did not err as a
    matter of law when it admitted evidence of paraphilia NOS in this case.
    that pathologically driven rape ... is not yet listed in the[DSM]... does not invalidate such a
    diagnosis.'" Id. at 28 (quoting Alexander D. Brooks, The Constitutionality and Morality of
    Civilly Committing Violent Sexual Predators, 15 U.Puget Sound L. Rev. 709,733 (1992)).
    10
    In re Det. ofBlack, No. 94494-6
    C.      The trial court did not abuse its discretion when it permitted expert
    testimony on the specific nature of Black's paraphilia
    Although Black does not challenge the diagnosis of paraphilia NOS
    generally, he does argue that the trial court erred by allowing Dr. Arnold to testify
    about the particular paraphilia NOS diagnosis in this case. We review the trial
    court's decision about the permissible scope of Dr. Arnold's expert testimony for
    abuse of discretion. Halgren, 
    156 Wn.2d at 802
    . "A trial court abuses its
    discretion if the 'exercise of its discretion is manifestly unreasonable or based upon
    untenable grounds or reasons.'" In re Det. ofPost, 
    170 Wn.2d 302
    , 309, 
    241 P.3d 1234
    (2010)(quoting State v. Powell, 
    126 Wn.2d 244
    , 258, 
    893 P.2d 615
     (1995)).
    Black argues that the trial court correctly determined hebephilia is not
    admissible pursuant to Frye, but erred when it nevertheless allowed testimony on
    the paraphilia NOS diagnosis because. Black reasons, the two diagnoses are
    synonym,ous. Black's argument does not account for the purpose of a Frye
    determination, and it ignores the very real differences between a potential
    paraphilic category of hebephilia and the specific paraphilia NOS diagnosis in this
    case.
    The purpose of a Frye hearing is not to verify the accuracy of each discrete
    conclusion that an expert reaches but to determine whether the expert reached
    those conclusions by properly applying accepted ''underlyingprinciples''' to the
    11
    In re Det. ofBlack, No. 94494-6
    information presented. State v. Copeland, 
    130 Wn.2d 244
    , 255,
    922 P.2d 1304
    (1996)(emphasis added). There is no question that the psychological community
    generally accepts the reliability of the underlying principle that paraphilia NOS is a
    valid diagnosis, which may include specifiers indicating the individual's paraphilic
    focus where appropriate. That was the only question regarding Dr. Arnold's
    testimony on paraphilia NOS that needed to be answered in a Frye hearing, and the
    Trial court correctly determined that the paraphilia NOS testimony offered by Dr.
    Arnold was admissible in accordance with. Frye.
    But even if a Frye hearing were intended to determine the validity of an
    individual expert's particular conclusions. Black overlooks the important
    differences between hebephilia and paraphilia NOS,persistent sexual attraction to
    pubescent aged females. Hebephilia is a generally unaccepted diagnosis that is
    broadly defined as paraphilic attraction to adolescents up to ages 16 or 17. RP
    (Sept. 13, 2013)at 75; CP at 1418. This expansive definition encompasses
    behavior that may be legal in many states.^ Meanwhile, paraphilia NOS as
    diagnosed in this case describes a very small subset ofthe adolescent population
    covered by a diagnosis of hebephilia.^ These pubescent aged females could not
    ^ We do not opine on whether the legality ofthe behavior plays a role in determining
    what constitutes a mental abnormality.
    ^ At oral argument, the State distinguished between hebephilia and paraphilia NOS by
    explaining,"If you want to think of it in terms of a Venn diagram, you would have hebephilia as
    a very large circle with what Dr. Arnold is talking about as a very small circle somewhere within
    12
    In re Det. ofBlack, No. 94494-6
    consent to sexual activity with Black as a matter oflaw, but Black nevertheless
    repeatedly pursued them as sexual targets.
    Finally, Black claims that the trial court unfairly restricted his ability to
    challenge the paraphilia NOS diagnosis by preventing him from introducing
    evidence of hebephilia. This assertion is contradicted by statements made at the
    Frye hearing and trial testimony. At the Frye hearing. Black's counsel confirmed
    that the judge's decision did not "in any way limit my ability to cross-examine [Dr.
    Arnold], including about the issues that were raised today." RP (Sept. 13, 2013) at
    161. The judge agreed.
    Black challenged Dr. Arnold's diagnosis during a half day of cross-
    examination. Dr. Arnold conceded that there is professional debate about whether
    attraction to pubescent aged females is a clinical disorder, and he admitted that
    sexual attraction to pubescent aged females "most often" is not a paraphilia. 6
    VRP (Oct. 29, 2013)at 514, 520. He also acknowledged that there was no
    research on his paraphilic specifier "persistent sexual interest in pubescent
    females." Id. at 521.
    Black's expert also undermined Dr. Arnold's diagnosis. He rebutted the
    basic principle of the diagnosis by testifying that attraction to pubescence can
    that circle at the very bottom edge of what constitutes pubescence." Wash. Supreme Court oral
    argument,In re Det. ofBlack, No. 94494-6 (Jan. 11, 2018), at 27 min., 10 see., video recording
    by TVW, Washington State's Public Affairs Network, http://www.tvw.org.
    13
    In re Det. ofBlack, No. 94494-6
    never be the basis of a sexual deviancy. 9 VRP(Nov. 4, 2013) at 945-47. He said
    he had never heard of Dr. Arnold's paraphilic specifier, and he testified at length
    about why it was inappropriate in general and in Black's case specifically. Id. at
    944-47. Therefore, the record reflects that Black disputed Dr. Arnold's testimony
    through rigorous cross-examination and the presentation of his own expert witness.
    In sum, we hold that the trial court did not abuse its discretion in admitting
    .expert testimony on paraphilia NOS,persistent sexual interesting in pubescent
    aged females for purposes of Black's SVP determination.
    CONCLUSION
    The trial court did not commit reversible error when it admitted expert
    testimony on paraphilia NOS,persistent sexual interest in pubescent aged females
    as evidence of Black's mental abnormality. There is nothing normal about an adult
    man's inability to control his sexual urges with pubescent aged females. We
    affirm.
    14
    In re Det. ofBlack, No. 94494-6
    /
    }
    WE CONCUR:
    f
    15
    In re Det. ofBlack(Mark)
    No. 94494-6
    MADSEN,J.(dissenting)—^Relying on the fact that "paraphilia not otherwise
    specified(NOS)" is generally an accepted diagnosis within the psychological community,
    the majority holds that the trial court properly admitted the State's expert testimony on
    "paraphilia NOS,persistent sexual interest in pubescent aged females." Majority at 8, 14.
    The problem, however, is that despite the paraphilia NOS label, the specifically identified
    condition substantially mirrors a diagnosis identified under another name—^hebephilia—
    that is controversial within the same scientific community. Further, by admitting the
    State's expert's testimonial evidence—regarding paraphilia NOS,persistent sexual
    interest in pubescent aged females—^but excluding Mark Black's expert's testimonial
    evidence^—^regarding hebephilia and the controversy surrounding such diagnosis—the
    trial court, in my view, improperly excluded rebuttal evidence crucial to Black's defense.
    For these reasons, as explained below,I dissent.
    This civil commitment case concerns the interplay of issues including(1) whether
    the trial court's admission of certain expert testimony on mental abnormality was proper
    No. 94494-6
    Madsen, J., dissenting
    under Frye^ and, if not,(2) whether the error was harmless, and (3) disregarding the
    improper testimony, whether the remaining evidenee was suffieient to sustain the jury
    verdict finding mental abnormality in light of the "alternative means" mental disorders
    asserted at trial.
    Relevant Facts
    Shortly before Black was released from incarceration on child molestation
    convictions, the State filed a petition seeking to commit him as a sexually violent
    predator. The matter proceeded to a jury trial in 2013.
    Dr. Dale Arnold, the State's expert, diagnosed Black with three mental disorders:
    (1)sexual sadism,(2)paraphilia not otherwise specified(NOS),persistent sexual interest
    in pubescent aged females, nonexclusive, and (3)personality disorder NOS with
    antisocial and narcissistic characteristics. Black moved pretrial to exclude Dr. Arnold's
    diagnosis of paraphilia NOS under Frye,ER 702, ER 703, and ER 403, contending that
    the diagnosis was the same as (or subsumed under) a diagnosis for hebephilia (i.e.,
    persistent sexual attraction to pubescent children), a disorder Black argued should be
    excluded because it was not generally accepted in the scientific community. The State
    moved to strike the Frye hearing, contending that there was nothing novel in Dr. Arnold's
    diagnosis.
    At the hearing on the motions. Black's expert testified about the controversy and
    professional criticism surrounding the hebephilia diagnosis. Dr. Arnold did not testify.
    ^ Frye v. United States, 
    54 App. D.C. 46
    ,
    293 F. 1013
     (1923).
    2
    No. 94494-6
    Madsen, J., dissenting
    The trial court granted Black's motion to exclude hebephilia evidence but denied his
    motion as to Dr. Arnold's diagnosis, thereby foreclosing Black from presenting testimony
    critical of hebephilia to undermine Dr. Arnold's diagnosis.
    The jury ultimately found Black met the definition of a sexually violent predator,
    and the trial court civilly committed him. Following an initial appeal and remand to
    Division One,the Court of Appeals held that the evidence was sufficient to support the
    commitment order and that the trial court did not commit reversible evidentiary error.^
    Black sought and was granted this court's review.
    Admissibilitv of Expert Testimonv and Harmless Error
    Black challenges the trial court's determination that Dr. Arnold's diagnosis of
    paraphilia NOS involving persistent sexual interest in pubescent females satisfies the
    Frye standard for admissibility of novel scientific evidence. Black contends that
    Arnold's diagnosis is merely a subcategory of hebephilia, a controversial diagnosis that
    was rejected for inclusion in the current edition of the American Psychiatric
    Association's Diagnostic and Statistical Manual ofMental Disorders (5th ed. 2013)
    ^ In the prior appeal of this case immediately following the commitment decision. Division One
    reversed, holding that the trial court violated Black's right to be present during jury selection. In
    re Det. ofBlack, 
    189 Wn. App. 641
    , 
    357 P.3d 91
     (2015). In light of its retrial decision. Division
    One did not decide Black's contentions concerning the admissibility of Dr. Arnold's paraphilia
    diagnosis and sufficiency of the evidence to justify commitment. Id. at 658-59. This court
    granted the State's petition for review, reversed, and remanded to the Court of Appeals for
    further proceedings. In re Det. ofBlack, 
    187 Wn.2d 148
    , 
    385 P.3d 765
     (2016).
    On remand, the Court of Appeals reasoned that it need not determine whether Dr.
    Amold's paraphilia diagnosis satisfied Frye because any trial court admissibility error was
    harmless because evidence supported the additional diagnoses of sexual sadism and personality
    disorder, both of which satisfy the statutory definition of a sexually violent predator. See RCW
    71.09.020(18). For the reasons discussed herein, 1 disagree.
    No. 94494-6
    Madsen, J., dissenting
    (DSM-V). See In re Pers. Restraint ofMeirhofer, 
    182 Wn.2d 632
    , 657-58, 
    343 P.3d 731
    (2015)(Wiggins, J., dissenting)(so noting). Hebephilia is a sexual "attraction to
    pubescent children." Id. at 658. Dr. Arnold diagnosed Black with persistent sexual
    interest in pubescent aged females, a population that falls within the hebephilia target
    group. As noted, the trial court granted Black's motion to exclude evidence of
    hebephilia, but permitted Dr. Arnold to testify regarding his diagnosis of paraphilia NOS.
    But Dr. Arnold conceded that his diagnosis was premised on the same science
    underlying hebephilia, see Clerk's Papers(CP)at 841-42, and he created the paraphilia
    NOS with the specific designation to describe Black's mental status because hebephilia is
    not a recognized diagnosis.^ Given Dr. Arnold's concession and other expert testimony
    ^ Dr. Arnold was asked at deposition,"[H]ow is Paraphilia NOS,Persistent sexual interest in
    pubescent females. Nonexclusive, different from hebephilia?" CP at 829. He answered as
    follows:
    [S]o there's eight paraphilias that are listed in the DSM,and that's always been
    that way since the DSM-III. And when you diagnose somebody and they have a
    paraphilia that's not included in the DSM,then the instruction is to diagnose
    Paraphilia Not Otherwise Specified, followed by a description of what it is you
    think that person is aroused to.
    And so that's what 1 did in this case is I diagnosed Paraphilia NOS,and
    then I described what it was that I thought was paraphilic for Mr. Black.
    In terms of hebephilia, that's a term that's been used in research and in the
    proposed diagnosis in the DSM-V. But it basically describes somebody who's
    attracted to somebody who has pubescent features.
    So I would say the underlying concept is the same. How one refers to it is
    different because hebephilia is not listed in the DSM,so it wouldn't be
    appropriate to say the guy is a hebephile, because that's not actually a diagnosis.
    I would just say the guy has Paraphilia NOS and his paraphilia is being sexually
    attracted to pubescent-aged females.
    Id. at 829-30(emphasis added). When pressed as to any differences between his diagnosis and
    hebephilia, he replied,"The underlying attraction is the same" and "it's basically the same
    construct." Id. at 831. Again, when asked,"Is the research term 'hebephilia' equivalent to your
    diagnosis?" Dr. Arnold responded, "It's a term that researchers often use. The underlying
    construct is the same." Id. at 842-43.
    No. 94494-6
    Madsen, J., dissenting
    at the Frye hearing noting the hebephilia designation and validity controversy, in my
    view, the trial court erred in allowing Dr. Arnold's paraphilia NOS testimony, which
    Arnold admits is the same diagnosis as hebephilia,just under a different label.
    '"Evidentiary error is grounds for reversal only if it results in prejudice.... An error is
    prejudicial if, within reasonable probabilities, had the error not occurred, the outcome of
    the trial would have been materially affected.'" In re Det. of West, 
    171 Wn.2d 383
    ,410,
    
    256 P.3d 302
    (2011)(alteration in original)(internal quotation marks omitted)(quoting
    State V. Neal, 
    144 Wn.2d 600
    ,611, 
    30 P.3d 1255
     (2001)). Here, the jury deliberated for
    four days and at one point informed the trial court that it was having difficulty reaching a
    verdict. CP at 1407. Under these circumstances, had the evidentiary error not occurred,
    "within reasonable probabilities" the outcome of the trial would have been different. See
    
    id.
    Alternative Means
    Assuming that the trial court erred in admitting Dr. Arnold's paraphilia NOS
    testimony, and thus disregarding that testimony, the sufficiency ofthe evidence to sustain
    the jury's verdict becomes doubtful in light of the instructions. To commit Black as a
    sexually violent predator, the State had to prove beyond a reasonable doubt, among other
    things, that he suffered from a "mental abnormality or personality disorder" that made
    him likely to commit future acts of predatory sexual violence if not confined in a secure
    institution. RCW 71.09.020(18),.060(1). As noted. Dr. Arnold testified that Black
    suffered from three mental disorders:(1)sexual sadism,(2)paraphilia not otherwise
    No. 94494-6
    Madsen, J., dissenting
    specified (NOS), persistent sexual interest in pubescent aged females, nonexclusive, and
    (3)personality disorder NOS with antisocial and narcissistic characteristics. The
    paraphilia NOS and sadism diagnoses were vigorously contested at trial. Blaek's expert
    testified and explained why Blaek's conduct was rough sex, but did not qualify as
    sadistic, and further testified that adult males' sexual attraction to pubescent females is
    not deviant.
    Whether evidence is sufficient to support eivil eommitment as a sexually violent
    predator is reviewed under the eriminal law sufficiency standard. In re Det. ofThorell,
    
    149 Wn.2d 724
    , 744-45, 
    72 P.3d 708
    (2003)("when viewed in the light most favorable to
    the State, there must be sufficient evidence in the finding of mental illness to allow a
    rational trier of faet to eonelude the person facing commitment has serious difficulty
    controlling behavior"). While credibility determinations are not reviewable on appeal, as
    noted, to commit an individual as a sexually violent predator, the State must prove that
    the individual "suffers from a mental abnormality or personality disorder" that makes the
    individual likely to commit future acts of predatory sexual violenee if not eonfmed in a
    secure institution. RCW 71.09.020(18), .060(1).
    That brings us to State v. Woodlyn, 
    188 Wn.2d 157
    , 
    392 P.3d 1062
    (2017). In my
    view, the majority's result is at odds with Woodlyn, concerning the alternative mental
    disorders that were asserted, the way that the jury was instrueted, and the general verdict
    that the jury reaehed. In Woodlyn, we held,"Our precedent addressing alternative means
    crimes requires unanimity as to means only when a general verdict raises due process
    No. 94494-6
    Madsen, J., dissenting
    concerns, i.e., when one or more alternatives presented to thejury are not supported by
    sufficient evidence.'''' Id. at 162(emphasis added). Relevant here, this court opined,
    "When one alternative means of committing a crime has evidentiary support and another
    does not, courts may not assume the jury relied unanimously on the supported means."
    Id. Explaining what is required, we opined:
    [TJhere are particular situations when express unanimity is required,
    specifically when at least one means lacks sufficient evidentiary support.
    Washington cases have adopted an analysis that turns on the sufficiency of
    evidence as a due process concern: if the jury is instructed on one or more
    alternative means that are not supported by sufficient evidence, a
    "particularized expression" ofjury unanimity as to the supported means is
    required. The purpose of this requirement is to ensure that when a verdict
    might be based on more than one alternative, the verdict is adequately
    supported.
    Id. at 164 (citations omitted)(quoting       v. Owens, 
    180 Wn.2d 90
    , 95, 
    323 P.3d 1030
    (2014)). Explaining the appropriate remedy, we opined:
    A general verdict satisfies due process only so long as each
    alternative means is supported by sufficient evidence. If there is
    insufficient evidence to support any of the means, a "particularized
    expression" ofjury unanimity is required. Thus, a reviewing court is
    compelled to reverse a general verdict unless it can rule out the possibility
    the jury relied on a charge unsupported by sufficient evidence.
    Id. at 165 (citations and emphasis omitted)(quoting Owens, 180 Wn.2d at 95; State v.
    Wright, 
    165 Wn.2d 783
    , 803 n.l2, 
    203 P.3d 1027
    (2009)).
    Applying Woodlyn here, instruction 5 stated in relevant part:
    To establish that Mr. Black is a sexually violent predator, the State
    must prove each of the following elements beyond a reasonable doubt:
    (1)That Mr. Black has been convicted of a crime of sexual violence;
    No. 94494-6
    Madsen, J., dissenting
    (2) That Mr. Black suffers from a mental abnormality or personality
    disorder which causes serious difficulty in controlling his sexually violent
    behavior; and
    (3) That this mental abnormality or personality disorder makes Mr.
    Black likely to engage in predatory acts of sexual violence unless confined
    to a secure facility.
    Although you must be unanimous in your verdict, mental
    abnormality and personality disorder are alternative means to providing
    element two. The jury need not be unanimous as to whether a mental
    abnormality or personality disorder has been proven beyond a reasonable
    doubt so long as each juror finds that at least one of these alternative means
    has been proved beyond a reasonable doubt.
    CP at 1385 (emphasis added). The jury delivered a general verdict answering the
    following two questions affirmatively: (1)"Has the State proven beyond a reasonable
    doubt that Mr. Black suffers from a mental abnormality and/or a personality disorder that
    causes serious difficulty in controlling sexually violent behavior?" and (2)"If you
    answered 'yes' to Question No. 1, has the State proven beyond a reasonable doubt that
    the mental abnormality and/or personality disorder makes Mr. Black likely to engage in
    predatory acts of sexual violence if not confined to a secure facility?" /168 Wn.2d 713
    , 720, 
    230 P.3d 576
    (2010). If the evidence is of"extremely high" probative value—for example if it is
    essentially a defendant's entire defense—no State interest will he compelling enough to
    warrant its exclusion. 
    Id. at 721-24
     (accused rapist's right to defense trumped application
    of rape shield statute, which would have required exclusion of evidence that alleged
    victim took money for sex with defendant and others eoneeming the incident in
    question). Here, testimonial evidence of the controversy concerning hebephilia was
    highly probative and crucial to Black's defense as it would have directly undermined Dr.
    Arnold's paraphilia NOS diagnosis describing an equivalent condition under a different
    The majority rejects Black's claim that the trial court unfairly restricted his ability to challenge
    the paraphilia NOS diagnosis by preventing him from introducing evidence regarding hebephilia.
    In the majority's view, Black had ample opportunity to cross-examine Dr. Amold and present his
    own expert testimony. See majority at 13. But Black's expert was limited by the exclusion of
    hebephilia evidence and thus could not inform the jury of the controversy surrounding a
    hebephilia diagnosis as a disorder. As a result ofthe trial court's evidentiary rulings. Black's
    expert was hamstrung and ineffective.
    No. 94494-6
    Madsen, J., dissenting
    name. I acknowledge that Black sought exclusion of hebephilia evidence. But he did so
    in the context of seeking the exclusion of Dr. Arnold's testimony, which diagnosed Black
    with the equivalent of hebephilia. The trial court's ruling, which permitted Dr. Arnold's
    testimony and barred evidence of hebephilia, in my view was error. See 
    id. at 719
    (de
    novo review applies to a claim that the trial court has violated the defendant's right to
    present a defense).^
    As noted, the trial court's evidentiary error was not harmless. "Error is harmless
    'if we are convinced beyond a reasonable doubt that any reasonable jury would have
    reached the same result without the error.'" 
    Id. at 724
    (quoting State v. Smith, 
    148 Wn.2d 122
    , 139, 
    59 P.3d 74
    (2002)). As discussed above, within reasonable probabilities the
    trial court's evidentiary error—admission of Dr. Arnold's paraphilia NOA testimony—
    affected the outcome of the civil commitment hearing. The same is true here, the trial
    court's ruling prevented Black from presenting crucial rebuttal evidence. This error was
    not harmless, and reversal and remand for a new civil commitment hearing is warranted.
    See id. at 724-25.
    For the reasons discussed, I dissent.
    ^ Under these cireumstances, the hebephilia controversy rebuttal evidence was clearly relevant
    and would have been helpful to the jury as it concerned specialized knowledge. No more is
    required for admissibility under ER 702. Anderson v. Akzo Nobel Coatings, Inc., 
    172 Wn.2d 593
    ,600, 260P.3d857(2011).
    10
    No. 94494-6
    Madsen, J., dissenting
    11