In Re The Detention Of J.b. ( 2021 )

Filed
Washington State
Court of Appeals
Division Two
October 26, 2021
IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
DIVISION II
In the Matter of the No. 54832-1-II
Detention of
J.B.,
Appellant.
UNPUBLISHED OPINION
CRUSER, J. – JB appeals the order detaining him for 180 days for involuntary treatment,
arguing that there was insufficient evidence to establish that he was gravely disabled under RCW
71.05.020(24)(b)1 and a less restrictive alternative was not in JB’s best interest.
We hold there was sufficient evidence to prove that JB was gravely disabled and that a less
restrictive alternative was not in JB’s best interest.
Accordingly, we affirm.
FACTS
I. PETITION
On behalf of Western State Hospital (WSH), Doctors Elwyn Hulse and Claude Parker
petitioned for JB to receive involuntary treatment for an additional 180 days. JB had been at WSH
for over 30 years; JB was first admitted to WSH in an effort to restore competency after he was
1
The legislature has amended RCW 71.05.020 multiple times. See LAWS OF 2021, ch. 264 § 20;
LAWS OF 2020, ch. 302 § 3; LAWS OF 2020, ch. 5 § 1. Because the amendments do not impact our
analysis, we cite to the current version of the statute.
No. 54832-1-II
accused of killing his father. The doctors included with their petition a declaration detailing why
they believed JB needed to continue to receive involuntary treatment.
II. HEARING
The court held a hearing on the petition at which Dr. Hulse and JB testified. Dr. Hulse was
a psychologist at WSH who had observed JB’s behavior, reviewed JB’s records, and discussed
JB’s case with JB’s treatment team. Dr. Hulse testified that he had determined that JB had acute
schizophrenia. JB had “a history of extreme and unending paranoid delusions.” Sealed Verbatim
Report of Proceedings at 7. The doctor explained that JB’s delusions included believing a former
psychiatrist had implanted transmitters in him to “homosexualize him,” North Korea had given
him nuclear weapons, and that he would be safe in the community upon being released if he could
have sex with a prostitute. Id. Additionally, JB “as of late” talked more about how his father had
asked JB to kill him so JB could escape the mafia. Id. The doctor also noted that JB had “[v]ery,
very poor” insight into his mental illness, explaining that JB showed no comprehension that killing
his father was likely a mistake or that he needed to move forward from that point in his life. Id. at
8. Additionally, JB refused to accept any feedback from his doctor and others when they told JB
that his delusions were not real and that he needed to move on.
Dr. Hulse also testified that JB’s judgment in making day-to-day decisions was very poor.
JB continually acted on his delusions by writing the treatment team letters that were based on his
delusions.
According to Dr. Hulse, JB’s volitional control was “marginal, at best.” Id. at 9. The doctor
noted that JB had been immediately suicidal upon transferring to the doctor’s ward a few months
earlier. JB had repeatedly told his treatment team, “ ‘I’m suicidal.’ ” Id. at 10. Additionally, JB
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No. 54832-1-II
had believed another individual had stolen JB’s property; even after the property had been
returned, JB kept wanting to fight the individual so JB was put on one-on-one monitoring to keep
him from acting on his impulse to fight.
Dr. Hulse also testified that JB could not take care of his basic needs of health and safety
if released. When the doctor tried to talk to JB about discharge plans and possibly going to a group
home, JB rejected the idea. JB “just want[ed] to get his own apartment and do his own thing.” Id.
at 11. The doctor did not believe that JB would even know where to start to look for housing.
Dr. Hulse also noted that JB’s day-to-day ability to function at the ward was impacted by
his delusions because he spent most of his day focusing on his delusions, not thinking about how
he could prepare for discharge. The doctor also noted that earlier in the year JB had been willing
to work with staff on a discharge plan but that willingness had faded.
Dr. Hulse testified that JB could move to a less restrictive placement at some point. But
before JB could move on to a less restrictive placement, he needed to go 90 days without one-on-
one monitoring or being involved in an altercation. After those 90 days, then JB would be allowed
“quad privileges.” Id. at 12. Once JB adjusted to functioning independently in the quad, then he
could move out of WSH and to a structured living community. Additionally, the only medication
JB required was a shot every two weeks, and JB got the shot “[b]egrudgingly.” Id. at 13. The
doctor reported that JB had stated that he did not need the medication and that the medication made
his mind weak. Dr. Hulse did not believe that JB would continue with his medication once released.
JB also testified. JB stated that he was ready to leave the hospital, and that he had prepared
a statement for the court. The prepared statement largely consisted of JB recounting his life prior
to being committed, a conversation between him and his father, and being under the mafia’s
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No. 54832-1-II
control. There is nothing in the record that indicates that JB spoke about why he should not receive
an additional 180 days of involuntary treatment or a less restrictive placement.
III. COURT’S RULING
The court found JB to be gravely disabled as a result of a behavioral health disorder that
resulted in a severe deterioration in routine functioning evidenced “by repeated and escalating loss
of cognitive or volitional control over actions” and that JB would not receive such care as is
essential for health and safety. RCW 71.05.020(23)(b); Sealed Clerk’s Papers (CP) at 30. The court
found JB had a history of “fixed and extreme paranoid delusions.” CP at 30. Additionally, the court
found JB has “[v]ery, very poor insight into mental illness,” no comprehension about his past or
“what brought him to WSH.” Id. According to the findings, JB also acted on his delusions, had
“very poor judgment,” had only “[m]arginal control,” and had “emotional dysregulation.” Id. The
court also found JB did not have a realistic plan upon discharge and without structure JB could not
care for himself.
The court determined that less restrictive treatment was not in JB’s best interest. The court
noted that JB still needed to complete three months without one-on-one monitoring, that JB also
stated that he does not need medication because it makes his mind weak, and JB is only
begrudgingly compliant with his medications.
JB appeals.
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No. 54832-1-II
ANALYSIS
I. SUFFICIENT EVIDENCE FOR THE COURT’S FINDINGS
JB argues that the evidence is insufficient to support the trial court’s conclusion that he is
gravely disabled. We disagree.
A. LEGAL PRINCIPLES
1. Gravely Disabled
An individual is gravely disabled if the individual “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.” RCW
71.05.020(24)(b). If an individual has stabilized after receiving care, and their condition is no
longer “ ‘escalating,’ ” the court would not be required to release the individual as long the
individual “otherwise manifests severe deterioration in routine functioning and, if released, would
not receive such as is essential for his or her health or safety.” In re Det. of LaBelle, 107 Wn.2d
196, 207, 728 P.2d 138 (1986).
2. Sufficient Evidence
We review a trial court’s decision on involuntary commitment to determine whether the
trial court’s findings of fact are supported by substantial evidence and if those findings of fact in
turn support the court’s conclusion of law and judgment. In re Det. of T.C., 11 Wn. App. 2d 51,
56, 450 P.3d 1230 (2019). “Substantial evidence is the quantum of evidence sufficient to persuade
a fair-minded person.” In re Det. of H.N., 188 Wn. App. 744, 762, 355 P.3d 294 (2015).
When seeking a 180-day commitment, the State must prove an individual is gravely
disabled by clear, cogent, and convincing evidence. RCW 71.05.310. In other words, the State
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must show the ultimate fact in issue is shown by evidence that is “ ‘highly probable.’ ” LaBelle,
107 Wn.2d at 209. Therefore, the court’s “findings must be supported by substantial evidence in
light of the ‘highly probable’ test.” Id. An appellate court will not reverse the trial court’s finding
that the person is gravely disabled if that conclusion is “supported by substantial evidence which
the lower court could reasonably have found to be clear, cogent[,] and convincing.” Id. When
considering if the evidence was sufficient, we view the evidence in the light most favorable to the
petitioner. In re Det. of B.M., 7 Wn. App. 2d 70, 85, 432 P.3d 459 (2019).
B. ANALYSIS
There was sufficient evidence that JB suffers from a severe deterioration in routine
functioning evidenced by a loss of cognitive or volitional control. Despite being told by staff and
his doctor that his delusions were not real, JB remained fixed on his delusions and refused to move
forward with his life. Dr. Hulse also testified that JB’s volitional control was marginal at best,
noting that within the last six months one-on-one monitoring had been required on two occasions,
once because JB had been suicidal upon transferring to the doctor’s ward and a second time to
prevent JB from acting on his impulse to fight another individual. Additionally, JB’s testimony at
the hearing also demonstrated how influential his mental illness is on his volitional and cognitive
control. Instead of taking an opportunity to address the court about why he was prepared to be
discharged, he read a statement that had nothing to do with whether he should continue to receive
involuntary treatment or have a less restrictive placement. Finally, the doctor testified JB spent
most of his day focusing on his delusions and writing letters, rather than preparing for potentially
being discharged.
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No. 54832-1-II
There was also sufficient evidence that, if released, JB would not receive the essential care
for his health or safety. JB took his medicine begrudgingly, and the doctor did not believe that JB
would continue to get his medication once released. JB had told his doctor that he did not think he
needed the medication and that it made his mind weak. Additionally, if JB was released, his plan
for being safe in the community was to have sex with a specific prostitute. Furthermore, as stated
above, JB spent his days focusing on his delusions and writing letters on his delusions, rather than
preparing for discharge, indicating if released he would focus on his delusions, not on obtaining
essential care for his health or safety.
There was sufficient evidence to conclude that JB was gravely disabled under RCW
71.05.020(24)(b).
II. LESS RESTRICTIVE ALTERNATIVE
JB argues that even if the court properly found JB to be gravely disabled, the State still
failed to establish that a less restrictive alternative was not in JB’s best interest because the doctor
did not explain or support his opinion that JB was not able to manage a less restrictive alternative.
We conclude there was sufficient evidence supporting the court’s finding that a less
restrictive alternative was not in JB’s best interest.
A. LEGAL PRINCIPLES
If the court finds that the individual is gravely disabled, then court must also find whether
the best interests of the person, or others, will be served by a less restrictive treatment. RCW
71.05.320(1);2 In re Det. of T.A.H.-L., 123 Wn. App. 172, 182, 97 P.3d 767 (2004). The State has
2
The legislature has amended RCW 71.05.320. See LAWS OF 2021, ch. 264 § 10; LAWS OF 2020,
ch. 302 § 45. Because the amendments do not impact our analysis, we cite to the current version
of the statute.
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No. 54832-1-II
the burden of proving that less restrictive treatment is not in the individual’s best interest of the
individual. T.A.H.-L., 123 Wn. App. at 186.
B. ANALYSIS
Here, the trial court’s finding that a less restrictive alternative was not in JB’s best interests
was supported by the evidence. Dr. Hulse testified that JB needed to demonstrate that he could
operate more independently and did not need one-on-one monitoring. Additionally, JB needed to
avoid altercations for three months before Dr. Hulse would even recommend giving JB more
independence within WSH. JB had required one-on-one monitoring on two occasions within the
last six months due to suicidal statements and fighting impulses. Furthermore, JB claimed he did
not need the medication; Dr. Hulse believed that JB would not continue to take the medication if
released. JB also spent most the day focused on his delusions, indicating if he were to be
discharged, he would focus on his delusions instead of caring for his needs in a less restrictive
environment.
We reject JB’s contention that the evidence did not support the trial court’s finding
regarding a less restrictive alternative.
CONCLUSION
The evidence was sufficient to support the trial court’s conclusion that JB was gravely
disabled and that a less restrictive alternative was not in JB’s best interest. Accordingly, we affirm.
A majority of the panel having determined that this opinion will not be printed in the
Washington Appellate Reports, but will be filed for public record in accordance with RCW 2.06.040,
it is so ordered.
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No. 54832-1-II
CRUSER, J.
We concur:
MAXA, J.
LEE, C.J.
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