Filed Washington State Court of Appeals Division Two
June 4, 2024
IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
DIVISION II In the Matter of the Detention of: No. 57862-0-II
C.F., UNPUBLISHED OPINION
Appellant.
CHE, J. ⎯ CF appeals the superior court’s order committing him to an additional 180
days of commitment at Western State Hospital due to his being gravely disabled as a result of a
mental or behavioral health disorder. CF argues that the superior court’s written findings of fact
and conclusions of law are inadequate to facilitate appellate review and that insufficient evidence
supports the superior court’s finding that he is gravely disabled. We disagree and affirm.
FACTS
After the trial court found CF incompetent to stand trial for criminal charges in February
2022, he was committed to Western State Hospital. His commitment was extended an additional
90 days upon a stipulated finding that he was gravely disabled as a result of a mental or
behavioral health disorder. In June 2022, CF’s commitment was extended another 180 days after
a court commissioner found that CF continued to be gravely disabled. In November 2022,
doctors at Western State petitioned for up to 180 days of additional commitment based on their
assessment that CF continued to be gravely disabled.
At a hearing on the petition before a superior court commissioner, Dr. Elwyn Hulse, a
clinical psychologist at Western State, and only witness, testified as to CF’s condition. Dr. Hulse No. 57862-0-II
testified that he personally observed, interviewed, and evaluated CF for mental illness, spoke
with the Western State treatment team and staff, and reviewed CF’s forensic and clinical hospital
records and chart notes. Dr. Hulse diagnosed CF with schizophrenia disorder continuous, and
cannabis and stimulant use disorders. Dr. Hulse determined that CF’s schizophrenia disorder was
prolonged, generally both unstable and stable, with no remission of the psychiatric symptoms.
He observed that CF exhibits cognitive disorganization including paranoid or grandiose
delusions. About two weeks prior, a staff member observed CF respond to internal stimuli
meaning CF also exhibited auditory or visual hallucinations during the commitment period. CF
made paranoid statements during the evaluation regarding the fear that he would become
infected with HIV or Hepatitis-C by someone using his safety razor. CF did not exhibit any
visual hallucinations during his interview with Dr. Hulse.
Dr. Hulse observed that CF had minimal insight into his mental health disorder,
vacillating between denying having any mental health disorder and suggesting “maybe I am
[mentally ill].” Clerk’s Papers (CP) at 88. During the interview, and supported by chart notes, CF
tended to be very impulsive with no long-term planning. Dr. Hulse assessed CF’s cognitive
control to be minimal, noting that CF admits to racing thoughts and mood swings. Staff noted CF
being demanding and impulsive to get his needs met. Dr. Hulse also assessed CF’s volitional
control to be limited as he is “very in the moment with his impulses.” CP at 90.
CF participates in his treatment groups and consistently takes his medications, but fails to
make rational decisions regarding treatment and tends to be very impulsive with no long-term
planning. Dr. Hulse noted that CF is experienced living on the streets in Seattle and could find
food, water, and clothes but that CF would be inconsistent in maintaining his treatments for his
2 No. 57862-0-II
mental disorder in the community. He noted this is CF’s third admission to Western State since
2020. Dr. Hulse recommended CF remain committed until a less restrictive alternative placement
could be found for him.
At the conclusion of the hearing, the commissioner ordered CF to be committed for up to
180 days of involuntary treatment on the basis of prong (b) of former RCW 71.05.020(24)
(2021), which provides that, as a result of a behavioral health disorder, CF manifests severe
deterioration in routine functioning evidenced by repeated and escalating loss of cognitive or
volitional control over his actions and is not receiving such care as is essential for his health or
safety. The court commissioner entered written findings summarizing Dr. Hulse’s testimony and
noting the reason for CF’s continued commitment under prong (b) of former RCW
71.05.020(24).
CF filed a motion for revision with the superior court, arguing that the State provided
insufficient evidence to support a finding that CF suffers from a behavioral health disorder or
continues to be gravely disabled. The superior court corrected scrivener’s errors in the
commissioner’s findings but otherwise denied CF’s motion to revise.
CF appeals.
ANALYSIS
I. ADEQUACY OF FINDINGS OF FACT
CF argues that the commissioner’s written findings of fact were inadequate to support
meaningful appellate review. We disagree.
“We review the superior court’s ruling, not the commissioner’s decision.” In re Det. of
L.K., 14 Wn. App. 2d 542, 550, 471 P.3d 975 (2020). Because the superior court denied CF’s
3 No. 57862-0-II
motion for revision, the commissioner’s decision becomes the decision of the superior court. Id.
(internal quotations omitted); RCW 2.24.050. Findings of fact are required following an
involuntary commitment hearing. MPR (Mental Proceedings Rule) 3.4(b). A superior court’s
written findings of fact “should at least be sufficient to indicate the factual bases for the ultimate
conclusions.” In re Det. of LaBelle, 107 Wn.2d 196, 218, 728 P.2d 138 (1986). “The purpose of
the requirement of findings and conclusions is to insure the [superior court] judge ‘has dealt fully
and properly with all the issues in the case before . . . decid[ing] it’” and so, on appeal, we “‘may
be fully informed as to the bases of [the] decision when it is made.’” Id. 107 Wn.2d at 218-19
(internal quotation marks omitted) (quoting State v. Agee, 89 Wn.2d 416, 421, 573 P.2d 355
(1977)). Where no exceptions to the findings of fact are taken below, we will give them a liberal
construction rather than overturn the judgment based thereon. LaBelle, 107 Wn.2d at 219.
“‘Findings may be sufficient even if they are implicit in the trial court’s formal written findings
of fact.’” In re Det. of A.F., 20 Wn. App. 2d 115, 123, 498 P.3d 1006 (2021).
CF likens this case to In re Det. of G.D., 11 Wn. App. 2d 67, 72-73, 450 P.3d 668 (2019).
In G.D., the superior court only made check-the-box findings without additional findings and
Division One found the boilerplate findings of fact insufficiently specific under LaBelle. Id.
Here, the court did more than make check-the-box findings. The superior court added detailed
summaries of Dr. Hulse’s testimony from the hearing to its findings of fact and based on the
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Filed Washington State Court of Appeals Division Two
June 4, 2024
IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
DIVISION II In the Matter of the Detention of: No. 57862-0-II
C.F., UNPUBLISHED OPINION
Appellant.
CHE, J. ⎯ CF appeals the superior court’s order committing him to an additional 180
days of commitment at Western State Hospital due to his being gravely disabled as a result of a
mental or behavioral health disorder. CF argues that the superior court’s written findings of fact
and conclusions of law are inadequate to facilitate appellate review and that insufficient evidence
supports the superior court’s finding that he is gravely disabled. We disagree and affirm.
FACTS
After the trial court found CF incompetent to stand trial for criminal charges in February
2022, he was committed to Western State Hospital. His commitment was extended an additional
90 days upon a stipulated finding that he was gravely disabled as a result of a mental or
behavioral health disorder. In June 2022, CF’s commitment was extended another 180 days after
a court commissioner found that CF continued to be gravely disabled. In November 2022,
doctors at Western State petitioned for up to 180 days of additional commitment based on their
assessment that CF continued to be gravely disabled.
At a hearing on the petition before a superior court commissioner, Dr. Elwyn Hulse, a
clinical psychologist at Western State, and only witness, testified as to CF’s condition. Dr. Hulse No. 57862-0-II
testified that he personally observed, interviewed, and evaluated CF for mental illness, spoke
with the Western State treatment team and staff, and reviewed CF’s forensic and clinical hospital
records and chart notes. Dr. Hulse diagnosed CF with schizophrenia disorder continuous, and
cannabis and stimulant use disorders. Dr. Hulse determined that CF’s schizophrenia disorder was
prolonged, generally both unstable and stable, with no remission of the psychiatric symptoms.
He observed that CF exhibits cognitive disorganization including paranoid or grandiose
delusions. About two weeks prior, a staff member observed CF respond to internal stimuli
meaning CF also exhibited auditory or visual hallucinations during the commitment period. CF
made paranoid statements during the evaluation regarding the fear that he would become
infected with HIV or Hepatitis-C by someone using his safety razor. CF did not exhibit any
visual hallucinations during his interview with Dr. Hulse.
Dr. Hulse observed that CF had minimal insight into his mental health disorder,
vacillating between denying having any mental health disorder and suggesting “maybe I am
[mentally ill].” Clerk’s Papers (CP) at 88. During the interview, and supported by chart notes, CF
tended to be very impulsive with no long-term planning. Dr. Hulse assessed CF’s cognitive
control to be minimal, noting that CF admits to racing thoughts and mood swings. Staff noted CF
being demanding and impulsive to get his needs met. Dr. Hulse also assessed CF’s volitional
control to be limited as he is “very in the moment with his impulses.” CP at 90.
CF participates in his treatment groups and consistently takes his medications, but fails to
make rational decisions regarding treatment and tends to be very impulsive with no long-term
planning. Dr. Hulse noted that CF is experienced living on the streets in Seattle and could find
food, water, and clothes but that CF would be inconsistent in maintaining his treatments for his
2 No. 57862-0-II
mental disorder in the community. He noted this is CF’s third admission to Western State since
2020. Dr. Hulse recommended CF remain committed until a less restrictive alternative placement
could be found for him.
At the conclusion of the hearing, the commissioner ordered CF to be committed for up to
180 days of involuntary treatment on the basis of prong (b) of former RCW 71.05.020(24)
(2021), which provides that, as a result of a behavioral health disorder, CF manifests severe
deterioration in routine functioning evidenced by repeated and escalating loss of cognitive or
volitional control over his actions and is not receiving such care as is essential for his health or
safety. The court commissioner entered written findings summarizing Dr. Hulse’s testimony and
noting the reason for CF’s continued commitment under prong (b) of former RCW
71.05.020(24).
CF filed a motion for revision with the superior court, arguing that the State provided
insufficient evidence to support a finding that CF suffers from a behavioral health disorder or
continues to be gravely disabled. The superior court corrected scrivener’s errors in the
commissioner’s findings but otherwise denied CF’s motion to revise.
CF appeals.
ANALYSIS
I. ADEQUACY OF FINDINGS OF FACT
CF argues that the commissioner’s written findings of fact were inadequate to support
meaningful appellate review. We disagree.
“We review the superior court’s ruling, not the commissioner’s decision.” In re Det. of
L.K., 14 Wn. App. 2d 542, 550, 471 P.3d 975 (2020). Because the superior court denied CF’s
3 No. 57862-0-II
motion for revision, the commissioner’s decision becomes the decision of the superior court. Id.
(internal quotations omitted); RCW 2.24.050. Findings of fact are required following an
involuntary commitment hearing. MPR (Mental Proceedings Rule) 3.4(b). A superior court’s
written findings of fact “should at least be sufficient to indicate the factual bases for the ultimate
conclusions.” In re Det. of LaBelle, 107 Wn.2d 196, 218, 728 P.2d 138 (1986). “The purpose of
the requirement of findings and conclusions is to insure the [superior court] judge ‘has dealt fully
and properly with all the issues in the case before . . . decid[ing] it’” and so, on appeal, we “‘may
be fully informed as to the bases of [the] decision when it is made.’” Id. 107 Wn.2d at 218-19
(internal quotation marks omitted) (quoting State v. Agee, 89 Wn.2d 416, 421, 573 P.2d 355
(1977)). Where no exceptions to the findings of fact are taken below, we will give them a liberal
construction rather than overturn the judgment based thereon. LaBelle, 107 Wn.2d at 219.
“‘Findings may be sufficient even if they are implicit in the trial court’s formal written findings
of fact.’” In re Det. of A.F., 20 Wn. App. 2d 115, 123, 498 P.3d 1006 (2021).
CF likens this case to In re Det. of G.D., 11 Wn. App. 2d 67, 72-73, 450 P.3d 668 (2019).
In G.D., the superior court only made check-the-box findings without additional findings and
Division One found the boilerplate findings of fact insufficiently specific under LaBelle. Id.
Here, the court did more than make check-the-box findings. The superior court added detailed
summaries of Dr. Hulse’s testimony from the hearing to its findings of fact and based on the
findings, the court concluded that CF continued to be gravely disabled. The court’s findings of
fact were sufficiently detailed for our review.
Next, CF contends that “mere recitation of testimony, without assessment of credibility or
attempt to tie such testimony to the appropriate legal standard, is inadequate.” Br. of Appellant at
4 No. 57862-0-II
21. However, as the State correctly points out, no court has held that summarizing testimony
alone is grounds for reversal. Additionally, the only witness who testified during the hearing is
Dr. Hulse. It is clear that the court’s reliance on Dr. Hulse’s testimony implied findings of
credibility and reliability by the court. See A.F., 20 Wn. App. 2d at 124.
We hold that the findings of fact are sufficient for appellate review.
II. SUFFICIENT EVIDENCE
CF also argues that insufficient evidence supported the superior court’s finding that he
continued to be gravely disabled.1 We disagree.
An individual may be involuntarily committed for behavioral health treatment if, as a
result of a behavioral health disorder, that person is “gravely disabled.” LaBelle, 107 Wn.2d at
201-02. The State must prove grave disability by clear, cogent, and convincing evidence. RCW
71.05.310; Morris v. Blaker, 118 Wn.2d 133, 137, 821 P.2d 482 (1992); LaBelle, 107 Wn.2d at
209. Appellate courts review challenges to the sufficiency of the evidence in a light most
favorable to the State. In re Det. of B.M., 7 Wn. App. 2d 70, 85, 432 P.3d 459 (2019).
When the standard is clear, cogent, and convincing evidence, “the ultimate fact in issue
must be shown by evidence to be ‘highly probable.’” LaBelle, 107 Wn.2d at 209 (quoting
Pawling v. Goodwin, 101 Wn.2d 392, 399, 679 P.2d 916 (1984)). “[A]ppellate review is limited
to determining whether substantial evidence supports the findings and, if so, whether the findings
1 CF also purports to argue that insufficient evidence supported the court’s conclusion that a less restrictive placement is not in his best interest. But he does not provide any further argument or authority to develop that argument and we do not address it. Weyerhaeuser Co. v. Com. Union Ins. Co., 142 Wn.2d 654, 692-93, 15 P.3d 115 (2000) (citing former RAP 10.3(a)(5) (1998) and RAP 12.1(a)).
5 No. 57862-0-II
in turn support the trial court’s conclusions of law and judgment.” Id. If substantial evidence
supports the trial court’s findings, then appellate courts will not disturb those findings. Id.
There are two ways the State may prove that a person is “gravely disabled.” Id. at 202. Under
former RCW 71.05.020(24), a gravely disabled person is one who:
as a result of a behavioral health disorder: (a) Is in danger of serious physical harm resulting from a failure to provide for his or her essential human needs of health or safety; or (b) 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, the commissioner found CF gravely disabled under prong (b). To establish “grave
disability” under prong (b) of former RCW 71.05.020(24), the State must produce evidence of
(1) severe deterioration in routine functioning as evidenced by “recent proof of significant loss of
cognitive or volitional control” and (2) “a factual basis for concluding that the individual is not
receiving or would not receive, if released, such care as is essential for his or her health or
safety.” LaBelle, 107 Wn.2d at 208. “Implicit in the definition of gravely disabled . . . is a
requirement that the individual is unable, because of severe deterioration of mental functioning,
to make a rational decision with respect to his need for treatment.” Id. (emphasis omitted).
“Prong (b) represents a legislative attempt to permit ‘intervention before a mentally ill
person’s condition reaches crisis proportions,’ as it ‘enables the State to provide the kind of
continuous care and treatment that could break the cycle and restore the individual to satisfactory
functioning.’” In re Det. of A.M., 17 Wn. App. 2d 321, 335, 487 P.3d 531 (2021) (quoting
LaBelle, 107 Wn.2d at 206).
The LaBelle court also explained that the statute incorporated under prong (b), the
definition of “decompensation,” meaning the progressive deterioration of routine functioning
6 No. 57862-0-II
supported by evidence of repeated or escalating loss of cognitive or volitional control of actions.
107 Wn.2d at 206. Prong (b) allows the State to involuntarily treat those discharged patients
who, “after a period of time in the community, drop out of therapy or stop taking their prescribed
medication and exhibit ‘rapid deterioration in their ability to function independently.’” LaBelle,
107 Wn.2d at 206. Stated another way, prong (b) also allows intervention before a mentally ill
person decompensates and provides for continuity of care. In re Det. of A.F., 20 Wn. App. 2d at
127. This definition of gravely disabled is meant to address and prevent “revolving door”
syndrome, in which patients often move from the “hospital to dilapidated hotels or residences or
even alleys, parks, vacant lots, and abandoned buildings, relapse, and are then rehospitalized,
only to begin the cycle over again.” LaBelle, 107 Wn.2d at 206.
Viewing the evidence in the light most favorable to the State, the superior court’s
findings were supported by the evidence. B.M., 7 Wn. App. 2d at 85. Relying upon his interview
and observation, CF’s patient chart notes, and discussion with CF’s treatment team, Dr. Hulse
diagnosed CF with schizophrenia, continuous⎯meaning there has been no remission of CF’s
psychiatric symptoms.
Dr. Hulse observed CF exhibit cognitive disorganization. In this observation period, CF’s
chart reflected observations of paranoid delusions involving a fear that CF would contract HIV
or Hepatitis-C from another patient using CF’s razor.
According to Dr. Hulse, CF had minimal cognitive control because CF had minimal
ability to control his thoughts. Dr. Hulse described CF as impulsive and demanding, noting that
CF exhibited racing thoughts and mood swings. CF got in between staff and another patient to
7 No. 57862-0-II
get his needs met. Dr. Hulse noted that approximately two weeks before testifying, a staff
member observed CF responding to internal stimuli.
Dr. Hulse explained that as to CF’s volitional control, CF tended to “very impulsive”
based on what CF wanted or needed in that moment without thought to long-term planning. CP
at 89. Additionally, CF’s chart reflected that he had been verbally aggressive during this
commitment period.
Lastly, Dr. Hulse opined that CF would be inconsistent in maintaining his treatment for
his mental disorder in the community and that CF is incapable of making rational decisions about
his treatment. Dr. Hulse noted that this was CF’s third admission to Western State Hospital since
2020, implying that CF’s inconsistency with treatment in the community puts him at risk for
“revolving door” phenomenon.
These facts support the court’s finding of recent significant loss of cognitive and
volitional control and a severe deterioration in routine functioning. The evidence is also
sufficient to support the court’s finding that CF would not receive such care as is essential for his
health or safety if released.
CONCLUSION
We hold that the court’s findings are supported by substantial evidence, and they support
the court’s conclusions of law that CF was gravely disabled as a result of a mental disorder under
former RCW 71.05.020(22)(b). Because the State met its burden of proof by clear, cogent, and
convincing evidence, we affirm the superior court’s 180-day involuntary commitment order.
We affirm.
8 No. 57862-0-II
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.
Che, J. We concur:
Lee, J.
Veljacic, A.C.J.