In Re The Detention Of H.h.

• Court: Court of Appeals of Washington
• Decided: January 26, 2026
• Docket: 87818-2
• Status: Unpublished

Opinion

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON

In the Matter of the Detention of No. 87818-2-I H.H. DIVISION ONE

UNPUBLISHED OPINION

HAZELRIGG, C.J. — Following revocation of a less restrictive alternative

treatment order, H.H. appeals and specifically challenges the admissibility of her

medical record, portions of which were admitted after a joint stipulation. However,

because she failed to preserve the error, we decline to consider it for the first time

on appeal. We also conclude that H.H. cannot establish ineffective assistance of

counsel and the evidence in the record supports factual findings that, in turn,

support the revocation order. Accordingly, we affirm.

FACTS

On October 4, 2024, seventeen-year-old H.H. was discharged from

behavioral health inpatient treatment and stipulated to a court order that

determined she was “gravely disabled” as defined by statute and provided for

outpatient treatment as a less restrictive alternative (LRA) to inpatient treatment.

The order required, among other things, that H.H. comply with outpatient treatment

for up to 180 days, take all prescribed medications, refrain from threats or acts of No. 87818-2-I/2

harm to herself or others, reside at an approved residence, and maintain her health

in the community.

About two months later, H.H. was admitted to Seattle Children’s Hospital

and referred to King County’s Designated Crisis Responders, who petitioned to

revoke the LRA treatment order. 1 According to a declaration in support of the

petition to revoke, H.H. suffers from acute and long-standing eating disorder

symptoms, associated chronic and acute malnutrition, and other health issues.

The petition alleged that H.H. stopped participating in required outpatient treatment

seven days after her discharge, stopped taking her prescribed medications, and

ran away from home with a plan to “jump from a height.” The petition further

asserted that H.H. was gravely disabled and unable to maintain her health, safety,

and basic needs outside of an inpatient setting.

A superior court commissioner held a hearing on the petition over two days

in January 2025. A psychiatric nurse practitioner who evaluated H.H., Andrew

Given, was the only witness to testify at the hearing. Given testified that H.H. was

admitted to the hospital based on multiple diagnoses, including major depressive

disorder, anorexia nervosa with both binge-purge and restrictive subtypes,

generalized anxiety disorder, and a complex history including medical issues

“secondary” to her eating disorder, chronic suicidal ideation, and multiple prior

suicide attempts. Given opined, based on multiple interviews with H.H.,

information in the hospital’s medical record, and discussions with members of her

1 The record indicates that H.H. was previously admitted to Seattle Children’s Hospital in February 2024 and, including the November 2024 admission, H.H. was admitted to a hospital a total of five times in 2024.

-2- No. 87818-2-I/3

treatment team, that H.H. had experienced a “substantial deterioration of

functioning” and violated the terms of the October 2024 LRA treatment order.

Before Given testified about the specific information he relied on from H.H.’s

medical record, the parties stipulated to the admissibility of the medical record as

a business record under RCW 5.45.020. No party subsequently moved to admit

the entire medical chart into evidence but Given read portions of the medical record

into evidence when, in response to questions from both parties, he described

H.H.’s condition and reported the observations of treatment providers. The

portions of the medical records Given read included numerous verbatim

statements made by H.H. and documented by treatment providers.

There was no objection to Given’s testimony until cross-examination when

the State objected to hearsay within the medical chart after H.H.’s counsel sought

to question Given about H.H.’s family’s wishes and her report of sexual abuse

during a prior inpatient placement. The commissioner overruled the State’s

objection to a question about statements made by H.H. and documented in the

medical chart but sustained an objection to questioning regarding H.H.’s mother’s

statements. The commissioner also told H.H.’s counsel that to the extent she

sought to admit out-of-court statements as substantive evidence, only those

statements that appeared in “direct quotation marks” would be admissible.

After the evidentiary hearing, H.H.’s counsel acknowledged in closing

argument that she had not objected to Given’s testimony. Nonetheless, she

argued that the court should not consider as substantive evidence any testimony

reporting hearsay statements that were “not in quotes” within the medical chart.

-3- No. 87818-2-I/4

The commissioner entered a written order that included a finding that H.H.

violated the terms of the LRA treatment order because, among other things, she

admitted to stopping her medication before she was hospitalized, had a “plan to

jump off a bridge,” and was “not complying with treatment.” The order also

included a finding that H.H.’s routine functioning had substantially deteriorated

because she was “highly suicidal,” had recent difficulty attending to hygiene and

other activities of daily living, and was not consistently willing to eat, drink, or take

her medications. Based on these findings, the commissioner revoked the LRA

order and committed H.H. to involuntary inpatient treatment for up to 180 days.

H.H. filed a motion to revise the commissioner’s order, arguing that the

State failed to meet its burden of proof because it relied on chart notes that

paraphrased H.H.’s statements and could not be considered for the truth of the

matter asserted because they were inadmissible hearsay. A superior court judge

denied the motion for revision.

H.H. timely appealed.

ANALYSIS

H.H. contends the State failed to establish that her medical record, which

encompassed entries authored by several treatment providers, was admissible

evidence under an exception to the hearsay rule. H.H. further argues that the trial

court’s error when it admitted hearsay evidence was not harmless because the

court relied on the hearsay documented in the medical record to support the

findings and revocation order. She also asserts in the alternative that her attorney

-4- No. 87818-2-I/5

was ineffective for failing to timely object to the purported hearsay evidence. For

the reasons set forth herein, we disagree.

I. Standard of Review

When a superior court decides a motion to revise, we review de novo the

superior court’s decision, not that of the court commissioner. In re Det. of L.K., 14

Wn. App. 2d 542, 550, 471 P.3d 975 (2020). We review the superior court’s

decision “‘based on the evidence and issues presented to the commissioner.’” Id.

(quoting In re Vulnerable Adult Pet. for Winter, 12 Wn. App.2d 815, 829, 460 P.3d

667 (2020)). The court commissioner’s findings and orders, if not successfully

revised, become the orders and findings of the superior court. Id.

II. Hearsay

The evidentiary rules apply to civil commitment proceedings under chapter

71.05 RCW. See RCW 71.05.310. The relevant rule of evidence here is the

hearsay rule. “Hearsay” is an out-of-court statement offered to prove the truth of

the matter asserted. ER 801(c). “Hearsay is not admissible except as provided

by these rules, by other court rules, or by statute.” ER 802. RCW 5.45.020

provides an exception for records kept in the ordinary course of business as

follows:

A record of an act, condition or event, shall in so far as relevant, be competent evidence if the custodian or other qualified witness testifies to its identity and the mode of its preparation, and if it was made in the regular course of business, at or near the time of the act, condition or event, and if, in the opinion of the court, the sources of information, method and time of preparation were such as to justify its admission.

-5- No. 87818-2-I/6

Another exception to the general hearsay rule allows an expert to relay otherwise

inadmissible hearsay to show the basis for their expert opinion, but this exception

does not allow the trier of fact to rely on that hearsay as substantive evidence. See

ER 703; In re Dependency of A.C., 1 Wn.3d 186, 192, 525 P.3d 177 (2023).

H.H. acknowledges that her own statements are exempt from the hearsay

rule as admissions, without regard to whether those statements were quoted

directly or “paraphrased.” See ER 801(d)(2) (party’s own out-of-court statements

not considered hearsay and admissible as substantive evidence when offered

against that party). However, she argues in briefing that a “medical record that

could potentially qualify under the business record exception to the hearsay rule,

RCW 5.45.020, remains inadmissible hearsay if a proper business record

foundation is not laid at trial.” This contention is premised on an implicit concession

that such medical records “could potentially qualify” under that hearsay exception.

Nevertheless, H.H. maintains that the State did not lay a proper foundation to admit

the medical chart as a business record under RCW 5.45.020 and, therefore, failed

to establish that “[e]ach level of hearsay” was “independently admissible” under an

exception to the hearsay rule. Thus, according to H.H., the entirety of Given’s

testimony about entries in her medical chart was hearsay and inadmissible and

could only be considered as the basis for Given’s opinions, but not as substantive

evidence.

This argument fails for several reasons but primarily because H.H. did not

object at any point when Given read portions of the medical record during his

testimony. A party challenging the admission of evidence must make a timely and

-6- No. 87818-2-I/7

specific objection at trial. See ER 103(a)(1); RAP 2.5(a); State v. Powell, 166

Wn.2d 73, 82, 206 P.3d 321 (2009) (plurality opinion). We have strictly applied

RAP 2.5(a) to claimed evidentiary errors because a failure to object deprives the

trial court of the opportunity to correct the error. See Powell, 166 Wn.2d at 82.

H.H. asserts that her objection during closing argument preserved the error

for review. This is incorrect. First, H.H.’s objection at the conclusion of the hearing

related only to the consideration of statements that were “not direct quotations”

and did not address the applicability of the business record exception to the chart

itself. Washington courts have long held that an objection is not preserved for

purposes of an appeal unless that particular basis for the objection was presented

in the trial court. See, e.g., State v. Korum, 157 Wn.2d 614, 648, 141 P.3d 13

(2006) (objecting to evidence in trial court on one ground does not preserve

objection for appeal based on different grounds); State v. Guloy, 104 Wn.2d 412,

422, 705 P.2d 1182 (1985) (accord). Second, challenging the medical record

evidence in closing argument did not provide the commissioner with an opportunity

to correct the error by addressing the foundational concerns H.H. now raises. See

State v. Kalebaugh, 183 Wn.2d 578, 583, 355 P.3d 253 (2015). Third and finally,

no authority supports H.H.’s position that a challenge to the admissibility of

evidence raised after the evidentiary portion of trial has closed can be considered

timely or contemporaneous. See Powell, 166 Wn.2d at 82.

H.H. also maintains that she “did not need to object to hearsay when

medical entries were read into evidence,” because in a bench trial, she was entitled

-7- No. 87818-2-I/8

to presume that the trial court would disregard inadmissible evidence. 2 See State

v. Read, 147 Wn.2d 238, 242, 53 P.3d 26 (2002) (“[I]n the absence of evidence to

the contrary, we presume the judge in a bench trial does not consider inadmissible

evidence in rendering a verdict.”). However, H.H. does not assert that medical

records cannot qualify as business records as a matter of law. And perhaps more

critically, the record shows that the State offered no testimony to establish a

foundation because H.H. expressly stipulated that the record qualified as a

business record. Because admissibility was not only uncontested but also

affirmatively conceded by written stipulation, the State was not required to lay a

foundation. See In re Pers. Restraint of Plunkett, 57 Wn. App. 230, 238, 788 P.2d

1090 (1990) (foundational prerequisites may be waived).

H.H. offers a variety of reasons why her stipulation was ineffective or should

have been disregarded. None are persuasive. While it is true that trial courts are

not bound by parties’ stipulations with regard to legal questions, there is no

disputed legal question here as the parties agree in their respective briefing on

appeal that medical records may qualify for admission as business records under

RCW 5.45.020. H.H. provides no authority that supports her position that the

stipulation at the start of the hearing on the LRA revocation was a “nullity” because

the court took no action to “ratify” it. Contrary to H.H.’s suggestion, nothing in the

record indicates that the trial court did not give effect to the stipulation or that the

State presented any objections that were inconsistent with the stipulation.

2 Perhaps more critically, her alternate assignment of error, addressed in Part III infra, that

avers counsel was ineffective for failing to timely object necessarily undercuts her contentions here that her objection during closing argument was sufficient to preserve the error or that an objection was not needed at all.

-8- No. 87818-2-I/9

H.H.’s challenge to the admissibility of her medical records is not preserved,

and we decline to reach the merits of her contention that various statements

contained therein were improper hearsay.

III. Ineffective Assistance of Counsel

Alternatively, H.H. claims she was deprived of effective assistance of

counsel because her attorney failed to timely and properly object to Given’s

testimony about information in her medical chart.

“[A] respondent in a civil commitment proceeding . . . has the statutory right

to the effective assistance of counsel.” In re Det. of T.A.H.-L., 123 Wn. App. 172,

178, 97 P.3d 767 (2004). To prevail on a claim of ineffective assistance of counsel,

H.H. must establish both that her attorney’s performance was deficient and

prejudicial such that “‘there is a reasonable probability that, but for counsel’s errors,

the result of the trial would have been different.’” Id. at 181-82 (quoting State v.

Hendrickson, 129 Wn.2d 61, 78, 917 P.2d 563 (1996), overruled on other grounds

by Carey v. Musladin, 549 U.S. 70 (2006)). “If either element of the test is not

satisfied, the inquiry ends.” State v. Kyllo, 166 Wn.2d 856, 862, 215 P.3d 177

(2009). Performance is deficient if, “given all the facts and circumstances, [the]

attorney’s conduct failed to meet an objective standard of reasonableness.”

T.A.H.-L., 123 Wn. App. at 181. We strongly presume that counsel’s

representation was effective. Id. at 182.

H.H. points to nothing in the record suggesting that the State would have

been unable to lay a proper foundation to admit the medical record as a business

record had her counsel objected and declined to stipulate to the admissibility of

-9- No. 87818-2-I/10

her medical chart. Where a claim of ineffective assistance of counsel is premised

on “their attorney’s failure to object, then ‘the [appellant] must show that the

objection would likely have succeeded.’” State v. Vazquez, 198 Wn.2d 239, 248,

494 P.3d 424 (2021) (quoting State v. Crow, 8 Wn. App. 2d 480, 508, 438 P.3d

541 (2019)). Case law addressing analogous records holds that once an adequate

foundation is established, those records are admissible as business records under

RCW 5.45.020. See In re Welfare of M.R., 200 Wn.2d 363, 387, 518 P.3d 214

(2022) (holding trial court did not abuse its discretion concluding drug rehabilitation

and testing center incident report qualified as business record under RCW

5.45.020); State v. Ziegler, 114 Wn.2d 533, 538-39, 789 P.2d 79 (1990) (holding

no error in concluding laboratory reports in medical records qualified as business

records). H.H. cannot demonstrate that an objection on this basis to the evidence

she now challenges on appeal would have been successful. Accordingly, she

does not establish deficient performance, and her claim of ineffective assistance

necessarily fails.

Further, even if there were reason to question the admissibility of the

medical chart, “decisions regarding whether and when to object fall firmly within

the category of strategic or tactical decisions.” State v. Johnston, 143 Wn. App. 1,

19, 177 P.3d 1127 (2007). While some medical chart entries unquestionably

supported the State’s position, there was also information in the records favorable

to H.H.’s position, which her counsel expressly relied on to oppose revocation. For

instance, H.H.’s attorney highlighted certain information in the medical record to

argue that H.H. was physically stable and had not recently engaged in some

- 10 - No. 87818-2-I/11

behaviors commonly associated with eating disorders. They also emphasized

certain portions of the chart to counter the State’s position that H.H. was actively

suicidal.

The record establishes that it was a legitimate trial strategy to stipulate that

the medical record was subject to the business records exception to the hearsay

rule and refrain from objection on that basis. Because counsel’s tactical decision

cannot be characterized as deficient, we need not address prejudice. See Kyllo,

166 Wn.2d at 862.

IV. Sufficiency of the Evidence

H.H. also challenges the sufficiency of the evidence supporting the

revocation and commitment order.

RCW 71.05.590(5)(d) sets forth the various bases on which a court may

revoke an LRA treatment order and includes in that list a showing that the detained

person failed to adhere to the terms and conditions of the LRA treatment order or

a substantial deterioration of the detained person’s functioning has occurred. We

review the superior court’s decision to determine whether substantial evidence

supports its findings of facts and whether the findings support its conclusions of

law and ultimate decision. In re Det. of A.F., 20 Wn. App. 2d 115, 125, 498 P.3d

1006 (2021). “‘Substantial evidence is the quantum of evidence sufficient to

persuade a fair-minded person’ that the premise is true.” In re Det. of A.M., 17

Wn. App. 2d 321, 330, 487 P.3d 531 (2021) (quoting In re Det. of H.N., 188 Wn.

App. 744, 762, 355 P.3d 294 (2015)). When evaluating the sufficiency of the

evidence, we consider the evidence in the light most favorable to the State. Id.

- 11 - No. 87818-2-I/12

The sole basis for H.H.’s challenge to the factual findings is that they could

not be supported by information and statements derived from medical chart entries

since that evidence was hearsay and no exception applied to render it admissible.

But as previously explained, H.H. failed to preserve for review any evidentiary

error. For this reason, H.H.’s reliance on a harmless error analysis is also

misplaced. See A.C., 1 Wn.3d at 194 (applying “materially affected” standard”).

Considering all properly admitted evidence, including testimony about

H.H.’s medical chart, the evidence supports the findings that H.H. violated the

terms of the October 2024 LRA order. Specifically, there was testimony that while

H.H. was living with family subject to the LRA order she stopped taking her

prescribed medications entirely and did not participate in outpatient treatment.

Also during this time, H.H. became physically violent toward family members.

Eventually, H.H. ran away from home at a time when she expressed suicidal intent.

The evidence presented also supports the finding that H.H. experienced a

substantial deterioration of functioning since the LRA order was issued. In the

month following her hospital admission, H.H. repeatedly expressed suicidal

ideation and that her inability to function was due to “brain fog.” H.H. also

intermittently refused water, nutrition, medications, and monitoring. There was

evidence that H.H. was, at times, unable to attend to her hygiene or activities of

daily living. H.H. admitted to hospital staff that she was unable to care for herself

and would not likely attend outpatient treatment if discharged.

The evidence in the record is sufficient to support the findings that H.H.

failed to adhere to the terms of the October 2024 LRA treatment order and

- 12 - No. 87818-2-I/13

experienced a substantial deterioration of functioning between the date it was

issued and the hospitalization material to this appeal. Those findings support the

decision to revoke the LRA treatment order and order involuntary inpatient

treatment. H.H. otherwise fails to establish error.

Affirmed.

WE CONCUR:

- 13 -