IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
In the Matter of the Detention of: No. 87550-7-I P.E. DIVISION ONE
UNPUBLISHED OPINION
DÍAZ, J. — P.E. challenges a superior court order committing him to 14 days
of involuntary treatment pursuant to the involuntary treatment act (ITA), chapter
71.05 RCW. He claims that the court erred when it found that a less restrictive
alternative was not in his or others’ best interest. We affirm.
I. BACKGROUND
On December 3, 2024, P.E. arrived at Virginia Mason Medical Center
seeking treatment for arm pain, but he would “not disclose what happened.” He
was disoriented and delusional at the hospital, screaming and yelling at hospital
staff. He spoke about sabotage, radiation, and being punished by mercenaries
from Norway. The hospital social worker could not get him to answer simple
questions or meaningfully participate in the psychiatric assessment. At this time,
P.E. was living at the Downtown Emergency Services Center (DESC) and No. 87550-7-I/2
receiving services from a care team there. However, he could not or would not tell
hospital staff where he lived.
Hospital staff referred P.E. to a King County designated crisis responder,
who met with and evaluated P.E., later filing a petition for 120-hour initial detention
under RCW 71.05.153. Fairfax Hospital, to which he had been admitted, then
petitioned for a 14-day involuntary commitment.
On December 10, 2024, the court held a hearing. At the hearing, a doctor
from Fairfax testified that P.E.’s “working diagnosis is unspecified schizophrenia
spectrum and related disorders.” Evidence of the disorder was primarily
disorganized thought. P.E. was “speaking in word salad a lot of the time.” But he
also showed signs of delusions, such as accusing hospital staff of stealing money
and indicating that “he had a team of medical professionals from the UK who he
needed to wait on.”
The court found that P.E. was gravely disabled. And the court found that a
less restrictive alternative treatment was not in P.E.’s best interest because he “is
not mentally stable, he does not understand he has a mental impairment, and is
still symptomatic in the inpatient setting.” The court ordered a 14-day involuntary
commitment. P.E. timely appeals.
II. ANALYSIS
P.E. claims that the court erred when it concluded, under RCW 71.05.240,
that a less restrictive alternative was not in his best interest. We hold that
substantial evidence supports that finding.
Pursuant to RCW 71.05.240, a court must hold a probable cause hearing
2 No. 87550-7-I/3
on a petition requesting an order for up to 14 days of involuntary treatment and it
may only enter such an order if, at the conclusion of the hearing:
the court finds by a preponderance of the evidence that a person detained for behavioral health treatment, as the result of a behavioral health disorder, presents a likelihood of serious harm, or is gravely disabled, and, after considering less restrictive alternatives to involuntary detention and treatment, finds that no such alternatives are in the best interests of such person or others.
RCW 71.05.240(4)(a) (emphasis added). The State has the burden of proving that
a less restrictive alternative is not in the best interests of person being committed.
In re Det. of T.A.H.-L., 123 Wn. App. 172, 186, 97 P.3d 767 (2004).
The ITA further provides two independently sufficient definitions of “gravely
disabled”; namely:
a condition in which a person, as a result of a behavioral health disorder:
(a) [i]s in danger of serious physical harm resulting from a failure to provide for his or her essential human needs for 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.
RCW 71.05.020(25).
The court found that P.E. was gravely disabled under RCW
71.05.020(25)(a), a.k.a., “prong A.” It specifically found that he “suffers from a
behavioral health disorder with a working diagnosis of unspecified schizophrenia
spectrum related disorder which has had a substantial adverse effect upon [his]
cognitive and volitional functioning,” and that therefore he was “in danger of serious
physical harm, resulting from a failure or inability to provide for his/her essential
3 No. 87550-7-I/4
human needs of health and safety.” P.E. effectively concedes that “his behavioral
health disorder negatively affects his ability to meet his needs, as shown by lab
results suggesting he was not eating properly.” He does not assign error to the
overall finding of grave disability, taking exception only to the finding that “a less
restrictive treatment is not appropriate.”
This court reviews whether substantial evidence supports the trial court’s
findings of fact, and whether the findings then support the conclusions of law. In
re LaBelle, 107 Wn.2d 196, 209, 728 P.2d 138 (1986). “We do not review a trial
court’s decision regarding witness credibility or the persuasiveness of the
evidence.” In re Det. of A.F., 20 Wn. App. 2d 115, 125, 498 P.3d 1006 (2021)
(citing In re Det. Of H.N., 188 Wn. App. 744, 763, 355 P.3d 294 (2015)). We hold
that there was substantial evidence to support the finding that P.E. would not
comply with a less restrictive treatment and the conclusion that a less restrictive
treatment was not in his best interest.
Medical testing showed that P.E. had ketones in his urine, indicating he was
suffering from malnourishment, and that he was underweight for his age. Doctors
at Fairfax hospital diagnosed him with hyponatremia, i.e., abnormally low sodium
levels. All this evidence together indicated that, even with support from DESC,
P.E. had not been eating enough to meet his needs, and a treating physician, Dr.
Robert Beatty, testified, that if these conditions continued, they would eventually
result in death.
Although P.E. was eating when directed at Fairfax hospital, he continued to
experience delusions, and Dr. Beatty testified that he did not think P.E. would
4 No. 87550-7-I/5
continue to eat on his own if he returned to DESC housing and services.
Furthermore, when first treated at Virginia Mason Medical Center, P.E. told staff
that he would refuse to return to his DESC residence, yelling, “I’m not going back
there.” The evidence above supports the court’s conclusion that P.E. would not
Free access — add to your briefcase to read the full text and ask questions with AI
IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
In the Matter of the Detention of: No. 87550-7-I P.E. DIVISION ONE
UNPUBLISHED OPINION
DÍAZ, J. — P.E. challenges a superior court order committing him to 14 days
of involuntary treatment pursuant to the involuntary treatment act (ITA), chapter
71.05 RCW. He claims that the court erred when it found that a less restrictive
alternative was not in his or others’ best interest. We affirm.
I. BACKGROUND
On December 3, 2024, P.E. arrived at Virginia Mason Medical Center
seeking treatment for arm pain, but he would “not disclose what happened.” He
was disoriented and delusional at the hospital, screaming and yelling at hospital
staff. He spoke about sabotage, radiation, and being punished by mercenaries
from Norway. The hospital social worker could not get him to answer simple
questions or meaningfully participate in the psychiatric assessment. At this time,
P.E. was living at the Downtown Emergency Services Center (DESC) and No. 87550-7-I/2
receiving services from a care team there. However, he could not or would not tell
hospital staff where he lived.
Hospital staff referred P.E. to a King County designated crisis responder,
who met with and evaluated P.E., later filing a petition for 120-hour initial detention
under RCW 71.05.153. Fairfax Hospital, to which he had been admitted, then
petitioned for a 14-day involuntary commitment.
On December 10, 2024, the court held a hearing. At the hearing, a doctor
from Fairfax testified that P.E.’s “working diagnosis is unspecified schizophrenia
spectrum and related disorders.” Evidence of the disorder was primarily
disorganized thought. P.E. was “speaking in word salad a lot of the time.” But he
also showed signs of delusions, such as accusing hospital staff of stealing money
and indicating that “he had a team of medical professionals from the UK who he
needed to wait on.”
The court found that P.E. was gravely disabled. And the court found that a
less restrictive alternative treatment was not in P.E.’s best interest because he “is
not mentally stable, he does not understand he has a mental impairment, and is
still symptomatic in the inpatient setting.” The court ordered a 14-day involuntary
commitment. P.E. timely appeals.
II. ANALYSIS
P.E. claims that the court erred when it concluded, under RCW 71.05.240,
that a less restrictive alternative was not in his best interest. We hold that
substantial evidence supports that finding.
Pursuant to RCW 71.05.240, a court must hold a probable cause hearing
2 No. 87550-7-I/3
on a petition requesting an order for up to 14 days of involuntary treatment and it
may only enter such an order if, at the conclusion of the hearing:
the court finds by a preponderance of the evidence that a person detained for behavioral health treatment, as the result of a behavioral health disorder, presents a likelihood of serious harm, or is gravely disabled, and, after considering less restrictive alternatives to involuntary detention and treatment, finds that no such alternatives are in the best interests of such person or others.
RCW 71.05.240(4)(a) (emphasis added). The State has the burden of proving that
a less restrictive alternative is not in the best interests of person being committed.
In re Det. of T.A.H.-L., 123 Wn. App. 172, 186, 97 P.3d 767 (2004).
The ITA further provides two independently sufficient definitions of “gravely
disabled”; namely:
a condition in which a person, as a result of a behavioral health disorder:
(a) [i]s in danger of serious physical harm resulting from a failure to provide for his or her essential human needs for 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.
RCW 71.05.020(25).
The court found that P.E. was gravely disabled under RCW
71.05.020(25)(a), a.k.a., “prong A.” It specifically found that he “suffers from a
behavioral health disorder with a working diagnosis of unspecified schizophrenia
spectrum related disorder which has had a substantial adverse effect upon [his]
cognitive and volitional functioning,” and that therefore he was “in danger of serious
physical harm, resulting from a failure or inability to provide for his/her essential
3 No. 87550-7-I/4
human needs of health and safety.” P.E. effectively concedes that “his behavioral
health disorder negatively affects his ability to meet his needs, as shown by lab
results suggesting he was not eating properly.” He does not assign error to the
overall finding of grave disability, taking exception only to the finding that “a less
restrictive treatment is not appropriate.”
This court reviews whether substantial evidence supports the trial court’s
findings of fact, and whether the findings then support the conclusions of law. In
re LaBelle, 107 Wn.2d 196, 209, 728 P.2d 138 (1986). “We do not review a trial
court’s decision regarding witness credibility or the persuasiveness of the
evidence.” In re Det. of A.F., 20 Wn. App. 2d 115, 125, 498 P.3d 1006 (2021)
(citing In re Det. Of H.N., 188 Wn. App. 744, 763, 355 P.3d 294 (2015)). We hold
that there was substantial evidence to support the finding that P.E. would not
comply with a less restrictive treatment and the conclusion that a less restrictive
treatment was not in his best interest.
Medical testing showed that P.E. had ketones in his urine, indicating he was
suffering from malnourishment, and that he was underweight for his age. Doctors
at Fairfax hospital diagnosed him with hyponatremia, i.e., abnormally low sodium
levels. All this evidence together indicated that, even with support from DESC,
P.E. had not been eating enough to meet his needs, and a treating physician, Dr.
Robert Beatty, testified, that if these conditions continued, they would eventually
result in death.
Although P.E. was eating when directed at Fairfax hospital, he continued to
experience delusions, and Dr. Beatty testified that he did not think P.E. would
4 No. 87550-7-I/5
continue to eat on his own if he returned to DESC housing and services.
Furthermore, when first treated at Virginia Mason Medical Center, P.E. told staff
that he would refuse to return to his DESC residence, yelling, “I’m not going back
there.” The evidence above supports the court’s conclusion that P.E. would not
comply with a less restrictive treatment option and so such an option would not
help him meet his basic needs and would not be in his best interest.
In response, P.E. claims that the court failed to consider the community
resources that would offer support to him in less restrictive treatment. As part of
the DESC housing program, P.E. has a care team that includes a health case
manager, a housing case manager, and an onsite nurse.
But even though P.E. had access to said resources when he first arrived at
Virginia Mason Medical Center, the evidence showed that he had been
malnourished for some time. Thus, it was not an abuse of discretion for the court
to find that these resources were not sufficiently providing for his essential human
needs even with such support.
Furthermore, P.E. said that he would refuse to return to DESC housing.
The court did not abuse its discretion in concluding that the services would be
insufficient when evidence showed that P.E. did not want to avail himself of the
services.
P.E. next claims that, because he had stabilized after being detained at
Fairfax hospital, at the time of the hearing, less restrictive treatment was
appropriate. It is true that, in an inpatient setting with constant care and
supervision, P.E.’s condition stabilized somewhat. Treating doctors testified that
5 No. 87550-7-I/6
P.E. had been prescribed a balanced diet, was eating with no problem, and was
also compliant regarding medication.
But per LaBelle, courts should avoid the cycle of releasing defendants who
have somewhat stabilized but who will immediately return to the same pattern that
caused them to need medical care. 107 Wn.2d at 206-7. This was the case here.
Dr. Beatty testified that, while his condition had somewhat stabilized,
ultimately he recommended that P.E. should remain in inpatient until they could
figure out “what additional supports are necessary to make sure that he stays
sufficiently fed in the community,” particularly given his near fatal condition upon
admission. This testimony provides substantial evidence to support the court’s
finding that, although P.E. had “stabilized somewhat in the hospital setting,” he
would not be able “to provide for his essential needs of health and safety outside
of the hospital.” This finding, in turn, supported the conclusion that P.E. remained
“too symptomatic to comply with a less restrictive treatment order.”
Finally, P.E. argues that, although P.E. had refused to return to DESC when
he was first detained, the court erred in considering this statement since “P.E.
made this statement a full week before the commitment hearing.” It is true that the
State must present “recent, tangible evidence of failure or inability” to provide for
essential human needs. LaBelle, 107 Wn.2d at 204-05 (emphasis added). But we
hold that a statement P.E. made a week before the hearing in question is
sufficiently recent to support the court’s decision. And P.E. provides no authority
stating otherwise. “‘Where no authorities are cited in support of a proposition, the
court is not required to search out authorities, but may assume that counsel, after
6 No. 87550-7-I/7
diligent search, has found none.’” City of Seattle v. Levesque, 12 Wn. App. 2d
687, 697, 460 P.3d 205 (2020) (quoting DeHeer v. Seattle Post-Intelligencer, 60
Wn.2d 122, 126, 372 P.2d 193 (1962)), review denied, 195 Wn.2d 1031, 468 P.3d
621 (2020)).
Furthermore, the record contained more recent evidence that P.E. had
continued to experience delusions. Nursing progress notes described him as “loud
and delusional” and that he told them he wanted to “get deported to Norway.”
During the hearing on the 14-day petition, P.E. tried to tell the court about his
medical team in the U.K., one of the delusions his doctor had described.
In summary, we reject P.E.’s argument that his “partial stabilization,
combined with [his] available housing and related case management services,
indicates that . . . a less restrictive order was appropriate.” The court did not abuse
its discretion in finding that such facts did not show a less restrictive alternative
was in his best interest.
III. CONCLUSION
We affirm the trial court’s order.
WE CONCUR: