IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
In the Matter of the Detention of: No. 88004-7-I D.L. DIVISION ONE
UNPUBLISHED OPINION
BUI, J. — The superior court ordered D.L. committed for 14 days of
involuntary commitment. D.L. appeals the order, arguing that there was not
substantial evidence to support the superior court’s finding that she was gravely
disabled. We disagree and affirm. 1
FACTS
On March 6, 2025, D.L. was involuntary detained when case workers at
St. Margaret’s Place, a supportive living facility where D.L. had been living since
November 2023, filed an initial petition to have her evaluated for involuntary
treatment. In their declarations, the case workers stated D.L. had deteriorated in
her baseline function and cited examples of missing medical appointments to
manage her diabetes, incontinence, and urinating, defecating, and disrobing in
1 Because an involuntary commitment order may have adverse collateral consequences
on future involuntary commitment determinations, this case is not moot even though the commitment order has since expired. See In re Det. of M.K., 168 Wn. App. 621, 629, 279 P.3d 897 (2012); RCW 71.05.245(3). No. 88004-7-I/2
the common areas. They noted her living area was in disarray, with open food
containers and clothes that appeared to be feces-soiled.
D.L. was transferred to the University of Washington Medical Center,
Northwest Campus (UW Hospital), where she was evaluated by clinical social
worker and court evaluator Joshua Cook. Based on that examination, Cook
opined that D.L. was gravely disabled and filed a petition for 14-day involuntary
treatment pursuant to the “Involuntary Treatment Act” (ITA), ch. 71.05 RCW.
Subsequently, a probable cause hearing was held on March 20, 2025, to
determine the merits of the petition.
Cook was the only witness to testify at the hearing. His testimony was
based on his personal observations of D.L. and review of the caseworkers’
declarations and medical charts. He testified D.L. had a diagnosis of dementia or
an early onset of a major neurocognitive disorder. During his personal interviews
and interactions with D.L., her recollection of dates and times was inaccurate,
such as indicating the wrong month and year, and when he asked how she will
meet her needs, she provided one-word responses, like saying the word “safe.”
Cook’s testimony also included the medical chart notes from UW Hospital,
which he read into the record. D.L. refused insulin, urinated all over the floor, was
unable to describe where she lived, had difficulty answering orientation questions
and word-finding. She also exhibited severe memory deficits, such as inability to
recall events occurring earlier on the same day and to recall staff members who
assisted her daily.
2 No. 88004-7-I/3
Based on his personal observations, review of the petition for initial
detention, and entries from D.L.’s medical chart from UW Hospital, Cook opined
that D.L. was gravely disabled as defined in RCW 71.05.020(25)(a). Cook based
his opinion on the struggles and deterioration D.L. experienced at St. Margaret’s
Place prior to her admission at UW Hospital, her inability to manage her own
needs even with extensive staff assistance in the hospital and observed memory
deficits and disorientation. Cook indicated that UW Hospital provided a
significantly higher level of care than St. Margaret’s Place. However, Cook noted
that despite the increased level of care, D.L. struggled to manage her own health
and safety needs without extensive staff prompting and assistance in a secure
environment. Cook consequently recommended that D.L. be treated for 14
additional days, so the hospital could stabilize D.L. and either arrange additional
support at St. Margaret’s Place or find her new supportive housing with a higher
level of care.
The trial court found D.L. was gravely disabled under subsection (a), as a
result of her behavioral health disorder, she was in danger of serious physical
harm due to an inability to provide for her essential needs of health and safety,
and a less restrictive alternative treatment 2 was not in her best interest. The trial
court ordered D.L. involuntary committed for 14 additional days. D.L. timely
appealed.
2 A “less restrictive alternative treatment” is a program of “individualized treatment in a
less restrictive setting than inpatient treatment.” RCW 71.05.020(35).
3 No. 88004-7-I/4
ANALYSIS
D.L.’s only contention on appeal is that substantial evidence does not
support the trial court’s finding that she was gravely disabled.
“Generally, where the trial court has weighed the evidence, appellate
review is limited to determining whether substantial evidence supports the
findings and, if so, whether the findings in turn support the trial court’s
conclusions of law and judgment.” In re Det. of LaBelle, 107 Wn.2d 196, 209, 728
P.2d 138 (1986) (citing Ridgeview Properties v. Starbuck, 96 Wn.2d 716, 719,
638 P.2d 1231 (1982)). “ ‘Substantial evidence is the quantum of evidence
sufficient to persuade a fair-minded person.’ ” In re Det. of A.F., 20 Wn. App. 2d
115, 125, 498 P.3d 1006 (2021) (quoting In re Det. of H.N., 188 Wn. App. 744,
762, 355 P.3d 294 (2015)). In considering whether there was sufficient evidence,
we review the evidence in the light most favorable to the petitioner. In re Det. of
A.M., 17 Wn. App. 2d 321, 330, 487 P.3d 531 (2021) (citing In re Det. of B.M., 7
Wn. App. 2d 70, 85, 432 P.3d 459, review denied, 193 Wn.2d 1017, 444 P.3d
1185 (2019)). “We do not review a trial court’s decision regarding witness
credibility or the persuasiveness of the evidence.” A.F., 20 Wn. App. 2d at 125.
“The burden is on the challenging party to demonstrate that substantial evidence
does not support a finding of fact.” In re Det. of T.C., 11 Wn. App. 2d 51, 56, 450
P.3d 1230 (2019).
Involuntary commitment for behavioral health disorders “is a significant
deprivation of liberty” which requires “due process of law.” LaBelle, 107 Wn.2d at
201. “In general, an individual may be involuntarily committed for mental health
4 No. 88004-7-I/5
treatment if, as a result of a mental disorder, the individual either (1) poses a
substantial risk of harm to him or herself, others, or the property of others, or (2)
is gravely disabled.” In re Det. of M.K., 168 Wn. App. 621, 630, 279 P.3d 897
(2012). Here, the superior court ordered D.L.’s commitment after finding her
gravely disabled.
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IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
In the Matter of the Detention of: No. 88004-7-I D.L. DIVISION ONE
UNPUBLISHED OPINION
BUI, J. — The superior court ordered D.L. committed for 14 days of
involuntary commitment. D.L. appeals the order, arguing that there was not
substantial evidence to support the superior court’s finding that she was gravely
disabled. We disagree and affirm. 1
FACTS
On March 6, 2025, D.L. was involuntary detained when case workers at
St. Margaret’s Place, a supportive living facility where D.L. had been living since
November 2023, filed an initial petition to have her evaluated for involuntary
treatment. In their declarations, the case workers stated D.L. had deteriorated in
her baseline function and cited examples of missing medical appointments to
manage her diabetes, incontinence, and urinating, defecating, and disrobing in
1 Because an involuntary commitment order may have adverse collateral consequences
on future involuntary commitment determinations, this case is not moot even though the commitment order has since expired. See In re Det. of M.K., 168 Wn. App. 621, 629, 279 P.3d 897 (2012); RCW 71.05.245(3). No. 88004-7-I/2
the common areas. They noted her living area was in disarray, with open food
containers and clothes that appeared to be feces-soiled.
D.L. was transferred to the University of Washington Medical Center,
Northwest Campus (UW Hospital), where she was evaluated by clinical social
worker and court evaluator Joshua Cook. Based on that examination, Cook
opined that D.L. was gravely disabled and filed a petition for 14-day involuntary
treatment pursuant to the “Involuntary Treatment Act” (ITA), ch. 71.05 RCW.
Subsequently, a probable cause hearing was held on March 20, 2025, to
determine the merits of the petition.
Cook was the only witness to testify at the hearing. His testimony was
based on his personal observations of D.L. and review of the caseworkers’
declarations and medical charts. He testified D.L. had a diagnosis of dementia or
an early onset of a major neurocognitive disorder. During his personal interviews
and interactions with D.L., her recollection of dates and times was inaccurate,
such as indicating the wrong month and year, and when he asked how she will
meet her needs, she provided one-word responses, like saying the word “safe.”
Cook’s testimony also included the medical chart notes from UW Hospital,
which he read into the record. D.L. refused insulin, urinated all over the floor, was
unable to describe where she lived, had difficulty answering orientation questions
and word-finding. She also exhibited severe memory deficits, such as inability to
recall events occurring earlier on the same day and to recall staff members who
assisted her daily.
2 No. 88004-7-I/3
Based on his personal observations, review of the petition for initial
detention, and entries from D.L.’s medical chart from UW Hospital, Cook opined
that D.L. was gravely disabled as defined in RCW 71.05.020(25)(a). Cook based
his opinion on the struggles and deterioration D.L. experienced at St. Margaret’s
Place prior to her admission at UW Hospital, her inability to manage her own
needs even with extensive staff assistance in the hospital and observed memory
deficits and disorientation. Cook indicated that UW Hospital provided a
significantly higher level of care than St. Margaret’s Place. However, Cook noted
that despite the increased level of care, D.L. struggled to manage her own health
and safety needs without extensive staff prompting and assistance in a secure
environment. Cook consequently recommended that D.L. be treated for 14
additional days, so the hospital could stabilize D.L. and either arrange additional
support at St. Margaret’s Place or find her new supportive housing with a higher
level of care.
The trial court found D.L. was gravely disabled under subsection (a), as a
result of her behavioral health disorder, she was in danger of serious physical
harm due to an inability to provide for her essential needs of health and safety,
and a less restrictive alternative treatment 2 was not in her best interest. The trial
court ordered D.L. involuntary committed for 14 additional days. D.L. timely
appealed.
2 A “less restrictive alternative treatment” is a program of “individualized treatment in a
less restrictive setting than inpatient treatment.” RCW 71.05.020(35).
3 No. 88004-7-I/4
ANALYSIS
D.L.’s only contention on appeal is that substantial evidence does not
support the trial court’s finding that she was gravely disabled.
“Generally, where the trial court has weighed the evidence, appellate
review is limited to determining whether substantial evidence supports the
findings and, if so, whether the findings in turn support the trial court’s
conclusions of law and judgment.” In re Det. of LaBelle, 107 Wn.2d 196, 209, 728
P.2d 138 (1986) (citing Ridgeview Properties v. Starbuck, 96 Wn.2d 716, 719,
638 P.2d 1231 (1982)). “ ‘Substantial evidence is the quantum of evidence
sufficient to persuade a fair-minded person.’ ” In re Det. of A.F., 20 Wn. App. 2d
115, 125, 498 P.3d 1006 (2021) (quoting In re Det. of H.N., 188 Wn. App. 744,
762, 355 P.3d 294 (2015)). In considering whether there was sufficient evidence,
we review the evidence in the light most favorable to the petitioner. In re Det. of
A.M., 17 Wn. App. 2d 321, 330, 487 P.3d 531 (2021) (citing In re Det. of B.M., 7
Wn. App. 2d 70, 85, 432 P.3d 459, review denied, 193 Wn.2d 1017, 444 P.3d
1185 (2019)). “We do not review a trial court’s decision regarding witness
credibility or the persuasiveness of the evidence.” A.F., 20 Wn. App. 2d at 125.
“The burden is on the challenging party to demonstrate that substantial evidence
does not support a finding of fact.” In re Det. of T.C., 11 Wn. App. 2d 51, 56, 450
P.3d 1230 (2019).
Involuntary commitment for behavioral health disorders “is a significant
deprivation of liberty” which requires “due process of law.” LaBelle, 107 Wn.2d at
201. “In general, an individual may be involuntarily committed for mental health
4 No. 88004-7-I/5
treatment if, as a result of a mental disorder, the individual either (1) poses a
substantial risk of harm to him or herself, others, or the property of others, or (2)
is gravely disabled.” In re Det. of M.K., 168 Wn. App. 621, 630, 279 P.3d 897
(2012). Here, the superior court ordered D.L.’s commitment after finding her
gravely disabled.
RCW 71.05.020(25) provides for two definitions of gravely disabled. The
trial court relied only on subsection (a). RCW 71.05.020(25)(a) provides:
In order to avoid the erroneous commitment of such persons under the gravely disabled standard, the State must present recent, tangible evidence of failure or inability to provide for such essential human needs as food, clothing, shelter, and medical treatment which presents a high probability of serious physical harm within the near future unless adequate treatment is afforded. Furthermore, the failure or inability to provide for these essential needs must be shown to arise as a result of mental disorder and not because of other factors.
LaBelle, 107 Wn.2d at 204-05. These strict requirements are designed to
mitigate the “danger of imposing majoritarian values on a person’s chosen
lifestyle which, although not sufficiently harmful to justify commitment, may be
perceived by most of society as eccentric, substandard, or otherwise offensive.”
LaBelle, 107 Wn.2d at 204. “Although uncertainty of living arrangements or lack
of financial resources will not alone justify continued confinement in a mental
hospital,” evidence supported involuntary treatment where it indicated that the
subject of the petition “plans to live on the streets are not the result of a choice of
lifestyle but rather a result of his deteriorated condition which rendered him
unable to make a rational choice with respect to his ability to care for his
essential needs.” LaBelle, 107 Wn.2d at 210. However, the risk of harm need not
5 No. 88004-7-I/6
be imminent at the time of the 14-day probable cause hearing. LaBelle, 107
Wn.2d at 203.
D.L. claims there is insufficient nonspeculative, nonhearsay evidence to
support the finding of grave disability. We disagree. Although some testimony
was not admitted as substantive evidence based on hearsay objections, Cook’s
personal observations, which were not objected to, established that D.L.
presented with a complicated major neurocognitive disorder. Her symptoms
included “disorientation in three out of four assessed spheres,” “severely
impaired memory,” and inability to independently attend to her daily living, health,
and safety needs. His observations also indicated that D.L. had no meaningful
release plan. When he asked how D.L. would meet her needs, she provided one-
word responses, “like just saying the word ‘safe.’ ” D.L. also struggled to
meaningfully interact with the UW Hospital environment, a more intensive care
facility. She was unable “to recall helping professionals,” and “events earlier in
the day.”
D.L.’s medical records, which were admitted as substantive evidence,
further support Cook’s personal observations. At UW Hospital D.L. urinated on
the floor, was incontinent and sometimes refused assistance changing her
diaper, was unable to recall her address, the city she lived in, or the date, and
refused insulin despite having high blood glucose levels. The substantive
evidence presented at the probable cause hearing supports D.L. was gravely
disabled under subsection (a). She suffered from a behavioral health disorder,
specifically a major neurocognitive disorder, exhibited failure to provide for her
6 No. 88004-7-I/7
essential needs of health and safety, and had extreme difficulty managing health
concerns, hygiene, and articulating a plan to stay safe in the community. See
RCW 71.05.020(25)(a).
Turning to D.L.’s contention that there was insufficient nonspeculative
evidence that she was gravely disabled, we disagree that Cook’s testimony about
the likelihood of harm to D.L. resulting from immediate release was based on
speculation. Cook opined that D.L. should be involuntarily treated for an
additional 14 days because her observed symptomology could potentially result
in her becoming lost in the community, or harmed by individuals, and further
decompensation. As stated above, the trial court does not need to find a person
is in “imminent” danger as a result of their grave disability in order to commit
them for involuntary treatment. Labelle, 107 Wn.2d at 203. Therefore, Cook’s
testimony did not need to articulate current danger D.L. faced in order to
demonstrate a danger of serious physical harm resulting from a grave disability.
See RCW 71.05.020(25)(a). The evidence on the record is sufficient to support
that D.L. was gravely disabled pursuant to the ITA.
D.L. cites examples to support her argument that there was insufficient
evidence that she was gravely disabled such as the chart notes and Cook’s
positive descriptions of D.L.’s demeanor, and good physical health and hygiene.
Cook testified D.L. appeared well-nourished and in good physical health and had
no major medical issues. In chart notes and during Cook’s personal
observations, D.L. was described as calm, pleasant, cheerful, and approachable,
with “no real behavioral concerns.” One chart note even indicated that she was
7 No. 88004-7-I/8
alert, followed commands appropriately, had fluid speech, and moved without
difficulty. She also articulated a desire to return to St. Margaret’s Place following
her release from commitment, and there was no testimony she could not return
there.
To be sure, there was evidence presented that touched upon D.L.’s ability
to address her health and safety needs. Importantly, however, the trial court
found that there was sufficient evidence D.L. could not independently take care
of herself without intensive instruction or direction. As previously mentioned,
there was admissible testimony that D.L. refused insulin, despite experiencing
high glucose levels, merely repeated the word “safe” when asked to articulate a
living plan post-release, and continued to experience significant incontinence
even with increased care. This evidence does not support a conclusion that D.L.
could address her health, safety, and hygiene needs without assistance. More
critically, the focus of substantial evidence review is not whether the facts in the
record could support other findings, but only whether the findings made by the
trial court were properly supported by that evidence. Sunnyside Valley Irr. Dist. v.
Dickie, 149 Wn.2d 873, 879-880, 73 P.3d 369 (2003) (“a reviewing court will not
substitute its judgment for that of the trial court even though it might have
resolved a factual dispute differently.”).
The trial court also properly found that a less restrictive alternative was not
appropriate for D.L., reasoning that D.L.’s symptoms and conditions persisted
even while under more intensive supervision and care. See RCW 71.05.240(4).
Affirmed.
8 No. 88004-7-I/9
WE CONCUR: