In The Matter Of The Detention Of D.w.

• Court: Court of Appeals of Washington
• Decided: March 9, 2026
• Docket: 88044-6
• Status: Unpublished

Opinion

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON

In the Matter of the Detention of No. 88044-6-I D.W. DIVISION ONE

UNPUBLISHED OPINION

BIRK, J. — The superior court ordered D.W. committed for 14 day

involuntary treatment. D.W. appeals the order, arguing that there was not

substantial evidence to support the superior court’s finding that he was gravely

disabled and that a less restrictive alternative treatment would not be in his best

interests. Because substantial evidence supports the superior court’s findings, we

affirm.

I

On March 17, 2025, a King County sheriff brought D.W. into the Multicare

Auburn emergency room because he was allegedly suffering from a behavioral

health disorder that allegedly made him a danger to others and unable to care for

himself. On March 18, a designated crisis responder filed a petition for D.W.’s

initial detention. On March 21, medical providers at Fairfax Hospital petitioned for

D.W. to be detained for 14 day involuntary treatment. The superior court held a

hearing to decide the petition on March 25. Three witnesses testified at D.W.’s No. 88044-6-I/2

commitment hearing, Dr. Bethany O’Neill, a psychologist, court evaluator, and

proxy witness for MultiCare Hospital; Brian Hayden, a court services manager and

court evaluator for Fairfax Community Behavioral Health; and D.W. Based on the

testimony of the three witnesses, the court found that D.W. was gravely disabled

under prong (a), that, as a result of a behavioral health disorder, he was in danger

of serious physical harm due to an inability to provide for his essential needs of

health and safety, and that a less restrictive alternative treatment was not in his

best interest. We discuss D.W.’s specific challenges to the evidence below.

II

In reviewing the superior court’s involuntary commitment order we consider

whether the findings of fact are supported by substantial evidence and if those

findings support the court’s conclusions of law. In re Det. of K.P., 32 Wn. App. 2d

214, 221, 555 P.3d 480 (2024), review denied, No. 103607-8 (Wash. Nov. 20,

2025). “ ‘Substantial evidence’ is a quantum of evidence ‘sufficient to persuade a

fair-minded person of the truth of the declared premise.” Id. (quoting In re Det. of

A.F., 20 Wn. App. 2d 115, 125, 498 P.3d 1006 (2021)). In considering whether

there was sufficient evidence, we review the evidence in the light most favorable

to the petitioner. Id. An appeal from an order of commitment is not moot, even

after the commitment period is ended, because “each commitment order has a

collateral consequence in subsequent petitions and hearings.” In re Det. of M.K.,

168 Wn. App. 621, 626, 279 P.3d 897 (2012).

Involuntary commitment for behavioral health disorders “is a significant

deprivation of liberty” that requires “due process of law.” In re Det. of LaBelle, 107

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Wn.2d 196, 201, 728 P.2d 138 (1986). “In general, an individual may be

involuntarily committed for mental health 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.” M.K., 168 Wn. App.

at 630. Here, the superior court ordered D.W.’s commitment after finding him

gravely disabled. If, at the conclusion of the probable cause hearing, the court

finds by a preponderance of the evidence that “as the result of a behavioral health

disorder” the individual is “gravely disabled,” the court must consider less

restrictive alternatives to involuntary detention, but if finding that no such

alternatives are in the best interest of the individual, the court “shall order that such

person be detained for involuntary treatment not to exceed 14 days.” RCW

71.05.240(4).1

RCW 71.05.020(25) provides for two definitions of gravely disabled. The

superior court relied only on “prong (a).” An individual is gravely disabled under

prong (a) if “as a result of a behavioral health disorder” they are “in danger of

serious physical harm resulting from a failure to provide for his or her essential

human needs of health or safety.” RCW 71.05.020(25)(a).

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

1 A “less restrictive alternative treatment” is a program of “individualized

treatment in a less restrictive setting than inpatient treatment.” RCW 71.05.020(35).

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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 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.” Id. 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 LaBelle’s “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.” Id. at 210.

The superior court found the testimony of Dr. O’Neill and Hayden credible.

In Hayden’s opinion, D.W. was gravely disabled under prong (a) and a less

restrictive alternative treatment was not in D.W.’s best interests. In forming his

opinion, Hayden relied on hospital records, consultation with D.W.’s treatment

team, his own interview with D.W., his own observations of D.W., and Dr. O’Neill’s

testimony. D.W. objected to much of the evidence presented at the commitment

hearing as hearsay, and for those objections, which the court sustained, the court

admitted the evidence as basis evidence for the limited purpose of informing the

expert’s opinion. See ER 703; In re Det. of L.S., 23 Wn. App. 2d 672, 681, 517

P.3d 490 (2022) (expert opinion is considered evidence and otherwise

inadmissible evidence may be admissible to explain basis of opinion).

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First, there was evidence that D.W. suffered from bipolar disorder, as shown

by his delusional thinking, pressured speech, irritability, and impaired impulse

control. Hayden testified that the working diagnosis for D.W.’s behavioral health

disorder was bipolar disorder type 1 currently manic with psychotic features. The

effects of D.W.’s behavioral health disorder were shown through testimony that

D.W. was hyperverbal, expressed grandiose delusions, showed impaired impulse

control, lacked insight, did not respect boundaries, and exhibited agitation and

irritability. D.W. regularly claimed that he was a famous and wealthy comedian.

He offered Hayden “$500 billion” if he could get D.W. out of the hospital.

Hayden relied on a progress note stating that D.W. claimed he owned the

hospital he was staying in and that he was going to build an airport and shopping

center on the property. D.W. also claimed that he was going to have the senior

center that he had been living in “destroyed and moved about 100 feet and built

better.” D.W. showed irritability and impaired impulse control through his treatment

of his peers. Hayden relied on a progress note stating that D.W. made

inappropriate comments toward female patients and staff, and he touched another

patient on the arm despite being told not to. The note continued, when hospital

staff told him not to touch people, D.W. replied to the staff member with an

expletive and said he “would do it when staff wasn’t looking.” In another progress

note relied on by Hayden, D.W. grazed the shoulder of a patient who told him,

“ ‘Don’t touch me, you pedophile,’ ” to which D.W. replied, while giggling, “ ‘I am a

pedophile.’ ” Staff regularly had to redirect D.W.

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Second, there was substantial evidence that D.W. was in danger of serious

physical harm due to his inability to provide for his essential needs. Hayden relied

on notes and testimony showing that D.W. denied his symptoms and denied the

events that led to his hospitalization, that D.W. regularly showed poor activities of

daily living, and that D.W. had trouble sleeping (which he denied), sometimes

sleeping less than two hours at night. Dr. O’Neill and Hayden relied on evidence

purportedly showing D.W.’s inconsistent and intermittent medication use. D.W.

struggled to pay for one medication, which was not covered by Medicare, but when

asked if he had done anything to get help with paying for the medication, he replied,

“I don’t know how.”

There was evidence that D.W. was not eating enough. Hayden referred to

D.W.’s body mass index (BMI) as “extremely low,” relying on a nursing assessment

that described D.W. as looking malnourished, and that listed D.W.’s BMI as 15.5,

while the bottom end of the normal range is 19. Additionally, Dr. O’Neill relied on

a report showing that there were ketones present in D.W.’s urine. Ketones in urine

are a “sign of malnutrition” and “indicative of someone not eating appropriately.”

Hayden’s opinion that D.W. was unable to care for himself was further bolstered

by evidence that hospital staff ordered a high protein diet, double portion due to

D.W.’s low weight and poor nutrition, that D.W. was 74 years old, and that D.W.

told Hayden that he was being evicted. When Hayden asked D.W. how he would

meet his needs in the face of eviction, D.W. was unable to explain how he would

secure food, clothing, or shelter. And there was evidence that D.W.’s condition

was progressively deteriorating, as D.W. went from calm, cooperative, and not

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showing “advanced symptoms” in February to his sleepless, delusional,

malnourished, and irritable state in March.2

D.W. asserts that “any risk of physical harm was due not to D.W.’s mental

health impairment—which D.W. had managed for decades—but to the exorbitant

cost of his medications.” D.W.’s argument is based on his testimony that he was

living on $3,000 a month and was unable to pay for sertraline, which he said cost

$375 a month. Asked by the court, “It sounds like you’re having a problem paying

for your medication in the community; is that right?” D.W. replied, “Just one.

Medicare and my insurance co-pay [UNINTELLIGIBLE] for additional ones. It pays

for everything else, but they will not pay for that.” The court asked, “Have you done

anything to get help with that?” And D.W. replied, “I don’t know how.” Other

evidence suggested that D.W. may have voluntarily discontinued use of sertraline

more than a year before the commitment hearing because he “got better.”

The record was otherwise undeveloped on the potential barriers D.W. faced

in obtaining mental healthcare or potential means to overcome them. LaBelle

supports that the mere inability to afford necessary care without more could not

justify involuntary treatment. See 107 Wn.2d at 210. Here, however, there was

evidence that, as a result of his working bipolar diagnosis, and at the age of 74,

D.W. was delusional, irritable, showed poor impulse control and poor boundaries,

had decompensated within the last month, was unable to rationally plan to meet

2 Dr. O’Neill relied on evidence for her expert opinion purporting to show

D.W.’s condition over two hospital visits on February 10 and February 21, 2025. Allegedly, D.W.’s first visit was because he fell while drawing a bath. And purportedly, in his second visit D.W. was wearing somewhat dirty clothes, though not soiled, he was alert and oriented, and was released without safety concerns.

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his needs in the community, and was acutely malnourished. There was tangible

evidence of an imminent and serious risk of physical harm to D.W.

In its oral ruling, the superior court found that D.W. was not “taking in

enough water to sustain himself in the community.” D.W. contends that this finding

is not supported by substantial evidence. D.W. is correct, the finding is not

supported by substantial evidence. Setting aside the superior court’s finding on

D.W.’s water intake and only considering those findings supported by substantial

evidence, the superior court’s conclusion that, because of D.W.’s behavioral health

disorder, D.W. was in danger of serious physical harm due to his inability to provide

for his essential needs is supported.

D.W. argues that substantial evidence did not support the finding that a less

restrictive alternative treatment was not in his best interests. There was evidence

that D.W. had been evicted. In its oral ruling the court acknowledged that

homelessness was not in and of itself a negative consequence that it was

concerned with, but that because of D.W.’s age, health, and impaired ability to act

appropriately with others, the court anticipated a likely medical emergency or law

enforcement contact that would send D.W. back to the hospital for inpatient

treatment. Counsel asked Hayden what harmful consequences he foresaw if D.W.

did not receive inpatient treatment, and Hayden replied, “Not to be hyperbolic, but

the concern is that he will die from his inability to care for himself; that he will not

seek appropriate care now; that he will not be able to feed himself or find shelter

for himself; and that this will lead to his death.”

8 No. 88044-6-I/9

At the hearing, D.W. did not argue that petitioners had failed to meet their

burden of showing that a less restrictive alternative treatment was not available.

The only testimony on the issue was Hayden’s, which the superior court was

entitled to believe. There was substantial evidence to support the court’s

conclusion that less restrictive alternative treatment was not in D.W.’s best

interests.

Affirmed.

WE CONCUR: