In The Matter Of The Detention Of M.b.

• Court: Court of Appeals of Washington
• Decided: March 9, 2026
• Docket: 88002-1
• Status: Unpublished

Opinion

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON

In the Matter of the Detention of: No. 88002-1-I M.B., DIVISION ONE Appellant. UNPUBLISHED OPINION

COBURN, J. — M.B. assaulted hospital staff and another patient while hospitalized

at Fairfax Behavioral Health. Fairfax petitioned to commit M.B. for 14 days of involuntary

treatment for a mental disorder. The trial court found that because of a mental disorder,

M.B. posed a likelihood of serious harm to others and granted Fairfax’s petition. M.B.

challenges the trial court’s order, arguing that the record lacks sufficient evidence to

support the trial court’s findings. We disagree and affirm.

FACTS

M.B. is a 33-year-old male diagnosed with schizoaffective disorder. Starting

around August or September 2024, M.B.’s mental health provider Elizabeth

Quackenbush, program manager for the Navos Mental Health PACT 1 team, observed

PACT is short for the Program for Assertive Community Treatment. The PACT team 1

provides multi-disciplinary wraparound mental health and stabilization services to clients living in the community who have a history of hospitalizations or incarcerations. 88002-1-I/2

M.B. as showing signs of decompensation and that he was refusing to take his

medication.

In December 2024 M.B. met with Quackenbush in her office after he made some

delusional requests to her. M.B. initially refused to leave when Quackenbush let him

know it was time to go. When Quackenbush moved to hand M.B’s bag to him, M.B.

became agitated, stood up and approached Quackenbush, got into her personal space,

and told her not to touch his things. As M.B. went to leave, he threatened to come back

and kill the PACT team. The interaction and M.B.’s statements caused Quackenbush to

worry that M.B. might harm her or her staff.

On January 22, 2025, Quackenbush referred M.B. for an evaluation by a county

designated responder (DCR) based on concerns that he was not caring for himself, was

expressing delusional beliefs about a fictional wedding, and had been hostile and

physically aggressive toward staff at the PACT team’s office. After evaluating M.B., a

DCR petitioned for M.B.’s initial detention under the involuntary treatment act (ITA). 2

The trial court granted the petition on the grounds that M.B. presented a likelihood of

serious harm to others and was gravely disabled.

Following M.B.’s initial detention, Fairfax petitioned for 14 days of involuntary

treatment under the ITA. Fairfax asserted that M.B. was suffering from a mental

disorder, presented a likelihood of serious harm to himself and others, and that he was

gravely disabled.

Quackenbush, Northwest Hospital court evaluator Joseph Cisneros, and Fairfax

lead court evaluator Brian Hayden testified at the 14-day involuntary treatment hearing.

2 Ch. 71.05 RCW. 2 88002-1-I/3

Both Cisneros and Hayden read from medical records that M.B. stipulated were

admissible under the business records exception to the rule against hearsay. 3 M.B. also

testified on his own behalf.

Quackenbush testified that she had worked with M.B. for about a year and a half

and that she had observed him decompensating over the last five or six months and

that he was refusing to take any medication. Quackenbush testified to M.B.’s history of

hospitalizations and that at least some of the prior hospitalizations occurred under

similar circumstances, including M.B.’s refusal to take medication.

Cisneros read aloud a portion of medical records, including chart notes, from

M.B.’s initial treatment at Northwest Hospital upon his detention. The records indicated

that M.B. was transported to the emergency department at Northwest Hospital on

January 28, where he arrived wearing a spit hood after spitting at staff. While in the

emergency department, M.B. demonstrated more agitation and verbally abusive

behavior toward staff. The following day M.B. spoke aggressively to staff at Northwest

Hospital before being transferred to Fairfax for continued treatment.

Hayden testified that M.B. was suffering from a mental impairment due to a

“working diagnosis [of] schizoaffective disorder, bipolar type, with a rule out of

schizophrenia.” Hayden testified that M.B.’s mental impairment was impacting his

cognitive and volitional functioning as demonstrated by impaired impulse control,

assaultive behavior toward staff and peers, verbal and physical aggression,

psychomotor agitation, irritability, and inappropriate sexual behavior. Additionally, M.B.

was “endorsing multiple delusions” that were preventing him from being able to work on

3 See ER 801(c), 802; RCW 5.45.020. 3 88002-1-I/4

a discharge plan.

Hayden based his evaluation in part on a review of M.B.’s medical chart at

Fairfax as well as his observations of M.B. Hayden read into the record from chart notes

relevant to his evaluation. A note by a psychiatrist who evaluated M.B. upon his arrival

to Fairfax on January 29 indicated that M.B. refused to participate in his psychiatric

evaluation and threatened to kill the psychiatrist. M.B. demonstrated delusional

thoughts, paranoid behavior, as well as hostile, aggressive, and threatening behavior.

M.B.’s affect was “inappropriate” and “labile.” The psychiatrist also documented M.B. as

presenting with passive homicidal ideation with self-reported means, poor insight based

on his denial of illness and need for treatment, and poor judgment based on his ability to

draw appropriate conclusions and his responses to social situations. Another chart note

from that same day stated that M.B. was agitated because he could not go to the gym.

M.B. threw hot oatmeal on a Fairfax staff member’s face, pushed the staff member to

the ground, and kicked them in the face. M.B. was put on a physical hold and given

medications in the form of a chemical restraint due to his imminent danger to others.

Another note stated that M.B. cussed at and threatened to kill staff at Fairfax. A

progress note from February 1 described M.B. as punching another patient while in the

hallway “with no clear apparent reason,” requiring staff to intervene. In a separate

incident on the same day, M.B. was noted as being anxious, pacing, and responding to

internal stimulus by talking to himself before threatening and punching another patient in

the face. Fairfax staff repeatedly documented M.B. as pacing while talking to himself or

responding to internal stimuli.

On February 9 M.B. called the front desk at Fairfax and made threatening

4 88002-1-I/5

comments about another patient. M.B. was on assault precautions at this time. During a

February 15 psychiatric evaluation, M.B. presented with delusions, poor and illogical

thought processing, an unstable mood, a labile affect, and restless, fidgety, and

hyperactive psychomotor behavior. His speech was pressured, hyperverbal, and loud.

On February 17 M.B. was noted as expressing delusional thoughts. On this day M.B.

was again documented as pacing and responding to internal stimuli and as talking

loudly on the phone, laughing loudly, and screaming.

The next day, on February 18, M.B. was documented by a nurse as having

auditory hallucinations. M.B. denied having them, demonstrating poor insight. This

same day M.B. denied having his first and last name and denied that his apartment was

burned despite a case manager showing him pictures of the unit that was damaged by

someone else. M.B. was observed by the case manager as telling nurses that he could

hear “wives” having sex with other men and needed to get out of the hospital.

Also on February 18, M.B. was assessed by a psychiatrist as demonstrating

worse anxiety, a hostile attitude as well as pressured, hyperverbal, and loud speech.

His psychomotor behavior was documented as restless, fidgety, and hyperactive.

Additionally, his thought process was “noted for poor processing, illogical,

circumstantial, and tangential,” with “[t]hought content noted for paranoia, delusions,

and grandiosity” and impaired insight and judgment.

Hayden testified that M.B. remained a risk of harm to others. Hayden described

M.B. as “showing very poor impulse control,” making threatening statements, being

unable to engage with reality, “highly delusional,” and demonstrating a lack of insight

regarding his problematic behavior. Hayden believed that due to M.B.’s continued lack

5 88002-1-I/6

of impulse control, M.B. would become assaultive and attempt to do the things he

threatens if he were in the community that “would put a reasonable person in adequate

fear.”

The trial court found that as the result of a mental disorder, M.B. presented a

likelihood of serious harm to others. The trial court found in its written findings:

The Court finds the testimony of [Fairfax’s] witnesses to be credible.

…

The Court finds that [M.B.] suffers from a behavioral health disorder with a working diagnosis of schizoaffective disorder. The Court finds that this disorder has a substantial and adverse effect on [M.B.’s] cognitive and volitional functioning as evidenced by his delusional thoughts, responses to internal stimuli, assaultive and agitated behaviors towards staff and peers, and inability to realistically plan for discharge or his own safety.

The Court finds that [M.B.] poses a risk of physical harm to others. The Court finds that [M.B.] was acting aggressive and agitated with his outpatient team prior to admission, including making threats to come back and kill them. The Court also finds that he has assaulted staff or peers multiple times in the hospital, including throwing hot oatmeal on someone’s face and then kicking them, punching a peer, and making threats to kill his provider. The Court finds that [M.B.] has made threats while having a history of prior violent acts, caused harm to others, and caused others to fear for their safety due to his behavior.

The Court does not find that [M.B.] is gravely disabled and dismisses that allegation.[4]

The Court finds that a less restrictive alternative is not currently appropriate because [M.B.] remains symptomatic at the hospital, is denying the need for any treatment, and does not demonstrate insight into his diagnosis.

The court also found as part of its oral ruling that M.B.:

continue[s] to be a likelihood of serious harm to others as a result of his

4 The trial court’s dismissal of Fairfax’s allegation that M.B. was gravely disabled is not at issue in the instant appeal. 6 88002-1-I/7

assaultive behavior in the hospital, especially given that he’s been assaultive of hospital staff which, as far as nurses, doctors, hospital staff constitute first responders which could be a charge of up to an Assault 2, Assault 3, if the hospital decided to have [M.B.] arrested.[5] The trial court involuntarily committed M.B. for a period not to exceed 14 days.

M.B. appeals.

DISCUSSION

Likelihood of Serious Harm

M.B. contends that the trial court erred when it entered the 14-day involuntary

commitment order because there was insufficient evidence that M.B. presented a

likelihood of serious harm to others. Because a fair-minded person could conclude that

Fairfax showed by a preponderance of evidence that M.B. as a result of his mental

disorder caused physical harm or placed persons in reasonable fear of sustaining such

harm, we disagree.

When presented with a challenge to the sufficiency of the evidence underlying

the trial court’s involuntary commitment order, our 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). “Substantial evidence is ‘evidence that is in

sufficient quantum to persuade a fair-minded person of the truth of the declared

premise.’” In re Det. of T.C., 11 Wn. App. 2d 51, 56, 450 P.3d 1230 (2019) (internal

quotation marks omitted) (quoting In re Det. of A.S., 91 Wn. App. 146, 162, 955 P.2d

836 (1998)). The burden is on the challenging party to show that substantial evidence

does not support the trial court’s findings of fact. Id. We do not disturb the trial court’s

5 The trial court adopted and incorporated its oral findings into its written findings of fact and conclusions of law. 7 88002-1-I/8

assessment of witness credibility or reweigh the evidence. In re Det. of A.F., 20 Wn.

App. 2d 115, 125, 498 P.3d 1006 (2021). “Unchallenged findings of fact are verities on

appeal.” In re Det. of L.S., 23 Wn. App. 2d 672, 686, 517 P.3d 490 (2022).

Under the ITA, the trial court may involuntarily commit an individual for up to 14

days if the petitioner proves by a preponderance of the evidence at the probable cause

hearing that the person, “as the result of a behavioral health disorder, presents a

likelihood of serious harm, or is gravely disabled.” RCW 71.05.240(4)(a). The trial court

must consider less restrictive alternatives, but if it finds that none are sufficient, the ITA

requires the trial court to order that the individual be detained to a licensed treatment

facility. Id. Because involuntary commitment is a “massive curtailment of liberty,” courts

must strictly construe the statutes regulating these proceedings. Humphrey v. Cady,

405 U.S. 504, 509, 92 S. Ct. 1048, 31 L. Ed. 2d 394 (1972); In re Det. of D.W., 181

Wn.2d 201, 207, 332 P.3d 423 (2014).

RCW 71.05.020(37)(a)(ii) defines “[l]ikelihood of serious harm” to others as a

substantial risk that “physical harm will be inflicted by a person upon another, as

evidenced by behavior which has caused such harm or which places another person or

persons in reasonable fear of sustaining such harm.” A substantial risk of harm need not

be “imminent” because “the practical effect of being placed in the hospital will usually

eliminate the ‘imminence’ of one’s dangerousness.” In re Det. of Harris, 98 Wn.2d 276,

283-84, 654 P.2d 109 (1982). A showing of substantial risk of physical harm instead

requires evidence of “‘a recent overt act,’” which may be an act that “‘caused harm or

creates a reasonable apprehension of dangerousness.’” T.C., 11 Wn. App. 2d at 57

(quoting Harris, 98 Wn.2d at 284-85). This court has previously interpreted “reasonable

8 88002-1-I/9

fear of sustaining such harm” under RCW 71.05.020 as requiring “that the person

threatened be in fear, that they must be in fear of harm to themselves, and that the

harm they are fearful of must be in the nature of the harm threatened.” In re Det. of

D.V., 200 Wn. App. 904, 907, 403 P.3d 941 (2017).

RCW 71.05.245(3) provides that in determining whether there is a likelihood of

serious harm, the trial court must give great weight to the person’s recent history of one

or more violent acts or recent history of one or more commitments based on a likelihood

of serious harm, though such history “shall not be the sole basis for determining

whether a person presents a likelihood of serious harm.” The provision defines “recent”

as the period of time that is three years or less before the probable cause hearing. RCW

71.05.245(3).

Here, the record presents sufficient evidence to support the trial court’s finding

that M.B. posed a likelihood of serious harm to others under RCW 71.05.020(37).

Fairfax presented evidence of multiple recent overt acts evidencing a substantial

risk of harm due to M.B.’s schizoaffective disorder, including evidence that M.B. spat at

hospital staff requiring him to wear a spit hood during his transport to Fairfax and that he

threatened and punched another patient in the face unprovoked during his

hospitalization. Additionally, M.B. threw hot oatmeal at a Fairfax staff member’s face,

pushed the staff member to the ground, and kicked them in the face. This latter incident

required M.B. to be put on a physical hold and administered chemical restraints due to

the imminent risk that he posed to others.

M.B. was also repeatedly documented as making threats to kill hospital staff

while at Fairfax. The record further supports that prior to his hospitalization at Fairfax,

9 88002-1-I/10

M.B. was acting agitated and aggressive toward his community mental health provider

Quackenbush and threatened to come back to her office to kill her and her PACT team

colleagues, causing Quackenbush to worry.

We reject M.B.’s argument that because no evidence was presented as to

whether M.B. caused physical injury to anyone, there is insufficient evidence to support

the trial court’s finding that M.B. posed a likelihood of serious harm. RCW 71.05.020

does not require proof of physical injury. See RCW 71.05.020(37)(a)(ii). The statute

requires a showing of a recent overt act that caused harm or creates a reasonable

apprehension of harm. T.C., 11 Wn. App. 2d at 57; D.V., 200 Wn. App. at 907. Here, the

record provides substantial evidence of multiple recent overt acts by M.B. that caused

harm to a patient and hospital staff and that created a reasonable apprehension of harm

to providers in the community and in the hospital.

M.B. also argues that Fairfax failed to meet its burden to prove by a

preponderance of evidence the likelihood of serious harm because “[t]he last noted

physical assault by M.B. occurred on February 1,” 19 days prior to the trial court’s entry

of the involuntary commitment order. M.B. asks this court to consider evidence that M.B.

was repeatedly documented by Fairfax staff as cooperative, compliant, and a low risk of

violence after February 1. We do not review a trial court’s decision regarding the

persuasiveness of evidence. A.F., 20 Wn. App. 2d at 125. As stated above, a

substantial risk of harm under RCW 71.05.020 need not be imminent. Harris, 98 Wn.2d

at 283-84. And here, all the above-referenced incidents that support the trial court’s

finding that M.B. posed a substantial risk of harm occurred within the statutory three-

year time frame under RCW 71.05.245(3).

10 88002-1-I/11

Moreover, the record supports that M.B.’s assaultive behavior, impaired impulse

control, irritability, and psychomotor agitation was indicative of the impact of M.B.’s

schizoaffective disorder on his cognitive and volitional functioning that presented a

likelihood of serious harm. A few days prior to the probable cause hearing, M.B. was

evaluated by a Fairfax psychiatrist as experiencing hallucinations, paranoia, and

delusions, and demonstrating worse anxiety, impaired judgment, hostility, and

psychomotor restlessness. Hayden further testified that M.B. remained a risk of harm to

others due to his delusional thinking, lack of impulse control and insight, and threatening

statements. Specifically, Hayden testified that due to M.B.’s continued lack of impulse

control, M.B. would become assaultive and act upon his threats in the community that

“would put a reasonable person in adequate fear.”

The evidence in the record supports that M.B.’s behavior due to a mental

disorder recently caused physical harm and/or created a reasonable apprehension of

dangerousness. We conclude that substantial evidence supports the trial court’s

findings and conclusion that M.B. presented a likelihood of serious harm to others.

Affirmed. 6

WE CONCUR:

6 Involuntary civil commitment cases are not moot on appeal even after the commitment period has ended because such commitments may constitute evidence in later proceedings. See In re Det. of M.K., 168 Wn. App. 621, 629, 279 P.3d 897 (2012); RCW 71.05.245(3). Fairfax does not argue otherwise. 11