In The Matter Of The Detention Of T.r.l.

• Court: Court of Appeals of Washington
• Decided: September 29, 2025
• Docket: 87118-8
• Status: Unpublished

Opinion

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON

In the Matter of the Detention of No. 87118-8-I T.R.L.,

Petitioner. DIVISION ONE

UNPUBLISHED OPINION

CHUNG, J. — A court commissioner ordered T.R.L. involuntarily committed for

treatment for up to 14 days according to the Involuntary Treatment Act (ITA), chapter

71.05 RCW. In issuing its order, the commissioner found that T.R.L. was gravely

disabled because she was in danger of serious physical harm that resulted from her

failure to provide for her essential health and safety needs. T.R.L. challenges her

commitment, contending there was not substantial evidence to support the findings and

that the commissioner erred in concluding she was gravely disabled. We disagree and

affirm.

FACTS

T.R.L., a 56-year-old female, was admitted to St. Anne Hospital on July 13, 2024,

for a mental health evaluation. T.R.L. had been released from jail five days prior to her

admission to St. Anne.

T.R.L. was brought to St. Anne by the King County Sheriff after she had been

knocking on doors at an apartment complex, entered a stranger’s apartment, and No. 87118-8-I/2

refused to leave. T.R.L. reportedly was unable to identify herself, screamed at the

responding police officers and asked “the deputy to murder her.” According to T.R.L.’s

medical records, upon admission to St. Anne, T.R.L. appeared tearful and was

“ ‘making nonsensical statements.’ ” The hospital ran a urinalysis and detected ketones.

While at St. Anne, T.R.L. was administered various medications including Haldol and

Benadryl. Various hospital staff attempted to engage with T.R.L. on the date of her

admission, but she “did not answer when asked various questions,” and when she did

answer, she told staff, “ ‘I don’t have a name. I don’t have a birthday.’ ” T.R.L. also

reportedly told hospital staff that she was homeless. The records also noted that T.R.L.

“started to play with the [feces] that she found in the [emergency department]

washroom.”

On July 14, 2024, Allison Ankney, a designated crisis responder, filed a petition

for T.R.L.’s initial detention, alleging T.R.L. posed an imminent likelihood of serious

harm to others and was in imminent danger due to grave disability and that no less

restrictive alternative was available. The petition sought to detain T.R.L. for an initial

period of 120 hours to evaluate and treat her. Aurora Casteel, a licensed social worker,

filed a declaration in support, stating that at her evaluation, T.R.L. presented with

“symptoms including: labile speech oscillating from mutism to hyperverbal

disorganized/nonsensical speech, disorganization, paranoia, verbal aggression,

irritability, delusion[].” For example, hospital notes indicate that T.R.L. poured cold water

all over a nursing assistant and stated that she was “falling in love with a man that she

married yesterday but [that] he never came back.”

2 No. 87118-8-I/3

On July 16, T.R.L. was transferred to Fairfax Behavioral Health. A commitment

hearing was scheduled for July 19, 2024. However, after the initial 120-hour hold, on

July 19, Brian Hayden, a licensed mental health counselor (LMHC) at Fairfax, signed a

petition for a 14-day involuntary treatment detention. The petition was also signed by an

advanced registered nurse practitioner. The petition alleged that T.R.L. was suffering

from a mental disorder that impacted her cognitive and volitional functions to the extent

that she posed a likelihood of serious harm to others and that she was gravely disabled.

In particular, the petition stated that T.R.L. had been diagnosed with “Schizoaffective

Disorder Bipolar Type” and had been previously “hospitalized at Fairfax” from February

11, 2023 through March 3, 2023. 1 The petition alleged that even after the initial hold,

T.R.L. was “showing an increased loss of cognitive and volitional functioning, [and] poor

insight regarding symptoms.” Further, the petition claimed that a less restrictive

alternative was not in the best interest of T.R.L. because she “requires the monitoring

and stabilization of an inpatient psychiatric hospital.”

A hearing was held on August 7 and 8, 2024, before a commissioner of King

County Superior Court. At the hearing, Fred Schwartz, a court evaluator and LMHC,

testified that he evaluated T.R.L., and that he had a working diagnosis for T.R.L. of

schizoaffective disorder bipolar type, which impacted her cognitive and volitional

functions, caused her to be gravely disabled, and put her in a serious risk of harm for

failing to provide for her health and safety needs. Schwartz also testified that she was

1 Testimony that T.R.L. had been “previously hospitalized at Fairfax in March [2023] where she

presented with similar psychiatric symptoms,” at which time she was eventually discharged on a less restrictive treatment order. 3 No. 87118-8-I/4

currently displaying symptoms of “delusional, grandiose, discharged focus,” and that

when he attempted to discuss discharge planning, T.R.L. gave “delusional housing

arrangements,” such as saying that she had a house in Burien “that they built for her,”

although upon verification, it was determined she was never an occupant of that

building. Schwartz also testified that T.R.L. told him that “she could go to her sister’s

home to live and she would walk from the hospital [in Kirkland] to Auburn,” but that the

hospital was unable to get in touch with T.R.L.’s sister. Schwartz concluded that the

presence of ketones in T.R.L.’s urine, her urinary tract infection, and other medical

problems at the time of her admission to the hospital were “an indication of poor self-

care” and she did not have “any outpatient services that we’ve been able to identify and

she currently has no family support.” As such, Schwartz concluded that T.R.L. was

gravely disabled.

The commissioner found by a preponderance of the evidence that T.R.L.

“currently suffers from a behavioral health disorder (working diagnosis: schizoaffective

disorder bipolar type),” which “had a substantial adverse effect upon [her] cognitive and

volitional functioning.” Further, it found by a preponderance of the evidence that due to

her mental health diagnosis, pursuant to RCW 71.05.020(25)(a), T.R.L. was “in danger

of serious physical harm from a failure or inability to provide for her essential needs of

health and safety” and that her mental health diagnosis also “interfer[ed] with her ability

to make a reasonable, rational decision about her treatment.” Further, the commissioner

explained that while T.R.L. “shows some improvement,” it was “limited improvement and

it’s certainly not enough to be released at this time because she does continue to exhibit

active symptoms of her behavior[al] health disorder,” and while in the hospital, T.R.L. 4 No. 87118-8-I/5

was not able to “meaningfully engage in conversation or discharge planning.” Therefore,

the commissioner found that pursuant to RCW 71.05.240, a less restrictive treatment

order was “not appropriate nor in [her] best interests because she has not stabilized, is

still exhibiting active symptoms of her behavioral health disorder, and is too

symptomatic to meet her needs in a less restrictive setting.” Ultimately, it ordered T.R.L.

be involuntarily detained for treatment for a period not to exceed 14 days at Fairfax

Hospital.

T.R.L. timely appeals. 2

DISCUSSION

T.R.L. challenges the commissioner’s ultimate conclusion that she was gravely

disabled as defined by RCW 71.05.020(25)(a) and must be involuntarily detained for

treatment, as well as the underlying findings of fact. In particular, T.R.L. argues that the

State failed to prove she was gravely disabled at the time of the hearing and instead,

improperly based its determination on her mental health diagnosis. We disagree.

On appeal, we review whether substantial evidence supports a trial court’s

findings of fact and, if so, whether those findings support its conclusions of law. In re

Det. of LaBelle, 107 Wn.2d 196, 209, 728 P.2d 138 (1986). Substantial evidence is “the

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

declared premise.’ ” In re Det. of K.P., 32 Wn. App. 2d 214, 221, 555 P.3d 480 (2024)

2 In her opening brief, T.R.L. argues that her petition was facially invalid because the State failed

to follow the procedure pursuant to RCW 71.05.290 requiring a petition be supported by two affidavits that each describe the person’s behavior and indicate the affiant’s willingness to testify to such facts. However, as the State points out, RCW 71.05.230 applies to T.R.L.’s 14-day involuntary detention for treatment, whereas RCW 71.05.290 provides the procedure for a petition for additional commitment following a 14-day treatment period. T.R.L. concedes this point in her reply brief. 5 No. 87118-8-I/6

(quoting In re Det. of H.N., 188 Wn. App. 744, 762, 355 P.3d 294 (2015)). We review

substantial evidence claims in the light most favorable to the State. In re Det. of B.M., 7

Wn. App. 2d 70, 85, 432 P.3d 459 (2019).

Under the ITA, a person may be involuntarily committed for treatment of

behavioral health disorders. 3 LaBelle, 107 Wn.2d at 201-02. However, a behavioral

health disorder alone is not enough to permit the significant deprivation of liberty

encompassed by commitment order for involuntary treatment. Id. at 201. A court can

order commitment for involuntary treatment if the person poses a likelihood of serious

harm or is gravely disabled. RCW 71.05.240(4)(a).

Here, the trial court concluded that T.R.L. was gravely disabled as defined by

RCW 71.05.020(25)(a). This subsection defines a person as “gravely disabled” if “as a

result of a behavioral health disorder[,] [the person] (a) is in danger of serious physical

harm resulting from a failure to provide for [their] essential human needs of health or

safety.” RCW 71.05.020(25). RCW 71.05.020(25)(a) requires the State to demonstrate

tangible evidence that the “individual has failed or is unable to provide for essential

needs such 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.’ ” In re Det. of A.F., 20 Wn. App. 2d 115, 126, 498 P.3d 1006 (2021) (quoting

LaBelle, 107 Wn.2d at 204-05). The State must also prove that the person’s failure or

inability to provide for their essential needs “arise[s] as a result of [their] mental

3 A “behavioral health disorder” is defined as “either a mental disorder as defined in this section, a

substance use disorder as defined in this section, or a co-occurring mental disorder and substance use disorder.” RCW 71.05.020(8). A “mental disorder” is defined as “any organic, mental, or emotional impairment which has substantial adverse effects on a person’s cognitive or volitional functions.” RCW 71.05.020(39).

6 No. 87118-8-I/7

disorder.” LaBelle, 107 Wn.2d at 205. However, a court should not impose “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.

Here, “[b]ased on the credible testimony of Fred Schwartz, the court evaluator,”

the commissioner found by a preponderance of the evidence that T.R.L. had a

behavioral health disorder, which “has had a substantial adverse effect upon [her]

cognitive and volitional functioning as evidenced by her symptoms and presentation.” 4

This finding was supported by Schwartz’s testimony that his working diagnosis for

T.R.L. was that she had schizoaffective disorder bipolar type, which impacted her

cognitive and volitional functioning. The commissioner also found that T.R.L. was

“delusional, grandiose, disorganized, confused, isolative, demonstrating poor

processing, and showing impaired insight and judgment.” The record supports this

finding as well, as Schwartz testified that T.R.L. was currently displaying symptoms of

“delusional, grandiose, discharged focus.” The commissioner also stated that a person’s

inability to engage in a “reality based conversation” can support a gravely disabled

finding, and it found this was the situation with T.R.L. 5 Relying in part on “the credible

testimony” of Song, St. Anne’s proxy witness as custodian of records, the commissioner

found that T.R.L. was unable to identify herself and threatened hospital staff. Several

4 Schwartz, an LMHC and Fairfax Hospital’s court evaluator, based his opinion on his evaluation

of T.R.L., a process that included “consider[ing] the medical record, consult[ing] with the treatment team, [listening to] the testimony . . . , the initial tension packet, [and his] observation and conversation with [T.R.L.].” 5 The court cited In re Det. of Kinta Hollins, an unpublished case, to support this proposition. No.

70605-5-I, slip op. at 1-10 (Wash. Ct. App. Aug. 4, 2014) (unpublished), https://www.courts.wa.gov/opinions/pdf/706055.pdf.

7 No. 87118-8-I/8

chart notes, which Song read into evidence, support this finding. T.R.L. reportedly

stated, “ ‘ I will martyr your family. I will eat your babies’ ” and “ ‘put that mask on before

you spit in my food . . . I’ll fuck you up if you do.’ ” Another chart note stated that T.R.L’s

“behavior is very unpredictable and labile,” and that she refused to give staff her name

or date of birth, responding instead, “ ‘I don’t have a name. I don’t have a birthday.’ ”

The commissioner also found by a preponderance of the evidence that T.R.L.

was in danger of serious physical harm due to “a failure or inability to provide for her

essential needs of health and safety.” Specifically, the commissioner found that T.R.L.

had “ketones in her urine, and she was observed to fill a cup and basi[n] with dirty toilet

water and a previous patient’s feces with her bare hands.” This finding was supported

by chart notes that stated that T.R.L. “fill[ed] [a] cup and basin with dirty toilet water and

a previous patient’s feces,” “us[ed] bare hands to handle feces,” and “started to play

with the stool that she found in the [emergency department] washroom.” Further, the

commissioner found that the fact that T.R.L. was “diagnosed with hyponatremia and a

urinary tract infection” demonstrated her inability to care for her essential needs and that

she was “unable to meaningfully engage in conversation or discharge planning.” This

finding was supported by Schwartz’s testimony that the presence of ketones in T.R.L.’s

lab results, a urinary tract infection (UTI), hyponatremia, and “other things that [he] had

read into the record” were “indication[s] of poor self-care.”

T.R.L. argues that despite evidence that she had hyponatremia and ketones in

her urine, the State did not provide evidence to explain “if or how these findings were

related to [her] alleged behavioral health disorder.” In particular, she argues that there

8 No. 87118-8-I/9

was no other evidence that she was receiving medical intervention or treatment to

address these issues.

But T.R.L. ignores Schwartz’s testimony that she “had significant medical

problems that were being treated in the hospital, [and] ketones was one indication,”

along with her UTI and other documented problems, of “poor self-care.” A patient’s

failure to obtain care due to an inability to articulate how they manage their needs and

their behavioral health disorder can support finding that the patient is gravely disabled

according to RCW 71.05.020(25)(a). See A.F., 20 Wn. App. 2d at 126-27; see also In re

Det. of A.M., 17 Wn. App. 2d 321, 333-35, 487 P.3d 531 (2021) (to find a person

gravely disabled for failure to provide for their own nutritional needs, the State needed

to show that this failure is, or could be, harmful to the person). For example, in A.F. the

reviewing court concluded that the trial court’s finding that the patient was gravely

disabled was supported by substantial evidence. 20 Wn. App. 2d at 127. Specifically,

the patient did not acknowledge his need for care and could not explain how he planned

to address his mental and physical care needs. Id. Further, the court noted that the

patient’s behavioral health disorder “symptoms that relate to delusional thought and lack

of volitional control, prevented [him] from seeking out and obtaining care.” Id.

Similar to the patient in A.F., here, as Schwartz testified, T.R.L. was unable to

“have a reality based discussion about her after-care if she were able to leave the

hospital.” This finding is also supported by a chart note from two days after T.R.L. was

admitted to St. Anne, where hospital staff reported that she was “not respond[ing]

clearly about how she’s doing with eating, drinking or sleeping.”

9 No. 87118-8-I/10

The commissioner also found that a less restrictive treatment alternative was

inappropriate and not in T.R.L.’s best interests “because she has not stabilized, is still

exhibiting active symptoms of her behavioral health disorder, and is too symptomatic to

meet her needs in a less restrictive setting.” This finding is supported by Schwartz’s

testimony that while he was evaluating T.R.L., they discussed discharge planning but

she described “a number of. . . . delusional housing arrangements.” For example, she

said that “she had a place in Burien,” but the property owner had no record of her. She

also claimed that “she could go to her sister’s home,” but the hospital was never able to

get in touch with her sister.

Schwartz further noted that T.R.L. was unwilling to engage with outpatient

services. He read chart notes from August 5, 2024, two days before the hearing,

indicating that T.R.L. “continues to present with grandiose delusions.” For example, she

“thought that she worked at Boeing and now makes her own planes.”

T.R.L. claims the evidence showed that she had improved and could address her

own health and safety. For example, she conveyed to hospital staff that she had a yeast

infection, was eating and sleeping well, was medication compliant, had health care

insurance through Molina Medicaid, was independently conducting her daily activities,

and planned to live with her sister. A chart note from August 6 indicated some

improvement where T.R.L. ate her dinner and was “cooperative and respectful to staff.”

But the fact that T.R.L. had demonstrated some improvements while being treated does

not negate the evidence that she continued to demonstrate delusional thinking at the

time of the hearing and had not communicated a discharge plan or identified a place to

stay after discharge.

10 No. 87118-8-I/11

We conclude that the commissioner’s findings are supported by substantial

evidence and the findings, in turn, support the conclusion that T.R.L. was gravely

disabled as defined by RCW 71.05.020(25)(a). We therefore hold that the trial court did

not err in ordering T.R.L. involuntarily committed for treatment for up to 14 days.

Affirmed.

WE CONCUR: