In The Matter Of The Detention Of K.p.

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON In the Matter of the Detention of No. 88455-7-I K.P. DIVISION ONE UNPUBLISHED OPINION BIRK, J. — The superior court ordered K.P. committed for 14 day involuntary treatment after the trial court found her gravely disabled under both RCW 71.05.020(25)(a) and RCW 71.05.020(25)(b). K.P. argues the evidence is insufficient to support the superior court’s conclusion that she was gravely disabled. Because substantial evidence supports the superior court’s conclusion, we affirm. I After a referral from the emergency department, a King County Designated Crisis Responder filed a petition for the initial detention of K.P. at an evaluation and treatment facility. According to a provider’s declaration filed with the petition, on May 2, 2025, the fire department found K.P., a 58 year old female, wandering aimlessly in a confused manner at a coffee shop and brought her to the emergency department at Evergreen Medical Center. On May 8, Fairfax Hospital petitioned for 14 day involuntary treatment of K.P., in part because it concluded that K.P. “continued to evidence symptoms of a behavioral health disorder by hyper-verbal No. 88455-7-I/2 speech, delusions, neglect of self-care, disorientation, word salad, disorganized thought process, and poor insight into symptoms or need for treatment.” The petition stated also that K.P. had had five prior hospitalizations. From June 5 through June 6, the superior court conducted a probable cause hearing for the petition for involuntary treatment. Dr. Bethany O’Neill, a psychologist employed by Evergreen Hospital, and Brian Hayden, a court services manager and lead court evaluator at Fairfax Hospital, both testified at the hearing. K.P. testified also. The superior court found that K.P. suffers from a behavioral health disorder, and that as a result of this disorder, K.P. is “in danger of serious physical harm from a failure or inability to provide for her essential needs of health and safety.” As a result of her mental impairment, K.P. shows “severe deterioration in routine functioning, evidenced by repeated and escalating loss of cognitive and volitional control over her actions such that, outside the hospital setting, she would not receive care that is essential to her health and safety.” The superior court concluded that K.P. was gravely disabled, that treatment in a less restrictive alternative setting than detention was not in the best interest of K.P. or others and ordered 14 day involuntary treatment at Fairfax. K.P. appeals the 14 day involuntary commitment order. II K.P. argues that the State presented insufficient evidence to support the superior court’s conclusion that K.P. was gravely disabled under RCW 71.05.020(25)(a) and (b). We disagree. 2 No. 88455-7-I/3 A In reviewing the trial court’s involuntary commitment order we consider whether the findings of fact are supported by substantial evidence and whether 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). “ ‘Substantial evidence’ is the quantum of evidence ‘sufficient to persuade a fair-minded person of the truth of the declared premise.’ ” Id. (quoting In re Det. of H.N., 199 Wn. App. 744, 762, 355 P.3d 294 (2015)). In considering whether there is sufficient evidence, we review the evidence in the light most favorable to the petitioner. Id. On appeal, we accept unchallenged findings as true. Id. The involuntary treatment act requires a court to order a person detained for no more than 14 days “if 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,” “either (1) possess a substantial risk of harm to him or herself, others, or the property of others, or (2) is gravely disabled.” RCW 71.05.240(4)(a); In re Det. of M.K., 168 Wn. App. 621, 630, 279 P.3d 897 (2012) (citing In re Det. of LaBelle, 107 Wn.2d 196, 201-02, 728 P.2d 138 (1986)). In making a determination of whether a person is gravely disabled under RCW 71.05.240, the court must consider the symptoms and behavior of the respondent in light of all available evidence concerning the respondent’s historical behavior. RCW 71.05.245(1). Gravely disabled has two definitions: “Gravely disabled” means a condition in which a person, as a result of a behavioral health disorder: (a) Is in danger of serious physical harm resulting from a failure to provide for his or her essential human 3 No. 88455-7-I/4 needs of 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). Because the superior court found K.P. gravely disabled under both subsections (a) and (b), we analyze each definition in turn. B Grave disability under RCW 71.05.020(25)(a) requires a showing of a substantial risk of danger of serious physical harm resulting from failure to provide for essential health and safety needs. LaBelle, 107 Wn.2d at 204 (citing former RCW 71.05.020(1) (1979), now renumbered as subsection (25)). The substantial risk of harm need not be evidenced by recent, overt acts. Id. 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. Id. at 204-05. 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. Id. at 205. 1 K.P. asserts the evidence showing K.P. failed to provide for her essential needs was speculative. In K.P., 32 Wn. App. 2d at 223, the evidence supported that the appellant could not provide for her own essential needs based on evidence of their prior hospitalizations, ability to be housed due to their mental health condition, and failure or refusal to take their medication. 4 No. 88455-7-I/5 In this case, Dr. O’Neill testified that K.P. has a history of multiple involuntary inpatient psychiatric hospitalizations, most recently at Fairfax in July 2024. Before then, K.P. was involuntarily detained on four other occasions. Dr. O’Neill testified that it was not clear if K.P. was eating on a regular basis. When asked about her last food intake, K.P. responded with, “When I get hungry all I say to myself is ‘three more weeks without eating and drinking.’ ” When asked where she lives, K.P. stated, “I do not live anywhere. My spirit runs all over the globe.” Hayden testified that K.P. could not discuss with him how she would meet her needs, like medication and housing, for her own health or safety after discharge from the hospital. A psychiatric progress note from June 4, 2025 reports that K.P. had “[o]ngoing tangential thought process. Loose associations. . . . Insight and judgment are noted as impaired.” Furthermore, an assessment of K.P. the next day on June 5 noted that “[u]nder the treatment plan focus, patient is confused. She endorsed suicidal ideation with no plan. She is illogical and delusional. . . . She endorses visual hallucinations. She said, ‘I see Santa Claus, the Easter Bunny.’ ” Substantial evidence supports a finding that K.P. was unable to provide for her essential needs. 2 K.P. contends that substantial evidence does not support that K.P. was at risk of serious physical harm. To establish grave disability under prong (a), there needs to be evidence not only of a failure to provide for nutritional needs but also that this deficiency was or could be harmful to the appellant. In re Det. A.M., 17 Wn. App. 2d 321, 335, 487 P.3d 531 (2021). The court concluded that the finding 5 No. 88455-7-I/6 that A.M. was gravely disabled under prong (a) was not supported by the evidence because the record was devoid of any evidence that A.M.’s reluctance to eat was or could be harmful. Id. at 335. In this case, substantial evidence supports the conclusion that K.P. was in danger of serious physical harm from her failure to meet essential needs. K.P.’s urine test showed trace amounts of ketones. The presence of ketones, even trace levels of it, could indicate malnutrition. K.P. “appeared thin, could not explain how she provided for her food needs.” K.P. stated, “[T]hree more weeks without eating and drinking” when asked about her food intake. K.P. reported foot pain due to chronic infections on her toenails, which suggests neglecting her needs. Taken in the light most favorable to the petitioners, and taken together, the presence of ketones, K.P.’s thin appearance, statement about not eating or drinking for three weeks, chronic foot infections, continued impairment in insight and judgment, and her endorsement of visual hallucinations provide substantial evidence that she was in danger of serious physical harm. C K.P. argues there was insufficient evidence that K.P. was gravely disabled under RCW 71.05.020(25)(b). We disagree. Grave disability under RCW 71.05.020(25)(b), , contains two requirements. LaBelle, 107 Wn.2d at 205 (citing former RCW 71.05.020(1)(b)). The State must show that a person “ ‘manifests severe deterioration in routine functioning evidenced by repeated and escalating loss of cognitive or volitional control,’ ” and that he or she “ ‘is not receiving such care as is essential for his or her health or 6 No. 88455-7-I/7 safety.’ ” Id. (quoting former RCW 71.05.020(1)(b)). This definition of grave disability allows the State to treat involuntarily those discharged patients who, after a period of time in the community, drop out of therapy or stop taking their prescribed medication and exhibit “ ‘rapid deterioration in their ability to function independently.’ ” Id. at 206 (quoting Durham & LaFond, The Empirical Consequences and Policy Implications of Broadening the Statutory Criteria for Civil Commitment, 3 YALE L. & POL’Y REV. 395, 410 (1985)). LaBelle explained, By permitting intervention before a mentally ill person's condition reaches crisis proportions, [former] RCW 71.05.020(1)(b) enables the State to provide the kind of continuous care and treatment that could break the cycle and restore the individual to satisfactory functioning. Such intervention is consonant with one of the express legislative purposes of the involuntary treatment act, which is to “provide continuity of care for persons with serious mental disorders.” Id. at 206-07(quoting former RCW 71.05.010(4) (1973)). The mere fact that an individual has a mental disorder does not also mean that the person so affected is incapable of making a rational choice with respect to his or her need for treatment. Id. at 208. RCW 71.05.20 (25)(b) requires that the individual is unable, because of severe deterioration of mental function, to make a rational decision with respect to his or her need for treatment. Id. A causal nexus must exist between proof of “ ‘severe deterioration in routine functioning’ ” and proof that the person so affected “ ‘is not receiving such care as is essential for his or her health or safety.’ ” Id. (quoting former RCW 71.05.020(1)(b)). 1 To support a finding of grave disability, the State must prove that the individual manifested a severe deterioration in routine functioning. Id. Such 7 No. 88455-7-I/8 evidence must include recent proof of significant loss of cognitive or volitional control. Id. Evidence of prior history or pattern of decompensation is given great weight. In re Det. of H.T., 37 Wn. App. 2d 339, 349, 592 P.3d 663 (2026). H.T. held that substantial evidence supported the conclusion that H.T. manifested severe deterioration from routine functioning because there was testimony about the baseline for H.T.’s health before deterioration and testimony about H.T.’s deterioration. 37 Wn. App. 2d at 348. In this case, Hayden testified to the progress notes from K.P.’s case manager. K.P.’s case manager verified that K.P. was in a relationship and confirmed with K.P.’s boyfriend that she could return to live with him. Case manager notes indicated that K.P.’s boyfriend ensures K.P. takes her medications. K.P. was hospitalized previously in 2024. At discharge in January and August 2024, K.P. was “fully oriented, more organized and linear and able to engage in reality based, linear conversations.” K.P.’s case manager reported that at baseline, K.P. is organized and linear. K.P. has shown some improvement in the hospital. Hayden testified to K.P.’s deterioration from baseline by pointing to discharge notes indicating that when K.P. was last discharged, her ability to speak was primarily based in reality, and there were only slight delusions, but her statement leading to her current detention was not. This time, an emergency department social worker observed K.P. pull her pants down and expose her buttocks to security. K.P.’s social worker noted that K.P. typically took good care of herself and was able to participate in linear conversation, but her observation of K.P. in the emergency department shows that K.P. was “significantly 8 No. 88455-7-I/9 decompensated from her baseline.” Hayden testified that K.P. had periods of time where she was linear, but she had difficulty maintaining linear conversations and devolved into “delusions and looseness of association when she discussed her care or her day-to-day experiences.” Relying on a case management progress note detailing an incident from June 3, 2025, Hayden testified that K.P. began hitting and kicking the case manager’s door with the case manager locked inside. K.P. shouted, “[Y]ou will be thrown into prison for the murder of my son, the murder of my mom and the murder of me. Got it, you warlock?” K.P. continued repeatedly slamming on the case manager’s door and making nonsensical accusations about the case manager interfering with her upcoming job interview, being the cause of her children being taken away, and the patient being detained involuntarily. Substantial evidence supports the conclusion that K.P. manifested severe deterioration from routine functioning as evidenced by repeated and escalating loss of cognitive or volitional control. 2 The evidence must reveal a factual basis for concluding that the individual is not receiving or would not receive, if released, such care as is essential for his or her health or safety. LaBelle, 107 Wn.2d at 208. To justify commitment, such care must be shown to be essential to an individual’s health or safety and the evidence should indicate the harmful consequences likely to follow if involuntary treatment is not ordered. Id. In LaBelle, the court concluded there was sufficient evidence that treatment for the respondent’s mental disorder was essential for his 9 No. 88455-7-I/10 health and safety by considering the necessity of the respondent’s medications, his ability to understand his need for treatment, and his inability to follow through with the prescribed treatment. 107 Wn.2d at 213. In this case, Hayden testified that during her hospital stay, K.P. took her medications and showed improvement, notably in her ability to complete daily living activities more regularly. K.P. ate her meals. Hayden attributed K.P.’s improvement to the structured hospital environment where she received prompts to complete her activities of daily living, take her medications, and eat. K.P. did not show that she understood her symptoms and behaviors, and she could not differentiate between her symptoms and reality. Hayden testified that there was a concern that K.P. would decompensate to the state that led to her hospitalization and not be able to meet her basic needs for her own health or safety if she did not continue receiving inpatient care. In response to the question whether she would seek medical help if necessary, K.P. testified, “I would probably seek out my aunt who runs a pharmacy, along with her husband, and they would give me good advice or great advice. And that does it for me.” Although K.P.’s boyfriend offered assurance that he would prompt K.P. with medication, history of K.P.’s repeated hospitalization and improvement during hospitalization supported that without treatment, K.P. would exhibit those symptoms that resulted in her initial detention. Substantial evidence supported the 10 No. 88455-7-I/11 superior court’s finding that K.P. would not receive care that is essential for her health and safety if she did not remain in inpatient care. Affirmed. WE CONCUR: 11