IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON

DIVISION II

In the Matter of the Detention of No. 57773-9-II

A.O.-A.

Appellant.

UNPUBLISHED OPINION

CRUSER, A.C.J. — AO-A was involuntarily committed based on a civil conversion 

following the dismissal of his charges of two counts of rape of a child in the first degree. AO-A 

appeals the trial court’s order extending his involuntary commitment for an additional 180 days of 

mental health treatment. AO-A argues that the State failed to prove that he was gravely disabled. 

We affirm the trial court’s commitment order because the finding that AO-A was gravely disabled 

was supported by clear, cogent, and convincing evidence. 

FACTS

I. BACKGROUND

AO-A is 48 years old. In 2008, he was charged with two counts of rape of a child in the 

first degree for incidents that occurred in 1999 and 2002, when AO-A allegedly molested his 

cousin’s minor daughter. His case went to trial and he was found guilty by a jury, but the sentencing 

judge ultimately overturned his conviction after finding that AO-A had been incompetent to stand 

trial. He was first evaluated in 2010, at which point he was diagnosed with borderline intellectual 

Filed

Washington State

Court of Appeals

Division Two

January 17, 2024
No. 57773-9-II

2

functioning, but the evaluator did not note any psychotic symptoms. His charges were dismissed 

and he remained in the King County Jail for nearly a decade before being civilly committed to 

Western State Hospital (WSH) in 2020. Between 2010 and 2020, AO-A underwent six competency 

evaluations. He was found to be incompetent in 2010, competent in 2012 and 2019, and then 

incompetent again during two evaluations in 2020. No opinion was offered from the physician 

who conducted the second evaluation, which was in 2011. It was not until the evaluation in 2020 

that AO-A was diagnosed with a psychosis-related disorder. Specifically, he was diagnosed with 

“Unspecified Schizophrenia Spectrum and Other Psychotic Disorder.” Clerk’s Papers (CP) at 54.

II. PETITION TO EXTEND INVOLUNTARY TREATMENT

In September 2022, doctors from WSH petitioned the superior court for an additional 180 

days of involuntary treatment for AO-A. The doctors, Peter Bingcang, MD, and Rosario Archer, 

PhD, alleged in their petition that AO-A remained gravely disabled but opined that he was ready 

for a less restrictive alternative (LRA) placement once an appropriate placement became available. 

III. HEARING

A. Dr. Archer’s Testimony 

Dr. Archer, an evaluator for the Commitment Center at WSH, was the first witness to testify 

at the commitment hearing. Her testimony was based on the mental status examination (MSE) she 

conducted, interactions with AO-A’s health providers and treatment team, a review of AO-A’s 

medical records, as well as the multiple occasions on which she observed AO-A during her visits 

to the WSH ward where he resides. She conducted the MSE in Spanish, AO-A’s native language, 

because when he initially approached her, he spoke in Spanish and indicated that he felt fully 

comfortable speaking in Spanish. Dr. Archer conducted the MSE in-person, which she opined was 
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important in that it provided her the opportunity to observe his body language and the small 

physical movements he made throughout the evaluation. 

Dr. Archer opined that AO-A has “a mental health disorder labeled as unspecified 

schizophrenia spectrum disorder or other psychotic disorder.” Id. at 245. She testified that during 

the evaluation, AO-A “displayed delusional ideation, [and] auditory and visual hallucination.” Id.

AO-A told Dr. Archer that he could hear spirits speaking to him from the corner of the room. He 

spoke of his belief that the sun was guiding him in his life and directing his departure from WSH. 

Dr. Archer testified that AO-A’s hospital record notes that he repeated similar beliefs regarding 

spirits, God, and demons during his interactions with other WSH staff. 

During the evaluation, AO-A frequently interrupted Dr. Archer and presented “unstable 

mood, demanding behavior,” and agitation. Id. at 246. AO-A demanded that Dr. Archer open the 

doors to the hospital to release him. Dr. Archer testified that AO-A repeatedly interrupted her, 

exhibited an unregulated mood, as well as a disorganized and confused thought process. She 

unsuccessfully tried to redirect AO-A when he became agitated and went off track. AO-A told Dr. 

Archer that he was the victim of a plot who had been kidnapped against his will and WSH staff 

were infringing upon his liberty. Additionally, AO-A stated that he did not have a mental illness 

and refused psychotropic medications. Regarding AO-A’s cognitive and volitional control, Dr. 

Archer explained that AO-A has not exhibited any aggressive behavior at WSH, but opined that 

his cognitive control is impaired as evidenced by his irrational thoughts, agitation, and demanding 

behavior. 

Dr. Archer opined that AO-A would not be able to meet his basic health and safety needs 

if he were to be released from WSH at the time of the hearing. She testified that he would not be 
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able to attend to the needs of his diagnosis because he did not demonstrate an awareness of his 

disorder, and therefore was unable to make rational decisions regarding treatment. Dr. Archer said 

AO-A’s judgment was impaired and provided an example where she asked him “What goes 

through your mind when I tell you there’s no use to cry over spilled milk?” His response was “I 

would clean the milk on the floor. I like to clean here in the ward.”1Id. at 251.

While AO-A attended to his hygiene and appearance, he was reportedly uncooperative with 

a social worker in preparing potential discharge plans. Dr. Archer was concerned that AO-A did 

not allow the social worker to contact his sisters who he planned to stay with upon release and 

explained that AO-A would not be deemed ready for release until he participated more actively in 

discharge planning. Additionally, Dr. Archer expressed concern that if AO-A was released from 

WSH, he may neglect his needs and could decompensate, especially given the ways in which his 

delusional thinking may prevent him from seeking help and making rational decisions. In support 

of her opinion that AO-A would not function successfully in the community at that time, Dr. 

Archer explained that AO-A participates minimally in group therapy, he is disruptive when he 

does participate and acts hostile and argumentative, he is difficult to redirect, and he refuses to 

take psychotropic medications. Moreover, Dr. Archer testified that AO-A appears to be unaware 

of his disorder, and unaware that his behaviors are inappropriate and disruptive. 

In conclusion, Dr. Archer’s opinion was that AO-A needed to remain at WSH until an 

appropriate LRA was identified for him in order to ensure that his basic health and safety needs 

would be met. 

 

1 At no point did Dr. Archer clarify whether that saying is common in Spanish or in El Salvador, 

where AO-A migrated from. While Dr. Archer is also a native Spanish speaker, she came to the 

United States from Spain, not El Salvador.
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B. Dr. Stanfill’s Testimony 

Defense counsel called Dr. Michael Stanfill to testify. Dr. Stanfill holds a doctorate in 

clinical psychology. He previously worked as the psychiatric services director for the King County 

jail system, and as a part-time forensic evaluator for the Special Commitment Center. Dr. Stanfill 

conducted two evaluations of AO-A, one a month prior to the hearing in question, and another 

roughly a year before that, when Dr. Stanfill evaluated AO-A for a previous civil commitment 

petition. In preparation of those evaluations, Dr. Stanfill reviewed the previous competency 

evaluations of AO-A within the past decade. He spoke with AO-A in English and via Zoom. 

During his first evaluation of AO-A, Dr. Stanfill administered two psychological measures 

aimed to assess risk of recidivism in sex offenses. The measures are known as Static-99 and 

STABLE-2007. He found that AO-A “was in the low risk range, low risk categorization of 

potential sexual reoffense.” Id. at 276.

Dr. Stanfill agreed with both the initial borderline intellectual functioning diagnosis, and 

with the diagnosis of unspecified schizophrenia or other psychotic disorder. He also confirmed 

that according to the record, AO-A refuses to take antipsychotic medications at WSH. AO-A did 

not tell Dr. Stanfill that he would seek treatment in the community if released. Dr. Stanfill 

explained that throughout AO-A’s competency evaluations he has “consistently presented with 

some amount of what has been conceptualized and deemed by numerous evaluators and 

clinician[s] as delusions, often with a religious preoccupation.” Id. at 278.

Dr. Stanfill noted a “complete lack of aggression” in AO-A’s hospital records. Id. at 285.

Dr. Stanfill opined that AO-A exhibited cognitive control over his actions and provided an example 

where AO-A demonstrated that control in a potentially agitating and exacerbating situation. In that 
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situation, AO-A’s roommate at WSH repeatedly used AO-A’s toothbrush and spit on his clothes. 

AO-A was able to maintain cognitive control over his actions and handle the situation 

appropriately by first asking his roommate to stop, and when that did not work, going to staff and 

asking them to intervene. According to Dr. Stanfill, there is “no evidence of any concerns in [AOA’s] ability to meet his essential human needs both before his incarceration, during, or his time 

while at Western.” Id. at 283-84.

C. AO-A’s Testimony

AO-A testified briefly at the hearing. He testified that if he were to be released from WSH, 

he would go stay at his sister’s house and begin looking for a job. He testified that prior to his 

commitment, he always held a job and has various skillsets. He also testified that he would not 

seek mental health treatment upon release. He did not believe that he suffered from a mental illness 

and testified, “I have no problems. I’ve never had any problems.” Id. at 305.

D. Court’s Ruling

In the findings of fact and conclusions of law, the court found that AO-A continued to be 

gravely disabled due to his behavioral health disorder, and manifested “severe deterioration in 

routine functioning evidenced by repeated and escalating loss of cognitive or volitional control 

over actions.” Id. at 156. Additionally, the court found that an LRA was in AO-A’s best interest.

The court determined that AO-A presented a “significant loss of cognitive control,” and 

that based on the evidence presented, it was highly-probable that AO-A “would not receive such 

care as is essential for his health and safety if discharged without a[n LRA] order.” Id. at 163.

Additionally, the court found that “it is highly probable that [AO-A’s] cognitive control is 

significantly impaired.” Id. The court based this finding on AO-A’s undisputed unspecified 
No. 57773-9-II

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schizophrenia spectrum or other psychotic disorder, auditory and visual hallucinations, unstable 

mood, agitation, rapid speech, “delusional ideations regarding spirits and the Father Sun,” 

“perseverating on being the victim of a plot and on discharging from WSH,” “and impaired insight 

and judgment as evidenced by his non-compliance [in regard to] prescribed psychiatric 

medications even within the hospital.” Id.

The court determined that AO-A would not receive essential care for his health and safety 

if he were released without an LRA. This finding was based, in part, on AO-A’s decision not to 

participate in discharge planning from the hospital and failure to comply with psychiatric 

medication, as well as his testimony that he would not seek treatment if released. As such, the 

court concluded, AO-A was unable to make rational decisions regarding his treatment. The court 

ultimately found that AO-A was gravely disabled under prong (b), and found that an LRA was in 

his best interest. Because no appropriate LRA was available at the time, the court ordered up to 

180 days of intensive inpatient treatment. 

The court’s ruling, in part, was based on its finding that Dr. Archer’s testimony was slightly 

more credible than that of Dr. Stanfill because Dr. Archer spoke with AO-A in Spanish, his native 

language, and they met in-person, rather than via Zoom.2

 

2 AO-A filed a motion to revise, arguing that the evidence presented in the petition and at the 

commitment hearing was not sufficient to support a finding that AO-A was gravely disabled. The 

superior court agreed with the commissioner that the State satisfied their burden and proved that 

AO-A was gravely disabled by clear, cogent, and convincing evidence. Accordingly, the superior 

court denied the motion for revision. Following a motion to revise a commissioner’s order, we 

“review the superior court’s ruling, not the commissioner’s decision.” In re Det. of L.K., 14 Wn. 

App. 2d 542, 550, 471 P.3d 975 (2020). “[T]he findings and orders of a court commissioner not 

successfully revised become the orders and findings of the superior court.” Maldonado v. 

Maldonado, 197 Wn. App. 779, 789, 391 P.3d 546 (2017).
No. 57773-9-II

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ANALYSIS

I. STANDARD OF REVIEW

When reviewing the trial court’s involuntary commitment order, we consider whether, 

taking the evidence in the light most favorable to the State, the trial court’s findings of fact are 

supported by substantial evidence and whether the court’s findings of fact support its conclusions 

of law and judgment. In re Det. of T.C., 11 Wn. App. 2d 51, 56, 450 P.3d 1230 (2019); In re Det. 

of B.M., 7 Wn. App. 2d 70, 85, 432 P.3d 459 (2019). “ ‘Substantial evidence’ is the quantum of 

evidence sufficient to persuade a fair-minded person.” In re Det. of H.N., 188 Wn. App. 744, 762, 

355 P.3d 294 (2015). We do not review a trial court’s decision regarding witness credibility or the 

persuasiveness of the evidence. In re Det. of A.F., 20 Wn. App. 2d 115, 125, 498 P.3d 1006 (2021), 

review denied, 199 Wn.2d 1009 (2022).

II. GRAVE DISABILITY

AO-A argues that the “State failed to prove by clear, cogent, and convincing evidence that 

at the time of the hearing, [AO-A] was experiencing recent, significant, repeated, and escalating 

loss of cognitive or volitional control.” Br. of Appellant at 26. Additionally, AO-A argues that the 

State failed to prove that AO-A would not receive essential care if released from WSH. 

A. Legal Principles 

The State bears the burden of establishing a person is gravely disabled by clear, cogent, 

and convincing evidence. In re Det. of LaBelle, 107 Wn.2d 196, 209, 728 P.2d 138 (1986). Clear, 

cogent, and convincing evidence means that the ultimate fact at issue is shown to be “ ‘highly 

probable.’ ” Id.
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Under chapter 71.05 RCW, a person “may be involuntarily committed for treatment of 

mental disorders if, as a result of such disorders, they . . . are gravely disabled.” Id. at 201-02.

“Gravely disabled” is defined in relevant part as:

a condition in which a person, as a result of a behavioral health disorder: . . . 

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)(b).

This provision enables the State to provide the kind of continuous care and treatment that 

can break “ ‘revolving door’ syndrome, in which patients often move from the hospital to 

dilapidated hotels or residences or even alleys, parks, vacant lots, and abandoned buildings, 

relapse, and are then rehospitalized, only to begin the cycle over again.” LaBelle, 107 Wn.2d at 

206.

To prove that AO-A manifested a severe deterioration in routine functioning, the evidence 

had to establish a “recent proof of significant loss of cognitive or volitional control.” Id. at 208.

Additionally, petitioners must produce evidence of “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.” Id. “Implicit in the definition of gravely disabled . . . is a requirement that the 

individual is unable, because of severe deterioration of mental functioning, to make a rational 

decision with respect to [their] need for treatment.” Id. (emphasis omitted).

B. Application 

Here, the trial court was presented with clear, cogent, and convincing evidence that AO-A 

was gravely disabled. The petitioners’ evidence showed that AO-A had a psychotic disorder, 

denied having a mental disorder, experienced delusional thinking, refused to take medication, 
No. 57773-9-II

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exhibited agitation and rapid speech, would be unlikely to meet his basic health and safety needs 

if released, and would not seek treatment if released to the community.

1. Severe Deterioration in Routine Functioning 

AO-A argues that the record is insufficient to prove that he experienced severe 

deterioration in routine functioning or escalating decompensation. He asserts that the State needed 

to prove that his condition had worsened in order for the court to find that he was gravely disabled. 

However, this understanding misinterprets the statute and LaBelle. Explaining the rationale behind 

the legislature's expansion of grave disability under the statute, the supreme court in Labelle

rejected an interpretation of former RCW 71.05.020(1)(b) (1979) that would “exclude those 

persons whose condition has stabilized or improved, even if minimally (i.e., is not ‘escalating’), 

by the time of the commitment hearing.” Id. at 205. The supreme court cautioned that such an 

interpretation would

result in absurd and potentially harmful consequences, for a court would be required 

to release a person whose condition, as a result of the initial commitment, has 

stabilized or improved minimally—i.e., is no longer “escalating”—even though 

that person otherwise manifests severe deterioration in routine functioning and, if 

released, would not receive such care as is essential for his or her health or safety.

Id. at 207. AO-A’s circumstances present the potential for decompensation that the supreme court 

in Labelle cautioned against, wherein a committed individual has benefited from treatment but not 

so extensively so as to no longer meet the definition of grave disability under RCW 

71.05.020(25)(b). With respect to the first requirement under RCW 71.05.020(25)(b), while AOA did not display outright aggression, and examples of his recent deterioration may have been 

minimal, he continued to exhibit cognitive challenges related to his lack of insight into his 

condition. In particular, AO-A continuously denied that he had a mental health condition. AO-A 
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also disagreed that he would benefit from medication, refused to take it, and indicated that he 

would not seek treatment upon discharge from WSH. While in treatment, AO-A expressed 

delusions related to the reasons for his confinement, explaining that he was at WSH because he 

was the victim of a plot. 

2. Essential Care

AO-A also argues that the record does not establish that he would not receive such care as 

is essential for his health or safety if released. He maintains that the State failed to show that his 

health would be at risk if released, even if he continues to refuse psychotropic medication. 

Additionally, he argues that his lack of participation in discharge planning does not amount to 

proof of grave disability, and neither do the hospital’s concerns about AO-A’s plan to live with his 

sisters and rely on their support. 

AO-A is correct that uncertainty of living arrangements and lack of resources cannot alone 

establish that he would not receive such care as is essential for his health or safety. LaBelle, 107 

Wn.2d at 210 (“[U]ncertainty of living arrangements or lack of financial resources will not alone 

justify continued confinement in a mental hospital.”). Moreover, “mental illness alone is not a 

constitutionally adequate basis for involuntary commitment.” Id. But Dr. Archer did not just 

express concern about AO-A’s living arrangements, resources, or the fact that he has been 

diagnosed with a psychotic disorder.

Dr. Archer also testified that AO-A was not capable of making rational decisions regarding 

his treatment. He denied having a mental disorder, refused to take medication, experienced 

delusional thinking and hallucinations incongruent with reality, exhibited impaired judgment, and 
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made it clear that he would not seek treatment if released from WSH. He also exhibited agitation, 

disruptiveness, hostility towards others, and unstable mood. 

Although Dr. Stanfill testified that AO-A did not present a risk of reoffending, exhibited 

cognitive control, did not exhibit aggression, and showed promise regarding his ability to function 

successfully in society, the court gave more weight to Dr. Archer’s testimony. The court explained 

that it found Dr. Archer’s testimony to be slightly more credible because she spoke with AO-A in 

his native language and conducted the evaluation in-person rather than via video. 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.

Taking Dr. Archer’s testimony and AO-A's history in the light most favorable to the State, 

the evidence was sufficient to establish that AO-A would not receive such care as is essential for 

his health or safety if released. Thus, the evidence was sufficient to establish that the State proved 

that AO-A was gravely disabled by clear, cogent, and convincing evidence.

CONCLUSION 

We conclude that the State presented sufficient evidence to support the court’s finding that 

AO-A was gravely disabled. Therefore, we affirm the superior court’s commitment order.

A majority of the panel having determined that this opinion will not be printed in the 

Washington Appellate Reports, but will be filed for public record in accordance with RCW 2.06.040, 

it is so ordered.
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CRUSER, A.C.J.

We concur:

MAXA, J.

PRICE, J.