Court Opinion

ID: 9962193
Source: CourtListenerOpinion
Date Created: 2024-04-22 21:19:14.878984+00
Date Added: 2024-06-11T08:19:58.842546
License: Public Domain

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON

In the Matter of the Detention of
                                                 No. 85138-1-I
A.M.D-L.

                                                 DIVISION ONE

                                                 UNPUBLISHED OPINION

       CHUNG, J. — The court issued a 180-day involuntary commitment order for

A.M.D.-L., a teenager with a history of severe mental health issues and

substance use. A.M.D.-L. claims the court erred by determining that involuntary

commitment was the only option because evidence supports that he would

voluntarily enter inpatient treatment. However, testimony by A.M.D.-L., his

mother, and a psychiatric nurse practitioner provided substantial evidence to

support the court’s findings that A.M.D.-L. did not want inpatient treatment and

would not voluntarily enter inpatient treatment. The 180-day involuntary

commitment was the only means of ensuring A.M.D.-L. would receive the

necessary treatment. Therefore, we affirm.

                                     FACTS

       A.M.D.-L. is a teenager who struggles with severe mental health issues

including major depressive disorder, unspecified substance use disorder,

unspecified disruptive impulse control disorder, autism spectrum disorder, and
No. 85138-1-I/2

attention deficit hyperactivity disorder. He lives with his mother in Section 8

housing.

       A.M.D.-L. has a history of suicide attempts and drug overdoses resulting

in hospitalizations. In August 2022, A.M.D.-L. overdosed on fentanyl at home.

First responders administered Narcan and transported him to Seattle Children’s

Hospital (SCH). After discharge from the hospital, A.M.D.-L. left drug

paraphernalia by a garden outside the family’s apartment. When his mother and

a social worker confiscated the items, A.M.D.-L. screamed about wanting to kill

himself and then grabbed a knife from the kitchen and chased them. A.M.D.-L.

“started crying that he wanted to commit suicide, that he wanted to die.”

       On September 23, 2022, A.M.D.-L. was voluntarily admitted to SCH’s

Psychiatry and Behavioral Medicine Unit (PBMU) “because he was a danger to

himself and others.” By early November 2022, A.M.D.-L. was no longer willing to

remain hospitalized voluntarily. On November 8, 2022, a designated crisis

responder filed a petition for initial detention of a minor, alleging continuing

“aggressive, violent, and risky behaviors.” A.M.D.-L. “threatened to harm others,

caused property destruction, was physically violent with staff, tried to harm

himself, and he continues to lack insight into his behaviors.” He tested positive

for THC1 with suspected use of substances while hospitalized. SCH petitioned for

14 days of involuntary treatment on November 15, 2022. A.M.D.-L. agreed to the

14-day commitment on December 22, 2022.

       1 Tetrahydrocannabinol.

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No. 85138-1-I/3

       Because SCH’s PBMU is a crisis stabilization unit that typically treats

patients for seven to 10 days, it does not have the capacity for “more

longstanding, ongoing work.” However, A.M.D.-L. was denied from “essentially

every referral” for treatment programs—both in Washington and out of state—

due to “the significance and severity” of his behavior. SCH was working to

transition A.M.D.-L. to the Children’s Long-term Inpatient Program (CLIP) facility

for treatment, including family engagement and a “step down process” to

integrate back into the community.

       SCH subsequently petitioned on December 30, 2022, for 180-day

involuntary treatment, alleging “an extensive history of psychiatric

hospitalizations, high lethality suicide attempts, violent behaviors towards self

and others, and property destruction.” A.M.D.-L. also continued to exhibit drug-

seeking behavior while hospitalized, “as evidenced by [a] recent attempt to

smoke his medication when he gained access to a lighter.”

       After hearing testimony from a psychiatric nurse practitioner from SCH’s

PBMU, A.M.D.-L., and his mother, the trial court granted the petition for 180 days

of involuntary treatment. A.M.D.-L. appeals.

                                   DISCUSSION

       Medical professionals from the Inpatient Psychiatry Unit of SCH filed a

petition for 180-day involuntary treatment of A.M.D.-L. For a 180-day

commitment of a minor:

       The court must find by clear, cogent, and convincing evidence that
       the minor:
       (i) Is suffering from a mental disorder or substance use disorder;

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       (ii) Presents a likelihood of serious harm or is gravely disabled; and
       (iii) Is in need of further treatment that only can be provided in a
       one hundred eighty-day commitment.

RCW 71.34.750(6)(a). Clear, cogent and convincing evidence “means the

ultimate fact in issue must be shown by evidence to be ‘highly probable.’ ” In re

Det. of LaBelle, 107 Wn.2d 196, 209, 728 P.2d 138 (1986). “Generally, where the

trial court has weighed the evidence, appellate 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.” Id.

Substantial evidence is evidence sufficient to persuade a fair-minded person that

the premise is true. In re Det. of A.M., 17 Wn. App. 2d 321, 330, 487 P.3d 531

(2021). For the clear, cogent and convincing standard, the findings must be

supported by substantial evidence in light of the “highly probable” test. LaBelle,

107 Wn.2d at 209. We evaluate the evidence in the light most favorable to the

petitioner, the State. A.M., 17 Wn. App. 2d at 330.

       A.M.D.-L. does not contest the court’s findings that he suffers from a

mental disorder 2 and presents a likelihood of serious harm. Nor does he argue

that treatment other than inpatient care at CLIP is appropriate. Rather, A.M.D.-L.

challenges the court’s determination that a 180-day commitment order was the

only available option to ensure necessary treatment. According to A.M.D.-L., the

180-day order “was not the ‘sole’ or ‘exclusive’ option” because “the record

demonstrates voluntary treatment was a viable option.” A.M.D.-L. supports this

       2 The court found that A.M.D.-L. “suffers from behavioral health disorders.” A “behavioral

health disorder” means a mental health disorder or substance use disorder as defined by RCW
71.34.020, or co-occurring mental and substance use disorders. RCW 71.34.020(9).

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No. 85138-1-I/5

argument with evidence from the record that he filled out the CLIP voluntary

application, indicated he was looking forward to the CLIP program, repeatedly

asked for updates on his application, and expressed hope that he could move to

CLIP soon.

       The court determined that “a less restrictive treatment alternative is not

appropriate nor in Respondent’s best interests because the evidence shows he is

too symptomatic to comply and would be unable to keep himself safe, which

does not bode well for compliance with a less restrictive treatment order at this

time.” The court noted that A.M.D.-L. had said that he did not want any more

treatment. In assessing A.M.D.-L’s expressed desire to go to CLIP, the court was

“not convinced that he would actually—when a CLIP bed become[s] available,

voluntarily go . . . if he’s released from the hospital at this time and waiting a

bed.” The court based this conclusion on testimony from A.M.D.-L.’s mother and

the nurse practitioner.

       The nurse practitioner testified that A.M.D.-L’s expressions of intent to

enter CLIP voluntarily have been “very back and forth.” She said, “There has

been expression of going voluntarily. There’s always been numerous statements

about not needing further treatment.” In fact, the day before the commitment

hearing, A.M.D.-L. told the nurse-practitioner he “didn’t need any more

treatment.” He also said that felt he was mentally stable and that ongoing

treatment was not necessary. When the nurse-practitioner told A.M.D.-L. of her

concerns about his high-risk behavior, including suicide attempts, A.M.D.-L

responded that the behavior happened in the past and he would not be engaging

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No. 85138-1-I/6

in the behavior moving forward. The nurse-practitioner testified that “the

message that [A.M.D.-L.] was telling me is that ongoing treatment following the

hospital wasn’t necessary.” A.M.D.-L.’s mother testified that similarly, A.M.D.-L.

told her “that he just wants to see his friends and have fun with his friends, and

he doesn’t seem to think that he needs any more treatment. He thinks that he’s

gotten all the help he needs at Children’s Hospital, PBMU.” The nurse-

practitioner noted concern that if A.M.D.-L. “were to go voluntarily, that [he] would

also leave voluntarily very quickly.”

         A.M.D.-L. expressed to the court that he did not want to be “held against

my own will.” He testified that he was willing to go to CLIP and would continue his

application to CLIP if he were released. But A.M.D.-L.’s testimony demonstrates

that he was resistant to inpatient treatment in general. He said he would continue

to pursue CLIP but “I’m not going to like it.” A.M.D.-L. said, “I feel like I should be

given more options” and wanted to explore other outpatient treatment. His

explanation for self-harming behavior while inpatient at SCH provided insight into

his preference for outpatient care: “I feel trapped inside of here and I feel like it’s

just not good for me to be not in my life. I’m just stuck here against my own

will . . . .”

         Because CLIP—whether entered voluntarily or involuntarily—is an

inpatient facility, while there, A.M.D.-L. would again “be not in [his] life.” Even if at

points A.M.D.-L. indicated he would go voluntarily, testimony from all three

witnesses, A.M.D.-L., his mother, and the nurse practitioner, demonstrates that

A.M.D.-L. was resistant to inpatient treatment and provides substantial evidence

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No. 85138-1-I/7

for the court’s finding that A.M.D.-L. would not voluntarily go to CLIP for inpatient

treatment. Given A.M.D.-L.’s history of, and continued resistance to, voluntary

treatment, the court properly concluded that a 180-day involuntary commitment

was the sole option to secure A.M.D.-L. the treatment he needs.

       Affirmed.

  WE CONCUR:

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