Court Opinion

ID: 9898071
Source: CourtListenerOpinion
Date Created: 2023-11-14 19:28:17.851026+00
Date Added: 2024-06-11T09:16:08.851844
License: Public Domain

Filed
                                                                                           Washington State
                                                                                           Court of Appeals
                                                                                            Division Two

                                                                                         November 14, 2023

       IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON

                                            DIVISION II
    In the Matter of the Detention of:                                 No. 57439-0-II

    C.R.,
                                                                 UNPUBLISHED OPINION
                                   Appellant.

            GLASGOW, C.J. — After CR sprayed her father in the face with pepper spray, the State

charged her with second degree assault. CR was found incompetent to stand trial. Medical

professionals then petitioned for a 180-day involuntary commitment order, which the superior

court granted.

            CR appeals, arguing that there was not sufficient evidence to support the superior court’s

conclusions that she was gravely disabled, that she committed second degree assault, and that she

was substantially likely to commit similar acts upon release. We affirm.

                                                 FACTS

                                             I. BACKGROUND

            In 2021, CR pepper sprayed her father in the face. As a result of the incident, the State

charged CR with second degree assault.1

1
 CR was also charged with another count of second degree assault and two counts of violating a
protection order. The State later dismissed these charges, and they are not relevant to this appeal.
No. 57439-0-II

       CR was found incompetent to stand trial. In August 2022, after CR underwent competency

restoration, the superior court found that CR was still incompetent and “unlikely to regain

competency in a reasonable period of time.” Clerk’s Papers (CP) at 1. The superior court dismissed

CR’s charges. The superior court then ordered a short-term commitment to evaluate her for the

purpose of filing a civil commitment petition.

                            II. INVOLUNTARY TREATMENT PETITION

       A physician and a mental health professional ultimately petitioned for CR to undergo 180

days of involuntary inpatient treatment. They alleged that CR was gravely disabled. They also

alleged that she had “committed acts constituting a felony, and as a result of a behavioral health

disorder,” she presented “a substantial likelihood of repeating similar acts,” and that these acts

constituted “a violent offense.” CP at 6. Finally, they alleged that CR was “not ready for a less

restrictive placement” in the community. CP at 7 (emphasis omitted).

       The physician and mental health professional submitted a sworn declaration supporting the

petition. They listed CR’s diagnosis as “[u]nspecified schizophrenia spectrum and other psychotic

disorder.” CP at 16. They declared that, since 2017, CR had engaged with crisis intervention

services at a hospital 20 times and had been involuntarily committed 3 times.

       During the most recent competency restoration period, CR was “able to navigate the ward

effectively and attend to daily activities without significant prompting by staff.” CP at 13. But

recent forensic evaluations “demonstrated ongoing psychiatric symptoms in the context of

inconsistent medication adherence.” CP at 10. CR displayed “a range of behaviors consistent with

a severe psychotic episode,” including “reactivity to delusional beliefs, escape attempts,” and

“verbal outbursts that [provoked] peers.” Id. She sometimes became “‘assaultive or threatening,’”

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No. 57439-0-II

and as a result, she had to be “‘placed in seclusion or restraints on multiple occasions.’” Id. She

also received multiple visits from the psychiatric emergency response team.

       Most “attempts to . . . evaluate her more directly” were hampered by her refusal to

communicate or “by interference from delusional content.” Id. She participated “in a limited

fashion with her treatment,” following “staff direction and redirection adequately some of the

time.” CP at 15-16. She was “under a forced medication order,” and while she remained “compliant

with medication,” she had “not yet achieved an optimal or responsive therapeutic dose.” CP at 10,

16.

       The declaration described CR’s most recent mental status examination, which took place

3 days before the petition was filed. The evaluator found CR to be “oriented at a basic level to

person, place[,] and time.” CP at 13. CR “appeared able to maintain a general awareness of the

interview’s purpose and communicate effectively for approximately” 35 minutes, despite going on

some “delusional tangents.” CP at 14. But CR said “her antipsychotic medications [were]

unnecessary, and that she [needed] to return to” the medication she took when she lived in the

community. Id.

       The evaluator predicted that CR’s “inability to manage emotions during [delusional]

episodes . . . would likely lead to medication [noncompliance] and further interactions with law

enforcement, arrests, and/or” recommitment. CP at 15. While the evaluator noted that CR had “not

demonstrated any injurious, assaultive behavior during” her most recent commitment, “her

behaviors on the ward [placed] her at great risk [of] retaliation or accidental injury.” Id.

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No. 57439-0-II

                      III. HEARING ON INVOLUNTARY TREATMENT PETITION

A.     Testimony About Grave Disability

       At a hearing on the involuntary treatment petition, the petitioning mental health

professional testified that CR had “a fixed delusion regarding sex trafficking and the belief that

she is god.” 2 Verbatim Rep. of Proc. (VRP) at 3. He said that CR’s symptoms rendered her

“frequently unable to participate in treatment,” and that her “high level of agitation” required

hospital staff to use “seclusion and restraints.” 2 VRP at 3, 5.

       CR, however, denied that her statements about sex trafficking were delusional. She testified

that there was sex trafficking at the Pierce County Jail. She said she had “spoken to [her] brother

about it and . . . spoken to [her] ex about it, and they verified it.” 1 VRP at 11. She said she had

been warned that people would call her psychotic for talking about the sex trafficking, and she

denied that she was psychotic or schizophrenic. She explained that before her arrest, she was

planning to adopt a 16-year-old girl who was being trafficked. After she told two friends about the

situation, she saw fake Facebook profiles for those friends. “And the things that happened within

Pierce County Jail matched the fake profiles.” 1 VRP at 17. CR also said there were false

allegations that she was involved with Jeffrey Epstein.

       When asked if she suffered from a psychotic disorder, CR testified that there were “varying

opinions from doctors” at the hospital where she was committed. 1 VRP at 13. CR incorrectly

stated she was “already deemed competent off medication.” 1 VRP at 18. But she acknowledged

she had “some mental issues right now.” 1 VRP at 13. She then began discussing a religious

television program, where people “find the spirit of mental illness, declare you have the mind of

Christ, you have the mind of Christ, you’re not mentally ill.” 1 VRP at 14.

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No. 57439-0-II

         The mental health professional opined that CR lacked insight into her condition, explaining

that she associated her behavior with “just having anxiety.” 2 VRP at 4. And he testified that CR

had impaired judgment because she had denied needing medication and had to be the subject of a

forced medication order. He predicted that CR “would not be able to meet her basic health and

safety needs” in the community because “if released,” she would “not take her medications, which

would result in decompensation.” Id. He added that when CR “is decompensated, she reaches a

manic state” that puts her “at risk of harm.” Id.

         In contrast, CR testified that she would seek treatment if released. CR said that if a provider

of her choosing prescribed her medication, including antipsychotic medication, she would take it.

CR also described a postrelease plan for housing, accessing medical care, and supporting herself

financially. She said she would first live with her brother in Tacoma. In Tacoma, she would go to

a clinic as well as a private psychiatrist, whom she had seen before and whose opinion she trusted.

Then, she would live with her grandfather in Morton, although when she lived with him two years

ago, she “walked out in the snow” to a friend three houses down because she did not like the way

her grandfather treated her. 1 VRP at 15. In Morton, she would go to “a small clinic” she had

“visited one time.” 1 VRP at 12. Separately, CR mentioned attending “an online counseling

program . . . specifically for dancers.” 1 VRP at 15. And CR said she had a counselor through a

church who knew about the incident leading to her arrest.

         Describing her financial resources, CR said she had money in savings, a car, and the ability

to teach ballet or work at a restaurant that had previously employed her. She added that her

“husband . . . makes good money” and that her grandfather had offered to help support her. 1 VRP

at 10.

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No. 57439-0-II

B.     Testimony About the Underlying Offense

       CR’s father testified about the incident that led to CR’s arrest. He said CR went to his home

and demanded his car keys. He thought CR “appeared manic.” 2 VRP at 2. When he refused to

give CR the keys, she “sprayed his face with what he believed to be pepper spray,” causing him to

temporarily lose the ability to see. 2 VRP at 1. He “did not seek medical treatment but did rinse

his eyes with milk.” 2 VRP at 1-2.

       The mental health professional testified that when CR committed the offense, she was

“manic . . . and had a delusion about sex trafficking.” 2 VRP at 6. He said that CR “still

[experienced] these exact symptoms.” Id. And he said that “in reviewing both [CR’s] criminal

history and her mental health history,” he observed that “the two records [correlated] with one

another.” Id. He thus opined that CR committed second degree assault as “the result of her

behavioral health disorder.” Id.

                          IV. SUPERIOR COURT COMMISSIONER’S RULING

       The commissioner ordered 180 days of involuntary inpatient treatment on 2 separate

grounds: that CR was gravely disabled, and that CR committed acts constituting second degree

assault and was substantially likely to repeat similar acts.

A.     Grave Disability

       The commissioner found that CR had “a number of prior community contacts,” involuntary

treatment evaluations, and emergency room visits “related to her condition.” CP at 23. CR did not

believe she had “any condition other than anxiety,” in spite of the fact that her symptoms were

“not consistent with that diagnosis.” Id. During her treatment, CR had needed restraints, and the

psychiatric emergency response team had become involved in her care because of her level of

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No. 57439-0-II

agitation. Additionally, forced “medication orders [had] been required, most recently a few weeks”

before the ruling, and CR had only recently begun responding to the medication. Id.

       The commissioner found that CR had “a fixed delusion concerning sex trafficking in Pierce

County,” as well as “religious fixations.” Id. She was “unable to suppress her constant discussion

of her beliefs.” Id. Moreover, because of her delusion, CR was unable “to process information in

a rational manner.” Id. The commissioner noted that the mental health professional did not believe

she would take medication or seek treatment in the community because she did “not recognize her

condition.” Id. Moreover, the mental health professional believed that if CR were “released

without condition, . . . she would decompensate again.” Id. And if CR “were to experience another

manic event,” she would not be able to “meet basic needs” due to preoccupation with her delusion.

Id. To be ready for a less restrictive alternative to commitment, CR needed to show a “consistent

pattern of compliance with” her medication. CP at 23-24.

       The commissioner thus concluded that CR was gravely disabled because, due to a

behavioral health disorder, she manifested “severe deterioration in routine functioning evidenced

by repeated and escalating loss of cognitive or volition control,” and because she was “not

receiving such care as is essential for health and safety.” CP at 23.

B.     Likelihood of Repeating Similar Acts

       The commissioner found that CR pepper sprayed her father in the face while she was

“manic” and “acting more and more irrationally.” Id. As a result, CR’s father could not see. “He

used milk to treat himself per 911 direction.” Id. The commissioner thus concluded that CR

committed second degree assault and that her acts constituted a violent offense.

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No. 57439-0-II

       The commissioner also found that when CR became preoccupied, she experienced “an

urgent need to take action and [became] aggressive and assaultive.” Id. The commissioner found

that if CR were “to experience another manic event,” she “would engage in activities similar to

criminal acts.” Id. And the commissioner found “a correlation between her psychiatric instability

and the number of assaults” in her records. Id. Therefore, the commissioner concluded that “as a

result of a behavioral health disorder,” CR presented “a substantial likelihood of repeating similar

acts.” CP at 22.

       CR appeals the commissioner’s order.

                                            ANALYSIS

       When reviewing a commissioner’s decision on involuntary commitment, we consider

whether substantial evidence supports the commissioner’s findings of fact and whether those

findings of fact support the commissioner’s conclusions of law and judgment. In re Det. of A.F.,

20 Wn. App. 2d 115, 125, 498 P.3d 1006 (2021), review denied, 199 Wn.2d 1009 (2022).

“‘Substantial evidence’ is the quantum of evidence sufficient to persuade a fair-minded person.’”

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

       We “view the evidence in the light most favorable to the petitioner,” and we do not disturb

decisions “regarding witness credibility or the persuasiveness of the evidence.” Id. Additionally,

we view unchallenged findings of fact as verities on appeal. In re Det. of L.S., 23 Wn. App. 2d

672, 686, 517 P.3d 490 (2022).

                                       I. GRAVE DISABILITY

       CR argues that substantial evidence does not support the commissioner’s findings of fact

about her grave disability and that those findings do not support the conclusion that she was gravely

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No. 57439-0-II

disabled. CR points out that she described where she would live, work, and receive treatment. We

disagree.

       The State may involuntarily commit a person if a petitioner proves by clear, cogent, and

convincing evidence that the person “is gravely disabled.” Former RCW 71.05.280(4) (2022); see

also In re Det. of R.H., 178 Wn. App. 941, 945-46, 316 P.3d 535 (2014). One definition of grave

disability states that a person is gravely disabled if, “as a result of a behavioral health disorder,”

they manifest “severe deterioration in routine functioning evidenced by repeated and escalating

loss of cognitive or volitional control over [their] actions and [they are] not receiving such care as

is essential for [their] health or safety.” Former RCW 71.05.020(24)(b) (2022). This definition

permits the State to involuntarily treat “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.’” In re Det. of LaBelle, 107 Wn.2d 196, 206, 728 P.2d 138

(1986) (quoting Mary L. Durham & John Q. La Fond, The Empirical Consequences and Policy

Implications of Broadening the Statutory Criteria for Civil Commitment, 3 YALE L. & POL’Y REV.

395, 410 (1985)). Thus, it “allows intervention before a mentally ill person decompensates and

provides for continuity of care.” A.F., 20 Wn. App. 2d at 127.

       When a petitioner seeks to prove that a person is gravely disabled under former RCW

71.05.020(24)(b), they must present “recent proof of significant loss of cognitive or volitional

control.” LaBelle, 107 Wn.2d at 208. They must also show “a factual basis for concluding that the

individual is not receiving or would not receive, if released, such care as is essential for [their]

health or safety.” Id. Finally, the petitioner must demonstrate “that the individual is unable,

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No. 57439-0-II

because of severe deterioration of mental functioning, to make a rational decision with respect to

[their] need for treatment.” Id.

        For example, in In re Det. of A.M., we held that a person was gravely disabled under this

definition. 17 Wn. App. 2d 321, 336, 487 P.3d 531 (2021). We reasoned that the person’s “recent

felony harassment of a stranger,” “his health concerns that impacted his ability to feed himself,

and his continuing agitated and angry state, which were all due to his persistent delusional beliefs,”

demonstrated “recent significant loss of cognitive or volitional control.” Id. at 335-36. And we

reasoned that, along with having “‘a history of noncompliance with medication in the

community,’” the person “had no insight into his mental illness, did not believe that he was

mentally ill, and did not believe that he needed any medication,” so he “would not receive care

that is essential for his health or safety if released.” Id. at 336.

        Here, the commissioner found that CR’s behavior demonstrated a significant loss of

cognitive and volitional control. The commissioner also found that CR would not receive care

essential for her health and safety if released. Finally, the commissioner found CR did not

“recognize her condition” and her delusional beliefs prevented her from processing information in

a rational manner and making rational decisions about her care. CP at 23.

        Substantial evidence supports these findings. It is true that unlike the person in A.M., CR

acknowledged at least “some mental issues,” and she said she would take antipsychotic

medications if a provider in the community prescribed them. 1 VRP at 13. But despite her

diagnosis, CR denied that she had a form of schizophrenia and that her statements about sex

trafficking were delusional. Moreover, the petitioners declared that “interference from delusional

content” hampered attempts to evaluate CR and that CR participated “in a limited fashion with her

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No. 57439-0-II

treatment.” CP at 10, 15. Similarly, the mental health professional testified that CR’s symptoms

rendered her “frequently unable to participate in treatment.” 2 VRP at 5. The petitioners declared

that CR had “inconsistent medication adherence” and predicted that she would not take her

medication if released before receiving more treatment. CP at 10. And the mental health

professional testified that without medication, CR would decompensate. The commissioner relied

on these assessments in their findings, and we do not reweigh the persuasiveness of the evidence.

A.F., 20 Wn. App. 2d at 125.

          Like the person facing commitment in A.M., CR’s delusional beliefs caused her to become

“aggressive and assaultive.” CP at 23. She was hospitalized after attacking another person and she

displayed considerable agitation in the hospital, needing restraints as well as care from the

psychiatric emergency response team. And like the person in A.M., CR had a history of

noncompliance with medication.

          In sum, the commissioner’s findings of fact, which are supported by substantial evidence,

show that CR recently suffered a loss of cognitive or volitional control because of a behavioral

health disorder and that she would not receive care essential for her health and safety if released

into the community. These findings support the conclusion that CR was gravely disabled.

          We affirm CR’s commitment on the basis of grave disability.

                                 II. ACTS CONSTITUTING A FELONY

          CR argues that petitioners presented insufficient evidence to prove that she committed

second degree assault and was substantially likely to commit similar acts if released. This basis for

commitment allows the State to commit her for 180 days rather than 90. See RCW 71.05.320(1)(a),

(1)(c).

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No. 57439-0-II

       The State may involuntarily commit a person if a petitioner proves by clear, cogent, and

convincing evidence that the person has “been determined to be incompetent,” “criminal charges

have been dismissed,” the person has “committed acts constituting a felony, and as a result of a

behavioral health disorder,” the person presents “a substantial likelihood of repeating similar acts.”

Former RCW 71.05.280(3); see also A.M., 17 Wn. App. 2d at 330. Clear, cogent, and convincing

evidence “is a quantum of proof that is more than a preponderance of the evidence, but less than

what is needed to establish proof beyond a reasonable doubt.” In re Est. of Barnes 185 Wn.2d 1,

10 n.5, 367 P.3d 580 (2016).

A.     Second Degree Assault

       CR argues that substantial evidence does not support the commissioner’s finding that she

committed second degree assault. Specifically, CR argues that she did not inflict substantial bodily

harm, pointing out that CR’s father “was able to retrieve milk to wash out his eyes” so “any

inability to see was of very short duration.” Br. of Appellant at 17. And CR argues that if we were

to hold that second degree assault encompasses “spraying a substance resulting in a temporary

inability to see,” our holding “would lead to absurd results,” such as second degree assault

convictions for “blowing smoke or splashing water.” Id. at 17-18. We disagree.

       A person commits second degree assault when, under circumstances not amounting to first

degree assault, they intentionally assault another person “and thereby recklessly [inflict]

substantial bodily harm.” 9A.36.021(1)(a). “‘Substantial bodily harm’” includes “bodily injury . .

. which causes a temporary but substantial loss or impairment of the function of any bodily part or

organ.” RCW 9A.04.110(4)(b). The “term ‘substantial,’ as used in” the second degree assault

statute, “signifies a degree of harm that is . . . ‘considerable in amount, value, or worth.’” State v.

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No. 57439-0-II

McKague, 172 Wn.2d 802, 806, 262 P.3d 1225 (2011) (quoting WEBSTER’S THIRD NEW

INTERNATIONAL DICTIONARY 2280 (2002)). The term “necessarily requires a showing greater than

an injury merely having some existence.” Id.

          In proving that a person “committed acts constituting a felony” under former RCW

71.05.280(3), a petitioner need not “show intent, willfulness, or state of mind as an element of the

crime.” Former RCW 71.05.280(3)(a). Additionally, if “the charge underlying the finding of

incompetence is for a felony classified as violent under RCW 9.94A.030,” the commissioner must

“determine whether the acts the person committed constitute a violent offense under” that statute.

Former RCW 71.05.280(3)(b).

          Here, CR committed acts constituting second degree assault, a violent offense. RCW

9.94A.030(58)(a)(viii).2 The commissioner found that CR pepper sprayed her father in the face,

and CR does not challenge this finding. As a result of CR’s actions, CR’s father briefly lost

eyesight. While “temporary,” this loss constituted a “substantial loss . . . of the function of” his

eyes because he was completely unable to use them. RCW 9A.04.110(4)(b). The petitioners did

not need to prove that CR acted intentionally and recklessly because they were not required to

show “state of mind as an element of the crime.” Former RCW 71.05.280(3)(a). And the fact that

CR’s father was able to treat himself with milk is irrelevant: the statutory definition of substantial

bodily harm does not require the harm to last a long time or necessitate treatment from a medical

professional.

          CR argues that this interpretation of RCW 9A.36.021 would make a person guilty of

committing second degree assault for blowing cigarette smoke or splashing water in another

2
    We cite to the current statute as the relevant definitions and language have not changed.

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No. 57439-0-II

person’s face. But her argument does not acknowledge the fact that cigarette smoke dissipates by

itself almost instantly, and a splash of water causes momentary stinging at most. In contrast,

“[p]epper spray can cause severe irritation of the eyes, skin, and mucous membranes, resulting in

temporary blindness, cough and shortness of breath, chest pain, and skin rashes, blisters, or burns.”

Alexandra Chen, Chemical Weapons and Their Unforeseen Impact on Health and the

Environment, 12 SEATTLE J. TECH., ENV’T & INNOVATION L. 1, 5 (2022).

B.     Likelihood of Committing Similar Acts

       CR argues the State failed to adequately prove that she “presents a substantial likelihood

of committing similar acts to the originally charged offense.” Br. of Appellant at 22. We disagree.

       The commissioner found that when CR became preoccupied with her delusions, she

became “aggressive and assaultive.” CP at 23. The commissioner also found a correlation between

CR’s past behavioral health episodes and assaults. Substantial evidence supports these findings.

The sworn declaration contained an evaluator’s prediction that CR’s “inability to manage emotions

during [delusional] episodes . . . would likely lead to medication non-compliance,” more

interactions with police, and more arrests. CP at 15. The mental health professional testified that

CR was still experiencing the “exact symptoms” she experienced when she committed second

degree assault. 2 VRP at 6. And the mental health professional noted the correlation between CR’s

conviction history and mental health history, and he testified that CR’s delusions cause her to

behave aggressively toward others when she stops taking medication to treat her behavioral health

condition.

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No. 57439-0-II

       The commissioner’s findings that CR’s delusions tended to make her assaultive in turn

support the ultimate conclusion that, as a result of CR’s behavioral health disorder, CR was

substantially likely to repeat acts similar to second degree assault under former RCW 71.05.280(3).

       We affirm CR’s commitment on the basis that she committed second degree assault and

was substantially likely to commit similar acts if released.

                                          CONCLUSION

       We affirm the commissioner’s order committing CR for 180 days of involuntary treatment.

       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.

                                                      Glasgow, C.J.
 We concur:

 Maxa, J.

 Lee, J.

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