In Re The Detention Of S.c.

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
In the Matter of the Detention of 	;I 	No. 70410-9-1
s.c., 	;) 	DIVISION ONE 	S
Appellant. 	]
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> 	UNPUBLISHED OPINIO^!
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) 	FILED: July 28, 2014 	Xl 	''.J*:"-
Appelwick, J. — S.C. appeals the revocation of her conditional release1p
outpatient 	treatment 	during 	her 	commitment 	for 	involuntary 	mental 	health
treatment. 	S.C. asserts that the trial court's factual finding that she experienced
a substantial deterioration in functioning is not supported by substantial evidence.
We affirm.
FACTS
Between June 2012 and March 2013, S.C. agreed to various orders of
commitment for involuntary mental health treatment. 	On April 1, 2013, a mental
health 	court 	commissioner 	entered 	an 	agreed 	order for 	180 	days 	of 	less
restrictive outpatient mental health treatment. 	The order directs S.C. to reside in
independent housing in Tukwila and participate in treatment at Sound Mental
Health.
On May 6, 2013, a King County designated mental health professional
filed a 	petition 	for 	revocation 	of S.C.'s conditional 	release to 	less 	restrictive
alternative treatment. 	The 	petition 	indicates that 	S.C. 	was 	detained 	at the
hospital where "Harborview Psychiatric Emergency Services and Sound Mental
Health after hours called Crisis and Commitment Services." 	A declaration of
crisis worker Owen 	Riley accompanied the petition. 	In his declaration, 	Riley

No. 70410-9-1/2
stated that S.C. was "too disoriented/disorganized to participate in a plan for safe
discharge 	into 	the 	community." 	As 	grounds 	for 	revocation 	under 	RCW
71.05.340(3)(a), the petition alleges that S.C. was (1) failing to adhere to the
terms and conditions of her less restrictive treatment order; (2) demonstrating a
substantial 	deterioration 	of 	functioning; 	and/or 	(3) 	showing 	evidence 	of
substantial decompensation that, with reasonable probability, could be reversed
by further inpatient treatment.
At 	a 	hearing 	on 	May 	10, 	2013, 	Dr. 	Rachel 	Eisenhauer, 	a 	clinical
psychologist, testified that she last evaluated S.C. in the hospital on March 15,
2013. 	Dr. Eisenhauer stated that S.C. "indicated to me that she was told that
they were waiting for her to have a discharge plan," but she "had no idea what
the 	plan 	might 	be 	and 	indicated that it was 	up to the doctors." 	When 	Dr.
Eisenhauer asked if she had a place to live, S.C. said, "'[H]old on. 	I'm trying to
think. 	No, I don't. 	I don't know where I want to go.'" 	Dr. Eisenhauer described
S.C. as vague, with meandering and incomplete thoughts, confused, irritable,
suspicious, and tangential. 	On cross-examination, Dr. Eisenhouer clarified that
S.C. 	was "just confused" 	but 	not "very confused." 	She also explained that
"Tangential makes a presumption you're starting at the right point, and then you
go off on a different direction; whereas, non-responsive means you never even
started at the right point."
Owen Riley, an after-hours crisis worker and mental health clinician at
Sound Mental Health, testified that he visited S.C. at the hospital on May 5, 2013,
to evaluate her for possible revocation of the less restrictive order. 	Riley testified

No. 70410-9-1/3
that S.C. "was minimally responsive . . . and had a very hard time answering
any . . . questions. . . . And pretty much almost none of the answers really fit the
question, which indicated to me that she was pretty disorganized." 	Riley testified
that S.C. "was not able to really communicate" when he asked her about where
she lived, what she would do for food, 	or how she would take care of herself
outside the hospital. 	Based on his visit to S.C. and his review of her clinical
record, Riley concluded that S.C. "was disorganized and decompensated to the
extent that she was not able to take care of herself out in the community and that
the less restrictive order should be revoked."
Dr. Corre Spence testified that she reviewed S.C.'s chart, consulted her
psychiatrist, reviewed her treatment team recommendations, and listened to the
testimony at the hearing, but that S.C. had declined an interview. 	Dr. Spence
testified that the chart indicated that during her current hospitalization at Fairfax
Hospital, S.C. acknowledged auditory hallucinations; had impaired concentration
and difficulty attending to a conversation with a therapist on May 7; and on May 9,
refused to answer any staff questions, appeared internally preoccupied, made
bizarre, irrelevant statements, and 	later pushed another patient while walking,
causing the other patient to fall down. 	When asked for her opinion on whether
S.C. 	had 	suffered 	a 	substantial 	deterioration 	in 	functioning, 	Dr. 	Spence
responded,
Based on the testimony of her evaluation ... in March, it's clear
from 	the 	notes of that interview that she was 	able to 	respond
appropriately to questions. 	That her thoughts were more clear and
goal-directed. 	That she was able to be engaged in the discussion

No. 70410-9-1/4
of her discharge plan, discussion of her place to live, so she was
able to be planful and interact more meaningfully with others.
Since her admission to Fairfax, she's been highly confused
and 	disorganized, 	disoriented. 	She's 	largely 	been 	unable 	to
interact meaningfully with staff at all.
Following the hearing, the trial court found that a substantial deterioration
of 	S.C.'s 	functioning 	had 	occurred, 	revoked 	her 	less 	restrictive 	alterative
treatment, and remanded her to the hospital for inpatient treatment.
S.C. appeals.
DISCUSSION
RCW 	71.05.340(1) 	authorizes 	the 	court 	to 	conditionally 	release 	a
committed person who, in the opinion of the mental health treatment provider,
can 	be 	appropriately 	served 	by 	outpatient treatment. 	When 	considering 	a
petition for conditional release, the court must determine at a hearing "whether or
not the person may be conditionally released without substantial danger to other
persons, or substantial likelihood of committing criminal acts jeopardizing public
safety or security." 	RCW 71.05.340(1 )(b). 	"If the court disapproves of the
conditional release, 	it may do so only on the basis of substantial evidence."
RCW 71.05.340(1 )(b).
The mental health treatment provider may petition the court to revoke an
order for conditional release on the following grounds:
(i) 	A conditionally released person is failing to adhere to the
terms and conditions of his or her release;
(ii) 	Substantial 	deterioration 	in 	a 	conditionally 	released
person's functioning has occurred;

No. 70410-9-1/5
(iii) There is evidence of substantial decompensation with a
reasonable probability that the decompensation can be reversed by
further inpatient treatment; or
(iv) The person poses a likelihood of serious harm.
RCW 71.05.340(3)(a). 	At a hearing on the petition, the court determines whether
any of the grounds have been met, and if so, "whether the terms of conditional
release should be modified or the person should be returned to the facility."
RCW 71.05.340(3)(d). 	According to 	RCW 71.05.340(5), 	"The grounds and
procedures for revocation of less restrictive alternative treatment shall be the
same as those set forth in this section for conditional release."
Where, as here, a trial court 	has weighed the evidence, our review is
limited to determining whether substantial evidence supports the findings, and if
so, whether the findings support the court's conclusions of law and judgment, 	jn
reDet.ofA.S.. 91 Wn. 146, 162, 955 P.2d 836 (1998), affd, 138 Wn.2d 898, 982
P.2d 1156 (1999). 	"Substantial evidence is 'evidence in sufficient quantum to
persuade a fair-minded person of the truth of the declared premise.'" 	Id. (quoting
Holland v. Boeing Co.. 90 Wn.2d 384, 390, 583 P.2d 621 (1978)).
Without 	citation 	to 	relevant authority, 	S.C. 	contends that a 	finding of
substantial deterioration of functioning requires direct evidence establishing her
level of functioning on the day of her conditional release, April 1, to serve as a
baseline for comparison. 	She also claims that the evidence presented at the
hearing as to deterioration did not qualify as substantial.
Contrary 	to 	S.C.'s 	claim, 	nothing 	in 	RCW 	71.05.340 	requires 	direct
evidence establishing a definite baseline level of functioning as of the entry of a

No. 70410-9-1/6
conditional release order before a 	court can find a 	substantial deterioration of
functioning at a hearing to revoke that order. 	And, we conclude the trial court's
finding that S.C. 	had experienced a substantial deterioration in functioning 	is
supported by substantial evidence.
Dr. Eisenhauer described S.C.'s functioning as of just two weeks before
her conditional 	release. 	And, 	Riley described 	her behavior just prior to the
revocation hearing. 	Both Riley and Dr. Spence testified that they based their
professional opinion that S.C. 	had experienced a 	substantial deterioration 	in
functioning 	in part on 	their review of 	her treatment records, 	which 	included
professional descriptions of her level of functioning at various times over the past
year of her commitment proceedings. 	Although the 	records upon which the
experts relied were not admitted as evidence, S.C. fails to identify any authority
prohibiting the trial court from considering the experts' opinions when making a
determination 	as 	to 	a 	substantial 	deterioration 	in 	functioning 	under 	RCW
71.05.340(3)(d). 	In fact, 	in its oral 	ruling, 	the trial 	court 	indicated 	that 	Dr.
Spence's opinion was particularly convincing because it was "based on things
that seem logical, especially ... in terms of [S.C.'s] ability to work with staff' prior
to 	her 	conditional 	release 	as 	opposed 	to 	her 	inability 	to 	meaningfully
communicate with staff at the time of the revocation hearing.
We conclude that the expert opinions and the testimony demonstrating a
change in S.C.'s ability to communicate before and after her conditional release
constitute evidence of a sufficient quantum to persuade a fair-minded person that

No. 70410-9-1/7
S.C. had experienced a substantial deterioration in functioning. 	S.C. fails to
demonstrate error.
Affirmed.
WE CONCUR:
/l^cifef^