Involuntary Treatment Orders Should Be Dismissed If the Requirements of a Commitment Statute Are Violated and Totally Disregarded
In In re Det. of A.C., 533 P.3d 81 (Wash. 2023), the Supreme Court of Washington ruled a petition for involuntary commitment should be dismissed when the requirements of the state’s involuntary treatment act are disregarded. Moreover, it was asserted in circumstances where a patient’s rights under the act were “plainly violated,” appropriate remedies should be implemented.
Facts of the Case
In 1973, Washington State passed the Involuntary Treatment Act (ITA), providing a statutory framework for crisis responders to investigate, evaluate, detain, and commit individuals experiencing acute psychiatric symptoms. Individuals can be involuntarily treated without judicial oversight if their symptoms present a serious risk of harm or grave disability. Following this brief emergency detention, if the risk persists, a petition for involuntary treatment must be filed and the court must conduct a hearing to rule on an additional 14-day commitment. If stabilization is not attained, the court may order a consecutive 180-day commitment.
The present case involves three patients, identified as NG, CM, and AC. NG and CM were involuntarily hospitalized at Western State Hospital (WSH) under 180-day commitment orders. Although NG’s commitment order expired because of a technological oversight, WSH held NG for over one month after the expiration. Similarly, CM was detained more than one month past the commitment’s expiration. Although staff prepared an additional 180-day petition for CM’s commitment, they failed to file because of a technical problem. When staff became aware of NG’s and CM’s expired orders, they reinitiated the ITA procedures; both patients were subsequently placed in emergency custody following evaluations. Shortly after, WSH filed new 14-day petitions to continue detaining NG and CM.
Both NG and CM moved to dismiss the petitions claiming the ITA’s requirements were disregarded and violated. For NG, the state successfully argued the legislature would have not intended dismissal of her case, given how “gravely disabled” she was, and the case was not dismissed. NG appealed this denial and the order granting the ITA petition. In CM’s case, a county commissioner granted the motion to dismiss after the state unpersuasively argued the legislature did not intend dismissal of the petition.
AC was placed under a 14-day commitment at Telecare North Sound Evaluation and Treatment Center. During this hospitalization, AC invoked her right to not be medicated 24 hours before her upcoming court hearing; however, she was involuntarily medicated within that time frame. The judge continued the hearing for 24 hours after learning AC had been involuntarily medicated, extending the commitment. AC moved to have the ITA petition dismissed claiming her rights under the ITA were violated by continuing her commitment, but this was denied as the court concluded the state’s interest in reaching the merits of the petition outweighed any violations of the ITA. Division One of the Court of Appeals affirmed the decision on appeal.
NG’s and CM’s cases were consolidated and heard by Division Two. The state argued that dismissal of new petitions in response to the commitment orders’ expiring was not an appropriate remedy. Division Two held that dismissal of a new 14-day petition for involuntary treatment is acceptable when a committed person is improperly detained beyond the expiration of an involuntary commitment order and the ITA’s requirements have been totally disregarded. Together, AC, MG, and CM sought review, which was granted by the Supreme Court of Washington.
Ruling and Reasoning
The Supreme Court of Washington ruled that if the requirements of the ITA are totally disregarded, the petition must be dismissed. But not every violation necessitates a dismissal. The court reviewed all three cases to determine if there was a total disregard for the statutory requirements and if the trial courts properly applied the law. The decision relied heavily on the holding from In re Det. of Swanson, 804 P.2d 1 (Wash. 1990), another case that addressed the ITA statutory requirements. The court in Swanson said that the goals of “continuity of care and protecting the public are decidedly not met if dismissal of properly filed and properly supported petitions turns on [things other] than on the court’s determination of whether or not legal grounds for commitment exist” (Swanson, p 5).
The court must decide if there are legal grounds for a commitment based on legislative intent, including protecting both the patient and public, prevention of inappropriate and indefinite commitments, implementing prompt evaluation and treatment for those with behavioral health disorders, safeguarding patient rights, and ensuring care continuity for those with behavioral health disorders.
The court considered how neither “totally” nor “disregarded” are defined in the ITA. Considering common definitions of these words, it was concluded the ITA is totally disregarded when a person is involuntarily detained without legal authority set forth by the act. As the ITA noted, a person must be released once the order authorizing their detention expires, and NG and CM should have been released before new proceedings were initiated, afforded an attorney, and brought before a judge to reinstitute the commitment. Initiation of new proceedings while a person is still involuntarily detained under an expired court order is not permitted by the ITA and is not a remedy for disregard of the ITA requirements. Moreover, it would have been appropriate for NG and CM to be released into the community prior to a new evaluation. The court ruled that NG’s and CM’s rights were totally disregarded, and the new petitions should have been dismissed.
In the case of AC, the court determined her rights under the ITA were plainly violated but not totally disregarded. It was noted the trial court acted quickly to address the violation and detainment was under authority of the law. Focusing on the merits of the petition, the trial court did not abuse its discretion in denying her motion to dismiss.
Dissent
The dissent suggested that interpreting total disregard needs to be considered with the totality of circumstances constituting the alleged violation. According to the dissent, in all three of the petitioners’ cases, the requirements of the ITA were not totally disregarded, and dismissal was not an appropriate remedy.
Discussion
In re AC provides guidance on what it means to totally disregard the requirements of Washington’s ITA and, if the ITA is violated, what constitutes appropriate remedies. These matters were previously raised in In re Det. of C.W., 53 P.3d 979 (Wash. 2002) and Swanson. Given a lack of definition of total disregard in the ITA, the court relied on use of common definitions as provided in the Merriam-Webster dictionary. The court acknowledged the legal interpretation of these words can vary by the context.
In re Det. of AC brings to light the intricacies of semantics within the law and how varying interpretations can depend on select words. This matter becomes more complex when interpretations may differ in legal and clinical settings. For instance, clerical oversights or errors led to the ITA’s being “totally disregarded” and a dismissal of a commitment petition. But, in a clinical context, providers must consider the implications of failing to provide mental health services for patients who are psychiatrically unstable. Providers are obligated, by their professional associations and licensing boards, to deliver ethical, empirically based care. For instance, the ethical guidelines of the American Psychological Association states that providers must avoid interruption of psychological services whenever possible (American Psychological Association. Ethical principles of psychologists and code of conduct. 2017). Similarly, The American Psychiatric Association’s Principles of Medical Ethics (2013) highlights the importance of responsibility for patient care overlaid with community and public health. Although there were technical violations of the ITA, once known, it would have been unethical for providers to totally disregard their professional obligations and recommend patients who demonstrated a “serious risk of mortality” and “violent and assaultive” behavior be released, as was the case for NG and CM
In re Det. of AC highlights how interpretation of the law may be at odds with clinical practice, but also how legal remedies that fail to consider a patient’s circumstances may be clinically contraindicated. It is prudent for clinicians to be aware of the requirements in law. When there are competing interests, clinicians may be able to clearly explain, based on a clinical justification, the rationale for continued detention. To ameliorate the inconsistencies between the legal and clinical professions, it is useful to engage in interdisciplinary consultation to improve how the law is applied to clinical matters and understanding of operational definitions within statutes and interpretive case law.
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