A juvenile recently challenged guilty adjudications arising from her actions while being detained and forcibly changed into scrubs at the hospital.
According to the appeals court’s unpublished opinion, a deputy went to the high school because the juvenile refused to leave the school. The juvenile made statements about suicide and self-harm. She was transported to the hospital’s emergency department. When she refused to change clothes, she was restrained and forcibly changed into scrubs. Two nurses told the deputy the juvenile assaulted them.
The juvenile was charged with interference with a health care facility and two counts of assault in the third degree.
The deputy testified the juvenile’s father came to the school, but left to go back to work. The juvenile told the deputy she did not want to go with her father and did not feel safe. When the father returned, the juvenile started talking about self-harm.
The appeals court noted the deputy’s body cam footage showed juvenile was wearing a bra, crop top, and leggings at the hospital. The deputy and a nurse told her they would restrain her if she did not comply. After the juvenile refused to change clothes, security came into the room. The juvenile did not want to change while they were there. The nurse said they could turn around, but needed to stay because the hospital had to take the threats the juvenile had made seriously.
The juvenile swore at them and screamed she would “. . . kill all of you.” The staff told the deputy the juvenile had kicked them and they wanted to file charges. The juvenile kept screaming while they cut her clothes off and put the scrubs on her.
A registered nurse (“RN”) testified hospital policy required a patient detained by police to change into scrubs so they could be identified if they left their room and to ensure they did not have anything that could be used to harm themselves or others.
The RN testified the juvenile threatened to kill her. Hospital security was called. The juvenile was restrained when she continued to refuse to change. The RN said the juvenile kicked her while she was removing her clothes. She testified the juvenile’s behavior interfered with the staff’s ability to do their jobs and that the resources she required kept staff from treating others.
A certified nursing assistant (“CNA”) also testified the juvenile kicked her repeatedly. She testified the juvenile caused a commotion and interfered with the emergency room’s ability to effectively operate.
The juvenile testified she did not want to change. The nurses called security. She started to change, but did not want to change in front of the male security staff. They grabbed her by the arms and held her, face down. She said she was kicking on the floor trying to get loose. She said she did not know anyone was behind her and was not trying to kick anyone. She said she did not know she had kicked anyone.
The trial court found the hospital had a policy to require behavioral health patients to wear scrubs for identification and to prevent using their own clothing as a ligature. The trial court also found the juvenile’s clothes could all be used as a ligature.
The court -found that the juvenile knew the RN and CNA were behind her because they were talking to her and giving her instructions. The court found the juvenile screamed and kicked the RN and the CNA. The court further found her actions were intentional assaults on the RN and the CNA. The trial court also found the juvenile’s behavior was unreasonable and disruptive to hospital operations and disturbed the peace.
The court adjudicated the juvenile guilty of the charges.
Self-Defense
The juvenile appealed, arguing there was insufficient evidence supporting the assault adjudications because the state had not disproved self-defense.
A person who assaults a nurse, physician or other health care provider performing health care duties at the time is guilty of assault in the third degree. RCW 9A.36.031(1)(i).
The self-defense statute provides that the use of force is not unlawful if used by the party to prevent or attempt to prevent an offense against their person. RCW 9A.16.020. Once a defendant produces some evidence of self-defense, the burden shifts to the state to disprove self-defense beyond a reasonable doubt.
The juvenile argued she was entitled to use force in self-defense even if the hospital was legally authorized to use force to change her clothes. The appeals court rejected this argument, noting that self-defense may only be used to protect against unlawful force.
The appeals court also noted the juvenile had been permitted to raise self-defense as a defense. The trial court, however, found the hospital’s use of force was lawful.
The appeals court concluded the court’s findings supported its conclusion the hospital had a duty to protect its patients and took reasonable and necessary steps to protect the juvenile and hospital personnel. The court had concluded the force used by the hospital was lawful and the state had therefore disproved self-defense.
The juvenile argued RCW 71.34.355 permits a minor to wear their own clothing while receiving behavioral health treatment and the hospital was not acting with legal authority when it forced her to change.
The appeals court, however, determined the rights set forth in RCW 71.34.355(1) are applicable to minors who are treated in an evaluation and treatment facility, which is different from a minor taken into custody and transported to a hospital emergency department.
Health Care Provider
The juvenile also argued the state had not presented sufficient evidence the CNA was a “health care provider” under the statute. RCW 9A.36.031(1)(i) defines a “health care provider” as “a person regulated under Title 18 RCW and employed by, or contracting with, a hospital licensed under chapter 70.41 RCW.” The appeals court determined that it was a reasonable inference from the CNA’s testimony that she was a certified nursing assistant and regulated pursuant to Title 18. The appeals court further concluded that, based on the testimony, it was also a reasonable inference that the hospital was licensed under chapter 70.41. The appeals court concluded there was sufficient evidence that the CNA qualified as a health care provider under the third degree assault statute.
Interference with a Health Care Facility
The juvenile also argued there was insufficient evidence that her threats were “true threats” to support her adjudication for interference with a health care facility. RCW 9.A.50.020 makes it unlawful for a person to willfully or recklessly interfere with access to or from a health care facility or to recklessly disrupt the facility’s normal functioning by, in relevant part, threatening to inflict injury on the facility’s agents, owners, employees, patient’s or property.
A “true threat” of violence is not protected by the First Amendment. The U.S. Supreme Court has stated that “True threats are ‘serious expression[s]’ conveying that a speaker means to ‘commit an act of unlawful violence.” Counterman v. Colorado. Pursuant to Counterman, the state must prove “that the defendant consciously disregarded a substantial risk that [the] communications would be viewed as threatening violence.”
The state argued it had presented sufficient evidence to prove this recklessness standard.
The appeals court disagreed, noting there was little evidence showing the juvenile’s subjective state of mind. She had not testified about the threats. The body cam footage showed she made the threats while she was being restrained, so it could not be reasonably inferred that she consciously disregarded a risk they would be viewed as true threats. She did not have an opportunity to carry out such actions. The appeals court concluded there was insufficient evidence to meet the recklessness standard and show the juvenile’s statements constituted true threats. The appeals court reversed the interfering with a health care facility adjudication.
The appeals court affirmed the two assault in the third degree adjudications but reversed the adjudication for interfering with a health care facility. The appeals court also remanded with instructions for the juvenile court to strike the fee for DNA collection.
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