Baylor v. United States

• Decision Date: 19 October 1979
• Docket Number: No. 12534.,12534.
• Citation: 407 A.2d 664
• Parties: Paige T. BAYLOR, Jr., Appellant, v. UNITED STATES, Appellee.
• Court: D.C. Court of Appeals

Page 664

407 A.2d 664

Paige T. BAYLOR, Jr., Appellant, v. UNITED STATES, Appellee.

No. 12534.

District of Columbia Court of Appeals.

Argued September 27, 1978.

Decided October 19, 1979.

David M. Barrett, Washington, D. C., for appellant.

John A. Terry, Asst. U. S. Atty., Washington, D. C., with whom Earl J. Silbert, U. S. Atty., Washington, D. C., at the time the brief was filed, and Frederick A. Douglas, Asst. U. S. Atty., Washington, D. C., were on the brief, for appellee.

Before KERN, GALLAGHER and MACK, Associate Judges.

GALLAGHER, Associate Judge:

This appeal raises questions on the issue of medical treatment as an intervening cause of death of the victim in criminal homicide cases. Appellant was charged with second-degree murder¹ and was convicted of the lesser-included offense of involuntary manslaughter. The government's evidence showed that appellant struck his wife (Mrs. Baylor) in the side with great force, thereby rupturing her spleen and causing severe internal bleeding.² Mrs. Baylor was taken to the hospital and operated on, but died thirteen days later from complications. There was testimony by one government medical witness on cross-examination that but for a twohour delay in treatment at the Washington Hospital Center, and a laceration in her pancreas which surgeons at the Center might have caused while removing her spleen, Mrs. Baylor's chances of survival would have been good. On the basis of this testimony appellant requested an instruction on intervening gross negligence in medical treatment at the close of all the evidence. This request was denied. The trial court also declined to permit closing argument on what might have happened to Mrs. Baylor had she gotten better medical care.

On appeal, appellant contends "the trial court's refusal to instruct the jury on intervening contributing causation and its refusal to permit the jury to consider the issue affected the very ability of the jury to give [a]ppellant a fair trial." He also contends the trial court erred in not permitting the medical examiner to testify concerning the effect of the two-hour delay in treatment on Mrs. Baylor. His final contention is that the trial court erred in not instructing the jury on the lesser-included offense of assault. We affirm.³

I.

The evidence showed that ever since a fall taken by Mrs. Baylor during an out-oftown trip in October 1976, she experienced swelling in her back, was continuously in pain, and drank between a pint and a quart of vodka almost every day to ease the pain. Appellant acknowledged he knew his wife had "a lot of pain" but stated he "didn't think she was sick." Because of her heavy drinking, Mrs. Baylor developed cirrhosis of the liver.

During the early afternoon of Sunday, February 6, 1977, the Baylors were conversing, drinking, and listening to music in their apartment with a neighbor. At one point Mrs. Baylor suddenly poured wine into appellant's beer. The neighbor, testifying for the defense, stated appellant sounded "irritated" when this happened. Appellant then struck his wife in the side, causing a two-inch laceration in her spleen. One medical witness testified that a spleen rupture such as this can be caused only by "a severe blow" such as someone "getting hit with a baseball bat, . . . a hockey stick, . . a baseball, or a metallic object," or getting "kicked" or "struck . . . with any object [or] fist." He denied that a mere tap to the side would be sufficient to rupture a spleen. Although appellant attempted to show on cross-examination that a spontaneous or delayed rupture to the spleen might occur without severe force being applied, the medical witness disagreed.⁴

After being struck, Mrs. Baylor experienced severe pain. An ambulance had to be called twice before it arrived at 1:45 p. m. The timing of events after her arrival at the Washington Hospital Center is unclear. Mrs. Baylor spent an undisclosed amount of time in the waiting room. Some time later an abdominal tap was performed in the emergency room, which showed internal bleeding. The diagnosis was not produced until two hours after her admission to the emergency room. There was no indication of how long it usually takes to make such diagnoses.

A surgeon was called to operate on Mrs. Baylor "in the early evening hours." He arrived in about two minutes. At about 6 p. m., the surgeon, together with the resident doctor and an intern, operated on Mrs. Baylor "to explore . . . for a ruptured intra-abdominal viscus." She was already in shock from loss of blood at the time of the operation and was rated a poor risk for surgery. This rating was due to shock, blood loss, cirrhosis of the liver, her history of heavy alcohol intake, and her elevated alcohol level when she entered the hospital.

The doctors discovered a recent two-inch laceration in Mrs. Baylor's spleen and approximately two quarts of fresh blood in her abdominal cavity, and they removed her spleen. There was testimony that a ruptured spleen will not heal itself in time to prevent the patient from hemorrhaging to death, that it cannot be repaired by surgery, and that it must be removed or else the patient will almost invariably bleed to death. There was also testimony that the spleen is a "dispensable organ []," like an appendix.

After the spleen was removed, the doctors discovered a laceration in the tail of the pancreas, and so they removed that part of this organ. The operating surgeon stated that the pancreas is located "right underneath the spleen" and that it might have been injured either "the same time the spleen was injured" or "with a retractor while we were going up trying to mobilize the spleen." He could not be certain of the cause, he stated, because the pancreas could not be seen until the spleen had been removed. The medical examiner who testified also expressed the opinion that the pancreas was injured either by surgery necessary to save life or by the original blunt force trauma to the abdomen area.

The surgeon explained that a retractor or clamp is used in removing the spleen because of the spleen's close proximity to the pancreas. Moreover, he stated that he had removed perhaps a hundred spleens and that the pancreas is not infrequently injured or "traumatized" by retractors during removal of the spleen. There was testimony that a surgeon is very careful when he gets close to the pancreas since it is very susceptible to injury, and there was no testimony that the surgeons here were careless or negligent.

After surgery Mrs. Baylor's condition continued to deteriorate. The day after the operation she developed shocked lung and was placed on a respirator. This developed into bronchopneumonia. Her clotting mechanism, kidneys, and heart failed. There was testimony that all these complications related back to her poor preoperative condition and having to undergo surgery.

Other complications also resulted from the injury to Mrs. Baylor's pancreas. Pancreatitis developed, which caused body fat to be digested by enzymes secreted from the pancreas. This led to peripancreatic abscesses, or accumulation of dead fat tissue. A second operation was performed on February 15. Although appellant contends in his brief that this second operation was necessary to correct the injury to the pancreas, the only testimony in the record relating to this operation is that the purpose was to search for the cause of an infection that had set in.

The cause of death was not disputed. On February 19 Mrs. Baylor experienced cardiac arrest and died. In the medical examiner's opinion, cause of death was "bronchopneumonia and peripancreatic abscess resulting from or due to a blunt injury to her abdomen." It was stated by the operating surgeon that had Mrs. Baylor been operated on immediately and had there been no injury to her pancreas, her chances of survival would have been good, in his opinion.

The trial judge told the parties he would instruct on manslaughter as a lesser-included offense would give the standard jury instruction in this jurisdiction on causation. Unfortunately, the instructions actually given are not transcribed in the record on appeal. The standard instruction on causation reads as follows:

One who inflicts an injury which starts a chain of causation leading to the death of another is held responsible for his death, although it may appear that the deceased might have recovered if he had received proper care, or that improper treatment or lack of care aggravated the injury and contributed to the death. Thus, if you find beyond a reasonable doubt that the death of the deceased was a result of an injury inflicted on him by the defendant, even though you may believe the deceased would not have died but for the lack of proper care, and the Government has proved beyond a reasonable doubt all the other elements of the offense, you may find the defendant guilty of murder in the second degree or manslaughter. [Criminal Jury Instructions for the District of Columbia, No. 4.27 (3d ed. 1978).]

During closing argument, appellant's counsel attempted to argue that Mrs. Baylor would not have died had she "gotten the kind of care that she was entitled to, . the kind of care that some people do get." The government objected, and the trial court stated:

Ladies and gentlemen, if this person died because of negligence of the hospital, that's totally irrelevant to your decision.

So do not pursue that further, counsel.

As a matter of law negligence by the hospital, if it occurred, does not excuse the defendant's conduct in any way.

II.

In this jurisdiction the case of Hopkins v. United States, 4 App.D.C. 4.30 (1894), established the rule that where the victim dies from a wound wrongfully inflicted by the defendant, the victim's failure to obtain medical treatment for the injury is no defense to homicide, even if he would have lived had proper medical care been obtained. More recently, in United States v. Hamilton, 182 F.Supp. 548 (D.D.C.1960), the...