People v. Saavedra-Rodriguez

• Decision Date: 14 December 1998
• Docket Number: No. 97SC543,R,SAAVEDRA-RODRIGUE,97SC543
• Citation: 971 P.2d 223
• Parties: 98 CJ C.A.R. 6083 The PEOPLE of the State of Colorado, Petitioner, v. Patricioespondent.
• Court: Colorado Supreme Court

Page 223

971 P.2d 223

98 CJ C.A.R. 6083

The PEOPLE of the State of Colorado, Petitioner, v. Patricio SAAVEDRA-RODRIGUEZ, Respondent.

No. 97SC543.

Supreme Court of Colorado En Banc.

Dec. 14, 1998.

Rehearing Denied Jan. 11, 1999.

As Modified Feb. 11, 1999.

Gale A. Norton, Attorney General, Martha Phillips Allbright, Chief Deputy Attorney General, Richard A. Westfall, Solicitor General, John Daniel Dailey, Deputy Attorney General, Robert Mark Russel, First Assistant Attorney General, Catherine P. Adkisson, Assistant Attorney General, Criminal Enforcement Section, Denver, for Petitioner.

David F. Vela, Colorado State Public Defender, Joan E. Mounteer, Deputy State Public Defender, Denver, for Respondent.

Justice MARTINEZ delivered the Opinion of the Court.

We granted certiorari to review the court of appeals' ruling that a defendant on trial for homicide should have been allowed to present evidence of inadequate medical treatment as the intervening cause of the victim's death. See People v. Saavedra-Rodriguez, 949 P.2d 86, 88 (Colo.App.1997). The trial court determined that the defendant had not offered sufficient evidence to submit an intervening cause defense to the jury. The court of appeals ordered a new trial. We hold that grossly negligent medical treatment is an intervening cause of death only if the initial wound would probably not have been fatal without the treatment. We also hold that a defendant need only offer some evidence that the medical treatment was the intervening cause of death to be entitled to submit the defense to a jury. We reverse the decision of the court of appeals because the defendant's offer of proof did not meet this standard.

I.

On September 9, 1994 the defendant, Patricio Saavedra-Rodriguez, stabbed Pedro Avila in the chest. The victim was found by his roommates and brought to the hospital by ambulance. Upon arrival at North Colorado Medical Center, the victim was treated by an emergency room doctor, Dr. Claman; a surgeon, Dr. Wikholm; and several nurses. Despite treatment, the victim's condition deteriorated and he did not survive. According to the autopsy, the victim died of a stab wound that penetrated approximately four and one-half inches into the victim's chest cavity, punctured his lung, and cut a one-inch hole in his heart.

During treatment of the victim, Drs. Claman and Wikholm disagreed about the severity of the wound, the appropriate course of treatment, and whether to continue resuscitative measures. Dr. Claman subsequently filed an "incident report" with the hospital criticizing Dr. Wikholm's treatment. The hospital's internal peer review concluded that Dr. Wikholm failed to provide "aggressive trauma management."

The defendant was charged with second-degree murder. Based upon the victim's medical records and interviews with hospital personnel, who were involved in the victim's care, the defendant sought to raise an intervening cause defense. The prosecution moved to prevent the defense based on its argument that, although Dr. Wikholm's care may have been substandard, it did not rise to the level of an intervening cause.

At the pretrial hearing on the prosecution's motion to prevent the defendant from presenting an intervening cause defense, the parties disputed the standard of proof required for an intervening cause defense. The prosecution argued that the defendant had the burden of proving within a reasonable degree of medical certainty that Dr. Wikholm's gross negligence caused the death. The defense argued that, in order to raise the defense, there need be only a scintilla of evidence to support an intervening cause theory.

The defense made an offer of proof as to the testimony of a number of medical practitioners. This testimony would have been that Dr. Wikholm made several errors in his diagnosis and treatment of the victim. Additional testimony would have been that Dr. Wikholm unnecessarily delayed treatment and that given proper timely treatment the patient may have had a better chance of survival. Finally, the defense would have offered testimony that the patient survivability rate after a heart wound is higher than 50% and in certain circumstances increases to 80% if afforded proper treatment.

Although the defendant offered to present testimony of doctors and nurses who were critical of Dr. Wikholm's care, he did not offer testimony that Dr. Wikholm's allegedly substandard care was the cause of the victim's death. In fact, all of the doctors would have testified that the cause of the victim's death was the stab wound inflicted by the defendant.

In a written order issued on October 19, 1995, the trial court disallowed the defendant's intervening cause defense. The court found that, according to People v. Calvaresi, 188 Colo. 277, 283, 534 P.2d 316, 319 (1975), a defendant is entitled to an intervening cause instruction only if the improper medical care is a cause "but for which death would not have occurred." According to the trial court's reasoning, the victim would have died from the stab wound had no care been rendered. Therefore, "no acts or omissions by [Dr. Wikholm] changed the course of natural effects that flowed from the stabbing of the victim." Furthermore, the trial court concluded that, despite evidence that given proper medical care the defendant would have had a better chance of survival, the treatment received by the victim did not contribute to his death, it merely failed to prevent it. Therefore, the physician's treatment did not constitute an intervening cause.

The defendant was found guilty of manslaughter as a lesser-included offense of second-degree murder, and the trial court entered a judgment of conviction. The court of appeals reversed the conviction and ordered a new trial. See Saavedra-Rodriguez, 949 P.2d at 88. The court of appeals held that Calvaresi stands for the proposition that "once a physician undertakes a duty to treat a victim, grossly negligent delay in diagnosing and providing medical treatment can amount to an intervening cause of death if adequate timely medical treatment would have saved the victim's life." See id. The court of appeals found that the question of whether Dr. Wikholm's care amounted to gross negligence constituting an intervening cause should have gone to the jury. See id.

We agree with the trial court. We hold that improper medical treatment does not relieve the defendant of liability for the death of the victim unless the treatment is grossly negligent and death probably would not have otherwise occurred. Therefore, we reverse the judgment of the court of appeals.

II.

In order to resolve the issue before us, we must first set forth the essential components of an intervening cause defense in criminal law. We then define the quantum of evidence necessary to raise this issue before a jury and determine whether the defendant's offer of proof met this standard.

A.

A conviction for criminal homicide requires proof beyond a reasonable doubt that death was a natural and probable consequence of the defendant's unlawful act. See Hamrick v. People, 624 P.2d 1320, 1324 (Colo.1981). The prosecution therefore must prove that the defendant's conduct was the actual cause of death, in the sense that it began a chain of events the natural and probable consequence of which was the victim's death. See id. at 1323. However, under certain circumstances, the defendant may be relieved of liability for the death of the victim if there has been an independent intervening act. See Calvaresi, 188 Colo. at 283, 534 P.2d at 319. An independent intervening cause is an act of an independent person or entity that destroys the causal connection between the defendant's act and the victim's injury and, thereby becomes the cause of the victim's injury.

In Calvaresi, we adopted Wharton's rule on intervening cause:

To warrant a conviction for homicide, the death must be the natural and probable consequence of the unlawful act, and not the result of an independent intervening cause in which the accused does not participate, and which he could not foresee. If it appears that the act of the accused was not the proximate cause of the death for which he is being prosecuted, but that another cause intervened, with which he was in no way connected, and but for which death would not have occurred, such supervening cause is a defense to the charge of homicide.

1 Ronald A. Anderson, Wharton's Criminal Law and Procedure § 200, at 448 (12th ed.1957); see Calvaresi, 188 Colo. at 283, 534 P.2d at 319. We explained that an intervening cause is a defense to the charge of homicide if it is unforeseeable, and a cause without which death would not have occurred. We discuss these components in turn.

For an independent intervening cause to relieve a defendant of liability it must not be reasonably foreseeable. Simple negligent medical treatment, although hopefully unusual, is sufficiently ordinary that we consider it foreseeable. "[N]egligence, unfortunately, is entirely too frequent a human conduct to be considered 'abnormal' ". Calvaresi, 188 Colo. at 283, 534 P.2d at 319, (citing Perkins on Criminal Law § 9, at 716 (2d ed.1969)). For this reason, we have previously stated that mere negligence on the part of an attending physician does not constitute a defense. See id., at 283, 534 P.2d at 319. Therefore, one who has inflicted a wound or injury upon another is criminally responsible for the victim's death even where different or more skillful medical treatment might have saved the victim's life, or where death was immediately caused by a surgical operation rendered necessary by the wound or injury. See State v. Jackson, 223 N.W.2d 229, 233 (Iowa 1974).

In Calvaresi, we recognized that unlike simple negligence, gross negligence is sufficiently extraordinary to be classified as unforeseeable. See 188 Colo. at 283, 534 P.2d at 319. Where medical treatment is so deficient as to constitute gross negligence or intentional malpractice,...