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State v. Saintil-Brown

Supreme Court of New Hampshire

April 17, 2019


          Argued: March 13, 2019

          Gordon J. MacDonald, attorney general (Brandon H. Garod, assistant attorney general, on the brief and orally), for the State.

          Christopher M. Johnson, chief appellate defender, of Concord, on the brief and orally, for the defendant.

          HICKS, J.

         The defendant, Katherine Saintil-Brown, appeals her convictions by a jury in Superior Court (Delker, J.) for negligent homicide, see RSA 630:3 (2016), criminal neglect of an elderly adult, see RSA 631:8 (2016) (amended 2016), and failure to report adult abuse, see RSA 161-F:46 (2014) (amended 2016), :50 (2014). The defendant's convictions were based upon her failure to call for help while her elderly mother, the victim, lay in her own waste on the floor of their shared home for multiple days. On appeal, the defendant argues that the evidence was insufficient for the jury to have convicted her of the three charges. She also argues that the trial court erroneously instructed the jury on the criminal neglect of an elderly adult charge and that this error requires reversal of her conviction on that charge. The defendant raises her appellate arguments under our plain error rule. See Sup. Ct. R. 16-A. As to the jury instruction issue, the State agrees that the trial court's instruction was erroneous and that the error was plain, but asserts that the error does not require reversal. We affirm.

         I. Background

         The jury could have found the following facts based upon the evidence at trial and the reasonable inferences to be drawn therefrom. The victim was nearly 76 years old when the events that led to her death occurred. See RSA 631:8, I(d) (defining an elderly adult as a person who is 60 years of age or older). For years, the victim's personal hygiene was lacking. Former co-workers testified that as early as the 1990's, the victim would not use the toilet, but would instead urinate and defecate wherever she was sitting or standing.

         When the victim's husband died in 2012, the victim became depressed, and her depression caused her to neglect her personal hygiene even more than before. After her husband died, the victim essentially ceased taking showers. Nor did she clean her home. The walls and floors of her home were full of feces. At one point, her sink was so clogged with food that mice built nests in it. Towards the end of her life, the victim spent her days sitting in a chair, watching television, and talking on the telephone with her sister. She would not leave her chair to toilet, but would instead relieve herself where she sat and would not clean herself after having done so.

         The victim's depression also led her to neglect her medical needs. After her husband died, the victim ceased seeing medical service providers because she blamed them for his death. Thus, although her feet were perpetually swollen because of injuries she sustained in a car accident in the 1960s, she refused to get medical care. In addition, the victim was "morbidly obese" and used a walker.

         In September 2014, the defendant and her daughter (the victim's granddaughter) moved into the victim's mobile home to take care of her. They "essentially liv[ed] there for free" as the victim paid the monthly rent and for all household utilities, except for internet service. The defendant knew before moving into the victim's home that the home was "filthy" and that the victim "had no personal hygiene." The defendant told her daughter that "the house might be a hazard" and that her daughter would "get sick from living there."

         However, even with the defendant and her daughter living with the victim, the victim's personal hygiene remained lacking. One of her feet was swollen and purple, and her home was "unkept, dirty, [and] smelled inside."

         The defendant and the victim had a strained relationship. Over the years, the defendant was heard telling the victim, "I can't wait until you die so I can get your money."

         The victim had an annuity account valued at $50, 000 that she opened in March 2014; the defendant and her daughter were the co-beneficiaries of the account. She also had an IRA valued at $17, 280; the defendant and her daughter were also the co-beneficiaries of this account.

         On February 12, 2016, the victim fell to the floor of her mobile home. She remained there for five days, lying in her own waste, before the defendant called the fire department for a "lift assist." The day of the fall, the defendant and her daughter attempted to lift the victim off the floor, but were unable to do so. The victim also attempted unsuccessfully to lift herself off the floor. According to the victim's granddaughter, the victim was wearing neither pants nor underclothing that day.

         The next day, the defendant and her daughter again attempted to lift the victim off the floor, but were, again, unable to do so. On the fourth day after the victim fell to the floor, the defendant and her daughter searched the internet for symptoms of strokes and other ailments because they "wanted to know why she wasn't getting up" and "was just laying there." Nevertheless, the defendant did not call the fire department for help that day. Rather, the defendant decided that if the victim was still unable to get off the floor the following day, she would call for help then. On the fifth day after the fall, because the victim could not get up from the floor, the defendant called the fire department.

         When firefighters found the victim, she "was covered in urine and feces." Her thin, cotton nightgown was wet and filthy. Firefighters saw a hole in the floor of the mobile home, approximately four feet from where the victim lay. Firefighters asked the victim to identify the President and to tell them what day and month it was. Firefighters had to ask the victim questions two or three times before she would respond. Her responses were sometimes inappropriate, such as when asked who the President was, she responded, "No." Eventually, she answered the firefighters' three questions, but gave wrong answers to two of them. Based upon her inability to answer all three questions correctly and upon the fact that she had obviously urinated and defecated on herself, the firefighters concluded that the victim had an "altered mental state." Because it was winter and the victim had been on the floor for five days, in addition to taking her blood pressure, firefighters also took her temperature, and discovered that her blood pressure was low (89/54) and that she was hypothermic. Given her altered mental state, the firefighters decided that they had "to do what's best" for the victim and transport her to the emergency room of a local hospital for care.

         When firefighters removed the victim from her home, she did not protest going to the hospital. The defendant appeared not to show any "concern at all for what was going on" as firefighters attended to the victim. When firefighters asked the defendant why she had not called for help sooner, she did not answer. The defendant told the firefighters that she did not know how the victim ended up on the floor, but guessed that the victim might have tried to sit on her chair and then decided to lie on the floor instead.

         The defendant called the hospital twice while the victim was being treated. In the first call, the defendant said that the victim was able to walk around, but that she simply refused to do so. The defendant also said that a social worker had visited the home and told her "that they were not able to force [the victim] to go" and that the defendant should "let [the victim] stay on the floor." However, in February 2016, the first and only report made to adult protective services regarding the victim's fall was made on February 17 by emergency responders. There were no documented visits in February 2016 to the victim's home by adult protective services. The defendant also told the emergency department that, if the victim was soiled, she must have soiled herself on the way to the hospital.

         The defendant called the hospital again approximately an hour later, hysterical. She screamed at the nurse who answered the call: "[E]veryone is blaming [me] and it's not [my] fault." She also screamed, "I can't force her to get off the floor. What am I supposed to do? She has rights. Her social worker was here the other day and told me that I couldn't force her." When the nurse explained that no one was blaming her, the defendant continued to scream.

         The emergency department physician who examined the victim found her to be "calm and cooperative." Based upon the victim's low blood pressure and body temperature and upon the fact that she had been lying on the floor in her own waste for five days, the physician was concerned that the victim might have a severe infection. Specifically, she was concerned that the victim's infection might have become septic. Such an infection, if left untreated, results in death.

         The physician later discovered that the victim had an ulcer on her left inner thigh and black tissue "about the size of a computer mouse" in the same area. An ulcer is the breakdown of skin from pressure. According to the physician, "[b]lack tissue is dead rotting flesh." Based upon CT scans and laboratory test results, the physician diagnosed the victim with necrotizing fasciitis, which is the most common type of necrotizing soft tissue infection.[1]

         Necrotizing soft tissue infection is a rare, serious, aggressive bacterial infection that, in effect, kills the body's soft tissue. It is caused by bacteria that gain entry to the body through an open wound and then burrow into the body's layers of fat and muscle, below the skin. Necrotizing soft tissue infection spreads "[v]ery, very quickly." So-called "flesh-eating disease" is one form of necrotizing soft tissue infection. According to the physician, "[t]he sooner you can initiate treatment[, ] the better" because "[t]he longer you wait, the higher [the] likelihood that you die." As another physician testified, "every hour counts" with these kinds of infections. To treat necrotizing soft tissue infection, the infection must be removed surgically. Treatment usually also involves skin ...

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