Argued: March 13, 2019
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.
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.
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
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.
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.
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
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."
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
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.
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.
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.
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.
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.
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.
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
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
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
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 ...