Showing posts with label subdural haemorrhage (acute). Show all posts
Showing posts with label subdural haemorrhage (acute). Show all posts

Thursday, 24 November 2011

SBS: Oklahoma: Raven Koch death homicide

November 16th, 2011,

DAVIS, Okla. -- An Oklahoma mom is seeking justice. Her 11-month-old daughter is dead. Raven Koch was at a babysitter's house when police reports show something went horribly wrong. The OSBI has investigated the case; however, so far they have not been able to name any suspects or make any arrests.
In fact, the family is starting to believe no one will ever face charges.
According to the Medical Examiner, Raven died of accute subdural hematoma due to shaken baby syndrome.
The case was ruled a homicide but to this day no arrests have been made.
Taryn Koch, Raven's mom, said, "It's very discouraging to know my daughter was murdered violently and no one will ever pay for it."
The Medical Examiner's report shows there was not only hemorrhaging on her brain, but that she had been shaken so violently her eyes were no longer attached.
The M.E. also said the abuse was recent.
While doctors at Children's Hospital told Taryn the injury was fresh, a doctor at the first hospital to treat Raven said it could have happened anytime within the two weeks leading up to that day.
Because of that doctor's analysis, investigators have to look at anyone who had contact with Raven in her last two weeks of life.
Taryn said, "Everyone has basically told me their hands are tied. Without a confession, nothing can be done."
The district attorney here in Murray County refused to do an on-camera interview with us.
However, he did tell us there are numerous people who could be potential suspects in this case.
He also said there is not enough evidence to prove any one person did this, which means there may never be justice for Raven.
Taryn said, "Crying myself to sleep the rest of my life isn't going to work."
Taryn said she doesn't want just anyone convicted, but she does hope the person responsible will some day come forward.
She said, "I miss Raven dearly and she deserves justice and I deserve closure."
Investigators are hoping someone out there has more information that could lead to an arrest and charges in this case.
If you have information, you are asked to contact the OSBI or the Murray County District Attorney's Office
http://mcclaincounty.kfor.com/news/news/86446-mom-wants-justice-shaken-baby-syndrome-death

SBS: Oklahoma: Helen Terrell charged

http://tahlequahdailypress.com/local/x229373632/Woman-charged-with-shaking-baby

Saturday, 14 May 2011

SBS: Ohio: John Wilbert Jones' expert medical witness

Ed Meyer :
The lead detective in the Summit County murder trial of 18-year-old John Wilbert Jones unequivocally told the jury Friday that the defense theory on the case was wrong.
Gary Shadie, the Akron police detective who investigated the fatal head injuries to the defendant's 6-month-old daughter, Jada Ruiz Jones, based his testimony on the case timeline.
Both sides have agreed that Jada's mother, Deja Ruiz, the 19-year-old former girlfriend of Jones, left her Springdale Drive apartment and caught a bus for school at 8:05 on the morning of March 19, 2010.
A recorded 911 call, in which Jones told police he saw Ruiz off then awoke to find Jada was not breathing, began at 9:44 a.m.
At that time, Jones alone was caring for Jada, her twin sister and their 2-year-old brother in the Akron Metropolitan Housing Authority apartment.
Based on the Akron police investigative reports, as well as input from all of the doctors who treated Jada's head injuries that day at Akron Children's Hospital, Shadie told the jury that the effects of those injuries would have rendered her unconscious within ''a very narrow window.''
That period of time, Shadie testified, would have been ''immediately to within 30 minutes.''
''There was no possible way that Deja could have caused the injuries prior to her leaving at the agreed upon time, which they both said was 8 o'clock in the morning,'' Shadie testified.
He said that based on input from the doctors, Jada was a victim of shaken baby syndrome.
Lead defense counsel Joseph F. Gorman told the 30-member jury pool Tuesday morning — hours before the final panel was chosen — that the defense's position was that Deja Ruiz inflicted the injuries before leaving for school.
Common Pleas Judge Patricia Cosgrove is hearing the case. Jury instructions and closing arguments are scheduled for Monday morning.
Jones, who was 17 at the time of Jada's injuries, had his case bound over to adult court months after the incident. He was indicted Nov. 2 on two counts of murder, two counts of felonious assault and three felony counts of child endangering.
The murder charges were filed after Jada was removed from life support and pronounced dead July 16.
Children's Hospital doctors who treated Jada testified previously that, in addition to her head injuries, she had retinal detachments, fractures of the right and left upper arm, right thigh and lower right leg, left thigh and lower left leg and a spinal injury.
After the state rested Friday, the defense challenged the analysis of the head injuries by local authorities with lengthy testimony by Dr. Jonathan L. Arden, a veteran forensic pathologist from McLean, Va.
Arden received his medical degree from the University of Michigan in 1980. He did his residency at New York University Medical Center, later served as an assistant medical examiner for the state of Delaware and worked in the New York City medical examiner's office for nine years, eventually rising to a position there of second in command.
He was on the witness stand for more than three hours.
Arden testified that Jada had two types of head trauma — both collections of blood on the brain known in medical terms as hematomas.
He told the jury one was an ''acute,'' or fresh hematoma, which could have occurred up to one week before Jada's brain scans at Children's Hospital.
The other was a ''sub-acute,'' or older hematoma, which was in the middle stages of healing and could have occurred from one to three weeks before the hospital brain scans, Arden said.
Arden said he strongly disagreed with the opinions of the local medical authorities that the effects of Jada's head injuries would have left her unconscious immediately.
He told the jury he had the experience of 2,300 to 2,400 forensic autopsies during his long career and at least 400 pediatric autopsies.
If Jones is convicted of either of the murder charges, he could be sentenced to life in prison.
http://www.ohio.com/news/121418709.html

Thursday, 7 April 2011

SBS: Virginia: Dedrick Fisher acquitted

Ebony Horton 
FORT RUCKER – Civilian defense attorney Victor Kelley patted the back of Spec. Dedrick Fisher on Thursday after what Kelley said was the most important day in the rest of Fisher’s life.
Perhaps it was, as the Fort Rucker soldier walked away a free man after a six-soldier panel unanimously acquitted him in a general court martial of all charges relating to the death of his infant son, Dedrick Fisher Jr., according to Fort Rucker Public Affairs Officer Lisa Eichhorn.
Baby Dedrick died Feb. 2 after he was unable to recover from brain injuries he suffered when prosecutors said Fisher shook him in November 2008. The baby, who was seven weeks old at the time of the alleged incident, could not eat or breathe on his own, according to authorities.
If Fisher had been convicted after the three-day trial, he would have faced dishonorable discharge and up to 10 years in a federal prison for a charge of involuntary manslaughter.
He also could have faced lesser charges, including negligent homicide or battery.
Kelley said expert testimony in the three-day trial showed there was no way shaking could have caused the degree of injuries from which baby Dedrick died.
“You’ve heard Dr. Uscinski say ‘this was a case of subdural injury created by a birth trauma,’ and that he did not agree with the government’s case … that shaking did not cause Dedrick’s death,” Kelley said.
“Everybody is sorry they lost a son, but there’s nothing we can do to make it better. What could (have) made it worse was to convict an innocent man.”
Fisher’s case included testimony from both he and his wife, Eliana.
Fisher maintained he was feeding baby Dedrick when he choked on milk.
Authorities said Fisher never called 911, but instead traveled through Fort Rucker in search for help.
Prosecutors maintained the bleeding baby Dedrick’s brain suffered was not caused by a baby choking and that Fisher had admitted at least twice to shaking his son, who military prosecutor Capt. Shawn Tate said Fisher referred to using an explicative.
Tate said Fisher also claimed other reasons as to how his child died.
“We (were) here for baby Dedrick. He doesn’t get a second chance. He’s not here to tell us what happened … (but) only one story makes sense, and that is that Dedrick Fisher Jr. died from abusive head trauma,” Tate said.
“Spec. Fisher lost a son. He was a good soldier, but no matter how good he has been, he made a mistake that day. He messed up.”
According to presiding military Judge James Pohl, Fisher was able to go home after the case.
The case will not appear in his record and there have been no other arrests in the case, according to Eichhorn.

SBS: Florida: Anibal Angel Rios 2006 trial

ALEXANDRA ZAYAS: Published March 9, 2006


TAMPA - Anibal Angel Rios had remained composed throughout his trial this week in Hillsborough Circuit Court, but he choked up Wednesday when he spoke of the infant son he is accused of fatally shaking.
Rios, 21, testified in his own behalf Wednesday.
He said he had been a surrogate father to his two younger siblings, and helped his girlfriend Jacqueline Santiago, 26, care for her two children. In 2003, when he was 19, he learned that the baby Santiago had just given birth to was his. He said he was exhilarated to be a father.
And he was determined to be a good one.
"I didn't want to run out on his life like my father did to me," Rios said, his voice cracking. "I just wanted to be there."
He quit his job to care for the baby and Santiago's two other children full time. The dirty diapers, nightly feedings and the baby's crying didn't bother him, he said.
"I loved him," Rios said. "That's my son."
But Rios was charged with first-degree murder and aggravated child abuse after his 3-month-old son Victor Smith died on Christmas Eve 2003. Authorities say the child died of shaken baby syndrome. Rios told a different story.
He said he needed to shower, so he placed Victor on a pallet of blankets and pillows to watch him. Victor began to cry.
Rios jumped out of the shower and quickly picked the baby up underneath its armpits, and the baby's head rolled back, he said. Victor stopped crying. He wasn't breathing.
"I know I picked him up quick, but I didn't pick him up quick to hurt him," Rios said. "I just picked him up quick to hold him in my arms and get him to stop crying."
Rios denied violently shaking the baby.
Dr. Ronald Uscinski, a Maryland neurosurgeon who testified as an expert witness for the defense, cast doubt on the shaken baby accusation, saying there was no damage to Victor's neck, and no grab marks on his body.
Doctors for the prosecution have testified that neither need to exist to prove a baby was shaken.
Uscinski thinks the baby died of a subdural hematoma, an accumulation of blood in the tissue around the brain, that could have occurred as early as birth. The collection of blood on the surface of the baby's brain was evidence of a chronic condition that could have been aggravated independently of Rios, he said.
Uscinski, who has testified for the defense in shaken baby cases across the nation, said he thinks subdural hematoma is often confused for shaken baby syndrome.
The trial is expected to end today. The case was originally heard in May 2005, but ended in a mistrial when the jury failed to arrive at a verdict.
http://www.sptimes.com/2006/03/09/Hillsborough/Emotional_father_deni.shtml

AHT: Tiffani Calise has benefit of experience defense witness

Ed Meyer

 Aaliyah Ali, age 23 mos.

The Summit County case of a 20-year-old baby sitter accused of murdering a toddler is being challenged in a new report.
An expert for the defense asserts that blunt impact to the little girl's head ''did not cause her death'' and was of such a nature that ''she could have recovered.''
Accidental death cannot be ruled out, the report concluded.
The forensic report by Ronald H. Uscinski, a neurosurgeon on the faculties of Georgetown University Hospital and George Washington University Medical Center in Maryland, was filed in Common Pleas Court for the upcoming trial of Tiffani D. Calise of Green.
And by the court's own admission, it could carry considerable weight in the determination of innocence or guilt. Uscinski has garnered headlines for past testimony on behalf of defendants in shaken-baby cases.
Judge Alison McCarty addressed the importance of forensic analysis of the toddler's injuries when the two sides met in a pretrial hearing last November, saying this is a case in which ''medical testimony is going to be rather crucial.''
Calise is to go to trial April 11 on charges of murder, involuntary manslaughter and two counts of child endangering.
Evidence not in dispute shows she was caring for two children at her Mayfair Road apartment — her 34-month-old daughter and a 23-month-old, Aaliyah Ali — when Aaliyah suffered a head injury late in the evening of Aug. 9.
Calise, who had been baby-sitting the children for two days over the weekend, told sheriff's deputies and family members she gave Aaliyah a bath and left her alone in a nearly empty tub for only moments to retrieve a towel.
 While she was away, Calise said, she heard a thud and returned to find Aaliyah unconscious.
According to the autopsy's Report of Investigation, Calise called 911 and tried to administer CPR, following the dispatcher's instructions.
A Green emergency squad arrived at the apartment nine minutes later, at 11:52 p.m, and found Aaliyah unresponsive.
Aaliyah was face up on the living room floor ''with a small amount of vomit on the floor next to her,'' a medical examiner's investigator, Michael McGill, said in his report.
Some 30 minutes later, Aaliyah arrived at Akron Children's Hospital. Emergency room personnel tried unsuccessfully at 12:31 a.m. to insert a breathing tube.
Hospital reports stated that doctors found a bread-like substance obstructing Aaliyah's airway, removed it and inserted the breathing tube in a second attempt two minutes later.
Brain scans showed bleeding had occurred in the right side of the brain. Aaliyah did not improve and was pronounced dead at 1:57 a.m. Aug. 12.
Medical dispute
That is where the medical dispute begins, and why the court agreed to pay for a forensic expert for the defense.
The Summit County Prosecutor's Office has declined to comment about the case, saying any comment could jeopardize the fairness of trial proceedings or the selection of the jury.
But from subpoenas it appears that much of the prosecution case has been built around forensic evidence from the Summit County autopsy report; the testimony of the forensic pathologist who performed the autopsy, Deputy Medical Examiner Dorothy E. Dean; and the testimony of Dr. R. Daryl Steiner, who heads the Children's Hospital child abuse center.
In Dean's autopsy report, she said that Aaliyah died from ''complications of blunt impact(s) to the head.''
Dean's ruling on manner of death was ''homicide, assaulted by another person(s).''
The ''Opinion'' section of the report contained Dean's observation that Aaliyah died ''from the severe injuries to her brain that she sustained during the assault.''
According to Dean, those injuries included internal pressure on the brain; bleeding between the brain and skull layer; optic nerve and retinal bleeding; bleeding of the right-side gel in the eye; and oxygen deprivation in the brain.
As he has done in numerous Summit County cases during the past three decades, Steiner is expected to testify that Aaliyah died from brain injuries in a case of shaken baby syndrome.
The forensic report by the defense expert, Uscinski, who has more than 40 years of experience in neurosurgery, is expected to counter those findings.
Defense's report
Attorney William T. Whitaker, co-defense counsel for Calise, said it would be inappropriate for Uscinski to comment about his findings before the trial.
But in Uscinski's forensic report, filed March 21 in the court record, he said Aaliyah suffered a ''subdural hematoma'' — the term for collection of blood on the brain's surface — ''not inconsistent with the reported fall in the bathtub.''
''The right-sided subdural hematoma is not large and the impact that resulted in the subdural hemorrhage [bleeding] did not cause her death and was an injury from which she could have recovered,'' Uscinski's report stated.
Uscinski noted that vomiting is one of the ''common effects of a head injury resulting from an impact of this nature.''
He said the breadlike substance found in Aaliyah's throat ''would serve to obstruct her airway and resulted in an interruption in Aaliyah's ability to breathe, and this resulted in lack of oxygen to the brain.''
Uscinski also noted that the brain has ''an absolute metabolical requirement for oxygen,'' and that after about four minutes of complete oxygen deprivation, brain cells begin to die.
The breadlike substance was removed from Aaliyah's throat ''some 30 or more minutes'' after she began vomiting, Uscinski said.
Results of the hospital CT scans were consistent with brain-cell death from oxygen deprivation caused by the obstruction ''to the airway of this baby,'' Uscinski wrote.
A nonaccidental injury such as abuse or assault, as noted in Aaliyah's Summit County autopsy, ''is a diagnosis that is only arrived at after ruling out all other reasonable possibilities.''
''In this case,'' Uscinski concluded, ''I do not believe other reasonable possibilities including accidental injury have been ruled out. Therefore, I do not believe there is any basis upon which to conclude that Aaliyah Ali's death was caused by the intentional infliction of trauma by Tiffani Calise or by anyone else.''
Whitaker, Calise's lawyer, won a case in juvenile court several years ago by challenging Summit County autopsy findings and Steiner's shaken-baby testimony.
The forensic expert in Whitaker's juvenile case also was Uscinski.
http://www.ohio.com/news/119165754.html

Thursday, 31 March 2011

AHT: STATE OF IDAHO v. STACEY LEWIS GROVE



Filed March 25, 2011.
Stacey Lewis Grove appeals from the judgment of conviction entered upon a jury verdict finding him guilty of first degree felony murder, by aggravated battery of a child under twelve years old. For the reasons set forth below, we affirm.
Stacey Grove was indicted for the first degree felony murder of K.M., his girlfriend's twenty-three-month-old son, who was beaten and died as a result of his injuries on July 11, 2006. On July 7, 2006, it was observed that K.M. was not acting normally and that he appeared lethargic and "puny." Lisa's mother took him to the doctor, but nothing of significance was found. That evening, Lisa brought K.M. home, but Grove was absent from the house overnight and was never around K.M. The next morning, Todd's wife picked up K.M. for an overnight visitation. Lisa and Grove went on a recreational outing and Lisa's daughter was with a relative in Oregon.
At approximately 4 p.m. on July 8, Todd and his wife decided it was necessary to take K.M. to the emergency room, where they expressed concerns about a sore on K.M.'s nose and several bruises on his jaw and one under his armpit and requested that Child Protection Services (CPS) be called. A doctor examined K.M. and called CPS who consulted with the family. K.M. left the hospital with his father and stepmother at approximately 7:10 p.m.
On July 9, Todd returned K.M. to Lisa who proceeded to bathe K.M. She testified that K.M. was continuing to act ill and wanted to be held for a prolonged period, which was unusual. When K.M.'s older sister arrived home, K.M. was excited to see her and briefly acted more lively. He opened a gift from his sister and the two played with a balloon. At dinner K.M. exhibited a normal appetite, but after dinner he acted tired and declined to color in a book his sister had provided to him. Lisa put him to bed an hour early.
The next morning, Monday, July 10, Lisa awoke at approximately 5:15 a.m. and checked on K.M. She found him awake, laying on his back with his eyes open, and noticed there was dry vomit in the bed. Lisa put K.M. in the bathtub and noticed that he was "very, very pale" and, unlike his usual behavior, did not enjoy his bath. K.M. was placed on Lisa and Grove's bed where he watched cartoons and, according to Grove, again attempted to throw up and his lips turned purple. Because she was the only one who could open the building, Lisa left K.M. with Grove and took her daughter with her to work, planning to come home as soon as she could.
After arriving at work, Lisa noticed that Grove had called and she returned his call at approximately 7:54 a.m. Grove told her that K.M. was worse than when she had left, he was worried about K.M., and he wanted Lisa to come home. Lisa spoke to her son and told him she loved him to which he responded "I too." Lisa testified that K.M. sounded "droopy" on the phone.
At around 8:20 a.m., a hysterical Grove called Lisa and demanded that she come home immediately. He told her that K.M. was not breathing right and that he was getting him ready to take him to the doctor. Lisa arrived home approximately ten minutes later. When she entered, K.M. was laying on the floor on a blanket, struggling to breathe. He appeared to be having convulsions and his eyes were rolling back into his head. Lisa called 911 at 8:54 a.m.
After arriving at the home, paramedics immediately transported K.M. to the hospital where Dr. Jay Hunter quickly diagnosed him as having a severe head injury, which he characterized as "shaken baby syndrome" that occurred in the last twenty-four hours. After Dr. Hunter determined that K.M. needed more specialized care than the hospital could provide, he was taken by helicopter to a hospital in Spokane. At approximately 3 p.m., doctors informed Lisa that K.M. was not going to survive. He was declared brain dead on July 11 at 9:20 a.m., the date on which his death certificate indicates was his date of death. Cardiac death occurred on the morning of July 12 when the organ donation procedure was performed.
The night of July 12, Grove and Lisa stayed at Grove's father's house during which time Grove tearfully told Lisa that something had happened to K.M. while he had been watching him on July 10. Lisa loudly asked Grove what had happened, causing Grove's father and stepmother to enter the room. Grove told them that he had placed K.M. on the counter, left him there to go get a brush, and K.M. had fallen off.
Approximately six months later, a grand jury indicted Grove for first degree felony murder, Idaho Code §§ 18-4001, 18-4002, 18-4003(d). Count 1 reads as follows:
That the Defendant, Stacey L. Grove, on or about the 10th day of July 2006, in the County of Nez Perce, State of Idaho, did, during the perpetration of or attempt to perpetrate the crime of Aggravated Battery, on a child, to-wit: [K.M.], a human being, who was under the age of twelve (12) years, to-wit: approximately twenty-three months old . . . by striking him in the stomach and/or head and/or back and legs which caused abdominal bleeding, brain injury and musculature hemorrhaging from which he died.
At trial, both the state and the defense presented the testimony of several medical experts. The emergency room doctor, Dr. Hunter, testified that his opinions regarding K.M.'s condition had changed after reviewing the autopsy report. He first testified that he did not believe that K.M. had "simple" shaken baby syndrome and testified that his injuries were consistent with either being ejected from an automobile or being beaten very severely. Dr. Hunter also testified that based on the autopsy report, it was his opinion that K.M. would have been immediately symptomatic after being beaten—including having a severe headache and confusion—and would have been close to unconsciousness. Thus, Dr. Hunter opined, K.M. could not have been fatally injured prior to the morning of July 10.
Dr. Marco Ross, who, at the time of K.M.'s death, was employed as the county's medical examiner and performed the autopsy of K.M.'s body, testified as the state's forensic pathologist. He stated that he had noted bruising on the body, several hemorrhages in K.M.'s brain and eyes and in other parts of his body, and internal bruising. Dr. Ross indicated that he removed K.M.'s brain, and consistent with his office's procedure, sent it to Dr. Ross Reichard, a neuropathologist at the University of New Mexico. He testified that Dr. Reichard performed an autopsy of the brain and sent a report of his findings and conclusions to Dr. Ross. Dr. Ross summarized Dr. Reichard's report, which indicated that K.M.'s brain showed a bilateral subdural hemorrhage, bilateral subarachnoid hemorrhage, and several other injuries as well as a laceration in the corpus callosum "which is a part of the brain that connects the two separate hemispheres of the brain[.]" Dr. Ross then testified that:
[T]he laceration itself would sever some nerve bundles that travel between each side of the brain. And actually that injury, in and of itself, per se, may or may not have a lot of recognizable changes in a person who survives such as that.
But what's more significant is the fact that—that a tear did occur is indicative of a degree of force that was impacted upon the head that an individual who sustained a laceration of the corpus callosum as a result of blunt force impact, you know, probably would have been rendered unconscious or nearly unconscious at the time of the impact.
Dr. Ross explained that according to Dr. Reichard's report, K.M.'s brain injuries showed a lack of inflammation and therefore would have been inflicted shortly before death. He also testified that applying the force necessary to lacerate the corpus callosum would likely have caused K.M. to become unconscious at the time of impact. He testified that based on his examination, all of the injuries, with the exception of a few bruises on K.M.'s lower back and jaw, were caused at approximately the same time—which was less than three to four days before K.M.'s cardiac death on July 11, and more likely one to two days before. He indicated that K.M.'s abdominal injuries would have immediately caused him debilitating pain and that his brain injuries would have rendered him almost immediately unconscious or nearly so. On this basis, he opined that K.M. could not have suffered such an injury prior to going to bed the night before based on the testimony from Lisa and others about K.M.'s physical activity that night and on Monday morning as those activities would have been impossible had K.M. already suffered the beating which eventually caused his death. Dr. Ross specifically noted that K.M. would not have been able to speak on the phone with his mother.
On cross-examination, Dr. Ross testified that he had not performed any independent testing on K.M.'s brain. He testified that he would have generally been able to identify several of the hemorrhages, but not other injuries including a corpus callosum laceration which can only be identified through microscopic examination. Dr. Ross indicated that while it would be possible to review Dr. Reichard's findings by viewing the "recuts" with a microscope, he had not done so. He further testified that he did not recall if photographs had been taken of the tissues viewed by Dr. Reichard or whether he had reviewed any such photographs.
Based on his observations and the injuries described in Dr. Reichard's written report, Dr. Ross testified that it was his expert opinion that K.M.'s death was caused by homicide, specifically due to blunt impact injuries to his head which caused a subdural hemorrhage and secondary brain swelling. Again relying on Dr. Reichard's report, Dr. Ross concluded that the hemorrhages in K.M.'s brain were "acute," meaning that the injury likely occurred "sometime immediately before death or within a day or two prior to death." Because it was determined that K.M. was brain dead at 9:20 a.m. on July 11, Dr. Ross opined that Grove had been alone with K.M. during the window in which K.M.'s head injuries likely occurred—from around 7 a.m. to approximately 8:45 a.m. on July 10.
The state also called Dr. Deborah Harper, a Spokane pediatrician with special training in child physical and sexual abuse and neglect who had been called to the hospital to examine K.M. before he died. After first describing her own observations of K.M.'s injuries when she saw him, examining his records, and speaking to his mother, Dr. Harper testified that she had relied on the autopsy reports of Dr. Ross and Dr. Reichard (without specifically telling the jury what those reports contained) and the surgery notes from the organ harvest procedure to come to a conclusion about the cause of K.M.'s death and his physical manifestations of injury prior to his death. Regarding K.M.'s injuries, she opined that
[K.M.] died as a result of two fatal injuries. The one that actually killed him first was the extremely serious brain injury that caused enormous brain swelling to the point that his brain pressure—the swelling was so great that the blood pumping from his heart could not get into the brain to feed the brain cells.
In addition to that, the pressure on the brain was pushing down through the big hole at the base here where your spinal cord goes, so he had a herniation in midbrain, which is really important for breath, and other things [were] being squished down through that.
In addition, he had really quite awful abdominal injuries. At the time of his organ harvest, the surgeon noted that he had bruising in his colon so the big— that's the large bowel. He had bruising there and bruising in his small intestine as well.
And even more than that, the—the root—that's called the mesentery. But the root that holds your intestines in place, and it's a very strong tissue. It's like— it's like really strong material, like canvas. And it's important because it holds the intestines where they belong so they don't get twisted up, and it—the blood vessels and nerves come through it. That had a rip in it. And that's just enormous force, and that was—we always suspect when children have a bad brain injury, they may have abdominal trauma. I was quite surprised myself at the extent of that major, major abdominal trauma that [K.M.] suffered.
When asked about her opinion as to when the injuries that caused his death occurred, she stated:
When these injuries occurred, he immediately looked awful. He would have been unconscious or semi-conscious, limp, not—probably not breathing well, perhaps still breathing at that time. But he would have immediately—on the blows that dealt these injuries, would have been obviously critically ill.
She also indicated her opinion that his behavior on the morning of July 10, as testified to by his mother and sister, was not consistent with having already received the injuries that would eventually kill him. She also opined that falling off the counter would not have caused the catastrophic injuries K.M. sustained, nor could such a fall have exacerbated an existing injury and caused it to become fatal because the type of injury that actually killed K.M. was a single injury that caused immediate swelling of the brain. Dr. Harper then addressed whether K.M. could have had a delayed response to the injuries to his brain—for example, a slow bleeding in his brain that would not have produced physical symptoms for a few days after the injury. When asked by the defense attorney whether she was aware that there are studies and reports in various medical journals indicating that there can be a delayed response to subdural hematomas, Dr. Harper answered:
There can be a delayed response to subdural hematomas. In [K.M.'s] case, he [had] subdural hematomas, which are interesting that they're there, but that wasn't his main brain injury. His main brain injury was actually to the physical solid part of his brain.
Grove called Dr. Jonathan Arden, a forensic pathologist based in Virginia, to testify as an expert. Dr. Arden testified that he had reviewed, among other things, the autopsy report, including the brain examination report prepared by Dr. Reichard, recuts of the microscopic slides of tissue from K.M.'s body and brain that had been used by Dr. Reichard and Dr. Ross in conducting the autopsy, and autopsy photographs. He testified that based on his review of these materials, he agreed with Dr. Ross that K.M.'s death was the result of homicide and caused by blunt impact injuries to his head—specifically referencing a subdural hemorrhage and brain swelling, but disagreed with Drs. Ross and Harper as to the timing of the injuries, stating that he believed that the significant injuries to K.M.'s head and abdomen had been inflicted at least three days prior to his death—on either July 8 or 9. He testified that his opinion on this matter had come largely from microscopic examination of relevant tissues and his observations as certain body processes which are used to date injuries.
Dr. Arden also testified that he disagreed with Dr. Reichard's conclusion that there was a laceration of the corpus callosum, rather he believed that what Dr. Reichard had perceived as a laceration was merely something that occurred during the processing of K.M.'s brain after his death. He testified that the existence of a laceration would have significant impact on whether a person would be rendered immediately unconscious or not. He testified that it was his opinion that K.M. could have engaged in all of the activities testified to—including, among other things, playing with his sister when she returned from her trip and sitting in his high chair and eating dinner—having already sustained the head injuries that would lead to his death.
Dr. Arden also opined that K.M. having thrown up in bed, being pale, and dry-heaving on the morning of July 10 are all possible symptoms of the type of head injury and abdominal injuries that Dr. Arden believed that K.M. had sustained and that it was reasonable that having sustained these injuries, K.M. would not have immediately shown symptoms and that his symptoms could have waxed and waned over a period of time. He did admit that if he assumed that the injuries had occurred on Monday morning (which he did not agree with due to his dating of the injuries through viewing the microscopic slides), it would have been consistent with his injuries for K.M. to become immediately unconscious. Dr. Arden further indicated his opinion that many of K.M.'s abdominal injuries were older and therefore there was no reason to conclude that K.M. would have been showing signs of being in excruciating pain from those injuries on July 8 or 9.
The jury found Grove guilty of first degree felony murder. Grove now appeals.

II.

ANALYSIS
On appeal, Grove raises two main issues—that his right to confrontation was violated by the testimony of Dr. Ross and Dr. Harper as to Dr. Reichard's findings and conclusions and that the district court erred in instructing the jury.
A. Right to Confrontation
Grove contends that his Sixth Amendment right to confrontation1 was violated when Drs. Ross and Harper testified as to Dr. Reichard's opinions concerning K.M.'s brain injuries, because Dr. Reichard did not testify at trial and therefore Grove had no opportunity to cross-examine him. It is undisputed that defense counsel did not object to either Dr. Ross's or Dr. Harper's testimony in this regard and thus we must examine whether it constitutes fundamental error such that we can review it for the first time on appeal.
Initially, we clarify that the crux of this issue affects the central disputed question in this case—when the injuries which ultimately caused K.M.'s death occurred and whether it was likely that K.M. would have lost consciousness and/or shown severe symptoms immediately after the injuries were inflicted. In other words, did the injuries occur on the morning that K.M. lost consciousness—and was alone with Grove—or several days prior, when it was undisputed that the injuries could not have been inflicted by Grove because he was not alone with K.M. In this regard, important to the state's theory of the case that Grove caused the fatal injuries on the morning of July 10 was the conclusion of Dr. Reichard, based on his microscopic examination of K.M.'s brain, that K.M. had suffered a laceration of the corpus callosum, which would have likely caused immediate loss of consciousness, thereby implicating Grove as the cause of K.M.'s injuries during the 36-45 minute period of time during which he was alone with K.M. Grove points out that both Dr. Ross and Dr. Harper recited Dr. Reichard's observations in this regard, as gleaned from the autopsy report, as neither was present during the autopsy nor conducted their own microscopic analysis, and relied on these observations in forming their respective opinions that K.M.'s injuries had been inflicted on July 10.
By contrast, Grove's expert, Dr. Arden, testified that he did not agree with Dr. Reichard that a laceration was present and that the anomaly was the result of handling of the brain after death. He also offered his opinion, after examination of the microscopic slides, that K.M.'s injuries had been inflicted at least three days prior to death (thus absolving Grove of having caused them) and that they would not have necessarily resulted in immediate loss of consciousness.
Generally, Idaho's appellate courts will not consider error not preserved for appeal through an objection at trial. State v. Perry, 150 Idaho 209, 224, 245 P.3d 961, 976 (2010); State v. Johnson, 126 Idaho 892, 896, 894 P.2d 125, 129 (1995). This limitation on appellate court authority serves to induce the timely raising of claims and objections, which gives the trial court the opportunity to consider and resolve them. Puckett v. United States, 129 S.Ct. 1423, 1428 (2009); Perry, 150 Idaho at 224, 245 P.3d at 976. Ordinarily, the trial court is in the best position to determine the relevant facts and to adjudicate the dispute. Perry, 150 Idaho at 224, 245 P.3d at 976. In the case of an actual or invited procedural error, the trial court can often correct or avoid the mistake so that it cannot possibly affect the ultimate outcome. Id. Furthermore, requiring a contemporaneous objection prevents the litigant from sandbagging the court, i.e., remaining silent about his objection and belatedly raising the error only if the case does not conclude in his favor. Id. However, every defendant has a Fourteenth Amendment right to due process and it is axiomatic that a fair trial in a fair tribunal is a basic requirement of due process. Caperton v. A.T. Massey Coal Co., Inc., 129 S.Ct. 2252, 2259 (2009); Perry, 150 Idaho at 224, 245 P.3d at 976. Accordingly, when an error has not been properly preserved for appeal through objection at trial, the appellate court's authority to remedy that error is strictly circumscribed to cases where the error results in the defendant being deprived of his or her Fourteenth Amendment due process right to a fair trial in a fair tribunal. Perry, 150 Idaho at 224, 245 P.3d at 976.
Recently in Perry, our Supreme Court summarized the analysis which applies in cases of unobjected-to error:
(1) the defendant must demonstrate that one or more of the defendant's unwaived constitutional rights were violated; (2) the error must be clear or obvious, without the need for any additional information not contained in the appellate record, including information as to whether the failure to object was a tactical decision; and (3) the defendant must demonstrate that the error affected the defendant's substantial rights, meaning (in most instances) that it must have affected the outcome of the trial proceedings.
id. at 226, 245 P.3d at 978 (footnote omitted).
Given that the Confrontation Clause violation issue complained of in this case implicates a constitutional right (a conclusion not disputed by the state), in determining whether we may address the issue on appeal, we first examine whether Grove has shown that the alleged error was "clear or obvious" and that there is no need for additional information on the record as to whether Grove's failure to object was a tactical decision.
In determining whether plain error exists here, we note that the Perry Court expounded on the "plain error" factor, stating that the error "must be clear or obvious, without the need for any additional information not contained in the appellate record, including information as to whether the failure to object was a tactical decision . . . ." Id. Initially, the state contends that we cannot find fundamental error, because Grove has failed to establish from the record that the lack of objection by Grove's trial counsel was not the result of a strategic decision to not object to evidence of the findings in the neuropathologist's report. Specifically, the state contends that the record indicates that the defense "tried to gain a tactical advantage" from the fact that Dr. Reichard did not testify at trial, noting:
The very first thing the defense cross-examination of the state's pathologist established was that he had not independently reviewed the brain microscopically and was instead relying solely on the examination and findings of injury to the brain done by the neuropathologist in New Mexico. The defense later spent considerable effort to rebut the findings of injury in the neuropathologist's report based upon the defense expert's personal examination of tissue samples. The defense's expert pathologist testified that personal examination of the slides of the tissue sample in this case, which Dr. Ross had not done, was a "requirement . . . to do a competent job" and "essential to a fair and competent and accurate autopsy." At argument defense counsel contended that the testimony of the defense pathologist was more reliable than the testimony of the state's pathologist because the state's pathologist relied on the "faulty information" in the neuropathologist's report, that he did not "independently review" the tissue samples, and that only the defense expert did "due diligence" by showing the jury exactly how he came to his conclusions about brain injuries. If the defense had made an objection, and excluded the evidence of the findings in the neuropathological examination, it would have lost the tactical advantage of claiming that the state's pathologist was relying on "faulty information." Perhaps even worse for the defense would have been if its objection forced the state to call the neuropathologist to the stand to give testimony on why his examination was not "faulty." (citations omitted). The state thus argues that because the record is insufficient to rule out the possibility that defense counsel's choice not to object was a tactical choice, Grove has failed to show fundamental error.
Idaho case law is not particularly developed on this issue, however in laying out the clarified fundamental error paradigm, the Perry Court cited to State v. Adams, 147 Idaho 857, 216 P.3d 146 (Ct. App. 2009) in a footnote as an example of a case where the defendant's failure to object was deemed to be a tactical decision. Perry, 150 Idaho at 226 n.5, 245 P.3d at 978 n.5. In Adams, the appellant contended that even though he had not tried to exclude the juror for cause or used a peremptory challenge, the district court had erred in failing to sua sponte remove a juror for cause for exhibiting bias where that juror had expressed some uncertainty at voir dire about whether she would "hold it against" the state or the defense if there were occasion where the jurors had to leave the room while the parties discussed a legal issue. On appeal, this Court first noted that to provide relief, the error must be fundamental and noted the limited nature of the fundamental error doctrine, recognizing that it is an exception, not the rule, and should not be "a mechanism for criminal defendants to obtain judicial review of every plausible claim of trial error." Adams, 147 Idaho at 861, 216 P.3d at 150. We then noted:
Appellate courts should be particularly careful in applying the fundamental error doctrine to what may be a matter of legitimate strategic or tactical choices by defense counsel which generally cannot be discerned from the record on appeal. See Mintun v. State, 144 Idaho 656, 662, 168 P.3d 40, 46 (Ct. App. 2007). Decisions whether to challenge a potential juror for cause fall within that category. In assessing whether to challenge a particular juror, attorneys must not only weigh the perceived negative features against the favorable features of that particular juror, they must also consider whether eliminating the juror could result in an even less acceptable individual moving into that position on the jury panel. Here, the absence of a challenge to Juror 608 may have been a tactical decision by defense counsel, because although Juror 608 gave some problematical answers in voir dire, other factors may have led defense counsel to believe that she was, on balance, a person that he wanted on the jury or that she was more acceptable than another who might be substituted for her. After his conviction, and in hindsight, Adams now contends that the trial court should have intervened sua sponte to exclude the juror for cause. We are of the view that trial courts should not be required or encouraged, in any but the most extreme circumstances, to interfere with legitimate tactics of counsel by excusing for cause a juror who has not been challenged by either party. Therefore, we will not find fundamental error in such trial court inaction in the absence of a clear record that a potential juror would be so biased against a criminal defendant, or otherwise excludable for cause, that neither the trial court nor defense counsel could have reasonably allowed the juror to serve.
id. at 861-62, 216 P.3d at 150-51. We concluded that there was not a clear record in the case that the juror in question was so biased that neither the court nor defense counsel could have reasonably allowed her to serve—she did not indicate that she was biased against criminal defendants or in favor of the state and while she indicated that she resented the removal of jurors from the courtroom when attorneys' objections required discussion in absence of the jury and that she could not promise not to hold this against the state or the defense, this was an expression of resentment toward the system, not against the defendant. Id. at 862, 216 P.3d at 151.
Importantly in the context of this case, it is well established that counsel's choice of witnesses, manner of cross-examination, and lack of objection to testimony fall within the area of tactical, or strategic, decisions. Giles v. State, 125 Idaho 921, 924, 877 P.2d 365, 368 (1994). With this is mind, we conclude that we cannot ascertain from the record whether Grove's failure to object to Dr. Ross's and Dr. Harper's testimony as to Dr. Reichard's findings and conclusions was not a tactical decision—the record simply does not eliminate the possibility that the failure to object was strategic. In assessing whether to object in this instance, defense counsel would have not only had to weigh the best case scenario that the testimony would be excluded, but also the more likely possibility that a timely objection would have prompted the state to subpoena Dr. Reichard to "defend" his findings and conclusions. Had that occurred, anything short of the unlikely circumstance of Dr. Reichard admitting that he erred in his methods and/or findings would have resulted in diminishing the ability for Grove to argue that Dr. Reichard's findings were "faulty" and thus question the reliability of the testimony of each doctor that relied on the brain autopsy to come to the conclusion that the injuries must have been inflicted during the time that Grove was alone with K.M.—as he did at trial both through cross-examination of Dr. Ross and through the testimony of Dr. Arden. To refrain from objecting and instead attack Dr. Reichard's report in absentia is certainly a viable trial strategy, and thus we cannot say that it would not be reasonable for either the court or defense counsel to allow the testimony. As we noted above, our Supreme Court has made it clear that application of the fundamental error doctrine is to be limited, and we abide by that pronouncement and conclude here that Grove cannot challenge admission of the testimony for the first time on appeal.
B. Jury Instructions
Grove argues that the district court erred in several respects in regard to the jury instructions. Specifically, he contends that the court erred in instructing the jury on the requisite mental element for felony murder by failing to instruct the jury on malice aforethought or specific intent. He also contends that the district court erred in failing to instruct the jury on the merger doctrine of felony murder and that the court created a fatal variance when it failed to limit the elements instruction for first degree murder to the factual allegations contained in the indictment.
It is undisputed that Grove did not object to any of these four issues before the district court. Thus, as above, we must determine whether there existed fundamental error such that we may review the claims for the first time on appeal. As indicated previously, to amount to fundamental error, the defendant must demonstrate that one or more of his unwaived constitutional rights were violated, that the error is clear or obvious without the need for any additional information not contained in the appellate record, including information as to whether the failure to object was a tactical decision, and that the error affected the outcome of the trial proceedings. Perry, 150 Idaho at 226, 245 P.3d at 978.
1. Malice aforethought instruction
Grove contends that because the plain language of Idaho's homicide statutes define murder as an unlawful killing committed with malice aforethought, it was error for the jury not to be instructed that they must find malice aforethought to convict him of K.M.'s murder. The state disagrees, contending that the law is clear that the intent element as encompassed by the felony murder statute requires only an intent to commit the underlying felony, not the intent to murder. In this case, the elements instruction provided that:
In order for the Defendant to be guilty of First Degree Murder, the State must prove each of the following:
1. On or about July 10, 2006,
2. in the State of Idaho,
3. the Defendant, Stacey L. Grove, committed an aggravated battery upon [K.M.], a child under the age of twelve (12) years of age,
4. which caused the death of [K.M.].
If you find that the State has failed to prove any of the above, then you must find the Defendant not guilty of First Degree Murder. If you find that all of the above have been proven beyond a reasonable doubt then you must find the Defendant guilty of First Degree Murder.
In addition, the district court instructed the jury that "[a] person commits aggravated battery who, in committing battery, causes great bodily harm, permanent disability, or permanent disfigurement." The court also instructed the jury on the elements of battery:
A "battery" is committed when a person:
(1) wilfully and unlawfully uses force or violence upon the person of another;
(2) actually, intentionally and unlawfully touches or strikes another person against the will of the other; or (3) unlawfully and intentionally causes bodily harm to another individual.
The jury was also instructed on the definition of "wilfully" which stated that "[a]n act is `wilful' or is done `wilfully' when done on purpose. One can act wilfully without intending to violate the law, to injure another, or to acquire any advantage."
Murder is defined in Idaho as "the unlawful killing of a human being with . . . malice aforethought . . . ." I.C. § 18-4001. Malice is implied "when no considerable provocation appears, or when the circumstances attending the killing show an abandoned and malignant heart." I.C. § 18-4002. Felony murder, of which Grove was convicted, is defined in I.C. § 18-4003(d) which provides that "[a]ny murder committed in the perpetration of, or attempt to perpetrate, aggravated battery on a child under twelve (12) years of age . . . is murder of the first degree." Contrary to Grove's contention that the district court was required to instruct the jury as to malice aforethought, Idaho courts have consistently held that the intent necessary to commit the underlying felony (which in this case was aggravated battery on a child under twelve) substitutes for the malice element of murder. See State v. Lundquist, 134 Idaho 831, 835, 11 P.3d 27, 31 (2000); State v. Pratt, 125 Idaho 594, 598, 873 P.2d 848, 852 (1994); State v. Dunlap, 125 Idaho 530, 533-34, 873 P.2d 784, 787-88 (1993); State v. Lankford, 116 Idaho 860, 866, 781 P.2d 197, 203 (1989); State v. Windsor, 110 Idaho 410, 419, 716 P.2d 1182, 1191 (1985). Thus, it was not error for the court to fail to give a malice aforethought instruction, much less fundamental error. To the extent that Grove argues that the long line of cases upholding this proposition are wrongly decided, such an assertion is irrelevant in the context of fundamental error where the error must be plain under current law.
2. Specific intent instruction
Grove also argues that felony murder requires the "specific intent to commit the underlying felony" and therefore the district court erred in not instructing the jury that Grove had to have specific intent to commit an aggravated battery, specifically specific intent to cause "great bodily harm, permanent disability, or permanent disfigurement."
However, as the state points out and as Grove concedes in his appellant's brief, this exact argument has been rejected by this Court in State v. Carlson, 134 Idaho 389, 3 P.3d 67 (Ct. App. 2000). Carlson, like Grove, had been convicted of first degree felony murder by aggravated battery on a child under twelve. On appeal, Carlson asserted that in order to have been properly instructed, the jury should have been informed that to sustain a charge of first degree felony murder based on the aggravated battery of a child under twelve, the state was required to prove beyond a reasonable doubt that he possessed the specific intent to commit an aggravated battery. After examining the history of the felony murder statute, this Court concluded that there was nothing to suggest that the legislature intended the underlying felony of aggravated battery on a child under twelve to be a specific intent crime when it was the basis of a felony murder conviction. Id. at 400, 3 P.3d at 78. We explicitly held that in order to permit a conviction for felony murder for the aggravated battery of a child under twelve, a jury need only be instructed that the state needs to prove, beyond a reasonable doubt, that the perpetrator had the general intent to commit the underlying predicate felony. Id.
Grove contends, however, that Carlson is in conflict with State v. Scroggins, 110 Idaho 380, 716 P.3d 1152 (1985), which was recently reaffirmed by State v. Pina, 149 Idaho 140, 233 P.3d 71 (2010) and therefore Carlson was wrongly decided and should not be followed here. In Scroggins, the Court stated that "[i]n a prosecution for felony murder, the state is relieved of the burden of proving that a defendant had the specific intent to kill and instead need only prove that all individuals charged as principals had the specific intent to commit the predicate felony." Scroggins, 110 Idaho at 386, 716 P.2d at 1158. Pina reiterated the proposition, citing to Scroggins. Pina, 149 Idaho at 147, 233 P.3d at 78. However, as we pointed out in Carlson, the underlying felony in Scroggins was attempted rape and attempts are, by definition, specific intent crimes. Carlson, 134 Idaho at 401-02, 3 P.3d at 79-80. Thus, we concluded that the facts in Carlson were factually distinguishable from Scroggins and Carlson's reliance on Scroggins for the proposition that general intent crimes may not be utilized as the basis for felony murder was misplaced. Id. at 402, 3 P.3d at 80. Similarly, the underlying felony in Pina was kidnapping, also a specific intent crime. I.C. § 18-4501; State v. Peteja, 139 Idaho 607, 612 n.4, 83 P.3d 781, 786 n.4 (Ct. App. 2003). Thus, we do not interpret Scroggins and Pina as setting forth a broad pronouncement that for any felony to be the predicate for felony murder, specific intent must be proven—it is evident that in both cases the Court was speaking in the context of cases where the underlying felonies always require specific intent. Put another way, there is no indication that the Court intended to alter the plain language of the aggravated battery statute by adding a specific intent element when it forms the basis of felony murder.
In addition, we note that in Pina, a key issue was whether Pina could be convicted of felony murder where the actual killing had been committed by a co-defendant and there was no evidence of a "common scheme or plan" between him and the killer to commit the underlying felony of kidnapping. Thus, the Court's comment regarding specific intent must be viewed in the context of the fact that the underlying felony was a specific intent crime and there existed the question of whether culpability for murder can extend to a co-defendant who did not actually "pull the trigger"—both issues which are not present in the instant case. Thus, we conclude that Pina and Scroggins are distinguishable from the case at bar, that Carlson controls the issue and therefore, under current Idaho law, the court's failure to instruct the jury on specific intent was not error.
3. Merger doctrine instruction
Grove contends that under the doctrine of "merger" which is applied in "a number of states," assaultive felonies "merge[] with the homicide and cannot be the basis of a felony murder instruction" and that the court erred in not instructing the jury as much. Idaho's felony murder statute as amended in 1991, however, explicitly includes aggravated battery on a child under twelve (12) years of age as a felony which can form the basis for first degree murder, the plain language of which is not trumped by a judicially created doctrine that is applied in states without a similar statute. See Schultz v. State, 749 P.2d 559, 561-62 (Okla. Crim. App. 1988) (noting that the legislature effectively overruled precedent applying the merger doctrine when it amended the felony murder statute to make the crime of unreasonable force upon a child a basis for felony murder). Thus, the merger doctrine is not the law in Idaho and therefore there is no error in not instructing a jury as to the doctrine.
4. Variance
Grove contends that there was a fatal variance between the elements instruction (quoted above) and the indictment charging him with first degree murder which stated:
That the Defendant, Stacey L. Grove, on or about the 10th day of July 2006, in the County of Nez Perce, State of Idaho, did, during the perpetration of or attempt to perpetrate the crime of Aggravated Battery, on a child, to-wit: [K.M.], a human being, who was under the age of twelve (12) years . . . by striking him in the stomach and/or head and/or back and legs which caused abdominal bleeding, brain injury and musculature hemorrhaging from which he died.
Grove argues that the problem with the district court's elements instruction is that it did not limit the state, in its attempt to prove an aggravated battery, to the striking act described in the indictment—rather, he contends, the jury was instructed that it could find Grove guilty of first degree murder based on any alleged aggravated battery, either intentionally or negligently caused. He contends that this is "fatal" given that Dr. Hunter testified that his initial impression upon seeing K.M. at the emergency room was that he had suffered from "shaken baby syndrome" and that Grove had testified that K.M. had fallen from the counter on the morning of July 10. Thus, Grove reasons, the elements instruction allowed the jury to find that he had committed aggravated battery by shaking K.M. or by negligently allowing him to fall off the counter, which was contrary to the indictment that alleged that he had committed aggravated battery by striking K.M. in the stomach and/or head and/or back and legs—and he was not given notice of the possibility of having to defend against these scenarios. Grove concedes that he did not object to this alleged error below, and thus we must again determine whether there is fundamental error such that we may address the issue for the first time on appeal.
The existence of an impermissible variance is a question of law over which we exercise free review. State v. Alvarez, 138 Idaho 747, 750, 69 P.3d 167, 170 (Ct. App. 2003); State v. Sherrod, 131 Idaho 56, 57, 951 P.2d 1283, 1284 (Ct. App. 1998). Our task in resolving the issue presented is two-fold. First, we must determine whether there is a variance between the information used to charge the defendant and either the instructions presented to the jury or the evidence adduced at trial. See State v. Brazil, 136 Idaho 327, 329, 33 P.3d 218, 220 (Ct. App. 2001). Second, if a variance exists, we must examine whether it rises to the level of prejudicial error requiring reversal of the conviction. Id. A determination of whether a variance is fatal depends on whether the basic functions of the pleading requirement have been met. Id. at 330, 33 P.3d at 221; State v. Windsor, 110 Idaho 410, 417, 716 P.2d 1182, 1189 (1985). A charging instrument meets the basic functions of the pleading requirement if it fairly informs the defendant of the charges against which he or she must defend and enables him or her to plead an acquittal or conviction in bar of future prosecutions for the same offense. United States v. Bailey, 444 U.S. 394, 395 (1980); Brazil, 136 Idaho at 330, 33 P.3d at 221. A variance is fatal if it amounts to a "constructive amendment." State v. Jones, 140 Idaho 41, 49, 89 P.3d 881, 889 (Ct. App. 2003). A constructive amendment occurs if a variance alters the charging document to the extent that the defendant is tried for a crime of a greater degree or a different nature. Id.; State v. Colwell, 124 Idaho 560, 566, 861 P.2d 1225, 1231 (Ct. App. 1993). In sum, a variance between a charging document and a jury instruction or the evidence adduced at trial requires reversal only when it deprives the defendant of his substantial rights by violating the defendant's right to fair notice or leaving him or her open to the risk of double jeopardy. State v. Wolfrum, 145 Idaho 44, 47, 175 P.3d 206, 209 (Ct. App. 2007); Brazil, 136 Idaho at 330, 33 P.3d at 221; Sherrod, 131 Idaho at 59, 951 P.2d at 1286; Colwell, 124 Idaho at 566, 861 P.2d at 1231. A review of whether the defendant was deprived of his or her right to fair notice requires the court to determine whether the record suggests the possibility that the defendant was misled or embarrassed in the preparation or presentation of his or her defense. Brazil, 136 Idaho at 330, 33 P.3d at 221; Windsor, 110 Idaho at 418, 716 P.2d at 1190.
Here, even assuming without deciding that a variance existed, there is no plain error, because such a variance is not fatal. Grove contends that the variance was fatal, because he was denied fair notice to defend against assertions that he committed aggravated battery leading to the death of K.M. by shaking him or by negligently allowing him to fall off the counter. However, as we stated above, a defendant is only deprived of his right to fair notice if the record suggests the possibility that the defendant was misled or embarrassed in the preparation or presentation of his defense. See id. Such is not the case here—there was no evidence presented at trial that either of these actions were the cause of K.M.'s injuries—thus there was no reason for Grove to defend against them as the basis of his felony murder charge. The only reference to "shaken baby syndrome" by Dr. Hunter was his testimony that upon cursory examination of K.M. he had initially thought this was the cause of K.M.'s injuries, but he later changed that diagnosis after learning the full severity of K.M.'s injuries and indicated that K.M. did not have shaken baby syndrome. In regard to Grove's testimony that K.M. had fallen from the counter, every expert that testified indicated that such a fall could not have caused the massive injuries suffered by K.M. which led to his death. Accordingly, Grove cannot show that a fatal variance existed such that there was fundamental error that we may review for the first time on appeal.
C. Cumulative Error
Finally, Grove asserts that based on the fact that there were "three substantial errors" that occurred at trial, the doctrine of cumulative error applies and reversal for a new trial is required. Under the cumulative error doctrine, an accumulation of irregularities, each of which might be harmless in itself, may in the aggregate reveal the absence of a fair trial in contravention of the defendant's right to due process. State v. Severson, 147 Idaho 694, 723, 215 P.3d 414, 443 (2009). Since we have found that there was no fundamental error, the cumulative error doctrine is not applicable.

III.

CONCLUSION
Because there is not fundamental error, we will not address Grove's contention that his right to confrontation was violated by witness testimony as to the findings and conclusions of a non-testifying expert. Similarly, Grove has not shown fundamental error in the district court's instructing of the jury. Grove's conviction of first degree felony murder, by aggravated battery of a child under twelve years old, is affirmed.

STATE OF IDAHO v. STACEY LEWIS GROVE,

Thursday, 17 March 2011

SBS: Colorado; Tember Rector court of appeals decision reversed by Supreme Court


PEOPLE v. RECTOR

The People of the State of Colorado, Petitioner,
v.
Tember Terri Rector, Respondent.



John W. Suthers, Attorney General, Susan Eileen Friedman, Assistant Attorney General, Denver, Colorado, Attorneys for Petitioner.
Paul Grant, Parker, Colorado, Attorney for Respondent.

JUSTICE RICE delivered the Opinion of the Court.
A jury convicted respondent, Tember Rector, of felony child abuse. The court of appeals reversed the conviction, concluding that the trial court abused its discretion by failing to make sufficient findings regarding the reliability and potential prejudice of an expert's testimony and by failing to instruct the jury on the difference between medical and legal child abuse. We granted certiorari to review two of the evidentiary issues.1 We now reverse the court of appeals.
I. Facts and Proceedings Below
Tember Rector and her husband were three-year-old T.D.'s foster parents in 2004. T.D. suffered a severe head injury on February 2, 2004, while in Rector's care. Conflicting testimony was presented at trial regarding Rector's whereabouts during the time the injury occurred. Rector testified that she did not witness T.D.'s injury because she was in the shower while T.D. was watching television on the bed in the master bedroom. Rector testified that she heard a crash and jumped out of the shower to find T.D. sitting on the floor with his arm twisted and the contents of the nightstand knocked to the floor. In contrast, the responding paramedic testified that Rector told him she was downstairs when she heard the crash upstairs.
Rector called 9-1-1 and the Castle Rock Fire Department was dispatched to Rector's home. The People presented evidence that Rector waited forty-five minutes before calling for medical assistance. When the paramedics arrived, they found T.D. unconscious, unresponsive, and exhibiting signs of severe head trauma. T.D. was taken to the closest hospital and from there airlifted to Children's Hospital. The treating physicians diagnosed T.D. with non-accidental head trauma. T.D. suffered life-threatening brain injuries that included retinal hemorrhaging in both eyes and a right-side acute subdural hematoma that caused significant bleeding and swelling in his brain. T.D. underwent emergency neurosurgery at Children's Hospital to alleviate the pressure in his brain and survived the injury. Rector was charged with felony child abuse under section 18-6-401(1)(a) and (7)(a)(III), C.R.S. (2010).2
Prior to trial, Rector's counsel submitted a motion entitled Defense Motion to Restrict People's Experts Including Ken Winston from Making Medical Speculation. In that motion, Rector sought to exclude any speculative testimony by the People's experts and asked to have an evidentiary hearing in accordance with People v. Shreck, 22 P.3d 68 (Colo. 2001). Rector's motion was general in nature and specifically challenged only one expert, Dr. Ken Winston, and only with respect to testimony about shaken-baby syndrome. At a hearing held as a result of this and other motions, Rector argued that she was entitled to a Shreck hearing "to determine whether or not . . . [the] diagnosis and opinions that [we]re going to be used at trial by medical experts who were inferring a cause from the evidence . . . [were] reliable." Rector did not, however, point to specific expert testimony that she sought to exclude — other than shaken-baby syndrome testimony — and she argued that she required additional expert discovery. The trial court denied a Shreck hearing on shaken-baby syndrome, ordered additional expert discovery, and deemed the request for a Shreck hearing premature in light of the requested additional expert discovery. Rector did not make another request for a Shreck hearing.
Later, at the trial, several of T.D.'s treating physicians testified as medical experts for the People, including Dr. Andrew Sirotnak, a pediatrician and Director of the Child Protection Team, who examined T.D. at Children's Hospital; Dr. Arlene Drack, a pediatric ophthalmologist, who examined T.D. at the emergency room; and Dr. Ken Winston, the neurosurgeon who performed T.D.'s emergency surgery. They each testified to the severity of T.D.'s injuries and opined that the injuries were non-accidental or inflicted and unlikely to have been caused by a fall from a bed.
Prior to Dr. Sirotnak's testimony regarding T.D., the prosecution established Dr. Sirotnak's qualifications and moved for his admission as an expert in the fields of pediatric medicine and child abuse under CRE 702. Rector's counsel requested an opportunity to examine Dr. Sirotnak about his qualifications, but did not inquire about Dr. Sirotnak's qualifications or introduce any evidence to suggest he was not qualified in pediatrics or child abuse. Instead, Rector's counsel asked Dr. Sirotnak about the different definitions of medical child abuse and legal child abuse. Dr. Sirotnak declined to provide a legal definition of child abuse, but acknowledged that the legal definition of child abuse differs from the medical definition. Rector's counsel then stated that he objected to Dr. Sirotnak's qualification as an expert in the field of child abuse, but that he did not object to Dr. Sirotnak "rendering opinions about his understanding of the medical use of the term child abuse." The trial court admitted Dr. Sirotnak as an expert in pediatrics and child abuse.3
Dr. Sirotnak then testified that T.D. suffered a right-sided acute subdural hemorrhage, a shift in the tissue of the brain, and retinal hemorrhages. Dr. Sirotnak testified that his responsibilities at Children's Hospital included evaluating and diagnosing patients when abuse or neglect was suspected. According to Dr. Sirotnak, the medical diagnosis of child physical abuse takes into consideration the presence of a severe traumatic injury with no history of trauma to explain that injury. Dr. Sirotnak stated that the explanation offered by Rector did not account for the severity of T.D.'s injuries. Dr. Sirotnak concluded that, in his expert opinion, within a reasonable degree of medical certainty, T.D.'s injuries were the result of abuse. Rector's counsel made no objection to Dr. Sirotnak's trial testimony.
A jury convicted Rector of felony child abuse. She was sentenced to fifteen years in prison plus five years of mandatory parole. Rector appealed her conviction, arguing, among other issues, that the trial court erred in denying her a Shreck hearing related to Dr. Sirotnak's testimony regarding medical child abuse. The court of appeals reversed Rector's conviction and remanded for a new trial, concluding that the trial court abused its discretion in failing to make adequate inquiry or specific findings regarding the reliability and potential prejudice of Dr. Sirotnak's testimony under Shreck. The court of appeals further determined that Dr. Sirotnak's testimony that T.D.'s injuries resulted from child abuse was not proper because such testimony concerned the ultimate legal determination of Rector's guilt.4
PART EXCISED
III. Conclusion
The trial court did not abuse its discretion when it declined to hold a Shreck hearing. Rector's pretrial Shreck motion challenged testimony by Dr. Winston about shaken-baby syndrome — a diagnosis none of the experts intended to offer. The pretrial motion did not challenge testimony by Dr. Sirotnak or the medical diagnosis of child abuse and no subsequent Shreck challenge was raised. Likewise, no contemporaneous objection was made during Dr. Sirotnak's trial testimony to alert the trial court that Rector challenged the expert testimony as to reliability or prejudice. Whether Dr. Sirotnak's testimony about medical child abuse usurped the role of the jury was not properly before the court of appeals, nor did the admission of the testimony amount to plain error. Accordingly, we reverse the court of appeals.
March 14, 2011.
Supreme Court of Colorado, EN BANC.
Case No. 09SC708.