Betty Thompson v. State of Arkansas

ARKANSAS COURT OF APPEALS

NOT DESIGNATED FOR PUBLICATION

SAM BIRD, JUDGE

DIVISION II

BETTY THOMPSON,

APPELLANT

V.

STATE OF ARKANSAS,

APPELLEE

CACR02-561

APRIL 23, 2003

APPEAL FROM THE UNION COUNTY CIRCUIT COURT,

NO. CR1999-0537,

HON. CAROL CRAFTON ANTHONY, JUDGE

AFFIRMED

Betty Thompson was tried before a jury for second-degree murder regarding the death of her husband, Henry Thompson, a stroke victim who had been removed from her care some eight months before his death. Appellant moved for a directed verdict, arguing that the State failed to introduce sufficient evidence that her neglect caused Mr. Thompson's death. The motion was denied. Appellant was convicted of the lesser-included offense of manslaughter and was sentenced to ten years' imprisonment in the Arkansas Department of Correction. Her sole point of appeal is that there was insufficient evidence upon which the jury could have found her guilty of manslaughter. We hold that the evidence was sufficient to uphold the verdict; therefore, the conviction is affirmed.

A motion for a directed verdict is a challenge to the sufficiency of the evidence. Laster v. State, 76 Ark. App. 324, 64 S.W.3d 800 (2002). The test for determining the

sufficiency of the evidence is whether the verdict is supported by substantial evidence, direct or circumstantial. Id. Substantial evidence is evidence that is of sufficient certainty and precision that it compels a conclusion one way or another. Id. On appeal, this court views the evidence in the light most favorable to the State and sustains a judgment of conviction if there is substantial evidence to support it. Id.

Mr. Thompson's daughter Jaunice Bush testified that in early November 1998 she received a phone call from a friend, informing her that she needed to go to El Dorado, where her father lived with appellant, if she wanted to see her father alive. Bush and her sisters drove from Little Rock to El Dorado and found their father in bed, dirty, with an uncharacteristically long beard and uncut hair, and with covers pulled up to his neck. Bush's sister Beverly Caple testified that there was a foul odor in the apartment, and Ms. Bush testified that there were air fresheners throughout the home. The sisters arranged for Mr. Thompson's transportation to an El Dorado hospital the next day and then to a hospital in Little Rock. The following February he was discharged from the Little Rock hospital to home care in Bush's home. Bush testified that when she checked on her father the morning of July 30, 1999, he had aspirated on his feeding tube. He died that day after being taken to a hospital.

Emergency medical technician Scotty Points and paramedic Jimmy Davis of the El Dorado Fire Department testified that on November 7, 1998, they responded to the call to transport Mr. Thompson to the hospital. Points testified that the mattress where Thompson lay matched the contour of his body, indicating that he had been there "a while"; that the bedlinens were dirty with food, urine, and feces; that Thompson was dehydrated and had bleeding sores on his "back part"; and that there was an awful odor of garbage and sores. Davis testified that Thompson was an incoherent skeleton of a man-- dried up and skinny; and that "skin was hanging off of him, he had sores, smells that I have never run upon before or since." Davis described Thompson as sunk in the bed in a hole where he had been lying with food, feces, and urine; and stuck to a mattress that had dissolved and "just crusted to him, all to the fester and the stuff of the sores it had." Davis described the skin "just wrapped around his bones," so dry and loose that the personnel were afraid they would tear it in the move. Davis stated that this was an extreme state that he had never seen anybody in "and still be alive," that the odor was of rot, that the skin was rotting off where the sores were, and that there were big wads of sores where Thompson had lain in body fluids.

Police officer Randall Gilbert testified that he went to the hospital in response to a call regarding possible abuse and neglect of Mr. Thompson. Gilbert's first observation was the strong odor of decaying flesh, human excrement, or something rotten. He further observed yellow, dry skin that appeared to be dead; food caked up and dried on Thompson's hands; long and unkempt toenails and fingernails, with what appeared to be dried food and human excrement underneath them; a draining sore on Thompson's upper left leg; and a large blister-like sore on the end of his penis. Gilbert stated that Thompson was awake but not coherent.

Dr. Larry Ezell, who cared for Mr. Thompson after he was admitted to the emergency room, testified that Thompson smelled as if he were rotting. Dr. Ezell testified that hevividly recalled the degree of filth on the patient and his sheet, which looked as if someone had used it to mop a chicken-house floor. Dr. Ezell said that he could stick his finger to the first or second joint into Thompson's sores; that the sores were basically everywhere that Thompson's body could touch the bed, including the back of his head and underneath his penis, places where Ezell had never before seen sores. He testified that there were corn flakes embedded in the skin of Thompson's back; that there was petrified, rock-hard fecal material under his fingernails; and that his back was partially skinned from removal of the sheet. Dr. Ezell stated that he had never seen anything like it, and that his first impression was to wonder how this guy got in this shape. Dr. Ezell stated that he wanted to know who the caretakers were and how Thompson got in "this mess," which Ezell described as much worse than abuse and neglect. Ezell testified that Thompson's vital signs indicated he was malnourished, dehydrated, and septic, meaning that germs in the bloodstream could cause infection in the brain, lung, kidneys, bowel, and wherever the blood was going. Blood tests showed an aggressive white blood-cell count indicating an infection, a red blood-cell count indicating anemia, hemoglobin so low that he needed a blood transfusion, and positive cultures for staph germs.

The family had Mr. Thompson transported to a Little Rock hospital on November 7, 1998, where he came under the care of general surgeon William Rutledge. Dr. Rutledge testified that the patient arrived in critical condition as a result of multiple pressure sores, infection, and severe malnutrition, and that the pressure sores were the worst Rutledge had seen. Dr. Rutledge stated that Thompson's infection was the biggest threat to his life; thatpus from a pocket on the left thigh "throws bacteria into the blood stream"; that bacteria growth could occur on the heart valves; and that kidney infections, multiple problems related to the infectious nature, and respiratory problems could result. Dr. Rutledge testified that procedures he performed in order to control the infection included removal of dead skin, debridement, and amputation of the left leg and a right toe. Stating that severe malnutrition was "a big culprit" in Thompson's demise, Rutledge further explained, "When you are malnourished you cannot fight infection as well. You cannot heal tissues and you cannot even, kidney function is altered and worsened. Cardiac performance is poor and the heart has more effort to work."

Dr. Rutledge testified regarding Mr. Thompson's medical records from November 7, 1998, until his death on July 30, 1999. Rutledge stated that the sepsis or the infection was never completely gone, and that the associated problems had never been totally eliminated. He reviewed a letter of July 20, 1999, in which he wrote that if Thompson should experience a demise in the near future "it would be causally related to the initial periods of neglect with ulcer formation, sepsis, and [its] cascading of multiple problems." Rutledge testified that cascading of multiple medical problems meant one thing leading to another, with malnutrition leading to the pressure sores, which led to infection and kidney disease, lung disease, and even cardiac problems. Rutledge testified that he was present when Thompson died, and he stated his medical opinion regarding the cause of Thompson's death:

[H]is demise was pulmonary failure and later the autopsy proved it was pneumonia. I am still of the opinion that it is the result and related to his malnutrition, multiple pressure ulcers and sepsis more or less bacteria in the blood. The complications ofthe November 1998 [sic] were significantly related.

Dr. William Sturner, who performed the autopsy, testified that Mr. Thompson's death was caused by bronchial pneumonia related to old and recent multiple decubitus ulcerations as a result of chronic malnutrition and dehydration. He said that the malnutrition and ulcerations discovered on November 7, 1998, "could significantly contribute to the pneumonia" of July 30, 1999.

Appellant argues that the State failed to prove that she caused the death of her husband. She points to evidence presented at trial that the usual life expectancy for a black male in Arkansas is seventy-eight years; that Mr. Thompson was a black male who was eighty-three-years old when he died on July 30, 1999; and that she had last seen him on November 7, 1998. She notes that his medical history included digestive complaints in 1984, gout in 1989, a stroke in 1993, congestive heart failure and acute renal failure in 1993, and paralysis of his left side in 1994. She notes the testimony of Dr. Ezell that Mr. Thompson was in bad shape but had no evidence of pneumonia in the emergency room in November 1998, that a patient with a life-threatening condition is generally not discharged from a medical facility, and that Mr. Thompson was in several medical facilities after his November 1998 emergency room visit and before release to his daughter's home.

Causation may be found where the result would not have occurred but for the conduct of the defendant operating either alone or concurrently with another cause unless the concurrent cause was clearly sufficient to produce the result and the conduct of the defendant clearly insufficient. Ark. Code Ann. § 5-2-205 (Repl. 1997). Thus, in the present case, theState was required to prove only that appellant's conduct was a contributing cause rather than the sole cause of her husband's death. See Courtney v. State, 14 Ark. App. 76, 79, 684 S.W.2d 835, 837 (1985) (quoting Taylor v. State, 193 Ark. 691, 101 S.W.2d 956 (1937), "The evidence was sufficient to take to the jury the question of the cause of death, and, as we have seen, it was not necessary that the wounds should be the `proximate' or `exclusive' cause, but only if they were the cause of the cause, either the mediate or the immediate cause of death"). Here, testimony about Mr. Thompson's condition on November 7, 1998, when he had been under appellant's care, coupled with the opinions of Dr. Rutledge and Dr. Sturner that pulmonary failure or pneumonia resulting from those conditions caused his death, constituted sufficient evidence to support a finding that Thompson's death would not have occurred but for appellant's conduct.

Affirmed.

Gladwin and Vaught, JJ., agree.