STATEOF NEW JERSEY v. MEGAN PLANK

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      Although it is posted on the internet, this opinion is binding only on the
        parties in the case and its use in other cases is limited. R. 1:36-3.




                                       SUPERIOR COURT OF NEW JERSEY
                                       APPELLATE DIVISION
                                       DOCKET NO. A-1244-13T1

STATE OF NEW JERSEY,

        Plaintiff-Appellant/
        Cross-Respondent,

v.

MEGAN PLANK,

     Defendant-Respondent/
     Cross-Appellant.
___________________________________

              Argued March 7, 2017 – Decided February 28, 2018

              Before Judges Fisher, Ostrer and Leone.

              On appeal from Superior Court of New Jersey,
              Law Division, Union County, Indictment No. 10-
              11-1145.

              Kimberly L. Donnelly, Special Deputy Attorney
              General/Acting Assistant Prosecutor, argued
              the   cause   for   appellant/cross-respondent
              (Grace   H.    Park,   Acting   Union   County
              Prosecutor, attorney; Milton S. Leibowitz,
              Special    Deputy    Attorney   General/Acting
              Assistant Prosecutor, of counsel and on the
              brief).

              Jay L. Wilensky, Assistant Deputy Public
              Defender, argued the cause for respondent/
              cross-appellant (Joseph E. Krakora, Public
             Defender, attorney; Jay L.            Wilensky,   of
             counsel and on the brief).

     The opinion of the court was delivered by

OSTRER, J.A.D.

     A jury found defendant Megan Plank guilty of distributing

heroin, which caused the deaths of Christopher Coppola and Sara

Malaker. The issue of causation was controversial, because Malaker

had health problems, and Coppola ingested other substances as well

as heroin.    The State's key witness on causation, the county's new

medical examiner, relied on the victims' autopsies.               But, he did

not perform, observe, or supervise them.            The autopsies were the

work of his predecessor, who was living out of state by the time

of trial. On appeal, defendant principally argues the medical

examiner's     testimony    violated       her   constitutional     right    of

confrontation.    We agree and reverse her convictions of two counts

of first-degree strict liability for causing drug-induced death.


N.J.S.A. 2C:35-9(a).       However, we affirm her conviction of third-

degree distribution of heroin.         
N.J.S.A. 2C:35-5(a)(1), -5(b)(3).

                                    I.

     Proof of defendant's heroin distribution was circumstantial.

The jury heard from no one who saw defendant possess or distribute

the drug.    The State introduced a series of text messages between

defendant and Malaker in which, the State contended, the two agreed


                                       2                              A-1244-13T1
to meet to transfer the heroin, which they referred to only as

"it."   According to the texts, defendant arranged to meet Malaker,

who was in a car with Coppola, at the house of "fat boy Jon" in

the Finderne section of Bridgewater.       Malaker wanted to meet

elsewhere, but defendant declined, saying she did not want to

"drive with it."   Malaker texted she felt uncomfortable "doing it"

in front of others, and asked if she could pull defendant aside

and "do this privately."     Defendant agreed.   The text messages

ended as Malaker approached her destination.

     Malaker's mother testified her daughter and Coppola borrowed

her car shortly before defendant and Malaker texted.     Cellphone

tower records showed that Malaker travelled in the evening rush

hour between her mother's home in Union County and Bridgewater.

Before the trip, Coppola withdrew $260 from an ATM.      The State

argued Malaker used part of that to buy the heroin.

     The next day, Malaker's mother found the lifeless bodies of

her daughter and Coppola in her daughter's bedroom.    Coppola was

sprawled on the bed.    Malaker was hunched over a trash basket.

There were heroin packets in the room — five empty and five full.

Coppola had only $165 in his wallet.

     Although defendant did not testify, she relied on the second

of two recorded police interviews that the State introduced.       In

the second interview – on the day of her arrest and almost a year

                                 3                          A-1244-13T1
after the deaths – she admitted she met Malaker at Fat Boy Jon's

house, but she thought Malaker wanted "weed."        After Malaker

arrived and defendant realized she wanted heroin, defendant told

her she did not have it and she should get it elsewhere.         The

defense suggested that Malaker may have obtained heroin from a

person she called repeatedly after she met defendant, or that

Coppola, who had a history of heroin abuse, may have already

possessed it.

     The State challenged defendant's credibility.   In her initial

statement, she denied any contact with Malaker or Coppola shortly

before their deaths. Even after she was confronted with the texts,

she denied making them, stating someone borrowed her phone while

she was at Fat Boy Jon's house.   The State contended defendant and

Malaker expressed caution in their texts because their transaction

involved a more serious drug than marijuana. The State also argued

the numerous voice conversations between defendant and Malaker

made it unlikely that defendant misunderstood what Malaker wanted.

     Shortly after the deaths, the county medical examiner at the

time, Zhongxue Hua, M.D., wrote in Coppola's and Malaker's autopsy

reports that the causes of death were "[p]ending further studies"

and their manner of death was "[p]ending investigation."
1 After

 1
  The reports stated the autopsies were performed the day after
the victims were found, but were signed nine days later.

                                  4                         A-1244-13T1
receiving toxicology reports from an outside laboratory, Dr. Hua

amended his autopsy reports with one-page addenda.                  He simply

stated that Coppola's cause of death was "[a]cute intoxication of

heroin, Xanax, Clonazepam and cannabinoids"; and that Malaker's

cause   of    death   was   "[a]cute    morphine   intoxication",     and   the

"contributory cause" was "[b]ronchial asthma."                  The manner of

death in both cases was "Accident."2

     By the time of trial almost four years later, Junaid Shaikh,

M.D.,   had    succeeded    Dr.   Hua   as   county   medical    examiner   and

testified as to the cause of death.           Although Dr. Hua was living

in New York, the State declined to call him as a witness, claiming

it was a matter of cost.          Dr. Shaikh testified Dr. Hua had been

asked to leave his position, but did not elaborate about the

reasons.

     Dr. Shaikh did not observe or supervise the autopsies, nor

did Dr. Hua consult with him.           He explained that he reviewed the

case for the first time several months before the trial.                      He

reviewed Dr. Hua's autopsy reports; the autopsy photographs; Dr.

Hua's histopathology reports; the chief medical investigator's




2
  Dr. Hua's autopsy reports were marked for identification, but
not introduced into evidence.



                                        5                              A-1244-13T1
Reports of Investigation by Medical Examiner (RIMEs);3 photographs

of Malaker and Coppola in the bedroom where Malaker's mother found

them; and the toxicology reports of the outside laboratory.4

     In presenting his opinion, Dr. Shaikh repeated Dr. Hua's

gross findings and observations of Malaker and Coppola.        Asked to

explain the internal examinations of the two victims, Dr. Shaikh

paraphrased for the jury Dr. Hua's findings as to each major body

area and system.     He included Dr. Hua's findings that Malaker's

brain was swollen, there was mucous in the bronchi, and the lungs

were hyperinflated.    In addition to Dr. Hua's findings, Dr. Shaikh

found independent evidence of lividity in Malaker from scene

photographs he reviewed.

     Dr. Shaikh repeated Dr. Hua's findings in his histopathology

reports.   In particular, Malaker had bronchial asthma, which was

consistent with Dr. Hua's gross findings regarding her lungs.

There   were   no   significant   histopathology   findings   regarding

Coppola.   Notably, Dr. Shaikh criticized Dr. Hua's histopathology

reports as conclusory, explaining that he should have described

in detail what he observed on the slides.     Yet, Dr. Shaikh did not


3
  Although the chief medical investigator, Mark Bannworth, prepared
the RIMEs, Dr. Hua apparently reviewed them, as there are initials,
although indiscernible, on the "M.E." line.
4
  The RIMEs, the toxicology reports, the histopathology reports,
and the autopsy photographs, were also marked for identification,
but not introduced into evidence.

                                    6                           A-1244-13T1
review   those   slides   himself,   and    stated    they   contained    no

information that affected the cause of death.

     Dr. Shaikh reviewed the effect of heroin on the body, as well

as its interaction with bronchial asthma.        He also discussed the

interaction of heroin, benzodiazepines and cannabinoids, with

respect to Coppola.   Dr. Shaikh explained that heroin breaks down

in the body into a metabolite, 6-monoacetylmorphine or 6-MAM, and

then into free morphine.    Both 6-MAM and free morphine were found

in Coppola, reflecting heroin use.         Only free morphine was found

in Malaker, which could have come from heroin, or morphine itself

– Dr. Shaikh did not know.    However, no morphine was found in the

bedroom where the victims died.

     Dr. Shaikh testified that he "agree[d] with the finding" of

Dr. Hua that Malaker died of acute morphine intoxication, although

bronchial asthma contributed to her death.           He stated that "[a]s

a routine practice, we use the drugs as the primary cause of death

and list any other contributory causes that might be there."             Dr.

Shaikh noted that the amount of free morphine in Malaker's system

was .026 milligrams per liter, or 26 nanograms per milliliter, and

the toxic level was .5 milligrams per liter, roughly twenty times

that.    He also conceded that Malaker had in her system less than

half the amount of a therapeutic dose of morphine.           He added that

the toxic effect of certain drugs, including morphine, often

                                     7                             A-1244-13T1
depends on other factors personal to the drug user.           He explained

that he viewed Malaker's bronchial asthma as an ongoing condition

and the morphine as a "triggering factor."           He conceded that

Malaker's hyperinflated lung could have been a sign of a bronchial

asthma attack.

     Dr. Shaikh also joined Dr. Hua's conclusion, quoted above,

regarding Coppola's cause of death.          Dr. Shaikh reviewed the

quantities of other drugs in Coppola's system, and concluded:

"[W]hen there are multitudes of drug present in the system, it's

always appropriate as a convention of medical examiners that it

implicates all of them, as long as there are drugs that can cause

a person's demise.   So, we use that as the cause of death . . . ."

     He declined to opine as to the significance of the level of

drugs   in   Coppola's   blood,   stating   repeatedly   he    was    not    a

toxicologist.    However, he also stated that: "some of the levels

are high"; the free morphine in Coppola's system, .100 milligrams

per liter, which was roughly four times that of Malaker, was in

the toxic range (although he earlier had testified that the "usual

toxic level" was .5 milligrams); and the drugs in Coppola's system

had a synergistic effect.         He agreed that the "combination of

the[] four drugs [in his system] . . . caused him to die" and he

could not say that "it was just the morphine."



                                    8                                A-1244-13T1
      A forensic pathologist from the outside testing laboratory,

Wendy Adams, Ph.D., discussed the toxicology test results.                   She

conceded that the level of free morphine in Malaker's system was

below that found in people who received morphine therapeutically,

but that a person with less tolerance could succumb to lesser

quantities.    She noted a study of two reported fatalities in which

free morphine levels were 70 and 350 nanograms per milliliter –

Coppola's level was 100 – but admitted that the two fatalities did

not describe a lethal range.           She cited another study of eight

fatalities,    in   which   the    blood   level    was   360    nanograms   per

milliliter.    She also opined that the benzodiazepines in Coppola's

system were within or below therapeutic levels.                 She agreed that

use of the cited ranges was an insufficient basis to determine

cause of death in a particular person.              Contrary to Dr. Shaikh,

she asserted that the drugs in Coppola's system had an additive –

as opposed to a synergistic – effect.

      The sole witness for the defense was forensic pathologist,

Charles Wetli, M.D., who addressed Malaker's cause of death, but

not Coppola's.      In addition to the documents Dr. Shaikh reviewed,

Dr.   Wetli   reviewed   the      slides   from    Malaker's     histopathology

examination, and Malaker's medical records, which showed a history

of bronchial asthma, anxiety, and panic attacks. Dr. Wetli opined,

based on the state of Malaker's lungs, her body's position at time

                                       9                                A-1244-13T1
of death, and her medical history, that she died not from a heroin

overdose, but succumbed instead to acute asthmatic bronchitis.            He

opined that the asthma attack was triggered by the panic and

anxiety of seeing her boyfriend overdosing.         He asserted the level

of free morphine in her body was too low to have been listed as a

contributing cause.       On cross-examination, the State confronted

Dr. Wetli with two studies that reported cases of asthma attacks

precipitated by snorting heroin.

       The jury found defendant guilty of distributing heroin, and

distributing heroin that Malaker and Coppola ingested, causing

their deaths.     At sentencing, the court was satisfied defendant

met the prerequisites for a downgraded sentence, and imposed

concurrent    five-year   terms   for   the   two   first-degree   counts,

subject to the No Early Release Act, 
N.J.S.A. 2C:43-7.2, and a

concurrent flat four-year term on the third-degree count.5

       The State filed an appeal of the sentence.       Defendant cross-

appealed, raising the following points:

            POINT I

            THE DEFENDANT'S CONSTITUTIONAL RIGHT TO
            CONFRONTATION WAS VIOLATED BY THE TRIAL COURT
            PERMITTING THE STATE TO PRESENT ITS MEDICAL
            EVIDENCE VIA A WITNESS WHO HAD NO INVOLVEMENT
            IN THE INVESTIGATION OF THE DEATHS.      U.S.
            CONST., AMENDS. VI, XIV; N.J. CONST. (1947),
            ART. 1, PARS. 9, 10.

5
    The court granted defendant bail pending appeal.

                                   10                              A-1244-13T1
POINT II

THE TRIAL COURT ERRED TO DEFENDANT'S GREAT
PREJUDICE BY DECLINING TO CHARGE THE JURY AS
TO JOINT POSSESSION.
POINT III

THE TRIAL COURT ERRED IN DENYING BOTH
DEFENDANT'S MOTION FOR DISMISSAL AT THE
CONCLUSION OF THE STATE'S CASE AND FOR A NEW
TRIAL. U.S. CONST., AMEND. XIV; N.J. CONST.
(1947), ART. 1, PARS. 9, 10.

A.   The State Failed to Sustain Its Burden
     of Introducing Sufficient Evidence to
     Support the Charges.

B.   The Verdict was Manifestly Against the
     Weight of the Evidence.

POINT IV

THE TRIAL COURT ERRED TO DEFENDANT'S PREJUDICE
IN DENYING DISCOVERY AS TO THE DECEDENTS'
MEDICAL RECORDS.    U.S. CONST., AMEND. XIV;
N.J. CONST. (1947), ART. 1, PARS. 9, 10.

POINT V

THE STATE PRESENTED INCOMPLETE AND MISLEADING
TESTIMONY TO THE GRAND JURY, AND PROVIDED
DEFICIENT LEGAL INSTRUCTIONS, NECESSITATING
VACATION OF THE CONVICTIONS AND DISMISSAL OF
THE INDICTMENT. U.S. CONST., AMEND. XIV; N.J.
CONST. (1947), ART. 1, PAR. 8.

A.   The State Presented Incomplete and
     Misleading Testimony As to a Crucial
     Issue.

B.   The State's Legal Instructions to the
     Grand   Jury  Were  Insufficient  and
     Misleading.


                     11                          A-1244-13T1
                                       II.

       The   principal    issue   on   appeal    is    whether   Dr.   Shaikh's

testimony violated defendant's right of confrontation.6                 We are

guided by principles our Supreme Court enunciated in Bass, 
224 N.J.   at    285.   The    Bass   Court      applied   Confrontation     Clause

principles established in Crawford v. Washington, 
541 U.S. 36

(2004), to a case in which an assistant county medical examiner

testified based on the autopsy of a recently deceased county

medical examiner.        Bass, 
224 N.J. at 311-21.          Bass was charged



6
  Although defense counsel did not expressly reference the
Confrontation Clause in objecting to Dr. Shaikh's testimony, she
preserved the issue by seeking to exercise her rights and objecting
as necessary.    See State v. Wilson, 
227 N.J. 534, 543 (2017)
(noting Confrontation Clause issue preserved under similar
circumstances); State v. Bass, 
224 N.J. 285, 312 (2016). Before
trial began, defense counsel objected to Dr. Shaikh's testimony
because the State provided no report of his opinion. The court
overruled the objection. With the prosecutor's concurrence, the
court ruled Dr. Shaikh could do no more than "rubber stamp what
Dr. Hua said" and "not deviat[e] from that one iota." Before Dr.
Shaikh testified, the defense renewed its objection, contending
that by presenting Dr. Hua's opinions through Dr. Shaikh, the
State would impermissibly rely on hearsay, and deprive the defense
of its ability to cross-examine Dr. Hua. The court overruled the
objection, stating that Dr. Shaikh could rely on Dr. Hua's
findings, consistent with N.J.R.E. 703, and the defense could call
Dr. Hua if it wanted, which defense counsel responded it was not
obliged to do.

                                       12                               A-1244-13T1
with the fatal shooting of one victim, Jessica Shabazz, and the

non-fatal shooting of another, James Sinclair.                  Id. at 290.        The

assistant        medical   examiner,        Dr.    Frederick         DiCarlo,     read

significant portions of the report of the deceased examiner, Dr.

Jay Peacock, who opined that Shabazz bled as she ran away from the

defendant, and died from a single gunshot wound to the back.                      Id.

at 318.

      As in Bass, we must first decide whether the absent medical

examiner's report was "testimonial."                 Id. at 316.         That is a

threshold question because the United States Supreme Court held

in Crawford that the confrontation right applies to a "testimonial

statement"       against   a   defendant.         
541 U.S.  at    68.       "Where

testimonial       statements    are    at   issue,      the    only    indicium     of

reliability sufficient to satisfy constitutional demands is the

one the Constitution actually prescribes: confrontation."                       Id. at

68-69.       A     prosecutor    may    introduce       "testimonial"        hearsay

statements only if the criminal defendant is able to cross-examine

the declarant, or the declarant is unavailable and the defendant

had a prior opportunity to cross-examine.                Id. at 53-54.

      Applying a "fact-specific analysis," Bass, 
224 N.J. at 317

n.9, the Bass Court noted an active homicide investigation had

already begun when the autopsy was performed; an investigator for

the   county     prosecutor     observed    the    autopsy;     and    the   medical

                                       13                                    A-1244-13T1
examiner transmitted evidence to the investigator.     Id. at 316-

17.   Based on those facts, the Supreme Court held that the autopsy

report was testimonial because its "primary purpose . . . was to

establish facts for later use in the prosecution of [the] case."

Id. at 317; see also Davis v. Washington, 
547 U.S. 813, 822 (2006).

      We reach the same conclusion here.   As the RIMEs noted, the

reason for the investigation was the "suspicious" circumstances

of the two deaths.    Drug use was obvious, as the RIMEs stated an

empty glycine bag and a straw were found on a shiny disk on the

bed near Coppola's body.    Virtually any fatal drug overdose case

raises the specter of a violation of 
N.J.S.A. 2C:35-9. The medical

examiner was required to perform an autopsy because the deaths

were suspicious.    See 
N.J.S.A. 52:17B-86 (mandating investigation

of human deaths "under suspicious circumstances"); N.J.A.C. 13:49-

1.1(a)(2) (same).     Dr. Hua provided his autopsy report to the

county prosecutor.     See 
N.J.S.A. 52:17B-87, -88.     Dr. Shaikh

explained that "[a]ll the medical/legal autopsies or the autopsies

performed by the medical examiner are done . . . in a forensic

setting. . . . cognizant of preserving evidence and chain of

custody."   At least by the time Dr. Hua amended his reports to

conclude that heroin or morphine intoxication was a cause of death,

the primary purpose was to establish facts for later use at a

trial.

                                 14                         A-1244-13T1
     In Bass, Dr. DiCarlo reviewed Dr. Peacock's autopsy report

and photographs, inspected the crime scene, and examined the

clothing Shabazz wore when she died, but Dr. DiCarlo did not write

his own report.     
224 N.J. at 317-18.          Rather, he wrote a one-

sentence letter to the prosecutor stating that he reviewed Dr.

Peacock's "post-mortem examination and autopsy report" and agreed

with his findings. Id. at 318. Over objection, the State prompted

Dr. DiCarlo at trial to "read the contents of various portions of

Dr. Peacock's autopsy report, as if [he] had been present at the

autopsy and Dr. Peacock's findings were his own."           Ibid.   Included

among   Dr.   DiCarlo's     readings     was    Dr.     Peacock's   ultimate

conclusions as to cause and manner of death.            Ibid.

     The   Court   found   this   violated     the    defendant's   right    of

confrontation.7    The Court began with the premise established in

State v. Michaels, 
219 N.J. 1 (2014), that "a truly independent

reviewer or supervisor of testing results can testify to those

results and to his or her conclusions about those results, without

violating a defendant's confrontation rights, if" the independent

reviewer or supervisor meets three requirements.             Bass, 
224 N.J.

at 315 (quoting Michaels, 
219 N.J. at 45-46).                The testifying


7
  However, the Court did not reverse the defendant's convictions
on that ground because it had already found the trial court
committed reversible error in limiting the defendant's cross-
examination of Sinclair. Id. at 291.

                                    15                                A-1244-13T1
reviewer must (1) be "knowledgeable about the testing process";

(2) "independently verif[y] the correctness of the machine-tested

processes and results"; and (3) "form[] an independent conclusion

about the results."        Ibid. (quoting Michaels, 
219 N.J. at 45-46).

The Court found those principles applied in Bass, notwithstanding

that Michaels and a companion case, State v. Roach, 
219 N.J. 58

(2014), involved "the evaluation of machine-generated data" –

blood analysis in Michaels and DNA analysis in Roach – and Bass

involved an autopsy.        Bass, 
224 N.J. at 316.

       The Court held that Dr. DiCarlo's testimony did not meet the

Michaels standard.         Id. at 318.    Dr. DiCarlo "was permitted to

engage in precisely the type of 'parroting' of the autopsy report

that has been held to violate the Confrontation Clause."             Id. at

319.   The Court reached that conclusion notwithstanding that "Dr.

DiCarlo was asked to generally comment about autopsy techniques

based on his own expertise, and offered independent observations

and conclusions on several autopsy photographs." Id. at 318. "[A]

testimonial report that is not admitted into evidence can engender

a   violation   of   the    Confrontation   Clause   if   that   report     is

'integral' to the testimony of a substitute witness."            Id. at 317.

The Court noted that "Dr. DiCarlo could have testified as an

independent reviewer of the information generated by the autopsy,"

and offered an opinion "entirely on the basis of his own review

                                     16                              A-1244-13T1
of the evidence."      Id. at 319.        His failure to do so offended the

Confrontation Clause.        Ibid.8

     Applying the principles set forth in Bass, we conclude that

Dr. Shaikh's testimony violated defendant's confrontation rights.

Like Dr. Peacock's opinion in Bass, Dr. Hua's opinion was integral

to his successor's testimony.             Dr. Shaikh did not even write a

one-sentence      report,    as   did    Dr.   DiCarlo.     He   headlined   his

testimony by expressing his agreement with, and adopting verbatim,

Dr. Hua's conclusion as to the cause and manner of death of each

victim.    Dr. Shaikh also paraphrased at length Dr. Hua's findings

regarding his external and internal examinations.

     Dr. Shaikh did not independently verify the correctness of

Dr. Hua's results; notably, he failed to view the histopathology

slides, contending they would not have changed his conclusions.

Although    Dr.    Shaikh,    like      Dr.    DiCarlo,   offered   independent

observations and conclusions, Dr. Shaikh's opinion was intertwined

with Dr. Hua's.       In summation, the prosecutor highlighted that

"Dr. Shaikh said he reviewed the autopsy report that was . . .



8
  The Court recognized medical examiners may sometimes become
unavailable when "a medical examiner who conducted an autopsy
dies, becomes incapacitated or relocates out of state before
trial." Ibid. However, with proper planning, a substitute expert
can still comply with the command of the Confrontation Clause.
Id. at 320.


                                         17                             A-1244-13T1
done by Dr. Hua, and he agreed with his findings . . . ."         In sum,

the   State   presented   the   opinions   of   two   experts.        Yet,

confrontation of the first was denied entirely, and confrontation

of the second was limited by the second's reliance on the first.9

      As defendant preserved her confrontation clause claim, we

must reverse the conviction unless we are persuaded that the error

was "harmless beyond a reasonable doubt."       See Bass, 
224 N.J. at
 307-08 (quoting Delaware v. Van Arsdall, 
475 U.S. 673, 684 (1986)).

Although the evidence of heroin ingestion was overwhelming, we are

not satisfied, beyond a reasonable doubt, that the violation of

defendant's confrontation rights was harmless.

      Once the jury determined that defendant distributed heroin,

the critical issue was causation.      The State was required to prove

that the ingestion of the heroin was "an antecedent but for which

the death would not have occurred"; and the death was not "too

remote . . . to have a just bearing on the defendant's liability",

or it was not "too dependent upon conduct of another person which

was unrelated to the . . . ingestion of the [heroin] or its effect

as to have a just bearing on the defendant's liability."         N.J.S.A.



9
  We note that the court, in delivering the model charge on
consideration of expert opinion in its final instructions to the
jury, identified all the experts who testified at trial except Dr.
Shaikh. No apparent explanation was given. However, the omission
only exacerbates the prejudice of Dr. Shaikh's testimony.

                                  18                              A-1244-13T1
2C:35-9(b).   The State's proof of causation rested upon the dual

opinions of Dr. Shaikh and Dr. Hua.

     As a result of the deprivation of defendant's right of

confrontation, neither opinion was fully tested.                Dr. Shaikh

repeated the causation opinions of Dr. Hua, which lacked the "why

and wherefore" that supported them.         See Townsend v. Pierre, 
221 N.J. 36, 54 (2015).    Dr. Hua's autopsy addenda simply provided his

revised conclusions without any explanation or discussion.

     Also problematic was Dr. Shaikh's statement regarding the

medical   examiner's    standard    operating       procedure   for     cases

involving multiple causes of death.         Regarding Malaker, he stated

that "as a routine practice" medical examiners cite drug use as

the principal cause of death, and any underlying health condition

as a contributing cause.       Dr. Shaikh did not expressly state that

heroin use was a "but for" cause of death in Malaker's particular

case.

     In   connection    with     Coppola,      he   stated   "it's     always

appropriate as a convention of medical examiners" to blame all of

the drugs in a person's system, "as long as there are drugs that

can cause a person's demise."       Dr. Shaikh did not expressly state

that heroin was a "but for" cause of Coppola's death.                Thus, we

are not persuaded, beyond a reasonable doubt, that denial of

defendant's   confrontation      right   was    harmless.       We    reverse

                                    19                                A-1244-13T1
defendant's two first-degree convictions for causing drug-induced

deaths, and remand for a new trial.

                                     III.

     Defendant's       remaining     points       deserve    relatively     brief

discussion.    We are unpersuaded by defendant's argument that the

trial court was obliged to charge joint possession as a lesser-

included offense of distribution.             There was no "rational basis

. . .   in   the   evidence   for    a     jury"    to   acquit   defendant      of

distribution and convict her of joint possession.                 See State v.

Savage, 
172 N.J. 374, 396 (2002).              In her recorded interview,

defendant     denied    possessing       heroin    at    all.     The     State's

circumstantial evidence was that she possessed it, and then sold

it to Malaker, who used Coppola's funds.                 There was no evidence

in the record for the jury to conclude that defendant jointly

possessed the heroin with Malaker or Coppola.               Defendant misplaces

reliance on State v. Morrison, 
188 N.J. 2, 19-20 (2006), where the

evidence supported a joint purchase by the defendant and a cohort,

who later died.

     We also do not disturb the trial court's denial of defendant's

motion for acquittal at the close of the State's case, and for a

new trial after the verdict.         Applying the familiar and indulgent

standard of State v. Reyes, 
50 N.J. 454, 458-59 (1967), the court

decided that the State had presented sufficient evidence on all

                                      20                                  A-1244-13T1
three counts for the case to go to the jury, although the judge

acknowledged that the evidence of distribution was marginal.               We

apply the same standard of review as does the trial court.            State

v. Dekowski, 
218 N.J. 596, 608 (2014).          We agree with the trial

court's assessment that the evidence of distribution was far from

overwhelming.   Yet, the circumstantial evidence was sufficient,

substantially for the reasons the trial judge set forth.            As for

the first-degree counts, putting aside the confrontation right

violation, a reasonable jury could find causation and guilt based

on the favorable opinions of Drs. Hua, Shaikh and Adams, and the

"favorable inferences which reasonably could be drawn therefrom."

Reyes, 
50 N.J. at 459.

     We also discern no error in the trial court's denial of

defendant's   pretrial   motion   to   compel    the   State   to   produce

Coppola's medical records, and Malaker's psychological and medical

records (with the exception of records of her asthmatic condition

for one year prior to her death, which the court ordered released).

We lack the benefit of defendant's written motion and supporting

certification, if any.    See Cmty. Hosp. Grp. v. Blume Goldfaden,


381 N.J. Super. 119, 127 (App. Div. 2005) (stating an appellate

court is not "obliged to attempt review of an issue when the

relevant portions of the record are not included").            There also

is no indication that the State possessed              or controlled the

                                  21                                A-1244-13T1
requested   records,   or   that   defendant   provided   notice   to   the

victims' estates, which likely possessed them.       See State v. Kane,


449 N.J. Super. 119, 132-34 (App. Div. 2017) (finding State was

not obliged to produce medical records of victim that it did not

possess or control, and suggesting that victim was entitled to

notice of defendant's request for her mental health records);

N.J.R.E. 506(a) (noting that physician-patient privilege may be

claimed by the personal representative of a deceased patient);

N.J.R.E. 505 (by incorporating N.J.R.E. 504 standard, providing

that psychologist-patient privilege may be claimed by personal

representative of deceased patient).10

     In any event, defendant did not demonstrate that the requested

production of privileged medical records was essential to protect

her constitutional right to a fair trial.           See Kane, 
449 N.J.

Super. at 135 (stating that privilege is not subject to a general

equitable balancing with the requester's need; rather, the court

may pierce it "only in the most narrow of circumstances, such as

where a privilege is in conflict with a defendant's right to a

constitutionally guaranteed fair trial" (quoting State v. Mauti,


208 N.J. 519, 538 (2012)).          In sum, we discern no abuse of

discretion.   Id. at 132.


10
  Trial preceded adoption of N.J.R.E. 534, which consolidated the
privileges of mental health patients.

                                    22                             A-1244-13T1
      We also reject defendant's contention that the trial court

erred in denying her motion to dismiss the indictment.               Defendant

contends that a prosecutor's office detective mischaracterized,

before the grand jury, statements made by the man known as Fat Boy

Jon, who gave numerous – in some respects conflicting – statements

to law enforcement about defendant's possession and distribution

of heroin at his house.11         The motion to dismiss is "directed to

the sound discretion of the court."           State v. Williams, 
441 N.J.

Super. 266, 272 (App. Div. 2015).            Furthermore, "dismissal of an

indictment is a draconian remedy and should not be exercised except

on the clearest and plainest ground."              Id. at 271-72 (quoting

State v. Peterkin, 
272 N.J. Super. 25, 38 (App. Div. 1988)).               Even

assuming the detective mischaracterized Fat Boy Jon's statements

by   presenting    them   as    coherent,    instead   of   inconsistent     and

equivocal, that is not sufficient to warrant reversal. Even absent

those statements, the "grand jury could reasonably believe that a

crime   occurred    and   the    defendant    committed     it."     State    v.

Nicholson, 
451 N.J. Super. 534, 541-42 (App. Div. 2017) (quoting

State v. Feliciano, 
224 N.J. 351, 380-81 (2016)).                  Indeed, the




11
  Although the prosecutor expressed the intention to call him as
a witness at trial, he reportedly was prepared to invoke his right
to remain silent, and the State did not call him.

                                      23                               A-1244-13T1
petit jury reached that conclusion beyond a reasonable doubt

without Fat Boy Jon's testimony.

                                     IV.

      The State contends the court erred in imposing a sentence in

the second-degree range, citing State v. Megargel, 
143 N.J. 484,

496-97 (1996).      We may not reach the issue, as the State's notice

of appeal was not filed within ten days, as required by 
N.J.S.A.

2C:44-1(f)(2).      The time limit is strictly enforced.          State v.

Sanders, 
107 N.J. 609, 616 (1987); State v. Watson, 
183 N.J. Super.
 481, 484 (App. Div. 1982).        After oral argument, the State filed

a    motion    to   relax   the    deadline,    but   the   time-frame      is

jurisdictional.      Ibid.; see also State v. Gould, 
352 N.J. Super.
 313, 318-19 (App. Div. 2002) (vacating for lack of jurisdiction

court's prior order granting State's motion to file late notice

of appeal and dismissing appeal).          Therefore, we are constrained

to deny the motion, despite the minor deviation from the deadline.

                                     V.

      In sum, we affirm the conviction of third-degree distribution

of   heroin;    reverse     the   convictions   of    first-degree    strict

liability causing drug-induced deaths; and remand for further

proceedings consistent with this opinion.

      Affirmed in part, reversed in part, and remanded.          We do not

retain jurisdiction.

                                     24                              A-1244-13T1


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