STATE OF NORTH CAROLINA
v.
KIMBERLY BRAXTON FRITSCH aka KIMBERLY RAINS FRITSCH
On discretionary review pursuant to N.C.G.S. § 7A-31 of a
unanimous decision of the Court of Appeals, 132 N.C. App. 262,
511 S.E.2d 325 (1999), holding that the trial court erred in
denying defendant's motions to dismiss and reversing a judgment
entered by Cobb, J., on 26 March 1997 in Superior Court, Carteret
County. Heard in the Supreme Court 17 November 1999.
Michael F. Easley, Attorney General, by Grady L. Balentine,
Jr., Assistant Attorney General, for the State-appellant and
-appellee.
Stephen M. Valentine for defendant-appellant and -appellee.
PARKER, Justice.
Defendant was indicted for felonious child abuse and
involuntary manslaughter of her seven-year-old daughter (victim).
The jury convicted defendant of nonfelonious child abuse and
involuntary manslaughter. The convictions were consolidated for
judgment, and the trial court sentenced defendant to a term of
sixteen to twenty months imprisonment.
At trial the State's evidence tended to show that the victim
suffered from cerebral palsy and severe mental retardation,
functioning at the level of an infant. The victim died on
1 January 1996 at her home in Carteret County. The victim was a
student at the Newport Developmental Center (Center), atherapeutic day program for children with special needs, from
June 1989 until January 1992 and then again from April 1993 until
16 October 1995. While at the Center, the victim never exhibited
any eating problems or inability to swallow. In February 1994
the victim weighed twenty-six and a half pounds. The victim was
then absent from the Center from 8 June 1994 until 30 August
1994. When the victim returned on 30 August 1994, the Center
observed that she was dirty and thinner and that she had sores on
her back. The victim then weighed twenty-two pounds. The Center
then contacted the Department of Social Services (DSS)
concerning the victim's physical condition. The DSS's
investigation revealed that the victim had fresh and old bed
sores on her spine, that the victim had a severe diaper rash, and
that she appeared emaciated. The DSS then contacted Dr. William
Stanley Rule for a child medical evaluation as to whether the
victim's condition was due to neglect or her disability. The
DSS's investigation also revealed that the victim had not been
seen regularly by a physician. After the DSS substantiated a
case for neglect of the victim, defendant entered into two
intervention plans with the DSS which included choosing a doctor
to perform regular weight checks and medical examinations of the
victim, having the victim followed by a home health agency or a
similar organization, taking advantage of respite services for
additional home support, obtaining counseling regarding
defendant's care of the victim, having the victim attend the
Center on a regular basis, and obtaining regular employment and
independence. The DSS's service regarding this neglect complaint
of the victim ended in May 1995. Dr. Rule, an expert in the field of pediatrics, saw the
victim from infancy in 1988 until 1992. According to Dr. Rule,
the victim was a premature twin who had numerous medical
problems, including severe kidney disease with a swollen left
kidney, a collapsed lung, pulmonary disease, cerebral atrophy,
and visual and hearing difficulties. Pursuant to the DSS's
request to examine the victim, Dr. Rule concluded that
[t]he pressure sore and evidence of prior similar
lesions, along with chronic diaper rash and diminished
subcutaneous tissue, a possible sign of inadequate
caloric intake, along with the apparent lack of
consistent medical, home and medical follow-up of
problems, all raise valid concerns regarding the
child's care, regarding child care issues. There is no
suggestion of abuse. . . . Cerebral palsy could
possibly explain the child's size and growth status,
but I still believe the situation is suspect. . . .
The skin lesions and her diaper rash, those areas I
felt were indicative of suboptimal care or poor care.
I thought that the weight of the child was something
that should raise concern.
After regular attendance at the Center, the victim weighed
twenty-seven pounds on 21 September 1994. The victim was again
absent from the Center from 4 January 1995 until 4 April 1995.
On 4 April 1995 the victim weighed twenty-four and a half pounds.
After numerous absences from the Center in April and May 1995,
the victim weighed twenty-two and a half pounds on 10 May 1995.
The victim was again absent from the Center from 2 September
1995 until 2 October 1995. On 2 October 1995 the victim returned
to the Center unkempt and with sores. The victim weighed twenty-
three pounds. The Center contacted the DSS again regarding the
victim's physical condition. On 4 October 1995 the DSS observed
that the victim appeared emaciated; that her arms and legs were
in a fetal position; that she looked and smelled bad; that she
had crusted dirt between her toes and various folds of her skin;that her left foot was swollen; and that she had pressure sores
on her right foot, right ear, back, and the back of her head at
the hairline. When questioned about the victim's physical
condition, defendant responded that the pressure sores were
actually ant bites that had not healed. The DSS then told
defendant to take the victim to the doctor for a medical
evaluation. On or about 19 October 1995, the victim was treated
for an ear and upper respiratory infection; and the physical
examination was rescheduled. However, defendant missed two
scheduled appointments to have the victim physically examined.
Despite numerous calls and visits to defendant's home and a
mailed certified letter requesting contact, the DSS was unable to
contact defendant until 18 December 1995. On 19 December 1995
the DSS stressed to defendant that the victim needed a physical
evaluation and that she needed to be back at the Center. On
20 December 1995 the DSS substantiated neglect for lack of
proper care and lack of proper medical care of the victim by
defendant based on observations made at the Center on 4 October
1995 and defendant's continued failure to take the victim to a
doctor for a physical examination. The victim died on 1 January
1996 before case workers were scheduled to visit defendant's
home.
On 2 January 1996 Dr. John Leonard Almeida, Jr., a
pathologist, performed an autopsy of the victim's body. The
autopsy revealed that the victim weighed eighteen pounds at her
death and that the victim's stomach contained approximately a
quart of food. Dr. Almeida opined that the underlying cause of
the victim's death was starvation malnutrition. He found noevidence that [the victim] could not digest and ingest food.
Dr. Almeida further opined that
the malnutrition was of relatively long standing
chronic condition, and that the child had very little
strength or energies left. And although she had been
fed and had ingested a significant amount of food, that
she was unable to use that food for the final meal to
any useful purpose.
According to defendant, the victim was able to eat only
pureed food prepared in a blender. Dr. Richard Stevenson,
defendant's expert in pediatrics and developmental disabilities
in children, testified that it was common for children with
cerebral palsy to be malnourished. Although Dr. Stevenson never
physically examined the victim, he reviewed the victim's medical
records and concluded that the victim had been significantly
malnourished for at least two years prior to her death.
Dr. Stevenson explained that
[the victim's] ability to eat was limited by the
severity of her disability, so that she could only take
in a certain number of calories. I think that she
became malnourished and stay[ed] malnourished
chronically. I think that malnutrition was then
complicated by medical factors. Most importantly, I
think her bed sores, and that the combination of
[mal]nutrition and the bed sores, as well as
intervening colds and other things like that, lead
[sic] to a vicious circle of continued malnutrition,
increased weakness and eventually, death.
In forming his opinions, Dr. Stevenson relied on a medical
article that contained a study revealing that 43 percent of
children with that severity of handicap [as the victim] were dead
by age five and 70 percent were dead by age ten.
Defendant presented testimony of numerous family members and
friends who testified that they witnessed defendant feeding the
victim many times. They all attested to the fact that the
feeding process was long and arduous since the victim had adifficult time swallowing food. They also testified that the
victim had always been very thin for a child her age. Dr. Donald
Jason, an expert in the field of forensic pathology, reviewed the
victim's autopsy report and concluded that the victim died not
from starvation malnutrition, but from severe dehydration since
the stomach was not emptying properly. Defendant testified that
the missed appointments for medical physicals were due to car
problems. Defendant also testified that she kept the victim out
of the Center during the winter months on account of the victim's
respiratory problems.
Prior to trial on the charges of felonious child abuse and
manslaughter, defendant filed five motions in limine to suppress
the evidence of (i) the pathologist's conclusion that the victim
died from the withholding of food; (ii) defendant's lifestyle;
(iii) the injury to the victim's brother's eye; (iv) the victim's
diaper rash, bed sores, unclean or unsanitary appearance or
evidence of marks, rashes, bites, [or] other conditions; and
(v) the four investigations by the DSS into allegations of
neglect of the victim by defendant. The trial court granted
defendant's first three motions, denied the fourth motion, and
granted the fifth motion only with regard to the March 1994 and
July 1994 DSS investigations into allegations of neglect of
defendant's other children that were not substantiated.
At the close of the State's evidence and at the close of all
the evidence, defendant moved to have the charges dismissed; the
trial court denied the motions. After the jury returned it
verdicts, defendant renewed her motion to dismiss and moved to
have the jury verdicts set aside; the trial court denied the
motions. Defendant appealed, arguing, inter alia, that the trial
court erred by not granting her motions to dismiss the charges at
the close of the State's evidence and at the close of all the
evidence since there was insufficient evidence of the crimes
charged. The Court of Appeals, agreeing with defendant, reversed
the trial court, holding that the State has failed to present
substantial evidence of either felonious or misdemeanor child
abuse, or of involuntary manslaughter, sufficient to survive
defendant's motions to dismiss. State v. Fritsch, 132 N.C. App.
262, 271, 511 S.E.2d 325, 332 (1999). This Court allowed both
the State's petition for discretionary review and defendant's
conditional petition for discretionary review as to additional
issues.
The State contends that the Court of Appeals erred in
holding that the trial court erred by denying defendant's motions
to dismiss. The State argues that it presented substantial
evidence of involuntary manslaughter and felonious or misdemeanor
child abuse sufficient to survive defendant's motions to dismiss.
We agree.
In State v. Barnes, 334 N.C. 67, 430 S.E.2d 913 (1993), this
Court again reiterated the standard of review for motions to
dismiss in criminal trials. The Court stated,
This Court reviewed the law in State v. Powell,
299 N.C. 95, 261 S.E.2d 114 (1980):
Upon defendant's motion for dismissal, the
question for the Court is whether there is
substantial evidence (1) of each essential element
of the offense charged, or of a lesser offense
included therein, and (2) of defendant's being the
perpetrator of such offense. If so, the motion is
properly denied.
If the evidence is sufficient only to raise a
suspicion or conjecture as to either thecommission of the offense or the identity of the
defendant as the perpetrator of it, the motion
should be allowed.
Id. at 98, 261 S.E.2d at 117 (citations omitted). In
reviewing challenges to the sufficiency of evidence, we
must view the evidence in the light most favorable to
the State, giving the State the benefit of all
reasonable inferences. State v. Benson, 331 N.C. 537,
544, 417 S.E.2d 756, 761 (1992). Contradictions and
discrepancies do not warrant dismissal of the case but
are for the jury to resolve. Id. The test for
sufficiency of the evidence is the same whether the
evidence is direct or circumstantial or both. State v.
Bullard, 312 N.C. 129, 322 S.E.2d 370 (1984).
Circumstantial evidence may withstand a motion to
dismiss and support a conviction even when the evidence
does not rule out every hypothesis of innocence.
State v. Stone, 323 N.C. 447, 452, 373 S.E.2d 430, 433
(1988). If the evidence presented is circumstantial,
the court must consider whether a reasonable inference
of defendant's guilt may be drawn from the
circumstances. Once the court decides that a
reasonable inference of defendant's guilt may be drawn
from the circumstances, then 'it is for the jury to
decide whether the facts, taken singly or in
combination, satisfy [it] beyond a reasonable doubt
that the defendant is actually guilty.' State v.
Thomas, 296 N.C. 236, 244, 250 S.E.2d 204, 209 (1978)
(alteration in original) (quoting State v. Rowland, 263
N.C. 353, 358, 139 S.E.2d 661, 665 (1965)).
Barnes, 334 N.C. at 75-76, 430 S.E.2d at 918-19. Both competent
and incompetent evidence must be considered. State v. Lyons,
340 N.C. 646, 658, 459 S.E.2d 770, 776 (1995). In addition, the
defendant's evidence should be disregarded unless it is favorable
to the State or does not conflict with the State's evidence.
See State v. Earnhardt, 307 N.C. 62, 67, 296 S.E.2d 649, 653
(1982). The defendant's evidence that does not conflict may be
used to explain or clarify the evidence offered by the State.
Id. When ruling on a motion to dismiss, the trial court should
be concerned only about whether the evidence is sufficient for
jury consideration, not about the weight of the evidence. See
id. at 67, 296 S.E.2d at 652. Defendant was charged with felonious child abuse and
involuntary manslaughter. The jury found defendant guilty of
nonfelonious child abuse and involuntary manslaughter. To
sustain a charge of felonious child abuse, the State must present
substantial evidence that defendant is
[a] parent or any other person providing care to or
supervision of a child less than 16 years of age who
intentionally inflicts any serious physical injury upon
or to the child or who intentionally commits an assault
upon the child which results in any serious physical
injury to the child . . . .
N.C.G.S. § 14-318.4(a) (1999). To sustain a charge of
misdemeanor child abuse, the State must present substantial
evidence that defendant is
[a] parent of a child less than 16 years of age, or any
other person providing care to or supervision of such
child, who inflicts physical injury, or who allows
physical injury to be inflicted, or who creates or
allows to be created a substantial risk of physical
injury, upon or to such child by other than accidental
means . . . .
N.C.G.S. § 14-318.2(a) (1999).
To sustain a charge of involuntary manslaughter, the State
must present substantial evidence that defendant committed
the unlawful and unintentional killing of another human
being without malice and which proximately results from
the commission of an unlawful act not amounting to a
felony or not naturally dangerous to human life, or
from the commission of some act done in an unlawful or
culpably negligent manner, or from the culpable
omission to perform some legal duty.
State v. Everhart, 291 N.C. 700, 702, 231 S.E.2d 604, 606 (1977).
Under the applicable standard of review, substantial
evidence existed from which the jury could infer that defendant
willfully, or through her culpable negligence, deprived the
victim of food and nourishment, or that the victim's death was
proximately caused by defendant's actions or inactions. State'sevidence tended to show that the seven-year-old victim, who had
cerebral palsy and was profoundly mentally retarded, was absent
from the Center for extended periods of time while in the care
and custody of defendant. In February 1994 the victim weighed
twenty-six and a half pounds. After being absent from the Center
from 8 June 1994 until 30 August 1994, the victim returned
thinner, dirty, and with sores on her back. The victim's weight
had dropped to twenty-two pounds. After another extended absence
from the Center from 2 September 1995 until 2 October 1995, the
victim returned unkempt and with sores, weighing twenty-three
pounds. Responding to the Center's allegations of neglect on
4 October 1995, the DSS observed that the victim appeared
emaciated, that she looked and smelled bad, that there was
crusted dirt between her toes and in the various folds of her
skin, and that she had numerous pressure sores. Dr. Rule, who
examined the victim at the DSS's request, concluded that the
victim's skin lesions and diaper rash were indicative of
suboptimal care or poor care. I thought that the weight of the
child was something that should raise concern. The State's
evidence further showed that the Center never observed the victim
having problems eating or swallowing food. When the victim
attended the Center regularly, she gained and maintained weight.
At no time did the victim weigh more than twenty-seven pounds.
Defendant's expert, Dr. Stevenson, acknowledged that the evidence
that the victim's weight dropped after extended absences from the
Center and rose again after regular attendance would support the
assumption that the victim was not being fed as opposed to
suffering from chronic malnutrition. The victim's autopsy on
2 January 1996 revealed that the victim weighed eighteen poundsat the time of her death, that her death was caused by
starvation malnutrition, and that there was no evidence that
the victim could not digest and ingest food.
Moreover, the State's evidence showed that the Center
contacted the DSS twice concerning the victim's physical
condition. The DSS's 1994 investigation revealed that the victim
had not been seen regularly by a physician. After the DSS
substantiated a case for neglect of the victim, defendant signed
two intervention plans which detailed the level of care that she
was expected to provide for the victim, including, inter alia,
regular doctor visits and regular Center attendance. As part of
the DSS's 1995 investigation, defendant was to take the victim
for a medical evaluation scheduled for 18 October 1995. The
medical evaluation was rescheduled; however, defendant missed two
scheduled appointments. The DSS substantiated neglect on
20 December 1995 for lack of proper care and lack of proper
medical care based on observations of the victim's physical
condition and the continued failure to take the victim to a
doctor for a physical examination.
The State contends that the Court of Appeals improperly
weighed the evidence by considering defendant's exculpatory
evidence that was in conflict with the State's evidence. We
agree. Comparing this case with State v. Mason, 18 N.C. App.
433, 197 S.E.2d 79, cert. denied, 283 N.C. 669, 197 S.E.2d 878
(1973), which involved an involuntary manslaughter conviction for
the starvation death of a child who was found in squalid living
conditions, the Court of Appeals described the victim in this
case as one who lived in a properly heated, well stocked home
with several healthy, well-fed children. Fritsch, 132 N.C. App.at 270-71, 511 S.E.2d at 331. This description identifies a
contradiction or discrepancy with the State's evidence of the
victim's condition, which is for the jury to resolve. See
Benson, 331 N.C. at 544, 417 S.E.2d at 761. The Court of Appeals
also noted that the victim suffered from several significant
medical conditions, that no treating or examining physicians
ever recommended hospitalization or feeding the victim through
the insertion of a gastrostomy tube, and that friends and family
members never expressed great concern with the victim's well-
being. Fritsch, 132 N.C. App. at 271, 511 S.E.2d at 331. This
evidence conflicts with the State's evidence and could not
properly be considered on a motion to dismiss. See Earnhardt,
307 N.C. at 67, 296 S.E.2d at 653.
We conclude that all the evidence, taken in the light most
favorable to the State, was sufficient to support a finding that
defendant was guilty of nonfelonious child abuse and involuntary
manslaughter. The fact that some evidence in the record supports
a contrary inference is not determinative on the motion to
dismiss. Accordingly, the Court of Appeals erred in reversing
the trial court's denial of defendant's motions to dismiss.
Defendant contends that the trial court erred by denying
defendant's motion in limine to suppress and by overruling
defendant's objections during trial to evidence that DSS
substantiated two cases of neglect of the victim by defendant.
We disagree.
Defendant made a motion in limine to suppress evidence of
four DSS investigations into allegations that defendant's
children were neglected. The trial court granted the motion as
to the DSS's March 1994 and July 1994 investigations thatinvolved unsubstantiated allegations of neglect of defendant's
other children. The trial court denied the motion as to the
DSS's August 1994 and October 1995 investigations that involved
substantiated allegations of neglect of the victim by defendant.
The trial court permitted Pamela Stewart and Daniel Sullivan,
employees of the DSS, to testify, over defendant's objection,
that they investigated the Center's allegations of neglect by
observing the victim's physical condition at the Center. Stewart
testified that based on her observation in August 1994 of the
pressure sores, the weight loss, the diaper rash, and the fact
that [the victim] had not been seen by a regular medical
physician, the DSS substantiated a case of neglect of the victim
by defendant. Based on his October 1995 observations of the
victim, Sullivan testified that the DSS substantiated a case of
neglect of the victim for lack of proper care and lack of proper
medical care by defendant. The trial court instructed the jury
that this evidence could be considered only for the limited
purpose of showing that the defendant had at least some
knowledge that the [DSS] had concerns regarding the level of care
she was providing for her child, not as evidence of defendant's
guilt.
The decision to either grant or deny a motion in limine is
within the sound discretion of the trial court. See State v.
Hightower, 340 N.C. 735, 746-47, 459 S.E.2d 739, 745 (1995). The
trial court also has the sound discretion to exclude relevant but
prejudicial evidence under Rule 403. See State v. Handy, 331
N.C. 515, 532, 419 S.E.2d 545, 554 (1992). The trial court must
exclude evidence of other crimes, wrongs, or acts if the purpose
of the evidence is to show defendant's propensity to commit thecrime. See State v. Coffey, 326 N.C. 268, 278-79, 389 S.E.2d 48,
54 (1990). However, such evidence may be admissible for other
purposes, such as proof of motive, opportunity, intent,
preparation, plan, knowledge, identity, or absence of mistake,
entrapment or accident. N.C.G.S. § 8C-1, Rule 404(b) (1999).
Our courts have consistently held that past incidents of
mistreatment are admissible to show intent in a child abuse
case. State v. West, 103 N.C. App. 1, 9, 404 S.E.2d 191, 197
(1991).
Defendant contends that the testimony of the DSS employees
that the DSS had substantiated a case of neglect of the victim by
defendant was unduly prejudicial in that it invaded the province
of both the judge and jury. In other words, the testimony was
the equivalent of the involuntary manslaughter instruction given
to the jury that defendant's failure to act constituted a
criminally negligent failure to perform a legal duty and that
defendant's act proximately caused the victim's death. We
disagree. The State contends that the evidence was not used to
show defendant's propensity to commit the crime, but rather to
show that defendant had knowledge of the level of care that she
was expected to provide and maintain for the victim. The jury
could infer from the evidence of the DSS's substantiation of
neglect that defendant's failure to follow the two intervention
plans provided by the DSS was not a mistake. We hold that
defendant's past incidents of her failure to provide proper care
for the victim are relevant and admissible to show intent. The
trial court properly balanced the probative value of this
relevant evidence for the State against any unduly prejudicial
effect to defendant by giving a limiting instruction to the jury. Further, we note that the trial court granted defendant's motions
in limine to suppress evidence of the pathologist's conclusion
that the victim died from the withholding of food, of defendant's
lifestyle, of the injury to the victim's brother's eye, and of
two investigations by the DSS into unsubstantiated allegations of
neglect of other children. Therefore, we conclude that the trial
court did not abuse its discretion in failing to grant
defendant's motion in limine to suppress and in overruling
defendant's objections during trial to evidence of the DSS's
substantiation, based on its investigations, of allegations of
neglect of the victim by defendant.
In conclusion, we affirm the decision of the Court of
Appeals upholding the trial court's denial of defendant's motion
in limine and overruling defendant's objections at trial to
exclude evidence of the DSS's investigations. However, we
reverse the Court of Appeals' decision reversing defendant's
convictions.
REVERSED.
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