Case Title: Correll v. Commonwealth

Citation: 

Docket Number: 040746

State: virginia

Court: Virginia Supreme Court

Date: 2005-01-14T00:00:00Z

Document:
Present:  All the Justices 
 
SHIRLEY P. CORRELL 
OPINION BY CHIEF JUSTICE LEROY R. HASSELL, SR. 
v.  Record No. 040746 
January 14, 2005 
 
COMMONWEALTH OF VIRGINIA 
 
FROM THE COURT OF APPEALS OF VIRGINIA 
 
I. 
 
Shirley P. Correll was indicted by a Bedford County grand 
jury for the murder of her incapacitated mother, Nellie S. 
Paxton, and felonious abuse or neglect of Paxton that resulted 
in serious bodily injury or disease to her in violation of 
Code §§ 18.2-33 and -369.  At the conclusion of a bench trial, 
the circuit court acquitted Correll of the murder charge, but 
convicted her of felony neglect.1  The court fixed her 
punishment at two years in the penitentiary, suspended upon 
the service of 30 days in jail.  The Court of Appeals affirmed 
the judgment of the circuit court, Correll v. Commonwealth, 42 
Va. App. 311, 591 S.E.2d 712 (2004), and Correll appeals.  
Correll challenges the sufficiency of the evidence to sustain 
the conviction. 
II. 
                     
1 At the conclusion of the guilt phase of the trial, 
Correll retained a different attorney to represent her during 
the sentencing phase and on appeal.  Her new attorney 
requested that the circuit court consider additional evidence 
not presented during the guilt phase of the trial.  The 
circuit court denied this request. 
 
2
 
Applying well-established principles of appellate review, 
we will consider the evidence and all reasonable inferences 
fairly deducible therefrom in the light most favorable to the 
Commonwealth, the prevailing party below.  Zimmerman v. 
Commonwealth, 266 Va. 384, 386, 585 S.E.2d 538, 539 (2003); 
Phan v. Commonwealth, 258 Va. 506, 508, 521 S.E.2d 282, 282 
(1999). 
Nellie Paxton lived in Bedford County.  In 1991, she 
began to lose weight, and she refused to eat.  Dr. Donald B. 
Nolan, a neurologist, examined Paxton that year.  Six months 
before her visit with Nolan, Paxton had experienced episodes 
of confusion, "had passed out, and a CAT scan had shown that 
she had possibly had a right-sided, right hemisphere stroke."  
When Dr. Nolan examined her, he "was alarmed at her general 
appearance."  He suggested that a physician who practices 
internal medicine examine Paxton.  She was examined and 
admitted to a hospital for treatment for weight loss and 
anemia.  Paxton's condition improved, and she gained weight.  
Paxton was able to conduct her affairs. 
In 1992, Dr. Nolan noted that Paxton "began to show signs 
of Parkinson's disease."  She also began to experience 
hallucinations, and she may have had a form of dementia "which 
mimics Alzheimer's and has Parkinson's as part of it." 
 
3
 
Dr. Nolan did not monitor Paxton's nutritional status.  
However, he testified that:  "She always looked terrible.  She 
just was emaciated.  And her appearance, that's just her.  It 
was her normal body habitus, I suppose.  [Her physicians] 
really never found a good cause for why she had lost the 
weight when I first saw her.  She was just a very skinny, thin 
lady." 
 
In 1997, Shirley Correll was appointed by the circuit 
court as the legal guardian for her mother.  That same year, 
Paxton fell and broke her hip.  She was admitted to a hospital 
for treatment.  The medical personnel who treated Paxton 
explained to Correll and her sister, Carol P. Gray, that 
Paxton "would need to be up and moving and not lying in bed" 
to prevent complications such as pneumonia and decubiti. 
 
Between 1997 and February 2000, Paxton continued to lose 
weight.  In January 2000, Dr. Adel Salama, a physician who 
practices internal medicine, examined and treated Paxton.  He 
diagnosed her condition as advanced Parkinsonism, multi-
infarct dementia, hypertension, atrial fibrillation, 
osteoarthritis, along with early stage 2 decubiti.  Dr. Salama 
described decubiti, commonly referred to as bedsores, as 
follows: 
"Decubiti is a break in the layer of the skin.  And 
there are four stages.  One stage, first stage is 
just redness in the skin. . . .  [w]hich when you 
 
4
push on it, it does not blanch.  Stage 2, early 
Stage 2 is a breakdown in the skin layers.  It can 
involve the epidermis, which is a superficial layer 
of the skin, or it can go down to the dermis, which 
is a deeper layer of the skin.  Or Stage 3 is 
involving the subcutaneous tissue under the skin.  
And Stage 4 is involving down to the bone." 
 
Paxton had one stage 2 decubitus that was located on her lower 
back. 
 
Dr. Salama prescribed the use of a Duoderm patch to treat 
the decubitus.  The Duoderm patch is a hydrochloride material 
that is placed on the decubitus and helps the regeneration of 
the skin cells.  Dr. Salama spoke with Correll regarding the 
care and health needs of Paxton, who was predisposed to 
decubiti. 
 
In January 2000, Dr. Salama did not observe any physical 
signs or symptoms that indicated to him that Paxton was 
malnourished.  Her albumin was checked on January 17, 2000.  
Paxton's albumin level was in the normal range of 3.8 to 5.2.  
According to Dr. Salama, Paxton's albumin level indicated that 
she had a "good nutritional status." 
 
Dr. Salama told Correll to bring Paxton to his office for 
another examination "[i]n six months.  Earlier, if there is 
any problem."  Dr. Salama testified that he would have 
expected to examine Paxton sooner than six months if Paxton 
"lost more weight, if the decubiti is not getting better, and 
so on."  Even though Dr. Salama's office made an appointment 
 
5
for him to examine Paxton in July 2000, "[t]hey called and 
cancelled it."  Dr. Salama stated:  "I don't know who called 
because I'm not the one who cancelled the appointment." 
Carol Gray, who was estranged from her sister, Correll, 
saw her mother in February 2000.  Gray stated that Paxton 
"looked worse.  She lost a lot more weight."  When Gray saw 
her mother on Mother's Day in May 2000, Paxton had "lost more 
weight. . . .  She was beginning to really look bad."  Gray 
saw her mother again in August 2000.  "She just had really 
lost down until she was – looked like a skeleton.  You know, 
she was just really small."  Gray next saw Paxton at a wedding 
in September 2000.  Her mother's condition had worsened. 
 
On September 18, 2000, Correll made a telephone call to 
Dr. Salama's office.  Correll was very concerned about 
Paxton's condition, and Dr. Salama's employees scheduled an 
appointment for 2:30 that afternoon.  Ten minutes after 
Correll made this appointment, she decided to contact 
emergency medical personnel so that her mother could be 
transported immediately to the emergency room of a hospital. 
 
Sherry W. Weeks, a certified emergency medical technician 
and a member of the rescue squad in Bedford County, responded 
to the Paxton residence.  Paxton was seated at a kitchen 
table.  Weeks assessed her condition as follows: 
 
6
"Immediately upon our arrival, [Paxton] was 
severely dehydrated. . . .  She was unresponsive, 
other than to painful stimuli, which means that we 
would basically have to pinch [her] before we could 
get any response out of her at all.  She was 
severely dehydrated.  Her eyes were very sunken in.  
Her cheek bones were sunken.  Just severely 
dehydrated.  Her pulse was low.  Her blood pressure 
was low.  She was pretty close to going into shock." 
 
 
Correll informed Weeks that "her mother had not eaten for 
the last day and had gotten dehydrated."  Weeks testified, 
without objection, that her physical assessment of Paxton was 
not consistent with the history that Correll had provided.  
Weeks stated that "the condition that Ms. Paxton was in was 
not consistent with only being dehydrated for a day."  Dixie 
Daniel, Paxton's primary nurse in the emergency room of 
Carilion Roanoke Memorial Hospital, testified that Paxton's 
"appearance, her thinness, the dryness of her skin is 
something that you would usually see taking longer than two 
days to occur."  Daniel observed a decubitus on Paxton's right 
hip, and she stated:  "It ranked up there with some of the 
worst ones that I've seen." 
 
Dr. Salama treated Paxton at the emergency room of the 
hospital.  He testified that she had "advanced Parkinsonism, 
dementia, dehydration, [and] cachexia."  He defined cachexia 
as undernutrition.  Dr. Salama described Paxton's 
undernutrition as "[v]ery severe."  He stated that it was 
 
7
unlikely that this degree of undernutrition would have 
developed during the course of a weekend. 
Paxton suffered moderate to severe dehydration, and she 
had stage 3 and early stage 4 decubiti.  Dr. Salama testified 
that stage 3 decubiti developed "over days, weeks – to weeks, 
but not hours or not 24.  I don't think that I have ever seen 
Stage 4 or Stage 3 decubiti developing over 48 hours."  Paxton 
also suffered from bacteremia, a condition in which bacteria 
is present in the blood.  The source of the bacteria may have 
been the presence of decubiti on Paxton's body.  The presence 
of the bacteremia indicated to Dr. Salama that the decubiti 
had not been treated properly. 
Dr. Salama stated that Paxton's albumin level upon 
admission to the hospital was 2.6.  This level was a 
significant and drastic change from Paxton's albumin level 
that existed when Dr. Salama treated her in January 2000.  
Paxton's low albumin level indicated that "she [was] 
undernourished."  Dr. Salama testified that Paxton's decubiti, 
severe dehydration, and undernourishment posed a significant 
threat to her life or health.  He also stated that had Paxton 
merely refused to eat or drink water for only two days, this 
limited deprivation would not have affected her albumin level.  
He said that "albumin [has] a long life.  To make a change, it 
needs twenty-one days." 
 
8
 
Various nurses who rendered care to Paxton when she was a 
patient in the hospital testified at trial.  Tracy A. Mann 
stated that Paxton's "condition upon admission . . . was 
shocking. . . .  She was morbidly emaciated and covered with 
decubitus or bedsores."  Mann testified, without objection, 
that two of the decubiti present on Paxton's body would have 
taken a month or more to develop because they were black in 
appearance and "had hardened."  Mann also testified without 
objection that Paxton's "oral mucous membranes were dry and 
her tongue was cracked, which is consistent with dehydration."  
Mann stated that "[b]ased on her physical appearance, [Paxton] 
was severely malnourished." 
 
Correll informed Martha Anderson, a geriatric clinical 
nurse who performed an assessment of Paxton, that Correll was 
aware that her mother had decubiti, but that she did not know 
how to use the Duoderm patch correctly.  Anderson stated, 
without objection, "I've seen a fair amount of bedsores in my 
many years of nursing.  And most Stage 3 ulcers have taken 
months to develop, but certainly weeks.  Weeks to months."  
Anderson also testified without objection that Paxton's poor 
physical health could have been prevented with proper 
treatment. 
 
Doris P. Jones, a registered nurse and a certified wound 
care nurse, testified that if a patient does not receive 
 
9
adequate nutrition, wounds will not heal.  Jones stated 
without objection that a patient with Paxton's medical 
condition would not always develop decubiti and that Paxton's 
decubiti were preventable. 
Dr. Salama stated that Paxton's decubiti began healing 
while she was in the hospital.  Tracey Mann testified that 
Paxton's decubiti started to heal within four days, as 
indicated by "pinking around the margins" of the decubiti.  
Martha Anderson testified that Paxton's nutritional status 
improved from September 22nd to October 30th, as indicated by 
an increase in Paxton's fatty tissue and the healing of the 
skin around Paxton's decubiti. 
Paxton was discharged from the hospital to a nursing home 
on October 3, 2000, and her condition improved.  Mark L. 
Pittman, a nurse who rendered care to Paxton at the nursing 
home, testified that Paxton was not able to feed herself and 
that she was dependent upon others to assist her.  Pittman 
explained that Paxton ate food while in the nursing home, and 
she interacted with the staff and assisted in her daily living 
activities. 
Paxton was transported to the hospital again on October 
25, 2000 because a nursing assistant heard a "rattle" in her 
chest.  She was admitted to the hospital where she died of 
pneumonia three days later. 
 
10
 
Dr. William Massello, a forensic pathologist who is the 
assistant chief medical examiner for western Virginia, 
performed an autopsy upon Paxton's body.  He testified that 
her body "was extremely emaciated.  She had virtually no fat 
beneath her skin.  Her bones were visible externally.  She had 
virtually no muscle that – no muscle mass that could be 
observed."  Dr. Massello stated that his findings during the 
autopsy indicated that Paxton had experienced "a state of 
chronic starvation."  Paxton's lack of nutrition and food had 
caused her body to "cannibalize its own tissue as a food 
source.  And the fat has been utilized and then some of the 
important proteins of the body which give the body structure 
such as the muscle have been utilized by the body for food." 
Dr. Massello testified that his findings during the 
autopsy were consistent with Paxton's condition on admission 
to the hospital on September 18, 2000.  Dr. Massello stated 
that in his opinion, when Paxton was admitted to the hospital 
on that date, she was experiencing "a severe case of 
malnourishment."  He testified within a reasonable degree of 
medical probability that Paxton had been malnourished for at 
least a few months before her admission to the hospital in 
September 2000.  He further explained he found no indication 
that Paxton was physically unable to eat.  Dr. Massello stated 
that Paxton's cause of death was pneumonia due to corporeal 
 
11
emaciation and inanition due to chronic starvation.  
Continuing, Dr. Massello stated:  "Emaciation is loss of mass.  
Being very skinny and without, as I say, any fat or muscle.  
And inanition is the state of weakness and debilitation caused 
by the lack of proper nutrition."  Finally, Dr. Massello 
testified Paxton's undernourishment was not normal for a 
patient of 83 years, even a patient with Parkinson's disease, 
dementia, or Alzheimer's. 
III. 
 
Code § 18.2-369 states in relevant part:2 
 
"A.  It shall be unlawful for any responsible 
person to abuse or neglect any incapacitated adult 
as defined in this section.  Any responsible person 
who abuses or neglects an incapacitated adult in 
violation of this section and the abuse or neglect 
does not result in serious bodily injury or disease 
to the incapacitated adult shall be guilty of a 
Class 1 misdemeanor.  Any responsible person who is 
convicted of a second or subsequent offense under 
this subsection shall be guilty of a Class 6 felony. 
 
 
"B.  Any responsible person who abuses or 
neglects an incapacitated adult in violation of this 
section and the abuse or neglect results in serious 
                     
2 Code § 18.2-369 was amended in 2001 and 2004.  The 
standard of felony liability for abuse or neglect that 
"results in serious bodily injury or disease to the 
incapacitated adult" set out in paragraph (A) of the statute 
as it existed during the events in the year 2000 that form the 
basis of the present prosecution, is unchanged and is now set 
out in a separately numbered paragraph (B) of this Code 
provision, and the definitions formerly in paragraphs (A) and 
(B) have been renumbered in subparagraph (C) without 
substantive change.  We will use the current numbering in this 
opinion. 
 
12
bodily injury or disease to the incapacitated adult 
shall be guilty of a Class 4 felony. 
 
 
"C. For purposes of this section: 
 
. . . . 
 
 
" 'Neglect' means the knowing and willful 
failure by a responsible person to provide 
treatment, care, goods or services which results in 
injury to the health or endangers the safety of an 
incapacitated adult." 
 
 
The circuit court concluded that the defendant knowingly 
and willfully neglected her mother and that such neglect 
resulted in serious bodily injury to her mother.  Correll 
argued in the circuit court and Court of Appeals, and she also 
argues in this Court, that the evidence was not sufficient to 
find her guilty of felony neglect of an incapacitated adult 
resulting in serious bodily injury because there is no 
evidence that she knowingly or willfully caused any injuries 
or failed to provide treatment or care to her mother.  We 
disagree. 
 
When a defendant contests the sufficiency of the evidence 
on appeal, this Court must give the judgment of the circuit 
court sitting without a jury the same weight as a jury 
verdict.  Commonwealth v. Duncan, 267 Va. 377, 384, 593 S.E.2d 
210, 214 (2004); McCain v. Commonwealth, 261 Va. 483, 492, 545 
S.E.2d 541, 547 (2001); Tarpley v. Commonwealth, 261 Va. 251, 
256, 542 S.E.2d 761, 763 (2001); Hickson v. Commonwealth, 258 
 
13
Va. 383, 387, 520 S.E.2d 643, 645 (1999).  Additionally, this 
Court has the duty to review the evidence that tends to 
support the conviction and affirm the circuit court's judgment 
unless it appears from the evidence that the judgment is 
plainly wrong or without evidence to support it.  Code § 8.01-
680; Duncan, 267 Va. at 384, 593 S.E.2d at 214; Jackson v. 
Commonwealth, 267 Va. 178, 204, 590 S.E.2d 520, 535 (2004); 
McCain, 261 Va. at 492-93, 545 S.E.2d at 547; Tarpley, 261 Va. 
at 256, 542 S.E.2d at 763; Phan, 258 Va. at 511, 521 S.E.2d at 
284. 
 
The record before this Court clearly establishes that the 
evidence was sufficient beyond a reasonable doubt to support 
the conviction.  Pursuant to Code § 18.2-369:  " 'Neglect' 
means the knowing and willful failure by a responsible person 
to provide treatment, care, goods or services which results in 
injury to the health or endangers the safety of an 
incapacitated adult."  Even though this Court has not 
previously discussed the meaning of the word "willful" as used 
in this statute, this Court has interpreted the meaning of the 
word "willful" as used in Code § 18.2-371.1(B)(1), which is a 
child abuse and neglect criminal statute.  We stated: 
 
"The statutory requirement that such conduct be 
'willful' means that the conduct must be knowing or 
intentional, rather than accidental, and be done 
without justifiable excuse, without ground for 
believing the conduct is lawful, or with a bad 
 
14
purpose.  See Bryan v. United States, 524 U.S. 184, 
191-92 (1998); United States v. Murdock, 290 U.S. 
389, 394-95 (1933); Ellis [v. Commonwealth, 29 Va. 
App. 548, 554, 513 S.E.2d 453, 456 (1999)].  Thus, 
the term 'willful,' as used in Code § 18.2-
371.1(B)(1), contemplates an intentional, purposeful 
act or omission in the care of a child by one 
responsible for such child's care." 
 
Duncan, 267 Va. at 384-85, 593 S.E.2d at 214-15.  Accord 
Barrett v. Commonwealth, 268 Va. 170, 183, 597 S.E.2d 104, 
110-11 (2004).  This definition is equally applicable to Code 
§ 18.2-369(B) and (C). 
 
We hold that in the context of Code § 18.2-369, the word 
"willful" describes conduct that must be knowing or 
intentional, rather than accidental, and undertaken without 
justifiable excuse, without ground for believing the conduct 
is lawful or with a bad purpose.  Thus, "willful," as used in 
Code § 18.2-369, contemplates an intentional, purposeful act 
or omission in the care of an incapacitated adult by one 
responsible for that adult's care. 
 
The evidence in the record before this Court establishes, 
beyond a reasonable doubt, that Correll knowingly and 
willfully failed to provide medical treatment to her 
incapacitated mother.  Dr. Salama had discussed Paxton's 
medical condition with Correll in January 2000 and told her to 
return to his office with her mother in six months or sooner 
if Paxton's condition deteriorated.  Paxton's condition 
 
15
deteriorated.  Without question, Paxton was incapacitated and 
totally dependent upon her daughter, Correll. 
Paxton's severe dehydration and chronic starvation may 
have been caused by several factors:  Paxton may have refused 
to eat, she may have been unable to eat, or no one provided 
nutrition to her.  As a result of one or more of the 
aforementioned factors, Paxton experienced severe starvation.  
Dr. Salama described the decedent's undernutrition as "[v]ery 
severe," and he concluded that it was unlikely that this 
condition developed during the course of two days.  In spite 
of Paxton's malnutrition, irrespective of its cause, Correll 
failed to seek treatment for Paxton even though Dr. Salama had 
instructed Correll to bring Paxton to his office for treatment 
if she experienced any problems. 
The necrotic decubiti that were present on Paxton's body 
had been there for at least a month before Correll sought 
medical assistance, and the decubiti would not heal because 
Paxton had not received adequate nutrition.  Correll admitted 
to a nurse that Correll was unable to properly apply treatment 
to the decubiti.  Yet, Correll did not seek medical treatment 
for Paxton, although she was her court-appointed legal 
guardian and under a duty to do so.  As we have already stated 
in Part II of this opinion, Dr. Massello stated within a 
reasonable degree of medical probability that Paxton had been 
 
16
malnourished for at least a few months prior to her admission 
to the hospital in September 2000 and that her chronic 
starvation, dehydration, and infected decubiti constituted a 
serious threat to her health and safety.  These facts, as well 
as the other facts described in Part II of this opinion, are 
more than sufficient to permit the fact finder to conclude 
beyond a reasonable doubt that the defendant's conduct was 
knowing and willful within the intendment of Code § 18.2-369. 
 
The defendant's contention that her conduct did not 
result in "Paxton suffering 'serious bodily injury or 
disease' " is without merit.  Code § 18.2-369 defines "serious 
bodily injury or disease" as, among other things, "life-
threatening internal injuries or conditions, whether or not 
caused by trauma."  As we have already stated, Dr. Salama 
testified that Paxton's severe dehydration, undernourishment, 
and infected decubiti were conditions that imposed a 
significant threat to her life or health.  Dr. Massello 
testified that Paxton suffered from chronic starvation and 
that this condition, along with her dehydration and infected 
decubiti, was a serious threat to her health and safety.  Dr. 
Massello also opined that Paxton died of pneumonia and that 
the pneumonia was a foreseeable and expected consequence of 
chronic starvation. 
IV. 
 
17
 
For the foregoing reasons, we will affirm the judgment of 
the Court of Appeals. 
Affirmed.