Case Title: Velazquez v. Commonwealth

Citation: 

Docket Number: 010926

State: virginia

Court: Virginia Supreme Court

Date: 2002-01-11T00:00:00Z

Document:
Present:  All the Justices 
 
EDUARDO V. VELAZQUEZ 
 
OPINION BY 
v.  Record No.  010926 
JUSTICE LAWRENCE L.  KOONTZ, JR. 
 
January 11, 2002 
COMMONWEALTH OF VIRGINIA 
 
FROM THE COURT OF APPEALS OF VIRGINIA 
 
In this appeal of a conviction for rape, we consider 
whether the trial court erred in permitting a Sexual Assault 
Nurse Examiner (SANE) to testify regarding her expert medical 
opinion on the causation of the victim’s injuries and, if not, 
whether that testimony improperly invaded the province of the 
jury. 
BACKGROUND 
Under well established principles, we review the evidence 
and the reasonable inferences arising therefrom in the light 
most favorable to the Commonwealth, the party prevailing below.  
Turner v. Commonwealth, 259 Va. 645, 648, 529 S.E.2d 787, 789 
(2000).  The fifteen-year-old female victim, A.L., was a regular 
visitor in the home of Eduardo V. Velazquez.  Velazquez’s wife 
was a good friend of A.L.’s mother, and A.L. considered her to 
be “my second mom.”  On one occasion when A.L. was visiting the 
home, Velazquez “was drunk and he tried kissing [A.L.].”  A.L. 
did not tell anyone about the incident because she was afraid 
that she would not be believed. 
On March 18, 1997, A.L. went to the Velazquez home after 
school to retrieve a school library book which she had lent to 
Velazquez’s wife.  Velazquez and a male friend of his were 
present in the home.  Velazquez told A.L. that he would get the 
book for her and then he asked his friend to go outside. 
Velazquez told A.L. to sit down, and he removed her 
backpack from her shoulders.  A.L. told Velazquez that she 
wanted to leave, but Velazquez attempted to kiss her.  A.L. told 
him to stop.  While she attempted to push Velazquez away from 
her, A.L. tripped and they both fell to the floor.  At that 
point, A.L. was on her back; Velazquez was on top of her.  
Velazquez attempted to remove A.L.’s pants, while she again told 
him “no” and fought to get away. 
After Velazquez succeeded in pulling A.L.’s pants and 
underwear down to her knees, he then pulled his own pants down.  
While Velazquez was on top of A.L. with his waist positioned 
between her knees and his hands beside her hips, A.L. felt a 
sharp pain in her vaginal area.  The “bottom half” of 
Velazquez’s body was making “an up and down movement” when A.L. 
felt that pain.  During the assault, A.L. feared that she would 
“lose [her] virginity” and would become pregnant.  Velazquez 
remained on top of A.L. for five minutes and then stood up after 
he became irritated with A.L.’s struggles to get away.  A.L. 
attempted to leave, but Velazquez stopped her and told her “to 
 
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clean [herself] up.”  Velazquez left the room, and A.L. grabbed 
her backpack and left. 
When A.L. arrived at her home, she telephoned a cousin and 
told her that she “was hurting in [her] vagina [sic] area.”  
Later that evening, A.L.’s mother, who had spoken to the cousin, 
telephoned A.L. and asked her what was wrong.  A.L. told her 
mother that Velazquez had “forced [her] to have sex with him.” 
A.L.’s mother contacted the Fairfax County Police, who 
subsequently interviewed A.L. at her home.  The police also 
collected A.L.’s clothing for forensic analysis.  A.L.’s mother 
then took her to a local hospital where Barbara Jean Patt, a 
registered nurse who was a certified SANE, examined her. 
A.L.’s mother also contacted Velazquez’s wife, who told her 
husband that A.L. had accused him of rape.  Velazquez left 
Virginia that night, abandoning his wife, step-daughter, and 
infant daughter.  Velazquez was subsequently apprehended in 
Texas in November 1997. 
On December 21, 1997, Velazquez was indicted for the rape 
of A.L. pursuant to Code § 18.2-61.  A jury trial commenced in 
the Circuit Court of Fairfax County on March 29, 1999.  On that 
same day, Velazquez filed a motion in limine “to exclude any 
. . . ‘conclusions’ made by” Patt, contending that such 
testimony would invade the province of the jury.  The motion was 
argued immediately prior to trial.  Relying on Hussen v.  
 
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Commonwealth, 257 Va. 93, 511 S.E.2d 106, cert. denied, 526 U.S. 
1137 (1999), the trial judge overruled the motion in limine, 
ruling that the SANE “can express an opinion as to whether [her 
findings were] consistent with consensual sex or not,” but 
admonishing the Commonwealth that “I think it would be very 
limited in my view as to how far I’d let her go beyond that.” 
A.L. gave testimony in accord with the facts recited above.  
The Commonwealth called Patt to testify “as an expert in [the] 
diagnosis of sexual assault.”  Patt testified that she had been 
a registered nurse for 26 years, had 40 hours of classroom 
training and 40 hours of clinical training to qualify as a SANE, 
and had worked as a SANE for six and one half years.  Patt 
further testified that as a SANE she had conducted approximately 
150 examinations of children under the age of 16 who were 
victims of sexual assault and 350 examinations of adult victims 
of sexual assault. 
Velazquez objected to Patt being qualified as an expert on 
the ground that experts qualified to testify about medical 
diagnosis “are doctors and scientists . . . .  [S]he’s a nurse 
. . . she does not have the scientific training to testify as to 
. . . causation.”  After the Commonwealth further examined Patt 
on the nature and extent of her clinical training, the trial 
court overruled the objection and ruled that Patt was qualified 
as an expert in the diagnosis of sexual assault. 
 
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Patt then testified that she had examined A.L. on the 
evening of March 18, 1997.  Describing the injuries that she had 
found during a pelvic examination, Patt stated that one deep 
tear in the labial tissue “most likely is consistent with 
attempted intercourse.”  Velazquez objected to this testimony.  
The trial court sustained the objection, admonished the jury to 
“disregard the answer as given,” but indicated to the 
Commonwealth’s Attorney that he could “rephrase the question.” 
After eliciting further testimony on the nature of A.L.’s 
injuries, the Commonwealth’s Attorney asked Patt whether she had 
“an opinion within a reasonable degree of medical certainty as 
to whether the physical findings . . . are consistent with 
consensual sexual intercourse?”  Patt replied, “I have an 
opinion that it’s inconsistent with consensual intercourse.”  
Velazquez objected “[t]o the phraseology” of Patt’s answer.  The 
trial court overruled the objection.  The Commonwealth’s 
Attorney then asked, “Why is it you have that opinion?”  Patt 
responded, “Because the injuries she had are consistent with 
non-consensual intercourse.” 
Forensic analysis of the DNA profile of a semen stain found 
on A.L.’s clothing was consistent with Velazquez’s DNA.  The 
forensic expert testified that the possibility of a random match 
to an unrelated individual was “one in greater than the 
population of the world.” 
 
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Velazquez testified in his own defense.  He maintained that 
A.L. had initiated a relationship with him sometime prior to 
March 18, 1997, and that they “did things that we shouldn’t have 
done.”  Velazquez denied having had sexual intercourse with A.L. 
on March 18, 1997, and claimed that he fell on top of A.L. while 
they were engaged in consensual foreplay.  He further testified 
that A.L. had pulled her own pants down and that he had inserted 
his fingers into her vagina, but that he complied with A.L.’s 
request that they not have intercourse because “I think we both 
believed that we were going too far.”  Velazquez admitted that 
he had ejaculated after A.L. asked him not to have intercourse. 
The jury found Velazquez guilty of rape and recommended a 
sentence of seven years.  By order entered July 7, 1999, the 
trial court imposed sentence in accord with the jury’s verdict. 
On July 9, 1999, Velazquez filed a motion to set aside the 
jury’s verdict, asserting that the trial court had erred in 
qualifying Patt as an expert and in permitting her to testify on 
an ultimate issue of fact.  Velazquez asserted that Patt was not 
qualified to “render a medical diagnosis or opinion” because she 
had not gone to medical school and had not been licensed to 
practice medicine in Virginia.  Velazquez further asserted that 
 
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the evidence was insufficient to support a finding that he had 
actually penetrated A.L.’s vagina with his penis.1
Velazquez filed an appeal in the Court of Appeals of 
Virginia.  In that appeal, he reasserted the issues raised in 
the motion to set aside the jury’s verdict. 
Addressing the threshold issue whether Patt was qualified 
to give expert testimony, the Court of Appeals held that Patt’s 
training and experience established that she “had knowledge 
concerning matters beyond a lay person’s common knowledge and 
would assist the jury in understanding the evidence” and, thus, 
that she qualified as “an expert in the diagnosis of a sexual 
assault.”  Velazquez v. Commonwealth, 35 Va. App. 189, 196, 543 
S.E.2d 631, 635 (2001).  Addressing what it characterized as an 
issue “of first impression,” the Court of Appeals further held 
that a SANE can testify as an expert regarding the cause of 
trauma in a sexual assault case.  In doing so, the Court of 
Appeals specifically rejected Velazquez’s contention that only a 
licensed physician may testify regarding causation of injuries.2  
Id. at 197-99, 543 S.E.2d at 635-36. 
                     
1The trial court took no action on the motion to set aside 
the jury’s verdict prior to the expiration of its jurisdiction 
under Rule 1:1. 
 
2The Court of Appeals declined to address Velazquez’s 
contention that permitting a SANE to provide a medical diagnosis 
would constitute the unlawful practice of medicine, finding that 
 
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Relying on Hussen, the Court of Appeals also rejected 
Velazquez’s contention that Patt’s testimony had invaded the 
province of the jury by expressing an opinion on an ultimate 
issue of fact.  The Court held that “Patt’s testimony only dealt 
with consistencies and inconsistencies.  Patt did not testify 
that, in her opinion, [Velazquez] engaged in sexual intercourse 
with A.L. against A.L.’s will, the ultimate issue of the case.”  
Velazquez, 35 Va. App. at 200, 543 S.E.2d at 637. 
Finally, addressing the sufficiency of the evidence to 
prove penile penetration, the Court of Appeals held that the 
inconsistencies between A.L.’s testimony and that offered by 
Velazquez presented issues of credibility for the jury to 
consider.  The Court held that A.L.’s testimony corroborated by 
the evidence of the injuries A.L. suffered was sufficient to 
allow the jury to find the necessary penile penetration.  Id. at 
202, 543 S.E.2d at 638. 
For these reasons, the Court of Appeals affirmed 
Velazquez’s conviction.  By order dated July 31, 2001, we 
awarded Velazquez this appeal. 
                                                                  
he had not adequately preserved the issue in the trial court.  
Velazquez, 35 Va. App. at 196 n.2, 543 S.E.2d at 635 n.2.  
 
 
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DISCUSSION 
Velazquez first contends, as he did in the Court of 
Appeals, that the trial court erred in permitting Patt to 
testify as an expert in the field of sexual assault diagnosis 
because such diagnosis constitutes the practice of medicine and 
Patt is not a licensed physician.3  In support of this 
contention, Velazquez cites Combs v. Norfolk & Western Railway 
Co., 256 Va. 490, 496, 507 S.E.2d 355, 358 (1998), for the 
proposition that “the question of the causation of a human 
injury is a component part of a diagnosis, which in turn is part 
of the practice of medicine.” 
Velazquez’s reliance on Combs is misplaced.  In Combs, we 
held that a witness, who had completed all the academic 
requirements for a degree in medicine but was not a licensed 
medical doctor, could not offer an opinion on medical causation 
                     
3To the extent that Velazquez asserts that Patt’s testimony 
could constitute the unlawful practice of medicine, the 
Commonwealth contends that the Court of Appeals correctly 
determined that Velazquez failed to adequately preserve this 
issue in the trial court because it was raised for the first 
time only in the motion to set aside the jury’s verdict. 
However, reviewing the record of the oral argument on his motion 
in limine to exclude SANE testimony and subsequently when he 
opposed Patt’s qualification as an expert, we find that the 
issue was adequately preserved, albeit inartfully, by 
Velazquez’s assertion that Patt was not a physician and would 
require specialized scientific training beyond that of a 
registered nurse to testify regarding the causation of A.L.’s 
injuries. 
 
 
9
upon being qualified by the trial court to testify as an expert 
in biomechanical engineering.  However, we reached this holding 
because a medical diagnosis was not within the field of 
expertise in which the witness had been qualified by the trial 
court, rather than because the expert was not a licensed medical 
doctor, as Velazquez asserts.  Id. at 497-98, 507 S.E.2d at 359-
60.  The Court of Appeals correctly interpreted our holding in 
Combs. 
The sole purpose of permitting expert testimony is to 
assist the trier of fact to understand the evidence presented or 
to determine a fact in issue.  Generally, a witness is qualified 
to testify as an expert when the witness possesses sufficient 
knowledge, skill, or experience to make the witness competent to 
testify as an expert on the subject matter at issue.  See Sami 
v. Varn, 260 Va. 280, 284, 535 S.E.2d 172, 174 (2000); Noll v. 
Rahal, 219 Va. 795, 800, 250 S.E.2d 741, 744 (1979).  “An 
expert’s testimony is admissible not only when scientific 
knowledge is required, but when experience and observation . . . 
give the expert knowledge of a subject beyond that of persons of 
common intelligence and ordinary experience.  The scope of such 
evidence extends to any subject in respect of which one may 
derive special knowledge by experience, when [the witness’s] 
knowledge of the matter in relation to which [the witness’s] 
opinion is asked is such, or is so great, that it will probably 
 
10
aid the trier [of fact] in the search for the truth.”  Neblett 
v. Hunter, 207 Va. 335, 339-40, 150 S.E.2d 115, 118 (1966); cf. 
Code § 8.01-401.3.  In essence, all that is necessary for a 
witness to qualify as an expert is that the witness have 
sufficient knowledge of the subject to give value to the 
witness’s opinion.  Norfolk & Western Railway Co. v. Anderson, 
207 Va. 567, 571, 151 S.E.2d 628, 631 (1966). 
Velazquez does not cite any specific authority for the 
proposition that a SANE may not testify as an expert in sexual 
assault cases because she neither is a licensed medical doctor 
nor holds a medical degree.  Rather, his entire argument is 
based on the premise that the statutes governing the practice of 
medicine as a profession, Code §§ 54.1-2900 through 54.1-2903, 
prohibit the expert testimony of a SANE in a sexual assault case 
because such testimony constitutes the practice of medicine.  We 
disagree. 
Code § 54.1-2900 defines the practice of medicine as “the 
prevention, diagnosis and treatment of human physical or mental 
ailments, conditions, diseases, pain or infirmities by any means 
or method.”  We are of opinion that the testimony of a SANE 
regarding the causation of physical injuries to a victim of a 
sexual assault is not the practice of medicine as contemplated 
by this statutory definition.  Velazquez takes “diagnosis” of 
“human physical . . . conditions” entirely out of context to 
 
11
support his argument.  Moreover, it has long been accepted that 
nurses and other healthcare professionals with the proper 
training, expertise, and experience are qualified to give expert 
opinions on medical causation in appropriate circumstances.  
See, e.g., Cates v. Commonwealth, 111 Va. 837, 843, 69 S.E. 520, 
522 (1910); see also Gregory v. State, 56 S.W.3d 164, 179-80 
(Tex. App. 2001) and cases collected therein at n.10; State v. 
White, 457 S.E.2d 841, 858 (N.C. 1995).  Accordingly, we hold 
that a SANE need not be licensed to practice medicine to express 
an expert opinion on the causation of injuries in the context of 
an alleged sexual assault, nor does the expression of such an 
opinion by a SANE in a trial constitute the unlawful practice of 
medicine.  Thus, there is no error in the judgment of the Court 
of Appeals on this issue. 
“The issue whether a [potential] witness is qualified to 
testify as an expert on a given subject is a matter submitted to 
the trial court’s discretion, and the trial court’s ruling in 
this regard will not be disturbed on appeal unless it plainly 
appears that the witness was not qualified.”  Johnson v. 
Commonwealth, 259 Va. 654, 679, 529 S.E.2d 769, 783 (2000).  
Velazquez does not contend that Patt’s knowledge, skill, and 
experience were insufficient to give value to her opinion, and 
the record amply demonstrates that she possessed specialized 
knowledge of the subject matter at issue beyond that of persons 
 
12
of common intelligence and ordinary experience.  Accordingly, 
the Court of Appeals correctly held that the trial court did not 
err in permitting Patt to testify as an expert in this case. 
Velazquez next contends that, even if Patt was qualified to 
express an opinion on the causation of A.L.’s injuries, her 
testimony on that issue improperly invaded the province of the 
jury because she expressed an opinion on an ultimate issue of 
fact.  Velazquez contends that the expert opinion in this case 
went beyond that permitted in Hussen and effectively “closed the 
circle” by permitting the expert witness to testify that the 
injuries were, in her opinion, the result of non-consensual 
intercourse.4  We agree with Velazquez’s contention. 
We consistently have held that the admission of expert 
opinion upon an ultimate issue of fact in a criminal case is 
impermissible because it invades the province of the jury.  
Llamera v. Commonwealth, 243 Va. 262, 264, 414 S.E.2d 597, 598 
(1992); Bond v. Commonwealth, 226 Va. 534, 538, 311 S.E.2d 769, 
771-72 (1984); Cartera v. Commonwealth, 219 Va. 516, 519, 248 
                     
4We reject the Commonwealth’s contention that Velazquez’s 
failure to object to Patt’s ultimate conclusion that “the 
injuries [A.L.] had are consistent with non-consensual 
intercourse” at the time the statement was made constituted a 
waiver.  In the context of the entire trial, it is clear that 
Velazquez had a continuing objection to Patt’s testifying as to 
causation and any “conclusions” she had drawn.  The trial court 
was aware of and fully considered that objection. 
 
 
13
S.E.2d 784, 786 (1978); Webb v. Commonwealth, 204 Va. 24, 34, 
129 S.E.2d 22, 29 (1963). 
The Cartera case is particularly instructive in this 
instance.  In that case, the defendant was charged with two 
counts of rape.  A physician, who had examined and treated the 
victims, was permitted to express his opinion that the victims 
had been raped.  219 Va. at 518, 248 S.E.2d at 785.  We held 
that this was reversible error because “[w]hether rape had 
occurred was the precise and ultimate issue in the case.  
Determination of this issue did not require special knowledge or 
experience.  To permit the doctor to express his opinion upon 
the subject invaded the province of the jury.”  Id. at 519, 248 
S.E.2d at 786. 
In Hussen, we held that the SANE’s testimony that the 
victim’s injury “was not consistent with consensual, first time 
intercourse,” was “not a comment on one of the ultimate issues 
of fact to be determined by the jury, that is, whether the 
defendant’s conduct was against the victim’s will.”  257 Va. at 
99, 511 S.E.2d at 109.  By contrast, in the present case Patt 
initially testified that A.L.’s injuries were “inconsistent with 
consensual intercourse,” and that she held that opinion because 
those injuries were “consistent with non-consensual 
intercourse.”  Under the rationale of Hussen, Patt’s initial 
opinion, that A.L.’s injuries were “inconsistent with consensual 
 
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intercourse,” does not preclude a finding that A.L.’s injuries 
resulted from some trauma other than a rape.  However, Patt’s 
additional opinion, that A.L.’s injuries were “consistent with 
non-consensual intercourse,” when expressed specifically in 
connection with her initial opinion, significantly expands that 
initial opinion.  In doing so, Patt’s testimony as a whole 
clearly expressed her opinion that A.L. was raped because her 
opinion excluded all other trauma as the cause of A.L.’s 
injuries.  In this sense, the combination of the two opinions 
“closed the circle.”  As in Cartera, whether rape had occurred 
was the precise and ultimate issue in the case.  Accordingly, we 
hold that Patt’s opinion testimony improperly invaded the 
province of the jury on the ultimate issue of fact to be decided 
in the case, and the Court of Appeals erred in holding 
otherwise. 
Although the error in admitting improper expert opinion 
testimony requires reversal of Velazquez’s conviction, we must 
nonetheless consider his challenge to the sufficiency of the 
evidence.  If the evidence adduced at trial, excluding the 
improperly admitted expert opinion testimony, was insufficient 
to convict Velazquez, he is entitled to an acquittal; if he is 
so entitled, a remand for retrial would violate the 
Constitution’s prohibition against double jeopardy.  See Parsons 
v. Commonwealth, 32 Va. App. 576, 581, 529 S.E.2d 810, 812-13 
 
15
(2000); see also Overbee v. Commonwealth, 227 Va. 238, 245, 315 
S.E.2d 242, 245 (1984). As established in Burks v. United 
States, 437 U.S. 1, 18 (1978), a full sufficiency analysis is 
required to satisfy the mandate of the Double Jeopardy Clause of 
the federal Constitution. 
Velazquez contends that the evidence supports the 
reasonable hypothesis that he only penetrated A.L.’s vagina with 
his fingers.  Stressing A.L.’s testimony concerning the position 
of his body when she first felt a sharp pain in her vagina, he 
contends that it would have been impossible for him to have 
achieved penile penetration of her vagina.  In addition, because 
he admitted inserting his fingers into A.L.’s vagina and A.L. 
testified that she did not know what caused the sharp pain, 
Velazquez contends that the evidence was insufficient to prove 
penile penetration and, thus, all the necessary elements of 
rape.  We disagree. 
Velazquez’s interpretation of the evidence discounts 
several element’s of A.L.’s testimony, particularly her 
description of the motion of his body during the time that she 
felt the pain and the length of time this activity continued.  
While Velazquez’s contention that A.L.’s pain and injuries could 
have resulted from digital penetration is not wholly without 
support in the record, neither is the evidence contradictory to 
a finding of penile penetration.  As such, the matter was one to 
 
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be decided by the trier of fact.  Accordingly, we hold that the 
evidence was sufficient to support the jury’s verdict and, thus, 
that Velazquez is not entitled to an acquittal and upon remand 
the Commonwealth may retry Velazquez for rape. 
CONCLUSION 
For these reasons, we will affirm in part and reverse in 
part the judgment of the Court of Appeals, vacate Velazquez’s 
conviction, and remand the case to the Court of Appeals with 
direction that the case be remanded to the trial court for a new 
trial, if the Commonwealth be so advised. 
Affirmed in part,
reversed in part, 
   and remanded. 
 
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