Title: The People v. Michael Spicola

State: new-york

Issuer: New York Appellate Court

Document:

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This opinion is uncorrected and subject to revision before
publication in the New York Reports.
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No. 60  
The People &c.,
            Respondent,
        v.
Michael Spicola,
            Appellant.
Paul J. Cambria, for appellant.
Shawn P. Hennessy, for respondent.
READ, J.:
On November 16, 2006, defendant Michael Spicola was
charged in a 10-count indictment with six counts of first-degree
sodomy (Penal Law § 130.50 [3]), three counts of first-degree
sexual abuse (Penal Law § 130.65), and one count of endangering
the welfare of a child (Penal Law § 260.10) stemming from three
occasions when he was accused of engaging in reciprocal oral to
genital contact with a young boy.  These sexual encounters were
alleged to have occurred between March 1, 1999 and April 30,
1999, a 61-day period when the boy was a six-year old first
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grader; June 15, 2000 and August 31, 2000, a 77-day period during
which the boy turned from seven to eight years old; and September
1, 2000 to November 30, 2000, a 91-day period when the boy was an
eight-year old third grader. 
At defendant's subsequent jury trial, the boy's mother,
a single parent, explained that defendant, her cousin, had been
"involved in [her] life" after she moved back to western New
York, where she grew up; he helped her out with chores, and
occasionally watched her young son.  The boy was friendly with
defendant's daughter and youngest stepson, who were just a few
years older than he was; he visited defendant's residence and
slept over in 1999 and 2000 a "[f]ew times a year," including
during spring break in 1999.  Defendant took the boy to sporting
events, and was his soccer coach during 2004.
The mother first sensed that "something wasn't right"
in early 2006, when defendant, who had a college degree in
advanced accounting and was self-employed as a tax preparer,
stopped by her house to drop off her tax return.  Defendant
approached her son and started to tickle him, which the mother
did not consider to be anything other than ordinary horseplay;
however, she thought her son's reactions were "weird."  First, he
"went . . . chest down on the ground . . . and tightened up and
then . . . walked away" from defendant and retreated to the couch
next to the chair in which she was seated.  When defendant sat
down beside the boy and rubbed his back, he responded by curling
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up into "the fetal position . . . and leaned away from"
defendant.
At some point the week after this episode, the mother
cautioned her son that if "anyone touche[d] [him] wrong, [he]
need[ed] to tell," and reassured him that she would not care who
it was, even if one of several male relatives whom she named,
including defendant.  The boy indicated that he had never
experienced such a thing, saying "[N]o mom, it's fine."  He
testified that he answered in this way because he "didn't know if
[he] could go to the police or not" and "thought [he] would get
in trouble," and defendant "was close to the family and [he] just
thought something really bad would happen" if he revealed that
defendant had touched him inappropriately.  But after the boy saw
a video about on-line sexual predators, shown in his eighth-grade
technology class in early April 2006, he realized that what
defendant had done to him "was wrong," and "felt like [he] should
tell someone."  He resolved to confide in his mother, but still
hesitated.  Then, as he was showering before going to school on
May 15, 2006, the day after Mother's Day, he felt as though he
"couldn't hold it in anymore," and he "just ran and told" his
mother that "Mike had touched [him] many different ways." 
The boy made this disclosure at the age of 13, seven
years after the first and almost six years after the last
instance of alleged molestation.  Upon hearing her son's account,
the mother immediately called her own mother, who was at work at
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the time, and the boy's father, asking them to come to her house
urgently.  She testified that her son sat on the living room
couch and cried for a long time after he divulged his secret, and
that he was "withdrawn, sad, scared" as the day wore on, and for
many months thereafter.  The boy's grandmother and father
recalled finding him crying when they arrived; they described the
mother as angry and distraught.  The mother contacted the police,
and a detective from the Erie County Sheriff's Department called
her back later that day.  The following day, she took the boy to
the Child Advocacy Center (CAC) in Buffalo, where he was
interviewed by a prosecutor and examined by a nurse-practitioner,
who recommended counseling. 
  
On the witness stand, the boy recounted the sexual
abuse as having taken place while defendant played "knee hockey"
alone with him, in the nude, in the living room of defendant's
home, generally in the afternoon.  In this game, the players got
down on their knees and tried to shoot a ball into designated
goals, using miniature hockey sticks.  On cross-examination,
defense counsel pressed two considerations in particular: that
the boy had taken a long time to report these events; and that he
had continued to associate with defendant in the meantime.  Thus,
defense counsel asked questions causing the boy to acknowledge
that for six or seven years he neglected to inform his mother,
his grandmother, his friends, his teachers or any doctor who
examined him; and that he visited defendant's house after the
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last alleged sexual encounter, saw defendant several times a week
during soccer season in 2004, when defendant coached his team,
and accompanied him on outings to stock car races and
professional hockey games when he was 12 or 13 years old. 
Defense counsel also elicited an admission that the boy had not
mentioned one vivid detail of his story to the grand jury.
Defendant testified on his own behalf.  He stated that
the boy first slept over at his residence during Christmas
vacation in 1999, not the spring of 1999, and that he next slept
over, accompanied by a friend, during Christmas vacation in 2000
and the Martin Luther King holiday weekend in 2001.  Defendant
asserted that he was never at any time alone in his house with
the boy because there were always other family members around
while the boy was there.  Further, the boy "beg[ged]" to stay
overnight after a family reunion in the summer of 2001 because "a
week or two before [he] bought [his] kids a trampoline and [the
boy] was having a lot of fun playing on the trampoline." 
According to defendant, the next time the boy slept over was
after accompanying him and his youngest stepson to a stock car
race over Memorial Day weekend of 2004; and he stayed over again,
with another boy, after again going to a stock car race with
defendant, this time in late September 2004.  Defendant testified
that he took the boy to professional hockey games in November
2005 and March 2006.
In defendant's telling, "knee hockey" was a game
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"invented" by his three stepsons, which the children played in
the living room of his house.  He sometimes joined in, "[j]ust to
have fun with [his] kids," and the boy played with them when he
visited.  Defendant flatly denied ever having played "knee
hockey" alone with the boy; he flatly denied the charges in the
indictment.
On cross-examination, the prosecutor brought out that
defendant had omitted his several-year stint as a full-time
school bus driver from the lengthy work history he gave during
direct examination.  Defendant admitted that he was given a
directive by the school superintendent in January 2002, and
resigned from his post in May 2003 by mutual agreement with the
union and the school district, although he denied ignoring the
directive.1  He called the boy "a normal kid" with whom he had
enjoyed good relations; he likewise indicated that he had always
gotten along well with the boy's mother.  Although defendant
suggested that he might have "some ideas" about why the boy would
lie, he never shared these ideas with the jury.  He admitted
tickling and wrestling with the boy on occasion.  Defendant
denied having told the detective with whom he spoke by telephone
on May 20, 2006 that he may have accidentally touched the boy in
an intimate area, but noted that "whenever someone is wrestling
you can accidentally touch someone's private parts."
1Defense counsel obtained a Sandoval ruling proscribing
inquiry into the "parent concern" prompting the directive.  
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The jury convicted defendant on all counts.  On August
9, 2007, the trial judge sentenced him to concurrent determinate
terms of 12 years for first-degree sodomy; seven years for first-
degree sexual abuse; and one year for endangering the welfare of
a child.  Defendant appealed on numerous grounds, including that
the trial judge erred when he permitted testimony from a nurse-
practitioner who examined the boy and expert testimony from a
clinical social worker relating to Child Sexual Abuse
Accommodation Syndrome (CSAAS).  On April 24, 2009, the Appellate
Division affirmed (61 AD3d 1434 [4th Dept 2009]).  A Judge of
this Court granted defendant permission to appeal (14 NY3d 805
[2010]), and we now affirm.
I.
The Nurse-Practitioner
A.  The Objection
Defense counsel sought to preclude the testimony of the
pediatric nurse-practitioner who examined the boy the day after
he confided in his mother.  He advanced several arguments: first,
that the nurse "would not be in any position to give an opinion
that the young man was abused"; second, she found no physical
evidence of sexual abuse; and third, 
"she would be asked about a history that she received
from [the boy], and by allowing that testimony that
would be improper bolstering.  It's not outcry because
it's 6 or 7 years later.  Even though they are
statements made to a nurse they wouldn't have any
relevance to any diagnosis because she doesn't make any
diagnosis.
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"So . . . to allow her to testify and to tell the
jury about the history she received and any of her
alleged findings would be unfairly prejudicial."
When the trial judge asked the prosecutor why the nurse
was being called, she gave several reasons.  First, she pointed
out that a nurse-practitioner is, unlike a registered nurse,
competent and authorized to make a medical diagnosis; she cited
CPLR 4518 (Business records); she asserted that jurors may
question the lack of physical evidence in a sexual abuse case,
and the nurse could explain that this circumstance was not
inconsistent with the boy's account, which was especially
important "when there [are] references by the defense . . . there
is no medical evidence."
The prosecutor also told the judge that she expected
the nurse "to describe her actual observations, both in terms of
physical findings . . . the lack of objective evidence [of sexual
abuse], but also her observations of the child's demeanor [which]
would relate to his credibility to rebut a potential defense of
fabrication here."  Finally, she argued that the delay in
reporting did "not in any way make [the nurse's] subjective
history or the patient's objective history irrelevant," as the
nurse would still have to ask the same questions and perform the
same examination "whether it's 1 month or 6 years" after the
alleged sexual abuse occurred.
The judge agreed that "the issue" was whether the boy's
statements were germane to his treatment, and asked what the boy
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told the nurse.  The prosecutor responded that he had
"describe[d] basically the oral contact."  The judge then said,
"I presume it's not a detailed account?"  The prosecutor answered
affirmatively, and told the judge that she had warned the nurse
to stay away from identifying the perpetrator, or where or how
many times the alleged sexual abuse occurred.  The judge asked if
she planned to offer the medical record into evidence.  The
prosecutor responded that she would rely solely on the nurse's
testimony "because there [were] so many things . . . that would
be improper [she] would have to redact the whole record."  The
judge ruled that the nurse could testify.     
B.  The Testimony
The nurse, who had extensive and specialized training
and experience examining child victims of sexual and physical
abuse, was asked to perform a medical examination of the boy on
May 16, 2006 at the CAC, where she was employed.  The boy was at
the CAC that day for an "MD, multiple disciplinary interview." 
She testified that she would first take a child's medical history
and then perform a "top to bottom physical exam."  In terms of
taking a medical history, she would ask a child why he or she was
at the CAC, and would inquire about the child's health because
she "need[ed] to understand if there [were] any concerns or
problems going on [and] what [the child's] developmental ability
[was]."  She stated that it would be necessary for her to take a
subjective history from a patient even where suspected sexual
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abuse occurred a number of years earlier because she "need[ed] to
know [of] any problems, any lesions, any sores, any concerns." 
When asked if that was why she took a subjective history of the
boy, she answered, "Yes, it is."
The prosecutor reminded the witness that she could not
"discuss . . . details other than what was specifically told to
[her] that was relevant to [her] diagnosis and treatment"; and
then asked what the boy said about what had happened to him.  She
answered that the boy indicated that "he had been touched
inappropriately," and "gestured to his groin that it had been put
in his [sic] mouth and he was asked to put somebody else's in his
mouth."  She testified that the boy was "embarrassed, [with]
downcast eyes, flushed face" when he gave her this information.
The prosecutor next posed questions to the nurse about
the physical examination that she performed on the boy.  The
nurse described the first part as a general examination akin to a
regular physical; she testified that the boy's heart rate was
elevated, which indicated to her that he was "nervous."  The last
part of the examination focused on the genital and rectal area. 
Because of what he told her "about what had happened to him," she
"was looking to make sure that the exam would have been normal,
that there were no lesions, sores, discharges."  The prosecutor
next asked the nurse if the absence of lesions was in any way
"inconsistent with what [the boy] told [her] about what had
happened."  She replied that it was not "[b]ecause we generally
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would not see or many times . . . do not see medical evidence
from children who have been touched inappropriately."
The nurse added that she "spent quite awhile talking
with" the boy, who was concerned that "people would know that
this happened to him."  Additionally, "he had some body changes
as he was growing up and he was very uncomfortable with that, so
[she] spent a long time talking about body change, hormones,
normal growth, normal things that happen to your body."  The
nurse was asked how she could spot the boy's discomfort, and she
replied, "He had downcast eyes.  He was flushed, heart rate was
up."  She "reassured [the boy] that he hadn't done anything wrong
and that his body was normal."
On cross-examination, the nurse acknowledged that she
had no way of knowing whether the history of sexual abuse that
the boy related to her was true or false; and that it would not
be unusual for a 13-year old boy to exhibit signs of nervousness
when talking to a stranger about "private matters."  Further,
defense counsel brought out that she knew what physical signs or
symptoms to look for that "could be consistent with abuse," and
that she "found no physical evidence to support the history that
[the boy] even had been touched inappropriately."
This cross-examination caused the prosecutor to return
on redirect examination to ground that she had already covered:
whether it was "at all unusual" that the nurse did not detect
"any lesions or actual physical injury."  The nurse replied that
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it was not unusual.  On recross-examination, defense counsel
countered, asking "And the fact that you found nothing is just as
consistent with this child never having been abused or never
having been molested, right?"  The nurse responded "That is
correct, sir."
C.  Discussion
Defendant contends that the nurse-practitioner's
testimony improperly bolstered the boy's credibility "with regard
to exactly what he claimed had occurred" by "describ[ing] the
exact acts" that he related to her.  To the extent that the boy's
responses to the nurse's inquiries about why he was at the CAC
were germane to diagnosis and treatment -- and she testified that
they were -- these responses were properly admitted as an
exception to the hearsay rule (see People v Ortega, 15 NY3d 610
[2010]).  Indeed, without the boy's explanation of what he
claimed to have happened and when, the nurse would hardly have
known where to begin her examination.  Moreover, the nurse did
not identify who the boy said touched him (cf. People v Caccese,
211 AD2d 976, 977 [3d Dept 1995] [allowing nurse to testify that
child informed her that foster mother had caused bruises on his
hand]); she acknowledged that she did not know whether the boy
was being truthful.  The testimony about the nature of the
alleged abuse consisted of a single question and a brief answer. 
And the nurse's observations of the boy's demeanor and manner
were relevant to her medical decisions about the necessity for
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counseling or psychological therapy or other treatment.2
In People v Buie (86 NY2d 501 [1995]), we considered
whether the admission of a 911 tape under the hearsay exception
for present sense impression, where the declarant was available
and testified at trial, improperly bolstered his trial testimony. 
We explained that the term "bolstering" has "doctrinally referred
to two distinct situations, both related to the rule against
hearsay" (id. at 509-510).  The first common use of the term
arose "in the context of eyewitness identification, [where] the
testimony of a third party (typically, a police officer) to the
effect that the witness identified a defendant as the perpetrator
on some prior occasion [was] generally inadmissible" because the
"identification [was] hearsay, not falling within any exception"
(id. at 510).  Second, the term "bolstering" "refers to the
fortification of a witness's testimony and credibility through
the use of a prior consistent statement . . . Such evidence may
be admissible, but only to rebut a claim of recent fabrication .
2The dissent disagrees, stating that the "[c]omplainant's
embarrassment or nervousness . . . had no medical significance
whatsoever" (dissenting op at 3).  While we believe the boy's
demeanor was relevant to diagnosis and treatment, this fact has
no bearing on the admissibility of the nurse's testimony in this
regard.  The boy's flushed skin and elevated heart rate are not
"statements" and thus do not constitute inadmissible hearsay.  We
know of no decisions holding that a witness's testimony
describing a hearsay declarant's demeanor or expression is
inadmissible.  A jury has to decide a declarant's truthfulness,
and the manner in which a statement was made can be important to
that assessment -- and might cut either (or no particular) way
(see discussion at p 15, infra).
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. . A prior consistent statement is admitted under these limited
circumstances as an exception to the hearsay rule" (id.
[citations omitted]). 
We concluded that the admission of the 911 tape did not
constitute improper bolstering, observing that "merely because a
statement suffers some impediment under one hearsay exception
does not preclude the proponent of the evidence from satisfying a
court that a different, better-fitting exception fully applies. 
That is when the trial courts . . . exercise their evaluation of
probativeness versus undue prejudice" (id. at 511).  Although the
911 tape "plainly did not qualify for admission under the prior
consistent statement exception, as there was no charge of recent
fabrication . . . [it] fulfilled all the requirements
independently for the present sense impression exception" and was
therefore admissible (id.).  Similarly, the nurse's complained-of
testimony, as already discussed, falls within the exception to
the hearsay rule for statements relevant to diagnosis and
treatment.  As a result, they do not improperly bolster the boy's
testimony.
The nurse's testimony rounded out the narrative of the
immediate aftermath of the boy's disclosure to his mother and,
more importantly, addressed the negative inference that jurors
might draw from the absence of medical evidence of abuse.3  The
3In his closing argument, defense counsel commented that
although the nurse testified that she "found nothing, but that is
consistent with this type of case[,] [i]t's also consistent with
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jury learned essentially three things: that a very thorough
medical examination turned up no evidence of sexual abuse, that
the boy told the nurse roughly what he told his mother the day
before, and that he struck the nurse as nervous and
uncomfortable.  The first two pieces of information were not
harmful to defendant.  And assuming the jury believed that the
nurse accurately perceived the boy's state of mind, there were,
as defense counsel pointed out, any number of different
explanations for his demeanor, none conclusively bearing on
credibility.  After all, he might have appeared nervous whether
telling the truth or lying.
     II.
The Clinical Social Worker
A.  The Objection
The day jury selection was scheduled to begin, defense
counsel argued a motion in limine, seeking to preclude certain
evidence, including "the alleged expert testimony of an
undisclosed prosecution witness on the topic of" CSAAS.4  In the
motion papers, defense counsel mentioned that the prosecution, at
the claim never happened."
4Defense counsel also sought to preclude the prosecution
from introducing in its case-in-chief statements alleged to have
been made by defendant to the detective in the May 20, 2006
telephone conversation; and asked for a Sandoval ruling
precluding the questioning of defendant, if he took the stand,
"about a matter concerning a student at the North Collins Central
Elementary School" (see p 6 n 1, supra).
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a pre-trial conference on March 2, 2006, "stated that it
anticipate[d] calling an expert witness on the topic of" CSAAS
"to address the delayed reporting of the alleged incident"; and
that defense counsel, in turn, "anticipated that this prosecution
expert [would] testify about CSAAS, a term initially coined by
Dr. Roland Summit" to describe a pattern of "secrecy,
helplessness, entrapment [and] accommodation, delayed disclosure,
and recantation as common characteristics in children who report
sexual abuse" ([internal quotation marks omitted]; see Roland C.
Summit, "The Child Sexual Abuse Accommodation Syndrome," 7 Child
Abuse & Neglect 177 [1983]; see also Roland C. Summit, "Abuse of
the Child Sexual Abuse Accommodation Syndrome," 1 Journal of
Child Sexual Abuse 153 [1992] [emphasizing that CSAAS was not a
diagnostic tool -- i.e., the fact that a child exhibits one or
more aspects of CSAAS does not tend to prove that sexual abuse
occurred]).
Defense counsel argued that "[d]elayed disclosure may
be indicative of abuse and it might not"; therefore, CSAAS
"cannot establish or state that sexual abuse did in fact occur in
this case."  Further, he complained that 
"[t]o present a prosecution expert to testify that any
way a child responds to sexual abuse and later reports
the alleged abuse is consistent with the way other
children have been observed to have reacted only
suggests that any story told by any child should be
believed.  There is no way for the defense to refute
such testimony since it cannot cross-examine that
testimony without the expert having the ability to
speak to the facts of the case the testimony relates
to.  Under the guise of objective assistance, the
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expert is a prosecution advocate by binding him or
herself in ignorance of the facts of the case.  This
sends a message that the jury should consider that no
matter the specific facts of this case, the child's
report has been made in a manner consistent with how
some other sexually abused children reported in the
past."
Finally, defense counsel quoted a lengthy excerpt from
an article reviewing the disclosure patterns of children with
validated histories of sexual abuse.  In the excerpt, the authors
criticized courts for permitting CSAAS testimony without
"carefully scrutiniz[ing]" its scientific basis, and opined that,
under the testimonial standard established by Daubert v Merrell
Dow Pharmaceuticals, Inc. (509 US 579 [1993]), 
"the only component of the CSAAS that has empirical
support is that delay of abuse disclosure is very
common.  However, the probative value of expert
testimony on delayed disclosure, whether for
evidentiary or rehabilitative reasons, is undetermined;
some evidence suggests that knowledge about delay of
disclosure is within the ken of the jury, perhaps
therefore obviating the need for expert evidence on the
issue of delay . . . [T]here is no convincing evidence
that CSAAS testimony on denial or recantation provides
relevant or reliable assistance to the fact finder to
assess allegations" (Kamala London et al., "Disclosure
of Child Sexual Abuse: Does the Research Tell Us About
the Ways That Children Tell?", 11 Psychol Pub Pol'y & L
194, 220 [2005]).
Defense counsel took the position that, in light of the quoted
excerpt, there did not "appear to be either acceptance within the
scientific community that CSAAS identifies and describes
behavioral characteristics commonly found in victims of child
sexual abuse or that such behavioral characteristics require the
use of an expert to assist the jury."
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In oral argument of the motion in limine, defense
counsel emphasized that there was a "fairly lengthy delay of 6 or
7 years" in this case, and he assumed the prosecution's expert
would "say that children who are abused invariably delay
reporting . . . The expert will say there are reasons for that
because of secrecy and other reasons personal to the child."  He
contended, however, that "[j]uries understand that" and that it
was not necessary for "an expert [to] come in and tell a jury
that children who are abused don't report it right away and
sometimes it takes a long time."
The trial judge then asked "Do you want to stipulate to
that."  Defense counsel demurred, but he still maintained there
was no need for an expert as potential jurors are "besieged with
this [information] from the Oprah Show to Montel Williams to
Jerry Springer" such that "the proverbial bottom line" was that
they "understand [delayed reporting] and we don't need an expert
to come in and tell us."  He also objected because he assumed
"the expert's testimony . . . will be that this is the pattern
with people who are abused.  And when you are abused you wait" so
that "even though the expert will say, oh, I never interviewed
the victim or his family, the unavoidable inference almost always
is that this kid must have been abused because he fits into this
so-called pattern."
The prosecutor rejoined that defense counsel's
arguments "pertain[ed] to the weight that the jury [would] afford
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the expert's testimony"; and that the Fourth Department in People
v Miles (294 AD2d 930 [2002]) had held that expert testimony
about CSAAS was admissible; the prosecutor also cited our
decision in People v Carroll (95 NY2d 375, 387 [2000]).  She
concluded by arguing that
"[e]ssentially, as long as there is no attempt to the
diagnostic or to offer an opinion that . . . abuse
occurred, certainly counsel can conduct an extensive
cross examination as to whether or not the presence of
certain factors leads him or anyone to the conclusion
that abuse did or did not occur.  The expert is very
cautious and careful in not invading the province of
the jury by indicating that this is simply a discussion
of a broad range of behaviors.  And while it may not
appear necessary [to defense counsel] . . . to have
such an expert, unfortunately in today's day and age it
is necessary for the People to rely on this expert
because many of the factors or components of the
syndrome are completely counterintuitive . . . We know
that based on our prior trial record in Erie County
where jurors have acquitted defendants basically
indicating well, if such and such abuse occurred that
child never would have returned to the scene or
location of the abuse . . . [Jurors] expect children to
tell right away . . . [J]uries watch a lot of CSI and
all the various shows associated with the law and they
do often expect children to tell right away."
The judge indicated that it was "pretty well settled" that this
type of testimony was admissible, apparently referring to Carroll
and Miles, and that it was "going to come in."  Defense counsel
noted that it was "discretionary with the court," causing the
judge to reiterate "It's coming in."
B.  The Testimony
The expert was a licensed clinical social worker at
Child and Adolescent Treatment Services in Buffalo, who had
extensive and specialized training and experience in the field of
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child sexual abuse.  He testified that since 1975 he had provided
direct treatment to over 3,000 children, and had testified in
court 222 times, on behalf of both the defense and the
prosecution.  The expert was asked by the prosecutor if he was
"familiar with any of the specific facts of this case," and if he
knew "anything at all about the parties involved."  He responded
negatively on both counts.  The prosecutor then questioned him as
follows:
"Q.  And is it true that you are not here to offer this
jury an opinion as to whether or not the victim in this
case was in fact a victim of sexual abuse?
"A.  That is correct.  I'm not here to offer an
opinion.
"Q.  What is the purpose of your testimony, sir?
"A.  The purpose of my testimony is to provide
information to a jury or the trier of fact regarding
how children respond to being sexually abused and what
is commonly seen.  The other side is what are the
common misconceptions that people have regarding
children and child sex abuse.
"Q.  Is it fair to say then that you are here to talk
about the range of behaviors that are associated with
child victims of child sexual abuse?
"A.  Yes, I am here to speak about the range that you
observe."
The prosecutor asked the expert if he was familiar
"with the scientific research" in the field; specifically, CSAAS. 
The expert answered that he was.  He identified CSAAS as
originating with Dr. Summit’s work in 1983, and listed its five
categories –- secrecy; helplessness; entrapment and
accommodation; delayed, conflicted or unconvincing disclosure;
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and retraction or recantation.  The prosecutor asked if the
syndrome was "a diagnosis in any way," and the expert responded
"No, it was never intended to be."
The expert testified that CSAAS was generally accepted
as valid within the relevant scientific community of his
specialty, and that many follow-on studies, "some focusing on how
children disclose," had been undertaken since 1983.5  The
prosecutor asked the expert if "the concepts of the syndrome show
contradiction to widely held beliefs and views about behaviors of
child sexual abuse victims."  He replied "Yes" and that "[f]or
one . . . adults think that kids are going to immediately say
when something happened to them."  He was asked if the presence
of any one of the five kinds of behavior "mean[s] in and of
itself that the child was abused," to which he again warned that
CSAAS "was never intended to be used that way."  He was then
asked if the "absence of any one of these categories or behaviors
necessarily mean[s] that [a] child was not abused," to which he
similarly responded "Again, it was not intended. It's intended
[to] get you to think, to include ideas."  
The prosecutor next called on the expert to explain
5The expert mentioned the 2005 study by London and
colleagues, referenced by defense counsel in his motion in
limine, and a subsequent revision of it (see London et al.,
"Disclosure of Child Sexual Abuse: A Review of the Contemporary
Empirical Literature" in Child Sexual Abuse: Disclosure, Delay
and Denial, at 11 [Margaret-Ellen Pipe et al. eds (2007)]
[hereafter, "London 2007"]).
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No. 60
each of the five categories in more detail, and posed various
questions in this context; specifically, whether the degree of
helplessness might vary, depending on the child's age; whether a
child is more likely to be abused by a stranger or someone whom
the child knows; how a child abused by a trusted adult reacts;
whether victims are predominantly male or female; how a child
might react if the abuser was someone close to his or her mother;
whether the abuse typically occurs outside the direct view of
others; whether there are circumstances where the abuse occurs in
the presence of others and in what type of case this might
happen; whether the concept of secrecy requires a verbal threat;
what types of activities, including sexual activity, an abused
child might employ as a coping mechanism; whether a child's
psychological immaturity might affect willingness to return to
the scene of the abuse; whether a child who had been sexually
abused might still want to associate with the abuser; whether
there was any research linking a higher incidence of delayed
disclosure to one sex or the other, and, if so, the factors
associated with such a phenomenon and the relative length of
delay; whether a delayed disclosure on the order of six or seven
years would be unusual; whether the range of delay might include
waiting even longer; if the age of the child at the time of the
abuse might affect whether there was a delay in reporting;
whether a triggering event might prompt disclosure; whether "an
educational component about the awareness of sexual abuse" might
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No. 60
constitute a triggering event; the emotional consequences for a
child after disclosure and whether such consequences might last a
long time; how a delay in disclosure might affect a child's
memory of the actual abuse; and whether abused children always
recant.  To "recap," the prosecutor asked "if the child's
behavior shows aspects of the first four categories that you
discussed, but there is no recantation involved, does that
automatically mean or does it still fit within the parameters of
the syndrome?"  The expert replied that "[s]ince the parameters
are meant to get me to think about the child, it's presence or
absence is just something I note.  It doesn't have a diagnostic
value."
Defense counsel did not object to any of the questions
posed to the expert.  On cross-examination, he brought out that
the expert had testified only 20 times for the defense, and was
not a physician, psychologist or PhD; that CSAAS referred to a
broad range of behaviors; that every case was different; that the
expert knew nothing about the facts of this case, and, in
particular, had never met, interviewed or had any discussions
with the boy, his mother or anyone else in his family; and that
he did not know whether the boy's allegations were true.
When defense counsel questioned whether the allegations
might have been something the boy "made up" and "may never have
happened," the expert replied "I don't know."  The following
questions and answers ensued:
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No. 60
"Q.  And in many of the cases that you have seen
children do make up these allegations from time to
time, do they not?
"A.  Well, you use the word many, and the answer to
that is, no.  Because in the 154 cases that I did for
the Department of Social Services, we had 4 cases where
the allegations were unfounded.6
"Q.  But whether or not the allegations are unfounded
in this case, you don't know?
"A.  That is correct, I don't.
"Q.  Whether there was any motive for this young man to
make up a story, you don't know?
"A.  I don't know anything about the case.
"Q.  Whether he has some problem with his mother that
would have caused this to happen you don't know, true?"
At this juncture, the prosecutor objected; the judge ruled that
defense counsel could "make his point." 
Defense counsel next reviewed with the expert his
testimony that young children might return to the scene of their
sexual abuse for various reasons, and asked if a child might
return because no abuse had, in fact, taken place.  The expert
answered that "A youngster could go back for that reason," and
that he didn't know "this child's state of mind."  Defense
6When describing his education, training and experience, the
expert mentioned that he had treated 154 "perpetrators of sexual
offenses."  Defense counsel having provoked a damaging answer on
cross-examination about the incidence of false claims, the
prosecutor followed up on redirect examination.  She elicited
testimony from the expert that three of these false claims
occurred in the context of divorces where the children had been
coached, and the remaining case involved an adolescent female who
was trying to get her father to pay attention to her in this
"very misguided" way.  Defense counsel did not object.
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No. 60
counsel then added "Because all you have talked about here today
are generalizations from these studies, right?"  The expert
agreed.  Defense counsel concluded "And you don't know anything
specific about this case, what any motivations were or whether
this young man was truthful or not, correct?" and the expert
agreed "That's correct.  That's the job of the jury."  
C.  Discussion
Defendant maintains that the trial judge improperly
admitted the expert's testimony regarding CSAAS because it
bolstered the boy's credibility to prove that the abuse, in fact, 
occurred.  This is not the first time we have dealt with this
type of bolstering argument, or a close variation of it.  In
People v Keindl (68 NY2d 410 [1986]), the defendant was convicted
of 26 counts of sodomy, sexual abuse and endangering the welfare
of his stepchildren.  He contended that the trial court erred in
admitting the testimony of a psychiatrist, "presented to explain
how children who have been repeatedly sexually abused by their
stepfather[] [were] likely to suffer psychologically," because
such testimony would go to the "ultimate question" of the
defendant's guilt of endangering the welfare of a child, which
was "within the province of the jury to decide [and] not a
subject matter beyond the ken of the ordinary juror" (id. at
422).
We disagreed, concluding that "[f]or the Trial Judge to
have ruled that the range of psychological reactions of child
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No. 60
victims who suffer from sexual abuse at the hands of their
stepparents is not a subject within the ken of the typical juror,
and therefore may be addressed by expert testimony, cannot be
said to be an abuse of discretion as a matter of law" (id.).  In
Keindl, the defendant (as was the case here) had attempted to
discredit the children by evidence that they had not promptly
complained of the crimes (see People v Taylor, 75 NY2d 277, 288
[1990]).
In Matter of Nicole V., 71 NY2d 112 (1987), the child
made statements to her therapist describing sexual abuse by her
father.  In addition to relating the child's hearsay statements
describing incidents of sexual abuse, the therapist also
testified that the child's behavior was symptomatic of a sexually
abused child.  The father contended that this opinion testimony
was not corroborative within the meaning of Family Court Act §
1046 (a) (vi), which provides that a child's out-of-court
statements may be corroborated by any other evidence tending to
support their reliability.  Citing Keindl, we observed that
"[t]he psychological and behavioral characteristics and reactions
typically shared by victims of abuse in a familial setting are
not generally known by the average person and the courts have
become increasingly more receptive to admitting expert testimony
on the subject" (id. at 120).  Additionally, we remarked that
"such evidence has been accepted by us," referring to Keindl,
"and by courts of other jurisdictions, even in criminal cases,
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No. 60
either to bolster credibility of infant victims or to corroborate
the victim's testimony" (id. at 121 [citations omitted] [emphasis
added]).
In Taylor and People v Banks (75 NY2d 277 [1990]), two
cases decided together, we explored the proper and improper uses
of expert testimony regarding rape trauma syndrome, affirming the
conviction and sentence in Taylor and reversing in Banks.  This
case is relevant because we analogized this type of expert
behavioral testimony to CSAAS, citing Nicole V. and Keindl.  In
Taylor, the complainant first told the police that she did not
know who her attacker was, but then revealed to her mother that
her attacker was the defendant, whom she had known for years. 
The expert -- who had not examined the witness and was therefore
not reflecting on her behavior specifically -- testified "on the
specifics of rape trauma syndrome[,] explain[ing] why the
complainant might have been unwilling during the first few hours
after the attack to name the defendant as her attacker where she
had known [him] prior to the incident" (id. at 283).  Second, the
expert testified that "it was common for a rape victim to appear
quiet and controlled following an attack, [which] responded to
evidence that the complainant had appeared calm after the attack
and tended to rebut the inference that because she was not
excited and upset . . ., it had not been a rape" (id.).  We ruled
that this expert evidence was "relevant to dispel misconceptions
that jurors might possess regarding the ordinary responses of
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No. 60
rape victims in the first hours after their attack" (id. at 293).
In Banks, an 11-year-old girl claimed that the
defendant had raped and sodomized her.  Both the complainant and
her grandmother testified that after this alleged incident, the
girl had suffered from nightmares and cold sweats in the middle
of the night, had been afraid to return to school, had become
fearful and had been running and staying away from home.  The
prosecution's expert then testified "hypothetically that the kind
of symptoms demonstrated by the complainant were consistent with
a diagnosis of rape trauma syndrome" (id. at 285 [emphasis
added]).  We reversed because 
"[u]nlike Taylor, the evidence was not offered to
explain behavior exhibited by the victim that the jury
might not understand; instead, it was offered to show
that the behavior that the complainant had exhibited
after the incident was consistent with a set of
symptoms commonly associated with women who had been
forcibly attacked.  The clear implication of such
testimony would be that because the complainant
exhibited these symptoms, it was more likely than not
that she had been forcibly raped" (id. at 284).
We commented that although we had "accepted that rape produces
identifiable symptoms in rape victims, we [did] not believe that
evidence of the presence, or indeed of the absence, of those
symptoms necessarily indicate[d] that the incident did or did not
occur" (id. at 293); and emphasized that this type of evidence
may not be introduced to show that a crime took place.
The defendant in Carroll was convicted of first-degree
rape and first-degree sexual abuse.  His appeal challenged the
legal sufficiency of the proof supporting the rape convictions as
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No. 60
well as evidentiary rulings, including the trial court's
preclusion of a police-recorded audiotape of the defendant's
conversation with the complainant, his stepdaughter.  We agreed
that the evidence was legally insufficient to sustain the rape
convictions and that the complained-of evidentiary ruling was an
abuse of discretion "result[ing] in a trial that was decidedly
skewed in the People's favor" (Carroll, 95 NY2d at 387 [citation
and internal quotation marks omitted]).  Accordingly, we reversed
the Appellate Division's order sustaining the defendant's
convictions, dismissed the counts of the indictment charging
rape, and ordered a new trial on the counts charging sexual
abuse.
In light of the retrial, we addressed the defendant's
objections to expert testimony explaining CSAAS.  Citing Keindl
and Taylor, we noted that 
"[w]e have long held that expert testimony regarding
rape trauma syndrome, abused child syndrome or similar
conditions may be admitted to explain behavior of a
victim that might appear unusual or that jurors may not
be expected to understand.  In [Keindl], expert
testimony was permitted to rebut defendant's attempt to
impair the credibility of [sexually abused children] by
evidence that they had not promptly complained of the
abuse.  Here, the People properly offered [the
expert's] testimony for the purpose of instructing the
jury about possible reasons why a child might not
immediately report incidents of sexual abuse" (id.
[internal citations and quotation marks omitted]
[emphases added]). 
   
We pointed out that the expert "did not attempt to
impermissibly prove that the charged crimes occurred," and that
he "referred to [CSAAS] only generally insofar as it provides an
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No. 60
understanding of why children may delay in reporting sexual
abuse," and "never opined that [the] defendant committed the
crimes, that [the] stepdaughter was sexually abused, or even that
her specific actions and behavior were consistent with such
abuse.  In fact, [the expert] had not interviewed either [the]
defendant or his stepdaughter and was not aware of the facts of
this case" (id. [internal citations omitted]).7  
Here, there was no way for defendant to achieve an
acquittal if the jury believed the boy because there was no way
that the boy might have been honestly mistaken about defendant's
conduct; put another way, for defendant to succeed at trial, the
jurors had to conclude that the boy was likely deliberately
lying.  And so from the beginning, defendant attacked the boy's
credibility, principally on the basis that he neglected to report
the alleged abuse promptly and continued to associate with
defendant after the abuse was claimed to have taken place. 
Defense counsel in his opening statement emphasized the boy's
7The only other cases cited by the dissenting opinion are
People v Ciaccio (47 NY2d 431 [1979]) and People v Mercado (188
AD2d 941 [3d Dept 1992]).  The facts in Ciaccio are quite
different from the facts here or in any of the other cases
discussed: a detective gave "'opinion' evidence . . . that many
hijackings occur as the victim had related" (47 NY2d at 439). 
Mercado was a case much like Banks.  The defendant was accused of
abusing his two stepchildren, and a social worker who had
examined the two children testified that their behavior was
"consistent" with the way abuse victims comport themselves.  The
court concluded that this testimony was impermissible, requiring
reversal, but that "[t]o the extent that the expert testimony was
directed to the issue of timely reporting, it was properly
admitted" (188 AD2d at 943).
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- 31 -
No. 60
lengthy silence, the six or seven years when he said nothing "to
his mother, to his father, to his grandmother . . . to a teacher
at school, to a counselor at school . . . to a friend."  He
followed up by describing the several occasions after the fall of
2000 and before May of 2006 when the boy visited defendant's
house or went on outings with him.  Defense counsel's cross-
examination of the boy similarly zeroed in on the delay in
reporting and the boy's continued association with defendant
after the alleged molestations.8
8To complete the circle, defense counsel in his closing
argument detailed several so-called "unanswered questions,"
including "[W]hy would that young man go back and return to
[defendant's house] time after time if what he says happened
happened?" and "[W]hy was there such a long delay, . . . some 6
or 7 years before the young man said anything?"  He asked for,
and received, the following instruction from the trial judge
related to the boy's delay in reporting:
"There is another consideration that I want to mention
to you.  That's a word about [the boy's] failure to promptly
complain.  Obviously, that's been raised throughout this
proceeding.  The defendant contends that the failure of [the
boy] to complain to family members, school personnel or law
enforcement until approximately 6 or 7 years following the
events of March '99 through November of 2000 should be
considered by you in assessing the credibility of [the boy]. 
With reference to the time when [the boy] first complained
to his mother . . . it is for you, the jury, to determine
whether or not such complaint was made within a reasonable
time or was in fact unreasonably delayed.  Either
circumstance may be considered by you as a jury as bearing
upon the credibility of the complainant.  Your evaluation of
[the] time in which the complaint was made must be
considered in light of all of the surrounding circumstances,
particularly including, but not limited to, the opportunity
of the complainant to make the complaint.  Among other
factors that you may wish to consider would be the
complainant's age, past experiences, mental state, fear for
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- 32 -
No. 60
In this context, the trial judge did not abuse his
discretion when he allowed the expert to testify about CSAAS to
rehabilitate the boy's credibility.  The expert stressed that
CSAAS was not a diagnosis; rather, it describes a range of
behaviors observed in cases of validated child sexual abuse, some
of which seem counterintuitive to a lay person.  He confirmed
that the presence or absence of any particular behavior was not
substantive evidence that sexual abuse had, or had not, occurred. 
He made it clear that he knew nothing about the facts of the case
before taking the witness stand; that he was not venturing an
opinion as to whether sexual abuse took place in this case; that
it was up to the jury to decide whether the boy was being
truthful.  In short, defendant staked his defense on the
proposition that the boy's behavior, as demonstrated by the
evidence, was inconsistent with having been molested; the
legitimate purpose of the expert's testimony was to counter this
inference.  And in the end, the jury obviously believed the boy
his own safety or the safety of others in the household or
the lack of such fear.  You may also wish to consider the
circumstances that motivated the complainant and any and all
other circumstances which you may find operated to trigger a
delayed disclosure.  Whatever weight is to be given to the
circumstances is entirely in your hands" (see CJI 2d [NY]
Prompt Outcry [emphasis added]).
At defense counsel's request, the trial judge also gave the
standard expert-witness charge (see CJI 2d [NY] Expert Witness). 
He added that "Basically, . . ., opinions of expert witnesses are
subject to the same rules and tests concerning reliability as the
testimony of any other witness."
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No. 60
and disbelieved defendant, who never offered the jurors a motive
for the boy to fabricate a report of sexual abuse.
As the discussion of our decisions in Keindl, Nicole
V., Taylor9 and Carroll shows, we have "long held" evidence of
psychological syndromes affecting certain crime victims to be
admissible for the purpose of explaining behavior that might be
puzzling to a jury (see Carroll, 95 NY2d at 387).  Indeed, the
majority of states, "permit expert testimony to explain delayed
reporting, recantation, and inconsistency," as well as "to
explain why some abused children are angry, why some children
want to live with the person who abused them, why a victim might
appear 'emotionally flat' following sexual assault, why a child
might run away from home, and for other purposes" (see Myers on
Evidence § 6.24, pp 416-422 [collecting cases and noting that
Kentucky, Pennsylvania and Tennessee are the only apparent
exceptions]).  
Defendant complains that the expert's testimony was not
adequately constrained because certain of the hypothetical
questions too closely mirrored the boy's circumstances and
9In Nicole V. we called CSAAS "a recognized diagnosis" (71
NY2d at 120); and in Taylor, we repeated this passage from Nicole
V. (75 NY2d at 288).  As our opinion in Taylor establishes,
though, CSAAS is not a diagnosis in the sense that the presence
of a CSAAS behavior proves child sexual abuse (see 1 J. Myers,
Myers on Evidence in Child Domestic and Elder Abuse Cases § 6.20,
pp 408-411 [rev ed of Evidence in Child Abuse and Neglect Cases
(3d ed 1997)] [2005] [hereafter, "Myers on Evidence"] [explaining
the difference between diagnostic and nondiagnostic syndromes]).
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No. 60
therefore improperly bolstered or vouched for his credibility so
as to prove that the charged crimes occurred.  To the extent
defendant now complains of specific questions, his argument is
not preserved because the questions were not objected to at
trial.  As a whole, the expert's testimony certainly supported
the boy's credibility by supplying explanations other than
fabrication for his post-molestation behavior.  It was offered,
after all, for purposes of just such rehabilitation.  But as
already discussed, the expert did not express an opinion on the
boy's credibility.  Early on in his testimony he disavowed any
intention of giving an opinion about whether the boy was a victim
of sexual abuse.  And the jurors could not have become confused
on this score since it was made plain to them that the expert
could not, in fact, even possess an opinion about the boy's
credibility: he had never talked to the boy and was ignorant of
the particulars of his allegations; he did not know, for example,
that the boy waited six or seven years to claim sexual abuse (the
subject of one of the complained-of hypothetical questions) until
defense counsel informed him of this on cross-examination.  We
note that in Taylor, the expert, who similarly had not
interviewed the complainant before the trial and was not
therefore testifying about her behavior as such, offered
testimony about conduct that closely resembled the facts of that
case (see p 27-28, supra). 
Defendant also attacks the scientific reliability of
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No. 60
CSAAS, citing the Second Circuit's decision in Gersten v
Senkowski (426 F3d 588 [2d Cir 2005]).  Referring to an expert's
affidavit in support of the defendant's federal petition for a
writ of habeas corpus, the court declared in Gersten that "[i]t
would appear" that CSAAS "lacked any scientific validity for the
purpose for which the prosecution utilized it: as a generalized
explanation of children's reactions to sexual abuse, including
delayed disclosure" (id. at 611).  While we have no way of
knowing whether the record in Gersten justified the Second
Circuit's conclusions about CSAAS, the record here does not
support a similar result.
Defense counsel in this case disputed the scientific
reliability of CSAAS in the motion in limine, quoting from a
review written by London and colleagues, critics of CSAAS;
however, the quoted passage does not question the empirical basis
for delayed reporting (see p 17, supra; see also Thomas D. Lyon,
"Scientific Support for Expert Testimony on Child Sexual Abuse
Accommodation," in Critical Issues in Child Sex Abuse:
Historical, Legal, and Psychological Perspectives 107, 108 [2002]
["Observational research demonstrates that a substantial
proportion of abused children either delay reporting or fail to
report their abuse"; John E. B. Myers, "Expert Testimony in Child
Sexual Abuse Litigation: Consensus and Confusion," 14 UC Davis J
Juv L and Pol'y 1, 22 [2010] ["Psychological research
demonstrates that delayed reporting is common among sexually
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No. 60
abused children"]).10  Rather, London and colleagues have
reservations about the prevalence of denial and recantation,
aspects of CSAAS not at issue in this case (see London 2007 at
12-13 ["[A]lthough a substantial portion of children delay
reporting or altogether fail to report incidents of child sexual
abuse (the secrecy stage), there is little evidence to suggest
that denials, recantations, and redisclosures are typical when
the abused children are directly asked about abuse during
forensic interviews"]).
III.
Finally, we conclude that the record is insufficient to
permit our review of defendant's claim of ineffective assistance
of counsel, which he may raise in a CPL 440.10 motion; his
remaining claims have been considered and are without merit. 
Accordingly, the order of the Appellate Division should
be affirmed. 
10And while London and colleagues assert that CSAAS does not
in the main comport with Daubert (see p 17, supra), this does not
necessarily mean, even if true, that CSAAS is not generally
accepted as reliable in the relevant scientific community (see
e.g. London 2007 at 12 ["The CSAA (Child Sexual Abuse
Accommodation) model has been endorsed by many clinicians and
scholars and has been the basis of clinical and forensic
judgments . . . Summit's (1983) paper . . . was rated by
professionals as one of the most influential papers in the field
of child sexual abuse"]).
- 36 -
People v Spicola (Michael)
No. 60
LIPPMAN, Chief Judge (dissenting):
This trial concerned events occurring between 7 and 8
years earlier, as to which no physical evidence could be
produced.  Defendant did not admit to any unlawful conduct; nor
was there any other direct evidence linking him to the crimes. 
The case, therefore, was essentially a credibility contest
between complainant and defendant.  The prosecutor thereupon took
several steps to improperly and prejudicially bolster the
credibility of complainant, as a result of which defendant was
deprived of a fair trial.  Accordingly, I would reverse and remit
to County Court for a new trial.
After defendant reported the alleged sexual abuse to
his mother, his physical examination was conducted by a nurse
practitioner at the Erie County Child Advocacy Center.  Defense
counsel sought to preclude the nurse practitioner's testimony for
several reasons, including that it would constitute improper
bolstering of the complainant's testimony and that it would be
prejudicial to defendant.  In response to an inquiry by the
court, the prosecutor indicated that the testimony was being
offered for several reasons.  Notably, the prosecutor stated
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- 2 -
No. 60
that, among other things, the nurse practitioner would testify
to:
"her observations of the child's demeanor,
his accelerated heart rate, his flushed face,
his downcast eyes, everything that would
relate to his credibility to rebut a
potential defense of fabrication here.
So in other words, when the nurse is asking
him she's documenting things in the chart
that are certainly relevant not only to her
diagnosis but in the broader sense to his
credibility as a witness because she's
showing that he's embarrassed, he['s]
flustered, et cetera, and that she's actually
looking for lesions."
I agree with the majority that those portions of the
nurse practitioner's testimony that were relevant to diagnosis
and treatment were properly admitted.  For example, testimony
concerning complainant's account of what had happened to him, the
extent of the ensuing physical examination, the absence of any
lesions or other visible signs of sexual abuse on complainant's
body and the significance of such absence were all properly
admitted as relevant to diagnosis and treatment (see People v
Ortega, 15 NY3d 610, 617 [2010]).
The same cannot be said about the nurse practitioner's
testimony concerning complainant's demeanor during the
examination.  The nurse practitioner testified that when
complainant related what had happened to him, "[h]e was
embarrassed, downcast eyes, flushed face."  She indicated that
she had recorded these details "[b]ecause they were definitely
- 2 -
- 3 -
No. 60
significant when I saw them.  He was embarrassed."  The nurse
practitioner further testified that complainant's elevated heart
rate during the examination indicated to her that "[h]e was
nervous."
Complainant's embarrassment or nervousness attending
the examination had no medical significance whatsoever.  The
majority's purported justification for the elicitation of this
testimony -- that it was relevant to whether some type of
counseling or therapy would be required (majority op. at 12-13) -
- is pure invention.  To the contrary, the prosecution was
perfectly blunt about why the testimony as to complainant's
demeanor was being offered: it was for credibility purposes.  The
nurse practitioner's testimony on this point was not relevant to
diagnosis and treatment and its admission on that basis was
error.
Furthermore, in this situation the error cannot be
considered harmless.  "[U]nless the proof of the defendant's
guilt, without reference to the error, is overwhelming, there is
no occasion for consideration of any doctrine of harmless error"
(People v Crimmins, 36 NY2d 230, 241 [1975]).  As noted, the
People's case rested almost entirely on the credibility of the
alleged victim.  It was therefore blatantly improper and
prejudicial to use the testimony of a medical professional to
bolster complainant's testimony in this manner.
Moreover, the error was egregiously compounded by the
- 3 -
- 4 -
No. 60
scope of the expert testimony on Child Sexual Abuse Accommodation
Syndrome (CSAAS).  Prior to trial, defense counsel sought to
preclude the CSAAS expert's testimony for two reasons.  Counsel
argued, first, that the subject matter of the expert's testimony
-- that children often delay reporting abuse -- was not outside
the ken of the average juror.  In addition, counsel asserted that
the expert's testimony would be "overwhelmingly prejudicial and
unfair" because the jury would inevitably draw the conclusion
that complainant had been abused because he fit within the
pattern of behavior recognized by CSAAS.  The request was denied
and the prosecutor proceeded to ask the expert, in hypothetical
terms, about virtually every detail in the case.
Several aspects of complainant's testimony were later
raised with the CSAAS expert.  Specifically, during his direct
testimony, complainant detailed his sexual abuse by a family
member -- his mother's second cousin.  Complainant also related
two incidents where he and his young friends had touched each
other's penises, which complainant explained was, at least in
part, because he was repeating behavior that had been done to him
by defendant.  Complainant further testified that what ultimately
convinced him to tell his mother about the sexual abuse was a
video about catching on-line predators that he had watched with
his eighth grade computer tech class.  Additionally, on cross-
examination, complainant testified that his memory had improved
as the years passed.  Complainant also testified that he was not
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- 5 -
No. 60
afraid to return to defendant's house after the alleged abuse,
but rather that he wanted to go the house and had fun when he was
there. 
The expert testified after the jury had heard
complainant's version of events.  In response to the
prosecution's questions, the expert testified that abuse by a
stranger was rare; a child was more likely to be abused by a
person he knows and the child's feelings of helplessness would be
enhanced if the abuser were a trusted adult who was close to the
child's mother.  The expert also testified that he had seen
children become hypersexualized and use sexuality as a coping
mechanism.  In response to a questions about a child's
willingness to return to the scene of the abuse, the expert
testified that the child could convince himself that the abuse
would not happen again and that the child could be willing to
spend time with the abuser because he would want to repeat any
positive experiences he had with that person.  The expert also
testified that boys were "far more likely to delay" reporting
sexual abuse and that any period of delay was likely to be far
longer than for girls -- specifically, that a delay of 6 or 7
years would not be unusual.  The expert also responded in the
affirmative to the prosecutor's query as to whether "an
educational component about the awareness of sexual abuse [could]
be a triggering event" for the disclosure of abuse.  Finally, the
expert testified that a child's memory could actually improve and
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No. 60
that more details could come to mind after the child disclosed
the abuse.*
"Expert opinion is proper when it would help to clarify
an issue calling for professional or technical knowledge,
possessed by the expert and beyond the ken of the typical juror"
(People v Taylor, 75 NY2d 277, 288 [1990] [citations omitted]). 
However, where "the sole reason for questioning the 'expert'
witness is to bolster the testimony of [the complainant] by
explaining that his version of the events is more believable than
the defendant's, the 'expert's' testimony is equivalent to an
opinion that the defendant is guilty, and the receipt of such
testimony may not be condoned" (People v Ciaccio, 47 NY2d 431,
439 [1979]).  Although we have recognized that CSAAS can be used
for the purpose of explaining behavior by a complainant that
might appear unusual to the average juror -- such as why a child
might not immediately report sexual abuse -- we have contrasted
the permissible use of such testimony with testimony that opines
that complainant's "behavior [was] consistent with such abuse"
(People v Carroll, 95 NY2d 375, 387 [2000]; see also People v
Mercado, 188 AD2d 941, 942 [3d Dept 1992] [expert's testimony
"constitute(d) an impermissible comparison of the complainants'
behavior with that commonly associated with victims of these
*On cross and re-direct, the expert even managed to inform
the jury that in his experience of 154 cases, he had seen only 4
instances of false allegations, 3 of them in the context of
divorce battles.
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No. 60
crimes"]).
Even though the expert did not expressly render an
opinion as to whether or not complainant was a victim of sexual
abuse, the expert's confirmation of nearly every detail of the
case and of complainant's behavior as consistent with that of a
victim of sexual abuse was the functional equivalent of rendering
an opinion as to complainant's truthfulness (see Ciaccio, 47 NY2d
at 439).  The expert's testimony had the effect of improperly
bolstering complainant's testimony and, in the context of this
case, was extremely prejudicial.
As noted above, this was a case where the credibility
of the parties was the key issue facing the jury.  Each of the
errors, in bolstering complainant's testimony with the nurse
practitioner's perception of his demeanor and the CSAAS expert's
validation of his behavior as consistent with that of a victim of
sexual abuse, and certainly their cumulative effect, deprived
defendant of a fair trial.
*   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *
Order affirmed. Opinion by Judge Read. Judges Graffeo, Smith and
Pigott concur. Chief Judge Lippman dissents and votes to reverse
in an opinion in which Judges Ciparick and Jones concur. 
Decided March 31, 2011
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