Title: State v. Monroe

State: north-carolina

Issuer: North Carolina Supreme Court

Document:

NO. COA13-46 
NORTH CAROLINA COURT OF APPEALS 
Filed: 21 January 2014 
 
 
STATE OF NORTH CAROLINA 
 
 
 
 
v. 
 
Wake County 
No. 09 CRS 209725 
JOSHUA ANDREW STEPP 
 
 
 
 
Appeal by Defendant from judgment entered 13 September 2011 
by Judge W. Osmond Smith III, in Wake County Superior Court.  Heard 
in the Court of Appeals 14 August 2013. 
 
Attorney General Roy Cooper, by Assistant Attorney General 
Anne M. Middleton and Sherri Horner Lawrence, for the State. 
 
Appellate Defender Staples Hughes, by Assistant Appellate 
Defender Barbara S. Blackman, for Defendant. 
 
 
DILLON, Judge. 
 
 
Joshua Andrew Stepp (Defendant) appeals from a judgment 
sentencing him to lifetime imprisonment, based on a jury verdict 
finding him guilty of first-degree murder, under the felony murder 
rule, for the death of his ten-month old stepdaughter Cathy.1  We 
conclude Defendant is entitled to a new trial based on the trial 
court’s failure to instruct the jury on an affirmative defense to 
                     
1 Cathy is a pseudonym. 
-2- 
 
 
the underlying felony, which supported the first-degree murder 
conviction.  
I: Background 
On the night of 8 November 2009 at approximately 8:50 P.M., 
Defendant placed a 911 call from his Wake County apartment, where 
he resided with three other people:  Brittany Yarley (“Ms. 
Yarley”), his wife of six months; Cathy, Ms. Yarley’s ten-month 
old daughter; and Defendant’s four-year old daughter.  
A: Physical Evidence at the Scene 
Police officers and EMS responded to Defendant’s 911 call and 
discovered that Cathy had no pulse and was not breathing.  The 
responders attempted resuscitation and were able to get a pulse in 
the ambulance before Cathy went into cardiac arrest.  When Cathy 
arrived at Wake Medical Center, she had no vital signs.  Cathy’s 
pupils were fixed and dilated, indicating brain death; Cathy was 
declared dead fifteen minutes after her arrival.  
In a trash can at the apartment the officers found a urine-
soaked diaper, three diapers containing baby wipes, feces, and 
blood, and empty rum, whiskey, and beer bottles.  Blood and feces 
were visible in a number of locations throughout the apartment.  
Blood was also found on Defendant’s underwear.  Defendant smelled 
of alcohol.  
-3- 
 
 
B: Cathy’s Injuries 
During the course of the evening, Cathy sustained injuries to 
her head and back as well as to her rectal and genital areas.  Her 
head and back injuries included several bruises, a broad abrasion 
on her forehead, lacerations in her mouth, and hemorrhaging in her 
brain and retinas.  Cathy’s rectal injuries included bruising and 
several deep and superficial tears in and around her anal opening.   
The injuries to her genital area, which were less severe than 
those in her rectal area, included two superficial tears on the 
forward portion and a single wider tear at the rear portion.  
However, there was no evidence of injuries indicating deep 
penetration; and her hymen was intact. 
II: The Trial 
On 30 November 2009, Defendant was indicted on charges of 
first-degree murder and first-degree sexual offense.  The matter 
came on for trial at the 18 July 2011 criminal session of Wake 
County Superior Court.   
A: State’s Evidence 
At trial, the State offered the testimonies of a number of 
medical witnesses, which tended to show as follows:  Cathy’s head 
injuries were likely caused by multiple blows which were consistent 
with non-accidental trauma “caused by an abusive person.”  Her 
-4- 
 
 
rectal injuries were consistent with the introduction of a penis 
or other object that penetrated the anus but most likely not by a 
single finger wrapped in a wipe.  Her genital injuries may have 
been caused by a finger or an object, and were also consistent 
with an adult attempting, unsuccessfully, to insert his penis into 
her vagina.   
B: Defense Evidence 
Defendant testified in his own behalf and offered the 
testimonies of other witnesses, including experts, which tended to 
show as follows:  Defendant was a member of the Army Reserves, 
having resigned from active duty after completing a tour in Iraq.  
He suffered from post-traumatic stress disorder and alcohol 
dependency.  Ms. Yarley was also an Army reservist, who worked at 
Fort Bragg.   
During the day of 8 November 2009, Defendant took four Vicodin 
capsules and drank several shots of liquor and cans of beer.  He 
spent the afternoon at a sports bar where he continued drinking.  
Because Ms. Yarley was scheduled to work the night shift on that 
day, Defendant returned to the apartment at 7:25 P.M. to watch the 
children for the evening.  Upon his return, Cathy was crying and 
screaming; and Ms. Yarley noticed that Defendant was lethargic and 
stumbling.   
-5- 
 
 
After Ms. Yarley’s departure, Defendant ate dinner and then 
attempted to calm Cathy down by holding her and giving her a 
bottle.  He then placed Cathy on the floor of his bedroom closet 
and walked away to escape the sound of her crying.  Defendant 
returned to her, grabbed her by the back of the head, and rubbed 
her face into the carpet.  Cathy’s face became raw and began to 
bleed, and she cried even harder.  Defendant used a damp washcloth 
to dab the blood and then carried Cathy into the living room, put 
Vaseline on her face, and laid her down on the living room floor.  
This episode occurred at approximately 8:00 P.M., which was the 
time that, according to a defense witness, Defendant’s blood 
alcohol level likely peaked at 0.141%. 
Moments later, Defendant opened Cathy’s diaper and discovered 
that it was full of feces.  Cathy flailed and screamed as Defendant 
tried to clean her with a baby wipe.  Defendant wiped aggressively 
to get the feces and urine off of Cathy’s body.  Cathy began 
bleeding from her anus, and Defendant tried to stop the bleeding 
with a baby wipe.  A few minutes later, Cathy was still bleeding 
and had defecated again.  Defendant cleaned Cathy again with a 
baby wipe and put on a second fresh diaper.  However, the second 
diaper became soiled, and Defendant cleaned and changed Cathy a 
third time.   
-6- 
 
 
Cathy continued to scream and cry.  Defendant then grabbed 
some toilet paper, wet it, and put it in Cathy’s mouth in an 
attempt to stop the screaming.  However, Cathy started gagging.  
Defendant was unable to retrieve the toilet paper from Cathy’s 
mouth with his fingers; so he picked Cathy up, shook her, and hit 
her on her back to try to dislodge the toilet paper.  He was then 
able to pull the toilet paper out of Cathy’s mouth with his 
fingers; however, by this time, Cathy was barely breathing.  
Moments later, Cathy stopped breathing, whereupon Defendant made 
the 911 call.  
The testimonies of Defendant’s witnesses tended to show that 
Defendant suffered from substance abuse issues and post-traumatic 
stress disorder caused by his military service, conditions which 
affected his impulse control and decision making; that on the 
evening in question, he had trouble coping with Cathy’s crying; 
and that his intentions all along were to stop Cathy from crying.  
Regarding Cathy’s injuries, one defense medical witness testified 
that he had frequently seen vaginal and rectal tears caused by 
parents using force to clean feces, and that Cathy’s injuries to 
her rectal and genital areas were consistent with harsh cleaning 
with a finger and baby wipes and were not consistent with a sexual 
assault.    
    
-7- 
 
 
C: Closing Arguments 
During closing arguments, the State asserted that the jury 
should find Defendant guilty of first-degree murder.  The State 
contended that Defendant’s acts involved premeditation and 
deliberation.  Alternatively, the State contended that Defendant 
was guilty of first-degree murder based on the felony murder rule, 
as the evidence showed that Defendant had either raped or attempted 
to rape Cathy, or otherwise committed a sexual offense upon Cathy.  
Defendant admitted that he was responsible for Cathy’s death, 
but contended that he had not acted with premeditation and 
deliberation due to his condition, nor had he sexually assaulted 
Cathy in any way; and, therefore, Defendant asserted the jury 
should consider returning a guilty verdict for second degree 
murder.   
D: The Verdict and Judgment 
The jury found Defendant guilty of first-degree murder.  
Specifically, the verdict sheet submitted to and answered by the 
jury stated as follows:   
We, the jury, return as our unanimous verdict that the 
defendant is: 
 
 X 
Guilty of first degree murder 
 
 
If you find the defendant guilty of first degree murder, 
is it: 
 
-8- 
 
 
A. 
On the basis of malice, premeditation, and 
deliberation? 
ANSWER:   NO 
 
B. 
Under the first degree felony murder rule in the 
perpetration of rape of a child by an adult? 
ANSWER: 
NO 
 
C. 
Under the first degree felony murder rule in the 
attempted perpetration of rape of a child by an adult? 
ANSWER: 
NO 
 
D. 
Under the first degree felony murder rule in the 
perpetration of sexual offense with a child by an adult? 
ANSWER: 
YES 
 
If you find the defendant guilty of first degree murder 
under the first degree felony murder rule in the 
perpetration of a sexual offense with a child by an 
adult, is it: 
 
1. Based upon a sexual act of anal intercourse? 
ANSWER:   NO   
  
2. Based upon a sexual act of penetrating by an object 
into the genital opening of the alleged victim? 
ANSWER: 
YES 
 
3. Based upon a sexual act of penetration by an object 
into the anal opening of the alleged victim? 
ANSWER: 
NO 
 
__   Guilty of second degree murder2 
 
__ 
Not guilty 
 
                     
2 Having convicted Defendant of first-degree murder, the jury did 
not reach the question of Defendant’s guilt of second degree 
murder. 
-9- 
 
 
Based on the jury’s verdict, the trial court imposed a sentence of 
life imprisonment without parole.  From this judgment, Defendant 
appeals.   
III: Analysis 
 
In Defendant’s sole argument on appeal, he contends the trial 
court committed reversible error by failing to instruct the jury 
on an affirmative defense to the predicate felony on which the 
jury based its first-degree murder conviction.  We agree. 
As reflected by its responses to the issues presented on the 
verdict sheet, the jury convicted Defendant of first-degree murder 
based solely on its determination that Defendant was also guilty 
of committing a “sexual offense with a child” in violation of N.C. 
Gen. Stat. § 14-27.4 (2011), a Class B1 felony which proscribes, 
inter alia, the engagement of a “sexual act” with a child by an 
adult.  Further, the jury concluded that Defendant was guilty of 
committing this offense based solely on its determination that 
Defendant had committed a “sexual act,” as defined in N.C. Gen. 
Stat. § 14-27.1(4) (2011), upon Cathy by penetrating her genital 
opening with an object.3   
                     
3 Though the jury could have found Defendant guilty of first-degree 
murder based on either premeditation and deliberation or based on 
a finding that Defendant either had vaginal intercourse or 
attempted to have vaginal intercourse with Cathy, the jury found 
Defendant not guilty based on these theories. Further, the jury 
-10- 
 
 
 N.C. Gen. Stat. § 14-27.1(4) (2011), defines “sexual act,” 
in relevant part, as: 
. . . the penetration, however slight, by any 
object into the genital . . . opening of 
another person’s body:  provided, that it 
shall be an affirmative defense that the 
penetration was for accepted medical purposes.  
 
Id. (emphasis added).  The “penetration” of the female “genital 
opening” is accomplished when the defendant has caused an object 
to enter the labia without entering the vagina, see State v. 
Bellamy, 172 N.C. App. 649, 658, 617 S.E.2d 81, 88 (2005), disc. 
review denied, 360 N.C. 290, 628 S.E.2d 384 (2006); and an “object” 
can be, not only an inanimate object, but also a human body part, 
such as a finger, see State v. Lucas, 302 N.C. 342, 345, 275 S.E.2d 
433, 436 (1981). 
At trial, Defendant admitted that he penetrated Cathy’s 
genital opening with his finger; however, he requested an 
instruction on the affirmative defense provided by N.C. Gen. Stat. 
§ 14-27.1(4), that he penetrated her genital opening for “accepted 
                     
could have found that Defendant committed a “sexual act” by 
penetrating Cathy’s anal opening with either his penis or another 
object; however, the jury found Defendant not guilty of felony 
sexual offense based on these theories as well.  Accordingly, our 
review must be limited to the evidence regarding the penetration 
of Cathy’s genital opening with an object, and, for the reasons 
stated herein, we must view this evidence in the light most 
favorable to Defendant. 
-11- 
 
 
medical purposes.”  Defendant based his request on the evidence 
tending to show that he penetrated Cathy’s genital opening with 
his finger wrapped in a wipe for the purpose of cleaning feces and 
urine during the course of changing her diapers and that this 
purpose is an “accepted medical purpose.”  However, the trial court 
denied the request, to which Defendant properly excepted. 
A: Defendant was Entitled to the Instruction 
We believe that Defendant was entitled to have the jury 
instructed on the affirmative defense for “accepted medical 
purpose” as provided in N.C. Gen. Stat. § 14-27.1(4).   
We have held that “[f]or a jury instruction to be required on 
a particular defense, there must be substantial evidence of each 
element of the defense when ‘the evidence [is] viewed in the light 
most favorable to the defendant.”  State v. Hudgins, 167 N.C. App. 
705, 711, 606 S.E.2d 443, 446 (2005) (citation and quotation marks 
omitted).  The burden rests with Defendant to establish the 
affirmative defense.  State v. Caddell, 287 N.C. 266, 289, 215 
S.E.2d 348, 363 (1975) (describing an affirmative defense as “one 
in which the defendant says, ‘I did the act charged in the 
indictment, but I should not be found guilty of the crime charged 
because * * * ”). 
In his brief, Defendant points to evidence that, when viewed 
-12- 
 
 
in the light most favorable to him, supports giving the 
instruction.  Specifically, he points to his own testimony that he 
digitally penetrated Cathy’s genital opening for the purpose of 
cleaning feces and urine during diaper changes.  He points to the 
testimony of his medical expert who stated that Cathy’s injuries 
to her genital opening were consistent with Defendant’s stated 
purpose.  For example, this witness testified as follows: 
The source of the [genital] injuries were – 
again, by the information that I was provided, 
Mr. Stepp in his testimony has admitted to 
trying to clean a poopy diaper in a very rough 
way using wipes, his fingers, and in a way 
that was consistent with this type of trauma. 
This was harsh, harsh physical trauma in 
cleaning out a diaper.  I have seen more cases 
than I would like of parents trying to clean 
out poopy diapers and how difficult it is to 
get stool out of the vaginal and rectal areas 
on occasion, and the kind of force that they 
have to use sometimes. This was excessive, but 
it is consistent with a digital attack, if you 
will, on those areas there.   
 
He points to the evidence presented by the State regarding the 
soiled diapers and wipes found by the police at the apartment.  He 
points to the testimonies of the State medical experts that the 
injuries to the genital opening were more superficial in nature – 
in that there was no evidence of deep penetration or that the hymen 
was broken - and could have been caused by fingers.   
-13- 
 
 
Neither party cites to a case in which a North Carolina court 
has construed the phrase “accepted medical purposes” as contained 
in N.C. Gen. Stat. § 14-27.1(4).  We believe that when the 
Legislature defined “sexual act” as the penetration of a genital 
opening with an object, it provided the “accepted medical purposes” 
defense, in part, to shield a parent4 - or another charged with 
the caretaking of an infant - from prosecution for engaging in 
sexual conduct with a child when caring for the cleanliness and 
health needs of an infant, including the act of cleaning feces and 
urine from the genital opening with a wipe during a diaper change.  
To hold otherwise would create the absurd result that a parent 
could not penetrate the labia of his infant daughter to clean away 
feces and urine or to apply cream to treat a diaper rash without 
committing a Class B1 felony, a consequence that we do not believe 
the Legislature intended. 
Though not controlling on our resolution of this issue, we do 
find decisions from other jurisdictions, involving statutory 
language similar to “accepted medical purposes,” instructive.  For 
instance, the Texas Court of Criminal Appeals, that State’s highest 
appellate court for criminal cases, handed down a decision on 6 
                     
4 There is no language in N.C. Gen. Stat. § 14-27.1(4) which limits 
its application of the defense to acts performed by medical 
professionals. 
-14- 
 
 
November 2013 ordering a new trial for a defendant, convicted of 
sexual assaulting a child – where he admitted to digitally 
penetrating the genital opening of a three-year old girl for the 
purpose of applying medication for a diaper rash - because the 
trial court failed to instruct the jury on an affirmative defense 
provided in the Texas Penal Code, excusing “conduct [which] 
consisted of medical care for the child[.]”  Villa v. Texas, 2013 
Tex. Crim. App. LEXIS 1655 (2013) (interpreting TEX. PENAL CODE § 
22.011(d) (2012)).  On the same day it decided Villa, the Texas 
Court of Criminal Appeals also handed down Cornet v. Texas, 2013 
Tex. Crim. App. LEXIS 1654 (2013), in which it held, as in Villa, 
that it was error not to instruct on the “medical care” defense, 
where a defendant was convicted of sexual assault based on 
digitally penetrating the genital opening of his step-daughter.  
However, unlike its holding in Villa, the court concluded that the 
error was harmless because the jury in Cornet also convicted the 
defendant of a second sexual assault count based on the defendant’s 
oral contact with the child’s anus during the same event.5  Id. 
(reasoning that it “is inconceivable that the jury would have found 
[the defendant] guilty of causing the anus of the complainant to 
                     
5 Under TEX. PENAL CODE § 21.011(d), the “medical care” defense is 
not available where the conduct involves contact of a genital 
opening by a defendant’s mouth.  Id.   
-15- 
 
 
contact his mouth . . . had it believed his claim that he was 
providing medical care to the complainant [when he digitally 
penetrated her genital opening] during the same event”).      
In a case involving the prosecution of a defendant for 
digitally penetrating the genital opening of his young step-child 
– where the defendant admitted to the conduct, but contended that 
he did so for the purpose of applying salve to treat the child’s 
diaper rash - the Oregon Court of Appeals held that it was 
reversible error for the trial court not to instruct the jury on 
an affirmative defense provided by statute which excused such 
conduct where the “penetration is part of a medically recognized 
treatment[.]”  Oregon v. Ketchum, 206 Ore. App. 635, 138 P.3d 860, 
review denied, 341 Ore. 450, 143 P.3d 773 (2006) (quoting Or. Rev. 
Stat. § 163.412 (2003)).  The court ordered a new trial, holding 
that the defense was not limited to the conduct of medical 
personnel.  Id. 
We believe the facts of our case are similar to the facts of 
Villa and Ketchum – where the courts ordered a new trial – because 
Defendant was convicted solely on a finding that he digitally 
penetrated Cathy’s genital opening with an object.   
In the present case, the State makes a number of arguments in 
support of the trial court’s refusal to give the “accepted medical 
-16- 
 
 
purpose” affirmative defense instruction.  First, the State argues 
that Defendant failed to meet his evidentiary burden by failing to 
produce any evidence to establish that penetrating the genital 
opening of an infant to clean out feces and urine is, in fact, an 
“accepted medical purpose,” citing State v. Hageman, 307 N.C. 1, 
27, 296 S.E.2d 433, 448 (1982) (stating that “in this State, we 
have traditionally placed the burden of production and persuasion 
on defendants who seek to avail themselves of affirmative 
defenses”).  In other words, the State argues that though there 
was expert testimony suggesting that Defendant penetrated the 
genital opening to clean it, none of the experts ever expressly 
testified that Defendant’s actions constituted an “accepted 
medical purpose.”   
We agree that there may be circumstances where a defendant 
would be required to offer direct evidence through the testimony 
of a medical expert to establish that certain conduct constitutes 
an “accepted medical purpose,” rather than allowing a jury to infer 
it from the evidence.  However, we do not believe that Defendant 
was required, in this instance, to offer direct evidence 
establishing that penetrating the genital opening of an infant for 
the purpose of cleaning the feces and urine during a diaper change 
constitutes an “accepted medical purpose.”  Our appellate courts 
-17- 
 
 
have held on a number of occasions that, in the context of a 
criminal trial, direct evidence need not be provided to prove a 
fact if it otherwise is within the “common knowledge and 
experience” of the jury.  State v. Packer, 80 N.C. 439, 441-42 
(1879).  In Packer, the defendant appealed his conviction for 
selling an “intoxicating liquor” where the evidence showed that he 
sold “port wine,” but the State did not produce evidence that “port 
wine” was, in fact, an “intoxicating liquor.”  Id.  In upholding 
the conviction, our Supreme Court held that “the jury could 
rightfully as to matters of common knowledge and experience, find 
without any testimony as to [whether “port wine” is an 
“intoxicating liquor.”]  Id.; see also State v. Fields, 201 N.C. 
110, 114, 159 S.E. 11, 12 (1931); State v. Payne, 328 N.C. 377, 
400, 402 S.E.2d 582, 595 (1991) (stating, in a prosecution for 
murder and rape, that “[i]t is common knowledge that homeowners do 
not change or replace carpets as frequently as once every several 
months”); State v. Becker, 241 N.C. 321, 326, 85 S.E.2d 327, 331 
(1954) (stating, in a prosecution for manslaughter where there was 
testimony as to the defendant’s driving speed and his distance 
from the victim, that “[i]t would seem as a matter of common 
knowledge and experience that it would have been a physical 
impossibility for the defendant to have stopped his car in so short 
-18- 
 
 
a distance if at the time in question it was traveling at such a 
rate of speed”); State v. Purdie, 93 N.C. App. 269, 280, 377 S.E.2d 
789, 795 (1989) (stating, in a prosecution for involuntary 
manslaughter, that “it is common knowledge that intoxication 
impairs the ability to drive”).   
We also believe this evidentiary issue is similar to those in 
cases involving professional malpractice, where we have stated 
that an exception to the rule requiring expert testimony to 
establish the professional standard of care is “where the common 
knowledge and experience of the jury is sufficient to evaluate 
compliance with a standard of care.”  Russell v. DENR, __ N.C. 
App. __, __, 742 S.E.2d 329, 333 (2013) (quoting Handex v. Haywood, 
168 N.C. App. 1, 11, 607 S.E.2d 25, 31 (2005)).  In conclusion, 
while there may be circumstances where expert testimony may be 
required to establish that certain conduct constitutes an 
“accepted medical purpose” pursuant to N.C. Gen. Stat. § 14-
27.1(4), we believe that it is within the common knowledge and 
experience of the jury that penetrating the genital opening of an 
infant to clean feces and urine during a diaper change is an 
“accepted medical purpose.”   
The State next argues that the “accepted medical purpose” 
defense did not apply to the facts of this particular case.  
-19- 
 
 
Specifically, the State contends that even if Defendant’s purpose 
of cleaning the genital opening was an “accepted medical purpose,” 
doing so in a manner that causes injury is not “accepted,” and, 
therefore, Defendant was not entitled to the instruction.  We 
believe the State’s argument is misplaced.  First, the plain 
language of the statute provides that the “medical purpose,” and 
not the manner, must be “accepted.”  We do not believe that the 
Legislature intended to criminalize, as a Class B1 felony, an 
action by a doctor or a parent who penetrates a genital opening of 
a child under 13 years of age for an “accepted medical purpose,” 
but does so in a negligent manner, thereby unintentionally causing 
injuries.6  
The State further argues the following:  
By defendant’s logic, a robber sticking a gun 
in a victim’s vagina or anus to intimidate the 
victim would not be a sexual offense; torture 
by inserting objects into a person’s genitals 
or anus would not be a sexual offense; a 
perpetrator 
forcefully 
punching 
and 
penetrating a victim’s genitalia to harm and 
degrade them would not be guilty of a sexual 
offense; a caretaker forcefully penetrating a 
child in a rage would not be guilty of a sexual 
                     
6 We do not imply that the evidence conclusively establishes that 
Defendant did not intend to cause the injuries to Cathy’s genital 
opening.  This is a matter for a jury to resolve.  Rather, we 
believe that a jury could reasonably conclude from the evidence - 
when taken in the light most favorable to Defendant – that 
Defendant unintentionally caused Cathy’s injuries to her genital 
opening while cleaning her. 
-20- 
 
 
offense.  By defendant’s analysis, if in any 
of these scenarios, the perpetrator merely 
claimed to be doing a medical check or 
administering 
medication, 
the 
“accepted 
medical purpose” instruction must be given 
upon request. 
 
However, assuming arguendo any of the foregoing scenarios were 
properly before us, it stretches credulity to propose that these 
acts could ever be performed for an “accepted medical purpose.”  
Further, as discussed above, the evidence relied upon by Defendant 
in this case consists of more than his self-serving assertion that 
he penetrated Cathy’s genital opening to clean feces.  See State 
v. Sessoms, __ N.C. App. __, __, 741 S.E.2d 449, 452 (2013) 
(holding that the trial court did not commit error by refusing to 
instruct the jury on “the defense of others” in the prosecution 
for assault with a deadly weapon where the only evidence supporting 
the defense was the defendant’s self-serving testimony).   
Finally, the State argues that the trial court did not err by 
refusing to instruct the jury on the “accepted medical purpose” 
defense because the specific instruction tendered by Defendant for 
the trial court’s consideration was an incorrect statement of law.  
Specifically, the State argues that the “proposed instruction can 
be construed to incorrectly place the burden on the State to 
disprove the affirmative defense beyond a reasonable doubt.”  We 
believe this argument is misplaced.   
-21- 
 
 
Our Supreme Court has stated that “it is the duty of the trial 
court to instruct the jury on all of the substantive features of 
a case. . . .  All defenses arising from the evidence presented 
during the trial constitute substantive features of a case and 
therefore warrant the trial court’s instruction thereon.”  State 
v. Loftin, 322 N.C. 375, 381, 368 S.E.2d 613, 617 (1988).  This 
duty arises even where a defendant fails to request the 
instruction.  Id.; see also State v. Scanlon, 176 N.C. App. 410, 
424, 626 S.E.2d 770, 780 (2006).  “Failure to instruct upon all 
substantive or material features of the crime charged is error.”  
State v. Bogle, 324 N.C. 190, 195, 376 S.E.2d 745, 748 (1989).   
In this case, the “accepted medical purpose” defense is a 
“substantive feature” of this case; and, therefore, the trial court 
was required to give the instruction even if Defendant never made 
a request for the instruction.  We believe that State v. Hudgins, 
167 N.C. App. 705, 606 S.E.2d 443 (2005), is instructive on this 
point.  In Hudgins, the defendant requested an instruction on the 
defense of “necessity” in a DWI prosecution.  The Court stated the 
general rule that the defense of “necessity” is available to excuse 
a person from criminal liability where he acts “to protect life or 
limb or health[.]”  Id. at 710, 606 S.E.2d at 447.  The defendant 
provided the trial court with an instruction that was not a correct 
-22- 
 
 
statement of the law in that “it [further] suggested that the 
defense was available for attempts to [protect property from] 
damage.”  Id.  We held that “[a] trial court is not, however, 
‘relieved of his duty to give a correct . . . instruction [as to 
a defense], there being evidence to support it, merely because 
defendant’s request was not altogether correct.”  Id. (quoting 
State v. White, 288 N.C. 44, 48, 215 S.E.2d 557, 560 (1975)).  
Accordingly, we do not need to reach whether Defendant’s tendered 
instruction was a correct statement of the law:  Since the 
instruction pertained to a substantive feature of the case, the 
trial court was required to give it. 
B: The Error Was Reversible 
Having determined that the trial court erred by failing to 
instruct the jury on the affirmative defense of “accepted medical 
purpose,” we must determine whether the error is reversible 
pursuant to N.C. Gen. Stat. § 15A-1443 (2011).  Defendant argues 
that the error is a constitutional error and, therefore, the burden 
is on the State to show that the error was harmless beyond a 
reasonable doubt, pursuant to N.C. Gen. Stat. § 15A-1443(b).  We 
believe that “insofar as the error committed is not one of 
constitutional dimension, [D]efendant has met his burden of 
satisfying us that had the error in the instruction . . . not been 
-23- 
 
 
made, there is a reasonable possibility that a different result 
would have been obtained at trial[,]” pursuant to N.C. Gen. Stat. 
§ 15A-1443(a).  State v. Mash, 323 N.C. 339, 349-50, 372 S.E.2d 
532, 538-39 (1988).  Further, “[i]nsofar as the error is one of 
constitutional dimension, the [S]tate has not satisfied us beyond 
a reasonable doubt that the error was harmless.”  Id. at 350, 372 
S.E.2d at 539.  Accordingly, we believe that the error is 
reversible based on either standard.     
 
Specifically, Defendant admitted to penetrating and causing 
the superficial tears to Cathy’s genital opening.  In other words, 
his defense includes an admission to the elements of the crime of 
sexual conduct with a child, that is, he admitted that he digitally 
penetrated Cathy’s genital opening.  However, Defendant presented 
evidence that he committed these acts for the purpose of cleaning 
feces and urine away from Cathy while changing her diapers.   
In the State’s closing arguments, the prosecutor contended 
that “even under the defendant’s version of the facts, penetrated 
her with his finger, however slight, . . . .  That’s what a sexual 
act is, the defendant’s guilty of that charge.”  In other words, 
the prosecutor implied that the jury could convict Defendant of 
felony sexual offense based upon his digital penetration of Cathy’s 
genital opening – conduct to which Defendant admitted – even if 
-24- 
 
 
the jury believed Defendant’s testimony and evidence that he 
engaged in the conduct for the purpose of cleaning feces and urine.  
Furthermore, the trial court instructed the jury that it was their 
duty to return a verdict of guilty of committing a sexual offense 
with a child if they found that Defendant had caused the 
“penetration, however slight, . . . by an object into [Cathy’s] 
genital [] opening[;] that the “object may be an animate or an 
inanimate object[;] that Cathy was “a child of under the age of 13 
years[;]” and that Defendant was “at least 18 years of age.”  The 
jury was not given any option in the instruction to, otherwise, 
find Defendant not guilty even if they determined that Defendant 
engaged in the conduct for an “accepted medical purpose.”  Based 
on the foregoing, we believe that there is a possibility that the 
jury, or some number of jurors, would have been satisfied that 
Defendant penetrated Cathy’s genital opening for an “accepted 
medical purpose.”  Therefore, Defendant’s conviction of felony 
first-degree murder must be reversed. 
 
Finally, the State contends that “[i]f this Court allows 
[Defendant] relief, judgment should be entered on second-degree 
murder as a lesser-included offense of first-degree murder under 
both the theory of premeditation and deliberation and felony 
murder,” contending that “[s]econd-degree murder is a lesser 
-25- 
 
 
included offense of felony murder.”  The State’s argument based on 
the theory of premeditation and deliberation is inapposite, as the 
jury did not convict Defendant based on premeditation and 
deliberation.  As to the State’s argument that second degree murder 
is a lesser included offense of felony murder, neither case cited 
by the State stands for the proposition that the proper remedy 
from this Court, where we find reversible error in the conviction 
of felony first-degree murder, is to direct the trial court to 
enter judgment on second degree murder.  State v. Gwynn, 362 N.C. 
334, 338, 661 S.E.2d 706, 708 (2008); State v. Millsaps, 356 N.C. 
556, 565, 572 S.E.2d 767, 774 (2002).  Rather, Gwynn and Millsaps 
were concerned with the trial court’s failure to instruct a jury 
on the lesser-included offense of second degree murder in a 
prosecution of felony first-degree murder.  We note that, in Gwynn, 
the Supreme Court stated that voluntary manslaughter is also a 
lesser included offense of felony murder.  Gwynn, supra.  
Therefore, we do not believe that it is the duty of this Court to 
invade the province of a jury to determine whether the actions of 
Defendant constituted second degree murder or some other lesser-
included offense of felony murder. 
IV: Conclusion 
-26- 
 
 
Defendant inflicted numerous and severe injuries on his ten-
month old stepdaughter Cathy on the evening of 8 November 2009, 
which led to her tragic death.  There was substantial evidence 
presented at trial from which the jury could have convicted 
Defendant of first-degree murder based on a number of theories.  
However, the jury based its verdict solely on the finding that 
Defendant had penetrated Cathy’s genital opening with an object 
prior to inflicting the injuries that caused her death.  The 
evidence was conflicting as to whether Defendant penetrated 
Cathy’s genital opening for the sole purpose of cleaning feces and 
urine while changing her diapers or whether he ever deviated from 
this purpose.  However, a jury could infer from the evidence - 
when taken in the light most favorable to Defendant - that 
Defendant penetrated Cathy’s genital opening, causing superficial 
tears thereto, while he was cleaning the feces and urine.  
Therefore, Defendant was entitled to the “accepted medical 
purpose” instruction pursuant to N.C. Gen. Stat. § 14-27.1(4), a 
defense 
which 
was 
a 
substantive 
feature 
of 
the 
case, 
notwithstanding that a proposed instruction tendered by Defendant 
may have contained an incorrect statement of the law.  Defendant 
properly objected to the trial court’s refusal to give the 
instruction.  Given that Defendant admitted to the conduct which 
-27- 
 
 
formed the sole basis by which the jury returned a guilty verdict 
of first-degree murder, the trial court’s error by not giving the 
affirmative defense instruction by which the jury could have 
excused Defendant of his admitted conduct, we believe the error 
was prejudicial. Accordingly, we are compelled to reverse the 
verdict of the jury convicting Defendant of felony first-degree 
murder and remand this case for a new trial. 
NEW TRIAL. 
Judge STEPHENS concurs in separate opinion. 
Judge BRYANT dissents in separate opinion. 
-28- 
 
 
 
NO. COA13-46 
NORTH CAROLINA COURT OF APPEALS 
Filed: 21 January 2014 
 
 
STATE OF NORTH CAROLINA 
 
 
 
 
v. 
 
Wake County 
No. 09 CRS 209725 
JOSHUA ANDREW STEPP 
 
 
 
 
STEPHENS, Judge, concurring. 
 
 
I am constrained by statute, case law, and the evidence 
presented at trial to agree with the majority opinion that we must 
grant Defendant a new trial.  However, I write separately because 
I believe the result we are compelled to reach in this appeal is 
not what our General Assembly envisioned or intended when it 
provided the affirmative defense of penetration for an “accepted 
medical purpose[]” under section 14-27.1.  See N.C. Gen. Stat. § 
14-27.1 
(2011) 
(defining 
“[s]exual 
act” 
to 
include 
“the 
penetration, however slight, by any object into the genital or 
anal opening of another person’s body:  provided, that it shall be 
an affirmative defense that the penetration was for accepted 
medical purposes”).   
I believe that, in the context of sexual abuse prosecutions, 
-29- 
 
 
our legislature intended this affirmative defense to distinguish 
between necessary penetrations required by medical, hygiene, or 
other health needs from those which are criminal in nature.  I 
cannot believe that our legislators intended this affirmative 
defense be used as a shield by a drunken, drugged, and enraged 
Defendant who by his own admission (1) rubs a baby’s face into 
carpet until she bleeds from second-degree rug burns, (2) bruises 
her face and head in multiple locations, and then (3) attempts to 
“clean” her genital and anal regions with such violence that her 
rectum and vagina are left torn and bleeding (all before 
asphyxiating the helpless infant by shoving wet toilet paper into 
her mouth in an effort to silence her hysterical screams of pain).  
I would draw our General Assembly’s attention to the discussion in 
the majority opinion regarding the distinction between penetration 
for an accepted medical purpose and penetration which occurs for 
such a purpose in a medically accepted manner.  Surely it should 
be a criminal offense, even if not sexual abuse, to penetrate a 
baby’s vagina, even in an alleged attempt to clean feces away, if 
that action is undertaken in a drunken rage and results in injuries 
such as those Cathy suffered in the last moments of her brief life. 
I further note the State could have elected to charge 
Defendant with felony child abuse, as the predicate felony to his 
-30- 
 
 
first-degree murder charge, pursuant to various provisions of N.C. 
Gen. Stat. § 14-318.4: 
(a) A parent or any other person providing 
care to or supervision of a child less than 16 
years of age who intentionally inflicts any 
serious physical injury upon or to the child 
or who intentionally commits an assault upon 
the child which results in any serious 
physical injury to the child is guilty of a 
Class E felony . . . . 
 
. . . 
 
(a3) A parent or any other person providing 
care to or supervision of a child less than 16 
years of age who intentionally inflicts any 
serious bodily injury to the child or who 
intentionally commits an assault upon the 
child which results in any serious bodily 
injury to the child, or which results in 
permanent or protracted loss or impairment of 
any mental or emotional function of the child, 
is guilty of a Class C felony.  
 
(a4) A parent or any other person providing 
care to or supervision of a child less than 16 
years of age whose willful act or grossly 
negligent omission in the care of the child 
shows a reckless disregard for human life is 
guilty of a Class E felony if the act or 
omission results in serious bodily injury to 
the child. 
 
(a5) A parent or any other person providing 
care to or supervision of a child less than 16 
years of age whose willful act or grossly 
negligent omission in the care of the child 
shows a reckless disregard for human life is 
guilty of a Class H felony if the act or 
omission results in serious physical injury to 
the child. 
 
-31- 
 
 
. . . 
 
(d) The following definitions apply in this 
section: 
 
   (1) Serious bodily injury. — Bodily injury 
that creates a substantial risk of death or 
that causes serious permanent disfigurement, 
coma, a permanent or protracted condition that 
causes 
extreme 
pain, 
or 
permanent 
or 
protracted loss or impairment of the function 
of any bodily member or organ, or that results 
in prolonged hospitalization. 
 
   (2) Serious physical injury. — Physical 
injury that causes great pain and suffering.  
The term includes serious mental injury. 
 
N.C. Gen. Stat. § 14-318.4 (2011).  As noted supra, Defendant 
admitted that his actions caused second-degree rug burns to Cathy’s 
face and deep tears to her anus.  These injuries would surely 
qualify, at a minimum, as “serious physical injur[ies]” under the 
statute.  Likewise, Defendant’s actions were plainly willful.  I 
cannot understand the decision by the State to proceed against 
Defendant on charges for sexual offense felonies without also 
charging him with felony child abuse, an offense for which 
Defendant’s shocking claim of “diaper changing” would have 
provided little or no defense.   
 
 
-32- 
 
 
 
NO. COA13-46 
 
 
NORTH CAROLINA COURT OF APPEALS 
 
 
Filed:  21 January 2014 
 
STATE OF NORTH CAROLINA 
 
v. 
 
 
 
 
Wake County 
 
 
 
 
 
 
 
 
 
 
No. 09 CRS 209725 
JOSHUA ANDREW STEPP 
 
 
BRYANT, Judge, dissenting. 
 
The majority opinion holds that the trial court erred and 
grants defendant a new trial, stating that defendant is entitled 
to an affirmative defense instruction based upon evidence showing 
that defendant’s actions were for an “accepted medical purpose.”  
Because I do not believe there was sufficient evidence that 
defendant’s actions fell within the definition of accepted medical 
purpose, I do not believe defendant was entitled to an instruction 
on this affirmative defense; therefore, I respectfully dissent. 
The majority maintains that it is a matter of common knowledge 
and common sense that cleaning feces from a body is an act 
performed for an accepted medical purpose.  I would agree that 
cleaning feces is necessary for purposes of good hygiene (as is 
washing one’s hands and body, and cleaning one’s teeth), and that 
failure to clean feces could eventually result in an infection or 
-33- 
 
 
condition which might require medical attention.  But, I would not 
agree that, standing alone, defendant’s act of cleaning feces from 
the infant should be considered an act that was performed for an 
accepted medical purpose. 
“Medical” means “[o]f or relating to the study or practice of 
medicine.”  AMERICAN HERITAGE COLLEGE DICTIONARY 846 (3d ed. 1993).  
“Accepted” means “[w]idely encountered, used, or recognized.”  Id. 
at 8.  General Statutes, section 14-27.1, defining “sexual act,” 
provides an affirmative defense for penetration of the genital or 
anal opening of a person where the act is done for an accepted 
medical purpose.  N.C. Gen. Stat. § 14-27.1(4). 
A common sense reading of General Statutes, section 14-
27.1(4), suggests that the affirmative defense of penetration for 
an accepted medical purpose is available only to a defendant who 
can show the act was clearly done for a purpose generally approved 
or accepted by a physician or was done for purposes accepted in 
the medical field or in the practice of medicine. 
In the case before us, no one testified that defendant’s 
actions were carried out for an accepted medical purpose.  Neither 
defendant’s medical expert nor any other medical professional 
testified that cleaning feces from an infant is an act that is 
recognized as having an accepted medical purpose.  Had defendant’s 
-34- 
 
 
medical expert testified that the cleaning was for an accepted 
medical purpose, we would be in a different posture.  However, 
what we do have is evidence, including defendant’s own admission, 
which supports a finding that defendant’s conduct caused the 
injuries to the infant.  There was testimony that vaginal tears 
may be common place with harsh cleaning and that the penetration 
of the infant’s anus and vagina in an effort to clean off feces 
was responsible for the injuries inflicted.  Yet, none of the 
evidence supports a finding that such conduct was for an accepted 
medical purpose. 
At trial before the jury, and now before this Court, defendant 
asks not only that we accept his theory that his actions in causing 
the injuries to the genital and anal area of the child were not 
sexual in nature, but that we make the extraordinary leap to 
determine defendant’s actions were conducted for an accepted 
medical purpose and, thus, within the safe harbor of an affirmative 
defense.  Because I am unable to make such a leap, I do not believe 
the trial court erred in refusing to give an instruction on the 
affirmative defense of penetration for an accepted medical 
purpose. 
The majority cites Cornet v. Texas, No. PD-0205-13, 2013 Tex. 
Crim. App. LEXIS 1654 (Tex. Crim. App. 6 Nov. 2013), and other 
-35- 
 
 
Texas and Oregon cases7 as persuasive authority for its reasoning 
that defendant should have been entitled to the affirmative defense 
instruction.  However, while the language of the statutes8 involved 
in those cases is similar in the context of allowing an affirmative 
defense to an act of penetration, our statute clearly requires 
that acts of penetration be for accepted medical purposes before 
allowing the defense.  I am not persuaded that the cases 
interpreting statutes in Texas and Oregon should inform the result 
of the case before us. 
While I would not go so far as to posit that non-medical 
professionals are not entitled to this defense, I do believe it is 
necessary to require some direct testimony that the considered 
conduct is for a medically accepted purpose in order to be entitled 
                     
7 Villa v. Texas, No. PD-0792-12, 2013 Tex. Crim. App. LEXIS 1655 
(Tex. Crim. App. 6 Nov. 2013), and Oregon v. Ketchum, 206 Or. App. 
635, 138 P.3d 860 (2006). 
 
8 Tex. Penal Code ' 22.011(d) (2012) (“It is a defense to 
prosecution [for sexual assault of a child] that the conduct 
consisted of medical care for the child and did not include any 
contact between the anus or sexual organ of the child and the 
mouth, anus, or sexual organ of the actor or a third party.”), as 
quoted in Villa, 2013 Tex. Crim. App. LEXIS, at *12 (emphasis 
added); Or. Rev. Stat. ' 163.412(1) (2003) (“[Neither first nor 
second degree sexual penetration statute]  prohibits a penetration 
described in either of those sections when: The penetration is 
part 
of 
a 
medically 
recognized 
treatment 
or 
diagnostic 
procedure[.]”), as quoted in Ketchum, 206 Or. App. at 637-38, 138 
P.3d at 862 (emphasis suppressed). 
-36- 
 
 
to the affirmative defense instruction.  To this end, I agree with 
the language of the dissent in Cornet v. Texas, 359 S.W.3d 217 
(Tex. Crim. App. 25 Jan. 2012): “[w]hen asserting a ‘medical care’ 
defense, the defendant bears the burden of offering some evidence 
that his conduct was, in fact, a legitimate, accepted medical 
methodology. Before a trial judge is required to instruct on . . 
. a defense . . . there must be evidence in the record that raises 
. . . that defense as a valid, rational alternative to the charge.”  
Id. at 229-30 (Cochran, J., dissenting). 
Here, the majority states its belief that our legislature 
provided for the affirmative defense  
in part, to shield a parent or other charged 
with the caretaking of an infant, from 
prosecution for engaging in sexual conduct 
with a child when caring for the cleanliness 
and health needs of an infant, including the 
act of cleaning feces and urine from the 
genital opening with a wipe during a diaper 
change. 
 
This is a most expansive reading of the affirmative defense portion 
of the statute.  I must agree with the concurring opinion that the 
legislature could not have intended this statute to be used as a 
shield by a defendant whose attempt to “clean” the child’s genital 
and anal area was performed “with such violence that her rectum 
and vagina [was] left torn and bleeding.” 
-37- 
 
 
While I do not agree that defendant is entitled to an 
affirmative defense instruction on penetration for an accepted 
medical purpose, I also point out that defendant was not denied 
the opportunity to put on a defense.  Defendant testified that his 
cleaning feces was the reason for the digital insertion into the 
child’s genital and rectal area.  However, defendant did not put 
forth evidence that his actions were for an accepted medical 
purpose.  There was no testimony from defendant’s medical experts 
or any other witnesses to support an instruction to the jury that 
the act of cleaning feces from the infant could be considered an 
act performed for accepted medical purposes.  And, a trial court 
is not required to instruct the jury on an affirmative defense for 
which there is not sufficient evidence.  Perhaps it would be a 
closer question had defendant’s request for this affirmative 
defense instruction been based on his application of medication to 
treat a diaper rash or to treat some other medical condition.  
However, this appeal concerns defendant’s actions of wiping feces 
from a baby, a common, everyday occurrence in the life of a child 
necessary to maintaining good hygiene, not the treatment of a 
medical condition. 
Therefore, because I do not believe that defendant met his burden 
of showing that his actions were for an accepted medical purpose, 
-38- 
 
 
the trial court was not required to instruct on the requested 
affirmative defense.  I would find no error in the trial court’s 
refusal to so instruct.