Present: All the Justices 

COMMONWEALTH OF VIRGINIA 

v. Record No. 971537 OPINION BY JUSTICE BARBARA MILANO KEENAN 

 April 17, 1998 

ANTWAN R. JENKINS 

FROM THE COURT OF APPEALS OF VIRGINIA 

In this appeal of convictions of first degree murder and 

use of a firearm in the commission of murder, we consider 

whether the evidence was sufficient to prove that the victim 

died from gunshot wounds inflicted by the defendant. 

On May 21, 1995, in the City of Portsmouth, Antwan R. 

Jenkins fired several gunshots at Kelly Jackson, inflicting 

three wounds. Jackson was later taken to a hospital where he 

received medical treatment for his injuries, including emergency 

surgery to repair damage to his colon. Four days later, Jackson 

died while still in the hospital. 

Jenkins was indicted for unlawfully and feloniously killing 

Jackson, in violation of Code § 18.2-32, and for use of a 

firearm in the commission of a felony, in violation of Code 

§ 18.2-53.1. During a jury trial, Dr. Faruk Presswalla, Deputy 

Chief Medical Examiner for the Commonwealth, testified that he 

performed an autopsy on Jackson and determined that Jackson had 

sustained three gunshot wounds. One bullet entered Jackson’s 

back and moved through the skin and muscles of the back without 
penetrating any body cavity or vital organ. A second bullet, 

which entered Jackson’s chest on the right side and fractured a 

rib, did not injure any vital organ or structure. The third 

bullet entered Jackson’s abdomen, ultimately perforating his 

colon. 

Dr. Presswalla testified that Jackson had aspirated vomit, 

as indicated by vomit found in Jackson’s “airway” and in his 

lungs. Dr. Preswalla explained that the “vomit [went] up and 

down into the airway, into his lungs.” When asked whether he 

had formed an opinion regarding the cause of Jackson’s death, 

Dr. Presswalla stated that Jackson “died as a result of this 

aspiration following the gunshot wound to the abdomen.” 

Dr. Jeff Carney, a surgical resident who treated Jackson at 

the hospital, testified that on May 25, 1995, he entered 

Jackson’s room and noted that Jackson was markedly pale and was 

sweating profusely. Dr. Carney then observed Jackson, who was 

lying on his back, begin vomiting. After rolling Jackson onto 

his side, Dr. Carney waited until the vomiting episode had 

ended. He then placed Jackson on his back and observed that 

Jackson “was in respiratory arrest or that he was not 

breathing.” Shortly thereafter, Jackson died. 

Dr. Carney testified that Jackson appeared to have been 

healthy before he sustained the gunshot wounds. Dr. Carney also 

stated that, at the time of his death, Jackson might have had 

2
“some type of seizure activity.” Dr. Carney explained, “I am 

not a neurologist, I simply base [the statement regarding a 

possible seizure] on the opinion that [Jackson] had some spastic 

movements in his extremities.” Dr. Carney stated that he could 

not offer an opinion whether Jackson actually had suffered a 

seizure. 

Jenkins introduced into evidence a typewritten discharge 

summary, which was dictated and signed by Dr. Carney. On this 

document, a handwritten notation entered in the top margin of 

the first page stated: 

Many Factors contributed to his death but all were result 

of Gun Shot wound 

Bowel injury and contamination 

Extensive laporotomy 

Intubated. 

The record contains no testimony from any witness concerning the 

origin of this handwritten notation. When Jenkins’ counsel 

offered the document in evidence, he did not request that the 

handwritten entry be excluded from the exhibit. 

The jury found Jenkins guilty of first degree murder and 

fixed his punishment at 23 years’ imprisonment. The jury also 

found Jenkins guilty of use of a firearm in the commission of 

murder and fixed his punishment for that offense at three years’ 

imprisonment. The trial court entered judgment in accordance 

with the jury’s verdict. The Court of Appeals awarded Jenkins 

an appeal from this judgment. 

3
In the Court of Appeals, Jenkins argued that the evidence 

failed to show beyond a reasonable doubt that any of the three 

gunshot wounds he inflicted on Jackson was the cause of 

Jackson’s death. The Court of Appeals agreed, holding that “the 

fact finder had no way of determining whether Dr. Presswalla 

meant that the aspiration was simply an unrelated event which 

coincidentally occurred after the gunshot wound, or a result of 

the gunshot wound with a causal relationship thereto.” In an 

unpublished opinion, the Court of Appeals acknowledged the 

presence of the handwritten note on the discharge summary but 

held that, because “[t]here is no indication in the record of 

the source or author of this handwritten note . . . . we can 

only speculate as to its origin, authenticity, and authorship, 

and we are constrained by the record before us to disregard it.” 

The Court of Appeals reversed Jenkins’ convictions and dismissed 

the indictments. 

The Commonwealth filed a petition for appeal in this Court 

pursuant to Code §§ 17-116.08 and 19.2-317(c).* We awarded the 

Commonwealth an appeal. 

The Commonwealth argues that Dr. Presswalla’s testimony 

provided sufficient evidence to prove that Jackson died from the 

 *

These statutes allow the Commonwealth to seek a writ of 

error if it is aggrieved by a judgment of the Court of Appeals 

in any criminal case in which the judgment is not made final 

under Code §§ 17-116.07 or 19.2-408. 

4
gunshot wounds inflicted by Jenkins. The Commonwealth also 

contends that the handwritten notation on the discharge summary 

constitutes further competent evidence to prove that Jackson 

died as a result of the gunshot wounds. In addition, relying on 

Gallimore v. Commonwealth, 246 Va. 441, 436 S.E.2d 421 (1993), 

the Commonwealth argues that even if Jackson had a seizure prior 

to his death, such an intervening event would not exonerate 

Jenkins because any such seizure would have been “put into 

operation” by Jenkins’ acts. 

In response, Jenkins argues that the Commonwealth failed to 

prove beyond a reasonable doubt that Jackson died from the 

gunshot wounds. Jenkins asserts that Dr. Presswalla did not 

state that the gunshot wounds caused Jackson to aspirate the 

vomit, and that Dr. Carney’s testimony suggests that Jackson’s 

death may have been caused by a seizure, rather than by the 

gunshot wounds. Thus, Jenkins contends that the evidence was 

insufficient to support his convictions. We disagree with 

Jenkins’ argument and the conclusion reached by the Court of 

Appeals. 

When a defendant challenges on appeal the sufficiency of 

the evidence to sustain his convictions, it is the appellate 

court’s duty to examine the evidence that tends to support the 

convictions and to permit the convictions to stand unless they 

are plainly wrong or without evidentiary support. Code § 8.01-

5
680; Tyler v. Commonwealth, 254 Va. 162, 165-66, 487 S.E.2d 221, 

223 (1997); Goins v. Commonwealth, 251 Va. 442, 466, 470 S.E.2d 

114, 130, cert. denied, 519 U.S. ___, 117 S.Ct. 222 (1996). If 

there is evidence to support the convictions, the reviewing 

court is not permitted to substitute its own judgment, even if 

its opinion might differ from the conclusions reached by the 

finder of fact at the trial. Tyler, 254 Va. at 165-66, 487 

S.E.2d at 223; Cable v. Commonwealth, 243 Va. 236, 239, 415 

S.E.2d 218, 220 (1992); Avent v. Commonwealth, 209 Va. 474, 477, 

164 S.E.2d 655, 657 (1968). 

Upon review, the appellate court must examine the evidence 

and all inferences reasonably deducible therefrom in the light 

most favorable to the Commonwealth, the prevailing party in the 

trial court. Tyler, 254 Va. at 165-66, 487 S.E.2d at 223; 

Goins, 251 Va. at 466, 470 S.E.2d at 130; Sheppard v. 

Commonwealth, 250 Va. 379, 387, 464 S.E.2d 131, 136 (1995), 

cert. denied, 517 U.S. 1110 (1996). All evidence properly 

admitted at the trial is subject to this review. See Tyler, 254 

Va. at 165-66, 487 S.E.2d at 223; Carter v. Nelms, 204 Va. 338, 

341, 131 S.E.2d 401, 403 (1963). 

When a defendant has inflicted wounds upon a victim that 

result in an affliction or a disease, the defendant is 

criminally responsible for the victim’s death from that 

affliction or disease if the wounds caused the death indirectly 

6
through a chain of natural effects and causes. Spain v. 

Commonwealth, 7 Va. App. 385, 394-95, 373 S.E.2d 728, 733 

(1988); see Gallimore, 246 Va. at 447, 436 S.E.2d at 425; Waller 

v. Commonwealth, 178 Va. 294, 307, 16 S.E.2d 808, 813 (1941). 

An intervening event, even if a cause of the death, does not 

exempt the defendant from liability if that event was put into 

operation by the defendant’s initial criminal acts. Gallimore, 

246 Va. at 447, 436 S.E.2d at 425; see Coleman v. Blankenship 

Oil Corp., 221 Va. 124, 131, 267 S.E.2d 143, 147 (1980); Baxley 

v. Fischer, 204 Va. 792, 798, 134 S.E.2d 291, 295 (1964). 

Here, the evidence showed that Jackson, the victim, was in 

good health prior to being shot by Jenkins. Dr. Preswalla 

testified that Jackson “died as a result of [the] aspiration 

following the gunshot wound to the abdomen.” Moreover, the 

handwritten notation on the discharge summary, introduced into 

evidence by Jenkins, stated that “[m]any factors contributed to 

[Jackson’s] death but all were [the] result of Gun Shot wound.” 

This evidence plainly supports the jury’s finding that Jackson 

died as a result of the gunshot wounds inflicted by Jenkins. 

Thus, the evidence was sufficient to prove the required causal 

connection between Jenkins’ acts and the victim’s death. See

Gallimore, 246 Va. at 447, 436 S.E.2d at 425. 

We find no merit in Jenkins’ argument that the handwritten 

notation on the discharge summary was not competent evidence in 

7
this case. When Jenkins’ counsel offered the document into 

evidence, he did not request that the handwritten notation be 

excluded from the proffered exhibit. Thus, as the proponent of 

the discharge summary exhibit which was received in evidence, 

Jenkins has waived any later objection to its consideration by 

the trier of fact. See Rule 5:25; Frye v. Commonwealth, 231 Va. 

370, 386, 345 S.E.2d 267, 279 (1986); Moore v. Commonwealth, 211 

Va. 569, 570, 179 S.E.2d 458, 460 (1971). 

Since the handwritten notation on the discharge summary was 

received without objection as evidence in the case, the Court of 

Appeals erred in disregarding that portion of the exhibit in 

reviewing the sufficiency of the evidence to support Jenkins’ 

convictions. A reviewing court must consider all evidence 

properly admitted at trial in determining the sufficiency of the 

evidence, not merely the evidence that the reviewing court 

considers most trustworthy. See Tyler, 254 Va. at 165-66, 487 

S.E.2d at 223; Avent, 209 Va. at 477, 164 S.E.2d at 657; Nelms, 

204 Va. at 341, 131 S.E.2d at 403. 

For these reasons, we will reverse the Court of Appeals’ 

judgment and reinstate Jenkins’ convictions in accordance with 

the trial court’s judgment order. 

Reversed and final judgment.

8