Title: Commonwealth v. Santiago
Citation: N/A
Docket Number: SJC-11798
State: Massachusetts
Issuer: Massachusetts Supreme Court
Date: August 13, 2020

NOTICE:  All slip opinions and orders are subject to formal 
revision and are superseded by the advance sheets and bound 
volumes of the Official Reports.  If you find a typographical 
error or other formal error, please notify the Reporter of 
Decisions, Supreme Judicial Court, John Adams Courthouse, 1 
Pemberton Square, Suite 2500, Boston, MA, 02108-1750; (617) 557-
1030; SJCReporter@sjc.state.ma.us 
 
SJC-11798 
 
COMMONWEALTH  vs.  JOSE SANTIAGO. 
 
 
 
Hampden.     January 7, 2020. - August 13, 2020. 
 
Present:  Gants, C.J., Lenk, Gaziano, Lowy, Budd, Cypher, 
& Kafker, JJ. 
 
 
Homicide.  Criminal Responsibility.  Mental Impairment.  
Intoxication.  Practice, Criminal, Instructions to jury, 
Assistance of counsel, Capital case. 
 
 
 
 
Indictments found and returned in the Superior Court 
Department on June 19, 2012. 
 
 
The cases were tried before Constance M. Sweeney, J. 
 
 
 
Leslie W. O'Brien for the defendant. 
 
Katherine E. McMahon, Assistant District Attorney, for the 
Commonwealth. 
 
 
 
LENK, J.  After a jury trial, the defendant was convicted 
of murder in the first degree, G. L. c. 265, § 1, in the death 
of his girlfriend, Jessica Rojas, on theories of deliberate 
2 
 
 
premeditation and extreme atrocity or cruelty.1  On appeal, the 
defendant claims error warranting a new trial in the omission of 
instructions as to the defenses of a lack of criminal 
responsibility and mental impairment, as well as the judge's 
failure to reinstruct the jury regarding the effects of alcohol 
consumption upon whether the defendant acted with extreme 
atrocity or cruelty.  In the alternative, the defendant asks 
that we reduce his conviction to murder in the second degree, 
pursuant to G. L. c. 278, § 33E. 
 
We conclude that the claimed instructional errors, to which 
no objection was lodged at trial, do not give rise to a 
substantial likelihood of a miscarriage of justice, nor did the 
failure to so object constitute the ineffective assistance of 
counsel.  Having carefully reviewed the entire record, we 
discern no other grounds on which to disturb the verdict.  
Accordingly, we affirm the convictions. 
 
1.  Facts.  We recite the facts as the jury could have 
found them, reserving certain details for subsequent discussion.  
On March 2, 2012, the defendant and the victim gathered with 
family and friends at a Springfield nightclub to celebrate the 
victim's twenty-fifth birthday.  Witnesses described the 
                     
 
1 The defendant also was convicted of assault and battery by 
means of a dangerous weapon against Antonio Camacho, G. L. 
c. 265, § 15B (b); he was acquitted of the same charge against 
Jose Rivas. 
3 
 
 
defendant as intoxicated and apparently upset with the victim.  
At approximately 1:30 A.M. on March 3, the defendant got into an 
argument with the victim's cousin, Carmen Aviles, and was 
removed from the nightclub by a bouncer.  Aviles and the victim 
followed the defendant outside. 
 
Witness testimony differed as to the precise sequence of 
events that unfolded outside the nightclub; it appears that the 
defendant continued to argue with Aviles and with the victim.  
Upset with the defendant for "talking down" to the victim, 
Aviles punched the defendant, and he, in turn, punched her.  At 
that point, an unknown individual in the crowd that had gathered 
hit the defendant with enough force to knock him to the ground 
and, possibly, to lose consciousness.2 
 
A friend of the victim, Alisha Martinez, who had followed 
the defendant out of the nightclub, escorted the defendant 
across the street, accompanied by the victim and another friend, 
Suehaley Arce.  The defendant was swearing at the victim, whom 
he blamed for his having been punched.  The group attempted to 
steer the defendant towards the victim's vehicle, which was 
located in a nearby parking lot. 
                     
 
2 Medical records introduced at trial indicated that on 
March 5, 2012, the defendant was treated for multiple facial 
fractures; he told medical personnel that his injuries had been 
sustained on the evening of March 2, 2012.  The medical records 
also indicate that the defendant denied having lost 
consciousness when he was hit and knocked down. 
4 
 
 
 
They eventually arrived in a park across the street from 
the nightclub.  Arce recalled that the defendant continued to 
berate the victim and hit her in the mouth.  Arce also testified 
that, at about that point, another man entered the park, grew 
angry with the defendant for hitting the victim, began to 
wrestle with the defendant, and then left the area.  Antonio 
Camacho, who was also at the party and left the nightclub 
approximately five minutes after the defendant, looked across 
the street and saw the defendant in a heated discussion with the 
victim, Arce, and Martinez.  Camacho saw the defendant raise his 
hand towards one of the three women, but his view was obstructed 
as he crossed the street to join the group; Camacho did not see 
the altercation that followed.  By the time Camacho arrived in 
the park, the defendant was getting up from the ground, and 
saying that he had been "sucker punched." 
 
The group eventually arrived at the victim's vehicle.  At 
Camacho's urging, the victim agreed to allow Camacho, 
accompanied by the defendant, to drive her vehicle back to her 
house.  The victim agreed to return home with Arce and Martinez, 
who were to drive separately to her house.  Camacho testified 
that, during the drive, the defendant asked whether the victim 
was having an affair.  Camacho responded she was not, and the 
defendant told Camacho that he loved the victim.  The defendant 
5 
 
 
also repeatedly mentioned that he had been "sucker punched," and 
wanted to know who had hit him. 
 
Camacho and the defendant arrived at the victim's house 
before she did.  The defendant knocked on the door of her next-
door neighbor's house; the neighbor's boyfriend, Jose Rivas, 
answered.  Rivas, who was acquainted with the defendant, noticed 
that the defendant was visibly injured, and that he stumbled 
into the door while entering the house.  Shortly thereafter, the 
victim arrived with Arce and Martinez; Camacho and the defendant 
accompanied the three women into the victim's house. 
 
Inside, the defendant and the victim continued to argue; 
the defendant accused the victim of "cheating on him," and the 
victim was upset with the defendant for ruining her birthday 
celebration.  Camacho, Arce, and Martinez unsuccessfully tried 
to find someone to take the defendant home, while the defendant 
said that he wanted them to leave so he could be alone with the 
victim.  Eventually, Arce and Martinez departed; Camacho 
continued to make telephone calls in an effort to find a ride 
for the defendant.  The victim said that she wanted the 
defendant to leave. 
 
Camacho was making a call when the defendant emerged from 
the kitchen, pressing an object to his leg, and sat down on a 
couch next to the victim.  When the defendant noticed that 
Camacho was watching, he dropped the object -- a knife -- to the 
6 
 
 
floor and kicked it out of sight under the couch.  The defendant 
then approached Camacho and told him that everything would be 
okay, that Camacho should go home, and that he just wanted to 
"talk to [the victim] alone and resolve what's going on."  
Camacho refused, and suggested that all three leave and drive 
the defendant home in the victim's vehicle. 
 
Shortly thereafter, the defendant returned to the kitchen, 
emerged with a second knife, and began stabbing the victim.  
When Camacho tried to intervene, the defendant threatened him 
with the knife; Camacho left the victim's house and sought help 
from the victim's neighbor and from Rivas.  The victim's 
neighbor telephoned 911, and Rivas returned to the victim's 
house with Camacho.  Rivas entered first.  He testified that he 
saw the victim with a knife embedded in her chest, and the 
defendant and the victim telling each other that they loved each 
other.  Camacho's recollection was different.  He testified that 
the defendant was still stabbing the victim when he and Rivas 
returned, although he did hear the defendant tell the victim 
that he loved her. 
 
According to Rivas, the defendant told him to leave, and 
then began walking toward the kitchen.  Rivas at first thought 
that the defendant was going to leave, but instead he returned 
with a different knife, told Rivas to move out of the way, and 
began to walk back towards the victim.  Rivas recalled that the 
7 
 
 
defendant "was [not] the same person" as usual.  Rivas grabbed 
the defendant and told him to "wake up"; according to Rivas, the 
defendant seemed to grasp the situation, and immediately 
returned to the kitchen and left through the rear door. 
 
Police and medical personnel arrived shortly thereafter.  
The victim, who was still conscious despite extensive stab 
wounds, identified the defendant as her assailant.  She was 
transported to a hospital, where she succumbed to her injuries.  
The medical examiner testified that the victim had been stabbed 
more than one hundred times.  Police did not locate the 
defendant, but did recover a total of four knives -- one 
embedded in the victim, one on the floor by the couch, one in 
the kitchen, and one outside the rear door of the victim's house 
through which the defendant had left. 
 
The defendant was taken into custody on a later date and 
was indicted on charges of murder in the first degree, G. L. 
c. 265, § 1, and also on two counts of assault and battery by 
means of a dangerous weapon, G. L. c. 265, § 15B (b), against 
Camacho and Rivas. 
 
2.  Prior proceedings.  Prior to trial, the defendant filed 
a notice of an intent to rely on a defense of a lack of criminal 
responsibility, and requested funds to retain an expert witness 
in support of this defense.  On the Commonwealth's motion 
pursuant to Mass. R. Crim. P. 14 (b) (2) (B), as appearing in 
8 
 
 
463 Mass. 1501 (2012), the court ordered that the defendant also 
submit to examination by a court-appointed examiner.  The 
defendant refused to meet with the examiner, and the 
Commonwealth accordingly moved to preclude the defendant from 
calling his own expert witness.  The defendant did not oppose 
the motion.  At trial, the defendant did not testify or call any 
witnesses.  He did introduce his medical records from his 
treatment, two days after the assault, which documented his head 
injuries. 
 
The defendant was tried and convicted of murder in the 
first degree on theories of deliberate premeditation and extreme 
atrocity or cruelty, and also was convicted of assault and 
battery against Camacho; he was acquitted of the assault against 
Rivas. 
 
The defendant's appeal was filed in this court.  After oral 
argument was held, the defendant filed a motion to stay his 
appeal, so that he could pursue a motion for a new trial in the 
Superior Court on the ground of ineffective assistance of trial 
counsel.  We denied the motion to stay, and we will ourselves 
address the asserted ineffective assistance of counsel in 
conjunction with the defendant's direct appeal.  See 
Commonwealth v. Aguiar, 400 Mass. 508, 511 n.2 (1987).  As the 
defendant's motion for a new trial does not raise any additional 
arguments beyond those he raises in his appellate brief, we rely 
9 
 
 
on the defendant's brief, as supplemented by the affidavit of 
trial counsel appended to the motion for a new trial, to decide 
the motion. 
 
3.  Discussion.  The defendant argues (1) that the trial 
judge should have instructed the jury concerning a lack of 
criminal responsibility and mental impairment, and (2) that the 
judge did not properly instruct the jury that they could 
consider evidence of intoxication when determining whether a 
murder was committed with extreme atrocity or cruelty.  To each 
of these arguments, the defendant attaches a claim that trial 
counsel's failure to remedy the asserted error deprived him of 
the effective assistance of counsel.  The defendant also asks 
that this court reduce the verdict of murder in the first 
degree, pursuant to G. L. c. 278, § 33E. 
 
a.  Instructions on lack of criminal responsibility and 
mental impairment.  The defendant argues that the evidence 
submitted at trial pertaining to the head injuries he sustained 
during the altercation outside the nightclub was sufficient to 
warrant instructions on two defenses:  a lack of criminal 
responsibility, and mental impairment.  The defendant contends 
that the absence of such instructions created a substantial 
likelihood of a miscarriage of justice.  The defendant further 
maintains that trial counsel's failure to request these 
instructions constituted ineffective assistance of counsel. 
10 
 
 
 
While similar, the defenses of a lack of criminal 
responsibility and mental impairment are distinct.  The defense 
of a lack of criminal responsibility focuses on whether, 
notwithstanding sufficient evidence of the elements of a charged 
offense, a defendant nonetheless should be found not guilty by 
virtue of a mental disease or defect.  See, e.g., Commonwealth 
v. Monico, 396 Mass. 793, 799-801 (1986) (defense of lack of 
criminal responsibility was raised where evidence was sufficient 
to warrant jury finding that, by virtue of "frontal lobe 
dysfunction," defendant could "commit impulsive or violent acts 
even though such acts normally would be against that person's 
nature").  An instruction on a lack of criminal responsibility 
informs jurors that "[a] person is not responsible for criminal 
conduct if at the time of such conduct as a result of mental 
disease or defect he [or she] lacks substantial capacity either 
to appreciate the criminality [wrongfulness] of his [or her] 
conduct or to conform his [or her] conduct to the requirements 
of [the] law" (citation omitted).  Commonwealth v. McHoul, 352 
Mass. 544, 546-547 (1967).  The defense of a lack of criminal 
responsibility operates as a complete defense, in that a 
defendant cannot be found guilty of a crime if he or she lacks 
criminal responsibility. 
An instruction on mental impairment, by contrast, focuses 
on a defendant's ability to form the requisite intent necessary 
11 
 
 
to be convicted of the crime in question.  In an instruction on 
mental impairment, the jury are told that they "'may consider 
credible evidence' of the mental impairment 'in deciding whether 
the Commonwealth had met its burden of proving the defendant's 
state of mind beyond a reasonable doubt'" (citation omitted).  
See Commonwealth v. Mercado, 456 Mass. 198, 207 (2010).  Unlike 
a defense of a lack of criminal responsibility, a defense of 
mental impairment does not operate as a complete defense, but, 
rather, may reduce a defendant's degree of guilt.  For example, 
a jury could find that, by virtue of a mental impairment, a 
defendant lacked the requisite intent to commit murder in the 
first degree, but nonetheless was capable of forming the intent 
necessary to commit murder in the second degree.  See, e.g., 
Commonwealth v. Gould, 380 Mass. 672, 681 (1980) (where there is 
evidence of voluntary intoxication, or of mental illness or 
impairment, and jury find defendant to be incapable of 
deliberate premeditation, defendant cannot be found guilty of 
murder in first degree, but may be found guilty of murder in 
second degree.) 
 
Notwithstanding these differences, the analysis of both 
issues here is essentially the same.  Absent a request from a 
defendant, we have never held that a judge is required to 
instruct the jury on either defense.  See Commonwealth v. Gulla, 
476 Mass. 743, 747-748 (2017) (no error where judge did not give 
12 
 
 
instruction of lack of criminal responsibility that was not 
requested by defendant at trial).  See also Commonwealth v. 
Rutkowski, 459 Mass. 794, 798 (2011) (where defense counsel 
fails to request or object to absence of mental impairment 
instruction, issue is unpreserved and we review for substantial 
likelihood of miscarriage of justice).  See also Commonwealth v. 
Stroyny, 435 Mass. 635, 649 (2002).   Because the defendant did 
not request either instruction, the question thus becomes 
whether the absence of both gave rise to a substantial 
likelihood of a miscarriage of justice, and whether the failure 
to request such instructions constituted ineffective assistance 
of counsel.  The answer is no. 
 
In cases of murder in the first degree, we review claims of 
ineffective assistance under "the standard of G. L. c. 278, 
§ 33E, to determine whether there was a substantial likelihood 
of a miscarriage of justice."  See Gulla, 476 Mass. at 745-746.  
More precisely, we "determine whether there was an error in the 
course of trial by defense counsel . . . 'and, if there was, 
whether that error was likely to have influenced the jury's 
conclusion'" (citation omitted).  Id. at 746. 
The defendant argues that the evidence was sufficient to 
entitle him to instructions on a lack of criminal responsibility 
as well as on mental impairment, had defense counsel requested 
them.  According to the defendant, trial counsel's failure to 
13 
 
 
request such instructions was not a strategic choice, but the 
product of counsel's erroneous assumption that expert testimony 
would have been required to receive either instruction.3  The 
defendant contends that trial counsel's error deprived him of 
his best opportunity to obtain a verdict less than that of 
murder in the first degree, and thus "was likely to have 
influenced the jury's conclusion" (citation omitted).  See 
Gulla, 476 Mass. at 746.  Because the defendant's claim rests on 
the assumption that he was entitled to either instruction, we 
turn to consider whether the evidence presented would, in fact, 
warrant instructions on a lack of criminal responsibility or 
mental impairment, had they been requested. 
 
i.  Evidence pertaining to defenses of lack of criminal 
responsibility and of mental impairment.  At trial, defense 
counsel took steps to develop evidence that arguably was 
relevant to the defenses of a lack of criminal responsibility 
and mental impairment.  First, counsel introduced the 
defendant's medical records, dated two days after the stabbing; 
the records showed that the defendant had suffered multiple 
                     
3 The defendant's trial counsel acknowledged this error in 
an affidavit attached to the defendant's motion for a new trial.  
Expert testimony is not required in order to pursue a defense of 
a lack of criminal responsibility or mental impairment, or to 
seek relevant instructions.  See, e.g., Commonwealth v. Monico, 
396 Mass. 793, 798 (1986).  See also Commonwealth v. Frank, 433 
Mass. 185, 192 n.6 (2001). 
14 
 
 
facial fractures, noted that the defendant "[could] not stand 
alone," and indicated that his discharge materials included 
literature informing him of the warning signs of a concussion. 
The defendant did not present any expert testimony.  Prior 
to trial, he notified the Commonwealth of his intent to present 
expert testimony in furtherance of a defense of a lack of 
criminal responsibility, pursuant to Mass. R. Crim. P. 
14 (b) (2) (A).4  In response, the Commonwealth sought the 
appointment of a psychiatric examiner pursuant to Mass. R. Crim. 
P. 14 (b) (2) (B).5  The Commonwealth's motion was allowed.  
                     
 
4 Pursuant to Mass. R. Crim. P. 14 (b) (2) (A), as appearing 
in 463 Mass. 1501 (2012), 
 
"If a defendant intends at trial to raise as an issue his 
or her mental condition at the time of the alleged crime, 
or if the defendant intends to introduce expert testimony 
on the defendant's mental condition at any stage of the 
proceeding, the defendant shall . . . notify the prosecutor 
in writing of such intention." 
 
The notice must inform the prosecutor of the identity of any 
expert witnesses the defendant expects to call, and whether 
those expert witnesses "intend to rely in whole or in part on 
statements of the defendant as to his or her mental condition.  
See id. 
 
 
5 Pursuant to Mass. R. Crim. P. 14 (b) (2) (B), 
"If the notice of the defendant or subsequent inquiry by 
the judge or developments in the case indicate that 
statements of the defendant as to his or her mental 
condition will be relied upon by a defendant's expert 
witness, the court, on its own motion or on motion of the 
prosecutor, may order the defendant to submit to an 
examination . . . ." 
15 
 
 
After the defendant declined to meet with the court-appointed 
expert, the Commonwealth moved, pursuant to Mass. R. Crim. P. 
14 (b) (2) (B) (iv), to preclude the defendant from introducing 
his own expert opinion pertaining to his mental state.6  The 
defendant did not oppose the motion, and ultimately did not seek 
to introduce any expert testimony. 
Although the defendant did not testify or call any 
witnesses, defense counsel developed evidence through cross-
examination related to the impact of the injuries the defendant 
sustained during the altercation outside the nightclub.  
Witnesses testified, for example, as to the defendant's visually 
apparent facial injuries.  Rivas, the victim's neighbor's 
boyfriend, testified that, when he saw the defendant attacking 
the victim with the knife, the defendant seemed like a different 
person, and seemed to "wake" after Rivas confronted him.  Rivas 
further testified that, when he arrived to assist Camacho in 
coming to the victim's aid, the defendant and the victim were 
                     
 
6 Rule 14 (b) (2) (B) (iv) of the Rules of Criminal 
Procedure provides: 
"If a defendant refuses to submit to an examination ordered 
pursuant to and subject to the terms and conditions of this 
rule, the court may prescribe such remedies as it deems 
warranted by the circumstances, which may include exclusion 
of the testimony of any expert witness offered by the 
defense on the issue of the defendant's mental condition or 
the admission of evidence of the refusal of the defendant 
to submit to examination." 
16 
 
 
telling each other that they loved each other.  Defense counsel 
also vigorously cross-examined Martinez, who testified that the 
defendant did not lose consciousness when he was punched in the 
face, about her prior statement to police that the defendant had 
been "out cold."7 
 
In his closing argument, defense counsel reminded the jury 
of the evidence that the defendant might have lost 
consciousness, which counsel told the jury was relevant to the 
defendant's intent, and suggested that the defendant's conduct 
was "crazy."  Addressing conflicting witness testimony as to 
whether the defendant indeed had lost consciousness, counsel 
told the jury that witnesses "don't need to play that game 
unless there's something that's really seriously at risk.  And 
what's at risk is a determination . . . that [the defendant] 
couldn't form an intent that's necessary for first degree murder 
[or] second degree murder." 
ii.  Whether the defendant was entitled to instructions on 
a lack of criminal responsibility and of mental impairment.  To 
be entitled to an instruction on a lack of criminal 
                     
 
7 Defense counsel engaged in similar efforts in his cross- 
examination of Anthony Wilson, another witness to the 
altercation outside the nightclub.  On cross-examination, Wilson 
first acknowledged having signed a statement saying that the 
defendant had been "knocked out" (a statement he repeated in his 
testimony at trial), but also testified that he was unsure 
whether the defendant lost consciousness. 
17 
 
 
responsibility, a defendant first must establish, either through 
expert testimony, lay testimony, or the facts of the case, that 
he or she suffered from a mental defect.  See Commonwealth v. 
Seabrooks, 425 Mass. 507, 516 (1997), S.C., 433 Mass. 439 
(2001).  The defendant maintains that the evidence he sustained 
a head injury in the hours before the stabbing was sufficient to 
permit the inference of a mental disease or defect.  We 
disagree. 
The defendant's reliance on this court's decision in 
Monico, 396 Mass. at 800-801, for the proposition that evidence 
of a single blow to the head is sufficient to warrant an 
instruction on a lack of criminal responsibility, is misplaced.  
In that case, we did not hold that an isolated head injury, 
standing alone, was sufficient to entitle the defendant to an 
instruction on a lack of criminal responsibility.  There, the 
jury also heard evidence that the defendant had had a history of 
prior head injuries, as well as evidence that the defendant had 
been acting normally in the period immediately preceding the 
shootings, and that his behavior "appeared to change 
drastically" after he sustained a head injury.  See id. at 801. 
 
Here, by contrast, there is no evidence from witness 
testimony or medical records that the defendant's behavior 
changed as a result of his injuries.  To the contrary, the 
witnesses who had the opportunity to observe the defendant 
18 
 
 
throughout the evening testified that there was no notable 
change in his behavior, or in his ability to move or speak 
coherently, as a result of being punched in the face and knocked 
down.  According to the witnesses who were with the defendant 
immediately before and after the altercation, he had been angry 
and acting aggressively towards the victim and others throughout 
the evening.  Rivas did note that the defendant had stumbled 
into a door when the defendant initially entered the neighbor's 
house, but he also described no issues with the defendant's 
ability to speak or respond, or otherwise to walk and move 
normally.  Although Rivas testified that the defendant seemed 
like a different person following the assault, and seemed to 
"wake" when confronted by Rivas, he was not present before the 
defendant was punched in the head.  Thus, nothing in Rivas's 
testimony establishes the defendant's head injury as the source 
of his violent behavior. 
 
The medical records introduced by the defendant indicate 
that, two days after the encounter at the nightclub, he was 
treated for multiple injuries, which the defendant told medical 
providers had been sustained during an altercation outside the 
nightclub.  These injuries included multiple facial fractures 
and extensive swelling on the right side of his face.  The 
medical records also indicate that the defendant was having 
difficulty standing unaided.  The defendant was, however, 
19 
 
 
described as "alert." While he apparently was not diagnosed as 
having a concussion at that time, the records state that he was 
provided with written information advising him of the warning 
signs of a concussion, which, according to these materials, 
potentially could manifest multiple days after the injury. 
 
Although the defendant's medical records evince severe 
facial trauma, they do not establish that he had suffered any 
brain injury as a result of the encounter.  Significantly, as 
the attack occurred within a few hours of the altercation 
outside the nightclub, the fact that the defendant had 
difficulty standing several days later does not, without more, 
support an inference that he sustained any immediate brain 
injury. 
 
The only other evidence of a head injury is the nature of 
the assault itself, including Rivas's testimony that the 
defendant told the victim that he loved her during the attack.  
Even taken together with the other evidence, this is 
insufficient to have warranted an instruction on a lack of 
criminal responsibility.  "That the crimes were heinous would 
not alone support a conclusion that they were the product of an 
insane mind" (citation omitted).  See Commonwealth v. LaPlante, 
416 Mass. 433, 443-444 (1993), S.C., 482 Mass. 399 (2019).  See 
also Commonwealth v. Mattson, 377 Mass. 638, 643-644 (1979) 
(although defendant's "unprovoked 'Jekyll and Hyde' change 
20 
 
 
[from] 'soft-spoken'" to "violent" was "bizarre," this evidence 
was insufficient to warrant jury finding that defendant lacked 
capacity to appreciate wrongfulness of conduct or to conform 
conduct to law). 
 
Similar reasoning yields the same conclusion with regard to 
evidence of mental impairment.  As with an instruction on a lack 
of criminal responsibility, to be entitled to an instruction on 
mental impairment, a defendant must, at a minimum, introduce 
evidence that such an impairment existed at the time of the 
conduct in question.  See Gould, 380 Mass. at 680-681.  To be 
sure, "where evidence of . . . mental impairment is 
significant[,] and where it is a critical aspect of [the] 
defense, the failure to instruct the jury that they could 
consider evidence of that impairment" gives rise to a 
substantial likelihood of a miscarriage of justice.  See 
Rutkowski, 459 Mass. at 799.  In Rutkowski, for example, the 
issue of mental impairment was "critical" to the defense because 
a lack of criminal responsibility and mental impairment, due to 
mental illness and brain damage, were the sole defenses raised 
by the defendant.  See id. at 796-797, 799.  Moreover, there was 
no doubt that the defendant in that case had presented 
"significant" evidence of mental impairment.  Evidence was 
introduced that the defendant had a "long history" of mental 
illness.  See id. at 796.  The evidence also included, inter 
21 
 
 
alia, expert testimony that the defendant suffered from a brain 
injury that would impede her ability to reason effectively, and 
that her mental illness and head injuries played a role in her 
criminal conduct.  See id. at 796-797 & n.1. 
 
Here, however, the evidence of mental impairment was not 
"significant."  As discussed, the defendant did not introduce 
any evidence that established a relationship between his head 
injuries and his behavior on the night of the attack.  Mental 
impairment, moreover, was less "critical" to the defense here 
than it was in Rutkowski, where, unlike here, a lack of criminal 
responsibility and mental impairment were the sole defenses 
raised.  In this case, the defendant also argued that, by virtue 
of his consumption of alcohol, he could not have formed the 
requisite intent to commit murder in the first degree.  This 
line of defense was amply supported by the evidence at trial, 
and the jury were instructed on the impact of intoxication on 
the ability to form the necessary intent for murder. 
 
In sum, the evidence was not sufficient to warrant 
instructions on a lack of criminal responsibility or mental 
impairment.  Because the defendant has not shown that the judge 
would have been required to issue either instruction, had it 
been requested, the absence of the instructions did not create a 
substantial likelihood of a miscarriage of justice.  Cf. 
Commonwealth v. Doucette, 391 Mass. 443, 459 (1984) (no 
22 
 
 
prejudice from failure to pursue defense of lack of criminal 
responsibility where evidence insufficient to entitle defendant 
to jury instruction on issue). 
 
b.  Instruction on intoxication.  The defendant also claims 
error in the instructions given in response to the jury question 
on "the difference between first and second degree murder in 
regards to premeditation."  He argues that the judge omitted 
from that instruction a reminder that the jury could consider 
evidence of the defendant's intoxication when deciding whether 
the Commonwealth had proved that he acted with extreme atrocity 
or cruelty.  The defendant does not dispute that the judge 
included such an instruction in her original charge; rather, the 
defendant contends that the judge erred by not repeating that 
instruction in response to the jury question.  The defendant 
maintains that this error, and defense counsel's failure to 
object at trial, created a substantial likelihood of a 
miscarriage of justice.  We discern no error in the judge's 
instructions. 
i.  Original and supplemental instructions on intoxication.  
During her original charge, the judge instructed the jury that 
they could 
"consider [the defendant's] medical condition at the time 
of the killing, including any credible evidence of the 
effect on the defendant of his consumption of alcohol in 
determining whether the Commonwealth has proved beyond a 
23 
 
 
reasonable doubt that [the defendant] committed the killing 
with extreme atrocity or cruelty." 
 
The asserted error arose in a supplemental set of instructions 
given, as discussed, in response to a jury question asking the 
judge to clarify "the difference between first and second degree 
murder in regards to deliberate premeditation."  After having 
discussed the question with counsel, the judge decided to 
reinstruct the jury more broadly on the elements of murder in 
the first and second degrees. 
 
The judge began her reinstruction by saying, 
"I'm going to go through the elements with you of first 
degree murder, both theories, and then what second degree 
murder is.  I'm not going to give you the entire 
instruction I gave you before.  I ask that you recall all 
of the descriptions I gave you before, all the definitions 
I gave you before" (emphasis supplied). 
 
The judge proceeded to review the elements of murder in the 
first degree, including the elements required for the theories 
of deliberate premeditation and extreme atrocity or cruelty.  At 
the defendant's request, the judge also repeated her instruction 
that the jury could consider intoxication when deciding whether 
the Commonwealth had proved the element of intent.  She 
explained: 
"[T]he ingestion of alcohol by the defendant is a factor 
you may consider in determining whether or not the 
Commonwealth has proven beyond a reasonable doubt the 
necessary intent required of the particular crime and/or 
the state of mind required of the particular crime." 
 
24 
 
 
The judge did not, however, repeat her separate initial 
instruction that the jury also could consider evidence of 
intoxication when determining whether the defendant had acted 
with extreme atrocity or cruelty.  Defense counsel did not 
object to this omission. 
ii.  Whether the instructions were in error.  "We judge the 
adequacy of a particular instruction not in isolation but in the 
context of the entire charge, as the adequacy of instructions is 
determined by their over-all impact on the jury."  Commonwealth 
v. Stokes, 440 Mass. 741, 750 (2004).  In her initial charge, 
the judge properly instructed the jury that they could consider 
evidence of the defendant's consumption of alcohol when deciding 
whether the Commonwealth had proved that the killing was 
committed with extreme atrocity or cruelty.  Although the judge 
did not repeat this instruction in giving her supplemental 
charge, when considered as a whole, the instructions were 
adequate. 
 
The defendant maintains that the incomplete supplemental 
instructions "were the last statements of law that the jury 
heard on a critical aspect of the case" and, as such, undermined 
the original, correct instruction.  See Commonwealth v. Young, 
461 Mass. 198, 210 (2012).  When reinstructing the jury, 
however, the judge expressly stated that her supplemental 
instructions were incomplete, and that, in conjunction with the 
25 
 
 
new instructions, the jury also were to remember and consider 
all of her original instructions.  We discern no error in the 
judge's reinstruction of the jury and, accordingly, no 
substantial likelihood of a miscarriage of justice in counsel's 
decision not to object to that instruction.8 
 
c.  Review under G. L. c. 278, § 33E.  The defendant 
argues, in light of his intoxication, his head injury, and the 
asserted deficiency in the jury instructions, that it would be 
appropriate to reduce the verdict to one of murder in the second 
degree.  We see no reason to do so on these grounds.  In 
addition to considering the defendant's arguments, we have 
reviewed the entire record, as is our duty under G. L. c. 278, 
§ 33E, and identify no other grounds on which to reduce the 
degree of guilt or order a new trial. 
 
 
 
 
 
 
 
Judgments affirmed. 
                     
8 In any event, the asserted error in the judge's 
reinstruction applies only to the defendant's conviction on a 
theory of extreme atrocity or cruelty.  The defendant also was 
convicted of murder in the first degree on the theory of 
deliberate premeditation, and we could affirm his conviction of 
murder in the first degree on that theory even if the judge had 
erred in providing the reinstruction.  See Commonwealth v. 
Barbosa, 463 Mass. 116, 135 (2012).  Thus, any error in the 
reinstruction would not have resulted in prejudice to the 
defendant.