Opinion ID: 2637002
Heading Depth: 3
Heading Rank: 1

Heading: Instructions affecting all counts

Text: First, Vallery asserts that her responsibilities as the administrator of the facilities to adhere to administrative provisions and statutes are limited by the contract provision requiring only limited supervision of the residents. Therefore, any violation of the administrative codes or statutes could not be the basis for a finding of negligence because Sleepy Hollow had only partially assumed responsibility to care for an older person, and Vallery had not personally assumed any duty of care. Vallery proposed the following two instructions: A failure of Ms. Vallery to strictly adhere to a provision of the Nevada Administrative Code is not, of itself, a criminal act. In each of the charges in this case the State must prove beyond a reasonable doubt that Ms. Vallery assumed the responsibility to personally care for the older/elder persons. In this regard, you should consider any contracts which Ms. Vallery entered into for such care, and whether or not such contracts required that she personally provide such care. Vallery contends that Sleepy Hollow's contractual provisions relieve her of her responsibilities under state regulations or statutes. We disagree. An administrator charged with the supervision of a residential group care facility may not contractually limit his or her statutory or regulatory duties in order to avoid criminal liability. Vallery's contractual duties to Thomas, Barreto and Sullivan are separate from, not a replacement for, the duties imposed upon her as the administrator of the facility by statute or administrative regulation. NRS 654.015 defines an administrator of a residential facility for groups as the person who manages, supervises and is in general administrative charge of a residential facility for groups. Further, NRS 654.155(7) provides that each applicant for licensure as an administrator of a residential facility for groups must [c]omply with such other standards and qualifications as the [Nevada state board of examiners] prescribes. Lastly, NRS 449.0355 states: A residential facility for groups must not be operated except under the supervision of an administrator of a residential facility for groups licensed pursuant to the provisions of chapter 654 of NRS. In the present case, there was no dispute that Vallery was the licensed administrator for the Sleepy Hollow residential group care facilities. She therefore had a duty to see that twenty-four-hour supervision was provided to residents in the Panther facility. Moreover, the health division regulatory code required that she notify a resident's physician upon the onset of illness or injury [24] and that she provide protective supervision to avoid harm to the residents. [25] The regulations and statutes establish Vallery's duty of care, and a breach of the duty that causes an older person to suffer physical pain and/or mental suffering under the provisions of NRS 200.5099 may be the basis for criminal liability. The statutes and regulations contemplate that an administrator can be held liable for harm to a resident even though the administrator did not assume personal care over an individual or was not the assigned caregiver. The jury was properly instructed on the law, and the district court did not err in refusing to give Vallery's instructions on this issue. Next, Vallery contends that the district court erred when it refused to instruct the jury that criminal negligence is more than ordinary negligence. Vallery asserts that she cannot be held criminally liable for a negligent act unless the State proves beyond a reasonable doubt that her actions were aggravated, reckless or flagrant and that she was indifferen[t] to the consequences of those acts and their affect on human life. According to Vallery, she cannot be convicted if her actions were only the result of inattention, mistaken judgment or misadventure. There must be some evil intent. Vallery also contends that the standard is akin to gross negligence. We disagree. Vallery's construction of NRS 200.5099 and the terms defined in NRS 200.5092 are inconsistent with the plain language of the statutes. First, we note that both the 1993 and the 1995 versions of NRS 200.5099 refer to neglect, not negligence. The term neglect refers only to the failure to provide an older person with items necessary to maintain the physical or mental health of the older person. While the 1993 version of the statute does require that a person have actual knowledge that an older person is in need, there is no requirement under either version of the statute of ill will or recklessness towards the older person and we will not rewrite the statute to impose such a requirement. Next, Vallery contends that the district court erred in refusing to give a set of proffered instructions defining proximate cause and criminal causation. The district court instructed the jury on the statutory language, which uses the words causing and results when referring to substantial bodily harm, death or suffering physical pain. We conclude these terms have plain and ordinary meanings that did not require additional clarification. Therefore, the district court did not err in refusing to give Vallery's instructions as the concept of causation was covered by other instructions. Vallery also proffered instructions on intervening, superseding acts. Vallery asserts that such acts were the sole cause of the harm to Thomas and the deaths of Barreto and Sullivan. We have said that an intervening cause means not a concurrent and contributing cause but a superseding cause which is itself the natural and logical cause of the harm. [26] An act can only be a superseding cause if it is unforeseeable. [27] As to Thomas, Vallery contends that Coleman and Edwards were responsible for his care and that they were the sole cause of the failure to get him medical attention. The jury was instructed that Vallery had a right to rely on agents to perform the duties assigned to them. However, there was also testimony that Coleman and Edwards were instructed by Vallery, upon Thomas' admission, not to seek any medical help for Thomas without Vallery's express approval and that Edwards notified Vallery about Thomas' condition. There is no evidence that Vallery instructed Coleman or Edwards, as Vallery's agents, to seek medical attention for Thomas' condition. Given Vallery's position as the administrator of the facility and her admission that she did not investigate Thomas' condition when queried by Edwards, the facts do not support an instruction on intervening, superseding acts. The failure of Edwards and Coleman to take independent action to address Thomas' needs may be a concurring cause of his injuries, but it cannot be an intervening, superseding act. With respect to Barreto, Vallery brought out through cross-examination, that it was possible, though not probable, that Barreto suffered a cardiac arrest before he succumbed to the cold and was buried under the snow. In addition, evidence was introduced that Barreto's relatives refused to allow extraordinary resuscitation measures to be implemented at the hospital. As to the cardiac arrest theory, the record reflects no evidence that cardiac arrest alone, without the hypothermia, was the sole cause of Barreto's death. As to the failure to resuscitate, Barreto was already dead, and we decline to find that the decision of a family to refuse extraordinary resuscitation measures is an unforseeable, superseding event. Therefore, an intervening, superseding instruction would have been improper as to Barreto. Finally, as to Sullivan, the family was informed that Sullivan might have had a fifty percent chance of survival if he was transferred to a burn unit in Las Vegas and underwent extensive and extremely painful medical treatments. Assuming we were inclined to accept Vallery's argument that the family's decision was a cause of Sullivan's death, we conclude, as a matter of law, it would not be an unforeseeable act and again an intervening, superseding instruction was not warranted. The jury was properly instructed on the elements of the offenses on the Barreto and Sullivan cases. Even if the jury believed that Vallery was not the caregiver assigned to either man, both men were under her supervision when they were injured, and the testimony supports a finding of neglect. The testimony indicated that Barreto and Sullivan were in a twenty-four-hour supervision facility. Because of the advanced state of their Alzheimer's disease, they required more than limited supervision. Sadly, due to their impaired mental conditions, extensive supervision was necessary to prevent them from injuring themselves. Vallery knew Barreto was an elopement problem. She knew the chime setting on the alarm was insufficient to warn caregivers that a door had been opened without authorization and that residents could access and tamper with the settings. Despite this knowledge, she adopted a policy that allowed the alarms to be routinely set on chime and took no action to keep the residents away from the alarm settings or to install a different system. Vallery also knew that Sullivan needed extensive supervision. She left him unsupervised in a setting potentially dangerous to him. She knew a resident could be scalded by hot bath water and that Alzheimer's patients act in unpredictable ways. Based upon the record, we conclude that the district court did not err in refusing to give any of Vallery's proffered instructions on the Barreto and Sullivan counts. [28] As to Thomas, the district court did not err in refusing to give the instructions addressed above. However, as noted below, we conclude that the jury was improperly instructed on the issues of abuse and neglect in the Thomas case.