Opinion ID: 2635258
Heading Depth: 2
Heading Rank: 3

Heading: hales's trial attorneys rendered ineffective assistance of counsel because they failed to retain an expert to interpret critical ct scan evidence depicting luther's brain injuries

Text: ¶ 67 Hales argues that his trial attorneys failed to adequately investigate the facts of his case in that they did not have a qualified expert examine the CT scans depicting Luther's brain injuries. He argues that he was prejudiced by this failure because, as a result, Dr. Walker's expert testimony that the CT scans showed an injury caused by violent shaking that would have caused immediate unconsciousness went unrebutted despite the availability of other possible interpretations. We agree. ¶ 68 As explained by the United States Supreme Court in Strickland v. Washington, [67] the right to counsel embodied in the Sixth Amendment of the United States Constitution is a `right to the effective assistance of counsel.' [68] A defendant is deprived of this right where his counsel's conduct so undermine[s] the proper functioning of the adversarial process that the trial cannot be relied on as having produced a just result. [69] Therefore, a defendant is entitled to a new trial because of ineffective assistance of counsel if he proves (A) that counsel's performance was so deficient as to fall below an objective standard of reasonableness and (B) that but for counsel's deficient performance there is a reasonable probability that the outcome of the trial would have been different. [70] In this case, Hales has placed sufficient facts in the record to prove both of these prongs.
¶ 69 Because the State's interpretation of the CT scans was critical to the State's case against Hales, Hales's trial attorneys' failure to hire a qualified expert to review the CT scans constituted a failure to conduct an adequate investigation. In determining whether counsel's performance was objectively reasonable in light of all of the circumstances, we look to prevailing professional norms. [71] In accordance with these norms, our cases recognize that counsel has an important duty to adequately investigate the underlying facts of the case [72] because investigation sets the foundation for counsel's strategic decisions about how to build the best defense. As explained by the United States Supreme Court in Strickland, [S]trategic choices made after thorough investigation of law and facts relevant to plausible options are virtually unchallengeable; and strategic choices made after less than complete investigation are reasonable precisely to the extent that reasonable professional judgments support the limitations on investigation. In other words, counsel has a duty to make reasonable investigations or to make a reasonable decision that makes particular investigations unnecessary. [73] ¶ 70 Accordingly, we review Hales's trial attorneys' decision not to investigate the CT scans to determine whether it constituted a reasonable professional judgment. In doing so, we attempt to eliminate the distorting effects of hindsight by adopting Hales's trial attorneys' perspective at the time of their decision to limit their investigation. [74] And we indulge a strong presumption that counsel's conduct falls within the wide range of reasonable professional assistance; that is, [Hales] must overcome the presumption that, under the circumstances, the challenged action might be considered sound trial strategy. [75] ¶ 71 Hales has established in the record that his trial attorneys did not acquire the CT scans depicting Luther's brain injuries until the morning of trial and that they never subjected the CT scans to review by an expert qualified to interpret them. The reasons for this decision are not clear. Posttrial, Hales's appellate attorneys acquired access to the CT scans and obtained an expert opinion from a new expert, pediatric neuroradiologist Dr. Barnes, that contradicts the interpretation given by the State's expert, pediatric neurosurgeon Dr. Walker, and which suggests that Luther's injuries happened prior to the time when Hales was babysitting Luther. Accordingly, Hales moved for a new trial on two alternative grounds, both of which he has also raised before us: (1) that the State prevented Hales's trial attorneys from subjecting the CT scans to pretrial review by a qualified expert and that the new expert's testimony thus provides new evidence upon which we should grant a new trial or (2) that his counsel provided ineffective assistance. Because we find ineffective assistance of counsel, we do not reach Hales's new evidence claim. We note his new evidence argument, however, because some explanation is warranted regarding Hales's claim that his trial attorneys were improperly denied pretrial access to the CT scans by prosecutors. ¶ 72 Hales has placed facts in the record showing that after the preliminary hearing, where the State relied heavily on evidence from the CT scans, one of Hales's trial attorneys asked one of the prosecutors for copies of the CT scans. The prosecutor replied that copies could not be made for review. Although Hales has argued that because of this he was improperly denied access to the CT scans, the district court found that the decision [by the defense] not to seek review of the scans appears to be tactical. [W]hile Defendant may not have reviewed the scans, and Plaintiff may have stated that copies of such were not available, there is no evidence Defendant was denied access to the original CT scans. ¶ 73 Because the district court found that Hales's trial attorneys' decision not to seek review of the CT scans was tactical and then rejected Hales's ineffective assistance of counsel claim without further analysis, it likely concluded that Hales's trial attorneys' tactical decision not to review the original CT scans fell within the broad range of reasonable professional assistance. We accept the trial court's factual finding that the decision was tactical, but we disagree to the extent that the district court concluded that this tactical decision was reasonable. ¶ 74 The State's presentation of its case at the preliminary hearing put Hales's trial attorneys on notice that the State's interpretation of the CT scans depicting Luther's brain injuries was critical to the State's case against Hales. Because the State had no witness to the cause of Luther's injuries, the medical evidence in the case, and in particular the CT scans, was the primary source of information regarding what happened to Luther. In fact, the State itself stated in its closing argument that Dr. Walker's testimony regarding the CT scans was critical to determining what happened to Luther while he was in Hales's care on the night of December 5, 1985. ¶ 75 At the preliminary hearing, Dr. Walker testified to the following findings: the first CT scan, which was taken on December 5, 1985, showed initial signs of edema and bleeding over the surface and between the hemispheres of the brain (or subarachnoid hemorrhaging); the CT scans taken on December 8, 1985, and December 11, 1985, showed black brain, evidencing global injury caused by something like lack of blood flow and oxygen (or hypoxia-ischemia), which injured the brain throughout; the CT scan from December 8, 1985, showed that the degree of injury to the front and the back of the brain differed, indicating that arteries had been occluded by swelling; and finally, a CT scan taken three years later, on December 13, 1988, showed a shrunken brain evidencing severe loss of functions. ¶ 76 Combining these findings and his general observations about the appearance of the brain in the CT scans, Dr. Walker made crucial assertions regarding the cause, timing, and violence of the injury. He testified that the injury he observed from the CT scans would have rendered Luther immediately unconscious and that, therefore, there could have been no lucid interval between the injury and the onset of the severe symptoms. Specifically, he opined that the degree of injury we see on these scans tells us that this child's brain was severely injured and at the point of injury this child was unconscious, was deeply brain injured, and that the shrunken brain shown in the last CT scan is simply a reflection of the amount of injury that occurred on the 5th of December. Furthermore, Dr. Walker opined that the global nature of the brain injury indicated that the injury was not caused by an impact, and that the force required to cause the injuries to a baby's brain shown on the CT scans from shaking would be violent force. ¶ 77 Based on the CT scans and the other medical evidence regarding retinal hemorrhaging, Dr. Walker concluded that the injury to Luther must have been nonaccidental and caused by shaken baby syndrome. Dr. Walker explained that the constellation of injuries clinically associated with shaken baby syndrome is indicated by a brain scan that actually looks quite similar to what we've seen here today. It's a dark brain, suggesting that there is early injury that's massive and on both sides. There frequently is evidence of bleeding over the surface of the brain called subarachnoid hemorrhage. Oftentimes, there is another layer of bleeding called subdural hemorrhage. There is the finding of hemorrhage into the eyebrows we call retinal hemorrhaging. And then occasionally we find other evidence of abuse in these children, they have a higher incidence of having other forms of abuse. For example, a skeletal survey might show evidence of other fractures that are old. Dr. Walker testified that all of these markers were present except for the subdural hemorrhaging and evidence of past abuse. ¶ 78 Despite the centrality of the CT scans of Luther's brain to the State's case, Hales's trial attorneys did not have a radiologist or other qualified expert review Luther's CT scans as part of their pretrial investigation. Instead, they decided to rely solely on cross-examination of Dr. Walker and the testimony of an expert forensic pathologist, Dr. Plunkett, whose primary theory was that shaking can damage an infant's neck, but cannot produce brain injury, and that, therefore, the most reasonable explanation for the injury was the near-miss car accident described by Hales that occurred two days before Luther was hospitalized. Hales's trial attorneys had apparently hoped that Dr. Plunkett would be able to testify regarding injuries depicted in the CT scans, but they waited to show those scans to Dr. Plunkett until the morning of trial, and they failed to verify that Dr. Plunkett would be qualified to testify regarding the CT scans. In fact, the district court prohibited Dr. Plunkett from offering testimony interpreting the CT scans because he admitted on voir dire that he did not read CT scans in his work. ¶ 79 We are convinced that the testimony at the preliminary hearing would have indicated to an attorney providing reasonable professional assistance that the evidence contained in the CT scans was critical to the case and that Hales would suffer a significant disadvantage at trial if he were unable to use the CT scans to illustrate how the injuries would fit into his theory of the case. Further, because the findings from the CT scans were crucial to establish the cause, timing, and violence of Luther's injuries, we are convinced that an attorney providing reasonable professional assistance would have sought another opinion from a qualified expert regarding what could and could not be seen in the CT scans. This is particularly so where, as here, the defense's theory that the injuries were caused by the near-miss car accident depended upon convincing the jury that the brain injury shown in the CT scans could have been caused by an impact injury and would not have caused immediate unconsciousness as Dr. Walker had testified. ¶ 80 We have previously held that an attorney may often provide adequate assistance without hiring an expert to do a separate examination of the evidence. For instance, in Taylor v. Warden, [76] we found that a reasonable investigation did not necessarily require the defense to hire an expert to testify regarding a fingerprint match because the defendant's counsel acknowledged the strength of the State's expert's testimony that thirty-two points of positive comparison and matching prints from adjacent fingers eliminat[ed] any possibility of a misidentification. [77] However, this case differs significantly from Taylor. Here, the defense's theory required the jury to disbelieve Dr. Walker's interpretation of the CT scans, including the cause, timing, and violence of the injury. Further, although we have indicated that in many circumstances defense attorneys may reasonably decide to rebut an expert's testimony without hiring a competing expert, the centrality of this medical evidence to the jury's determination of Hales's guilt or innocence made an expert necessary in this case. ¶ 81 Nevertheless, the State urges us to conclude that Hales's trial attorneys provided adequate assistance because he had three experienced attorneys from the legal defenders office who did hire an expert who supported their theory of the case. The State asserts that once the defense finds one expert to support their position, it is not necessary to search for another. ¶ 82 We note, however, that this is not a case where the defense already subjected the CT scans to review by one qualified expert. Dr. Plunkett was a forensic pathologist who did not interpret CT scans in his practice, not a radiologist. Regardless of the strength of the theory supported by Dr. Plunkett, the existence of that theory cannot excuse the failure to hire an expert to interpret the CT scans. The defense prematurely rejected the possibility that the CT scans might contain evidence that would contradict Dr. Walker's interpretation of the scans and cast doubt upon the cause, timing, or violence of the injury. Moreover, because of the central role that interpretation of the CT scans played in the case, it should have been evident to an attorney rendering reasonable professional assistance that the defense would be under a distinct disadvantage if it were not allowed to use the CT scans to support his theory of defense at trial. It is unlikely that acquisition of another expert opinion would have harmed the defense's theory. And the opportunity to acquire another expert opinion presented a significant opportunity to discover crucial new information about what happened to Luther. Accordingly, viewed from the perspective of the pretrial investigation, the defense's decision to limit the investigation this way was not a reasonable professional judgment. ¶ 83 This is not to say that the defense could not have made a reasonable professional judgment to rely on Dr. Plunkett and his theory of the case, but only that the defense could not reasonably have made this decision without first conducting a full investigation of the merits of the case. In other words, Hales's trial attorneys were not in a position to make a reasonable strategic choice as to whether to rely solely on the theory posited by Dr. Plunkett because the investigation supporting their choice was unreasonable. [78]
¶ 84 Hales argues that he was prejudiced by his trial attorneys' failure to hire a qualified expert to examine the CT scans for the defense because the initial CT scan taken between 8:41 p.m. and 8:45 p.m. on December 5, 1985, shows changes in gray/white differentiation that usually do not show up on a scan until approximately 6 to 12 hours after the injury occurred-meaning that the scans provide evidence that Luther was not in Hales's care when he was injured. Hales supported these assertions in his motion for a new trial before the district court with an affidavit from Dr. Barnes, a pediatric neuroradiologist. ¶ 85 In addressing this issue, we initially note that the State suggested at oral argument that if we conclude that Hales's trial attorneys' investigation was unreasonable, we should remand for an evidentiary hearing regarding whether that decision was prejudicial. Although the State has admitted that Dr. Barnes would be qualified as an expert, it indicated that because Dr. Barnes's testimony has not been tested, it would like the opportunity to challenge Dr. Barnes's medical opinions with other medical opinions and texts and thus to establish that his testimony would likely not affect the outcome of the trial. Because the record before us is adequate, and because the State previously has repeatedly represented that an evidentiary hearing on this specific issue is unnecessary, [79] we decline to remand for an evidentiary hearing. ¶ 86 Under Strickland, even when counsel's performance is inadequate, a defendant who has been convicted of a crime is not entitled to a new trial unless the defendant establishes that there is a reasonable probability that, absent the errors, the factfinder would have had a reasonable doubt respecting guilt. [80] A reasonable probability is a probability sufficient to undermine confidence in the [jury verdict]. [81] Because [s]ome errors will have had a pervasive effect on the inferences to be drawn from the evidence, altering the entire evidentiary picture, and some will have had an isolated trivial effect, in determining the effect of the error, we consider the totality of the evidence before the . . . jury. [82] ¶ 87 In support of his claim of prejudice, Hales points to the affidavit from pediatric neuroradiologist Dr. Barnes in which Dr. Barnes concludes that the CT scan of Luther's brain taken between 8:41 p.m. and 8:45 p.m. on December 5, 1985, shows a change in cell structure observable as changes in gray/white differentiation that takes time to develop. According to Dr. Barnes, [a]lthough there is some variability, edema and changes in gray/white differentiation will not appear in a CT scan until at least 6 to 12 hours after the initiating insult. If believed by a jury, this testimony would establish that the injury to Luther most likely happened prior to the 20 to 30 minute period on the night of December 5 when he was in Hales's care and may have happened while he was in Westerman's care. According to the records, Luther was admitted to Cottonwood Hospital's emergency room at 7:34 p.m., and police reports indicate that the incident occurred at 7:03 p.m. Hales was with Luther for just 20 to 30 minutes. If the injury did indeed occur six hours prior to Luther's admission, that would place the injury sometime around 2:45 p.m. ¶ 88 Hales argues in his brief that had the defense retained any qualified radiologist to interpret the CT scans, that expert would likely have discovered the significance of the changes in gray/white differentiation in Luther's original CT scan and would have interpreted it properly. Dr. Barnes characterizes his opinions as consistent with the current medical literature. The State does not contest that an alternative opinion in line with Dr. Barnes's interpretation of the CT scans could have been easily obtained. In fact, the State noted in its argument on a separate point of appeal that Dr. Barnes's testimony did not meet the standard for new evidence because Dr. Barnes was a prominent physician in his field whom the defense could have discovered with a 30-second search on Google. ¶ 89 If introduced at trial, Dr. Barnes's testimony or similar testimony from a different expert regarding the gray/white differentiation and timing of edema would likely alter the defense's theory at trial as well as the entire evidentiary picture presented to the jury. In Hales's trial, the jury was presented with no basis in the CT scans for believing that Luther's injury happened prior to the time when Hales cared for him on the night of December 5. In fact, the only witness at trial who was qualified to explain the injuries in Luther's CT scans to the jury and to anchor his opinions regarding the cause and timing of the injury in the overall picture presented by those scans was the State's expert, Dr. Walker. Dr. Walker testified that the brain injury shown in the CT scans was so severe that it would have caused immediate unconsciousness. In closing arguments, the State focused on this testimony, arguing that because Hales testified that he responded to noises made by Luther, Luther must have been conscious when Westerman left for the grocery store. Thus, according to the State, Dr. Walker's testimony established that the injury must have occurred while Luther was in Hales's care on the night of December 5, 1985, and was not accidental. ¶ 90 Instead of directly challenging Dr. Walker's conclusions by pointing to evidence contained in the CT scans, the defense called a forensic pathologist, Dr. Plunkett, to testify that shaking an infant could not cause brain damage (only damage to the neck) and that, therefore, the most likely cause of Luther's brain injury was the near-miss car accident two days prior, followed by an unusually lengthy lucid interval. Hales's trial attorneys also attempted to undermine Dr. Walker's conclusions from the CT scans by asking general questions about CT scan interpretation on cross-examination. ¶ 91 In comparison, if the defense had presented testimony from Dr. Barnes or a similar expert regarding the timing of the gray/white differentiation and developing edema, the jury would have been presented with a competing interpretation of the CT scan evidence that would have required it to weigh Dr. Walker's interpretation against the interpretation provided by another qualified expert. This would have undermined the State's ability to use the CT scans to conclusively pin responsibility for Luther's injuries on Hales. This competing interpretation would have likely cast doubt on the State's ability to rule out theories that the injury may have been accidental or caused earlier in the day by Westerman. Additionally, it is relevant that Dr. Barnes's affidavit further indicates that other crucial portions of Dr. Walker's testimony are susceptible to attack by an expert who is qualified to read the CT scans. For instance, Dr. Barnes opines that there is nothing in these scans which would suggest that the injury was from a shaking as opposed to [an] impact injury or other possible causes, including nonaccidental causes. And he disputes Dr. Walker's conclusion that the global nature and degree of the brain injuries shown in the later CT scan images reflects an injury that would have caused immediate unconsciousness: Dr. Walker's opinions are not in any sense based upon or supported by the actual CT scans of Luther Deem. There is nothing in these scans which indicates what caused the injury or how fast the onset of symptoms would occur. There is nothing in these scans that is inconsistent with a period of consciousness [lucid interval] after the injury occurred. There is nothing in regards to the global nature of the injury which is indicative of cause or rapidity of the onset of symptoms. The scan shows the point to which the injury had progressed-not how it got there. Beyond that, his conclusions are unsupported by current medical literature and study. Dr. Barnes also asserts that [g]lobal brain injury is almost always the product of hypoxia-ischemia and does not necessarily correlate to the severity or violence of the original insult. In fact it may not be the product of traumatic injury. ¶ 92 Because the State's murder case against Hales hinged on the interpretation of the CT scans to show a nonaccidental injury caused while Luther was in Hales's care on the night of December 5, 1985, we think that the jury could have been swayed by a medical expert able to interpret the CT scans and challenge Dr. Walker's critical findings regarding the timing, cause, and violence of the injuries. Given the centrality of Dr. Walker's interpretation of the CT scans, we are convinced that there is a reasonable probability that, had Hales's trial attorneys investigated the CT scans, they could have presented an alternative interpretation of the CT scans sufficient to raise a reasonable doubt as to Hales's guilt. In finding that there was a reasonable probability that, but for the errors, Hales would not have been convicted, we do not need to find that the jury would have more likely than not believed another expert's interpretation over Dr. Walker's. A reasonable probability is a probability sufficient to undermine our confidence in the outcome. [83] That standard is met on the facts of this case because Hales's trial attorneys' failure to investigate had a pervasive effect on the key evidence at trial.