Opinion ID: 6498152
Heading Depth: 4
Heading Rank: 2

Heading: Evidence Regarding V.W.’s “Risk of Death”

Text: At trial, Dr. Rebecca Vogel testified as to the nature and extent of V.W.’s injuries. In so doing, she testified as to, inter alia, damage to V.W.’s abdominal and pelvic regions, as revealed in medical imaging. That imaging revealed “a lot of inflammation as well as some blood” in the part of the gastrointestinal system known as the duodenum. R. Vol. VIII at 512. Vogel testified the duodenum is a particularly important part of the gastrointestinal system. 9 She further noted the danger inherent in trauma to that organ, particularly identifying the difficulty of surgical intervention and, even absent the need for surgery, risk of tissue 9 Vogel testified as follows: The duodenum is so important not only because it’s the first part coming out of your stomach and into your small intestine, but it’s also where your liver drains something called bile that is necessary for life, as well as the pancreas which helps you with digestive enzymes, insulin, and multiple other functions. R. Vol. VIII at 513. -20- Appellate Case: 20-1228 Document: 010110706158 Date Filed: 07/06/2022 Page: 21 damage. 10 As to complications flowing from surgery on the duodenum, Vogel noted that both death and “long-standing infection” were significant possibilities. Id. at 514. Vogel testified that the percentage of morbidity associated with trauma to the duodenum—ranging from infection to “prolonged hospitalization”— exceeded sixty percent. Id. As to the question of mortality, Vogel testified that simple damage to the duodenum (i.e., damage not coupled with associated trauma), even if diagnosed and treated promptly, resulted in death in approximately six percent of cases. She also explained that delays in treatment and/or duodenum injury with associated trauma significantly increased the chances of mortality, to as much as forty percent. 10 In response to a question from the prosecution regarding medical concerns associated with damage to the duodenum, Vogel testified as follows: One, it’s an incredibly difficult area to surgically treat. It is a large, extensive operation to be able to address injuries here. And, number two, when you look at the stomach, which has acid in it, which is a very low pH, that can damage tissues around it quite extensively, as well as the pancreas actually has very, um, toxic enzymes that can eat away at the tissue in that area. And so when you have an injury to that area, if there’s a lot of fluid, it carries a very high risk of having complications or even death if misdiagnosed or not diagnosed properly. R. Vol. VIII at 513. -21- Appellate Case: 20-1228 Document: 010110706158 Date Filed: 07/06/2022 Page: 22 On appeal, Wells asserts all of the testimony recounted above is irrelevant, and its admission improper, because V.W. never faced a risk of death. 11 Wells has not shown the admission of Vogel’s testimony was error, let alone plain error. As a general matter, relevant evidence is admissible. See Fed. R. Evid. 402 (providing relevant evidence is admissible unless prohibited by the United States Constitution, a federal statute, the Federal Rules of Evidence, or other rules prescribed by the Supreme Court). To be relevant, evidence need only have “any tendency” to make the existence of any fact that is of consequence to the determination of the action more probable or less probable than it would be without the evidence. Fed. R. Evid. 401. This standard is not intended to impose a high burden to admissibility. Id. cmt. (“The standard of probability under the rule is ‘more . . . probable than it would be without the evidence.’ Any more stringent requirement is unworkable and unrealistic.” (alteration in original)); United States v. Leonard, 439 F.3d 648, 651 (10th Cir. 2006) (“Rule 401 is a liberal standard.”). “[A] fact is of consequence when its existence would provide the fact-finder with a basis for making some inference, or chain of inferences, about an issue that is necessary to a verdict,” but it only needs to have “any 11 The narrowness of Wells’s challenge—one based exclusively on the question of relevance and not in any way based on Fed. R. Evid. 403—is confirmed by his reply brief. Wells’s Reply Br. at 32 (asserting the government “set up a straw man” by raising Fed. R. Evid. 403 balancing and clarifying that the argument as to Vogel’s testimony was based exclusively on the claim her testimony was irrelevant). -22- Appellate Case: 20-1228 Document: 010110706158 Date Filed: 07/06/2022 Page: 23 tendency” to do so. United States v. McVeigh, 153 F.3d 1166, 1190 (10th Cir. 1998) (quotations omitted); see also id. (“The rule establishes that even a minimal degree of probability—i.e., any tendency—that the asserted fact exists is sufficient to find the proffered evidence relevant.” (quotation omitted)); United States v. Jordan, 485 F.3d 1214, 1218 (10th Cir. 2007) (“The bar for admission under Rule 401 is very low.” (quotation omitted)). Notably, because our review of this issue is for plain error, Wells can only prevail by demonstrating Vogel’s testimony is so obviously irrelevant that, despite his failure to object, the district court should have, sua sponte, excluded the evidence. See United States v. Brooks, 736 F.3d 921, 934 (10th Cir. 2013). The jury was instructed that to find Wells guilty, it had to find beyond a reasonable doubt, inter alia, Wells knowingly assaulted V.W. and, “as a result of the assault, [V.W.] suffered serious bodily injury.” R. Vol. I at 362; see 18 U.S.C. §§ 113(a)(6), 1365(h)(3). Consistent with the provisions of § 1365(h)(3), the jury was instructed that “‘serious bodily injury’ means bodily injury which involves a substantial risk of death[;] extreme physical pain[;] protracted and obvious disfigurement[;] or protracted loss or impairment of the function of a bodily member, organ, or mental faculty.” R. Vol. I at 362. Thus, the critical question is whether Vogel’s testimony had “any tendency” to demonstrate V.W. suffered such an injury. The answer to that question is “yes.” -23- Appellate Case: 20-1228 Document: 010110706158 Date Filed: 07/06/2022 Page: 24 Vogel, a trauma surgeon, testified Wells’s assault on V.W. (1) left V.W. with numerous traumatic injuries, including bruising, swelling, and bleeding all over her body; and (2) “a lot of inflammation as well as some blood in the area and swelling” in the duodenum. R. Vol. VIII at 512. Vogel testified that a duodenal injury without associated trauma, even if such an injury receives immediate treatment, carries a 6% risk of death. Critically, however, such injuries accompanied by associated trauma, such as that suffered by V.W., result in a 40% risk of death. Wells does not contend that a 40% chance that death will result is anything other than substantial. Thus, Vogel’s testimony had a clear tendency to prove a necessary element as to Wells’s guilt on the § 113(a)(6) charge and was, therefore, relevant. To the extent Wells’s brief asserts Vogel’s testimony was irrelevant because none of the risks associated with his assault on V.W. ultimately came to pass, his assertion is completely lacking in supporting precedent. Indeed, our limited precedents reject the notion a criminal defendant can escape § 113(a)(6) liability merely because timely medical treatment prevents risks associated with an assault from coming to fruition. See United States v. Whitethorne, No. 972165, 1998 WL 165167, at  (10th Cir. April 9, 1998) (unpublished disposition cited solely for its persuasive value) (“The question whether an injury is life threatening must be viewed at the time of the injury rather than, as defendant -24- Appellate Case: 20-1228 Document: 010110706158 Date Filed: 07/06/2022 Page: 25 argues, after medical treatment.”). This court and others have employed this same reasoning in analyzing the applicability of closely related provisions of the Sentencing Guidelines. See United States v. Tindall, 519 F.3d 1057, 1064 (10th Cir. 2008); see also United States v. Smith, 461 F. App’x 647, 649 (9th Cir. 2011); United States v. Young, 144 F. App’x 33, 36 (11th Cir. 2005). The district court did not err, let alone plainly err, in failing to, sua sponte, exclude Vogel’s testimony.