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

Heading: Hales's Trial Attorneys' Failure to Investigate the CT Scans was Prejudicial

Text: ¶ 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.