Court Opinion

ID: 9837005
Source: CourtListenerOpinion
Date Created: 2023-09-02 03:15:57.75554+00
Date Added: 2024-06-11T07:45:19.741275
License: Public Domain

CRAWFORD, Judge
(dissenting):
I disagree with the majority as to the holding of the Court of Criminal Appeals. 50 MJ at 415. The court differentiated between disregard for the foreseeable consequences of refusing to seek medical assistance and finding appellant obstructed medical care “with a culpable disregard for the foreseeable consequences to her newborn daughter.” 47 MJ at 608. Additionally, the failure to summon medical attention was only removed from the panel’s consideration, and subsequently from the court’s, as to negligent homicide. The facts reveal a calculated effort by appellant to act as an obstacle between her baby’s struggle to survive and the medical care offered to her. It would be a true miscarriage of justice to reverse the conviction in this case.
On July 3, 1995, appellant, herself 19 years old, gave birth to a full-term and otherwise healthy baby girl in an emergency-room bathroom at Dyess Air Force Base, Texas. Until that day, she had fully denied her pregnancy to friends, doctors, and, possibly, even herself.1 A hospital custodian found the baby dead in the bathroom trashean under *417many paper towels. An autopsy revealed that the baby had been born alive and had died from a “crush” injury to her skull.
Apparently, appellant had her first and only sexual experience while drunk one night at Tech School shortly after joining the Air Force. Though she was gaining weight despite dieting, went without menstruation for one year, suffered unusual cramping and lower back pain, had cravings and oily skin, and experienced occasional spotting, she claims she at no time thought she was actually pregnant. Particularly during the latter part of her second trimester and her third trimester, appellant spoke to several friends about her concerns that she had not had a menstrual cycle in months and that she had severe cramps. She even performed a home pregnancy test, which turned out positive. Yet, she continually denied she could be pregnant and sought other explanations for these symptoms of pregnancy. Her friends, who thought appellant was a virgin, agreed with her self-diagnosis, but entreated her to see a gynecologist for a professional explanation.
Appellant made an appointment at the OB/ GYN clinic, but canceled it. She also went to the emergency room for menstrual cramps or flu-like symptoms on at least two occasions. She adamantly denied that she could be pregnant when the subject was broached by the attending physician and refused a pelvic examination which would have revealed her true state of pregnancy.
On the day she went to the emergency room and eventually gave birth, she told the first doctor to see her, as well as the emergency room technicians, that she was suffering severe back pain from a racquetball injury. When the pain medication she was given for her professed symptoms did not have any effect and a second doctor approached her, she told him that she was also suffering severe cramps that might need additional pain killers. At this point, she told him that she was beginning her first menstrual cycle since June 1994. When the doctor asked if she could be pregnant, she said no, though he eventually persuaded her to give blood for a pregnancy test.
Appellant refused to lay upon the gurney while the blood was being drawn, indicating that she was more comfortable and the pain was less severe when she stood or squatted. While waiting for the pregnancy test results, Dr. Chengson went to his office to study some files.2 Appellant asked a technician where the bathroom was located. She was in the bathroom for 45-50 minutes.
She stated in her interview with an Abilene, Texas, detective and a military investigator that when she went into the bathroom, she sat on the toilet and pushed instinctively, feeling like she was about to have a strong bowel movement. After a couple of pushes, she looked down and saw “hair that wasn’t hers.” At some point, the evidence shows, she entirely removed her panties, shorts, and sneakers. According to appellant’s statement, after another push or two, the baby “squirted out” onto the floor face-up. Also, according to her statement, the infant never cried or moved or opened its eyes; did not have a heartbeat that she could feel; and did not respond to appellant’s prodding and slapping her. She washed the baby off, pulled the umbilical cord from her, flushed the placenta and the cord down the toilet, put the baby in the trash, and then tried to clean the blood from the floor. Two technicians knocked on the door a total of three times to see if she was okay, and she always responded calmly that she was fine. The third time, she requested a mop, stating that she had been sick in the bathroom and wanted to clean it up. The technician told her someone else would clean it up and that Dr. Chengson and a chaperone were waiting to see her.
When appellant emerged from the bathroom, she was walking erect but gingerly, and seemed to be in less pain. In fact, she asked if she could go home. Dr. Chengson told her the pregnancy test results were positive and that he needed to do an abdominal and pelvic exam. The examination revealed a fundus consistent with about 16 weeks’ pregnancy, which, coincidentally, is *418also consistent with that just following the birthing process. He asked her to prepare for a pelvic exam. Appellant told the chaperone that she had injured her vaginal area rollerblading the day before and that she had packed her bleeding vagina with paper towels. However, the testimony of one of appellant’s friends was that they had wanted to go rollerblading, but had been unable to borrow any blades.
Dr. Chengson was shocked at the amount of trauma to appellant’s vagina and suspected a mutilation attack or vicious rape. Pursuant to hospital practice, he called for the assistance of the OB/GYN doctor on-call. When Dr. O’Young and her chaperone arrived to continue the pelvic exam, she too was shocked at the trauma. She was also concerned about the bleeding and the health of the baby, so she performed an ultrasound, which revealed no baby in the womb but a cluster of either blood clots or a part of the placenta still attached to the uterus. She asked appellant several times whether she had passed any fetal tissue, baby parts, or a fetus, but appellant always answered in the negative. While Dr. O’Young was out of the room attempting to get appellant admitted to the OB/GYN clinic for care, appellant asked the chaperone if she had miscarried and seemed to latch on to that explanation.
It was at this time that the custodian discovered the baby’s body in the trashean. Dr. Chengson called Dr. O’Young over and they both examined the baby, concluding that it was dead and beyond resuscitation. They also both noticed a rolled up paper towel protruding from the baby’s mouth. However, that towel was never observed by the investigators and was not mentioned by the court below. Dr. O’Young searched the trash bag for the placenta, but never found it. Assuming that the baby was appellant’s, Dr. O’Young determined that surgery would be needed to confirm that the placenta was not still in her uterus, bleeding out. The medical staff agreed that no one was to tell appellant about the discovery, that the crime scene should be preserved, and that the Air Force investigators and civilian police should be notified.
The autopsy revealed signs that the baby had been born alive, including evenly aerated lungs and a hemorrhage where the umbilical cord had been yanked from the baby’s body. In addition, the autopsy revealed that the cause of death had been a “crush injury of the head that ha[d] fractured the skull.” The medical examiner also found abrasions on the baby’s neck “consistent with and suspicious of fingernail markings.”
Thus, the court below found appellant guilty of the lesser-included offense of involuntary manslaughter. The court determined that “based on the circumstances of this case, the members would have adjudged the maximum available punishment of a dishonorable discharge, 10 years confinement, forfeiture of all pay and allowances, and reduction to E-1,” which it found an appropriate sentence. 47 MJ at 609.
The only other issue before the Court of Criminal Appeals was whether appellant was prejudiced by her trial defense counsels’ conflict of interest, in that they “could not have devoted their full attention to appellant when they had to defend themselves against accusations of unethical conduct.” Id. Though this issue is not raised before this Court, the relevant facts may have some application to our consideration of some of the raised issues. Specifically, the trial defense team was the object of an informal, and then formal, ethics inquiry beginning in April 1996. “Ultimately, the Judge Advocate General’s Advisory Committee on Ethics and Standards determined that both defense counsel knew before sentencing that the judge’s instruction [allowing the members to reconsider their findings after they had been announced, as requested by defense counsel] conflicted with RCM 924(a) and they violated the rule of candor toward the tribunal by failing to bring the discrepancy to the judge’s attention____ Both trial defense counsel received letters of admonishment from the AFLSA Command-er____” Id. The court below found appellant’s argument unpersuasive. Id. at 610.
DISCUSSION

A. The Instructions on Appellant’s Failure to Act or Summon Medical Care:

During an Article 39(a) session at which the military judge, trial counsel, and defense *419counsel discussed the proposed instructions, individual defense counsel noted his concern that, while the Charge and specification did not allege appellant’s failure to act as a means of culpability, the proposed instructions did. The military judge agreed with the defense counsel to a point. He agreed to strike “or failed to summon medical assistance which was immediately available for the infant” where it appeared in the instructions. Trial counsel concurred, stating that the Government “ha[d] never been proceeding under the theory, and do not intend to argue, that [appellant’s] culpability stems from failure to summon medical assistance.”
However, the military judge was very adamant about retaining language referring to appellant’s failure “to prevent the fracture of’ her baby’s skull, stating that, “based on facts and the evidence that has been available to the defense, I would think, since this interview [depicted in Prosecution Exhibits 36 and 37] was taken on 4 July 1995.” The following colloquy followed:
IDC: If, indeed, we have been put on notice that her failure to prevent the fracture of her daughter’s skull was somehow an issue, we would have unequivocally put on Mental Health testimony regarding her state of mind in the restroom and her ability to prevent the fracture of Baby Girl Riley’s skull. That would be an additional
MJ: I would just simply say that it seems inconceivable to me that anyone who has read the transcript of that interview on 4 July 1995 would not be on notice that that’s an issue. To the extent that you’ve made your record on that, then that seems to me to be well preserved. Notwithstanding that position, I’m going to instruct as I have set forth there.
IDC: Understood, your Honor. With regard to the part that you have agreed to remove from this instruction, we would request a specific instruction to the members that Airman Riley’s failure to summon medical assistance from the bathroom is not to be considered in the issue of negligent homicide.
MJ: All right. Does the government have any position with regard to that request?
TC: Well only if you’re going to specifically mention what that fact cannot be used for. Then we would also request that you instruct something along the lines of, however, it could be considered by them in the areas of, perhaps, intent or consciousness of guilt.
MJ: You see the point there? Are you willing to ...
IDC: I agree, your Honor. I think the danger is great enough to justify what might seem, on its face, to be a harmful instruction. Perhaps the language that Captain Meier is concerned about would be more properly inserted at the point in the instructions where they talk about circumstantial evidence. I think that’s where Captain Meier was going with that.
MJ: Well, I think if I’m going to make a specific instruction along those lines, it would appear to me that rather than putting it in two parts in the instruction, it would seem to naturally flow that one follows the other.
IDC: To some extent, I agree.
The next morning, individual defense counsel brought the issue up again in the following colloquy:
IDC: Yes, your Honor. I beg the court’s forgiveness for not bringing this up yesterday during our instructions session. As we thought last night about the instruction on negligent homicide, in particular, that portion of the instruction that deals with Airman Riley’s failure to act, failure to prevent the fracture of her infant’s skull, of course, it was our position from the outset that that instruction was inappropriate. As we came to understand the court’s position that perhaps Airman Riley could have prevented the fracture, for example, if she had caught the baby during delivery, we began to believe and believe this morning that an instruction on physical impossibility should be given if, in fact, that is what the court is thinking in the arena of this failure to act.
MJ: That would appear to me to be what’s naturally raised by the evidence, based on the facts as we know them. The failure to *420prevent the fracture in the negligent homicide specification would, in the court’s view, be along the lines you stated, some action or some inaction on Airman Riley’s part which amounts to negligence, which did not prevent this skull of the infant being fractured, the fracture which caused the death of the infant____
MJ: I believe, regardless of the timing of this request, defense counsel, that it does appear to be a fair request, based on the status of the evidence with regard to the lesser included offense of negligent homi-cide____

B. Law of the Case:

1. The Doctrine:

The Supreme Court of the United States has held that “the law-of-the-case doctrine ‘merely expresses the practice of courts generally to refuse to reopen what has been decided, not a limit to their power.’ A court has the power to revisit prior decisions of its own or of a coordinate court in any ... circumstances such as where the initial decision was ‘clearly erroneous and would work a manifest injustice.’” Christianson v. Colt Industries Operating Corp., 486 U.S. 800, 817, 108 S.Ct. 2166, 100 L.Ed.2d 811 (1988), quoting Messenger v. Anderson, 225 U.S. 436, 444, 32 S.Ct. 739, 56 L.Ed. 1152 (1912); and then Arizona v. California, 460 U.S. 605, 618 n. 8, 103 S.Ct. 1382, 75 L.Ed.2d 318 (1983). The Supreme Court has also noted that the doctrine “directs a court’s discretion, it does not limit the tribunal’s power.” 460 U.S. at 618, 103 S.Ct. 1382.
Justice Brennan, joined by Justices Black-mun and Stevens, wrote a separate opinion in Arizona v. California, supra, in which they discussed the principle of “finality” and its application to the law-of-the-case doctrine, writing
that “finality” means different things in different contexts, and that the law accords finality different weight depending on the context____ In a case such as this, when a party seeks reconsideration of questions decided at an earlier stage of a single, continuing litigation, the law allows courts more discretion than in a case in whieh the party wants to upset a final judgment in another proceeding, before another judge. See generally 1B J. Moore & T. Currier, Moore’s Federal Practice [paras.] 0.401, 0.404[1] (1982) (hereinafter Moore); cf. United States v. United States Smelting Refining & Mining Co., 339 U.S. 186, 199, 70 S.Ct. 537, 94 L.Ed. 750 (1950).
A final judgment makes a difference. It marks a formal point at which considerations of economy, certainty, reliance, and comity take on more strength than they have before the judgment. A court’s decision to reconsider a prior ruling before the case becomes final, however, is ultimately a matter of “good sense.” Moore § 0.404[10], at 573. Concern for finality remains an important policy, even before final judgment. In the absence of some overriding reason, a court should be reluctant to reopen that which has been decided merely to correct an error, even though it has the power to do so. Nevertheless, federal courts have traditionally thought that correcting a manifest injustice was reason enough to reconsider a prior ruling. ...
460 U.S. at 643-44, 103 S.Ct. 1382 (citations omitted) (concurring in part and dissenting in part).

2. The Facts of This Case:

Appellant’s law-of-the-case argument is based on the claim that the Court of Criminal Appeals’ decision “imputes liability on the appellant for failing to seek medical care.” Final Brief at 9. Technically, that is not the basis for the lower court’s decision. They found her guilty of involuntary manslaughter through culpable negligence based on her “disregard for the foreseeable consequences of refusing and impeding assistance in the delivery and care of her child.” The court differentiated this from the “failure to seek medical care,” on which it recognized “that trial defense counsel persuaded the military judge not to instruct the members,” stating that appellant “did not merely fail to seek medical care — she obstructed it with a culpa*421ble disregard for the foreseeable consequences to her newborn daughter.” 47 MJ at 608.
This effort to distinguish was not necessary.
First of all, the military judge himself very consciously made the same distinction, as evidenced in those colloquies detailed in Part A of this discussion. Second, in reading through the actual instructions given to the members, I note that the “failure to summon medical” attention was only removed from their consideration with regard to the one lesser-ineluded offense of negligent homicide, about which the military judge specifically said: “In deciding the issue of negligence, you are instructed that Airman Riley’s failure to summon medical assistance may not, as a matter of law, constitute the negligent act or failure to act set out above.”
The military judge did have the members scratch “or failure to act” from the discussion of proximate cause in relation to culpable negligence during the involuntary-manslaughter portion of the instructions, but again, the Court of Criminal Appeals found appellant guilty of an act of obstruction, not a failure to act by failing to seek help. Otherwise, no instruction was given for this lesser-ineluded offense similar to that given for negligent homicide. In fact, the military judge instructed the members that to find appellant guilty of involuntary manslaughter, they had to find that she “by culpable negligence, killed or caused the death of Baby Girl Riley.” (Emphasis added.)

3. The Case Law:

Appellant cites United States v. McKinley, 27 MJ 78 (CMA 1988), in support of his proposition that the law-of-the-case doctrine applies here. We held in that case that “where (a) the Manual states that there are no lesser-ineluded offenses; (b) the judge rules that there are no lesser-ineluded offenses; and (e) counsel agree that there are no lesser-ineluded offenses, such a ruling becomes the law of the case, absent plain error materially, prejudicing a substantial right of an accused.” 27 MJ at 80. Here, the lesser-ineluded offense was never in question; but the theory underlying the charged offense or any of the lesser-ineluded offenses was. However, given the discussion above, even that allegation is specious.
Furthermore, appellant overlooks the fact that the McKinley holding was very narrow and that the Court also noted the general practice, which is that “we have long recognized that an appellate court may disapprove a finding because proof of an essential element is lacking or, as a result of instructional errors concerning lesser-ineluded offenses, may substitute a lesser-ineluded offense for the disapproved findings. This is true even if the lesser-ineluded offense was neither considered nor instructed upon at the trial of the case.” 27 MJ at 79.
The Supreme Court has noted that a criminal conviction cannot be affirmed “on the basis of a theory not presented to the jury.” Chiarella v. United States, 445 U.S. 222, 100 S.Ct. 1108, 63 L.Ed.2d 348 (1980). However, the facts of that case show that the theory upon which evidence was presented and the jury was instructed was that the defendant had failed “to disclose material, non-public information” to the sellers of target corporate stock, id. at 236,100 S.Ct. 1108, whereas the Second Circuit had affirmed his conviction on the basis that “anyone ... who regularly receives material nonpublic information may not use [it] ... without incurring an affirmative duty to disclose.” Id. at 231, 100 S.Ct. 1108. The elements of that duty were never presented to the jury; thus, the Supreme Court reversed.
The case sub judice is far more like the military case, United States v. LaFontant, 16 MJ 236 (CMA 1983). In that case, LaFon-tant was convicted of attempted sale of LSD and possession of LSD, but the then-Court of Military Review (see 41 MJ 213, 229 n. *) found that they could approve only the finding of guilty of the attempted sale and only so much of the specification of possession “as ... [found] appellant guilty of an attempt to possess LSD at the time and place and in the amount alleged.” 16 MJ at 236. This Court affirmed stating: “That the members were not instructed on the elements of an attempt as they pertain to possession is of no conse-*422quenee since they found the accused guilty of the consummated possession of LSD, and then* finding necessarily included all the elements ‘of an attempt to possess LSD.”’ 16 MJ at 238.

4. The Manifest-Injustice Exception:

The manifest-injustice exception has been recognized in this Court. For instance, in my opinion concurring in the result in United States v. Grooters, I noted that “[t]he ‘law of the case’ doctrine ... does not apply if the decision below would create ‘manifest injustice,’ Dobbs v. Zant, 506 U.S. 357, 358, 113 S.Ct. 835, 122 L.Ed.2d 103 (1993).... ‘Manifest-injustice’ and ‘clearly erroneous’ are concepts equally applicable to decisions favoring the Government and to decisions favoring the defense.” 39 MJ 269, 274 (CMA 1994).
Even if this Court were to determine that the circumstances of this record require that the law-of-the-case doctrine apply here, surely this would be an appropriate case for applying the manifest-injustice exception based on appellant’s patent criminality. It would be a manifest injustice if a conviction initially established for premeditated murder and a life sentence, which was reduced once erroneously and then again on appeal, were to be reduced to nothing because of rigid adherence to a mere rule of practice: the law-of-the-case doctrine.
In addition, the record implies that the defense team did in fact get the same evidence before the members that they would have wanted the members to see had the defense pursued this theory of culpable negligence at trial and that the members only found it reduced her offense from premeditated to unpremeditated murder. The members initially found appellant guilty of the premeditated murder of her daughter. The defense erroneously urged the military judge to instruct the members that they could reconsider them findings, when, in fact, the members should not have had that opportunity. The defense counsel also reminded the members that they could still reconsider their findings during his argument on sentencing. The defense team provided the members with a copy of a letter from Dr. Raisani, the president of appellant’s sanity board, for consideration on sentencing. The members specifically noted that that letter “caused” them to reconsider their findings. As a result, they changed the sentence from mandatory life to a panel-imposed 25 years.
During an Article 39(a) session on sentencing instructions, individual defense counsel made the following observation in support of submitting Dr. Raisani’s letter to the members: “One of the biggest concerns in this court, one of the concerns in this court anyway has been Airman Riley’s failure to summon help. That failure to make any kind of notification could easily be seen by these members as aggravation. If we can’t attempt to explain a matter in aggravation, then Airman Riley’s rights to present extenuation and mitigation don’t mean much____ This is Dr. Raisani’s opinion as to what her state of mind was certainly leading up to that point.” (Emphasis added.) The members apparently thought Dr. Raisani made a compelling argument against life imprisonment. However, they did not find it so compelling that it required no confinement or even as little confinement as the trial counsel requested (a minimum of 20 years).

5. Pleadings-Elements Approach:

Finally, appellant argues that due process requires that the defendant be on notice of the charges against her, and that in the military, following a line of cases on multiplicity, that means not only that the offense be defined by statute, but also by the specifications. Final Brief at 9-10. It is important to note that this Court has never said that either the language of the specification or the elements of the statute take precedence in defining the offense. In United States v. Weymouth, 43 MJ 329, 333 (1995), for instance, this Court noted that the specification and the statute are read together to provide “notice of the essential elements of the offense.” The Court also noted that the function of this approach was “to inform the accused of the conduct charged, to enable the accused to prepare a defense, and to protect *423the accused against double jeopardy.” 43 MJ at 333.
In my opinion concurring in the result in United States v. Neblock, 45 MJ 191, 203 (1996), I noted that the multiplicity test is not as simple as all that, stating:
We follow the statutory-elements test: If the elements are different, one can presume, in the absence of clear congressional intent, that the offenses are not multipli-eious.
One cannot literally apply the statutory-elements test when examining offenses under Article 133 or 134,____ Thus, in examining those offenses, one must look at the elements in Part IV of the Manual. If the elements are the same, then one employs the pleadings-elements test----
(Citations omitted.) No matter which approach you take, there is no clear indication that appellant was uninformed of the misconduct with which she was charged or unable to prepare her defense or that she will be at risk of double jeopardy. This is similar to the variance test and is discussed in greater detail below.

C. Variance:

This Court has held that “even where there is a variance in fact, the critical question is one of prejudice.” United States v. Lee, 1 MJ 15, 16 (CMA 1975), citing United States v. Craig, 8 USCMA 218, 24 CMR 28 (1957); United States v. Hopf, 1 USCMA 584, 5 CMR 12 (1952). With regard to prejudice, the Court has established this two-part test: “(1) has the accused been misled to the extent that he has been unable adequately to prepare for trial; and (2) is the accused fully protected against another prosecution for the same offense.” 1 MJ at 16.
As noted above, appellant was on notice of what misconduct she was charged with and she was able to prepare an adequate defense. Also as noted above, she brought that same evidence which she alleged she would have brought under other circumstances before the members during the sentencing phase of the court-martial. And, because of the erroneous instruction that the members could reconsider their findings following presentation of that evidence, the members considered that evidence in reducing their finding of premeditated murder to unpremeditated murder. Thus, there was, in any event, no prejudice.
Appellant does not even bring up the double jeopardy part of the test. As the Lee opinion points out, it would not be applicable to the facts here anyway. The Court noted in Lee that “protection against double jeopardy can be predicated upon the evidence in the record of the prior prosecution. An examination of the evidence and the findings in this record demonstrates sufficient safeguards exist against another charge of wrongful possession of marijuana on the date involved____ Since the facts of record can readily be established, the second arm of the test for determining lack of prejudice is fully met.” 1 MJ at 17. The record here is similarly fact-explicit and sufficient to guard against a second prosecution.
In those cases where this Court has found a fatal variance, the circumstances have been far more blatant and the opinions have been fact-specific. For example, in United States v. Wray, 17 MJ 375 (CMA 1984), the accused was charged with larceny by the taking on August 6,1980; however, the members found him guilty of larceny by withholding on August 25,1980.
In addition, where the Supreme Court has found a variance which “offends the most basic notions of due process,” it has been because of a discrepancy between the basis upon which the Court of Appeals sustained a verdict and both the indictment and the proof at trial. See Dunn v. United States, 442 U.S. 100, 106, 99 S.Ct. 2190, 60 L.Ed.2d 743 (1979).

D. Sufficient Intervening Proximate Cause:

Appellant correctly notes that the medical-malpractice evidence presented by the defense could be considered as an intervening proximate cause for the lesser-included offenses of involuntary manslaughter and negligent homicide. See also United States v. Taylor, 44 MJ 254 (1996). However, I reject *424the argument that because the members returned a verdict first on premeditated murder and then on unpremeditated murder and therefore never reached the proximate-cause issue, that the Court of Criminal Appeals has denied appellant the right to have her verdict determined by the panel. By this reasoning, the Courts of Criminal Appeals could never substitute a lesser-included offense for the offense found at a court-martial; yet, this is a well-regarded principle of the military appellate process. See United States v. McKinley, 27 MJ 78.
Furthermore, appellant’s argument ignores the special factfinding powers of the Courts of Criminal Appeals. See Art. 66(c), UCMJ, 10 USC § 866(c) (1994). Despite appellant’s assertion to the contrary, Final Brief at 15 n. 4, there is evidence in the Court of Criminal Appeals’ opinion that it considered the evidence of medical malpractice, 47 MJ at 608 (“[W]e note that medical professionals also overlooked Airman Riley’s pregnancy on three occasions.”)

E. Legal Insufficiency:

The standard of review for legal insufficiency is “whether, considering the evidence in the light most favorable to the prosecution, a reasonable factfinder could have found all the essential elements beyond a reasonable doubt.” United States v. Turner, 25 MJ 324 (CMA 1987), citing Jackson v. Virginia, 443 U.S. 307, 319, 99 S.Ct. 2781, 61 L.Ed.2d 560 (1979).
Appellant argues that there was no evidence at trial that any of the three times a medical technician knocked on the bathroom door the baby was actually alive. Final Brief at 14. The Court of Criminal Appeals, however, detailed appellant’s culpability as follows:
Dr. Chengson began the process of providing care and assistance when he ordered the pregnancy test. That care remained present and available until the death of Airman Riley’s daughter. Airman Riley specifically turned that care and assistance away three separate times while she was in the restroom. In doing so, she acted as a wall between her child and the immediately available care that the child needed. These acts demonstrated a degree of carelessness greater than simple negligence and were accompanied by a culpable disregard for the foreseeable consequences.
47 MJ at 608. Thus, the three times that medical technicians knocked on that bathroom door are the primary acts of obstruction on which the affirmed conviction of involuntary manslaughter was based.
However, it should not be assumed that these are the only acts which led the court to its decision. In fact, her decision to leave the care begun by Dr. Chengson and to go into the bathroom to give birth could be considered an act of obstruction if it is believed that she knew she was in labor, without getting into why she did not summon help once she was in the bathroom and actually giving birth.
Despite this, the three knocks on the door are the primary acts with which we must be concerned. Viewing the evidence in the light most favorable to the prosecution, I note that there is evidence in the record from which a factfinder could find that the baby was alive one or more of those times.
First of all, there is the autopsy and the testimony of Dr. Krouse, the deputy chief medical examiner. Dr. Krouse indicated that one of the three ways he could determine that the baby girl was born alive was the “[f|resh umbilical stump with fresh underlying hemorrhage.” Appellant stated in her interview with Air Force and police investigators that she “ripped” the umbilical cord from the baby and “ripped” or “pulled” the placenta and cord from her uterus. Dr. Krouse testified that after death, there is “precious little hemorrhage” because “[y]ou have to have arterial blood pressure to get this kind of soft tissue hemorrhage.” Thus, the factfinder could find that the hemorrhage beneath the umbilicus had to have occurred before the baby girl was dead. And, given appellant’s statements to the investigators, this hemorrhage occurred before the afterbirth was naturally delivered.
Also, in response to a member’s question, Dr. Krouse responded that the baby was breathing less than 4 to 6 hours, but could *425give no more precise “estimate.” Appellant was in the bathroom for approximately 45 minutes. The first knock on the door was approximately 30 minutes after she had gone into the bathroom. Given the doctor’s estimate, the approximate time she was in the bathroom before the first technician knocked on the door, and the evidence of the baby’s hemorrhages, the factfinder could have found that the baby was alive at least when the first knock came.
Additionally, defense counsel made an effort to ask the medical personnel if they even tried to resuscitate the baby when they found her in the bag, approximately a half hour after appellant exited the bathroom. While the defense team clearly tried to imply that this was part of their medical-malpractice defense, the factfinder could infer that there might have been a chance to resuscitate the baby at some time between her birth and her discovery in the trashcan, especially when viewed in conjunction with Mrs. Fox’s testimony. Mrs. Fox was the chaperone who assisted Dr. O’Young. She testified that appellant asked her how long a baby could survive on its own. The factfinder could infer from that statement that the baby was still alive when appellant left the bathroom.
Furthermore, this Court has held that where “the evidence is sufficient to establish an included offense, this Court may affirm the included offense, provided that it does not do so on a theory not presented to the trier of fact.” United States v. Standifer, 40 MJ 440, 445 (CMA 1994). As noted in the discussion above, the affirmance here was on a theory amply covered at trial.
Thus, based on the evidence presented to the members, I would affirm appellant’s conviction for involuntary manslaughter. To do otherwise would result in a true miscarriage of justice.

. Defense counsel raised the possibility that appellant was in a state of psychological denial of her pregnancy; but they never raised any mental-defect-type defense. It was undetermined at trial whether she knew she was pregnant and just chose not to deal with it, hoping it would go away, or she had honestly convinced herself that all the changes in her body could not be related to a pregnancy.

. It is implied in his testimony that one of the files he studied at this time was that comprising the records of appellant’s visits to the hospital.