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People v. Abdoush10/20/2005
e "was a reasonable and direct causal connection between the injury and death and that intervening medical error, if there was any, is not available as a defense in this case because the wound was a mortal wound." (Appendix B, p 52.) Evidence was presented that defendant intentionally ran over the victim with his van while driving at a high rate of speed. The victim was lying facedown and struggling to breathe when emergency personnel arrived. As a result of being struck by defendant's van, the victim suffered multiple injuries, including facial fractures of the mandible and zygoma, other acute external and internal injuries to her face, a femur fracture, and injuries to the small and large intestines, bladder, and mesentery. The medical examiner, as well as Drs. Kravolich and Alkhafaji, indicated that the subsequent stroke that the victim suffered was a result of an internal carotid artery dissection.
Both the medical examiner, Dr. Kanulen, and plaintiff's expert, Dr. Kravolich, testified that a carotid artery dissection injury was consistent with the type of massive facial injuries the victim sustained from being struck by a van, particularly the fractured mandible. Dr. Kravolich further testified that a carotid artery dissection occurs in 1 out of 150 automobile accidents. He explained that the force of the van pushed the victim's head backward and stretched the carotid artery to the extent that it caused a dissection separation of the artery. He noted that the force is applied to the head, not the neck so "the most common clinical picture in someone with a blunt carotid injury is facial, head and face injuries, not direct trauma to the neck." He indicated that, although the victim was seemingly improving from the initial injuries and trauma, the stretching caused the formation of a flap in the artery that was not externally visible, and which continued to grow and eventually "plug off" the artery. Dr. Kravolich opined that, even if medical personnel had discovered the carotid artery injury, it was surgically inaccessible because of the location of the artery, which was "at a high level up behind the jaw."
Further, as noted by the trial court, both defendant's medical expert and plaintiff's medical expert unequivocally testified that, without medical treatment, the victim would have died from the injuries sustained from being struck by defendant's van. In particular, Dr. Kravolich testified that the victim would not have survived had emergency personnel not inserted an endrotracheal tube to assist her breathing, and that her blood loss would have also been fatal if left untreated. He further testified that, even with medical assistance, the victim could not have survived the carotid artery injury. Although Dr. Alkhafaji opined that the victim's carotid artery injury might have occurred as a result of an intervening medical error, he acknowledged that a dissection could occur over time and eventually become a complete occlusion. Dr. Alkhafaji further indicated that the victim suffered "fatal" injuries as a result of being struck by a van and, if left untreated, would not have survived more than six to eight hours. From this testimony, viewed in a light most favorable to the prosecution, a rational trier of fact could reasonably infer that defendant inflicted a mortal wound on the victim, and that there is a reasonable and direct causal connection between his actions and the victim's death.
Furthermore, the evidence supports the trial court's conclusion that, even if the victim's injuries could be considered nonfatal, there was no evidence to support a finding that grossly erroneous medical treatment caused the victim's death. "If thoroughly and extraordinarily incompetent medical car
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