State of New York OPINION Court of Appeals This opinion is uncorrected and subject to revision before publication in the New York Reports.
No. 74 The People &c., Respondent, v. Yoselyn Ortega, Appellant.
Abigail Everett, for appellant. Dana Poole, for respondent. The Innocence Project; District Attorneys Association of the State of New York, amici curiae.
SINGAS, J.:
At issue in this case is whether the admission of two autopsy reports through an
expert witness who did not perform the autopsies, as well as that witness’s testimony,
violated defendant’s Sixth Amendment right to confrontation where defendant had not -1- -2- No. 74
been given a prior opportunity to cross-examine the performing medical examiner. We
hold that the admission of those reports and the expert witness’s testimony violated
defendant’s constitutional right to confrontation, but conclude that the error was
nevertheless harmless.
I.
In October 2012, defendant Yoselyn Ortega was employed as a nanny by a family
living in Manhattan and entrusted with the care of three young children. On October 25,
2012, defendant brought two of those children, aged two and six, into a bathroom of their
Upper West Side home where she repeatedly stabbed them, thereby killing them.
Defendant was charged with two counts of murder in the first degree and two counts of
murder in the second degree. During defendant’s 2018 trial, she conceded that she had
killed the two children but asserted a defense of not guilty by reason of insanity (see Penal
Law § 40.15).
The autopsy reports of the two victims were admitted into evidence at trial through
the People’s witness, Dr. Susan Ely of the New York City Office of Chief Medical
Examiner (OCME). Dr. Ely did not perform either autopsy, nor was she present when the
autopsies were conducted. Still, after a review of the autopsy reports, dictation tapes, and
autopsy photographs, Dr. Ely testified to the number, type, and pattern of the victims’
wounds, as well as to the cause and manner of death of each child. The autopsies were
performed, and the reports created, by Dr. James A. Hayes of OCME. It is undisputed that
defendant lacked the prior opportunity to cross-examine Dr. Hayes regarding these reports.
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Though the entirety of each report was available to the jury, the jury only viewed
seven diagrams of the decedents’ bodies. These diagrams were displayed during Dr. Ely’s
testimony. Three of the diagrams depicted the outline of a generic human body, with
indications of where the victims sustained stab wounds. The other diagrams narrowed in
on the victims’ necks and the six-year-old victim’s hands. On each diagram, Dr. Hayes
had drawn the location of the victims’ wounds and annotated these markings with
descriptions of the size, location, and type of the respective wound. During jury
deliberations, the jury requested to inspect the diagrams of the six-year-old victim’s body;
the jury did not request to view any other material from the autopsy reports.
Defendant objected to the admission of each autopsy report and Dr. Ely’s testimony
on the ground that they violated her constitutional right to confront the individual that
conducted the autopsies. Supreme Court overruled defendant’s objections. The jury
ultimately found defendant guilty of two counts of murder in the first degree and two counts
of murder in the second degree. The Appellate Division dismissed the two counts of
murder in the second degree as “inclusory concurrent counts of the first-degree murder
counts” and otherwise affirmed the judgment (202 AD3d 489, 492 [1st Dept 2022]). The
Court agreed with Supreme Court that the admission of the autopsy reports through Dr.
Ely did not violate defendant’s right to confrontation, concluding that the reports were not
testimonial because they “ ‘[did] not link the commission of the crime to a particular
person’ ” (id. at 491, quoting People v John, 27 NY3d 294, 315 [2016], and citing People
v Freycinet, 11 NY3d 38, 42 [2008]). Regardless, the Court determined that “any error
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was harmless under the standards for constitutional error” (id. at 492, citing People v
Crimmins, 36 NY2d 230 [1975]). A Judge of this Court granted defendant leave to appeal
(38 NY3d 1073 [2022]).
II.
A.
The Sixth Amendment of the Federal Constitution provides that “[i]n all criminal
prosecutions, the accused shall enjoy the right . . . to be confronted with the witnesses
against [them]” (US Const Amend VI). Pursuant to this Confrontation Clause, a witness’s
out-of-court “testimonial” statement may only be admitted for its truth where the witness
appears at trial or, if the witness is unavailable for trial, where the defendant has had a prior
opportunity to cross-examine that witness (Crawford v Washington, 541 US 36, 68 [2004]).
In Crawford, the United States Supreme Court defined “testimony” as “[a] solemn
declaration or affirmation made for the purpose of establishing or proving some fact” (id.
at 51 [internal quotation marks omitted]). The Court provided several examples of the
“core class of ‘testimonial’ statements” but acknowledged that “[v]arious formulations . .
. exist” (id.). These formulations include, as relevant here, “statements that were made
under circumstances which would lead an objective witness reasonably to believe that the
statement would be available for use at a later trial’ ” (id. at 51-52 [internal quotation marks
omitted]).
This Court had occasion to consider the impact of Crawford and its progeny on the
admission of autopsy reports in Freycinet, where it held that a redacted autopsy report was
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not testimonial for purposes of the Confrontation Clause (11 NY3d at 39). In reaching this
conclusion, the Court evaluated four purported “indicia of testimoniality”: (1) “the extent
to which the entity conducting the procedure is an arm of law enforcement”; (2) “whether
the contents of the report are a contemporaneous record of objective facts”; (3) “whether a
pro-law-enforcement bias is likely to influence the contents of the report”; and (4) “whether
the report’s contents are directly accusatory in the sense that they explicitly link the
defendant to the crime” (id. at 41 [internal quotation marks and citations omitted]). All
four factors, the Court concluded, weighed in the People’s favor and thus, the autopsy
report at issue was not testimonial (id. at 42).
Though the United States Supreme Court has never considered the testimonial
nature of autopsy reports, the Court did address the testimonial nature of forensic reports
in a trilogy of cases that inform our analysis here. Shortly after Freycinet, the Supreme
Court decided Melendez-Diaz v Massachusetts, in which the Court brought forensic reports
directly within the ambit of the Confrontation Clause (557 US 305 [2009]). In that case,
the Court considered whether sworn “certificates of analysis” were testimonial where the
certificates concluded that a substance recovered from the petitioner was cocaine and
further established the weight of that substance (id. at 308-309). The Court held that the
certificates were testimonial because they were affidavits—“a solemn declaration or
affirmation made for the purpose of establishing or proving some fact”—and the affidavits
were “made under circumstances which would lead an objective witness reasonably to
believe that the statement would be available for use at a later trial” (id. at 310-311, quoting
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Crawford, 541 US at 51, 52 [internal quotation marks omitted]). In fact, the Court stated,
“under Massachusetts law the sole purpose of the affidavits was to provide prima facie
evidence of the composition, quality, and the net weight of the analyzed substance” (id. at
311 [emphasis and internal quotation marks omitted]). Further, the certificates were
“functionally identical to live-in-court testimony, doing ‘precisely what a witness does on
direct examination’ ” (id. at 310-311, quoting Davis v Washington, 547 US 813, 830
[2006]). As such, the “affidavits were testimonial statements, and the analysts were
‘witnesses’ ” within the meaning of the Confrontation Clause (id. at 311). “Absent a
showing that the analysts were unavailable to testify at trial and that petitioner had a prior
opportunity to cross-examine them, petitioner was entitled to ‘be confronted with’ the
analysts at trial” (id., quoting Crawford, 541 US at 54 [internal quotation marks omitted]).
The Supreme Court emphasized that forensic evidence “is not uniquely immune
from the risk of manipulation,” particularly by law enforcement, nor is it insulated from
the possibility of incompetence (id. at 318-319). The Court observed that “there is wide
variability across forensic science disciplines with regard to techniques, methodologies,
reliability, types and numbers of potential errors, research, general acceptability, and
published material” (id. at 320-321 [internal quotation marks omitted]). These issues
“might be explored on cross-examination” and “there is little reason to believe that
confrontation will be useless in testing analysts’ honesty, proficiency, and methodology”
(id. at 320).
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Two years later in Bullcoming v New Mexico, the Supreme Court held that an
unsworn forensic laboratory report certifying that a sample of the defendant’s blood had
an alcohol concentration above the legal limit was testimonial (564 US 647 [2011]). The
report was materially similar to that in Melendez-Diaz—law enforcement had provided the
sample “to a state laboratory required by law to assist in police investigations” and the
report was sufficiently “formalized” (id. at 664-665 [internal quotation marks omitted]).
Thus, as in Melendez-Diaz, the “certificate” concerning the testing results was “made for
the purpose of establishing or proving some fact in a criminal proceeding” (id. at 663-664
[internal quotation marks omitted]).
The report was introduced into evidence through an analyst who did not perform or
observe the gas chromatograph test on the defendant’s blood sample. This “surrogate
testimony,” the Court concluded, did “not meet the constitutional requirement” (id. at 652).
The Court rejected the characterization of the performing analyst as a “mere scrivener” of
results “generated by the gas chromatograph machine” because the analyst’s statements in
the report “relat[ed] to past events and human actions not revealed in raw, machine-
produced data” (id. at 659 [internal quotation marks omitted]). The testifying witness could
not convey what “particular test and testing process” was employed, nor “expose any lapses
or lies” on the testing analyst’s part (id. at 661-662). Additionally, the testifying witness
did not offer “any independent opinion concerning” the defendant’s blood alcohol
concentration (id. at 662 [internal quotation marks omitted]).
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In a fractured opinion one year after Bullcoming, the Supreme Court held that an
expert witness’s testimony regarding a DNA profile developed from semen found on a rape
victim’s vaginal swabs did not violate the Confrontation Clause even though the witness
did not perform the DNA testing or construct the DNA profile (Williams v Illinois, 567 US
50 [2012]). The plurality offered two bases for its holding. First, the plurality asserted that
the DNA profile was not offered for the truth of the matter asserted and thus, was not a
testimonial statement (id. at 57-58). Alternatively, the plurality determined that the DNA
report was not testimonial because the report was created before a suspect was identified,
the report’s primary purpose was not to “obtain[ ] evidence to be used against petitioner”
but to assist in “finding a rapist who was on the loose,” and the DNA profile itself was not
“inherently inculpatory” (id. at 58). Justice Thomas, in a concurrence, disagreed with both
rationales of the plurality but would have held that the DNA report was not testimonial
because it lacked “the solemnity of an affidavit or deposition” (id. at 111 [Thomas, J.,
concurring]). Therefore, while five Justices agreed that the DNA report was not
testimonial, no rationale garnered a majority vote and Williams accordingly offers little
guidance to our analysis (see Marks v United States, 430 US 188, 193 [1977]).
Other federal courts have considered the testimonial nature of autopsy reports (see
e.g. United States v Ignasiak, 667 F3d 1217 [11th Cir 2012]; Nardi v Pepe, 662 F3d 107
[1st Cir 2011]; United States v Williams, 740 F Supp 2d 4 [DC Cir 2010]). Of particular
relevance here is the Second Circuit’s opinion in Garlick v Lee (1 F4th 122 [2d Cir 2021]).
On a petition for writ of habeas corpus, the court rejected a First Department decision that
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deemed an autopsy report non-testimonial in reliance on Freycinet and determined that the
autopsy report was testimonial (id. at 134). In that case, “[t]he autopsy was performed in
aid of an active police investigation” and “[t]he circumstances under which the autopsy
report was created would lead any objective witness to ‘believe that the [report] would be
available for use at a later trial’ ” (id., quoting Crawford, 541 US at 52). Further, the court
deemed the report “ ‘[a] solemn declaration or affirmation made for the purposes of
establishing or proving some fact’ ” (id., quoting Crawford, 541 US at 52). Applying
“clearly established Supreme Court precedent,” the Second Circuit rejected this Court’s
rationale in Freycinet (id. at 136).
We agree that Freycinet’s four-part framework for determining the testimonial
nature of evidence does not survive Melendez-Diaz and Bullcoming. First, the Supreme
Court in Melendez-Diaz made explicit that a statement need not be inherently inculpatory
or “directly accuse” a defendant of wrongdoing to be considered testimonial (Melendez-
Diaz, 557 US at 313). To the extent that the Williams plurality sought to establish such a
litmus test for out-of-court statements, five Justices expressly rejected that approach (see
Williams, 567 US at 114-117 [Thomas, J., concurring], 135-136 [Kagan, J., dissenting]).
Freycinet’s consideration of “whether the contents of the report are a contemporaneous
record of objective facts” also fails under Supreme Court scrutiny (11 NY3d at 42). That
a forensic report records “near-contemporaneous observations” of the test or procedure
does not shield it from the Confrontation Clause’s protections (Melendez-Diaz, 557 US at
315).
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Finally, the two factors of Freycinet that consider the witness’s independence from
law enforcement and their susceptibility to a “pro-law-enforcement bias” must similarly
fall (see Freycinet, 11 NY3d at 41). The Melendez-Diaz Court specifically rejected the
argument that statements “prone to distortion or manipulation” and those that are the
“resul[t] of neutral, scientific testing” should be treated any differently for purposes of the
Sixth Amendment (id. at 317-318). The reliability of an out-of-court statement has no
effect on the testimonial nature of that statement, for the Confrontation Clause “
‘commands, not that evidence be reliable, but that reliability be assessed in a particular
manner: by testing in the crucible of cross-examination’ ” (id. at 317, quoting Crawford,
541 US at 61). The Supreme Court again rejected this argument in Bullcoming where the
respondent asserted that the analyst’s statements “were simply observations of an
independent scientis[t] made according to a non-adversarial public duty” (Bullcoming, 564
US at 664 [“That argument fares no better here than it did in Melendez-Diaz”]). The
performing analyst “must be made available for confrontation even if they possess ‘the
scientific acumen of Mme. Curie and the veracity of Mother Teresa’ ” (id. at 661, quoting
Melendez-Diaz, 557 US at 319-320 n 6).
We now hold that Freycinet should no longer be followed because it is inconsistent
with the demands of the Confrontation Clause as articulated more recently by the Supreme
Court.
B.
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Turning now to the autopsy reports at issue here, we hold that the reports are
testimonial under established Supreme Court precedent. The reports are “solemn
declaration[s] or affirmation[s] made for the purpose of establishing or proving some fact”
(Crawford, 541 US at 52), namely the homicidal nature of these victims’ deaths. Further,
the reports contain indicia of formality that render them “solemn declaration[s] or
affirmation[s]” (Crawford, 541 US at 52). Both reports, labeled with the formal title of
“REPORT OF AUTOPSY,” bear the official OCME seal. Both reports include a signed
and dated certification that Dr. Hayes performed the autopsies. Specifically, the
certification, as it pertains to the autopsy performed on the six-year-old victim, reads:
“I hereby certify that I, John A. Hayes, M.D., City Medical Examiner – II, have performed an autopsy on the body of [the six-year-old victim] on the 26th day of October, 2012, commencing at 8:30 a.m., in the Manhattan Mortuary of the Office of Chief Medical Examiner of the City of New York. This autopsy was performed in the presence of Drs. Graham, Stahl-Herz and Vincent.”
The certification for the two-year-old victim’s autopsy is functionally identical. Finally,
the results of each autopsy were formalized on an introductory page bearing the name of
the performing examiner, the date on which the autopsies were conducted, and the “M.E.
Case” number.
The reports were also created “under circumstances which would lead an objective
witness reasonably to believe that the statement[s] would be available for use at a later
trial” (id.). The tragic condition of the bodies alone was indication enough to Dr. Hayes
that these autopsy reports would have been available one day for use in a criminal
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prosecution. Additionally, the autopsy reports do not merely state the location and size of
wounds; instead, they repeatedly mention that the children were killed and that they were
killed by defendant. The autopsy report of the six-year-old victim contained a
“SUPPLEMENTAL CASE INFORMATION” page which provided that the deceased died
“as a result of injuries caused by multiple stab wounds inflicted . . . by the nanny of the
children.” The autopsy report for the two-year-old victim also contained a
“SUPPLEMENTAL CASE INFORMATION” page which stated that the victim died “as
a result of injuries caused by three stab wounds inflicted to the neck of the decedent by the
nanny of the children.” Both reports acknowledged an open investigation and noted the
name of the assigned New York Police Department detective. The reports further stated
that, according to the assigned detective, “the exact circumstances of how or why the
decedents were stabbed by the live-in nanny [were] unclear” at the time of the autopsies.
Moreover, OCME was required by law to deliver “all records pertaining to” these
deaths to the New York County District Attorney’s Office because there was an “indication
of criminality” (NY City Charter § 557 [g]). Dr. Hayes, aware of his legal obligation to
report his findings to the District Attorney, should have reasonably believed that these
reports that he created could be used in a criminal prosecution. Because these autopsy
reports are testimonial and defendant was not given the opportunity to cross-examine the
performing medical examiner, the admission of the reports through an examiner who had
not performed the autopsies and did not create these reports violated defendant’s Sixth
Amendment right of confrontation. While some autopsies conducted under different
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circumstances may produce reports that do not rise to the level of testimoniality, that is
simply not the case here.
C.
It is clear that “we may not disregard [the Confrontation Clause] at our convenience”
(Melendez-Diaz, 557 US at 325), even where it has “the effect of allowing the guilty to go
free” (Davis v Washington, 547 US 813, 833 [2006]). It is also the case, however, that the
Confrontation Clause does not entirely preclude the use of information contained in
testimonial autopsy reports. The Supreme Court suggested an “independent analysis”
standard in Bullcoming (see 564 US at 662 [“Nor did the State assert that [the testifying
analyst] had any ‘independent opinion’ concerning Bullcoming’s BAC”]).
More recently, this Court in People v John, holding that a DNA report was
testimonial, explicitly delineated the circumstances in which expert analysts could testify:
“any analyst who witnessed, performed or supervised the generation of [a] defendant’s
DNA profile, or who used his or her independent analysis on the raw data” could testify in
satisfaction of the Confrontation Clause (27 NY3d at 315). Of course, autopsies and DNA
testing are hardly neat forensic parallels. DNA testing relies on computer-generated
information whereas autopsies involve, almost exclusively, “the skill, methodology, and
judgment of . . . highly trained examiners” without the aid of computer software (Ignasiak,
667 F3d at 1232). DNA testing may be repeated until the sample has been expended.
Autopsies necessarily carry a certitude of finality. Once a body has undergone an invasive
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examination and been returned to loved ones, there is rarely an opportunity to do any
confirmatory examination.
Though there are these critical differences between DNA testing and autopsies, we
find it appropriate to look to John to inform the standard here. Importing that approach,
we hold that an expert medical examiner may offer conclusions as to the cause and manner
of death, and surrounding circumstances, where that testifying expert performed,
supervised, or observed the autopsy or used their independent analysis on the primary data
(see State v Navarette, 294 P3d 435, 443, 2013-NMSC-003 [NM 2013].
Under New York’s evidentiary rules, a testifying expert may rely on inadmissible
hearsay material “if it is of a kind accepted in the profession as reliable in forming a
professional opinion” (People v Goldstein, 6 NY3d 119, 124 [2005], quoting People v
Sugden, 35 NY2d 453, 460 [1974]), so long as there is “evidence establishing the reliability
of the out-of-court material” (Hambsch v New York City Tr. Auth., 63 NY2d 723, 726
[1984]). While our evidentiary rules would permit an expansive foundation for expert
testimony from medical examiners, the more difficult question is which of these materials
a testifying expert may rely upon to meet the demands of the Confrontation Clause.
Autopsy files contain a variety of materials, such as autopsy reports, diagrams,
photographs, dictation tapes, microscopic slides, crime scene evidence, and more, which
are materials frequently relied upon by testifying medical examiners (see Commonwealth
v Reavis, 465 Mass 875, 883, 992 NE2d 304, 311-312 [2013]; see also Mahdavi v State,
2020 OK CR 12, 478 P3d 449 [2020]; Commonwealth v Brown, 646 Pa 396, 185 A3d 316
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[2018]; State v Bass, 224 NJ 285, 132 A3d 1207 [2016]; State v Joseph, 230 Ariz 296, 283
P3d 27 [2012]; State v Kennedy, 229 W Va 756, 735 SE2d 905 [2012]). Autopsy
photographs and video recordings of a conducted autopsy may properly be relied upon by
a testifying witness reaching their own independent conclusions. Further, standard
anatomical measurements devoid of the subjective skill and judgment of the performing
examiner constitute primary data upon which an expert may rely.
Here, we cannot be certain that any of Dr. Ely’s conclusions were based on her
independent review of primary data because such evidence was not elicited by the People.
At times during her testimony, Dr. Ely appeared to be reading from the displayed diagrams
or the autopsy reports themselves. Indeed, Dr. Ely provided details and language that was
entirely identical to that in Dr. Hayes’s reports.
At other times, however, Dr. Ely offered what appeared to be independent
conclusions. Specifically, two pieces of Dr. Ely’s testimony do not appear in the autopsy
reports and thus, at first glance, seem to be her conclusions alone: that the six-year-old
victim struggled against the attacker and that there was a reasonable possibility that the
perpetrator stood behind the two-year-old victim when the major neck wound was inflicted.
But the People failed to elicit testimony which would allow us to definitively say on which
materials within the autopsy files Dr. Ely based these conclusions. Dr. Ely testified that
the pattern of the wounds, the number of wounds, the placement of the wounds on the six-
year-old victim’s hands, and the “gaping” nature of certain wounds on the victim’s torso
led her to conclude that the victim was conscious and fighting against the attacker during
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the incident. We are unable to discern whether Dr. Ely based this conclusion on Dr.
Hayes’s various conclusions, such as his characterizations of some stab wounds as
“gaping” and the grouping and orientation of the varying wounds, or on an independent
analysis of permissible primary data, such as the photographs’ objective depiction of the
wounds and their patterning. As to the second conclusion, Dr. Ely based her finding on
the fact that the two-year-old’s neck wound was deeper on one side than the other. Again,
it is unclear from the record whether she impermissibly based this testimony on Dr. Hayes’s
conclusion that the stab wounds on the right side of the neck were superficial while the
wound on the left side of the neck was “gaping” and “deeper” than the right side or on the
primary data.
Nearly all of Dr. Ely’s testimony was the type of “surrogate testimony” rejected by
the Supreme Court in Bullcoming (see 564 US at 661) in that Dr. Ely simply “parrot[ed]”
the autopsy reports (see John, 27 NY3d at 309). We do not suggest that agreement between
the testifying expert and the performing examiner is itself impermissible. Rather, it is the
People’s obligation to establish that their testifying experts, who did not perform or observe
the relevant autopsy, reached their conclusions themselves based upon a review of the
proper materials rather than the conclusions of the performing examiner. Where the People
fail to do so, we cannot be sure that a defendant’s Sixth Amendment right has been
safeguarded. As for the rest of Dr. Ely’s testimony, we simply cannot tell whether it
reflected her own deliberate, interpretative work product based on the primary data. We
thus conclude that all of Dr. Ely’s testimony was improper under the Sixth Amendment.
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III.
Though defendant’s constitutional right to confrontation was violated by the
admission of the autopsy reports and Dr. Ely’s testimony, that error was harmless beyond
a reasonable doubt and does not mandate reversal (see Crimmins, 36 NY2d at 237). Under
the harmless error standard, this Court must first consider whether the evidence of a
defendant’s guilt is overwhelming (see People v Mairena, 34 NY3d 473, 484 [2019]). If
the proof was overwhelming, we must then consider whether “ ‘there is [a] reasonable
possibility that the error might have contributed to defendant’s conviction’ ” (id. at 485,
quoting Crimmins, 36 NY2d at 237). Because defendant did not dispute that she caused
the death of the victims but raised a defense of not guilty by reason of insanity, the harmless
error analysis must be conducted accordingly (see e.g. Goldstein, 6 NY3d at 130; People v
Maher, 89 NY2d 456, 462 [1997]; see also Ortega, 202 AD3d at 492 [“Nothing in the
autopsy report had any bearing on defendant’s defenses of insanity and lack of intent”]).
Here, we agree with the Appellate Division that the evidence of defendant’s guilt was
overwhelming and the error in admitting the autopsy reports and allowing Dr. Ely’s
improper testimony did not contribute to defendant’s conviction. Defendant argues that
the testimony regarding the six-year-old victim’s self-defense likely impacted the jury’s
view of the insanity defense. We disagree. The children’s reactions to defendant’s attack
and whether they defended themselves are entirely unrelated to whether defendant “lacked
substantial capacity to know or appreciate [t]he nature and consequences” of her actions
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(see Penal Law § 40.15 [1]). In sum, the autopsy reports and Dr. Ely’s testimony had little
to no bearing on defendant’s insanity defense.
We have reviewed defendant’s remaining contentions and conclude that they do not
provide grounds for reversal.
Accordingly, the order of the Appellate Division should be affirmed.
Order affirmed. Opinion by Judge Singas. Chief Judge Wilson and Judges Rivera, Garcia, Cannataro, Troutman and Duffy concur. Judge Halligan took no part.
Decided November 20, 2023
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