Tomlin v. Commonwealth

Supreme Court of Virginia·Decided June 29, 2023·No. 220223·Published

Opinion

PRESENT: Goodwyn, C.J., Powell, Kelsey, McCullough, Chafin, and Mann, JJ., and Lemons, S.J.

CATHERINE ANN TOMLIN OPINION BY

v. Record No. 220223 JUSTICE D. ARTHUR KELSEY JUNE 29, 2023

COMMONWEALTH OF VIRGINIA

FROM THE COURT OF APPEALS OF VIRGINIA Catherine Ann Tomlin left her 80-year-old mother in a squalid condition lying on the floor of her apartment for at least two days, resulting in her mother’s need for emergency medical care and hospitalization. The trial court convicted Tomlin of abuse or neglect of an incapacitated adult causing serious injury in violation of Code § 18.2-369(B). The Court of Appeals affirmed the conviction, as do we.

I.

“When presented with a sufficiency-of-the-evidence challenge in criminal cases, we review the evidence in the ‘light most favorable’ to the Commonwealth, the prevailing party in the trial court.” Commonwealth v. Barney, 302 Va. ___, ___, 884 S.E.2d 81, 88 (2023) (quoting Commonwealth v. Hudson, 265 Va. 505, 514 (2003)). “Viewing the record through this evidentiary prism requires us to ‘discard the evidence of the accused in conflict with that of the Commonwealth, and regard as true all the credible evidence favorable to the Commonwealth and all fair inferences to be drawn therefrom.’” Commonwealth v. Perkins, 295 Va. 323, 324 (2018) (citations omitted).

On April 24, 2020, an exterminator called 911 after he arrived at the Tomlin home to treat a bed-bug infestation and saw that Betty Tomlin, the defendant’s mother, needed urgent medical attention. He told the dispatcher that she was “in pretty bad shape” and was “being eat[en] up with bed bugs.” Def.’s Ex. A at 0:25 to 0:40.

First responder and firefighter Andy Tanner arrived shortly thereafter with another firefighter, and they entered the home where they found Betty lying on the floor just inside the door. Tomlin was standing nearby in the kitchen. Betty was “on her left side covered in feces and urine” with “what looked to be bed bugs crawling on her.” J.A. at 32. She had visible bug bites on her legs, and there was excrement on her nightgown and the floor nearby. Id. Tanner asked Tomlin how long her mother had been lying there, and she said, “about two days.” Id. at 34. When Tanner asked Tomlin why she hadn’t cleaned her mother up, she said, “I do not have time.” Id. After removing her clothing and Depends, which were “well over saturated” with “urine and feces,” the firefighters wrapped her in a sheet and transferred her to the ambulance. Id. at 32, 34.

At the emergency room, Physician Assistant Tyler Prewett treated Betty. When she came into the emergency room, she was “highly disheveled” and had “a very uncommonly large amount of feces on her, [as] well [as] urine.” Id. at 47. She was wrapped in a bed sheet, and “there [were] bed bugs about her person that fell to the floor.” Id. Prewett observed that Betty had multiple decubitus ulcers, or bedsores, on her legs and below her buttocks. Based on her condition, he believed that Betty needed medical care “immediately.” Id. at 67.

At trial, Prewett explained that a bedsore is dangerous because it is an “open sore[] on the body” or “skin breakdown” to the point of the skin being “actually broken open.” Id. at 50. Such ulcers are “generally often quite painful” and create “a huge nest for bacteria which can lead to concomitant or super infection” from which “you can get a skin infection called cellulitis.” Id. Cellulitis “can be deadly if not treated fairly rapidly.” Id. A bedsore is more concerning than a cut, Prewett explained, because the “possibility for infection to enter is greater,” as the wound is “much wider” and the “skin breakdown is larger” than with a cut. Id. at 68. Cellulitis is the “primary way” a bedsore can “become fatal.” Id. at 51.

Prewett clarified that he is “not [a] wound specialist[],” id. at 48, and without using the “official grading system by a wound care specialist,” id. at 54, he would generally describe most of Betty’s wounds as moderate ulcers. But some of these ulcers were “not anywhere near as serious as the others.” Id. at 76. One or more of the more severe ulcers, Prewett said, was “at least a moderate grade” of ulcer. Id. at 58 (emphasis added). He made a “conservative” estimate that Betty’s wounds had taken at least one week “at a minimum” to develop. Id. at 50. The more severe ulcers would have taken longer than a week to develop and had more likely been “present for at least three weeks.” Id. at 75.

Prewett described two of the ulcers as particularly “worrisome, from a medical perspective,” because they were “of a bigger depth.” Id. at 58. These ulcers had “broken the dermis and [were] approaching the fascia,” which is “the fat underneath the skin tissue.” Id. This is an indication of “at least a moderate grade ulcer” and “not a superficial ulcer.” Id. (emphasis added). Another ulcer he described as smaller in size but similar in depth. This ulcer was also “concerning” because of the redness around it. Id. at 58-59. The redness was potentially an indication of “early cellulitis, which means an infection of the skin.” Id. This wound was “certainly an advancing ulcer, if not skin infection.” Id. at 59.

While Prewett did not believe Betty was at risk of “imminent death,” id. at 66, he did believe that death was a risk if she did not receive proper medical care. During cross- examination, Prewett clarified his position:

Q. Okay. You didn’t feel a need to report to anyone that we really need to get on this right now because she might die?

A. We need to get on this because if this was to go untreated . . .

Q. We need to address these moderate ulcers because she might die.

A. Correct.

Q. You did not say anything like that and that was not the case?

A. Oh no, I do believe those ulcers would need to be, if proper medical care was administered that would need to be started immediately, proper medical care.

Id. at 67. Counsel then attempted to cabin Prewett’s answer by asking, “Would you think the

same if she actually had just cut her finger a little bit because of a splinter? Infection can certainly come in and that could also kill her, right?” Id. at 67-68. Prewett disagreed: “Most cuts, technically no. I’d be more concerned about this ulcer than I would be for a cut.” Id. at 68. The “difference between a cut and the ulcer,” Prewett opined, is that ulcers have a higher risk of infection than cuts. Id.

Betty’s condition was worsened, Prewett added, because of the “amount of stool and urine that she was covered in, essentially from head to toe.” Id. at 60. It was “stuck to her body,” id., and covered approximately “50% of [the] surface area” of her skin, id. at 69. Prewett explained that the “feces and urine [had gone] a long way to exacerbate” the condition of Betty’s ulcers. See id. at 79. Prewett also expressed concern with Betty’s apparent unawareness of her condition. Anyone who has reached that level of confusion could have suffered from “an infection that has caused her brain to not think correctly or a stroke,” among other conditions. Id. at 61. Because Betty’s bedsores needed treatment and could not “go on in the condition [they were] in,” Prewett recommended that Betty be admitted to the hospital. Id. at 72.

The Commonwealth charged Tomlin under Code § 18.2-369(B) with abuse or neglect of an incapacitated adult resulting in serious bodily injury. 1 At a one-day bench trial, the court heard testimony from the first responder, the physician assistant, and the social worker who had investigated numerous complaints regarding Tomlin leading up to Betty’s hospitalization. The

1 Tomlin was also charged with and convicted of financial exploitation of an incapacitated adult under Code § 18.2-178.1. The Court of Appeals vacated the conviction on this count. Only the decision to affirm the neglect conviction is before us on appeal, so we have limited our discussion accordingly.

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