STATE OF NEW JERSEY VS. RICHARD S. RANDAZZO (13-03-1026, CAMDEN COUNTY AND STATEWIDE) (RECORD IMPOUNDED) ( 2019 )


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  •                                       RECORD IMPOUNDED
    NOT FOR PUBLICATION WITHOUT THE
    APPROVAL OF THE APPELLATE DIVISION
    This opinion shall not "constitute precedent or be binding upon any court." Although it is posted on the
    internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3.
    SUPERIOR COURT OF NEW JERSEY
    APPELLATE DIVISION
    DOCKET NO. A-0407-16T4
    STATE OF NEW JERSEY,
    Plaintiff-Respondent,
    v.
    RICHARD S. RANDAZZO,
    Defendant-Appellant.
    _____________________________
    Submitted February 11, 2019 – Decided March 14, 2019
    Before Judges Fasciale, Gooden Brown and Rose.
    On appeal from Superior Court of New Jersey, Law
    Division, Camden County, Indictment No. 13-03-1026.
    Joseph E. Krakora, Public Defender, attorney for
    appellant (Margaret R. McLane, Assistant Deputy
    Public Defender, of counsel and on the briefs).
    Gurbir S. Grewal, Attorney General, attorney for
    respondent (Arielle E. Katz, Deputy Attorney General,
    of counsel and on the brief).
    PER CURIAM
    A grand jury indicted and charged defendant with committing first-degree
    murder, N.J.S.A. 2C:11-3(a)(1) and (2) (Count One); two counts of second-
    degree endangering the welfare of a child, N.J.S.A. 2C:24-4(a) (Counts Two and
    Four); and third-degree aggravated assault, N.J.S.A. 2C:12-1(b)(7) (Count
    Three). On Count One, the jury found him guilty of second-degree reckless
    manslaughter, N.J.S.A. 2C:11-4(b)(1). They found him guilty on Counts Two
    and Four (for offenses committed on different dates), and acquitted him on
    Count Three. We affirm.
    The victim in this case was defendant's two-month-old daughter. She
    sustained fractures to her left upper arm, legs, and fifth rib, stopped breathing,
    and went into cardiac arrest. An ambulance took her to the hospital and four
    days later, the doctors removed her from life support and she died. During those
    four days, she had suffered from internal bleeding; swelling and a subdural
    hemorrhage of the brain; fluid in her lungs; seizures; and massive retinal
    hemorrhages.
    The police asked defendant and his wife, who was not home when the
    injuries occurred, to give statements. They arrived at the police station for that
    purpose, and while defendant was giving his statement, the police received
    information from a doctor that the victim's injuries were consistent with abuse.
    A-0407-16T4
    2
    After the police conveyed that information to defendant, he then admitted that
    what he had said up to that point was a lie. He explained that he had killed his
    daughter, but that it was an accident.
    On appeal, defendant argues:
    POINT I
    BECAUSE    THE  POLICE   OBTAINED                    A
    CONFESSION   ONLY   AFTER  LYING                   TO
    DEFENDANT BY SPECIFICALLY TELLING                 HIM
    HE WAS REQUIRED TO EXPLAIN THAT                    HIS
    DAUGHTER'S DEATH WAS ACCIDENTAL,                  THE
    STATEMENT MUST BE SUPPRESSED.
    POINT II
    THE MOTION FOR A JUDGMENT OF ACQUITTAL
    ON ENDANGERING SHOULD HAVE BEEN
    GRANTED BECAUSE THE STATE FAILED TO
    PRESENT ANY EVIDENCE THAT DEFENDANT
    CAUSED THE RELEVANT INJURY.
    POINT III
    THE EVIDENCE OF HEALING FRACTURES WAS
    EITHER INTRINSIC OR ENTIRELY IRRELEVANT
    AND HIGHLY PREJUDICIAL.          THE COURT
    ERRED IN FAILING TO PROVIDE A LIMITING
    INSTRUCTION. (Not Raised Below).
    POINT IV
    THE COURT ERRED IN ALLOWING A DOCTOR
    TO TESTIFY AS AN EXPERT WITHOUT BEING
    PROPERLY QUALIFIED, AND FURTHER ERRED
    A-0407-16T4
    3
    IN ALLOWING THE SAME DOCTOR TO TESTIFY
    TO THE ULTIMATE ISSUE. (Not Raised Below).
    POINT V
    THE    COURT           ERRED   IN  IMPOSING
    CONSECUTIVE           SENTENCES,  AND   THE
    SENTENCE IS           OTHERWISE MANIFESTLY
    EXCESSIVE.
    I.
    We begin by addressing defendant's challenge to his confession.           He
    argues that the detectives lied to him about the victim's injuries, they told him
    that the assistant prosecutors would never believe his claim that he did not know
    what had happened, and that the detectives improperly suggested that they
    would "go to bat" for him if he provided a statement. Defendant contends
    therefore that his confession was involuntary, the judge erred by admitting it,
    and we should vacate the convictions.
    Defendant initially told the detectives that he had the victim propped up
    on a pillow and went into the kitchen for one or two minutes. When he returned
    to the room, defendant said that she was in the same position, but she had started
    gagging on a Cheerio and did not look right. He said he picked her up and
    started to hit her back for about thirty seconds to a minute, but then she became
    completely limp.    Defendant told the detectives he tried to revive her by
    A-0407-16T4
    4
    breathing into her mouth and doing chest compressions, and that he called
    9-1-1.
    During the interview, the detectives left the room and spoke on the
    telephone with a doctor. They then returned and informed defendant that the
    doctor advised them that the situation was "much more worse" than they
    previously thought because the victim had "many more broken bones." The
    detectives told defendant that the victim had broken bones "[a]ll over" and that
    they could have occurred within the last week. The detectives told defendant
    that someone had "brutally beat, and kicked and [threw]" her, or she was "either
    kicked, thrown, [or] dropped down a flight of steps."       Defendant told the
    detectives that he "never threw [his] child," "hurt [his] child," or "threw her
    down a flight of stairs." They probed further:
    DETECTIVE: You know what I think? I think there
    was an accident . . . and you're afraid to say it.
    DETECTIVE 2: That something happened, you just
    didn't [want to] tell your wife. That's all right.
    DETECTIVE: If it was an accident–
    DETECTIVE 2: I would [want to] fight for someone['s]
    rights that's not here right now to fight for.
    DETECTIVE: [Y]ou need to speak up–
    A-0407-16T4
    5
    DETECTIVE 2: I want you to tell me what the hell is
    going on here before we have to continue to go through
    this.
    ....
    DETECTIVE: [P]lease listen to me. Please listen. If
    you don't be a voice for [the victim] and tell us what
    happened, whether you did something, or something
    else happened, if it was an accident, you know, all that
    stuff is taken into consideration. But I'm telling you,
    when we take this down to the bosses, [they're going to]
    hang somebody's head. All right? If they hang you
    with a homicide . . . then all bets are off, and you're just
    [going to] have to fight it out.
    If there was an accident, that's what you need to
    tell us because if that's what happened, that is a much,
    much, much easier thing to explain to the bosses than
    you have no idea what happened to your daughter. The
    bosses don't want to hear that. The prosecutors will not
    accept an ["]I don't know["] answer. The only thing
    they will accept is a logical, heartfelt explanation for a
    father who loves his daughter and something tragically,
    accidentally happened. Other than that, dude, you are
    f[*****], and you can't let it be like that. You have to
    be her voice now.
    In response, defendant informed the detectives that he accidently hurt the
    victim, and acknowledged that he knew he could request a lawyer.               The
    detectives at that point told defendant they would "go to bat for him" and try to
    work with him:
    A-0407-16T4
    6
    DEFENDANT: I'm telling you I did not do anything
    intentionally . . . to my daughter and I never did—and
    I'd never intentionally hurt her. It kills me inside.
    ....
    DEFENDANT: And I never intentionally did anything
    to hurt her, but I was so scared . . . because I didn't know
    what was [going to] happen. I didn't want my—you're
    right. I did not want my wife to know, and find out, but
    it was an accident.
    DETECTIVE: Tell us what happened.
    ....
    DEFENDANT: I mean, I don't know—I'm just telling
    you—you're right. I mean, . . . I could get a lawyer right
    now, and I know that, but I don't—I don't want one. I
    mean at this point now I don't want one. . . .
    ....
    DETECTIVE: You just need to tell us what happened.
    DEFENDANT: I'm telling you . . . I didn't intentionally
    do this and . . . I killed my child, but I didn't intend it,
    and that, you know, it wasn't by a purposeful action. It
    was an accident.
    ....
    DEFENDANT: [L]ike I said, . . . I mean, if I wanted
    to, I could have gotten a lawyer and I could have said
    ["]I plead the Fifth["] right now, and ["]I'm not saying
    another word,["] . . . I had to get it out . . . for my
    daughter.
    A-0407-16T4
    7
    ....
    DEFENDANT: And like I said, . . . I know I'm being
    recorded, and people are seeing this or whatever.
    ....
    DETECTIVE: We will work with you. All right?
    We're not heartless.
    DEFENDANT: I did not do this on purpose.
    DETECTIVE: [J]ust tell us what happened. We can't
    help you unless we know the truth and we'll know what
    happened.
    ....
    DETECTIVE: We'll go to bat for you.
    Defendant then told the detectives his wife was "never [going] to forgive
    [him] because she's [going] to wonder why [he] lied, why [he] didn't . . . just say
    the truth in the beginning." Defendant said:
    [T]here was a time, when I was, you know, coming
    down the stairs and I dropped her, and I dropped her
    and she—I tried to, you know, stop it, but I couldn't
    help it and she—we have a hard floor, and a high set of
    stairs, and I dropped her, but she seemed okay. I mean,
    I would have taken her to a doctor right away. She
    seemed okay. I mean, she was crying and really fussy,
    and . . . she seemed okay. And . . . I was scared to death.
    And I mean, I'm just telling—I mean, honest to God, I
    never would intentionally hurt my child, and that—you
    know, the day that [the victim went into cardiac arrest],
    I had her on my knee and I was bouncing her on my
    A-0407-16T4
    8
    knee, like, you know, playing with her, and she went—
    and that's when I was playing with her, and she just
    went . . . and that's when I tried to save her . . . . I don't
    know what happened, but I guess . . . I shook her too
    hard, when I did that, and . . . she went into cardiac
    arrest, apparently, now that I know.
    The detective asked defendant if he became "frustrated with [the victim's]
    crying" and shook her. Defendant reiterated that he "had previously fallen [and]
    dropped her down the stairs when [he] was coming down" approximately one
    week and one-half prior to the victim's death. Defendant elaborated that the
    victim "landed right on that hard floor down at the bottom [of the stairs], and
    [he] kind of tripped a little bit when [he] dropped her and landed a little on top
    of her." He stated that his shoulder fell on top of her leg, but that he caught
    himself and did not hit her hard.
    Defendant again acknowledged he knew he could request a lawyer by
    stating, "I could have said I want a lawyer and I don't [want to] talk to you . . .
    I'm just telling you. I'm telling you as a father, you know, because [the victim
    did not] deserve this . . . obviously, I'm still [going to] need one now." After
    recounting these events, the detective told him, "We'll go to bat for you. I can't
    promise [you] anything, but we'll definitely go to bat for you." Defendant asked
    how he could get a lawyer, and the detectives stopped questioning him.
    A-0407-16T4
    9
    The judge allowed defendant's statement into evidence on the State's
    pretrial motion. "[O]n appellate review, a trial court's factual findings in support
    of granting or denying a motion to suppress must be upheld when 'those findings
    are supported by sufficient credible evidence in the record.'" State v. S.S., 
    229 N.J. 360
    , 374 (2017) (quoting State v. Gamble, 
    218 N.J. 412
    , 424 (2014)). After
    a testimonial hearing, "appellate courts defer to the trial court's factual findings
    because the trial court has the 'opportunity to hear and see the witnesses and to
    have the "feel" of the case, which a reviewing court cannot enjoy.'" 
    Ibid.
    (quoting State v. Elders, 
    192 N.J. 224
    , 244 (2007)). This deference extends to
    a trial court's determinations based on the review of a video, like here, because
    of the trial court's "experience and expertise in fulfilling the role of factfinder."
    Id. at 380. We "should not disturb a trial court's factual findings unless those
    findings are 'so clearly mistaken that the interests of justice demand intervention
    and correction.'" Id. at 374 (quoting Gamble, 218 N.J. at 425). The trial court's
    interpretation of the law and "the consequences that flow from established facts
    are not entitled to any special deference." Gamble, 218 N.J. at 425.
    "The right against self-incrimination is guaranteed by the Fifth
    Amendment to the United States Constitution and [New Jersey]'s common law,
    now embodied in statute, N.J.S.A. 2A:84A-19, and evidence rule, [Rule] 503."
    A-0407-16T4
    10
    S.S., 229 N.J. at 381 (quoting State v. Nyhammer, 
    197 N.J. 383
    , 399 (2009)).
    The State must establish beyond a reasonable doubt that the statement was
    voluntary and, if the defendant was in custody, that he was advised of his
    Miranda1 rights and "knowingly, voluntarily and intelligently waived" those
    rights. State v. W.B., 
    205 N.J. 588
    , 602 n.3 (2011); Nyhammer, 
    197 N.J. at 388
    .
    "Miranda safeguards come into play whenever a person in custody is subjected
    to either express questioning or its functional equivalent." State v. Hubbard,
    
    222 N.J. 249
    , 267 (2015) (quoting Rhode Island v. Innis, 
    446 U.S. 291
    , 300-01
    (1980)).
    On the State's motion, defendant did not argue that the detectives failed to
    give him his Miranda rights. Indeed, the judge found that defendant understood
    those rights and acknowledged he could request an attorney or stop talking if he
    chose to do so, which is exactly what he did at the end of his statement. Instead,
    he argued that he had been tired when he gave the statement, and that he did so
    within several hours of the victim's death. Nevertheless, the judge found that
    defendant never indicated he was unable to give the statement. After watching
    the confession video, the judge observed defendant was not falling asleep or
    1
    Miranda v. Arizona, 
    384 U.S. 436
     (1966).
    A-0407-16T4
    11
    having trouble concentrating. To the contrary, the judge found that defendant
    was "very talkative" and fully engaged.
    Defendant now contends that his statement was coerced and therefore
    involuntary. A statement is considered voluntary if it is "the product of an
    essentially free and unconstrained choice by its maker." State v. P.Z., 
    152 N.J. 86
    , 113 (1997) (quoting Schneckloth v. Bustamonte, 
    412 U.S. 218
    , 225-26
    (1973)). If the defendant's "will has been overborne and his capacity for self-
    determination critically impaired," the use of the statement "offends due
    process." 
    Ibid.
     (quoting Schneckloth, 
    412 U.S. at 225-26
    ).
    When determining whether a statement is voluntary, the judge examines
    "the totality of the circumstances to assess whether the waiver of rights was the
    product of a free will or police coercion." Nyhammer, 
    197 N.J. at 402
    . Factors
    to consider in this approach include the defendant's "age, education and
    intelligence, advice as to constitutional rights, length of detention, whether the
    questioning was repeated and prolonged in nature and whether physical
    punishment or mental exhaustion was involved." State v. Presha, 
    163 N.J. 304
    ,
    313 (2000). The judge should also consider the elapsed time between the
    police's administration of the Miranda rights and the defendant's statement.
    State v. Timmendequas, 
    161 N.J. 515
    , 614 (1999).
    A-0407-16T4
    12
    Although courts should consider misrepresentations made by police
    officers when analyzing the totality of the circumstances, "misrepresentations
    alone are usually insufficient to justify a determination of involuntariness or
    lack of knowledge." State v. Cooper, 
    151 N.J. 326
    , 355 (1997). Additionally,
    "a misrepresentation by police does not render a confession or waiver
    involuntary unless the misrepresentation actually induced the confession." 
    Ibid.
    Officers "may employ deception or trickery in an interrogation of a suspect
    unless such deception or trickery was calculated to produce an untruthful
    confession or was offensive to due process." State v. Baylor, 
    423 N.J. Super. 578
    , 588-89 (App. Div. 2011). "[U]se of a psychologically-oriented technique
    during questioning is not inherently coercive," and "[t]he real issue is whether
    the person's decision to confess results from a change of mind rather than from
    an overbearing of the suspect's will." State v. Galloway, 
    133 N.J. 631
    , 654-55
    (1993).
    A police officer's "promise that statements made will not be used against
    the defendant purports to remove the specter of proving one's own guilt by
    making a statement. Such a promise is a . . . powerful one, going to the heart of
    a declarant's reservations about giving a statement." State v. Pillar, 
    359 N.J. Super. 249
    , 273 (App. Div. 2003); accord State v. Fletcher, 
    380 N.J. Super. 80
    ,
    A-0407-16T4
    13
    92 (App. Div. 2005). If a defendant could "reasonably believe that the promise
    of an 'off-the-record conversation' 'meant that the statement would not be used
    against him,'" then "such a promise 'had the likelihood of stripping [the]
    defendant of his 'capacity for self-determination' and actually induced the
    incriminating statement." Fletcher, 
    380 N.J. Super. at 91-92
     (quoting Pillar, 349
    N.J. Super. at 272-73). "If [a] defendant believed that his statement could not
    be used against him, despite the earlier Miranda warnings, his statement made
    as a result of that false assurance could not be a free and voluntary one." Pillar,
    
    359 N.J. Super. at 273
    . Moreover, whether an investigator's statement amounts
    to a promise must be viewed from the defendant's perspective. 
    Id. at 272
    .
    We have previously found a defendant's statement was voluntary even
    though the detectives had "engaged in some deception." Baylor, 423 N.J. Super.
    at 589. In Baylor, the defendant asserted that the detectives acted as if they were
    his friends and cared about his welfare. He maintained that they erroneously
    told him "that he faced the death penalty," and that they "reduced him to tears
    by applying 'unrelenting pressure' on him to confess and/or name the shooter ."
    Id. at 588. He contended that they "attributed statements to him that were
    untrue" and that they "intended to 'trick' him into making inculpatory
    statements." Ibid. He said they had "lied about the evidence and witnesses
    A-0407-16T4
    14
    against him." Ibid. Even in light of these assertions, we affirmed the trial court's
    admission of the defendant's statement. Id. at 590.
    Here, the record supports the judge's determination that defendant's
    statement was voluntary under the totality of the circumstances. Although the
    detectives may have employed some deceptive tactics in stating that they would
    "go to bat" for defendant, that alone does not render his statement involuntary.
    The detectives' statements here do not rise to the level of the facts in Fletcher
    and Pillar, where the defendants were promised that their statements to
    investigators would be "off-the-record." Fletcher, 
    380 N.J. Super. at 92
    ; Pillar,
    
    359 N.J. Super. at 273
    . Those situations are different because a detective
    representing that a defendant's statements would be "off-the-record" suggests
    that the defendant could make the statement with impunity. On the other hand,
    a detective's use of the phrase "go to bat" for a defendant does not carry the same
    connotation that a defendant would not face any consequences.
    We reject defendant's arguments that the detectives lied about the extent
    and causes of the victim's injuries. The detective testified that he believed the
    victim had a skull fracture at the time of the interrogation because the doctor
    conveyed that information to him, even though he later learned that was
    incorrect. He also testified that after he spoke with the doctor about the injuries,
    A-0407-16T4
    15
    he "figured, due to those injuries" that it was "most likely" that the victim had
    been brutally beaten, kicked, dropped, or thrown, even if the doctor did not
    specifically tell him those were the causes. These statements are, therefore, not
    outright lies as defendant argues. Even if they could have been misleading,
    under the totality of the circumstances, the detective's remarks did not impair
    defendant's decision-making. Cf. Baylor, 423 N.J. Super. at 588-89 (stating
    officers "may employ deception or trickery in an interrogation" and affirming a
    defendant's statement as voluntary where defendant alleged officers presented
    themselves as friends and lied about evidence).
    Moreover, the detectives' statements that defendant would need to tell
    them if the injuries were an accident did not render defendant's statement
    involuntary. As the judge found, defendant stated multiple times throughout his
    statement that he knew he could end the interrogation, remain silent, or request
    an attorney, which demonstrated that he knew he did not have to provide a
    statement to the detectives. Nonetheless, defendant continued to speak with the
    detectives.
    Accordingly, the judge correctly found that defendant's waiver of his
    Miranda rights was knowing, intelligent, and voluntary—and not the product of
    coercion or official misconduct—in light of the totality of the circumstances,
    A-0407-16T4
    16
    and that his statement to police was voluntary, and, thus, admissible.
    II.
    Defendant argues that the judge erred by denying two motions for
    acquittal. He contends there was insufficient evidence regarding the victim's rib
    fracture to support his conviction for endangering the welfare of a child. He
    asserts that the State failed to present any evidence apart from defendant's police
    statement to prove he broke the victim's rib, and that the statement cannot be the
    sole evidence used to convict him of child endangerment.
    We apply the same standard the judge used when deciding a motion for
    acquittal. State v. Moffa, 
    42 N.J. 258
    , 263 (1964). The standard is
    whether the evidence viewed in its entirety, and giving
    the State the benefit of all of its favorable testimony and
    all of the favorable inferences which can reasonably be
    drawn therefrom, is such that a jury could properly find
    beyond a reasonable doubt that the defendant was guilty
    of the crime charged.
    [State v. Tindell, 
    417 N.J. Super. 530
    , 549 (App. Div.
    2011).]
    That standard applies regardless of whether the motion was made during
    trial under Rule 3:18-1, or after the jury returned a verdict under Rule 3:18-2.
    
    Id. at 548-49
    . However, if the motion was made at the close of the State's case,
    we do not consider any evidence adduced in the defendant's case. State v. Reyes,
    A-0407-16T4
    17
    
    50 N.J. 454
    , 459 (1967); State v. Foreshaw, 
    245 N.J. Super. 166
    , 185 (App. Div.
    1991). Rule 3:18-1 provides that after the State's case, "the court shall, on
    defendant's motion or its own initiative, order the entry of a judgment of
    acquittal of one or more offenses charged in the indictment . . . if the evidence
    is insufficient to warrant a conviction."
    If the State relies on a defendant's confession, it must also "introduce
    independent proof of facts and circumstances which strengthen or bolster the
    confession and tend to generate a belief in its trustworthiness, plus independent
    proof of loss or injury." State v. Lucas, 
    30 N.J. 37
    , 56 (1959); accord State v.
    Reddish, 
    181 N.J. 553
    , 617 (2004). This requirement "avoid[s] the danger of
    convicting a defendant solely out of his own mouth of a crime that never
    occurred or a crime committed by someone else." State v. Johnson, 
    31 N.J. 489
    ,
    502-03 (1960). If the State is able to provide "'any legal evidence, apart from
    the confession of facts and circumstances, from which the jury might draw an
    inference that the confession is trustworthy,'" then the trial court should "refuse
    to grant a judgment of acquittal on these grounds." Reddish, 
    181 N.J. at 617
    (quoting Lucas, 
    30 N.J. at 62
    ).
    Pursuant to N.J.S.A. 2C:24-4(a)(2), which addresses child endangerment:
    Any person having a legal duty for the care of a child
    or who has assumed responsibility for the care of a
    A-0407-16T4
    18
    child who causes the child harm that would make the
    child an abused or neglected child . . . is guilty of a
    crime of the second degree.
    The State must "prove defendant acted 'knowingly' to convict him of
    endangering the welfare of a child[.]" State v. Overton, 
    357 N.J. Super. 387
    ,
    393 (App. Div. 2003). Indeed, the judge instructed the jury:
    To find . . . defendant guilty of [endangering the welfare
    of a child], the State must prove beyond a reasonable
    doubt these elements: 1) [t]hat [the victim] was a child;
    2) [t]hat defendant knowingly caused the child harm
    that would make the child abused or neglected; 3) [t]hat
    defendant knew such conduct would cause the child
    harm that would make the child abused or neglected; 4)
    [t]hat defendant had a legal duty for the care of the child
    or had assumed responsibility for the care of the child.
    ....
    A person acts knowingly with respect to the
    nature of his conduct or the attendant circumstances if
    he is aware that the conduct is of that nature or that such
    circumstances exist or the person is aware of a high
    probability of their existence. A person acts knowingly
    with respect to a result of the conduct if [he] is aware
    that it is practically certain that such conduct will cause
    a result.
    ....
    It is within your power to find that such proof [of
    knowledge] has been furnished beyond a reasonable
    doubt by inferences which may arise from the nature of
    his acts and conduct and from all he said and did at the
    A-0407-16T4
    19
    particular time and place and from all surrounding
    circumstances established by the evidence.
    After the State rested its case, defendant moved for a judgment of
    acquittal. In denying the motion, the judge found that there was a substantial
    amount of medical testimony, which when viewed in favor of the State, indicated
    that the victim suffered trauma inflicted while in defendant's care. The judge
    stated that, although the evidence was circumstantial, "the jury could certainly
    find, beyond a reasonable doubt, that these injuries were caused by . . .
    defendant."
    At the sentencing hearing, defendant argued the merits of his second
    acquittal motion. The judge noted that according to defendant's statement to
    detectives, he dropped the victim down the stairs and accidently fell on top of
    her about a week or so before she stopped breathing, and yet he did not seek
    medical treatment for her or advise his wife of the occurrence. Additionally,
    there was medical evidence corroborating that the rib fracture occurred between
    one to six weeks before admission into the hospital. The judge, therefore, denied
    the motion for a judgment of acquittal and concluded that there was "little
    question that having been presented with these facts, the jury could have found
    . . . defendant endangered the welfare of" the victim, and that the jury did make
    such a finding.
    A-0407-16T4
    20
    Although the State relied on defendant's statement, it also presented expert
    medical testimony to support the timing and manner that the rib fracture
    occurred. Even though the medical experts disagreed on the specific age of the
    rib fracture, the evidence suggested that it occurred at least one week prior to
    the victim's hospitalization. The jury heard all of the testimony and could
    reasonably conclude that defendant caused the rib fracture when he dropped her
    down the stairs.
    III.
    We reject defendant's argument that the judge should have instructed the
    jury that it could not consider evidence of the victim's arm and leg fractures
    unless it found that those fractures were inflicted at the time of the brain injury.
    Defendant had argued that the evidence of the arm and leg fractures were
    inadmissible under N.J.R.E. 404(b), and he moved to exclude that evidence, for
    a mistrial, and for a new trial. The judge admitted this evidence, however, based
    on the State's theory of the case that the victim's arm and leg fractures occurred
    at the same time as her brain injury and, therefore, were intrinsic to the charged
    offenses. The judge reasoned that those fractures "while uncharged, are part and
    parcel of the State's allegation of [s]haken [b]aby [s]yndrome," and according to
    the State would "directly prove the charged offense and/or be performed
    A-0407-16T4
    21
    contemporaneously with" or facilitate the charged crime. The judge stated that
    the connection of the arm and leg fractures to the charged crime was a question
    of fact for the jury and, that it would not be unduly prejudicial under the facts
    of the case for the jury to consider the evidence.
    Defendant acknowledged, however, that details about the fractures on the
    victim's arms and legs were intrinsic evidence and that it "was a permissible
    basis to admit evidence of these fractures." But he asserts that the possibility
    that the evidence might be intrinsic, rather than evidence of other crimes
    admissible under Rule 404(b), "did not relieve the [judge] of its obligation to
    provide a limiting instruction" and the failure to do so unduly prejudiced him.
    Because defendant did not request a limiting instruction, we review his
    contentions for plain error. R. 2:10-2. See also State v. Cole, 
    229 N.J. 430
    , 455-
    56 (2017) (finding no plain error where a trial court did not sua sponte charge a
    jury with limiting instructions). Additionally, Rule 1:7-2 states that "no party
    may urge as error any portion of the charge to the jury or omissions therefrom
    unless objections are made thereto before the jury retires to consider its
    verdict[.]" Although the Supreme Court recognizes "the ordinary reluctance of
    reviewing courts to reverse on the grounds of plain error when no objection to a
    charge has been made," the Court has "repeatedly emphasized that incorrect
    A-0407-16T4
    22
    instructions of law are poor candidates for rehabilitation under the harmless
    error theory." State v. Weeks, 
    107 N.J. 396
    , 410 (1987).
    Proper instructions are essential to a fair trial. State v. Green, 
    86 N.J. 281
    ,
    287 (1981). If evidence of other crimes is admitted under Rule 404(b), the trial
    court should issue a limiting instruction, even if the defense does not request a
    limiting instruction. State v. Clausell, 
    121 N.J. 298
    , 323 (1990). See also Agha
    v. Feiner, 
    198 N.J. 50
    , 63 n.7 (2009) (stating that "[e]ven in the absence of a
    request, the judge should give a limiting instruction sua sponte where it is
    necessary to avoid an unjust result").
    Nevertheless, when a court is "reviewing any claim of error relating to a
    jury charge, the 'charge must be read as a whole in determining whether there
    was any error,' and the effect of any error must be considered 'in light of the
    overall strength of the State's case.'" State v. Gonzalez, 
    444 N.J. Super. 62
    , 70-
    71 (App. Div. 2016) (first quoting State v. Torres, 
    183 N.J. 554
    , 564 (2005),
    then quoting State v. Walker, 
    203 N.J. 73
    , 90 (2010)). If an error regarding the
    jury charge is harmless and there is "no indication that the jury was misled by
    the error," then the jury charge may not warrant a reversal. State v. Docaj, 
    407 N.J. Super. 352
    , 369 (App. Div. 2009).
    A-0407-16T4
    23
    Even if evidence constitutes "uncharged misconduct that would normally
    fall under Rule 404(b)," if it is "intrinsic to the charged crime [it] is exempt from
    the strictures of Rule 404(b) . . . because it is not evidence of other crimes,
    wrongs, or acts." State v. Rose, 
    206 N.J. 141
    , 177 (2011) (citation and internal
    quotation marks omitted). Rather, intrinsic evidence need only satisfy the Rule
    403 balancing test and the relevancy evidence rules. 
    Id. at 177-78
    . Rule 403
    permits relevant evidence "unless its probative value is substantially outweighed
    by a negative feature of the evidence[.]" 
    Id. at 178
    . See also State v. Santamaria,
    ___ N.J. ___ (2019) (slip op. at 23) (stating that "if evidence is found to be
    intrinsic to the crime at issue, it does not constitute other-acts evidence and is
    subject only to the limits of Rule 403").
    To determine if evidence is "intrinsic," our Supreme Court adopted the
    test articulated in United States v. Green, 
    617 F.3d 233
    , 248 (3d Cir. 2010),
    which limits intrinsic evidence to "two narrow categories of evidence." Rose,
    
    206 N.J. at 180
    ; State v. Brockington, 
    439 N.J. Super. 311
    , 327 (App. Div.
    2015). "The first category applies to evidence that 'directly proves' the charged
    offense," and the "operative factor is whether the evidence has probative value
    as to the charged offense." Brockington, 439 N.J. Super. at 327. The second
    category    defines   intrinsic   evidence    as   "uncharged     acts   performed
    A-0407-16T4
    24
    contemporaneously with the charged crime [that] . . . facilitate the commission
    of the charged crime." Rose, 
    206 N.J. at 180
    .
    The judge admitted the arm and leg fracture evidence as intrinsic evidence
    because he found the State presented those uncharged acts as part and parcel to
    the charged crime, and as direct proof of the charged crime. Defendant also
    acknowledged that this evidence was properly admitted as intrinsic evidence.
    Therefore, it was "exempt from the strictures of Rule 404(b)" and did not require
    a limiting instruction. Rose, 
    206 N.J. at 177
    .
    IV.
    Defendant asserts for the first time that the doctor who treated the victim
    at the hospital improperly testified as an expert—even though the State called
    him as a fact witness—without being qualified as such, and that his testimony
    went to the ultimate issue of the case—that the victim was abused. Defendant
    argues that the judge erred by not issuing "adequate instructions on how to
    evaluate [the doctor's] opinions." Defendant contends therefore that he received
    an unfair trial.
    We review evidentiary rulings for abuse of discretion. State v. Feaster,
    
    156 N.J. 1
    , 82 (1998). A trial court's evidentiary ruling must be upheld unless
    the appellant shows that the court's "finding was so wide of the mark that a
    A-0407-16T4
    25
    manifest denial of justice resulted." State v. Carter, 
    91 N.J. 86
    , 106 (1982).
    Additionally, when there is no objection (like here), we usually disregard an
    error not raised unless we find plain error—that is, error that is "clearly capable
    of producing an unjust result." R. 2:10-2. This possibility of "an unjust result
    must be 'sufficient to raise a reasonable doubt as to whether the error led the jury
    to a result it otherwise might not have reached.'" State v. Williams, 
    168 N.J. 323
    , 336 (2001) (quoting State v. Macon, 
    57 N.J. 325
    , 336 (1971)). Moreover,
    "no party may urge as error any portion of the charge to the jury or omissions
    therefrom unless objections are made thereto before the jury retires to consider
    its verdict[.]" R. 1:7-2.
    Courts distinguish between expert witnesses and treating physicians
    because "[u]nlike an expert retained to testify at trial, the treating doctors gained
    no confidential information about plaintiffs' trial strategy."         Stigliano v.
    Connaught Labs., Inc., 
    140 N.J. 305
    , 313-14 (1995). Our Supreme Court has
    stated that "[s]ubject to the notice and discovery requirements of our court rules
    and the requirements of [Rule] 701 and other Rules of Evidence, our case law
    authorizes a trial court to admit the testimony of a treating physician regarding
    the diagnosis and treatment of a patient." Delvecchio v. Twp. of Bridgewater,
    
    224 N.J. 559
    , 563 (2016). The treating physician's testimony is, nonetheless,
    A-0407-16T4
    26
    "subject to an important limitation." Id. at 579. That is, "[u]nless the treating
    physician is retained and designated as an expert witness, his or her testimony
    is limited to issues relevant to the diagnosis and treatment of the individual
    patient." Ibid.
    While treating physicians "are doubtless 'experts,'" they are "more
    accurately fact witnesses" where "[t]heir testimony relates to their diagnosis and
    treatment" of the patient.      Stigliano, 140 N.J. at 314.         A physician's
    determination of the cause of a condition "partakes of both fact and opinion,"
    and the "critical point is that the treating doctors to treat their patients must
    determine the cause of a disease, whether that determination is characterized as
    fact or opinion." Ibid. Accordingly,
    [a]s fact witnesses, the treating doctors may testify
    about their diagnosis and treatment of [an injury],
    including their determination of that [injury's] cause.
    Their testimony about the likely and unlikely causes of
    [a patient's injury] is factual information, albeit in the
    form of opinion. Because the determination of the
    cause of a patient's illness is an essential part of
    diagnosis and treatment, a treating physician may
    testify about the cause of a patient's disease or injury.
    [Ibid. (citation omitted).]
    Here, the doctor treated the victim for her cardiac arrest, fractures, and
    related injuries, the causes of which were relevant to his diagnosis and treatment.
    A-0407-16T4
    27
    His personal observations, diagnosis, and testimony about potential causes of
    the victim's injuries, as a treating physician, have been explicitly approved by
    the Court, as long as it is in accordance with the notice and discovery
    requirements and the rules of evidence.       See Delvecchio, 224 N.J. at 563;
    Stigliano, 140 N.J. at 314.
    The doctor testified consistently with Rule 701, which permits his
    "opinions or inferences" that are "(a) rationally based on the perception of the
    witness and (b) will assist in understanding the witness' testimony or in
    determining a fact in issue." In diagnosing and treating the victim's injuries, and
    in concluding that there were multiple signs leading to abuse, he referred—
    without objection—to the victim's lungs and heart "explod[ing]" and
    "sw[e]ll[ing]," the amount of "pulmonary edema [that existed] afterward," the
    "blood on [her] brain," the "massive retinal hemorrhages," and the amount of
    bleeding behind her eyes. The doctor's fact-witness testimony did not usurp the
    jury's function, opine about defendant's guilt or innocence, or bolster the
    testimony from other witnesses.
    V.
    Finally, defendant argues that the sentencing judge erred by imposing
    consecutive sentences, which he contends is excessive. She sentenced defendant
    A-0407-16T4
    28
    to eight years in prison on Count One, subject to the No Early Release Act
    (NERA), N.J.S.A. 2C:43-7.2. On Count Four, she imposed a consecutive eight-
    year prison term. The aggregate prison term was sixteen years in prison, subject
    to the NERA imposition on Count One.
    An appellate court applies "a deferential standard of review to the
    sentencing court's determination, but not to the interpretation of a law." State
    v. Bolvito, 
    217 N.J. 221
    , 228 (2014). "Appellate review of sentencing decisions
    is relatively narrow and is governed by an abuse of discretion standard." State
    v. Blackmon, 
    202 N.J. 283
    , 297 (2010). An appellate court may not "substitute
    [its] judgment for those of our sentencing courts." State v. Case, 
    220 N.J. 49
    ,
    65 (2014).
    The sentencing judge found aggravating factors three, N.J.S.A. 2C:44-
    1(a)(3) (risk of reoffending); six, N.J.S.A. 2C:44-1(a)(6) (prior record); and
    nine, N.J.S.A. 2C:44-1(a)(9) (need to deter). She found no mitigating factors
    and concluded that the aggravating factors substantially outweighed the non-
    existent mitigating factors.
    The sentencing judge imposed consecutive sentences in accordance with
    State v. Yarbough, 
    100 N.J. 627
    , 643 (1985). Five factors that a court should
    A-0407-16T4
    29
    consider in determining whether to impose a concurrent or consecutive sentence
    are:
    (a) the crimes and their objectives were predominantly
    independent of each other;
    (b) the crimes involved separate acts of violence or
    threats of violence;
    (c) the crimes were committed at different times or
    separate places, rather than being committed so closely
    in time and place as to indicate a single period of
    aberrant behavior;
    (d) any of the crimes involved multiple victims;
    (e) the convictions for which the sentences are to be
    imposed are numerous.
    [State v. Molina, 
    168 N.J. 436
    , 441-42 (2001) (quoting
    Yarbough, 
    100 N.J. at 644
    ).]
    These factors "should be applied qualitatively, not quantitatively." State v.
    Carey, 
    168 N.J. 413
    , 427 (2001). As to the imposition of consecutive sentences,
    she stated:
    Crimes committed by [defendant] occurred on
    wholly separate and distinct dates. Count One and Two
    pertain to an incident that took place on February 16[,]
    2012. Count Four, endangering the welfare of a child,
    took place on February 10[,] 2012. This is a wholly
    separate and distinct act for which [defendant] was
    convicted. . . . [T]hese are separate and distinct crimes.
    They are independent of each other, . . . [the] [c]rimes
    and their objectives on each of these dates were
    A-0407-16T4
    30
    independent. They involved separate acts and the
    crimes were committed at different times and different
    places.
    There are three offenses for which [defendant
    was] found guilty. Thus, the [c]ourt find[s] consecutive
    sentences are appropriate as to some of the crimes for
    which [defendant is] being sentenced.
    We are satisfied that in applying the sentencing guidelines, the judge gave
    adequate reasons to support the sentence, the sentence is not manifestly
    excessive or unduly punitive, and it does not constitute an abuse of discretion.
    See State v. Fuentes, 
    217 N.J. 57
    , 70 (2014); State v. Cassady, 
    198 N.J. 165
    ,
    180-81 (2009); State v. Roth, 
    95 N.J. 334
    , 362-63 (1984).
    We conclude that defendant's remaining arguments—to the extent that we
    may not have addressed them—are without sufficient merit to warrant
    discussion in a written opinion. R. 2:11-3(e)(2).
    Affirmed.
    A-0407-16T4
    31