State v. O'Bannon , 2012 UT App 71 ( 2012 )


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  •                          IN THE UTAH COURT OF APPEALS
    ‐‐‐‐ooOoo‐‐‐‐
    State of Utah,                               )                   OPINION
    )
    Plaintiff and Appellee,               )            Case No. 20090241‐CA
    )
    v.                                           )                  FILED
    )               (March 15, 2012)
    Cameron Clint O’Bannon,                      )
    )                
    2012 UT App 71
    Defendant and Appellant.              )
    ‐‐‐‐‐
    Fourth District, Provo Department, 051405003
    The Honorable Samuel D. McVey
    Attorneys:       Margaret P. Lindsay and Douglas J. Thompson, Provo, for Appellant
    Mark L. Shurtleff and Ryan D. Tenney, Salt Lake City, for Appellee
    ‐‐‐‐‐
    Before Judges Orme, Roth, and Christiansen.
    CHRISTIANSEN, Judge:
    ¶1     Defendant Cameron Clint O’Bannon appeals from his jury conviction of child
    abuse, a second degree felony. See Utah Code Ann. § 76‐5‐109(2)(a) (Supp. 2011).1
    O’Bannon asserts that the trial court erred in instructing the jury on the eggshell
    plaintiff doctrine because the instruction incorrectly explained the mental state the State
    1
    Because the relevant portions of the Utah Code have not been substantively
    amended, we cite the current code throughout this opinion for the reader’s convenience.
    See Utah Code Ann. § 76‐5‐109 amend. notes (2008 & Supp. 2011); id. § 76‐2‐103 amend.
    notes (2008).
    was required to prove to obtain a conviction for second degree felony child abuse. We
    reverse and remand for a new trial.
    BACKGROUND2
    I. The Victim’s Injuries
    ¶2     In the fall of 2005, a mother and her eleven‐month‐old son (the victim) moved
    into O’Bannon’s home. A few weeks later, O’Bannon and the victim spent some time
    together without the mother present, after which the mother noticed that the victim was
    bruised under one of his eyes and on the bridge of his nose. She asked O’Bannon what
    had happened, and he explained that the victim hurt himself after falling over some
    lawn furniture.
    ¶3     On October 31, the mother left the house with her daughter to take O’Bannon’s
    son to school and run some errands. Before they left, the mother’s daughter put the
    victim in bed with O’Bannon, who was still asleep. After dropping off O’Bannon’s son
    and eating breakfast, the mother noticed that she had missed two calls from O’Bannon
    to her cell phone. The mother called O’Bannon back immediately, and he asked her to
    rush home because something was wrong with the victim. O’Bannon explained to her
    that the victim was “barely conscious, and his breathing was shallow.” The mother
    urged O’Bannon to call an ambulance, but he resisted doing so, instead insisting that
    she “hurry and get home.” When the mother arrived at the house, an ambulance had
    arrived, apparently because O’Bannon had changed his mind and called for help. The
    paramedics described the victim as “extremely limp and unresponsive” and having
    “occasional jerking motions,” which are symptoms that are “indicative of some head
    trauma or possible head injury.”
    ¶4    O’Bannon told the police officer who responded with the ambulance that he had
    gone upstairs to gather some clothing for the children while the victim was at the
    bottom of the stairway playing, when O’Bannon heard “repeated thud sound[s].”
    O’Bannon stated that he went to the stairway and noticed the victim lying on his back at
    2
    “When reviewing a jury verdict, we recite the facts in the light most favorable to
    that verdict.” State v. Carreno, 
    2006 UT 59
    , ¶ 3, 
    144 P.3d 1152
    .
    20090241‐CA                                 2
    the bottom of the stairway. O’Bannon also testified that he attempted to revive the
    victim by “rubbing his belly.”
    ¶5     Dr. Bruce Herman, who is an emergency medicine physician, a general
    pediatrician, and a child abuse pediatrician, treated the victim that night after he was
    transported from the Payson hospital to Primary Children’s Medical Center in Salt Lake
    City. Although there were few external signs of severe injury, consisting only of a “few
    bruises here and there” and “a small mark on the top of his head,” a CT scan showed
    “intra‐cranial bleeding” or sub‐dural hemorrhages of two different ages, i.e., “acute and
    sub‐acute injury.” Dr. Herman opined that the acute bleeding was less than three days
    old and the sub‐acute bleeding appeared to be three days to two weeks old. Dr.
    Herman testified that he thought the “sub‐dural hemorrhages . . . [were] traumatic in
    origin.”
    ¶6     Dr. Herman also reported that the victim “had extensive bilateral retinal
    hemorrhages with retinoschisis.” At trial, Dr. Herman described retinal hemorrhages as
    “bleeding at the back of the eye,” and retinoschisis as “an actual splitting of layers of the
    retina,” essentially, “a blood blister at the back of the eye.” Dr. Herman testified that
    the victim’s “retinal hemorrhages are at the most extreme [e]nd of severity, and have
    never been reported to have come from a non‐fatal accidental cause.”
    ¶7      Dr. Herman concluded that the “constellation” of the victim’s injuries—the
    retinal hemorrhages, the retinoschisis, and the sub‐dural hemorrhages—were “quite
    consistent with inflicted trauma by shaking or shaking with impact.”3 Dr. Herman’s
    conclusion that the victim had been shaken that morning was supported by the victim’s
    immediate symptoms of severe brain injury while he was still with O’Bannon. Dr.
    Herman did not believe the victim likely sustained the sub‐dural hemorrhage and acute
    3
    Dr. Herman explained that it was not the existence of any one of the victim’s
    specific injuries that led to his conclusion that the victim had been intentionally harmed;
    rather, it was the combination of the severe injuries. Dr. Herman stated, “[W]hen we
    look at a child, we do [not] look at one finding in isolation. We have to look at all the
    findings and create a differential diagnosis for those—the constellation of findings.”
    20090241‐CA                                  3
    bleeding from falling down the stairs.4 Dr. Herman opined that while the victim
    experienced increased intra‐cranial pressure due to the swelling of the sub‐dural
    hemorrhage, this increased pressure did not likely cause the extensive retinal
    hemorrhages and retinoschisis.
    ¶8      Dr. David Christopher Dries, a pediatric ophthalmologist, examined the victim’s
    eyes the day after the victim was admitted to Primary Children’s Medical Center and
    diagnosed the victim with “bilateral diffuse intra‐retinal hemorrhages and hemorrhages
    in all of the retina on both eyes” and “retinoschisis.” At trial, Dr. Dries testified that
    “bilateral diffuse retinal hemorrhages with retinoschisis . . . is a pattern that is seen in
    non‐accidental trauma.” Dr. Dries testified that the “pattern” of retinal hemorrhages
    and retinoschisis that he recognized in the victim was consistent with non‐accidental
    trauma, such as shaking or shaking with impact. Dr. Dries also did “not know of any
    study or case report or child from [his] personal experience that had this pattern of
    retinal hemorrhages from a fall down six stairs or seven stairs. It takes far greater force
    for accidental trauma, far greater.” Finally, Dr. Dries did not believe that increased
    intra‐cranial pressure caused the victim’s retinal hemorrhages.
    4
    Dr. Herman stated that a fall down the stairs
    sounds bad, because you hear a thump, and then you hear
    [a] series of more thumps, but what the literature would
    suggest is that these are a series of small falls. . . . A fall
    from—say we have stairs from the top of this counter onto
    the floor. A child who just keels over from the top of this
    counter onto the floor I would say has a much bigger chance
    of being injured as opposed to going down the steps from
    here to the floor, because each step sort of is another small
    fall. So stairway falls can be thought of as a series of small
    falls.
    When asked about what type of injury he would expect to see in a child falling down
    five to eight carpeted steps, Dr. Herman testified that he would not expect to see very
    severe injuries in such a situation, specifically stating, “[A] child who is carried by [his
    or her] caretaker and falls down the steps is more likely to be injured than someone
    who’s just crawling or walking and falling down the steps.”
    20090241‐CA                                   4
    II. O’Bannon’s Defense
    ¶9     At trial, O’Bannon presented a “re‐bleed” defense supported by his expert
    witness, Dr. Robert Keith Rothfeder, formerly an emergency room physician and
    currently a physician in private practice with experience in treating traumatic injuries.
    As part of his current practice, Dr. Rothfeder consults in brain injury and child abuse
    cases. Dr. Rothfeder, who is also a lawyer, explained that the victim had a sub‐dural
    hematoma with “old blood” and “fresh blood.” The “old” sub‐dural hematoma had a
    “‘membrane’ . . . like a scab” that formed after the old bleeding stopped. Dr. Rothfeder
    stated that “re‐bleeding of an old sub‐dural hematoma can occur with little force, and
    perhaps with no force[, but] from biological factors.” Dr. Rothfeder testified “that a fall
    down [the] stairs is one of the things that could have caused a re‐bleed of that old sub‐
    dural hematoma” even though the old and new bleeding occurred in two different
    areas of the brain. In Dr. Rothfeder’s opinion, the victim’s injury occurred on October
    31, which caused re‐bleeding of the victim’s old sub‐dural hematoma (the preexisting
    hematoma). This re‐bleeding, he testified, would have “increase[d the victim’s] intra‐
    cranial pressure over time.” Dr. Rothfeder believed that the victim’s retinal
    hemorrhages and retinoschisis were likely caused by the increasing pressure of the re‐
    bleeding of the sub‐dural hematoma rather than by a new, acute injury.
    ¶10 O’Bannon took the stand and testified that he “did [not] hurt [the victim],” did
    not shake or strike the victim, and “would never hurt [the victim] in any way. . . ,”
    stating, “[H]e was one of my own kids.”
    III. The Jury Instructions
    ¶11 Several of the instructions given to the jury explained the elements of second
    degree felony child abuse, see Utah Code Ann. § 76‐5‐109(2)(a) (Supp. 2011).
    O’Bannon’s stipulation that the victim had suffered a serious physical injury resulted in
    Instruction No. 9, which instructed the jury to “find [that] this element of the [charged]
    offense has been prove[n] beyond a reasonable doubt.” See generally id. § 76‐5‐109(1)(f)
    (defining “serious physical injury”); id. § 76‐5‐109(2)(a). Instruction No. 4 tracked the
    language of second degree felony child abuse, see id. § 76‐5‐109(2)(a) (“Any person who
    inflicts upon a child serious physical injury or, having the care or custody of such child,
    causes or permits another to inflict serious physical injury upon a child is guilty of an
    offense as follows: (a) if done intentionally or knowingly, the offense is a felony of the
    20090241‐CA                                  5
    second degree . . . .”). And Instruction No. 6 defined what it means to be “engag[ing] in
    conduct” either “intentionally” or “knowingly.” See id. § 76‐2‐103(1)‐(2) (2008). The
    jury was also provided additional explanations regarding intent in Instructions Nos. 7
    and 8. Instruction No. 7 stated, in part,
    Intent, being a state of mind, is seldom susceptible of proof
    by direct and positive evidence and must ordinarily be
    inferred from acts, conduct, statements and circumstances.
    Thus, you would be justified in inferring that a person must have
    intended the natural and probable consequences of any act
    purposely done by him or her.
    (Emphasis added.) Instruction No. 8 provided in part, “As the jury, you may infer a
    defendant’s intent from a voluntary act which produces as its natural and probable consequence
    an unlawful result. You are instructed that circumstantial evidence is competent to prove
    that the defendant had the specific intent required when he committed the acts
    charged.” (Emphasis added.)
    ¶12 After O’Bannon presented his re‐bleed defense, the State proposed Instruction
    No. 9A because it was concerned that O’Bannon’s re‐bleed theory would confuse the
    jury about the cause of the victim’s severe injuries. In particular, the State wanted the
    jury to be instructed that it could find O’Bannon criminally responsible for inflicting
    serious physical injury on the child even if O’Bannon’s shaking of the victim caused
    only re‐bleeding of an older injury. Instruction No. 9A stated, “In criminal law the
    injurer takes his victim as he finds him. When injury ensues from deliberate
    wrongdoing, even if it is not an intended consequence, the injurer is responsible at law
    without the law concerning itself with the precise amount of harm inflicted.”
    ¶13 The trial judge gave Instruction No. 9A over O’Bannon’s objection,5 stating, “I
    believe this princip[le] is one that’s fairly long‐standing in the law, and we will allow
    this instruction to be given,” contingent on the prosecutor’s statement to the jury that
    the instruction would not apply if it found that the victim had fallen down the stairs.
    Ultimately, the jury found O’Bannon guilty of second degree felony child abuse. After
    5
    With the exception of Instruction No. 9A, O’Bannon does not challenge any of
    the jury instructions on appeal.
    20090241‐CA                                   6
    trial, O’Bannon filed motions to arrest judgment and for a new trial on the ground, inter
    alia, that Instruction No. 9A was erroneous. The trial court denied O’Bannon’s motions.
    O’Bannon appeals only the trial court’s issuance of Instruction No. 9A.
    ISSUE AND STANDARD OF REVIEW
    ¶14 O’Bannon challenges Instruction No. 9A, asserting that it incorrectly stated the
    law and erroneously applied the “eggshell plaintiff doctrine,” which originated in tort
    law, to a criminal matter. O’Bannon contends that Instruction No. 9A allowed the jury
    to find him criminally responsible for second degree felony child abuse without a
    determination that he intentionally or knowingly caused the victim serious physical
    injury. See generally Utah Code Ann. § 76‐5‐109(2)(a) (Supp. 2011). O’Bannon argues
    that this erroneous jury instruction prejudiced him and that we should therefore reverse
    his conviction and sentence and remand for a new trial.
    ¶15 “[W]e review jury instructions in their entirety to determine whether the
    instructions, taken as a whole, fairly instruct the jury on the applicable law.” State v.
    Malaga, 
    2006 UT App 103
    , ¶ 18, 
    132 P.3d 703
     (alteration in original) (internal quotation
    marks omitted). “Whether a jury instruction correctly states the law presents a question
    of law which we review for correctness.” State v. Houskeeper, 
    2002 UT 118
    , ¶ 11, 
    62 P.3d 444
    . If “a jury instruction is erroneous, we will reverse only if the defendant shows a
    reasonable probability the error affected the outcome of his case.” State v. Perez, 
    2002 UT App 211
    , ¶ 22, 
    52 P.3d 451
     (internal quotation marks omitted); accord State v. Davis,
    
    2007 UT App 13
    , ¶ 6, 
    155 P.3d 909
    .
    ANALYSIS
    ¶16 In reviewing the jury instructions as a whole, we determine that the trial court
    did not “fairly instruct the jury on the applicable law,” see Malaga, 
    2006 UT App 103
    ,
    ¶ 18 (internal quotation marks omitted). We agree with O’Bannon that Instruction No.
    9A confused the mental state required for a second degree felony child abuse conviction
    by stating that the jury could find O’Bannon guilty of second degree felony child abuse
    without determining that he intended to cause or knowingly caused the victim serious
    20090241‐CA                                 7
    physical injury. We also agree with O’Bannon that he was prejudiced as a result of the
    erroneous jury instruction.
    I. The Eggshell Jury Instruction Inaccurately Stated the Law.
    A. Elements for a Conviction Under Utah Code Section 76‐5‐109(2)(a)
    ¶17 We begin our analysis of the validity of Instruction No. 9A with a discussion
    about the mental state element of second degree felony child abuse. O’Bannon and the
    State fundamentally disagree about the mental state the State was required to prove at
    trial to convict O’Bannon of second degree felony child abuse. See generally Utah Code
    Ann. § 76‐2‐103(1)‐(2) (2008) (defining the mental states “intentionally” and
    “knowingly”); id. § 76‐5‐109(2)(a) (Supp. 2011) (stating the elements of second degree
    felony child abuse). We determine that Instruction No. 9A inaccurately stated the law
    with regard to the mental state required for the jury to find O’Bannon guilty of second
    degree felony child abuse.
    ¶18 According to O’Bannon, the required mental state under Utah Code section 76‐2‐
    103(1)‐(2) depends on whether the crime charged is a “conduct‐based crime” or a
    “result‐based crime.” See generally id. § 76‐2‐103(1)‐(2) (2008). “A conduct‐based
    crime,” he asserts, “is a crime where the statute prohibits engaging in certain conduct or
    behavior often regardless of whether or not the conduct causes any result,” and “[a]
    result‐based crime prohibits causing a certain result regardless of the means by which it
    is achieved.” Therefore, in the context of a conduct‐based crime, “a person engages in
    conduct intentionally . . . with respect to the nature of his conduct” when he “desire[s]
    to engage in the conduct” or when he is “aware of the nature of his conduct.” See id. In
    the context of a result‐based crime, “[a] person engages in conduct [] intentionally”
    when he “desire[s] to . . . cause the result” or “acts . . . with knowledge[] with respect to
    a result of his conduct when he is aware that his conduct is reasonably certain to cause
    the result.” See id. O’Bannon argues that the legislature intended for second degree
    felony child abuse to be a result‐based crime.
    ¶19 O’Bannon illustrates his position with an example of a person who intended to
    firmly hug a child or infant and did not intend the hugging to result in injury, but who
    nevertheless caused serious physical injury upon the child or infant. O’Bannon argues
    that the person’s conduct of hugging would be criminalized because the person
    20090241‐CA                                   8
    intended to engage in the hug. O’Bannon asserts that the legislature did not intend for
    the person’s conduct in such circumstances to be criminalized where he or she did not
    intend to cause harm, especially not the serious physical injury required for a second
    degree felony conviction. O’Bannon thus argues that the child abuse statute clearly
    provides that in order for him to be found guilty of second degree felony child abuse,
    “the State must prove [beyond a reasonable doubt] that he either intended to cause [the
    victim] serious physical injury or knew that his conduct was reasonably certain to cause
    [the victim] serious physical injury.”
    ¶20 By contrast, the State argues that O’Bannon was correctly convicted of second
    degree felony child abuse even if the State proved only that “the nature of [O’Bannon’s]
    conduct” was intentional, see id. § 76‐2‐103(1), or that O’Bannon “[was] aware of the
    nature of his conduct or the existing circumstances,” see id. § 76‐2‐103(2). The State
    emphasizes the disjunctive “or” in section 76‐2‐103(1)‐(2), to assert that, in order to
    convict O’Bannon of child abuse as a second degree felony, it was required to prove
    only that O’Bannon intentionally or knowingly engaged in the conduct (shaking), or
    that O’Bannon intended to cause a particular result or knew that a particular result
    would occur, but that it is not required to prove both that O’Bannon engaged in the
    conduct and intended the result or knew the conduct was reasonably certain to cause
    the result. See id. § 76‐2‐103(1)‐(2).
    ¶21 According to the State, O’Bannon could be convicted of second degree felony
    child abuse if he intended “the nature of his conduct” that “inflict[ed the] serious
    physical injury” on the victim regardless of whether he intended to actually cause the
    child a serious physical injury. See id. § 76‐2‐103(1); id. § 76‐5‐109(2)(a) (Supp. 2011).
    The State alternatively argues that O’Bannon could be found guilty of second degree
    felony child abuse if it proved that O’Bannon was aware of the nature of his conduct or
    the existing circumstances of his infliction of serious physical injury on the victim
    regardless of whether O’Bannon was aware that his conduct was reasonably certain to
    cause the result. See id. § 76‐2‐103(2) (2008); id. § 76‐5‐109(2)(a) (Supp. 2011). In other
    words, the State argues that it was only required to prove beyond a reasonable doubt
    that O’Bannon intended to shake the victim, not that O’Bannon intended to cause the
    victim serious physical injury. Were this not the result, the State argues, then a person
    who intentionally shakes a child could “avoid liability for any brain damage by
    claiming that she intended only to scare the child, not to seriously injure him.”
    20090241‐CA                                  9
    ¶22 Thus, the parties’ contrary interpretations of section 76‐5‐109(2)(a) center on
    whether, to sustain a conviction for second degree felony child abuse in these
    circumstances, the State need only prove that O’Bannon acted intentionally because he
    “desire[d] to engage in the conduct” that caused the serious physical injury or acted
    knowingly because he knew that engaging in such “conduct [was] reasonably certain to
    cause” serious physical injury to the victim. See Utah Code Ann. § 76‐2‐103(1)‐(2)
    (2008); id. § 76‐5‐109(2)(a) (Supp. 2011).
    ¶23 We agree with O’Bannon’s interpretation of the statute and determine that, for
    the jury to find him guilty of second degree felony child abuse, the State had the burden
    at trial of proving that O’Bannon intended his conduct to cause the victim serious
    physical injury or of proving that O’Bannon knew that his conduct was reasonably
    certain to cause the victim serious physical injury.
    When interpreting statutes, we first look to the plain
    language of the statute and give effect to that language
    unless it is ambiguous. Thus, a statutory provision should
    be read literally, unless it would result in an unreasonable or
    inoperable result. When examining the statutory language
    we assume the legislature used each term advisedly and in
    accordance with its ordinary meaning.
    Our duty to give effect to the plain meaning of a
    statute, however, should give way if doing so would work a
    result so absurd that the legislature could not have intended
    it. Where a statute’s plain language creates an absurd,
    unreasonable, or inoperable result, we assume the
    legislature did not intend that result. To avoid an absurd
    result, we endeavor to discover the underlying legislative
    intent and interpret the statute accordingly.
    State v. Jeffries, 
    2009 UT 57
    , ¶¶ 7‐8, 
    217 P.3d 265
     (citations and internal quotation marks
    omitted).
    20090241‐CA                                  10
    ¶24    Utah Code section 76‐5‐109(2)(a) provides,
    Any person who inflicts upon a child serious physical injury
    or, having the care or custody of such child, causes or
    permits another to inflict serious physical injury upon a
    child is guilty of an offense as follows: (a) if done
    intentionally or knowingly, the offense is a felony of the
    second degree . . . .
    Utah Code Ann. § 76‐5‐109(2)(a) (Supp. 2011). Section 76‐2‐103 defines the mental states
    of intentional and knowing:
    A person engages in conduct: (1) Intentionally, or with
    intent or willfully with respect to the nature of his conduct
    or to a result of his conduct, when it is his conscious
    objective or desire to engage in the conduct or cause the
    result. (2) Knowingly, or with knowledge, with respect to
    his conduct or to circumstances surrounding his conduct
    when he is aware of the nature of his conduct or the existing
    circumstances. A person acts knowingly, or with
    knowledge, with respect to a result of his conduct when he is
    aware that his conduct is reasonably certain to cause the
    result.
    Id. § 76‐2‐103(1)‐(2) (2008).
    ¶25 Interpreted literally, section 76‐5‐109(2)(a) provides that a person who inflicts
    serious physical injury upon a child commits second degree felony child abuse if he or
    she intentionally engages in conduct that leads to the child’s serious physical injury and
    (1) desires to engage in that conduct or (2) desires to cause the result. See id. § 76‐2‐
    103(1); id. § 76‐5‐109(2)(a) (Supp. 2011). Alternatively, a person who inflicts serious
    physical injury upon a child commits second degree felony child abuse if he or she
    knowingly engages in conduct that leads to the child’s serious physical injury and (1) is
    aware of the nature of his or her conduct or the existing circumstances or (2) is aware
    that his or her conduct is reasonably certain to cause the result. See id. § 76‐2‐103(2)
    (2008); id. § 76‐5‐109(2)(a) (Supp. 2011). Additionally, the plain meaning of the word
    20090241‐CA                                 11
    “inflict” from the child abuse statute is “to give by or as if by striking ” or “ to
    cause (something unpleasant) to be endured.” See Merriam‐Webster’s Collegiate
    Dictionary 641 (11th ed. 2003).
    ¶26 Interpreting section 76‐5‐109(2)(a) literally would lead to an unintended,
    unreasonable, and even absurd result.6 See Jeffries, 
    2009 UT 57
    , ¶ 8. To avoid an
    unintended result, we read this statute to mean that second degree felony child abuse
    requires a culpable mental state that relates to the result of the conduct and not to the
    nature of the circumstances surrounding the conduct itself. That is, to be found guilty
    of second degree felony child abuse, the person must have intended to cause the victim
    serious physical injury or must have been aware that his or her conduct was reasonably
    certain to cause the victim serious physical injury. Moreover, we do not apply the word
    “inflict” to only non‐accidental acts.
    ¶27 By way of example, literally interpreting section 76‐2‐103 as it applies to section
    76‐5‐109(2)(a) would mean that a person who engages in innocent horseplay with a
    child could be convicted of second degree felony child abuse if the child suddenly falls
    off the person’s back, hits his head, and suffers serious physical injury. The person thus
    inflicted serious physical injury upon the child and either desired to engage in the
    conduct or was aware of the nature of his or her conduct, even though he or she did not
    desire and was not aware that the conduct was reasonably certain to cause the child to
    fall and suffer a serious physical injury.
    ¶28 In our hypothetical example, however accidental it was, the person still inflicted
    the child’s serious physical injury. If inflict meant only a non‐accidental action against a
    person, it would preclude the criminalization of a reckless or criminally negligent
    action, something that is contrary to our statutes. Inflicting serious physical injury upon
    a child applies not only to intentional and knowing (second degree felony) child abuse,
    but also to reckless child abuse, see 
    id.
     § 76‐5‐109(2)(b) (Supp. 2011) (“[I]f done
    recklessly, the offense is a felony of the third degree.”), and to criminally negligent child
    abuse, see id. § 76‐5‐109(2)(c) (“[I]f done with criminal negligence, the offense is a class A
    misdemeanor.”). Thus, under the statute, a defendant can inflict serious physical injury
    6
    Our interpretation of section 76‐2‐103(1)‐(2) is limited to second degree felony
    child abuse. See Utah Code Ann. § 76‐2‐103(1)‐(2) (2008); id. § 76‐5‐109(2)(a) (Supp.
    2011).
    20090241‐CA                                  12
    upon a child with different levels of culpable mental states, i.e., intentionally or
    knowingly, which imply non‐accidental infliction of injury; or recklessly or negligently,
    which imply accidental infliction of injury.
    ¶29 Furthermore, were we to literally interpret the statute as requiring the State to
    prove only that one intended to engage in the conduct surrounding the injury to a child,
    then the general public might not know when conduct could possibly be criminalized in
    an instance where a person intended to engage in certain conduct even though they did
    not intend the serious physical injury that resulted. Instead of that absurd result, it is
    far likelier that the legislature intended the public to understand that if a person
    intentionally or knowingly causes serious physical injury to a child, he or she commits a
    second degree felony regardless of how he or she causes the injury.
    ¶30    We also observe the following directive:
    The rule that a penal statute is to be strictly construed
    shall not apply to [the criminal] code, any of its provisions,
    or any offense defined by the laws of this state. All
    provisions of [the criminal] code and offenses defined by the
    laws of this state shall be construed according to the fair
    import of their terms to promote justice and to effect the
    objects of the law and general purposes of Section 76‐1‐104.
    Utah Code Ann. § 76‐1‐106 (2008). The general purposes of the criminal code, as
    described in section 76‐1‐104, include “[f]orbidd[ing] and prevent[ing] the commission
    of offenses” and “[d]efin[ing] adequately the conduct and mental state which constitute
    each offense and safeguard conduct that is without fault from condemnation as
    criminal.” Id. § 76‐1‐104(1)‐(2). In the context of second degree felony child abuse,
    applying the conduct portion of the intentional definition (desires to engage in that
    conduct), see id. § 76‐2‐103(1), and the knowing definition (is aware of the nature of his
    or her conduct or the existing circumstances), see id. § 76‐2‐103(2), would contradict the
    general purpose of the criminal code to “safeguard conduct that is without fault from
    condemnation as criminal,” see id. § 76‐1‐104(2). In State v. Miller, 
    2008 UT 61
    , 
    193 P.3d 92
    , the supreme court similarly declined to “[s]trictly constru[e] the term ‘possesses’” in
    Utah Code section 58‐37‐8 when doing so would promote injustice to those innocently
    20090241‐CA                                  13
    possessing a controlled substance and would “create[] a myriad of absurd prosecutorial
    possiblities.” 
    Id. ¶¶ 20
    ‐21.
    ¶31 Consequently, we agree with O’Bannon that, to convict him of second degree
    felony child abuse, the State was required to prove that O’Bannon intended to cause the
    victim serious physical injury to the victim or that OʹBannon was aware that his actions
    were reasonably certain to cause serious physical injury to the victim. It follows that it
    is insufficient for a second degree felony child abuse conviction for the State to prove
    only that O’Bannon intended to be, or knew that he was, engaged in certain conduct
    without the requisite intent or knowledge that a serious physical injury would likely
    result from his commission of that conduct.
    B. The Eggshell Plaintiff Doctrine
    ¶32 Based upon our determination that the State was required to prove that
    O’Bannon intended to cause the victim serious physical injury or that he was aware that
    his actions were reasonably certain to cause the victim serious physical injury, we agree
    with O’Bannon that Instruction No. 9A improperly applied the eggshell plaintiff
    doctrine in his criminal case. The “common law tort principle commonly referred to as
    the ‘thin skull’ or ‘eggshell skull’ doctrine [is that] one who injures another takes the
    injured as she finds him.” Ryan v. Gold Cross Servs., Inc., 
    903 P.2d 423
    , 428 (Utah 1995).
    We determine that Instruction No. 9A was misleading because it confuses the mental
    state required for a second degree felony child abuse conviction. The instruction
    incorrectly allowed the jury to find O’Bannon guilty of second degree felony child
    abuse when it determined that he intentionally or knowingly shook the victim, rather
    than requiring the State to prove that O’Bannon intended to cause the victim serious
    physical injury or that O’Bannon knew that his actions were reasonably certain to cause
    the victim serious physical injury.
    ¶33 The State modeled Instruction No. 9A on Brackett v. Peters, 
    11 F.3d 78
     (7th Cir.
    1993), cert. denied, 
    511 U.S. 1072
     (1994), in which the Seventh Circuit affirmed the
    murder conviction of a defendant who had raped and assaulted an eighty‐five‐year‐old
    woman. See 
    id. at 82
    . The victim’s death was partially caused by the injuries she
    suffered during the defendant’s attack. See 
    id. at 79
    ‐80. The Brackett court concluded
    that it was sufficient that the injuries the defendant inflicted on the victim constituted
    some of the myriad causes of the victim’s death and thus stated that “when injury or
    20090241‐CA                                 14
    death ensues from deliberate wrongdoing, even if . . . [death] is not an intended
    consequence, the criminal law comes down heavily on the defendant without worrying
    overmuch about the precise amount of harm inflicted.” 
    Id. at 82
    .
    ¶34 A critical distinction between Brackett and this case is that Brackett involved
    felony murder. See 
    id.
     To obtain a conviction for felony murder, the prosecution was
    not required to prove that the defendant had the specific intent to kill, only that the
    defendant had the intent to engage in certain proscribed conduct that resulted in the
    death of another. See 
    id.
     Thus, the intent requirement for a felony murder conviction is
    different than that required for second degree felony child abuse, which, as explained
    above, requires the State to prove intent to cause serious physical injury or that the
    defendant acted with knowledge of the reasonably certain consequences of his conduct.
    Compare 
    id.,
     with Utah Code Ann. § 76‐5‐109(2)(a) (Supp. 2011). Contrasting felony
    murder with intentional murder, the Seventh Circuit explained, “[t]he eggshell‐skull
    principle does not quite fit a case of intentional murder, for the murderer must intend
    his victim’s death and ordinarily this will presuppose some awareness of the likely
    consequences of his act.” Brackett, 
    11 F.3d at 81
    ‐82. The Seventh Circuit acknowledged
    that a tort law concept such as the eggshell plaintiff doctrine focuses on compensation
    for injuries “while criminal law, which emphasizes deterrence and incapacitation,
    focuses on the dangerousness of the defendant’s conduct.” 
    Id. at 82
    . Nevertheless, the
    Seventh Circuit upheld the trial court’s application of the tort doctrine in the felony
    murder criminal case. See 
    id. ¶35
     Instruction No. 9A incorporated the tort law concept of the eggshell plaintiff
    doctrine: “In criminal law the injurer takes his victim as he finds him,” and “[w]hen
    injury ensues from deliberate wrongdoing, even if it is not an intended consequence,
    the injurer is responsible at law without the law concerning itself with the precise
    amount of harm inflicted.” These statements distort the mental state requirement that
    must be proven to sustain a conviction for second degree felony child abuse. As we
    explained above, a second degree felony child abuse conviction requires a finding that
    the defendant intended to cause the child serious physical injury or that the defendant
    knew that by engaging in certain conduct, “he or she was reasonably certain to cause”
    the child serious physical injury. See Utah Code Ann. § 76‐2‐103(1)‐(2) (2008); id. § 76‐5‐
    109(2)(a) (Supp. 2011). The eggshell plaintiff doctrine confuses the mental state element
    of second degree felony child abuse because if a person did not intend to cause serious
    physical injury to the child or know that his or her conduct was reasonably certain to
    cause serious physical injury to the child, then he or she cannot be found guilty of
    20090241‐CA                                 15
    intentionally or knowingly causing serious physical injury to the child, even if the child
    is unusually vulnerable. The State must prove that the defendant knowingly or
    intentionally caused a “precise amount of harm.” See Brackett, 
    11 F.3d at 82
    . The fact
    that the victim may have been extra susceptible to injury does not relieve the State of its
    burden to prove that O’Bannon intentionally or knowingly caused the serious physical
    injury that the victim suffered.
    ¶36 The State asserts that the Utah appellate courts have applied the eggshell plaintiff
    doctrine in the criminal law context in State v. Hamblin, 
    676 P.2d 376
     (Utah 1983), and
    State v. Gonzales, 
    2002 UT App 256
    , 
    56 P.3d 969
    . In Hamblin, although the supreme court
    did not refer to the eggshell plaintiff doctrine, it affirmed the trial court’s decision not to
    instruct the jury that it was required to find the defendant, who had been speeding and
    had a blood alcohol content of .12 percent, the “‘sole proximate cause’” of the death of
    the victim, who had been driving with a blood alcohol content of .10%, in order to find
    the defendant guilty of automobile homicide. See Hamblin, 676 P.2d at 377‐79. The
    supreme court quoted an Alaska Supreme Court case to explain the following:
    “The state, in a criminal case, is not required to prove
    beyond a reasonable doubt that the defendant’s negligence
    was the sole proximate cause of the death. When a
    defendant negligently creates a risk of death to another
    person, the fact that the person actually died as a result of
    the combination of that negligence plus some other
    contributing factor does not serve to exculpate.”
    Id. at 379 (emphasis in original) (quoting Wren v. State, 
    577 P.2d 235
    , 240 (Alaska 1978)).
    ¶37 In Gonzales, this court held that the trial court properly instructed the jury on
    causation in that it could correctly convict the defendant of manslaughter even if there
    was another significant contributing factor to the victim’s death, such as the victim’s
    intoxication. See 
    56 P.3d 969
    , ¶¶ 20‐21 (“A defendant’s acts may be found to be the
    proximate cause of the victim’s death even if the victim ‘actually died as a result of the
    combination of [the defendant’s acts] plus some other contributing factor.’” (alteration
    in original) (quoting Hamblin, 676 P.2d at 379)).
    20090241‐CA                                   16
    ¶38 Gonzales and Hamblin do not support the application of the eggshell plaintiff
    doctrine in a criminal case. We agree that Gonzales and Hamblin are instructive in that
    these cases recognize a basis under Utah law for holding a defendant culpable for
    causing death even when other factors contributed to the victim’s death. See generally
    Hamblin, 676 P.2d at 379; Gonzales, 
    2002 UT App 256
    , ¶¶ 20‐21. In this case, however,
    Instruction No. 9A is not comparable to those issued in Gonzales and Hamblin.
    Instruction No. 9A advised the jury that it could find O’Bannon guilty of a specific
    result‐based offense without determining that he had the requisite intent or knowledge
    that his conduct would cause that result. Thus, Instruction No. 9A improperly allowed
    the jury to find O’Bannon guilty without the required proof that he intentionally or
    knowingly caused the victim’s serious physical injuries.
    ¶39 Finally, after reviewing the jury instructions in their entirety, we cannot say that,
    “taken as a whole,” they “fairly instruct[ed] the jury on the applicable law.” See State v.
    Malaga, 
    2006 UT App 103
    , ¶ 18, 
    132 P.3d 703
     (internal quotation marks omitted); see also
    State v. Harper, 
    2006 UT App 178
    , ¶ 14, 
    136 P.3d 1261
     (“If taken as a whole [the
    instructions] fairly instruct the jury on the law applicable to the case, the fact that one of
    the instructions, standing alone, is not as accurate as it might have been is not reversible
    error.” (internal quotation marks omitted)). We acknowledge that the jury was
    instructed that it was “justified in inferring that a person must have intended the
    natural and probable consequences of any act purposely done by him or her,” and that
    it could infer intent from circumstantial evidence such as “a voluntary act which
    produces as its natural and probable consequence an unlawful result.” Although these
    instructions are consistent with Utah law, see, e.g., State v. James, 
    819 P.2d 781
    , 789‐90
    (Utah 1991) (stating that “[an] inference is made that the natural consequences of that
    act were intended to occur” and that “intent is of necessity proven by circumstantial
    evidence”); State v. Sisneros, 
    631 P.2d 856
    , 859 (Utah 1981) (“[A] person is presumed to
    intend the natural and probable consequences of his acts.” (internal quotation marks
    omitted)); State v. Robertson, 
    2005 UT App 419
    , ¶ 15, 
    122 P.3d 895
     (“[T]he intent to
    commit [a crime] is a state of mind, which is rarely susceptible of direct proof, it can be
    inferred from conduct and attendant circumstances in the light of human behavior and
    experience.” (internal quotation marks omitted)), they do not compensate for
    Instruction No. 9A, which confuses the mental state element for a second degree felony
    child abuse conviction.
    II. The Erroneous Jury Instruction Constitutes Reversible Error Because O’Bannon Was
    20090241‐CA                                   17
    Prejudiced by Instruction No. 9A.
    ¶40 O’Bannon argues, and we agree, that Instruction No. 9A improperly instructed
    the jury that it could find O’Bannon guilty of second degree felony child abuse without
    determining that O’Bannon actually intended to cause or knowingly caused the victim
    serious physical injury. The prosecutor highlighted Instruction No. 9A in closing
    argument, stating,
    In criminal law, the injurer takes the victim as he finds him.
    That means that if there was [a] sub‐acute hemorrhage in
    this [victim’s] head, if he causes injury and shakes this child
    to cause not only the new injury, but a re‐bleed of the old, he
    is responsible for all of the damage that may be because of
    the re‐injury to an old injury.
    In closing argument the prosecutor also stated, “All the State is required to show is that
    [O’Bannon] intended to do the shaking.”
    ¶41 Instruction No. 9A, combined with the State’s closing argument, instructed the
    jury that it could find O’Bannon guilty of second degree felony child abuse without
    determining that he had the requisite intent or knowledge to cause the victim serious
    physical injury. Therefore, we agree with O’Bannon that the court erred by so
    instructing the jury. However, an error is reversible only if the defendant persuades us
    that there was “a reasonable probability the error affected the outcome of his case.’”
    State v. Perez, 
    2002 UT App 211
    , ¶ 22, 
    52 P.3d 451
    . “An error is prejudicial if it tends to
    mislead the jury to the prejudice of the complaining party or insufficiently or
    erroneously advise[s] the jury on the law.” State v. Penn, 
    2004 UT App 212
    , ¶ 28, 
    94 P.3d 308
     (alteration in original) (internal quotation marks omitted).
    ¶42 The State contends, even if we determine as we have, that O’Bannon could be
    convicted of second degree felony child abuse only if he intended to cause serious
    physical injury or acted knowing that his actions were reasonably certain to cause
    serious physical injury, the evidence presented at trial was sufficient to prove beyond a
    reasonable doubt that O’Bannon intentionally or knowingly caused the victim serious
    physical injury. The State argues that because the jury accepted the State’s theory of the
    victim’s injuries—that they were caused by O’Bannon violently shaking the
    20090241‐CA                                 18
    victim—and because the jury was instructed that it was “justified in inferring that a
    person must have intended the natural and probable consequences of any act purposely
    done by him or her,” and could infer intent from circumstantial evidence such as “a
    voluntary act which produces as its natural and probable consequence an unlawful
    result,” we must conclude that there is no reasonable possibility that O’Bannon
    violently shook the victim without intending the natural and probable consequences of
    his actions, and therefore, that O’Bannon intended to cause the victim serious physical
    injury.
    ¶43 Proof of a culpable mental state comes by way of circumstantial evidence, and
    proof of intent or knowledge is an inference that may be drawn by the factfinder both
    from direct and from circumstantial evidence. See James, 819 P.2d at 789‐90. A jury can
    infer intent or knowledge from the defendant’s acts, conduct, and remarks as well as
    from the circumstances surrounding the alleged crime. In this case, the State sought to
    prove O’Bannon’s mental state through circumstantial evidence. No direct evidence
    was presented to prove O’Bannon’s intent to cause the victim’s serious physical injury
    or to prove O’Bannon’s knowledge that serious physical injury was reasonably likely to
    result from his conduct. While the State’s witnesses testified and common sense
    indicates that violent shaking of a child provides for a substantial and unjustifiable risk
    of serious physical injury to that child, the fact that the victim had a prior injury and
    may have been especially vulnerable to further bleeding in his brain demonstrates that
    O’Bannon could have caused the victim serious physical injury without the requisite
    intent to do so. Though O’Bannon did not present evidence that he unintentionally
    caused the victim’s serious physical injuries, (i.e., shook the victim just a little bit), the
    State suggested that very defense by arguing that the jury could find O’Bannon guilty of
    second degree felony child abuse if it found that he shook the victim only enough to
    cause a re‐bleed of the old injury in the victim’s brain.
    ¶44 The error in giving Instruction No. 9A was prejudicial because “‘we cannot be
    sure’ that the jury based its” determination on the State’s argument that the victim did
    not fall down the stairs and that O’Bannon violently shook the victim, rather than on the
    State’s closing argument that O’Bannon shook the victim only enough to cause a re‐
    bleed of an older injury. Cf. State v. Davis, 
    2007 UT App 13
    , ¶ 13, 
    155 P.3d 909
     (reversing
    a conviction and stating, “‘we cannot be sure’ that the jury based its drug‐free zone
    determination on the public parking lot instruction and not on the erroneous bicycle
    path instruction” (quoting State v. Dunn, 
    850 P.2d 1201
    , 1209 (Utah 1993))).
    20090241‐CA                                  19
    ¶45 Thus, the jury instructions, specifically Instruction No. 9A, did not fairly instruct
    the jury on the mental state requirement for second degree felony child abuse, and we
    determine that there is a reasonable likelihood that the trial court’s error in giving
    Instruction No. 9A affected the outcome of the trial. See Perez, 
    2002 UT App 211
    , ¶ 22.
    CONCLUSION
    ¶46 The trial court erred by giving Instruction No. 9A, which misled the jury as to the
    mental state required, and which improperly applied the tort concept known as the
    eggshell plaintiff doctrine to the child abuse statute. Because the error was prejudicial,
    we reverse O’Bannon’s conviction and remand for a new trial.
    ____________________________________
    Michele M. Christiansen, Judge
    ‐‐‐‐‐
    ¶47   WE CONCUR:
    ____________________________________
    Gregory K. Orme, Judge
    ____________________________________
    Stephen L. Roth, Judge
    20090241‐CA                                 20