USA v. Tiofila Santillana

Filing 511080226

Case: 09-50298

Document: 00511080226

Page: 1

Date Filed: 04/14/2010

IN THE UNITED STATES COURT OF APPEALS United States Court of Appeals FOR THE FIFTH CIRCUIT Fifth Circuit FILED
N o . 09-50298 April 14, 2010 Lyle W. Cayce Clerk

U N IT E D STATES OF AMERICA, P la in tiff-A p p e lle e , v ersu s T IO F IL A SANTILLANA, D e fe n d a n t-A p p e lla n t.

A p p e a l from the United States District Court fo r the Western District of Texas

B e fo r e GARWOOD, SMITH, and CLEMENT, Circuit Judges. J E R R Y E. SMITH, Circuit Judge.

T io fila Santillana was convicted by a jury of distributing methadone res u ltin g in the death of Brandon Moore. She argues that there is insufficient evid e n c e to convict. We affirm.

Case: 09-50298

Document: 00511080226

Page: 2

Date Filed: 04/14/2010

No. 09-50298 I. T h e facts are not disputed. On April 9, 2008, Moore obtained an unknown q u a n t it y of Xanax 1 pills from a friend, Emily Suckarieh. Later that evening, M o o r e and a friend, Tyler Dickson, went to Santillana's home. Dickson bought a b o u t fourteen methadone pills from Santillana, then left. Moore stayed a few m in u t e s longer, then briefly rejoined Dickson outside. Though she could not rem e m b e r the precise date, Santillana later admitted that she also sold methadone t a b le ts to Moore at her house on or around April 9. A t about 10:30 p.m., Moore left the home of a friend, Dona Shaw, where h e had taken up temporary residence. Moore returned around 3:30 a.m. Shaw t e s t ifie d that when he came in, Moore looked "a little more hyped up" than he u s u a lly did. At approximately 5:30 a.m., Moore went to sleep on Shaw's sofa and c o n t in u e d to sleep there throughout the day. At 6 p.m., Shaw tried to rouse M o o r e , who was largely unresponsive. Shaw called another of Moore's friends t o help shake Moore awake. When neither of them could do so, they called Sucka r ie h , who decided to take Moore to the hospital at about 7 p.m. M o o r e was admitted to the emergency room. A urine screen tested positive fo r at least four different drugs: cocaine, amphetamine, benzodiazepines (i.e., X a n a x ), and methadone; he also tested positive for opiates, though that result c o u ld have been caused by the methadone.2 He had a small amount of alcohol in his system.3 Steven Rea, the attending physician, put Moore on a ventilator
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Xanax is a prescription drug used to treat anxiety disorders.

Dr. Stacey Hail, a government expert, testified that opiates are naturally-occurring compounds derived from the poppy plant, including morphine, codeine, and heroin. Methadone is a member of a class of synthetic compounds known as opioids. Synthetic opioids mimic the chemical behavior of natural opiates. As a result, an opioid such as methadone can sometimesSSbut not alwaysSScause a false positive test for opiates. Dr. William Rohr, an expert witness for Santillana, testified that the hospital report showed Moore's alcohol level at 10 milligrams per decileter, which he estimated was equiva(continued...)
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No. 09-50298 a n d administered Narcan, a reversal agent for narcotics. Moore responded briefly to the Narcan but then had to be sedated to prevent him from pulling out his b r e a t h in g tube. Moore spent the next eleven days in intensive care and another t w o days in hospice care. He died on April 23. A fte r an investigation by the Drug Enforcement Administration ("DEA"), S a n t illa n a was charged with distributing a schedule II controlled substance (m e th a d o n e ) to Moore, resulting in his death, in violation of 21 U.S.C. § 841(a)(1) a n d (b)(1)(C). The jury heard testimony from three medical experts. Dr. Nizam Peerwani performed Moore's autopsy and testified that Moore d ie d from brain death resulting from acute mixed drug intoxication. Peerwani c o n c lu d e d that methadone was probably the cause of death, because it was the o n ly positively identified drug in Moore's body that would have restricted breathin g and thus reduced oxygen to the brain. On cross-examination, however, Peerw a n i conceded that if another unidentified opiate were present in Moore's body, it could have also contributed to depressed respiration and brain death. He dec lin e d to identify one particular drug as the exclusive cause of death. S t a c e y Hail, an emergency medical physician and toxicologist, was a gove r n m e n t witness. Based on her review of Moore's medical records, she concluded th a t death was caused by a "poison cocktail" of methadone and Xanax. She testifie d that methadone is a highly lethal drug and that, when paired with Xanax (w h ic h is not very lethal by itself), methadone becomes even more lethal.4 She a ls o stated that Moore's presentation in the emergency roomSSpinpoint pupils a n d long-lasting depression of the central nervous system and respirationSSwas

(...continued) lent to one-half of one drink. Rohr estimated that Moore's alcohol level had been substantially higher during the night and early morning of April 9-10. According to Hail, some speculate that Xanax may slow down the body's metabolism of methadone, giving methadone a longer-lasting effect.
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No. 09-50298 c o n s is te n t with lethal methadone use. Hail discounted the possibility that one of the other drugs in Moore's syst e m caused his death. She testified that Xanax by itself would not have lowered r e s p ir a t i o n and thus reduced oxygen to the brain. Likewise, cocaine and amp h e t a m in e , as stimulants, would not have had the depressive effect Moore exhibite d . An opiate such as heroin was unlikely to have caused Moore's death, Hail r e a s o n e d , because heroin, unlike methadone, has a short-lasting effect; the drug a ffe c t in g Moore was long-lasting. Finally, another opioid such as hydrocodone w o u ld have been accompanied by a positive test for Tylenol, for which Moore t e s t e d negative. Though she thus concluded that a combination of methadone a n d Xanax killed Moore, Hail also testified that methadone alone could have b e e n the cause of death.5 W illia m Rohr, a county medical examiner, testified that he agreed with P e e r w a n i's conclusion that Moore died from mixed drug intoxication. Although h e acknowledged that methadone played a role in Moore's death, he did not b e lie v e it was possible to identify a single drug as the cause. Rohr explained t h a t the urine screen identifying the drugs in Moore's body did not indicate the q u a n t it ie s of any of the drugs. Moreover, Rohr testified that in his training as a medical examiner, he had learned that when there are several drugs in a per-

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Hail's testimony included the following exchange:

Q: "Let's assume there was no Xanax in this case. For whatever reason, Mr. Moore didn't take any benzodiazepine. Is this the kind of situation where you could opine that methadone alone might have resulted in Mr. Moore's death? A: Absolutely. Q: And why do you say that? A: Because methadone, again, is a very potent, long-acting drug. And even in the smallest, normal therapeutic dose, it can cause respiratory depression and death."

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Case: 09-50298

Document: 00511080226

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Date Filed: 04/14/2010

No. 09-50298 s o n 's system at the time of death, he could not "pick and choose" which one c a u se d the death, because "you don't know exactly how all of these [drugs] int e r p la y ." Rather, his practice was to "list all the drugs involved and leave it at th a t." A t the close of testimony, the jury deliberated for approximately forty m in u t e s . It returned a verdict of guilty.

II. S a n t illa n a raises two arguments on appeal, both regarding the sufficiency o f the evidence. First, she alleges there was insufficient evidence to establish t h a t the methadone in Moore's body at the time of his death was the same metha d o n e Santillana sold to him. Santillana also claims there was insufficient evid e n c e to show that Moore's death "result[ed]" from methadone according to § 841(b)(1)(C). W h e n reviewing sufficiency of the evidence, we will affirm if a reasonable t r ie r of fact could have concluded that the evidence established the essential elem e n ts of the offense beyond a reasonable doubt. United States v. Lopez, 74 F.3d 5 7 5 , 577 (5th Cir. 1996). We consider all evidence, credibility determinations, a n d reasonable inferences drawn therefrom in the light most favorable to the p r o s e c u tio n . Id. The jury may choose among reasonable constructions of the evid e n c e : The evidence need not exclude every reasonable hypothesis of innocence o r be wholly inconsistent with every conclusion except that of guilt. Id. We will r e v e r s e , however, if after viewing the evidence in the light most favorable to the p r o s e c u t io n , the evidence still gives equal or nearly equal support to a theory of g u ilt and a theory of innocence, id., because in that event, a reasonable trier of fa c t must necessarily entertain reasonable doubt, United States v. Sanchez, 961 F .2d 1169, 1173 (5th Cir. 1992).

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Case: 09-50298

Document: 00511080226

Page: 6

Date Filed: 04/14/2010

No. 09-50298 A. T h e statute under which Santillana was convicted imposes a minimum s e n t e n c e on defendants who distribute a schedule I or II drug when the subseq u e n t use of that drug causes death or serious injury. Under 21 U.S.C. § 841(a )(1 ) and (b)(1)(C), it is u n la w fu l for any person knowingly or intentionally . . . to . . . distr ib u te . . . a controlled substance[.] .... I n the case of a controlled substance in schedule . . . II [such as m e t h a d o n e ] . . . if death or serious bodily injury results from the use o f such substance [an offender] shall be sentenced to a term of imp r i s o n m e n t of not less than twenty years or more than life, a fine n o t to exceed the greater of that authorized in accordance with the p r o v is io n s of Title 18, or $1,000,000 if the defendant is an individual o r $5,000,000 if the defendant is other than an individual, or both. I t is thus an essential element of the conviction that Moore died as a result of the s p e c ific methadone distributed by Santillana. S a n t illa n a argues that there was insufficient evidence to link the methad o n e she admits selling to Moore to the methadone present in his body at the t im e of his admission to the hospital. Santillana points to evidence that Moore w a s a heavy drug user who had multiple drugs in his system when he arrived a t the emergency room and to the lack of testimony that Moore ever ingested the p a r tic u la r methadone tablets he received from Santillana. She therefore reasons t h a t there was equal evidence that Moore obtained his fatal dose of methadone fr o m another supplier. S a n t illa n a 's reasoning is unpersuasive. Although the evidence did not prov id e an airtight chain-of-custody account of the methadone tablets Santillana s o ld to Moore, there was ample support for a reasonable jury to infer that Moore in g e s t e d those tablets before slipping into his fatal coma. Santillana admitted s e llin g methadone to Moore just hours before he passed out. A DEA agent testi-

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Case: 09-50298

Document: 00511080226

Page: 7

Date Filed: 04/14/2010

No. 09-50298 fie d that approximately an hour-and-a-half after Moore and Dickson purchased m e t h a d o n e from Santillana, at the outset of his night of partying, Moore sent D ic k s o n a text message asking for advice on taking methadone. The jury also le a r n e d that Santillana was a regular methadone supplier for a number of peop le in Moore's circle of friends. Santillana does not point to any evidence that Moore received methadone, a s opposed to the other drugs in his system, from another source. As noted a b o v e , the evidence need not foreclose every possible theory of innocence; the ju r y is free to choose among reasonable constructions of the evidence. Viewed in the light most favorable to the verdict, the evidence does not lend equal or n e a rly equal support to the theories that Moore ingested methadone from ano t h e r source and that he ingested the methadone Santillana sold to him. The ju r y could have reasonably concluded that the methadone Moore ingested the n ig h t before he was admitted to the hospital was the same methadone he purc h a s e d from Santillana.

B. S a n tilla n a contends there was insufficient evidence for the jury to conclude t h a t Moore's death "result[ed]" from the methadone in his system, within the m e a n in g of § 841(b)(1)(C). Santillana concedes that all three medical witnesses, in c lu d in g her own expert, Rohr, concluded that methadone was at least a cont r ib u t i n g cause of death. She argues, however, that the plain meaning of "res u lts " implies "a stronger degree of causation than mere contribution." Santill a n a does not explain what this "stronger degree of causation" might be. She d o e s not argue, for instance, that a drug must be the exclusive cause of death to c r e a te culpability under § 841(b)(1)(C). Nor does she contend that the commonla w understanding of proximate cause should be the standard. Even if Santillana is correct that "results" implies a "stronger degree of 7

Case: 09-50298

Document: 00511080226

Page: 8

Date Filed: 04/14/2010

No. 09-50298 c a u s a t io n than [does] mere contribution," we still will not disturb the verdict. T h e jury heard evidence from Hail, the only expert witness certified in toxicolog y , that methadone was more than a mere contributing cause to Moore's death; in Hail's opinion, methadone was the determinative cause of death, either in c o m b in a tio n with Xanax or by its own effect. The jury was free to weigh the rela t iv e persuasiveness of Hail's testimony against that of Peerwani and Rohr, n e it h e r of whom gave a detailed explanation of his disagreement with Hail's reas o n in g . Thus, there was sufficient evidence for a reasonable jury to conclude t h a t Moore's death resulted from his use of methadone under a heightened stand a r d of causation. A F F IR M E D .

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