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Wells v. State (12/10/2004) ap-1963

Wells v. State (12/10/2004) ap-1963

                             NOTICE
     The  text  of this opinion can be corrected before  the
     opinion  is published in the Pacific Reporter.  Readers
     are  encouraged to bring typographical or other  formal
     errors  to  the attention of the Clerk of the Appellate
     Courts:

             303 K Street, Anchorage, Alaska  99501
                      Fax:  (907) 264-0878
       E-mail:  corrections@appellate.courts.state.ak.us


         IN THE COURT OF APPEALS OF THE STATE OF ALASKA


RALPH N. WELLS,                        )
                              )          Court of Appeals Nos. A-
8645 & A-8661
                                        Appellant,   )      Trial
Court  Nos. 4FA-S02-3818  Cr  &                                 )
4FA-S00-1788 Cr
                  v.                             )
                              )             O  P  I  N  I  O  N
STATE OF ALASKA,                       )
                              )
                                           Appellee.            )
                              [No. 1963  December 10, 2004]
                                                      )

          Appeal from the Superior Court, Fourth  Judi
          cial  District, Fairbanks, Mark I. Wood  and
          Charles R. Pengilly, Judges.

          Appearances:  Robert S. Noreen,  Law  Office
          of  Robert  S.  Noreen, Fairbanks,  for  the
          Appellant.  Kenneth M. Rosenstein, Assistant
          Attorney   General,   Office   of    Special
          Prosecutions  and  Appeals,  Anchorage,  and
          Gregg  D. Renkes, Attorney General,  Juneau,
          for the Appellee.

          Before:   Coats, Chief Judge, and Mannheimer
          and Stewart, Judges.

          STEWART, Judge.
          MANNHEIMER, Judge, concurring.


          Ralph  N. Wells lived in Salcha with Tina Woellert  and

her  nine-month-old son, G.W.  While Wells was caring  for  G.W.,

G.W.   sustained numerous bruises on his head.  A jury  convicted

Wells  of  third-degree  assault  (for  recklessly  causing  G.W.

physical  injury that reasonably required medical treatment  when

Wells  was  18  or  older and G.W. was under 10 years  of  age).1

Based  on  this  conviction, the superior  court  revoked  Wellss

probation  on  a  prior conviction for removal of  identification

marks.2

          Wells  argues that there was insufficient  evidence  to

conclude   that  Wells  had  recklessly  caused  G.W.s  injuries.

Second,  Wells  argues that there was insufficient evidence  that

G.W.s  injuries  reasonably required  medical  treatment.   Wells

argues  that because there was insufficient evidence  to  support

his  conviction,  the superior court erred when  it  revoked  his

probation.

          Wellss   first   argument  fails  because   the   State

presented  circumstantial evidence that G.W. was in  Wellss  care

when  he  was injured, that Wells persuaded Woellert not to  take

G.W.  to  the  hospital the day he was injured, and  that  Wellss

explanation  of  how  G.W. was injured was  contradicted  by  the

medical  evidence.   However, we accept  Wellss  second  argument

because the term medical treatment in AS 11.41.220(a)(1)(C)(i) is

susceptible of more than one meaning, and under the meaning  most

favorable to Wells, the medical care that G.W. received  was  not

treatment.   Accordingly,  we  must reverse  Wellss  third-degree

assault  conviction.  Because we reverse Wellss  conviction,  the

superior  court  must reconsider its decision  to  revoke  Wellss

probation.



          Background facts and proceedings

          On  September  22, 2002, Wells called Woellert  at  her

workplace  and  reported that G.W. had piled  blankets  and  toys

inside  his  crib to crawl out and had fallen out  of  the  crib.

Although  Woellert thought that G.W. should go to  the  hospital,

Wells  convinced her that was unnecessary.  Wells called Woellert

back  and  told her that he had phoned a doctor at the  hospital,

and  was told by the doctor that if G.W. was acting normally,  it

was  not  necessary  to  take him to  the  hospital.  Wells  also

reported that the doctor recommended that he keep G.W. awake  for

two  hours, in case G.W. had a concussion, and that if G.W.  fell

asleep  and stopped breathing, to administer CPR.  When  Woellert

saw G.W. after work, she noticed lots of bruises on his head.

          Woellert  took G.W. to Fairbanks Memorial Hospital  the

next  day.   Dr.  Sean  Wormuth,  an  emergency  room  physician,

examined  G.W.    Dr.  Wormuth found numerous  bruises  on  G.W.s

scalp,  face, and ears.   Dr. Wormuth ordered a CT scan of  G.W.s

head to check for any brain injury.  In addition, Wormuth ordered

lab tests to determine whether G.W.s blood was clotting normally,

or  whether  a  bleeding disorder was causing the bruising.   Dr.

Wormuth  contacted Dr. James Foote, another physician, to  ensure

that  he  would examine G.W. later to determine whether G.W.  was

healing properly.  Foote examined G.W. two days later.



          Was  there  sufficient  evidence that  Wells  assaulted

G.W.?

          Wells  argues that there was insufficient  evidence  to

support the jurys finding that Wells had recklessly caused  G.W.s

injuries.   Viewing the evidence presented at trial in the  light

most  favorable  to  upholding  the  verdict,  the  evidence   is

sufficient  to support a conviction if fair-minded  jurors  could

find the defendant guilty beyond a reasonable doubt.3

          The  State  presented evidence that G.W. sustained  the

head injuries while in Wellss care.  Woellert testified that  she

had  not seen G.W. the morning of the incident, but that  he  was

          not bruised when she put him to bed the night before.  Woellert

also  testified  that Wells had claimed that G.W. piled  blankets

and  toys inside his crib to climb out and had fallen out of  the

crib.  In addition, Woellert testified that, on the day G.W.  was

injured, Wells persuaded her not to take G.W. to the hospital.

          Dr.  Wormuth  and  Dr. Foote testified  that  G.W.  was

incapable  of piling his belongings up in the crib to climb  out,

as  Wells  had claimed.  Both doctors also testified  that  G.W.s

injuries  were  inconsistent with a  fall  from  his  crib.   Dr.

Wormuth explained that a fall from the crib could not have caused

G.W.s  injuries because G.W. had bruises on every surface of  his

head.   In  contrast, a fall would injure only one  side  of  the

skull  at a single point of impact.  Also, because G.W.s  bruises

were  in differing stages of healing, he could not have sustained

them  in  a single fall.  Finally, Dr. Foote testified that  G.W.

could  not  have  caused his head injuries by  banging  his  head

against his crib because he could not have generated enough force

to  cause injuries as severe as those he had sustained.   Because

the State presented sufficient circumstantial evidence that could

have  convinced  a reasonable juror that Wells recklessly  caused

G.W.s injuries, Wellss argument fails.



          Did   G.W.s   injuries   reasonably   require   medical

treatment?

          Wells  argues that there was insufficient  evidence  to

support the jurys finding that G.W.s injuries reasonably required

medical  treatment.  Wells argues that because both  Dr.  Wormuth

and  Dr.  Foote testified that they had determined G.W.s  bruises

would  heal  naturally,  medical  treatment  was  not  reasonably

required.

          If  the  answer  to this question only required  us  to

consider the sufficiency of the evidence presented, the answer is

obvious  because  Dr.  Wormouth  testified  that  G.W.s  injuries

required medical treatment.

          But  Wells actually raises a question that he  did  not

present  to  the superior court.  Wells moved for a  judgment  of

acquittal after the State rested its case, but mentioned  nothing

concerning  the  failure to prove medical  treatment.   The  jury

instructions provided no definition of medical treatment.   Wells

did not object to the instructions, nor did he ask that the court

define medical treatment.

          During  final argument, Wells contended that  G.W.  did

not  reasonably  require  medical treatment  because  the  childs

injuries  healed  on their own, implying that  medical  treatment

requires  some  form  of  remedy  or  active  intervention.    In

rebuttal, the prosecutor discussed medical treatment.

               Prosecutor:  Medical  treatment,   what

          does   medical   treatment  mean?    Medical

          treatment means something different  between

          lay  people  and doctors.  When  lay  people

          think of medical treatment, they think of  a

          cast.   They  think of a  bandage.   When  a

          doctor  thinks  of  medical  treatment,  its

          broader  than  that.  What did  the  doctors

          testify  about what medical treatment  meant

          to them?  Medical treatment meant seeing the

          injury, analyzing the injury, diagnosis,  x-

          rays,  CAT  scans, and then if  any  further

          treatment   was  necessary,   then   further

          treatment.   CAT  scans  and  x-rays,  those

          things  are medical treatment.  Thats  whats

          meant  by medical treatment.  Did this  baby

          need  to  go to the doctor?  Yes.  Did  this

          baby  need to be seen by a doctor, analyzed?

          Yes.   Treated  by  a doctor?   Yes.   Thats

          medical   treatment.    Just   because   the

          injuries  heal  without  casts  or   surgery

          doesnt   mean   [that]   its   not   medical

          treatment.

          Wells  did not object to the prosecutors discussion  of

medical  treatment (nor has he claimed in this  appeal  that  the

prosecutors  argument misled the jury).  Wells did  not  ask  the

court  to provide any contrary or clarifying instruction  to  the

jury on medical treatment before it retired to deliberate.

          Immediately  after  the jury convicted  Wells  and  was

excused, Wells again moved for a judgment of acquittal,  but  did

not  assert  that  there  was  any deficiency  regarding  medical

treatment.  If the jury needed a definition of medical treatment,

Wells could have requested an instruction.  Because Wells made no

objection  to the instructions at trial, we review this  question

for plain error.

          The  evidence shows that the course of care  that  G.W.

received was intended to promote G.W.s physical health.  When Dr.

Wormuth saw G.W. in the emergency room, G.W. had numerous bruises

on his scalp, face, and ears.  Dr. Wormuth concluded that testing

was  warranted  to examine whether there was any hemorrhaging  in

G.W.s  brain.   G.W. was sedated intravenously to immobilize  him

for  a CAT scan.  Dr. Wormuth also ordered blood testing to check

if  G.W.  had  a  blood disorder that exacerbated  the  bruising.

Later,  when Dr. Wormuth contacted Dr. Foote, the two  physicians

decided  that G.W. was stable enough that he did not have  to  be

admitted  to the hospital.  Instead, they scheduled a  follow  up

with  Dr.  Foote  in  two  days  to  make  sure  that  G.W.   was

progressing.

          Obviously,  G.W. received more than first aid  for  his

injuries.  Dr. Wormuth concluded that G.W.s injuries were of such

magnitude  that  he needed to examine G.W. for internal  bleeding

and  also make sure that his progress was monitored after he left

the hospital.

          Alaska  Statute 11.41.220(a)(1)(C)(i) provides  that  a

person  commits  third-degree assault if  the  person  recklessly

while  being 18 years of age or older ... causes physical  injury

to  a  child  under  10  years of age and the  injury  reasonably

requires   medical   treatment[.]   The   legislature   did   not

specifically  define medical treatment.  Wells contends  that  to

prove  medical  treatment, the State must prove that  the  victim

needs something more than medical attention.

          In  S.R.D.  v.  State,4 a decision  issued  before  the

enactment of AS 11.41.220(a)(1)(C)(i), one of the appellants  was

convicted of three counts of criminal nonsupport.  That appellant

claimed  that the evidence was insufficient to establish criminal

nonsupport  because  the  children did not  require  any  medical

treatment.  However, the criminal nonsupport statute penalizes  a

parents  failure  to  provide  a  child  with  necessary  medical

attention.5  And we agreed with the States argument that  medical

attention expressed a broader concept than medical treatment.6

          We  agree with the state that attention must
          be  construed  more broadly than  treatment.
          It  is  conceivable that children may suffer
          injuries sufficiently threatening to require
          a   medical   examination,  even   if   that
          examination ultimately discloses no need for
          treatment.
               In    the    present   case,   evidence

          concerning  A.D.s and S.E.D.s  injuries  and

          the  manner  in  which those  injuries  were

          inflicted was sufficient, when viewed in the

          light most favorable to the state, to permit

          a  reasonable  juror  to  infer  that,  even

               though no treatment was required, medical

          attention was actually necessary to rule out

          the   possibility  of  life-threatening   or

          potentially disabling conditions.[7]

          When  the  legislature uses a word or phrase  but  does

not   define  it,  a  court  should  normally  assume  that   the

legislature  intended  the word or phrase  to  have  its  common,

ordinary  meaning.8  The legislature has enacted  other  statutes

that   addressed  the  medical  process.   For  example,  in   AS

18.20.130(3),  the  legislature provided that hospital  means  an

institution   or   establishment,  public  or  private,   devoted

primarily  to  providing diagnosis, treatment, or care  (emphasis

added).  And in AS 25.20.025(a)(4), the legislature declared that

all  minors (even those who are unemancipated and who  are  still

living  with  a parent or guardian) have the legal  authority  to

consent  to  a  broad  range of medical services  and  treatments

associated  with  sexual  activity (except  abortion),  including

diagnosis,  prevention  or  treatment  of  pregnancy,   and   ...

diagnosis  and  treatment of venereal disease  (emphasis  added).

Additionally,  in AS 47.17.290(7), the legislature provided  that

institution means a private or public hospital or other  facility

providing medical diagnosis, treatment, or care (emphasis added).

          Our  supreme court recognized a similar distinction  in

the Rules of Evidence. Alaska Rule of Evidence 504(b) provides in

part:   A  patient has a privilege to refuse to disclose  and  to

prevent   any   other   person   from   disclosing   confidential

communications made for the purpose of diagnosis or treatment  of

the  patients physical, mental or emotional conditions  (emphasis

added).  And Evidence Rule 803(4) provides:

          Statements for Purposes of Medical Diagnosis
          or  Treatment.  Statements made for purposes
          of   medical  diagnosis  or  treatment   and
          describing  medical  history,  or  past   or
          present  symptoms, pain, or  sensations,  or
          the  inception or general character  of  the
          cause or external source thereof insofar  as
          reasonably   pertinent   to   diagnosis   or
          treatment.

(Emphasis added.)

          In  case law, our supreme court has also used the terms

diagnosis  and  treatment as expressing different  steps  in  the

medical  process.   For example, in Bradbury v. Chugach  Electric

Assn,9  the court stated:  Two physicians, Dr. Kenneth Flora  and

Dr.  David Nelson, testified on behalf of Chugach Electric.   Dr.

Flora  is a hepatologist whose subspecialty is the diagnosis  and

treatment of chronic liver disease.10

          When  the  scope  of  a  criminal statute  is  unclear,

courts   should  normally  construe  the  statute   against   the

government   that  is, construe it so as to limit  the  scope  of

criminal  liability.11   And  when a  word  or  phrase  has  been

construed in a particular way  as we construed the word treatment

in  S.R.D.  v.  State   courts are to presume that  later-enacted

statutes carry forward the existing judicial construction of that

word or phrase.

          At  best, the construction of medical treatment in  the

statute that is endorsed by the State, and the construction  that

was advocated by the prosecutor in summation to the jury, is only

arguable.   We therefore must interpret the statute  against  the

government.12     Accordingly, we conclude that we  must  reverse

Wellss conviction.

          If  the  State  elects  not to re-prosecute  Wells  for

third-degree  assault,  the superior  court  may  enter  judgment

against  Wells  for  fourth-degree assault13  because  the  jurys

verdict  necessarily  found  that  Wells  had  recklessly  caused

physical injury to the victim.14

     

          Why  we vacate the superior courts revocation of Wellss

probation

          The  superior  court revoked Wellss  probation  in  his

conviction  for  removal of identification marks because  he  was

convicted  of  third-degree assault in  this  case.   Because  we

reversed  Wellss third-degree assault conviction, we  vacate  the

probation revocation.

          However,  as  we discussed above, the jury  necessarily

found that Wells recklessly caused physical injury to G.W.   That

jury  finding is sufficient to support a conviction  for  fourth-

degree  assault.   In  addition,  this  jury  finding  would   be

sufficient  for the superior court to exercise its discretion  to

revoke  Wellss  probation.  Accordingly, we direct  the  superior

court to reconsider the petition to revoke Wellss probation.



          Conclusion

          The judgment of the superior court is REVERSED.

MANNHEIMER, Judge, concurring.


          Under  AS  11.41.220(a)(1)(C)(i), a person commits  the

crime  of  third-degree  assault  (a  class  C  felony)  if  they

recklessly cause physical injury to a child under the age of  10,

and  if  this injury reasonably requires medical treatment.   Our

task in this appeal is to determine what the legislature meant by

the phrase medical treatment.



     The legislative history of AS 11.41.220(a)(1)(C)
     

               AS  11.41.220(a)(1)(C) began  life  as  House

     Bill 396 in the Seventeenth Legislature (1991-92).   As

     originally  proposed, Section 4 of HB  396  would  have

     added  a  provision to the third-degree assault statute

     to  make  a  person  guilty  of  that  felony  if  they

     violate[d]  AS  11.41.230(a)(1) or [(a)](2)   i.e.,  if

     they  committed  fourth-degree  assault  by  recklessly

     causing  physical  injury  to  another  person,  or  by

     negligently  causing physical injury to another  person

     by  means of a dangerous instrument  and if the  victim

     of the offense [was] under the age of 10.

               This  proposed change was criticized  by  the

     Alaska  Action  Trust (the lobbying arm of  the  Alaska

     Association of Trial Lawyers).1  In a position paper on

     House  Bill  396,  the Trust argued that  the  proposed

     change  to  the  third-degree assault statute  was  too

     broad and should not be adopted.  The Trust wrote:

               Apparently,  the Legislatures
          [purpose] is to make it  a  felony
          rather   than  a  misdemeanor   to
          repeatedly  or  severely  beat   a
          child.  While we agree that it may
          well   be   appropriate  to   make
          repeated or severe beatings  of  a
          child   a   felony,  the  proposed
          amendment would make it  a  felony
          even  to  cause pain  to  a  child
          without  actual  injury[,]  or  to
               bruise  a child.  That lesser
          conduct  should not be  punishable
          by a felony conviction.
     
          [The] proposed amendment ... would  make
     a   ...  felon  of  a  person  who  one  time
     recklessly  cause[d]  physical  injury  to  a
     child  under  the  age  of  10  ...  .    The
     difficulty with the proposed revision is that
     physical injury is very broadly defined as  a
     physical  pain  or  [any]  impairment  of   a
     physical  condition.   AS 11.81.900(b)[(45)].
     Therefore, if this amendment becomes law, any
     person  can be ... convicted [of a]  felon[y]
     for  recklessly causing pain to a child, even
     when  the  child  suffers  no  actual  injury
     whatsoever[,]    or    [for]    negligen[tly]
     caus[ing]  pain  to a child  by  means  of  a
     dangerous instrument.
     
          Even  the most caring and loving  person
     who   is   around  a  child  might  sometimes
     recklessly  cause  ... pain  to  that  child.
     A   person  who  angrily  briefly  touches  a
     child[,] causing pain but no actual injury[,]
     would become a ... felon.  [Moreover,]  under
     Alaska  law,  an  automobile is  a  dangerous
     instrument.  Even the most caring and  loving
     person ... might negligently cause pain to  a
     child  by  causing  an automobile  accident[,
     even   though]  there  was  no   ...   injury
     whatsoever  to the child  because  the  child
     was  buckled in a seat belt ... .   A  person
     who  slammed a childs finger in  a  car  door
     would  become  a  ... felon under  this  law.
     A  relatively  minor lapse by  an  ordinarily
     caring  parent  or  other person  should  not
     cause   the   person  to  suffer   a   felony
     conviction.
     
     Accordingly, the Trust proposed that the  new

     offense  be  limited to physical injury  that

     requires medical treatment.

          Apparently   responding   to    the

Trusts  recommendation, the  House  Judiciary

Committee  re-wrote Section 4 of  House  Bill

396  to  make the proposed offense recklessly

...  caus[ing]  physical injury  to  a  child

under   10  years  of  age  [if]  the  injury

reasonably requires medical treatment.   CSHB

396 (Jud),  4.

          In  its  Sectional Analysis of  the

bill,  the Judiciary Committee described  the

purpose of Section 4:


     [This]   section   elevates   what    is
currently   classified   as   fourth[-]degree
assault  to  third[-]degree  assault  if   an
offender  is  18 years of age  or  older  and
[either]  repeatedly assaults a  child  under
the  age of 10, or assaults a child under  10
and  the  assault requires medical treatment.
This  amendment  is  in response  to  several
recent  Anchorage cases[,] including  one  in
which  an infant had 56 different bruises  on
its  body  caused  by  a series  of  beatings
committed  over a three[-]week time period[,]
and  one in which a 5[-]year[-]old child  was
intentionally  burned by being  placed  in  a
bath  of  scalding water.  Because there  was
not  a  substantial  risk that  either  child
would die[,] and [because] neither child  was
permanently   disfigured,   [neither   injury
qualified  as  serious  physical  injury   as
defined in AS 11.81.900(b)(55), and thus] the
offenders   could   only  be   charged   with
misdemeanors  [i.e., fourth-degree  assault].
[This  section  makes such  conduct]  third[-
]degree assault[,] a class C felony.

But neither the bill itself nor the Judiciary

Committees  accompanying analysis  offered  a

definition of medical treatment.



The problem presented in this appeal:  ascertaining the
meaning of treatment in AS 11.41.220(a)(1)(C)


     The  State  prosecuted Wells under  this  new

provision  of  the  third-degree assault  statute,

alleging  that  Wells had recklessly  caused  head

injuries to a nine-month-old infant and that these

injuries    had   reasonably   required    medical

treatment.

          Viewing  the  evidence  in  the  light   most

favorable  to  the  State,  Wells  inflicted   multiple

injuries  on a nine-month-old infant over a  period  of

two weeks, resulting in numerous bruises to the infants

face,  scalp, and ears.  When the childs mother brought

him  to  the hospital, doctors were concerned that  the

child might have significant internal injuries, so they

performed  blood  tests and a CAT  scan  as  diagnostic

measures.   Fortunately, the child had  no  significant

injuries;  the  doctors concluded that  the  child  was

medically stable and that the childs bruises would heal

on their own.

          The  State  and Wells disagree as to  whether

this   medical   examination  and  diagnostic   testing

constituted treatment.

          The    State   argues   that,   because   the

legislature   failed  to  provide   a   definition   of

treatment,  we should interpret the statute  using  the

common  definition of that term.  The State  relies  on

the  first  sentence of AS 01.10.040(a), which  states:

Words and phrases [in statutes] shall be construed  ...

according to their common and approved usage.2

          According   to  the  State,  the  common   or

dictionary   meaning  of  treatment  includes   medical

examinations  and diagnostic testing.  But  as  can  be

seen from the four dictionary definitions quoted by the

State in its brief, various dictionaries have differing

definitions of treatment.  Some dictionaries define the

word broadly enough to include diagnostic efforts,  but

other  dictionaries appear to limit the word to actions

taken to treat or cure a medical condition after it has

been diagnosed.3

          In  short,  the  States brief overstates  the

          matter when it declares, These definitions make clear

that treatment includes not only ... remedial care, but

also  diagnostic  care.  Rather, these definitions  are

ambiguous concerning the issue raised in this appeal.

          Moreover, AS 01.10.040(a) does not direct  us

to  always adopt the common usage of words or  phrases.

The statute has a second sentence:  Technical words and

phrases[,] and those which have acquired a peculiar and

appropriate meaning, whether by legislative  definition

or  otherwise, shall be construed according  to  [that]

peculiar and appropriate meaning.

          Medical   literature  draws   a   distinction

between,  on the one hand, examination and testing  for

purposes of diagnosis and, on the other, treatment.  By

searching   the   internet,  one  can  find   literally

thousands of books and articles whose titles  refer  to

diagnosis  and treatment  thus indicating a distinction

between  diagnosis (efforts to determine the nature and

extent  of a medical condition) and treatment  (efforts

to cure or ameliorate a medical condition).

          Our  own  supreme court appears to have  used

the  terms  diagnosis and treatment in this  same  way.

For  example,  in  Bradbury v. Chugach  Electric  Assn,

71  P.3d 901, 905 (Alaska 2003), the court stated:  Two

physicians,  Dr.  Kenneth Flora and Dr.  David  Nelson,

testified on behalf of Chugach Electric.  Dr. Flora  is

a  hepatologist whose subspecialty is the diagnosis and

treatment of chronic liver disease.

          Moreover, the Alaska Legislature has  enacted

statutes  that  use  the  word  treatment  as   meaning

something     distinct     from     diagnosis.      See

AS  18.20.130(3), which defines the word hospital as an

institution   or  establishment,  public  or   private,

devoted primarily to providing diagnosis, treatment, or

care.    (Emphasis   added)   And  AS   25.20.025(a)(4)

declares   that   all  minors  (even  those   who   are

unemancipated and who are still living with a parent or

guardian)  have  the legal authority to  consent  to  a

broad   range   of  medical  services  and   treatments

associated  with  sexual  activity  (except  abortion),

including   diagnosis,  prevention  or   treatment   of

pregnancy, and ... diagnosis and treatment of  venereal

disease.  (Emphasis added)

          This  same  distinction is  found  in  Alaska

Evidence Rule 504(b), which states that [a] patient has

a  privilege  to refuse to disclose and to prevent  any

other     person     from    disclosing    confidential

communications  made for the purpose  of  diagnosis  or

treatment of the patients physical, mental or emotional

conditions ... .  (Emphasis added)

          Finally,  this Courts decision in  S.R.D.  v.

State, 820 P.2d 1088 (Alaska App. 1991), hinges on  the

distinction  between diagnostic efforts and  treatment.

In  S.R.D.,  a  mother was convicted of  criminal  non-

support,  AS  11.51.120(a), for failing to provide  her

children  with  necessary medical attention  after  the

children  were  injured  by  acts  of  physical   abuse

perpetrated   by   her  husband.   In  each   instance,

[medical] examinations revealed injuries resulting from

[the]  abuse,  but the injuries did not require  actual

treatment.4

          On   appeal,  the  mother  claimed  that  the

evidence  did not establish her guilt of criminal  non-

support because neither child was found to require  any

medical  treatment.5  This Court rejected  the  mothers

argument because the criminal non-support statute  does

not  speak of a parents failure to obtain treatment for

their  child,  but rather a parents failure  to  obtain

necessary  ... medical attention.  See AS 11.51.120(b).

We  held  that medical attention was a broader  concept

          than treatment because it also included medical

examinations for diagnostic purposes:

     
     We  agree with the state that attention  must
     be construed more broadly than treatment.  It
     is   conceivable  that  children  may  suffer
     injuries sufficiently threatening to  require
     a   medical   examination,   even   if   that
     examination ultimately discloses no need  for
     treatment.
     
          In    the    present   case,    evidence
     concerning [the childrens] injuries  and  the
     manner in which those injuries were inflicted
     was sufficient, when viewed in the light most
     favorable   to  the  state,   to   permit   a
     reasonable  juror to infer that, even  though
     no  treatment was required, medical attention
     was   actually  necessary  to  rule  out  the
     possibility     of    life-threatening     or
     potentially disabling conditions.  The  trial
     court  did  not err in declining to  enter  a
     judgment of acquittal as to these two counts.
     
     S.R.D., 820 P.2d at 1090-91.

               Based  on the foregoing, I conclude

     that  we  must  reject  the  States  proposed

     definition of treatment and instead adopt the

     narrower   definition  reflected   in   these

     statutes, court rules, and court decisions.

          First,   because  the  third-degree

assault   statute  uses  the  phrase  medical

treatment,  we are searching for the  meaning

of  treatment not in its general context, but

rather  in its medical context.  And in  that

medical  context, both the Alaska Legislature

(in  statutes)  and the Alaska judiciary  (in

court rules and in court decisions) have used

treatment  in  a  narrow  sense   as  meaning

something  distinct from diagnostic  efforts.

When  a  word  or phrase has previously  been

legislatively defined or judicially construed

in  a  particular way, we are to presume  (in

the absence of evidence to the contrary) that

later-enacted  statutes  carry  forward   the

existing meaning of that word or phrase.6

          Second,  to  the  extent  that  the

meaning  of  treatment remains ambiguous,  we

must  interpret it in favor of the  defendant

and  against the State.  When the scope of  a

criminal statute remains unclear or ambiguous

after   it   has  been  subjected  to   legal

analysis,  we  are  bound  to  construe   the

statute  against  the  government   that  is,

construe  it  so  as to limit  the  scope  of

criminal liability.7

          At  Wellss  trial, the  judge  gave

the   jury  no  instruction  concerning   the

meaning  of  treatment,  and  the  prosecutor

argued  to  the jury that treatment  included

the  examination  and diagnostic  testing  in

this  case.   This argument, as a  matter  of

law,  was incorrect.  I therefore agree  with

my  colleagues  that  Wellss  conviction  for

third-degree assault must be reversed.



_______________________________
     1 AS 11.41.220(a)(1)(C)(i).

     2 AS 11.46.260(a).

3 See Dorman v. State, 622 P.2d 448, 453 (Alaska 1981).

4 820 P.2d 1088 (Alaska App. 1991).

     5 AS 11.51.120(b).

     6 S.R.D., 820 P.2d at 1090.

     7 Id. at 1090-91.

     8  See  AS  01.10.040; Lynch v. McCann, 478  P.2d  835,  837
(Alaska  1970); Lambert v. State, 694 P.2d 791, 793 (Alaska  App.
1985).

     9  71 P.3d 901 (Alaska 2003).

     10   Id. at 905.

     11   See State v. ABC Towing, 954 P.2d 575, 579 (Alaska App.
1998); Magnuson v. State, 843 P.2d 1251, 1253 (Alaska App. 1992).

     12    See  Brookins v. State, 600 P.2d 12, 17 (Alaska 1979);
Whitesides  v. State, 88 P.3d 147, 151 (Alaska App. 2004);  State
v.  Andrews,  707  P.2d  900, 907 (Alaska App.  1985);  State  v.
Rastopsoff, 659 P.2d 630, 640 (Alaska App. 1983).

     13   AS 11.41.230(a)(1).

     14    See Nathaniel v. State,  668 P.2d 851, 857 n.4 (Alaska
App.1983); Nix v. State, 624 P.2d 823, 824-25 (Alaska App. 1981).

1                                                             See
www.alaskatriallawyers.org/ak/index.cfm?event=showPage&pg=About
for a brief history of the organization.

2  See  Lynch  v.  McCann, 478 P.2d 835, 837 (Alaska  1970);
Lambert v. State, 694 P.2d 791, 793 (Alaska App. 1985) (when
the legislature uses a word or phrase without defining it, a
court  should normally assume that the legislature  intended
the word or phrase to have its common, ordinary meaning).

3  Compare  Merriam-Webster Collegiate Dictionary (11th  ed.
2003),  p.  1333 (car[ing] for or deal[ing] with  [a  health
problem]  medically  or  surgically);  Websters  New   World
College   Dictionary  (4th  ed.  2000),  p.  1525  (medical,
surgical, or cosmetic care, esp[ecially] a systematic course
of   this);  Oxford  American  Dictionary  (2003),  p.  1626
(application  of medical care or attention  to  a  patient);
American  Heritage Dictionary of the English  Language  (4th
ed.  2000),  p.  1838  (administration  or  application   of
remedies to a patient for a disease or injury; medicinal  or
surgical management; therapy).

4 S.R.D., 820 P.2d at 1090.

5 Id.

6 Gillispie v. Beta Construction Co., 842 P.2d 1272, 1273
(Alaska  1992); see City of Fairbanks v. Schaible,  375
P.2d 201, 207-08 (Alaska 1962); Patterson v. State, 708
P.2d  712,  716  (Alaska App. 1985); and  see  Hart  v.
State, 702 P.2d 651, 659 (Alaska App. 1985).

7 See Brookins v. State, 600 P.2d 12, 17 (Alaska 1979);
State  v.  ABC  Towing, 954 P.2d 575, 579 (Alaska  App.
1998);  Magnuson v. State, 843 P.2d 1251, 1253  (Alaska
App. 1992).