Background
In early 2020, police responding to a welfare check found six-year-old MA living in a filthy trailer with visible bruising, swelling, and thick ligature scarring on his wrists and ankles. His mother, Gwendolyn Alexander, and her partner Errown Scott were arrested after Alexander admitted to police that she and Scott had repeatedly tied MA up with a belt around his wrists for hours at a time. MA testified at trial that Scott zip-tied him on multiple occasions while Alexander was present. The emergency room physician diagnosed MA with suspicious, nonaccidental lesions consistent with possible child abuse.
At the September 2022 joint trial, the prosecution called Dr. Dena Nazer, medical director of a children’s advocacy center and an expert in child abuse pediatrics, who testified that she had diagnosed MA with “medical torture” — a clinical designation she explained required at least two separate physical assaults combined with at least two forms of psychological maltreatment. On cross-examination, Dr. Nazer acknowledged that the legal and medical definitions of “torture” were not necessarily the same and that she could not speak to the legal definition. Defense counsel did not object to the use of the term at trial.
The jury convicted Alexander of torture (MCL 750.85), two counts of second-degree child abuse, and one count of third-degree child abuse, and she was sentenced to 17 to 30 years on the torture count. The Court of Appeals affirmed the convictions but vacated her sentences due to an offense-variable scoring error and remanded for resentencing. Alexander sought leave to appeal in the Supreme Court on the expert testimony issue.
The Court’s Holding
In a unanimous opinion authored by Chief Justice Cavanagh, the Michigan Supreme Court held that Dr. Nazer’s “medical torture” diagnosis testimony was improper on three independent grounds. First, the diagnosis was unhelpful to the jury under MRE 702 because it did not explain the nature, extent, or timing of MA’s physical injuries in a way that assisted the jury in determining whether he suffered “great bodily injury,” a required element of the torture statute. Second, the psychological maltreatment component of the diagnosis lacked a reliable foundation because it rested largely on Dr. Nazer crediting MA’s own account of events, without any qualifying expertise in credibility assessment. Third, the testimony invaded the province of the jury by importing the emotionally and legally charged word “torture” into the expert’s diagnosis at the very trial where torture was the charged offense — mirroring the problem the Court of Appeals identified in People v. McFarlane, 325 Mich App 507 (2018), where “abusive head trauma” was improperly used in a child abuse case.
The Court rejected the Court of Appeals’ reasoning that the “medical” qualifier neutralized the risk of confusion, noting that the diagnosis in McFarlane was also framed as a medical finding, yet was still impermissible. Because the lay meaning of “torture” — inflicting intense pain to punish, coerce, or afford sadistic pleasure — maps closely to the statute’s intent element, the diagnosis risked impressing upon the jury an expert opinion on Alexander’s criminal responsibility. Nevertheless, the Court affirmed the convictions because the issue was unpreserved, and Alexander could not satisfy the plain-error standard: even setting aside Dr. Nazer’s problematic testimony, ample untainted evidence supported the verdict, including MA’s testimony, Alexander’s own admissions, and the treating physician’s medical findings.
Key Takeaways
- A child abuse pediatrician’s diagnosis of “medical torture” in a trial for the crime of torture is inadmissible under MRE 702 because it is unhelpful, unreliable, and invades the jury’s province — the same logic that barred “abusive head trauma” testimony in abuse cases under McFarlane.
- The “medical” label does not insulate diagnostic terminology from exclusion when the term itself carries lay connotations that mirror the charged crime’s intent element and risk confusing the medical diagnosis with a legal conclusion.
- Expert opinions on psychological maltreatment that rest primarily on crediting the child victim’s own account — without independent expertise in credibility assessment — lack the reliable foundation required by MRE 702.
- Unpreserved evidentiary errors of this type will not warrant reversal where the record contains strong independent evidence of guilt, including the defendant’s own admissions.
Why It Matters
This decision extends and clarifies the McFarlane framework, signaling that Michigan courts must scrutinize any diagnostic label that borrows the language of a charged crime — not just “abusive head trauma” in abuse cases, but any expert terminology whose ordinary meaning tracks a criminal statute’s elements. Prosecutors and child-abuse experts will need to use more neutral descriptive language (e.g., testifying that injuries are consistent with zip-tie restraint or that the child suffered nonaccidental trauma) rather than adopting clinical shorthand that echoes the charged offense.
The case also illustrates the practical limits of the plain-error doctrine: even clearly erroneous expert testimony will not yield reversal when the defendant failed to object at trial and the remaining evidence is strong. Defense counsel in child abuse and torture cases should be alert to diagnostic labels that track statutory language and lodge contemporaneous objections to preserve the issue for meaningful appellate review.