Background
In early 2020, a police welfare check at a trailer in Wayne County, Michigan revealed six-year-old MA with thick scarring and ligature marks on his wrists and ankles, facial bruising, and swelling. MA’s mother, Gwendolyn Alexander, and her partner Errown Scott were arrested. Alexander admitted to police that she had tied MA up with a belt around his wrists on at least two occasions and that Scott did so repeatedly, sometimes for hours at a time, because she was unable to watch him. At trial, MA testified that Scott had zip-tied his hands and restrained him to a couch on multiple occasions, and that Alexander was present when this occurred.
The prosecution called Dr. Dena Nazer, a child abuse pediatrics expert, who testified that she had diagnosed MA with “medical torture”—a clinical diagnosis she described as reserved for children exposed to at least two distinct physical assaults accompanied by at least two forms of psychological maltreatment. On cross-examination, Dr. Nazer acknowledged that the medical and legal definitions of “torture” were not necessarily the same and that she was not qualified to opine on the legal definition. Defense counsel did not object to this testimony at trial. Alexander was ultimately convicted of torture under MCL 750.85, two counts of second-degree child abuse, and one count of third-degree child abuse, and was sentenced to 17 to 30 years on the torture count.
The Court of Appeals affirmed the convictions but vacated the sentences due to a guidelines-scoring error and remanded for resentencing. It rejected Alexander’s argument that the “medical torture” testimony was improper, reasoning that the diagnosis did not conflate medical findings with legal responsibility and did not speak to Alexander’s intent. Alexander sought leave to appeal in the Michigan Supreme Court, which ordered oral argument specifically on whether Dr. Nazer’s use of the phrase “medical torture” invaded the province of the jury.
The Court’s Holding
In a unanimous opinion by Chief Justice Cavanagh, the Michigan Supreme Court held that Dr. Nazer’s medical torture diagnosis testimony was improper on three independent grounds. First, it 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 would assist the jury in determining whether he suffered “great bodily injury,” a required element of the torture statute. The diagnosis merely recited that two physical assaults and two forms of psychological maltreatment occurred—it added nothing beyond the lay evidence already before the jury. Second, the psychological maltreatment component of the diagnosis lacked a reliable foundation because it was based almost entirely on Dr. Nazer crediting MA’s own account of events, without any expertise in assessing witness credibility. Third, and most significantly, the testimony invaded the province of the jury by coming too close to a legal conclusion on the charged offense.
The Court drew a direct parallel to People v. McFarlane, 325 Mich App 507 (2018), which held that an expert’s diagnosis of “abusive head trauma” and “child abuse” in an abuse prosecution improperly expressed an opinion on the defendant’s criminal responsibility. The Court reasoned that the lay meaning of “torture”—the infliction of intense pain to punish, coerce, or afford sadistic pleasure—maps closely to the intent element of the crime of torture under MCL 750.85(1), namely that a defendant intended “to cause cruel or extreme physical or mental pain and suffering.” Labeling the diagnosis “medical” rather than “legal” did not cure the defect; the terminology itself risked confusing the jury into treating a medical opinion as an expert endorsement of criminal guilt.
Nonetheless, the Court affirmed Alexander’s convictions. Because defense counsel never objected to the testimony, review was limited to the plain-error standard, which requires a defendant to show the error was clear or obvious and affected the outcome of the proceedings. The Court found the error was at least questionable under that standard, given the absence of controlling precedent directly on point. More decisively, the record contained substantial untainted evidence—including medical photographs and testimony about MA’s injuries, MA’s own account of being zip-tied, his sister’s corroborating testimony, and Alexander’s own admissions to police—sufficient to support the jury’s verdict independent of the expert diagnosis.
Key Takeaways
- An expert’s medical diagnosis that shares the same terminology as the charged crime—here “medical torture” in a torture prosecution—invades the province of the jury and risks being treated as an expert opinion on the defendant’s criminal guilt, even when explicitly framed as a clinical rather than legal determination.
- Expert medical testimony must do more than repackage the victim’s own account or restate what the fact-finder can already infer; the psychological maltreatment component of the diagnosis was unreliable because it rested almost entirely on crediting the child’s narrative without independent expert assessment of credibility.
- Failure to object at trial limits appellate relief to plain-error review: an error that might warrant reversal on preserved review can still be affirmed where pre-existing precedent did not clearly put the trial court on notice and where overwhelming independent evidence supports the verdict.
- The McFarlane rule against diagnostic labels that imply willfulness or moral culpability—such as “abusive head trauma” or “child abuse”—extends to analogous terms like “medical torture” whenever those terms track the legal elements of the charged offense.
Why It Matters
This decision extends Michigan’s prohibition on expert diagnostic labels that effectively opine on a defendant’s criminal intent, applying the McFarlane framework to a new and increasingly common diagnosis in child maltreatment cases. Prosecutors and child abuse experts must now carefully distinguish testimony about the physical nature and mechanism of injuries—which remains admissible and valuable—from diagnostic labels whose lay connotations mirror the elements of a charged offense. A label like “medical torture” may carry scientific legitimacy in clinical settings, but when used in front of a jury deciding a torture charge, it risks functioning as an expert declaration of guilt.
The ruling also provides a practical lesson about preservation. The Court acknowledged the testimony was improper yet denied relief entirely because defense counsel failed to object at trial. For practitioners in child abuse cases, this underscores the importance of scrutinizing expert diagnostic terminology before and during trial, particularly where the diagnosis shares terminology with the charged crime. The opinion invites trial courts and parties to police this boundary proactively rather than rely on appellate correction after the fact.