Court of Appeals of Missouri, Eastern District, First Division
from the Circuit Court of Audrain County Honorable Wesley C.
S. ODENWALD, JUDGE.
C. Ashcraft ("Ashcraft") appeals from the judgment
of the trial court, entered after a jury trial, convicting
him of one count of first-degree endangering the welfare of a
child and one count of abusing a child. Ashcraft challenges
the sufficiency of the evidence supporting his child-abuse
conviction and further contends that the trial court plainly
erred in admitting testimony about the victim's
immunization history. Because there was sufficient evidence
to sustain Ashcraft's child-abuse conviction and the
admission of testimony regarding the victim's
immunization history did not result in manifest injustice, we
affirm the trial court's judgment.
and Procedural History
State charged Ashcraft with one count of first-degree
endangering the welfare of a child for failing to provide
adequate nutrition to his three-month-old son
("Child"). The State also charged Ashcraft with one
count of neglecting a child, or in the alternative of abusing
a child, for injuring Child's arm. J.S., the mother of
Child, was a co-defendant in the case, but was prosecuted
separately. The case proceeded to a jury trial.
Stuart Jay Thompson ("Det. Thompson") testified
that Ashcraft and J.S. brought Child to the Audrain Medical
Center Emergency Room with an injured arm on May 30, 2014.
Child's right forearm showed significant and visible
swelling. Ashcraft and J.S. told Det. Thompson that they did
not know how Child injured his arm. Ashcraft claimed that he
had noticed Child's swollen arm a few days before the
emergency-room visit, and speculated to Det. Thompson that
Child had injured his arm by sleeping on it or by pushing up
on it. Ashcraft and J.S. reported that no one else had
watched Child since May 25 and that Child had been in their
exclusive care. As Det. Thompson went to speak with
Child's doctors, Ashcraft fled the hospital. Det.
Thompson left the hospital with J.S. and told her to call
Ashcraft and tell him to return to their residence.
arriving at the residence, Det. Thompson arrested Ashcraft on
an outstanding warrant. During further questioning, Ashcraft
stated that Child was fine during the day of May 27. Ashcraft
acknowledged that, on the night of May 27, he grabbed
Child's right forearm when picking him up, and Child then
began crying very loudly. Ashcraft admitted that he first
noticed Child's swollen right forearm on May 28. Ashcraft
proclaimed that only he, J.S., and God knew what caused
Blackwell ("Blackwell") was a friend of Ashcraft
and occasional caregiver for Child. Blackwell testified that
Ashcraft showed her Child on May 30, 2014. Seeing that
Child's right forearm was raised, bruised, and red,
Blackwell told Ashcraft that Child needed emergency medical
care. Blackwell stated that she would sometimes watch Child
without Ashcraft present, but denied that she or any of her
kids broke Child's arm. Blackwell adamantly denied ever
leaving her children unattended with Child. Blackwell
supervised Child alone on May 20, but she did not notice
anything wrong with Child at that time. Stating that she had
a sexual relationship with Ashcraft during Child's first
three months of life, Blackwell explained that Ashcraft
instructed her to lie about this aspect of their relationship
Connor ("Connor") testified that, on May 30, 2014,
she arrived at Ashcraft's residence to visit Child.
Connor stated that Child started crying when she picked him
up. Ashcraft and J.S. told Connor that Child injured his arm
by rolling over on it. Connor then transported Ashcraft,
J.S., and Child to the hospital.
James Brillhart ("Dr. Brillhart"), a doctor in the
Audrain Medical Center Emergency Room, examined Child. Dr.
Brillhart confirmed that Child was not using his right arm
and ordered x-ray photos. The x-ray photos determined that
Child's right forearm was broken. Specifically, the x-ray
photos revealed that there was a transverse fracture of the
radius and ulna in Child's right forearm. Dr. Brillhart
testified that it would take "a lot of force" to
break Child's forearm. Dr. Brillhart explained that this
forearm injury was inconsistent with an injury caused by a
baby sleeping on his or her arm or pushing up on it. After
stabilizing Child's arm, Dr. Brillhart transferred Child
to the Women's and Children's Hospital in Columbia.
Dana Vietti ("Dr. Vietti"), an internal medicine
pediatric resident, testified that she provided care to Child
upon his transfer. Dr. Vietti ordered additional x-ray
photos, revealing that Child had three rib fractures.
Specifically, the x-ray photos established that Child had
experienced posterior fractures of the right tenth and
eleventh ribs, as well as a posterior fracture of the left
tenth rib. These rib fractures were callused to different
degrees, indicating that they had started healing. Dr. Vietti
opined that, based on the different stages of healing and the
fractures' locations, she highly suspected that
Child's injuries were caused by non-accidental trauma.
After inspecting Child's medical history, Dr. Vietti also
confirmed that Child gained only an average of eight grams
per day since birth, whereas most infants gain between twenty
and thirty grams per day. Dr. Vietti testified that Child was
significantly under the weight curve and malnourished. Dr.
Vietti stated that the hospital staff fed Child consistently
through his hospitalization, and Child gained 200 grams in
his first twelve hours at the hospital.
Rashmi Srivistava ("Dr. Srivistava"), a pediatric
hospitalist, testified that Child demonstrated appropriate
cues for feeding and hunger but his muscle tone was
substantially underdeveloped. After observing Child, Dr.
Srivistava stated that, because of his subsequent weight
gain, Child's initial inability to gain weight was not
due to any underlying medical condition; instead, Child
simply needed to be fed. Dr. Srivistava also explained that
Child's injuries were the result of abusive trauma. In
particular, Dr. Srivistava explained that the rib fractures
were consistent with non-accidental compression from
forcefully being held.
Ahmad Muraywid ("Dr. Muraywid"), Child's
primary pediatrician, also testified for the State. Dr.
Muraywid maintained that he instructed Ashcraft and J.S. on
how to properly feed and care for Child. Dr. Muraywid noted
that Child's poor weight gain concerned him and he
communicated his concerns over Child's weight to
Douglas Beal ("Dr. Beal"), a pediatrician and a
member of the State Technical Assistance Team, reviewed
Child's case. After examining Child's history as
reported by his caregivers, Dr. Beal opined that Child's
right forearm injury occurred late on May 27. Dr. Beal
believed that the swelling of Child's forearm would have
started immediately after the fracture occurred. Dr. Beal
concluded that, within a reasonable degree of medical
certainty, Child's injury was due to neglect and abuse,
and not an accident. Even considering Child's
malnourished state, Dr. Beal contended that it would require
"a great deal of abusive force" to break
State offered into evidence Child's medical records
without objection. Child's medical records noted his lack
of immunizations due to parental choice. The State then asked
Drs. Vietti, Muraywid, and Beal about Child's
immunization history without objection. Dr. Vietti testified
that Ashcraft and J.S. decided not to vaccinate Child, which
concerned her because vaccines prevent numerous childhood
diseases. Dr. Muraywid also explained the benefits of
vaccination, but noted that J.S. refused to vaccinate Child
for her own personal beliefs. Dr. Muraywid commented that
some parents refuse immunization for religious reasons, for
medical concerns, or for their own personal beliefs. Dr. Beal
testified that "Well, I believe in immunizations.
We've come a long way in the last hundred years
preventing deaths from measles, mumps, chickenpox, diptheria
[sic], tetanus. There's a big movement under way, kind of
a cult ...