Case: 09-50298 Document: 00511080226 Page: 1 Date Filed: 04/14/2010
IN THE UNITED STATES COURT OF APPEALS
FOR THE FIFTH CIRCUIT United States Court of Appeals
Fifth Circuit
FILED
April 14, 2010
No. 09-50298
Lyle W. Cayce
Clerk
UNITED STATES OF AMERICA,
Plaintiff-Appellee,
versus
TIOFILA SANTILLANA,
Defendant-Appellant.
Appeal from the United States District Court
for the Western District of Texas
Before GARWOOD, SMITH, and CLEMENT, Circuit Judges.
JERRY E. SMITH, Circuit Judge.
Tiofila Santillana was convicted by a jury of distributing methadone re-
sulting in the death of Brandon Moore. She argues that there is insufficient evi-
dence to convict. We affirm.
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No. 09-50298
I.
The facts are not disputed. On April 9, 2008, Moore obtained an unknown
quantity of Xanax 1 pills from a friend, Emily Suckarieh. Later that evening,
Moore and a friend, Tyler Dickson, went to Santillana’s home. Dickson bought
about fourteen methadone pills from Santillana, then left. Moore stayed a few
minutes longer, then briefly rejoined Dickson outside. Though she could not re-
member the precise date, Santillana later admitted that she also sold methadone
tablets to Moore at her house on or around April 9.
At about 10:30 p.m., Moore left the home of a friend, Dona Shaw, where
he had taken up temporary residence. Moore returned around 3:30 a.m. Shaw
testified that when he came in, Moore looked “a little more hyped up” than he
usually did. At approximately 5:30 a.m., Moore went to sleep on Shaw’s sofa and
continued to sleep there throughout the day. At 6 p.m., Shaw tried to rouse
Moore, who was largely unresponsive. Shaw called another of Moore’s friends
to help shake Moore awake. When neither of them could do so, they called Suck-
arieh, who decided to take Moore to the hospital at about 7 p.m.
Moore was admitted to the emergency room. A urine screen tested positive
for at least four different drugs: cocaine, amphetamine, benzodiazepines (i.e.,
Xanax), and methadone; he also tested positive for opiates, though that result
could 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
1
Xanax is a prescription drug used to treat anxiety disorders.
2
Dr. Stacey Hail, a government expert, testified that opiates are naturally-occurring
compounds derived from the poppy plant, including morphine, codeine, and heroin. Metha-
done 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 some-
timesSSbut not alwaysSScause a false positive test for opiates.
3
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...)
2
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and administered Narcan, a reversal agent for narcotics. Moore responded brief-
ly to the Narcan but then had to be sedated to prevent him from pulling out his
breathing tube. Moore spent the next eleven days in intensive care and another
two days in hospice care. He died on April 23.
After an investigation by the Drug Enforcement Administration (“DEA”),
Santillana was charged with distributing a schedule II controlled substance
(methadone) to Moore, resulting in his death, in violation of 21 U.S.C. § 841(a)(1)
and (b)(1)(C). The jury heard testimony from three medical experts.
Dr. Nizam Peerwani performed Moore’s autopsy and testified that Moore
died from brain death resulting from acute mixed drug intoxication. Peerwani
concluded that methadone was probably the cause of death, because it was the
only positively identified drug in Moore’s body that would have restricted breath-
ing and thus reduced oxygen to the brain. On cross-examination, however, Peer-
wani conceded that if another unidentified opiate were present in Moore’s body,
it could have also contributed to depressed respiration and brain death. He de-
clined to identify one particular drug as the exclusive cause of death.
Stacey Hail, an emergency medical physician and toxicologist, was a gov-
ernment witness. Based on her review of Moore’s medical records, she concluded
that death was caused by a “poison cocktail” of methadone and Xanax. She testi-
fied that methadone is a highly lethal drug and that, when paired with Xanax
(which is not very lethal by itself), methadone becomes even more lethal.4 She
also stated that Moore’s presentation in the emergency roomSSpinpoint pupils
and long-lasting depression of the central nervous system and respirationSSwas
3
(...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.
4
According to Hail, some speculate that Xanax may slow down the body’s metabolism
of methadone, giving methadone a longer-lasting effect.
3
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No. 09-50298
consistent with lethal methadone use.
Hail discounted the possibility that one of the other drugs in Moore’s sys-
tem caused his death. She testified that Xanax by itself would not have lowered
respiration and thus reduced oxygen to the brain. Likewise, cocaine and am-
phetamine, as stimulants, would not have had the depressive effect Moore exhib-
ited. An opiate such as heroin was unlikely to have caused Moore’s death, Hail
reasoned, because heroin, unlike methadone, has a short-lasting effect; the drug
affecting Moore was long-lasting. Finally, another opioid such as hydrocodone
would have been accompanied by a positive test for Tylenol, for which Moore
tested negative. Though she thus concluded that a combination of methadone
and Xanax killed Moore, Hail also testified that methadone alone could have
been the cause of death.5
William Rohr, a county medical examiner, testified that he agreed with
Peerwani’s conclusion that Moore died from mixed drug intoxication. Although
he acknowledged that methadone played a role in Moore’s death, he did not
believe it was possible to identify a single drug as the cause. Rohr explained
that the urine screen identifying the drugs in Moore’s body did not indicate the
quantities 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-
5
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.”
4
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No. 09-50298
son’s system at the time of death, he could not “pick and choose” which one
caused the death, because “you don’t know exactly how all of these [drugs] in-
terplay.” Rather, his practice was to “list all the drugs involved and leave it at
that.”
At the close of testimony, the jury deliberated for approximately forty
minutes. It returned a verdict of guilty.
II.
Santillana raises two arguments on appeal, both regarding the sufficiency
of the evidence. First, she alleges there was insufficient evidence to establish
that the methadone in Moore’s body at the time of his death was the same meth-
adone Santillana sold to him. Santillana also claims there was insufficient evi-
dence to show that Moore’s death “result[ed]” from methadone according to
§ 841(b)(1)(C).
When reviewing sufficiency of the evidence, we will affirm if a reasonable
trier of fact could have concluded that the evidence established the essential ele-
ments of the offense beyond a reasonable doubt. United States v. Lopez, 74 F.3d
575, 577 (5th Cir. 1996). We consider all evidence, credibility determinations,
and reasonable inferences drawn therefrom in the light most favorable to the
prosecution. Id. The jury may choose among reasonable constructions of the evi-
dence: The evidence need not exclude every reasonable hypothesis of innocence
or be wholly inconsistent with every conclusion except that of guilt. Id. We will
reverse, however, if after viewing the evidence in the light most favorable to the
prosecution, the evidence still gives equal or nearly equal support to a theory of
guilt and a theory of innocence, id., because in that event, a reasonable trier of
fact must necessarily entertain reasonable doubt, United States v. Sanchez, 961
F.2d 1169, 1173 (5th Cir. 1992).
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A.
The statute under which Santillana was convicted imposes a minimum
sentence on defendants who distribute a schedule I or II drug when the subse-
quent use of that drug causes death or serious injury. Under 21 U.S.C. § 841-
(a)(1) and (b)(1)(C), it is
unlawful for any person knowingly or intentionally . . . to . . . dis-
tribute . . . a controlled substance[.]
....
In the case of a controlled substance in schedule . . . II [such as
methadone] . . . if death or serious bodily injury results from the use
of such substance [an offender] shall be sentenced to a term of im-
prisonment of not less than twenty years or more than life, a fine
not to exceed the greater of that authorized in accordance with the
provisions of Title 18, or $1,000,000 if the defendant is an individual
or $5,000,000 if the defendant is other than an individual, or both.
It is thus an essential element of the conviction that Moore died as a result of the
specific methadone distributed by Santillana.
Santillana argues that there was insufficient evidence to link the metha-
done she admits selling to Moore to the methadone present in his body at the
time of his admission to the hospital. Santillana points to evidence that Moore
was a heavy drug user who had multiple drugs in his system when he arrived
at the emergency room and to the lack of testimony that Moore ever ingested the
particular methadone tablets he received from Santillana. She therefore reasons
that there was equal evidence that Moore obtained his fatal dose of methadone
from another supplier.
Santillana’s reasoning is unpersuasive. Although the evidence did not pro-
vide an airtight chain-of-custody account of the methadone tablets Santillana
sold to Moore, there was ample support for a reasonable jury to infer that Moore
ingested those tablets before slipping into his fatal coma. Santillana admitted
selling methadone to Moore just hours before he passed out. A DEA agent testi-
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fied that approximately an hour-and-a-half after Moore and Dickson purchased
methadone from Santillana, at the outset of his night of partying, Moore sent
Dickson a text message asking for advice on taking methadone. The jury also
learned that Santillana was a regular methadone supplier for a number of peo-
ple in Moore’s circle of friends.
Santillana does not point to any evidence that Moore received methadone,
as opposed to the other drugs in his system, from another source. As noted
above, the evidence need not foreclose every possible theory of innocence; the
jury 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
nearly equal support to the theories that Moore ingested methadone from an-
other source and that he ingested the methadone Santillana sold to him. The
jury could have reasonably concluded that the methadone Moore ingested the
night before he was admitted to the hospital was the same methadone he pur-
chased from Santillana.
B.
Santillana contends there was insufficient evidence for the jury to conclude
that Moore’s death “result[ed]” from the methadone in his system, within the
meaning of § 841(b)(1)(C). Santillana concedes that all three medical witnesses,
including her own expert, Rohr, concluded that methadone was at least a con-
tributing cause of death. She argues, however, that the plain meaning of “re-
sults” implies “a stronger degree of causation than mere contribution.” Santil-
lana does not explain what this “stronger degree of causation” might be. She
does not argue, for instance, that a drug must be the exclusive cause of death to
create culpability under § 841(b)(1)(C). Nor does she contend that the common-
law understanding of proximate cause should be the standard.
Even if Santillana is correct that “results” implies a “stronger degree of
7
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causation than [does] mere contribution,” we still will not disturb the verdict.
The jury heard evidence from Hail, the only expert witness certified in toxicolo-
gy, 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
combination with Xanax or by its own effect. The jury was free to weigh the rel-
ative persuasiveness of Hail’s testimony against that of Peerwani and Rohr,
neither of whom gave a detailed explanation of his disagreement with Hail’s rea-
soning. Thus, there was sufficient evidence for a reasonable jury to conclude
that Moore’s death resulted from his use of methadone under a heightened stan-
dard of causation.
AFFIRMED.
8