The Michigan Supreme Court has ruled that a child abuse expert for the prosecution should not have told jurors in a child abuse trial that she diagnosed a young victim with "medical torture," but it unanimously concluded that the error did not warrant a new trial because other evidence overwhelmingly supported the conviction. 

The high court affirmed Gwendolyn Alexander's torture and child abuse convictions Wednesday, ruling that although the testimony crossed important evidentiary lines, it did not affect the outcome of the case under the state's plain-error standard. 

"We hold that admission of this testimony was erroneous, but we nonetheless affirm defendant's convictions because we are unpersuaded that she has established entitlement to relief under the plain-error standard of review," Chief Justice Megan K. Cavanagh wrote for the majority. 

The case arose from allegations that Alexander and her partner repeatedly restrained a 6-year-old, whom the opinion refers to as MA, with zip ties and belts while living in a trailer in early 2020, the opinion said. Police responding to a welfare check found the child with bruises, swelling and ligature scars on his wrists and ankles. 

Alexander later admitted during a police interview that she tied up the child multiple times, the opinion said. 

At trial, prosecutors called Dr. Dena Nazer, medical director of Kids-TALK Children's Advocacy Center, as an expert in child abuse pediatrics, the opinion said. 

After examining MA, reviewing medical records and other materials, Nazer testified that she diagnosed him with "medical torture." 

Nazer explained that the diagnosis is "a clinical diagnosis" used for children exposed to "at least two different physical assaults" along with "at least two psychological maltreatments or two forms of psychological abuse."  The opinion said she also described it as an uncommon diagnosis "reserved for severe cases." 

Alexander did not object to the testimony during trial, leaving the issue subject to plain-error review on appeal.

The Supreme Court concluded that the diagnosis should never have been presented to the jury. 

First, the justices said the testimony failed the basic requirement that expert opinions help jurors understand evidence beyond ordinary knowledge. 

While expert testimony explaining the nature and timing of MA's injuries was appropriate, the justices said, the diagnosis itself did not help jurors decide whether the prosecution proved the elements of torture. 

The court also found the psychological portion of the diagnosis lacked a reliable scientific foundation because it depended largely on believing MA's account rather than on independent medical findings. 

Quoting prior precedent, the court explained that "an examining physician cannot give an opinion" that simply amounts to believing "the victim had told the truth."

Finally, the court held that the testimony improperly invaded the jury's role. 

Drawing heavily from the Michigan Court of Appeals' earlier decision in People v. McFarlane, which rejected expert testimony diagnosing "abusive head trauma" in a child abuse case, the justices said "medical torture" posed the same danger. 

The court stressed that experts can't express opinions suggesting a defendant is guilty of the charged offense. 

"The lay meaning of 'torture' would be generally understood as 'the infliction of intense pain ... to punish, coerce, or afford sadistic pleasure,'" the opinion said, noting that definition closely mirrors Michigan's criminal torture statute. 

Because of that overlap, the justices said the diagnosis "likely impressed upon the jury an opinion on defendant's criminal responsibility for the crime for which she was on trial." 

The opinion concluded that the testimony "was unhelpful, lacked a reliable foundation, and invaded the province of the jury."

Despite identifying those errors, however, the court held Alexander could not satisfy the third requirement of plain-error review because the improperly admitted testimony did not affect the verdict. 

Doctors, police officers and an emergency medical technician all documented ligature marks and scarring consistent with restraint, the opinion said. Both MA and his younger sister testified that MA had been zip-tied. 

Most damaging, the court said, Alexander herself admitted during a recorded police interview that she had tied up MA multiple times because she could not control him. 

The court also noted evidence that Alexander told the child's godmother she was "tired of him" and wanted to "give him away," that MA slept on the trailer floor and that he wasn't regularly fed. 

"Taken together, the evidence strongly supported that defendant intended to cause MA cruel or extreme physical or mental pain and suffering and that she inflicted great bodily injury," Justice Cavanagh wrote. 

The justices also observed that Dr. Nazer acknowledged during cross-examination that she was testifying only about a medical diagnosis, not the legal definition of torture, and that prosecutors reminded jurors during closing argument that "medical torture" was "different than legal torture." 

Jurors were also instructed that they alone were responsible for deciding the facts and were free to accept or reject expert testimony.

"We're pleased the Michigan Supreme Court agreed with us that this expert testimony crossed the line. The court got it right on that issue, and the ruling should provide important guidance for trial courts across the state," Michael Mittlestat, assistant defender with the Michigan State Appellate Defender Office, said in a statement to Law360 on Thursday. "That said, we respectfully disagree, both legally and factually, with the court's conclusion that the error did not prejudice Ms. Alexander, and with its decision to deny her a new trial. We are evaluating all available options on her behalf."

Wayne County Prosecutor's Office Chief of Appeals Jon Wojtala said in a statement to Law30 late Thursday that his office was pleased the court unanimously upheld the convictions despite excluding the expert testimony.

"The defendant repeatedly tortured her six-year-old son, causing psychological and physical scarring that the child will deal with for the rest of his life," Wojtala said. "Defendant's conduct merited her convictions and the sentences imposed."

Wojtala added that the convictions "should not have been placed in jeopardy simply because a medical doctor testified to a medical diagnosis," and said the prosecutor's office remains concerned by what it views as a growing trend of courts excluding "reliable and established medical testimony simply because the medical diagnosis presented sounds similar to terms used in the law."

The state is represented by Daniel E. Hebel of the Wayne County Prosecutor's Office. 

Alexander is represented by Michael Mittlestat and Katherine L. Marcuz of the Michigan State Appellate Defender Office. 

The case is People of the State of Michigan v. Gwendolyn Josephine Alexander, case number 168009, in the Michigan Supreme Court. 

--Editing by Rich Mills.

Update: This story has been updated with comments from Jon Wojtala of the Wayne County Prosecutor's Office.