Commonwealth v. Strickland , 87 Mass. App. Ct. 46 ( 2015 )


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    10-P-666                                           Appeals Court
    COMMONWEALTH   vs.   JASON STRICKLAND.
    No. 10-P-666.
    Hampden.     September 8, 2014. - January 23, 2015.
    Present:   Berry, Kafker, & Maldonado, JJ.
    Assault and Battery. Assault and Battery by Means of a
    Dangerous Weapon. Evidence, Medical record, Relevancy and
    materiality, Third-party culprit, Impeachment of
    credibility, Prior misconduct, Expert opinion. Minor,
    Medical treatment. Witness, Impeachment, Expert.
    Practice, Criminal, Assistance of counsel. Dangerous
    Weapon.
    Indictments found and returned in the Superior Court
    Department on July 24, 2006.
    The cases were tried before Judd J. Carhart, J., and a
    motion for a new trial was considered by Bertha D. Josephson.
    Michael J. Fellows & Myles D. Jacobson for the defendant.
    Katherine E. McMahon, Assistant District Attorney, for the
    Commonwealth.
    KAFKER, J.   When eleven year old Haleigh Poutre arrived at
    the hospital on September 11, 2005, she was unconscious and
    barely breathing, her pale, emaciated body was covered in
    2
    bruises and huge burns, and the back of her head was swollen,
    lacerated, and bleeding.   Her horrible injuries had been
    inflicted in her own home, where she lived with her mother Holli
    Strickland1 and stepfather, the defendant.   After a trial in
    Superior Court, a jury convicted the defendant of (1) wantonly
    or recklessly permitting, or wantonly or recklessly permitting
    another to commit an assault and battery causing, substantial
    bodily injury to Haleigh on or about September 10, 2005 (head
    injury); (2) wantonly or recklessly permitting, or wantonly or
    recklessly permitting another to commit an assault and battery
    causing, bodily injury to Haleigh on or before September 11,
    2005 (multiple injuries of various ages);2 (3) assault and
    battery by means of a dangerous weapon (bat); (4) assault and
    battery by means of a dangerous weapon (wand or stick or tube);
    and (5) assault and battery.   The jury acquitted the defendant
    of one count of assault and battery by means of a dangerous
    weapon (shod foot).
    1
    After being released on bail, Holli Strickland was found
    dead along with her adoptive mother, as a result of an apparent
    murder-suicide.
    2
    In each of the first two counts, the defendant was charged
    under both theories of G. L. c. 265, § 13J(b), namely, (1)
    assault and battery upon a child causing substantial bodily
    injury (count 1) or bodily injury (count 2), and (2) having care
    and custody of a child and wantonly or recklessly permitting, or
    wantonly or recklessly permitting another to commit an assault
    and battery causing, substantial bodily injury (count 1) or
    bodily injury (count 2). The jury's verdicts rested only on the
    second theory.
    3
    On appeal from his convictions and from the denial of his
    new trial motion, the defendant argues that (1) the trial judge
    improperly excluded medical evidence from Haleigh's pediatrician
    and nurse with respect to the second, multiple injury count; (2)
    the wand that the defendant used to hit Haleigh was not a
    dangerous weapon; (3) the head injury conviction may have been
    based on a theory not supported in the evidence; (4) the motion
    for new trial should have been allowed where counsel was
    ineffective (a) for failing to impeach a witness, and (b) for
    failing to obtain an expert witness on a psychiatric condition
    known as Munchausen syndrome by proxy; and (5) an evidentiary
    hearing on the new trial motion was required.   We affirm the
    convictions and the order denying the defendant's motion for a
    new trial.
    Background.   We recite the facts the jury could have found,
    reserving some facts for later discussion.
    On Sunday, September 11, 2005, at about 2:45 P.M., eleven
    year old Haleigh was brought to the emergency room at Noble
    Hospital by her mother, Holli Strickland (Holli), and Holli's
    uncle, Brian Young.   Haleigh was unconscious and unresponsive,
    her vital signs were very poor, and she was barely breathing.
    The back of her head was bleeding and so badly damaged that
    medical personnel described it as "boggy," i.e., swollen due to
    blood filling the scalp tissue.   "Huge" burns were observed on
    4
    her chest, and her face was bloody, bruised, and "distorted."      A
    "CT scan" of her brain was taken, as were photographs of her
    body.
    Haleigh was transferred to the pediatric intensive care
    unit at Baystate Medical Center at about 5 P.M. that day.    The
    admitting nurse testified that Haleigh's body core temperature
    was just eighty-one degrees, her pupils were "fixed," and she
    was "posturing" her limbs, signaling a traumatic brain injury.
    A second CT scan was performed at 7:30 P.M., and an "MRI" scan
    was completed the next morning.   Haleigh's body was covered with
    other injuries of varying age from her head to her toes.
    Dr. Richard Hicks reviewed Haleigh's scans, and opined at
    trial that Haleigh had suffered severe injuries to the brain, of
    the type "ordinarily . . . associated with high velocity motor
    vehicle accidents."   Dr. Hicks explained that such injuries
    would have rendered Haleigh unconscious immediately and that
    based on the MRI and CT scans, he placed the brain injuries as
    having occurred at about 4 P.M. on Saturday, September 10, 2005,
    the day before Haleigh was first brought to the hospital.    Dr.
    Hicks opined that a simple fall down the stairs would not have
    the force necessary to cause these injuries in a child.
    Another trial expert, Dr. Christine Barron, corroborated
    Dr. Hicks's testimony, stating that for the injuries to
    Haleigh's brain to have resulted from a staircase fall, it
    5
    "would have to be a fall down the stairs with significant
    external forces, such as a [strong] push or a kick of the child
    at the top of the stairs."   Dr. Barron estimated that Haleigh
    had sustained the severe head injuries some twelve to twenty-
    four hours before the Noble Hospital staff took the photographs.
    Dr. Barron also proffered her opinion as to the nature and
    manner of infliction of Haleigh's multiple other injuries.3    She
    stated that the red bruises on the child's body were consistent
    with blunt force trauma, also inflicted twelve to twenty-four
    hours before the pictures were taken.   Dr. Barron specifically
    identified two injuries that in her opinion could not be self-
    inflicted:   a linear scar that ran from Haleigh's right ribcage,
    across her torso, and behind her hip; and a dry contact burn to
    her chest.   Dr. Barron further testified that she could not give
    an opinion that any of the injuries were self-inflicted.     Dr.
    Barron opined that the multiple injuries and scars occurred at
    different times, some having occurred within the twenty-four
    3
    Dr. Barron's description of Haleigh's multiple other
    injuries covers almost one hundred pages of transcript. Dr.
    Barron identified multiple lacerations, linear abrasions, scars,
    and bruises on Haleigh's trunk and legs. Haleigh had cigarette
    burns on her left foot and left upper arm. Dr. Barron opined
    that the burns were not consistent with the appearance of
    accidental cigarette burns. Dr. Barron also identified "D"-
    shaped injuries, consistent with Haleigh having been struck with
    a hard, solid object. Haleigh also had a large, curvilinear
    "C"-shaped laceration and identically shaped bruising on her
    buttocks. Dr. Barron also testified that Haleigh had restraint
    injuries on her leg and left wrist.
    6
    hours preceding her hospitalization, while others were at least
    one week old; she could not date some injuries.
    At the time of the injuries, Haleigh was living in the
    family home with her stepfather, who is the defendant; her aunt
    and adoptive mother, Holli; Haleigh's sister, who was nine years
    old in 2005; and Haleigh's brother, who was two years old in
    2005.   After being alerted to Haleigh's injuries, the police
    searched her home and noticed holes, indentations, and small
    brown blood stains on the walls of the stairway leading to the
    basement.    Blood stains were also located on three walls of the
    basement playroom area, as well as in the first-floor bathroom.
    The blood stains on the walls of the basement stairway and in
    the bathroom were swabbed, tested, and determined to match
    Haleigh's blood.
    In the master bedroom, a "Leatherman" tool with the
    brownish material on it and handcuffs were seized from the night
    table next to the bed.    Tests on the Leatherman tool indicated a
    mixture of blood was present, to which Haleigh was a potential
    contributor.   Handcuffs were also found in a "My Little Kitty"
    backpack in the family van, and a belt was recovered from the
    floor of the van.    An aluminum bat with Haleigh's name on it was
    found in a basement closet.    Work tools were strewn throughout
    the house.
    7
    At trial, Haleigh's sister was twelve.    She testified that
    she had seen Holli and the defendant hit Haleigh with their
    hands, a belt, and a baseball bat, and that she saw scabs and
    bruises all over Haleigh, with whom she shared a bedroom.
    Haleigh's sister also recounted how Holli and the defendant
    would push Haleigh down the basement stairs to punish her and
    how the defendant began pushing Haleigh down the stairs shortly
    after he moved into the home, around 2002.
    Haleigh's sister testified that after her soccer game on
    Saturday, September 10, 2005, she saw the defendant push Haleigh
    down the basement stairs and that this time Haleigh did not
    "wake up."   Haleigh's sister heard the defendant order Haleigh
    to get up and then saw both Holli and the defendant shaking
    Haleigh to awaken her, but she remained on her back at the
    bottom of the stairs.    Haleigh's sister saw the defendant carry
    Haleigh upstairs and place her in the bathtub in the first-floor
    bathroom.4   Haleigh's sister added that a little later she saw
    the defendant carry Haleigh up to bed.    Haleigh was not awake.
    That evening Holli told a friend, a certified home health
    aide, that Haleigh was ill and that she had stayed home with
    Haleigh while the defendant went to the mall with Haleigh's
    4
    This testimony   was corroborated by forensic evidence
    indicating that blood   found in and around the bathtub and on the
    walls of the basement   stairway matched Haleigh's
    deoxyribonucleic acid   (DNA) profile.
    8
    sister and brother.       Holli declined the home health aide's offer
    to come over and take a look at Haleigh.5      The next morning,
    Holli again spoke to her friend and told her that Haleigh was
    still sleeping and then called a pediatrician at about 10:30
    A.M.       The doctor on call who returned the message was not
    Haleigh's regular pediatrician.       He testified that Holli
    reported that Haleigh had the stomach flu and had vomited twice;
    he offered to see Haleigh in one hour, but Holli declined the
    appointment.
    The family had another soccer game to attend that
    afternoon, and because Haleigh was still "asleep," Holli asked
    Alicia Weiss, her neighbor and close friend, to watch Haleigh.
    Weiss arrived after noon, and the family left at about 12:30
    P.M., leaving Weiss alone with Haleigh.       Weiss testified that
    she checked on Haleigh three times.       She saw some foam on
    Haleigh's mouth and testified that Haleigh neither moved nor
    woke up.       The family returned at about 2:30 P.M., accompanied by
    Holli's uncle, Brian Young.       At Holli's urging, Young checked on
    Haleigh and immediately realized something was very wrong; he
    carried her downstairs and brought her to Noble Hospital.
    At trial, the Commonwealth introduced other eyewitness
    accounts of the defendant abusing Haleigh, including incidents
    5
    The defendant testified that he came home at approximately
    9 P.M. and saw Haleigh sleeping at approximately 10:30 P.M.
    9
    in which the defendant (1) struck Haleigh in the hand with a
    plastic tubular wand; (2) aided Holli in interrogating Haleigh
    as Holli beat her lower legs with a bat; (3) dragged Haleigh
    into the house by her ear, causing her to cry; (4) together with
    Holli took Haleigh into the bathroom, after which a muffled cry
    was heard and Haleigh emerged with a bloody lip; and (5) struck
    her in the head with his hand.6
    The new trial motion judge (who was not the trial judge)
    accurately summarized the main elements of the defense at trial:
    "The defense called a treating health professional,
    . . . Pamela Krzyzek, who testified that when she came to
    the family's home, the defendant was not present because he
    was at work.[7] [Krzyzek testified that Haleigh told her she
    heard voices telling her to hurt herself and that she had
    hit her knees with a hammer.] She also testified that the
    defendant did not report Haleigh's injuries to her, but
    that it was always Holli who did. The defense also called
    Stephanie Trent Adams ('Adams'), whose children had
    attended Holli's daycare . . . . Adams testified that the
    defendant worked during the day . . . . Adams also
    recalled that she had seen Haleigh 'stair-surfing,'
    punching herself, and hitting her head against the wall of
    a cubby.
    "Defense counsel called two expert witnesses. Dr.
    Jonathan Arden testified that the kind of brain injury
    6
    The primary sources of these other accounts of abuse were
    Weiss and Angela Harris, a friend of Haleigh's sister.
    7
    Krzyzek was a clinical case coordinator working for an
    organization that provided voluntary assistance to families
    designed to stabilize a child's behavior transitioning from a
    hospital stay to home. In this case, Krzyzek received a
    referral to assist with Haleigh's transition to home after a
    stay at a hospital for an eating disorder. She saw Haleigh in
    the home approximately once per week from July, 2004, to
    September 7, 2005.
    10
    Haleigh suffered did not require the equivalent of a high
    speed car crash in order to cause it. [Arden gave an
    opinion that the head injury could have occurred between
    two or three hours and twenty-four hours before the 4 P.M.
    CT scan was taken on Sunday.] The other expert witness,
    Dr. Brian Wraxall, testified that he had examined the DNA
    taken from the Strickland home, and that [the defendant]
    was excluded as a potential source of that DNA.
    "The defendant took the stand and denied any
    wrongdoing. He testified that he believed Holli when she
    told him that Haleigh was injuring herself and was
    receiving treatment for this condition. . . . Only Holli
    would take Haleigh to these appointments and would speak
    with the medical providers. The defendant learned of
    Haleigh's injuries through Holli."
    The defense also attempted to discredit both Weiss and
    Haleigh's sister with prior inconsistent statements.   For
    example, Haleigh's sister did not reveal that she had seen the
    defendant push Haleigh down the stairs on Saturday, September
    10, until more than two years after the incident.   In the
    interviews immediately after Haleigh was hospitalized, Haleigh's
    sister had claimed that she saw Haleigh hit her head on the
    floor in the basement while performing a back flip on Friday
    night and that as a result Haleigh briefly lost consciousness.
    For her part, Weiss initially told police that Holli was a good
    mother and volunteered that "[i]t's not like Holli would ever
    throw her kids down the stairs or, like, hit them," but Weiss
    testified at trial that she had "left out certain things" in an
    effort to "protect[] [her] best friend."
    11
    Discussion.   1.   Excluded evidence.   a.   Exclusion of
    medical provider evidence as to the second count, involving
    multiple injuries that occurred on or before September 11, 2005.
    On appeal, the defendant challenges the exclusion of
    testimony and records from Haleigh's pediatrician, Dr. Rukmini
    Kenia, and Dr. Kenia's nurse practitioner, Susan Malloy,8 that
    the defendant claims established his defense to the count
    charging multiple injuries inflicted on or before September 11,
    2005.9   This argument is not directed at count one, the head
    injury, as Dr. Kenia and Malloy never treated Haleigh for the
    head injury, and the defense did not pursue a theory at trial
    that the head injury was the product of self-abuse.      The records
    reflect that Haleigh was regularly seen in Dr. Kenia's office
    from at least 2001 until September 2, 2005, eight days before
    the injury to her head, and that she was sometimes treated by
    Dr. Kenia, but more often by Malloy.
    The defense sought to introduce the testimony and records
    to establish that Dr. Kenia and Malloy saw Haleigh on numerous
    occasions, observed bruises and burns on her, and were treating
    8
    Malloy had a master's degree in nursing, in addition to
    being a registered nurse and a certified pediatric nurse
    practitioner, and in accordance with G. L. c. 112, § 80B, she
    was licensed to make clinical decisions regarding care, the
    prescription of medications, therapeutics, and treatment.
    9
    The medical records were marked for identification at
    trial and are part of the record appendix.
    12
    her for self-abuse.    Defense counsel wanted to conclude his
    questioning of Dr. Kenia and Malloy by asking, "on any occasion,
    did you consider the possibility that . . . any of her injuries
    were . . . caused by another?"    Defense counsel explained that
    he was "trying to corroborate [the defendant's] belief" that
    "[the defendant] had no reason to protect [Haleigh] because he
    thought it was self-abuse, so did the doctors, so did everybody
    else."    Defense counsel further explained that he sought to
    introduce the testimony regarding Malloy's determination
    regarding self-abuse, not for "the truth of the matter; [but
    because] it goes to [Malloy's] state of mind.   It is her
    determination which happens to corroborate the determination
    that [the defendant] testified to.   On that basis, I would like
    to offer that."10
    10
    It is difficult to discern which particular visits and
    records were of interest to the defense. On appeal the defense
    references various visits and records, most of which involve
    Malloy but not Dr. Kenia. These include an April 12, 2004,
    record observing, "Pt. states she did hit face last pm
    intentionally because she was frustrated"; a June 18, 2004,
    record which reads, "pt admits to self-inflicting injury [with]
    spoons, forks [and] knives in her room"; a July 7, 2004, report
    where "pt states will write in book daily when feels frustrated
    instead of hurting self"; and a report from what appears to be
    November, 2004, involving "stair surfing" and a fall down cement
    steps. The defendant also references in his brief an April 12,
    2005, visit during which Holli reported that Haleigh had been
    limping since they returned from a hotel stay where Haleigh
    surfed on cement stairs. At trial, several other visits with
    Malloy and Dr. Kenia were referenced. These include a January
    10, 2005, report where Haleigh "admit[ted] to hitting self
    [with] hammer"; an August 5, 2005, report reflecting a variety
    13
    The trial judge would not admit the medical provider
    evidence to corroborate the defendant's own beliefs.    The judge
    emphasized that the defendant never spoke to Dr. Kenia or
    Malloy.    The judge further concluded that the evidence was being
    offered for the impermissible purpose of corroborating Holli's
    and Haleigh's hearsay statements, as he determined "no one could
    tell" from the bruises alone whether a child had been hit by
    another, and the medical providers' testimony would necessarily
    be based on these statements.
    A defendant in a criminal case has a constitutional right
    to present evidence, and that right extends to proof of facts
    that make a defendant's or another witness's testimony more
    credible.   See Commonwealth v. Emence, 
    47 Mass. App. Ct. 299
    ,
    301 (1999).   The admission of such corroborative evidence turns
    on its relevancy, and rests in the discretion of the trial
    judge.    See Commonwealth v. Galvin, 
    310 Mass. 733
    , 747 (1942)
    ("[A] trial judge may in his discretion allow a witness to
    testify to facts and circumstances corroborative of his
    testimony"); Commonwealth v. DeBrosky, 
    363 Mass. 718
    , 725 (1973)
    (hotel registration records admissible in judge's discretion to
    corroborate testimony of witness that group was registered in
    motel); Commonwealth v. 
    Emence, 47 Mass. App. Ct. at 301-302
    of bruises and wounds diagnosed as self-injury; and a similar
    July, 2005, report.
    14
    ("The very existence of information that, as a matter of common
    sense and experience, supports the credibility of a witness
    prompts the conclusion that, so long as it is not remote, it
    ought to be admitted. . . .   It is not necessary that the
    evidence in question bear directly on the issue or be conclusive
    of it").
    The excluded evidence here involves the novel use of
    medical testimony and reports to buttress the defendant's
    credibility on the wanton or reckless mens rea element of the
    offense.   The essential argument is that the excluded evidence
    from the medical providers would have corroborated the
    defendant's testimony (and therefore his defense) that he
    reasonably believed Holli when she told him that Haleigh's
    injuries resulted from self-abuse, and that he reasonably
    concluded that Haleigh was being appropriately treated by
    medical professionals, and that he therefore did not need to
    take additional actions to protect her.   According to the
    defendant, the admission of the challenged testimony, namely,
    that the providers were indeed treating her injuries on numerous
    occasions and diagnosing them as self-inflicted and as not
    requiring further medical treatment or other action, would have
    corroborated the inferences the defendant drew to the same
    effect.
    15
    We conclude that this evidence was sufficiently relevant to
    the mens rea element of the offense and corroborative to be
    admissible in the judge's discretion.   See Commonwealth v.
    
    Emence, 47 Mass. App. Ct. at 301-302
    .   See also Commonwealth v.
    Twitchell, 
    416 Mass. 114
    , 126-130 (1993) (defendants were
    entitled to present affirmative defense grounded on belief that
    their conduct was not violation of law, based on reliance on
    Christian Science church publication on legal obligations of
    Christian Scientists, even if publication was later determined
    to be wrong, and publication should have been put before jury).
    "However, we need not decide whether the judge's ruling
    excluding the evidence amounted to an abuse of discretion
    because its exclusion did not prejudice the defendant's case."
    Commonwealth v. Smith, 
    460 Mass. 385
    , 398 (2011).   See
    Commonwealth v. Aguiar, 
    78 Mass. App. Ct. 193
    , 205-206 (2010)
    ("Under the prejudicial error standard, the reviewing court must
    be able to say with fair assurance that the error did not
    influence the jury, or had but very slight effect").
    Most importantly, the multiple eyewitness accounts of the
    defendant's own brutality, and his knowledge and acceptance of
    Holli's brutality, overwhelmingly support the jury's
    determination that he was not merely a duped bystander.   For
    example, in addition to Haleigh's sister's testimony that she
    saw the defendant and Holli repeatedly push Haleigh down the
    16
    basement stairs, Weiss testified that the defendant was present
    when she saw Holli hit Haleigh in the lower leg with an aluminum
    bat with Haleigh's name on it.    Before Haleigh could answer,
    Holli struck her with the bat and Haleigh cried and fell to the
    floor.    Holli made her get back up, and the defendant and Holli
    repeated the interrogation and assault.    Holli explained to
    Weiss, while the defendant was still present, that she was using
    Haleigh's bat because it would look like Haleigh was hitting
    herself.    Weiss also recounted the defendant striking the back
    of Haleigh's hands with a "tubular wand" made out of plastic
    that was about two feet long.    Other brutal acts by the
    defendant were described by additional witnesses.
    Important differences between the medical providers' and
    the defendant's access to Haleigh also detract from the excluded
    evidence's probative value.     Unlike the medical providers, the
    defendant lived in the home and saw Haleigh on a daily basis.
    His observations, unlike theirs, were direct and
    contemporaneous, and not susceptible to distortion or
    obscuration by delayed reporting.     Trial evidence demonstrated
    that Holli kept significant control over the timing and
    circumstances in which Haleigh would be seen by her health
    providers.    The jury could infer that Holli took steps to
    mislead the physicians, but did not conceal her abuse in the
    home.    For example, Holli told Weiss, "If I kick an existing
    17
    bruise, there is no new evidence."   Similarly Holli's calls to
    the home health provider and the pediatrician about Haleigh
    being asleep with the flu, when Haleigh had just suffered a
    traumatic head injury, and Holli's refusals of their offers to
    see Haleigh, seem calculated to mislead the medical providers.
    Additionally, the medical records are not devoid of suspicions
    of abuse.   Notations in the medical records show at least two
    reports of suspected abuse were filed in January, 2005, and May,
    2005, in accordance with G. L. c. 119, § 51A.
    We also take into consideration the limited purpose for
    which the defendant offered the excluded evidence, namely, to
    merely corroborate his belief that Haleigh was being
    appropriately treated by her medical providers.11   As such, the
    value of its admission was limited to bolstering that
    proposition, and it was not offered to establish its truth, a
    point counsel recognized.   See Commonwealth v. 
    DeBrosky, 363 Mass. at 725
    ; Commonwealth v. Williams, 
    30 Mass. App. Ct. 543
    ,
    548 (1991) (not unreasonable for counsel to elicit otherwise
    inadmissible testimony of victim's state of mind where it could
    be used to corroborate defendant's insanity defense).   Given
    this limited purpose, any prejudice that accrued from its
    exclusion was similarly minimized.
    11
    Corroborative evidence is defined in Black's Law
    Dictionary 414 (4th ed. 1968) as "[e]vidence supplementary to
    that already given and tending to strengthen or confirm it."
    18
    Here the probative value of the medical providers' proposed
    testimony in terms of corroborating the defendant's own beliefs
    was particularly limited because the defendant never spoke to
    the medical providers despite Haleigh's numerous injuries, their
    severity and suspiciousness, and his superior knowledge of what
    was occurring in the home.    A jury would undoubtedly question
    why any parent would not speak to a doctor when his child was
    continually suffering such horrible injuries.   When the
    defendant's failure to speak to the medical providers in these
    circumstances is combined with multiple eyewitness accounts
    describing his own abuse of Haleigh and his presence when Holli
    abused Haleigh, any corroborative value of the medical providers
    is virtually extinguished.
    In addition, the corroborative testimony was largely
    cumulative of other proof that informed the jury of incidents of
    self-abuse reported by Haleigh and treatment and monitoring of
    Haleigh for these injuries.   In particular Krzyzek, the clinical
    case coordinator, testified that she visited the home weekly
    during the year preceding the last incident and observed bruises
    on Haleigh and heard Haleigh's explanations for the injuries.12
    Krzyzek explained that she stayed in regular communication with
    12
    Krzyzek testified that she saw bruises on Haleigh, but
    was told by Haleigh that she hit herself in the knees with a
    hammer, that her sister had "clocked" her in the face with a
    flashlight, and that she had hurt her throat choking on a
    "grinder."
    19
    "Holli, Haleigh, DSS,[13] the therapist, [and] Malloy", and that
    Malloy was assigned to do regular body checks on Haleigh.
    Defense counsel was also able to elicit from Dr. Barron that she
    had reviewed the medical records of Dr. Kenia and Malloy, and
    those records showed that Malloy regularly examined Haleigh,
    usually on a weekly basis, and that in July, 2005, Malloy
    observed bruises and abrasions that she characterized as "self-
    injury."14
    In sum, we are convinced for all of these reasons that the
    exclusion of this limited evidence did not influence the jury,
    or had but very slight effect.
    13
    The Department of Social Services, now known as the
    Department of Children and Families (DCF).
    14
    Finally, even if the jury were inclined to credit some of
    the defendant's testimony regarding his lack of knowledge of,
    and participation in, the brutality, the evidence would have
    been inculpatory with respect to an alternate theory of guilt.
    To this point the focus has been on the objective measure of
    wanton or reckless conduct, but there is a subjective measure:
    "[i]f the grave danger was in fact realized by the defendant,
    his subsequent voluntary act or omission which caused the harm
    amounts to wanton or reckless conduct, no matter whether the
    ordinary man would have realized the gravity of the danger or
    not." Commonwealth v. Welansky, 
    316 Mass. 383
    , 398 (1944). See
    Commonwealth v. Pugh, 
    462 Mass. 482
    , 496-497 (2012). If the
    defendant truly believed Haleigh was engaging in self-injurious
    behavior, a belief he argues was bolstered by the excluded
    evidence, then leaving tools and other instruments all over the
    house with which Haleigh could harm herself was strong proof of
    wanton or reckless behavior. See Commonwealth v. Hendricks, 
    452 Mass. 97
    , 103-105 (2008) (engaging in high-speed nighttime car
    chase with police while three year old was in back seat
    constituted wanton or reckless behavior). As even Krzyzek
    testified, if she had seen tools out like a hammer or pliers,
    she would have considered them unsafe for Haleigh.
    20
    b.   Additional arguments against the exclusion of the
    medical provider evidence.    The defendant also raises several
    additional arguments regarding the medical provider evidence for
    the first time on appeal.    We review for a substantial risk of a
    miscarriage of justice.   See Commonwealth v. Ivy, 55 Mass. App.
    Ct. 851, 859 (2002).
    The defendant contends that the opinion testimony should
    have been offered for its truth to prove what he calls a "third
    party culprit" theory because it shows that Haleigh, rather than
    the defendant, was responsible for her injuries.    This
    represents a significant shift from his position at trial where
    defense counsel emphasized that he was not offering the medical
    evidence for its truth, but rather to corroborate that the
    defendant, like the doctors, was "fooled" by Holli.    Blaming
    Haleigh for all of these horrible injuries was not a viable
    trial strategy, as trial counsel undoubtedly correctly
    understood and carefully avoided.    His defense was crafted to
    focus on the reasonableness of the defendant's beliefs and
    assumptions regarding the abuse, not whether Haleigh was
    actually inflicting all the injuries on herself.
    Regardless, we consider this third-party culprit evidence
    irrelevant to count one, as neither Dr. Kenia nor Malloy treated
    Haleigh's head injury and therefore could offer no direct
    testimony on whether it was self-inflicted.    Moreover, the
    21
    thrust of the defense at trial to count one was never self-abuse
    but rather that the injury was inflicted by someone other than
    the defendant.   Thus, exclusion of the medical provider
    testimony on self-abuse certainly did not create a substantial
    risk of a miscarriage of justice on this count.
    We also discern no such risk on count two, involving
    multiple injuries.   The record makes clear that many of the
    injuries observed on Haleigh's body were either not seen by the
    providers or not referenced in their records.     The omitted
    injuries included two wounds Barron specifically identified as
    not having been self-inflicted, namely, the injury consistent
    with being whipped by a wire and the multiple burns to Haleigh's
    chest that were about one week old.   Other omitted injuries
    included the curvilinear or "C"-shaped laceration and bruising
    on her buttocks consistent with blunt force trauma using a thin
    metal object; injuries consistent with blunt force trauma on
    multiple occasions using a hard object with a "D" shape
    (inferably, from whippings with a belt and buckle); and parallel
    linear restraint injuries on her leg and left hand.     The
    defendant provides no explanation of how the excluded evidence
    suggests that any of these injuries could reflect self-abuse.
    Finally, as explained above, there was ample evidence of self-
    22
    abuse before the jury, which the jury considered in their
    verdict.15
    The defendant also claims that his inability to impeach
    Barron with the medical providers' diagnosis of self-abuse
    created a substantial risk of a miscarriage of justice.     We
    disagree.    Barron was confronted with at least one instance of
    the medical providers' diagnosis of self-abuse and acknowledged
    the diagnosis and discounted it.   Further exploration of Dr.
    Kenia's and Malloy's diagnosis of particular injuries with
    Barron would have opened the defense up to an expert attack on
    the competence of the medical providers' care of Haleigh.     See
    Commonwealth v. Wall, 
    469 Mass. 652
    , 663-665 (2014) (failure to
    impeach witness is generally not reversible error).
    Finally, the defendant argues that Holli's and Haleigh's
    statements were admissible because they were made for the
    "purpose of medical diagnosis or treatment."    Bouchie v. Murray,
    
    376 Mass. 524
    , 529 (1978).    See Commonwealth v. Irene, 
    462 Mass. 600
    , 611-615, cert. denied, 
    133 S. Ct. 487
    (2012) (discussing
    standards for admitting medical records and opinions).     See also
    Commonwealth v. Arana, 
    453 Mass. 214
    , 231 (2009).     Even if we
    15
    Finally, evidence of Haleigh's self-abuse, and the
    defendant's knowledge of it, would be inculpatory on the
    alternative theory that he was wanton or reckless in leaving
    tools around the house; thus, as discussed above, its exclusion
    could not create a substantial risk of a miscarriage of justice
    on this ground as well.
    23
    were to assume, without deciding, that some of Holli's or
    Haleigh's statements may have been admissible for this purpose,
    we discern no substantial risk of a miscarriage of justice for
    the reasons discussed above and because they were cumulative of
    testimony given by Krzyzek, the defendant, and others.
    c.   Exclusion of Holli's statement to Weiss as alternative
    third-party culprit.   The defendant argues for the first time on
    appeal that he should have been permitted to elicit from Weiss
    that Holli told Weiss that Haleigh's misbehavior was so severe
    that Holli had to use extreme measures to discipline her.    The
    defendant asserts this evidence was probative of Weiss's motive
    and intent to push Haleigh down the stairs when Weiss was alone
    with her on the morning of Sunday, September 11.   At trial,
    however, the defendant sought to admit this statement on the
    ground that it was relevant to show Holli's and the defendant's
    states of mind and to show Weiss's bias.   Because the issue has
    not been preserved, we review the error, if any, to determine if
    it created a substantial risk of a miscarriage of justice.     See
    Commonwealth v. Rivera, 
    425 Mass. 633
    , 636-637 (1997).
    There is no such risk where evidence supporting Weiss's
    testimony that Haleigh never woke up while she was with her on
    September 11, was overwhelming, to say nothing of the virtually
    nonexistent possibility that Haleigh rose from her "sick" bed
    and engaged in behavior that was so "severe" that she had to be
    24
    kicked or pushed down the stairs to be controlled.    Even the
    defendant testified that Haleigh began to feel ill on Saturday,
    September 10, and that he did not see her walking around at any
    time after he left for the mall on Saturday night.
    d.   Exclusion of Weiss's prior bad acts.   The defendant
    proffered testimony from a witness who was in Weiss's daycare in
    2004.   He would testify that Weiss would duct tape a "binky" in
    his mouth and tell him that "if he was going to act like a baby,
    she would treat him like a baby."   She would also "tie [his
    older brother] in a chair and lead [the chair] across the room."
    According to the defendant the evidence was probative of Weiss's
    motive and intent to injure Haleigh, as part of a third-party
    culprit defense.   We agree with the Commonwealth that the judge
    did not abuse his substantial discretion in excluding these
    incidents where they involved different children and were
    markedly different in terms of the degree of force employed.
    See Commonwealth v. Hunter, 
    426 Mass. 715
    , 716-717 (1998);
    Commonwealth v. Bregoli, 
    431 Mass. 265
    , 274 (2000).
    2.   Wand as a dangerous weapon.   There is no merit to the
    defendant's contention that the evidence was insufficient to
    establish that the plastic tube or wand the defendant used to
    strike Haleigh's hands was dangerous.   "The essential question,
    when[, as here,] an object which is not dangerous per se is
    alleged to be a dangerous weapon, is whether the object, as used
    25
    by the defendant, is capable of producing serious bodily harm."
    Commonwealth v. Marrero, 
    19 Mass. App. Ct. 921
    , 922 (1984).     The
    evidence that the two-foot-long wand was used to repeatedly
    strike Haleigh on the back of the hands and caused her to scream
    and cry so loudly that Weiss, on another floor of the house,
    heard her and came to her aid was sufficient to permit the jury
    to conclude that it was being used in a manner capable of
    producing serious bodily injury.   See, e.g., Commonwealth v.
    Appleby, 
    380 Mass. 296
    , 303-305 (1980) (riding crop);
    Commonwealth v. Cruz, 
    430 Mass. 182
    , 194-195 (1999) (duct tape);
    Commonwealth v. Barrett, 
    12 Mass. App. Ct. 1001
    , 1002 (1981)
    (aerosol spray can); Commonwealth v. Rossi, 
    19 Mass. App. Ct. 257
    , 261 (1985) (large ring worn on hand); Commonwealth v.
    
    Marrero, 19 Mass. App. Ct. at 922-923
    (boots); Commonwealth v.
    McIntosh, 
    56 Mass. App. Ct. 827
    , 830-831 (2002) (windowpane).
    3.   Sufficiency of the evidence to sustain the conviction
    related to the brain injury.   On appeal, the defendant makes a
    somewhat confusing argument that the evidence was insufficient
    to support his conviction on count one.    We discern no merit to
    this argument.   The trial evidence sufficiently establishes the
    defendant's wanton or reckless conduct.   Haleigh's sister had
    seen both the defendant and Holli kick Haleigh down the basement
    stairs on numerous occasions and described the defendant as
    pushing Haleigh down the stairs on September 10.   Weiss also
    26
    observed Holli beat Haleigh, with the defendant sometimes
    participating and other times observing without objection.
    Thus, the evidence demonstrated that he was participating in the
    abuse of Haleigh, including pushing her down the stairs, or was
    knowledgeable that it was occurring and was permitting it to
    happen.   See Commonwealth v. Torres, 
    442 Mass. 554
    , 568 (2004),
    quoting from G. L. c. 265, § 13J(b) ("Whatever forms of conduct
    might come within the term permit[ting]" another to commit
    assault and battery, encouraging such batteries by hitting the
    children himself, and then turning them over to Fappiano for
    further abuse, would surely come within the concept of
    'permit[ting]' such a battery").16   Given the extent of this
    abuse of Haleigh by both the defendant and Holli, including
    their punishing of Haleigh by pushing her down the stairs, the
    jury were warranted in finding the defendant wanton or reckless
    even if he was not present and it was Holli who threw Haleigh
    down the stairs when the brain injuries occurred.   See
    Commonwealth v. Welansky, 
    316 Mass. 383
    , 387 (1944) (defendant
    nightclub owner not present on night of fatal fire);
    Commonwealth v. Pugh, 
    462 Mass. 482
    , 496-497 (2012);
    Commonwealth v. Robinson, 
    74 Mass. App. Ct. 758-759
    (2009).
    Moreover, his conduct after the injury was wanton or reckless,
    16
    In any event, there was ample evidence to refute the
    notion posited by the defendant on appeal that Haleigh alone
    caused her head injury.
    27
    as "a reasonable person, knowing what the defendant knew, would
    have realized that there was a high likelihood that [the child]
    would suffer a substantial bodily injury if she did not receive
    timely medical attention."   
    Id. at 758.
    4.    Motion for new trial.   The defendant presses three
    claims on appeal that he argued in his motion for new trial:
    counsel's failure to utilize certain impeachment evidence at
    trial, the failure of trial counsel to obtain an expert, and the
    judge's denial of an evidentiary hearing on the new trial
    motion.   We discern no merit to the arguments.
    A judge's decision to deny a motion for a new trial "will
    not be disturbed unless a review of the defendant's case shows
    that the decision, if not reversed, will result in 'manifest
    injustice.'"   Commonwealth v. Vazquez, 
    69 Mass. App. Ct. 622
    ,
    631 (2007), quoting from Commonwealth v. Delong, 60 Mass. App.
    Ct. 122, 127 (2003).   "[T]he decision whether to decide the
    motion on the basis of affidavits or to hear oral testimony, is
    left largely to the sound discretion of the judge."
    Commonwealth v. Stewart, 
    383 Mass. 253
    , 257-258 (1981).     See
    Commonwealth v. Grace, 
    397 Mass. 303
    , 312-313 (1986).
    a.   Impeachment evidence.    Contrary to the defendant's
    contention, counsel's failure to impeach Weiss with ambiguous
    evidence -- the omission from her prior written statement to
    police dated September 19, 2005, that the defendant was present
    28
    when she saw Holli beating Haleigh with the bat on one
    particular occasion -- did not deprive him of an "otherwise
    available, substantial ground of defence."    Commonwealth v.
    Saferian, 
    366 Mass. 89
    , 96 (1974).    See Commonwealth v. 
    Wall, 469 Mass. at 663-665
    (generally failure to impeach a witness
    does not constitute ineffective assistance of counsel).     As
    previously explained, defense counsel effectively cross-examined
    Weiss on her change in testimony, her failure to intervene to
    prevent the abuse, and the circumstances in which she eventually
    implicated the defendant and Holli.
    b.   Failure of counsel to obtain an expert on Munchausen
    syndrome by proxy (MSBP).   The defendant claims that his
    attorney was ineffective for failing to obtain an expert to
    testify that Holli was suffering from MSBP.   In support of this
    claim, the defendant attached two affidavits and reports from
    Dr. Robert Chabon, and Beth Wechsler, a licensed social worker,
    to his motion for new trial.   Each expert had prepared the
    materials in April, 2011, on behalf of Pamela Krzyzek and her
    employer, Brightside, Inc., to defend a civil lawsuit brought by
    Haleigh's legal guardian.   Wechsler described MSBP as a
    condition involving caregivers who cause injury to someone else,
    often a child, in order to be viewed as "a loving rescuer of a
    child who has severe problems."   Dr. Chabon explained that the
    "family constellation typically includes fathers who are 'away
    29
    at work' a great deal and are completely oblivious and are
    uninvolved in the process that involves numerous office visits
    and hospitalizations of their own children."   According to Dr.
    Chabon, "[n]early all individuals who come into contact with
    [MSBP] cases experience some resistance to believing that
    mothers could intentionally harm their children in this
    horrifying way.   The disbelief is in part engendered by a
    dramatic discrepancy between the public presentation and the
    private reality of these families" (emphasis supplied).      See
    Commonwealth v. Robinson, 
    30 Mass. App. Ct. 62
    , 74 n.10 (1991),
    citing People v. Phillips, 
    122 Cal. App. 3d 69
    , 76-77, 78-79, 85
    n.1 (1981), for a description of MSBP.
    Both Dr. Chabon and Wechsler gave an opinion that Holli
    presented a case of MSBP and that in the circumstances neither
    Krzyzek nor her employer reasonably could have been expected to
    determine that Haleigh was the victim of child abuse.
    Because the proffered evidence was prepared in relation to
    defending a social worker, the materials failed to address the
    issue at bar, namely, whether the defendant was among those
    reasonably misled.   The reports discuss Holli's deception that
    was directed solely toward her medical providers and, as Dr.
    Chabon notes, "dramatic" discrepancies occur between the public
    presentation (medical office visits) and the family home.     That
    information concerning the defendant's role was not considered
    30
    by Wechsler or Dr. Chabon is clear from the detailed list of
    sources they reviewed, which omits the transcript from the trial
    and interviews with Weiss, Haleigh's sister, and any other
    witnesses who saw the defendant abuse Haleigh.
    Absent evidence that Holli's deception extended beyond her
    public presentation to the professionals working with Haleigh,
    the defendant has failed to demonstrate that MSBP would have
    been relevant in assessing his role in the abuse.   The motion
    judge similarly concluded that the evidence "would not have
    exculpated [him] as it does not directly contradict the
    eyewitness testimony that the defendant was present and partook
    in the violent acts against Haleigh."   In these circumstances,
    the defendant has not shown that counsel's behavior fell below
    that of an ordinary fallible lawyer and likely deprived him of
    an otherwise available, substantial ground of defense.    See
    Commonwealth v. 
    Saferian, 366 Mass. at 96
    .
    c.   Hearing on motion for new trial.    The defendant argues
    that he should have been granted a hearing on his motion for new
    trial because the evidence regarding MSBP was newly discovered.
    According to the defendant, the experts' proffered opinions in
    the materials attached to his motion were dependent on discovery
    from the related civil trial, materials which were not released
    until after he had been convicted.   As the motion judge found,
    "the defendant's attorneys could have uncovered any link to MSBP
    31
    through the information provided by Haleigh's medical providers,
    [DSS], and law enforcement investigators,"17 particularly because
    MSBP, also known as factitious disorder by proxy, had been
    identified as a disorder well in advance of the defendant's
    trial.    See Commonwealth v. 
    Robinson, supra
    ; American
    Psychiatric Association, Diagnostic and Statistical Manual of
    Mental Disorders 781-783 (4th ed. text revision 2000).    Also,
    trial defense counsel had informed appellate counsel that he had
    considered MSBP at the time of trial and concluded it was not
    relevant.   Thus, the evidence related to MSBP was not newly
    discovered.   See Commonwealth v. LeFave, 
    430 Mass. 169
    , 176
    (1999).
    Judgments affirmed.
    Order denying motion for new
    trial affirmed.
    17
    The DSS workers whose depositions were reviewed by Dr.
    Chabon and Wechsler were on the defendant's witness lists.