The People &c.,
Respondent,
v.
Ana Marie Santi,
Appellant.
The People &c.,
Respondent,
v.
Peter Corines,
Appellant.
2004 NY Int. 127
We are asked to determine whether a licensed physician
is subject to prosecution under Education Law § 6512 (1) for
aiding and abetting an unauthorized individual in the unlawful
practice of medicine. We conclude that the only reasonable
interpretation of the statute does not exempt licensed
Both appeals here arise out of the same set of facts. Defendant Peter Corines, a licensed medical doctor, owned and operated two medical offices -- Surgical Consultants, P.C. and Ambulatory Anesthesia, P.C. -- in Queens County, New York. From 1997 to 1998 defendant Ana Marie Santi worked intermittently for Corines at Surgical Consultants. Defendant Santi was licensed to practice medicine in August 1972. Originally, Corines hired Santi as an anesthesiologist, but on March 16, 1998, the Department of Health suspended Santi's license to practice medicine. Despite her suspension, Santi continued to work, in some capacity, at Surgical Consultants. Corines described her as a "medical assistant."
The Attorney General charged each defendant with four counts of unauthorized practice of medicine under Education Law § 6512 (1). The charges stemmed specifically from the treatment of three patients of defendant Corines.
On June 22, 1998, Patient A visited Surgical
Consultants to have laser surgery. Defendant Santi entered the
operating room where Patient A was waiting and started an
intravenous, or "I.V." line, placing the needle in the patient's
right hand. The patient testified she immediately felt relaxed.
During the procedure, Patient A awoke twice, nauseous and in pain. The second time she awoke, Corines was not present in the room. To calm her, Santi gave her an injection and laid her down. Ultimately, following the procedure, she was led to a recovery room and fell asleep.
On July 28, 1998, Corines treated Patient B at Surgical Consultants. As Patient B testified, shortly after his arrival there, Santi entered the examination room and directed him to lie on his back. Santi then prepped and cleaned Patient B's right hand, unwrapped an I.V. needle and inserted it into the back of his hand. The needle was connected to tubing which led to an I.V. bag. Patient B said he felt a warm sensation and observed Santi adjust the flow of the liquid. Defendant Corines thereafter entered the room and performed the procedure. After it was complete, Santi returned and removed the needle from Patient B's hand, at which point he said he felt "woozy" and "a bit weak." He received no subsequent medical treatment from Corines.
Patient C testified that on December 4, 1998 she
visited Surgical Consultants to have cosmetic eye surgery. Both
Corines and Santi were present in the operating room. Corines,
situated on Patient C's right side, engaged her in conversation.
Santi, standing to the patient's left, inserted an I.V. into her
At trial, the People proceeded on the theory that, in each of the aforementioned instances, Santi engaged in the unauthorized practice of medicine by administering anesthesia, and that Corines aided and abetted her. Defendants, by contrast, claim that the I.V. lines contained either a simple water and glucose, or glucose saline, solution and that the I.V. lines that Santi initiated contained no anesthesia, and that she merely prepared the patients and Corines administered the anesthesia.
Following the People's proof, Corines moved for a trial
The Appellate Division remanded the case for a hearing on the juror misconduct issue ( see People v Corines, 295 AD2d 445 [2d Dept 2002]; People v Santi, 295 AD2d 457 [2d Dept 2002]). Following the hearing, the court again denied defendants' motions. Defendants again appealed.
The Appellate Division, this time addressing the
merits, affirmed. The court conducted both a sufficiency and
factual review and ultimately concluded that "[t]he evidence
We begin our discussion with an analysis of defendant Corines' primary claim assailing the lower courts' interpretation of Education Law § 6512 (1). Specifically, defendant Corines contends that the plain language of section 6512 (1) exempts licensed individuals from criminal prosecution under the statute. We disagree.
Title VIII of the New York State Education Law
regulates professional conduct and requires certain enumerated
professionals, including physicians, to obtain a license in order
to practice such professions lawfully ( see generally Education Law § 6500 et. seq.; Education Law §§ 6520, 6521). Education Law § 6512 (1) criminalizes the conduct of any individual who
practices any of the enumerated professions in Title VIII without
authorization. Similarly, it criminalizes the conduct of anyone
Specifically, Education Law § 6512 (1) provides that:
"Anyone not authorized to practice under this title who practices or offers to practice or holds himself out as being able to practice in any profession in which a license is a prerequisite to the practice of the acts, or who practices any profession as an exempt person during the time when his professional license is suspended, revoked or annulled, or who aids or abets an unlicensed person to practice a profession, or who fraudulently sells, files, furnishes, obtains, or who attempts fraudulently to sell, file, furnish or obtain any diploma, license, record or permit purporting to authorize the practice of a profession, shall be guilty of a class E felony."
In interpreting the statute we are guided by a well-settled principle of statutory construction: courts normally accord statutes their plain meaning, but "will not blindly apply the words of a statute to arrive at an unreasonable or absurd result" ( Williams v Williams, , 23 NY2d 592, 599 [1969]; see also Matter of Rouss 221 NY 81, 91 [1917]; Church of The Holy Trinity v United States, 143 US 457, 460 [1892]).
It is equally well settled that, "[i]n implementing a
statute, the courts must of necessity examine the purpose of the
statute and determine the intention of the Legislature"
( Williams, 23 NY2d at 598). Indeed, "the primary consideration
of the courts is to ascertain and give effect to the intention of
Corines claims that a plain reading of Education Law § 6512 (1) makes clear that only individuals "not authorized to practice under [the Education Law]" may be prosecuted under the statute. Defendant also contends that a comparison of the distinct language used in section 6512 (1) and Education Law § 6512 (2) further supports his reading of the statute and thereby renders subdivision (1) superfluous.[2] Both the trial court and the Appellate Division disagreed with defendant's interpretation, as do we.
While we acknowledge that defendant's interpretation of
the statute represents a fair and literal reading of the text,
such an interpretation ignores the legislative intent underlying
the statute's enactment. If the phrase "not authorized to
In effect, the statute, read as defendant asks, would enable licensed individuals of all professions under the purview of Title VIII to engage in conduct that would otherwise be criminal. We cannot accept that the Legislature intended to enable such conduct, nor do we believe that it intended to create such a disparity in the statute's application. Insofar as we must interpret a statute so as to avoid an "unreasonable or absurd" application of the law, we reject defendant's interpretation ( Williams, 23 NY2d at 599). Instead, we look to the legislative intent underlying the statute's enactment for guidance. A review of the legislative history makes apparent that only one reasonable interpretation of the statute exists.
Title VIII has a clear regulatory purpose.
Specifically, the statute's legislative introduction indicates
that it "provides for the regulation of the admission to and the
Allowing licensed physicians to aid and abet unauthorized individuals in the unlawful practice of medicine does not in any way promote the general welfare or otherwise ensure public safety.
A deeper look at the legislative history underlying the enactment of Education Law § 6512 further supports our interpretation. In juxtaposing section 6512, as originally enacted in 1971, with the enactment of section 6512 (2) five years later, it is apparent that the Legislature did not intend to exempt licensed individuals from prosecution under the law for aiding and abetting fewer than three individuals in the unauthorized practice of a profession.
In 1971, as part of a greater revision of the Education
Law, the Legislature enacted section 6512. At that time, it
consisted of only a single section with wording substantially
similar to that of section 6512 (1) as it exists today (L 1971 ch
987).[3]
The unauthorized practice of a profession, originally,
In 1976, the Legislature increased the existent sanction by enacting section 6512 (2) (L 1976 ch 689). This section, as evidenced by the extensive legislative discussion that preceded its passage, was enacted primarily to combat the growing problem of massage parlor prostitution in urban areas ( see Lipschutz Memo, Bill Jacket, L 1976, ch 689). The Legislature passed the law with the hope that "increasing the penalty in cases where three or more persons are involved in the unauthorized practice of a profession would facilitate law enforcement efforts to eradicate certain evils such as the illicit practice of massage" ( id.). In 1979 the Legislature, without explanation, raised the penalty for a violation of section 6512 (1) to a class E felony.
The statute's evolution makes obvious that section 6512
(2) was enacted to combat a specific perceived evil, distinct
from that covered in section 6512 (1). Again, there was no
We conclude that Education Law § 6512 (1) does not
exempt licensed physicians from prosecution under the statute.
To the contrary, section 6512 (1) allows for the prosecution of
any individual, licensed or not, that aids and abets an
unauthorized individual in the practice of medicine. Defendant
Corines fits neatly within the statute's scope. Furthermore,
under the accessorial liability statute, he is likewise liable as
he knew defendant Santi was not authorized to practice medicine,
and he "intentionally aided" her in the practice of medicine on
his patients through the administration of anesthesia ( see Penal
Law § 20.00).[4]
Corines's argument here is thus without merit.
We next turn to the sufficiency claim raised by both defendants.
Evidence is legally sufficient to support a conviction
where, "if accepted as true, [it] would establish every element
of an offense charged and the defendant's commission thereof"
(CPL 70.10). This Court's role on sufficiency review is limited
to determining whether, "after viewing the evidence in the light
most favorable to the prosecution, any rational trier of fact
could have found the essential elements of the crime beyond a
reasonable doubt" ( Jackson v Virginia, 443 US 307, 319
[1979][emphasis in original]; see also People v Contes, , 60 NY2d 620, 621 [1983]). Ultimately, so long as the evidence at trial
establishes "any valid line of reasoning and permissible
inferences [that] could lead a rational person" to convict, then
the conviction survives sufficiency review ( People v Williams, , 84 NY2d 925, 926 [1994]). Both defendants Corines and Santi contend that the
evidence at trial was insufficient to support Santi's conviction
for the unauthorized practice of medicine and Corines' conviction
for aiding and abetting such unauthorized practice. They focus
their claim on the People's failure to call an expert witness to
testify to the effects of anesthesia. They assert on appeal
that, in the absence of expert testimony establishing a causal
connection between the sensations each of the complaining
patients experienced and the typical effects attendant to the
administration of anesthesia, the evidence at trial was
insufficient to support their convictions. Expert testimony is properly admitted "when it would
help to clarify an issue calling for professional or technical
knowledge * * * beyond the ken of the typical juror" ( DeLong v
County of Erie, , 60 NY2d 296, 307 [1983]). Admission of expert
testimony is a matter largely left to the discretion of the trial
court ( see People v Brown, , 97 NY2d 500, 505 [2002]). While expert testimony may be properly admitted in
certain cases, it is not always required to prove a particular
crime ( see e.g. People v Cratsley, , 86 NY2d 81, 87-88 1995]).
Additionally, an expert is not necessarily required to testify to
the effects of a particular drug; lay testimony on this issue
suffices in some instances ( see People v Kenny, , 30 NY2d 154, 156-
157 [1972]). Simply, expert testimony is used to "aid a lay jury
in reaching a verdict" ( People v Taylor, , 75 NY2d 277, 288
[1990]). Expert testimony was not required in this case. We recognized long ago that "modern juries are not
bereft of education and intelligent persons who can be expected
to apply their ordinary judgment and practical experience" ( Havas
v Victory Paper Stock, , 49 NY2d 381, 386 [1980]). The
administration of anesthesia, a commonly employed means of
relieving pain during surgical procedures, is not a matter so
foreign or esoteric as to require an expert explanation. Jurors,
equipped with their everyday knowledge and experience, could
reasonably have concluded that the sensations and experiences
described by each of the patient-witnesses were caused by the
The three patient-witnesses described in detail their
experiences with defendants. Each testified regarding a warm
sensation following Santi's introduction of the I.V. line. Both
Patient A and Patient C fell into unconsciousness shortly after
Santi started the respective I.V. line. After Corines directed
Santi to increase the flow of the I.V., Patient C immediately
lost consciousness. When one patient regained consciousness, she
needed assistance dressing, and she remained weak and semi-
conscious for a significant period following the procedure. While Patient B did not lose consciousness, his medical
records stated that he received sedatives to ease his pain. He
recalled a warm, burning sensation that followed Santi's
insertion of the I.V. prior to Corines ever entering the room.
Following the procedure Patient B was weak and "woozy." He was
unable to rise up off the operating table without holding on to
something for support. This evidence, both direct and
circumstantial, supported the People's theory. Furthermore, defendant Corines' own testimony, and his
own medical records, proved helpful to the People ( see generally
People v Hines, , 97 NY2d 56, 61 [2001]). Corines described
anesthesia as a type of pain reliever, and he described the
Reviewing the evidence in the light most favorable to
the People, the jury could have used a clear and valid line of
reasoning to convict Santi and, consequently, Corines as acting
in concert on each of the four counts of the indictment.
III. Jury Inquiry and the Trial Court's Response CPL 310.30 provides, in pertinent part, that during
deliberations, upon a jury's request for clarification, "the
court must direct that the jury be returned to the courtroom and,
after notice to both the people and counsel for the defendant,
and in the presence of the defendant, must give such requested
information or instruction as the court deems proper." The court
does not have discretion in deciding whether to respond ( see
People v Almodovar, , 62 NY2d 126, 131 [1984]; People v Malloy, , 55 NY2d 296, 301 [1982]; People v Gonzalez, 293 NY 259, 262 [1944]).
Moreover, the court, in response, "must give meaningful
supplemental instructions" ( Malloy, 55 NY2d at 301). Therefore,
while a trial court is without discretion in deciding whether to
respond, the court does have discretion as to the substance of
the response. Simple reiteration of an original instruction may,
under appropriate circumstances, constitute a meaningful response
sufficient to satisfy the statutory mandate ( see id. 55 NY2d at
298). Specifically, when the original instruction is accurate
and "[w]here the jury expresses no confusion [regarding the
original charge]," a simple reiteration of the original
instruction suffices as a meaningful response ( id. at 302). This
case gives rise to the unique circumstances under which a
rereading of the original charge suffices. The trial court originally instructed the jury, in
pertinent part, that: "in order for you to find the defendant
Ana Marie Santi guilty of the crime of
practicing medicine without a license as
charged in the four counts of this
indictment, the People are required to
prove from all of the evidence in the case
beyond a reasonable doubt each of the
following three elements." In describing the third element, the trial judge instructed the
jury that the People must prove defendant Santi "knowingly
practiced medicine upon [each patient] through the administration
of anesthesia." During deliberations the jury inquired whether "[u]nder
the conditions of Dr. Santi's suspension as performing the duties
of a medical assistant, was Dr. Santi permitted to introduce an
I.V. to a patient?" The trial judge, after hearing both parties,
responded to the note by rereading the original instruction,
including the language specifically requiring proof that Santi
Finally, defendants claim that during deliberations a
juror improperly influenced the others. The juror worked at a
hospital as a patient care associate. Defendants claim that she
asserted her medical expertise, became an "unsworn witness" in
the jury room and improperly swayed the jury to convict. Firstly, we are presented with findings of fact made by
Supreme Court on remittitur and affirmed by the Appellate
Division. Therefore, our review here is limited to whether there
is any "possible view of the evidence that would support the
determination" below ( People v Damiano, , 87 NY2d 477, 486 1996]).
Clearly, there is record support for the trial court's factual
findings and refusal to set aside the verdict based on juror
misconduct. Juror misconduct constitutes reversible error where
"(1) jurors conduct[ ] personal specialized assessments not
within the common ken of juror experience and knowledge (2)
The record indicates that the juror, while perhaps
assertive, was not an "expert." Her experiences in the medical
field were limited. Moreover, she did not conduct any experiment
or investigation that was later used to influence the jury.
Instead, the record makes clear that she merely gave her lay
opinions regarding the introduction of an I.V. line, drawing on
both her life experiences and the trial evidence. This was
proper. These record facts support the conclusion below that the
juror's participation in the deliberations did not rise to the
level of juror misconduct. Defendants' remaining claims are without merit. Accordingly, in each case, the order of the Appellate
Division should be affirmed.
1 This second motion to dismiss was actually made the day after summations, just before the judge's charge to the jury.
2 Education Law § 6512 (2) provides that "[a]nyone who knowingly aids and abets three of more unlicensed persons to practice a profession or employs or holds such unlicensed persons out as being able to practice in any profession in which a license is a prerequisite to the practice of the acts, or who knowingly aids or abets three or more persons to practice any profession as exempt persons during the time when the professional licenses of such persons are suspended, revoked or annulled, shall be guilty of a class E felony."
3 The original 1971 enactment read as follows: "§ 6512. Unauthorized practice a crime
"Anyone not authorized to practice under this title who practices or offers to practice or holds himself out as being able to practice in any profession in which a license is a prerequisite to the practice of the acts, or who aids and abets an unlicensed person to practice a profession, or who fraudulently sells, files, furnishes, obtains, or who attempts fraudulently to sell, file, furnish or obtain any diploma, license, record or permit purporting to authorize the practice of a profession, shall be guilty of a class A misdemeanor" (McKinney's Session Laws of New York, L 1971 ch 987, at 1577).
4 Penal Law § 20.00 provides that "[w]hen one person engages in conduct which constitutes an offense, another person is criminally liable for such conduct when, acting with the mental culpability required for the commission thereof, he solicits, requests, commands, importunes, or intentionally aids such person to engage in such conduct."