## Facts

- Regina Denise McKnight gave birth in May 1999 to a nearly full-term stillborn child.
- An autopsy found chorioamnionitis, funisitis, and the cocaine metabolite benzoylecgonine; the report attributed death to the inflammation conditions and cocaine consumption and labeled the death a homicide.
- McKnight was charged with homicide by child abuse under S.C. Code Ann. § 16-3-85.
- At the first trial, State experts testified that cocaine use, together with the inflammatory conditions, caused the stillbirth; one conceded the inflammatory conditions alone could have caused death.
- The defense presented medical testimony at the first trial that recent studies did not link cocaine use to stillbirth, but also presented a defense expert who conceded cocaine could not be ruled out; juror misconduct led to a mistrial.
- At the second trial, the State presented the same expert testimony, but defense counsel called only the expert who conceded cocaine could not be ruled out, did not effectively challenge the State’s experts, and did not introduce medical research disputing causation.
- The trial court instructed that homicide by child abuse required extreme indifference to human life, but also stated criminal intent may arise from negligence, recklessness, or indifference to consequences; when the jury asked for a definition of criminal intent, the court repeated the same language.
- The jury returned a guilty verdict after a short deliberation; the conviction was affirmed on direct appeal.
- McKnight sought post-conviction relief alleging ineffective assistance; the PCR court denied relief, and the Supreme Court of South Carolina granted certiorari.

## Issues

1. Whether trial counsel provided ineffective assistance by failing to investigate and present available medical and scientific evidence disputing the State’s causation theory linking prenatal cocaine use to stillbirth.
2. Whether trial counsel was ineffective for failing to obtain accurate, clarifying jury instructions on the mens rea required for homicide by child abuse, particularly the meaning of “criminal intent” and “extreme indifference to human life.”
3. Whether counsel’s additional alleged deficiencies (including failure to pursue an equal protection challenge to the statutory scheme and failure to introduce the autopsy report) warranted post-conviction relief.

## Decision

- The Supreme Court of South Carolina reversed the denial of post-conviction relief.
- The court vacated McKnight’s conviction and sentence for homicide by child abuse.
- The court held counsel’s performance was constitutionally deficient, chiefly for failing to investigate and present available medical literature and expert testimony bearing on causation, and for failing to secure proper instructions distinguishing extreme indifference from negligence.
- The court found prejudice because there was a reasonable probability that competent presentation of the causation defense and proper mens rea instructions would have produced a different outcome.

## Legal Principles

- Under Strickland v. Washington, ineffective assistance requires (1) deficient performance below an objective standard of reasonableness and (2) prejudice shown by a reasonable probability of a different result absent counsel’s errors.
- In prosecutions turning on scientific causation, reasonable performance includes adequate investigation and use of available, relevant medical or scientific literature and expert testimony when it would materially test the State’s theory.
- When a statute requires a heightened mental state (extreme indifference to human life), jury instructions must not permit conviction based on a lesser standard such as negligence; counsel may be ineffective for failing to obtain clarifying instructions when jurors express confusion.
- Prejudice may be established where the State’s proof of causation is contestable and counsel’s failures leave the jury without meaningful adversarial testing of the State’s scientific claims and the required mens rea standard.

## Conclusion

The court vacated McKnight’s homicide-by-child-abuse conviction because counsel failed to investigate and present available medical evidence challenging the State’s cocaine-causation theory and failed to obtain jury instructions that accurately conveyed the statute’s extreme-indifference mens rea, creating a reasonable probability the verdict would have differed with competent representation.


McKnight v. State, 661 S.E.2d 354 (S.C. 2008)