## Facts

- Jarvis Stewart went to his former girlfriend’s apartment in Brooklyn on October 8, 1971 and found Daniel Smith there.
- Stewart ordered Smith to leave at knifepoint; when Smith suggested they talk, Stewart stabbed him once in the abdomen, puncturing Smith’s stomach.
- Smith was taken to a hospital and underwent surgery that night; he was given a paralytic anesthetic requiring assisted ventilation.
- Surgeons repaired the stomach injury and then operated on an unrelated incarcerated hernia.
- During the hernia portion of the procedure, Smith suffered cardiac arrest, causing oxygen deprivation and brain damage.
- Smith never regained consciousness and died on November 8, 1971.
- Stewart was initially arrested and charged with assault; after Smith’s death, he was charged with homicide.
- At trial, the prosecution’s causation proof consisted of hospital records and testimony from a medical examiner who reviewed reports and performed an autopsy but did not participate in the surgery.
- The operative reports suggested competing explanations for the cardiac arrest (e.g., interruption of ventilation versus bronchial spasm), and the medical examiner could not determine which occurred; he conceded that failure to provide oxygen alone could have caused the arrest and death.
- The jury convicted Stewart of manslaughter in the first degree; the Appellate Division affirmed.

## Issues

1. Whether the evidence was sufficient to prove beyond a reasonable doubt that Stewart’s stabbing was the legal (proximate) cause of Smith’s death, rather than death resulting solely from an independent intervening medical cause.

## Decision

- The Court of Appeals modified the judgment.
- The court held the People failed to prove beyond a reasonable doubt that the stab wound caused Smith’s death.
- Because the record left a reasonable doubt whether death resulted from an intervening medical cause unrelated to the risk created by the stabbing, the manslaughter conviction could not stand.
- The court reduced the conviction from first-degree manslaughter to first-degree assault, based on undisputed proof that Stewart intentionally stabbed Smith and caused serious physical injury.

## Legal Principles

- In homicide prosecutions, the People must prove beyond a reasonable doubt that the defendant’s conduct was a sufficiently direct (proximate) cause of death.
- Subsequent medical treatment, even if negligent, ordinarily does not break causation; however, the defendant is not guilty of homicide if the proof leaves a reasonable doubt that death was caused by an independent intervening medical act rather than by the original injury.
- A jury may not speculate between equally plausible causal explanations when one would negate the “causing death” element of homicide.

## Conclusion

Because the medical evidence did not permit a rational finding beyond a reasonable doubt that the stabbing, as opposed to an independent medical cause during surgery, brought about Smith’s death, the homicide conviction was reduced to first-degree assault.


People v. Stewart, 40 N.Y.2d 692 (N.Y. 1976)