## Facts

- Russell West and Ann West assumed long-term care of Russell’s adult sister, Lillian West, a 54-year-old woman with Down syndrome and serious heart disease, after their mother died.
- Lillian lived with the Wests and became fully dependent on them for nutrition, hygiene, mobility assistance, and medical attention.
- Russell withdrew Lillian from an external program serving individuals with intellectual disabilities, after which Lillian’s condition progressively worsened.
- When Lillian was taken to an emergency room, medical personnel observed severe malnourishment, extensive bedsores, and extreme neglect-related hygiene conditions.
- Physicians attributed Lillian’s death to sepsis and bronchial pneumonia linked to infected bedsores caused by prolonged immobility and inadequate care.
- The Commonwealth charged Russell with second-degree manslaughter (with reckless homicide referenced in some accounts as an alternative) and charged Ann as a complicitor based on their alleged neglect.

## Issues

1. Whether a person who voluntarily assumes care of a dependent adult relative has a legal duty to provide necessary care such that omission can support homicide liability.
2. Whether the evidence was sufficient for a jury to find wantonness and causation for second-degree manslaughter and complicity based on prolonged caretaker omissions.

## Decision

- The Court of Appeals of Kentucky affirmed the convictions and one-year sentences.
- The court held that the Wests’ voluntary, long-term assumption of Lillian’s care created a caretaker–dependent relationship imposing a legal duty to provide necessary care.
- The court concluded the evidence permitted a reasonable jury to find wanton omission, given the extended and extreme nature of Lillian’s deterioration and the obvious risks to her life.
- The court held the jury could find causation because medical testimony linked the fatal sepsis and pneumonia to bedsores and neglect-related immobility, notwithstanding Lillian’s preexisting conditions.
- The court upheld Ann West’s conviction as a complicitor based on her shared caretaking role and participation through omission in the prolonged neglect.

## Legal Principles

- Criminal liability generally does not attach to a mere failure to act, but omission can be punishable when the defendant has a legal duty to act.
- A legal duty may arise from voluntary assumption of care where the defendant becomes the primary caregiver and the dependent person is rendered reliant on the defendant for basic needs.
- Second-degree manslaughter may be supported by wanton omission when a caretaker consciously disregards a substantial and unjustifiable risk to the dependent person’s life by failing to provide essential care and timely medical attention.
- Preexisting disabilities or illness do not preclude causation if the defendant’s omission is a substantial factor producing the fatal condition.
- Complicity can be established where a person, sharing responsibility and awareness, participates in the offense through omission that contributes to the prohibited result.

## Conclusion

The court affirmed manslaughter and complicity convictions where caregivers voluntarily assumed responsibility for a severely dependent adult and, through wanton failure to provide basic care and medical attention, caused fatal neglect-related conditions.


West v. Commonwealth, 935 S.W.2d 315 (Ky. Ct. App. 1996)