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United States v. Mathews

United States Court of Appeals, Eleventh Circuit

October 30, 2017


         Appeal from the United States District Court for the Southern District of Florida D.C. Docket No. 1:15-cr-20576-JEM-1

          Before HULL, JORDAN, and GILMAN, [*] Circuit Judges.


         Defendant Enrique Martinez Mathews ("Martinez") appeals his total 60-month sentence. After careful review of the briefs and the record, and with the benefit of oral argument, we affirm the district court's increases to Martinez's offense level for (1) alteration and falsification of an "especially probative record" under U.S.S.G. § 2J1.2(b)(3)(B), and (2) knowing that the victim of the offense was vulnerable under § 3A1.1(b)(1). However, the district court erroneously concluded that it lacked any legal authority to grant an acceptance-of-responsibility reduction under § 3E1.1. We thus vacate Martinez's sentence and remand for the district court to decide only the acceptance of responsibility issue and resentence Martinez.


         The following facts are not in dispute.[1] Beginning in 2007, Martinez was employed by the Miami Veterans Affairs Hospital (the "Miami VA") as a nurse in the Surgical Intensive Care Unit (the "SICU"). In August 2014, a 76-year-old veteran who was recovering from heart surgery was in the SICU (the "Patient").

         At approximately 7:30 a.m. on September 2, 2014, the attending physician reviewed the Patient's records and determined that he was stable enough to be transferred to a lower-level-care ward within the Miami VA. At 8:00 a.m. that morning, Martinez was assigned to care for the Patient. Martinez had no other patients assigned to him that day.

         In the SICU, all patients are connected to machines that automatically and continuously read and record vital signs, which allows nurses and other medical providers to constantly monitor the patients. Shortly after Martinez assumed responsibility for the Patient's care, the Patient's vital signs began to deteriorate- his blood oxygenation, blood pressure, respiratory rate, and heart rate were all fluctuating abnormally. There were also extended periods of time when no vital signs were entered in the computer system, meaning that either the system had been manually deactivated or the cables had been unplugged.

         For the remainder of the day on September 2, the Patient's vital signs were either not recorded by the computer system or, if recorded, showed serious degradation. Defendant Martinez did not inform anyone of the Patient's deteriorating vital signs. Instead, at approximately 5:00 p.m., Martinez transferred the Patient to the lower-level-care ward in accordance with the physician's morning transfer instructions. Had the SICU attending physicians been aware of the Patient's degrading health, they would not have allowed this transfer. During the transfer, Martinez did not inform the receiving unit of the Patient's wildly fluctuating vital signs.

         At approximately 7:25 p.m. that evening, after Martinez returned to the SICU from transferring the Patient, he logged into the computer system used by the SICU to monitor and record patients' vital signs. Using an "edit" function, Martinez entered and altered data in the Patient's record to make it appear as though the Patient had been stable throughout the day. It is Miami VA policy that any time a data point is entered or altered in the computer system, the person entering that data must include a note. There were no such notes in the Patient's record. According to the computer system, all of the points entered or altered on the Patient's record were done by Martinez.

         Later that evening, after Martinez had left the Miami VA, the Patient's condition worsened. Shortly before 3:00 a.m. on September 3, about 10 hours after he was transferred out of the SICU, the Patient died of heart failure.

         Martinez returned to work on the morning of September 4. One of his supervisors confronted him regarding the Patient's care. Martinez knew that, per Miami VA regulations, there would be an investigation into the Patient's death and the quality of the Patient's care. Martinez then went back into the Patient's record on September 4 and entered a number of notations and comments relating to activities that had taken place on September 2.

         As a result of the Patient's death, the Miami VA opened a medical case review, and Martinez was interviewed by "criminal investigators." Martinez admitted to the investigators that he falsified data in the Patient's medical record both on September 2 and September 4 "in an attempt to avoid responsibility for his misconduct, and the poor quality of care he provided to the [P]atient."[2]


         A. Indictment and Guilty Plea

         An indictment charged Martinez with (1) intentionally causing damage to a protected computer (the computer system of the Department of Veterans' Affairs (the "Department")) that resulted in the modification and impairment of the medical care of an individual, in violation of 18 U.S.C. § 1030(a)(5)(A) and (c)(4)(B) (Count 1); and (2) knowingly altering, destroying, concealing, covering up, falsifying, and making a false entry in data stored within the Department's computer system with the intent to impede, obstruct, and influence the investigation and proper administration of a matter within the Department's jurisdiction, in violation of 18 U.S.C. § 1519 (Count 2).

         In December 2015, Martinez pled guilty to both counts of the indictment. At the change-of-plea hearing, Martinez stated that, on September 2, 2014, he was in charge of the entire SICU and "because of the many emergencies and situations and because I was working and I was very busy, I did not provide my patient with the direct care that he should have had."

         B. Presentence Report

         Martinez's presentence report ("PSR") assigned him a base offense level of 14 and added the following offense-level increases: (1) a two-level increase because the offense "involved the destruction, alteration, or fabrication of a substantial number of records, " under U.S.S.G. § 2J1.2(b)(3)(A); (2) a two-level increase because Martinez knew or should have known that the victim was vulnerable, under § 3A1.1(b)(1); and (3) a two-level increase for abusing a position of public trust, under § 3B1.3. The PSR also awarded a three-level reduction for acceptance of responsibility pursuant to § 3E1.1(a) and (b).

         With a total offense level of 17 and a criminal history category of I, the PSR fixed Martinez's advisory guidelines range as 24 to 30 months' imprisonment. In addition, Martinez's convictions carried statutory maximum terms of 10 and 20 years' imprisonment, respectively.

         Martinez filed objections to the PSR contesting the alteration-of-records and the vulnerable-victim increases, arguing that: (1) he compromised only one record in this case, not a "substantial number of records"; (2) the United States, not the Patient, was the "victim" of his criminal conduct; and (3) he had not "targeted" the Patient as a victim.

         The government responded that Martinez did alter or falsify a "substantial number of records" because he had entered or altered at least 43 data points and/or written comments in the Patient's medical chart (29 data points on September 2 and an additional 14 written comments on September 4). Furthermore, the government argued that even if Martinez did not qualify for an offense-level increase under subsection (A) of § 2J1.2(b)(3) by altering a "substantial number" of records, he nonetheless qualified under subsection (B) by altering or fabricating "essential or especially probative" records because the records that Martinez had altered would reveal whether Martinez furnished an acceptable level of care to the Patient.

         The government also argued that the vulnerable-victim increase was proper because Martinez harmed a real person-a 76-year-old critically ill veteran-by failing to provide adequate care and then attempting to avoid responsibility for that victim's death. Moreover, Martinez had necessarily "targeted" the Patient when he failed to monitor the Patient's condition during his shift.

         C. Sentencing Hearing

         At the sentencing hearing, the district court overruled Martinez's objection to the alteration-of-records increase, stating: "It would appear to me that he did alter a substantial number of records. But even if he didn't he altered essential and probative records." The district court also overruled Martinez's vulnerable-victim objection because Martinez was the nurse in ...

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