by David Kim

In a unanimous decision, the Supreme Court of Pennsylvania held that expert testimony regarding the manner of a decedent’s death must be stated to a reasonable degree of certainty in order to be admissible – the identical standard governing all other expert opinion testimony. The Court rejected the Superior Court’s creation of a lesser “probability” standard for manner-of-death opinions and reversed that court’s ruling that a forensic pathologist could testify at the defendant’s murder retrial despite having conceded that his opinion was held only to a “more likely than not” standard rather than to a reasonable degree of medical certainty.

Background

On June 6, 2012, Annemarie Fitzpatrick drowned in Muddy Creek, a tributary of the Susquehanna River in York County, Pennsylvania. Her husband, Joseph Fitzpatrick, claimed the drowning resulted from an ATV accident. Two days later, investigators received information from Annemarie’s co-workers who had discovered a note in her day planner dated June 6, 2012, reading: “If something happens to me – JOE.” That same day, Annemarie had emailed herself with the subject line “if something happens to me,” describing marital problems and a near-accident involving a falling log while her husband stood atop a woodpile.

An autopsy performed by Dr. Barbara Bollinger, a forensic pathologist, confirmed drowning as the cause of death but could not definitively establish the manner of death. Bollinger documented over 25 injuries consistent with blunt force trauma but testified that these injuries could have resulted from an ATV accident, from being held underwater, from resuscitation efforts, or from embalming.

The investigation revealed that Fitzpatrick had been conducting an extramarital affair, stood to receive over $1.7 million in life insurance proceeds upon Annemarie’s death, and had conducted internet searches about insurance contestability periods and polygraph admissibility shortly before her death. Fitzpatrick was charged with murder and convicted of first-degree murder in 2015.

In post-sentence proceedings, the trial court granted Fitzpatrick a judgment of acquittal, finding the Commonwealth’s evidence insufficient to prove that a homicide had occurred. The Superior Court reversed and remanded. On subsequent appeal regarding hearsay issues, the Pennsylvania Supreme Court held that Annemarie’s note was inadmissible because it contained both a permissible state-of-mind component and an impermissible factual assertion identifying Fitzpatrick as her killer. Ruling the error was not harmless, particularly given Bollinger’s inability to offer a definitive opinion on manner of death, the Supreme Court remanded for a new trial.

In preparation for retrial, the Commonwealth retained Dr. James Caruso, a forensic pathologist, to opine on the manner of Annemarie’s death. At a pretrial hearing in January 2023, Caruso testified that, in his opinion, the manner of death was homicide. When asked on direct examination whether he held this opinion to a reasonable degree of medical certainty, Caruso responded affirmatively.

However, on cross-examination, Caruso’s testimony shifted materially. After extensive questioning about the factors underlying his conclusion, defense counsel asked whether it was “equally possible” that the manner of death was accidental. Caruso then stated that “manner is actually more likely than not, not to a reasonable degree of medical certainty.” When asked to clarify, he repeated: “It’s not held to a reasonable degree of medical certainty. It’s more likely than not.” The trial court sought further clarification, asking whether his homicide opinion was “held more likely than not, not to a reasonable degree of scientific certainty.” Caruso confirmed: “Yes.”

The trial court denied the Commonwealth’s motion in limine seeking admission of Caruso’s manner-of-death testimony, ruling that the testimony failed to meet the requisite certainty standard for expert opinions.

The Superior Court reversed in a divided opinion. The majority concluded that because manner of death is an issue a jury may determine without expert assistance, expert opinions on this topic need only be “probable,” not held to a reasonable degree of certainty. The majority characterized such testimony as “opinions, not facts” and held that an expert’s opinion is admissible “as long as [that] opinion is sturdy.”

Analysis

The Court framed the central question as “whether, in the event such expert testimony – even though not required by law – is presented, must it comply with the legal standards that apply to all expert testimony?” The Court answered “unequivocally, yes.”

The Court began by distinguishing cause of death from manner of death. The former refers to the physiological process precipitating death, such as asphyxiation or organ failure, and requires expert testimony to establish. The latter addresses the circumstances surrounding the death and must be classified as natural, accident, homicide, suicide, or undetermined. Unlike cause of death, manner of death may be determined by a jury without expert assistance. However, the Court stressed that this distinction does not exempt manner-of-death expert testimony from otherwise applicable evidentiary standards.

The Court examined Pennsylvania Rule of Evidence 702, which governs the admissibility of expert testimony. While the rule’s text does not specify the required level of certainty, the comment states that “Pa.R.E. 702 does not change the requirement that an expert’s opinion must be expressed with reasonable certainty.” The Court traced the historical development of the reasonable-certainty standard, noting its origins in early twentieth-century Illinois jurisprudence and its adoption in Pennsylvania beginning in 1968.

The Court surveyed its own precedents applying this standard uniformly across disciplines. In Commonwealth v. Webb, 296 A.2d 734 (Pa. 1972), the Supreme Court held that a pathologist’s opinion stated “with a reasonable degree of medical certainty” was sufficient to prove causation. In Commonwealth v. Spotz, 756 A.2d 1139 (Pa. 2000), the Supreme Court applied this same standard to manner-of-death testimony, holding that such opinions must be “based on a reasonable degree of medical certainty rather than upon mere speculation.” The Spotz Court stated that this principle extends beyond medical testimony to all expert disciplines, citing cases involving utility regulations, driver licensing, and accident reconstruction.

The Court concluded that the Superior Court’s analysis was fundamentally flawed on multiple grounds. First, the Superior Court mischaracterized the trial court’s ruling as prohibiting all expert testimony on manner of death, when the trial court had merely ruled that Caruso’s specific testimony failed to meet admissibility standards. Second, the Superior Court erroneously concluded that because manner-of-death testimony is not required, it need not comply with governing evidentiary rules when offered. The Court found no authority supporting this proposition and noted that it contradicts the universal application of Rule 702.

The Court rejected the Superior Court’s attempt to distinguish Griffin v. University of Pittsburgh Medical Center, Braddock Hospital, 950 A.2d 996 (Pa. Super. 2008). In Griffin, the Superior Court held inadmissible an expert’s opinion that causation was 51% likely, finding this “more likely than not” standard insufficient under the reasonable-certainty requirement. The panel below distinguished Griffin because it was a civil malpractice case involving cause of injury rather than manner of death. The Court found these distinctions irrelevant, explaining that Rule 702 applies equally to civil and criminal proceedings and that the Griffin Court’s ruling was not limited to any particular topic of expert opinion.

The Court criticized the Superior Court’s novel “sturdiness” standard as undefined, unprecedented, and incapable of consistent application. The Court observed that the concerns underlying the Superior Court’s analysis, requiring opinions grounded in fact rather than conjecture, are adequately addressed by the existing reasonable-certainty standard without manufacturing a new measure applicable only to manner-of-death testimony.

Finally, the Court rejected the Superior Court’s characterization of its holding as consistent with Spotz. In Spotz, the Supreme Court held that a qualified forensic pathologist could testify to manner of death and stated that the opinion must be “based on a reasonable degree of medical certainty rather than upon mere speculation.” The Court determined that the Superior Court’s diminution of this standard was irreconcilable with Spotz’s application of the full measure of that standard.

Conclusion

Applying the correct legal standard, the Court concluded that Caruso’s testimony was inadmissible. Although Caruso initially used the requisite “magic words,” his subsequent testimony demonstrated these words did not accurately describe his actual level of certainty, according to the Court. His frequent use of conditional language such as “unlikely,” “possibility,” and “probably,” combined with his unambiguous admission that his opinion was held only to a “more likely than not” standard, rendered his manner-of-death testimony inadmissible.

Accordingly, the Court reversed the Superior Court’s order and remanded for further proceedings. See: Commonwealth v. Fitzpatrick, 2026 Pa. LEXIS 82 (2026).  

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