Peo v. Abcug

22CA2201 Peo v Abcug 06-05-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 22CA2201
Douglas County District Court No. 19CR1074
Honorable Patricia D. Herron, Judge

The People of the State of Colorado,

Plaintiff-Appellee,

v.

Cynthia Lee Abcug,

Defendant-Appellant.

JUDGMENT AFFIRMED

Division II
Opinion by JUDGE FOX
Harris and Schutz, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced June 5, 2025

Philip J. Weiser, Attorney General, Brenna A. Brackett, Assistant Attorney
General, Denver, Colorado, for Plaintiff-Appellee

Esteban A. Martinez, Alternate Defense Counsel, Longmont, Colorado, for
Defendant-Appellant
¶1 Defendant Cynthia Lee Abcug appeals her convictions for

conspiracy to commit second degree kidnapping and child abuse,

arguing that an expert’s testimony related to the child abuse charge

usurped the role of the jury and the court. We affirm Abcug’s

convictions.1

I. Background

¶2 Shortly after her son, C.R., was born in February 2012, Abcug

began reporting that C.R. was experiencing medical issues. Abcug

twice took C.R. to the emergency room for reported seizures, and

C.R. was prescribed an anti-seizure medication.

¶3 In the fall of 2017, C.R. was referred to neurology specialists

with the Children’s Hospital of Colorado. Neurologists observed

that C.R. had had several “abnormal” EEG tests, but they did not

diagnose him with a seizure disorder.

¶4 That fall, C.R. started kindergarten. Abcug told the school

principal that C.R. had a “seizure disorder,” a potentially fatal heart

condition, and a “muscular skeletal condition” that could cause

1 Because this appeal only concerns testimony related to the child

abuse charge, we have omitted discussion of the conspiracy to
commit kidnapping charge.

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spontaneous weakness and required C.R. to wear leg braces. The

principal and the school nurse, however, saw no signs of any

medical conditions; to them, C.R. appeared to be a highly energetic

child in “excellent health.” Abcug resisted the school’s efforts to

obtain full medical records and to speak with C.R.’s specialists. In

October 2018, Abcug withdrew C.R. from school.

¶5 Meanwhile, Abcug enrolled C.R. in physical therapy. She told

the physical therapist that C.R. was suffering from a fatal “brain

tumor,” “vascular Ehlers syndrome,” spontaneous collapses, and

seizures. The physical therapist, who described C.R. as “generally a

fairly healthy kid,” requested documentation for these diagnoses,

but Abcug never provided any, so in January 2019, the therapist

reported his concerns to the Department of Human Services (DHS).

¶6 DHS then met with Abcug, who told them that C.R. “was

terminally ill” and had “several diagnoses, such as brain tumors,

the potential for a connective tissue disorder, seizures, epilepsy,

[and] autism.” Several months later, DHS removed C.R. from

Abcug’s care and placed him with a foster family. After the removal,

C.R. had no recurrences of the reported medical issues and doctors

could not substantiate the alleged diagnoses.

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¶7 The prosecution charged Abcug with conspiracy to commit

kidnapping and misdemeanor child abuse, alleging, with respect to

the latter charge, that she had caused C.R. harm by subjecting him

to unnecessary medical treatment.

¶8 At trial, the prosecution presented testimony from Dr. Jessica

Panks, an expert in “medical child abuse and pediatric child

abuse.” Panks described her involvement with C.R.’s treatment and

her expertise in diagnosing and treating medical child abuse. She

explained that “medical child abuse” “is a particular type of abuse

where the harm to the child is actually the medical system,” which

occurs when a parent or caregiver subjects a child to unnecessary

treatments. She testified that despite reassurances by medical

professionals, Abcug may have been misinterpreting or

“exaggerating” C.R.’s medical conditions, and that Abcug’s accounts

of C.R.’s symptoms did not align with those of the medical

professionals and others.

¶9 During direct examination, the prosecutor asked Panks, “Did

you form an opinion in this case about whether or not [C.R.] was

subject to medical child abuse?” Panks answered, “His

presentation is most consistent with medical child abuse.”

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¶ 10 The jury convicted Abcug as charged.

II. Issue on Appeal

¶ 11 On appeal, Abcug contends that Panks usurped the roles of

the jury and the court because Panks “defined” medical child abuse

and testified that C.R.’s “presentation [was] most consistent with

medical child abuse.” Abcug argues that this testimony effectively

told the jury what conclusion to reach, and Panks’ definition of

medical child abuse usurped the court’s duty to correctly instruct

jurors on the law.2

¶ 12 The People contend Abcug waived any objection to the

challenged testimony because the defense explicitly conceded that

experts could testify about medical child abuse.

2 In two sentences, Abcug also asserts that Panks improperly

commented on Abcug’s truthfulness, citing one instance where
Panks discussed concerns about Abcug misrepresenting or
exaggerating C.R.’s symptoms with doctors and school employees.
Abcug adds that the prosecution “amplified” this testimony by
introducing a Kempe Center report that noted discrepancies in what
Abcug was telling different medical professionals. Abcug also
claims that the evidence was weak and resulted in convictions
“more theoretical than factual.” Because these arguments are
undeveloped, we do not address them. See People v. Draper, 2021
COA 120, ¶ 85 n.9, overruled on other grounds by Garcia v. People,
2023 CO 30; see also People v. Montgomery, 2014 COA 166, ¶ 6 (we
do not address underdeveloped arguments “replete with conclusory
statements supported by little or no case law”).

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¶ 13 We agree with the People.

III. Analysis

A. Standard of Review and Waiver

¶ 14 “Under CRE 704, a witness may offer testimony that embraces

an ultimate issue of fact but may not usurp the function of the

jury.” People v. McMinn, 2013 COA 94, ¶ 51. Generally, because

the district court “has broad discretion to determine the

admissibility of expert testimony,” if the issue was preserved we

review whether an expert’s testimony usurped the jury’s or the

court’s roles for an abuse of discretion, and for harmless error if an

error occurred. People v. Baker, 2019 COA 165, ¶¶ 11-13, aff’d,

2021 CO 29. “A trial court abuses its discretion if its decision is

manifestly arbitrary, unreasonable, or unfair, or if it misapprehends

or misapplies the law.” Id. at ¶ 12. If unpreserved, we review such

claims for plain error. See McMinn, ¶¶ 41-42; see also People v.

Rector, 248 P.3d 1196, 1202-03 (Colo. 2011). “Plain error review

addresses error that is obvious and substantial and that so

undermines the fundamental fairness of the trial itself as to cast

serious doubt on the reliability of the judgment of conviction.”

McMinn, ¶ 42.

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¶ 15 Whether a claim has been waived, however, requires the

“intentional relinquishment of a known right or privilege,” a high

bar because “a waiver extinguishes error, and therefore appellate

review.” People v. Rediger, 2018 CO 32, ¶ 40. As a result, “[w]e ‘do

not presume acquiescence in the loss of fundamental constitutional

rights, and therefore indulge every reasonable presumption against

waiver.’” Id. at ¶ 39 (citation omitted).

B. Waiver Analysis

¶ 16 We conclude that Abcug waived her claim that the court erred

by allowing the prosecution’s question, “Did you form an opinion in

this case about whether or not [C.R.] was subject to medical child

abuse?” and Panks’ response that “[C.R.’s] presentation is most

consistent with medical child abuse.”

¶ 17 The issue first arose at a pretrial hearing, where the

prosecution and the defense debated Panks’ proposed testimony

and whether she could testify about medical child abuse or

“Munchausen by proxy.” The defense began the hearing by

challenging the prosecution’s summary of its expert’s testimony and

argued the summary did not provide enough information to detail

their specific opinions, that the opinions would be confusing and

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irrelevant, and the expert would improperly opine on witnesses’

credibility by expressing concerns with Abcug exaggerating C.R.’s

symptoms. The prosecution responded by highlighting that medical

child abuse and Munchausen by proxy diagnoses include whether a

caregiver is fabricating or exaggerating a child’s symptoms,

resulting in unnecessary medical care. Therefore, the expert had to

be able to testify to any concerns that Abcug exaggerated or

fabricated symptoms because this is part of a medical child abuse

diagnosis.

¶ 18 The defense countered that the jury should be permitted to

determine whether Abcug was exaggerating C.R.’s symptoms, and

the prosecution noted that the jury would be instructed that it

would be free to believe the expert’s testimony or not and decide

what weight to give the testimony. The defense summarized its

objection by stating that “information about an expert opining as to

whether or not [Abcug] was exaggerating . . . it’s those words, Your

Honor, that we are really objecting to.” The defense added that it

also objected to “anybody referring to Munchausen by proxy.”

¶ 19 The prosecution stated,

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Judge, I agree, there’s no one who’s going to
testify that they have diagnosed Ms. Abcug
with Munchausen by proxy; however, the
conclusion of the doctors, both in the reports
and in the Kempe Center report, is that this
child suffered from medical child abuse. And
as I just read a few minutes ago, the definition
of medical child abuse is exaggeration of
symptoms or fabrication of symptoms.

¶ 20 Focusing on medical child abuse specifically, the court asked

for a response. The defense stated,

Your Honor, we think ‘medical child abuse’ is
fair game. And . . . I understand the experts
are going to be coming in saying those types of
things, and that is fine. . . . While ‘medical
child abuse,’ Your Honor, we believe is fair
game, the definition of medical child abuse is
different than the definition of child abuse that
we have in our criminal laws. So while I don’t
disagree with [the prosecution] about those
definitions . . . . I do think that we cannot
confuse the jurors by telling them, necessarily,
medical child abuse is the definition of child
abuse pursuant to the laws here in Colorado.

¶ 21 The prosecution then represented that, pursuant to People v.

Weeks, 2015 COA 77, ¶ 90, its experts would testify to “whether a

child’s injuries constitute medical child abuse” but they would not

testify “that it is legal child abuse” and the jury would be instructed

that it could accept or reject this opinion. The defense responded,

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I’m not saying he can’t say the words ‘medical
child abuse.’ Our concerns with that interplay
of ‘child abuse’ and ‘medical child abuse,’ [the
prosecution] addressed that. . . . So as far as
the Munchausen by proxy, Your Honor . . . we
would like the Court order that no individuals
are allowed to make that diagnosis, make
those statements, say ‘Munchausen by proxy.’
‘Medical child abuse,’ like we said, fine, no
objection to that. But Munchausen by proxy is
a mental health diagnosis on an individual
that we do not believe should be brought up
during the trial.

¶ 22 The prosecution agreed and stated that it would instruct its

witnesses not to mention Munchausen by proxy.

¶ 23 In light of this pretrial exchange, and given that the defense

did not object to the challenged testimony at trial, we agree with the

People that the issue on appeal has been waived and may not be

reviewed.

¶ 24 Before trial, the defense and the prosecution came to an

explicit understanding. The defense was concerned with the

prosecution’s witnesses implying that Abcug had lied, and the

prosecution responded that making a medical child abuse diagnosis

would require their witnesses to comment on whether they believed

Abcug was fabricating or misrepresenting C.R.’s symptoms. But

the prosecution represented that its witnesses would not opine on

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whether Abcug committed legal child abuse or diagnose Abcug with

Munchausen by proxy. As a result, the defense concluded that its

concerns had been addressed and stated that expert testimony on

“medical child abuse” was “fair game” and “fine,” and explicitly

stated that it had no objections to this testimony so long as no

witness diagnosed Abcug with Munchausen by proxy or testified

that she committed legal child abuse.

¶ 25 The record therefore establishes that the defense deliberately

chose not to challenge Panks’ medical child abuse diagnosis

testimony after a lengthy discussion on the subject, and with a

clear awareness of the concerns with experts usurping the jury’s

role by opining on legal child abuse. See Forgette v. People, 2023

CO 4, ¶ 28 (“A waiver may be explicit, as, for example, when a party

expressly abandons an existing right or privilege or it may be

implied, as when a party engages in conduct that manifests an

intent to relinquish a right or privilege or acts inconsistently with its

assertion.”). Abcug cannot now argue that Panks usurped the

jury’s role by stating that C.R.’s “presentation is most consistent

with medical child abuse.” That testimony is exactly what the

parties agreed, before trial, was permissible.

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¶ 26 Abcug, however, notes in her reply brief that on the first day of

trial, before jurors had been selected, this issue came up again and

argues that the defense again objected to the testimony challenged

on appeal. But the record does not support this contention. In the

discussion Abcug highlights, the defense objected to a portion of the

Kempe Center report detailing harms C.R. sustained on the

grounds that mentions of Munchausen by proxy should be

excluded. The defense argued that, while Pank’s testimony was

admissible, the report itself and testimony diagnosing Abcug with

Munchausen by proxy or a “factitious disorder” should not be

admissible. The defense specifically asked the court to make a

ruling that Panks “can’t opine on . . . [medical child abuse] possibly

causing [C.R.] damage further on in his life based on some type of

factitious disorder.”

¶ 27 The prosecution, noting there was a “fine line” on this issue,

agreed that Panks would not testify to Abcug’s conditions and

agreed to redact the challenged portions of the report. But the

prosecution insisted that Panks could testify to the harms C.R.

sustained from medical child abuse and “how it may affect him

down the road.”

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¶ 28 The defense responded:

Well, how about if we do this. Number one, we
can talk about getting rid of that . . . [section of
the report]. . . . When [Panks is] on the stand,
you know, I am certainly going to be renewing
this objection. I don’t think that she should be
able to opine on that. I know we had
previously objected to the finding of medical
child abuse by her, and the Court has ruled
that it is admissible at the previous . . . pretrial
conference. So I understand that ruling.

I was going to renew the objection today, just
for the record. But I understand the Court’s
already ruled on that. So as long as it is not a
basis that they’re saying that her Munchausen
by proxy or her factitious disorder would cause
him to have issues down the line, I think we
can deal with the rest with the witness on the
stand.

¶ 29 (Emphasis added.) It is this emphasized language that Abcug

argues in the reply brief shows the defense “objected to Dr. Panks

testifying about medical child abuse.”

¶ 30 At trial the defense objected to the admission of the report

entirely, arguing it duplicated expert testimony and was hearsay.

The court deemed the report admissible, but indicated it would only

send it back with the jury if requested. The parties also agreed to

various redactions.

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¶ 31 Reviewed in context with the pretrial hearing and the

objections at trial, the objection Abcug highlights in the reply brief

was not to Panks testifying about medical child abuse generally, nor

did the defense argue that Panks could not diagnose C.R. with

medical child abuse. Like in the pretrial hearing, the defense’s

objection was to testimony that implied that Abcug had lied or been

untruthful, adding objections to testimony about future harms C.R.

might suffer. But in the pretrial hearing the defense and the

prosecution agreed that Panks’ discussion of medical child abuse

was admissible; thus, the objections the defense renewed in the

highlighted discussion is not the same contention Abcug now raises

on appeal. And again, the defense never objected to the testimony

now challenged on appeal.

¶ 32 Therefore, we conclude that Abcug has waived any objection to

the challenged testimony because the defense knew of this

proposed testimony, explicitly stated that it had no objections after

discussing the issue at length, and never objected to it at trial. As a

result, we may not review this issue on appeal. Compare Rediger,

¶¶ 41-44 (no waiver where counsel stated he was “satisfied” with

jury instructions despite discrepancy with charging documents

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when no evidence showed that counsel was aware of the

discrepancy and the record showed no discussion on the

instruction at issue), with Forgette, ¶¶ 31-35 (challenge to a

sleeping juror was waived when counsel was “fully aware” of the

issue but did not take any action to address the issue or object even

after the court explained how it had addressed the problem), and

Stackhouse v. People, 2015 CO 48, ¶ 17 (“Defendants in Colorado

affirmatively waive their right to public trial by not objecting to

known closures.”).

IV. Disposition

¶ 33 We affirm Abcug’s convictions.

JUDGE HARRIS and JUDGE SCHUTZ concur.

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