United States v. CottonUnited States v. Cotton
The Court assumes the parties’ familiarity with the underlying facts.
A. Procedural Background
Cotton was charged by Indictment with Conspiracy to Distribute and to Possess with the Intent to Distribute Fentanyl Resulting in Death (Count 1) and Distribution of Fentanyl Resulting in Death (Count 2).3 Trial on those charges took place March 18, 2026, through March 25, 2026.4 On March 24, 2026, Cotton moved for a judgment of acquittal under
B. Legal Standard
1. Motion for a Judgment of Acquittal
2. Motion for a New Trial
A motion for a new trial based “on any reason other than newly discovered evidence must be filed within 14 days after the verdict or finding of guilty.”19 The Supreme Court has held that time limits for a defendant’s motion for a new trial grounded on a reason other than newly discovered evidence are inflexible, nonjurisdictional claim-processing rules.20 However, “the court on its own may extend the time, or for good cause may do so on a party’s motion made . . . before the originally prescribed or previously extended time expires[.]”21
3. Independently Sufficient Cause of Death Under 21 U.S.C. § 841(b)(1)(C)
The Supreme Court considered the standard of causation in cases dealing with the sentencing enhancement under
at least where use of the drug distributed by the defendant is not an independently sufficient cause of the victim’s death or serious bodily injury, a defendant cannot be liable under the penalty enhancement provision of
21 U.S.C. § 841(b)(1)(C) unless such use is a but-for cause of the death or injury.24
C. Discussion
At the outset, the parties agree that “[a]t trial, Cotton stipulated to the offense conduct of distribution, and the jury was tasked with deciding only the sentence enhancement issue: whether the fentanyl Cotton distributed was the [] cause of [J.C.’s] and [A.B.’s] death[s].”28 Accordingly, the Court will only address the sentencing enhancement arguments.29
1. Dr. Gallagher’s Testimony was Sufficient to Support a Jury Verdict on the Issue of Cause of Death as to Each Decedent.
Cotton argues that the testimony of Dr. Kenneth Gallagher, a forensic pathologist deputy medical examiner at the Alaska State Medical Examiner’s Office who performed autopsies on both J.C.
a) Dr. Gallagher’s Opinion Regarding Whether Fentanyl Toxicity was an Independently Sufficient Cause of Death was Given with Medical Certainty.
Cotton argues that Dr. Gallagher’s testimony is not sufficient in part because, when asked if he would opine that fentanyl toxicity was an independently sufficient cause of death, Dr. Gallagher testified, “It can be, yes,” as to J.C., and “Yes,” as to A.B.33 Cotton heavily emphasizes Dr. Gallagher’s answer to this question as to J.C., asserting that Dr. Gallagher’s answer was not given with medical certainty.34 However, Dr. Gallagher’s answer to the immediately preceding question provides context:
Q[:] Based on your training and experience, do you – even taking into consideration postmortem redistribution, do you still opine that fentanyl is the cause of death in this case?
A[:] Yes.
Q[:] Is the amount of fentanyl in Mr. Cook’s body sufficient to opine that it is an independently sufficient cause of death?
A[:] It can be, yes.35
This answer does not appear to be the equivocal statement Cotton frames it to be. Moreover, none of the cases cited by Cotton suggest a medical expert need invoke talismanic words in order for his testimony to be considered by a jury.36 Cotton cites one case by a sister circuit in which the
The Court therefore is not persuaded by defense’s argument that Dr. Gallagher’s testimony was uncertain or otherwise equivocal as it related to either decedent in general or as it related to J.C. in particular. Dr. Gallagher did express confidence in his opinion about both autopsies; the lack of a specific phrase does not undermine the conclusions to which he testified regarding the decedents’ causes of death.
b) The Amount of Fentanyl in the Decedents’ Blood, the Decedents’ Opioid Tolerance, and Other Autopsy Findings Do Not Undercut the Government’s Forensic Medical Expert’s Testimony.
Cotton offers several reasons for giving greater weight to the testimony of defense’s medical expert, Dr. Brooks, than to that of Dr. Gallagher; however, each reason is similarly not compelling. Dr. Brooks testified, in effect, that the amount of fentanyl found in each man’s blood following post-mortem blood draw (11 ng/ml for A.B. and 31 ng/m for J.C.) are not believable.38 His reasons for this were that the draw sites (subclavian and the heart) are more susceptible to postmortem redistribution (“PMR”)39 and that Dr. Gallagher did not “adequately” account for opioid tolerance.40 PMR was described at trial by Dr. Brooks:
[D]rug concentrations will actually change after death[.] . . . [A]s your body decomposes after death . . . drugs can move from one location into another location, and that can actually artifactually [sic] elevate the toxicology result that you see. It’s important to bear in mind that it doesn’t depress it. So if postmortem redistribution is a concern -- and it doesn’t actually work with all drugs, but fentanyl is one of the drugs that is prone to it -- it would artifactually [sic] elevate the concentration in your toxicology.41
i. Dr. Gallagher Testified that He Considered PMR When Calculating the Amounts of Fentanyl in the Decedents’ Post-Mortem Blood Draw Results.
Beginning with the reliability of the post-mortem blood draw results for each man, the Government notes that Dr. Gallagher did, in fact, take PMR into consideration; he recalculated the estimated amounts of fentanyl in the blood of both J.C. and A.B.:
[S]o those are different ranges that the fentanyl could be, depending on how much redistribution may have occurred. In both cases, those [adjusted] numbers are high enough, they fall within the NMS Laboratory’s range of reported fatalities, between 0.3 to 110. So[,] it’s still, still in the fatal range with the [PMR] calculation.43
Dr. Brooks testified at trial that reverse-calculating PMR cannot produce a precise calculation.44 Comparatively, Dr. Gallagher testified that, even taking the highest possible level of PMR coefficient to estimate what J.C.’s level would be without PMR, the level would still be within the fatal range.45 These differing testimonies46 were appropriate for a factfinder to weigh and consider, as “[i]t is the exclusive function of the jury to determine the credibility of witnesses, resolve evidentiary conflicts, and draw reasonable inferences from proven facts.”47
ii. Dr. Gallagher Testified that He Considered Opioid Tolerance When Forming His Opinion of Cause of Death as to Each Decedent.
iii. The Absence of Certain Findings Documented in the Autopsy Reports is not Conclusive of the Physiology of the Decedents.
Cotton argues that pulmonary edema, cerebral edema, urinary retention, and gastric dysmotility should have been present in the decedents, as such findings are “commonly” found in opioid deaths.54 Regarding the findings which were not specifically documented in A.B.’s and J.C.’s autopsy reports (all but pulmonary edema), the Court notes that such absences are not conclusive of whether these findings were or were not present in either A.B. or J.C. Dr. Brooks testified that “Dr. Gallagher only documented one of those findings in each of [the decedents’] autopsies[,] and that was pulmonary edema.”55 From this testimony, the record does not support the absence of these medical findings in A.B. and J.C., only their absence from A.B.’s and J.C.’s autopsy reports. The absence of such findings in the autopsy reports does not make it more or less likely that either man died of fentanyl toxicity.
2. The Testimony of Dr. Gallagher Was Not the Government’s Only Evidence Presented at Trial Regarding Causation.
Cotton further contends that “Dr. Gallagher’s testimony was the [G]overnment’s only evidence regarding medical causation.”56 He argues that Dr. Gallagher’s opinion “was not expressed to any degree of certainty” and characterizes such opinion as “equivocal” to conclude that “it was insufficient, even construing all evidence in favor of the [G]overnment[] to support a jury verdict on the issue of causation[.]”57 The Court disagrees. In addition to the testimony of Dr. Gallagher, the Government presented the testimony of forensic toxicologist Dr. Sherri Kacinko,58 whose testimony included describing opioid tolerance,59 quality control in illicit manufacture of fentanyl,60 the symptoms of fentanyl overdose,61 PMR,62 and the metabolites produced by the body from fentanyl consumption or ingestion which were found in A.B.’s63 and J.C.’s blood samples.64 The Government additionally called two lay witnesses, Scott Singleton65 and Blake Perry,66 who testified to the strength of the fentanyl and its adverse effects on them personally. Although Singleton and Perry are not medical experts, their testimonies do speak to the potency of the drugs at issue and may be considered by the jury when considering the sentencing enhancement. Moreover, the Government submitted Exhibit 81, A.B.’s toxicology report, and Exhibit 82, A.C.’s toxicology report, which underpinned the analyses provided by Drs. Kacinko and Gallagher.67
3. The Government’s Evidence was Sufficient to Support a Jury Verdict on the Issue of Causation as Required to Find the Sentencing Enhancement for Each Count.
Applying
4. A New Trial is Not Warranted, as the Evidence Does Not Preponderate Against the Verdict.
Under
The testimony of Dr. Gallagher does not appear to have been given equivocally or with uncertainty. He testified that fentanyl toxicity was an independently sufficient cause of death as to each decedent,70 and he indicated that he considered opioid tolerance when forming that opinion.71 Dr. Gallagher also testified that he considered PMR when he calculated the estimated amounts of fentanyl in the blood samples.72
Additionally, the Government called Dr Kacinko to testify to the physiological effects of such opioid tolerance and how quickly it can be lost.73 Finally, two of the Government’s lay witnesses, Scott Singleton and Blake Perry, provided testimony regarding the unusual strength of the fentanyl at issue.74
Comparatively, the testimony of Cotton’s expert witness on the issue of medical causation, Dr. Jared Brooks, was not sufficient to show the evidence presented preponderates against the jury’s
From the evidence presented at trial and outlined above, the Court concludes that the evidence does not preponderate against the verdict.
D. Conclusion
For the foregoing reasons, Cotton’s Motion at Docket 126 is DENIED.
Entered at the direction of the Honorable Timothy M. Burgess, United States District Judge.
DATE: July 20, 2026.
THE HONORABLE TIMOTHY M. BURGESS
UNITED STATES DISTRICT JUDGE