State of Minnesota, Respondent,

This opinion is nonprecedential except as provided by
Minn. R. Civ. App. P. 136.01, subd. 1(c).

STATE OF MINNESOTA
IN COURT OF APPEALS
A20-0626

State of Minnesota,
Respondent,

vs.

Nathaniel Ambrose,
Appellant.

Filed April 19, 2021
Affirmed
Bratvold, Judge

Mower County District Court
File No. 50-CR-18-1868

Keith Ellison, Attorney General, St. Paul, Minnesota; and

Kristen Nelsen, Mower County Attorney, Megan A. Burroughs, Assistant County
Attorney, Austin, Minnesota (for respondent)

Cathryn Middlebrook, Chief Appellate Public Defender, Jenna Yauch-Erickson, Assistant
Public Defender, St. Paul, Minnesota (for appellant)

Considered and decided by Bjorkman, Presiding Judge; Bratvold, Judge; and Bryan,
Judge.
NONPRECEDENTIAL OPINION
BRATVOLD, Judge
Appellant’s infant was injured while in appellant’s care. Mother took the infant to
the emergency room after she returned from work, and treating physicians concluded that
the infant’s injuries were “strongly suggestive” of child abuse and specifically abusive head
2
trauma. In this direct appeal from a final judgment of conviction of first-degree assault,
appellant seeks to withdraw his guilty plea, contending that the factual basis for the plea
was deficient. Because the district court followed the Alford1 procedure at appellant’s
request and the record contains an adequate factual basis, appellant’s guilty plea is accurate
and therefore valid. Thus, we affirm.
FACTS
The state charged appellant Nathaniel Ambrose with first-degree assault, Minn. Stat.
§ 609.221, subd. 1 (2018). The following summarizes the evidence received at Ambrose’s
plea hearing.
In August 2018, Ambrose lived in an apartment in Lyle with his partner, C.S., and
their two children—an eight-week-old son, Z.A., and a one -year-old daughter. Ambrose
cared for the children while their mother was at work.
On August 25, 2018, C.S. returned from work at about 3:30 p.m. Z.A. was behaving
unusually, as explained below, and C.S. brought him to Olmsted Medical Center. A
physician examined Z.A. and observed facial bruising, bruising on his genitals, and rectal
tearing. Some testing revealed a possible brain bleed. The physician determined that Z.A.’s
injuries were recent. Because of the seriousness of the injuries, the physician transferred
Z.A. to St. Mary’s Hospital at the Mayo Clinic and contacted the Lyle Police Department.

1 See North Carolina v. Alford, 400 U.S. 25, 38, 91 S. Ct. 160, 168 (1970) (holding that a
court may constitutionally accept a defendant’s guilty plea even though the defendant
maintains his innocence).
3
Officers interviewed C.S. and Ambrose. According to Ambrose, during the morning
after C.S. had left for work, he heard Z.A. coughing or choking and saw that Z.A. was
coughing up blood. Ambrose saw blood in an open cut in Z.A.’s mouth, so he took Z.A. to
the bathroom and used water to clean him.2 Because Z.A. seemed “limp,” Ambrose
tried to revive him. Ambrose stated that he “lightly tapped” Z.A.’s cheek and shook him.
Ambrose stated that Z.A. “came back to .” Ambrose contacted C.S. several times a bout
Z.A. while she was at work. At 3 p.m., Ambrose told C.S. that Z.A. was “acting weird”
because Z.A. was not crying as he usually did and his eyes rolled back. Ambrose texted
C.S. stating, “Some is wrong with [Z.A.],” and Z.A.’s “eyes roll back and he just act like
he in pain.”
During his interview, Ambrose stated several times that he “shook” Z.A., but
described the motion as not a “rough shaking.” Ambrose told the officers that he did not
“mean” to shake Z.A., but he panicked and was frightened because the infant was bleeding
and nonresponsive. Ambrose was unable to provide another explanation for the cause of
Z.A.’s injuries other than his shaking. Ambrose told officers he did not bump Z.A. into
anything and that he could not think of anything that w ould have caused Z.A.’s head
trauma.
During C.S.’s interview, she said that Z.A. had not fallen or been dropped while in
her care and that no one else cared for Z.A. in the past week other than C.S. and Ambrose.

2 Both parents told police that they had noticed Z.A.’s torn frenulum (the small fold of skin
below the tongue) before his hospitalization and also stated they did not know how it
happened.
4
She also stated that she had worked 47 hours that week and Ambrose was the only one who
cared for Z.A. while she was at work. C.S. told police that when she left for work at about
8:30 a.m., she fed and changed Z.A.; he was fussy but not unusually so. When she returned
home from work around 3:30 p.m., she noticed that Z.A. was acting strangely and “seemed
different.” But then Z.A. started to behave normally, so she took him to a family party in
Rochester. Shortly after they arrived, C.S.’s family noticed that Z.A.’s face was bruised
and his eye movement was unusually rapid, so C.S. took Z.A. to the hospital.
Officers also interviewed other witnesses, including one witness who stated that she
saw Z.A. a week before his hospitalization, and he did not have any bruises and was
behaving normally . Officers also obtained video-surveillance footage of the hallway
outside Ambrose and C.S.’s apartment, which showed Ambrose leaving the children in the
apartment several times on the day Z.A. was hospitalized and before C.S. had returned
from work.
The state charged Ambrose by complaint about three days after Z.A. was
hospitalized. In October 2019, Ambrose and his attorney told the district court that he
wanted to enter an Alford plea to first-degree assault. In exchange for the Alford plea, the
state agreed to recommend a guidelines sentence of 86 months in prison.
The state submitted many exhibits as its offer of proof at the plea hearing. The
exhibits included police reports summarizing witness interviews—for example, six
separate interviews with Z.A.’s treating physicians. Physicians diagnosed Z.A. with an
acute subdural hematoma (brain bleed), brain bruises, retinal hemorrhage, bruises on his
face and buttocks, a tear inside Z.A.’s mouth, rectal injuries, seizures, and a partially healed
5
ulna (“buckle” fracture of his wrist). The medical summaries stated that physicians
performed tests and excluded most explanations for Z.A.’s injuries, but could not exclude
abusive trauma. Z.A.’s physicians concluded that his injuries were less than 24 hours old
when he was admitted. Based on many tests, the medical experts opined that there was no
reasonable medical explanation for Z.A.’s injuries other than “non-accidental trauma.” The
physicians also concluded that Z.A.’s injuries were “strongly suggestive of child abuse and
abusive head trauma.” Finally, the state presented photographs of Z.A. before and after his
injuries, and neurological scans of Z.A.’s brain and a normal infant brain.
The district court questioned Ambrose under oath. Ambrose agreed that he
understood his constitutional trial rights, and wanted to waive them to accept the state’s
offer. Ambrose submitted a written petition to plead guilty with an Alford addendum.
Ambrose agreed that he had discussed the case and the medical reports with his attorney
and wanted to proceed as requested.
In response to questions from his own attorney, Ambrose confirmed that he was the
only person to care for Z.A. on the day of his hospitalization. He agreed that
surveillance-video evidence from the apartment would prove that only he, C.S., and their
daughter, were with Z.A. that day. Ambrose agreed that he messaged C.S. stating that Z.A.
was “acting weird” and his eyes “were rolling back in his head.” Ambrose agreed that he
had admitted he shook Z.A. He also agreed that the state could show that “someone” had
inflicted intentional and great bodily harm upon Z.A ., the evidence showed a “strong
likelihood” the jury would find him guilty of assault, and the jury would find that Z.A. was
vulnerable.
6
In response to questions from the prosecuting attorney, Ambrose acknowledged that
the state’s experts had diagnosed Z.A. with non-accidental abusive head trauma, among
other injuries, and that Z.A. had permanent brain damage as a result of these injuries. In
response to three separate questions, Ambrose agreed that he admitted to police that he
shook Z.A. on the day he was hospitalized. Ambrose also agreed that his text messages
confirmed this.
Ambrose stated that he understood the state’s exhibits would be “all the evidence at
trial” and that, based on this evidence, there was a substantial likelihood that the jury would
find him guilty as charged. Ambrose agreed that the evidence presented would be sufficient
to show he caused Z.A.’s injuries. Ambrose also agreed that if he took the case to trial, he
would be facing far more prison time, because the jury was like to find that Z.A. was a
vulnerable victim. At the close of his testimony, Ambrose again agreed that there was a
substantial likelihood that the court or a jury would find him guilty beyond a reasonable
doubt.
The district court found that the factual basis was sufficient and that the plea was
voluntary and accurate, and accepted Ambrose’s guilty plea to first-degree assault. After
the hearing, the district court entered supplemental findings on the Alford plea because the
court neglected “to make an independent and specific finding with respect to the
sufficiency of the testimony and exhibits offered in support of the plea, which was an
unintentional omission.” The district court found that based on the facts offered in support
of the plea, there was sufficient evidence to support a jury verdict of guilty. The district
court later sentenced Ambrose to 86 months in prison.
7
This appeal follows.
DECISION
Ambrose asks this court to reverse his conviction and allow him to withdraw his
guilty plea because the state failed to establish that Ambrose’s actions “caused the great
bodily harm.” The state argues that we should affirm because the plea-hearing evidence
sufficiently supports Ambrose’s conviction for first-degree assault.
A defendant does not have an absolute right to withdraw a valid guilty plea. State v.
Farnsworth, 738 N.W.2d 364, 371 (Minn. 2007). The Minnesota Rules of Criminal
Procedure allow a defendant to seek to withdraw a guilty plea after sentencing if
“withdrawal is necessary to correct a manifest injustice.” Minn. R. Crim. P. 15.05, subd. 1.
Manifest injustice is proven when an appellate court determines that a guilty plea is invalid.
State v. Theis, 742 N.W.2d 643, 646 (Minn. 2007). To be constitutionally valid, a guilty
plea must be accurate, voluntary, and intelligent. Alford, 400 U.S. at 31, 91 S. Ct. at 164,
accord Butala v. State , 664 N.W.2d 333, 339 (Minn. 2003) (“The involuntariness of a
guilty plea constitutes such a manifest injustice as to entitle a defendant to withdraw his
plea.” (internal quotation omitted)). A defendant bears the burden of showing his plea was
invalid. Alanis v. State , 583 N.W.2d 573, 577 (Minn. 1998). A defendant may challenge
the validity of his plea for the first time on appeal. State v. Iverson, 664 N.W.2d 346, 350
(Minn. 2003). Assessing the validity of a plea presents a question of law that this court
reviews de novo. See State v. Rhodes, 675 N.W.2d 323, 326 (Minn. 2004).
Ambrose primarily argues that his guilty plea was inaccurate. A plea must be
accurate to ensure that a defendant does not “plead[] guilty to a more serious offense than
8
that for which he could be convicted if he insisted on his right to trial.” State v. Raleigh,
778 N.W.2d 90, 94 (Minn. 2010). “To be accurate, a plea must be established on a proper
factual basis.” Id. “The factual -basis requirement is satisfied if the record contains a
showing that there is credible evidence available which would support a jury verdict that
defendant is guilty of at least as great a crime as that to which he pled guilty.” State v.
Genereux, 272 N.W.2d 33, 34 (Minn. 1978). That said, “[t]he factual basis of a plea is
inadequate when the defendant makes statements that negate an essential element of the
charged crime because such statements are inconsistent with a plea of guilty.” State v.
Iverson, 664 N.W.2d 346, 350 (Minn. 2003).
“The district court typically satisfies the factual basis requirement by asking the
defendant to express in his own words what happened.” Raleigh, 778 N.W.2d at 94. The
supreme court has “cautioned against the use of exclusively leading questions to establish
a proper factual basis for a guilty plea.” Lussier v. State, 821 N.W.2d 581, 589 (Minn.
2012). Still, “a defendant may not withdraw his plea simply because the court failed to
elicit proper responses if the record contains sufficient evidence to support the conviction.”
Raleigh, 778 N.W.2d at 94.
Ambrose makes two arguments in support of his position that he should be allowed
to withdraw his plea.
First, Ambrose contends that the district court failed to conduct an independent
examination as required by the Alford plea procedure. An Alford plea occurs when a
defendant maintains his innocence but pleads guilty because the record establishes, and the
defendant reasonably believes, that the evidence is sufficient to obtain a conviction.
9
Alford, 400 U.S. at 37, 91 S. Ct. at 167; accord State v. Goulette, 258 N.W.2d 758, 761
(Minn. 1977). Thus, an Alford plea allows a defendant to plead guilty without expressly
admitting the facts underlying the offense of conviction. Id. An Alford plea is valid only
“if the court, on the basis of its interrogatories of the accused and its analysis of the factual
basis offered in support of the plea, concludes that the evidence would support a jury
verdict of guilty, and that the plea is voluntarily, knowingly, and understandingly entered.”
Goulette, 258 N.W.2d at 761. Because the defendant’s decision to plead guilty while
maintaining innocence casts doubt on the rationality of the defendant’s decision, the
factual-basis requirement is “absolutely crucial” to determining the validity of the Alford
plea. Id.
The Minnesota Supreme Court has held that, to sustain an Alford plea as accurate,
there must be a “strong factual basis and the defendant’s agreement that the evidence is
sufficient to support his conviction.” Theis, 742 N.W.2d at 649. The district court must
“independently conclude that there is a strong probability that the defendant would be
found guilty of the charge to which he pleaded guilty, notwithstanding his claims of
innocence.” Id.
Although best practice is for the district court to make a separate determination
during the plea hearing, we examine the record as a whole. State v. Trott, 338 N.W.2d 248,
251 (Minn. 1983). Here, the district court accepted Ambrose’s guilty plea, and found that
Ambrose stated “a valid factual basis” for his guilty plea to first-degree assault. Later, the
district court provided supplemental written findings and determined that “there is
sufficient evidence to support a jury verdict of guilty.” We conclude that the district court
10
conducted an independent examination of the evidence and concluded that it satisfied the
requirements of an Alford plea.
Second, Ambrose contends that the plea-hearing evidence does not prove beyond a
reasonable doubt that Ambrose caused Z.A.’s injuries. To sustain Ambrose’s conviction of
first-degree assault, the plea-hearing evidence must prove that Ambrose “assault[ed]
another and inflict[ed] great bodily harm.” Minn. Stat. § 609.221, subd. 1. “Great bodily
harm” is defined as “bodily injury which creates a high probability of death.” Minn. Stat.
§ 609.02, subd. 8 (2018). Assault is a general -intent crime which “requires only that the
defendant engaged intentionally in specific, prohibited conduct.” State v. Fleck,
810 N.W.2d 303, 308 (Minn. 2012) (quotation omitted). Ambrose agrees that the
plea-hearing evidence established Z.A. suffered great bodily harm, but contends that the
evidence is insufficient to prove that he caused Z.A.’s injuries.
Ambrose argues that the plea-hearing evidence is insufficient because he never
admitted that he cause d Z.A.’s injuries and the state’s exhibits did not prove causation.
3
We are not persuaded. The plea-hearing evidence established that Ambrose admitted to

3 Ambrose relies on caselaw from other jurisdictions that have questioned the validity of
the “shaken-baby syndrome”/abusive head trauma diagnosis. See State v. Consaul,
332 P.3d 850 (N.M. 2014); People v. McFarlane, 926 N.W.2d 339 (Mich. Ct. App. 2018);
State v. Edmunds, 746 N.W.2d 590 (Wis. Ct. App. 2008); In Re Fero, 367 P.3d 588 (Wash.
Ct. App. 2016). These cases do not apply for two reasons. First, the opinions either
evaluated the sufficiency of evidence supporting a conviction or discussed the admissibility
of expert evidence. Second, the infants had injuries and medical diagnoses that differed
from Z.A.’s injuries and medical diagnoses. Ambrose also relies on medical articles that
discuss some of Z.A.’s diagnoses. See, e.g., Kent Hymel et al., Intracranial Hemorrhage
and Rebleeding in Suspected Victims of Abusive Head Trauma, in 7 Child Maltreatment
329, 332 (2002). But the articles are not helpful, as they speak generally about the
diagnoses. More importantly, these articles are not record evidence in this case.
11
shaking Z.A. and that Ambrose was the only caregiver for Z.A. on the day he was injured
as well as the day before his injury . Indeed, C.S. was working the day of Z.A.’s
hospitalization. Medical evidence showed that Z.A.’s brain injury occurred within 24 hours
of Z.A.’s hospitalization.
The plea-hearing evidence established that Z.A.’s injuries were recent and
consistent with being shaken, Ambrose admitted that he had shaken Z.A., and the medical
evidence ruled out other causes of Z.A.’s injuries. Ambrose’s testimony agreed with this
summary of the state’s evidence.
Q: Okay. And that the evidence the State has that you had
shaken him, that he has injuries consistent with being shaken,
and those injuries, as the doctors opined, are what caused the
abusive head trauma, right? You understand that that’s what
the State’s evidence showed?
A: What you say?

Q: That shaking is consistent with those injuries?
A: Okay.

Q: And that there were no other medical causes they could
find which would cause those injuries, right?
A: Yeah.

Q: Is that a yes?
A: Yeah.

Thus, the plea-hearing evidence showed that Z.A. experienced abusive head trauma by a
non-accidental injury that occurred when he had one caregiver, Ambrose, who admitted
shaking the infant. In addition, Ambrose agreed that, based on the evidence at the plea
hearing, there was a substantial likelihood the jury or a court would find him guilty beyond
a reasonable doubt.
12
We conclude that the factual basis was sufficient to support Ambrose’s conviction
of first-degree assault. As a result, Ambrose’s guilty plea is accurate and therefore valid.
Affirmed.