Case Title: State v. Hinnant

Citation: 351 N.C. 277

Docket Number: 22A99

State: north-carolina

Court: North Carolina Supreme Court

Date: 2000-02-04T00:00:00Z

Document:
IN THE SUPREME COURT OF NORTH CAROLINA
No. 22A99
STATE OF NORTH CAROLINA
v.
GEORGE ELTON HINNANT
Appeal pursuant to N.C.G.S. § 7A-30(2) from the decision of
a divided panel of the Court of Appeals, 131 N.C. App. 591, 508
S.E.2d 537 (1998), finding no error in a judgment entered
14 March 1997, in Superior Court, Wake County.  On 24 June 1999
the Supreme Court retained defendant’s notice of appeal as to a
substantial constitutional question pursuant to N.C.G.S. §
7A-30(1) and allowed discretionary review of additional issues. 
Heard in the Supreme Court 15 November 1999.
Michael F. Easley, Attorney General, by Kendrick C. Fentress
and Amy C. Kunstling, Assistant Attorneys General, for the
State.
John F. Oates, Jr., for defendant-appellant.
MARTIN, Justice.
On 19 February 1996 defendant was indicted for one count of
first-degree rape, one count of first-degree sexual offense, and
one count of taking indecent liberties with a minor.  Defendant
was tried before a jury at the 10 March 1997 Criminal Session of
Superior Court, Wake County.  The jury found defendant guilty of
all charges.  After finding factors in aggravation and
mitigation, the trial court sentenced defendant to a consolidated
active term of 384 to 460 months.  After discovering an incorrect
sentence calculation, the trial court entered a corrected
judgment and commitment providing for a maximum sentence of 470
 We note that defendant abandoned review of the admission
1
of hearsay statements made by the alleged victim to Officer
Taylor and Theresa Burnett by not presenting arguments or citing
authority against their admission in his brief.  N.C. R. App. P.
28(a); State v. Kilpatrick, 343 N.C. 466, 475, 471 S.E.2d 624,
630 (1996); Markham v. Nationwide Mut. Fire Ins. Co., 125 N.C.
App. 443, 481 S.E.2d 349, disc. rev. denied, 346 N.C. 281, 487
S.E.2d 551 (1997).
months.  The Court of Appeals, with one judge dissenting, found
no error.  See State v. Hinnant, 131 N.C. App. 591, 597, 508
S.E.2d 537, 541 (1998).  Defendant appealed to this Court as a
matter of right based on the dissent below and a constitutional
question.  On 24 June 1999 we allowed defendant’s petition for
discretionary review of additional issues.1
At trial the state called the five-year-old alleged victim,
J., as its first witness.  Defendant objected to J. being
permitted to testify on the ground that J., being of tender years
and limited understanding, could not understand the meaning of
the oath.  Defendant then made a motion for the trial court to
determine whether J. was competent to testify.  As the state
proceeded to conduct voir dire of J., J. started crying and had
to leave the courtroom.  Despite repeated attempts, J. could not
be calmed.  During a fifteen-minute recess J. broke down crying
and screaming.
Because J. could not be calmed, the state called Kim
Alexander (Alexander), a clinical social worker for the Wake
County Department of Human Resources.  Alexander testified that,
in her opinion, it was traumatizing and detrimental to J.’s well-
being to be in the courtroom with defendant.  Thereafter, based
on J.’s continued emotional state, the trial court concluded,
over defendant’s objection, that J. was unable to testify and
was, therefore, unavailable as a witness.
The state’s evidence at trial tended to show that at the
time of the alleged incidents, defendant lived at his mother’s
home along with his sister, Theresa Burnett (Burnett), Burnett’s
four-year-old daughter, J., and Burnett’s infant daughter,
Jaylan.  On 16 December 1995 defendant left the residence and
walked to a nearby store to drink alcoholic beverages with
friends.  Around 12:00 p.m. Burnett took J. and Jaylan to meet
defendant at the store, and Burnett began drinking.  Upon
arriving home that afternoon, defendant entered the kitchen to
cook dinner, and J. accompanied him.  Burnett and Jaylan sat in
the living room and watched television.  Five or ten minutes
later, J. ran into the living room, “running and crying and
saying [defendant] had touched her.”  When asked where defendant
had touched her, J. replied that he had touched her “on her butt”
and pointed to the area.  Burnett called the police, and Officers
J.A. Taylor (Officer Taylor) and Sean R. Woolrich (Officer
Woolrich) of the Raleigh Police Department responded to the call.
The police arrived around 4:00 p.m. and met defendant, 
Burnett, and J. on the porch.  Burnett and defendant were
intoxicated at the time.  Burnett told the officers that J. told
her defendant touched J.’s buttocks and vagina.  J. told Officer
Taylor that “[m]y uncle touched my butt this morning.  When he
touched me, it hurt.”  J. pointed to her vagina and buttocks to
show both officers where defendant had touched her.  J. also told
Officer Woolrich that defendant put his hands into her pants that
morning when she was getting out of bed and that he had also
touched her buttocks and vagina when she was playing outside on
her bicycle that morning.
The police transported defendant, Burnett, J., and Jaylan to
the police station for further interviews.  At the police station
Burnett was uncooperative.  She told Detective Albert O’Connell
that defendant could not have done what J. indicated and that J.
“would lie about most anything.”  Detective O’Connell interviewed
J. in a separate room.  J. told Detective O’Connell that
defendant had hurt her.  When asked how he hurt her, J. pointed
to her crotch and her buttocks and said, “here and here.”  The
detective handed J. an anatomically correct doll and asked her to
show him where she had been hurt on the doll.  J. took the
clothes off the doll and pointed to the doll’s vagina.  J.
undressed a male doll, pointed to his penis, and said, “he hurt
me with that.”  J. then took the male doll and placed it facedown
on top of the female doll.
That evening J. was taken to Wake Medical Center for an
external genital examination.  The doctor performing the exam
reported no signs of trauma to J.’s genitals.  A follow-up
examination was conducted on 2 January 1996, approximately two
weeks after the reported abuse.  Prior to receiving follow-up
medical attention, J. was interviewed by Lauren Rockwell-Flick
(Rockwell-Flick), a clinical psychologist specializing in child
sexual abuse.
Rockwell-Flick testified that she talked with J. about the
alleged sexual abuse to obtain information for the examining
physician in this case, Dr. Vivian Denise Everett (Dr. Everett). 
Over objection, Rockwell-Flick testified as to what J. told her
prior to Dr. Everett’s physical examination.  Using an
anatomically correct doll, Rockwell-Flick asked J. if anyone had
ever touched her vagina.  J. said defendant “put his hand down
there” and “it hurt.”  Rockwell-Flick asked J. whether defendant
had “kissed or licked her any place.”  J. said defendant had
licked her and pointed to her vagina.  Rockwell-Flick asked J. if
she had seen defendant’s penis, and J. said yes.  When asked what
defendant did with his penis, J. responded, “He took it off.” 
When Rockwell-Flick asked whether defendant ever touched J. with
his penis, J. said yes.  Rockwell-Flick asked J. where defendant
placed it.  J. pointed directly between her own legs to her
vagina.  When asked whether he put it on the inside or the
outside, J. said, “the inside.”
Dr. Everett performed a follow-up examination of J. after
Rockwell-Flick’s interview.  Dr. Everett was concerned because
J.’s hymenal tissue was very narrow, but testified that such a
finding does not “definitely mean sexual abuse.”  Dr. Everett
also stated that the exam was “consistent with the history [J.]
gave Ms. Flick, which was a history of genital fondling, digital
vaginal penetration and cunnilingus.”
Alexander began treating J. on 7 May 1996.  Alexander was
qualified at trial as an expert clinical social worker with an
emphasis on sexually abused children.  During the course of
treatment, J. told Alexander that defendant had touched her and
pointed to her vagina and buttocks.  Alexander testified J.’s
conduct was consistent with that of a child who had been sexually
abused because J. “expresses fear and anger toward the
perpetrator” and demonstrates some sexualized behavior.
Defendant offered evidence at trial which tended to show as
follows:  On 16 December 1995 defendant did not see Burnett or J.
until they arrived at the store around noon.  After returning
home, Burnett began arguing with defendant about the whereabouts
of her boyfriend, Thomas Rice (Rice).  Defendant told Burnett he
did not know where Rice was.  Defendant then went into the
kitchen to cook dinner.  According to defendant, he saw J. in the
kitchen and told her to get out because grease was popping on the
stove.  Defendant left food in the kitchen for the others and
took his meal into the dining room.  The police arrived
approximately thirty minutes after defendant finished his meal. 
Defendant testified that he was not aware Burnett had called the
police until he met them on his way out the door.  Defendant
denied having ever touched J. in an inappropriate fashion.
Defendant also introduced the testimony of his daughter,
Doralena Hayes (Hayes).  Hayes testified that she arrived at
defendant’s residence after the alleged incident in the kitchen
and heard Burnett and defendant arguing.  Burnett told Hayes that
defendant had touched J.  When Hayes asked J. about the
accusation, J. told her that Burnett had told J. to say that
because Burnett was upset that Rice had not come home the
previous night.
At the conclusion of trial, the jury found defendant guilty
of first-degree rape, first-degree sexual offense, and taking
indecent liberties with a minor.  Defendant appealed.
On appeal to the Court of Appeals, defendant argued that the
trial court improperly admitted hearsay testimony into evidence
in violation of defendant’s right to confront witnesses under the
Sixth Amendment Confrontation Clause of the United States
Constitution.  See Hinnant, 131 N.C. App. at 594, 508 S.E.2d at
539.  Defendant asserted that the trial court, in order to admit
the proffered hearsay evidence, was required to make specific
findings of fact concerning the trustworthiness and probative
value of J.’s statements.  Id.  Defendant also argued that the
trial court erred in denying his motion to dismiss the charge of
first-degree rape at the close of the state’s evidence.  Id. at
596, 508 S.E.2d at 540.  Alternatively, defendant argued that if
appellate review of the sufficiency of the evidence had been
waived, and the trial court’s denial of defendant’s motion to
dismiss did not constitute plain error, the court should consider
whether defendant’s trial counsel rendered ineffective assistance
by failing to file a motion to dismiss at the close of all the
evidence.  Id.
The Court of Appeals found no error in the trial court’s
admission of the hearsay testimony.  Specifically, the Court of
Appeals held that the challenged statements fell within firmly
rooted exceptions to the hearsay rule and, accordingly, satisfied
the Confrontation Clause.  Id. at 595, 508 S.E.2d at 540.  The
Court of Appeals also concluded that defendant had waived
appellate review of his sufficiency of the evidence claim and
that defendant failed to demonstrate that trial counsel was 
ineffective.  Id. at 596, 508 S.E.2d at 540-41.
In his dissent, Judge Hunter recognized that, pursuant to
Rule 10(b)(3) of the North Carolina Rules of Appellate Procedure,
defendant failed to properly preserve for review the issue of the
sufficiency of the evidence.  Id. at 598, 508 S.E.2d at 541. 
Nonetheless, Judge Hunter opined that the court should invoke
Rule 2 of the North Carolina Rules of Appellate Procedure and
review the merits of defendant’s claim.  Id.  Based on his review
of the record, Judge Hunter concluded that the evidence was
insufficient to support defendant’s first-degree rape conviction. 
Id. at 601, 508 S.E.2d at 543.
Defendant contends before this Court that the Court of
Appeals erred in determining that the trial court properly
admitted the hearsay testimony of Rockwell-Flick under the
medical diagnosis or treatment exception to the hearsay rule.  We
agree.
“‘Hearsay’ is a statement, other than one made by the
declarant while testifying at the trial or hearing, offered in
evidence to prove the truth of the matter asserted.”  N.C.G.S. § 
8C-1, Rule 801(c) (1999).  Hearsay is not admissible except as
provided by statute or the Rules of Evidence.  N.C.G.S. § 8C-1, 
Rule 802 (1999).  Rockwell-Flick’s testimony was hearsay because
it recounted J.’s out-of-court statements to her and was offered
in evidence to prove the truth of the matter asserted -- that
defendant committed various sexual offenses against the alleged
victim, J.  The trial court admitted Rockwell-Flick’s testimony
under the medical diagnosis or treatment exception to the hearsay
rule.  See N.C.G.S. § 8C-1, Rule 803(4) (1999).  Rule 803(4)
provides:
The following are not excluded by the hearsay
rule, even though the declarant is available as a
witness:
. . . .
(4)
Statements for Purposes of Medical Diagnosis
or Treatment. -- Statements made for purposes
of medical diagnosis or treatment and
describing medical history, or past or
present symptoms, pain, or sensations, or the
inception or general character of the cause
or external source thereof insofar as
reasonably pertinent to diagnosis or
treatment.
N.C.G.S. § 8C-1, Rule 803(4).  Rule 803(4) requires a two-part
inquiry:  (1) whether the declarant’s statements were made for
purposes of medical diagnosis or treatment; and (2) whether the
declarant’s statements were reasonably pertinent to diagnosis or
treatment.  See State v. Aguallo, 318 N.C. 590, 595-97, 350
S.E.2d 76, 80-81 (1986); accord United States v. Iron Shell, 633
F.2d 77, 83 (8th Cir. 1980) (federal rule), cert. denied, 450
U.S. 1001, 68 L. Ed. 2d 203 (1981).
Defendant contends the Court of Appeals erred in concluding
that the trial court properly admitted Rockwell-Flick’s hearsay
testimony under Rule 803(4) without first considering J.’s
purpose in making statements to Rockwell-Flick.  At trial, upon
defendant’s objection, the trial court questioned Rockwell-Flick
about her purpose for interviewing J.  The trial court, however,
apparently did not consider J.’s purpose in talking to Rockwell-
Flick.  Based on Rockwell-Flick’s claim that she interviewed J.
to obtain information for the examining physician, Dr. Everett,
the trial court overruled defendant’s objection.
This Court has not squarely addressed the question of
whether the purpose inquiry under Rule 803(4) is limited to
consideration of the declarant’s intent.  We have recognized,
however, that Rule 803(4) is based on the rationale that
statements made for purposes of medical diagnosis or treatment
are inherently trustworthy and reliable because of the patient’s
strong motivation to be truthful.  See State v. Jones, 339 N.C.
114, 145, 451 S.E.2d 826, 842 (1994) (quoting N.C.G.S. § 8C-1,
Rule 803(4) official commentary (1992)), cert. denied, 515 U.S.
1169, 132 L. Ed. 2d 873 (1995); Aguallo, 318 N.C. at 595, 350
S.E.2d at 79; State v. Stafford, 317 N.C. 568, 573, 346 S.E.2d
463, 467 (1986); State v. Smith, 315 N.C. 76, 84, 337 S.E.2d 833,
839 (1985).  The “‘[declarant’s] health -- even life -- may
depend on the accuracy of information supplied [to] the doctor.’” 
Robert R. Rugani, Jr., Comment, The Gradual Decline of a Hearsay
Exception:  The Misapplication of Federal Rule of Evidence
803(4), The Medical Diagnosis Hearsay Exception, 39 SANTA CLARA L.
REV. 867, 878 (1999) (quoting 1 John E.B. Myers, EVIDENCE IN CHILD
ABUSE AND NEGLECT CASES 415 (3d ed. 1992)) [hereinafter Rugani, The
Gradual Decline]; see MCCORMICK ON EVIDENCE § 277, at 488 (John W.
Strong ed., 4th ed. 1992) [hereinafter MCCORMICK ON EVIDENCE];
Robert P. Mosteller, Child Sexual Abuse and Statements for the
Purpose of Medical Diagnosis or Treatment, 67 N.C. L. REV. 257,
260 (1989) [hereinafter Mosteller, Child Sexual Abuse].  
The
rationale we have articulated has been recognized by many
jurisdictions.  See, e.g., Iron Shell, 633 F.2d at 83-84
(patient’s motive guarantees trustworthiness of statements); R.S.
v. Knighton, 125 N.J. 79, 85, 592 A.2d 1157, 1160 (1991) (“[T]he
declarant knows that he or she is injured and therefore is
motivated to describe accurately his or her symptoms and their
source.”); State v. Boston, 46 Ohio St. 3d 108, 121, 545 N.E.2d
1220, 1234 (1989) (“[T]he child’s statement must have been
motivated by her desire for medical diagnosis or treatment.”);
State v. Barone, 852 S.W.2d 216, 220 (Tenn. 1993) (“[M]otive of
obtaining improved health increases statement’s reliability and
trustworthiness.”).
Based on the rationale underlying Rule 803(4), we have held
inadmissible statements to a doctor made solely for purposes of
trial preparation rather than diagnosis or treatment.  See Jones,
339 N.C. at 145-46, 451 S.E.2d at 842; Stafford, 317 N.C. at 574,
346 S.E.2d at 467; State v. Bock, 288 N.C. 145, 163, 217 S.E.2d
513, 524 (1975), death sentence vacated, 428 U.S. 903, 49 L. Ed.
2d 1209 (1976).  In so holding, we recognized that the
information the patient gave “lacked the indicia of reliability
based on the self-interest inherent in obtaining appropriate
medical treatment.”  Stafford, 317 N.C. at 574, 346 S.E.2d at
467.  When the declarant’s statements have been motivated by the
express purpose of receiving medical treatment, however, we have
consistently upheld their admission under Rule 803(4).  See,
e.g., State v. Bullock, 320 N.C. 780, 782, 360 S.E.2d 689, 690
(1987); State v. Jackson, 320 N.C. 452, 462, 358 S.E.2d 679, 684
(1987); Aguallo, 318 N.C. at 597, 350 S.E.2d at 81; Smith, 315
N.C. at 84, 337 S.E.2d at 839.
Some courts, by not requiring a treatment motive on the part
of declarant, have expanded the scope of the medical diagnosis or
treatment exception beyond the common law moorings of Rule
803(4).  See, e.g., United States v. Joe, 8 F.3d 1488, 1494 & n.5
(10th Cir. 1993) (explaining that Rule 803(4) requires only
reasonable reliance by a physician for admission), cert. denied,
510 U.S. 1184, 127 L. Ed. 2d 579 (1994); Gong v. Hirsch, 913 F.2d
1269, 1274 n.4 (7th Cir. 1990) (“[A] fact reliable enough to
serve as the basis for a diagnosis is also reliable enough to
escape hearsay proscription.”); O’Gee v. Dobbs Houses, Inc., 570
F.2d 1084, 1089 (2d Cir. 1978); State v. Robinson, 153 Ariz. 191,
199, 735 P.2d 801, 809 (1987).  See generally L. Timothy Perrin,
Expert Witnesses Under Rules 703 and 803(4) of the Federal Rules
of Evidence:  Separating the Wheat from the Chaff, 72 IND. L.J.
939 (1997).  As a result, the “firmly rooted” status of Rule
803(4) has been questioned.  See 4 Christopher B. Mueller &
Laird C. Kirkpatrick, FEDERAL EVIDENCE § 442, at 464 (2d ed. 1994)
(“Admitting [hearsay] statements because doctors rely on them
. . . is highly questionable.”); Mosteller, Child Sexual Abuse at
290 (“[W]hen a [hearsay] statement is offered . . . exclusively
on the basis that a medical expert has relied upon it to form her
opinion, the statement is not within a firmly rooted hearsay
exception.”); Rugani, The Gradual Decline at 868 (“the current
trend of expanding the . . . medical diagnosis exception is
effectively making Rule 803(4) a less ‘firmly rooted’ and well-
established hearsay exception”).
The medical diagnosis or treatment exception to the hearsay
rule is considered inherently reliable because of the declarant’s
motivation to tell the truth in order to receive proper
treatment.  N.C.G.S. § 8C-1, Rule 803(4) official commentary;
Jones, 339 N.C. at 145, 451 S.E.2d at 842.  If a treatment motive
on the part of the declarant is not required, however, the
jurisprudential basis upon which we conclude that statements of
the declarant are inherently reliable is undeniably diminished. 
It has been observed that evidence admitted under Rule 803(4)
without considering the declarant’s motive
has less inherent reliability than evidence admitted
under the traditional common-law standard underlying
the physician treatment rule. . . .  [T]he veracity of
the declarant’s statements to the physician is less
certain where the statements need not have been made
for purposes of promoting treatment or facilitating
diagnosis in preparation for treatment.
Morgan v. Foretich, 846 F.2d 941, 952 (4th Cir. 1988) (Powell,
J., concurring in part and dissenting in part).
To ensure the inherent reliability of evidence admitted
under Rule 803(4), we reaffirm our adherence to the common law
rationale underlying the rule -- that a patient has a strong
motivation to be truthful in order to obtain appropriate medical
treatment.  See N.C.G.S. § 8C-1, Rule 803(4) official commentary;
Jones, 339 N.C. at 145, 451 S.E.2d at 842; Stafford, 317 N.C. at
573, 346 S.E.2d at 467.  Accordingly, the proponent of Rule
803(4) testimony must affirmatively establish that the declarant
had the requisite intent by demonstrating that the declarant made
the statements understanding that they would lead to medical
diagnosis or treatment.  Our holding applies only to trials
commencing on or after the certification date of this opinion or
to cases on direct appeal.  To the extent that cases such as
State v. Jones, 89 N.C. App. 584, 367 S.E.2d 139 (1988), are
inconsistent with our holding, they are overruled.
Having so concluded, we recognize the difficulty of
determining whether a declarant understood the purpose of his or
her statements.  Because of this evidentiary challenge, some
courts have refused to apply Rule 803(4) in cases involving young
children.  See, e.g., Webb v. Lewis, 44 F.3d 1387, 1390-91 (9th
Cir. 1994), cert. denied, 514 U.S. 1128, 131 L. Ed. 2d 1003
(1995); United States v. White, 11 F.3d 1446, 1450 (8th Cir.
1993) (insufficient evidence to establish that child-victim
understood social worker was conducting an interview in order for
her or another to provide medical diagnosis or treatment); Ring
v. Erickson, 983 F.2d 818, 820 (8th Cir. 1992) (no evidence that
child knew she was talking to doctor); State v. Wade, 136 N.H.
750, 756, 622 A.2d 832, 836 (1993).  See generally Krista M. Jee,
Note, Hearsay Exceptions in Child Abuse Cases:  Have the Courts
and Legislatures Really Considered the Child?, 19 WHITTIER L. REV.
559, 569 (1998) (“The rationale of the medical treatment
exception fails when applied to a child declarant . . . .”).
Other courts, while adhering to the common law rationale
underlying Rule 803(4), have looked to objective record evidence
to determine whether the declarant had the proper treatment
motive.  See, e.g., United States v. Barrett, 8 F.3d 1296, 1300
(8th Cir. 1993); United States v. Renville, 779 F.2d 430, 438-39
(8th Cir. 1985); Boston, 46 Ohio St. 3d at 121, 545 N.E.2d at
1234.  For example, some courts have found the intent requirement
satisfied where some adult explained to the child the need for
treatment and the importance of truthfulness.  See, e.g.,
Renville, 779 F.2d at 438-39 (physician explained purpose of
examination to eleven-year-old victim).  Others have considered
the presence of corroborating physical evidence.  See, e.g.,
United States v. Nick, 604 F.2d 1199, 1202 (9th Cir. 1979).  The
latter example, however, is no longer a viable consideration. 
The United States Supreme Court has squarely rejected the use of
corroborating physical evidence to support the trustworthiness of
hearsay testimony.  See Idaho v. Wright, 497 U.S. 805, 822, 111
L. Ed. 2d 638, 656-57 (1990).  “Hearsay evidence used to convict
a defendant must possess indicia of reliability by virtue of its
inherent trustworthiness, not by reference to other evidence at
trial.”  Id.
Courts have also considered with whom, and under what
circumstances, the declarant was speaking.  This Court has stated
that Rule 803(4) “‘might’” include “‘[s]tatements to hospital
attendants, ambulance drivers, or even members of the family.’” 
Smith, 315 N.C. at 84, 337 S.E.2d at 839 (quoting N.C.G.S. §
8C-1, Rule 803(4) official commentary); see MCCORMICK ON EVIDENCE,
at 489.  Other courts have recognized that a young child is more
likely to possess the requisite treatment motive when speaking to
medical personnel.  See, e.g., State v. Harris, 247 Mont. 405,
411-12, 808 P.2d 453, 456-57 (1991); State v. Dever, 64 Ohio St.
3d 401, 410, 596 N.E.2d 436, 444 (1992) (“Once the child is at
the doctor’s office, the probability of understanding the
significance of the visit is heightened and the motivation for
diagnosis and treatment will normally be present.”), cert.
denied, 507 U.S. 919, 122 L. Ed. 2d 672 (1993); State v. Eastham,
39 Ohio St. 3d 307, 311, 530 N.E.2d 409, 413 (1988) (Brown, J.,
concurring).  In addition, courts have analyzed the surrounding
circumstances, including the setting of the interview and the
nature of the questioning.  White, 11 F.3d at 1450; Barrett, 8
F.3d at 1300.  These objective circumstances provide evidence
“that the child understood the [witness’] role in order to
trigger the motivation to provide truthful information.” 
Barrett, 8 F.3d at 1300.
In our view, the trial court should consider all objective
circumstances of record surrounding declarant’s statements in
determining whether he or she possessed the requisite intent
under Rule 803(4).
The second inquiry under Rule 803(4) is whether the
statements of the declarant are reasonably pertinent to diagnosis
or treatment.  See N.C.G.S. § 8C-1, Rule 803(4); Aguallo, 318
N.C. at 595-97, 350 S.E.2d at 80-81.  Defendant contends that
J.’s statements to Rockwell-Flick, a clinical psychologist, made
two weeks after J.’s initial medical examination, were not
reasonably pertinent to medical diagnosis or treatment.
The common law rationale we have recognized is equally
relevant during the second inquiry under Rule 803(4).  If the
declarant’s statements are not pertinent to medical diagnosis,
the declarant has no treatment-based motivation to be truthful. 
We have held, for example, that a victim’s statements to rape
task force volunteers, when the victim had already received
initial diagnosis and treatment, were not reasonably pertinent to
medical diagnosis or treatment.  Smith, 315 N.C. at 86, 337
S.E.2d at 840.  The logical inference arising from Smith is that
Rule 803(4) does not include statements to nonphysicians made
after the declarant has already received initial medical
treatment and diagnosis.  This inference comports with the common
law rationale underlying the rule.  If the declarant is no longer
in need of immediate medical attention, the motivation to speak
truthfully is no longer present.
We have also refused to apply Rule 803(4) where the victim
was interviewed solely for purposes of trial preparation.  See
Stafford, 317 N.C. at 574, 346 S.E.2d at 467; Bock, 288 N.C. at
163, 217 S.E.2d at 524.  In such cases, the declarant’s
statements “lack[] the indicia of reliability based on the self-
interest inherent in obtaining appropriate medical relief.” 
Stafford, 317 N.C. at 574, 346 S.E.2d at 467.
We hold that hearsay evidence is admissible under Rule
803(4) only when two inquiries are satisfied.  First, the trial
court must determine that the declarant intended to make the
statements at issue in order to obtain medical diagnosis or
treatment.  The trial court may consider all objective
circumstances of record in determining whether the declarant
possessed the requisite intent.  Second, the trial court must
determine that the declarant’s statements were reasonably
pertinent to medical diagnosis or treatment.
In the present case, after thoroughly reviewing the record
and transcript, we cannot conclude that J. understood Rockwell-
Flick was conducting the interview in order to provide medical
diagnosis or treatment.  Rockwell-Flick testified that she
interviewed J. in order to relay information to Dr. Everett, the
examining physician, about what had or had not happened to J. 
While this testimony provides Rockwell-Flick’s motive for
obtaining the statements at issue, it sheds no light on the
motive of the four-year-old declarant who provided them.
There is no evidence that J. had a treatment motive when
speaking to Rockwell-Flick.  The record does not disclose that
Rockwell-Flick or anyone else explained to J. the medical purpose
of the interview or the importance of truthful answers.  See
Renville, 779 F.2d at 438-39.  In addition, the interview was not
conducted in a medical environment.  Instead, it was held in what
Rockwell-Flick described at trial as a “child-friendly” room, one
in which all of the furniture was child-sized.  In our view, such
a setting did not reinforce to J. her need to provide truthful
information.  See Barrett, 8 F.3d at 1300.  Therefore, there is
no affirmative record evidence indicating that J.’s statements
were medically motivated and, therefore, inherently reliable. 
See N.C.G.S. § 8C-1, Rule 803(4) official commentary; Stafford,
317 N.C. at 574, 346 S.E.2d at 467; Bock, 288 N.C. at 162-63, 217
S.E.2d at 524.
The lack of inherent reliability in J.’s statements is
further demonstrated by the manner in which the interview was
conducted.  The entire interview consisted of a series of leading
questions, whereby Rockwell-Flick systematically pointed to the
anatomically correct dolls and asked whether anyone had or had
not performed various acts with J.  “Inherent in this type of
suggestive questioning is the danger of planting the idea of
sexual abuse in the mind of the child.”  Harris, 247 Mont. at
415, 808 P.2d at 459; see Robert G. Marks, Note, Should We
Believe the People Who Believe the Children?:  The Need For a New
Sexual Abuse Tender Years Hearsay Exception Statute, 32 HARV. J.
ON LEGIS. 207, 222 (1995) (discussing dangers of suggestive
interview practices).
Because the record fails to demonstrate that J. possessed
the requisite intent when speaking with Rockwell-Flick, J.’s
statements were not made for purposes of medical diagnosis or
treatment.
Likewise, J.’s statements to Rockwell-Flick were not
reasonably pertinent to medical diagnosis or treatment. 
Rockwell-Flick did not meet with J. until approximately two weeks
after J. had received her initial medical examination.  The
initial examination was conducted on the night in question and
consisted of an external genital exam.  That examination did not
reveal any signs of trauma.  Rule 803(4) was not “created to
except from the operation of the hearsay rule” statements made to
a nontreating clinical psychologist two weeks after the alleged
victim received initial medical diagnosis.  See Smith, 315 N.C.
at 86, 337 S.E.2d at 840.  Therefore, J.’s statements to
Rockwell-Flick were not reasonably pertinent to medical diagnosis
or treatment.
Because J.’s statements to Rockwell-Flick were not made for
purposes of, or reasonably pertinent to, medical diagnosis or
treatment, the Court of Appeals erred in determining that
Rockwell-Flick’s testimony was properly admitted under Rule
803(4).  
We note that Rockwell-Flick’s testimony may be admissible
under the residual exceptions to the hearsay rule.  See N.C.G.S.
§ 8C-1, Rules 803(24), 804(b)(5) (1999); see also Wright, 497
U.S. 805, 111 L. Ed. 2d 638 (analyzing hearsay statements of
child declarant under Idaho’s Rule 803(24)); Mosteller, Child
Sexual Abuse, at 294 (suggesting Rule 803(24) as a more
appropriate exception to the hearsay rule in child sexual abuse
cases).  These exceptions allow the admission of hearsay not
falling within a firmly rooted exception but “having equivalent
circumstantial guarantees of trustworthiness.”  N.C.G.S. § 8C-1,
Rules 803(24), 804(b)(5).  Hearsay may not be admitted under a
residual exception, however, unless the trial court makes certain
required findings of fact and conclusions of law.  See State v.
Deanes, 323 N.C. 508, 515, 374 S.E.2d 249, 254-55 (1988), cert.
denied, 490 U.S. 1101, 104 L. Ed. 2d 1009 (1989); State v.
Triplett, 316 N.C. 1, 8-9, 340 S.E.2d 736, 740-41 (1986); Smith,
315 N.C. at 92, 337 S.E.2d at 844.
In the instant case, the state does not contend that
Rockwell-Flick’s testimony was admissible under the residual
exceptions.  Therefore, we do not address this question.  
The
erroneous admission of hearsay “is not always so prejudicial as
to require a new trial.”  State v. Ramey, 318 N.C. 457, 470, 349
S.E.2d 566, 574 (1986).  Rather, defendant must show “a
reasonable possibility that, had the error in question not been
committed, a different result would have been reached at . . .
trial . . . .”  N.C.G.S. § 15A-1443(a) (1999).  Concerning
defendant’s convictions for first-degree sexual offense and
taking indecent liberties with a minor, defendant has not met his
burden.  Based on our review of the evidence of record, there is
no reasonable possibility that, absent the trial court’s error, a
different result would have been reached at trial.  Therefore, we
affirm the Court of Appeals as to those convictions.
As to defendant’s first-degree rape conviction, however, we
cannot say that admitting the hearsay evidence was harmless. 
Rockwell-Flick’s improperly admitted hearsay testimony was the
only noncorroborative evidence of penetration presented at trial. 
Therefore, we reverse the decision of the Court of Appeals as to
defendant’s conviction for first-degree rape and remand this case
to the Court of Appeals for further remand to the Superior Court,
Wake County, for proceedings consistent with this opinion.
AFFIRMED IN PART AND REVERSED IN PART.
=======================
Justice LAKE concurring.
I concur with the majority’s holding that it is the
declarant’s motivation to receive medical treatment or diagnosis
which supports the “inherent reliability” characteristic of the
firmly rooted hearsay exception of Rule 803(4).  Recognizing the
significant interest of society in protecting our children from
any type of abuse and the inherent difficulty in determining
whether a child’s statement was made for the purpose of medical
diagnosis or treatment, I am compelled to emphasize that although
the testimony as presented in the instant case is not admissible
under Rule 803(4), such evidence, if properly obtained, might be
admissible under the residual hearsay exceptions, Rule 803(24)
(availability of declarant immaterial) and Rule 804(b)(5)
(declarant unavailable), as suggested by the majority.
I am further compelled to emphasize the importance of the
forethought and proper interview techniques required on the part
of child advocates (medical, legal or otherwise) in obtaining
statements from children to ensure, to the fullest extent
possible, their trustworthiness and the need for trial courts to
adequately present findings of fact and conclusions of law
supporting that trustworthiness.  The standard for admissibility
is increased under the residual exceptions to the hearsay rule,
as discussed by this Court in State v. Triplett, 316 N.C. 1, 340
S.E.2d 736 (1986), and State v. Smith, 315 N.C. 76, 337 S.E.2d
833 (1985).  Therefore, planning is necessary to ensure that the
admissibility requirements of notice, materiality,
trustworthiness, probative value and the interests of justice are
met and properly presented.