Case Title: State v. Arnold

Citation: 2010-Ohio-2742

Docket Number: 20081693

State: ohio

Court: Ohio Supreme Court

Date: 2010-06-17T00:00:00Z

Document:
[Until this opinion appears in the Ohio Official Reports advance sheets, it may be cited as 
State v. Arnold, Slip Opinion No. 2010-Ohio-2742.] 
 
 
 
 
NOTICE 
This slip opinion is subject to formal revision before it is published in 
an advance sheet of the Ohio Official Reports.  Readers are requested to 
promptly notify the Reporter of Decisions, Supreme Court of Ohio, 65 
South Front Street, Columbus, Ohio 43215, of any typographical or 
other formal errors in the opinion, in order that corrections may be 
made before the opinion is published. 
 
SLIP OPINION NO. 2010-OHIO-2742 
THE STATE OF OHIO, APPELLEE, v. ARNOLD, APPELLANT. 
[Until this opinion appears in the Ohio Official Reports advance sheets, it 
may be cited as State v. Arnold, Slip Opinion No. 2010-Ohio-2742.] 
Statements made to interviewers at child-advocacy centers that serve primarily a 
forensic or investigative purpose are testimonial and are inadmissible 
pursuant to the Confrontation Clause — Statements made to interviewers 
at child-advocacy centers that are made for medical diagnosis and 
treatment are nontestimonial and are admissible without offending the 
Confrontation Clause. 
(No. 2008-1693 — Submitted September 1, 2009 — Decided June 17, 2010.) 
APPEAL from the Court of Appeals for Franklin County, 
No. 07AP-789, 2008-Ohio-3471. 
__________________ 
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SYLLABUS OF THE COURT 
1. Statements made to interviewers at child-advocacy centers that serve primarily 
a forensic or investigative purpose are testimonial and are inadmissible 
pursuant to the Confrontation Clause. 
2. Statements made to interviewers at child-advocacy centers that are made for 
medical diagnosis and treatment are nontestimonial and are admissible 
without offending the Confrontation Clause. 
__________________ 
O’CONNOR, J. 
{¶ 1} Appellant, Michael Arnold, appeals his conviction for raping his 
four-year-old daughter, M.A.  Arnold argues that statements that M.A. made to 
social worker Kerri Marshall at the Center for Child and Family Advocacy at 
Nationwide Children’s Hospital (“CCFA”) were admitted contrary to his rights 
under the Confrontation Clause of the Sixth Amendment to the United States 
Constitution and Section 10, Article I of the Ohio Constitution.  The court of 
appeals affirmed Arnold’s conviction, holding that Marshall did not act as an 
agent of the police when she questioned M.A. and that M.A.’s statements during 
the interview were nontestimonial. 
{¶ 2} In interviewing M.A. at the CCFA, Marshall occupied dual 
capacities: she was both a forensic interviewer collecting information for use by 
the police and a medical interviewer eliciting information necessary for diagnosis 
and treatment.  We hold that statements made to interviewers at child-advocacy 
centers that are made for medical diagnosis and treatment are nontestimonial and 
are admissible without offending the Confrontation Clause.  Thus, we affirm the 
judgment of the court of appeals to the extent that M.A.’s statements to Marshall 
for the purpose of medical treatment and diagnosis were properly admitted.  We 
further hold that statements made to interviewers at child-advocacy centers that 
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serve primarily a forensic or investigative purpose are testimonial and are 
inadmissible pursuant to the Confrontation Clause.  We agree with Arnold that the 
trial court erred in admitting the forensic statements made by M.A. to Marshall 
and reverse the court of appeals insofar as it held that these forensic statements 
were admissible.  However, because the court of appeals did not consider whether 
the admission of M.A.’s forensic statement to Marshall was harmless, we remand 
this case to the court of appeals to consider this issue. 
Relevant Background 
{¶ 3} In December 2005, Arnold and Wendy Otto lived together in 
Hilliard, Ohio, with their two young children.  Otto testified that upon awakening 
one night, she discovered that Arnold and their four-year-old daughter, M.A., 
were locked in a bedroom.  Otto demanded that Arnold unlock the door, and when 
he did, she observed that his boxer shorts were halfway off.  Otto also observed 
that M.A.’s underwear was around her ankles.  She suspected sexual abuse, 
demanded that Arnold leave the premises, and called 9-1-1.  Arnold left 
immediately.  By the time paramedics arrived, many police officers were present.  
M.A. told firefighter-paramedic Charles Fritz that she had been touched in her 
private area. 
{¶ 4} Paramedics took Otto and M.A. to Nationwide Children’s Hospital, 
where evidence for a rape kit was collected.  While at the hospital, Otto was 
advised to take M.A. to the CCFA the next day.  The record is unclear whether 
this advice came from the police, paramedics, hospital personnel, or some other 
source.  At some point that evening, M.A. was released. 
{¶ 5} The next morning, Otto took M.A. to the CCFA.  The CCFA is part 
of Children’s Hospital and is located across the street from the main hospital.  At 
the CCFA, Marshall, a Nationwide Children’s Hospital employee, interviewed 
M.A.  M.A.’s responses to Marshall’s questions indicated that she had been 
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sexually abused.  This interview is at the heart of Arnold’s Confrontation Clause 
claim. 
{¶ 6} The interview yielded a variety of relevant information.  For 
example, M.A. stated that Arnold's “pee-pee” went inside her “pee-pee” and that 
Arnold’s mouth touched her “pee-pee.”  These statements were necessary for 
M.A.’s medical evaluation and treatment.  But M.A. also answered questions that 
related to the ongoing investigation.  For example, in response to Marshall’s 
questions, M.A. stated that Arnold closed and locked the bedroom door before 
raping her and that Arnold removed her underwear. 
{¶ 7} After the interview with Marshall, M.A. was physically examined by 
a pediatric nurse practitioner, Gail Horner, a hospital employee who worked in the 
CCFA.  Horner found two abrasions to M.A.’s hymen, which she concluded had 
been caused by acute trauma, likely from penetration, within the previous 24 to 72 
hours.  Horner testified that the abrasions were “diagnostic” of sexual abuse. 
{¶ 8} Based on this and other information, including Otto’s testimony, 
Arnold was indicted for two counts of rape in violation of R.C. 2907.02.  The first 
count charged rape by vaginal intercourse; the second charged rape by 
cunnilingus. 
{¶ 9} At trial, the court determined that M.A. was unavailable to testify.  
After watching the DVD recording of M.A.’s interview with Marshall, the court 
determined that the statements had been made for the purpose of medical 
diagnosis and were admissible hearsay under Evid.R. 803(4).  The court also 
determined that the statements were not barred by the Confrontation Clause.  
Accordingly, the DVD was played for the jury. 
{¶ 10} The jury found Arnold guilty of rape by vaginal intercourse, but not 
guilty of rape by cunnilingus.  R.C. 2907.02.  Arnold was sentenced to life in 
prison. 
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{¶ 11} On appeal, the Tenth District affirmed Arnold’s conviction.  State 
v. Arnold, Franklin App. No. 07AP-789, 2008-Ohio-3471.  We accepted Arnold’s 
discretionary appeal to determine whether, in a criminal prosecution, the out-of-
court statements made by a child to an interviewer employed by a child-advocacy 
center violates the right to confront witnesses provided by the Sixth Amendment 
to the United States Constitution and Section 10, Article I of the Ohio 
Constitution.  State v. Arnold, 120 Ohio St.3d 1452, 2008-Ohio-6813, 898 N.E.2d 
967. 
Analysis 
Confrontation Clause 
{¶ 12} “The Sixth Amendment's Confrontation Clause provides that, ‘[i]n 
all criminal prosecutions, the accused shall enjoy the right * * * to be confronted 
with the witnesses against him.’ We have held that this bedrock procedural 
guarantee applies to both federal and state prosecutions.  Pointer v. Texas, 380 
U.S. 400, 406, 85 S.Ct. 1065, 13 L.Ed.2d 923 (1965).”  Crawford v. Washington 
(2004), 541 U.S. 36, 42, 124 S.Ct. 1354, 158 L.Ed.2d 177.  “Section 10, Article I 
[of the Ohio Constitution] provides no greater right of confrontation than the 
Sixth Amendment.”  State v. Self (1990), 56 Ohio St.3d 73, 79, 564 N.E.2d 446. 
{¶ 13} In Crawford, the Supreme Court of the United States considered 
whether the introduction of a hearsay statement admissible under state law 
violated a defendant’s Sixth Amendment right to confront the witnesses against 
him.  The court held that out-of-court statements violate the Sixth Amendment 
when they are testimonial and the defendant has had no opportunity to cross-
examine the declarant.  541 U.S. at 68, 124 S.Ct. 1354, 158 L.Ed.2d 177.  See 
also State v. Siler, 116 Ohio St.3d 39, 2007-Ohio-5637, 876 N.E.2d 534, ¶ 21-26.  
The court did not comprehensively define “testimonial” but stated that the core 
class of testimonial statements includes “ ‘statements that were made under 
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circumstances which would lead an objective witness reasonably to believe that 
the statement would be available for use at a later trial.’ ”  Crawford, 541 U.S. at 
52, quoting Brief of Amicus Curiae National Association of Criminal Defense 
Lawyers 3.  Accord State v. Stahl, 111 Ohio St.3d 186, 2006-Ohio-5482, 855 
N.E.2d 834, paragraph one of the syllabus.  The court emphasized that the 
objective-witness test was but one of many possible ways to determine whether a 
statement is testimonial, and it expressly stated that “[w]e leave for another day 
any effort to spell out a comprehensive definition of ‘testimonial.’ ” Crawford, 
541 U.S. at 68. 
{¶ 14} Two years later, in  Davis v. Washington (2006), 547 U.S. 813, 
821, 126 S.Ct. 2266, 165 L.Ed.2d 224, the court considered whether a caller’s 
responses to a dispatcher’s interrogation during a 9-1-1 telephone conversation 
were testimonial when the caller failed to appear to testify at trial.  The court 
stated (1) that the statements described the events as they were happening, as 
opposed to explaining events that had happened in the past, (2) that any 
reasonable listener would conclude that the statements were made in the face of an 
ongoing emergency, (3) that the interrogation was objectively necessary to resolve 
the ongoing emergency, and (4) that the interrogation was informal because it was 
conducted over the phone and the answers were provided frantically while in an 
unsafe environment.  Id. at 827.  The court concluded that the circumstances 
surrounding the interrogation “objectively indicate its primary purpose was to 
enable police assistance to meet an ongoing emergency. [The caller] simply was 
not acting as a witness; she was not testifying.”  (Emphasis sic.)  Id. at 828.  
Accordingly, the court concluded that the caller’s hearsay statements were not 
testimonial and, therefore, that they were not barred by the Sixth Amendment.  Id. 
at 829. 
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{¶ 15} In Davis, the court also considered a second case in which a 
domestic-violence complainant did not appear at trial.  Id. at 819-820, 126 S.Ct. 
2266, 165 L.Ed.2d 224.  The police officer who interviewed the victim at the 
scene of the incident and who witnessed her complete and sign an affidavit 
concerning the abuse testified at trial in order to authenticate the affidavit.  Id. at 
820.  The court determined (1) that the interrogation sought to determine what had 
happened, not what was happening, (2) that there was no ongoing emergency, (3) 
that the interrogation was not needed to resolve an emergency, and (4) that the 
interrogation was “formal enough” that it was conducted in a room separate from 
the complainant's husband.  Id. at 830.  The court concluded that “[i]t is entirely 
clear from the circumstances that the interrogation was part of an investigation 
into possibly criminal past conduct – as, indeed, the testifying officer expressly 
acknowledged.”  Id. at 829.  Accordingly, the court concluded that the hearsay 
evidence was testimonial and, therefore, that it was barred by the Sixth 
Amendment.  Id. at 834. 
{¶ 16} The court held that “[s]tatements are nontestimonial when made in 
the course of police interrogation under circumstances objectively indicating that 
the primary purpose of the interrogation is to enable police assistance to meet an 
ongoing emergency.  They are testimonial when the circumstances objectively 
indicate that there is no such ongoing emergency, and that the primary purpose of 
the interrogation is to establish or prove past events potentially relevant to later 
criminal prosecution.”  Id. at 822, 126 S.Ct. 2266, 165 L.Ed.2d 224.  Accord Siler, 
116 Ohio St.3d 39, 2007-Ohio-5637, 876 N.E.2d 534, paragraph one of the 
syllabus. 
Stahl, Muttart, and Siler 
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{¶ 17} In Stahl, this court considered whether hearsay statements by a rape 
victim to a nurse practitioner during a medical examination at a hospital DOVE1 
unit were admissible when the victim was not available to testify at trial.  Stahl, 
111 Ohio St.3d 186, 2006-Ohio-5482, 855 N.E.2d 834, at ¶ 1.  The defendant 
argued that the statements violated his Sixth Amendment right to confront 
witnesses.  Id. at ¶ 1, 9.  This court distinguished Davis, stating: “They involve 
statements made to law-enforcement officers, while the statement at issue here 
covers one made to a medical professional at a medical facility for the primary 
purpose of receiving proper medical treatment and not investigating past events 
related to criminal prosecution.”  (Emphasis sic.)  Id. at ¶ 25.  We concluded that 
the primary purpose of the examination was to receive medical treatment, not to 
investigate past events, applied the objective-witness test outlined in Crawford, 
and held that the challenged statements were nontestimonial.  Id. at ¶ 47, 48. 
{¶ 18} In State v. Muttart, 116 Ohio St.3d 5, 2007-Ohio-5267, 875 N.E.2d 
944, a child victim of sexual abuse was interviewed by a social worker at a child-
advocacy center.  Id., ¶ 14-15.  As in the case before us now, the social worker 
interviewed the child before she was examined by a doctor.  Id., ¶ 15.  During the 
interview, the child disclosed to the social worker that her father had put his penis 
in her mouth and had “ ‘put his pee-pee in her pee-pee.’ ”  Id., ¶ 16.  The child 
also disclosed that similar conduct had happened “ ‘a whole bunch of times.’ ”  Id.  
We held that the child’s statements were nontestimonial because “[s]tatements 
made to medical personnel for purposes of diagnosis or treatment are not 
inadmissible under Crawford.”  Id., ¶ 63.  This is true because statements for 
medical diagnosis and treatment “are not even remotely related to the evils that 
the Confrontation Clause was designed to avoid.”  Id. 
                                                 
1.  “DOVE” stands for “Developing Options for Violent Emergencies.”  Stahl, 111 Ohio St.3d 
186, 2006-Ohio-5482, 855 N.E.2d 834, at ¶ 2.  The unit specializes in health-care services for 
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{¶ 19} In Siler, we considered whether statements made by a child to a 
sheriff's deputy in the course of a police interrogation were testimonial.  Siler, 116 
Ohio St.3d 39, 2007-Ohio-5637, 876 N.E.2d 534, at ¶ 2.  We concluded that “the 
statements made to the deputy sheriff were testimonial because the circumstances 
objectively indicate that no ongoing emergency existed and that the primary 
purpose of the police interrogation was to establish past events potentially relevant 
to a later criminal prosecution.”  Id.  We held that courts in Ohio should apply the 
primary-purpose test set forth in Davis to determine “whether a child declarant's 
statement made in the course of police interrogation is testimonial or 
nontestimonial.”  Id. at paragraph one of the syllabus, citing Davis, 547 U.S. at 
821-822, 126 S.Ct. 2266, 165 L.Ed.2d 224. 
Other State Supreme Court Decisions 
{¶ 20} Since Crawford, many state supreme courts have considered 
whether statements made by children during interviews at child-advocacy centers, 
or their functional equivalent, are testimonial and whether statements by child 
victims of sexual abuse for medical diagnosis and treatment are testimonial. 
{¶ 21} We recognize that a number of those decisions held that statements 
by child-sexual-abuse victims at child-advocacy centers or their functional 
equivalent are testimonial and, therefore, inadmissible pursuant to the 
Confrontation Clause and Crawford.  See, e.g., State v. Contreras (Fla.2008), 979 
So.2d 896; State v. Hooper (2007), 145 Idaho 139, 176 P.3d 911; In re Rolandis 
G. (2008), 232 Ill.2d 13, 902 N.E.2d 600; State v. Bentley (Iowa 2007), 739 
N.W.2d 296; State v. Henderson (2007), 284 Kan. 267, 160 P.3d 776; State v. 
Snowden (2005), 385 Md. 64, 867 A.2d 314; State v. Justus (Mo.2006), 205 
S.W.3d 872; State v. Blue, 2006 ND 134, 717 N.W.2d 558.  But in each of these 
cases, the interviews were conducted solely for forensic purposes.  The situation 
                                                                                                                                     
victims of sexual assault and domestic disturbances.  Id. 
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we are presented with in this case is distinct from those considered in the above-
cited cases. Here we are asked to determine whether statements that contain 
distinct forensic and medical diagnostic information and were made to a social 
worker during one interview are in violation of the Confrontation Clause. For 
example, in Contreras, the Florida Supreme Court held that a statement taken by 
the coordinator of a “child protection team” (“CPT”) was testimonial.  Id. at 905.  
The interview was conducted and videotaped at a shelter for victims of domestic 
violence, and a police officer was connected electronically to the CPT coordinator 
in order to suggest questions.  Id.  There was no evidence that the child received 
medical treatment based on the interview.  The court held that “the primary, if not 
the sole, purpose of the CPT interview was to investigate whether the crime of 
child sexual abuse had occurred, and to establish facts potentially relevant to a 
later criminal prosecution.”  Id. 
{¶ 22} Similarly, the Illinois Supreme Court excluded statements made in 
a forensic interview when there was “absolutely no indication that * * * [the] 
interview * * * was conducted, to a substantial degree, for treatment rather than 
investigative purposes.”   In re Rolandis G., 232 Ill.2d at 33, 902 N.E.2d 600.  In 
that case, after stating that an older child forced him to perform fellatio, a six-
year-old was taken to a child-advocacy center and was interviewed by a child 
advocate.  Id. at 19.  The interview was video recorded and observed by a 
detective through a one-way mirror.  Id.  As with Contreras, there was no 
indication that the child received a medical evaluation or treatment based on the 
interview.  The Illinois Supreme Court concluded that “the interview took place at 
the behest of the police so that a more detailed account of the alleged sexual abuse 
could be obtained by a trained interviewer and memorialized on videotape” and 
held that the child’s statements were testimonial.  Id. at 32. 
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{¶ 23} In Hooper, the Idaho Supreme Court excluded statements in a 
video-recorded forensic interview taken at a Sexual Trauma Abuse Response 
Center (“STAR”).  145 Idaho at 141, 176 P.3d 911.  In that case, a child was taken 
to the STAR center after her mother discovered the child and her father locked in 
the bathroom and suspected sexual abuse.  Id. at 140.  Upon arrival at the STAR 
center, the child met with a doctor and the doctor conducted a sexual-abuse 
examination.  Id. at 141.  After the medical examination, a forensic interviewer 
conducted a video-recorded interview with the child, which a detective observed 
via a closed-circuit system.  Id.  Because the interview occurred after the child met 
with and was examined by the physician, the subsequent interview served a 
forensic, not a medical or treatment-oriented, purpose. 
{¶ 24} In the same vein, the Kansas Supreme Court held that a child’s 
statements during an interview conducted by a detective and a social worker, both 
members of the Exploited and Missing Children Unit, were testimonial.  
Henderson, 284 Kan. at 294, 160 P.3d 776.  In Henderson, a mother took her 
three-year-old daughter to a medical clinic after noticing discharge from the 
child’s vagina and after the child complained that her “potty place” hurt.  Id. at 
269.  Test results revealed that the child had gonorrhea.  Id.  After learning about 
the test results, the detective and social worker interviewed the child, who 
disclosed that her mother’s boyfriend had “touched her ‘potty in a bad way.’ ”  Id. 
at 270.  This interview was video and audio recorded.  Id.  Again, there is no 
indication that the child received additional medical treatment based on the 
interview. 
{¶ 25} These cases that stand for the proposition that the admission of 
statements obtained during interviews at CACs or their functional equivalents 
result in violations of the Confrontation Clause arise from scenarios in which the 
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statements at issue were solely for forensic purposes, rather than for ameliorative 
or therapeutic ones. 
{¶ 26} In the latter category, our sister courts hold that statements made by 
child-sexual-abuse victims for the purpose of medical diagnosis and treatment are 
not testimonial and, therefore, are not barred by the Confrontation Clause even if 
they are used subsequently by the state in a prosecution.  Seely v. State (2008), 
373 Ark. 141, 282 S.W.3d 778 (holding that a child’s statements about abuse to a 
social worker at a children’s hospital before the child was examined by a doctor 
were nontestimonial); State v. Arroyo (2007), 284 Conn. 597, 935 A.2d 975 
(holding that statements made to a social worker were nontestimonial because the 
primary purpose of the interview was to provide medical assistance to the child); 
State v. Krasky (Minn.2007), 736 N.W.2d 636 (holding that a child’s statements 
to a nurse alleging sexual abuse were nontestimonial because the nurse’s primary 
purpose was to assess and protect the child’s health and welfare); State v. Spencer, 
339 Mont. 227, 2007 MT 245, 169 P.3d 384 (holding that statements to a 
counselor regarding sexual abuse were nontestimonial); People v. Vigil 
(Colo.2006), 127 P.3d 916 (holding that responses to questions by a doctor as part 
of a sexual-assault examination were nontestimonial); Commonwealth v. 
DeOliveira (2006), 447 Mass. 56, 849 N.E.2d 218 (holding that statements to a 
physician were made for the purposes of medical evaluation and treatment and 
were not testimonial); Hobgood v. State (Miss.2006), 926 So.2d 847 (holding that 
a child’s description of sexual abuse to his doctor was not given for the purpose of 
prosecuting the accused and was not testimonial); State v. Vaught (2004), 268 
Neb. 316, 682 N.W.2d 284 (holding that a child’s statements to an emergency-
room physician identifying the perpetrator of sexual assault were nontestimonial). 
{¶ 27} With this background in mind, we turn to whether M.A.’s 
statements to Marshall were testimonial. 
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{¶ 28} Pursuant to Stahl, Muttart, and Siler, to determine whether M.A.’s 
statements to Marshall were testimonial, we must identify the primary purpose of 
the statements.  Statements made for the purpose of medical diagnosis and 
treatment are nontestimonial.  Muttart, 116 Ohio St.3d 5, 2007-Ohio-5267, 875 
N.E.2d 944, ¶ 63.  However, statements made to agents of the police for the 
primary purpose of forensic investigation are testimonial.  Siler, 116 Ohio St.3d 
39, 2007-Ohio-5637, 876 N.E.2d 534, at ¶ 2. 
Child-Advocacy Centers and the CCFA 
{¶ 29} The objective of a child-advocacy center like the CCFA is neither 
exclusively medical diagnosis and treatment nor solely forensic investigation.  “ 
‘The purpose of a Children’s Advocacy Center is to provide a comprehensive, 
culturally competent, multidisciplinary response to allegations of child abuse in a 
dedicated, child friendly setting.’ ”  Nancy Chandler, Children’s Advocacy 
Centers:  Making a Difference One Child at a Time (2006), 28 Hamline J.Pub.L. 
& Policy 315, quoting National Children’s Alliance, Accreditation Guidelines for 
Children’s Advocacy Centers (2004) 5. 
{¶ 30} “Prior to the development of the Children’s Advocacy Center 
model, ‘traditional child abuse investigations often subject(ed) the child to 
multiple interviews.’ ”  Id. at 332, quoting Lisa Snell, Child Advocacy Centers: 
One Stop on the Road to Performance-Based Child Protection, Reason 
Foundation, Los Angeles, CA (June 2003) 1.  A child-advocacy center’s “ 
‘number one goal’ ” is to reduce trauma to a child-abuse victim by coordinating 
the interview to include professionals from multiple agencies, which, in turn, can 
reduce the number of interviews needed and improve the quality of the 
investigation, the diagnosis, and the recommendation for treatment.  Id. at 323.  
Additionally, “ ‘[t]hey help children avoid the trauma of repeating their story at 
various stops along the legal and judicial path.’ ”  Id.  These interdisciplinary 
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teams often include law-enforcement professionals, prosecutors, medical and 
mental-health personnel, and child advocates.  Id. at 324. 
{¶ 31} At the CCFA, Marshall, a social worker employed by Nationwide 
Children’s Hospital, interviews children who are suspected victims of physical or 
sexual abuse.  The purpose of the interview is to gather “as much information as 
possible.”  The interview is both recorded on a DVD and broadcast into another 
room via closed-circuit television.  Typically, a nurse practitioner or doctor, a 
children’s services caseworker, and a law-enforcement representative watch the 
interview from a separate room.  Marshall does not inform the child that the team 
members are watching the interview, but does tell him or her that he or she will be 
examined by a doctor or nurse after the interview. 
{¶ 32} After Marshall interviews the child, she meets with the doctor or 
nurse practitioner who will perform the medical examination to review the child’s 
statements.  The nurse or doctor conducts the appropriate medical examination 
based on the child’s statements during the interview.  The nurse or doctor relies 
on information obtained during Marshall’s interview to determine what 
examination and tests are needed.  For example, information regarding the identity 
of the perpetrator, the age of the perpetrator, the type of abuse alleged, and the 
time frame of the abuse allows the doctor or nurse to determine whether to test the 
child for sexually transmitted infections. 
The Interviewer’s Dual Capacity 
{¶ 33} Child-advocacy centers are unique.  Multidisciplinary teams 
cooperate so that the child is interviewed only once and will not have to retell the 
story multiple times.  Most members of the team retain their autonomy.  Neither 
police officers nor medical personnel become agents of the other.  However, to 
ensure that the child victim goes through only one interview, the interviewer must 
elicit as much information from the child as possible in a single interview and 
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must gather the information needed by each team member.  Thus, the interview 
serves dual purposes:  (1) to gather forensic information to investigate and 
potentially prosecute a defendant for the offense and (2) to elicit information 
necessary for medical diagnosis and treatment of the victim.  The interviewer acts 
as an agent of each member of the multidisciplinary team. 
1. 
{¶ 34} Certainly, some of the statements that M.A. made to Marshall 
primarily served a forensic or investigative purpose.  Those statements include 
M.A.’s assertion that Arnold shut and locked the bedroom door before raping her; 
her descriptions of where her mother and brother were while she was in the 
bedroom with Arnold, of Arnold’s boxer shorts, of him removing them, and of 
what Arnold’s “pee-pee” looked like; and her statement that Arnold removed her 
underwear.  These statements likely were not necessary for medical diagnosis or 
treatment.  Rather, they related primarily to the state’s investigation.  Marshall 
effectively acted as an agent of the police for the purpose of obtaining these 
statements. 
{¶ 35} Because Marshall acted as an agent of the police in obtaining these 
statements, pursuant to Davis and Siler, we must employ the primary-purpose test 
to determine whether the primary purpose of the interrogation was “ ‘to enable 
police assistance to meet an ongoing emergency.’ ”  Siler, 116 Ohio St.3d 39, 
2007-Ohio-5637, 876 N.E.2d 534, at paragraph one of the syllabus, quoting 
Davis, 547 U.S. at 822, 126 S.Ct. 2266, 165 L.Ed.2d 224.  We hold that it was 
not.  First, the statements involved a description of past events.  The alleged abuse 
occurred the previous evening, and the questioning specifically attempted to 
obtain a description of the abuse.  Second, a reasonable observer would not 
perceive an ongoing emergency at the time of questioning.  The patient had been 
discharged from the hospital the previous evening.  At oral argument, counsel 
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conceded that no medical emergency existed at the time of Marshall’s interview.  
Third, the questioning was not objectively necessary to resolve an emergency 
because there was no ongoing emergency.  Finally, the interview was rather 
formal, more akin to the videotaped, planned interview of Crawford than to the 
frantic 9-1-1 call or the sequestered but spur-of-the-moment interview recounted 
in Davis. 
{¶ 36} The primary purpose of that portion of the interview was not to 
meet an ongoing emergency but, rather, to further the state’s forensic 
investigation.  Thus, these statements were testimonial in nature and their 
admission without a prior opportunity for cross-examination is prohibited by the 
Confrontation Clause.  Crawford, 541 U.S. at 68, 124 S.Ct. 1354, 158 L.Ed.2d 
177. 
2. 
{¶ 37} Although the statements obtained during Marshall’s interview of 
M.A. that related primarily to the state’s forensic investigation are testimonial and 
thus, inadmissible pursuant to Crawford, other statements provided information 
that was necessary to diagnose and medically treat M.A.  The history obtained 
during the interview is important for the doctor or nurse practitioner to make an 
accurate diagnosis and to determine what evaluation and treatment is necessary.  
For example, the nurse practitioner conducts a “head to toe” examination of all 
children, but only examines the genital area of patients who disclose sexual abuse.  
That portion of the exam is to identify any trauma or injury sustained during the 
alleged abuse. 
{¶ 38} M.A.’s statements that described the acts that Arnold performed, 
including  that Arnold touched her “pee-pee,” that Arnold’s “pee-pee” went inside 
her “pee-pee,” that Arnold’s “pee-pee” touched her “butt,” that Arnold’s hand 
January Term, 2010 
17 
 
touched her “pee-pee,” and that Arnold’s mouth touched her “pee-pee,” were thus 
necessary for the proper medical diagnosis and treatment of M.A. 
{¶ 39} In his dissent, Justice Pfeifer states that he is troubled by our 
conclusion that these statements were medically necessary because M.A. had been 
examined at the hospital on the night of the rape.  However, although M.A. was 
taken to the hospital on the night of the rape, the record establishes only that a 
rape-kit examination was performed, not that she was examined for medical 
diagnosis or treated.  M.A. was referred to the CCFA for further medical 
examination and treatment.  Justice Pfeifer also contends that the nurse 
practitioner who examined M.A. after the interview would have asked all 
medically relevant questions during the examination.  This is not true.  The history 
obtained during Marshall’s interview was necessary for the nurse practitioner to 
make an accurate diagnosis and to determine what treatment was necessary.  
Horner, the nurse practitioner who examined M.A., testified that the “forensic 
interview guides my exam in that it lets me know whether or not I need to test the 
child for sexually transmitted infection.  For instance, if a child says that a penis 
touched their vagina, it means to me that I need to test to make sure that child 
didn’t get a sexually transmitted infection.” 
{¶ 40} In eliciting these medically necessary statements, Marshall acted as 
an agent of the nurse practitioner who examined M.A., not of the investigating 
police officers.  Because Marshall did not act as an agent of the police in 
obtaining these statements, they are not inadmissible pursuant to Davis.  Stahl, 
111 Ohio St.3d 186, 2006-Ohio-5482, 855 N.E.2d 834, at ¶ 25, 36. 
{¶ 41} Statements made for medical diagnosis and treatment are 
nontestimonial.  Muttart, 116 Ohio St.3d 5, 2007-Ohio-5267, 875 N.E.2d 944, ¶ 
63.  There is no basis in the law for concluding that Marshall’s dual capacity 
renders statements made by M.A. for the purpose of medical diagnosis and 
SUPREME COURT OF OHIO 
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treatment inadmissible pursuant to the Confrontation Clause.  Indeed, in Davis, 
the United States Supreme Court acknowledged that the same interview or 
interrogation might produce both testimonial and nontestimonial statements.  
Davis, 547 U.S. at 828-829, 126 S.Ct. 2266, 165 L.Ed.2d 224.  As the court stated 
in Davis, “This presents no great problem.”  Id. at 829.  “[T]rial courts will 
recognize the point at which, for Sixth Amendment purposes, statements in 
response to interrogations become testimonial.  Through in limine procedure, they 
should redact or exclude the portions of any statement that have become 
testimonial, as they do, for example, with unduly prejudicial portions of otherwise 
admissible evidence.”  Id. 
{¶ 42} Both dissents criticize our reliance on Davis in support of our 
conclusion that although M.A.’s forensic statements to Marshall were testimonial, 
her statements for the purpose of medical diagnosis and treatment were properly 
admitted.  First, Justice Pfeifer argues that pursuant to Davis, when evidence 
includes testimonial and nontestimonial statements, the testimonial statements 
must be redacted or excluded to avoid violating the defendant’s right to confront 
witnesses against him.  We agree that M.A.’s testimonial statements should have 
been excluded and we remand the case to the court of appeals to determine 
whether the admission of M.A.’s testimonial statements was harmless error.  
Next, both dissents argue that our reliance on Davis is erroneous because we 
examine the statements on a question-by-question basis and the testimonial and 
nontestimonial statements were interspersed, rather than being obtained in 
separate and distinct portions of the interview.  Justice Pfeifer argues that this will 
make it difficult to distinguish the statements that should be redacted from those 
that may be properly admitted.  However, our guiding consideration is the purpose 
for which the statements are made, not the order in which they are obtained.  
Finally, both dissents note that unlike in Davis, there was no ongoing emergency 
January Term, 2010 
19 
 
in this case and, therefore, there was no occasion for the questioning in this case 
to evolve from nontestimonial to testimonial.  Our decision is not based on the 
evolution of M.A.’s statements, but on the fact that the statements were made for 
different purposes.  The fact that Davis involved an “evolution” from 
nontestimonial to testimonial statements does not preclude its application in 
instances in which an interview simultaneously serves dual purposes. 
{¶ 43} Further, the fact that police officers watched the interview and that 
it was recorded does not change the fact that the statements were necessary for 
M.A.’s medical diagnosis and treatment.  Similarly, the fact that information 
gathered for medical purposes is subsequently used by the state does not change 
the fact that the statements were made for medical diagnosis and treatment.  
Muttart, 116 Ohio St.3d 5, 2007-Ohio-5267, 875 N.E.2d 944, ¶ 62.  M.A.’s 
statements that were necessary for medical diagnosis and treatment were 
nontestimonial and were properly admitted without violating Arnold’s 
Confrontation Clause rights. 
Conclusion 
{¶ 44} When Marshall interviewed M.A. at the CCFA, she occupied dual 
capacities: she was both a forensic interviewer collecting information for use by 
the police and a medical interviewer eliciting information necessary for diagnosis 
and treatment.  We hold that statements made to interviewers at child-advocacy 
centers that are made for medical diagnosis and treatment are nontestimonial and 
are admissible without offending the Confrontation Clause.  Thus, we affirm the 
judgment of the court of appeals to the extent that M.A.’s statements to Marshall 
for the purpose of medical treatment and diagnosis were properly admitted.  We 
further hold that statements made to interviewers at child-advocacy centers that 
serve primarily a forensic or investigative purpose are testimonial and are 
inadmissible pursuant to the Confrontation Clause.  We agree with Arnold that the 
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trial court erred in admitting the forensic statements made by M.A. to Marshall 
and reverse the court of appeal’s judgment insofar as it held that these forensic 
statements were admissible.  However, because the court of appeals did not 
consider whether the admission of M.A.’s forensic statement to Marshall was 
harmless, see State v. Conway, 108 Ohio St.3d 214, 2006-Ohio-791, 842 N.E.2d 
996, we remand the case to the court of appeals to consider this issue. 
Judgment affirmed in part 
and reversed in part,  
and cause remanded. 
LUNDBERG STRATTON, LANZINGER, and CUPP, JJ., concur. 
 
PFEIFER and O’DONNELL, JJ., dissent. 
BROWN, C.J., not participating. 
__________________ 
PFEIFER, J., dissenting. 
{¶ 45} The majority opinion misconstrues the applicable case law in 
reaching its conclusion.  I conclude that a forensic interview cannot be both 
testimonial and nontestimonial without violating a defendant’s Sixth Amendment 
right to confront the witnesses against him. 
{¶ 46} The majority opinion ably explains the law of the Sixth 
Amendment’s Confrontation Clause as elucidated by various federal and Ohio 
cases.  I will not re-describe these cases.  The majority opinion also fairly 
characterizes the case law from other states that it summarizes in the section titled 
“Other State Supreme Court Decisions.”  I dissent, not based on the majority 
opinion’s understanding of the law, but because of the way the majority opinion 
applies the law to this case. 
{¶ 47} The majority opinion acknowledges that many of the questions 
asked by the forensic interviewer, Kerri Marshall, were asked “to gather forensic 
January Term, 2010 
21 
 
information” and are, therefore, testimonial.  In Davis v. Washington (2006), 547 
U.S. 813, 828-829, 126 S.Ct. 2266, 165 L.Ed.2d 224, the court held that 
statements that are testimonial should be redacted or excluded to avoid violating 
the defendant’s right to confront witnesses against him.  The testimonial 
statements in this case were not redacted or excluded.  Furthermore, the 
testimonial statements in this case are different from those discussed in Davis.  In 
Davis, the testimonial statements were made after a series of nontestimonial 
statements had concluded.  Id.  The interrogator in that case had elicited 
statements to assist the police in meeting an ongoing emergency: those statements 
were nontestimonial, and their admission as evidence was permissible.  Id.  After 
eliciting the initial statements, the interrogator asked a series of questions 
attempting to elicit information about the alleged crime.  Id. at 828.  The court 
found “no great problem” with this approach because the nontestimonial 
statements were separate and distinct from the testimonial statements.  Id. at 829.  
The court stated that questioning could evolve from addressing an emergency to 
eliciting forensic information.  Id. at 828.  According to the Supreme Court, 
testimonial statements may not be introduced as evidence and if they are part of a 
transcript or other document, they must redacted.  Id. at 829. 
{¶ 48} The majority opinion makes creative use of the Davis opinion.  
First, it concludes that the concept of nontestimonial statements evolving into 
nontestimonial statements applies when an interrogator has a dual purpose.  Davis 
does not support this conclusion.  The interrogator in Davis did not have dual 
purposes: she had two separate purposes.  She completed the questions regarding 
the ongoing emergency and then moved on to elicit information that could be used 
as evidence.  Marshall’s questions, which elicited, in the opinion of the majority, 
both testimonial and nontestimonial statements, were interspersed, rendering it 
difficult to distinguish those that should be redacted from those that need not be 
SUPREME COURT OF OHIO 
22 
 
redacted.  Second, in this case there was no ongoing emergency.  The emergency 
occurred the night before, so there was no occasion for the questioning to evolve 
from eliciting nontestimonial statements to eliciting testimonial ones.  Third, the 
testimonial statements in this case, which the majority opinion concedes exist, 
were not redacted.  The majority opinion relies on Davis, but only to the extent 
that Davis suits its purposes.    
{¶ 49} Although remanding the cause to enable the court of appeals to 
determine whether the error is harmless is better than finding it harmless, we 
should do neither.  It is clear from the record that the error in this case was not 
harmless.  In State v. Conway, 108 Ohio St.3d 214, 2006-Ohio-791, 842 N.E.2d 
996, ¶ 78, we stated that the determination of whether a constitutional error is 
harmless “is not simply an inquiry into the sufficiency of the remaining evidence.  
Instead, the question is whether there is a reasonable possibility that the evidence 
complained of might have contributed to the conviction.”  It is patently obvious 
that the testimonial statements in this case “might have contributed to the 
conviction.” 
{¶ 50} Another troubling aspect of the majority opinion is its implicit 
conclusion that Marshall’s questions were medically necessary.  Although I 
concede that they may have been helpful, they were not necessary.  First, a doctor 
had examined M.A. the previous evening.  That doctor would have done and 
asked everything necessary to treat M.A. at that time.  See State v. Hooper (2007), 
145 Idaho 139, 141, 176 P.3d 911, about which the majority opinion states, 
“Because the interview occurred after the child met with and was examined by the 
physician, the subsequent interview served a forensic, not a medical or treatment-
oriented, purpose.”  Second, as discussed below, a nurse practitioner examined 
M.A. after Marshall’s questioning.  She would have asked all medically relevant 
questions during her examination. 
January Term, 2010 
23 
 
{¶ 51} The testimonial statements in this case were neither redacted nor 
harmless.  Nevertheless, the majority opinion concludes that the testimonial 
statements do not violate the defendant’s right to confront witnesses.  I will now 
explain why I believe that all of the statements elicited by Marshall were 
testimonial and, therefore, improperly admitted into evidence.   
 
Marshall’s Interview with M.A. 
{¶ 52} Kerri Marshall is a licensed social worker employed by CCFA as a 
medical forensic interviewer.  Marshall described her job duties as interviewing 
children who are alleged to be victims of sexual or physical abuse.  She testified 
that law-enforcement personnel customarily observe the interviews that she 
conducts and that the children are not aware that they are being observed.  
Marshall’s interview with M.A. was contemporaneously broadcast to another 
room over closed-circuit television, where it was viewed by several people, 
including a police detective.  It was also recorded on a DVD. 
{¶ 53} During her interview with M.A., Marshall asked many questions 
about the events of the previous evening.  Some of the questions were not relevant 
to an ongoing medical emergency or to medical treatment.  For example, Marshall 
asked M.A., “How did your underwear get off?” “Did daddy’s pee-pee touch your 
pee-pee?” and “Were you laying down or sitting up when daddy played pee-pees 
with you?”  Marshall subsequently prepared a report of the interview, entitled 
“Medical Forensic Interview Summary.”  In this report, Marshall noted that 
Arnold “fled the home by stealing [Otto’s] purse and her car” after Otto 
confronted him.  Marshall recommended that M.A. be “protected from any 
contact with alleged perpetrator as this investigation continues.” 
Statement made in the course of a police interrogation 
{¶ 54} The issue in this case, as it was in Stahl and Siler, is to determine 
whether the hearsay statements that were offered by the prosecution and that the 
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defendant argued violated his right under the Sixth Amendment to confront a 
witness are testimonial.  A threshold question, however, is whether the statements 
were made in the course of a police interrogation.  See Davis, 547 U.S. at 822, 
126 S.Ct. 2266, 165 L.Ed.2d 2266; Siler, 116 Ohio St.3d 39, 2007-Ohio-5637, 
876 N.E.2d 534, at ¶ 30-31.  What constitutes “police interrogation” for purposes 
of Confrontation Clause analysis has not been addressed by the United States 
Supreme Court.  See Davis at 823, fn. 2. 
{¶ 55} It is, of course, plainly obvious that a police officer did not conduct 
the interrogation in this case; social worker Kerri Marshall conducted the 
interrogation.  The question becomes:  was Marshall an agent of law enforcement 
when she conducted the interrogation?  Id.  For the reasons that follow, I conclude 
that she was. 
{¶ 56} Although the state argues that Crawford and Davis apply only 
when the interviewer is a law-enforcement officer, the cases do not support such a 
narrow interpretation.  I am persuaded that Crawford and Davis define a broader 
constitutional protection from out-of-court statements that are obtained primarily 
to assist in a criminal prosecution, regardless of whether the interrogator is a 
police officer or an agent of the police.  Davis, 547 U.S. at 822-823, 126 S.Ct. 
2266, 165 L.Ed.2d 2266; Crawford, 541 U.S. at 51-53, 124 S.Ct. 1354, 158 
L.Ed.2d 177.  See Crawford at 50 (“the principal evil at which the Confrontation 
Clause was directed was the civil-law mode of criminal procedure, and 
particularly its use of ex parte examinations as evidence against the accused”). 
{¶ 57} In Siler, we stated that “courts have consistently applied the 
primary-purpose test to statements that a child declarant made to police or those 
determined to be police agents.”  Siler, 116 Ohio St.3d 39, 2007-Ohio-5637, 876 
N.E.2d 534, at ¶ 29.  In one of those cases, the Supreme Court of North Dakota 
stated, “In cases since Crawford, other states with the functional equivalent of the 
January Term, 2010 
25 
 
Children’s Advocacy Center (“CAC”) involved in this case have held that similar 
statements made by a child with police involvement inevitably are testimonial.”  
State v. Blue (2006), 199 ND 50, 717 N.W.2d 558, ¶ 15.  A Florida court of 
appeals has considered four factors to determine whether the interrogation at issue 
was “the functional equivalent of a police interrogation. These four factors are (1) 
the effect of the Florida statutes pertinent to the establishment and functioning of 
the CPT [the Florida equivalent of a CAC], (2) the nature and extent of law 
enforcement involvement in the examination of the child by [the nurse 
practitioner] at [the hospital], (3) the purpose of the examination performed by 
[the nurse practitioner] in her capacity as a member of the CPT, and (4) the 
absence of any ongoing emergency at the time [the nurse practitioner] conducted 
her examination of the child.”  Hernandez v. State (Fla.App.2007), 946 So.2d 
1270, 1280.  Although I would not adopt this four-part test, the factors are helpful 
in determining whether Marshall was acting as an agent of the police when she 
interrogated M.A. 
{¶ 58} First, the statutory scheme that authorized the creation of CACs 
contains provisions that establish a link between the CACs and law enforcement.  
R.C. 2151.426 and 2151.427.  See Ohio Adm.Code 5101:2-33-26.  Second, a 
police detective watched the interrogation as it was happening and the 
interrogation was recorded and saved to a DVD.  Third, focusing primarily on 
issues that were not medical, the interview was memorialized as a “Medical 
Forensic Interview Summary,” suggesting that the purpose was forensic, not 
medical.  Fourth, there was no ongoing emergency while the interview was 
conducted. 
{¶ 59} Furthermore, Marshall is not a medical professional; her job title is 
“medical forensic interviewer.”  “Forensic” means “[u]sed in or suitable to courts 
of law or public debate.”  Black's Law Dictionary (9th Ed.2009) 721.  The 
SUPREME COURT OF OHIO 
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Michigan Department of Human Services has stated that “[t]he goal of a forensic 
interview is to obtain a statement from a child * * * that will support accurate and 
fair decision-making in the criminal justice and child welfare systems,” and that 
“the interview is not part of a treatment process.”  State of Michigan, Forensic 
Interviewing Protocol, at http://www.michigan.gov/documents/dhs/DHS-PUB-
0779_211637_7.pdf (accessed May 25, 2010). 
{¶ 60} I conclude that Marshall was an agent of the police when she 
conducted her forensic interview of M.A.  See Blue, 2006 ND 134, 717 N.W.2d 
558, ¶ 14 – 16, and the cases cited therein; State v. Mack (2004), 337 Ore. 586, 
593, 101 P.3d 349 (Department of Human Services caseworker was a proxy for 
the police). 
Application of the primary-purpose test 
{¶ 61} The next step is to determine whether the primary purpose of the 
interrogation was “ ‘to enable police assistance to meet an ongoing emergency.’ ”  
Siler, 116 Ohio St.3d 39, 2007-Ohio-5637, 876 N.E.2d 534, at paragraph one of 
the syllabus, quoting Davis, 547 U.S. at 822, 126 S.Ct. 2266, 165 L.Ed.2d 224.  
First, the interview involved a description of past events.  The alleged abuse had 
occurred the previous evening, and the questioning specifically attempted to 
obtain a description of the abuse.  Second, a reasonable observer would not 
perceive an ongoing emergency at the time of questioning.  The patient had been 
discharged from the hospital the previous evening.  At oral argument, counsel 
conceded that no medical emergency existed at the time of Marshall’s interview.  
Third, the questioning was not necessary to resolve an emergency because there 
was no ongoing emergency.  Finally, the interview was rather formal, more akin 
to the videotaped, planned interview of Crawford than to the frantic 9-1-1 call or 
the sequestered but spur-of-the-moment interview recounted in Davis.  Each 
January Term, 2010 
27 
 
factor independently suggests that there was no ongoing emergency; collectively, 
the conclusion is manifest. 
{¶ 62} Because the primary purpose of the Marshall interview was not to 
meet an ongoing emergency, the next step is to evaluate the entirety of the factual 
circumstances surrounding the interview to establish whether its primary purpose 
was “to establish or prove past events potentially relevant to later criminal 
prosecution.”  Davis, 547 U.S. at 822, 126 S.Ct. 2266, 165 L.Ed.2d 224. 
{¶ 63} A CAC can be established only by a children’s services agency, law 
enforcement, or a prosecutor, and the CAC is responsible for assembling a 
multidisciplinary team.  R.C. 2151.426 and 2151.427(A).  The multidisciplinary 
team must include law enforcement and prosecuting attorneys as members.  Id.  
The statutory connection between CACs and law enforcement suggests that CACs 
are not solely medical-treatment providers and that a CAC interviewer can be an 
agent of the police. 
{¶ 64} The circumstances of the interview indicate that its primary 
purpose was “to establish or prove past events potentially relevant to later 
criminal prosecution.” Davis, 547 U.S. at 822, 126 S.Ct. 2266, 165 L.Ed.2d 224.  
See Siler, 116 Ohio St.3d 39, 2007-Ohio-5637, 876 N.E.2d 534, paragraph one of 
the syllabus.  Police observed the interview, which the state concedes is a 
customary practice.  A DVD recording of the interview was preserved, a strong 
indication that the purpose of the interview was to obtain evidence for use by the 
prosecution.  I am unaware of doctors videotaping patient interviews to assist 
them in medical treatments or of doctors allowing police officers to routinely 
observe them when they examine their patients. 
{¶ 65} Furthermore, many of the questions asked were investigatory in 
nature and similar to the questions asked in a direct examination in a judicial 
proceeding.  See Davis, 547 U.S. at 830, 126 S.Ct. 2266, 165 L.Ed.2d 224.  For 
SUPREME COURT OF OHIO 
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example, questions about how the underwear was removed, who did so, and the 
specific positions – standing up or lying down – in which the alleged abuse 
occurred represent an attempt to gain specific details of past events.  If the 
questions have a medical purpose, it is secondary to their investigatory purpose.  I 
might view Marshall’s questions differently if she were a nurse, as in Stahl, but 
she is not.  Furthermore, the nurse practitioner would have made all inquiries 
relevant to medical treatment during the physical examination after the social 
worker questioned M.A.  That the nurse practitioner stated that Marshall’s 
interview “guides my exam” is no doubt true to some degree.  But nurse 
practitioners are highly educated professionals; they do not need an intermediary.  
In my opinion, the intermediary was interjected in order to elicit forensic 
evidence, not to assist in the medical examination. 
{¶ 66} It is objectively apparent from the record that Marshall asked 
questions to assist in the police investigation.  The circumstances of this case are 
quite different from State v. Muttart, 116 Ohio St.3d 5, 2007-Ohio-5267, 875 
N.E.2d 944, ¶ 62, in which hearsay statements obtained by medical personnel in 
the course of treatment survived a Sixth Amendment challenge.  In Muttart, police 
did not observe the interview and the interview was not videotaped.  The state 
argues that the questions that Marshall asked M.A. helped to assess the need for 
future counseling but fails to show whether any counseling occurred.  Even if it 
had occurred, a recommendation for counseling alone would be insufficient to 
establish that the interview was primarily for medical purposes. 
{¶ 67} The critical evidence in this case is Marshall’s report, something 
the majority opinion does not address.  It uses the words “perpetrator” and 
“allegations” and includes a witness list, an item typically not found in a medical 
report.  The report states that the patient should have no contact with the “alleged 
perpetrator as this investigation continues.”  The report indicates that Marshall 
January Term, 2010 
29 
 
believed that she was assisting an ongoing investigation targeting a particular 
criminal suspect.  When interviewers believe themselves to be participants in an 
investigation that has targeted a particular criminal suspect, they conduct precisely 
the type of ex parte examinations that the Confrontation Clause protects against.  
Crawford, 541 U.S. at 50-53, 124 S.Ct. 1354, 158 L.Ed.2d 177. 
Conclusions reached by sister states 
{¶ 68} Since Crawford was decided, many state supreme courts have 
addressed the issue before us.  In at least eight cases, state supreme courts have 
concluded that out-of-court statements by child sexual-assault victims to various 
non-law-enforcement personnel were nontestimonial.  Seely v. State (2008), 373 
Ark. 141, 282 S.W.3d 778; People v. Vigil (Colo.2006), 127 P.3d 916; State v. 
Arroyo (2007), 284 Conn. 597, 935 A.2d 975; Commonwealth v. DeOliveira 
(2006), 447 Mass. 56, 849 N.E.2d 218; State v. Krasky (Minn.2007), 736 N.W.2d 
636; Hobgood v. State (Miss.2006), 926 So.2d 847; State v. Spencer (2007), 339 
Mont. 227, 2007 MT 245, 169 P.3d 384; State v. Vaught (2004), 268 Neb. 316, 
682 N.W.2d 284.  Each of these cases turned on factual determinations that are 
not present in this case.  See, e.g., Seely, 373 Ark. at 156, 282 S.W.3d 778 (the 
primary purpose of an interview conducted by a social worker “was medical 
treatment”); Vigil, 127 P.3d at 927 (statements to doctor were for purposes of 
medical diagnosis); Hobgood, 927 So.2d at 852 (statements were made to people 
who “were not working in connection with the police” or were made for the 
purpose of seeking medical treatment). 
{¶ 69} At least nine state supreme courts have concluded that out-of-court 
statements by child sexual assault victims to non-law-enforcement personnel are 
testimonial.  State v. Contreras (Fla.2008), 979 So.2d 896; Hooper, 145 Idaho 
139, 176 P.3d 911; In re Rolandis G., 232 Ill.2d 13, 902 N.E.2d 600; State v. 
Bentley (Iowa 2007), 739 N.W.2d 296; State v. Henderson (2007), 284 Kan. 267, 
SUPREME COURT OF OHIO 
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160 P.3d 776; State v. Snowden (2005), 385 Md. 64, 867 A.2d 314; State v. Justus 
(Mo.2006), 205 S.W. 3d 872; Blue, 2006 ND 134, 717 N.W.2d 558; Mack, 337 
Ore. 586, 101 P.3d 349.  Each of these cases involves an interviewer who 
performed in circumstances substantially similar to the facts before us.  See, e.g., 
Blue, 2006 ND 134, 717 N.W.2d 558, ¶ 2 -3 (a forensic interviewer conducted the 
interview while a police officer watched; the officer was given a videotaped 
recording of the interview); Contreras, 979 So.2d at 905 (interview by child-
protection-team coordinator was watched by police officer and recorded); Bentley, 
739 N.W.2d at 297, 300 (interview by counselor at child-protection center was 
watched by police officers, who took videotaped copy of interview with them).  
My conclusion in this case is bolstered by the fact that the majority of our sister 
courts that have considered substantially the same issue have reached the same 
conclusion that I reach. 
Conclusion 
{¶ 70} I conclude that the primary purpose of Marshall’s forensic 
interview was to establish or prove past events potentially relevant to later 
criminal prosecution.  I conclude, therefore, that the statements were testimonial 
and that their admission violates the Confrontation Clause of the Sixth 
Amendment to the United States Constitution.  I would reverse the decision of the 
court of appeals.  I dissent. 
_____________________ 
O’DONNELL, J., dissenting. 
{¶ 71} The issue in this case concerns whether the trial court violated 
Michael Arnold’s constitutional right to confront the witnesses against him when 
it admitted hearsay statements that Arnold’s four-year-old daughter, M.A., made 
to Kerri Marshall, a medical forensic interviewer at the Center for Child and 
Family Advocacy at Nationwide Children’s Hospital, who interviewed M.A. as 
January Term, 2010 
31 
 
part of the investigation into allegations of sexual abuse.  I agree with the majority 
that Marshall acted as an agent of law enforcement when she interviewed M.A. 
because Marshall had a purpose to collect information for use by the police.  
However, because the majority decides that Marshall simultaneously acted as an 
agent of medical professionals, rendering M.A.’s statements relevant to diagnosis 
and treatment nontestimonial, notwithstanding Marshall’s primary purpose to 
collect that same information for the police, I respectfully dissent. 
Facts and Procedural History 
{¶ 72} Arnold and Wendy Otto married in their teens and had two 
children: a girl, M.A., who was four-years old at the time relevant to this case, and 
a boy, M.S.A, who was five.  The couple had a volatile relationship, which 
included physical violence, accusations of infidelity, and an unsubstantiated claim 
that Arnold had abused M.S.A.  According to Arnold’s mother, Otto had made up 
stories involving the children to get back at Arnold for cheating on her.  After 
Otto filed for divorce in July 2005, Arnold moved to Ohio.  However, the two 
reconciled, and in November 2005, Otto followed him to Ohio. 
{¶ 73} On the evening of December 7, 2005, Otto fell asleep in the living 
room with M.S.A, but noises upstairs woke her, and she went to the bedroom to 
investigate.  Arnold, however, had locked the bedroom door, and she yelled for 
him to open it.  Once he did, Otto saw his “boxers halfway off on his side” and 
M.A. lying on the couple’s air mattress. Otto pulled a blanket off of M.A. and 
discovered her daughter’s underwear around her ankles.  At that point, Otto, 
concerned about abuse, told Arnold to leave.  He told Otto that nothing happened, 
but he left the house when Otto called 9-1-1.  Paramedics and officers responded, 
and M.A. told firefighter-paramedic Charles Fritz that someone touched her 
private area.  Fritz took Otto and both children to the emergency room at 
Children’s Hospital, where authorities performed a rape-kit examination on M.A. 
SUPREME COURT OF OHIO 
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{¶ 74} Otto received instructions to take M.A. to the Center for Child and 
Family Advocacy at Children’s Hospital (the “CCFA”) the next morning.  The 
CCFA is a child-advocacy center, which is defined by R.C. 2151.425(A) to mean 
“a center operated by participating entities * * * to perform functions and 
activities and provide services * * * regarding reports * * * of alleged sexual 
abuse of a child or another type of abuse of a child.”  Pursuant to R.C. 
2151.426(A), the participating entities operating a child-advocacy center may 
include children’s services, law enforcement, and the prosecuting attorney.  The 
Columbus Police Department, the prosecutor, and children’s services each have 
offices in the CCFA building. 
{¶ 75} Kerri Marshall, a medical forensic interviewer working for the 
CCFA, interviews children when there are allegations of sexual or physical abuse. 
These interviews are recorded on DVD and observed on closed-circuit television 
by the nurse or doctor who will perform a physical examination, law enforcement, 
a children’s services caseworker, and sometimes a prosecutor.  According to 
Marshall, her interview is for purposes of medical diagnosis and treatment.  
However, she also explained the purpose of having doctors, nurses, detectives, 
children’s services caseworkers, and prosecutors watch the interview: “Before we 
were all in the same building.  You know, we would do the same process.  I would 
interview the children.  They would have their medical exam done.  We would 
forward our reports on to medical services, law enforcement.  They will have to 
review [—] law enforcement may have to interview the child.  So in this way we 
set it up so the child will have to go through one interview.  The child won’t have 
to relive the story again.  So that’s really the purpose of having the other — the 
other people there watching the interview.” Thus, the interview had a goal to 
obtain enough information so that law enforcement would not have to reinterview 
the child. 
January Term, 2010 
33 
 
{¶ 76} In this case, Gail Horner, a nurse practitioner, Monte Nommay, a 
police detective, Joelle Nielson, a victim advocate, and Vanise Dunn, a children’s 
services caseworker, observed the interview.  Marshall interviewed M.A. in a 
separate room with DVD cameras.  She explained to M.A. that she would ask her 
some questions and that a nurse would give her a check-up, and she attempted to 
build a rapport with introductory questions; however, the interview quickly 
focused on the prior night’s events:   
{¶ 77} “And who takes care of you? 
{¶ 78} “A. My mom and my dad. 
{¶ 79} “Q. Your mom and your dad take care – 
{¶ 80} “A. But my dad’s not at my home. 
{¶ 81} “Q. Your dad’s not at your home? How come? 
{¶ 82} “A. Because he got in jail. 
{¶ 83} “Q. Him got in jail. Okay.  How come him got in jail? What did 
daddy do? 
{¶ 84} “A. Nothing.  He just got in jail.” 
{¶ 85} Marshall continued asking M.A. why Arnold had gone to jail, and 
M.A. explained that he had done something to Otto and that Arnold and Otto were 
fighting. M.A. also stated that Arnold had locked the bedroom door and that 
neither she nor Otto were in the room, but upon further questioning, M.A. 
revealed that she had been in the bedroom with Arnold sleeping on the bed. 
{¶ 86} When that line of questioning stalled, Marshall asked M.A. whether 
she had ever been to a doctor for a check-up.  M.A. responded “Today.”  When 
Marshall asked why, M.A. said, “Because my legs were hurting.”  Marshall did 
not explore the source of M.A.’s medical complaint, but instead returned the focus 
to Arnold’s arrest:   
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34 
 
{¶ 87} “Your legs were hurting? Okay.  Now, when daddy —  you said 
daddy went to jail and him not at the home, who took daddy to jail? 
{¶ 88} “A. Cops. 
{¶ 89} “* * *  
{¶ 90} “Q. Who called the cops? 
{¶ 91} “A. My mom. 
{¶ 92} “Q. Why did she call the cops? 
{¶ 93} “A. Because them was fighting.” 
{¶ 94} Marshall asked why Otto had to call the police, and continued:  
{¶ 95} “I don’t understand what your mom and dad were fighting about.  
Were they fighting about something that happened to you? Yeah? Okay.  I just 
want you to tell the truth, that’s all I want you to do.  Okay.  You are not in any 
trouble.  Okay? I am going to tell you the truth, [M.A.], and I want you to tell me 
the truth. Okay? So your mom and your dad were fighting about something that 
happened to you. 
{¶ 96} “A. I can’t – I can’t say it.” 
{¶ 97} Marshall then brought out a picture of a girl and had M.A. identity 
the parts of her body.  She then continued questioning M.A.: 
{¶ 98} “[W]hat would you do if someone touched one of your private 
parts? What would you do? 
{¶ 99} “A. You get in trouble. 
{¶ 100} “Q. Who gets in trouble? 
{¶ 101} “A. Him.” 
{¶ 102} Upon further questioning, M.A. denied that anyone had touched or 
put anything in her private parts.  Marshall then asked whether anyone had asked 
her to keep a secret:  
{¶ 103} “Has your mom ever told you to keep a secret? 
January Term, 2010 
35 
 
{¶ 104} “A. Yeah. 
{¶ 105} “Q. What secret did your mom tell you to keep? 
{¶ 106} “A. (Inaudible.) 
{¶ 107} “Q. How about your dad? Did your dad ever tell you to keep a 
secret? 
{¶ 108} “A. No. 
{¶ 109} “Q. No? Has anyone ever told you not to tell? 
{¶ 110} “A. No. 
{¶ 111} “Q. No?  Well, I don’t understand how come there were cops at 
your house last night and how come you had to go to the doctor’s across the street. 
{¶ 112} “A. Because. 
{¶ 113} “* * * 
{¶ 114} “Q. Did mommy ever come in the bedroom when the door was 
locked when you and dad were sleeping?  Did mom ever come in? 
{¶ 115} “A. Oh, yeah. 
{¶ 116} “Q.  Yeah.  What did mom see when she came in? 
{¶ 117} “A. My underwear was off. 
{¶ 118} “Q.  Your underwear was off? Okay.  How did your underwear get 
off? 
{¶ 119} “A. Because my dad took them off. 
{¶ 120} “Q. Oh, okay.  And then what happened when your dad took your 
underwear off? Do you want to say it really fast in my ear what happened? After 
dad took your underwear off? 
{¶ 121} “A.  (Inaudible) My dad — 
{¶ 122} “Q.  Took your underwear off? And then what? 
{¶ 123} “A. (Inaudible) and pee-pee with me. 
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{¶ 124} “Q. Your daddy took your underwear off and touched your pee-
pee? 
{¶ 125} “A. No.  And was doing pee-pees. 
{¶ 126} “Q. And was what? 
{¶ 127} “A.  Him was touching my pee-pee.  But he was doing pee-pees 
with me.  That’s why he got in jail.” 
{¶ 128} On further questioning, M.A. explained that Arnold’s “pee-pee” 
went inside her “pee-pee,” that he had touched her “pee-pee” with his hand, that 
he had been on top of her while “playing pee-pees,” that his “pee-pee” had 
touched the outside of her “butt,” and that his mouth had touched her “pee-pee.”2  
Once Marshall had this information, she did not ask M.A. about any other 
instances of abuse or any other potential abusers, but rather remained focused on 
Arnold and reconfirmed this specific instance of abuse. 
{¶ 129} Marshall then took M.A. to Horner, the nurse, for a physical 
exam.  According to Horner’s testimony, she would have conducted a head-to-toe 
examination of M.A. regardless of M.A.’s answers to Marshall’s questions, but 
she explained that “that forensic interview guides my exam in that it lets me know 
whether or not I need to test the child for sexually transmitted infection.” The 
physical exam of M.A. revealed abrasions on the hymen consistent with a 
penetrating injury. 
{¶ 130} Based on this interview, the state charged Arnold with two counts 
of rape in violation of R.C. 2907.02.  Over objection, the trial court found M.A. to 
be unavailable for trial and that her hearsay statements to Marshall were 
nontestimonial and admissible.  The state played the video recording of the 
interview for the jury, which subsequently found Arnold guilty of vaginal rape.  
January Term, 2010 
37 
 
The Tenth District affirmed, holding that Marshall was not an agent of the police 
and that M.A.’s statements were not testimonial. 
{¶ 131} We accepted Arnold’s appeal to determine whether Marshall’s 
interview elicited testimonial statements subject to the Confrontation Clause. 
The Confrontation Clause 
{¶ 132} The Sixth Amendment to the United States Constitution provides 
that “[i]n all criminal prosecutions, the accused shall enjoy the right * * * to be 
confronted with the witnesses against him.”   Prior to 2004, the Supreme Court of 
the United States had interpreted the Confrontation Clause to permit the state to 
use the hearsay statements of a declarant who did not appear at trial if the hearsay 
fell within “a firmly rooted hearsay exception” or if it otherwise bore 
“particularized guarantees of trustworthiness.”  See, e.g., Ohio v. Roberts (1980), 
448 U.S. 56, 66, 100 S.Ct. 2531, 65 L.Ed.2d 597.  Thus, statements made for 
purposes of medical diagnosis or treatment were admissible notwithstanding the 
inability of the accused to cross-examine the declarant.  White v. Illinois (1992), 
502 U.S. 346, 356-357, 112 S.Ct. 736, 116 L.Ed.2d 848, and fn. 8. 
{¶ 133} In Crawford v. Washington (2004), 541 U.S. 36, 124 S.Ct. 1354, 
158 L.Ed.2d 177, however, the court recognized that the interpretation of the 
Sixth Amendment articulated in Roberts could not be reconciled with the 
historical underpinnings of the Confrontation Clause.  It held that the Sixth 
Amendment “commands, not that [hearsay] evidence be reliable, but that 
reliability be assessed in a particular manner: by testing in the crucible of cross-
examination.” Crawford at 61.  Because the Sixth Amendment guarantees the 
accused’s right to confront those who “bear testimony,” the Confrontation Clause 
bars admission of testimonial statements unless the witness appears at trial or, if 
                                                                                                                                     
2.  M.A. also said that Arnold’s “pee-pee” was green, that his “butt” and a needle touched her 
“butt,” and that his ears touched her “pee-pee,” to which Marshall responded, “[M.A.], this stuff is 
SUPREME COURT OF OHIO 
38 
 
the witness is unavailable, the accused had a prior opportunity for cross-
examination.  Id. at 51.  The court explained that “[w]hatever else the term 
[‘testimonial’] covers, it applies at a minimum to prior testimony at a preliminary 
hearing, before a grand jury, or at a former trial; and to police interrogations.”  Id. 
at 68. 
{¶ 134} The Supreme Court revisited the issue in Davis v. Washington 
(2006), 547 U.S. 813, 126 S.Ct. 2266, 165 L.Ed.2d 224.  The court held, 
“Statements are nontestimonial when made in the course of police interrogation 
under circumstances objectively indicating that the primary purpose of the 
interrogation is to enable police assistance to meet an ongoing emergency.  They 
are testimonial when the circumstances objectively indicate that there is no such 
ongoing emergency, and that the primary purpose of the interrogation is to 
establish or prove past events potentially relevant to later criminal prosecution.”  
Davis at 822.  The court held that statements to a 9-1-1 operator made during a 
police interrogation conducted in response to an ongoing emergency are 
nontestimonial; however, statements made to police after the emergency had 
ended are testimonial. 
Stahl, Muttart, and Siler 
{¶ 135} This court has previously applied Crawford and Davis to 
determine whether statements admitted at trial were testimonial or nontestimonial. 
{¶ 136} In State v. Stahl, 111 Ohio St.3d 186, 2006-Ohio-5482, 855 
N.E.2d 834, we considered whether statements made by a rape victim to a DOVE-
unit nurse in the presence of a police officer were testimonial.  There, we 
“adopt[ed] the ‘objective witness’ test in Ohio. For Confrontation Clause 
purposes, a testimonial statement includes one made ‘under circumstances which 
would lead an objective witness reasonably to believe that the statement would be 
                                                                                                                                     
important.”   
January Term, 2010 
39 
 
available for use at a later trial.’ ” Id. at ¶ 36, quoting Crawford, 541 U.S. at 52, 
124 S.Ct. 1354, 158 L.Ed.2d 177.  We concluded that the victim’s statements to 
the nurse were nontestimonial because the victim could reasonably have assumed 
that repeating to a nurse or other medical professional the same information 
provided to police served a separate and distinct medical purpose from the 
criminal investigation.  Id. at ¶ 46. 
{¶ 137} Following Stahl, in State v. Muttart, 116 Ohio St.3d 5, 2007-
Ohio-5267, 875 N.E.2d 944, we examined the issue whether a child’s statements 
to a social worker at the Child Maltreatment Clinic at Mercy Children’s Hospital 
in Toledo were testimonial.  We held that “[s]tatements made to medical 
personnel for purposes of diagnosis or treatment are not inadmissible under 
Crawford, because they are not even remotely related to the evils that the 
Confrontation Clause was designed to avoid.”  Id. at ¶ 63.  We also noted that 
“[t]he fact that the information gathered by the medical personnel in this case was 
subsequently used by the state does not change the fact that the statements were 
not made for the state’s use.”  Id. at ¶ 62.  Notably, however, law enforcement had 
not been involved in the interview or examination. 
{¶ 138} The court distinguished Stahl in State v. Siler, 116 Ohio St.3d 39, 
2007-Ohio-5637, 876 N.E.2d 534, and, relying on Davis, held that the primary-
purpose test applies to a child declarant’s statements made to police or those 
determined to be police agents:  “ ‘[Statements] are testimonial when the 
circumstances objectively indicate that there is no * * * ongoing emergency, and 
that the primary purpose of the interrogation is to establish or prove past events 
potentially relevant to later criminal prosecution.’ ” Id. at ¶ 30, quoting Davis v. 
Washington, 547 U.S. at 822, 126 S.Ct. 2266, 165 L.Ed.2d 224.  The court 
rejected the argument that because of a child’s limited understanding of the 
system of criminal justice, the child could not reasonably expect his or her 
SUPREME COURT OF OHIO 
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statements to be used at a later trial, and therefore, the child’s statements to police 
interrogators are nontestimonial under the primary-purpose test. 
{¶ 139} Our cases applying Crawford and Davis thus recognize the use of 
different standards when the interviewer is an agent of law enforcement and when 
the interviewer is an agent of a medical provider.  When the questioner is an agent 
of law enforcement, the court, in accordance with Siler, looks to whether the 
primary purpose of the interrogation is to establish or prove past events potentially 
relevant to later criminal prosecution.  When the questioner is a medical 
professional not related to law enforcement, the court, following Stahl, applies the 
objective-witness test and determines whether the circumstances would lead an 
objective witness reasonably to believe that the statement would be available for 
use at a later trial. 
The Majority’s Dual-Capacity Test 
{¶ 140} Today’s majority, however, charts a course different from the 
Confrontation Clause jurisprudence of the Supreme Court of the United States and 
adopts its own dual-capacity test in which the interrogation is examined on a 
question-by-question basis to determine whether the interviewer acted as an agent 
of law enforcement or as an agent of some other entity when eliciting a particular 
statement.  Applying this test,  it finds that testimonial and nontestimonial 
statements are interspersed throughout Marshall’s interview and that Marshall 
acted variously as an agent of law enforcement and as a medical examiner.  This 
analysis is contrary to United States Supreme Court jurisprudence, which directs 
that we should look to the primary purpose of the interrogation, not the secondary 
or tertiary purpose. 
{¶ 141} Here, Marshall acted as an agent of law enforcement when she 
interviewed M.A., as she asked questions on behalf of the police in the absence of 
an ongoing emergency to establish or prove past events relevant to later criminal 
January Term, 2010 
41 
 
prosecution.  The interview she conducted focused solely on confirming the single 
instance of sexual abuse that Otto had accused Arnold of committing: the child’s 
medical history went no further than the night before, Marshall did not ask M.A. 
about any prior instances of sexual abuse she had experienced, and Marshall did 
not evaluate whether it would be safe to return the child home with Otto.  Further, 
as the majority explains, “the interview was rather formal, more akin to the 
videotaped, planned interview of Crawford than to the frantic 9-1-1 call or the 
sequestered but spur-of-the-moment interview recounted in Davis.”  Majority 
opinion at ¶ 35. 
{¶ 142} The majority therefore properly holds that M.A.’s statement that 
Arnold locked the bedroom door with her inside, her descriptions of where her 
mother and brother were and what Arnold’s boxer shorts and “pee-pee”  looked 
like, and her statements that Arnold had removed both his and her underwear are 
testimonial because “[t]hese statements likely were not necessary for medical 
diagnosis or treatment.  Rather, they related primarily to the state’s investigation.”  
Majority opinion at ¶ 34. 
{¶ 143} Yet the majority determines that Marshall acted as an agent of 
medical providers when she asked questions in any way relevant to medical 
diagnosis and treatment, so that the statements that “described the acts that Arnold 
performed, including that Arnold touched her ‘pee-pee,’ that Arnold’s ‘pee-pee’ 
went inside her ‘pee-pee,’ that Arnold’s ‘pee-pee’ touched her ‘butt,’ that 
Arnold’s hand touched her ‘pee-pee,’ and that Arnold’s mouth touched her ‘pee-
pee,’ were thus necessary for the proper medical diagnosis and treatment of M.A.”  
According to the majority, “[i]n eliciting these medically necessary statements, 
Marshall acted as an agent of the nurse practitioner who examined M.A., not of 
the investigating police officers.”  Majority opinion at ¶ 40. 
SUPREME COURT OF OHIO 
42 
 
{¶ 144} In my view, it is not enough that these statements were relevant 
for medical diagnosis; rather, the question is whether the totality of the 
circumstances objectively indicate that the primary purpose of the interview was 
to facilitate medical diagnosis and treatment or whether it was to establish or 
prove past events potentially relevant to later criminal prosecution. 
{¶ 145} It is manifest that Marshall’s questions sought to confirm the 
allegations of sexual abuse and that proving these past events would be relevant at 
a criminal prosecution, and the totality of the circumstances indicates that the 
whole interview served primarily an investigative and prosecutorial purpose.  
Notably, M.A. revealed the abuse in response to a series of questions asking why 
her parents were fighting, why the police had come to her house, and why Arnold 
had gone to jail, and M.A. stated that Arnold “was doing pee-pees” with her and 
that “[t]hat’s why he got in jail.” 
{¶ 146} Thus, M.A.’s recorded statements “are functionally identical to 
live, in-court testimony, doing ‘precisely what a witness does on direct 
examination.” Melendez-Diaz v. Massachusetts (2009), ___ U.S. ___, 129 S.Ct. 
2527, 2532, ___ L.Ed.2d ___, quoting Davis, 547 U.S. at 830, 126 S.Ct. 2266, 
165 L.Ed.2d 224.  Her statements share the same “ ‘striking resemblance’ of the 
Crawford statement to civil-law ex parte examinations” that the court recognized 
in Davis: Marshall separated M.A. from her mother for the interview but not for 
the physical exam, M.A. “deliberately recounted, in response to police 
questioning, how potentially criminal past events began and progressed,” and the 
interview occurred after the incident and any related exigencies had ended.  Davis 
at 830.  Further, the CCFA perpetuated the interview for trial. 
{¶ 147} The fact that the answers to Marshall’s questions may also be used 
for a nontestimonial purpose does not mean that M.A.’s statements are not 
testimonial or that the nontestimonial purpose takes precedence.  As the Eighth 
January Term, 2010 
43 
 
Circuit Court of Appeals explained in United States v. Bordeaux (C.A.8, 2005), 
400 F.3d 548, 556, “That [the child’s] statements may have also had a medical 
purpose does not change the fact that they were testimonial, because Crawford 
does not indicate, and logic does not dictate, that multi-purpose statements cannot 
be testimonial.”   Accord State v. Henderson (2007), 284 Kan. 267, 293, 160 P.3d 
776, (“while one purpose of the interview was to enable some assistance to [the 
child victim], the circumstances of this case objectively indicate that its primary 
purpose was to establish past events potentially relevant to a later criminal 
prosecution of Henderson”); State ex rel. Juvenile Dept. of Multnomah Cty. v. S.P. 
(2009), 346 Or. 592, 624, 215 P.3d 847 (recognizing that statements to a child-
abuse-evaluation team served dual purposes of providing treatment to the victim 
and obtaining evidence against the accused, but holding that “statements in a 
formal setting, in response to structured questions about past events” asked by 
persons who were proxies for law enforcement, were testimonial). 
{¶ 148} Contrary to the majority’s assertion, Davis does not support the 
proposition that “[t]here is no basis in the law for concluding that Marshall’s dual 
capacity renders statements made by M.A. for the purpose of medical diagnosis 
and treatment inadmissible pursuant to the Confrontation Clause.”  Majority 
opinion at ¶ 41.  Rather, the United States Supreme Court in Davis emphasized 
that it had not held that “a conversation which begins as an interrogation to 
determine the need for emergency assistance cannot, as the Indiana Supreme 
Court put it [In Hammon v. State], ‘evolve into testimonial statements,’ 829 
N.E.2d, at 457, once that purpose has been achieved.”  (Emphasis added.)  Davis, 
547 U.S. at 828, 126 S.Ct. 2266, 165 L.Ed.2d 224. 
{¶ 149} However, by the majority’s reckoning, the converse occurred here: 
an interrogation eliciting testimonial statements (i.e., that Arnold locked the door 
and pulled down M.A.’s underwear) evolved into a conversation to obtain 
SUPREME COURT OF OHIO 
44 
 
medically necessary statements (i.e., Arnold raped the child).  Further, the United 
States Supreme Court in Davis did not perform the question-by-question analysis 
that the majority undertakes in this case; rather, the court focused on whether the 
totality of the circumstances indicate that “the primary purpose of the 
interrogation is to establish or prove past events potentially relevant to later 
criminal prosecution.”  Davis at 822. 
{¶ 150} In my view, the primary purpose of Marshall’s questioning was to 
establish what had been done to M.A. and who had done it.  Accordingly, M.A.’s 
statements are testimonial and their admission at trial without a prior opportunity 
to cross-examine M.A. violated Arnold’s right to confront the witnesses against 
him. 
{¶ 151} Tellingly, this view that statements elicited by interviewers 
cooperating with law enforcement are testimonial is supported by the weight of 
authority addressing similar circumstances.  See, e.g., Bordeaux, 400 F.3d at 556; 
People v. Sisavath (2004), 118 Cal.App.4th 1396, 1402, 13 Cal.Rptr.3d 753; State 
v. Hooper (2007), 145 Idaho 139, 146, 176 P.3d 911; In re Rolandis G (2008), 
232 Ill.2d 13, 32-33; 902 N.E.2d 600; State v. Bentley (Iowa 2007), 739 N.W.2d 
296, 302; State v. Henderson (2007), 284 Kan. 267, 293, 160 P.3d 776; Hartsfield 
v. Commonwealth (Ky.2009) 277 S.W.3d 239, 245; State v. Justus (Mo.2006), 
205 S.W.3d 872; State v. Blue, 2006 ND 134, 717 N.W.2d 558, at ¶ 17-18; State 
v. Mack (2004), 337 Or. 586, 593, 101 P.3d 349. 
{¶ 152} The Confrontation Clause ensures that “evidence admitted against 
an accused is reliable and subject to the rigorous adversarial testing that is the 
norm of Anglo-American criminal proceedings.”  Maryland v. Craig (1990), 497 
U.S. 836, 845-846, 110 S.Ct. 3157, 111 L.Ed.2d 666.  Because the principal evil 
at which the Confrontation Clause is directed is the use of ex parte examinations 
January Term, 2010 
45 
 
as evidence against the accused such as occurred in this case, I would reverse the 
judgment of the court of appeals. 
__________________ 
Ron O’Brien, Franklin County Prosecuting Attorney, and Kimberly Bond, 
Assistant Prosecuting Attorney, for appellee. 
Yeura R. Venters, Franklin County Public Defender, and David L. Strait, 
Assistant Public Defender, for appellant. 
Vorys, Sater, Seymour & Pease, L.L.P., Lisa Pierce Reisz, and Melissa J. 
Mitchell, urging affirmance for amici curiae Nationwide Children’s Hospital and 
the Center for Child and Family Advocacy. 
Richard Cordray, Attorney General, Benjamin C. Mizer, Solicitor General, 
Elisabeth A. Long, Deputy Solicitor, and Rebecca L. Thomas, Assistant Solicitor, 
urging affirmance for amicus curiae Attorney General of Ohio. 
Timothy Young, Ohio Public Defender, and Kelly K. Curtis, Assistant 
Public Defender, urging reversal for amicus curiae Ohio Public Defender. 
Ian N. Friedman & Associates, Ian N. Friedman, and Eric C. Nemecek, 
urging reversal for amicus curiae Ohio Association of Criminal Defense Lawyers. 
______________________