Case Title: Sanders v. Commonwealth

Citation: 

Docket Number: 101870

State: virginia

Court: Virginia Supreme Court

Date: 2011-06-09T00:00:00Z

Document:
Present: Kinser, C.J., Lemons, Goodwyn, Millette, and Mims, 
JJ., and Carrico and Koontz, S.JJ.  
 
GEOFFREY SANDERS 
 
 
 
OPINION BY 
v. Record No. 101870 
SENIOR JUSTICE LAWRENCE L. KOONTZ, JR. 
 
 
 
June 9, 2011 
COMMONWEALTH OF VIRGINIA 
 
FROM THE COURT OF APPEALS OF VIRGINIA 
 
 
In this case, the Circuit Court of the City of Portsmouth 
allowed the Commonwealth's medical expert to rely on the 
results of a laboratory report as the basis of her opinion 
that the victim of acts of sexual abuse had a sexually 
transmitted infection.  The sole issue we consider is whether 
the Court of Appeals erred in holding that this portion of the 
expert's testimony did not violate the defendant's right to 
confront witnesses against him as guaranteed by the 
Confrontation Clause of the Sixth Amendment to the United 
States Constitution. 
BACKGROUND 
 
On June 12, 2008, allegations that Geoffrey Sanders had 
sexually abused his daughter "CL," who was under the age of 
thirteen, first came to light when CL reported the abuse to 
her mother.  An ensuing investigation resulted in Sanders 
being indicted on May 7, 2009 for three counts of forcible 
sodomy, four counts of rape, four counts of object sexual 
penetration, and two counts of taking indecent liberties with 
a child. 
 
Prior to trial, Sanders filed a motion in limine 
requesting the circuit court to "order that the Commonwealth's 
witnesses refrain from stating that [CL] ever had a sexually 
transmitted disease and that she got the STD from the 
defendant."  On November 24, 2009, the court held a hearing on 
the motion in limine.  Expanding on the request of the motion, 
Sanders sought to exclude alleged hearsay statements contained 
in a laboratory report showing that CL had contracted 
chlamydia, a sexually transmitted infection. 
 
At the hearing, Dr. Michelle Clayton, "a child abuse 
pediatrician at the Child Abuse Program at the Children's 
Hospital of The King's Daughters in Norfolk" (hereafter "the 
clinic"), testified that she examined CL on July 9, 2008.  As 
part of the examination, Dr. Clayton obtained a urine sample 
and vaginal swabs from CL.  According to Dr. Clayton, the 
"samples were obtained for testing of sexual transmitted 
infections." 
 
Dr. Clayton sent the samples to the hospital's main 
laboratory, which then sent them for testing to Quest 
Diagnostics, an independent laboratory in California.  The 
Commonwealth introduced into evidence a printout of the 
hospital's electronic medical records showing the results of 
 
2
that testing, which had been received from the independent 
laboratory.  Dr. Clayton did not know the name of the 
laboratory technician who tested the samples nor did she test 
the samples herself.  Instead, "[u]sing well-established 
procedures," she relied on the transmission of the results 
from the laboratory to determine "whether the tests were 
positive or negative." 
 
In this instance, tests were done for chlamydia and 
gonorrhea.  Based on the test results and the physical 
examination, Dr. Clayton diagnosed CL with chlamydia.  When 
asked whether CL showed any visible signs of chlamydia, Dr. 
Clayton responded that CL had some vaginal discharge, but that 
vaginal discharge is present in a variety of conditions and is 
not necessarily a specific symptom of chlamydia.  However, Dr. 
Clayton noted that "when a child, that I'm examining, has 
vaginal discharge, I always obtain samples of it and send it 
for testing." 
 
Follow-up testing on July 22, 2008 confirmed Dr. 
Clayton's diagnosis.  Additional testimony established that 
the test for chlamydia is a diagnostic test used to determine 
whether a "medical condition" exists.  The test determines 
whether the individual has the infection, but that, unlike a 
DNA test, the test does not provide information identifying 
the source of the infection. 
 
3
 
Following this testimony, Sanders contended that Dr. 
Clayton's testimony was based on inadmissible hearsay.  
Sanders maintained that, by allowing Dr. Clayton to rely on 
the results of the laboratory report as the basis for her 
diagnosis, the Commonwealth was attempting to elicit testimony 
from an unknown laboratory technician.  Relying upon Melendez-
Diaz v. Massachusetts, 557 U.S. ___, 129 S.Ct. 2527 (2009), 
Sanders argued that the admission of testimony concerning the 
results of the laboratory test into evidence violated his 
Sixth Amendment right to confront and cross-examine witnesses. 
 
The Commonwealth conceded that Dr. Clayton's opinion was 
based on hearsay.  The Commonwealth contended, however, that 
"the doctor, by the rules of evidence, is allowed to render an 
opinion as to a diagnosis that she made for the purposes of 
medical treatment as to a condition."  The Commonwealth 
further contended that Dr. Clayton was entitled to rely "on 
the history given, the physical exam she did, and the test 
that she ordered" in expressing her opinion as to a diagnosis.  
Consequently, the Commonwealth maintained that, "once 
qualified as an expert," Dr. Clayton would be entitled to 
testify that CL had contracted chlamydia based upon the 
results of the laboratory test.  
 
The circuit court agreed that the "lab report itself 
under Melendez[-Diaz] is probably not admissible" and thus 
 
4
sustained Sanders' motion with respect to the admissibility of 
the laboratory report.  However, the court further ruled that 
it would allow "Dr. Clayton as an expert witness . . . to rely 
upon the lab report as part of her diagnosis in the case." 1 
                     
1 The Commonwealth's contention that Dr. Clayton could 
testify that she "diagnosed" CL as having contracted chlamydia 
based on the results of the laboratory test, and the circuit 
court's subsequent ruling that she would be allowed to "rely 
upon the lab report as part of her diagnosis" even though the 
report was "probably" inadmissible hearsay, does not correctly 
reflect the law regarding expert witness testimony in criminal 
prosecutions in Virginia.  In Simpson v. Commonwealth, 227 Va. 
557, 566, 318 S.E.2d 386, 391 (1984), we noted that Code 
§ 8.01-401.1, which permits "an expert to base his opinion on 
facts made known or perceived by him at or before trial, 
whether admissible in themselves or not, provided they are 
facts of a type normally relied on by other experts in the 
field," is limited by the express language of the statute to 
civil cases.  In Simpson, we declined the Commonwealth's 
invitation to judicially expand this rule to criminal 
prosecutions.  Id.; see also Wright v. Commonwealth, 245 Va. 
177, 197, 427 S.E.2d 379, 392 (1993); Buchanan v. 
Commonwealth, 238 Va. 389, 416, 384 S.E.2d 757, 773 (1989); 
Charles E. Friend & Kent Sinclair, The Law of Evidence in 
Virginia § 17-18(e) (6th ed. 2003 & Supp. 2010-11). 
In this instance, it is clear that Dr. Clayton's 
testimony concerning her "diagnosis" that CL had contracted 
chlamydia was based solely on the lab report, not upon any 
independent observation or analysis made by her and, thus, if 
the lab report was not to be admitted at trial, her testimony 
on this point would lack a proper foundation.  Cf. Simpson, 
227 Va. at 566, 318 S.E.2d at 391-92 (holding that an expert's 
testimony "[b]ased entirely upon his personal observations" 
and records admitted into evidence was properly admitted).  
However, Sanders has not asserted that Dr. Clayton's trial 
testimony lacked a proper foundation.  Rather, both at trial 
and on appeal, he has limited his argument to whether Dr. 
Clayton's testimony concerning the content of the lab report 
violated his right to confront and cross-examine the 
technician who prepared the report.  Accordingly, the issue of 
whether Dr. Clayton's trial testimony on this point lacked an 
adequate foundation is not before us, and we will not address 
 
5
 
A jury trial was held on the indictments against Sanders 
beginning on December 21, 2009.  The Commonwealth's case 
against Sanders consisted chiefly of the following evidence:  
CL's testimony concerning her father's assaults on her, a 
suicide attempt by Sanders after CL's allegations against him 
were made, and evidence that both Sanders and CL had 
contracted chlamydia.  As relevant to our resolution of this 
appeal, we necessarily will focus our analysis on this third 
element of the evidence. 
 
At trial, Dr. Clayton testified as an expert in the field 
of child abuse pediatrics.  As a child abuse pediatrician, Dr. 
Clayton stated that her duties are "multifaceted."  She 
explained that whenever "there is a suspicion of child abuse, 
including physical abuse, sexual abuse or neglect," child 
abuse pediatricians are "called to complete an assessment and 
give an opinion regarding the likelihood of abuse or neglect" 
or interpret their "examination findings." 
 
Regarding her medical examination of CL on July 9, 2008, 
Dr. Clayton testified that CL was referred to the clinic "by 
an investigative agency because of an allegation or disclosure 
of sexual abuse."  Dr. Clayton "only performed a medical 
                                                                
it further.  Moreover, we are of opinion that our resolution 
of the confrontation issue will moot the question of whether 
admission of the testimony was proper. 
 
 
6
evaluation of [CL]."  Dr. Clayton did not discuss with CL what 
happened to her, as the clinic has specialists such as 
forensic interviewers who interview the children.  However, 
based on information from CL's "mother and the police," Dr. 
Clayton understood that she was examining CL for signs of 
sexual abuse and vaginal penetration. 
 
Dr. Clayton testified that the medical exam she performs 
is much like a regular gynecological exam.  The major 
differences are that the clinic's examinations are recorded on 
video and are limited to the outside of the child's genital 
area. 
 
Aside from "a moderate vaginal discharge," Dr. Clayton 
noted that "[e]verything looked perfectly normal and healthy" 
with CL's examination.  Dr. Clayton also noted that the "vast 
majority of children who have made an allegation or disclosure 
of sexual abuse have a normal examination" and that "often 
there is no physical sign of that injury once you're more than 
a few days out from the . . . alleged event." 
 
Dr. Clayton further testified that the clinic orders a 
variety of laboratory studies when there is a concern of 
sexual abuse.  For instance, for children already in puberty 
like CL, the clinic takes "a urine pregnancy test just to 
insure there's no pregnancy."  That urine is also tested for 
gonorrhea and chlamydia.  Dr. Clayton obtained swabs of the 
 
7
vaginal discharge that she noticed during CL's exam and sent 
the swabs for laboratory testing of gonorrhea and chlamydia as 
well.  Dr. Clayton knew the samples of the vaginal discharge 
were sent to a laboratory in California, but did not know 
precisely how the test was conducted.  When asked about her 
diagnosis, Dr. Clayton responded, "I diagnosed [CL] with 
Chlamydia on the basis of the test results that were performed 
on July 9th, 2008."2 
 
Tonya Gardner, a child protective service worker with the 
Portsmouth Department of Social Services, testified that she 
met with Sanders on July 21, 2008 to interview him regarding 
the allegations of sexual abuse made by his daughter.  During 
this interview, Sanders spontaneously told Gardner that he had 
chlamydia. 
 
During closing argument, the Commonwealth asserted that 
the jury could convict Sanders based solely on CL's testimony, 
but they did not have to because there was more than just the 
testimony of the victim in this case.  The Commonwealth 
stated: 
[Sanders] gave [CL] chlamydia.  You have [heard] 
that from Dr. Clayton and Tonya Gardner.  It's clear 
that the defendant had it.  He admitted to it.  
                     
2 Chlamydia is a treatable sexually transmitted infection.  
On July 22, 2008, Dr. Clayton had CL return to the clinic to 
receive a prescription to treat the infection.  When CL 
returned to the clinic again on September 17, 2008, it was 
determined that the infection had been cured. 
 
8
Unprompted, he told Tonya Gardner that he had 
chlamydia.  And we know from Dr. Clayton that [CL] 
had it. 
 
 
The jury returned its verdicts convicting Sanders of 
two counts of forcible sodomy, three counts of rape, four 
counts of object sexual penetration, and two counts of 
taking indecent liberties with a child.  Following the 
preparation of a presentence report, the circuit court 
sentenced Sanders in accord with the jury verdicts to 
multiple sentences of life imprisonment on the forcible 
sodomy, object sexual penetration, and rape charges, and 
five years imprisonment on the indecent liberties 
charges. 
 
The Court of Appeals denied Sanders' petition for appeal 
by an unpublished per curiam order, finding that the 
"laboratory report which [Dr.] Clayton obtained in the course 
of her continued medical treatment of the victim was not 
'testimonial' for purposes of Sixth Amendment confrontation."  
Sanders v. Commonwealth, Record No. 0374-10-1, slip op. at 2 
(September 1, 2010).  We awarded Sanders this appeal. 
DISCUSSION 
 
Sanders contends that allowing Dr. Clayton to state the 
conclusion of the unknown laboratory technician as expressed 
in the laboratory report indicating the CL had contracted 
chlamydia violated his right to confront and cross-examine 
 
9
witnesses as guaranteed by the Confrontation Clause of the 
Sixth Amendment to the United States Constitution.  In 
Sanders' view, Dr. Clayton did not express her opinion that CL 
had chlamydia.  Rather, she merely read into evidence the 
laboratory test results.  Sanders asserts that the test 
results are like the certificates of analysis found 
inadmissible in Melendez-Diaz in that they are clearly 
"testimonial" and not admissible at trial unless the defendant 
is afforded an opportunity to cross-examine the declarant, or 
had an opportunity on a previous occasion to cross-examine the 
declarant.  Crawford v. Washington, 541 U.S. 36, 51 (2004). 
 
As evidence of the testimonial character of the test 
results, Sanders submits that CL was referred to Dr. Clayton, 
a "child abuse pediatrician," "because of an allegation or 
disclosure of sexual abuse," and that Dr. Clayton received the 
information about this alleged sexual abuse from CL's "mother 
and the police," not CL.  Under these circumstances, Sanders 
maintains that his rights under the Confrontation Clause were 
violated because an objective person could reasonably expect 
that the test results provided to Dr. Clayton would be used in 
a later criminal prosecution.  Melendez-Diaz, 557 U.S. at ___, 
129 S.Ct. at 2537-39; Davis v. Washington, 547 U.S. 813, 822 
(2006).  
 
10
 
The Commonwealth responds that the evidence in question 
was not testimonial.  The Commonwealth submits that the 
Supreme Court in Melendez-Diaz expressly noted that "medical 
reports created for treatment purposes" are not testimonial. 
557 U.S. at ___, 129 S.Ct. at 2533 n.2.  The Commonwealth 
contends that the evidence in this case reflects that the 
"primary purpose" of the laboratory test was medical 
treatment, rather than "to prove past events potentially 
relevant to later criminal prosecutions."  Davis, 547 U.S. at 
833.  The Commonwealth therefore maintains that there was no 
violation of Sanders' Sixth Amendment right to confrontation. 
 
The Confrontation Clause of 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."  In Crawford, the 
Supreme Court limited the application of the Confrontation 
Clause to testimonial statements.  541 U.S. at 68.  The Court 
stated, "[w]here testimonial statements are at issue, the only 
indicium of reliability sufficient to satisfy constitutional 
demands is the one the Constitution actually prescribes: 
confrontation."  Id. at 68-69.  Consequently, the Court held 
that the Confrontation Clause does not allow the admission of 
testimonial statements of a witness who did not testify at 
trial "unless [the witness] was unavailable to testify, and 
 
11
the defendant had had a prior opportunity for cross-
examination."  Id. at 53-54. 
 
The Supreme Court did not comprehensively define 
"testimonial" but offered suggestions as to its meaning.  The 
Court described the "core class of testimonial statements" as 
follows: 
ex parte in-court testimony or its functional 
equivalent – that is, material such as affidavits, 
custodial examinations, prior testimony that the 
defendant was unable to cross-examine, or similar 
pretrial statements that declarants would reasonably 
expect to be used prosecutorially[;] extrajudicial 
statements . . . contained in formalized testimonial 
materials such as affidavits, depositions, prior 
testimony, or confessions[;] statements that were 
made under circumstances which would lead an 
objective witness reasonably to believe that the 
statement would be available for use at a later 
trial. 
 
Id. at 51-52 (citations and internal quotation marks omitted).  
We likewise have acknowledged there are different classes of 
testimonial statements in Walker v. Commonwealth, 281 Va. 227, 
231, 704 S.E.2d 124, 126 (2011).  See also Crawford v. 
Commonwealth, 281 Va. 84, 99-100, 704 S.E.2d 107, 116-17 
(2011). 
 
In Davis, the Supreme Court provided guidance on what 
constitutes a testimonial statement when made during the 
course of a police interrogation.  There, the Court held: 
Statements are nontestimonial when made in the 
course of police interrogation under circumstances 
objectively indicating that the primary purpose of 
 
12
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. 
 
547 U.S. at 822.   Although this definition focused on the 
"primary purpose of the interrogation," the Court emphasized 
that statements made in the absence of interrogation were not 
necessarily nontestimonial:  "[I]t is in the final analysis 
the declarant's statements, not the interrogator's questions, 
that the Confrontation Clause requires us to evaluate."  Id. 
at 822-23 n.1. 
 
In Melendez-Diaz, the Court considered whether 
certificates of analysis reporting the results of forensic 
tests were testimonial, "rendering the affiants 'witnesses' 
subject to the defendant's right of confrontation under the 
Sixth Amendment."  557 U.S. at ___, 129 S.Ct. at 2530.  At 
trial, the prosecution introduced three certificates of 
analysis establishing that substances seized by the police 
contained cocaine.  Id. at ___, 129 S.Ct. at 2531.  The 
certificates were sworn by the forensic analysts before a 
notary public as required by Massachusetts law.  Id.  The 
defendant objected to the admission of the certificates, 
asserting that Crawford required the analysts to testify in 
person.  Id. 
 
13
 
Relying on the "core class of testimonial statements" 
adverted to in Crawford, the Court concluded that the 
certificates were "quite plainly affidavits."  Id. at ___, 129 
S.Ct. at 2532.  The Court explained that the certificates were 
"functionally identical to live, in court testimony, doing 
'precisely what a witness does on direct examination.' "  Id. 
(quoting Davis, 547 U.S. at 830).  The Court further 
explained:  
[N]ot only were the affidavits made under 
circumstances which would lead an objective witness 
reasonably to believe that the statement would be 
available for use at a later trial, but under 
Massachusetts law the sole purpose of the affidavits 
was to provide prima facie evidence of the 
composition, quality, and the net weight of the 
analyzed substance.  We can safely assume that the 
analysts were aware of the affidavits' evidentiary 
purpose. 
 
Id. (citations and internal quotation marks omitted).  The 
Court therefore held that the "analysts' affidavits were 
testimonial statements, and the analysts were 'witnesses' for 
purposes of the Sixth Amendment."  Id.  Absent a showing that 
the analysts were unavailable to testify at trial and that the 
defendant had had a prior opportunity to cross-examine them, 
the defendant was "entitled to 'be confronted with' the 
analysts at trial."  Id. (quoting Crawford, 541 U.S. at 54). 
 
With these principles in mind, we turn to our analysis of 
the issue in this case.  Before doing so, we note that this 
 
14
case differs from Melendez-Diaz in that the laboratory report 
in question was never admitted into evidence at trial.  The 
circuit court ruled that the laboratory report itself was 
inadmissible, but that Dr. Clayton could "rely upon the lab 
report as part of her diagnosis."  In Melendez-Diaz, the 
Supreme Court noted that "medical reports created for 
treatment purposes" are nontestimonial.  557 U.S. at ___, 129 
S.Ct. at 2533 n.2.  This is so because statements made for 
medical treatment purposes are not made in anticipation of or 
for use in an investigation or prosecution of a crime.  
Therefore, the focus of our analysis in this case is whether 
the laboratory report as referenced in Dr. Clayton's testimony 
was created for medical treatment purposes or forensic 
investigation purposes. 
 
A recent decision by the United States Court of Appeals 
for the Fourth Circuit addressed whether the testimony of two 
expert witnesses who based their opinions in part on 
testimonial statements from unidentified declarants violated 
the defendant's Sixth Amendment right to confrontation.  
United States v. Johnson, 587 F.3d 625 (4th Cir. 2009).  
There, the court reasoned: 
Crawford forbids the introduction of testimonial 
hearsay as evidence in itself, but it in no way 
prevents expert witnesses from offering their 
independent judgments merely because those judgments 
 
15
were in some part informed by their exposure to 
otherwise inadmissible evidence. 
 
 
An expert witness's reliance on evidence that 
Crawford would bar if offered directly only becomes 
a problem where the witness is used as little more 
than a conduit or transmitter for testimonial 
hearsay, rather than as a true expert whose 
considered opinion sheds light on some specialized 
factual situation.  Allowing a witness simply to 
parrot out-of-court testimonial statements . . . to 
the jury in the guise of expert opinion would 
provide an end run around Crawford.  For this 
reason, an expert's use of testimonial hearsay is a 
matter of degree.  The question is whether the 
expert is, in essence, giving an independent 
judgment or merely acting as a transmitter for 
testimonial hearsay.  As long as he is applying his 
training and experience to the sources before him 
and reaching an independent judgment, there will 
typically be no Crawford problem.  The expert's 
opinion will be an original product that can be 
tested through cross-examination. 
 
587 F.3d at 635 (citations and internal quotation marks 
omitted). 
 
Beyond question, there is a forensic aspect to Dr. 
Clayton's duties as a child abuse pediatrician.  Part of her 
duties include "complet[ing] an assessment [of the victim] and 
giv[ing] an opinion regarding the likelihood of [sexual] 
abuse."  This involves working with law enforcement and other 
investigative agencies such as the Department of Social 
Services.  In this case, CL was referred to Dr. Clayton from 
an investigative agency.  Dr. Clayton received information 
about the sexual abuse allegations from CL's "mother and the 
police."  Dr. Clayton also understood that she was examining 
 
16
CL for signs of sexual abuse and vaginal penetration.  
Finally, clearly unlike the situation when a female patient is 
examined during a regular gynecological exam, the clinic's 
exams are recorded on video, which suggests that these videos 
could be turned over to the Commonwealth for prosecutorial 
purposes.   
 
Nevertheless, Dr. Clayton also provided medical diagnosis 
and treatment to CL.  In fact, Dr. Clayton "only performed a 
medical evaluation of [CL]," as the clinic has specialists 
such as forensic interviewers who interview the children about 
what happened to them.  Certainly, an aspect of examining a 
child for signs of sexual abuse involves diagnosing and, when 
indicated, treating the patient for injury and sexually 
transmitted infections.  Here, Dr. Clayton after observing a 
vaginal discharge sent CL's urine and vaginal swabs for 
routine testing of sexually transmitted infections.  There is 
no evidence that law enforcement requested this testing.  
There is also no evidence that Dr. Clayton knew that Sanders 
had chlamydia, as that fact was not disclosed to investigators 
until after Dr. Clayton's examination of CL.  Furthermore, the 
test for chlamydia is a diagnostic test to determine if a 
"medical condition" exists, and that unlike a DNA test, it 
does not provide information regarding the source of the 
infection.  Lastly, when the testing results came back 
 
17
positive for chlamydia, Dr. Sanders actually treated CL and 
cured the infection. 
 
Under these circumstances, Dr. Clayton's medical 
examination of CL served a dual purpose:  (1) to gather 
forensic information to investigate and potentially prosecute 
a defendant for the alleged offenses and (2) to obtain 
information necessary for medical diagnosis and treatment of 
the victim.  The laboratory report was for medical treatment 
purposes as it was created to permit Dr. Clayton to medically 
diagnose and treat CL for sexually transmitted infections.  
Because reports created for medical treatment purposes are 
nontestimonial, Sanders' Sixth Amendment right to confront 
witnesses against him was not violated.  
 
The fact that the Commonwealth sought to use the 
laboratory report in a criminal prosecution does not change 
its nontestimonial character.  In order to determine if a 
statement is testimonial, the statement must be evaluated as 
to whether the statement was "made under 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. 
 
Unlike Melendez-Diaz, where the forensic analysts 
understood that their reports would be used prosecutorially, 
there is no evidence here that the laboratory technicians that 
 
18
tested CL's samples understood that the report would be used 
to prosecute Sanders for a crime.  The victim's medical 
condition must be considered, and "[i]n determining whether a 
declarant's statements are testimonial, courts should look to 
all of the relevant circumstances."  Michigan v. Bryant, ___ 
U.S. ___, 131 S.Ct. 1143, 1161-62 (2011).  Thus, "objectively 
evaluat[ing] the circumstances," there is no basis presented 
in this record for concluding that the "primary purpose" of 
eliciting the report would reasonably have been understood by 
the laboratory technicians in California to be the development 
of a statement for use at trial.  See id. at ___, 131 S.Ct. 
1154-57 (the "medical condition of the victim" is a prominent 
consideration in determining primary purpose); see also id. at 
___, 131 S.Ct. at 1157 (reiterating that statements for 
medical treatment are "by their nature, made for a purpose 
other than use in a prosecution").  The Supreme Court has 
stated that when a court must determine whether the 
Confrontation Clause bars the admission of a statement at 
trial, it should determine the "primary purpose" of the 
statement "by objectively evaluating the statements and 
actions of the parties to the encounter."  Id. at ___, 131 
S.Ct. at 1162. 
 
The record in the present case only reflects that the 
independent laboratory performed the testing after receiving 
 
19
the samples from the clinic.  Furthermore, unlike a crime 
laboratory testing for narcotics or DNA, there are any number 
of typically non-prosecutorial reasons to test urine and 
vaginal discharge, such as for infections arising from both 
consensual sexual and nonsexual exposure to pathogens.  Thus, 
under these circumstances, a laboratory technician would not 
have reason to believe or suspect that the results of his or 
her testing would be used in a later trial.  Accordingly, we 
conclude that the lab report, and by extension Dr. Clayton's 
testimony as to its content, were not subject to exclusion 
under Melendez-Diaz.  Compare Cypress v. Commonwealth, 280 Va. 
305, 309-16, 699 S.E.2d 206, 208-11 (2010) (certificates of 
analysis admitted into evidence "establishing" that the 
substances seized were illegal narcotics, and stating the 
weight of the samples, were "testimonial"), with Aguilar v. 
Commonwealth, 280 Va. 322, 333-35, 699 S.E.2d 215, 220-22 
(2010) (the admitted material was from the live witness, who 
did not recount the "declaration[s]" or "affirmation[s]" of 
other personnel who performed functions in the analysis of 
samples, and "nothing from [the other professional] was 
presented to the fact-finder in a form 'functionally identical 
to live, in-court testimony,' doing 'precisely what a witness 
does on direct examination' "). 
 
 
20
CONCLUSION 
 
For these reasons, we hold that there is no error in the 
judgment of the Court of Appeals that the laboratory report in 
question was not testimonial for purposes of Sixth Amendment 
confrontation.  Accordingly, we will affirm Sanders' 
convictions. 
Affirmed. 
 
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