Title: STATE V. SMITH

State: new-mexico

Issuer: New Mexico Supreme Court

Document:

IN THE SUPREME COURT OF IOWA 
 
No. 13–1202 
 
Filed March 4, 2016 
 
 
STATE OF IOWA, 
 
 
Appellee, 
 
vs. 
 
TRENT D. SMITH, 
 
 
Appellant. 
 
 
 
On review from the Iowa Court of Appeals.   
 
 
Appeal from the Iowa District Court for Black Hawk County, 
Jeffrey L. Harris, Judge.   
 
 
Defendant appeals from conviction for domestic abuse assault 
causing bodily injury.  DECISION OF COURT OF APPEALS AFFIRMED 
IN PART AND VACATED IN PART; DISTRICT COURT JUDGMENT 
REVERSED AND REMANDED.   
 
 
Mark C. Smith, State Appellate Defender, and Melinda J. Nye, 
Assistant Appellate Defender, for appellant.   
 
 
Thomas J. Miller, Attorney General, Jean C. Pettinger, Assistant 
Attorney General, Thomas J. Ferguson, County Attorney, and Jeremy 
Westendorf, Assistant County Attorney, for appellee.   
 
 
 
2 
 
CADY, Chief Justice.   
 
In this appeal from a conviction for domestic abuse assault, we 
consider whether hearsay statements made to an emergency room nurse 
and doctor by a victim that identified the perpetrator of the attack were 
admissible under Iowa Rule of Evidence 5.803(4) as statements made for 
purposes of medical diagnosis or treatment.  The court of appeals found 
the hearsay statements were properly admitted at the trial.  On our 
review, we conclude there was insufficient foundation to admit the 
statements under rule 5.803(4).  We affirm the decision of the court of 
appeals in part and vacate in part, reverse the decision of the district 
court, and remand for further proceedings.   
I.  Background Facts and Proceedings.   
 
On June 9, 2012, at 1:03 a.m., the Black Hawk county emergency 
call center received a 911 call from M.D.  She gave her address and said, 
“Just get here, thank you, please!”  A short time later, M.D.’s mother 
called the center on a nonemergency line.  She told the phone operator 
that M.D. asked her to call the police to report that Trent Smith had 
threatened M.D. and that M.D. was afraid of him.   
 
Two officers were dispatched to M.D.’s residence.  They found M.D. 
sitting in a car outside the residence with her five-year-old daughter and 
a dog.  The officers checked the residence for intruders and began their 
investigation by interviewing M.D.    
 
M.D. told the officers she had been upstairs and after hearing a 
sound was “hit” by something when going downstairs in the dark to 
investigate.  She also said she lost consciousness after she was kicked in 
the head.  She told the officers she believed the assailant had entered her 
residence through a locked door.  M.D. eventually identified her assailant 
as “Trent Daniel,” whom dispatch officers later identified as Trent Smith.  
 
3 
 
M.D. said Smith did not live at her residence but had been abusing her 
for ten years.  She mentioned one prior assault when Smith beat her 
after he was released from jail following an arrest for domestic abuse.   
 
The officers took M.D. to the emergency room of a local hospital 
around 2:40 a.m.  She was treated by a doctor and a nurse for her 
injuries.  The doctor found M.D. to be “in a moderate amount of distress” 
and “extremely shaken up.”  The nurse asked M.D. to explain what had 
happened to her.  M.D. responded that she was “assaulted by her baby’s 
daddy around midnight.”  She told the nurse that she had been kicked in 
the head and right arm, and she felt that her front teeth were loose.  The 
nurse also pursued several standard screening questions at some point 
during the evening.  Three questions pertained to domestic abuse.  In 
response to these questions, M.D. indicated she did “feel afraid 
of/threatened by someone close to me.”  She also responded she had 
“been hurt by someone.”  She further agreed that “someone is taking 
advantage of [her].”   
 
In response to an inquiry by the doctor about how she sustained 
her injuries, M.D. said she had been assaulted by her child’s father.  
However, the doctor did not make any domestic abuse diagnosis or 
render any treatment for emotional or psychological injuries based on the 
identity of the perpetrator.  The identity of the assailant or the effects of 
domestic abuse were not mentioned as a part of any treatment or 
diagnosis.  The treatment consisted of radiology testing and other 
medical care to those areas of the body that had sustained physical 
injury.  The diagnosis by the doctor pertained solely to the physical 
injuries sustained by M.D.  It was limited to a closed head injury, 
cervical strain, facial contusion, and arm contusions.   
 
4 
 
 
M.D. was released from the hospital around 5 a.m.  She was 
prescribed pain and antianxiety medications.  The officers took her to the 
law enforcement center to obtain a written statement.  An officer wrote a 
statement based on M.D.’s statements earlier in the night, but M.D. 
refused to acknowledge it with her signature.   
 
Smith was subsequently charged with domestic abuse assault with 
intent to cause serious injury and domestic abuse assault causing bodily 
injury, both in violation of Iowa Code section 708.2A(2) (2011).  At a 
pretrial hearing, the State informed the district court that M.D. intended 
to recant her statements identifying Smith as her assailant.  The State 
further informed the court it intended to prove Smith was the assailant 
through the statements made by M.D. to the officers and medical 
personnel.  In particular, the State indicated they would offer M.D.’s 
statements of identification made to the emergency room nurse and 
doctor under the medical treatment and diagnosis exception to the rule 
against hearsay.  In response, Smith claimed the statements were not 
part of any medical diagnosis or treatment.  The district court ultimately 
determined the identification statements were admissible at trial under 
the medical treatment and diagnosis exception to the rule against 
hearsay.  It also determined M.D.’s statements to police were admissible 
at trial under the excited-utterance exception to the rule against hearsay.  
The State never argued the statements to the nurse and doctor were also 
admissible as excited utterances, and the district court did not rely on 
the excited-utterance exception in admitting them.   
 
The case proceeded to trial.  Law enforcement officers and medical 
personnel at the hospital testified at trial for the State, as well as a 
domestic abuse expert.  The officers and medical providers recalled the 
statements M.D. made to them the night of the incident that identified 
 
5 
 
Smith as her assailant.  There was no testimony that M.D. was told how 
the questions related to her treatment or diagnosis, and there was no 
testimony how they were used or needed by medical providers in her 
treatment or diagnosis.  The domestic abuse expert explained the 
dynamics of domestic abuse, including the control exercised by the 
perpetrator.  M.D. testified for Smith at trial.  She said she was injured 
when she fell from a trampoline after drinking in excess.   
 
The jury found Smith guilty of domestic abuse assault and 
domestic abuse assault causing bodily injury.  Following sentencing, 
Smith appealed.  He claimed the district court erred in admitting the 
hearsay statements made to police and medical personnel.  He also 
claimed the district court erred in failing to merge the two convictions for 
purposes of sentencing.   
 
We transferred the case to the court of appeals.  It found the 
district court erred by admitting M.D.’s statements to police as excited 
utterances.  However, it found the district court did not err in admitting 
M.D.’s statements made to the nurse and doctor as statements for 
purposes of medical diagnosis or treatment.  As a result, the court of 
appeals found Smith was not prejudiced by the admission of the hearsay 
statements to police.  It merged the convictions and affirmed the 
judgment and sentence for domestic abuse assault causing bodily injury.   
 
Smith sought, and we granted, further review.  The primary claim 
asserted by Smith is the statements of identity made to the doctor and 
nurse were inadmissible under the medical treatment and diagnosis 
exception.  The State did not seek further review from the decision by the 
court of appeals that the statements made to police were not admissible 
as excited utterances.  Accordingly, that decision stands as the final 
determination on that issue.  See State v. Guerrero Cordero, 861 N.W.2d 
 
6 
 
253, 258 (Iowa 2015) (addressing on further review only one of four 
issues raised on appeal).   
 
II.  Scope of Review.   
Although we normally review evidence-admission decisions by the 
district court for an abuse of discretion, we review hearsay claims for 
correction of errors at law.  State v. Paredes, 775 N.W.2d 554, 560 (Iowa 
2009).  “[T]he question whether a particular statement constitutes 
hearsay presents a legal issue,” leaving the trial court no discretion on 
whether to admit or deny admission of the statement.  State v. Dullard, 
668 N.W.2d 585, 589 (Iowa 2003).   
With respect to the issue now raised on further review involving 
the district court’s decision to admit at trial the statements of identity 
made to the medical providers, we recognize we may affirm a ruling on 
the admission of evidence by using a different rationale than relied on by 
the district court.  See DeVoss v. State, 648 N.W.2d 56, 62 (Iowa 2002).  
However, the rule described in DeVoss is discretionary, and we must be 
careful not to exercise our discretion to decide an issue concerning the 
admissibility of evidence on an alternative ground when the parties have 
not had an opportunity to properly develop or challenge the foundation 
for the evidence.    
III.  Admission of Statements Identifying Perpetrator.   
 
“ ‘Hearsay’ is a statement, other than one made by the declarant 
while testifying at the trial or hearing, offered in evidence to prove the 
truth of the matter asserted.”  Iowa R. Evid. 5.801(c).  Hearsay is not 
admissible at trial subject to certain exceptions and exclusions.  See id. 
r. 5.802.   
 
The statements at issue in this case—third-party accounts of 
identification statements made by M.D.—are hearsay.  The question is 
 
7 
 
whether they are admissible under an exception to the rule against 
hearsay.   
 
The general rationale for the rule against hearsay is that out-of-
court statements are inherently unreliable because false perception, 
memory, or narration of the declarant cannot be addressed through the 
admission of an oath or exposed through cross-examination of the 
declarant.  See 5 Jack B. Weinstein & Margaret A. Berger, Weinstein’s 
Federal Evidence § 802.02[3], at 802-6 to -7 (Mark S. Brodin 2d ed. 
2015) [hereinafter Weinstein].  Thus, the exceptions to the rule against 
hearsay generally overcome this rationale through the identification of 
circumstances surrounding the issuance of the statement that 
demonstrate its reliability and necessity.  See id. § 802.03[3] [a], at 802-
8.   
 
One exception to the rule against hearsay relates to statements 
made for the purposes of medical diagnosis and treatment.  Iowa R. Evid. 
5.803(4).  This exception applies to  
[s]tatements made for purposes of medical diagnosis or 
treatment and describing medical history, or past or present 
symptoms, pain, or sensations, or the inception or general 
character of the cause or external source thereof insofar as 
reasonably pertinent to diagnosis or treatment. 
Id.  The rationale for the exception is that statements made by a patient 
to a doctor for purposes of medical diagnosis or treatment are “likely to 
be reliable because the patient has a selfish motive to be truthful.”  
Weinstein § 803.06[1], at 803-41 to -42; see 7 Laurie Kratky Doré, Iowa 
Practice Series: Evidence § 5.803:4, at 951–52 (2015–2016 ed. 2015) 
[hereinafter Doré].  This motive exists because the effectiveness of the 
medical treatment rests on the accuracy of the information imparted to 
the doctor.  Weinstein § 803.06[1], at 803-41 to -42.  A patient 
 
8 
 
understands that a false statement in a diagnostic context could result in 
misdiagnosis.  State v. Tornquist, 600 N.W.2d 301, 304 (Iowa 1999), 
overruled on other grounds by State v. DeCamp, 622 N.W.2d 290 (Iowa 
2001).  Thus, the circumstances of statements made for diagnosis and 
treatment provide “special guarantees of credibility” and justify the 
exception to the rule against hearsay.  State v. Hildreth, 582 N.W.2d 167, 
169 (Iowa 1998).   
 
The medical diagnosis or treatment exception imposes two 
requirements.  First, the exception applies to statements “made for 
purposes of medical diagnosis or treatment.”  Iowa R. Evid. 5.803(4).  
Second, the statements must describe “medical history, or past or 
present symptoms, pain, or sensations, or the inception or general 
character of the cause or external source thereof insofar as reasonably 
pertinent to diagnosis or treatment.”  Id.  Thus, the first requirement is 
directed at the purpose and motive of the statement, and the second 
requirement is directed at the content or description of the statement.  
Yet as to both requirements, the statements must also “be reasonably 
pertinent to diagnosis or treatment.”  Doré § 5.803:4, at 952.  These 
requirements track with the two-part test we adopted in State v. Tracy for 
establishing the admission of hearsay statements identifying a child 
abuser under the exception for medical diagnosis and treatment.  482 
N.W.2d 675, 681 (Iowa 1992) (“[F]irst[,] the declarant’s motive in making 
the statement must be consistent with the purposes of promoting 
treatment; and second, the content of the statement must be such as is 
reasonably relied on by a physician in treatment or diagnosis.” (quoting 
United States v. Renville, 779 F.2d 430, 436 (8th Cir. 1985))).   
 
The fighting issue in this case is whether the portion of the 
statement made to a doctor or nurse that identifies the person who 
 
9 
 
caused or was the source of the injury is reasonably pertinent to 
diagnosis or treatment.  This is a question that can be vexing for judges 
and lawyers.  Normally, the identity of the perpetrator of physical injuries 
is not understood to be necessary information for effective medical 
treatment.  United States v. Joe, 8 F.3d 1488, 1494 (10th Cir. 1993).  
Thus, these statements generally lack the inherent reliability of 
statements by patients to doctors for medical diagnosis or treatment.  
Colvard v. Commonwealth, 309 S.W.3d 239, 245–46 (Ky. 2010) (finding 
no inherent trustworthiness in identification statement not arising from a 
desire for effective treatment).  When the identity of the perpetrator of an 
injury is not necessary information for effective medical treatment, a 
declarant could remain motivated to truthfully describe the cause of 
injuries while being motivated to suppress or twist the identity of the 
perpetrator towards their own ends.  See State v. Long, 628 N.W.2d 440, 
444 (Iowa 2001) (noting ulterior motives aside from treatment may affect 
statements of causation made to medical providers).  In other words, self-
motivation to be truthful that supports the admission of statements 
under the exception may be absent when the identity of the perpetrator 
is not necessary or pertinent to the medical diagnosis or treatment.  See 
id.  Accordingly, each assertion sought to be admitted that is contained 
within a broader statement made to medical providers must meet the 
requirements of the exception to be admissible.   
 
We have identified some circumstances when statements that 
identify perpetrators are admissible under Iowa Rule of Evidence 
5.803(4).  One circumstance involves the identity of perpetrators of child 
abuse.  See Tracy, 482 N.W.2d at 681–82.  When the “alleged abuser is a 
member of the victim’s immediate household, statements regarding the 
abuser’s identity are reasonably relied on by a physician in treatment or 
 
10 
 
diagnosis.”  Id. at 681.  The emotional and psychological injuries of such 
abuse are treated by the doctor along with the physical injury.  Id.  The 
doctor is also often concerned about the possibility of recurrent abuse.  
Id.  In Tracy, the doctor followed a standard dialogue for purposes of 
diagnosis and treatment, and the victim understood that the doctor 
needed truthful responses to provide treatment.  Id.  This circumstance 
is key to admitting statements of identity.  The circumstances need to 
show that the victim’s statements are “not prompted by concerns 
extraneous to the patient’s physical or emotional problem.”  Hildreth, 582 
N.W.2d at 169–70.   
 
The State argues that cases of domestic abuse fall within the same 
rule that commonly allows statements of the identity of perpetrators in 
cases of child abuse to be admitted.  It argues the circumstances of this 
case fit within the reasoning behind the child-abuse exception because 
they do not show M.D. was motivated to be untruthful when she 
identified Smith as the assailant.   
 
The State’s overarching argument suggests that a categorical rule 
has emerged from rule 5.803(4) that admits statements of identity made 
to medical personnel by victims of child abuse and that should also 
apply to victims of domestic abuse.  Yet, no such categorical rule for 
victims of child abuse has been recognized.  While it is common for 
statements of identity made by victims of child abuse to be admitted 
under rule 5.803(4), the statements are not admitted simply because 
they fall within a category of statements made to doctors or medical 
personnel by victims of abuse.  Instead, these statements are admitted 
only when there is evidence that the statements of identity were made by 
a child-abuse victim for purposes of diagnosis or treatment by a doctor or 
medical provider and the identity was pertinent to the diagnosis or 
 
11 
 
treatment.  See State v. Dudley, 856 N.W.2d 668, 676 (Iowa 2014) (“The 
child must make the statements to a trained professional for the 
purposes of diagnosis or treatment to be admissible under rule 
5.803(4).”); Doré § 5.803:4, at 957–58 & nn.22–23 (collecting cases and 
contrasting how courts apply the rule); see also State v. Neitzel, 801 
N.W.2d 612, 621–22 (Iowa Ct. App. 2011) (discussing the steps taken by 
health care professionals to ensure truthfulness and the need to assess 
safety risks and the child’s need for further counseling).  Eliciting the 
identity of a perpetrator of child abuse can be a normal aspect of medical 
treatment and diagnosis for child abuse victims; however, the value of 
that information is established by the foundational testimony of the 
doctors and medical providers in each case, and that testimony explains 
the pertinence of the perpetrator’s identity to the diagnosis and 
treatment of the victim in the uinique circumstances of each case.  See, 
e.g., Hildreth, 582 N.W.2d at 169–70 (setting foundation for social 
workers’ diagnosis of child’s emotional disturbance resulting from sexual 
abuse).  The need to establish foundation for the admission of evidence 
under rule 5.803(4) is compatible with the standard approach to the 
admission of evidence under most other rules of evidence.  In other 
words, proper foundation must normally be established before evidence 
may be admitted.  See State v. Tompkins, 859 N.W.2d 631, 639 (Iowa 
2015) (requiring the State to lay a proper foundation before finding 
hearsay statements identifying a domestic abuse assailant and his 
actions admissible).  There is no rule that provides a categorical 
exception for victims of child abuse or domestic abuse.   
 
The profound and serious problem of domestic abuse in this nation 
and this state does not escape us in our analysis of this case.  These 
problems are significant for victims of domestic abuse and the children 
 
12 
 
who have suffered by witnessing the abuse.  The consequences to these 
victims and society as a whole are diverse and immense.  These are 
problems and consequences this court has been addressing for decades.  
See generally Final Report of the Supreme Court Task Force on Courts’ and 
Communities’ Response to Domestic Abuse (1994) (compiling statistics on 
the incidence of domestic abuse in Iowa, identifying the courts’ role, and 
formulating recommendations to address the problem from the judicial 
standpoint).  We are also aware that the underlying dynamics of 
domestic abuse can create many obstacles in the criminal prosecution of 
perpetrators.  See Laurie S. Kohn, The Justice System and Domestic 
Violence: Engaging the Case but Divorcing the Victim, 32 N.Y.U. Rev. L. & 
Soc. Change 191, 200–06 (2008) (discussing the influence of outside 
factors on victims’ behavior both before and after reporting abuse and 
affecting their cooperation with the justice system).  These complex 
dynamics can lead many victims to refrain from reporting abuse and 
then further lead to the recantation of statements of identity prior to 
trial.  See id. at 203–05 (noting victims may ask to drop the criminal 
case, refuse to testify, recant, or downplay their risks); Jennifer L. 
Truman & Rachel E. Morgan, U.S. Dep’t of Justice, Nonfatal Domestic 
Violence, 2003–2012, at 9 & tbl. 8, http://www.bjs.gov/content/pub/ 
pdf/ndv0312.pdf (revealing only around fifty-five percent of domestic 
violence is reported to police).  Nevertheless, our role in reviewing the 
admission of the hearsay statements at trial in this case is not to inject 
this policy into the analysis to create a new rule of evidence.  Our 
authority to establish rules to govern the trial of a case exists 
independent of our authority to decide issues presented to us on appeal 
in cases.  Today, we only address the issue of admission of statements of 
 
13 
 
identity through our existing rule of evidence.  Our role is to interpret the 
rule as it is written and apply the hearsay exception as it exists.   
 
Moreover, any categorical evidentiary rule must carefully consider 
the competing interests at stake.  These interests include those found in 
the constitutional right of people accused of crimes to be confronted by 
their accusers.  See, e.g., State v. Bentley, 739 N.W.2d 296, 300–01 (Iowa 
2007) (weighing accused’s confrontation right against the interests of a 
child abuse victim).  They are also found in the concept of fundamental 
fairness.  See Iowa R. Evid. 5.102.  The sheer complexity of domestic 
abuse would need to be considered, including both the interests of the 
victim and the rights of the accused.  It has been observed that “there is 
neither a ‘typical’ victim of domestic violence, nor ‘typical’ responses, nor 
‘typical’ circumstances in which such violence occurs.”  Jane C. Murphy 
& Robert Rubinson, Domestic Violence and Mediation: Responding to the 
Challenges of Crafting Effective Screens, 39 Fam. L.Q. 53, 58 (2005) 
(footnotes omitted).  Thus, any categorical rule cannot be adopted that 
would “ignore[] variables such as the seriousness of the assault, the 
frequency of the abuse against the victim, the type of domestic 
relationship, or the presence or absence of emotional or psychological 
harm.”  State v. Robinson, 718 N.W.2d 400, 407 (Minn. 2006) (refusing to 
adopt a categorical exception to rule 803(4) in domestic violence cases).   
 
We understand how the identity of an abuser could be pertinent to 
the treatment of a domestic abuse victim by a doctor.  Domestic abuse 
victims suffer from far more than physical injuries.  Emotional and 
psychological injuries are also inflicted with an assault, and it is 
understandable how the depth and breadth of those injuries would vary 
depending on the identity of the abuser.  As a result, we see how 
complete medical treatment could normally include information on the 
 
14 
 
identity of the abuser.  Yet, until a categorical rule exists, this 
understanding must be supplied from the testimony of doctors in the 
form of foundation pursuant to the broad rule providing for the 
admission of hearsay statements for all types of medical treatment.  See 
Joe, 8 F.3d at 1494 & n.6 (citing to doctor testimony that established 
foundation despite finding there is general need for identity knowledge in 
domestic abuse cases).   
 
In this light, we reject the argument by the State that statements of 
identity by victims of domestic abuse should be categorically admissible 
because such statements are now commonly admitted in cases of child 
abuse.  Instead, we hold that in each case, the trial court must, as with 
other statements made during medical diagnosis and treatment, apply 
the test we adopted in Tracy to determine whether the statements made 
in that case should fall within this exception to the hearsay rule.1  482 
N.W.2d at 681.  The State, as the proponent of the evidence, has the 
burden to show the statements fit within rule 5.803(4).2  Long, 628 
N.W.2d at 443.   
1Several other courts also examine whether criteria similar to our Tracy test 
have been met before admitting identity statements.  E.g., United States v. Bercier, 506 
F.3d 625, 632 (8th Cir. 2007) (requiring foundation that the statements were essential 
to diagnosis and treatment in domestic sexual abuse case); Robinson, 718 N.W.2d at 
407 (holding domestic abuse victim’s identification of her assailant inadmissible 
without sufficient evidentiary foundation establishing the identity was reasonably 
pertinent to diagnosis or treatment); State v. Moen, 786 P.2d 111, 118–21 (Or. 1990) 
(en banc) (examining prior statements made concerning domestic abuse causing 
victim’s depression to determine whether they met the foundational criteria of 
pertinence to medical diagnosis in murder case); Oldman v. State, 998 P.2d 957, 961–62 
(Wyo. 2000) (utilizing the Renville criteria to determine the identity in a domestic abuse 
case was pertinent for treating bite marks for infectious condition).   
2We recognize that statements made to emergency personnel in order to obtain 
medical treatment can also fall within the excited-utterance exception to the hearsay 
rule.  Iowa R. Evid. 5.803(2); State v. Harper, 770 N.W.2d 316, 319–20 (Iowa 2009) 
(finding no need to determine if the statements would fall within rule 5.803(4) by 
holding other exceptions applied).  However, the State made no claim in the district 
court or its appeal that the excited-utterance rule should apply.   
                                      
 
 
15 
 
The foundation required to admit a statement identifying a 
perpetrator of domestic abuse under rule 5.803(4) need not be elaborate.  
It establishes why the identity of the assailant is important in a domestic 
abuse case, as opposed to stranger assault, and what effect that identity 
has on diagnosis or treatment.  It recognizes there is a difference between 
the need to know the cause or external source of the injuries—i.e., “what 
happened”—and the need to know the identity of the person causing the 
injuries.  See United States v. Iron Shell, 633 F.2d 77, 84 (8th Cir. 1980) 
(“It is important to note that the statements concern what happened 
rather than who assaulted her.  The former in most cases is pertinent to 
diagnosis and treatment while the latter would seldom, if ever, be 
sufficiently related.”).3  It requires evidence that the identity of the 
perpetrator was reasonably pertinent to medical treatment or diagnosis.  
We now turn to the evidence in this case.   
The trial record in this case shows the nurse and the doctor only 
asked M.D. how she was injured, and their treatment efforts that 
followed only focused on the physical trauma to her head, arm, and 
hand.  The nurse also asked three questions pertaining to domestic 
abuse in general pursuant to a broader screening protocol.  However, the 
State offered no evidence that the protocol questions prompted any 
treatment of M.D. for her emotional or psychological response to the 
injuries or were asked in order to make a diagnosis relating specifically to 
domestic assault over other types of assault.  In other words, the 
foundational evidence relating to her statements only pertained to the 
3The United States Court of Appeals for the Eighth Circuit found five years later 
that a child-abuse victim who lived in the same household with the abuser was 
sufficiently different to fall within the narrow seldom-sufficiently-related category left 
open by Iron Shell.  Renville, 779 F.2d at 436.   
                                      
 
 
16 
 
treatment she received for her physical injuries, not treatment she might 
have needed for her emotional, psychological, or other injuries as a result 
of the domestic violence. 
 
M.D. was prescribed antianxiety medication prior to her discharge, 
but there was no evidence that the medication pertained to treatment of 
domestic abuse rather than the same anxiety as might be felt in a 
stranger-assault situation.  It would be pure speculation to conclude the 
antianxiety medication related to the identity of the perpetrator.  The rule 
requires that the connection between the statement and the treatment be 
“reasonable.”  Iowa R. Evid. 5.803(4).   
Importantly, there was no evidence to suggest M.D. believed the 
identity of the perpetrator was reasonably pertinent to her treatment or 
diagnosis.  There was no evidence the nurse or doctor told M.D. the 
identity of the perpetrator was important to the treatment or diagnosis of 
her injuries.  There was no evidence the nurse or doctor used the identity 
of the perpetrator to treat or diagnosis M.D.’s injuries.  In fact, there was 
nothing from the circumstances at the hospital to reasonably indicate 
M.D.’s treatment or diagnosis would have been different if she had not 
mentioned the identity of her perpetrator in describing how she was 
injured. 
In short, the State presented insufficient evidence that the identity 
of the assailant was reasonably pertinent to M.D.’s diagnosis or 
treatment.  Consequently, the circumstances mandated by the exception 
to show M.D. was self-motivated to truthfully describe her assailant were 
not established.  Without this foundation, the trial court erred in 
admitting the portion of the statement that identified Smith as the 
assailant.   
 
17 
 
We acknowledge that the general circumstances presented at trial 
do not suggest a motivation by M.D. to be untruthful in her identification 
of Smith as her assailant to the emergency room nurse and doctor.  Her 
statements of identity were not prompted by any cues asking for the 
identity of the perpetrator, and she only conveyed Smith’s identity as 
part of the description of how she was injured.4  Yet the exception does 
not seek to use the absence of a motive to be untruthful, but it requires 
evidence of a specific motivation to be truthful derived from its rationale.  
We are required to follow rule 5.803(4) as it is written.   
This conclusion does not mean the identity of a perpetrator of 
domestic abuse can never be admitted into evidence under rule 5.803(4).  
It only means that the State must introduce evidence to establish the 
necessary foundation regarding both the declarant’s motive in making 
the statement and the pertinence of the identification in diagnosis or 
treatment.  This foundation requires evidence that a statement of identity 
was made for the purpose of medical diagnosis or treatment and the 
identity was part of a medical history reasonably pertinent to diagnosis 
or treatment.   
IV.  Conclusion.   
We conclude the trial court committed legal error by admitting the 
hearsay statements of M.D. through the testimony of the emergency 
room nurse and doctor without sufficient foundation.  This error resulted 
in prejudice and requires a new trial.  To be fair to both parties, we 
decline to consider for the first time on appeal whether the evidence 
4M.D. recanted not only the identity of an assailant, but even the existence of an 
assault causing her injuries when she testified in court.  However, the treating nurse 
and physician both testified that M.D.’s injuries were consistent with the description of 
the assault that evening.   
                                      
 
 
18 
 
would have been admissible under another exception to the rule against 
hearsay.  Accordingly, we reverse the judgment and sentence of the 
district court and remand for a new trial.   
DECISION OF COURT OF APPEALS AFFIRMED IN PART AND 
VACATED IN PART; DISTRICT COURT JUDGMENT REVERSED AND 
REMANDED.   
All justices concur except Waterman, Mansfield, and Zager, JJ., 
who dissent.   
 
 
 
19 
 
 
#13–1202, State v. Smith 
 
WATERMAN, Justice (dissenting). 
 
I respectfully dissent.  I agree with the court of appeals that the 
district court properly allowed the emergency room physician and nurse 
to testify regarding the victim’s identification of Smith, her ex-boyfriend 
and the father of her child, as her attacker.  That information was 
elicited pursuant to the hospital’s screening protocol to protect patients 
traumatized by suspected domestic abuse.  As the medical community 
and many other courts have long recognized, identifying the abuser is a 
key component in treating the patient’s mental and physical injuries and 
ensuring the patient’s safety.  The majority errs by holding the district 
court abused its discretion by admitting the testimony under Iowa Rule 
of Evidence 5.803(4) and misses the opportunity to adopt a categorical 
rule allowing medical treatment providers to testify regarding a patient’s 
identification of an intimate partner as the assailant.  In my view, our 
court adopted a categorical rule in child abuse cases, and the rationale 
easily extends to adult domestic abuse.  I would join the parade of courts 
adopting a categorical rule.  Our application of this rule of evidence 
should evolve in response to the growing understanding and body of 
medical literature on intimate-partner violence.   
Moreover, even if I agreed with the majority that admission of this 
kind of evidence should occur only on a case-by-case basis, I would find 
the record here adequate to warrant its admission.  The State in this 
case laid the requisite foundation for the admission of the evidence under 
rule 5.803(4).  This case is emblematic of the recurring problem in 
domestic abuse cases—a victim who identifies the attacker while 
traumatized but then later, controlled by his or her abuser, changes his 
or her story or refuses to cooperate with the prosecution.  I trust Iowa 
 
20 
 
juries to find the truth.  In this case, the jury disbelieved the victim’s trial 
testimony that her injuries resulted from falling off a trampoline and 
believed what she told her treating physician and nurse the night of her 
attack.   
I would also affirm the district court ruling allowing the physician 
and nurse to testify as to the victim’s identification of her assailant on an 
alternative ground the majority understandably declines to reach—the 
excited-utterance exception to the hearsay rule.  The victim was still 
reeling from the assault when she spontaneously identified Smith at the 
hospital simply when asked what happened to her.  We may affirm an 
evidentiary ruling on any valid alternative ground supported by the 
record.  See DeVoss v. State, 648 N.W.2d 56, 62 (Iowa 2002).  The State, 
however, did not raise that ground in district court or brief it on appeal, 
and the court of appeals did not reach it as to the emergency room 
personnel.  The majority appropriately chooses to defer deciding the 
issue under these circumstances, and nothing in today’s opinion 
precludes the State from relying on the excited-utterance exception in 
the second trial.   
 
I.  Additional Facts.   
 
The majority’s recitation of the facts is truncated.  To put the 
issues in better context, I will recapitulate what happened to M.D.  When 
police officers responding to her 911 call arrived at her home at 1 a.m., 
M.D., age twenty-nine, was sitting in her car with her five-year-old 
daughter and dog.  M.D. was crying, upset, tense, and scared, with 
visible injuries—a swelling in her arm and around one eye, and scratches 
on her shoulder and knees.  She initially told police an intruder had 
jimmied the side door lock and attacked her.  She said he called her a 
“dirty whore,” punched her, knocked her to the floor, and kicked the 
 
21 
 
back of her head repeatedly.  She told officers she had blacked out 
during the attack and thought her arm was broken.  At first she claimed 
she did not know her assailant.  The officers were skeptical because they 
had previously been summoned to M.D.’s home over an altercation with 
Trent Daniel Smith, the father of her child.5  The police persisted in 
questioning M.D. and urged her to be honest with them.  She indicated 
she was afraid of her attacker and told police, “[Y]ou guys can’t protect 
me forever.”  She then said “Trent Daniel” attacked her.  Under further 
questioning, M.D., who seemed scared, gave Smith’s full name. 
The police officers gave M.D. a ride to the emergency room at Allen 
Memorial Hospital for treatment.  When she arrived, she was “extremely 
shaken up.”  Nurse Trisha Knipper asked M.D. what happened and wrote 
down that M.D. said she “was assaulted by her baby’s daddy around 
midnight.”  Knipper, pursuant to the hospital’s protocol, asked M.D. 
screening questions that are asked of every patient who presents with a 
traumatic injury.  M.D. answered that “there was domestic violence going 
on,” “she was afraid of or threatened by someone close to her,” “she had 
been physically hurt by her baby’s dad,” and “she felt as if someone was 
taking advantage of her.”   
Approximately eleven minutes after being admitted to the 
emergency room, M.D. spoke with Dr. Robert Mott.  Dr. Mott asked what 
happened, and she replied she “was assaulted by the father of her child.”  
She said she was knocked to the ground and kicked in the head and face 
multiple times.  Dr. Mott noted that she was in a lot of pain and her arm 
5Smith was the father of M.D.’s daughter.  M.D. and Smith also had a son 
together, but the son died.   
                                      
 
 
22 
 
was very tender.  No bone fractures were found.  M.D. was given 
antianxiety medication and discharged at 5 a.m.   
At trial eleven months later, M.D. changed her story to claim her 
injuries resulted from falling off a trampoline.  The jury heard the 
testimony of the emergency room nurse and physician and police that 
M.D. had identified Smith as her attacker.  The jury convicted Smith of 
domestic abuse assault and domestic abuse causing bodily injury.  The 
court of appeals affirmed his convictions, concluding the district court 
properly admitted the testimony of the emergency room physician and 
nurse under Iowa Rule of Evidence 5.803(4) and that it was harmless 
error to admit the police officer’s testimony of M.D.’s identification of 
Smith under the excited-utterance exception, rule 5.803(2).  I would 
affirm the decisions of the district court and court of appeals.
 
II.  The Medical Diagnosis and Treatment Exception.   
 
The fighting issue is whether the patient’s identification of her 
assailant is admissible under the hearsay exception for  
[s]tatements made for purposes of medical diagnosis or 
treatment and describing medical history, or past or present 
symptoms, pain, or sensations, or the inception or general 
character of the cause or external source thereof insofar as 
reasonably pertinent to diagnosis or treatment.   
Iowa R. Evid. 5.803(4).  In State v. Tracy, we adopted the Renville two-
part test to establish the admissibility of statements under this 
exception:  
[F]irst[,] the declarant’s motive in making the statement 
must be consistent with the purposes of promoting 
treatment; and second, the content of the statement must be 
such as is reasonably relied on by a physician in treatment 
or diagnosis.   
482 N.W.2d 675, 681 (Iowa 1992) (quoting United States v. Renville, 779 
F.2d 430, 436 (8th Cir. 1985)).  In Renville, the United States Court of 
 
23 
 
Appeals for the Eighth Circuit applied that test to affirm a trial court 
ruling that admitted a treating physician’s testimony regarding the child 
abuse victim’s identification of her abuser during a medical examination.  
779 F.2d at 438–39.  As I show below, our decisions in child abuse cases 
reach the same conclusion and demonstrate that a domestic abuse 
victim’s identification of his or her attacker is admissible under this test.   
A.  M.D.’s Statement Was Reasonably Pertinent to Medical 
Diagnosis or Treatment.  The emergency room nurse, Knipper, testified 
that M.D., like every patient admitted into the emergency room, was 
asked screening questions under the hospital’s standard protocol.  These 
questions covered topics including domestic violence, suicide, and 
workplace injuries.  M.D.’s responses indicated she had experienced 
domestic violence.  Each response was noted in M.D.’s chart.  Knipper 
testified that she is required to “document complaints and treatment and 
diagnoses” on a chart for every patient that enters the hospital.  The 
chart is maintained as a reference “for continued care” or “for any other 
needs that come about.”  Knipper’s testimony shows that the 
documented responses to these standardized questions are used by the 
medical community in crafting a treatment plan and diagnosing the 
patient.  M.D. replied to the standard questions by identifying Smith.  
M.D.’s statement was responsive to the questions being asked, and that 
information can be useful for diagnosis or treatment.   
Dr. Mott’s testimony showed that he considers the patient’s version 
of what happened to be highly relevant to treatment.  Dr. Mott testified 
regarding how he approaches new patients in the emergency room:  
 
Q.  And do you try to find out from the patient what 
had happened?  A.  Absolutely.   
 
Q.  Is that necessary for treating the patient?  A.  That 
is key.   
 
24 
 
When M.D. entered the emergency room, Dr. Mott followed his protocol 
to determine how to proceed with treatment:  
 
Q.  And did you speak with [M.D.] about what had 
happened?  A.  I did.   
 
Q.  And what did she say occurred?   
 
MS. LAVERTY: Objection.   
 
THE COURT: Same ruling.  Overruled.   
 
Q.  You may answer.  A.  Okay.  She said that she was 
assaulted by the father of her child, was pretty much the 
first thing that she told me.   
 
Q.  And did she explain to you how she was assaulted?  
A.  She stated that she was knocked to the ground.  And 
then once she was on the ground, then she was kicked in 
the head and the face multiple times.   
His medical testimony showed that M.D.’s explanation of why she came 
to the emergency room was key to determine a proper course of 
treatment.  See Vasconez v. Mills, 651 N.W.2d 48, 56 (Iowa 2002) (noting 
a doctor “who is called to treat and actually treats the patient” may 
testify under the hearsay exception because there is an increased 
“probability that the patient will not falsify in statements made to his 
physician at a time when he is expecting and hoping to receive from him 
medical aid and benefit.” (quoting Devore v. Schaffer, 245 Iowa 1017, 
1021, 65 N.W.2d 553, 555 (1954))).   
M.D. consistently identified Smith as her attacker to medical 
personnel that night.  That she recanted nearly a year later at trial does 
not cast doubt on her motives when seeking treatment the night of her 
attack.  See Douglas E. Beloof & Joel Shapiro, Let the Truth Be Told:  
Proposed Hearsay Exceptions to Admit Domestic Violence Victims’ Out of 
Court Statements as Substantive Evidence, 11 Colum. J. Gender & L. 1, 
3–4 (2002) (listing reasons why victims recant).  The rate of recantation 
among domestic violence victims has been estimated between eighty and 
ninety percent.  Id.; Lisa Marie De Sanctis, Bridging the Gap Between the 
 
25 
 
Rules of Evidence and Justice for Victims of Domestic Violence, 8 Yale J.L. 
& Feminism 359, 367 (1996); see also People v. Brown, 94 P.3d 574, 576 
(Cal. 2004) (approving the use of expert testimony stating that “[a]bout 
80 to 85 percent of victims ‘actually recant at some point in the 
process’ ”); State v. Dority, 324 P.3d 1146, 1152 (Kan. Ct. App. 2014) 
(noting that a fact finder may use common knowledge that “victims of 
domestic violence often recant their initial statements to police” (quoting 
State v. Coppage, 124 P.3d 511, 515 (Kan. Ct. App. 2005))).   
Dr. Mott and Knipper treated M.D. for her emotional or 
psychological response to the attack.  She was prescribed antianxiety 
medication.  The hospital’s screening questions do not exist in a vacuum.  
The questions about domestic abuse are asked for a reason—to allow the 
treating physicians and nurses to understand what happened and 
properly conduct follow-up treatment as necessary.  In any event, Rule 
5.803(4) does not condition admissibility on a showing that the patient’s 
statements given for medical treatment and diagnosis were actually used 
for treatment.  See State v. Hildreth, 582 N.W.2d 167, 170 (Iowa 1998) 
(holding medical diagnosis and treatment hearsay exception applies to 
child sex abuse cases because “the identity of the abuser is a matter that 
may assist in diagnosis or treatment of an emotional or psychological 
injury” (emphasis added)).  The context in which the identification is 
made is what matters, not what the treating physician and nurse did 
with that information.   
 
For these reasons, M.D.’s statements were admissible under the 
medical diagnosis and treatment hearsay exception.   
B.  We Should Adopt a Categorical Rule.  A categorical rule  
would be a logical extension of our jurisprudence regarding this hearsay 
exception’s application to child abuse cases.  Our precedents recognize 
 
26 
 
that a statement to a treating physician by a child identifying his or her 
abuser is admissible under rule 5.803(4).  State v. Tornquist, 600 N.W.2d 
301, 306 (Iowa 1999) (holding a child’s “responses in a dialogue initiated 
for purposes of diagnosis or treatment” for child abuse “may assist in 
diagnosis or treatment”), overruled on other grounds by State v. DeCamp, 
622 N.W.2d 290, 293 (Iowa 2001); Hildreth, 582 N.W.2d at 170 
(“[A]scertaining the identity of the [child’s] abuser is a matter that may 
assist in diagnosis or treatment of an emotional or psychological 
injury.”); Tracy, 482 N.W.2d at 682  (“Because of the nature of child 
sexual abuse, the only direct witnesses to the crime will often be the 
perpetrator and the victim.  Consequently, much of the State’s proof will 
necessarily have to be admissible hearsay statements made by the victim 
to relatives and medical personnel.”); see also Renville, 779 F.2d at 436 
(“Statements by a child abuse victim to a physician during an 
examination that the abuser is a member of the victim’s immediate 
household are reasonably pertinent to treatment.”).   
In Tracy, we stressed that a child seeking medical treatment will 
generally lack an improper motive, and the identification of an abuser is 
reasonably pertinent to medical treatment.  482 N.W.2d at 681.  In that 
case, a minor told her doctor during an examination that she had been 
sexually abused by her stepfather.  Id.  We concluded the first 
requirement is met when “the examining doctor emphasize[s] to the 
alleged victim the importance of truthful responses in providing 
treatment” and when the “child’s motive in making the statements [is] 
consistent with a normal patient/doctor dialogue.”  Id.   
 
The second part of the Renville test for admissibility 
under rule 803(4) requires that the content of the statement 
be such as is reasonably relied on by a physician in 
treatment or diagnosis.  Where the alleged abuser is a 
member of the victim’s immediate household, statements 
 
27 
 
regarding the abuser’s identity are reasonably relied on by a 
physician in treatment or diagnosis. Since child abuse often 
involves more than physical injury, the physician must be 
attentive to treating the emotional and psychological injuries 
which accompany this offense.  To adequately treat these 
emotional and psychological injuries, the physician will often 
times need to ascertain the identity of the abuser.  
Id. at 681 (emphasis added) (citations omitted).  The same reasoning 
applies to adult domestic abuse victims. 
In Hildreth, A.E., a minor, made several comments that led her 
parents to suspect the child had been sexually abused by her 
babysitter’s husband, Steven Hildreth.  582 N.W.2d at 168.  A.E. was 
referred to a therapist, who interviewed A.E. about her recollections of 
the abuse and the identity of her abuser.  Id. at 169.  The trial court 
permitted the therapist to testify regarding A.E.’s identification of her 
abuser at trial.  Id.  In affirming the trial court ruling, we emphasized 
that “where a child’s statements are made during a dialogue with a 
health care professional and are not prompted by concerns extraneous to 
the patient’s physical or emotional problem, the first prong of the Renville 
test is satisfied.”  Id. at 170.  We held the second requirement was 
satisfied because “ascertaining the identity of the abuser is a matter that 
may assist in diagnosis or treatment of an emotional or psychological 
injury.”  Id. 
The justifications expressed in Hildreth and Tracy for a physician 
treating child abuse parallel a physician treating adult domestic abuse.  
Regarding the first prong, a domestic violence victim has no motive to lie 
to a doctor or nurse.  The identification of the abuser is “consistent with 
a normal patient/doctor dialogue” because standard screening questions 
elicit this information.  See Tracy, 482 N.W.2d at 681.  The second 
requirement is met because, as with child abuse, doctors must be 
 
28 
 
attentive to treating the emotional and psychological injuries that 
accompany domestic violence. 
The United States Court of Appeals for the Tenth Circuit 
recognized these similarities in United States v. Joe and explained why a 
categorical rule for adult domestic violence logically follows from child 
abuse jurisprudence: 
[T]he identity of the abuser is reasonably pertinent to 
treatment in virtually every domestic sexual assault case, 
even those not involving children. All victims of domestic 
sexual abuse suffer emotional and psychological injuries, the 
exact nature and extent of which depend on the identity of 
the abuser. The physician generally must know who the 
abuser was in order to render proper treatment because the 
physician’s treatment will necessarily differ when the abuser 
is a member of the victim’s family or household. In the 
domestic sexual abuse case, for example, the treating 
physician may recommend special therapy or counseling and 
instruct the victim to remove herself from the dangerous 
environment by leaving the home and seeking shelter 
elsewhere. In short, the domestic sexual abuser’s identity is 
admissible under Rule 803(4) where the abuser has such an 
intimate relationship with the victim that the abuser’s 
identity becomes ‘reasonably pertinent’ to the victim’s proper 
treatment. 
8 F.3d 1488, 1494–95 (10th Cir. 1993) (footnote omitted).  I agree.   
 
We should adopt a categorical rule to allow healthcare providers to 
testify as to the adult domestic abuse victim’s identification of an 
intimate partner as the assailant.  The Louisiana Supreme Court recently 
surveyed current medical literature and practices to adopt a categorical 
rule that  
reflects the current integrated approach to the treatment of 
domestic violence cases in the medical community. See 
American Medical Association Policy Statement on Family 
and Intimate Partner Violence H–515.965 Chicago: AMA 
(2014) (advocating that physicians: (a) “Routinely inquire 
about the family violence histories of their patients as this 
knowledge is essential for effective diagnosis and care; ” and 
(e) “Screen patients for psychiatric sequelae of violence and 
make appropriate referrals for these conditions upon 
identifying a history of family or other interpersonal 
 
29 
 
violence.”) (emphasis added); see also U.S. Dep’t of Health & 
Human Serv., Screening for Domestic Violence in Health 
Care Settings (August 2013), Office of the Assistant 
Secretary for Planning and Evaluation (“Screening and 
counseling for domestic violence was first institutionalized in 
1992 when the Joint Commission on the Accreditation of 
Hospitals and Health Care Organizations (JCAHO) mandated 
that emergency departments develop written protocols for 
identifying and treating survivors of domestic violence in 
order to receive hospital accreditation (Joint Commission, 
2009). Since then, many health associations have supported 
screening across health care specialties. The American 
Medical 
Association 
(AMA), 
American 
Congress 
of 
Obstetrician Gynecologists (ACOG), and the American 
Nurses Association (ANA) all recommend routine universal 
screening.”).   
State v. Koederitz, 166 So. 3d 981, 985–86 (La. 2015) (footnote omitted).   
 
Mandatory screening procedures, such as the one used in the 
emergency room in this case, recognize the harsh reality that many 
people are repeatedly victimized by the same person during the domestic 
abuse cycle.  Approximately two-thirds of people—65.5% of women and 
66.2% of men—physically assaulted by an intimate partner are 
victimized multiple times by the same partner.  See Patricia Tjanden & 
Nancy Thoennes, U.S. Dep’t of Justice, Extent, Nature, and Consequences 
of Intimate Partner Violence 39 (2000).  Domestic violence survivors are 
often caught in cycles of violence that may persist for years.  The average 
female domestic violence survivor reported the domestic violence cycle 
involving an intimate partner lasted over 4.5 years, whereas the average 
male domestic survivor’s cycle lasted 3.6 years.  Id. at 39–40.  In 
consideration of these sobering statistics, we should adopt a per se rule 
that the identification of the perpetrator of domestic violence is pertinent 
to medical diagnosis or treatment and admissible under rule 803(4).   
Other jurisdictions have reached this conclusion and adopted a 
categorical rule.  See Joe, 8 F.3d at 1494–95; Moore v. City of Leeds, 1 
So. 3d 145, 150 (Ala. Crim. App. 2008) (“We believe that the rationale 
 
30 
 
employed by the [Alabama] Supreme Court in [Ex parte C.L.Y., 928 So. 2d 
1069 (Ala. 2005), announcing a categorical rule to admit a child–patient’s 
identification of their abuser] would also apply to victims of domestic 
violence.”); Nash v. State, 754 N.E.2d 1021, 1025 (Ind. Ct. App. 2001) 
(“[I]n cases such as the present one where injury occurs as the result of 
domestic violence, which may alter the course of diagnosis and 
treatment, trial courts may properly exercise their discretion in admitting 
statements regarding identity of the perpetrator.”); Koederitz, 166 So. 3d 
at 985–86 (“[W]e see no principled basis for confining statements of fault 
under [the medical diagnosis and treatment exception] solely to cases 
involving domestic sexual assault, whether of adults or children, as 
opposed to other instances of physical assault and abuse taking place in 
a context that may be fairly described in terms of domestic violence.”); 
People v. Pham, 987 N.Y.S.2d 687, 690–91 (App. Div. 2014) (“Details of 
the abuse, even including the perpetrator’s identity, may be relevant to 
diagnosis and treatment when the assault occurs within a domestic 
violence relationship because the medical provider must consider the 
victim’s safety when creating a discharge plan and gauging the patient’s 
psychological needs.”); State v. Moen, 786 P.2d 111, 121 (Or. 1990) 
(en banc) (“Admissibility of statements of the type challenged here[—i.e., 
a domestic abuse victim identifying her abuser—]is not limited to cases 
involving child abuse.”); State v. Bong, No. 33000–1–III, 2015 WL 
3819223, at * 5 (Wash. Ct. App. 2015) (“Although statements attributing 
fault are generally not relevant to diagnosis or treatment, this court has 
found statements attributing fault to an abuser in a domestic violence 
case are an exception because the identity of the abuser is pertinent and 
necessary to the victim’s treatment.”); State v. Moses, 119 P.3d 906, 911 
(Wash. Ct. App. 2005) (same); Oldman v. State, 998 P.2d 957, 961 (Wyo. 
 
31 
 
2000) (“There is no logical reason for not applying [the sexual domestic 
abuse exception in Joe] to non-sexual, traumatic abuse within a family 
or household, since sexual abuse is simply a particular kind of physical 
abuse.”); Commonwealth v. O’Connor, 6 N. Mar. I. 125, 129 (N. Mar. I. 
2000) (“[I]n cases of domestic and child abuse . . . the identity of the 
abuser becomes ‘reasonably pertinent to diagnosis or treatment[,’] and a 
statement identifying the abuser is admissible under the medical hearsay 
exception.”).  These decisions are persuasive and should be followed.   
 
The majority concludes there are too many variables in domestic 
violence cases to adopt a categorical rule, relying on State v. Robinson, 
without mentioning the Minnesota Supreme Court in that decision 
expressly left open the possibility it would adopt a categorical rule for 
domestic abuse cases in the future.  718 N.W.2d 400, 407 (Minn. 2006) 
(“We do not foreclose the possibility that we might in the future adopt a 
properly limited categorical rule of admissibility under the medical 
exception to hearsay for statements of identification by victims of 
domestic violence.”).   
 
The majority also refers to “the constitutional right of people 
accused of crimes to be confronted by their accusers,” citing for support 
State v. Bentley.  739 N.W.2d 296, 300–01 (Iowa 2007).  Bentley is 
nothing like this case.  There, the police investigating child abuse 
arranged a “forensic interview” of the ten-year-old victim who was told at 
the outset of her interview that “a police officer and a DHS representative 
were listening on the other side of the observation window.”  Id. at 300.  
When the child asked to halt the interview, her interrogator “specifically 
implored [the victim] to continue because ‘it’s just really important the 
police know about everything that happened.’ ”  Id.  The interrogator 
during breaks consulted with the police officer about additional 
 
32 
 
questions to ask.  Id.  By contrast, M.D. asked the police to take her to 
the emergency room for treatment, and the police had no involvement 
when Dr. Mott and nurse Knipper examined her.   
 
The majority cites no case holding that a statement made to a 
treating physician or nurse in the emergency room is “testimonial” for 
purposes of the Confrontation Clause.  By definition, a statement made 
for purposes of medical treatment or diagnosis is not testimonial, as the 
Louisiana Supreme Court observed: “The statements at issue in the 
present case are also non-testimonial for purposes of the Sixth 
Amendment Confrontation Clause because they were not ‘procured [with 
a] primary purpose of creating an out-of-court substitute for trial 
testimony.’ ”  Koederitz, 166 So. 3d at 986–87 (quoting Michigan v. 
Bryant, 562 U.S. 344, 358, 131 S. Ct. 1143, 1155, 179 L. Ed. 2d 93, 107 
(2011) (emphasis added)); see Bryant, 562 U.S. at 358–59, 131 S. Ct. at 
1155, 179 L. Ed. 2d at 107 (“In making the primary purpose 
determination, standard rules of hearsay, designed to identify some 
statements as reliable, will be relevant.”); White v. Illinois, 502 U.S. 346, 
356, 112 S. Ct. 736, 743, 116 L. Ed. 2d 848 (1992) (“[A] statement made 
in the course of procuring medical services, where the declarant knows 
that a false statement may cause misdiagnosis or mistreatment, carries 
special guarantees of credibility that a trier of fact may not think 
replicated 
by 
courtroom 
testimony.”); 
cf. 
Melendez–Diaz 
v. 
Massachusetts, 557 U.S. 305, 312 n.2, 129 S. Ct. 2527, 2533 n.2, 174 
L. Ed. 2d 314 n.2 (2009) (“[M]edical reports created for treatment 
purposes . . . would not be testimonial under our decision today.”); Giles 
v. California, 554 U.S. 353, 376, 128 S. Ct. 2678, 2692–93, 171 L. Ed. 2d 
488 (2008) (“[O]nly testimonial statements are excluded by the 
Confrontation Clause.  Statements to friends and neighbors about abuse 
 
33 
 
and intimidation [by women in abusive relationships], and statements to 
physicians in the course of receiving treatment would be excluded, if at 
all, only by hearsay rules . . . .”).  In any event, in this case, M.D., 
Dr. Mott, and nurse Knipper all testified live at trial subject to cross-
examination.  The majority’s reference to the Confrontation Clause is a 
red herring.   
 
III.  Excited-Utterance Exception.   
Under the DeVoss rule, we may affirm an evidentiary ruling under 
any valid alternative ground supported in the record.  See State v. 
Newell, 710 N.W.2d 6, 23 (Iowa 2006) (“Although we base our decision on 
a different rationale, we find no reversible error in the trial court’s 
ruling.”); DeVoss, 648 N.W.2d at 62–63 (noting that evidentiary rulings 
are an exception to our error preservation requirements and the district 
court ruling will be upheld if sustainable on any ground).  In my view, 
M.D.’s statements to her doctor and nurse identifying Smith as her 
abuser were admissible under the excited-utterance exception.  Iowa R. 
Evid. 5.803(2).6   
 
An excited utterance is “[a] statement relating to a startling event 
or condition made while the declarant was under the stress of excitement 
caused by the event or condition.”  Id.  “[S]tatements made under the 
stress of excitement are less likely to involve deception than if made upon 
reflection or deliberation.”  State v. Harper, 770 N.W.2d 316, 319 (Iowa 
2009) (quoting State v. Tejeda, 677 N.W.2d 744, 753 (Iowa 2004)).  We 
6When an alternative ground supports a ruling admitting evidence, the 
proponent should brief and argue the alternative ground on appeal.  Otherwise, our 
court may defer deciding the issue until a case in which we have the benefit of 
adversarial briefing.   
                                      
 
 
34 
 
consider five nonexclusive factors in determining whether a statement 
qualifies as an excited utterance:  
(1) the time lapse between the event and the statement, 
(2) the extent to which questioning elicited the statements 
that otherwise would not have been volunteered, (3) the age 
and condition of the declarant, (4) the characteristics of the 
event being described, and (5) the subject matter of the 
statement.   
Id. (quoting State v. Atwood, 602 N.W.2d 775, 782 (Iowa 1999)).   
 
Our court considered a similar fact pattern in Atwood.  Atwood 
was charged with vehicular homicide after killing two pedestrians.  602 
N.W.2d at 777.  Atwood’s passenger, Chris Sivertsen, was hospitalized.  
Id. at 782.  A police officer interviewed Sivertsen approximately two and 
one-half hours after the accident.  Id.  The officer spoke with Sivertsen 
for about four to six minutes.  Id.  The officer asked Sivertsen what 
happened, and Sivertsen responded the defendant “jerked the wheel—or 
steering wheel way too hard and I thought he was mad.”  Id.  We held the 
statement was admissible.  Id. at 783.  We noted that Sivertsen had been 
through a very traumatic experience; “he had just been involved in a 
serious car accident and had apparently seen a child hit the windshield.”  
Id.  We did not find that the time-lapse or the officer’s question brought 
the statement outside the excited-utterance exception.  Id. at 782.7   
7We have applied the excited-utterance exception after significantly longer time-
lapses.  See State v. Galvan, 297 N.W.2d 344, 347 (Iowa 1980) (holding the passage of 
two days “leaves [the evidence] close enough to the transaction so that the trial court 
could have believed any presumption of fabrication was excluded”); State v. Stafford, 
237 Iowa 780, 785–87, 23 N.W.2d 832, 835–86 (1946) (holding statements made 
fourteen hours following the alleged crime satisfied “the test of spontaneity” and were “a 
natural expression of what had happened to [the victim]”).  But see Tejeda, 677 N.W.2d 
at 754 (finding a thirty-minute time gap between the startling event and the statement 
“weigh[s] heavily against the [statement’s] admission”).   
                                      
 
 
35 
 
The circumstances surrounding M.D.’s statements show her 
statements to Knipper and Dr. Mott were excited utterances.  M.D. was 
extremely upset from the time she called 911 through her emergency 
room visit.  She was anxious, in pain, and separated from her daughter 
in the middle of the night.  Against this backdrop, M.D. twice identified 
Smith as her abuser in response to the first question asked by the nurse 
and then to another asked by the doctor—“what happened?”  The 
substance of M.D.’s statement was the very reason she was so upset—
because she had been assaulted by her intimate partner, the father of 
her child.  We have found the excited-utterance exception applies in 
similar circumstances.  See State v. Richards, 809 N.W.2d 80, 95 (Iowa 
2012) (holding domestic violence victim’s statement to her daughter that 
the defendant had put a cane to her neck was an admissible excited 
utterance because the victim had just come down the stairs, she “was 
upset and crying,” and her “neck was red”).   
Accordingly, I would affirm the district court’s admission of those 
statements as excited utterances.  I agree with the court of appeals that 
any error in allowing the police officer to testify about what M.D. told him 
was harmless error.  For these reasons, I would affirm the judgment of 
the district court and decision of the court of appeals.   
Mansfield and Zager, JJ., join this dissent.