Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca10-92-02104/USCOURTS-ca10-92-02104-0/pdf.json

Parties Involved:
Matthew Wayne Tome
Appellant
United States of America
Appellee

Document Text:

PUBLISH 

FILED 

United States Court of App~h Ttnth Circuit 

UNITED STATES COURT OF APPEALS JUL 3 1 1995 

UNITED STATES OF AMERICA, 

Plaintiff-Appellee, 

v. 

MATTHEW WAYNE TOME, 

Defendant-Appellant. 

TENTH CIRCUIT 

PATRICI( FISHER 

C:lri; 

No. 92-2104 

APPEAL FROM THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF NEW MEXICO 

(D.C. No. CR-91-314 SC) 

ON THE BRIEFS: 

Joseph W. Gandert, Assistant Federal Public Defender, Albuquerque, 

New Mexico, for the Appellant. 

Louis M. Fischer, Attorney, Department of Justice, Washington, DC 

(John J. Kelly, United States Attorney, District of New Mexico, 

with him on the brief) for the Appellee. 

Before ANDERSON, TACHA, and HOLLOWAY, Circuit Judges. 

OPINION ON REMAND 

TACHA, Circuit Judge. 

I. BACKGROUND 

A jury convicted defendant Matthew Wayne Tome of aggravated 

sexual abuse in violation of 18 U.S.C. §§ 1153, 2241(c), and 

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2246(A) and (B) .1 In his appeal to this court, defendant 

challenged the admissibility of the hearsay statements relayed by 

six witnesses. Each witness related out-of-court statements made 

by the child victim (A.T.). We concluded that the testimony of 

these witnesses was admissible because it was not hearsay under 

the Federal Rules of Evidence and affirmed defendant's conviction. 

United States v. Tome, 3 F.3d 342, 347 (lOth Cir. 1993), rev'd, 

115 S. Ct. 696 (1995). We reasoned that the government offered 

the testimony of these six witnesses to rebut defendant's implied 

charge that the victim fabricated her allegations. Id. at 349. 

Consequently, we held that, even though A.T. made the statements 

after her alleged motive to fabricate had arisen, the statements 

were prior consistent statements admissible under Fed. R. Evid. 

801 (d) (1) (B) . Id. at 351. 

The United States Supreme Court reversed our decision. Tome 

v. United States, 115 S. Ct. 696, 705 (1995). Specifically, the 

Court held that Rule 80l(d) (1) (B) "permits the introduction of a 

declarant's consistent out-of-court statements to rebut a charge 

of recent fabrication or improper influence or motive only when 

those statements were made before the charged recent fabrication 

or improper influence or motive." Id. 

The case is now before us on remand.2 Pursuant to our order, 

1 At the time of defendant's trial, the offenses now codified 

at 18 U.S.C. § 2246(2) (A) and (B) were found at 18 U.S.C. § 

2245(2) (A) and (B). The substance of the offense has not changed. 

2 Because the facts of this case are set out at length in both 

our earlier decision and in the Supreme Court's opinion, see Tome, 

3 F.3d at 344-46; Tome, 115 S. Ct. at 699-700, we will refer to 

the facts only as necessary in disposing of the remaining issues. 

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the parties have submitted supplemental briefs addressing the 

remaining issues.3 On remand, we must first determine whether the 

challenged evidence could have been admitted under another rule of 

evidence. See Fortier v. Dona Anna Plaza Partners, 747 F.2d 1324, 

1331 (lOth Cir. 1984) ("We may affirm the rulings on admission of 

evidence if that evidence is admissible under any of the Federal 

Rules of Evidence."). If we find that any of the statements were 

inadmissible, we must then assess whether the district court's 

error in admitting them was nevertheless harmless. See United 

States v. Flanagan, 34 F.3d 949, 955 (lOth Cir. 1994). 

II. STANDARD OF REVIEW 

Evidentiary decisions rest within the sound discretion of the 

trial court, and we review those decisions only for an abuse of 

that discretion. United States v. Cestnik, 36 F.3d 904, 906 (lOth 

Cir.), cert. denied, 115 S. Ct. 1156 (1994). Our review is 

especially deferential when the challenged ruling concerns the 

admissibility of evidence that is allegedly hearsay. Id. at 906-

07. "Finally, we consider the record as a whole in reviewing 

evidentiary rulings." Id. at 907. 

III. DISCUSSION 

3 After examining the briefs and appellate record, this panel 

has determined unanimously that oral argument would not materially 

assist the determination of this appeal. See Feq. R. App. P. 

34(a); lOth Cir. R. 34.1.9. The case is therefore ordered 

submitted without oral argument. 

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A. Testimony of Karen Kuper, Laura Reich, and Jean Spiegel 

We first_address the testimony of three pediatricians who 

examined A.T. In their testimony, the three doctors relayed 

statements made by A.T. either before or during the doctors' 

physical examinations of the child. At trial, the district court 

admitted the doctors' hearsay testimony under both Rules 

8 0 1 ( d) ( 1 ) (B) and 8 0 3 ( 4 ) . 

Although hearsay testimony is generally inadmissible, Fed. R. 

Evid. 802, the Federal Rules of Evidence contain a number of 

exceptions to the hearsay prohibition. See Fed. R. Evid. 803, 

804. One of these exceptions, Rule 803(4), makes admissible 

"[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." Fed. R. Evid. 803(4). This exception is 

premised on the theory that a patient's statements to her 

physician are likely to be particularly reliable because the 

patient has a self-interested motive to be truthful: She knows 

that the efficacy of her medical treatment depends upon the 

accuracy of the information she provides to the doctor. United 

States v. Joe, 8 F.3d 1488, 1493 (lOth Cir. 1993), cert. denied, 

114 S. Ct. 1236 (1994). Stated differently, "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." White 

v. Illinois, 502 U.S. 346, 356 (1992). 

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A declarant's statement to a physician that identifies the 

person responsible for the declarant's injuries is ordinarily 

inadmissible under Rule 803(4) because the assailant's identity is 

usually unnecessary either for accurate diagnosis or effective 

treatment. Joe, 8 F.3d at 1494. This court held in Joe, however, 

that a hearsay statement revealing the identity of a sexual abuser 

who is a member of the victim's family or household "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." Id. at 

1495. In so holding, we reasoned that 

[a]ll 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. 

Id. at 1494-95 (footnote omitted). Although the victim in Joe was 

an adult, we stated that "the identity of the abuser is reasonably 

pertinent in virtually every domestic sexual assault case," 

including those in which the victim is a child. Id. at 1494. 

Thus, when a victim of domestic sexual abuse identifies her 

assailant to her physician, the physician's recounting of the 

identification is admissible under Rule 803(4) when it is 

"reasonably pertinent" to the victim's treatment or diagnosis. 

Id. at 1495; see also John W. Strong et al., 2 McCormick on 

Evidence § 277, at 248 (4th ed. 1992) (hereinafter McCormick). 

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After reviewing the testimony of each pediatrician, we conclude 

that A.T.'s statements to those doctors were reasonably pertinent 

to her diagnosis or treatment. 

1. Testimony of Karen Kuper 

Kae Ecklebarger of Child Protection Services referred A.T. to 

Dr. Karen Kuper, a board certified pediatrician, for a physical 

examination. Kuper testified that she examined A.T. on two 

occasions, in September and October 1990. Prior to the first 

examination, Kuper interviewed A.T. Kuper testified that the 

purpose of the interview was "to ascertain exactly what injuries 

had occurred." In response to Kuper's questions, A.T. told Kuper 

about the sexual abuse, at times pointing to the appropriate areas 

of dolls to answer Kuper's questions. A.T. also identified 

defendant as her abuser. After the interview, Kuper performed a 

complete physical examination of A.T. 

We find it clear that A.T.'s statement to Kuper was 

reasonably pertinent to Kuper's proper diagnosis and treatment of 

A.T. The information contained in the statement was important to 

Kuper's determination of A.T.'s condition. This statement was 

therefore admissible under Rule 803(4). 

2. Testimony of Laura Reich 

A.T. saw Dr. Laura Reich on September 21, 1990, for treatment 

of a skin rash in the vaginal area that was unrelated to any 

sexual abuse. At the time of Reich's examination of A.T., Reich 

was aware of the allegations of sexual abuse. Reich testified 

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that, prior to conducting the physical examination, she asked A.T. 

several personal questions. One of these questions was whether 

"anybody had ever touched her in her private area." According to 

Reich's testimony, A.T. replied "that her father had put his thing 

in her." The remainder of Reich's testimony concerned her 

findings and conclusions from the physical examination. 

Reich testified that the reason she had conducted a 

preexamination interview with A.T was "that the child needs to be 

comfortable with me before I examine her." Because the adequacy 

of Reich's examination in part depended on the child's comfort 

with her, we find that A.T.'s statement was reasonably pertinent 

to Reich's diagnosis or treatment. It consequently was admissible 

under Rule 803(4). 

3. Testimony of Jean Spiegel 

Dr. Jean Spiegel, an assistant professor of pediatrics at the 

University of New Mexico, testified that she examined A.T. for the 

purpose of offering a second opinion as to whether the child had 

been sexually abused. Spiegel had extensive training in the area 

of child sexual abuse, and teaches other doctors how to examine 

children to detect molestation. Most of Spiegel's testimony 

focused on the technical aspects of her examination of A.T. and 

her conclusion that A.T. had experienced chronic vaginal 

penetration. 

On redirect examination, Spiegel testified that A.T. told her 

where on her body she had been touched during the abuse. Spiegel 

did not ask, nor did A.T. volunteer, who had touched her. 

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Clearly, A.T.'s statement regarding where she had been touched was 

pertinent to Spiegel's diagnosis of A.T. The district court 

therefore properly admitted the statement under Rule 803(4). 

B. Testimony of Kae Ecklebarger 

Kae Ecklebarger, a caseworker for Colorado Springs Child 

Protection Services, interviewed A.T. on August 29, 1990. 

Ecklebarger testified that during the interview, A.T. gave 

Ecklebarger a detailed account of the alleged abuse, at times 

using anatomically correct dolls to demonstrate what had occurred. 

Ecklebarger also testified that A.T. claimed she had told her 

grandmother and aunt of the abuse. The government argues that 

Ecklebarger's testimony is admissible under either Rule 803(4) or 

Rule 803(24), the residual hearsay exception.4 We discuss the 

applicability of these two exceptions in order. 

For a hearsay statement to be admissible under Rule 803(4), 

the declarant need not have necessarily made the statement to a 

physician. As the advisory committee's note to the rule explains, 

"[s]tatements to hospital attendants, ambulance drivers, or even 

members of the family might be included." Fed. R. Evid. 803(4) 

4 It is not clear from the trial transcript under which 

exceptions to the hearsay rule the district court admitted 

Ecklebarger's testimony containing A.T.'s statements. The 

government offered the statements under Rules 801(d) (1) (B), 

803(4), and 803(24). Because the basis of the district court's 

ruling is unclear, we are unable to review its judgment with the 

deference normally accorded to Rule 803(24) rulings. Cf. Huff v. 

White Motor Corp., 609 F.2d 286, 292 (7th Cir. 1979) (explaining 

that, because the district court did not mention the residual 

hearsay exception in its ruling excluding certain evidence, the 

court had "little choice except to attempt to replicate the 

exercise of discretion that would be made by a trial judge in 

making the ruling"). 

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advisory committee's note. Accordingly, the government argues 

that A.T.'s statement to Ecklebarger is admissible because the job 

of a Child Protection Services caseworker "was equivalent to that 

of a doctor under Fed. R. Evid. 803(4) ,"and because A.T. 

understood that Ecklebarger's role was to "help kids." 

As stated previously, however, the test for admissibility 

under Rule 803(4) is "whether the subject matter of the statements 

is reasonably pertinent to diagnosis or treatment." McCormick§ 

277, at 248. Ecklebarger neither diagnosed nor treated A.T. She 

described her role as "the initial short-term investigat[or] ." 

Ecklebarger spoke to A.T. two times, after which "[t]he case was 

sent on to an ongoing protection worker." Clearly, Ecklebarger 

did not treat A.T. in any way. 

Nor did Ecklebarger diagnose A.T. Indeed, Ecklebarger 

referred the child to Dr. Kuper for a medical opinion regarding 

the allegations of abuse. Moreover, Ecklebarger testified that 

she interviewed A.T. only to the extent necessary to make a 

decision whether a protective order was appropriate. Because 

Ecklebarger did not diagnose or treat A.T., the child's statement 

to Ecklebarger could not have been for the "purpose[] of medical 

diagnosis or treatment," and thus was not properly admitted under 

Rule 803(4). 

We next turn to whether the statement could have been 

admitted under the residual hearsay exception, Rule 803(24). The 

residual exception to the hearsay rule makes admissible 

[a] statement not specifically covered by any of the 

foregoing exceptions but having equivalent circumstantial 

guarantees of trustworthiness, if the court determines that 

(A) the statement is offered as evidence of a material fact; 

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(B) the statement is more probative on the point for which it 

is offered than any other evidence which the proponent can 

procure through reasonable efforts; and (C) the general 

purposes of these rules and the interests of justice will 

best be served by admission of the statement into evidence. 

Fed. R. Evid. 803(24). Courts must use caution when admitting 

evidence under Rule 803(24), for an expansive interpretation of 

the residual exception would threaten to swallow the entirety of 

the hearsay rule. As this court has warned, Rule 803(24) should 

be used only "in extraordinary circumstances where the court is 

satisfied that the evidence offers guarantees of trustworthiness 

and is material, probative and necessary in the interest of 

justice." United States v. Farley, 992 F.2d 1122, 1126 (lOth Cir. 

1993) . 

Defendant argues that A.T.'s statement to Ecklebarger was 

inadmissible under Rule 803(24) because it lacked circumstantial 

guarantees of trustworthiness and because it was not more 

probative on the point for which it was offered than any other 

evidence the government could introduce. In response, the 

government contends that, because of the similarity between the 

roles of a social worker and a doctor in child abuse cases, A.T.'s 

statements to Ecklebarger had circumstantial guarantees of 

trustworthiness similar to those on which Rule 803(4) is based. 

The government also argues that the testimony was necessary 

because "A.T. gave Ecklebarger the most detailed description of 

the abuse that she provided anyone." 

The first requirement for admissibility under Rule 803(24) is 

that the statement have circumstantial guarantees of 

trustworthiness equivalent to the twenty-three specific hearsay 

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exceptions enumerated in Rule 803. Thus, "if the declarant's 

truthfulness is so clear from the surrounding circumstances that 

the test of cross-examination would be of marginal utility, then 

the hearsay rule does not bar admission of the statement at 

trial." Idaho v. Wright, 497 U.S. 805, 820 (1990) .5 When 

applying this exception, the circumstantial guarantees of 

trustworthiness that we consider "'are those that existed at the 

time the statement was made and do not include those that may be 

added by using hindsight.'" Id. (quoting Huff v. White Motor 

Corp., 609 F.2d 286, 292 (7th Cir. 1979)). Moreover, other 

evidence that corroborates the truth of a hearsay statement is not 

a circumstantial guarantee of the declarant's trustworthiness. 

Id. at 823 ("[W]e think the presence of corroborating evidence 

5 The precise issue in Idaho v. Wright was not the 

admissibility of evidence under Rule 803(24). Rather, the 

petitioner in Wright challenged the admission of a hearsay 

statement on Confrontation Clause grounds. 497 U.S. at 808. One 

of the requirements of the Confrontation Clause, however, is that 

the hearsay statement "bear[] adequate 'indicia of reliability.'" 

Id. at 815 (internal quotation marks omitted) . It was this 

requirement that the Court discussed at length in Wright. In 

doing so, it cited and discussed several lower court decisions 

that identify factors which should be considered in assessing the 

reliability of out-of-court statements by child witnesses in 

sexual abuse cases. Id. at 821-22. Importantly, each of the 

cases cited by the Court addressed the admissibility of such 

statements under exceptions to the hearsay rule -- not the 

Confrontation Clause. Indeed, two of the cases involved the 

reliability requirement of the residual hearsay exception. See 

Arizona v. Robinson, 735 P.2d 801, 811 (Ariz. 1987); Wisconsin v. 

Sorenson, 421 N.W.2d 77, 83-86 (Wis. 1988). In essence, the Court 

saw no meaningful distinction between Rule 803(24)'s requirement 

that a statement have "circumstantial guarantees of 

trustworthiness" and the Confrontation Clause requirement that it 

"bear adequate indicia of reliability." Thus, even though Wright 

is technically a Confrontation Clause case, its discussion of the 

reliability of hearsay statements by child victims of sexual abuse 

is equally pertinent to both Confrontation Clause cases and Rule 

803(24) cases. 

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more appropriately indicates that any error in admitting the 

statement might be harmless, rather than that any basis exists for 

presuming the declarant to be trustworthy.") (footnote omitted). 

In Idaho v. Wright, the Supreme Court identified several 

factors that courts should consider in determining "whether 

hearsay statements made by a child witness in child sexual abuse 

cases are reliable." Id. at 821. These factors include the 

spontaneity of the child's statement, the consistent repetition of 

the child's allegation, the mental state of the child, the use of 

terminology unexpected of a child of similar age, and the lack of 

a motive to fabricate. Id. We considered the admissibility of 

the hearsay statements of a child victim of sexual abuse in United 

States v. Farley, 992 F.2d 1122. In that case, we found 

sufficient guarantees of trustworthiness in a child's statement to 

her mother where the child made the statement soon after she was 

assaulted, employed childish terminology, and was emotional when 

she told her mother of the assault. Id. at 1126. 

In analyzing the trustworthiness of A.T.'s statement to 

Ecklebarger, we emphasize that, to hold the statement admissible 

under Rule 803(24), we must find that A.T. "was particularly 

likely to be telling the truth when the statement was made." 

Wright, 497 U.S. at 822. It is not enough merely to find an 

absence of evidence that the statement was unreliable. 

At least three circumstances surrounding the statement 

support its trustworthiness. First, Ecklebarger was highly 

trained and experienced in interviewing children who were 

allegedly victims of abuse. Second, because of her experience, 

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Ecklebarger's interview with A.T. consisted of open-ended, nonleading questions. Finally, although A.T. used childish language, 

she described the sexual abuse with specificity and in graphic 

detail. 

Three other circumstances, however, indicate that the 

statement does not meet the high threshold of being "especially 

trustworthy." First, the statement was not spontaneous; 

Ecklebarger testified that A~T. knew she had been brought to 

Ecklebarger to tell her about "what [defendant] had done to her." 

Second, Ecklebarger's interview with A.T. was not close in time to 

the abuse, occurring more than one year after the events that A.T. 

described. Finally, the interview took place when A.T. arguably 

had a motive to fabricate the story: She wanted to remain with 

her mother instead of being returned to her father's custody. 

Because the circumstances surrounding A.T.'s statement to 

Ecklebarger are equivocal, we find that the statement lacked the 

"circumstantial guarantees of trustworthiness" required by Rule 

803(24) .6 The statement was therefore inadmissible hearsay, and 

the district court erred in admitting this testimony. 

C. Testimony of Lisa Rocha 

A.T. first mentioned the abuse to Lisa Rocha, who was A.T.'s 

babysitter during the summer of 1990. During her testimony, Rocha 

related two separate out-of-court statements by A.T. 

6 Because the statements do not meet the trustworthiness 

requirement of Rule 803(24), we need not address defendant's 

contention that Ecklebarger's testimony was unnecessary. 

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The first occurred on August 22, 1990. Rocha testified that, 

while babysitting A.T. at Rocha's home on that day, A.T. 

spontaneously asked Rocha not to let her mother send her back to 

her father. When Rocha asked A.T. why she did not want to return 

to her father, A.T. replied, "Because my father gets drunk and he 

thinks I'm his wife." The district court ruled that this 

statement was admissible under Rules 801(d) (1) (B) and 803(24). 

The district court found the statement admissible under Rule 

803(24) because there were "circumstantial guarantees of 

trustworthiness . . . equivalent to the circumstances which . 

permit hearsay statements under [Fed. R. Evid. 803(3)] ." The 

government now argues that A.T.'s August 22 statement to Rocha was 

admissible under either Rule 803(3) or Rule 803(24). 

Under Rule 803(3), "a statement of the declarant's then 

existing state of mind, emotion, sensation, or physical condition 

. , but not including a statement of memory or belief to prove 

the fact remembered or believed," is not excluded by the hearsay 

rule. Fed. R. Evid. 803(3). We recently addressed the scope of 

Rule 803(3) in United States v. Joe, 8 F.3d 1488. The defendant 

in Joe had allegedly raped his wife eight days before murdering 

her. Id. at 1491. While being treated for injuries sustained in 

the rape, the victim told her doctor that she was "afraid 

sometimes" because her husband had threatened to kill her. Id. 

We held that the victim's out-of-court statement that she was 

"afraid sometimes" was admissible under Rule 803(3) because it 

reflected her then existing state of mind. Id. at 1492. The 

remainder of the statement, however, did not indicate her state of 

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mind. Rather, it was "an assertion of why she was afraid (i.e., 

because she thought her husband might kill her)." Id. at 1493. 

Because this second part of the statement was clearly a statement 

of memory or belief, it was not admissible under Rule 803(3). Id. 

In the present case, A.T.'s first statement to Rocha does not 

meet the requirements of Rule 803(3). The statement does not 

reveal A.T.'s "then existing state of mind, emotion, sensation, or 

physical condition." Fed. R. Evid. 803(3). The government argues 

that the first part of A.T.'s statement -- asking Rocha not to let 

her be taken back to New Mexico -- is a statement expressing fear. 

We disagree. A.T. did not say that she was afraid; she merely 

expressed a desire to remain with her mother in Colorado. 

Moreover, the second part of the statement, responding to Rocha's 

question, falls within Rule 803(3)'s express prohibition-- it is 

"a statement of memory ... to prove the fact remembered." Fed. 

R. Evid. 803(3). Thus, A.T.'s August 22 statement to Rocha was 

not admissible under Rule 803(3). 

The district court also ruled that A.T.'s first statement to 

Rocha was admissible under Rule 803(24) -- the residual hearsay 

exception -- a ruling we review for an abuse of discretion. See 

Cestnik, 36 F.3d at 906. The district court analogized A.T.'s 

statement to one admissible under Rule 803(3), finding that, 

because it was spontaneous and unsolicited, it had the requisite 

circumstantial guarantees of trustworthiness. Moreover, the court 

noted that, when A.T. made the statement, she was a "child . 

asking the aid of a person who apparently she felt was a friend." 

Cf. Farley, 992 F.2d at 1126 (noting that the declarant's "youth 

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greatly reduce[s] the likelihood that reflection and fabrication 

were involved") (internal quotation marks omitted). 

We must disagree with the district court's ruling. The 

circumstances here, like those surrounding A.T.'s statements to 

Ecklebarger, are equivocal. While the spontaneity of the 

statement favors its trustworthiness, A.T. made the statement more 

than a year after the abuse had occurred and at a time when she 

arguably had a motive to fabricate a story. We therefore cannot 

find that A.T.'s "truthfulness is so clear from the surrounding 

circumstances that the test of cross-examination would be of 

marginal utility." Wright, 497 U.S. at 820. The district court 

abused its discretion by admitting the statement under Rule 

803 (24) . 

A.T.'s second statement to Rocha occurred on August 27, 1990, 

at the home of A.T.'s mother, Beverly Padilla. Rocha had related 

A.T.'s August 22 statement to Padilla, and, after Padilla had 

unsuccessfully attempted to discuss the matter further with A.T, 

Padilla asked Rocha to broach the subject again with A.T. 

According to Rocha's testimony, when Rocha asked A.T. to explain 

her earlier remarks, A.T. described several details regarding one 

specific instance of abuse by her father. The district court 

admitted this testimony under Rule 801(d) (1) (B) and expressly 

ruled it inadmissible under Rule 803(24). Upon review of the 

record, we conclude that the district court did not abuse its 

discretion in ruling the statement inadmissible under Rule 

803 (24). 7 

7 In its supplemental brief, the government concedes that 

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D. Testimony of Beverly Padilla 

Beverly Padilla, A.T.'s mother, testified that she was in 

another room of her apartment on August 27, 1990, when A.T. 

described her father's abuse to Rocha (A.T.'s second statement to 

Rocha). Padilla related to the jury a portion of A.T.'s statement 

to Rocha about the instance of abuse by her father. The district 

court admitted this testimony under Rule 801(d) (1) (B), and the 

government does not now argue that it was admissible under any 

other evidentiary rule. We likewise find no other basis on which 

this statement was admissible. Padilla's testimony regarding 

A.T.'s second statement to Rocha was therefore inadmissible 

hearsay. 

E. Harmless Error Analysis 

Having concluded that A.T.'s hearsay statements to 

Ecklebarger, Rocha, and Padilla were inadmissible, we must 

determine whether their erroneous admission by the district court 

was nevertheless harmless. "In conducting a harmless error 

review, we review the record de novo." Flanagan, 34 F.3d at 955. 

Because the erroneous admission of hearsay testimony is a 

nonconstitutional error, see United States v. Perez, 989 F.2d 

1574, 1583 (lOth Cir. 1993) (en bane), we apply the harmless error 

standard from Kotteakos v. United States, 328 U.S. 750, 765 

A.T.'s August 27 statement was inadmissible hearsay. 

Nevertheless, the government argues that admitting the statement 

was harmless error. We discuss the harmlessness of the 

erroneously admitted hearsay statements below. 

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(1946). Under this standard, we must ask whether the jury's 

verdict was 

substantially swayed by the error .... The inquiry cannot 

be merely whether there was enough to support the result, 

apart from the phase affected by the error. It is rather, 

even so, whether the error itself had substantial influence. 

If so, or if one is left in grave doubt, the conviction 

cannot stand. 

Kotteakos, 328 U.S. at 765. Moreover, "the government has the 

burden of proving that the non-constitutional error was harmless." 

Flanagan, 34 F.3d at 955. 

The Kotteakos standard requires a reviewing court to examine 

the entire record, focusing particularly on the erroneously 

admitted statements. The question is not whether, omitting the 

inadmissible statements, the record contains sufficient evidence 

for a jury to convict the defendant. Rather, we must discern 

whether the statements, in light of the whole record, 

"substantially influenced" the outcome of the trial, or whether we 

are left in "grave doubt" as to whether it had such an effect. 

United States v. Birch, 39 F.3d 1089, 1094 (lOth Cir. 1994); 

United States v. Mejia-Alarcon, 995 F.2d 982, 990 (lOth Cir.), 

cert. denied, 114 S. Ct. 334 (1993). If our answer to either of 

these questions is yes, the error requires reversal. 

In this case, the erroneously admitted evidence was extremely 

compelling. A.T.'s statements to Rocha and Ecklebarger were the 

most detailed accounts of the abuse presented at trial. As 

discussed earlier, these statements vividly described a particular 

instance of abuse with great specificity and in graphic terms. 

They painted a rather brutal picture of defendant. By comparison, 

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Appellate Case: 92-2104 Document: 01019277815 Date Filed: 07/31/1995 Page: 18 
the victim's own testimony at trial was not nearly as articulate 

or comprehensive in its description of the abuse. Moreover, most 

of the prosecution's remaining evidence concerned not the abuse 

itself -- nor the abuser's identity -- but medical evidence that 

A.T. had suffered penetration. 

Given the strength of the erroneously admitted statements, 

this court is left in grave doubt as to whether the testimony 

substantially influenced the outcome of defendant's trial. 

Because we cannot say that the district court's errors in 

admitting these statements were harmless, defendant's conviction 

cannot stand. 

IV. CONCLUSION 

A.T.'s statements related by Kuper, Reich, and Spiegel were 

admissible hearsay pursuant to Rule 803(4). But the statements of 

A.T. included in the testimony of Ecklebarger, Rocha, and Padilla 

were inadmissible hearsay. Because the erroneous admission of 

this evidence was not harmless, the judgment of the district court 

is REVERSED, and the case is REMANDED for further proceedings 

consistent with this opinion. 

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Appellate Case: 92-2104 Document: 01019277815 Date Filed: 07/31/1995 Page: 19 
No. 92-2104 

United States v. Tome 

HOLLOWAY, Circuit Judge, concurring and dissenting: 

I concur fully in the majority's well-reasoned analysis of 

the testimony of Kae Ecklebarger, Lisa Rocha, and Beverly Padilla 

and agree that the out-of-court statements made by A.T. to these 

witnesses were inadmissible hearsay. I also agree that the 

erroneous admission of these statements through the testimony of 

Ecklebarger, Rocha, and Padilla was not harmless and that 

therefore defendant Tome is entitled to a new trial. 

However, I disagree with the majority's conclusion that 

A.T.'s out-of-court statements to Drs. Kuper, Reich, and Spiegel 

were admissible under Fed. R. Evid. 803(4). In United States v. 

Joe, 8 F.3d 1488, 1493 (lOth Cir. 1993), cert. denied, 114 S. Ct. 

1236 (1994), we said "[t]he Rule 803(4) exception to the hearsay 

rule is founded on a theory of reliability that emanates from the 

patient's own selfish motive--her understanding 'that the 

effectiveness of the treatment received will depend upon the 

accuracy of the information provided to the physician.' 2 

McCormick on Evidence, § 277, at 246-47 (John w. Strong ed., 4th 

ed. 1992) ." (Emphasis added.) It is the patient's self-interest 

in furnishing accurate information which provides the guarantee of 

trustworthiness which justifies excepting these types of 

out-of-court statements from the general bar on the admission of 

hearsay. See White v. Illinois, 502 U.S. 346, 356 (1992) ("a 

statement made in the course of procuring medical services, where 

the declarant knows that a false statement may cause misdiagnosis 

Appellate Case: 92-2104 Document: 01019277815 Date Filed: 07/31/1995 Page: 20 
or mistreatment, carries special guarantees of credibility that a 

trier of fact may not think replicated by courtroom testimony." 

(Emphasis added.)). Thus, unless the declarant appreciates the 

fact that giving 

proper treatment 

truthful information is 

or diagnosis, there 

necessary to ensure 

is no guarantee of 

trustworthiness justifying the admission of the statement under 

Rule 803(4). 

In United States v. White, 11 F.3d 1446 (8th Cir. 1993), the 

defendant was convicted of sexually abusing his wife's two 

grandsons, R.H. and L.H., who were nine and seven years old 

respectively at the time of defendant's trial. On appeal, the 

defendant argued that statements made by R.H. to a social worker 

were not admissible under 803(4). The court noted that in order 

for the statements to be admitted under 803(4) the government 

"must show that R.H. understood that he was speaking to a trained 

professional for the purposes of obtaining diagnosis of, or 

providing treatment for, emotional or psychological injuries." 11 

F.3d at 1449. The court concluded "[t]here is nothing in the 

record to suggest that R.H. appreciated that it was in his best 

interests to tell the truth and was therefore unlikely to lie." 

Id. at 1450. "How [the social worker] explained her role and 

purpose to R.H., how she asked him questions, and how and where 

she conducted the interview are matters that can provide evidence 

'that the child understood the physician's [or therapist's] role 

in order to trigger the motivation to provide truthful 

2 

Appellate Case: 92-2104 Document: 01019277815 Date Filed: 07/31/1995 Page: 21 
information.'" Id., quoting United States v. Barrett, 8 F.3d 

1296, 1300 (8th Cir. 1993) .1 

The court in White also relied on Ring v. Erickson, 983 F.2d 

818 (8th Cir. 1992), a habeas case which held that the admission 

at trial, under Minn. R. Evid. 803(4),2 of out-of-court statements 

made by a three year old child, C.R., to a physician violated the 

petitioner's confrontation rights. In so holding, the Eighth 

Circuit said: 

C.R.'s mother, not C.R., sought the "medical 

treatment," and there was no evidence suggesting that at 

the time of the interview C.R. even knew Dr. Levitt was 

a doctor. C.R. was three years old at the time. The 

principal reason why 803(4) is a traditional hearsay 

exception automatically carrying the 

indicia-of-reliability label is because of the 

selfish-motive doctrine. This exception is based on the 

belief that a person seeking medical treatment is 

unlikely to lie to a doctor she wants to treat her, 

since it is in her best interest to tell the truth. 

White [v. Illinois], U.S. 112 S. Ct. at 

742-43. 

983 F.2d at 820.3 

1 

The court in White upheld the defendant's conviction on the 

grounds that the erroneous admission of the statements was 

harmless error. 11 F.3d at 1451. 

2 

Minn. R. Evid. 803(4) is identical to the federal rule. 

3 

See also People of Territory of Guam v. Ignacio, 10 F.3d 608, 

613 n.3 (9th Cir. 1993) ("whether a statement is admissible under 

the medical treatment exception does not depend solely on the 

intent of the person asking the questions, but also on whether the 

respondent understands herself to be providing information for 

purposes of medical treatment." (Emphasis added.)); Morgan v. 

Foretich, 846 F.2d 941, 951-52 (4th Cir. 1988) (Powell, J. (ret.), 

concurring in part and dissenting in part) ("[t]here is no 

evidence in the record that [the girl's] frame of mind was 

comparable to a patient seeking treatment. . . . [T]here is no 

evidence that Dr. Harrison ever explained to [the child] that his 

(Footnote continued on next page) 

3 

Appellate Case: 92-2104 Document: 01019277815 Date Filed: 07/31/1995 Page: 22 
Here the majority opinion correctly notes that the exception 

of Rule 803(4) "is premised on the theory that a patient's 

statements to her physician are likely to be particularly reliable 

because the patient has a self-interested motive to be truthful: 

She knows that the efficacy of her medical treatment depends upon 

the accuracy of the information provided to the doctor." Majority 

Opinion at 4, citing Joe. The majority thus appropriately 

recognizes the selfish treatment interest rationale supporting the 

exception. However, without proof that A.T. had such knowledge, 

the guarantee of trustworthiness disappears, and the statement 

(Footnote continued) : 

questions and relationship with her arose, at least in part, from 

a desire to treat her. . . . Absent a finding that [the child] 

made her statements believing they would be used by Dr. Harrison 

to help her, I am reluctant to rest my decision on the cases 

relied on by the court."); Oldsen v. People, 732 P.2d 1132, 

1135-36 (Colo. 1986) (holding statements inadmissible under 

Colo. R. Evid. 803(4) (which is identical to the federal rule) 

because there was no evidence that the five-year old child "was 

capable of recognizing, at the time the challenged statements were 

made, the need to provide accurate information for purposes of 

medical diagnosis or treatment within the meaning of CRE 

803(4) ."). Oldsen holds that the prosecution, as proponent of the 

hearsay statements, has the burden of establishing the foundation 

for admitting them under an exception to the hearsay rule. 732 

P.2d at 1135 n.7. The court in Oldsen did uphold the conviction 

because the challenged testimony was admitted properly on the 

alternative ground of being circumstantially trustworthy. Id. at 

1137. . 

But see United States v. George, 960 F.2d 97, 100 (9th Cir. 

1992) ("As a general matter, the age of the child and her other 

personal characteristics go to the weight of the hearsay 

statements rather than their admissibility."); cf. State v. 

Robinson, 735 P.2d 801, 809 (Ariz. 1987) (upholding admission of 

statements under Ariz. R. Evid. 803(4) (also identical to the 

federal rule), concluding "[t]he record is not as clear regarding 

[the child's] motive in making the challenged statements. The 

record does indicate, however, that [the] statements were elicited 

in the course of treatment. And nothing in the record indicates 

that [the child victim's] 'motive in making these statements was 

other than as a patient seeking [or at least needing] treatment.' 

[Citation omitted.]"). 

4 

Appellate Case: 92-2104 Document: 01019277815 Date Filed: 07/31/1995 Page: 23 
then stands on no more reliable grounds than any other hearsay 

statement. 

Turning to the trial record, there is no showing which 

demonstrates that A.T., who was four years old at the time of the 

alleged abuse, five at the time she saw Drs. Kuper and Reich, and 

six when she saw Dr. Spiegel, had the necessary understanding that 

"the efficacy of her medical treatment depend[ed] upon the 

accuracy of the information she provide[d] to the doctor." 

Majority Opinion at 4. A.T.'s own testimony did not establish 

that she appreciated the importance of being truthful with the 

doctors. The government did not explore this area on direct 

examination. On cross-examination, defense counsel attempted to 

ask A.T. about the doctors she saw: 

Q What you talked with Tara [Neda, the 

prosecutor,] about Matthew, [the defendant,] that's what 

I'm asking you about, what you told Tara about Matthew, 

whatever it was, did you tell that to any doctor? And 

you can say yes or no or you don't remember. 

A (No audible response.) 

Q Do you remember, [A.T.]? 

A No. 

Q Do you know any doctors, [A. T.] ? 

A (No audible response.) 

Q Do you know the names of any doctors that you 

went to see? 

A (No audible response.) 

Q Do you know the name of Dr. Kuper? 

A Yes. 

Q Is that doctor's job to help kids too? 

5 

Appellate Case: 92-2104 Document: 01019277815 Date Filed: 07/31/1995 Page: 24 
A Yes. 

Q Do you know the name of Dr. Spiegel? 

A No. 

Q How about Dr. Kuper, did she hurt you in any 

way? 

A No. 

Q 

remember 

remember? 

. . . . When you talked to Dr. Kuper, do you 

telling her the truth or not the truth, do you 

A No. 

VII R. at 152, 154-56. On re-direct, the prosecutor asked 

Q Did you tell Dr. Kuper that Matthew did bad 

things to you, Dr. Kuper, the lady doctor? 

A (No audible response.) 

Q Do you remember? 

A (No audible response.) 

Id. at 159. 

Thus, A.T.'s testimony is insufficient to establish that she 

knew the importance of telling the truth to Drs. Kuper, Reich, and 

Spiegel, and is therefore insufficient to satisfy the selfish 

interest rationale under Rule 803(4). Likewise, the testimony of 

the doctors themselves and of Beverly Padilla, A.T.'s mother, 

shows no such proof. See Appendix to this opinion. Because the 

record does not show that A.T. appreciated the importance of 

telling the truth to the doctors, I must conclude that A.T.'s 

out-of-court statements to the doctors are not admissible under 

6 

Appellate Case: 92-2104 Document: 01019277815 Date Filed: 07/31/1995 Page: 25 
Rule 803(4). I therefore respectfully dissent from the majority's 

conclusion that those statements are admissible under Rule 803(4). 

The government argues in the alternative that the testimony 

of the three examining physicians concerning A.T.'s statements to 

them was admissible under Rule 803(24). I am persuaded that the 

testimony was not properly admissible under that rule. The 

majority opinion carefully applies the proper analysis under this 

provision to the testimony of Kae Ecklebarger, and I agree with 

the majority's conclusion that the out-of-court statements made by 

A.T. to her were inadmissible hearsay. For the same reasons, I am 

convinced that the statements made by A.T. to the three physicians 

were not admissible under Rule 803(24) .4 

Finally, I am impressed with the importance of care in the 

application of the hearsay exceptions because of the caveat in the 

4 

As with Ecklebarger's testimony, three circumstances 

surrounding A.T.'s statements to the physicians indicate 

trustworthiness: the experience and training of the physicians in 

interviewing child abuse victims; the use of non-leading 

questions; and the specificity of the statements. On the other 

hand, as with the statements made to Ecklebarger, the statements 

were not spontaneous, were not close in time to the abuse, and 

were made at a time when the child arguably had a motive to 

fabricate. 

Thus, on balance, it is far from clear that A.T. "was 

particularly likely to be telling the truth when [her] 

statement[s] [were] made." Idaho v. Wright, 497 U.S. 805, 822 

(1990). Consequently, it could not be said that, at the time the 

statements were made, A.T.'s "truthfulness [was] so clear from the 

surrounding circumstances that the test of cross-examination would 

be of marginal utility .... " Id. at 820. As the majority 

opinion correctly notes, although Wright involved a challenge to 

the admission of hearsay testimony under the Confrontation Clause, 

"its discussion of the reliability of hearsay statements by child 

victims of sexual abuse is equally pertinent to both Confrontation 

Clause cases and Rule 803(24) cases." Majority Opinion at 11 n.4. 

7 

Appellate Case: 92-2104 Document: 01019277815 Date Filed: 07/31/1995 Page: 26 
Supreme Court's opinion in this case, where Justice Kennedy 

stated: 

Courts must be sensitive to the difficulties 

attendant upon the prosecution of alleged child abusers. 

In almost all cases a youth is the prosecution's only 

eye witness. But "[tlhis court cannot alter evidentiary 

rules merely because litigants might prefer different 

rules in a particular class of cases." United States v. 

Salerno, 505 U.S. , (1992), 112 S. Ct. 2503, 

2507, 120 L.Ed.2d 255~992---) .---

Tome v. United States, 115 S. Ct. 696, 705 (1995) (emphasis 

added) . 

In sum, while I concur in the other evidentiary conclusions 

the majority reaches and in the remand for a new trial, I 

respectfully dissent from the majority's holding that the 

statements by A.T. introduced through the testimony of the doctors 

were admissible. 

8 

Appellate Case: 92-2104 Document: 01019277815 Date Filed: 07/31/1995 Page: 27 
APPENDIX 

Dr. Kuper, a pediatrician, testified that she saw A.T. on two 

occasions, once in September 1990 and then again in October 1990. 

VII R. at 251. During the September 1990 visit, Dr. Kuper 

interviewed A.T. "in order to ascertain exactly what injuries had 

occurred." Id. at 251-52. Dr. Kuper said that A.T.'s mother was 

in the room at the time of the interview. The doctor explained 

that the purpose for that was that "[A.T.] had just turned five at 

that point. And with young children I always have parents in the 

room." Id. at 267. 

On cross-examination, defense counsel asked "Do you let 

[patients] know that you're there to help kids?" to which 

Dr. Kuper replied "I don't believe I use that term exactly, no." 

VII R. at 265. Defense counsel then asked "Do you ever talk with 

a child about truth telling?" Id. Dr. Kuper answered "No, I 

don't because that is part of Protective Services." Id. Later, 

defense counsel asked "[alnd you had no discussion with [A.T.J 

about truth telling?" Id. at 267 (emphasis added). Dr. Kuper 

replied "No, I did not." Id. (emphasis added). Nor did Dr. Kuper 

have any discussion with A.T.'s mother about truth telling. Id. 

It is clear from this and from the rest of Dr. Kuper's testimony 

that Dr. Kuper did not convey to A.T. the importance of telling 

the truth. Thus, Dr. Kuper's testimony does nothing to satisfy 

the preliminary requirement that the declarant understand the 

importance of candor with the doctor. 

Dr. Laura Reich, another pediatrician, testified about an 

examination of A.T. on September 21, 1990. VII R. at 289-90. In 

questioning the child about personal history, the doctor said A.T. 

"was extremely calm during the examination and very friendly and 

said her father had put his thing in her." Id. at 292. The 

doctor concluded from her examination that the vaginal opening was 

definitely larger than normal and the hymen was not intact. Id. 

at 293. The doctor said the child was approximately five years 

old when she saw her. Her conclusion was that she had "definitely 

had penile penetration in her vaginal area." Id. at 294. 

Dr. Reich was asked about whether she had discussed with A.T. 

the importance of giving truthful answers: 

Q Did you talk to her at all about the 

importance of truth telling with you? 

A No, I didn't talk to her about that. 

Q Did you get any sense that she 

else had talked with her about that, 

important to tell you the truth? 

if anyone 

that it was 

A No, that particular issue didn't come up. I 

didn't get any sense of that. 

Appellate Case: 92-2104 Document: 01019277815 Date Filed: 07/31/1995 Page: 28 
Q Did you talk with her at all about what might 

happen if she didn't wasn't completely honest with 

you about things? 

A No, I didn't. 

VII R. at 299. 

Another pediatrician, Dr. Jean Spiegel, testified about 

examining A.T. on September 3, 1991. A.T. was six years old then. 

IX R. at 472. Dr. Spiegel said her findings from the examination 

were consistent with hymenal penetration or vaginal penetration 

which was "chronic" in nature or had occurred more than one time. 

Id. at 473. She testified that while it was difficult to time 

such penetrations, nothing would have likely happened to the child 

within the prior four to six months, and that "the findings are 

old." Id. 

There was no testimony by Dr. Spiegel about any statements by 

A.T. that the defendant had committed any of these acts. The 

doctor did say that A.T .. was very shy and quiet and the doctor 

asked A.T. where her body was touched. She said that "her breasts 

were touched and her front privates were touched, and she also 

told [Dr. Spiegel] that her bottom where her poop comes out was 

touched." Id. at 509. There was no testimony by Dr. Spiegel 

about any discussion with A.T. concerning truth telling or its 

importance in the examination of the child. 

2 

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