IN THE SUPREME COURT OF IOWA

No. 13–0588

Filed June 30, 2015

STATE OF IOWA,

Appellee,

vs.

HILLARY LEE TYLER,

Appellant.

On review from the Iowa Court of Appeals.

Appeal from the Iowa District Court for Webster County, Thomas J. 

Bice, Judge.

Defendant appeals her conviction for murder in the second degree 

for the death of her newborn son. DECISION OF COURT OF APPEALS 

VACATED; DISTRICT COURT JUDGMENT AFFIRMED IN PART AND 

REVERSED IN PART AND CASE REMANDED.

Mark C. Smith, State Appellate Defender, and Maria Ruhtenberg, 

Assistant Appellate Defender, for appellant.

Thomas J. Miller, Attorney General, Tyler J. Buller and Laura 

Roan, Assistant Attorneys General, and Ricki Osborn and Cori Kuhn 

Coleman, County Attorneys, for appellee.
2

Randall D. Armentrout and Ryan G. Koopmans of Nyemaster 

Goode, P.C., Des Moines, for amicus curiae Iowa Association of County 

Medical Examiners.
3

ZAGER, Justice.

Hillary Tyler appeals her conviction for murder in the second 

degree for the death of her newborn son (Baby Tyler). See Iowa Code 

§§ 707.1, .3 (2011). She maintains the district court erred in denying 

several of her trial motions, including: a motion in limine to exclude a

medical examiner’s testimony and autopsy report opining to the cause 

and manner of Baby Tyler’s death, a motion to suppress evidence 

obtained by police during the search of Tyler’s hotel room, and a motion 

to suppress statements Tyler made to police. She also maintains there 

was insufficient evidence to support her conviction. The court of appeals 

held the district court abused its discretion in allowing the medical 

examiner to testify to the cause and manner of Baby Tyler’s death and in 

admitting the unredacted autopsy report into evidence. Accordingly, it 

reversed the judgment of the district court and remanded the case for a 

new trial. The court of appeals did not address the remaining issues 

raised in the appeal.

The State applied for further review, which we granted. On further 

review, we conclude the district court abused its discretion in allowing 

the medical examiner to testify to the cause and manner of Baby Tyler’s 

death because the medical examiner based his opinions primarily, if not 

exclusively, on Tyler’s inconsistent and uncorroborated statements to 

the police as opposed to objective, scientific, or medical evidence. For the 

same reason, the district court should have redacted any reference to 

cause and manner of death in the autopsy report. Additionally, we 

conclude the district court erred in denying Tyler’s motion to suppress 

evidence obtained by the police during the search of the hotel room 

based solely on the legal conclusion that Tyler had no reasonable 

expectation of privacy in the room because she obtained it for the 
4

purpose of committing a crime. Thus, we reverse this motion and 

remand the issue for further hearing and ruling by the district court 

concerning the applicability of exceptions to the warrant requirement or 

exclusionary rule. We affirm the district court’s denial of Tyler’s motion 

to suppress statements she made to police. We vacate the decision of the 

court of appeals, affirm the judgment of the district court in part and 

reverse in part, and remand the case for additional proceedings 

consistent with this opinion and a new trial.

I. Background Facts and Proceedings.

Tyler and Rodney Cyphers began dating in 2010. In early 2011, 

Cyphers noticed Tyler was beginning to exhibit signs of pregnancy and 

asked her if she was pregnant. Tyler denied being pregnant. She told 

Cyphers she was suffering from a medical condition that caused her to 

exhibit signs typically associated with pregnancy. Tyler was in fact 

pregnant. Over time, Tyler exhibited increased signs of pregnancy and 

began wearing looser fitting clothing. Even so, Tyler continued to deny 

she was pregnant to anyone who asked and refused to allow Cyphers to 

touch her abdomen.

In the summer of 2011, Cyphers’s employer assigned him to a job 

at a plant located in Fort Dodge, Iowa. At the end of August, Tyler and 

Cyphers temporarily relocated to Coalville, Iowa, which is approximately 

ten miles south of Fort Dodge. While there, Tyler and Cyphers lived in a 

fifth-wheel trailer in a trailer park.

At approximately 3:00 a.m. on September 19, Tyler began 

experiencing mild contractions. At approximately 6:30 a.m., she called 

the Super 8 Hotel in Fort Dodge to inquire about a room. She spoke with 

the hotel manager who advised her that a room was available. Tyler 

arrived at the hotel approximately twenty minutes later and checked into 
5

room 225. Tyler occupied room 225 from approximately 6:50 a.m. until 

4:30 p.m. At approximately 12:00 p.m., she gave birth to Baby Tyler in 

the bathroom of room 225. She then “laid around for a little bit” and 

“cleaned the bathroom floor” before returning to the trailer in Coalville. 

Cyphers was home when she arrived. Shortly before 7:00 p.m., Cyphers 

left to work a night shift. Tyler stayed alone at the trailer for the night.

After working the night shift, Cyphers returned to the trailer at 

approximately 7:15 a.m. on September 20. Tyler was present when he 

arrived. The couple ate breakfast and ran a few errands before returning

to the trailer so that Cyphers could sleep. At approximately 10:15 a.m.,

Tyler returned to the hotel to check out of room 225. Upon Tyler’s 

arrival, the hotel manager informed Tyler there had been a cancellation 

and room 225 was available for an additional night. Another member of 

the hotel staff had previously informed Tyler room 225 was not available 

for an additional night. Tyler rented room 225 for the night of September 

20. Shortly thereafter, she left the hotel and returned to the trailer in 

Coalville. She intended to return to the room later that evening to clean 

it further.

At approximately 11:00 a.m., a housekeeper at the hotel entered 

room 225 to clean it. Because Tyler had not rerented the room until late 

that morning, the sheet informing the housekeeper of the room’s rental 

status had not been updated to reflect that the room was a “stayover” as 

opposed to a “checkout.” The doorknob to the room had a “Do Not 

Disturb” sign hanging from it. Upon entering the room, the housekeeper 

observed the carpet was saturated with blood. Upon entering the 

bathroom, she further discovered “a lot of blood smear[ed] . . . on the 

floor.” The housekeeper then exited the bathroom and discovered a 

“hoodie coat.” She picked it up and observed the inside of the coat was 
6

saturated with blood. Additionally, she observed two discarded vodka 

bottles and “$8 . . . on the dresser by the TV,” which she thought was a 

tip. She also observed a garbage can in the room, which contained a 

“white towel bundled up” among other trash. She “slid the garbage can” 

across the room and discovered it was “heavy.” She did not empty the 

garbage can or further examine its contents. In a panicked state, she left 

the room and reported her findings to the hotel manager. The manager 

and the housekeeper returned to the room. Another housekeeper also 

entered the room “because she could tell there was something going on 

in the room.” The other housekeeper “pulled the can liner out of the 

garbage can” and the group observed the towel in the garbage can had 

some blood on it and the bottom of the garbage bag contained “fluid and 

some blood.” Although they did not see Baby Tyler’s body, they were 

very concerned about the contents of the garbage can. The manager 

then called the police to report these findings.

Police were dispatched to the hotel at approximately 11:36 a.m. 

According to the responding officer, the original complaint “was for . . . 

criminal mischief . . . or . . . vandalism[,] . . . so that’s what [he] was 

thinking going into it.” Upon arrival at the hotel, the responding officer 

spoke with the hotel manager who advised him what the hotel staff had 

observed. Accompanied by hotel staff, the officer entered room 225 to 

investigate. Thereafter, he contacted his supervisor who arrived within 

approximately ten minutes. Over the next twenty to fifty minutes, the 

officers looked around the room as several additional officers arrived at 

the scene. In the course of their investigation, officers observed that, in 

addition to the blood, there appeared to be other bodily fluids present in 

the room. Eventually, one of the officers moved the towel and other 

items in the garbage can. Beneath these items, he discovered Baby 
7

Tyler’s body. At that point, it “didn’t appear that there was any need to 

render any aid,” so the officers secured the room until they could obtain 

a search warrant.

After officers discovered Baby Tyler’s body, Fort Dodge police 

contacted the Iowa Division of Criminal Investigation (DCI). Detectives 

from the Fort Dodge Police Department, in cooperation with the DCI, 

were subsequently able to identify and locate Tyler. At approximately 

2:08 p.m., Special Agent Michael Roehrkasse of the DCI, Special Agent 

Ray Fiedler of the DCI, and Detective Jody Chansler of the Fort Dodge 

Police Department went to the trailer in Coalville.1 The officers were 

dressed in plain clothes as opposed to police uniforms. The officers 

approached the trailer and knocked on the door. Tyler answered. The 

officers’ encounter with Tyler was audio recorded.

After making contact with Tyler, the officers told her they needed to 

speak with her. She told them she understood that she needed to speak 

with them. Detective Chansler asked Tyler if she needed any medical 

attention. She replied, “No.” He then stated, “I want to have you go with 

this guy right here,” and pointed to Special Agent Roehrkasse. He 

further stated, “We need to get to the bottom of what’s going on.” He

then asked Tyler, “Are you okay with that?” Tyler responded, “Yea.”

Tyler followed the officers to Special Agent Roehrkasse’s vehicle 

and entered it. Outside of Tyler’s presence, the officers discussed how 

Special Agent Roehrkasse should ask Tyler if the baby was born alive. 

Special Agent Roehrkasse then entered the vehicle and proceeded to 

drive to the Fort Dodge police station. He did not read Tyler her Miranda

rights at this time. During the ride, Special Agent Roehrkasse asked 

1We will refer to the special agents of the DCI and the officers of the Fort Dodge 

Police Department as “officers” when referred to collectively.

 
8

Tyler if the baby had moved. She responded, “No.” He also asked her if 

the baby had cried. She responded, “No.” Special Agent Roehrkasse and 

Tyler did not discuss anything else of significance during the ride to the 

police station.

After arriving at the police station, Tyler was escorted to an 

interview room in the basement. Thereafter, Special Agent Roehrkasse, 

along with Special Agent Jim Thiele of the DCI, questioned Tyler over a 

period of approximately three hours. The interview was video recorded. 

Both officers were wearing guns on their hips. During the interview, the 

door to the room was closed; however, it was unlocked and Tyler’s path 

to it was unobstructed.

Special Agent Roehrkasse began the interview by asking Tyler if 

she needed any medical attention. She responded, “No.” He then 

informed her that although she had ridden with him to the police station, 

she was free to leave at any time. He also informed her that if she 

desired, he would drive her back to the trailer. He told her that although 

the door was shut, that should not deter her from leaving. During the 

interview, the special agents again reminded Tyler she was not in 

custody and was free to leave. The special agents twice suggested that 

Tyler seek medical treatment.

During the first half of the interview, the special agents asked Tyler 

open-ended questions about her background and the events surrounding 

Baby Tyler’s birth. During this period, Tyler told the special agents that 

after Baby Tyler was born he was silent, he did not move, and she 

immediately placed him in the garbage can. After approximately fortyfive minutes, the special agents took a forty-three minute break. Before 

they left the room, Special Agent Thiele reminded Tyler the door was 

unlocked and informed her that she was free to “get up and roam 
9

around” if she wanted. After the break, Special Agent Roehrkasse 

returned alone, began asking Tyler more pointed questions about the 

birth, and posited several hypothetical questions about what the autopsy 

would show. Tyler eventually stated that after Baby Tyler was born he 

moved and cried and she placed him in the bathtub and turned the 

water on for the purpose of drowning him. Special Agent Roehrkasse 

then took another thirty-minute break before returning to ask Tyler 

several follow-up questions. Special Agent Roehrkasse then took another 

fifteen-minute break. Upon his return, he informed Tyler she would be 

“charged today” and read Tyler her Miranda rights. After waiving her 

Miranda rights by signing a written waiver form, Special Agent 

Roehrkasse reviewed Tyler’s statements with her. Tyler confirmed that 

after Baby Tyler was born he moved and cried and she placed him in the 

bathtub and turned on the water for the purpose of drowning him. At 

the conclusion of the interview, the special agents took Tyler to the 

hospital for medical treatment.

Although the exact time is not clear from the record, officers filed 

an application for search warrant after they completed the interview at 

the police station. Through the warrant application, officers sought 

authorization to search for and seize items from room 225, a pickup 

truck registered to Cyphers, and the trailer in Coalville. Officers also 

sought to obtain DNA samples from both Tyler and Cyphers for analysis. 

In the warrant application, Detective Cory Husske wrote that at 

approximately 11:00 a.m. the Super 8 cleaning staff “found . . . room 

[225] in disarray,” “saw what looked like blood in multiple locations 

around the room and bathroom,” “observed a garbage can in the room 

containing towels soaked in blood and female menstruation pads,” 

noticed the garbage can “had a heav[y] weight about it,” and contacted 
10

police. The warrant application noted that after officers confirmed the 

information provided by the hotel staff and found Baby Tyler’s body in 

the garbage can, they decided to “get as much information extracted from 

[the] room as [was] possible through the use of a search warrant.” The 

warrant application explained the officers then sought to locate Tyler 

and, in cooperation with the DCI, were successful in doing so. Finally, 

the warrant application noted that officers had “obtained audio/video 

recorded statements from [Tyler] in which she . . . admitted to giving 

birth to a baby and discarding it.” Officers subsequently seized a 

number of items from room 225, including Baby Tyler’s body and a piece 

of the umbilical cord. Officers also seized a number of items from the 

trailer in Coalville, including the placenta.

After Tyler arrived at the hospital on September 20, Dr. Daniel Cole 

treated her and ordered several lab tests. He testified at the suppression 

hearing and at trial that Tyler was alert and aware of her surroundings

when he was treating her. Thereafter, Tyler received surgical repair for a 

tear from childbirth. She had lost a large amount of blood and her blood 

pressure was high. She received a blood transfusion and several 

medications.2 Tyler was also suffering from a condition called 

preeclampsia. This is a condition that occurs in pregnancy and causes 

the patient to become hypersensitive and leads to increased blood 

pressure.

2Some of the medications Tyler received include Labetol, magnesium sulfate, 

and codeine. At the suppression hearing, Dr. Cole testified that Labetol is used to treat 

high blood pressure, magnesium sulfate is used to treat high blood pressure in 

pregnancy, and codeine is a narcotic. He testified that because Tyler was taking several 

medications to reduce high blood pressure, it was possible these medications caused 

her blood pressure to drop too low, which could potentially affect her mental status. 

Additionally, he testified that codeine could affect a person’s mental status if given in a 

“high enough dose.” However, no evidence was presented suggesting these medications 

in fact affected Tyler’s mental status.

 
11

The next day, September 21, Special Agent Roehrkasse and Special 

Agent in Charge Larry Hedlund of the DCI went to Tyler’s hospital room 

to question Tyler again. This interview was audio recorded and lasted for 

approximately fifty minutes. At the start of the interview, Special Agent 

in Charge Hedlund read Tyler her Miranda rights. “[H]e went through 

each of [her rights] and had her explain what each of the rights meant to 

her.” Tyler explained each of her rights back to the special agents in her 

own words. She acknowledged that she understood her rights and 

signed another written waiver form. Tyler told the special agents she was 

“really out of it.” However, she remembered speaking with Special Agent 

Roehrkasse the previous day and that his name was “Mike.” She also 

knew that she was at the hospital.3 Additionally, when the special 

agents asked Tyler if she would prefer “[they] come back later,” Tyler 

responded, “You can talk to me.” The special agents told Tyler that if she 

got too tired or upset, they would stop the questioning. During the 

questioning Tyler never appeared confused and was alert and tracking 

with the special agents’ questions. During this follow-up interview, Tyler 

again stated that after Baby Tyler was born he moved and cried and she 

placed him in the bathtub and turned on the water for the purpose of 

drowning him.

Baby Tyler’s body, a piece of the umbilical cord, and the placenta 

were taken to the offices of the State Medical Examiner. Thereafter, Dr. 

Jonathan Thompson, an Associate State Medical Examiner trained in the 

field of forensic pathology, performed an autopsy on Baby Tyler’s body

and a pathology examination on the body and related items. Dr. 

3A psychiatric evaluation conducted on September 21 stated that at the time of 

the examination, Tyler was oriented to time and place.

 
12

Thompson subsequently issued a “Report of Autopsy” summarizing his 

findings.

After performing the autopsy and pathology examination, Dr. 

Thompson’s opinions on both the cause and manner of Baby Tyler’s 

death were “Undetermined.” In his final report, however, Dr. Thompson 

concluded the cause of death was “Bathtub drowning” and the manner of 

death was “Homicide.” His final report indicated that in reaching these

conclusions he performed both an external and internal examination of 

Baby Tyler’s body. His report further indicated that in forming his 

opinions he relied on Tyler’s statements to police. The report stated: 

“The mother claimed she had given birth the previous day in the motel 

room and then placed the infant in a bathtub partially filled with water 

shortly after the birth. The baby reportedly moved and cried after birth.”

Based on Tyler’s statements to police and other evidence obtained 

during the investigation, the State charged Tyler with murder in the first 

degree for the death of Baby Tyler on September 28. See Iowa Code 

§§ 707.1, .2(1), .2(5). Tyler entered a plea of not guilty.

Prior to trial, Tyler filed several motions relevant to this appeal, 

including: a motion in limine to exclude Dr. Thompson’s testimony and 

autopsy report opining to the cause and manner of Baby Tyler’s death; a 

motion to suppress evidence obtained by police during the search of 

room 225 in violation of the Fourth Amendment to the United States 

Constitution and article I, section 8 of the Iowa Constitution; and a 

motion to suppress Tyler’s statements to police in violation of the Fifth 

and Fourteenth Amendments to the United States Constitution and 

article I, section 9 of the Iowa Constitution.

After hearings on the motions, the district court denied both of 

Tyler’s motions to suppress. On the motion to suppress evidence 
13

obtained by police during the search of room 225, the district court 

concluded Tyler did not have a reasonable expectation of privacy in the 

room because she had not intended to use the room as a residence, but 

instead as a venue for the commission of an alleged crime. Thus, the 

district court concluded Tyler’s Fourth Amendment rights were not 

implicated. On the motion to suppress Tyler’s statements to police, the 

district court concluded Tyler was not in custody at the trailer, during 

the ride to the police station, or during the questioning at the police 

station on September 20. As a result, the district court concluded her 

Fifth Amendment rights were not violated. The district court also 

concluded the special agents’ follow-up questioning of Tyler at the 

hospital did not violate her rights because the special agents informed

her of her Miranda rights and she executed a knowing, intelligent, and 

voluntary waiver.

On January 15, 2013, the district court held a hearing on Tyler’s 

motion in limine to address the admissibility of Dr. Thompson’s expert 

opinion on the cause and manner of Baby Tyler’s death. Tyler’s motion 

requested that the district court “prohibit[] the State . . . from soliciting 

or introducing any evidence from [Dr. Thompson] on his conclusions of 

the truthfulness of [Tyler’s] statements that were provided to him by law 

enforcement.” Tyler maintained this evidence impermissibly “passe[d] on 

[her] guilt or innocence” and constituted an improper comment on her

credibility. Tyler’s motion also requested that the district court 

“prohibit[] the State . . . from soliciting or introducing any evidence from 

[Dr. Thompson] as to scientific or medical opinions on the cause or 

manner of death.” Tyler maintained Dr. Thompson’s opinion on these 

matters “would not be based on any scientific or medical knowledge, 
14

scientific standards, or technical training, but merely from the witness 

adopting the statements and conclusions of law enforcement.”

At the hearing, Tyler’s counsel questioned Dr. Thompson about the 

autopsy he performed and the foundation for his conclusions of the 

cause and manner of Baby Tyler’s death. The following exchange 

occurred:

Q. Okay. So the examination includes your visual 

examination, both inside and outside of the body that you’re 

examining, correct? A. Yes, sir.

Q. And then it also includes various . . . scientific 

tests? A. Yes, it does.

. . . .

Q. In this case, if you based your opinions speaking 

strictly on medical or scientific evidence, you were unable to 

give a conclusion as to whether or not this was a homicide, 

correct? A. Just on the autopsy findings, that would be 

correct, yes.

Q. Okay. And also based just on the autopsy 

findings, you would be unable to determine whether or not

this was a drowning, correct? A. That would be correct, yes.

Q. The autopsy findings were consistent with 

intrauterine fetal demise,[4] correct? A. They could be, yes.

Q. They could also be consistent with a baby that died 

immediately after birth, correct? A. It could be, yes.

. . . .

Q. Okay. So the specific autopsy, the testing that you 

did, the toxicology test, the examination of the lungs, all of 

the things you did, the examination of the stomach contents, 

all of that led you to an inconclusive determination, 

correct? A. That’s correct, yes.

Q. And the only way that you reached the conclusion 

of homicide as the manner of death, as drowning as a cause 

of death, is through observing and watching the videotapes 

that the law enforcement officers supplied to you, 

correct? A. Yes, it is.

Q. So that would be of Miss Tyler’s interview with the 

police, correct? A. That’s correct.[5]

4Intrauterine fetal demise, commonly referred to as a “stillbirth,” occurs when a 

fetus dies in utero.

 
15

. . . .

Q. Okay. So from that standpoint, ultimately your 

opinion as to whether or not this was a homicide . . . and 

what the cause of death was, is based entirely on your belief 

of her statements, correct? A. That’s correct, yes.

. . . .

Q. Okay. . . . [E]ssentially what you’re saying is that 

since the autopsy didn’t disprove her statement, you’re going 

to believe her statement? A. That’s correct, yes. There’s 

nothing inconsistent between what she said and what I saw 

at the autopsy.

Q. Hypothetically speaking, if her statement to the 

police was the baby was a stillborn, your conclusion then 

would have had to have been stillborn birth, natural cause of 

death, correct? A. . . . I would probably classify as 

[stillbirth].

. . . .

Q. And that’s just because the actual medical 

examination, medical testing, scientific testing is 

inconclusive? A. That’s correct, yes.

The district court overruled Tyler’s motion in limine. In its ruling, 

it noted that “in Iowa, the courts are committed to a liberal rule on the 

admission of expert testimony” and that Dr. Thompson’s reliance on 

Tyler’s statements to police was “no different than a physician relying on 

a patient’s history in reaching a diagnosis.” Consequently, the district 

court overruled Tyler’s motion in limine, “subject to [her] right to 

vigorously and thoroughly cross-examine” Dr. Thompson.

Trial in this matter commenced on February 11. The central issue 

in the case was the cause of Baby Tyler’s death. Specifically, whether 

Baby Tyler was born alive and survived for a sufficient period for Tyler to 

drown him, or whether he was stillborn or died immediately after birth 

5Based on the record, it is unclear whether Dr. Thompson listened to the audio 

recording of the ride from the trailer to the police station. Testimony given by Dr. 

Thompson at a deposition taken prior to the hearing on the motion in limine, at the 

hearing on the motion in limine, and at trial confirms that he both viewed the video of 

the interview at the police station and listened to the audio recording of the follow-up 

interview at the hospital.

_________________________________
16

such that Tyler could not drown him. The State presented, among other 

evidence, testimony from Cyphers, members of the hotel staff, officers

who investigated room 225, and the special agents who interviewed Tyler. 

The State also presented Tyler’s interviews at both the police station and 

the hospital by way of video and audio recordings, respectively.6

Dr. Thompson also testified on behalf of the State. On direct 

examination, he explained to the jury that the autopsy he conducted on 

Baby Tyler involved both an external and internal examination of the 

body. He explained that he found fluid in Baby Tyler’s lungs. However, 

he also explained that this fluid was, at least in part, amniotic fluid. Dr. 

Thompson testified that because amniotic fluid is in part composed of 

water, there was no scientific basis for determining whether some of the

fluid was bathwater. Dr. Thompson further testified that there were 

indications Baby Tyler may have taken a breath because the alveoli in 

the lungs were partially, although not entirely, expanded. He then 

testified that based on this finding, and “[g]iven the history that Baby 

Tyler cried and moved, . . . Baby Tyler probably took a few breaths.” Dr. 

Thompson further testified that based on his findings, he was able to 

rule out several possible alternative causes of death. He then opined 

that Baby Tyler’s cause of death was “drowning,” and that his manner of 

death was “homicide”—meaning “death at the hands of another 

individual.” Finally, Dr. Thompson testified that his opinions on the 

cause and manner of Baby Tyler’s death were based on “a combination of 

history, which includes scene findings, it includes witness statements; 

it’s also based on a combination of physical exam, which is [the] autopsy 

findings; and then supplemental testing.”

6The jury did not listen to the audio recording of the officers’ initial contact with 

Tyler or the ride from the trailer to the police station.

 
17

On cross-examination, defense counsel called attention to the 

inconclusive nature of Dr. Thompson’s autopsy findings. Counsel asked 

Dr. Thompson if there was an alternative explanation for the partially 

expanded alveoli in Baby Tyler’s lungs. Dr. Thompson explained that 

partially expanded alveoli would also be consistent with the production of 

methane gas by bacteria found in the body after death, which “will 

diffuse up into the lungs and can expand those a[l]veolar spaces.” 

Counsel also questioned Dr. Thompson as to whether it was possible, 

based on the autopsy, that Baby Tyler was stillborn or died immediately 

after birth. Dr. Thompson testified there were several other possible 

causes of death he could not rule out based on the autopsy findings 

alone. He agreed with defense counsel that it was possible Baby Tyler 

died either in utero or immediately after birth. Defense counsel and Dr. 

Thompson also had an exchange in which counsel pressed Dr. 

Thompson on the basis for his conclusion of the cause and manner of 

Baby Tyler’s death. The following exchange occurred:

Q. Okay. It is true that you cannot say from your 

autopsy alone that the child in this case ever took a breath, 

correct? A. That’s correct, yes.

Q. . . . For that opinion, you are entirely relying on the 

review of the interview in this case; is that correct? A. Uh, 

not necessarily, because there’s nothing inconsistent with 

what the witness statement said with the autopsy findings.

Q. Well -- A. But without the witness statements, I 

could not have diagnosed drowning in this case.

Q. You had conducted your autopsy, correct? A. Yes.

Q. Your opinion was undetermined at that 

time? A. That’s correct, yes.

Q. And then the only way you came up with your 

decision in this case was based on the interview you 

watched? A. Yes, sir, that’s correct.

Q. Now, you’re relying on the fact that [Tyler] said 

prior to putting the baby in the tub, the baby moved and 

cried, correct? A. Yes, sir.
18

Tyler’s defense was that her statements to police were not credible 

and the product of coercion. Counsel noted that during the first half of 

the interview at the police station, Tyler denied the baby cried or moved 

after the birth. It was only after being interviewed for forty-five minutes

and a forty-three minute break that Tyler stated the baby cried and

moved. Tyler maintained these statements were not credible due to the 

length of the interview and her need for medical care. As to her second 

interview at the hospital, Tyler’s defense was that these statements were 

also not credible due to her medicated and vulnerable state. Tyler also 

presented a medical expert who testified in her defense. This pathologist 

testified that there was not sufficient information to determine the cause

or manner of death.

The jury found Tyler guilty of the lesser included offense of murder 

in the second degree. See Iowa Code §§ 707.1, .3. Tyler appealed and we 

transferred the case to the court of appeals. The court of appeals held 

the district court abused its discretion in allowing Dr. Thompson to 

testify to the cause and manner of Baby Tyler’s death and in admitting 

the unredacted autopsy report into evidence. The court of appeals 

reasoned Dr. Thompson’s reliance on Tyler’s statements in forming his 

opinions on the cause and manner of death amounted to an improper

comment on Tyler’s credibility. It also concluded Dr. Thompson’s 

opinions could not fairly be characterized as expert medical opinions. 

The court of appeals further determined the erroneous admission of 

Dr. Thompson’s testimony and autopsy report into evidence was

reversible error because Tyler’s credibility was the central issue in the 

case. The court of appeals reversed the conviction and remanded the 

case for a new trial. It did not address the remaining issues raised in the 

appeal.
19

The State applied for further review, which we granted. We will 

provide additional facts in the discussion of specific issues below.

II. Standard of Review.

Evidentiary rulings are reviewed for an abuse of discretion. State 

v. Elliott, 806 N.W.2d 660, 667 (Iowa 2011). “ ‘An abuse of discretion 

occurs “when the district court exercises its discretion on grounds or for 

reasons clearly untenable or to an extent clearly unreasonable.” ’ ” State 

v. Miller, 841 N.W.2d 583, 586 (Iowa 2014) (quoting Rowedder v. 

Anderson, 814 N.W.2d 585, 589 (Iowa 2012)). “ ‘A ground or reason is 

untenable when it is not supported by substantial evidence or when it is 

based on an erroneous application of the law.’ ” State v. Redmond, 803 

N.W.2d 112, 117 (Iowa 2011) (quoting Graber v. City of Ankeny, 616 

N.W.2d 633, 638 (Iowa 2000)). “Thus, under our abuse-of-discretion 

standard, ‘we will correct an erroneous application of the law.’ ” Miller, 

841 N.W.2d at 586 (quoting Rowedder, 814 N.W.2d at 589). “ ‘ “When 

the error is not of constitutional magnitude, the test of prejudice is 

whether it sufficiently appears that the rights of the complaining party 

have been injuriously affected or that the party has suffered a 

miscarriage of justice.” ’ ” Id. (quoting State v. Marin, 788 N.W.2d 833, 

836 (Iowa 2010)).

We review determinations of whether to suppress both evidence 

obtained and statements made in violation of constitutional guarantees 

de novo. State v. Watts, 801 N.W.2d 845, 850 (Iowa 2011); State v. 

Palmer, 791 N.W.2d 840, 844 (Iowa 2010). “[W]e make ‘ “an independent 

evaluation of the totality of the circumstances as shown by the entire 

record,” ’ ” considering “both the evidence introduced at the suppression 

hearing as well as the evidence introduced at trial.” Palmer, 791 N.W.2d 

at 844 (quoting State v. Turner, 630 N.W.2d 601, 606 (Iowa 2001)); see 
20

also Watts, 801 N.W.2d at 850. “ ‘We give deference to the district 

court’s fact findings due to its opportunity to assess the credibility of 

witnesses, but we are not bound by those findings.’ ” Palmer, 791 

N.W.2d at 844 (quoting Turner, 630 N.W.2d at 606). In considering 

whether a defendant’s statements were voluntarily given, we give 

considerable weight to the district court’s findings. State v. Payton, 481 

N.W.2d 325, 328 (Iowa 1992). When the alleged error concerns the 

erroneous admission of evidence in violation of a defendant’s 

constitutional rights, such error is typically subject to harmless-error 

analysis. See State v. Peterson, 663 N.W.2d 417, 430 (Iowa 2003).

III. Discussion of Medical Examiner Testimony.

In our analysis of this case, we must determine when medical 

examiners may rely on witness statements and the results of police 

investigations, in addition to their medical examination and findings, in 

forming their opinions on cause or manner of death. We begin by setting 

forth the role of expert testimony within our system of justice. Next, we 

consider the duties and responsibilities of our state medical examiners. 

We then consider whether medical examiners may rely on witness 

statements and information obtained through police investigations in 

forming their opinions on cause or manner of death. Finally, we consider 

whether under the unique circumstances of this case, it was appropriate 

for Dr. Thompson to opine on the cause and manner of Baby Tyler’s 

death.

A. The Role of Expert Testimony in Iowa. Iowa is generally 

“committed to a liberal view on the admissibility of expert testimony.” 

Ranes v. Adams Labs., Inc., 778 N.W.2d 677, 685 (Iowa 2010). Iowa Rule 

of Evidence 5.702 allows expert opinion testimony “[i]f scientific, 

technical, or other specialized knowledge will assist the trier of fact to 
21

understand the evidence or to determine a fact in issue.” Iowa Rule of 

Evidence 5.703 provides further insight into the information experts may 

rely on in forming their opinions. This rule provides:

The facts or data in the particular case upon which an 

expert bases an opinion or inference may be those perceived 

by or made known to the expert at or before the trial or 

hearing. If of a type reasonably relied upon by experts in the 

particular field in forming opinions or inferences upon the 

subject, the facts or data need not be admissible in evidence.

Iowa R. Evid. 5.703.

“[T]here is no requirement that the expert be able to express an 

opinion with absolute certainty. A lack of absolute certainty goes to the 

weight of the expert’s testimony, not to its admissibility.” Johnson v. 

Knoxville Cmty. Sch. Dist., 570 N.W.2d 633, 637 (Iowa 1997) (citation 

omitted). In the context of cause of death determinations, in order to be 

considered by the trier of fact “ ‘it is only necessary that the witness 

entertain a “reasonable degree of medical certainty” for his conclusions.’ ” 

State v. Webb, 309 N.W.2d 404, 413 (Iowa 1981) (quoting Commonwealth 

v. Stoltzfus, 337 A.2d 873, 879 (Pa. 1975)). “ ‘ “Whether the . . . evidence 

is sufficient to warrant a finding of causal connection is initially a legal 

question for the court, but whether it is persuasive beyond a reasonable 

doubt is for the jury to say.” ’ ” Id. at 413–14 (quoting Stoltzfus, 337 A.2d 

at 879).

“[O]therwise admissible [opinion testimony] is not objectionable 

because it embraces an ultimate issue to be decided by the trier of fact.” 

Iowa R. Evid. 5.704. However, an expert may not opine as to whether a 

particular legal standard has been satisfied or to “the defendant’s guilt or 

innocence.” State v. Smith, 522 N.W.2d 591, 593–94 (Iowa 1994). 

Further, we have continually held that expert testimony is not admissible 

merely to bolster a witness’s credibility. See State v. Dudley, 856 N.W.2d 
22

668, 676 (Iowa 2014) (“[W]e continue to hold expert testimony is not 

admissible merely to bolster credibility.”); State v. Myers, 382 N.W.2d 91, 

97 (Iowa 1986) (“[M]ost courts reject expert testimony that either directly 

or indirectly renders an opinion on the credibility or truthfulness of a 

witness.”). As we recently explained with respect to this rule:

Our system of justice vests the jury with the function of 

evaluating a witness’s credibility. The reason for not 

allowing this testimony is that a witness’s credibility “is not a 

‘fact in issue’ subject to expert opinion.” Such opinions not 

only replace the jury’s function in determining credibility, 

but the jury can employ this type of testimony as a direct 

comment on defendant’s guilt or innocence. Moreover, when 

an expert comments, directly or indirectly, on a witness’s 

credibility, the expert is giving his or her scientific certainty 

stamp of approval on the testimony even though an expert 

cannot accurately opine when a witness is telling the truth. 

In our system of justice, it is the jury’s function to determine 

the credibility of a witness. An abuse of discretion occurs 

when a court allows such testimony.

Dudley, 856 N.W.2d at 676–77 (citations omitted) (quoting State v. 

Hulbert, 481 N.W.2d 329, 332 (Iowa 1992)). Notwithstanding, “[w]e 

recognize there is a very thin line between testimony that assists the jury 

in reaching its verdict and testimony that conveys to the jury that [a 

witness’s] out-of-court statements and testimony are credible.” Id. at 

677.

B. The Role of the Medical Examiner. A state medical examiner

must be “a physician and surgeon or osteopathic physician and surgeon, 

. . . licensed to practice medicine in the state of Iowa, and . . . board 

certified or eligible to be board certified in anatomic and forensic 

pathology by the American board of pathology.” Iowa Code § 691.5. 

Forensic pathologists are physicians who specialize in forensic pathology, 

meaning they received a Doctor of Medicine or a Doctor of Osteopathy, 

spent at least four years in a residency program, and then spent another 
23

year in a forensic pathology fellowship. See Iowa Code § 331.801(2)

(outlining requirements to serve as a county medical examiner); id. 

§ 691.5 (outlining requirements to serve as a state medical examiner); 

David Dolinak et al., Forensic Pathology: Principles and Practice, at xxiii 

(Mark Listewnik et al. eds., 2005) [hereinafter Dolinak] (outlining 

qualifications of forensic pathologists). In certain cases, state law 

requires medical examiners to investigate the cause and manner of a 

death, conduct an autopsy, and prepare a written report of their findings. 

See Iowa Code § 331.802(2)(a) (requiring county medical examiners to 

“conduct a preliminary investigation of the cause and manner of death 

[and] prepare a written report of the findings” when “a person’s death 

affects the public interest”); id. § 691.6(7)–(8) (requiring the state medical 

examiner to “perform an autopsy or order that an autopsy be performed”

if required by law and to “retain tissues, organs, and bodily fluids as 

necessary to determine the cause and manner of death”); Iowa Admin. 

Code r. 641—127.3(1), (5) (requiring county medical examiners to 

“perform an autopsy or order that an autopsy be performed” in specified 

cases and submit a “complete record of the findings of the autopsy . . . to 

the state medical examiner’s office”).

The administrative code defines “Cause of death” as “the disease or 

injury which sets in motion the chain of events which eventually result in 

the death of a person.” Iowa Admin. Code r. 641—127.1. The

administrative code defines “Manner of death” as “the circumstances 

under which the cause of death occurred.” Id. The manner of death

“may be specified as . . . natural, accident, suicide, homicide, 

undetermined, or pending.” Id. In this context, and as explained by Dr. 

Thompson at trial, the term “homicide” means “[t]he killing of one human 

being by . . . another.” Black’s Law Dictionary 734 (6th ed. 1990). The 
24

term “homicide” expresses no opinion as to the criminality of the killing

or the culpability of the killer.7 See id.

In making cause and manner of death determinations, medical 

examiners conduct an autopsy, defined as “the external and internal 

postmortem examination of a deceased person.” Iowa Admin. Code 

r. 641—127.1; see Iowa Code § 691.6(7); Iowa Admin. Code r. 641—

127.3(1). Further, in making these determinations, medical examiners 

routinely rely on the circumstances that surround the death, as revealed 

by independent investigation, police investigation, and eyewitness 

accounts. See Iowa Code § 691.6(5) (“The duties of the state medical 

examiner shall be: To conduct an inquiry, investigation, or hearing and 

administer oaths and receive testimony under oath relative to the matter 

of inquiry, investigation, or hearing, and to subpoena witnesses and 

require the production of records, papers, and documents pertinent to 

the death investigation.”); Dolinak at 4 (“Before the autopsy is 

interpreted, circumstances prior to death must be considered.”); Michael 

J. Shkrum & David A. Ramsay, Forensic Pathology of Trauma: Common 

7As Black’s Law Dictionary explains:

Homicide is not necessarily a crime. It is a necessary ingredient 

of the crimes of murder and manslaughter, but there are other cases in 

which homicide may be committed without criminal intent and without 

criminal consequences, as, where it is done in the lawful execution of a 

judicial sentence, in self-defense, or as the only possible means of 

arresting an escaping felon.

Black’s Law Dictionary at 734. Our statutes reflect this same concept. See, e.g., Iowa 

Code § 707.1 (defining murder as “kill[ing] another person with malice aforethought” 

(emphasis added)); id. § 707.5(1)–(2) (defining involuntary manslaughter as 

“unintentionally caus[ing] the death of another person by the commission of a public 

offense other than a forcible felony or escape [or] . . . by the commission of an act in a 

manner likely to cause death or serious injury” (emphasis added)); id. § 707.6A(1) 

(defining homicide by vehicle as “unintentionally caus[ing] the death of another by 

operating a motor vehicle while intoxicated” (emphasis added)).

 
25

Problems for the Pathologist 2 (2007) (“A complete autopsy requires the 

integration of information from various investigative sources . . . .”).

C. Reliance on Witness Statements and Information Obtained 

Through Police Investigation. Whether a medical examiner may opine 

on cause or manner of death when his or her opinions are based largely 

on uncorroborated witness statements or information obtained through 

police investigation is an issue of first impression in Iowa. Other 

jurisdictions that have considered the issue have failed to reach a 

consensus. State v. Sosnowicz, 270 P.3d 917, 923–24 (Ariz. Ct. App. 

2012) (collecting cases and noting that “[t]o the extent that there is a 

common thread amongst these cases, it is that the admissibility in a 

criminal case of a medical examiner’s opinion regarding the manner of 

death depends on the particular facts and circumstances of each case”). 

We turn now to survey the authority on the issue.

As discussed above, expert opinion testimony is admissible “[i]f 

scientific, technical, or other specialized knowledge will assist the trier of 

fact to understand the evidence or to determine a fact in issue.” Iowa R.

Evid. 5.702. Thus, we must determine whether a medical examiner’s 

opinion on cause or manner of death assists the trier of fact. Clearly, 

such opinions can assist the trier of fact in certain circumstances. 

Specifically, a medical examiner’s opinion on cause or manner of death 

can help the jury determine whether the medical and scientific evidence 

is consistent with a particular view of the evidence. See State v. Dao 

Xiong, 829 N.W.2d 391, 397 (Minn. 2013) (noting that medical 

examiner’s opinion that the victim’s manner of death was homicide 

“assisted the jury’s understanding of the medical evidence offered at trial 

by explaining that the autopsy results were consistent with homicide”).
26

Notwithstanding, when a medical examiner over-relies on witness 

statements or information obtained through police investigation in 

forming his or her opinions on cause or manner of death, such opinions

may not assist the trier of fact. Numerous jurisdictions have held that 

when a medical examiner bases his or her opinions on cause or manner 

of death largely on statements of lay witnesses or information obtained 

through police investigation, such opinions are inadmissible under rules 

similar to our rule 5.702. Iowa R. Evid. 5.702; see, e.g., Sosnowicz, 270 

P.3d at 922 (noting that “it does not appear that [the medical examiner]

relied on any ‘specialized knowledge’ to classify the death as a ‘homicide’ 

rather than an ‘accident’ ” when the medical examiner “based his 

conclusion that the death was a homicide on the circumstances reported 

to him by the police”); Maxwell v. State, 414 S.E.2d 470, 473–74 (Ga. 

1992) (holding “[t]he medical examiner should not have been permitted to 

testify as to his conclusion or opinion of the manner of death” when “his 

opinion that the manner of death was due to homicide was based entirely 

upon the circumstances surrounding [the victim’s] demise as related to 

him by a detective working on the case” because “his expertise as a 

forensic pathologist was not needed or used in reaching that 

conclusion”), overruled on other grounds by Wall v. State, 500 S.E.2d 904,

907 (Ga. 1998); People v. Perry, 593 N.E.2d 712, 716 (Ill. App. Ct. 1992) 

(noting “[the pathologist’s] opinion as to homicide, caused by the 

defendant’s body being positioned on top of her sleeping son, did not in 

any way add to the evidence already presented to the jury or assist them 

in reaching their own conclusions,” but upholding the conviction because 

error was harmless); State v. Vining, 645 A.2d 20, 20–21 (Me. 

1994) (concluding “the medical examiner’s opinion that [the victim’s] 

death was a homicide was not a product of her expertise” and “amounted 
27

to an assessment of the credibility and investigatory acumen of the 

police” when “[she] conceded that there was no physical evidence that 

[the victim’s] death had been caused by a human agent as opposed to an 

accidental fall”); State v. Jamerson, 708 A.2d 1183, 1189, 1195 (N.J. 

1998) (holding a forensic pathologist’s opinion that a car crash was a

homicide as opposed to an accident was inadmissible because his 

opinion was based on “circumstances leading up to the accident that 

were within the understanding of the average juror,” such that his 

opinion “could not be of assistance to the jury”); People v. Eberle, 697 

N.Y.S.2d 218, 219 (App. Div. 1999) (holding a medical expert’s opinion 

that an infant’s death was caused by “homicidal suffocation” as opposed 

to sudden infant death syndrome was inadmissible when “the results of 

the autopsy equally supported two possible causes of death” because her 

opinion was not based on the medical evidence, but rather on her review 

of “statements by defendant and other individuals” (internal quotation 

marks omitted)); Bond v. Commonwealth, 311 S.E.2d 769, 772 (Va. 

1984) (“The ultimate question was whether the decedent jumped 

intentionally, fell accidentally, or was thrown to her death. The facts and 

circumstances shown by the testimony of lay witnesses were sufficient to 

enable a jury to decide that question. The expert’s opinion was based 

largely, if not entirely, upon the same facts and circumstances.”). These 

cases generally stand for the proposition that when a medical examiner’s 

opinion on cause or manner of death is based largely on statements of 

lay witnesses or information obtained through police investigation, such 

opinions are not sufficiently based on scientific, technical, or specialized 

knowledge that would assist the jury in weighing the evidence.

For example, in Sosnowicz, the defendant was accused of running 

over the victim with his Hummer. 270 P.3d at 919. At trial, the medical 
28

examiner testified that based on his autopsy of the victim’s body, the 

cause of death was “blunt force trauma.” Id. at 921. He also testified 

that based on the autopsy and information he received from police 

regarding the circumstances surrounding the victim’s death, the manner 

of death was “homicide.” Id. He explained that in reaching his 

conclusion on the manner of death he determined the circumstances of 

the victim’s death as reported to him by police were consistent with his 

autopsy findings and that those circumstances were consistent with 

homicide. Id. 

In concluding the medical examiner’s testimony was inadmissible 

under Arizona Rule of Evidence 702, the Court of Appeals of Arizona

reasoned:

[I]t does not appear that [the medical examiner] relied on any 

“specialized knowledge” to classify the death as a “homicide” 

rather than an “accident.” Under cross-examination, [he] 

agreed with defense counsel that he based his conclusion 

that the death was a homicide on the circumstances 

reported to him by the police. Indeed, [he] was in no better 

position to determine the manner of death than was the jury 

who heard the actual trial testimony of witnesses and had 

the opportunity to evaluate their credibility.

Id. at 922–23.

In Vining, the victim “died after falling over backwards and hitting 

his head on a cement floor.” 645 A.2d at 20. The victim was intoxicated 

at the time. Id. At trial, an eyewitness who was also intoxicated at the 

time of the incident testified that the defendant and the victim were in a 

fight at the time of the fall and that the defendant was standing in front 

of the victim when the victim fell. Id. However, the eyewitness did not 

actually see the defendant push the victim. Id. “The State Medical 

Examiner testified that although there was no physical evidence from 

[the victim’s] body that would allow her to determine whether [the victim] 
29

fell or was pushed, she concluded based on her conversations with the 

police investigators that [the victim’s] death was a homicide.” Id. 

In concluding the medical examiner’s opinion that the victim’s 

death was a homicide was inadmissible, the Supreme Court of Maine 

reasoned:

[T]he medical examiner’s opinion . . . was not a product of 

her expertise. The medical examiner conceded that there 

was no physical evidence that [the victim’s] death had been 

caused by a human agent as opposed to an accidental fall. 

Her opinion was based solely on her discussions with the 

police investigators and therefore amounted to an 

assessment of the credibility and investigatory acumen of the 

police. The credibility of witnesses is the exclusive province 

of the jury.

. . . [T]he State argues that “[the medical examiner’s] 

opinion assisted the jury in determining whether [the victim’s] 

fatal injuries resulted from accidentally falling backwards off 

his chair onto the floor or from the severe force applied by 

another person.” That argument begs the issue. It is 

appropriate for the medical examiner to testify, as she did, 

that the damage to the skull shows that severe force was 

applied. It is another thing entirely, however, to testify that 

although the physical evidence was insufficient for her to 

distinguish whether [the victim] fell or was pushed, the police 

investigators have convinced her that [the victim’s] death was 

a homicide. That is not an expert medical opinion.

Id. at 20–21 (footnote omitted)(citation omitted).

In Eberle, a case closely analogous to the present case, a medical 

examiner testified that an infant victim’s cause of death was “homicidal 

suffocation.” 297 N.Y.S.2d at 219 (internal quotation marks omitted). 

However, she admitted “there were no medical findings to explain the 

death of the infant” and that “the results of the autopsy equally 

supported two possible causes of death, i.e., suffocation and Sudden 

Infant Death Syndrome (SIDS).” Id. Additionally, she stated that “her 

opinion that the death was caused by homicidal suffocation rather than 
30

SIDS was not based on medical evidence but rather . . . on her review of 

statements by defendant and other individuals.” Id. 

In concluding the medical examiner’s opinion concerning cause 

and manner of death was inadmissible, the Supreme Court, Appellate 

Division, of New York reasoned:

[T]he opinion of the . . . expert was not based on professional 

or medical knowledge but rather was based on inferences 

and conclusions drawn from various statements presented to 

her by the police. It is, however, for the jury to determine 

whether to credit such statements and to determine the 

inferences to be drawn therefrom. . . . Because the jury was 

able to comprehend the issues and evaluate the evidence, 

the expert’s opinion, which intruded on the province of the 

jury to draw inferences and conclusions from that evidence, 

was improperly admitted.

Id. (citation omitted).

The State asserts the weight of out-of-state authority supports a 

more liberal approach regarding the admissibility of medical examiner

opinions on cause or manner of death under rule 5.702. Iowa R. Evid. 

5.702; see, e.g., Baraka v. Commonwealth, 194 S.W.3d 313, 314–16 (Ky. 

2006) (holding the trial court did not abuse its discretion in admitting a 

medical examiner’s opinion that the victim’s manner of death was 

homicide when the medical examiner’s opinion was “based, in part, on 

disputed information regarding the circumstances of the victim’s death 

that was provided to her by police”); Rollins v. State, 897 A.2d 821, 849, 

851–52 (Md. 2006) (holding a medical examiner’s opinion that the victim

was “smothered” was admissible when her opinion was based, in part, on 

witness statements and information provided by police), abrogated on 

other grounds as recognized by Derr v. State, 29 A.3d 533, 548–49 (Md. 

2011); Dao Xiong, 829 N.W.2d at 397–98 (holding the trial court did not 

err in admitting a medical examiner’s testimony that the victim’s manner 

of death was “homicide” when the medical examiner’s opinion “was based 
31

on [his] examination of [the victim’s] body”); State v. Bradford, 618 

N.W.2d 782, 790, 793 (Minn. 2000) (holding a medical examiner’s 

testimony that the victim’s death was a “homicide” was admissible 

because the “testimony was helpful to the jury” and assisted it in

“differentiat[ing] between a self-inflicted intraoral gunshot wound and 

one inflicted by another”); State v. Wilson, 248 P.3d 315, 323–25 (N.M. 

2010) (holding the trial court did not abuse its discretion in admitting a 

medical expert’s testimony that the victim’s death was “consistent with 

smothering” when the expert “considered several sources of information 

when forming his opinion, including the medical record and the autopsy 

report, as well as Defendant’s confession and the police report”), 

overruled on other grounds by State v. Tollardo, 275 P.3d 110, 121 (N.M. 

2012); State v. Commander, 721 S.E.2d 413, 420 (S.C. 2011) (“Because 

the anecdotal history is an essential component of any autopsy, we find 

testimony concerning findings based on this information falls within the 

umbrella of the expert’s specialized knowledge.”); State v. Boyer, 741 

N.W.2d 749, 757 (S.D. 2007) (holding a forensic pathologist’s testimony 

that the victim’s manner of death was “homicide” was admissible when 

his conclusion was “based on [his] interview with the law enforcement 

officers that were investigating the death and . . . the autopsy findings”); 

State v. Richardson, 603 A.2d 378, 379 (Vt. 1992) (holding, in a case 

where the defendant did not raise a rule 702 argument, a medical 

examiner’s testimony that the victim’s death was a “homicide” did not 

impermissibly state a legal conclusion concerning the defendant’s guilt 

because the jury “still had to decide the ultimate question of whether 

defendant was at all involved in the homicide”); State v. Scott, 522 S.E.2d 

626, 632 (W. Va. 1999) (holding, in a case where the defendant did not 

raise a rule 702 argument, a medical examiner’s testimony that the 
32

victim’s death was a “homicide” did not impermissibly state a legal 

conclusion concerning the defendant’s guilt). However, unlike the cases 

discussed above, in many of the cases cited by the State the medical 

experts based their opinions primarily on the autopsy results, as 

opposed to witness statements or other information provided by police.

For example, in Dao Xiong, the Supreme Court of Minnesota

approved the admission of a medical examiner’s testimony that the 

manner of death of a victim of a gunshot wound to the abdomen was 

homicide. 829 N.W.2d at 394–95, 98. In concluding the testimony 

would assist the jury, the court noted that the medical examiner based 

his opinion on his “examination of [the victim’s] body.”8 Id. at 397. 

8The extent to which the medical examiner in Dao Xiong relied on witness 

statements or information provided by police in forming his opinion on manner of death 

is somewhat unclear. However, in approving the medical examiner’s testimony, the Dao 

Xiong court compared the case to its earlier Bradford decision in which the medical 

examiner based his manner-of-death opinion primarily on his examination of the 

victim’s body. See Dao Xiong, 829 N.W.2d at 397 (“[I]n . . . Bradford, we concluded that 

no error was committed when the district court admitted a medical examiner’s expert 

testimony that, based on his autopsy of the victim’s body, the victim’s manner of death 

was homicide rather than suicide.”). This suggests the medical examiner in Dao Xiong

based his opinion largely on his examination of the victim’s body.

The court further noted that Dao Xiong was unlike its prior decision Hestad v. 

Pennsylvania Life Insurance Co., 204 N.W.2d 433, 436 (Minn. 1973). See Dao Xiong, 

829 N.W.2d at 397. There, the trial court excluded testimony from a coroner who 

would have testified on behalf of the defendant that an individual’s cause of death was 

carbon monoxide poisoning and manner of death was accident, as opposed to suicide. 

Hestad, 204 N.W.2d at 435. In concluding the coroner’s opinion was inadmissible, the 

Minnesota Supreme Court noted the coroner based his opinion largely “on information 

received from the sheriff.” Id. at 436. As a result, “the medical expert did not . . . 

possess[] any peculiar knowledge or ability to assist the jury in the determination of 

whether the death was accidental or suicide.” Id. Thus, the Dao Xiong court’s effort to 

distinguish Hestad further suggests the medical examiner in Dao Xiong based his 

opinion largely on his examination of the victim’s body.

The Dao Xiong court did note that subsequent decisions of the court 

“establish[ing] that expert testimony regarding the victim’s manner of death can be 

helpful to the jury” have somewhat limited the scope of Hestad’s holding. Dao Xiong, 

829 N.W.2d at 397. However, the court did not overrule Hestad or hold medical 

examiners may testify to cause or manner of death irrespective of the extent to which

they base such opinions on witness statements or information provided by police. Id.

 
33

Bradford similarly involved a medical examiner’s opinion that appears to 

have been primarily based on the autopsy.9 See 618 N.W.2d at 790; see 

also Sosnowicz, 270 P.3d at 923 (“Bradford, however, is inapposite 

because the pathologist’s opinion . . . appears to have been based on his 

external and internal examination of the victim rather than a history 

provided to him by law enforcement investigators.”); Dao Xiong, 829 

N.W.2d at 397 (“[I]n . . . Bradford, we concluded that no error was 

committed when the district court admitted a medical examiner’s expert 

testimony that, based on his autopsy of the victim’s body, the victim’s 

manner of death was homicide rather than suicide.” (emphasis added)). 

Likewise, the expert in Rollins relied largely on the autopsy in concluding 

the victim’s cause of death was “asphyxiation” and manner of death was 

“smothering.”10 See 897 A.2d at 849–50.

9The Bradford court described the basis of the medical examiner’s opinion as 

follows:

The medical examiner who performed an autopsy on [the victim’s] 

body noted a single intraoral gunshot wound with an exit wound on the 

back of her neck. The examiner concluded that [the victim] died from the 

gunshot wound. He also observed numerous bruises on [the victim’s] 

scalp, left eye, ear, face, abdomen, hands, feet, arms, and legs and 

abrasions on her left eye, back, shoulders, buttocks, and knees. The 

examiner concluded that the injury to [the victim’s] left eye was 

consistent with her having been struck with a fist.

618 N.W.2d at 790.

10The expert in Rollins did not base her opinion primarily on witness statements 

or information provided by police, but also relied on evidence of physical injuries on the 

victim indicating there had been an altercation and other physical findings consistent 

with smothering. See 897 A.2d at 848. Specifically, she noted:

There was a hemorrhage in her mouth where it shouldn’t be, indicating 

pressure on the mouth, hemorrhage, bleeding. That is indicative of 

smothering, pressure to the mouth in some manner from an external 

force, be it a hand, be it a pillow, something pushing on her mouth. . . .

In addition, there are other injuries on her that you can’t ignore 

also. They might not be part of the exact smothering but it is part of the 

injury that you have to take into consideration. Of course smothering is 

holding something over the mouth. Just because I have bruises in my

 
34

In Baraka, a fight between the defendant and the victim allegedly 

caused the victim to have a fatal heart attack. 194 S.W.3d at 314. A

medical examiner testified the victim’s cause of death was heart attack 

and manner of death was “homicide.” Id. The defendant asserted the 

medical examiner’s testimony regarding manner of death did not assist 

the jury because it was “based, in part, on disputed information 

regarding the circumstances of the victim’s death that was provided to 

her by police.” Id. In concluding the testimony was admissible, the 

Supreme Court of Kentucky observed that “it is axiomatic that a 

determination of the cause and manner which led to a person’s death is 

generally scientific in origin and outside the common knowledge of 

layperson jurors.” Id. Accordingly, the court concluded the testimony, 

based in part on information provided by police, assisted the jury. Id.

Three of seven justices concurred. Id. at 320 (Cooper, J., 

concurring). In summarizing the state of the law concerning medical 

examiner opinions on manner of death, the concurrence noted,

[M]ost jurisdictions that have addressed the issue hold that 

a qualified expert can express an opinion that the manner of 

a disputed death was homicide, i.e., that the death of one 

person was due to an act or omission of another, as opposed 

to natural causes or suicide, though not that the homicide 

was intentional, wanton, reckless, or accidental, which 

would constitute an opinion as to the guilt or innocence of 

the defendant.

Id. at 318. However, the concurrence also noted,

arms doesn’t mean that I’m smothered. But she does have bruises on 

her arms as I stated. So she has additional injuries.

Id. 

The expert also relied on witness statements and other information provided by 

police, namely that the house in which the incident occurred was recently ransacked; 

however, she expressly noted her physical findings indicated asphyxiation and 

smothering. Id. at 849.

_________________________________
35

The consensus of these cases is that an expert medical 

examiner or forensic pathologist can express an opinion not 

only as to the cause of death, but also that the manner of 

death was homicide . . . where such would not be readily 

ascertainable by a layperson, thus would assist that trier of 

fact in determining a fact in issue. However, the expert 

cannot express an opinion as to the mental state of the 

accused which would constitute an expression as to guilt or 

innocence, and cannot base the opinion solely on facts that 

are just as easily understood by a layperson.

Id. at 319 (emphasis added).

Two of seven justices dissented. Id. at 324 (Johnstone, J., 

dissenting). The dissent concluded the medical examiner exceeded the 

scope of her expertise and that her testimony did not assist the jury. Id.

at 321. The dissent explained,

The jury did not require expert testimony to determine 

whether the altercation between [the victim] and [the 

defendant] was highly emotional; testimony from the 

investigating officers and the 911 recording would have been 

sufficient evidence upon which the jury could base an 

informed decision. Likewise, [the medical examiner’s] expert 

opinion was unnecessary to an intelligent determination as 

to whether [the victim] did or did not perceive a physical 

threat that would induce stress. This question does not 

require specialized knowledge beyond the understanding of 

the average juror.

Id. at 321. Ultimately, five of seven justices agreed that, depending on 

the extent to which experts base their opinions on facts just as easily 

understood by laypersons, there is a point when such opinions do not 

assist the jury. The justices disagreed on when the line is crossed.

In Boyer, “[t]he issue . . . was whether [a nineteen-month-old 

victim’s] injuries were either accidental from falling down the stairs or 

the subject of homicide from being thrown to the floor.” 741 N.W.2d at 

751–52, 756. A forensic pathologist testified the manner of death was 

homicide because the likelihood the victim’s “injuries occurred as a 

result of falling down a flight of stairs was extremely small.” Id. at 756–
36

57. While the pathologist in that case did base his opinion in part on 

information provided to him by police, there is no indication the 

information formed a substantial basis of his opinion. See id. at 757. 

Instead, the pathologist’s opinion appears to have been primarily based 

on the fact that the victim’s injuries were simply not consistent with an 

accident or suicide. See id. (“[T]he autopsy findings . . . suggested that 

natural disease certainly was not an option in this case nor was suicide 

an option in this case”).

One of the State’s strongest cases is Commander. 721 S.E.2d 413. 

There, a victim’s “family members discovered [her] mummified and 

partially decomposed body covered by a blanket and lying on a sofa 

inside her home.” Id. at 415 (footnote omitted). Despite the fact that 

“the autopsy did not uncover any evidence of violence or trauma to [the]

[v]ictim’s body,” a medical examiner opined the cause of death was 

asphyxiation and the manner of death was homicide “due to the 

suspicious nature of [the] [v]ictim’s death.” Id. He based his opinion in 

part on anecdotal evidence provided to him by police concerning the 

scene of the incident, coupled with the absence of typical indicators of 

physical violence.11 Id. 

In concluding the medical examiner’s opinion was admissible, the 

Supreme Court of South Carolina concluded that “[b]ecause the 

anecdotal history is an essential component of any autopsy, . . . 

11In explaining the basis for his opinion, the medical examiner stated,

“I believe [the] [v]ictim died of unnatural causes. And as a result of 

elimination [of other manners of death], and like you mentioned, the 

interpolation of the facts of the case, that being her purse is gone, her 

car is gone, the house is locked up and somebody went through an awful 

lot of effort to cover up this death, that I feel that [the] v[ictim] died as a 

result of homicide due to asphyxiation.”

Commander, 721 S.E.2d at 416 (third alteration in original) (footnote omitted).

 
37

testimony concerning findings based on this information falls within the 

umbrella of the expert’s specialized knowledge.” Id. at 420. However, the 

court also acknowledged that “in certain circumstances, expert medical 

testimony of this type has the potential to invade the province of the 

jury” and distinguished the facts of the case from cases in which the 

expert “base[d] his opinion exclusively on the circumstantial information 

provided by the police officers at the scene.” Id. at 420 & n.11.

Having surveyed the authority on the issue, we conclude there are 

circumstances when a medical examiner’s opinions on cause or manner 

of death may assist the jury, even when such opinions are based in part

on witness statements or information obtained through police 

investigation.12 However, our review of the caselaw confirms there is no 

bright-line rule for determining whether a medical examiner may opine 

on cause or manner of death when his or her opinions are based, in 

whole or in part, on such information. Instead, whether a medical 

examiner’s opinion on cause or manner of death is admissible depends 

on the particular circumstances of each case. For example, when a 

medical examiner bases his or her opinion of cause or manner of death 

largely on witness statements or information obtained through police 

investigation, such opinions would ordinarily be inadmissible under rule 

5.702 because they would not assist the trier of fact. See Iowa R. Evid. 

5.702; see also, e.g., Sosnowicz, 270 P.3d at 922; Maxwell, 414 S.E.2d at

473–74; Perry, 593 N.E.2d at 716; Vining, 645 A.2d at 20–21; Jamerson, 

708 A.2d at 1195; Eberle, 297 N.Y.S.2d at 219; Bond, 311 S.E.2d at 771–

12We note that this case does not present an issue of whether an expert witness 

may rely on facts or data not in evidence under rule 5.703. See Iowa R. Evid. 5.703. 

Here, the facts and data relied on by Dr. Thompson were ultimately admitted into 

evidence. Thus, insofar as rule 5.703 is concerned, Dr. Thompson could rely on such 

information. See id.

 
38

72. In contrast, when a medical examiner bases his or her opinion on

cause or manner of death primarily on the autopsy, such opinions will

likely assist the jury in understanding the evidence and would ordinarily 

be admissible. See Iowa R. Evid. 5.702; see also, e.g., Rollins, 897 A.2d 

at 848–49, 851–52; Dao Xiong, 829 N.W.2d at 397–98; Bradford, 618 

N.W.2d at 790, 793; Boyer, 741 N.W.2d at 757.

D. Dr. Thompson’s Testimony. We turn now to consider 

whether it was appropriate for Dr. Thompson to opine on the cause and 

manner of Baby Tyler’s death. First, we consider whether Dr. 

Thompson’s opinions were sufficiently based on “scientific, technical, or 

other specialized knowledge” so as to “assist the trier of fact to 

understand the evidence or to determine a fact in issue.” Iowa R. Evid.

5.702. Second, we consider whether under the unique facts of this case, 

Dr. Thompson’s opinions amounted to an impermissible comment on 

Tyler’s credibility. See Dudley, 856 N.W.2d at 676. We address each of 

these points in turn.

First, we conclude Dr. Thompson’s opinions on the cause and 

manner of Baby Tyler’s death were not sufficiently based on scientific, 

technical, or other specialized knowledge so as to assist the jury. Rather, 

Dr. Thompson admitted that his opinions on the cause and manner of 

Baby Tyler’s death were based primarily, if not exclusively, on Tyler’s 

inconsistent and uncorroborated statements to police, as opposed to

objective medical findings. The central issue in this case was whether 

Baby Tyler was born alive and survived for a sufficient period of time for 

Tyler to drown him, or whether he was stillborn or died immediately after 

birth such that Tyler could not have drowned him. Without the benefit 

of objective medical findings, Dr. Thompson testified to the ultimate 

issues of fact questions for the jury to determine. Clearly, a medical 
39

examiner could testify concerning the medical signs of drowning, 

whether the autopsy findings were consistent with drowning, whether 

there were other possible causes of death, whether he or she could rule 

out other possible causes of death, and whether he or she could 

legitimately render definitive opinions on cause or manner of death. 

Much of Dr. Thompson’s testimony assisted the jury in these respects. 

However, the record in this case does not support the conclusion that Dr. 

Thompson relied on scientific, technical, or other specialized knowledge 

to classify the cause of Baby Tyler’s death as bathtub drowning or the 

manner of his death as homicide, rather than undetermined. Instead,

the record established Dr. Thompson’s opinions were based primarily, if 

not exclusively, on Tyler’s inconsistent and uncorroborated statements to 

police.

After performing the autopsy and pathology examination, Dr. 

Thompson’s opinions on the cause and manner of Baby Tyler’s death 

were undetermined. In his final report, however, Dr. Thompson 

concluded the cause of death was bathtub drowning and the manner of 

death was homicide. His final report clearly indicated that in forming his 

opinions he relied on Tyler’s statements to police. His report stated: “The 

mother claimed she had given birth the previous day in the motel room 

and then placed the infant in a bathtub partially filled with water shortly 

after the birth. The baby reportedly moved and cried after birth.” At the 

hearing on the motion in limine, Dr. Thompson agreed with defense 

counsel that based on the autopsy, he was unable to reach a conclusion 

on both the cause and manner of Baby Tyler’s death. He admitted the 

only way he reached his final opinions was by reference to Tyler’s 

statements to police during her interview at the police station.
40

At trial, Dr. Thompson testified on direct examination that there 

was nothing inconsistent with his autopsy findings and the State’s theory 

that Baby Tyler was born alive and survived for a sufficient period for 

Tyler to drown him. Based on his physical examination of Baby Tyler’s 

body, he ruled out several possible alternative causes of death. He 

further testified that there were indications Baby Tyler may have taken a 

breath because the alveoli in the lungs were partially, although not 

entirely, expanded. He then opined, “given the history that Baby Tyler 

cried and moved . . . Baby Tyler probably took a few breaths.” He further 

opined the cause of death was drowning and the manner of death was 

homicide. On cross-examination, defense counsel pressed Dr. Thompson 

on the basis for his conclusions. Ultimately, Dr. Thompson testified 

there were several other possible causes of death he could not rule out 

based on the autopsy. He explained that partially expanded alveoli 

would also be consistent with the production of methane gas by bacteria 

found in the body after death, which “will diffuse up into the lungs and 

can expand those a[l]veolar spaces.” He agreed with defense counsel that 

it was possible Baby Tyler died either in utero or immediately after birth. 

He then stated, “without the witness statements, I could not have 

diagnosed drowning in this case.”

Thus, the record shows Dr. Thompson’s opinions that the cause of 

death was drowning and manner of death was homicide were not based 

on scientific, technical, or other specialized knowledge. Iowa R. Evid. 

5.702. Instead, the record shows that absent Tyler’s statements, Dr. 

Thompson would have been unable to render definitive opinions on both 

cause of death and manner of death. Further, the record does not 

support the conclusion that Dr. Thompson relied on any other 

corroborating evidence, aside from Tyler’s statements, in reaching his 
41

opinions on cause or manner of death. Dr. Thompson did testify that his 

opinions were based on “a combination of history, which includes scene 

findings [and] witness statements,” in addition to “[the] autopsy findings . 

. . and . . . supplemental testing.” However, he did not explain how the 

scene findings or other objective information factored into his opinions. 

In fact, the record is devoid of any such objective evidence. Instead, he 

admitted Tyler’s statements to police were the but-for factor in rendering 

his opinion. Consequently, Dr. Thompson’s opinions on the cause and 

manner of death were not sufficiently based on scientific, technical, or 

other specialized knowledge as required by our rules. Iowa R. Evid. 

5.702. He was in no better position to determine the cause or manner of 

death than were the members of the jury who watched and listened to 

Tyler’s interviews with the special agents and had the opportunity to 

evaluate her credibility. His opinions on cause and manner of death did 

not assist the trier of fact and were therefore inadmissible under rule 

5.702.

This case closely resembles cases from other jurisdictions in which 

courts have excluded medical examiner testimony for similar reasons. 

As discussed above, in those cases the medical examiner performed an 

autopsy, was unable to render an opinion on cause or manner of death, 

and then after review of witness statements or information obtained 

through police investigation, rendered an opinion based largely on that 

information. See, e.g., Sosnowicz, 270 P.3d at 922; Maxwell, 414 S.E.2d 

at 473–74; Perry, 593 N.E.2d at 714; Vining, 645 A.2d at 20–21; 

Jamerson, 708 A.2d at 1189–90, 1195; Eberle, 297 N.Y.S.2d at 219; 

Bond, 311 S.E.2d at 772. This is not a case where the medical examiner 

simply considered witness statements or information obtained from 

police, but based his or her opinions primarily on the physical evidence. 
42

See, e.g., Rollins, 897 A.2d at 848–49, 851–52; Dao Xiong, 829 N.W.2d at 

397–98; Bradford, 618 N.W.2d at 790, 793; Boyer, 741 N.W.2d at 757. 

Nor is it a case where the medical examiner relied on information fairly 

characterized as “anecdotal.” See, e.g., Commander, 721 S.E.2d at 415. 

Instead, Dr. Thompson’s opinions on the cause and manner of Baby 

Tyler’s death were based primarily, if not exclusively, on Tyler’s 

inconsistent and uncorroborated statements to police.

We also conclude that under the unique facts of this case, Dr. 

Thompson’s opinions were inadmissible because they amounted to an 

impermissible comment on Tyler’s credibility. As discussed above, an 

expert witness cannot comment, directly or indirectly, on a witness’s 

credibility. See Dudley, 856 N.W.2d at 676–77. We prohibit such 

opinions because they “not only replace the jury’s function in 

determining credibility, but the jury can employ this type of testimony as 

a direct comment on defendant’s guilt or innocence.” Id. We recently 

addressed the application of this rule in three child sex-abuse cases.

In Dudley, we held an expert who opined that a child victim’s

“physical manifestations and symptoms were consistent with a child 

dealing with and suffering from sexual abuse trauma” impermissibly 

commented on the child’s credibility. Id. at 677–78. We reasoned that 

when an expert testifies that the child’s physical manifestations or 

symptoms are consistent with sexual abuse trauma, “the expert is saying 

these symptoms mean the child suffered a sexual abuse trauma; 

therefore, the child must be telling the truth when he or she relates his 

or her story to the jury.” Id. at 677. In Dudley, we also held another 

expert impermissibly commented on the child’s credibility in 

communicating to the jury that she recommended the child receive 

therapy and stay away from the defendant. Id. at 678. Because she 
43

based these recommendations on her belief that the defendant had 

sexually abused the victim as was related to her by the victim, we 

concluded the expert necessarily communicated to the jury that she 

believed the victim’s story. Id. at 673, 678. 

In State v. Brown, 856 N.W.2d 685, 688–89 (Iowa 2014), we held 

an expert impermissibly opined on a child victim’s credibility when the 

expert’s report stated the victim communicated to the expert that the 

defendant had inappropriately touched her and the expert believed “ ‘this 

disclosure [to be] significant and that an investigation [was] clearly 

warranted.’ ” We reasoned this final statement “indirectly convey[ed] to 

the jury that [the victim was] telling the truth about the alleged abuse 

because the authorities should conduct a further investigation into the 

matter.” Id. at 689. 

Finally, in State v. Jaquez, 856 N.W.2d 663, 665 (Iowa 2014), we 

held an expert crossed the line in testifying that a child victim’s 

demeanor was “ ‘completely consistent with a child who has been 

traumatized, particularly multiple times.’ ” We concluded this testimony 

indirectly vouched for the child’s credibility because the expert was in 

effect saying the child’s “demeanor means the child suffered a sexual 

abuse trauma, therefore, the child must be telling the truth.” Id.

An analogous situation occurred here. Tyler made various 

inconsistent statements to the special agents regarding whether Baby 

Tyler was born alive. During the ride from the trailer to the police station 

and for the first half of the three-hour interview at the police station, she 

told the special agents that after Baby Tyler was born he was silent, he 

did not move, and she immediately placed him in the garbage can. After 

the special agents interviewed her for over an hour and a half, Tyler then 

stated that after Baby Tyler was born he moved and cried and she placed 
44

him in the bathtub and turned the water on for the purpose of drowning 

him. There is no additional objective evidence indicating Baby Tyler was 

born alive. Therefore, aside from Dr. Thompson’s opinions, Tyler’s 

statements to police were the only evidence presented to the jury 

showing whether Baby Tyler was born alive. Dr. Thompson’s opinions 

that the cause of death was bathtub drowning and the manner of death 

was homicide were based primarily, if not exclusively, on Tyler’s 

statements. Significantly, Dr. Thompson did not credit Tyler’s initial 

statements to police that after Baby Tyler was born he was silent and did 

not move.13 Instead, he selectively credited her statements during the 

second half of the interview when she stated Baby Tyler was born alive

and described her actions after the birth. It is clear that if Tyler never 

stated Baby Tyler was born alive, Dr. Thompson could not have opined 

that the cause of death was drowning or that the manner of death was

homicide. Thus, in opining on cause and manner of death, Dr. 

Thompson necessarily credited one version of Tyler’s story over another. 

He at least indirectly communicated to the jury that he believed Tyler’s 

statements when he stated on direct examination, “given the history that 

Baby Tyler cried and moved . . . Baby Tyler probably took a few breaths.” 

As a result, Dr. Thompson’s opinions on the cause and manner of death 

crossed that very thin line between testimony that assists the trier of fact 

and testimony that vouches for a witness’s credibility.

Finally, for similar reasons, we have serious doubts as to whether 

Dr. Thompson possessed a reasonable degree of medical certainty with 

respect to his opinions on the cause and manner of Baby Tyler’s death. 

13In fairness to Dr. Thompson, police may not have provided him with the audio 

recording of the ride from the trailer to the police station in which Tyler stated Baby 

Tyler did not cry or move after the birth.

 
45

Again, the record showed that after conducting the autopsy, Dr. 

Thompson was unable to reach an opinion on cause or manner of death. 

He then watched Tyler’s interview with police and changed his opinion. 

By his own admission, he was only able to determine to a reasonable 

degree of forensic or medical certainty that Baby Tyler’s cause and 

manner of death were undetermined. For all of these reasons, the 

district court abused its discretion in allowing Dr. Thompson to 

communicate his opinions concerning the cause and manner of Baby 

Tyler’s death to the jury.14

E. Summary. In reaching the above conclusion, we do not create

a bright-line rule to govern every criminal case in which a medical 

examiner is called to testify to a victim’s cause or manner of death. Nor 

do we conclude medical examiners may never rely in part on witness 

statements or information obtained from police in forming their opinions. 

In this case, however, Dr. Thompson conceded he was unable to form an 

opinion on the cause or manner of Baby Tyler’s death based on the 

autopsy and his investigation. Instead, he based his opinions primarily, 

if not exclusively, on Tyler’s inconsistent and uncorroborated statements

to police. Without her statements, crediting some and discounting 

14“Error may not be predicated upon a ruling which admits or excludes evidence 

unless a substantial right of the party is affected . . . .” Iowa R. Evid. 5.103. “In cases 

of nonconstitutional error, we start with the presumption that the substantial rights of 

the defendant have been affected. The State has the burden to affirmatively establish 

the substantial rights of the defendant were not affected.” Dudley, 856 N.W.2d at 678 

(citation omitted); accord State v. Howard, 825 N.W.2d 32, 41–42 (Iowa 2012). While 

the State makes a passing reference to harmless error in its brief, in context, it is clear 

the State is not arguing harmless error in this case. The State failed to cite any 

authority in support of this issue and did not argue this in its application for further 

review or at oral argument. Therefore, the State has waived the issue of harmless error 

on appeal. See Iowa R. App. P. 6.903(2)(g)(3) (“Failure to cite authority in support of an 

issue may be deemed waiver of that issue.”); Dudley, 856 N.W.2d at 678 (finding the 

State waived a harmless-error argument by failing to raise it on appeal); In re Det. of 

Blaise, 830 N.W.2d 310, 320–21 (Iowa 2013) (acknowledging that the State waives a 

harmless-error argument by failing to raise it on appeal).

 
46

others, Dr. Thompson could not have offered an opinion on the critical 

issue in this case: whether Baby Tyler was born alive. His opinions were 

not sufficiently based on scientific, technical, or other specialized

knowledge and therefore did not assist the trier of fact. Iowa R. Evid. 

5.702. Further, under the unique facts of this case, Dr. Thompson 

indirectly vouched for Tyler’s credibility. Because Dr. Thompson’s 

opinions on these matters failed to comply with our evidentiary rules, we 

vacate the decision of the court of appeals, reverse the conviction, and 

remand the case for a new trial.

IV. Other Issues on Appeal.

Tyler raised other issues in this appeal. While not dispositive, 

these issues may form the basis for a subsequent appeal. Therefore, we 

elect to address them as part of this appeal. Specifically, we address

whether the search of room 225 violated the Fourth Amendment to the 

United States Constitution and whether the special agents’ various 

questionings of Tyler violated the Fifth and Fourteenth Amendments to 

the United States Constitution.15

A. Search of the Hotel Room. The Fourth Amendment to the 

United States Constitution provides: “The right of the people to be secure 

in their persons, houses, papers, and effects, against unreasonable 

15In district court, Tyler cited the Federal Constitution and the Iowa Constitution 

in both her motion to suppress evidence obtained during the search of room 225 and 

her motion to suppress her statements to the special agents. As it relates to both 

motions, Tyler did not make a specific argument based on the Iowa Constitution. 

Further, the district court’s rulings on both of these motions were based entirely on the 

Federal Constitution. Tyler did not file a motion to enlarge the trial court’s ruling. See 

State v. Mitchell, 757 N.W.2d 431, 435 (Iowa 2008). Thus, because Tyler’s state 

constitutional claims were not sufficiently raised or ruled on by the district court, any 

such claims she has raised in this appeal were not adequately preserved. See id.; Meier 

v. Senecaut, 641 N.W.2d 532, 537 (Iowa 2002) (“It is a fundamental doctrine of appellate 

review that issues must ordinarily be both raised and decided by the district court 

before we will decide them on appeal.”). Accordingly, we consider Tyler’s claims only 

under federal constitutional standards.

 
47

searches and seizures, shall not be violated . . . .” U.S. Const. amend. 

IV. In assessing whether a search resulted in a Fourth Amendment 

violation, we apply a two-step approach. State v. Brooks, 760 N.W.2d 

197, 204 (Iowa 2009). “First, the defendant must show that he or she 

has a legitimate expectation of privacy in the area searched. ‘Second, if 

the defendant had a legitimate expectation of privacy, we must then 

decide whether the State unreasonably invaded the protected interest.’ ” 

Id. (citations omitted) (quoting State v. Halliburton, 539 N.W.2d 339, 342 

(Iowa 1995)).

1. Expectation of privacy. To establish a legitimate expectation of 

privacy in the area searched, “a defendant challenging a search must 

show (1) a subjective expectation of privacy and (2) this expectation of

privacy was reasonable.” State v. Ortiz, 618 N.W.2d 556, 559 (Iowa 

2000); accord State v. Lowe, 812 N.W.2d 554, 567 (Iowa 2012). “ ‘The

determination of whether a person has a legitimate expectation of privacy 

with respect to a certain area is made on a case-by-case basis, 

considering the unique facts of each particular situation.’ ” State v. 

Fleming, 790 N.W.2d 560, 564 (Iowa 2010) (quoting State v. Breuer, 577 

N.W.2d 41, 46 (Iowa 1998)). Whether a defendant’s expectation of 

privacy is reasonable “is determined by examining property laws as well 

as society’s generally recognized and permitted expectations about 

privacy.” Id. We first analyze whether Tyler has demonstrated a 

subjective expectation of privacy in room 225.

Tyler originally rented room 225 in the early morning hours of 

September 19. She paid for the room at that time. Based on the record, 

it is reasonable to conclude she was having contractions and was looking 

for a private location in anticipation of the birth of Baby Tyler. Tyler 

brought nothing with her for an overnight stay. Further, after giving 
48

birth to Baby Tyler, Tyler left the room and returned to the trailer in 

Coalville where she stayed for the night. However, when Tyler returned 

to the hotel the next morning to check out, the hotel manager informed 

her that she could rent room 225 for an additional night. She did so and

paid for the second night at that time. It is undisputed that at all times 

during this period, the room was registered to Tyler. Shortly thereafter, 

she left the hotel and returned to the trailer. Upon her departure, she 

left a “Do Not Disturb” sign hanging from the doorknob of room 225. See 

United States v. Lanier, 636 F.3d 228, 231 (6th Cir. 2011) (concluding a 

“Do Not Disturb” sign hanging from a hotel room’s doorknob supported 

the conclusion that the defendant had a subjective expectation of privacy 

in his hotel room). She left her bloody hoodie coat, two vodka bottles, 

eight dollars, and Baby Tyler’s body in the room. See id. (suggesting a 

defendant’s decision to leave clothing and “a lot of cocaine” in his hotel 

room supported the conclusion that the defendant had a subjective 

expectation of privacy in his hotel room). The record further established 

that Tyler intended to return to the room later to clean up. Thus, while 

Tyler was not present when police entered the room, the record supports 

the conclusion that after she departed from the hotel on September 20, 

she maintained a subjective expectation of privacy in room 225.

Having concluded Tyler had a subjective expectation of privacy in 

room 225, we turn now to consider whether this expectation of privacy 

was one “ ‘that society is prepared to recognize as reasonable.’ ” Fleming, 

790 N.W.2d at 565 (quoting Minnesota v. Olson, 495 U.S. 91, 96–97, 110 

S. Ct. 1684, 1688, 109 L. Ed. 2d 85, 93 (1990)). The Fourth Amendment

clearly establishes a reasonable expectation of privacy in the home. 

Payton v. New York, 445 U.S. 573, 585, 100 S. Ct. 1371, 1379, 63 

L. Ed. 2d 639, 650 (1980). “The case law extends this protection to hotel
49

or motel rooms.” Brooks, 760 N.W.2d at 205; accord Stoner v. California,

376 U.S. 483, 486, 84 S. Ct. 889, 891, 11 L. Ed. 2d 856, 859 (1964); 

Fleming, 790 N.W.2d at 565; State v. Smith, 178 N.W.2d 329, 332 (Iowa 

1970). However, as we have previously explained:

The mere fact that a premise[s] may be characterized 

as a residence or a motel room does not, by itself, establish 

that a particular person has a reasonable expectation of 

privacy in the premises. For example, the use of a hotel or 

motel room as a center for drug transactions and not as a 

residence does not give rise to legitimate expectations of 

privacy within the ambit of the Fourth Amendment. A 

defendant does not have a reasonable expectation of privacy 

when the motel or hotel room is nothing more than “a 

convenient processing station” for the packaging and 

distribution of drugs.

Brooks, 760 N.W.2d at 205 (quoting Minnesota v. Carter, 525 U.S. 83, 

102, 119 S. Ct. 469, 479, 142 L. Ed. 2d 373, 388 (1998) (Kennedy, J., 

concurring)).

Ultimately, a defendant must establish that he or she was using a

hotel or motel room as a residence, or for some other purpose for which 

he or she had a legitimate expectation of privacy. See Brooks, 760 

N.W.2d at 205. “A bald assertion that one has been staying in a hotel, 

without further proof, is generally insufficient; as is the defendant’s mere 

presence in the motel room at the time of the search.” Id. Whether the 

guest checked into and paid for the room is one factor we consider in 

assessing whether an individual had a reasonable expectation of privacy 

in the room. United States v. Cooper, 203 F.3d 1279, 1284 (11th Cir. 

2000); United States v. Carter, 854 F.2d 1102, 1105–06 (8th Cir. 1988). 

We also consider whether the room is rented to the defendant at the time 

of the search. See United States v. Huffhines, 967 F.2d 314, 318 (9th Cir.

1992) (“A guest in a motel has no reasonable expectation of privacy in a 

room after the rental period has expired.”); United States v. Parizo, 514 
50

F.2d 52, 54 (2d Cir. 1975) (“[W]hen the term of a guest’s occupancy of a 

room expires, the guest loses his exclusive right to privacy in the room.”). 

Another relevant factor is “the presence of the defendant’s belongings.” 

Brooks, 760 N.W.2d at 205; accord Cooper, 203 F.3d at 1284.

We turn now to apply these principles to the unique facts of this 

case. We must decide, based upon the record developed, whether Tyler 

was using room 225 as an overnight guest, thereby giving rise to a 

reasonable expectation of privacy, or whether she was using the room for 

a purpose for which she had no reasonable expectation of privacy. Upon 

our de novo review of the record, we conclude Tyler’s expectation of 

privacy in room 225 was reasonable. Tyler rented room 225 in her own 

name. She paid for the room on both September 19 and September 20. 

The room was rented to her at the time of the search. She brought 

personal property with her to the room, albeit a minimal amount. She 

placed a “Do Not Disturb” sign on the door indicating she expected 

privacy. As stated earlier, it is reasonable to assume she checked into 

the room believing she was about to give birth. These actions are 

consistent with her continuing efforts to conceal the pregnancy from her 

friends and family. The mere fact that she gave birth to a child in the 

room does not, alone, diminish her otherwise reasonable expectation of 

privacy in the room. On this record, we cannot conclude Tyler’s sole 

purpose for renting room 225 was to commit a criminal offense. 

Considering the totality of the circumstances, Tyler had a reasonable 

expectation of privacy in room 225.

2. Invasion of protected interest and the exclusionary rule.

“ ‘Warrantless searches are per se unreasonable if they do not fall within

one of the well-recognized exceptions to the warrant requirement.’ ” 

Lowe, 812 N.W.2d at 568 (quoting State v. Naujoks, 637 N.W.2d 101, 107 
51

(Iowa 2001)). Further, if a defendant had a legitimate expectation of 

privacy in the searched area, and the search does not fall within an 

exception to the warrant requirement, “[t]he exclusionary rule requires 

the suppression of evidence discovered as a result of [the] illegal 

government activity.” State v. McGrane, 733 N.W.2d 671, 680 (Iowa 

2007). “However, there are exceptions to the exclusionary rule.” Id. at 

681. There is no dispute that police initially entered room 225 without a 

warrant. Therefore, any analysis should include whether an exception to 

the warrant requirement or exclusionary rule applies in this case.

In its ruling on the motion to suppress evidence obtained by police 

during the search of room 225, the district court concluded Tyler did not 

have a reasonable expectation of privacy in the room because “as was the 

case in Brooks, the motel room was not intended to be used as a 

‘residence’ but rather a venue for the commission of an alleged crime.” 

As discussed above, the district court erred in denying Tyler’s motion on 

that basis alone because the conclusion that Tyler rented room 225 for 

the sole purpose of committing a criminal offense is not supported by the 

record. Because of the district court’s specific ruling on that issue, it did 

not address whether any exceptions to the warrant requirement or 

exclusionary rule may apply to law enforcement’s search of room 225.

One potentially applicable exception to the warrant requirement in 

this case is the community caretaking exception. See State v. Kern, 831 

N.W.2d 149, 172 (Iowa 2013). “A core notion of the community 

caretaking exception is that . . . it is ‘totally divorced from the detection, 

investigation, or acquisition of evidence relating to the violation of a 

criminal statute.’ ” Id. (quoting Cady v. Dombrowski, 413 U.S. 433, 441, 

93 S. Ct. 2523, 2528, 37 L. Ed. 2d 706, 715 (1973)). “ ‘The community 

caretaking function involves the duty of police officers to help citizens an 
52

officer reasonably believes may be in need of assistance.’ ” Id. at 172–73 

(quoting State v. Mireles, 991 P.2d 878, 880 (Idaho Ct. App. 1999)).

We have recognized that “ ‘the community caretaking exception 

encompasses three separate doctrines: (1) the emergency aid doctrine, (2) 

the automobile impoundment/inventory doctrine, and (3) the “public 

servant” exception.’ ” State v. Kurth, 813 N.W.2d 270, 274 (Iowa 2012) 

(quoting State v. Crawford, 659 N.W.2d 537, 541 (Iowa 2003)). The 

emergency aid doctrine and the public servant exception are closely 

related. Crawford, 659 N.W.2d at 541. As we have previously 

recognized:

Under the emergency aid doctrine, the officer has an 

immediate, reasonable belief that a serious, dangerous event 

is occurring. . . . [I]n contrast, the officer in a public servant 

situation might or might not believe that there is a difficulty 

requiring his general assistance. For example, an officer 

assists a motorist with a flat tire under the public servant 

doctrine, but an officer providing first aid to a person 

slumped over the steering wheel with a bleeding gash on his

head acts pursuant to the emergency aid doctrine.

Id. at 541–42 (alterations in original) (quoting Mary Elisabeth Naumann,

Note, The Community Caretaker Doctrine: Yet Another Fourth Amendment 

Exception, 26 Am. J. Crim. L. 325, 333–34 (1999)).

The determination of whether the community caretaking exception 

applies

require[s] a three-step analysis: (1) was there a seizure 

within the meaning of the Fourth Amendment?; (2) if so, was 

the police conduct bona fide community caretaker activity?; 

and (3) if so, did the public need and interest outweigh the 

intrusion upon the privacy of the citizen?

Crawford, 659 N.W.2d at 543; accord Kern, 831 N.W.2d at 173. While 

the test “does not primarily focus on searches,” we have previously 
53

applied the community caretaking exception to justify searches in several 

cases. Kern, 831 N.W.2d at 173 (collecting cases).

One potentially applicable exception to the exclusionary rule in 

this case is the inevitable discovery doctrine. See McGrane, 733 N.W.2d 

at 681. Under the inevitable discovery doctrine, “relevant, probative 

evidence gathered despite Fourth Amendment violations is not 

constitutionally excluded when the police would have inevitably 

discovered the same evidence acting properly.” State v. Christianson, 627 

N.W.2d 910, 912 (Iowa 2001).

Unfortunately, the State did not develop an adequate a record on 

these issues in the district court. While it was error for the district court

to conclude Tyler had no reasonable expectation of privacy in room 225, 

we will allow the State to develop an additional record on whether these 

or any other potential exceptions to the warrant requirement or 

exclusionary rule apply. On this record, we reverse the district court’s 

denial of the motion to suppress and remand this issue for further 

hearing and ruling by the district court.

B. Tyler’s Statements to Police. In Miranda v. Arizona, 384 U.S. 

436, 471, 478–79, 86 S. Ct. 1602, 1626, 1630, 16 L. Ed. 2d 694, 722, 

726 (1966), the Supreme Court of the United States required police to 

advise suspects of their rights under the Fifth Amendment to the United 

States Constitution before a custodial interrogation. The Court required 

that police tell the suspect

he has the right to remain silent, that anything he says can 

be used against him in a court of law, that he has the right 

to the presence of an attorney, and that if he cannot afford 

an attorney one will be appointed for him prior to any 

questioning if he so desires.

Id. at 479, 86 S. Ct. at 1630, 16 L. Ed. 2d at 726.
54

In determining the admissibility of a defendant’s inculpatory 

statements over a Fifth Amendment challenge we apply a two-part test. 

State v. Countryman, 572 N.W.2d 553, 557 (Iowa 1997). “We first 

determine whether Miranda warnings were required and, if so, whether 

they were properly given. Second, we ascertain whether the statement is 

voluntary and satisfies due process.” Id. Miranda warnings are only 

required if, at the time of police questioning, the suspect is both: 1) in 

custody, and 2) subject to interrogation. Berkemer v. McCarty, 468 U.S. 

420, 429, 104 S. Ct. 3138, 3144, 82 L. Ed. 2d 317, 328 (1984); accord 

Countryman, 572 N.W.2d at 557. Once police give a suspect the 

requisite warning, the “[s]uspect[] may waive [his or her] Miranda rights 

as long as the suspect has done so knowingly, intelligently, and 

voluntarily.” State v. Ortiz, 766 N.W.2d 244, 251 (Iowa 2009). We turn 

now to address Tyler’s specific arguments.

1. Custodial interrogation. Tyler asserts she was in custody when 

the special agents questioned her at the police station, prior to giving her

Miranda warnings, in violation of her Fifth Amendment rights. For 

purposes of the Fifth Amendment, a suspect is in custody “as soon as a 

suspect’s freedom of action is curtailed to a ‘degree associated with 

formal arrest.’ ” Berkemer, 468 U.S. at 440, 104 S. Ct. at 3150, 82 L. Ed. 

2d at 335 (quoting California v. Beheler, 463 U.S. 1121, 1125, 103 S. Ct. 

3517, 3520, 77 L. Ed. 2d 1275, 1279 (1983) (per curiam)). “ ‘[A] court 

must examine all of the circumstances surrounding the interrogation, 

but “the ultimate inquiry is simply whether there was ‘a formal arrest or 

restraint on freedom of movement’ of the degree associated with a formal 

arrest.” ’ ” Countryman, 572 N.W.2d at 557–58 (quoting Stansbury v. 

California, 511 U.S. 318, 322, 114 S. Ct. 1526, 1528–29, 128 L. Ed. 2d 

293, 298 (1994) (per curiam)). In deciding whether a suspect is in 
55

custody at a given time, “we examine the extent of the restraints placed 

on the suspect during the interrogation in light of whether ‘a reasonable 

man in the suspect’s position would have understood his situation’ to be 

one of custody.’ ” Ortiz, 766 N.W.2d at 251 (quoting Berkemer, 468 U.S. 

at 442, 104 S. Ct. at 3151, 82 L. Ed. 2d at 336). We consider four 

factors in making this determination:

(1) the language used to summon the individual; (2) the 

purpose, place, and manner of interrogation; (3) the extent to 

which the defendant is confronted with evidence of her guilt; 

and (4) whether the defendant is free to leave the place of 

questioning.

Countryman, 572 N.W.2d at 558. We turn now to determine whether 

Tyler was in custody at the Fort Dodge police station on September 20 

when she stated she drowned Baby Tyler.

First, we must assess the language the officers used to summon 

Tyler. When the officers approached Tyler at the trailer, they did not 

demand that she go with them. They knocked on the door to the trailer, 

told her they needed to speak with her, and asked her if she needed 

medical attention. Tyler agreed to speak with them and said she did not 

need medical attention. Detective Chansler asked Tyler if she was “okay” 

with going with Special Agent Roehrkasse and speaking with the officers. 

Tyler responded, “Yea.” Tyler was neither handcuffed nor forcibly placed 

in the back of Special Agent Roehrkasse’s vehicle. See State v. Miranda, 

672 N.W.2d 753, 760 (Iowa 2003) (considering the fact that the suspect 

was handcuffed as weighing in favor of custody). The record shows that 

Tyler voluntarily accompanied Special Agent Roehrkasse to the police 

station. See State v. Smith, 546 N.W.2d 916, 923 (Iowa 1996) (“Although 

coming to the center voluntarily is not alone enough to negate a finding 

of custody, it is indicative of the state of mind of a reasonable person in 
56

the situation.”); State v. Brown, 341 N.W.2d 10, 16 (Iowa 1983) (“He 

accompanied officers to the police station voluntarily and was at no time 

subjected to either physical or verbal restraint.”); see also Purvis v. 

Dugger, 932 F.2d 1413, 1415, 1419 (11th Cir. 1991) (considering 

suspect’s voluntary decision to accompany officers to the police station in 

a police vehicle as weighing against custody); State v. Atkinson, 670 A.2d 

276, 285 (Conn. 1996) (considering a suspect’s voluntary decision to 

accompany “two plainclothes detectives in an unmarked vehicle” to the 

police station as weighing against custody). This factor weighs against 

custody.

Second, we must examine the purpose, place, and manner of the 

interrogation. As we have previously recognized, while a three-hour 

interview may seem like a long time, this does not necessarily mean the

suspect was in custody. See Countryman, 572 N.W.2d at 558 (“The 

three-hour length of the conversation did not render it custodial.”); 

Brown, 341 N.W.2d at 16 (finding no custody despite two and one-half 

hours of questioning). Further, that an interview takes place at the 

police station does not, itself, render the suspect in custody. See 

Countryman, 572 N.W.2d at 558 (finding no custody when interview 

occurred at the sheriff’s office). In examining the purpose, place, and 

manner of an interrogation, we examine factors including the number of 

persons conducting the questioning, the number of breaks taken during 

the questioning, the availability of restroom breaks or other breaks, and 

the type of questioning in which those conducting the interview engage. 

See id; see also Smith, 546 N.W.2d at 924.

Here, although the interrogation took place over the course of a 

three-hour period, the room in which it occurred was carpeted and well 

lit. See Smith, 546 N.W.2d at 924 (considering building’s furnishings in 
57

assessing custody). Although the special agents who questioned Tyler 

were armed, they were dressed in plain clothes. Id. (finding the fact that 

officers were casually dressed weighed against custody). During the 

questioning, only two special agents were present at any given time. See 

id. (noting “[o]ne fact of particular significance is the number of law 

enforcement officers taking part in the interview process” and finding no 

custody when two officers conducted the interview). In fact, for the 

majority of the questioning only Special Agent Roehrkasse was present. 

See id. (considering the fact that only one officer was present for a 

majority of the questioning as weighing against custody). At the start of 

the interview, Special Agent Thiele asked Tyler if she needed to go to the 

restroom and told her that if she needed anything to drink, to let them 

know. The special agents again asked Tyler if she needed medical 

treatment. She responded, “No.” The special agents did not engage in 

confrontational or aggressive questioning, but rather asked Tyler openended questions about the events that transpired at the hotel. See 

Countryman, 572 N.W.2d at 558 (finding nonconfrontational nature of 

questioning weighed against custody). During the course of the 

interview, the special agents did not raise their voices, but conducted 

themselves in a calm, respectful manner, often times prefacing questions 

with statements such as “[we] are not here to judge you.” Finally, while 

“[a] policeman’s unarticulated plan has no bearing on the question 

whether a suspect was ‘in custody’ at a particular time,” Berkemer, 468 

U.S. at 442, 104 S. Ct. at 3151, 82 L. Ed. 2d at 336, the record revealed 

the special agents were not attempting to get Tyler to confess to a crime. 

Rather, their discussion outside of Special Agent Roehrkasse’s vehicle 

before transporting Tyler to the police station suggests they did not know 

what had happened at the hotel. Specifically, one of the officers stated,
58

“We don’t know what we got.” Thus, the purpose of the questioning was 

to ascertain what had happened, as opposed to getting Tyler to confess to 

a murder. Importantly, the special agents intentions manifested in the 

manner of their questioning, as they repeatedly informed Tyler that they 

were only trying to gather information. Their demeanor, tone, and line of 

questioning do not suggest a reasonable person would have understood 

him or herself to be in custody. This factor weighs against custody.

Third, we must examine the extent to which the special agents 

confronted Tyler with evidence of her guilt. Again, the record revealed 

that when the special agents began questioning Tyler they did not know 

whether Baby Tyler was born alive. While Special Agent Roehrkasse did 

ask Tyler if the autopsy would show that there had been air in the baby’s 

lungs or that the baby was born alive, he did not suggest the autopsy 

would in fact show that Baby Tyler ever took a breath or was born alive. 

These questions were not accusatory in nature, but rather intended to 

encourage her to tell the truth. See Smith, 546 N.W.2d at 925 (finding 

officers decision to tell the defendants their stories did not match was a 

“tool with which to urge the defendants to provide more information,” as 

opposed to an accusation of guilt). Prior to her confession, the special 

agents did not confront Tyler with any other evidence that she drowned

Baby Tyler. This factor weighs against custody.

Finally, we must consider whether Tyler was free to leave the 

place of questioning. At the start of the interview, Special Agent 

Roehrkasse informed Tyler that, although she had ridden with him to the 

police station, she was free to leave at any time and that he would give 

her a ride back to Coalville if she desired. See Miranda, 672 N.W.2d at 

760 (“ ‘The most obvious and effective means of demonstrating that a 

suspect has not been taken into custody or otherwise deprived of 
59

freedom of action is for the police to inform the suspect that an arrest is 

not being made and that the suspect may terminate the interview at 

will.’ ” (quoting United States v. Griffin, 922 F.2d 1343, 1349 (8th Cir. 

1990))). Although the door to the interview room was closed, it was 

unlocked and Tyler’s path to it was unobstructed. Special Agent 

Roehrkasse told Tyler that the fact that the door was shut should not 

deter her from leaving. During the interview, the special agents told 

Tyler she was free to leave one additional time. Immediately before the 

forty-three minute break, Special Agent Thiele reminded Tyler that the 

door was unlocked and informed her that she was free to “get up and 

roam around” if she wanted.

We recognize that Tyler had given birth the day before the 

interview and possibly remained under the stress of that event. 

Notwithstanding, the record revealed her physical state did not affect her 

ability to leave. Specifically, the afternoon of the birth Tyler drove herself 

from the hotel to the trailer and spent the night there. The following 

morning, she ate breakfast with Cyphers, ran errands, and returned to 

the hotel to check out. After renting room 225 for an additional night, 

she drove herself back to the trailer. Thus, Tyler’s own conduct following 

Baby Tyler’s birth undermines any claim that her medical condition 

precluded her from leaving the interview. Further, the special agents 

asked Tyler if she needed any medical attention prior to transporting her 

to the police station and several more times during the interview. Tyler 

coherently answered the special agents’ questions and told them she did 

not need medical attention. We do not find that her medical state 

precluded her from leaving. This factor weighs against custody.

Upon our de novo review, we conclude Tyler was not in custody at 

any time prior to when she confessed to drowning Baby Tyler. Because 
60

Tyler was not in custody when she initially confessed to drowning Baby 

Tyler, her initial confession was not obtained in violation of the Fifth 

Amendment.

2. Waiver. Tyler next argues that she did not execute a valid 

waiver of her Miranda rights at the police station before her confirmation 

confession or later at the hospital when she again admitted to drowning 

Baby Tyler. She maintains that she did not voluntarily waive her 

Miranda rights during these police encounters. In order to execute a 

valid waiver of one’s Miranda rights, the waiver must be made 

“knowingly, intelligently, and voluntarily.” Ortiz, 766 N.W.2d at 251. 

“ ‘[V]oluntariness’ for . . . due process purposes and Miranda purposes

are identical.” Countryman, 572 N.W.2d at 559. Therefore, “a Miranda

waiver is involuntary only when it is shown to be the product of police 

misconduct or overreaching.” Id. “For a waiver to be made voluntarily, 

the relinquishment of the right must have been voluntary, meaning it 

was the product of the suspect’s free and deliberate choice rather than 

intimidation, coercion, or deception.” Ortiz, 766 N.W.2d at 251. The 

question of whether a suspect voluntarily waived his or her Miranda

rights “is to be made by inquiring into the totality of the circumstances 

surrounding the interrogation, to ascertain whether the suspect in fact 

‘decided to forgo his rights to remain silent and to have the assistance of 

counsel.’ ” Id. (quoting Fare v. Michael C., 442 U.S. 707, 724–25, 99 S.

Ct. 2560, 2571–72, 61 L. Ed. 2d 197, 212 (1979)). The State has the 

burden to prove by a preponderance of the evidence that Tyler voluntarily 

waived her Miranda rights. Payton, 481 N.W.2d at 328.

A number of factors are helpful in determining whether a 

defendant voluntarily waived their Miranda rights. These factors include:
61

defendant’s age; whether defendant had prior experience in 

the criminal justice system; whether defendant was under 

the influence of drugs; . . . whether defendant was mentally 

“subnormal”; whether deception was used; whether 

defendant showed an ability to understand the questions 

and respond; the length of time defendant was detained and 

interrogated; defendant’s physical and emotional reaction to 

interrogation; whether physical punishment, including 

deprivation of food and sleep, was used.

Id. at 328–29 (citations omitted). Further, while “[a] written waiver of 

constitutional rights is not alone sufficient to establish the waiver as . . . 

voluntary[,] [i]t is . . . strong proof of its validity.” Countryman, 572 

N.W.2d at 559 (citation omitted). We now turn to consider whether Tyler 

voluntarily waived her Miranda rights, both at the police station after 

Special Agent Roehrkasse informed her she was going to be charged, and 

the next day at the hospital during the special agents’ follow-up 

questioning.

After Tyler initially confessed at the police station, Special Agent 

Roehrkasse took two breaks before telling Tyler she would be “charged 

today.” He then read Tyler her Miranda rights aloud, and she signed a 

written waiver form. This is strong proof that Tyler executed a voluntary 

waiver. Id. Further, prior to reading Tyler her Miranda rights, Special

Agent Roehrkasse asked Tyler if she was forced to make any of the 

statements she had previously made. She responded, “No.” At the time 

of the questioning, Tyler was thirty-one years old. She had prior 

experience with the criminal justice system from a prior theft 

prosecution. She had graduated from high school and had taken several 

college courses. The record reflects that prior to the interview, Tyler had 

taken some cold medicine and felt “spacey” as a result. She also gave

birth the day before the interview and was questioned for a long period. 

However, the record shows that the special agents took several breaks 

during the questioning and offered Tyler food, drink, and the opportunity
62

to use the bathroom. She was readily capable of understanding and 

answering the special agents’ questions. Further, she voluntarily stayed 

at the police station and answered questions despite Special Agent 

Roehrkasse’s offer to take her home. While on several occasions she 

began to cry, she never lost control or had a breakdown. The special 

agents never threatened Tyler, nor did they make any promises of 

leniency in exchange for her cooperation. Finally, the special agents did 

not engage in any deceptive tactics during the questioning. Tyler 

voluntarily answered the special agents’ questions and then, after Special 

Agent Roehrkasse read Tyler her Miranda rights, she voluntarily waived 

her rights and confirmed her prior confession. Considering the totality of 

the circumstances, Tyler voluntarily waived her Miranda rights at the 

police station on September 20.

Many of the same factors also support the conclusion that Tyler 

voluntarily waived her Miranda rights at the hospital on September 21. 

Before this follow-up interview, Special Agent in Charge Hedlund again 

read Tyler her Miranda rights. Tyler explained what each of her rights 

meant to her, acknowledged that she understood her rights, and signed 

another written waiver form. Prior to this second interview, Tyler 

received a surgical repair for a tear from childbirth, she had lost a large 

amount of blood, her blood pressure was high, and she was taking 

several medications. Further, she initially told the officers she was 

“really out of it.” However, she remembered speaking with Special Agent 

Roehrkasse the previous day and that his name was “Mike,” knew she 

was at the hospital, never appeared confused, and was alert and tracking 

with the special agents’ questions. See Countryman, 572 N.W.2d at 559 

(finding a defendant’s statements were voluntarily given despite the fact 

that the defendant was “under the influence of drugs and was confused” 
63

because “she was easy to understand”); State v. Edman, 452 N.W.2d 169, 

170 (Iowa 1990) (“Being ‘under the influence’ does not, standing alone, 

render inculpatory statements involuntary.”). Additionally, when the 

special agents asked Tyler if she would prefer “[they] come back later,”

Tyler responded, “You can talk to me.” Considering the totality of the 

circumstances, Tyler voluntarily waived her Miranda rights at the 

hospital on September 21.

3. Voluntariness of confessions. Finally, Tyler maintains that all of 

her confessions to the special agents were involuntary and therefore in 

violation of her due process rights under the Fourteenth Amendment to 

the United States Constitution. As noted above, “ ‘voluntariness’ for . . . 

due process purposes and Miranda purposes are identical.” Countryman, 

572 N.W.2d at 559. Thus, the same factors outlined in the preceding 

subsection are relevant in determining whether Tyler’s confessions were 

voluntarily given.

For many of the same reasons noted above, our de novo review of 

the record reveals that each of Tyler’s confessions was voluntarily given. 

During the first interview, Special Agent Roehrkasse told Tyler that she 

was free to leave and that he would give her a ride home if she desired. 

The special agents asked her if she needed medical treatment. She 

responded, “No.” While she had just given birth and had taken cold 

medicine, her own actions that morning suggest that she was capable of 

leaving if she desired. She voluntarily remained at the police station and 

answered questions. Her responses to the questioning clearly indicated 

she was capable of both understanding and answering the special agents’

questions. The special agents made no threats or any promises of 

leniency in exchange for her cooperation. Neither did they engage in 

deceptive tactics. Tyler voluntarily answered the special agents’ 
64

questions, and then after being informed both that she would be 

“charged today” and of her Miranda rights, she told the special agents

she had not been forced to confess previously. She then proceeded to 

confirm her initial confession.

At the hospital, although Tyler was tired, medicated, and had 

undergone surgery recently, she again agreed to speak with the special 

agents despite their offer to return later. She never appeared confused 

and was alert and tracked with the special agents’ questions. While she 

had previously confessed, making it difficult for her to change her story, 

her prior confession was not the product of coercion. Although Special 

Agent Roehrkasse again participated in the follow-up interview, the 

interview took place at an entirely different location and a day later. The 

record does not reflect a woman whose will was overborne. Considering 

the totality of the circumstances, Tyler’s confessions both at the police 

station and later at the hospital were voluntarily given and therefore not 

in violation of her due process rights.

Tyler was not in custody during her initial confession to the special 

agents at the police station. She voluntarily waived her Miranda rights 

both at the police station and later at the hospital. Each of her 

confessions was voluntarily given. The district court properly denied 

Tyler’s motion to suppress her statements to police.

V. Conclusion.

The district court abused its discretion in allowing Dr. Thompson

to opine on the cause and manner of Baby Tyler’s death because he

based his opinions primarily, if not exclusively, on Tyler’s inconsistent 

and uncorroborated statements to police as opposed to objective, 

scientific, or medical evidence. On retrial, should the State attempt to 

use Dr. Thompson as an expert witness, the district court should 
65

prohibit him from testifying that the cause of death was “drowning” and 

the manner of death was “homicide.” Likewise, it should redact the 

portions of the autopsy report stating his ultimate opinions on cause and 

manner of death.

With respect to Tyler’s motion to suppress evidence obtained by 

police during the search of room 225, we conclude the district court 

erred in denying this motion based solely on the legal conclusion that

Tyler had no reasonable expectation of privacy in room 225 because she 

obtained it for the purpose of committing a crime. We reverse this 

motion and remand the issue for further hearing and ruling by the 

district court concerning the applicability of exceptions to the warrant 

requirement or exclusionary rule. With respect to Tyler’s motion to 

suppress statements made to police during her initial contact with law 

enforcement, at the police station, and at the hospital, we affirm the 

district court’s ruling. We vacate the decision of the court of appeals, 

affirm the judgment of the district court in part and reverse in part, and 

remand the case for additional proceedings consistent with this opinion 

and a new trial.

DECISION OF COURT OF APPEALS VACATED; DISTRICT 

COURT JUDGMENT AFFIRMED IN PART AND REVERSED IN PART 

AND CASE REMANDED.

Hecht, J., files a concurrence in part and dissent in part in which 

Wiggins and Appel, JJ., join. Appel, J., files a concurrence in part and 

dissent in part in which Wiggins and Hecht, JJ., join. Waterman, J., files 

a concurrence in part and dissent in part in which Cady, C.J., and 

Mansfield, J., join.
66

#13–0588, State v. Tyler

HECHT, Justice (concurring in part and dissenting in part).

I agree the district court erred in allowing the medical examiner to 

rely primarily upon Tyler’s uncorroborated statements in forming an 

opinion as to the cause of Baby Tyler’s death. I also agree the district 

court erred in concluding Tyler had no reasonable expectation of privacy 

in the hotel room. However, I dissent in part because I conclude all of 

Tyler’s statements to the police are inadmissible. The circumstances—

especially the officers’ repeated verbal assurances that Tyler was not in 

custody and their subsequent decision to administer warnings only after 

Tyler made all of the inculpatory statements they sought—demonstrate a 

calculated strategy to circumvent Miranda. In my view, the police 

questioning in this case constitutes a “midstream recitation of warnings 

after interrogation and unwarned confession” in violation of Missouri v. 

Seibert, 542 U.S. 600, 604, 124 S. Ct. 2601, 2605, 159 L. Ed. 2d 643, 

650 (2004) (plurality opinion), and all of Tyler’s statements made during 

the police station and hospital interrogations should have been 

suppressed.

Our court has not had occasion to apply Seibert. Thus, this case 

presents the first opportunity to consider the problem of midstream 

Miranda warnings in successive interrogations. Seibert was a split 4–1–4 

decision, so courts applying it must determine whether the plurality 

opinion or Justice Kennedy’s concurring opinion provides the controlling 

rule. See Kuhne v. Commonwealth, 733 S.E.2d 667, 673 (Va. Ct. App. 

2012) (“The Seibert plurality would review all two-step interrogations 

under a multi-factor test . . . . Justice Kennedy’s opinion would apply a 

form of heightened scrutiny only to those two-step cases in which law 

enforcement officers deliberately employed a two-step procedure designed 
67

to weaken Miranda’s protections.”). A majority of federal Circuit Courts 

of Appeals have adopted Justice Kennedy’s standard, and so have several 

state courts. See generally id. at 672 & nn. 5–6 (collecting cases); see 

also State v. Nightingale, 58 A.3d 1057, 1066–67 (Me. 2012); State v. 

Fleurie, 968 A.2d 326, 332–33 (Vt. 2008). 

I would not expressly adopt either standard in this case because I 

conclude the officers violated both. See United States v. Aguilar, 384 

F.3d 520, 525 (8th Cir. 2004) (finding a Miranda violation under both the 

Seibert plurality opinion and Justice Kennedy’s concurring opinion in the 

same case); see also United States v. Pacheco-Lopez, 531 F.3d 420, 427 

n.11 (6th Cir. 2008) (same). The officers’ strategy and technique in this 

case clearly exemplify the use of a “question-first tactic” that subverts 

Miranda’s rationale, see Seibert, 542 U.S. at 617, 124 S. Ct. at 2613, 159 

L. Ed. 2d at 658, and epitomizes a “deliberate two-step strategy,” id. at 

622, 124 S. Ct. at 2616, 159 L. Ed. 2d at 661 (Kennedy, J., concurring in 

the judgment).

This case involves two successive interrogations: one beginning in 

the police car and continuing at the police station, and another at the 

hospital. Tyler received Miranda warnings toward the end of the threehour police station interrogation only after she made incriminating 

statements regarding Baby Tyler’s death. After receiving Miranda 

warnings at the police station, Tyler did not repeat her incriminating 

statements anew, but simply answered “Yes” as the officers confirmed 

what she had previously said.16 She also received additional Miranda

16The transcript of the police station interview in the record fills sixty-eight 

pages. Miranda warnings precede only the final six pages, which span the final sixteen 

minutes of the three-hour interrogation. During that time, Tyler overwhelmingly 

provided one-word answers, likely because the officers asked almost exclusively yes-orno questions—for example, “You gave birth at approximately 12:00 p.m., okay?”; “[Y]ou 

said you filled up the bathtub with approximately two to three inches of water?”; and 

 
68

warnings at the hospital the next day where she repeated her 

incriminating statements.

I. Custody Principles.

As a threshold matter, Tyler brings claims under both the Federal 

and State Constitutions. Because I conclude Seibert is dispositive, I 

would not reach the question whether the Iowa Constitution provides 

different standards. Cf. State v. Kooima, 833 N.W.2d 202, 212 (Iowa 

2013) (“We do not decide this case under the Iowa Constitution because 

we resolve this issue based upon the Fourth Amendment of the United 

States Constitution.”).

Custody for Miranda purposes is ordinarily an objective test that 

considers the totality of the circumstances. Stansbury v. California, 511 

U.S. 318, 323, 114 S. Ct. 1526, 1529, 128 L. Ed. 2d 293, 298 (1994) (per 

curiam). “[T]he ultimate inquiry is . . . whether there is a ‘formal arrest 

or restraint on freedom of movement’ of the degree associated with a 

formal arrest.” California v. Beheler, 463 U.S 1121, 1125, 103 S. Ct. 

3517, 3520, 77 L. Ed. 2d 1275, 1279 (1983) (per curiam) (quoting Oregon 

v. Mathiason, 429 U.S. 492, 495, 97 S. Ct. 711, 714, 50 L. Ed. 2d 714, 

719 (1977) (per curiam)). When making this inquiry, courts must keep 

in mind the purpose of the Miranda rule: to protect individuals from 

coerced or involuntary self-incrimination. See Seibert, 542 U.S. at 608, 

124 S. Ct. at 2608, 159 L. Ed. 2d at 652–53 (plurality opinion); Berkemer

v. McCarty, 468 U.S. 420, 433, 104 S. Ct. 3138, 3146–47, 82 L. Ed. 2d 

317, 330 (1984). 

“[Y]ou brought the baby out of the tub and placed him in a trash can, correct?” In the 

few instances in which the officers did not ask a yes-or-no question, Tyler still answered 

very briefly. For example, to answer a question about where she gave birth, Tyler used 

just five words: “I was in the bathroom.”

_________________________________
69

Our cases generally examine four factors in determining whether a 

suspect is in custody:

“(1) the language used to summon the individual;

(2) the purpose, place, and manner of interrogation;

(3) the extent to which the defendant is confronted with 

evidence of her guilt; and

(4) whether the defendant is free to leave the place of 

questioning.”

State v. Bogan, 774 N.W.2d 676, 680 (Iowa 2009) (quoting State v. 

Miranda, 672 N.W.2d 753, 759 (Iowa 2003)). These factors, however, are 

not exclusive, and no one fact or factor is determinative. State v. Smith, 

546 N.W.2d 916, 922 (Iowa 1996) (en banc). 

II. Applying Custody Principles to This Case.

Recognizing their primary purpose was to obtain admissions of 

criminal conduct from the only suspect in their investigation, and 

understanding the circumstances surrounding the transaction had 

characteristics of interrogation raising Miranda implications, the officers 

told Tyler she was free to leave soon after she arrived at the police station 

and as the questioning began. They told Tyler she was free to leave 

because they knew a suspect’s freedom to leave the interrogation room is 

a relevant factor in determining whether that suspect is in custody. See 

Bogan, 774 N.W.2d at 680; State v. Ortiz, 766 N.W.2d 244, 251–52 (Iowa 

2009); accord United States v. Griffin, 922 F.2d 1343, 1349 (8th Cir. 

1990). But telling Tyler she was free to leave “is not ‘talismanic’ or 

sufficient in and of itself to show a lack of custody.” United States v. 

Hargrove, 625 F.3d 170, 180 (4th Cir. 2010). Actions speak louder than 

words in this context, and several other factors convince me that Tyler 

was in custody from the time the officers took her from her residence and 
70

should have received Miranda warnings before the questioning began. 

See People v. Minjarez, 81 P.3d 348, 357 (Colo. 2003) (en banc) (declining 

to credit officers’ assurances the defendant was free to leave “when all 

external circumstances appear[ed] to the contrary”); Buck v. State, 956 

A.2d 884, 908 (Md. Ct. Spec. App. 2008) (finding custody despite “what 

the detectives said about . . . not being under arrest and being free to 

leave,” in part because the detectives used “catchphrases” in an effort “to 

create an interrogation that could be labeled non-custodial”); see also 2 

Wayne R. LaFave et al., Criminal Procedure § 6.6(d), at 737 n.57 (3d ed. 

2007 & Supp. 2014) [hereinafter LaFave] (noting an assurance the 

suspect is free to leave “will not carry the day where it is, in effect, 

nullified by other police conduct”). 

First, Tyler did not voluntarily contact the police to offer a 

statement. See Griffin, 922 F.2d at 1351 (“[W]hen the confrontation 

between the suspect and the criminal justice system is instigated at the 

direction of law enforcement authorities, rather than the suspect, 

custody is more likely to exist.”). 

Second, the words the three officers used when they arrived at 

Tyler’s residence did not constitute a mere invitation for Tyler to come 

with them to the police station. Within fifteen seconds of Tyler opening 

the door, one officer told Tyler, “What we’re going to do . . . I want to have 

you go with . . . this guy right here. OK. We need to get to the bottom of 

what’s going on. OK.” The officers discussed waking Cyphers, asking, 

“He knows what’s going on?” Tyler responded that he did not. One 

officer stated, “May I ask you why not?” Tyler gave an inaudible 

response and the officer stated, “There’s no way around this right now, 

he’s going to know.” Another officer stated, “We need to talk to him” and 

“We might as well get this over with.” Thereafter, the officer told Tyler, 
71

“why don’t you ride with Mike,” another officer. A DCI agent then 

directed Tyler to a police vehicle. 

“If the so-called ‘invitation’ involves the person going to the station 

in the company of the police, then a finding of custody is much more 

likely.” 2 LaFave § 6.6(d), at 735. Here, the words spoken at Tyler’s 

residence communicated the notion that the officers insisted upon 

speaking with her at the police station about Baby Tyler. See Bogan, 774 

N.W.2d at 680 (noting we consider “the language used to summon the 

individual” when determining whether a suspect was in custody); Ortiz, 

766 N.W.2d at 251–52 (same); State v. Werner, 9 S.W.3d 590, 596 (Mo. 

2000) (en banc) (finding custody when a detective “requested” that a 

suspect accompany him to the police station and did not tell the suspect 

he could refuse to do so). 

Third, the questions posed to Tyler during the car ride to the police 

station and soon thereafter at the police station lasted more than three 

hours. While the duration of three hours certainly is not dispositive on 

the question whether Tyler was in custody, it is nonetheless a relevant 

consideration. See United States v. Wright, 777 F.3d 769, 775 (5th Cir. 

2015) (noting length of questioning is an important factor); Bogan, 774 

N.W.2d at 680 (noting we consider “the purpose, place, and manner of 

interrogation” (emphasis added)); see also Aguilar, 384 F.3d at 527 

(suppressing a confession in part because the “questioning was not 

brief”); Payne v. State, 854 N.E.2d 7, 15 (Ind. Ct. App. 2006) (finding a 

Seibert violation when pre-Miranda questioning lasted seven hours). 

Fourth, the officers took numerous lengthy breaks during the 

questioning at the police station and, after each of them, refocused their 

questions or asked specific follow-up questions about Baby Tyler’s death. 

They did not accept Tyler’s explanation that Baby Tyler was stillborn. 
72

These breaks in the action and accusatory follow-up questions were 

obviously in furtherance of the officers’ strategy for eliciting admissions 

establishing Tyler’s guilt on each of the elements of a first-degree murder 

charge prior to giving the Miranda warnings. See Bogan, 774 N.W.2d at 

680 (noting we consider the extent to which a suspect is confronted with 

evidence of guilt).

To be sure, the lengthy prewarnings session at the police station 

cannot reasonably be characterized as merely gathering nonsubstantive 

background facts. Compare State v. Lewis, 326 P.3d 387, 398 (Kan. 

2014) (finding no Seibert violation because “[t]he pre-warning interview 

lasted only 10 minutes with nothing of substance revealed”), and State v. 

Juranek, 844 N.W.2d 791, 803–04 (Neb. 2014) (finding no Seibert

violation when the prewarnings questions “did not touch upon key points 

in the investigation”), with Payne, 854 N.E.2d at 15 (finding a Seibert

violation because police “waited to advise [the defendant] of her Miranda

warnings until she essentially had divulged her entire involvement”). 

Notably, it was not until after Tyler stated she placed Baby Tyler face 

down in a bathtub containing water that Agent Roehrkasse left the room 

and returned with a written Miranda waiver form.17 He then thoroughly 

reviewed with Tyler each of the Miranda warnings before eliciting with 

leading questions all of the details of Tyler’s confession that had 

previously been methodically extracted from her. 

17Tyler had previously revealed that Baby Tyler cried briefly after he was born. I 

find it significant that the officer did not stop posing questions and administer the 

Miranda warnings at that point. Instead, the officer forged ahead with the interrogation 

and didn’t stop until Tyler had admitted she had placed the baby face down in water in 

the bathtub. See Seibert, 542 U.S. at 616, 124 S. Ct. at 2612, 159 L. Ed. 2d at 657 

(“When the police were finished there was little, if anything, of incriminating potential 

left unsaid.”).

 
73

Further, although Tyler was not informed of her arrest on the 

murder charge before she was taken from the police station to the 

hospital for medical attention, the record reveals a law enforcement 

officer was posted outside her hospital room while she was there. See 

Griffin, 922 F.3d at 1355 (concluding when a suspect was arrested at the 

end of an interview, the arrest was objective evidence weighing in favor of 

custody “from the inception of the encounter”); Buck, 956 A.2d at 908 

(finding custody even though officers repeatedly told the defendant he 

was free to leave and did not formally arrest him until after they drove 

him back home). On these facts, I would conclude Tyler was not free to 

leave the police station and therefore was in custody.

My conclusion that Tyler was in custody at all times en route to 

the police station and during the three hours of interrogation conducted 

after they arrived there is strongly influenced by the circumstances 

surrounding her physical and mental health. The officers knew from the 

outset of the questioning that Tyler had given birth at a hotel without 

medical assistance—indeed, without assistance from anyone—during the 

previous forty-eight hours. Although Tyler denied a need for medical 

assistance when the officers inquired, the officers either knew or 

certainly should have known that she had received no medical care 

during or after the delivery, and she therefore needed it promptly. There 

was clearly no urgent need for the interrogation to occur before a 

physical examination and postnatal medical treatment. Yet, the agents 

decided to interrogate Tyler as a suspect in a crime first, knowing that 

she had gone through a very traumatic event the night before. 

III. The Seibert Standard.

Because I conclude Tyler was in custody during the entire time she 

was en route to the police station and during the interrogations 
74

conducted there and at the hospital, I would apply Seibert. In Seibert, 

the Supreme Court’s plurality opinion set forth a number

of relevant facts that bear on whether Miranda warnings 

delivered midstream could be effective enough to accomplish 

their object: the completeness and detail of the questions 

and answers in the first round of interrogation, the 

overlapping content of the two statements, the timing and 

setting of the first and second, the continuity of police 

personnel, and the degree to which the interrogator’s 

questions treated the second round as continuous with the 

first. 

Seibert, 542 U.S. at 615, 124 S. Ct. at 2612, 159 L. Ed. 2d at 657. The 

police interrogation in this case meets each of those factors. The first 

round of interrogation was extremely detailed and complete and, as I 

have noted, the officers did not stop to administer Miranda warnings at 

the first sign Tyler might be culpable—her admission that Baby Tyler 

cried. The two statements fully overlap; indeed, the officers simply 

repeated Tyler’s statements back to her and asked for an 

acknowledgement that they were correct. As in Seibert, “[t]he warned 

phase of questioning proceeded after a pause of only 15 to 20 minutes, in 

the same place as the unwarned segment.” Id. The same officers 

conducted both interrogations. Finally, the officers expressly referred to 

previous statements using phrases such as “you told me” and “you said.” 

With every one of these factors satisfied, just as in Seibert, this 

interrogation “by any objective measure reveal[s] a police strategy . . . to 

undermine the Miranda warnings.” Id. at 616, 124 S. Ct. at 2612, 159 L. 

Ed. 2d at 657.

Additionally, the officers took no curative measures once they 

finally administered warnings. See Seibert, 542 U.S. at 622, 124 S. Ct. 

at 2616, 159 L. Ed. 2d at 661 (Kennedy, J., concurring in the judgment) 

(“If the deliberate two-step strategy has been used, postwarning 
75

statements that are related to the substance of prewarning statements 

must be excluded unless curative measures are taken before the 

postwarning statement is made.”). Only fifteen minutes passed between 

the prewarning statements and the first Miranda warning at the police 

station, leaving Tyler insufficient time “to distinguish the two contexts 

and appreciate that the interrogation ha[d] taken a new turn.” See id.; 

see also Aguilar, 384 F.3d at 525 (suppressing a confession when the 

“two interrogations were not separated in time, occurred in the same 

interrogation room, and the same officers participated in the 

questioning”). Compare Vasquez v. State, 453 S.W.3d 555, 574–75 (Tex. 

App. 2015) (concluding officers did not undertake curative measures 

when they provided Miranda warnings after just a short bathroom 

break), with United States v. Courtney, 463 F.3d 333, 339 (5th Cir. 2006) 

(concluding a properly Mirandized confession made “more than one year” 

after an unwarned confession need not be suppressed). 

Further, the officers interrogating Tyler did not augment the 

Miranda warning with an additional disclosure that her previous 

unwarned statements might be inadmissible against her. See Seibert, 

542 U.S. at 622, 124 S. Ct. at 2616, 159 L. Ed. 2d at 661. Instead, after 

administering the Miranda warnings at the police station and at the 

hospital, the officers expressly brought to Tyler’s attention and actively 

used the inculpatory statements she had made before the warnings. See 

Martinez v. State, 272 S.W.3d 615, 626–27 (Tex. Crim. App. 2008) 

(including abstention from reference to the prior statement among a list 

of nonexhaustive curative measures gleaned from the Seibert plurality 

and concurring opinions). Thus, no matter which opinion sets forth the 

controlling Seibert rule, the officers violated it and Tyler’s statements 

should be suppressed.
76

IV. Voluntariness.

After watching the video of the police station interrogation in this 

case, I find Tyler’s physical condition and her emotional state 

substantially augment the factors mentioned above in creating a 

custodial environment during all of the questioning. The video 

establishes beyond dispute that Tyler’s depleted physical condition was 

accompanied and aggravated by utter emotional despondency. 

Notwithstanding her obvious physical and extreme emotional 

vulnerability, however, the officers forged ahead with more than three 

hours of interrogation. They stopped and took her to the hospital, where 

she underwent surgery and was treated for blood loss,18 only after they 

were confident they had secured admissions supporting the essential 

elements of first-degree murder. Thus, under the circumstances 

presented here, I am persuaded that, apart from the Seibert issue, Tyler’s 

depleted physical and emotional state rendered all of her statements to 

the officers involuntary. See State v. Alspach, 524 N.W.2d 665, 667 

(Iowa 1994) (“A contention that a defendant’s statements were taken in 

violation of his [or her] Miranda rights and a contention that the 

statements were not voluntary are separate issues.”).

In determining whether statements are voluntary, we consider 

“[m]any factors,” including “the defendant’s physical and emotional 

condition.” State v. Hodges, 326 N.W.2d 345, 348 (Iowa 1982). In this 

case, Tyler’s depleted physical condition and despondent emotional 

condition carry significant weight. Several cases from other courts 

confirm that a highly vulnerable defendant’s statements are more likely 

18Tyler’s repeated denials when asked at her residence and again at the police 

station whether she needed medical attention informs and confirms my overall 

assessment of how poorly she was functioning physically and emotionally during the 

interrogation. 

 
77

to be involuntary, and I find them instructive here. See, e.g., Effland v. 

People, 240 P.3d 868, 878 (Colo. 2010) (en banc) (concluding statements 

were involuntary when the defendant was suffering from extreme 

depression and had recently attempted suicide, and the “officers were 

fully aware of [his] mental condition and the failed suicide attempt at the 

time of the interrogation”); People v. Humphrey, 132 P.3d 352, 362–63 

(Colo. 2006) (affirming a trial court’s determination that a detective’s 

interrogation was coercive “given [the defendant]’s weak and vulnerable 

state”); State v. Marshall, 642 N.W.2d 48, 55–56 (Minn. Ct. App. 2002) 

(finding statements involuntary in part because the defendant “became 

so emotionally upset that she cried . . . and had difficulty breathing” and 

officers expressed concern about a need for medical assistance but did 

not cease questioning); Xu v. State, 100 S.W.3d 408, 414–15 (Tex. App. 

2002) (suppressing statements made after a defendant accused of killing 

his wife had been at the police station for hours, “was intermittently 

crying and clutching [his wife]’s picture,” and became “so distraught[] it 

took almost twenty minutes to calm him down”). 

V. The Hospital Interrogation.

Tyler’s confession at the hospital did not cure the infirmity of the 

earlier police station confession and, in my view, should also be 

suppressed. The same officers conducted the serial interrogations less 

than twenty-four hours apart. The substance of the hospital 

interrogation reveals the officers’ purpose was to have Tyler again repeat 

the inculpatory statements she made before she received the Miranda

warnings. Both officers repeatedly referenced the previous day’s 

conversations, asking Tyler if she remembered their names, if she 

remembered receiving Miranda warnings the day before, and even 

expressly referencing Tyler’s previous statements with phrases such as 
78

“At some point I think you said . . . .” Early in Iowa’s history, this court 

concluded an invalid first confession rendered a second confession 

invalid even though ten months separated them. State v. Chambers, 39 

Iowa 179, 183 (1874) (“[B]elieving the first confession admissible, the 

strong probability is that [the defendant] concluded a repetition could 

make the case no worse, and the last confession was made under the 

influence of the preceding one.”). We reversed the defendant’s conviction 

despite that long temporal divide between the interrogation sessions. See 

id. I would apply the same principle here where the sessions were 

separated by less than twenty-four hours. 

VI. Conclusion.

The interrogating officer in Seibert candidly admitted a strategy to 

“question first, then give the warnings.” Seibert, 542 U.S. at 606, 124 S. 

Ct. at 2606, 159 L. Ed. 2d at 651 (plurality opinion). Although the 

interrogating officers in this case did not expressly acknowledge an 

identical strategy, their failure to do so cannot be dispositive.19 See id. at 

616 n.6, 124 S. Ct. at 2612 n.6, 159 L. Ed. 2d at 657 n.6 (recognizing 

that officers’ subjective intent to delay Miranda warnings until after 

inculpatory statements are made will “rarely be . . . candidly admitted” 

and recommending a “focus . . . on facts apart from intent that show the 

question-first tactic at work”). If express acknowledgement of such a 

strategy were dispositive, Seibert would provide an implausibly narrow 

fact-specific rule and officers could avoid the mandate of Miranda 

19Notwithstanding the absence of such an explicit admission by the officers in 

this case, their strategy of questioning Tyler first and warning her later is unmistakable 

on this record. Just prior to transporting Tyler to the police station, the officers are 

overheard conferring among themselves about the word choices they would use in 

questioning Tyler about whether Baby Tyler was born alive. They decided the 

interrogating officer driving Tyler to the station should not ask whether the baby was 

born alive, but whether it cried or moved.

 
79

without consequence as long as they did not admit their strategy. 

Rather, I agree with the Supreme Court’s observation that it is 

“unrealistic to treat two spates of integrated and proximately conducted 

questioning as independent interrogations subject to independent 

evaluation simply because Miranda warnings formally punctuate them in 

the middle.” Id. at 614, 124 S. Ct. at 2611, 159 L. Ed. 2d at 656. 

The same should be said in this case for obvious reasons. If police 

can cure Miranda violations by simply taking a break in the interrogation 

and giving the required warnings after securing a confession, law 

enforcement officers will always be powerfully encouraged to question 

first and warn later. As the plurality opinion explained in Seibert, that 

kind of strategy actively avoids fulfilling Miranda’s prophylactic objective:

Upon hearing warnings only in the aftermath of interrogation 

and just after making a confession, a suspect would hardly 

think he had a genuine right to remain silent, let alone 

persist in so believing once the police began to lead him over 

the same ground again. A more likely reaction on the 

suspect’s part would be perplexity about the reason for

discussing rights at that point, bewilderment being an 

unpromising frame of mind for knowledgeable decision. 

What is worse, telling a suspect that “anything you say can 

and will be used against you,” without expressly excepting 

the statement just given, could lead to an entirely reasonable 

inference that what he has just said will be used, with 

subsequent silence being of no avail.

Id. at 613, 124 S. Ct. at 2611, 159 L. Ed. 2d at 655–56 (footnote 

omitted). This quotation from Seibert succinctly explains why the 

question-first-warn-later approach utilized by the officers in interrogating 

Tyler does violence to the Miranda rule and should not be condoned here.

I respectfully dissent in part because I conclude Tyler was in 

custody at all times after she was taken from her residence. Her motion 

to suppress should have been granted because all of her statements to 

the officers in the car, at the police station, and at the hospital were the 
80

product of a violation of the Miranda rule and because they were 

involuntarily made.

Wiggins and Appel, JJ., join this concurrence in part and dissent 

in part.
81

#13–0588, State v. Tyler

APPEL, Justice (concurring in part and dissenting in part).

I concur in the majority’s resolution of the expert opinion issue and 

the search and seizure issue. I dissent in the court’s treatment of issues 

surrounding the custodial interrogation of Tyler. 

By a 4–3 margin, a majority of this court has concluded Tyler was 

not in custody during the ride to the police station and during her 

interview at the police station. For the reasons expressed by Justice 

Hecht, three justices, including myself, reach a different conclusion. A 

slight variation in the facts could well have led to a different result. 

Whether a person is in custody will turn on the facts of a particular case, 

but I trust it clear this court will not tolerate a two-step confession 

process in which law enforcement seeks to evade the requirements of 

Miranda.20 

In light of its conclusion Tyler was not in custody, the majority 

does not reach the question of proper remedy in the event of unlawful 

successive interviews. While I agree with Justice Hecht’s application of 

Seibert under federal law, I write separately to emphasize that in my 

view, when law enforcement improperly engages in a two-step 

interrogation to defeat Miranda, the Iowa Constitution requires any 

improperly obtained inculpatory statements be suppressed unless the 

state meets the “fruit of the poisonous tree” test of Wong Sun v. United 

States, 371 U.S. 471, 485–86, 83 S. Ct. 407, 416, 9 L. Ed. 2d 441, 454

(1963). 

20I note Tyler did not claim a different test should be utilized for determining 

custody under the Iowa Constitution. Cf. State v. Kittredge, 97 A.3d 106, 111 (Me. 

2014) (applying ten-factor test and noting the state bears the burden of proof of 

showing lack of custody).

 
82

While the United States Supreme Court in Oregon v. Elstad took a 

different approach, I find the dissents in that case much more persuasive 

than the majority opinion. Compare 470 U.S. 298, 307–08, 105 S. Ct. 

1285, 1292–93, 84 L. Ed. 2d 222, 231 (1985) (majority opinion) (finding 

“[i]t is an unwarranted extension of Miranda to hold that a simple failure 

to administer the warnings, unaccompanied by any actual coercion or 

other circumstances calculated to undermine the suspect’s ability to 

exercise his free will, so taints the investigatory process that a 

subsequent voluntary and informed waiver is ineffective for some 

indeterminate period”), with id. at 335, 105 S. Ct. at 1306–07, 84 L. Ed. 

2d at 249 (Brennan, J., dissenting) (“The correct approach . . . is to 

presume that an admission or confession obtained in violation of 

Miranda taints a subsequent confession unless the prosecution can show 

that the taint is so attenuated as to justify admission of the subsequent 

confession.”), and id. at 364–72, 105 S. Ct. at 1321–26, 84 L. Ed. 2d at 

268–73 (Stevens, J., dissenting). As noted by Justice Brennan in Elstad, 

the linkage between the unlawful confession and subsequent postMiranda confession will ordinarily be clearly established. Id. at 321–24, 

105 S. Ct. at 1299–1301, 84 L. Ed. 2d at 240–42 (Brennan, J., 

dissenting). Further, under Miranda, there is a presumption that the 

product of unwarned custodial interrogation is coerced. See id. If so, 

Wong Sun provides the proper standard for admission of inculpatory 

statements made after unwarned statements. To hold otherwise is to 

remove the strength of Miranda and encourage law enforcement to 

engage in quasi-custodial interrogations in the hope that a confession 

may be extracted without allowing the suspect to have the usual Miranda

warnings. 
83

Further, history demonstrates the voluntariness test is 

extraordinarily difficult to apply and leads to inconsistent results. See

Dickerson v. United States, 530 U.S. 428, 444, 120 S. Ct. 2326, 2336, 

147 L. Ed. 2d 405, 420 (2000) (noting that the totality of the 

circumstances test for voluntariness “is more difficult . . . for law 

enforcement officers to conform to, and for courts to apply in a 

consistent manner”); Louis Michael Seidman, Brown and Miranda, 80 

Calif. L. Rev. 673, 729–30 (1992) (describing Justice Frankfurter’s 

unsuccessful attempt to put spine into voluntariness). Indeed, that is 

one of the reasons why the Miranda rule was adopted in the first place. 

While not perfect, I view Miranda as an important protection to help 

ensure interrogations are truly voluntary. 

My views are consistent with decisions from a number of other 

state jurisdictions. For example, in Commonwealth v. Smith, the 

Supreme Judicial Court of Massachusetts rejected the Elstad approach. 

593 N.E.2d 1288, 1295–96 (Mass. 1992). According to the Smith court, a 

statement obtained in violation of Miranda is presumed to be tainted. Id. 

at 1295. As stated in Smith:

The presumption of taint was intended to deter law 

enforcement officials from circumventing the Miranda 

requirements by using the warnings strategically—first 

questioning the suspect without benefit of warnings, and 

then, having obtained an incriminating response or having 

otherwise benefitted from the coercive atmosphere, by giving 

the Miranda warnings and questioning the suspect again in

order to obtain an admissible statement.

Id. at 1292. Further, the Smith court found, “This presumption [of taint] 

supports one of the purposes of the ‘bright-line’ Miranda rule: to avoid 

fact-bound inquiries into the voluntariness of confessions.” Id. at 1295–

96. As a result, the Smith court held the prosecution has the burden of 
84

showing a break in the stream of events in order to gain admission of the 

subsequent incriminating statements. Id. at 1292, 1295. 

Appellate courts in Hawaii, New York, Tennessee, and Vermont 

have reached a similar conclusion based on similar reasons. See State v. 

Pebria, 938 P.2d 1190, 1196 (Haw. Ct. App. 1997) (rejecting Elstad under 

Hawaii Bill of Rights); People v. Bethea, 493 N.E.2d 937, 938–39 (N.Y. 

1986) (per curiam) (rejecting Elstad under state constitution); State v. 

Smith, 834 S.W.2d 915, 919 (Tenn. 1992) (adopting approach of Justice 

Brennan under state constitution); State v. Barron, 16 A.3d 620, 626–27 

(Vt. 2011) (endorsing the “fruit of the poisonous tree” analysis under 

state constitution). 

I agree with the approach of these state authorities. On the record, 

I would find there was no “break in the stream of events” sufficient to 

allow for the admission of subsequent interrogation under Wong Sun. 

See Elstad, 470 U.S. at 326, 345–46, 105 S. Ct. at 1302, 1312, 84 L. Ed. 

2d at 243, 255 (Brennan, J., dissenting) (internal quotation marks 

omitted).

Wiggins and Hecht, JJ., join this concurrence in part and dissent 

in part.
85

#13–0588, State v. Tyler

WATERMAN, Justice (concurring in part and dissenting in part).

I respectfully concur in part IV and dissent from part III of the 

majority opinion. The majority correctly concludes the district court 

properly denied Tyler’s motion to suppress her confessions that she 

drowned her baby in the bathtub. Yet, the majority erroneously 

concludes the district court abused its discretion by allowing the medical 

examiner to testify as to the cause and manner of death because he 

relied on the same voluntary confessions the jury was allowed to hear. 

Medical experts testifying in our courts routinely rely on patient 

histories. Medical examiners such as Dr. Thompson are no different. 

The medical examiner has a statutory duty to investigate and determine 

the cause and manner of the suspicious death of a child. Iowa Code 

§ 331.802(2)(a) (2015). Why fault Dr. Thompson for considering the 

mother’s own incriminating statements as to how she killed her baby? 

The majority breaks from long-standing Iowa law liberally allowing 

expert testimony, including testimony based on witness statements or 

patient histories. The majority acknowledges that “we have been 

committed to a liberal view on the admissibility of expert testimony.” 

Ranes v. Adams Labs., Inc., 778 N.W.2d 677, 685 (Iowa 2010). Indeed, 

Iowa courts have been committed to a liberal standard for over seventy 

years. See Grismore v. Consol. Prods. Co., 232 Iowa 328, 343, 5 N.W.2d 

646, 655 (1942) (“The modern tendency of the courts everywhere is to 

take a more liberal and rational view respecting the admissibility and 

scope of [expert] testimony.”); see also Leaf v. Goodyear Tire & Rubber 

Co., 590 N.W.2d 525, 530–31 (Iowa 1999) (noting the “expansive scope” 

of expert testimony under Iowa R. Evid. 5.702). In my view, we should

continue to trust our adversary system to expose weaknesses in an 
86

expert’s opinions and trust our juries to give appropriate weight to expert 

testimony in this case and generally. The majority’s opinion will 

inevitably lead to the exclusion of a wide variety of expert opinion 

testimony based on witness accounts. 

The majority opinion rests on a false premise—that Dr. Thompson 

based his opinion as to the cause (drowning) and manner (homicide) of 

death solely on Tyler’s statements to the police. To the contrary, his 

testimony confirms he based his opinions on his autopsy findings, lab 

reports, and the physical evidence at the crime scene as well as Tyler’s 

confession. Dr. Thompson conducted a thorough physical examination 

of the deceased infant and sent organs to three outside specialists for 

testing. Through his own investigation, he was able to rule out 

congenital defects, substance abuse, infections, and skeletal trauma as 

alternate causes of death. He explained what he relied on to determine 

the infant’s cause of death was drowning: 

Q. Do you have an opinion as to a reasonable degree 

of medical certainty regarding the cause of death in this 

case? A. Yes, I do. 

Q. And what is it? A. The cause of death is drowning. 

Q. And what do you base your opinion on? A. My 

opinion is based on a combination of history, which includes 

scene findings, it includes witness statements; it’s also based 

on a combination of physical exam, which is my autopsy 

findings; and then supplemental testing. 

Q. Supplemental testing, for example, when you sent 

certain organs to a specialist to examine; is that correct? A. 

Supplemental lab testing would be x-rays, microbiology, 

metabolic studies. 

Q. Okay. Toxicology? A. Toxicology. 

Dr. Thompson also explained how he determined the manner of death 

was homicide: 
87

Q. What is your opinion based on? A. Just like cause 

of death, my manner of death opinion is based on history, 

again, scene findings, witness statements; it’s based on a 

physical exam, or the autopsy; and then supplemental lab 

testing. 

Dr. Thompson’s autopsy findings corroborated Tyler’s confession 

that her baby was born alive, moved, cried, and took some breaths before 

being drowned in bathwater. Dr. Thompson testified that there was fluid 

that could be bathwater in the baby’s lungs consistent with drowning. 

Secondly, he testified that the expanded alveoli in Baby Tyler’s lungs 

indicate the infant was probably born alive: 

Q. In this case, is there any evidence that this baby 

took a breath? A. There could be, yes. 

Q. Explain that, please. A. When I looked under the 

microscope, the – there’s a structure in the lungs called 

alveoli, which are a grape-like structure. Some of those 

structures were expanded, which could be consistent with 

Baby Tyler taking a few breaths. 

. . . . 

Q. Do you have an opinion to a reasonable degree of 

medical certainty as to what that [partially expanded alveoli] 

indicates to you? A. Given the history that Baby Tyler cried 

and moved, to me that suggests that Baby Tyler probably 

took a few breaths. 

The majority recognizes that “in making these determinations 

[about cause and manner of death], medical examiners routinely rely on 

the circumstances that surround the death, as revealed by independent 

investigation, police investigation, and eyewitness accounts.” (Emphasis 

added.) I agree. As Dr. Thompson testified: 

Q. In your role as a medical examiner, how do these 

witness statements and your knowledge of the scene, how 

important is that in determining a diagnosis of manner and 

cause of death? A. Uh, it’s vital. 

Q. And explain that, please. A. Um, so I’m a 

physician first. Um, as I’ve been saying, my diagnosis, 

which we call cause of death, is based on history, physical 
88

exam, and then supplemental lab testing. Um, if I just did 

the physical exam, I would miss a significant number of 

cause and manner of death. It would be similar to you going 

to your primary care physician, sitting down on his exam 

table and just having -- have him start listening to your 

lungs, looking in your ears, checking your eyes without him 

asking you what’s wrong. I can’t obviously ask my patients 

what’s wrong with them, so I have to ask other people what’s 

wrong. I have to ask police what’s wrong. Sometimes 

witnesses will come forward and say what’s wrong or what 

happened. So that part of my diagnosis or cause of death, 

the history, is absolutely essential. 

. . . . 

So in every single case that I do, it’s always history, 

physical exam, and lab tests, just like when you go see your 

physician. 

It is well established that physicians may rely on self-reported 

patient histories. See, e.g., Walker v. Soo Line R.R., 208 F.3d 581, 586 

(7th Cir. 2000) (“Medical professionals reasonably may be expected to 

rely on self-reported patient histories. Such histories provide 

information upon which physicians may, and at times must, rely in their 

diagnostic work.” (Citation omitted.)). This applies equally to medical 

examiners who must determine the cause and manner of death. See 

Baraka v. Commonwealth, 194 S.W.3d 313, 315 (Ky. 2006) (“Indeed, the 

facts and data in this case, information regarding the circumstances of 

the victim’s death provided by investigating officers, is exactly the kind of 

information customarily relied upon in the day-to-day decisions 

attendant to a medical examiner’s profession.”); Rollins v. State, 897 A.2d 

821, 851 (Md. 2006) (“[W]e disagree with [the] contention that [an expert] 

relied upon improper information to render her expert opinion. [The 

expert’s] consideration of the medical examiner’s file in its entirety was 

proper. She testified that a review of all aspects of the file, including the 

criminal investigation, was necessary to form her opinion and was the 

accepted practice in her field.”), abrogated on other grounds as recognized 
89

by Derr v. State, 29 A.3d 533, 549 (Md. 2011); State v. Wilson, 248 P.3d 

315, 324–25 (N.M. 2010) (allowing a forensic pathologist to “consider 

evidence beyond the medical record” in forming his medical opinion), 

overruled on other grounds by State v. Tollardo, 275 P.3d 110, 121 (N.M. 

2012); State v. Commander, 721 S.E.2d 413, 420 (S.C. 2011) (“Because 

the anecdotal history is an essential component of any autopsy, we find 

testimony concerning findings based on this information falls within the 

umbrella of the expert’s specialized knowledge.”); State v. Boyer, 741 

N.W.2d 749, 757 (S.D. 2007) (“Although [the medical examiner] 

considered extrinsic information in reaching his opinion, he further 

explained that receiving extrinsic evidence was widely accepted in the 

medical field . . . .”); State v. Tucker, 96 P.3d 368, 371 (Utah Ct. App. 

2004) (“[The expert] testified that medical examiners regularly rely upon 

investigative information when forming their opinions. This practice is 

also supported in case law throughout the United States that examines 

this issue.”). 

These courts agree that medical examiners may rely on disputed 

witness testimony, with cross-examination as the proper tool to explore 

weaknesses in the opinions. See Walker, 208 F.3d at 586 (“In situations 

in which a medical expert has relied upon a patient’s self-reported 

history and that history is found to be inaccurate, district courts usually 

should allow those inaccuracies in that history to be explored through 

cross-examination.”); Baraka, 194 S.W.3d at 315 (“It has been long held 

that such underlying factual assumptions are properly left for scrutiny 

during cross-examination.”); Rollins, 897 A.2d at 853 (“All experts . . . 

were subject to cross-examination about their findings; once the experts’ 

opinions were admitted, it was within the province of the trier of fact to 

determine which expert should be believed.”); Wilson, 248 P.3d at 325 
90

(“Defendant was free to persuade the jury that [the expert’s] opinion 

relied too much on a questionable confession and not enough on hard 

science. The jury remained the ultimate arbiter of [the expert’s] 

credibility, and it was free to reject his opinion and conclude that [the 

victim’s] death was caused by natural causes.”). 

Dr. Thompson was vigorously cross-examined and conceded his 

autopsy findings could also be consistent with a stillborn child with 

amniotic fluid in the lungs and alveoli expanded by gases released after 

death. He acknowledged he was unable to determine the cause and 

manner of death until viewing Tyler’s confession. These weaknesses go 

to the weight of his opinion testimony, not its admissibility. See Williams 

v. Hedican, 561 N.W.2d 817, 823 (Iowa 1997) (“ ‘ “[A]n expert’s lack of 

absolute certainty goes to the weight of this testimony, not to its 

admissibility.” ’ ” (alteration in original) (quoting State v. Buller, 517 

N.W.2d 711, 713 (Iowa 1994))); Hutchison v. Am. Family Mut. Ins. Co., 

514 N.W.2d 882, 888 (Iowa 1994) (“[W]e believe with the aid of vigorous 

cross examination, the jury is fully capable of detecting the most 

plausible explanation of events.”). 

The cases the majority relies on are distinguishable. In People v. 

Eberle, an appellate court held the trial court erred by denying the 

defendant’s motions to suppress the statements relied on by the medical 

examiner. 697 N.Y.S.2d 218, 219–20 (App. Div. 1999). The medical 

examiner’s opinion that an infant’s death was “homicidal suffocation” 

rather than Sudden Infant Death Syndrome (SIDS) was based on the 

statements alone, not any “medical evidence.” Id. at 219. The 

statements, obtained in violation of defendant’s right to counsel, were the 

fruit of the poisonous tree. Id. at 219–20. The suppression remedy 

would be empty if the jury nevertheless heard the inadmissible 
91

statements through the medical examiner. By contrast, the majority 

correctly holds Tyler’s confessions were properly admitted into evidence. 

Dr. Thompson was entitled to rely on the same confessions the jury 

heard, in addition to the medical evidence (his autopsy findings) that 

corroborated Tyler’s self-incriminating statements to police. 

The majority relies on other cases that did not involve a medical 

examiner relying on the defendant’s confession. In State v. Vining, the 

medical examiner testified that “none” of the physical evidence supported 

her opinion that the fatal head injury “was caused at the hands of 

another as opposed to an accidental fall.” 645 A.2d 20, 21 n.1 (Me. 

1994). Dr. Thompson, however, testified that his opinion was supported 

by the physical findings of his autopsy, lab tests, and physical evidence 

at the crime scene, as well as Tyler’s confessions, and explained how the 

forensic evidence corroborated her history of the drowning death. In 

Maxwell v. State, the medical examiner was unable to determine the 

cause of death from his autopsy, and his opinion that the manner of 

death was homicide “was based entirely upon the circumstances 

surrounding Gina Maxwell’s demise as related to him by a detective 

working on the case.” 414 S.E.2d 470, 473–74 (Ga. 1992), overruled on 

other grounds by Wall v. State, 500 S.E.2d 904, 907 (Ga. 1998). The 

medical examiner “admitted that his opinion as to the manner of death 

‘[was] based on things the jury could determine themselves.’ ” Id. at 474 

(alteration in original). That is not so in this case. The jury needed 

expert medical testimony to explain the significance of the fluid found in 

the infant’s lungs and the partially expanded alveoli. Nor does State v. 

Jamerson help the majority. 708 A.2d 1183 (N.J. 1998). The medical 

examiner in that case strayed outside his zone of medical competence by 

acting as an accident reconstructionist in determining the defendant 
92

drove recklessly. See id. at 1194–95. By contrast, Dr. Thompson simply 

did what medical examiners are trained to do. 

Other cases cited by the majority conclude the use of the word 

“homicide” implies criminal guilt or intent, and prohibit medical 

examiners from testifying on that basis. State v. Sosnowicz, 270 P.3d 

917, 922 (Ariz. Ct. App. 2012) (“[The expert]’s testimony that the victim 

died as the result of a ‘homicide’ went to the key issue in the case: Did 

defendant intentionally, knowingly or recklessly cause the victim’s death 

by a criminal act or was the victim’s death the result of a non-criminal 

accident?”); People v. Perry, 593 N.E.2d 712, 716 (Ill. App. Ct. 1992) (“In 

fact, it might be construed as prejudicial, since a layperson might equate 

the word homicide with murder.”); Eberle, 697 N.Y.S.2d at 219 

(“Moreover, the expert’s statement that the infant died from ‘homicidal’ 

suffocation improperly states a conclusion regarding defendant’s 

intent.”); Bond v. Commonwealth, 311 S.E.2d 769, 771–72 (Va. 1984) 

(finding medical examiner impermissibly testified to an ultimate issue of 

fact—death by homicide). These cases are inapposite, because 

Dr. Thompson testified that “homicide,” as used in his report, is a 

neutral medical term: 

Q. And in this case, did you form an opinion to a 

reasonable degree of medical certainty regarding manner of 

death? A. Yes, I did. 

Q. And what is your opinion? A. In the manner of 

death is homicide. 

Q. And what does that mean? Homicide. A. 

Homicide is a medical term. It’s a neutral term. It doesn’t 

signify right or wrong. It simply means death at the hands of 

another individual. 

Such explanatory testimony is lacking in the foregoing cases relied upon 

by the majority. Tyler does not challenge the jury instructions given in 

this case, which correctly set forth the elements of the crimes charged. 
93

The district court properly allowed Dr. Thompson to testify regarding the 

medical definition of homicide. 

The majority inaccurately refers to Tyler’s confessions as 

“uncorroborated.” To the contrary, the police investigation and 

Dr. Thompson’s medical investigation corroborate key factual statements 

in her confessions. During Tyler’s first police interview, she described 

giving birth while standing up, which is corroborated by a bruise noted 

in the autopsy on Baby Tyler’s forehead where he hit the floor of the 

bathroom. The police found key physical evidence—the placenta and the 

scissors used to cut the exposed umbilical cord—exactly where Tyler said 

she put them. Most importantly, Dr. Thompson’s autopsy findings of 

fluid in the infant’s lungs and expanded alveoli corroborate her 

description of how she filled the tub with water and placed Baby Tyler, 

born alive, face down in the bathwater to drown. Dr. Thompson’s 

medical evaluation of Baby Tyler corroborated Tyler’s confession. See

State v. Polly, 657 N.W.2d 462, 467 (Iowa 2003) (“ ‘Corroboration need 

not be strong nor need it go to the whole case so long as it confirms some 

material fact connecting the defendant with the crime.’ ” (quoting State v. 

Liggins, 524 N.W.2d 181, 187 (Iowa 1994))). 

Dr. Thompson did not merely parrot Tyler’s confession to the jury; 

he considered her account in the context of his medical conclusions from 

the autopsy and lab tests. Dr. Thompson admittedly could not 

determine the cause and manner of death without Tyler’s confession. 

That does not mean his opinion rests on her confession alone. As 

medical examiners routinely do, he relied on his autopsy findings, lab 

test results, and physical evidence as well as the history provided by the 

only person present at the time of the baby’s death. I would not exclude 
94

testimony of medical witnesses because they necessarily rely on the 

history provided by family members present at the time of death. 

I disagree with the majority’s conclusion that “Dr. Thompson’s 

opinions were inadmissible because they amounted to an impermissible 

comment on Tyler’s credibility.” The majority relies on State v. Dudley in 

which we concluded the prosecution’s expert improperly vouched for the 

credibility of the child sex-abuse victim, not the defendant. 856 N.W.2d 

668, 676–77 (Iowa 2014). Such precedent is inapplicable to expert 

testimony relying in part on an adult defendant’s voluntary confession to 

establish the factual cause and manner of death. None of our court’s 

precedent that culminated in Dudley involved a defendant arguing the 

State’s expert improperly vouched for the defendant’s credibility. Tyler, 

who did not testify at trial, is complaining Dr. Thompson “vouched for” 

what Tyler herself told police. This is a far cry from Dudley, which 

involved a “he-said, she-said” swearing contest that turned on whether 

the jury believed Dudley (who denied abusing the victim), or the child 

victim (who said Dudley abused her). The State could gain an unfair 

advantage through expert testimony introduced to bolster the credibility 

of a victim testifying against the defendant. See id. That concern is not 

implicated when an expert relies on the defendant’s own words as to 

what happened.21 

Significantly, Dr. Thompson never commented on Tyler’s 

credibility, state of mind, or guilt in the presence of the jury. He gave no 

opinion as to her motive or intent. He simply relied, in part, on her 

21It is true Tyler initially denied her baby was born alive before confessing, twice, 

that it moved and cried and she drowned the infant in the bathwater. Yet, as the 

majority and district court correctly found, Tyler’s confessions were voluntary. Why 

would she make up the story? There is no evidence Tyler was coerced or duped into 

confessing through a promise of leniency. Why preclude a medical expert from relying 

on confessions deemed reliable enough for the jury to hear? 

 
95

confessions for determining the physical cause and manner of death. As 

the majority recognizes, the term “homicide” as used by medical 

examiners such as Dr. Thompson “expresses no opinion as to the 

criminality of the killing or the culpability of the killer.” A medical 

examiner testifying that the manner of death is homicide is rendering a 

neutral medical opinion, one required by statute. See Iowa Code 

§ 331.802(2)(a) (“[T]he county medical examiner shall conduct a 

preliminary investigation of the cause and manner of death, prepare a 

written report of the findings, . . . and submit a copy of the report to the 

county attorney.”). For a killing to be a crime, the requisite intent must 

be present. See id. §§ 707.1–.5. Intent, and therefore guilt or innocence, 

is for the jury to determine. 

Most courts agree the expert medical examiner only crosses the 

line by testifying to the intent or guilt of the defendant. See Commander, 

721 S.E.2d at 420 (“Of the many courts in other jurisdictions that have 

considered where to draw the line in these cases, we tend to agree with 

those courts that have found that expert testimony addressing the state 

of mind or guilt of the accused is inadmissible.”). Dr. Thompson did not 

cross this line. See id.; Willis v. State, 558 S.E.2d 393, 395 (Ga. 2002) 

(“Because this testimony did not improperly invade the province of the 

jury on the ultimate issue of whether the death was an intentional killing 

or an accident, the trial court did not err . . . .”); Baraka, 194 S.W.3d at 

318 (“Accordingly, most jurisdictions . . . hold that a qualified expert can 

express an opinion that the manner of a disputed death was 

homicide, . . . though not that the homicide was intentional, wanton, 

reckless, or accidental, which would constitute an opinion as to the guilt 

or innocence of the defendant.”); Rollins, 897 A.2d at 851–52 (discussing 

how all expert testimony is designed to bolster one view of the facts, 
96

which does not invade the province of the jury); State v. Dao Xiong, 829 

N.W.2d 391, 397 (Minn. 2013) (“Here, the district court properly 

admitted [the expert’s] testimony that the manner of [the victim’s] death 

was homicide. . . . [I]t did not constitute improper expert testimony 

regarding [the defendant’s] intent. [The expert’s] testimony assisted the 

jury’s understanding of the medical evidence offered at trial by explaining 

that the autopsy results were consistent with homicide. . . . [The 

expert’s] testimony as to [the victim’s] manner of death was based on [the 

expert’s] examination of [the victim’s] body.”); State v. Bradford, 618 

N.W.2d 782, 793 (Minn. 2000) (holding an examiner could testify to 

homicide as a manner of death, but not offer an opinion regarding 

intent); Boyer, 741 N.W.2d at 758 (“We finally note that neither expert 

usurped the function of the jury by testifying that [the victim] actually 

died as a result of being shaken or thrown down. Nor did the experts 

opine whether they thought [the defendant] was guilty.”); Tucker, 96 P.3d 

at 371 (“In light of [the expert’s] testimony that intent was not a factor in 

classifying [the victim’s] death, and that intent is a question for the jury, 

we see no error in the trial court’s rulings.”); State v. Richardson, 603 

A.2d 378, 379 (Vt. 1992) (“The testimony [that the manner of death was 

homicide] was not a comment on defendant’s guilt or innocence.”); State 

v. Scott, 522 S.E.2d 626, 632 (W. Va. 1999) (“Because the term ‘homicide’ 

is neutral and pronounces no judgment, we do not find that [the expert] 

testifying that [the victim’s] manner of death was homicide removed any 

defense available to [the defendant]. In fact, [the expert] testified that his 

opinion was not a legal conclusion—that he was neither trained nor 

qualified to render a legal conclusion concerning [the victim’s] death.”). I 

would follow these well-reasoned decisions. Medical examiners should 

be allowed to rely on witness accounts, including a defendant’s 
97

confession, in testifying the manner of death was homicide so long as 

they do not testify that the defendant is “guilty” or has criminal intent. 

I fear today’s majority opinion will have unintended consequences. 

Going forward, will an accident reconstructionist be allowed to give 

opinions based on witness statements? May a forensic accountant rely 

on a defendant’s confession to embezzlement or consider deposition 

testimony to determine a spouse dissipated marital assets? May a 

human-factors expert rely on disputed testimony as to how an accident 

happened when opining on the efficacy of a warning or safety of a 

product design? May a hydrologist rely on disputed testimony or a 

party’s admissions to determine the source of groundwater 

contamination? May medical witnesses continue to rely on patient 

histories? After today’s decision, it appears such testimony could be

excluded from evidence any time the expert admits his opinion depends 

on the witness’s account of what happened. This is an unwarranted and 

ill-advised sea change in our heretofore liberal approach to the 

admissibility of expert testimony. 

We have routinely allowed expert testimony based on witness 

testimony or statements. Is the expert thereby indirectly vouching that 

the witness is telling the truth? Do these cases remain good law? See, 

e.g., In re Det. of Stenzel, 827 N.W.2d 690, 702 (Iowa 2013) (concluding 

expert testimony based on an interview with defendant and defendant’s 

criminal history was sufficient to show that defendant had “a mental 

abnormality and had serious difficulty controlling his behavior”); Leaf, 

590 N.W.2d at 530 (affirming admissibility of expert’s opinion on product 

defect that depended on plaintiff’s recollection of events); Olson v. 

Nieman’s, Ltd., 579 N.W.2d 299, 308 (Iowa 1998) (discussing how expert 

considered statements of a third party when determining if an invention 
98

meets the nonobvious requirement of a patent); Johnson v. Knoxville 

Cmty. Sch. Dist., 570 N.W.2d 633, 639–40 (Iowa 1997) (discussing how 

expert relied on a two-hour interview, case documentation, and a family 

member’s journal detailing plaintiff’s symptoms to support opinion that 

plaintiff suffered from obsessive compulsive disorder); State ex rel. Leas 

in re O’Neal, 303 N.W.2d 414, 417 (Iowa 1981) (permitting clinical 

psychologist acting as an expert witness to use psychological testing and 

interviews to determine that parents were psychologically unfit to care for 

a child).22 These are just a few of the cases that could have gone the 

other way, had the majority’s opinion been the rule of law when they 

were decided. 

Finally, I note the State failed to argue on appeal that any error in 

the admission of Dr. Thompson’s testimony was harmless. The court of 

appeals concluded the error was not harmless. Given Tyler’s confession, 

I am not so sure. Several decisions cited by the majority held it was 

harmless or nonprejudicial error to allow a medical examiner to testify 

that the death was a homicide. Sosnowicz, 270 P.3d at 925–26; Perry, 

593 N.E.2d at 717. The dissent in Dudley concluded that the admission 

of the expert testimony in that case was harmless. 856 N.W.2d at 684–

85 (Cady, C.J., dissenting). I would trust our juries to give the expert 

testimony proper weight. But, because the State failed to argue harmless 

22Decisions of the court of appeals would likewise be called into question by the 

majority’s decision. See, e.g., State v. Gilmore, No. 11–0858, 2012 WL 3589810, at *5–6 

(Iowa Ct. App. Aug. 22, 2012) (allowing psychologist to consider defendant’s interview to 

determine that defendant could form the specific intent to kill); State v. Favara, No. 02–

1311, 2003 WL 21920959, at *1–2 (Iowa Ct. App. Aug. 13, 2003) (allowing sheriff’s 

deputy to testify as an expert witness as to how he believed a burglary took place after 

he “investigated the crime scene, photographed and weighed the items, and conducted 

interviews”); In re Det. of Rafferty, No. 01-0397, 2002 WL 31113930, at *1 (Iowa Ct. App.

Sept. 25, 2002) (concluding that expert could base his opinion that a person is a 

sexually violent predator and likely to reoffend on a clinical interview, official records, 

and actuarial assessment tools).

 
99

error in its appellate brief or application for further review, the majority 

could properly find it waived that issue. See Iowa R. App. P. 

6.903(2)(g)(3) (“Failure to cite authority in support of an issue may be 

deemed waiver of that issue.”). 

The district court, relying on our traditional liberal approach to the 

admissibility of expert testimony, correctly denied Tyler’s motion to 

suppress Dr. Thompson’s testimony and autopsy report stating the cause

and manner of Baby Tyler’s death. The district court properly equated 

Dr. Thompson’s reliance on Tyler’s confessions to “a physician relying on 

a patient’s history in reaching a diagnosis.” I would affirm Tyler’s 

conviction. 

Cady, C.J., and Mansfield, J., join this concurrence in part and 

dissent in part.