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IN THE SUPREME COURT OF THE STATE OF IDAHO

Docket No. 46371

STATE OF IDAHO,

 Plaintiff-Respondent,

v.

DAVID LEE CHRISTENSEN,

 Defendant-Appellant,

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Boise, November 2019 Term

Opinion Filed: February 24, 2020

Karel A. Lehrman, Clerk

Appeal from the District Court of the Fourth Judicial District of the 

State of Idaho, Ada County. Michael Reardon, District Judge.

The decision of the district court is affirmed. 

Nevin, Benjamin, McKay & Bartlett, Boise, attorney for Appellant. 

Dennis Benjamin argued.

Lawrence G. Wasden, Idaho Attorney General, Boise, attorney for 

Respondent. Andrew V. Wake argued.

BEVAN, Justice

I. NATURE OF THE CASE

Dave Lee Christensen was indicted by a grand jury on five counts of lewd conduct with 

two minors under sixteen. The State notified Christensen of its intent to introduce interviews of 

the two alleged victims at trial under Idaho Rules of Evidence (“I.R.E.”) 803(4) and 803(24). At 

a pretrial hearing, the district court ruled the interviews were admissible because the victims’ 

statements were made for purposes of medical diagnosis or treatment. The interviews were 

admitted at trial by stipulation. A jury found Christensen guilty on four of the five counts. 

Christensen appeals the district court’s admission of the interviews. We affirm.

II. FACTUAL AND PROCEDURAL BACKGROUND

On May 30, 2017, A.M.O. told a peer tutor that Christensen, her step-grandfather, had 

touched her inappropriately. That same day, A.M.O.’s twin sister, A.G.O., also told school 
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officials she had been inappropriately touched by Christensen. School officials reported the 

information to the Meridian Police Department and Detective Jeff Miller was assigned to 

investigate the allegations. After a brief investigation Detective Miller referred A.M.O. and 

A.G.O. to St. Luke’s Children at Risk Evaluation Services (“CARES”) to be assessed. 

CARES is designed to provide evaluation and treatment of abused or neglected children. 

A child can be referred to CARES by law enforcement, the Department of Health and Welfare, 

the court system, or other medical providers. Once a child is referred, the child is assessed in 

three ways: a forensic interview, a psychosocial assessment, and a medical examination. The 

forensic interview is performed first by a social worker who is part of the medical team. It is a 

structured conversation with the child in hopes of maintaining detailed information on something 

the child has experienced or witnessed. The forensic interview adheres to the National Institute 

of Child Health and Human Development (“NICHD”) guidelines designed to elicit disclosure 

from children in a non-leading and neutral way. The psychosocial assessment, also performed by 

a social worker, is completed after the forensic interview. The psychosocial assessment gathers 

information related to the child’s psychological well-being and their social well-being. The last 

step in the assessment process is the medical examination. The examination is a full head-to-toe 

medical examination that commonly involves a detailed examination of the genitals and 

evaluation for possible sexually transmitted diseases or infections. The medical examination is 

informed by the forensic interview and psychosocial assessment to determine issues the child 

may have, areas that may need extra focus, any clues about possible physical symptoms and any

ideas about possible infections or injuries. 

Lara Foster, a medical social worker at CARES, conducted the forensic interview of 

A.M.O. on June 9, 2017. In that interview A.M.O. disclosed to Foster that she had been 

inappropriately touched by Christensen. A.G.O. was interviewed by Foster on June 12, 2017. 

A.G.O. also disclosed that Christensen had inappropriately touched her. 

On August 8, 2017, Christensen was indicted on five counts of lewd conduct with a 

minor under sixteen. The State notified Christensen of its intent to introduce the CARES 

interviews under I.R.E. 803(4) and 803(24). Christensen objected. At a hearing, the district court 

held the CARES interviews were admissible under I.R.E. 803(4). The CARES interviews were 

admitted by stipulation at trial. Both A.M.O. and A.G.O. testified at trial. A jury found 
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Christensen guilty on four of the five counts of lewd conduct with a minor under sixteen.

Christensen timely appealed. 

III. ISSUES ON APPEAL

1. Whether the district court abused its discretion by admitting the CARES interviews under 

I.R.E. 803(4).

2. Whether the district court abused its discretion by admitting the CARES interviews

without first redacting statements elicited by A.M.O. and A.G.O. from introductory 

questions, questions designed to build trust and rapport, and questions designed to test 

episodic memory. 

IV. STANDARD OF REVIEW

“The trial court has broad discretion in deciding whether to admit hearsay evidence under 

one of the exceptions, and this Court will not overturn an exercise of that discretion absent a 

clear showing of abuse.” State v. Stanfield, 158 Idaho 327, 331, 347 P.3d 175, 179 (2015). This 

Court reviews an alleged abuse of discretion by determining whether the trial court “(1) correctly 

perceived the issue as one of discretion; (2) acted within the outer boundaries of its discretion; 

(3) acted consistently with the legal standards applicable to the specific choices available to it; 

and (4) reached its decision by the exercise of reason.” Lunneborg v. My Fun Life, 163 Idaho 

856, 863, 421 P.3d 187, 194 (2018). “Even if evidence was admitted in error, this Court will not 

grant relief if we find the error to be harmless.” Stanfield, 158 Idaho at 331, 347 P.3d at 179. 

V. ANALYSIS

Christensen argues the district court abused its discretion by failing to consider whether 

A.M.O. and A.G.O. understood that their statements were made for the purpose of medical 

diagnosis or treatment. Christensen also argues that even if statements by A.M.O. and A.G.O. 

were admissible under I.R.E. 803(4), the district court abused its discretion by admitting the 

CARES interviews without first redacting statements elicited from introductory questions, 

questions designed to build trust and rapport, or questions designed to test episodic memory. For 

the reasons below, we affirm the district court’s admission of the CARES interviews in their 

entirety. 

A. The district court did not abuse its discretion by admitting the CARES interviews 

under I.R.E. 803(4). 

Christensen first argues the district court abused its discretion by admitting the CARES 

interviews under I.R.E. 803(4). Idaho employs the totality of the circumstances approach when 

applying hearsay exceptions to children. State v. Kay, 129 Idaho 507, 518, 927 P.2d 897, 908 
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(Ct. App. 1996). This approach, when applied to the exception for statements made for the 

purpose of medical diagnosis or treatment, permits courts to consider several factors that 

establish a child made a statement which, though hearsay, would be admissible under Rule 

803(4). Christensen asserts the district court did not act consistently with applicable legal 

standards because it failed to consider these factors to determine whether the twins were 

informed of or otherwise appreciated the importance of speaking truthfully to the CARES 

interviewer. 

“Hearsay is an out-of-court statement offered in evidence to prove the truth of the matter 

asserted.” Takhsilov v. State, 161 Idaho 669, 674, 389 P.3d 955, 960 (2016) (internal quotations 

omitted). “Hearsay evidence is generally inadmissible unless it falls within an exception 

provided by the rules of evidence or another rule promulgated by this Court.” State v. Hill, 161 

Idaho 444, 448, 387 P.3d 112, 116 (2016). One exception exists for statements made for medical 

diagnosis or treatment. See I.R.E. 803(4). A proponent must show the statement “(A) is made 

for—and is reasonably pertinent to—medical diagnosis or treatment; and (B) describes medical 

history; past or present symptoms or sensations; or their source.” Id. The first step of the analysis

thus requires the statements not only be made for the purpose of medical diagnosis or treatment 

but also requires the statements be reasonably pertinent to that diagnosis or treatment. See Kay, 

129 Idaho at 518, 927 P.2d at 908 (explaining a declarant must show: “(1) that the statements 

were ‘made for purposes of medical diagnosis or treatment’; (2) that the statements described 

‘medical history, or past or present symptoms, pain, or sensations, or the source thereof’; and (3) 

that the statements were ‘reasonably pertinent to diagnosis or treatment.”). “[T]he evidentiary 

rationale for permitting hearsay testimony regarding spontaneous declarations and statements 

made in the course of receiving medical care is that such out-of-court declarations are made in 

contexts that provide substantial guarantees of their trustworthiness.” White v. Illinois, 502 US 

346, 355 (1992). Such statements are trustworthy because patients “seeking treatment will not be 

inclined toward deception and fraud” as that deception or fraud would be against a patient’s vital 

interest. See Gonzales v. Hodson, 91 Idaho 330, 332, 420 P.2d 813, 815 (1966).

1. The district court’s admission of the CARES interviews under I.R.E. 803(4) was not an 

abuse of discretion because A.M.O. and A.G.O. made their statements for the purpose of 

medical diagnosis or treatment.

The district court did not abuse its discretion by admitting the CARES interviews under 

I.R.E. 803(4) because the totality of the circumstances here establishes the twins’ statements 
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were made for the purpose of medical diagnosis or treatment. For guidance in making this 

determination we turn to the well-reasoned analysis in Kay. In Kay, the Idaho Court of Appeals

addressed the precise issue presented here–whether a child is capable of making statements for 

the purpose of medical diagnosis or treatment. 129 Idaho at 518, 927 P.2d at 908. There, the 

district court admitted under IRE 803(4) statements made by a four-year-old victim to two 

physicians during medical examinations describing what occurred when the victim was 

molested. Id. at 517, 927 P.2d at 907. The defendant argued, like Christensen here, that the 

prosecution failed to show that the four-year-old appreciated the importance of speaking 

truthfully to the physicians. Id. at 518, 927 P.2d at 908. The court rejected this argument and held 

that a child, even as young as four, can be motivated to give information for purposes of medical 

diagnosis or treatment falling within the parameters of I.R.E. 803(4). Id. The court recognized a 

“dilemma arises in attempting to apply to children evidentiary rules which were drafted with 

adults in mind.” Id. But, to remediate the dilemma, the court held the district court should

consider the totality of circumstances surrounding the statements to determine whether a young 

child’s statements were made for medical diagnosis or treatment. Id. In doing so, the court 

recognized that the district court “may consider any factors which bear upon the likelihood that 

the child made the statement for [a medical diagnosis or treatment] purpose.” Id. A nonexclusive list of the guiding factors would include:

The child’s age; whether the child understands the role of the physician in 

general; whether the child was suffering pain or distress at the time; whether the 

child’s statements were inappropriately influenced by others, as by leading 

questions from the physician or a previous suggestive interrogation by another 

adult; whether the examination occurred during the course of a custody battle or 

other family dispute; the child’s ability and willingness to communicate freely 

with the physician; the child’s ability to differentiate between truth and fantasy in 

the examination itself and in other contexts; whether the examination was 

initiated by an attorney (which would suggest that its purpose was for litigation 

rather than treatment); and the timing of the examination in relation to the trial. 

Id. The court then held so long as there is little reason to doubt the child’s motivation, district 

courts may infer the criteria of I.R.E. 803(4) are satisfied. Id. 

Applying these Kay factors, the Court of Appeals found the medical examinations were 

not associated with any domestic dispute, there was no motivation for any of the involved adults 

to try to influence the child’s story, the child readily answered questions, the physicians used 

simple, open-ended, non-leading questions when speaking with the child, both examinations 
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occurred shortly after the misconduct occurred, and both examinations were performed at the 

hospital where even the young child would realize health was the focus. Id. Thus, the court

ultimately held the district court’s admission of the four-year-old’s statements under I.R.E.

803(4) was not an abuse of discretion because the child made the statements for the purpose of 

seeking medical diagnosis or treatment. Id.

In State v. Nelson, 131 Idaho 210, 953 P.2d 650 (Ct. App. 1998), the Court of Appeals 

again held a child’s statements made to a medical professional were made for the purpose of 

medical diagnosis or treatment. 131 Idaho at 216, 953 P.2d at 656. In Nelson, the court held that 

a ten-year-old’s statements to an emergency room physician about the events leading to the 

sexual assault and particulars of the molestation were admissible under I.R.E. 803(4). Id. at 215, 

953 P.2d at 655. The court explained there was no basis in the record to infer that the child 

believed she was seeing the doctor for any reason other than diagnosis and treatment. Id. 

Specifically, the court relied on the facts that the child was taken to the emergency room within 

an hour of the sexual assault, the child had told other adults the defendant had hurt her, and the 

child complained about pain in sensitive areas. Id.

For purposes of this appeal it is important to note that Christensen focuses on whether the 

victims knew that their statements, made during their interviews and prior to physical 

examination, were for medical or diagnostic purposes. Christensen avoids the duty to analyze

these questions under a totality of the circumstances and myopically focuses on only one of the 

several Kay criteria listed above. In reviewing the totality of the circumstances before the district 

court we emphasize that the judge “has broad discretion in deciding whether to 

admit hearsay evidence under one of the exceptions, and this Court will not overturn an exercise 

of that discretion absent a clear showing of abuse.” Stanfield, 158 Idaho at 331, 347 P.3d at179. 

The record establishes that the trial court “(1) correctly perceived the issue as one of 

discretion; (2) acted within the outer boundaries of its discretion; (3) acted consistently with the 

legal standards applicable to the specific choices available to it; and (4) reached its decision by 

the exercise of reason.” Lunneborg, 163 Idaho at 863, 421 P.3d at 194. The district court met all 

of these factors, and most-importantly for the issue raised on this appeal, it acted consistently 

with the proper legal standard as required by Kay and found little reason to doubt the statements 

made by A.M.O. and A.G.O. in their respective CARES interviews were made for any reason 

other than medical treatment or diagnosis.
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The district court found that CARES’ focus is mainly on medical procedures intended to 

discover trauma inflicted on children, to address that trauma, and to treat it. This focus was 

relayed to A.M.O. and A.G.O. when Foster explained it was her job to keep their bodies safe and 

healthy and that they would see a doctor after the interview was completed. As in Kay, the 

district court also found the statements were elicited by non-leading questions as evidenced by 

the use of the NICHD protocols. As noted by the court’s analysis in Kay, the State need not show 

the child understands the need to speak truthfully to physicians for I.R.E. 803(4) to apply. 129 

Idaho at 518, 927 P.2d at 908. “Proof of such an awareness is not required as a matter of 

foundation when the declarant is an adult, and in our view it is inappropriate to impose a 

differing foundational rule where the declarant is of tender years.” Id. Here, the district court 

found little reason from the record to doubt that the statements made by A.M.O. and A.G.O. fell 

within the exception for medical diagnosis or treatment. We agree.

Even more, independently applying the factors listed in Kay also supports admissibility 

of the statements made by the twins during their CARES interviews. First, A.M.O. and A.G.O. 

were thirteen at the time of the interviews, but they were functioning at the level of a third 

grader.

1 Children of thirteen or six, or even as young as four, are capable of making statements 

for the purpose of medical diagnosis or treatment. Nelson, 131 Idaho at 216, 953 P.2d at 656; 

Kay, 129 Idaho at 518, 927 P.2d 897 at 908. Second, Foster explained the medical purpose of the 

interviews to A.M.O. and A.G.O., explaining that it was her job to keep them healthy and safe 

and explained they would be seen by a nurse or doctor after the interview. Even more, both 

A.M.O. and A.G.O. discussed pain they incurred during the incidents and vaginal bleeding that 

occurred after. These facts show A.M.O. and A.G.O. knew their statements were for the purpose 

of medical diagnosis or treatment because the statements themselves show they were aware of 

the medical staff and why the medical staff was involved. In addition, they freely communicated 

with the staff about physical pain and discomfort they experienced from the abuse. Third, the 

statements made by A.M.O. and A.G.O. were not inappropriately influenced by others. The 

twins had not been interrogated by law enforcement, had minimal investigation from school 

officials, and Foster used non-leading questions. Fourth, the interviews did not occur during a 

 

1 A.M.O. and A.G.O. were both born with chromosome deletion which affects their learning abilities. At the time of 

the alleged misconduct, A.M.O. and A.G.O. were thirteen-years-old and in the ninth grade but were functioning at a 

third grade level. 
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custody battle or other family dispute. Fifth, A.M.O. and A.G.O. both communicated freely with 

Foster and acknowledged they understood the difference between truth and falsity. Sixth, the 

interviews took place before trial. 

Finally, and most importantly, even though CARES interviews serve a dual medical and 

forensic purpose, A.M.O. and A.G.O.’s statements were admissible because their statements 

remain inherently reliable; they are gleaned from a process designed to aid and inform treatment 

and diagnosis of the child’s medical condition. In these circumstances, the child would “still 

have the requisite motive for providing the type of ‘sincere and reliable’ information that 

is important to that [medical] diagnosis and treatment.” Webster v. State, 827 A.2d 910, 920 

(Md. Ct. App. 2003). 

Under these circumstances, the questions and their answers were designed to assist in 

proper medical diagnosis or treatment of A.M.O. and A.G.O.’s medical conditions. Dr. Cox, the 

medical doctor who testified before the district court about the purpose of CARES interviews,

noted that the forensic interview helps undergird the medical examination. The medical doctor 

observes the forensic interview before performing the medical examination so that he or she can 

be informed of critical material disclosed during the interview. Dr. Cox testified that after the 

forensic interview and psychosocial assessments are completed, a full head-to-toe medical 

examination is performed which is often directed by the information learned from the history 

collected in those initial interviews. Dr. Cox testified that the forensic interview 

helps in first determining kind of what problems the child may have, what areas [a 

doctor] need[s] to focus [the] assessment on examination-wise. It give[s] [the 

doctor] clues about any physical symptoms the child may have had that may be 

something that needs to be evaluated further like bleeding or pain or discharge or 

other issues. It gives an idea of risk for infections.

Dr. Cox then testified that disclosures by A.G.O. in her forensic interview directly influenced his 

examination of her. Additionally, although Dr. Cox did not perform the medical examination on 

A.M.O., Dr. Cox testified that the assessment and examination process is standardized and that 

each examiner takes the same approach, using communication from the interview to inform the 

nature and scope of the medical examination. Thus, the same rationale applies to A.M.O.’s 

statements.

These factors, taken together, establish that the district court did not abuse its discretion 

in concluding that A.M.O. and A.G.O. made their statements for the purpose of medical 
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diagnosis or treatment. While there is also a “forensic” component to the interviews, that concern 

is overcome by the medical characteristic of such interviews. See State v. Vigil, 810 N.W.2d 687, 

695 (Neb. 2012) (“[A] statement is generally considered admissible under the medical purpose 

hearsay exception if gathered for dual medical and investigatory purposes.”); see also Webster, 

827 A.2d at 921 (collecting several cases that approve the admission of hearsay statements by a 

sexual assault victim given during a forensic interview due to the dual medical and forensic 

purposes for the examination).

In addition, the concern regarding the dual purpose of such interviews is allayed in two 

ways. First, the forensic nature of the interview is not primarily designed to gather evidence, 

though that is one of its byproducts; it is to help inform the medical process that takes place with 

the child throughout their experience at CARES. The interview assists and enlightens, as Foster 

testified, as part of the process in helping children keep their bodies safe and healthy, 

incorporating seeing a doctor after the interview is completed. Second, as explained below, the

interviews are “forensic” in nature because they are conducted under detailed guidelines 

designed, insofar as possible, to obtain untainted information from the child, rather than from the 

interviewer through leading questions. 

Thus, the “forensic” moniker given to these interviews does not supplant the prevailing

medical underpinning which supports their admission under Rule 803(4). Stated another way, 

while there is clearly a dual purpose to CARES interviews, to both gather information and 

inform medical treatment, the information-gathering purpose does not override the medical 

necessity of such interviews. As a result, the district court did not abuse its discretion by

admitting the CARES interviews under I.R.E. 803(4). 

B. The district court did not abuse its discretion by admitting the CARES interviews 

without first redacting statements given by A.M.O. and A.G.O. to introductory 

questions, questions designed to build trust and rapport, and questions designed to 

test episodic memory.

Christensen argues the district court abused its discretion by admitting the CARES 

interviews in their entirety without first determining whether particular statements were 

admissible under I.R.E. 803(4). Christensen acknowledged that the CARES interviews adhered 

to NICHD protocol which has four phases: (1) introductory questions; (2) questions designed to 

build trust and rapport; (3) questions designed to test episodic memory; and (4) substantive 

questions designed to illicit disclosure that may aid in medical diagnosis or treatment. 
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Christensen maintains statements elicited from A.M.O. and A.G.O. during the first three phases 

of the CARES interviews should have been redacted because those statements were not pertinent

to medical diagnosis or treatment. 

The State argues Christensen failed to preserve this issue below. But even if the issue 

were preserved, the State maintains the district court did not abuse its discretion because the 

statements elicited in the first three phases of the interview were not hearsay and the statements 

were pertinent to medical diagnosis or treatment. Lastly, the State argues if the district court 

abused its discretion by admitting the CARES interviews without redaction, the error was 

harmless because the statements elicited by A.M.O. and A.G.O. were both tested by crossexamination and thus any error in admitting the interviews did not contribute to the jury’s 

verdict. 

1. Whether the CARES interviews should have been redacted below was adequately 

preserved. 

“For an objection to be preserved for appellate review, ‘either the specific ground for the 

objection must be clearly stated, or the basis of the objection must be apparent from the context.’ 

” Hansen v. Roberts, 154 Idaho 469, 473, 299 P.3d 781, 785 (2013) (quoting Slack v. Kelleher, 

140 Idaho 916, 921, 104 P.3d 958, 963 (2004)). Below, Christensen made a general objection to 

the admission of the CARES interviews under I.R.E. 803(4). In response to the State’s notice of 

intent to use the CARES interviews, Christensen argued “any conversation for the purpose of 

building trust or establishing rapport is not relevant to or for the purpose of medical treatment” 

and thus should be excluded. Christensen then stated the specific grounds for the objection, 

I.R.E. 803(4). It was apparent from the context that Christensen was objecting to the admission 

of parts of the interview intended to build rapport and establish trust between the CARES 

interviewer and the child. Thus, we hold the issue was adequately preserved. 

2. The district court did not abuse its discretion by admitting the unredacted CARES 

interviews because the statements were not hearsay, or even if they were, Christensen 

failed to particularize his objection regarding the offending statements. 

The statements elicited by the CARES interviewer during the first three components of 

the interviews were directed at (1) introductory questions directed at whether the child was 

competent to testify; (2) questions designed to build rapport and eliciting information about what 

the child likes to do; and (3) probing episodic memory, where the forensic interviewer identified 

a recent event and then asked questions designed to elicit details about that event. The questions 
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included what the twins like to do for fun, and whether they understood the importance of telling 

the truth. While such answers were made out of court, they were not admitted for the “truth of 

the matter asserted.” I.R.E. 801(c). Hearsay is “a statement, other than one made by the declarant 

while testifying at the trial or hearing, offered in evidence to prove the truth of the matter 

asserted.” Hill, 161 Idaho at 448, 387 P.3d at 116 (emphasis added). The State had no interest in 

establishing that A.M.O. likes drawing or swimming. The statements were admitted so that the 

jury had the full context of the twins’ statements about the abuse committed by Christensen and 

not to establish any disputed facts. Thus, such statements are not hearsay and Christensen’s 

objection on that basis is erroneous. See State v. Siegel, 137 Idaho 538, 540–41, 50 P.3d 1033, 

1035–36 (Ct. App. 2002) (citing United States v. Gutierrez–Chavez, 842 F.2d 77, 81 (5th Cir.

1988) (“[S]tatements offered only to provide context to a defendant’s admissions are not 

hearsay.”). Such statements made during a conversation are admissible to provide background

and “for the limited purpose of putting the responses of the [child] in context and making them 

‘intelligible to the jury. . . .’ ” Id. at 541, 50 P.3d at 1036. Thus, such questions help inform the 

jury as to the nature, circumstances and “feel” of the interview in context. Simply revealing to 

the jury the victim’s statements about what Christensen did to them without more, as Christensen 

advocates, would make it difficult for the jury to properly weigh that evidence. As a result, we 

hold the district court did not abuse its discretion by admitting the unredacted CARES 

interviews.

Christensen also made no attempt to object specifically to those portions of the interviews 

that he wished to have redacted. Perhaps some statements made in the interviews were irrelevant, 

or could arguably be hearsay. Even so, without a specific objection to the allegedly inadmissible

portions of the interview, we are left only to surmise what might or might not amount to 

offending statements. A general objection to such interviews, without specifics as to which 

statements were inadmissible and why, is insufficient to preserve the error for appeal. I.R.E.

103(a)(1)(B). Thus, Christensen’s attempt to assail this portion of the interviews on appeal fails.

VI. CONCLUSION

The district court did not abuse its discretion by admitting the CARES interviews under 

I.R.E. 803(4). Additionally, admission of the CARES interviews without redaction was not an 

abuse of discretion. We affirm. 

Chief Justice BURDICK, Justices BRODY, STEGNER and MOELLER, CONCUR.