Opinion ID: 1494221
Heading Depth: 2
Heading Rank: 3

Heading: Admissibility of Fahey's Statements to Her Psychotherapists Under D.R.E. 803(4)

Text: We now turn to the issue concerning whether the medical diagnosis exception in D.R.E. 803(4) applies to statements made for purposes of psychotherapy  as distinct from statements made for purposes of diagnosing physical ailments. Specifically, Capano argues that the trial court erroneously admitted testimony from Fahey's psychotherapists recounting her statements to them during the course of Fahey's therapy. The State responds that the exception, by its terms, applies to statements made by a patient to licensed psychiatrists and psychologists during therapy. As an alternative holding, we conclude that Fahey's statements to her psychotherapists are admissible independently under the medical diagnosis or treatment exception set forth in D.R.E. 803(4). [204]
Rule 803(4) provides: (4) Statements for purposes of medical diagnosis or treatment. Statements made for purposes of medical diagnosis or treatment and describing medical history, or past or present symptoms or sensations, or the inception or general character of the cause or external causes thereof insofar as reasonably pertinent to diagnosis or treatment. Relying on the broad language of Rule 803(4), which neither specifies the type of person to whom a patient must make the statements nor explicitly restricts application of the exception to physical symptoms or ailments, the State argues that D.R.E. 803(4) applies to psychotherapists. Capano argues, among other things, that such a broad reading of the exception renders meaningless the requirement that the statement be reasonably pertinent to diagnosis or treatment because nearly everything that a person has experienced, including statements of fault, is relevant to psychoanalysis. Capano also argues that in treating patients, psychotherapists do not depend on the objective truth of the statements made by the patients (that is, the correlation between the content of the statements and some notion of objective reality), or even on the sincerity with which the statements are made. To ensure that the medical diagnosis exception imposes a meaningful limitation on the types of hearsay statements that would be admissible at trial, Capano contends that the exception should apply only to statements relevant to the diagnosis and treatment of physical ailments. [205] The State counters that statements made during therapy are likely to be highly reliable because patients have a strong motivation to be truthful in communicating with psychotherapists to ensure an accurate diagnosis and appropriate treatment. To the extent that unfairly prejudicial testimony may become admissible under a broad reading of the exception, the State maintains that such testimony may be excluded under the Rule 403 balancing test. This argument presents us with an issue of first impression. We have concluded that the better-reasoned view is that statements to either a psychiatrist (a medical doctor specializing and certified in psychodiagnosis or psychotherapy) and a psychologist (a trained and certified professional  not a medical doctor  who specializes in psychodiagnosis or psychotherapy) may be admissible under D.R.E. 803(4). We do not declare a general view that such statements will always  or even usually  be admissible. But if a firm foundation with respect to the qualifications of a psychotherapist and the proper professional circumstances is established, statements made to that professional by a patient voluntarily submitting to diagnosis or undergoing mental health treatment may, in the discretion of the trial court, be admissible in a given case. While in some cases statements of the patient made to the professional in the course of psychodiagnosis or psychotherapy may be unreliable, inappropriately far-ranging, or unduly prejudicial, they are not necessarily so. To establish the appropriate foundation, the proponent must show that the statements satisfy the two-part reliability test first developed in United States v. Iron Shell. [206] First, the declarant's motive in making the statement must be consistent with the purpose of promoting treatment, and the declarant must be aware that the diagnosis and treatment of her ailment depend on the accuracy of her statements. [207] Second, doctors must reasonably rely on this sort of information in diagnosis or treatment. [208] Finally, the trial judge must conduct a proper D.R.E. 403 analysis and determine that the probative value is not substantially outweighed by the danger of unfair prejudice. These safeguards must be employed by the trial judge to ensure that admission of psychotherapist testimony is consistent with the rationale underlying the medical diagnosis exception: [A] person seeking medical treatment is unlikely to lie to a doctor she wants to treat her, since it is in her best interest to tell the truth. [209] Limiting hearsay testimony in this manner also assures that psychotherapists' testimony about their patients is not used to circumvent the rule against hearsay. [210] Thus, where the patient's statements and the circumstances demonstrate reliable guarantees of trustworthiness we find no supportable reason why there should be a blanket exclusion of statements made to psychotherapists as compared to the general acceptance of statements made to doctors or medical paraprofessionals for physical ailments. [211] In this case, we find that the trial judge properly exercised his discretion under circumstances consistent with our holding. The qualifications of Dr. Neil Kaye, M.D., Dr. Michelle Sullivan, and Dr. Gary Johnson, the psychotherapists, were established. The professional circumstances of Fahey's diagnosis or treatment were appropriate: There is no evidence that Fahey had an improper motive in seeking help from the psychotherapists or that she believed that the success of her treatment was unrelated to the accuracy of her statements. In addition, Dr. Kaye testified that, in diagnosing and treating patients, psychotherapists necessarily rely on the patients' statements about their relationships in treating their psychological ailments. [212] Although Capano asserts that Fahey's ailments themselves (such as depression, anxiety, compulsive obsessive disorder, and anorexia) undermine the truthfulness of her statements in therapy, Capano fails to show how these disorders might have actually affected her ability to represent accurately her thoughts and feelings. [213] Similarly, Capano argues that Fahey often failed to disclose the full details of her life to her therapists. But Capano provides no reason to question the reliability of the statements and disclosures that Fahey did make during the course of her therapy. Fahey had a motive to be truthful and candid. There is no reasonable basis, therefore, to conclude that her statements were contrived or so far-ranging as to be irrelevant to her treatment or otherwise problematic. Moreover, the trial judge conducted a proper D.R.E. 403 balancing test and concluded that the probative value of the psychotherapists' testimony was not substantially outweighed by the danger of unfair prejudice. [214] Finally, it should be noted that the D.R.E. 803(4) exception for medical diagnosis or treatment does not contain the same limitation as the state of mind exception under D.R.E. 803(3) regarding a fact remembered or believed. Accordingly, to the extent that the psychotherapists' testimony regarding Fahey's statements included facts remembered or believed, they are not barred under D.R.E. 803(4). Therefore, they are either admissible under this alternative basis or constitute harmless error under the analysis previously set forth in this Opinion.
Although the medical diagnosis or treatment exception of D.R.E. 803(4) has been recognized in its generic form as firmly rooted for purposes of the Confrontation Clause, [215] the exception has not historically been extended to psychotherapists in Delaware. Capano therefore argues that the medical diagnosis exception is not firmly rooted as applied to psychotherapists. But we need not reach that issue because the alternative ground of particularized guarantees of trustworthiness under the Confrontation Clause jurisprudence is applicable here. As noted above, the plurality opinion in Lilly holds that the Confrontation Clause may be satisfied if the proponent of the evidence carries its burden of showing that the contested statements possess `particularized guarantees of trustworthiness' such that adversarial testing would be expected to add little, if anything, to the statement's reliability. [216] Reliance on this prong of the Confrontation Clause requires a showing that the declarant's truthfulness is so clear from the surrounding circumstances that the test of cross-examination would be of marginal utility. [217] In this regard, we believe that it is particularly important that the statements satisfy the general requirements for admissibility established in Derrickson. Derrickson, which applies to the state of mind exception, requires that the statement(s): i) must be relevant and material; ii) must relate to an existing state of mind when made; iii) must be made in a natural manner; iv) must be made under circumstances dispelling suspicion; and v) must contain no suggestion of sinister motives. [218] In the present case, Fahey made the statements to her psychotherapists in a natural manner during therapy sessions and  at least for the most part  did not make the statements in response to questioning. In addition, there is nothing to indicate that Fahey made the statements under suspicious circumstances or in a manner suggesting that she had sinister motives. Rather, it appears that Fahey was expressing her concerns and fears regarding her relationship with Capano to those persons in whom she regularly confided. This conclusion finds further support in the spontaneity and consistent repetition of the statements. [219] Fahey made nearly identical statements concerning her intentions and her emotional state to a number of her psychotherapists and friends. In short, the nature of Fahey's statements, the manner in which they were communicated, and the persons to whom the statements were directed collectively establish that Fahey was speaking candidly. We therefore conclude that the admissible hearsay testimony presented by Fahey's psychotherapists possesses indicia of reliability and guarantees of trustworthiness sufficient to satisfy the Confrontation Clause. Thus the D.R.E. 803(4) exception as applied here satisfies the Confrontation Clause. Finally, our decision to affirm the trial judge's decision in admitting the hearsay evidence is independently supported under the state of mind exception of D.R.E. 803(3) and the harmless error analysis, whether or not the psychotherapists' testimony is also independently admissible under D.R.E. 804(3). These conclusions apply both for Delaware evidentiary law purposes and for purposes of the federal Confrontation Clause analysis.