Opinion ID: 2358621
Heading Depth: 1
Heading Rank: 2

Heading: hearsay evidence: kre 803(4).

Text: Dr. Bright testified that when she examined T.J. on February 9, 1998, T.J. gave her a history of being sexually abused from age seven, including sexual touching, oral sodomy, and sexual intercourse. Dr. Bright was not permitted to repeat T.J.'s identification of the perpetrator or the details of the sexual acts described by T.J. Appellant asserts that Dr. Bright was an examining physician, not a treating physician, and, thus, her repetition of the history related to her by T.J. should have been excluded on grounds that its prejudicial effect outweighed its probative value. Drumm v. Commonwealth, Ky., 783 S.W.2d 380, 385 (1990); see also Miller v. Commonwealth, Ky., 925 S.W.2d 449, 451 (1995); Bell v. Commonwealth, Ky., 875 S.W.2d 882, 887-88 (1994); Sharp v. Commonwealth, Ky., 849 S.W.2d 542, 544-45 (1993). The Commonwealth responds that Dr. Bright was, in fact, a treating physician, because she testified that she saw T.J. for the purpose of both examination and treatment, thus obviating the need to apply the balancing test described in Drumm, supra . We conclude that the distinction between treating and examining physicians was eliminated by the adoption of KRE 803(4); thus, the balancing test as described in Drumm no longer applies. Prior to Drumm , the common law rule in Kentucky was that a physician consulted for the purpose of prescribing treatment could testify to the case history related by the patient, but that a physician consulted only for the purpose of examination or evaluation could not. Mary Helen Coal Corp. v. Bigelow, Ky., 265 S.W.2d 69, 70 (1954). [1] This was also the rule generally applied in federal courts prior to 1975. See e.g., Padgett v. S. Ry. Co., 396 F.2d 303 (6th Cir.1968); United States v. Calvey, 110 F.2d 327 (3rd Cir.1940); United States v. Nickle, 60 F.2d 372 (8th Cir.1932). This distinction between treating and examining physicians was eliminated in the federal courts with the 1975 adoption of the Federal Rules of Evidence (FRE). Pub.L. 93-595, § 1, Jan. 2, 1975, 88 Stat.1939. FRE 803(4) codified a hearsay exception for: Statements made for purposes of medical diagnosis or treatment and describing medical history, or past or present symptoms, pain, or sensations, or the inception or general character of the cause or external source thereof insofar as reasonably pertinent to diagnosis or treatment. (Emphasis added.) The FRE Advisory Committee left no doubt that the rule was drafted with an intent to eliminate the distinction between statements made to treating as opposed to examining physicians. Conventional doctrine has excluded from the hearsay exception, as not within its guarantee of truthfulness, statements to a physician consulted only for the purpose of enabling him to testify. While these statements were not admissible as substantive evidence, the expert was allowed to state the basis of his opinion, including statements of this kind. The distinction thus called for was one most unlikely to be made by juries. The rule accordingly rejects the limitation. This position is consistent with the provision of Rule 703 that the facts on which expert testimony is based need not be admissible in evidence if of a kind ordinarily relied upon by experts in the field. FRE 803(4) Advisory Committee's Note (1972) (emphasis added). There has been some dispute as to what information is reasonably pertinent to diagnosis or treatment. For example, statements identifying the perpetrator have been held reasonably pertinent to diagnosis and treatment of a child sexual abuse victim where the treatment was for psychological injuries and the abuser lived with the child, the theory being that the abuse would likely continue as long as the child remained in the same household with the abuser. United States v. Renville, 779 F.2d 430, 436-37 (8th Cir.1985); Edwards v. Commonwealth, Ky., 833 S.W.2d 842, 844 (1992) (decided prior to adoption of the Kentucky Rules of Evidence). Whether this analysis would apply if the physician were seeing the child only for diagnosis and not for treatment has not been addressed in the federal courts, although it was noted in the leading case of United States v. Iron Shell, 633 F.2d 77 (8th Cir.1980), cert. denied, 450 U.S. 1001, 101 S.Ct. 1709, 68 L.Ed.2d 203 (1981) that statements of identity are seldom if ever pertinent to diagnosis or treatment. Id. at 84; see also Souder v. Commonwealth, Ky., 719 S.W.2d 730, 735 (1986) (decided prior to adoption of the Kentucky Rules of Evidence); State v. Jones, 625 So.2d 821 (Fla.1993); People v. Pluskis, 162 Ill.App.3d 449, 113 Ill.Dec. 671, 515 N.E.2d 480 (1987), abrogated on other grounds, People v. Hill, 294 Ill.App.3d 962, 229 Ill.Dec. 324, 691 N.E.2d 797 (1998); Cassidy v. State, 74 Md.App. 1, 536 A.2d 666 (1988), superseded by rule in, Walker v. State, 107 Md.App. 502, 668 A.2d 990 (1995); People v. LaLone, 432 Mich. 103, 437 N.W.2d 611 (1989); R. Mosteller, Child Sexual Abuse and Statements for the Purpose of Medical Diagnosis and Treatment, 67 N.C. L.Rev. 257, 264-67 (1989). However, the federal cases have uniformly held that the adoption of FRE 803(4) abolished the distinction between the doctor who is consulted for the purpose of treatment and an examination for purpose of diagnosis only; the latter usually refers to a doctor who is consulted only in order to testify as a witness. United States v. Iron Shell, supra, at 83; see also United States v. Farley, 992 F.2d 1122, 1125 (10th Cir.1993); Morgan v. Foretich, 846 F.2d 941, 950 (4th Cir.1988); O'Gee v. Dobbs Houses, Inc., 570 F.2d 1084 (2d Cir.1978). Drumm v. Commonwealth, supra , was decided in January 1990, more than two years prior to the adoption of the Kentucky Rules of Evidence. Drumm departed from the previous common law rule of automatic exclusion of statements made to examining physicians and formulated a new rule that was, in fact, a modified version of FRE 803(4). While purporting to judicially adopt FRE 803(4), Drumm specifically retained the distinction between examining and treating physicians, thus rejecting sub silentio the holdings in United States v. Iron Shell, supra , and Morgan v. Foretich, supra . While not automatically excluding hearsay statements of medical history related to examining physicians, Drumm required exclusion if the `prejudicial effect outweighs ... probative value,' taking into account that when such statements are not made for the purpose of treatment they have `less inherent reliability than evidence admitted under the traditional common-law standard underlying the physician treatment rule.' Drumm, 783 S.W.2d at 385. [2] This hybrid of the former common law rule and FRE 803(4) was borrowed from a concurring opinion written by United States Supreme Court Justice Lewis Powell sitting with a panel of the Fourth Circuit Court of Appeals in Morgan v. Foretich, supra . As previously noted, the majority in Morgan rejected this view; and rehearing was denied en banc. No other federal or state court has adopted Justice Powell's interpretation of Rule 803(4), [3] presumably because his view directly contradicts the plain language of the rule, i.e., statements made for purposes of diagnosis or treatment (emphasis added), and is directly contrary to the intent of the rule as expressed in the Advisory Committee's Note, supra. Furthermore, the balancing test recommended by Justice Powell in Morgan v. Foretich was that contained in FRE 403 (subsequently adopted in Kentucky with minor modification as KRE 403), i.e., evidence may be excluded if its probative value is substantially outweighed by the danger of unfair prejudice. (KRE 403 substitutes undue for unfair.) Under Drumm , the evidence is excluded if its prejudicial effect outweighs [its] probative value, 783 S.W.2d at 385, a significantly lesser threshold for exclusion. The Drumm rule was subsequently applied to exclude hearsay statements of medical history in Bell v. Commonwealth, supra , Sharp v. Commonwealth, supra and Miller v. Commonwealth, supra . The offenses in Bell and Sharp were committed prior to July 1, 1992, the effective date of the Kentucky Rules of Evidence. See KRE 107(b). The offense in Miller was committed after July 1, 1992; however, the only pertinent issue addressed in Miller was whether the physician was, in fact, a treating physician or an examining physician. The effect of the adoption of KRE 803(4) on that issue was neither raised nor decided in Miller . The Kentucky Rules of Evidence were drafted with the intent of conformance with the Federal Rules. An early decision was made by the Committee to strive for uniformity with the Federal Rules of Evidence and to propose a departure from the Federal Rules only for good reason. Uniformity between the state and federal rules would serve the purpose of minimizing the possibility of forum shopping and would in time add to the efficiency of the judicial system. The Federal Rules have been in operation since 1975; several states have adopted Rules patterned after the Federal Rules. As a result there is a substantial and growing body of case law construing these Rules, case law which can be of invaluable assistance in the application of a new set of evidence rules for Kentucky. Prefatory Note, Evidence Rules Study Committee, Final Draft (1989). See also R. Lawson, Interpretation of the Kentucky Rules of EvidenceWhat Happened to the Common Law? 87 Ky. L.J. 517, 527 (1999). The language of KRE 803(4) is identical to that of its federal counterpart. Specifically, the Rule does not distinguish between statements made to treating and examining physicians and does not include the balancing test described in Drumm . KRE 402 provides: All relevant evidence is admissible, except as otherwise provided by the Constitutions of the United States and the Commonwealth of Kentucky, by acts of the General Assembly of the Commonwealth of Kentucky, by these rules, or by other rules adopted by the Supreme Court of Kentucky. This general rule of inclusion contains no exception for preexisting case law. The Commentary explains that the phrase other rules adopted by the Supreme Court of Kentucky refers to rules of court promulgated by the Supreme Court of Kentucky, i .e., the Civil and Criminal Rules of Procedure. Commentary to KRE 402, Evidence Rules Study Commission (Final Draft 1989). In Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 585-90, 113 S.Ct. 2786, 2792-94, 125 L.Ed.2d 469 (1993), the United States Supreme Court analyzed the effect of the adoption of the Federal Rules on preexisting case law, specifically, the effect of the adoption of FRE 702 on the preexisting general acceptance test [4] for determining the reliability of scientific evidence. The Court concluded that when there is an adopted Rule of Evidence that speaks to the contested issue, the adopted Rule occupies the field and supersedes the former common law interpretation. Id. at 587-89, 113 S.Ct. at 2794. [5] Preexisting common law remains only as a body of knowledge existing in the somewhat altered form as a source of guidance in the exercise of delegated powers. Id. at 588, 113 S.Ct. at 2794 (quoting E. Cleary, [6] Preliminary Notes on Reading the Rules of Evidence, 57 Neb. L.Rev. 908, 915 (1978)). See also Lawson, supra, at 560-61, 569. We conclude that the hybrid rule enunciated in Drumm , which labeled as inherently unreliable a statement made to a physician solely for the purpose of diagnosis and which required exclusion of such a statement if its prejudicial effect merely outweighed its probative value, did not survive the adoption of KRE 803(4). To the extent that Miller v. Commonwealth, supra , could be interpreted otherwise, it is overruled. Of course, KRE 803(4) is but an exception to the hearsay rule, not a rule of relevancy. Cf. Moseley v. Commonwealth, Ky., 960 S.W.2d 460, 461 (1997) (an out-of-court statement must satisfy the requirements of both Article IV and Article VIII of the Kentucky Rules of Evidence). Thus, a statement made to an examining physician for the purpose of diagnosis, like any other relevant evidence, is subject to exclusion if its probative value is substantially outweighed by the danger of undue prejudice [not if its prejudicial effect merely outweighs its probative value per Drumm ], confusion of the issues, or misleading the jury, or by considerations of undue delay, or needless presentation of cumulative evidence. KRE 403 (emphasis added). This balancing test is reserved to the sound discretion of the trial judge. Commonwealth v. English, Ky., 993 S.W.2d 941, 945 (1999). We find no abuse of discretion in the admission of the sanitized version of the history given by T.J. to Dr. Bright in this case.