Opinion ID: 658172
Heading Depth: 2
Heading Rank: 1

Heading: Statements Admitted Under the Medical Exception

Text: 21 The trial court found that the child victim's statements to a pediatrician and to a social worker regarding the nature of the molestation and the identity of the perpetrator fell within the medical diagnosis or treatment exception to the rule against hearsay. Section 803(4) admits as an exception to the hearsay rule: 22 [s]tatements made for purposes of medical diagnosis or treatment and describing medical history, or past or present symptoms, pain, or sensations or the inception or general character of the cause or external source thereof insofar as reasonably pertinent to diagnosis or treatment. 23 6 Guam Code Ann. Sec. 803(4) (emphasis added). Cf. Fed.R.Evid. 803(4). The medical treatment exception is a firmly rooted exception to the exclusion of hearsay evidence. White, --- U.S. at ---- n. 8, 112 S.Ct. at 741, n. 8. The basis for this exception is the presumption of reliability of statements which flow from the patient's strong motivation to be truthful. Fed.R.Evid. 803(4), Advisory Committee's Note. See also McCormick On Evidence Sec. 292 (Cleary, 3d ed. 1984); 6 J. Wigmore, Evidence in Trials at Common Law Sec. 1719 (Chadbourn, rev. ed. 1976). In Wright, the Supreme Court explained that statements admitted under a 'firmly rooted' hearsay exception satisfy the reliability requirements of the Confrontation Clause because they are so trustworthy that adversarial testing would add little to their reliability. Wright, 497 U.S. at 821, 110 S.Ct. at 3149. Similarly, in White, the Supreme Court noted that the 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 and statements are made in contexts that provide substantial guarantees of their trustworthiness. White, --- U.S. at ----, 112 S.Ct. at 742. The Court further explained that it is [their trustworthiness] that has led us to conclude that 'firmly rooted' exceptions carry sufficient indicia of reliability to satisfy the reliability requirement posed by the Confrontation Clause. Id. n. 8 (citing Wright, 497 U.S. at 806-07, 110 S.Ct. at 3141-42.). 24 Thus, a child victim's statements about the identity of the perpetrator are admissible under the medical treatment exception when they are made for the purposes of medical diagnosis and treatment. George, 960 F.2d at 99. The rationale for the exception is that the patient can be expected to tell the truth about her injury because she will want to be diagnosed correctly and treated appropriately. 25 In reviewing the trial court's decision, we consider separately the admissibility of the statements to the doctor and the social worker. 26 As we acknowledged in George, hearsay evidence can be admitted under the medical treatment exception whether the statements were made for purpose of physical or non-physical treatment and diagnosis. 27 Sexual abuse involves more than physical injury; the physician must be attentive to treating the victim's emotional and psychological injuries, the exact nature and extent of which often depend on the identity of the abuser. Furthermore, depending upon the nature of the sexual abuse, the identity of the abuser may be pertinent to the diagnosis and treatment of sexually transmitted diseases. 28 George, 960 F.2d at 99 (citations omitted) (emphasis added). 29 The victim's statements to Dr. McCaffrey about how she got hurt and who hurt her, fall within the exception because they pertain to the cause or external source of the injury and because they are pertinent to diagnosis or treatment. George, 960 F.2d at 99. Thus, admission of this hearsay evidence did not violate the Confrontation Clause. Id. at 100. 30 The record does not show that the statement to the social worker was for medical treatment. The testimony of Mr. Pereda, the social worker, establishes that he questioned the child to determine whether he needed to notify Child Protective Services of a case of suspected child abuse. [RT Vol. II 140-42]. Counsel for Guam acknowledged at oral argument that Mr. Pereda's questions about the identity of the abuser were aimed at ensuring the child's safety and were not aimed at treating or diagnosing the child's physical or psychological needs. 3 Therefore, admission of the child's statement to the social worker was an abuse of discretion because the record fails to support the trial court's finding that the statement was made in the course of medical treatment. 4 31 Although the trial judge improperly admitted the child's statement to the social worker under a firmly rooted hearsay exception, the requirements of the Confrontation Clause may still be satisfied upon a showing that the statement bears the requisite  'indicia of reliability.'  See Ohio v. Roberts, 448 U.S. 56, 66, 100 S.Ct. 2531, 2539, 65 L.Ed.2d 597 (1980) (Reliability can be inferred without more in a case where the evidence falls within a firmly rooted hearsay exception. In other cases, the evidence must be excluded, at least absent a showing of particularized guarantees of trustworthiness.); Wright, 497 U.S. at 816, 110 S.Ct. at 3147. 32 In Wright, the Supreme Court cautioned that unless an affirmative reason, arising from the circumstances in which the statement was made, provides a basis for rebutting the presumption that a hearsay statement is not worthy of reliance at trial, the Confrontation Clause requires exclusion of the out-of-court statement. Wright, 497 U.S. at 821, 110 S.Ct. at 3150. The hearsay statement in this case does not satisfy Wright. The child's statement was not spontaneous, the record does not show that the statement was accompanied by an emotional display that would indicate that she was telling the truth and the record does not support a finding that the child used terminology unexpected of a child of similar age or that the child lacked motive to fabricate evidence. See Id., at 821-22, 110 S.Ct. at 3150 (providing a nonexclusive list of factors to consider when determining the trustworthiness of hearsay statements admitted under a residual hearsay exception). The discussion in the child's presence between the social worker and the child's mother concerning the suspicion of sexual abuse arguably provided a basis for the child to report inaccurately the abuse and possibly the identity of the abuser in an attempt to please her mother. Thus the record before us does not provide an affirmative reason to believe that the hearsay statement was particularly trustworthy. 33 Although we hold that the court's admission of the victim's hearsay statement to the social worker was erroneous, its impact is subject to harmless error analysis. United States v. Vargas, 933 F.2d 701, 704-5 (9th Cir.1991). In this case, the only statement the victim made to the social worker concerned the identity of the perpetrator, information already properly in the record through the testimony of both the pediatrician and defendant's wife, Melinda Ignacio. Mrs. Ignacio's testimony about the child's identification of the defendant as the abuser was particularly powerful. She testified that the child was left in the Ignacio home alone with the defendant, that when she returned home the child told her that Uncle Ton touched her pee-pee, and that she then examined the child and discovered that the child's vagina was red and contained a yellow mucous-like fluid. We conclude that the social worker's testimony was cumulative of other compelling testimony and was, therefore, harmless beyond a reasonable doubt. 34