Opinion ID: 656636
Heading Depth: 3
Heading Rank: 1

Heading: The rape statement

Text: 20
21 Rule 803(4) excepts from the hearsay bar [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. Fed.R.Evid. 803(4). The Rule 803(4) exception to the hearsay rule is founded on a theory of reliability that emanates from the patient's own selfish motive--her understanding that the effectiveness of the treatment received will depend upon the accuracy of the information provided to the physician. 2 McCormick on Evidence § 277, at 246-47 (John W. Strong ed., 4th ed. 1992). The Supreme Court has noted that statements made in the course of receiving medical care ... are made in contexts that provide substantial guarantees of their trustworthiness. White v. Illinois, --- U.S. ----, ----, 112 S.Ct. 736, 742, 116 L.Ed.2d 848 (1992). 22 While this guaranty of trustworthiness extends to statements of causation, it does not ordinarily extend to statements regarding fault. Fed.R.Evid. 803(4) advisory committee's note. Thus, a declarant's statement relating the identity of the person allegedly responsible for her injuries is not ordinarily admissible under Rule 803(4) because statements of identity are not normally thought necessary to promote effective treatment. See United States v. Renville, 779 F.2d 430, 436 (8th Cir.1985). 23 Nevertheless, the Fourth, Eighth and Ninth Circuits have held that statements made by a child to a physician which identify the sexual abuser as a member of the family or household are reasonably pertinent to diagnosis or treatment and may therefore be admissible. See United States v. Balfany, 965 F.2d 575, 579 (8th Cir.1992) (citing Renville, 779 F.2d at 436); United States v. George, 960 F.2d 97, 99-100 (9th Cir.1992); Morgan v. Foretich, 846 F.2d 941, 949 (4th Cir.1988). 5 Statements revealing the identity of the child abuser are reasonably pertinent to treatment because the physician must be attentive to treating the child's emotional and psychological injuries, the exact nature and extent of which often depend on the identity of the abuser. Renville, 779 F.2d at 437. Moreover, physicians often have an obligation under state law to prevent an abused child from being returned to an abusive environment. Id. at 438. As a result, where the abuser is a member of the family or household, the abuser's identity is especially pertinent to the physician's recommendation regarding an appropriate course of treatment, which may include removing the child from the home. Id. 24 Unlike the victims in the cases cited above, Ms. Joe was not a child but rather the estranged wife of the alleged sexual abuser. However, the identity of the abuser is reasonably pertinent to treatment in virtually every domestic sexual assault case, even those not involving children. All victims of domestic sexual abuse suffer emotional and psychological injuries, the exact nature and extent of which depend on the identity of the abuser. 6 The physician generally must know who the abuser was in order to render proper treatment because the physician's treatment will necessarily differ when the abuser is a member of the victim's family or household. In the domestic sexual abuse case, for example, the treating physician may recommend special therapy or counseling and instruct the victim to remove herself from the dangerous environment by leaving the home and seeking shelter elsewhere. In short, the domestic sexual abuser's identity is admissible under Rule 803(4) where the abuser has such an intimate relationship with the victim that the abuser's identity becomes reasonably pertinent to the victim's proper treatment. 25 The facts of this case underscore the point. After performing a rape kit test on Ms. Joe, Dr. Smoker asked her several questions relating to her injuries. In answering these questions, Ms. Joe identified her husband, Melvin Joe, as her sexual abuser. Dr. Smoker testified that the identity of the sexual assailant was important for his recommendation regarding Ms. Joe's after-care, including appropriate counseling. Moreover, after discovering her assailant's identity, Dr. Smoker specifically recommended that Ms. Joe seek protection, offering her the number of the Navajo Police Department and referring her to the women's shelter in Shiprock, New Mexico. It is abundantly clear that the statement made by Ms. Joe revealing the identity of her alleged abuser was reasonably pertinent to her proper treatment by Dr. Smoker. Thus, we conclude that Dr. Smoker's testimony regarding Ms. Joe's rape statement, which identified Mr. Joe as her assailant, is admissible under Fed.R.Evid. 803(4). 26
27 Joe contends that, even if the rape statement is admissible under the hearsay rules, it is inadmissible other acts evidence under Fed.R.Evid. 404(b). Rule 404(b) is a special relevancy rule that deals with admission of evidence of a defendant's prior crimes or other bad acts. See Huddleston v. United States, 485 U.S. 681, 687, 108 S.Ct. 1496, 1500, 99 L.Ed.2d 771 (1988). We review the district court's determination that evidence is admissible under Rule 404(b) only for an abuse of discretion. United States v. Hamilton, 992 F.2d 1126, 1131 (10th Cir.1993). 28 Rule 404(b) prohibits the admission of evidence of other bad acts offered only for the purpose of adversely reflecting on the actor's character, but permits such evidence for other purposes, such as demonstrating intent. 7 Four general requirements emanating from Rule 404(b) and other relevancy rules must be met before evidence of prior acts will be admissible: (1) the evidence must be offered for a proper purpose under Rule 404(b); (2) the evidence must be relevant; (3) the trial court must make a Rule 403 determination that the probative value of the similar acts evidence is not substantially outweighed by its potential for unfair prejudice; and (4) under Rule 105, the trial court must, upon request, instruct the jury that the evidence of similar acts is to be considered only for the proper purpose for which it was admitted. United States v. Jefferson, 925 F.2d 1242, 1258 (10th Cir.1991); see Huddleston, 485 U.S. at 691-92, 108 S.Ct. at 1502. On appeal, Joe contends that the government failed to satisfy all four requirements. We disagree. 29 First, the government clearly offered Dr. Smoker's testimony for a proper purpose. The government filed a Notice of Intention to Offer Proof, stating that it intended to introduce proof of Mr. Joe's alleged sexual assault against Ms. Joe as evidence of his motive, specific intent, plan, and absence of mistake or accident. The defendant argues that the government and the trial court failed to articulate precisely the purpose for which the rape statement was offered as is generally required under United States v. Kendall, 766 F.2d 1426, 1436 (10th Cir.1985), cert. denied, 474 U.S. 1081, 106 S.Ct. 848, 88 L.Ed.2d 889 (1986). In United States v. Record, 873 F.2d 1363, 1375 n. 7 (10th Cir.1989), however, we held that even if the basis for admission has not been specifically articulated, the error is harmless as long as a proper purpose is apparent from the record. Based on the record, it is evident that the proper purpose for admitting the rape statement was to prove the defendant's intent to commit acts of violence against his wife. Therefore, we conclude that the failure to adhere to the Kendall specificity requirements was harmless and that Dr. Smoker's testimony regarding the rape statement satisfies the first prong of the four-part admissibility test. 30 Second, the rape statement was relevant because Mr. Joe's act of sexual violence is highly probative of his intent to commit acts of violence against Ms. Joe. See United States v. Russell, 971 F.2d 1098, 1107 (4th Cir.1992) (holding that evidence of husband's prior acts of abuse against his wife was probative of his motive and intent to kill her), cert. denied, --- U.S. ----, 113 S.Ct. 1013, 122 L.Ed.2d 161 (1993); Virgin Islands v. Harris, 938 F.2d 401, 420 (3d Cir.1991) (holding that evidence of husband's history of violence toward his wife, including his attempts to strangle and stab her, were highly probative in demonstrating his motive and intent). 31 Third, the trial court specifically made a Rule 403 determination that the probative value of the rape statement was not substantially outweighed by its potential for unfair prejudice. The trial court has broad discretion to determine whether or not prejudice inherent in otherwise relevant evidence outweighs its probative value. Jefferson, 925 F.2d at 1258 (quoting Record, 873 F.2d at 1375). We cannot say that the trial court abused its discretion here. 32 Fourth, upon the defendant's request, the district court instructed the jury that the evidence of Mr. Joe's alleged rape of Ms. Joe was to be considered only for very limited purposes. 8 The defendant argues that the limiting instruction was improper because it contained a laundry list of the possible Rule 404(b) uses which confused the jury and encouraged them to convict Mr. Joe on the basis of his criminal propensities. We disagree. 33 Although a limiting instruction containing a laundry list of permitted uses of Rule 404(b) evidence is disfavored, see United States v. Doran, 882 F.2d 1511, 1525 (10th Cir.1989) (stating that merely 'laundry list[ing]'  the text of the rule to the jury is not the best way to proceed in such matters); see also United States v. Cortijo-Diaz, 875 F.2d 13, 15-16 (1st Cir.1989), we have never held that such an instruction is improper per se. Moreover, the limiting instruction in this case did not merely recite a laundry list of the permitted uses of Rule 404(b) evidence; it was carefully worded to ensure that the jury would understand the proper purposes for which the prior act evidence could be used. In addition, the court gave the limiting instruction both at the time the evidence was admitted and at the end of the case, instructing the jury not to consider any of this evidence in deciding if the defendant committed the acts charged in the indictment. We conclude that the instruction was adequate. Thus, the rape statement is admissible under Rule 404(b) because all four requirements were met.c. The Confrontation Clause 34 Joe finally asserts that the admission of the rape statement was improper because it violated his rights under the Confrontation Clause. The Confrontation Clause of the Sixth Amendment provides: In all criminal prosecutions, the accused shall enjoy the right ... to be confronted with the witnesses against him.... U.S. Const. amend. VI. The Supreme Court has consistently held that the Clause does not necessarily prohibit the admission of hearsay statements against a criminal defendant, even though the admission of such statements might be thought to violate the literal terms of the Clause. Idaho v. Wright, 497 U.S. 805, 813, 110 S.Ct. 3139, 3145, 111 L.Ed.2d 638 (1990). However, the clause does bar[ ] the admission of some evidence that would otherwise be admissible under an exception to the hearsay rule. Wright, 497 U.S. at 814, 110 S.Ct. at 3146. 35 The Supreme Court has determined that a statement admissible under an exception to the hearsay rule does not violate the Confrontation Clause if the statement bears adequate 'indicia of reliability' . Id. (quoting Ohio v. Roberts, 448 U.S. 56, 66, 100 S.Ct. 2531, 2539, 65 L.Ed.2d 597 (1980). The indicia of reliability requirement may be satisfied in two ways. Reliability is assumed if the evidence is admitted under a firmly rooted hearsay exception. Id., 497 U.S. at 815, 110 S.Ct. at 3146. Otherwise, reliability is established if the evidence is supported by particularized guarantees of trustworthiness. Id. 36 Federal Rule of Evidence 803(4), the exception to the hearsay rule for statements made for purposes of medical diagnosis or treatment, is undoubtedly a firmly rooted hearsay exception. See White v. Illinois, --- U.S. ----, ---- n. 8, 112 S.Ct. 736, 742 n. 8, 116 L.Ed.2d 848 (1992); see also Wright, 497 U.S. at 820, 110 S.Ct. at 3149. Because the rape statement made by Ms. Joe to Dr. Smoker falls under the firmly rooted Rule 803(4) hearsay exception, the statement possesses the requisite indicia of reliability. Therefore, Joe's Confrontation Clause rights were not violated by the admission of the rape statement.