Opinion ID: 1990867
Heading Depth: 1
Heading Rank: 2

Heading: testimony of the nurse practitioner

Text: [¶ 16] At trial, the court admitted the testimony of a nurse practitioner who had treated Gould for depression. The State moved in limine to allow the testimony, and the court first heard the nurse practitioner's testimony out of the presence of the jury. The court found that the nurse practitioner was licensed to diagnose and treat common medical problems such as depression. Because of her license and experience, she was qualified to testify as an expert and she could testify about the diagnosis of depression as well as the history that she obtained from Gould. On appeal, Cookson challenges both the qualifications of the nurse practitioner to testify as an expert and the relevance of her testimony. Cookson preserved these challenges with timely objections. [¶ 17] The nurse practitioner worked as a registered nurse in emergency rooms, intensive care, and floor nursing for twenty-five years. She holds bachelor's and master's degrees and is licensed as a nurse practitioner in which capacity she had worked for three years. She testified that as a licensed nurse practitioner, she is authorized to diagnose and treat common medical problems. According to the nurse practitioner, depression is a common diagnosis and not a complex one. She is not supervised by a physician but consults with physicians on difficult cases. She is authorized to prescribe medications including narcotics. [¶ 18] The nurse practitioner first met Gould in July 1999. The appointment was for a routine physical, and Gould talked about how depressed she was. The nurse practitioner administered a test for diagnostic purposes, and the test results demonstrated that Gould was depressed. The nurse practitioner diagnosed Gould as suffering from depression, anxiety and situational stress secondary to emotional abuse by boyfriend. [1] She testified that Gould told her she was depressed because of her relationship with Cookson. The nurse practitioner provided medication and referred Gould to Womancare, which she described as a peer counseling advocacy group for abused women. [¶ 19] The nurse practitioner next heard from Gould in October when she saw her for a back injury resulting from an automobile accident. They spoke by telephone in November when Gould requested more medication for her depression, and Gould complained to the nurse practitioner that Cookson was following her. The nurse practitioner encouraged Gould to get a restraining order and to follow up with Womancare. When Gould went to the nurse's office to pick up the medication, they spoke further, and the nurse practitioner, with Gould's permission, phoned the police. The nurse practitioner testified that she did so because I wanted them to know that I felt she was in grave physical danger. At Cookson's request that last remark was stricken from the record, but his request for a mistrial was denied. [¶ 20] Cookson argues that because there was no evidence that the nurse practitioner had any training or education in diagnosing and treating mental illnesses, and very little evidence of her experience in doing so, she was not qualified to state her opinion of the diagnosis for depression, anxiety and situational stress secondary to emotional abuse by boyfriend. We review a trial court's determination of the qualifications of an expert under M.R. Evid. 702 for abuse of discretion. [2] In re Jon N., 2000 ME 123, ¶ 8, 754 A.2d 346, 349. [¶ 21] The State's presentation of evidence to establish the nurse practitioner's qualifications to diagnose and treat Gould's psychological condition was minimal. There was no evidence as to her training or education specific to diagnosing or treating depression or other psychological conditions. However, the court could have inferred sufficient training and experience from her testimony that she was licensed as a nurse practitioner; had a master's degree; commonly diagnosed depression; and had administered to others the same diagnostic test that she gave to Gould. [¶ 22] Rule 702 of the Maine Rules of Evidence provides that a person who is an expert by knowledge, skill, experience, training, or education may give an opinion concerning scientific, technical, or specialized knowledge. We defer to the trial court on the determination of whether the expert's qualifications are sufficient to allow the expert to testify. See State v. Tibbetts, 572 A.2d 142, 143 (Me.1990). As long as the expert is qualified, the extent of the qualifications goes to the weight of the expert's testimony. In re Erika R., 563 A.2d 369, 373 (Me.1989). The deferential standard of review leads us to conclude that the court did not abuse its discretion in determining that the nurse practitioner was an expert for purposes of testifying about Gould's diagnosis and treatment. [¶ 23] Cookson also argues that the nurse practitioner was not qualified to give a diagnosis because 32 M.R.S.A. § 2205-B(3) (1999) allows a nurse practitioner, who is certified and approved by the State Board of Nursing, to perform medical diagnosis ... when these services are delegated by a licensed physician. He points out that there was no evidence that she was certified and approved by the Board and, because she testified that she acts independently and without the supervision of a physician, she does not strictly adhere to the statutory requirements for making diagnoses. However, she testified that she was licensed, which may be a short-hand term for certified. The failure to demonstrate that she complies with section 2205-B(3) goes more to the weight of her opinion, rather than its admissibility. See State v. Gammon, 529 A.2d 813, 815 (Me.1987). [¶ 24] Cookson further objects to the admission of the nurse practitioner's diagnosis on the grounds of relevance. We review a determination of relevance under a clear error standard. Kaechele v. Kenyon Oil Co., Inc., 2000 ME 39, ¶ 6, 747 A.2d 167, 170. The court did not clearly err in admitting Gould's diagnosis of depression, anxiety and situational stress secondary to emotional abuse by boyfriend. It served as background for the jury to understand other testimony from the nurse practitioner regarding the medication and referral to Womancare. Even if the diagnosis was not relevant and it was error to admit it, the error was harmless. There was a great deal of evidence by other witnesses as to Gould's mental state in the days and months preceding her death as well as the stress that she was under because of her relationship with Cookson. Also, as discussed below, Gould's own statements to the nurse practitioner about her depression and her relationship with Cookson were properly admitted. Therefore, even if it was not relevant that Gould had been given an actual diagnosis of depression, it is highly probable that the admission of the diagnosis did not affect the jury's decision, and therefore, any error was harmless. See State v. White, 2002 ME 122, ¶ 16, 804 A.2d 1146, 1150. [¶ 25] Cookson's next contention is that the nurse practitioner should not have been permitted to state the cause of Gould's mental health diagnosis. The nurse practitioner testified that Gould herself had said that she was depressed because of her relationship with Cookson. Thus, whether the court erred in permitting the nurse to testify about the cause of Gould's depression is inextricably linked to Cookson's additional argument that the nurse practitioner's recitation of Gould's history was hearsay and was improperly admitted as a hearsay exception under M.R. Evid. 803(4). [¶ 26] Rule 803(4) allows hearsay statements made for purposes of medical diagnosis or treatment and describing ... general character of the cause or external source thereof insofar as reasonably pertinent to diagnosis or treatment. M.R. Evid. 803(4). The rationale behind the rule is the patient's strong motivation to be truthful. M.R. Evid. 803(4) advisers' note. Here, Gould went to the nurse practitioner to receive treatment for her self-diagnosed depression. Presumably, Gould was interested in accurately relating her symptoms and the cause for them in order to receive the appropriate treatment. Gould's statements to the nurse about having a problem with Cookson and about Cookson following and stalking her were made to describe to the nurse the external source of her depression. Gould's statements were also pertinent to her treatment, including the provision of antidepressant drugs, given by the nurse practitioner. For these reasons, the court did not err in allowing the nurse practitioner to testify about the cause of Gould's depression or to recite Gould's statements to her.