Opinion ID: 156896
Heading Depth: 3
Heading Rank: 2

Heading: Physician Testimony

Text: Pacheco argues the district court erred by admitting the testimony of two physicians, Drs. Corbett and Ornelas, regarding Jane Doe’s statements about the alleged incident of abuse and the identity of the alleged abuser. Pacheco claims the testimony was inadmissible hearsay. Because Pacheco did not object at trial to the testimony of the physicians, we review the district court’s admission of the testimony for plain error. See United States v. Martinez, 76 F.3d 1145, 1150 (10th Cir. 1996) (stating that in absence of timely objection, evidentiary rulings are reviewed only for plain error). 4 This court notes that because the child victim testified in this case, defense counsel had the opportunity to cross-examine her at length regarding her ability to appreciate the difference between the truth and a lie; whether her testimony was influenced by adults such as the prosecutor and the investigator; and whether she understood why she was in court testifying. In addition, defense counsel had the opportunity during closing arguments to question these aspects of the child’s testimony. Cf. Guam v. McGravey, 14 F.3d 1344, 1349 (9th Cir. 1994) (suggesting that “time-honored methods of educating a jury on issues of credibility,” such as cross-examination and argument, may be more effective than child witness instruction). -8- As discussed above, Dr. Corbett testified that he had examined Jane Doe in December 1994 and that during the examination she identified “Roy” as the person who hit her on the front side of her body and spanked her on the back side. Dr. Ornelas testified that after her examination of Jane Doe in March 1996, Jane Doe told her “Roy” had hurt her with his “hands.” The government contends the physicians’ statements are admissible under Rule 803(4) of the Federal Rules of Evidence, which provides that the following statements are not excluded by the hearsay rule: “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.” Fed. R. Evid. 803(4). The rationale behind the Rule 803(4) exception is that because a patient’s medical care depends on the accuracy of the information she provides, the patient has a selfish motive to be truthful; consequently, a patient’s statements to her physician are likely to be particularly reliable. See United States v. Tome, 61 F.3d 1446, 1449 (10th Cir. 1995); United States v. Joe, 8 F.3d 1488, 1493-94 (10th Cir. 1993); see also Fed. R. Evid. 803(4) advisory committee’s note. Pacheco asserts this rationale is suspect in cases involving young children because they may not understand the importance of telling the truth when meeting -9- with a doctor and because parents almost always initiate the medical consultation. Pacheco contends that in this case, no evidence was presented showing that Jane Doe understood she was speaking with a doctor when she met with Drs. Corbett and Ornelas. Further, according to Pacheco, there was no evidence that anyone advised Jane Doe of the special need for truthfulness. Pacheco argues that because the trustworthiness guarantee underlying Rule 803(4) was absent in this case, the rule cannot serve as a proper basis for admission of the physicians’ testimony. We have already rejected this argument. In United States v. Norman T., 129 F.3d 1099 (10th Cir. 1997), cert. denied, 118 S. Ct. 1322 (1998), the defendant, who was convicted of child sexual abuse, argued that the child victim’s statements regarding the alleged abuse to her physician should not be admissible under Rule 803(4) “because the victim did not understand the nature of her relationship with the medical personnel, thereby undermining the likelihood of credibility upon which the exception is based.” 5 Id. at 1105. In rejecting the defendant’s argument, the court noted that the defendant had cited no authoritative law supporting his contention. See id. To the contrary, the court 5 The defendant in Norman T. had made a timely objection to the admission of the physician’s testimony. See United States v. Norman T., 129 F.3d 1099, 1105 (10th Cir. 1997), cert. denied, 118 S. Ct. 1322 (1998). The court therefore reviewed the district court’s evidentiary ruling for abuse of discretion. See id. -10- concluded that case law from the Supreme Court and this circuit suggested otherwise. See id. (citing White v. Illinois, 502 U.S. 346, 356 (1992) and United States v. Tome, 61 F.3d 1446, 1449-51 (10th Cir. 1995)). The court therefore declined to create a presumption that Rule 803(4) is inapplicable to a child’s statements to her physician. See id. The court also noted that the defendant had failed to point to any actual evidence to show the victim did not understand she was seeking medical treatment. See id. Finally, the court noted that the victim had testified at trial and was subject to cross-examination, thereby “ensur[ing] the fairness and integrity of the proceedings.” Id. at 1106. The court therefore concluded the district court did not abuse its discretion in admitting the physician’s testimony pursuant to Rule 803(4). As in Norman T., Pacheco has not pointed to any actual evidence indicating that Jane Doe did not understand she was being examined by doctors and needed to be truthful in her discussions with them. In fact, Dr. Ornelas testified that when she meets with a child who is being examined for sexual abuse, she interviews the child upfront and explains “why they are there.” After the interview but before the actual medical exam, either she or the nurse shows the -11- child around the exam room, explains what the medical instruments are, and discusses the procedure. 6 Moreover, the child victim testified in this case and was subject to crossexamination. Defense counsel therefore had the opportunity to question Jane Doe regarding the circumstances surrounding her statements to the physicians. This court therefore rejects Pacheco’s argument that because there was no evidence showing Jane Doe appreciated the necessity for truthfulness when speaking with Drs. Corbett and Ornelas, the physicians’ testimony was not admissible under Rule 803(4). See id. at 1105-06 (concluding district court acted within its discretion in admitting physician testimony); see also Joe, 8 F.3d at 1494 n.5 (rejecting rule requiring inquiry into patient’s motive for making statements in determining admissibility of statements under Rule 803(4) and stating that “the rule itself has built-in guarantees that assure the trustworthiness of a statement made for purposes of medical diagnosis or treatment”); United States v. George, 960 F.2d 97, 100 (9th Cir. 1992) (noting that in determining admissibility of child’s statements under Rule 803(4), “the age of the child and her other personal characteristics go to the weight of the hearsay statements rather than their admissibility”). In this case, Jane Doe told Dr. Ornelas about the abuse after the medical 6 examination was complete. -12- Pacheco also argues the district court erred by admitting the portion of the physicians’ statements identifying him as the alleged abuser. Both Dr. Corbett and Dr. Ornelas testified Jane Doe told them during their examinations that “Roy” was the individual who had hurt her. Pacheco acknowledges circuit precedent holding that a child’s statement to a physician identifying the person who caused the injuries is admissible under Rule 803(4) if the alleged abuser was a member of the victim’s family or household. See Tome, 61 F.3d at 1450 (concluding child victim’s statements to her doctors identifying her father as her abuser were admissible under Rule 803(4)); Joe, 8 F.3d at 1495 (stating that in domestic sexual abuse cases, “[t]he 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”). Pacheco summarily asserts, however, that he was not a member of Jane Doe’s family or household, and therefore Jane Doe’s identification of him as the abuser was inadmissible. This court rejects Pacheco’s narrow reading of the term “household.” Although Pacheco was not Jane Doe’s natural father, he had an intermittent relationship with her mother. Though exact dates were never firmly established, the evidence at trial showed that Jane Doe often stayed at the Pacheco residence and was living with Pacheco and his parents when the abuse occurred. Cynthia -13- Begay, a social worker, testified that she removed Jane Doe and her younger sister from the Pacheco residence on March 6, 1996. Irma Pacheco, Pacheco’s mother, testified that Jane Doe and her mother spent approximately four months each year at the Pacheco residence. She further testified that Jane Doe stayed at her house for a few weeks during January and February 1996. Pacheco’s father Matthew also testified that Jane Doe occasionally stayed at the Pacheco residence. Pacheco’s sister Noreen, who lived with her parents, testified that Jane Doe stayed at their house during March 1996. Finally, Pacheco himself testified that Jane Doe and her mother stayed at the Pacheco residence approximately four months each year and that Jane Doe stayed there during January and March 1996. Contrary to Pacheco’s contentions, the evidence presented at trial established that Jane Doe was a member of Pacheco’s household. That Jane Doe may not have spent each and every day at the Pacheco residence is irrelevant. What is relevant is that Jane Doe’s relationship with Pacheco was such that his identity as her abuser was reasonably pertinent to her course of treatment. Cf. Joe, 8 F.3d at 1495 (holding woman’s statement to her physician that her husband, from whom she was separated, raped her was admissible and stating that “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 -14- ‘reasonably pertinent’ to the victim’s proper treatment”). Drs. Corbett and Ornelas testified that they questioned Jane Doe regarding the incidents of abuse and the identification of her abuser for the purpose of aiding in their diagnosis and treatment. Therefore, under the reasoning set forth in Tome and Joe, the district court did not err in admitting Jane Doe’s statements to Drs. Corbett and Ornelas identifying Pacheco as her abuser. See Tome, 61 F.3d at 1449-50; Joe, 8 F.3d at 1493-95. This court therefore rejects Pacheco’s claim of error based on the district court’s admission of the physicians’ testimony of Jane Doe’s statements concerning the incidents of abuse and her identification of Pacheco as the person who abused her.