Opinion ID: 2754971
Heading Depth: 2
Heading Rank: 1

Heading: Barker’s Testimony

Text: [¶12] An out-of-court statement offered to prove the truth of the matter asserted is hearsay and is inadmissible unless an exception applies. M.R. Evid. 801(c), 802. Pursuant to M.R. Evid. 803(4), hearsay statements are not excluded by the hearsay rule if they are “[s]tatements made for purposes of medical diagnosis or treatment and describing medical history, or past or present 7 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.” “A trial court’s decision to admit or exclude alleged hearsay evidence is reviewed for an abuse of discretion.” State v. Guyette, 2012 ME 9, ¶ 11, 36 A.3d 916. When the trial court must make preliminary factual findings pursuant to M.R. Evid. 104(a), however, those findings are reviewed only for clear error. State v. Snow, 438 A.2d 485, 487 (Me. 1981). [¶13] We have previously recognized that application of M.R. Evid. 803(4) is not limited to statements made for treatment of physical injuries; it applies to statements made for psychological and mental-health treatment as well. 2 For instance, in the context of a custody dispute, we affirmed the admission of a child’s statements to a licensed clinical social worker about why he was afraid of his father. Ames v. Ames, 2003 ME 60, ¶ 16, 822 A.2d 1201. In that case, the parties’ six-and-a-half-year-old son began “displaying problems with concentration, sleep, anger, fear, and stomachaches” and refused to visit his father. Id. ¶¶ 2, 4. The mother sought the advice of a licensed clinical social worker who “hoped to 2 A number of federal courts have also recognized that the exception in Fed. R. Evid. 803(4), which is substantively identical to M.R. Evid. 803(4), applies to statements made for the purpose of psychological or mental-health treatment. See, e.g., Morgan v. Foretich, 846 F.2d 941, 948-50 (4th Cir. 1988) (applying rule to child’s statements to a psychologist concerning sexual abuse); United States v. Kappell, 418 F.3d 550, 556-57 (6th Cir. 2005) (applying rule to child’s statements to a psychotherapist); United States v. Yellow, 18 F.3d 1438, 1442 (8th Cir. 1994) (explaining that the Eighth Circuit has “consistently upheld the admission of statements made to psychologists or trained social workers” that otherwise meet the rule’s requirements). 8 address the child’s concerns and help him become comfortable with his father.” Id. ¶ 5. The child told the social worker that he was afraid of his father and that it was the child’s idea to stop visitation. Id. At trial, the social worker testified about the child’s statements that he was afraid of his father and did not want to visit him. Id. ¶ 7. We explained that the child’s statements to the social worker “explained the source of his fear” and concluded, “Given that the purpose of the treatment was to identify the cause of his fear and overcome it, this statement was pertinent to his diagnosis and treatment and [was] properly admitted.” Id. ¶ 16. [¶14] Similarly, we held that a nurse practitioner’s diagnosis of a young woman’s “depression, anxiety, and situational stress secondary to emotional abuse by [her] boyfriend” was admissible at the boyfriend’s trial for the woman’s subsequent murder. State v. Cookson, 2003 ME 136, ¶¶ 18, 26, 837 A.2d 101. In that case, the woman told the nurse practitioner that she was depressed because her boyfriend had been stalking and harassing her. Id. ¶¶ 18-19. We held that the nurse practitioner’s testimony about these statements was admissible pursuant to M.R. Evid. 803(4) because “[the victim’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.” Id. ¶ 26. We further explained that “[the victim’s] statements were also pertinent to her 9 treatment, including the provision of antidepressant drugs, given by the nurse practitioner.” Id.
[¶15] Ireland argues that the child’s statements to Barker should have been excluded because they lacked the indicia of reliability typically associated with statements made for the purpose of securing medical treatment. The reliability of a hearsay statement, however, goes to its weight, not its admissibility; it is a matter for the fact-finder to consider in its evaluation of all the evidence, and not for the court to consider in determining the admissibility of the statement. See Handrahan v. Malenko, 2011 ME 15, ¶¶ 19-20, 12 A.3d 79 (concluding that the fact-finder “was justified in [its] assessment of the reliability of the child’s out-of-court statement” where the child was not shown to have a “strong motivation . . . to be entirely honest with her physician for purposes of medical diagnosis and treatment” (quotation marks omitted) (alteration omitted)); Field & Murray, Maine Evidence § 803.4 at 479 (6th ed. 2007) (explaining that a statement’s “trustworthiness is less when the purpose is [for diagnosis only rather than] for treatment, but this goes to its weight rather than its admissibility”); see also Danaipour v. McLarey, 386 F.3d 289, 297-98 (1st Cir. 2004) (holding that a mother’s statements to a medical provider describing two young children’s disclosures of sexual abuse were admissible pursuant to Fed. R. Evid. 803(4) and 10 observing that “[t]he [fact-finder] carefully considered the fact that statements by a young child, even if accurately recounted by an adult, may not reflect the truth”); United States v. George, 960 F.2d 97, 100 (9th Cir. 1992) (“As a general matter, the age of the child and her other personal characteristics go to the weight of the hearsay statements rather than their admissibility.”) Absent a change to the rules of evidence, we decline to require an additional showing of reliability for hearsay statements that fall within the Rule 803(4) exception.3 [¶16] Although the trial court did not explicitly find that the statement was made for the purpose of medical diagnosis or treatment, we must assume that it made this preliminary finding. See Pelletier v. Pelletier, 2012 ME 15, ¶ 20, 36 A.3d 903 (“In the absence of a motion for additional findings of fact . . . we will infer that the trial court made any factual inferences needed to support its ultimate conclusion.”). The trial court’s implicit finding concerning the purpose of the child’s statements was supported by Barker’s testimony that she explained her role to the child and that the child’s statements were important for developing a treatment plan. The court acted well within its role as fact-finder by inferring the purpose of the child’s statements. See Snow, 438 A.2d at 487-88 (explaining that the fact-finder is permitted to draw reasonable inferences in making a finding 3 Because this is not a criminal case, we do not address whether the Confrontation Clause may require additional guarantees of trustworthiness for the admission of hearsay statements in criminal prosecutions. See Handrahan v. Malenko, 2011 ME 15, ¶ 16 n.4, 12 A.3d 79. 11 preliminary to the admission of evidence). The child was sent to the therapist because her mother was concerned about the child not feeling loved, and Barker’s goal was to treat the child for anxiety. Although these facts could arguably support a finding that the statements were not made for purposes of diagnosis or treatment, on this record we cannot conclude that the trial court’s preliminary factual determination constituted clear error. See id. at 487 (“Use of the clearly erroneous test to review the trial judge’s preliminary finding of fact recognizes the superior opportunity that he enjoyed to hear the evidence as it was presented through live witnesses . . . .” (quotation marks omitted)). 2. The Pertinence of the Perpetrator’s Identity to Diagnosis or Treatment [¶17] Ireland’s primary contention is that the portions of the child’s statements identifying Ireland as her abuser were not pertinent to diagnosis or treatment because they served “merely [to] affix fault or blame.” See State v. Sickles, 655 A.2d 1254, 1257 (Me. 1995). “Pertinence, within the contemplation of Rule 803(4), is an objective consideration beyond the declarant’s state of mind.” Id. (quotation marks omitted). “Pertinence may be tested by asking whether the information is of a type on which a physician could reasonably rely to form a diagnosis or provide treatment.” Id. [¶18] In many cases, extraneous details of an assault, including the identity of the perpetrator, may not be pertinent to medical diagnosis or treatment. For 12 instance, in a case in which a victim described the time and location of an alleged rape and identified her brother as the perpetrator, we concluded: That it was intercourse that caused [the victim] to see the doctor and that it occurred the previous evening are facts reasonably pertinent to the diagnosis and treatment . . . . But the identity of the perpetrator and the scene of the alleged rape do not fall within that hearsay exception. State v. True, 438 A.2d 460, 467 (Me. 1981). Similarly, we concluded that hearsay statements describing medically irrelevant details of a sexual assault, such as that the victim “asked that it stop,” were improperly admitted pursuant to M. R. Evid. 803(4) where the testifying physician’s “role in examining the victim was limited to providing emergency room care” and the doctor “did not indicate whether or how the knowledge that the victim may have ‘asked that it stop’ helped her in her diagnosis.” Sickles, 655 A.2d at 1257. [¶19] We have concluded, however, that certain details that may not be relevant to treatment for physical injuries may be pertinent to treatment for emotional or psychological trauma. For instance, we determined that a sexual-assault victim’s statement to a doctor that she had been threatened with a knife “pertained to the emotional trauma that the physician was . . . addressing” where “the physician prefaced his remark by saying that the emotional ramifications of rape are a significant part of the victim’s problem in relation to treatment.” State v. Rosa, 575 A.2d 727, 729 (Me. 1990). Similarly, in Ames, we 13 determined that a young child’s statement that he was afraid of his father was pertinent to diagnosis and treatment “[g]iven that the purpose of the treatment was to identify the cause of his fear and overcome it . . . . ” 2003 ME 60, ¶¶ 14, 16, 822 A.2d 1201. [¶20] Here, Barker testified that the identity of the child’s abuser was important for developing a treatment plan for the child. Under these circumstances, as in almost any case involving a child who is abused by a family member, the identity of the perpetrator may indeed be pertinent to diagnosis and treatment. See Danaipour, 386 F.3d at 297 (“Child therapists routinely, as part of their diagnosis or treatment, obtain the type of statements made by the patients here . . . about the identity of the perpetrator of the abuse. . . . [Such statements] are usually reasonably pertinent to treatment of the child.”); United States v. Joe, 8 F.3d 1488, 1494 (10th Cir. 1993) (“[W]here 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 . . . . ”); Morgan v. Foretich, 846 F.2d 941, 949-50 (4th Cir. 1988) (“[A] physician in determining treatment may rely on factors in child abuse cases such as an assailant’s identity that would not be relied on were the patient an adult.”); United States v. Renville, 779 F.2d 430, 437 (8th Cir. 1985) (“The exact nature and extent of the psychological problems which ensue from child abuse often depend 14 on the identity of the abuser.”). The trial court did not abuse its discretion by admitting evidence of the statements the child made to Barker identifying Ireland as her abuser.