Opinion ID: 2384358
Heading Depth: 2
Heading Rank: 1

Heading: dr. martz's report

Text: Following the testimony of the Commonwealth's final witness, the trial court, over appellant's objection, admitted into evidence medical records from the office of Dr. Deborah Martz. Dr. Martz examined A.C. on January 30, 1992, more than two years after the sexual abuse alleged to have occurred in November of 1989. Dr. Martz's report relates A.C.'s detailed description of appellant's abuse of him. She wrote, evidently, there was penile penetration of the rectum at least twice and then a number of episodes, 18 to 20, of either oral or tactile touching of his penis. It should be noted that the number of episodes mentioned in this report is significantly higher than that contained either in the indictment or in A.C.'s actual testimony at trial. Further, the report indicated the existence of a small ulcer-like area about 0.1 mm located near A.C.'s rectum, ordered testing for chlamydia and recommended therapy for the child. The primary diagnosis on the report was listed as sexual abuse. The report also states that A.C. identified appellant as his abuser. Dr. Martz did not testify at trial. The following portion from the trial transcript reveals the circumstances under which Dr. Martz's office records were admitted into evidence: THE COURT: Okay. Bring us another witness, if you would? MR. LOCKRIDGE: Your Honor, we would next move to introduce as our next exhibit a certified copy of the medical records of Doctor Deborah Marts [sic], here in Lancaster. I would like to have these marked as our next exhibit. THE COURT: Have you seen them, Mr. Correll? MR. CORRELL: I have seen them. I would object, Your Honor. May I approach the bench, please? THE COURT: Yes. Come up. BENCH DISCUSSION THE COURT: Go ahead. Mark it for identification first. Go ahead. MR. CORRELL: Your Honor, if he is doing this by way of a deposition being taken or a statement being taken from a doctor, I have no way to cross examine this record. From that standpoint, to me there hasn't even been a foundation laid as to the creation of this record, who prepared it, where the examination came from. Or from that standpoint  THE COURT: Don't the new Evidence Code allow that as long as it's certified by the custodian of medical records. MR. LOCKRIDGE: Yes. Judge, we have here a copy that's certified by the custodian of medical records. THE COURT: Okay. There's the certification. I think the new Rules of Evidence allow it. I haven't read them all yet, but that's a few of them I read. I also understand your position. MR. CORRELL: Is there any reason why the doctor can't be here for this trial? THE COURT: There is no reason he couldn't. Anybody could have subpoenaed him. Anybody could have taken his deposition. We are all so afraid that a doctor may have to come and sit in court all day. But, all you have to do is subpoena him and I will enforce the subpoenas. And, there is another provision  never mind. MR. CORRELL: Objection is noted. THE COURT: I will note your objection. It's overruled. END OF BENCH DISCUSSION THE COURT: You can move to introduce it, Mr. Lockridge as Commonwealth Exhibit No. 2. MR. LOCKRIDGE: Yes, sir. Your Honor, we would move to introduce Exhibit No. 2. THE COURT: Okay. MR. CORRELL: Your Honor, we will move for a mistrial at this point. THE COURT: Overruled. (Emphasis added). As reflected by the transcript there are two basic defense objections to the admissibility of Dr. Martz's medical report. Both are valid and involve basic propositions of evidence law.
The threshold obstacle to the admissibility of this medical report is its lack of authentication. The concept of authentication (or the laying of a foundation,) relates to a trial court's need for preliminary proof of two things: (1) the pertinence of the proposed evidence to the litigation, and (2) that a document is what its proponent claims it to be. The relevant Kentucky Rule of Evidence states: KRE 901. Requirement of authentication or identification. (a) General provision. The requirement of authentication or identification as a condition precedent to admissibility is satisfied by evidence sufficient to support a finding that the matter in question is what its proponent claims. In this case the pertinence of Dr. Martz's medical report to the litigation is not questionable. However, without Dr. Martz's testimony, the proof obligation relating to the genuineness of the document is in no way satisfied. It is clear that calling Dr. Martz to the witness stand would have sufficed to authenticate the medical record. Indeed, the most widely used method of authentication is testimony by one with personal knowledge that a writing is what it is claimed to be. Lawson, The Kentucky Evidence Law Handbook, 3d ed., Sec. 7.05(I) (1993), KRE 901(b)(1). As the above-quoted transcript demonstrates, Dr. Martz's absence as an authenticating witness was objected to by defense counsel. Explicit in the trial judge's reply, But all you have to do is subpoena him [sic], is the suggestion that if defense counsel wanted to cross examine Dr. Martz, then defense counsel could have subpoenaed her as a witness. While theoretically a true statement, the judge's recommendation, if adopted, would improperly shift the burden of going forward with enough evidence to support a prima facie case for admissibility, to the non-offering party. It is most decidedly not the responsibility of defense counsel, in this case, to subpoena a witness to authenticate a document offered into evidence by the Commonwealth. [2] The transcript also lends itself to the following observation concerning the lack of authentication of this document. The trial judge did ask the prosecutor if the medical report had been certified, which it had. A fair inference might be drawn from that question that the trial court may have believed the document to be admissible under KRS 422.300, a statute which provides for medical records of a hospital to be proved by certification, without the preliminary authentication contemplated by KRE 901. However, KRS 422.300 is merely a convenient device for authenticating medical records [of a hospital]. It does not assure their admissibility or abrogate other rules of evidence relating to admission of documentary evidence. Young v. J.B. Hunt Transp., Inc., Ky., 781 S.W.2d 503, 508 (1989). While this Court does not expect trial courts to rule flawlessly on all matters coming before it during an emotionally-charged trial, this piece of crucial and damaging evidence implicates the most basic rules of authentication. The question of its admissibility required something more of the judge than the uncertainty evidenced by the transcript on this point of contention. The prosecution should have been ordered by the trial court to produce the author of this report as a witness. Only then could the trial judge have possibly ruled on whether this hearsay medical evidence, once authenticated, could survive the second hurdle of admissibility, a determination of whether the document contains sufficient indicia of reliability under Drumm .
In Drumm v. Commonwealth, Ky., 783 S.W.2d 380 (1990), this Court adopted FRE 803(4), now codified in Kentucky as KRE 803(4). Id. at 384. The rule announced in Drumm , also a child sexual abuse case, controls the admission of hearsay medical testimony like the doctor's report in this case. Under the law that prevailed before Drumm , the admissibility of hearsay medical testimony turned on whether the physician to whom an out-of-court statement was made, received the information in the capacity of a treating or non-treating (or testifying) physician. The purpose behind the distinction can be traced to a simple idea. Where statements are made to a physician responsible for actual diagnosis and treatment of a patient, not only can the professional objectivity of the physician be said to be greater, but more importantly, the veracity of the declarant's statements can uniformly be thought of as more reliable. Id. at 384-5 (citing Morgan v. Foretich, 846 F.2d 941, 952 (4th Cir.1988)). The rationale is obvious. In Drumm , this Court maintained the distinction between treating and nontreating physicians, but diminished its role in the trial court's analysis of admissibility. Rather than serving as the bright-line element which is solely determinative of admissibility, the motivation behind such declarations becomes a primary factor in the court's determination of reliability. See, Hellstrom v. Commonwealth, Ky., 825 S.W.2d 612, 615 (1992). A trial judge is to [make] a judgment as to whether prejudicial effect outweighs . . . probative value, taking into account that when such statements are not made for the purpose of treatment they have `less inherent reliability than evidence admitted under the traditional common-law standard underlying the physician treatment rule.' Id. See KRE 403. The medical report erroneously admitted in the present case contains not simply hearsay declarations, but hearsay upon hearsay. The statements of Dr. Martz reporting the statements A.C. made to her, are singularly subject to Drumm . However, from this record, it is impossible to state positively whether the medical report of Dr. Martz reflects the notes of a treating or testifying physician. The sexual abuse charged in the indictment allegedly occurred in November, 1989. A.C. was examined by Dr. Martz on January 30, 1992, one day after appellant was arrested on these charges. The timing of the examination and the over two-year gap between the charged offense and the physical examination is strong evidence that Dr. Martz's report, as it relates to sexual abuse, was prepared for the purpose of prosecuting appellant. On the other hand, appellant was also charged with assaulting A.C. on or about January 24, 1992, only a week before the examination of the child took place. Thus, there is reason to believe that the portion of the medical report that discusses swelling of the nose as well as bruising underneath the eyes are the notes of a treating physician. Also, the medical report did indicate a bump near the victim's rectum, which lends support to the argument that Dr. Martz was a physician treating for sexual abuse. However the record fails to answer relevant questions such as, How long had the bump been present? or Why was A.C. not examined for sexual abuse until the day after appellant's arrest? The conflicting evidence of the capacity in which Dr. Martz was acting demonstrates the absolute necessity of her testimony at trial. In short, this fact scenario provides a text-book example for application of the Drumm scheme of analysis: the judge must engage in an individual assessment for reliability, of any hearsay declarations contained in proposed medical testimony. We direct the trial court to decide the hearsay question regarding each of the various out-of-court statements . . . Id. at 385. Only if Dr. Martz had been called as a witness for the prosecution could the trial court have conducted the analysis required by law.
The error in admitting this medical report into evidence is one of constitutional magnitude which highlights the law's cardinal concern with hearsay evidence. The Sixth Amendment of the United States Constitution and Section Eleven of the Kentucky Constitution provide the accused with the right to personal confrontation with prosecution witnesses in a criminal trial. Fundamental guarantees to the criminally accused of due process and confrontation, established by both the United States and Kentucky Constitutions are transgressed by a . . . conviction based upon hearsay where no traditionally acceptable and applicable reasons for exceptions apply. Id. at 382. It is historically well-established that the Confrontation Clause has two purposes: The primary purpose is to secure for the accused the full and unfettered right of cross-examination of the witnesses against him. The secondary purpose is to allow through the personal appearance of the accuser, the judge and the jury to closely observe, first hand, the elusive and uncommunicable evidence of a witness' deportment while testifying. Commonwealth v. Willis, Ky., 716 S.W.2d 224, 234 (1986) (Stephens, C.J., dissenting) (quoting 5 Wigmore, Evidence Sec. 1395 (3d ed., Chadbourn revision, 1974)). While not precisely congruous, the Confrontation Clause and hearsay rules stem from the same roots and are generally designed to protect similar values. Lawson, supra, Sec. 8.00, pp. 354-5 (quoting California v. Green, 399 U.S. 149, 155-56, 90 S.Ct. 1930, 1933-4, 26 L.Ed.2d 489, 495-96 (1970)). A violation of the rule against hearsay is not, per se, a violation of a defendant's confrontation rights. Under the present facts, however, there is no doubt that appellant was unjustifiably denied his constitutional right to confront and cross-examine the author of this damning piece of evidence.