Opinion ID: 3063811
Heading Depth: 2
Heading Rank: 5

Heading: Medical Records Hearsay Exclusion

Text: Smith’s fifth issue on appeal involves testimony by a nurse who treated Officer Henderson for the wounds received in the fight with Smith.13 The district court ruled that the nurse could not testify as to notes in the hospital’s treatment records that allegedly indicated that (1) Officer Henderson was hit with a rock, (2) Officer Henderson was hit with a brick, and (3) Officer Henderson told a doctor that he thought he was hit with a silver CD player or a silver gun found at the 13 We review a district court’s hearsay rulings for abuse of discretion. United States v. Brown, 441 F.3d 1330, 1359 (11th Cir. 2006). 33 scene. The district court determined that these alleged statements by Henderson were made to doctors or emergency medical technicians, and not to the nurse herself, and thus were inadmissible hearsay. This proffered testimony presents a question of triple hearsay: statements by Officer Henderson to doctors/emergency medical technicians, to the nurse, who recorded them in hospital records. According to Federal Rule of Evidence 805, “[h]earsay included within hearsay” is inadmissible unless “each part of the combined statements conforms with an exception to the hearsay rule.” Fed. R. Evid. 805. Smith contends that the hearsay testimony was admissible through the combined operation of the medical treatment and business records hearsay exceptions found, respectively, in Federal Rule of Evidence 803(4)14 and (6).15 If Officer Henderson made statements to his doctors or the EMTs for 14 Rule 803(4) provides that the hearsay rule does not exclude: [s]tatements made for purposes of medical diagnosis or treatment and describing . . . 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). 15 Rule 803(6) similarly excepts from the hearsay rule: A memorandum, report, record, or data compilation, in any form, of acts, events, conditions, opinions, or diagnoses, made at or near the time by, or from information transmitted by, a person with knowledge, if kept in the course of a regularly conducted business activity, and if it was the regular practice of that business activity to make the memorandum, report, record or data compilation . . . unless the source of information or the method or circumstances of preparation indicate lack of trustworthiness. Fed. R. Evid. 803(6) (emphasis added). 34 treatment purposes, such statements would fall within the medical treatment hearsay exception in Rule 803(4). And, if the doctors or EMTs told the nurse what Officer Henderson said and the nurse entered that hearsay-excepted statement in the hospital treatment records, the records would come within the business records exception in Rule 803(6).16 However, the record reveals that the nurse was not sure who told her the information she recorded in the treatment records.17 Because the nurse does not know for sure who told her the information, Smith could not show that the information contained in the hospital treatment records was “transmitted by . . . a person with knowledge.” Fed. R. Evid. 803(6). This lack of knowledge, or at least uncertainty, about who transmitted the information contained in the treatment records also deprives the information of trustworthiness. See id. (stating the business records exception does not apply if “the source of information or the 16 Cf. Petrocelli v. Gallison, 679 F.2d 286, 289 (1st Cir. 1982) (“To be admissible as ‘business records’ under Rule 803(6), the referenced notations [in medical records] would have to represent either opinions or diagnoses of the Massachusetts General Hospital doctors who made the notations or the diagnoses of some other ‘person with knowledge’ (such as a medical colleague) who reported to the maker of the record as part of the usual business or professional routine of Massachusetts General Hospital.”). 17 According to the proffer of testimony, the nurse would testify only that “her emergency trauma notes most likely reflected conversations that she would have had with E.M.T.’s who transported Officer Henderson to the hospital” and that the doctor’s progress notes “would likely reflect the conversation that Officer Henderson was having with the doctor himself at that point.” Moreover, at trial the government indicated that, in interviews with government attorneys, the doctor who made the progress notes “does not know where that information [regarding the source of Officer Henderson’s head injury] came from in the doctor’s notes either.” 35 method or circumstances of preparation indicate lack of trustworthiness”); Ricciardi v. Children’s Hosp. Med. Ctr., 811 F.2d 18, 23 (1st Cir. 1987) (concluding notation in patient’s medical records made by doctor who lacked personal knowledge of the alleged event he noted and who did not recall where he obtained the information he recorded in the notation did not qualify under the business records exception because “[a]n unknown source is hardly trustworthy”). The “touchstone of admissibility under Rule 803(6) is reliability, and a trial judge has broad discretion to determine the admissibility of such evidence.” United States v. Arias-Izquierdo, 449 F.3d 1168, 1183 (11th Cir. 2006). We cannot say that the district court abused its broad discretion when it determined that the notations in the medical records that Smith sought to admit did not qualify under an exception to the hearsay rule.18