Opinion ID: 1316134
Heading Depth: 2
Heading Rank: 1

Heading: Admissibility of Testimony of Forensic Nurse

Text: The Appellant contends that the trial court erroneously admitted hearsay testimony from forensic nurse Cynthia Leahy under the medical testimony exception to the hearsay rule. [5] The Appellant maintains that Nurse Leahy was not a medical provider and that the victim was referred to Nurse Leahy by Deputy Link solely for forensic purposes. The State, however, maintains that the evaluation had a pronounced medical component and is admissible under what has been described as a dual purpose, comprising both medical and forensic purposes. In State v. Edward Charles L., 183 W.Va. 641, 398 S.E.2d 123 (1990), this Court addressed the admissibility of statements made by children during treatment with a psychologist and found that such statements were admissible under certain circumstances. In syllabus point five, this Court articulated the two-part test for admitting hearsay statements pursuant to West Virginia Rule of Evidence 803(4), as follows: The two-part test set for admitting hearsay statements pursuant to W.Va.R.Evid. 803(4) is (1) the declarant's motive in making the statements must be consistent with the purposes of promoting treatment, and (2) the content of the statement must be such as is reasonably relied upon by a physician in treatment or diagnosis. Consistent with that framework, this Court in Edward Charles L. found that the statements made by the victims of child sexual abuse to a treating psychologist did have a motive consistent with promoting treatment because the mother had presented the children to the psychologist for the purpose of treatment even before a criminal action was contemplated. Further, the statements were such that they would have been reasonably relied upon by the psychologist in diagnosis and treatment. In State v. Pettrey, 209 W.Va. 449, 549 S.E.2d 323 (2001), this Court examined Rule 803(4) in the context of testimony from a play therapist regarding allegations of sexual abuse disclosed during play therapy. Utilizing the reasoning of Edward Charles L., this Court addressed the issue of play therapy and held as follows in syllabus point nine of Pettrey: When a social worker, counselor, or psychologist is trained in play therapy and thereafter treats a child abuse victim with play therapy, the therapist's testimony is admissible at trial under the medical diagnosis or treatment exception to the hearsay rule, West Virginia Rule of Evidence 803(4), if the declarant's motive in making the statement is consistent with the purposes of promoting treatment and the content of the statement is reasonably relied upon by the therapist for treatment. The testimony is inadmissible if the evidence was gathered strictly for investigative or forensic purposes. The Pettrey Court concluded that the statements at issue in that case, made by a child abuse victim during play therapy treatment, were admissible under Rule 803(4). 209 W.Va. at 460, 549 S.E.2d at 334. This Court also addressed the application of Rule 803(4) in Misty D.G. v. Rodney L.F., 221 W.Va. 144, 650 S.E.2d 243 (2007). This Court explained that the evaluation of whether a child's statement to a therapist or counselor is admissible requires an examination of the child's motive in originally making the statement, rather than the use ultimately made of the child's statement. 221 W.Va. at 150-51, 650 S.E.2d at 249-50. The Misty D.G. Court found that a child's statement to a sexual abuse counselor regarding alleged sexual abuse was admissible in child custody modification proceedings under the medical diagnosis or treatment exception to the hearsay rule. Although the counselor initially evaluated the case in a forensic manner, this investigation was accomplished with the intent of gathering information necessary for evaluation and subsequent treatment over the course of numerous counseling sessions. Thus, the information was not gathered strictly for investigative or forensic purposes and was therefore deemed admissible. [6] Other jurisdictions encountering the question of admissibility of forensic nurse testimony in child sexual abuse cases have also focused upon the purpose for which the information was gathered. In State v. Anderson, 86 Conn.App. 854, 864 A.2d 35 (2005), cert. denied, 273 Conn. 924, 871 A.2d 1031, the Connecticut appellate court held that testimony from a certified nurse practitioner regarding information provided by a victim of sexual assault was admissible under the medical exception to the hearsay rule. 864 A.2d at 51. The defendant in that case had argued that because the victim went to the nurse practitioner at the suggestion of the police, rather than simply for medical care, the medical exception to the hearsay rule was not applicable. Id. at 47. The court disagreed, explaining that [t]he key on which the issue of admissibility of the victim's statements turns is the purpose of the examination and that the victim had believed she was seeing the nurse to be examined for injuries she may have sustained. Id. at 50. Thus, the court found that the testimony was admissible because the purpose of the examination was not investigatory but, rather, was for medical treatment. Id. at 51. Building upon that rationale, the Connecticut appellate court again addressed the issue in State v. Martin M., 115 Conn.App. 166, 971 A.2d 828 (2009). In that case, the defendant, having been charged with sexually abusing a minor victim, maintained that the forensic nurse practitioner was not in the chain of medical treatment and that the victim had been referred to the nurse by the police. 971 A.2d at 835. The victim had waited nine months to visit the nurse, and the police had referred the victim to this nurse. The court found that the victim here believed [the nurse's] examination was for medical purposes. Accordingly, the court properly admitted [the nurse's] testimony of the victim's statements under the medical exception to the hearsay rule. Id. Similarly, in State v. Williams, 137 Wash. App. 736, 154 P.3d 322 (2007), the Washington Appellate Court found that testimony regarding a victim's statements to a forensic nurse was admissible due to the fact that the statements were obtained for a combination of purposes, both medical and forensic. 154 P.3d at 328. Referencing guiding precepts very similar to those utilized by this Court in Edward Charles L. and Pettrey, the Williams court stated as follows: A party demonstrates a statement to be reasonably pertinent when (1) the declarant's motive in making the statement is to promote treatment, and (2) the medical professional reasonably relied on the statement for purposes of treatment. State v. Butler, 53 Wash.App. 214, 220, 766 P.2d 505 (1989). Id. The court in Williams explained that the forensic nurse indicated as follows: [T]he purpose of the questionnaire was two-fold: to gather evidence and to identify treatable describe. [The nurse] examined [the victim] based on the history she obtained and, after the examination, provided [the victim] with information on sexually transmitted diseases and the risk of pregnancy. She also used the questionnaire to determine what kind of follow-up referrals were necessary or helpful. Id. Interestingly, the factual scenarios in two cases from Maryland demonstrate the differences between circumstances warranting admission of forensic nurse testimony and those warranting exclusion. In Webster v. State, 151 Md.App. 527, 827 A.2d 910 (2003), the court permitted the testimony of a sexual assault nurse regarding the child victim's statements to her. The court, based upon reasoning very similar to that described above, found that the victim perceived the visit to be of a medical nature. Additionally, the actual examination was for the dual purpose of both medical and forensic evaluation. The court opined that [t]he rationale for admitting this type of hearsaythat statements in contemplation of medical diagnosis or treatment are inherently reliablemay still exist in such circumstances. 827 A.2d at 920. The court explained that [i]f the challenged statement has some value in diagnosis or treatment, the patient would still have the requisite motive for providing the type of `sincere and reliable' information that is important to that diagnosis and treatment. Id. (citation omitted). In permitting the challenged testimony, the court stated that [t]his rationale applies in the context of this case, when a hospital nurse trained in both emergency care and sexual assault forensic examination treats and forensically examines a child immediately following a sexual assault, and in doing so solicits a description of the incident. Id. Four years later, in Coates v. State, 175 Md.App. 588, 930 A.2d 1140 (2007), the Court of Special Appeals of Maryland encountered a situation in which the timing of the examination was extremely remote, the victim having been examined fourteen months after the alleged sexual abuse. Thus, the court found testimony of the pediatric nurse practitioner to be inadmissible since it could not be considered an examination for a medical purpose due to the remoteness in time. 930 A.2d at 1163. A similar result was reached in State v. Ortega, 143 N.M. 261, 175 P.3d 929 (N.M.App.2007) cert denied, 143 N.M. 213, 175 P.3d 307, wherein testimony of a sexual assault nurse examiner was held inadmissible where the examination was conducted after the alleged victim had already participated in formal legal proceedings and the medical needs of the alleged victim were not a primary object of the examination. 175 P.3d at 933. Thus, where evidence exists to support a finding that a statement by a sexual assault victim to a forensic nurse was obtained for dual medical and forensic purposes, the testimony has consistently been ruled admissible. See also North Carolina v. Isenberg, 148 N.C.App. 29, 557 S.E.2d 568, 574-75 (2001), cert. denied, 355 N.C. 288, 561 S.E.2d 268 (2002) (finding no error in admitting statements made to hospital nurse and physician who had dual medical and forensic purposes for examination and interview); State v. Janda, 397 N.W.2d 59, 63 (N.D.1986) (finding no error in admitting statement made to hospital nurse on duty when victim arrived for examination because the purpose of an examination of the kind involved here is not just the preservation of evidence, but diagnosis and treatment as well); Torres v. Texas, 807 S.W.2d 884, 886-87 (Tex.Ct.App.1991) (finding no error in admitting statements made to emergency room nurse who engaged in a dual role of collecting evidence and providing medical service). Consistent with the reasoned authority of the precedent referenced above, this Court holds that when a child sexual abuse or assault victim is examined by a forensic nurse trained in sexual assault examination, the nurse's testimony regarding statements made by the child during the examination is admissible at trial under the medical diagnosis or treatment exception to the hearsay rule, West Virginia Rule of Evidence 803(4), if the declarant's motive for making the statement was consistent with the purposes of promoting treatment and the content of the statement was reasonably relied upon by the nurse for treatment. In determining whether the statement was made for purposes of promoting treatment, such testimony is admissible if the evidence was gathered for a dual medical and forensic purpose, but it is inadmissible if the evidence was gathered strictly for investigative or forensic purposes. In the case sub judice, Nurse Leahy explained during her testimony that the evaluation included a medical component. Specifically, she stated as follows: Well, we actually perform some of the screening. For example, in sexual abuse cases we need to obtain a certain amount of medical information to make a determination on whether the patient is at any type of risk for pregnancy or sexually transmitted illnesses or other injuries that may require further medical evaluation so we are involved in that plan with the physician. She continued by explaining that we obtain their health history, their surgical history, some of their sexual history from the patient and the parent. T.F. testified that she did not know what a forensic nurse was, and with specific regard to Nurse Leahy, T.F. stated, I just know she is a nurse. In commenting on the decision to take T.F. to Winchester, T.F.'s mother stated that she took T.F. to Winchester Hospital to be checked. In ruling on the Appellant's objection to the introduction of Nurse Leahy's testimony, the trial court stated as follows: It appears to the Court from the testimony of [the nurse] that there is a large medical component to what she does and that the conversations she had with the alleged victim of this matter were based on evidence she was gathering for purposes of medical diagnosis and treatment which even extended beyond the immediate issue to whether or not there were any diseases that needed to be checked out and things of that nature. The Court does find that the information was given by this alleged victim to [the nurse] for purpose of medical diagnosis and treatment which does fall ... within a firmly routed hearsay exception, and it has adequate indicia of reliability, therefore, the Court is going to permit this line of inquiry. Based upon the evidence of record, this Court finds no abuse of discretion in the trial court's decision to admit the testimony of Nurse Leahy regarding her examination of T.F. and the information provided during that examination. [7]