Opinion ID: 2438728
Heading Depth: 1
Heading Rank: 3

Heading: Admissibility of Hospital Records

Text: The assignment relating to the admissibility of medical and hospital records of Baroness Erlanger Hospital presents a question of first impression in this jurisdiction. As has been pointed out, supra, petitioner had a previous history of mental problems with treatment at various hospitals. In order to show this medical history, along with the severity and degree of his previous mental difficulties, and to form a predicate for certain hypothetical questions to the psychiatrist testifying in his behalf, he attempted to introduce the records of Baroness Erlanger Hospital, covering three periods of hospitalization. The trial judge permitted their introduction for identification only. We briefly summarize these records. His first hospitalization in 1971 was for gunshot injuries to the right chest. He was next admitted on May 19, 1973 with admitting diagnosis of paranoid state. Two days after his admission the hospital forwarded a form letter to the Mental Health Officer at Chattanooga, requesting that proceedings be initiated to commit petitioner to Moccasin Bend Psychiatric Hospital stating that he is in need of continued care and treatment and is potentially dangerous to himself and others. The appropriate psychiatric diagnosis was listed as paranoid schizophrenia. Twelve days later, Dr. J.S. Cheatham, a psychiatrist at Baroness Erlanger, addressed an official letter to the then attorney general of Hamilton County, advising: A diagnosis of  schizophrenia, paranoid type  has been established. In my opinion, Mr. Graham is in need of continued psychiatric care and treatment and is potentially dangerous to himself and others. (Emphasis supplied). Pursuant to this letter an order was entered in the criminal court at Chattanooga directing that petitioner remain in the psychiatric ward at Erlanger until arrangements could be made to transfer him to Central State Hospital for further evaluation and treatment. A copy of this order was filed as a part of the medical records. The record contains nothing further in this regard, except memoranda indicating that he reached Central State Hospital and was treated there. The records so filed next reflect that he was again admitted to Baroness Erlanger on February 15, 1974 with an admitting diagnosis of PSYCHO, UNSTABLE & DEPRESSED and a final diagnosis of (1) Paranoid state and (2) alcohol addiction. The record indicates that he was discharged to Moccasin Bend for further treatment. It does not reveal how long he remained there but does show that he was there on June 17, 1974, approximately four (4) months before the episode forming the basis for this criminal action. These are the records the trial judge refused to admit and which petitioner insists are admissible under the Uniform Business Records as Evidence Act, sections 24-712, et seq. T.C.A. Section 24-714, T.C.A. reads as follows: Records as evidence.  A record of an act, condition or event, shall, insofar as relevant, be competent evidence if the custodian or other qualified witness, testifies to its identity and the mode of its preparation, and if it was made in the regular course of business, at or near the time of the act, condition or event, and if, in the opinion of the court, the sources of information, method and time of preparation were such as to justify its admission. Prior to discussing the pertinent court decisions construing this statute, it should be pointed out that these records were offered by the Director of Medical Records at Erlanger, their custodian, who identified them and testified that they were kept and filed in the ordinary course of the business of the hospital on each patient who is admitted there. This prima facie qualifies the records for admission under the statute. In Neas v. Snapp, 221 Tenn. 325, 426 S.W.2d 498 (1968), a workmen's compensation action, the widow of the deceased workman, as a part of her testimony, introduced an autopsy report which showed the cause of death. This Court, in holding the report to be inadmissible under the Business Records Act, was prompted by the facts that (1) the widow was not the custodian; (2) nor an other qualified witness; and (3) there was no evidence from which the trial judge could determine whether, `the sources of information, method and time of preparation' justified the admission of the report. 221 Tenn. at 330, 426 S.W.2d at 501. Further the Court said: Accordingly, a proper foundation for the introduction of the autopsy report does not appear in the record. Every report or other writing is not admissible simply because it was made or rendered in the conduct of some business or profession. A compliance with all the qualifications of the statute is a prerequisite to admissibility. (Citing cases). Ibid. This latter paragraph has caused some apparent confusion. What the Court was saying was that the mere fact that a report or writing was made during the conduct of some business or profession did not per se make it admissible, but such fact, coupled with compliance with the statutory requirements, did. In Covey v. State, 504 S.W.2d 387 (Tenn. Cr.App. 1973), the State called Nona Owensby, a licensed staff psychologist to testify to the defendant's sanity. She also testified that it was the opinion of the hospital staff that the defendant was sane. The State insisted that such testimony was competent under the Business Records Act. The Court of Criminal Appeals, relying upon and quoting at length from Neas v. Snapp, supra , held that it was error for the Court to permit Mrs. Owensby to testify as to what other alleged experts had said, and it was error to admit the report of such experts without establishing their qualifications.  (Emphasis supplied). 504 S.W.2d at 392. With utmost deference to our colleagues of the Court of Criminal Appeals, this holding is a misapplication of Neas . The testimony as to what other staff members thought, absent an admission of the hospital records in accordance with the statutory criteria, was rank hearsay and so inadmissible  but not because of the Business Records Act, but because the State did not proceed under it. The witness merely attempted to testify to conclusions reached by her colleagues. The introduction of the element of qualification into the Business Records Act has no sanction in Neas . There the first reason for declining to validate the introduction of the autopsy report was totally unrelated to the Business Records Act. It was that the admission of the report by the widow, vis a vis the custodian, gave the benefit of an opinion of Dr. Moss whose qualifications are not shown and deprived defendant of the right of cross examination. 221 Tenn. at 329, 426 S.W.2d at 500. This phraseology preceded the Court's discussion of admissibility as a business record. The admission of records and reports under the Business Records Act is subject to the same objection, from a practical standpoint; however, the mandate of the statute is clear. The records are admissible, as a general rule, when introduced in the proper manner and with the proper foundation. The qualifications of the individual preparing the record may be inquired into, may be challenged, or may be disputed but this goes to weight and not admissibility. The Tennessee statute came under the scrutiny of the United States Court of Appeals for the Sixth Circuit in Phillips v. Neil, 452 F.2d 337 (1971), cert. denied, 409 U.S. 884, 93 S.Ct. 96, 34 L.Ed.2d 141 (1972). In a most excellent and elaborate opinion, the late Judge William E. Miller, of Tennessee, held that for the State, in a criminal prosecution, to read from medical records of Eastern State Hospital, violated the Sixth Amendment right of confrontation. Judge Miller, made the following apt observation: It is likely that Tennessee courts would find that hospital records fall within the general application of the statute. The great weight of judicial and scholarly authority supports such a holding. Nevertheless, that proffered evidence is a business or hospital record does not alone dispose of the question of admissibility in a specific case. (Emphasis supplied). 452 F.2d at 343-44. The Business Records Act is itself an exception to the hearsay evidence rule. It is designed to avoid the unnecessary expense, inconvenience and sometimes impossibility, [3] of calling witnesses, particulary in  but not limited to  those instances wherein the matter sought to be established is routine or uncontroverted. In the case of hospital records, without the act, it could conceivably take numerous witnesses  doctors, technicians, nurses and attendants who joined forces to make a complete and composite history of a patient's hospital treatment. Thus it is that the admissibility of records made during the course of business is the general rule and their introduction is not subject to a blanket objection on the basis of hearsay. This does not mean, however, that other recognized rules of evidence may not preclude their introduction in whole, or in part. We would not attempt to catalogue all the possibilities, but most assuredly hospital records introduced under the Act must not deprive a criminal defendant of any constitutionally guaranteed right; must be connected or related to the observation, diagnosis and treatment of the patient; must be material and relevant; must not be self-serving; and must meet all the statutory criteria. As with all other evidence, the trial judge, acting in his sound discretion, may excise from the proffered records any portions which are objectionable. We hold that the trial court committed prejudicial and reversible error in declining to admit the Erlanger Hospital records for general evidentiary purposes.