Opinion ID: 201283
Heading Depth: 3
Heading Rank: 1

Heading: Objections to Portions of Doctor's Reports Admitted Under Fed. R.Evid. 803(4).

Text: 26 Danaipour objects to the admission of those portions of Dr. Luxenberg's reports containing statements by McLarey and her family about what the two children said. 27 Fed.R.Evid. 803(4) provides an exception to the hearsay rule for: 28 (4) Statements for purposes of medical diagnosis or treatment. Statements made for purposes of medical diagnosis or treatment and describing medical history, or 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. 29 Under the rule, there are three preconditions for admission of such statements: (1) the statements must be made for purposes of diagnosis or treatment 1 (2) about (i) medical history (ii) or past or present symptoms, pain, or sensations or (iii) about the inception or general character of the cause or external source thereof (3) insofar as they are reasonably pertinent to diagnosis or treatment. Child therapists routinely, as part of their diagnosis or treatment, obtain the type of statements made by the patients here, A.D. and C.D., about the identity of the perpetrator of the abuse. Morgan v. Foretich, 846 F.2d 941, 948-50 (4th Cir.1988). Statements by young children amounting to disclosure to treating therapists that they have been abused by a member of their family are usually reasonably pertinent to treatment of the child. United States v. Yazzie, 59 F.3d 807, 812-13 (9th Cir.1995)([S]exual abuse involves more than physical injury; the physician must be attentive to treating the victim's emotional and psychological injuries, the exact nature and identity of which depend upon the identity of the abuser.) (quoting United States v. George, 960 F.2d 97, 99 (9th Cir.1992)); Morgan, 846 F.2d at 949; United States v. Renville, 779 F.2d 430, 436 (8th Cir.1985). Danaipour agrees that statements made directly by A.D. and C.D. to Dr. Pierre and Dr. Luxenberg are admissible under Rule 803(4). 30 The problem presented here concerns statements by a parent or family member, not the child, to a doctor of what C.D. and A.D. said. The plain language of the rule does not require the statements to be made by the patients, or even to a physician. Yazzie, 59 F.3d at 813; Davignon v. Clemmey, 322 F.3d 1, 8 & n. 3 (1st Cir. 2003) (permitting, under 803(4), testimony about statements by parents to a social worker concerning emotional distress of children). In situations in which there are no incentives for parental bias, parental reports to doctors of statements by their children are routinely admitted under Rule 803(4). See 4 Christopher B. Mueller and Laird C. Kirkpatrick, Federal Evidence 465 (2d ed. 1994) ([The 803(4)] exception does not require that the speaker be the patient or that the listener be the doctor. Clearly it reaches statements by family members (parent, sibling, or spouse) who bring a patient to a hospital or doctor's office.); 4 Stephen A. Saltzburg et al., Federal Rules of Evidence Manual § 803.02[5][d] (8th ed. 2002) ([S]tatements by bystanders, family members, and others, made for the purposes of treating an injured person and pertinent to that treatment, have often been admitted under Rule 803(4).). One example would be a parental report of a five year old's statement explaining where and how she scraped her knee badly. In such situations, the incentives are strong for the parent to recount the child's statement accurately and honestly. The Rule recognizes the reality of the situation. The Advisory Committee's Notes contemplate that statements made to members of the family may be within the exception. Fed. R.Evid. 803(4) advisory committee's notes. 31 Under Rule 803(4), the declarant's motive to promote treatment or diagnosis is the factor crucial to reliability. Jack B. Weinstein & Margaret A. Berger, Weinstein's Federal Evidence § 803.06[01] (Joseph M. McLaughlin ed., 4th ed.2004). In sexual abuse cases, especially where one parent accuses the other of abuse, the motives and incentives of the reporting parent may be mixed or, indeed, may not be to tell the truth. Yazzie, 59 F.3d at 813. It may be clear from the circumstance or context that the parental report of a child's statement of abuse to a doctor is made for purposes other than for diagnosis or treatment. See United States v. Balfany, 965 F.2d 575 (8th Cir.1992) (considering that theory). 32 In a situation such as this where there are reasons to look skeptically on the motives of the declarant, the context in which the statements are made is relevant to whether they bear adequate indicia of trustworthiness. Yazzie, 59 F.3d at 813. McLarey brought her children to Dr. Luxenberg, not for the purposes of determining whether the children had been sexually abused, but for treating their symptoms as manifested by their disturbed behavior. Thus, the statements made by McLarey to Dr. Luxenberg were for the purposes of treatment. 33 Most of the cases cited by Danaipour in attempting to challenge the district court's admission of the objected-to statements are criminal cases, in which the evidence was subjected to Confrontation Clause analysis. The Supreme Court has stated that the Confrontation Clause creates a higher bar for the admission of hearsay evidence than do the Federal Rules alone. Idaho v. Wright 497 U.S. 805, 814, 110 S.Ct. 3139, 111 L.Ed.2d 638 (1990) (The Confrontation Clause . . . bars the admission of some evidence that would otherwise be admissible under an exception to the hearsay rule.). This is a civil case. 34 In the end Danaipour's claim that the district court committed error by admitting and considering for the truth of the matter asserted the parental and family statements concerning C.D. and A.D.'s statements in the reports of Dr. Luxenberg fails, for several reasons. First, the statements made by McLarey, her mother, and Morin in the doctor's reports were tested when each person took the witness stand, testified directly to the same statements by A.D. and C.D., and was subjected to cross examination about the hearsay to the doctors. There were no discrepancies. 35 Second, Dr. Luxenberg testified that the children made the same statements (as reported by McLarey, her mother, and Morin) directly to her during their therapy, corroborating the statements reported to her by the mother and her family. This is true for each of the statements to which objection was made. Indeed, C.D. made statements to Dr. Luxenberg about her father's actions which went beyond what she told her mother. 36 Danaipour's real objection is not that reports containing McLarey's and others' recounting of the children's statements were inadmissible double hearsay but rather that the children's statements were inherently unreliable, being a product of the mother's coaching of the children. The district court carefully considered the fact that statements by a young child, even if accurately recounted by an adult, may not reflect the truth. A child may say something in order to get attention. Further, a story once told may, for several reasons, be subject to repetition and elaboration. The court also carefully considered the concern expressed by the husband's expert that repeated inquiry on the topic would taint C.D.'s recollections; the court found this had not happened. The court was very attentive to the possibility of coaching and found that improbable, and that the statements did not bear the indicia of a suggested script. In evaluating the reliability of the reported statements by the two children, the court utilized the indicia of credibility in sexual abuse cases referenced both in the literature and by Dr. Carole Jenny, a recognized expert. 2 The court was well within its discretion in considering the truth of the statements by C.D. and A.D. as reported by McLarey and the others to Dr. Luxenberg. 37