Court Opinion

ID: 9388321
Source: CourtListenerOpinion
Date Created: 2023-04-20 16:04:55.541952+00
Date Added: 2024-06-11T17:18:19.817118
License: Public Domain

IN THE COURT OF APPEALS OF THE STATE OF IDAHO

                                        Docket No. 49039

 STATE OF IDAHO,                                )
                                                )        Opinion Filed: April 20, 2023
        Plaintiff-Respondent,                   )
                                                )        Melanie Gagnepain, Clerk
 v.                                             )
                                                )
 JASON M. ROBERTS,                              )
                                                )
        Defendant-Appellant.                    )
                                                )

       Appeal from the District Court of the Third Judicial District, State of Idaho, Payette
       County. Hon. Susan E. Wiebe, District Judge.

       Judgment of conviction for two counts of lewd conduct with a minor child under
       sixteen, affirmed.

       Eric D. Fredericksen, State Appellate Public Defender; Elizabeth A. Allred, Deputy
       Appellate Public Defender, Boise, for appellant.

       Hon. Lawrence G. Wasden, Attorney General; Andrew V. Wake, Deputy Attorney
       General, Boise, for respondent.
                 ________________________________________________

HUSKEY, Judge
       Jason M. Roberts appeals from his judgment of conviction for two counts of lewd conduct
with a minor child under sixteen. For the reasons that follow, we affirm Roberts’ judgment of
conviction.
                                                    I.
                     FACTUAL AND PROCEDURAL BACKGROUND
       When asked about recent negative behavior, Roberts’ fifteen-year-old son informed his
mother that she would understand if she saw the signs that Roberts “was sexually hurting” him.
The mother called a friend and, ultimately, an interview at a Children at Risk Evaluation Services
(CARES) facility was arranged for the child.

                                                    1
        At the beginning of the CARES interview, the interviewer informed the child that the
interviewer was going to introduce the child to a nurse after the interview. The interviewer also
told the child that “it’s just our job today to make sure that you’re safe and that your body is safe
and healthy.” Upon hearing this, the child appeared taken aback. The interviewer clarified that
“they’re just going to see how tall you are and how much you weigh.” The child responded, “Okay,
I thought they were going to test me for [sexually transmitted infections]. I was like, ummm.”
The interviewer said, “They’re just going to check in with you,” and asked, “Does that sound
okay?” The child answered, “Yeah.”
        During the CARES interview, the child detailed how Roberts had sexually abused the child
starting when he was seven or eight years old. The child related that the last episode of sexual
abuse occurred about two and one-half years prior to the CARES interview. While discussing the
instances of sexual abuse, the child stated that after the abuse, he struggled with “suicidal stuff”
that resulted in the child being “locked up.” The child indicated that after his release, he again
struggled with “suicidal stuff” because the abuse continued. He admitted during the interview that
he was having “a couple” thoughts about suicide, described his preferred method of self-harm, and
indicated that at the time of the interview, he felt like engaging in self-harm a “little bit.”
        The interviewer took a break and later testified the break was to consult the doctor about
the disclosures. Upon returning to the interview and following up with the disclosure of self-harm,
the child stated, “I can guarantee you that I’m safe . . . . I don’t want to get locked up again.” Near
the interview’s end, after talking about the abuse, the child volunteered that he was “just over it”
and he “want[ed] this dealt with.” Following the interview, the child saw a physician for a medical
examination but declined an examination of his genitals or anus. The child also declined testing
for sexually transmitted infections. According to the physician, he and the child talked about
“doing an exam” and the child responded that “he wasn’t concerned, that it had been so long and
he was acting and feeling normal.” The physician also relayed that the child “didn’t want [the
physician] to look because [the child] wasn’t having any current problems.”
        After the CARES interview, a grand jury indicted Roberts for two counts of lewd conduct
with a minor child under sixteen. I.C. § 18-1508. At trial, the district court admitted a recording
of the CARES interview over Roberts’ objection. In doing so, the district court found that the
child was capable of making statements for medical purposes and that “there is little reason to

                                                   2
doubt [the child’s] motivation in making the disclosures.” Both the child and Roberts testified at
trial. Ultimately, the jury found Roberts guilty of both counts. Roberts appeals.
                                                 II.
                                   STANDARD OF REVIEW
       The decision to admit evidence is generally reviewed for an abuse of discretion. State v.
Almaraz, 154 Idaho 584, 590, 301 P.3d 242, 248 (2013). When a trial court’s discretionary
decision is reviewed on appeal, the appellate court conducts a multi-tiered inquiry to determine
whether the trial court: (1) correctly perceived the issue as one of discretion; (2) acted within the
boundaries of such discretion; (3) acted consistently with any legal standards applicable to the
specific choices before it; and (4) reached its decision by an exercise of reason. State v. Herrera,
164 Idaho 261, 270, 429 P.3d 149, 158 (2018).
                                                III.
                                           ANALYSIS
       Roberts asserts the district court erred in admitting the recording of the CARES interview
and that the error was not harmless. The State responds that the CARES interview was admissible
pursuant to Idaho Rule of Evidence 803(4) because the child’s statements during the interview
were made for a medical purpose. Alternatively, the State contends that any error in the admission
of the CARES interview is harmless. We hold that, in this case, the district court did not err in
admitting the CARES interview because the child’s statements made during the interview1 were,
under the totality of the circumstances, made for a medical purpose.

1
        Below, and on appeal, the parties made general arguments about the admissibility of the
Child at Risk Evaluation Services (CARES) interview pursuant to Idaho Rule of Evidence 803(4)
rather than conducting a specific analysis of individual statements. As such, we will take the same
general approach, but we note that I.R.E. 803(4) only provides an exception for hearsay if the
particular statement meets the rule’s criteria. That some statements within a CARES interview
could satisfy the criteria in I.R.E. 803(4) does not mean all statements made during a CARES
interview would. Statements that do not meet that criteria would have to be admitted pursuant to
another rule. See State v. Christensen, 166 Idaho 373, 381, 458 P.3d 951, 959 (2020) (noting “a
general objection” to a CARES interview, “without specifics as to which statements were
inadmissible and why, is insufficient to preserve the error for appeal”).

                                                 3
A.     Admissibility of the CARES Interview Recording
        Roberts asserts “it is clear that [the child] did not intend for his statements to be used for
medical diagnosis or treatment” and, consequently, the recording of the CARES interview
admitted at trial contains inadmissible hearsay. The State responds that the district court’s
determination regarding the child’s intent for making the statements is a factual finding and that
this finding is supported by substantial and competent evidence. In reply, Roberts asserts the
district court’s determination of the child’s intent is a legal conclusion, not a factual finding that
would be entitled to deference unless clearly erroneous.
       Hearsay is defined as an out-of-court statement offered “to prove the truth of the matter
asserted in the statement.” I.R.E. 801(c)(2). On appeal, the parties do not dispute that the child’s
statements given during the CARES interview constituted hearsay.              Generally, hearsay is
inadmissible during trial unless a recognized hearsay exception applies. I.R.E. 802; State v.
Stanfield, 158 Idaho 327, 341, 347 P.3d 175, 189 (2015). One such exception is for a statement
that “is made for--and is reasonably pertinent to--medical diagnosis or treatment” and that
“describes medical history; past or present symptoms or sensations; or their source.” I.R.E. 803(4).
The parties’ arguments on appeal center on one requirement of this exception--specifically,
whether the child’s statements were “made for” a “medical diagnosis or treatment.”
       When a child is the declarant, a trial court considers the totality of the circumstances to
determine whether the statements were made for a medical diagnosis or treatment. State v.
Christensen, 166 Idaho 373, 376, 458 P.3d 951, 954 (2020). Factors to consider may include:
       [T]he child’s age; whether the child understands the role of the physician in general;
       whether the child was suffering pain or distress at the time; whether the child’s
       statements were inappropriately influenced by others, as by leading questions from
       the physician or a previous suggestive interrogation by another adult; whether the
       examination occurred during the course of a custody battle or other family dispute;
       the child’s ability and willingness to communicate freely with the physician; the
       child’s ability to differentiate between truth and fantasy in the examination itself
       and in other contexts; whether the examination was initiated by an attorney (which
       would suggest that its purpose was for litigation rather than treatment); and the
       timing of the examination in relation to the trial.
State v. Kay, 129 Idaho 507, 518, 927 P.2d 897, 908 (Ct. App. 1996). If the foregoing factors, and
others reasonably related to the inquiry, give little reason to doubt the child’s motivation, “the

                                                  4
district courts may infer the criteria of I.R.E. 803(4) are met.” Christensen, 166 Idaho at 378, 458
P.3d at 956.
       We first address the parties’ dispute about whether a child’s intent is a factual finding or a
legal conclusion. Roberts asserts that the totality of the circumstances test in Christensen, while
based on various factual findings, results in a legal conclusion. Under his approach, a child’s age
is a factual finding while the impact of the child’s age on the totality of the circumstances is a legal
question. We disagree. When addressing a child’s intent under I.R.E. 803(4), Idaho precedent
indicates that this intent is a factual determination for a trial court. See Christensen, 166 Idaho at
387-79, 458 P.3d at 956-57 (noting trial court “found little reason from the record to doubt that the
statements made by [the children] fell within the exception for medical diagnosis or treatment”)
(emphasis added); Kay, 129 Idaho at 518, 927 P.2d at 908 (holding “several factors support the
trial court’s determination that [the child’s] statements were made for purposes of diagnosis or
treatment”) (emphases added). This approach is consistent with other inquiries regarding a
person’s state of mind. See, e.g., State v. Hansen, 138 Idaho 791, 796, 69 P.3d 1052, 1057 (2003)
(explaining whether consent to search was voluntary is question of fact to be determined by all
surrounding circumstances).       In addition, one federal circuit has held that a trial court’s
determination that a “doctor was consulted for purposes of medical treatment” is a “finding of
fact.”2 Ring v. Erickson, 983 F.2d 818, 820 (8th Cir. 1992). Finally, we note the Idaho Supreme
Court in Christensen agreed with the trial court’s finding that there was “little reason from
the record to doubt that the statements made by [the children] fell within the exception for medical
diagnosis or treatment” and then proceeded to observe that “independently applying the factors”
also “supports admissibility of the statements.” Christensen, 166 Idaho at 378-79, 458 P.3d at
956-57. If, as Roberts contends, a child’s intent for purposes of I.R.E. 803(4) is a legal question,
there would have been no need in Christensen to delineate between the trial court’s analysis and
the independent evaluation by the Idaho Supreme Court. For these reasons, we hold that a child’s
intent for purposes of I.R.E. 803(4) is a factual finding. On appeal, we will not overturn a factual

2
        Because the federal rule is similar to Idaho’s rule, compare F.R.E. 803(4), with
I.R.E. 803(4), federal case law aids our interpretation. See State v. Carrasco, 117 Idaho 295, 298,
787 P.2d 281, 284 (1990).

                                                   5
finding regarding a child’s intent if it is supported by substantial evidence. See State v. Crea, 119
Idaho 352, 354, 806 P.2d 445, 447 (1991).
       Regarding the child’s intent in making statements during the CARES interview, the district
court found: (1) “the medical examination was not associated with a domestic dispute”; (2) the
child’s parents “had already separated and/or divorced”; (3) an attorney did not initiate the CARES
interview; (4) there was “no indication that the examination did not comply with [National Institute
of Child Health and Human Development] protocol with non-leading questions”; (5) there was
“no suggestion that [the child] had been interrogated by law enforcement prior to the interview”;
(6) the child was not “inappropriately influenced by others”; (7) the CARES “interview took place
prior to trial”; (8) the child was fifteen years old at the time of the CARES interview and “capable
of making statements for purposes of medical diagnosis and/or treatment”; (9) there was “little
reason to doubt [the child’s] motivation in making the disclosures”; and (10) the child “was in
distress, as evidenced by his acting out.”      Initially, the district court also found that “the
examination was performed at the hospital” but, later at trial, the State represented that the CARES
interview took place at the Family Justice Center. The district court held that the Family Justice
Center was “not on the same level,” but that, “even without the hospital setting, [the] analysis
remains the same.”
       Because the factual determination of a child’s intent is based on a totality of the
circumstances, undue emphasis or analysis of only one factor is inappropriate. See Christensen,
166 Idaho at 378, 458 P.3d at 956 (holding Christensen’s focus on whether victims knew their
statements were made for medical purpose was myopic and failed to address totality of the
circumstances). The Christensen Court held:
       Finally, and most importantly, even though CARES interviews serve a dual medical
       and forensic purpose, A.M.O. and A.G.O.’s statements were admissible because
       their statements remain inherently reliable; they are gleaned from a process
       designed to aid and inform treatment and diagnosis of the child’s medical condition.
       In these circumstances, the child would “still have the requisite motive for
       providing the type of ‘sincere and reliable’ information that is important to that
       [medical] diagnosis and treatment.” Webster v. State, 151 Md.App. 527, 827 A.2d
       910, 920 (2003).
Christensen, 166 Idaho at 379, 458 P.3d at 957. Thus, Christensen holds that where a CARES
interview is conducted in conformity with the generally accepted standards for such interviews, a

                                                 6
child’s statements made during the interview are inherently reliable. Christensen also holds that
focusing only on one element of the totality of the circumstances in assessing the child’s intent in
making the statements is analytically inappropriate.
        Roberts argues the statements made by the child were not made for medical purpose as the
child did not intend for the statements to result in a medical diagnosis and was not seeking any
medical treatment. For example, Roberts argues that “within the first thirty seconds of the forensic
interview, [the child] made it clear that he was not interested in a physical examination.” We do
not agree with that characterization of the video. At most, the child reacts to the idea of testing for
sexually transmitted infections but does not say he is unwilling to undergo a medical exam and, in
fact, immediately thereafter, the child agrees to participate in at least a partial medical examination.
However, even if we were to focus only on the somewhat contradictory statements of the child,
like in Christensen, this argument focuses only on one element and ignores the totality of the
circumstances surrounding the statements and the context in which they are made. At the
beginning of the interview, the child reacted3 when informed that personnel at CARES would
“make sure that [the child is] safe and that [his] body is safe and healthy.” After the child’s
reaction, the interviewer clarified that “they’re just going to see how tall you are and how much
you weigh” and “they’re just going to check in with you.” The child thereafter agreed to participate
in a medical examination as explained by the CARES interviewer.
        At the time the CARES interview was scheduled, not the mother, law enforcement, or the
forensic interviewer had any information that the abuse ended approximately two and one-half
years before the interview. Temporal remoteness does not necessarily negate the need for a
medical examination following the disclosure of abuse. Additionally, I.R.E. 803(4) applies to
statements describing past symptoms, not just those experienced by the declarant at the time of
making the statements. That said, this Court recognizes the temporal remoteness of the alleged
abuse from the time of the CARES interview and the absence of current symptoms differentiate
this case from Christensen. In Christensen, two children were interviewed at CARES within two

3
       The description of the child’s reaction is difficult to correctly identify. On appeal, Roberts
characterizes it as a “recoil.” The correct adjective is subjective, demonstrating why undue
emphasis on one element (the intent of the declarant) is analytically inappropriate and requires
addressing the totality of the circumstances.

                                                   7
weeks of their disclosures of sexual abuse and “freely communicated with the staff about physical
pain and discomfort they experienced from the abuse.” See Christensen, 166 Idaho at 375-76, 379,
458 P.3d 953-54, 957. And, the remoteness of the abuse, coupled with the child’s statements in
this case, certainly weigh in the totality of the circumstances in assessing the indicia of reliability
surrounding the statements.
       Here, the child makes contradictory statements. For example, the child stated he was not
experiencing current physical symptomology as a result of the abuse. This was reiterated during
that subsequent exam; the child declined any testing for sexually transmitted infections and
declined an examination of his genitals and anus. The child informed the physician that the child
“wasn’t concerned,” that “it had been so long” since the abuse that he was “feeling normal” and
did not have any “current problems.”         However, other statements indicated the child was
experiencing physical symptoms related to the abuse that would both inform and warrant a medical
examination. For example, during the CARES interview, the child disclosed that as a result of the
abuse, he had previously struggled with “suicidal stuff” apparently serious enough to result in him
being in a secure facility. The child also indicated that participating in the CARES interview and
addressing “all this” and having it all “come up again” made him have a “couple thoughts” about
suicide and he was feeling a “little bit” like engaging in self-harm during the interview. However,
the child subsequently “guarantee[d]” he was safe because he didn’t “want to get locked up again.”
       The contradictory nature of all the statements clearly informed and guided the subsequent
medical exam. The Christensen Court described the medical examination as,
       a full head-to-toe medical examination that commonly involves a detailed
       examination of the genitals and evaluation for possible sexually transmitted
       diseases or infections. The medical examination is informed by the forensic
       interview and psychosocial assessment to determine issues the child may have,
       areas that may need extra focus, any clues about possible physical symptoms and
       any ideas about possible infections or injuries.
Id. at 375, 458 P.3d at 953. Even after the child disclosed the temporal remoteness of the abuse,
the doctor still conducted a medical examination, which is unsurprising in light of the child’s
statements about current feelings of self-harm and notwithstanding the temporal remoteness of the
abuse. And, even with the limitations imposed by the child during the exam, the doctor could
examine the child for existing signs or symptoms of self-harm and decide the appropriate course
of treatment as a result. Other statements made by the child during the interview, including those

                                                  8
indicating strong feelings about Roberts, were additional statements the district court could
consider in determining, under a totality of the circumstances, whether the child’s statements
during the CARES interview were made for a medical purpose.
       We now turn to the district court’s finding that the child was “in distress.” As discussed
above, during the interview, the child indicated he was experiencing mental distress as a result of
discussing the abuse and, as a result, he was having thoughts of suicide and self-harm.
Psychological distress from abuse can undoubtedly motivate a child to give statements for a
medical purpose and a medical examination for purposes of assessing self-harm would not
necessarily be the same type of medical examination that would follow disclosures of sexual abuse.
In other words, a medical examination to assess self-harm could be conducted even with the type
of limits the child placed on the medical examination in this case. The child’s statements during
the CARES interview provide substantial evidence to support the district court’s finding that at the
time of the CARES interview, the child was in physical pain or “acting out.”
       Roberts contends that statements given for purposes of mental health treatment do not
qualify under I.R.E. 803(4). The Idaho Supreme Court has held that “a psychologist does not
provide ‘medical’ treatment as contemplated by” I.R.E. 803(4). State v. Zimmerman, 121 Idaho
971, 974, 829 P.2d 861, 864 (1992). In response, the State asserts that “Zimmerman should be
overruled” to the extent that opinion “prevents admission of hearsay for purposes of medical
diagnosis or treatment of mental health issues.” This Court cannot overrule Idaho Supreme Court
precedent. However, Zimmerman is inapposite in this context. First, the statements at issue in this
case were not given to a psychologist; instead, the statements were made in a context that the Idaho
Supreme Court has held provides inherent reliability for those statements.          Second, unlike
Zimmerman, the statements given during a CARES forensic interview and psychosocial
assessment inform and guide the subsequent medical examination, which helps “determine issues
the child may have, areas that may need extra focus, any clues about possible physical symptoms
and any ideas about possible infections or injuries.” Christensen, 166 Idaho at 375, 458 P.3d at
953. Here, the disclosures of self-harm were discussed with the doctor who implicitly concluded
a medical evaluation was necessary to assess those symptoms because a medical examination was
conducted after the forensic interview.

                                                 9
       In this case, the district court concluded the child made statements that were sufficiently
reliable to be admitted pursuant to I.R.E. 803(4). If the trial court based its findings on substantial
evidence, even if the evidence is conflicting, this Court will not overturn those findings on appeal.
Additionally, this Court will not substitute its view of the facts for that of the trial court. State v.
Clark, 168 Idaho 503, 510, 484 P.3d 187, 194 (2021). Although some of the child’s statements
may be construed as indicating he did not want to undergo testing for sexual transmitted infections,
he also agreed to undergo a medical examination. Christensen holds that statements given during
a properly conducted CARES interview have inherent reliability and precludes focusing on only
one factor in determining the child’s intent in making the statements at issue. In light of the
deference given to the trial court, and the language of Christensen, we are constrained to hold the
district court did not abuse its discretion in finding the child’s statements were made for purposes
of medical treatment or examination and, thus, were admissible pursuant to I.R.E. 803(4). Given
the totality of the circumstances, there is substantial evidence to support the district court’s finding
that there was “little reason to doubt [the child’s] motivation in making the disclosures.”
       For the foregoing reasons, we conclude there was substantial evidence supporting the
district court’s factual finding that the child had a medical purpose in making his statements during
the CARES interview. Because the statements, under a totality of the circumstances, were made
for a medical purpose, the district court did not err in admitting the recording of the CARES
interview pursuant to this hearsay exception.
                                                  IV.
                                          CONCLUSION
       The district court did not err in admitting the recording of the CARES interview because it
satisfied the medical purpose exception in I.R.E. 803(4). Accordingly, we affirm Roberts’
judgment of conviction for two counts of lewd conduct with a minor child under sixteen.
       Judge GRATTON CONCURS.
       Chief Judge LORELLO, DISSENTS
       I would hold that admission of the Children at Risk Evaluation Services (CARES)
interview was reversible error because the child’s statements made during the interview were not
made for a medical purpose and the error was not harmless. As such, I dissent.

                                                  10
       In order for a hearsay statement to be admissible under the exception provided in
I.R.E. 803(4), the statement must be: (a) made for, and be reasonably pertinent to, medical
diagnosis or treatment; and (b) describe medical history, past or present symptoms or sensations,
or their source. The question in this case is whether the child’s statements to the CARES
interviewer were made for medical diagnosis or treatment.
       As noted, the district court made the following findings regarding the child’s intent in
making statements during the CARES interview: (1) “the medical examination was not associated
with a domestic dispute”; (2) the child’s parents “had already separated and/or divorced”; (3) an
attorney did not initiate the CARES interview; (4) there was “no indication that the examination
did not comply with [National Institute of Child Health and Human Development] protocol with
non-leading questions”; (5) there was “no suggestion that [the child] had been interrogated by law
enforcement prior to the interview”; (6) the child was not “inappropriately influenced by others”;
(7) the CARES “interview took place prior to trial”; (8) the child was fifteen years old at the time
of the CARES interview and “capable of making statements for purposes of medical diagnosis
and/or treatment”; (9) there was “little reason to doubt [the child’s] motivation in making the
disclosures”; and (10) the child “was in distress, as evidenced by his acting out.” Initially, the
district court also found that “the examination was performed at the hospital” but, later at trial, the
State represented that the CARES interview took place at the Family Justice Center. The district
court held that the Family Justice Center was “not on the same level,” but that, “even without the
hospital setting, [the] analysis remains the same.”
       Some of the district court’s findings negate some possible nonmedical motivations for the
child’s statements. Other findings touch on whether others influenced the child’s statements or
whether the child was capable of making statements for a medical purpose. These findings are
helpful to an I.R.E. 803(4) analysis because they eliminate possible concerns with a child’s
statements. See State v. Christensen, 166 Idaho 373, 377-78, 458 P.3d 951, 955-56 (2020) (noting
that an examination initiated by an attorney “would suggest that its purpose was for litigation rather
than treatment”). They do not, however, establish as a positive matter that the child had a medical
purpose. This leaves the findings that there was “little reason to doubt” the child’s motivation, he
was in distress, and the CARES interview took place at a Family Justice Center.

                                                  11
       The State asserts that there is substantial evidence supporting the district court’s “finding
regarding the purpose of [the child’s] statements in the interview,” ostensibly referring to the
finding that there was “little reason to doubt” the child’s motivation. First, the State notes that the
child was informed several times that the CARES interview “was part of a process to ensure he
was healthy.” What the child was told about the reason for the process does not necessarily reflect
the child’s intent. In other words, even if the child was expressly told the purpose of the interview
was for medical treatment, that advisory does not necessarily mean the child’s intent in making
subsequent statements was for that same purpose. The facts of this case illustrate that point. At
the beginning of the interview, the child reacted when informed that personnel at CARES would
“make sure that [the child is] safe and that [his] body is safe and healthy.” After the child’s
reaction, the interviewer clarified that “they’re just going to see how tall you are and how much
you weigh” and “they’re just going to check in with you.” The child’s response and agreement to
the limited examination as explained by the CARES interviewer shows that the child lacked a
relevant medical purpose in giving his statements detailing the sexual abuse. Notably, the child’s
statements during the CARES interview had little or nothing to do with his height or weight or a
generic “check in.” The child’s lack of a relevant medical purpose continued throughout the
CARES process, as evidenced by the child declining any testing for sexually transmitted diseases
and declining an examination of his genitals and anus during the medical exam performed after
the interview. The child informed the physician that the child “wasn’t concerned,” that “it had
been so long” since the abuse that he was “feeling normal,” and that he did not have any “current
problems.”1 In my view, the temporal remoteness of the alleged abuse from the time of the CARES
interview and the absence of current symptoms are significant and differentiate this case from
Christensen. In light of the child’s actions and statements (as well as the CARES interviewer’s
representations regarding the limited scope of the examination), the child being informed that the
purpose of the CARES process was to keep his body “safe and healthy” does not provide

1
        I recognize, as the State observes, that I.R.E. 803(4) applies to statements describing past
symptoms, not just those experienced by the declarant at the time of making the statements. See
I.R.E. 803(4)(B). The child’s statement that he was not experiencing any “current problems,”
however, indicates that he lacked a relevant medical purpose at the time regardless of whether he
described past symptoms.

                                                  12
substantial evidence that the child had a medical purpose behind any of his statements during the
interview. Contrary to the district court’s finding, there was ample reason to doubt the child’s
motivation for purposes of I.R.E. 803(4). Cf. State v. Nelson, 131 Idaho 210, 216, 953 P.2d 650,
656 (Ct. App. 1998) (where child went to emergency room within an hour of sexual assault
complaining of pain in rectal and vaginal area, there was no basis to infer the child “believed she
was seeing the doctor for any reason other than diagnosis and treatment”).
       Second, the State asserts that the child’s mother “understood that the interview was for
medical purposes” and that she spoke to the child “in general terms about the CARES interview
before it occurred.” But the State fails to provide any citation to the record showing that the mother
communicated the medical purpose to the child. As Roberts notes, the child related during the
CARES interview that his mother told him that he needed to go to the interview but that his mother
did not say anything else. Without being communicated to the child, the mother’s knowledge of
the purpose of the CARES interview does not provide support for the district court’s finding, much
less evidence supporting a conclusion that the child’s statements were made for a medical purpose.
       Third, the State notes that the child had been interviewed at CARES two times previously
and “would have been told on those prior occasions about the reason for those interviews” and
“would have been examined by a health care provider following those interviews.” In support, the
State cites to portions of the record showing that the child had been through the CARES process
twice before. However, the State fails to provide citations to the record regarding what the child
was told during those CARES interviews or if they were followed by a medical examination. Even
if we assumed that the child had been informed of the purpose of CARES interviews in the past
and had been medically examined as part of that process, this would not change his intent in
submitting to the CARES process at issue in this case or his agreement to a limited examination at
the inception of the CARES interview. Nor does the child’s purpose in making statements in a
prior CARES interview extend to subsequent CARES interviews, particularly interviews
conducted after the need for medical treatment has dissipated. As discussed, the child’s reaction
shows he lacked a relevant medical purpose.           Consequently, evidence of the past CARES
interviews does not provide substantial evidence for the district court’s finding.
        Next, the State asserts that “all of the same factors suggesting the reliability and medical
nature of the CARES process that the [Idaho Supreme Court] identified in Christensen are present

                                                 13
here.” The State reiterates many of the district court’s findings regarding these factors addressed
elsewhere in this opinion and adds that the CARES interviewer “emphasized the importance of
telling the truth” to the child. Again, this factor helps exclude a possible concern (that is, whether
the child was lying) but, by itself, does not establish that the child had a medical purpose. Thus,
the CARES interviewer’s emphasis on telling the truth does not provide substantial evidence that
the child had a medical purpose as required for admission of his statements under I.R.E. 803(4).
       The district court’s finding that the child was “in distress” (understood in context) concerns
the child’s psychological state, not his physical condition, given that the district court mentioned
that the child’s distress was “evidenced by his acting out” prior to the CARES interview. Notably,
however, there was no evidence that, at the time of the CARES interview, the child was in physical
pain or “acting out.” The only evidence was to the contrary, given that the child informed the
physician after the CARES interview that the child was “feeling normal” and there were not “any
current problems.” In addition, the last episode of abuse occurred about two and a half years before
the CARES interview. While psychological distress from abuse can undoubtedly motivate a child
to give statements for a medical purpose, in this case the child declined the relevant medical
examination and there was no indication during his CARES interview that he was seeking medical
diagnosis or treatment. Given that the child did not intend to seek relevant medical care, his
psychological distress, standing alone, is not substantial evidence that he gave his statements
during the CARES interview with a medical purpose.
       For largely the same reason, the district court’s finding that the interview occurred at a
Family Justice Center does not provide substantial evidence that the child had a medical purpose.
Although the setting of an interview can influence a declarant’s purpose, the child’s actions and
statements in this case reveal he lacked a relevant medical purpose despite the setting. This is
especially true given the child’s statements to the CARES interviewer that the child was “just over
it” and “want[ed] this dealt with,” which indicate his purpose was other than medical.
       Finally, Roberts contends that statements given for purposes of mental health treatment do
not qualify under I.R.E. 803(4). Roberts is correct. See State v. Zimmerman, 121 Idaho 971, 974,
829 P.2d 861, 864 (1992) (holding that “a psychologist does not provide ‘medical’ treatment as
contemplated by” I.R.E. 803(4)). Moreover, the record indicates that the child did not have a
mental health purpose either. The child started counseling many years prior to the interview and

                                                 14
had been in counseling off and on for many years. Even if the child needed additional counseling
as a result of the prior abuse, or for some other reason,2 such a need does not provide a cloak of
admissibility under I.R.E. 803(4) for a CARES interview.
       Having concluded admission of the CARES interview was error, the question becomes
whether admission of the interview was harmless. I do not think it was.
       Error is not reversible unless it is prejudicial. State v. Stell, 162 Idaho 827, 830, 405 P.3d
612, 615 (Ct. App. 2017).          Where a criminal defendant shows an error based on a
contemporaneously objected-to, nonconstitutional violation, the State then has the burden of
demonstrating to the appellate court beyond a reasonable doubt the error did not contribute to the
jury’s verdict. State v. Montgomery, 163 Idaho 40, 46, 408 P.3d 38, 44 (2017). Thus, we examine
whether the alleged error complained of in the present case was harmless. See id. Harmless error
is error unimportant in relation to everything else the jury considered on the issue in question, as
revealed in the record. Yates v. Evatt, 500 U.S. 391, 403 (1991); State v. Garcia, 166 Idaho 661,
674, 462 P.3d 1125, 1138 (2020). This standard requires weighing the probative force of the
record as a whole while excluding the erroneous evidence and at the same time comparing it
against the probative force of the error. Id. If the error’s effect is minimal compared to the
probative force of the record establishing guilt beyond a reasonable doubt without the error, then
the error did not contribute to the verdict rendered and is harmless. Id. The reviewing court must
take into account what effect the error had, or reasonably may have had, on the jury in the context
of the total setting and in relation to all else that happened, which necessarily includes the evidence
presented. Kotteakos v. United States, 328 U.S. 750, 764 (1946).
       Regarding the probative force of the error, the State asserts that the child’s statements in
the CARES interview “simply duplicate[d] the unobjected-to and properly admitted testimony at

2
        During the interview, the child noted he previously struggled with “suicidal stuff” and got
“locked up” as a result. He also stated he subsequently wrote a “graphic letter” about wanting to
kill Roberts, which resulted in him getting locked up again for “two and a half years,” and being
released approximately four months prior to the CARES interview at issue in this case. When
asked during the interview if he was having any current suicidal thoughts, the child stated “a
couple.” When asked to expand on that, the child responded, “not necessarily suicide, but cutting,
definitely cutting” and noted his girlfriend broke up with him “last night” and he had to do this
“stupid” interview, which he had already done two times before.

                                                  15
trial.” An error in admitting evidence can be harmless if other evidence, properly admitted,
provides the same information. See, e.g., State v. Miller, 157 Idaho 838, 846, 340 P.3d 1154, 1162
(Ct. App. 2014) (holding that erroneous admission of 911 call was harmless because it was
cumulative of victim’s testimony at trial). Roberts responds that the CARES interview contained
probative statements that were not part of the child’s trial testimony and that, to the extent the
CARES interview was cumulative, it was “improper corroboration of [his] testimony.”
       Roberts is correct that the CARES interview contains information not presented during the
child’s testimony at trial. During the CARES interview, the child represented that Roberts put his
“main area” (the child’s euphemism for “penis”) in the child’s “butt” and that Roberts did this
more than once. According to the child’s statements during the CARES interview, “once [Roberts]
first did it, it continued.” The child described one of these incidents as having occurred in his
room. At trial, however, the child testified that, the day after he first disclosed Roberts’ sexual
abuse of him,3 Roberts told the child, “You’re dead”; hit the child, causing the child to fall to the
ground; and then Roberts “put his penis in [the child’s] butt.” The child testified that this incident
occurred in the kitchen. After the child’s testimony regarding this incident, the following exchange
occurred:
       [State]:        So his, [Roberts’] penis in your butt, was that the only time that
                       happened?
       [Child]:        Yes.
       [State]:        Only time?
       [Child]:        (Nodding.)
       [State]:        The one time at home on the kitchen floor?
       [Child]:        Yes.
       [State]:        I’m sorry. I’ll have to start catching on to that. Okay. And so
                       contact of your butt with [Roberts’] penis only happened one time?
                       Is that correct?
       [Child]:        Yes.
       Thus, the CARES interview did not merely duplicate the child’s trial testimony. Instead,
the CARES interview provided evidence of more than one incident of lewd conduct, which at trial

3
        The child recanted this first disclosure within a day of making it. According to the child’s
mother, Roberts told the child that he and his sister would be taken away from Roberts and the
child’s mother if the child continued with the accusation.

                                                 16
he denied happening more than once, and gave an account of one of these incidents occurring in
his room, which he did not testify to at trial.
        This evidence of at least one additional incident of lewd conduct was highly probative
because it was tied to physical evidence that possibly corroborated the child’s account of the crime.
The physician who observed the child’s CARES interview testified at trial. The physician noted
that the child’s medical records revealed he had experienced rectal bleeding for a period of several
months but that, despite “extensive medical workup,” no medical disease had been diagnosed. The
physician testified “the timing of [the child’s] reported rectal bleeding and abdominal pain that he
had correlated with the timing that he described that he was being sexually abused.” According to
the physician, injuries to a child’s genitals or anus is “rarely seen,” with “less than five percent”
of cases having a “definitive finding on their medical exam of sexual kind of abuse injury.” In its
closing argument to the jury, the State highlighted the physician’s testimony, noted the child’s trial
testimony that there was only one incident, and then noted:
                [The child’s] CARES interview goes into a little bit more depth as to how
        that continued. And if that continued, it continued for a period of time where he
        tried to starve himself trying to, you know, losing weight, trying to make himself
        as small and as unnoticed as possible. There’s your connection. There’s the
        consistency. There is that less-than-5-percent case, according to [the physician],
        that [the child] was sexually abused.
        This shows that the State, in trying to draw a connection between the child’s rectal bleeding
and his testimony, relied on information from the CARES interview that the abuse occurred more
than one time. From the jury’s perspective, continued abuse of this nature, as opposed to a single
episode, would better explain why the child’s rectal bleeding continued for several months. For
this reason alone, the CARES interview carried significant probative force.
        Further, as Roberts notes, the CARES interview also contained accounts of physical abuse
that the child did not testify about during trial. During the CARES interview, the child described
being kicked by Roberts and that the child “threw up one time because [he] couldn’t catch [his]
breath.” During trial, the child described being hit by Roberts’ hand, but did not recount being
kicked. Similar to propensity evidence, evidence of this additional and more extreme physical
abuse may have led the jury to find Roberts guilty of the sexual crimes simply because of other
bad acts. Cf. State v. Folk, 157 Idaho 869, 878, 341 P.3d 586, 595 (Ct. App. 2014) (holding that a
defendant’s “prior convictions are merely propensity evidence that allow persons to infer that[,] if

                                                  17
[the defendant] committed the prior offenses, he must have committed the offense at issue”). This
additional evidence of physical abuse increased the probative force of the error in admitting the
CARES interview.
       Although Roberts asserts the CARES interview was “improper corroboration,” it is not
“corroboration” evidence in the strict sense because the statements were not from a third party.
Cf. State v. Harris, 132 Idaho 843, 847-48, 979 P.2d 1201, 1205-06 (1999) (addressing impact of
testimony from third party defense witness). But Roberts’ argument reflects a concern in our case
law that, when credibility is crucial to a case, even cumulative evidence can result in reversible
error. See id. (holding that exclusion of defense witness was not harmless error because it was “a
case of the alleged victim’s word against the defendant’s word” and the defense witness would
have corroborated defendant’s testimony that the top was down on his convertible, contrary to the
victim’s assertion that the top was up). When the credibility of a witness is at issue, evidence of
prior consistent statements by the witness may have a bolstering effect. See State v. Jones, 125
Idaho 477, 488, 873 P.2d 122, 133 (1994), overruled on other grounds by State v. Montgomery,
163 Idaho 40, 408 P.3d 38 (2017); see also Cook v. State, 157 Idaho 775, 781, 339 P.3d 1179,
1185 (Ct. App. 2014) (applying Jones in the post-conviction context). Generally, any bolstering
effect, standing alone, is insufficient to show reversible error when the jury had an opportunity to
observe the witness. See Jones, 125 Idaho at 488, 873 P.2d at 133; see also Cook, 157 Idaho at
781, 339 P.3d at 1185 (applying Jones in the post-conviction context). Here, the CARES interview
bolstered the victim’s credibility by providing prior consistent statements. Because the jury
observed the child’s trial testimony, the bolstering effect is not sufficient to show reversible error
by itself. Nevertheless, the bolstering effect contributed to the probative force of the error.
       In addition, the CARES interview was admitted as an exhibit, which differentiates this case
from Jones and Cook. In those cases, the evidence at issue was trial testimony, not an exhibit that
went to jury deliberations. See Jones, 125 Idaho at 488, 873 P.2d at 133; Cook, 157 Idaho at 781,
339 P.3d 1185. Here, in contrast, the CARES interview was admitted into evidence. As the
Appellate Court of Illinois has observed, this “effectively put the [victim] in the jury room during
its deliberations where she could continually repeat her testimony.” People v. Sanders, 375 N.E.2d
921, 924 (Ill. App. Ct. 1978). Admitting the CARES interview into evidence, which gave the jury

                                                 18
the option to review the interview during deliberations,4 exacerbated the bolstering effect and
further added to the probative force of the error.
       The State asserts that, “if anything,” the admission of the CARES interview “was beneficial
to Roberts.” The State notes that Roberts’ counsel, during closing argument, attempted to show
an inconsistency between the child’s testimony and his statements during the CARES interview.
Specifically, Roberts’ counsel asserted that, at trial, the child testified that Roberts’ semen had “no
taste” but that, during the CARES interview, the child represented that “it tastes like pepper.” The
State asserts that this argument shows that the admission of the CARES interview benefited
Roberts. Yet, at the same time, the State maintains “there was no inconsistency” because the
CARES interview shows that the child represented that Roberts’ penis--not his semen--tasted like
pepper. As the State notes, there was no inconsistency and Roberts’ counsel inaccurately
recounted the record. But that did not benefit Roberts. The district court instructed the jury that
what counsel said during closing argument “is not evidence” and that, “if the facts as you
remember them differ from the way the lawyers have stated them, follow your memory.” The jury
is presumed to have followed this instruction. See State v. Hall, 163 Idaho 744, 807, 419 P.3d
1042, 1105 (2018).
       Regarding the probative force of the entire record while excluding the error, the State notes
that the child’s testimony regarding the sexual abuse was detailed, he alleged several times that
Roberts sexually abused him, the child “suffered physical symptoms” that “could not be diagnosed
at the time” but that the physician testified “were indicative of the sort of sexual abuse [the child]
had alleged,” the child had mental health symptoms that indicated sexual abuse, and the CARES
interview was “trained to notice indications that disclosures are fabricated” but “saw nothing to
indicate as much” in his disclosures. The State also notes that portions of the child’s testimony
were corroborated by other witnesses, including his testimony that he was often alone with Roberts
and the child’s first disclosure that he later recanted. The probative force of much of this evidence,
however, is diminished by the inconsistencies between the child’s testimony at trial and his
statements during the CARES interview. In addition, the physician’s testimony regarding the

4
       The CARES interview was entered as an exhibit at trial but the record does not indicate
whether or not the jury actually reviewed the CARES interview during deliberations.

                                                  19
child’s rectal bleeding is connected to information found only in the CARES interview and,
consequently, loses much of its probative force when the CARES interview is excluded from the
analysis. Weighing the probative force of the error against the probative force of the record as a
whole without the error, I cannot conclude beyond a reasonable doubt that the error did not
contribute to the jury’s verdict. Consequently, I would hold the error in admitting the recording
of the CARES interview was not harmless.

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