Court Opinion

ID: 9781071
Source: CourtListenerOpinion
Date Created: 2023-08-30 16:06:20.61445+00
Date Added: 2024-06-11T12:09:46.810742
License: Public Domain

IN THE COURT OF APPEALS OF IOWA

                                   No. 21-1319
                              Filed August 30, 2023

STATE OF IOWA,
     Plaintiff-Appellee,

vs.

DAVID DWIGHT JACKSON,
     Defendant-Appellant.
________________________________________________________________

      Appeal from the Iowa District Court for Polk County, Scott J. Beattie (motion

to suppress) and David M. Porter (trial), Judges.

      The defendant appeals evidentiary rulings and the denial of his motion for

a new trial. AFFIRMED.

      Gary Dickey of Dickey, Campbell, & Sahag Law Firm, PLC, Des Moines, for

appellant.

      Brenna Bird, Attorney General, and Bridget A. Chambers, Assistant

Attorney General, for appellee.

      Considered by Bower, C.J., and Tabor and Greer, JJ.
                                         2

GREER, Judge.

      Following a fatal accident, David Jackson was convicted of vehicular

homicide by operating while intoxicated (OWI), reckless driving, leaving the scene

of an accident resulting in death, and operating a motor vehicle without the owner’s

consent. On appeal, he argues the district court should have suppressed the

admission of a toxicology report obtained through the use of an inaccurate search

warrant application. He also argues the district court erred in denying his motion

for a new trial after allowing testimony regarding his medical records without a

waiver of his physician-patient privilege. We affirm the district court’s admission

of the toxicology report; we also hold the district court did not err in allowing

testimony about Jackson’s medical records under Iowa Code section 622.10

(2020) or the rule against hearsay, so affirm the admission of that testimony.

I. Facts and Prior Proceedings.

      On the evening of August 9, 2020, a Toyota Prius1 was being driven

southbound down a two-way, four-lane section of Martin Luther King Jr. Parkway

(MLK) in Des Moines when the driver, later identified as Jackson, veered into the

northbound lane. Eyewitnesses stated Jackson accelerated and crossed both

northbound lanes before colliding with Bounleua Lovan, who was driving a Polaris

Slingshot.2 The Slingshot hit a telephone pole, and the Prius went over the street’s

curb, through a parking lot, and eventually crashed into a building.3 One witness

went to the car to offer assistance and noticed Jackson appeared dazed and

1 It was later determined the Prius had been stolen, although not by Jackson.
2 A Slingshot is a motorized vehicle with two front wheels and one back wheel.
3 Lovan died from the injuries sustained.
                                          3

confused as he got out of the driver’s side door; Jackson then left the scene on

foot. Police Officer Christopher Latcham was told Jackson’s description and found

him sitting at a nearby senior living facility; Jackson and Officer Latcham

exchanged a few words before Jackson began to run away. Officer Latcham used

pepper spray and eventually apprehended Jackson, who was then handcuffed by

Officer Nathan Nemmers. Officer Nemmers testified that Jackson “had bloodshot,

watery eyes, seemed a little paranoid, had some erratic behavior, [and was]

sweating profusely,” which indicated to him that Jackson was under the influence

of either drugs or alcohol.

       Jackson was transported to the hospital. Officer Nemmers later went there

to conduct an OWI investigation. While he testified this would typically involve field

sobriety tests (FSTs), he found Jackson was “incoherent and unable to follow,

really, any commands or instructions. Just simply trying to talk to him before I

could get to [FSTs], it was clear that he wasn’t going to be able to perform the

[FSTs] as requested.” Officer Nemmers applied for a search warrant to collect a

blood sample for testing. But he modified a previously used warrant application

and did not delete the FST information already present on the computer form. The

warrant was subsequently granted, and after running the testing, Jackson’s blood

sample came back positive for methamphetamine and amphetamines.                  The

toxicology report showed the presence of methamphetamine at a level above the

therapeutic dosage.

       Jackson was charged with vehicular homicide by OWI, vehicular homicide

by reckless driving, theft in the second degree, leaving the scene of an accident

resulting in death, and operating a motor vehicle without the owner’s consent.
                                         4

Before trial, Jackson moved to suppress the admission of the toxicology report on

his blood sample because of the defect in the warrant application. The district

court denied the suppression motion.

       At trial, Jackson’s main defense was the accident occurred because he had

a medical condition that caused him to pass out at the wheel. He testified about

“black outs” he had before the accident and explained that, while driving down

MLK, he “started to have, like, tightness in my chest, my breathing became

restricted, and I passed out, blacked out at the wheel.” Offering more details,

Jackson went on to say he was admitted to the ICU, where “[his] heart rate had

dropped, was at thirty-four” and care providers were concerned his “heart [might]

stop again.”

       After Jackson testified about his medical condition, the State called Dale

Peterson in rebuttal to testify about the details in Jackson’s hospital records.

Peterson was the health services administrator at Polk County Jail, and he

oversaw all medical records for the jail. Jackson objected, arguing that testimony

about his medical records was hearsay and protected by HIPAA4 and he had not

waived those protections. The district court allowed the evidence to be introduced

at trial. Peterson testified that, after reviewing Jackson’s medical records from the

hospital, he believed Jackson’s “vital signs were stable and within normal limits,”

including his blood-oxygen level. The jail medical staff was not alerted to Jackson

having a history of blacking out. Upon his admission to the jail, Jackson was

4 HIPAA is the commonly used acronym for the Health Insurance Portability and

Accountability Act, Pub. L. 104–191, 101 Stat. 1936 (codified as amended in
scattered sections of 42 U.S.C.),
                                          5

placed on a detoxification program. But, on cross-examination, Peterson clarified

that he had not read all of the records and he could not pinpoint the timing of the

testing of Jackson’s vitals.

       The jury ultimately found Jackson guilty of vehicular homicide by OWI,

reckless driving, leaving the scene of an accident resulting in death, and operating

a motor vehicle without the owner’s consent.

       Before sentencing, Jackson moved for a new trial and in arrest of judgment.

He again pointed to Peterson’s testimony, arguing it contained information

protected by HIPAA and Iowa Code section 622.10, which provides:

              A practicing attorney, counselor, physician, surgeon,
       physician assistant, advanced registered nurse practitioner, mental
       health professional, or the stenographer or confidential clerk of any
       such person, who obtains information by reason of the person’s
       employment, or a member of the clergy shall not be allowed, in giving
       testimony, to disclose any confidential communication properly
       entrusted to the person in the person’s professional capacity, and
       necessary and proper to enable the person to discharge the
       functions of the person’s office according to the usual course of
       practice or discipline.

The district court, in an oral ruling denying the motion, explained that in the cases

Jackson pointed to dealing with section 622.10’s protections, the disclosure

occurred in the pretrial process. It stated

               From this Court’s point of view, if Mr. Jackson noticed a
       witness who was going to testify about his condition, under the
       discovery rules, and particularly the reciprocal discovery agreement,
       that both parties signed on October 14, 2020, Mr. Jackson, as part
       of that discovery agreement, would have to turn over those records,
       because the State would then be entitled to the documents or
       records underlying that witness’ testimony.
               What Mr. Jackson did here was not call a witness to testify
       about his medical condition. Mr. Jackson himself talked about his
       medical condition. He talked about his blood pressure. He talked
       about whether his heart was going to stop again. He talked about
       the drugs that were in his system, both on that day and the days and
                                          6

       weeks preceding that incident. He talked about the effects of the
       pepper spray. He talked about a whole host of issues regarding his
       condition on the day the event occurred.
               Once he testifies about his condition, he absolutely opens the
       door for access to records that either support or refute that position.
       Effectively, what Mr. Jackson wants to do in Count II of the motion in
       arrest of judgment and motion for new trial is use chapter 622 both
       as a sword and a shield. He cannot do both.
               Once Mr. Jackson talked about his condition, the State was
       entitled to produce evidence and obtain evidence that refuted that
       position. . . . Mr. Jackson was entitled to the protection of privilege,
       and because he opened the door for it, those records were fair game.

       Jackson appeals.

II. Analysis.

       Jackson asks our court to grant him a new trial based on the admission of

(1) the results of the toxicology report and (2) Peterson’s testimony regarding

Jackson’s medical records.

       A. Toxicology Report.

       Jackson argues the district court should have suppressed the results of the

blood test obtained after the district court granted a search warrant application that

contained inaccurate information.5 The framework for Jackson’s claim, known as

a veracity claim, comes from Franks v. Delaware, 438 U.S. 154, 155–56 (1978);

Iowa courts adopted the Franks standard in State v. Groff, 323 N.W.2d 204, 206–

08 (Iowa 1982). Under the Franks standard, “a defendant [can] challenge the

veracity of an affidavit by showing that the affiant: (1) intentionally and knowingly

5 Our review focuses only on the FST information. On appeal, Jackson also argues

the warrant application omitted material facts by noting his bloodshot eyes but not
that he had been pepper sprayed. Because he did not make this argument to the
district court, it is not preserved for our review. See Meier v. Senecaut, 641 N.W.2d
532, 537 (Iowa 2002) (“It is a fundamental doctrine of appellate review that issues
must ordinarily be both raised and decided by the district court before we will
decide them on appeal.”).
                                           7

made a false statement, or (2) made a false statement with reckless disregard for

the truth.”   Groff, 323 N.W.2d at 207.        As our supreme court explained this

limitation,

       [t]he exclusionary rule “is not calculated to redress the injury to the
       privacy of the victim of the search and seizure.” Rather, its purpose
       is to deter constitutionally violative police conduct. When a police
       officer through negligence or innocent mistake includes a false
       statement in a search warrant affidavit, little deterrent function is
       served by invalidating the warrant and suppressing the evidence.

Id. (internal citations omitted). “Allegations of negligence or mistake are insufficient

to sustain an assault on the warrant.” State v. Niehaus, 452 N.W.2d 184, 187

(Iowa 1990). We review the claim de novo. Id.

       Jackson argues Officer Nemmers acted with a reckless disregard for the

truth by “just kind of flippantly not going through his affidavit . . . . [N]ot

proofreading that document [was] reckless.” In the past, courts have found an

affiant showed a reckless disregard for the truth when a defendant “show[ed]

directly that the affiant had serious doubts as to the veracity of an informant’s

statement” or by showing “an inference ‘from circumstances evincing “obvious

reasons to doubt the veracity” of the allegations.’” Id.

       Here, describing his actions as an “oversight,” Officer Nemmers testified

that he mistakenly left the FST information from a previously submitted application

in the current warrant application because he did not proofread it. The district

court, in ruling on Jackson’s Franks challenge, described it as “a scrivener’s error

(albeit a significant one).” While we agree with Jackson that this was more than

simply transposing numbers and we urge law enforcement officers to exercise

greater care in preparing their search warrant applications, Jackson has not
                                         8

established that the error was more than negligence or that Officer Nemmers

engaged in some kind of intentional act when filling out the application. See State

v. Baker, 925 N.W.2d 602, 614 (Iowa 2019) (“[The defendant] bears the burden of

proving that officers made materially false statements in the affidavit either

deliberately or with a reckless disregard for the truth.”). And, as Officer Nemmers

testified, the information presented on the warrant application, even without the

mistaken FST detail, still supported a finding of probable cause. See id. at 616

(noting an officer is only required to present the information supporting a probable

cause finding). Here, we conclude the grant of the warrant had a substantial basis

under the totality of circumstances that were accurate in the warrant application.

See State v. Bracy, 971 N.W.2d 563, 564 (Iowa 2022). Thus, on our de novo

review, we affirm the district court’s determination that this mistake did not meet

the Franks test requirements and even if we excised the admittedly incorrect

details, the other information in the affidavit supports a probable cause finding.

       B. Medical Record Testimony.

       Next, Jackson argues the district court erroneously allowed Peterson’s6

testimony about his medical information because it was both confidential and

hearsay. “We review the trial court’s interpretation of section 622.10 for errors of

law.” State v. Deases, 518 N.W.2d 784, 787 (Iowa 1994). We also “review rulings

on hearsay for the correction of legal error.” State v. Veverka, 938 N.W.2d 197,

202 (Iowa 2020).

6 Neither party contests that Peterson was bound by the requirements of
section 622.10.
                                           9

       i. Physician-Patient Privilege.

       Jackson argues his medical records were protected by HIPAA and the

testimony about the records was inadmissible because of Iowa Code

section 622.10. If a state law provides less stringent protection than HIPAA,

HIPAA supersedes and preempts that state law. 42 U.S.C. § 1320d–7(a)(1).

       As our supreme court has discussed before:

              Under HIPAA regulations, a covered entity generally is not
       permitted to use or disclose protected health information. 45 C.F.R.
       § 164.502(a)(1)(i-ii).   The federal rule is subject to several
       exceptions, including a broad exception for disclosures in judicial and
       administrative proceedings. 45 C.F.R. § 164.512(e). The judicial
       exception allows a covered entity to disclose any protected health
       information either in response to a court order or a subpoena. Id.

In re A.M., 856 N.W.2d 365, 379 (Iowa 2014). Pointing specifically to Iowa Code

section 622.10, the supreme court determined Iowa law was more protective than

HIPAA. Id. So, we can limit our analysis to section 622.10.

       a. Error Preservation. We begin with the State’s argument that Jackson did

not preserve error on his argument that the evidence was inadmissible because of

section 622.10. Before Peterson testified, Jackson objected to the testimony

outside of the presence of the jury; when asked by the district court to clarify exactly

what the objections were, Jackson responded

               I would raise the HIPAA violation. I would also raise hearsay
       violation. I would also raise this is not the best evidence, and this is
       not the witness to attest to what exactly is in the Broadlawns medical
       records. We’re lacking context.
               I also think that Mr. Peterson is not a competent witness to
       testify to the actions of a treating physician and what the—what’s in
       those actual reports. That would—those would be the issues that I
       would raise.
                                         10

       In the motion in arrest of judgment and for a new trial, however, Jackson

cited—for the first time—Iowa Code section 622.10. Generally a “[m]otion for a

new trial ordinarily is not sufficient to preserve error where proper objections were

not made at trial.” State v. Seltzer, 288 N.W.2d 557, 559 (Iowa 1980); see also

Mitchell v. Cedar Rapids Cmty. Sch. Dist., 832 N.W.2d 689, 695 (Iowa 2013) (“It is

well-settled that a party fails to preserve error on new arguments or theories raised

for the first time in a posttrial motion.”). But “error preservation does not turn on

‘hypertechnical’ challenges” or “on the thoroughness of counsel’s research and

briefing so long as the nature of the error has been timely brought to the attention

of the district court.” Segura v. State, 889 N.W.2d 215, 219 (Iowa 2017) (citations

omitted); Top of Iowa Co-op. v. Sime Farms, Inc., 608 N.W.2d 454, 470 (Iowa

2000) (“[O]ne purpose of our error preservation rules is to ensure that the opposing

party and the district court are alerted to an issue at a time when corrective action

can be taken or another alternative pursued.” (citation omitted)); State v. Williams,

695 N.W.2d 23, 27 (Iowa 2005) (“[W]e recognize an exception to the general error-

preservation rule when the record indicates that the grounds for a motion were

obvious and understood by the trial court and counsel.”).

       And while Jackson recognized, during the hearing on the motion, that his

section 622.10 claim is not synonymous with the HIPAA objection he actually

made, the State agreed at that hearing that it “[thought] everybody in the courtroom

understood what [Jackson] was saying when [he] raised the HIPAA objection,

which I think has become kind of the colloquial way of claiming privilege in all

medical matters. So I don’t dispute that [he]—I believe that [he] properly raised

the issue.” Moreover, the district court’s oral ruling on the motion referenced two
                                           11

cases, both of which focused on section 622.10. Because Jackson raised the

issue to the district court and it was ruled on, see Meier, 641 N.W.2d at 537, we

find error was preserved and turn to the substantive argument.

       b. Section 622.10. Arguing that a panel of this court decided a nearly-

identical case in the defendant’s favor, Jackson asks us to follow State v. Roling,

Nos. 0-710, 99-1774, 2001 WL 98935 (Iowa Ct. App. Feb. 7, 2001) and remand

for a new trial because of the trial court’s error in admitting Peterson’s testimony

about Jackson’s medical condition.          To counter, the State notes that an

unpublished opinion is not binding authority and urges that Roling’s reasoning is

not sound. See Iowa R. App. P. 6.904(2)(c). More pointedly, the State argues

Jackson waived any privilege by raising his medical condition as a defense at trial.

See State v. Pepples, 250 N.W.2d 390, 393–94 (Iowa 1977) (“The rule in Iowa is

that when one party introduces inadmissible evidence, with or without objection,

the trial court has discretion to allow the adversary to offer otherwise inadmissible

evidence on the same subject when it is fairly responsive.” (citation omitted)). So,

first, we must address the application of the statute that governs medical

information disclosure to see how it plays with the general rule of waiver. Harder

v. Anderson, Arnold, Dickey, Jensen, Gullickson & Sanger, L.L.P., 764 N.W.2d

534, 537 (Iowa 2009) (“Section 622.10 of the Code is the statutory rule for the

testimonial aspect of the [physician-patient] privilege in a litigation setting.”).

       We first note that the legislature confirmed “the prohibition [in section

622.10(1)] does not apply to cases where the person in whose favor the prohibition

is made waives the rights conferred . . . .”       Iowa Code § 622.10(2).        So, did

Jackson waive his privilege to keep his medical information private and is the
                                        12

district court correct that Jackson “opened the door” with his testimony about his

health? See Pepples, 250 N.W.2d at 393–94 (noting that testimony solicited on

direct examination can open the door to allow responsive inadmissible testimony).

      Following Jackson’s lead, we examine Roling. In Roling, the “[d]efendant

was charged following a three-vehicle accident where the pickup he was driving

crossed the centerline sideswiping a passenger car and forcing it off the road. The

defendant next collided nearly head-on with a limousine.” 2001 WL 98935, at *1.

The defendant testified he had six to eight beers the night of the accident. Id. As

a part of his defense, the “defendant testified he was seeking medical help for

sleep apnea, and he was unaware of the condition before the accident.” Id. at *3

(footnote omitted). At trial, the state sought to enter Roling’s hospital records,

which showed his blood alcohol content, “to impeach his testimony that he only

had six or eight beers,” and the district court admitted the medical records. Id. at

*2.   On appeal, the defendant argued the evidence violated Iowa Code

section 622.10,7 while the state maintained the defendant’s testimony about his

sleep-apnea treatment “opened the door to the evidence” and “privilege should be

waived whenever a defendant puts his medical condition in issue as a defense to

a charged crime.” Id. at *3.

      In Roling, our court concluded the district court erred in admitting the

defendant’s medical records. Id. at *4.8 In doing so, we recognized that while

“[t]he prohibition [against the admission of privileged information] does not

7 While Roling utilized an older version of the Code, the relevant parts remain

unchanged.
8 Even though we concluded the court erred, the defendant failed to show he was

prejudiced by the admission of the records, so we affirmed.
                                         13

apply . . . in a civil action in which the condition of the person in whose favor the

prohibition is made is an element or factor of the claim,” there was no comparable

language in the statute for criminal actions. Id. (citing Iowa Code § 622.10).

       But we are not persuaded Roling controls our analysis here. First, unlike

the situation here, in Roling the records were not sought to dispute a medical

condition; the State sought their admission to bolster the State’s proof of

intoxication. We understand Roling to address a general “opening of the door” to

seek admission of medical records for any purpose (i.e. disputing the level of

sobriety), rather than a specific attack on a condition raised by the defendant as a

defense (i.e. sleep apnea). In Roling the district court said the medical records

“were admitted not to prove the defendant’s blood alcohol was at a certain level,

but rather because the medical records contained evidence differing from the

defendant’s testimony as to his sobriety,” thus, the records were not used to rebut

the sleep apnea claim but rather to impeach the defendant’s testimony as to how

many beers he consumed. Id. at *2. But here, the State sought admission of the

medical records to directly dispute the medical condition Jackson maintained as a

defense. And Jackson placed his condition at issue. See 1 Kenneth S. Broun et

al., McCormick on Evidence § 103, at 384 (4th ed. 1992) (providing that policy

considerations support a finding of waiver when the patient has voluntarily placed

his condition in issue in a judicial proceeding); 8 J. Wigmore, Evidence § 2388, at

855 (1961) (providing that waiver may occur when the conduct places the claimant

in such position, with reference to the evidence, that it would be unfair and

inconsistent to permit retention of the privilege). And to the extent Roling, an

unpublished case, conflicts with other legal authority, we are required to follow
                                            14

published cases. See Iowa R. App. P. 6.904(2)(c) (“Unpublished opinions or

decisions shall not constitute controlling legal authority.”); see also Webster v.

State, No. 17-0539, 2018 WL 3873411, at *2 n.4 (Iowa Ct. App. Aug. 15, 2018)

(relying on Iowa Rule of Appellate Procedure 6.904 and concluding “a published

opinion . . . is controlling legal authority”).     In that vein, we find Rieflin more

dispositive. See State v. Rieflin, 558 N.W.2d 149, 154 (Iowa 1996), overruled on

other grounds by State v. Lyman, 776 N.W.2d 865 (Iowa 2010). Although Rieflin

addressed the waiver of the physician-patient privilege when a defendant gives

notice of the intent to rely on the defense of insanity or diminished responsibility,

the reasoning is applicable here:

       We believe the defense of diminished capacity waived the privilege
       here, even if it had existed, for the simple reason it would be
       incongruous to allow a party to put a matter in issue and then deny
       access of an opposing party to relevant information concerning it.
       Our modern concept of criminal trials favors full disclosure of facts,
       within constitutional limitations, on both sides of the table . . . . Even
       the most restrictive authorities would say [defendant] would have
       waived the privilege by introducing evidence on it . . . .

Id. (alterations in original) (citation omitted).

       We acknowledge that “[t]he rules of privilege . . . are not designed to

facilitate the fact-finding process.” Chung v. Legacy Corp., 548 N.W.2d 147, 148

(Iowa 1996). “The physician-patient privilege is intended to promote free and full

communication between a patient and his doctor so that the doctor will have the

information necessary to competently diagnose and treat the patient,” and “[w]e

construe [section 622.10] liberally to carry out its manifest purpose.” Deases, 518

N.W.2d at 787. But here, protecting the disclosure of his medical records was

controlled by Jackson, who could have kept his medical condition out of the trial.
                                           15

And, given Jackson’s insertion of his medical condition into the trial during his

direct examination, we agree with the district court and its interpretation that the

privilege under section 622.10 was waived so that the State could directly rebut

that medical claim. See State v. Hardin, 569 N.W.2d 517, 520 (Iowa Ct. App. 1997)

(noting the privilege is not “designed as a shield” to conceal patient information);

but see State v. Leedom, 938 N.W.2d 177, 189–90 (Iowa 2020) (noting medical

details disclosed through cross-examination would not result in a waiver of the

privilege). We find Peterson’s testimony concerning the medical records that

summarized the condition of Jackson was not barred by section 622.10.

       ii. Hearsay.

       We turn next to Jackson’s argument that Peterson’s testimony about

statements contained in Jackson’s medical records is hearsay. Hearsay is a

statement “[t]he declarant does not make while testifying at the current trial or

hearing” that is “offered into evidence to prove the truth of the matter asserted in

the statement” and is typically not admissible. Iowa Rs. Evid. 5.801(c), .802.

       Peterson testified that when an individual is taken to the hospital in between

arrest and incarceration and then discharged from the hospital directly to the jail,

the hospital will send the individual’s medical records to the jail, which the jail keeps

in the regular course of its business. When the individual arrives at the jail, jail

personnel do their own medical intake, which includes taking vitals. Providing

more detail, Peterson also testified that if “a patient states daily use or use of

opioids or alcohol more than one to five days a week, [the jail] start[s] them on [an

alcohol and opioid detoxification program].” Peterson also testified that, in his

professional role, he was the custodian of those records. During his testimony
                                          16

about Jackson’s medical records, he explained that (1) Jackson’s discharge

documents showed no concerns about his breathing; (2) his medical records

reflected his vitals were “stable and within normal limits”; (3) the records did not

reflect that Jackson had a history of blacking out; (4) Jackson was initially admitted

to the hospital for polysubstance use, rhabdomyolysis,9 and a motor vehicle

accident; and (5) at some point after the initial medical screening at the jail,

Jackson was placed on a detoxification program.           During cross-examination,

Peterson clarified he had only looked at—and was only testifying about—

Jackson’s paperwork from when he discharged from the hospital, not the records

for his whole stay at the hospital. He explained that discharge paperwork reflects

“what [the defendant] [was] treated for at the hospital. It will also show follow-up

appointments that are necessary.        It will also show any current medications

prescribed from that appointment.”        When asked, Peterson stated that the

discharge paperwork did not show any vitals.

       It is well established that hospital records are hearsay if offered to prove the

truth of the matter asserted. Madison v. Colby, 348 N.W.2d 202, 204 (Iowa 1984).

But, with the proper foundation, they can fall into one of the established exclusions

from or exceptions to the rule against hearsay. See State v. Buelow, 951 N.W.2d

879, 884-85 (Iowa 2020). Here, the district court held the testimony was not

hearsay because it was not offered for its truth but instead to show the jail’s

“subsequent course of conduct” for Jackson’s treatment. In the alternative, the

district court held the statements were admissible as describing Jackson’s then-

9 Peterson defined rhabdomyolysis as “damage of the muscular system typically

during a state of dehydration.”
                                          17

existing mental, emotional, or physical condition. See Iowa R. Evid. 5.803(3).

Jackson challenges both parts of the district court’s hearsay ruling.

       We agree with the district court that the evidence was not inadmissible

hearsay, but for other reasons. See State v. Smith, 876 N.W.2d 180, 184 (Iowa

2016) (“[W]e recognize we may affirm a ruling on the admission of evidence by

using a different rationale than relied on by the district court.”) As for the district

court’s rulings, the jail’s treatment of Jackson was not relevant to the case, which

is best demonstrated by how the State went on to use the evidence during closing

statements:

                 [Jackson] tells you, “I didn’t know I took meth.” He tells you,
       “I had—when I was admitted to the hospital, I couldn’t breathe. I had
       a heart rate of thirty-four,” but Mr. Peterson had the records, the
       records that the defendant couldn’t produce, wouldn’t produce. Mr.
       Peterson had the records that said when he was admitted to the
       hospital, his oxygen level was 98[%].[10] When your oxygen level is
       almost perfect, you don’t have a problem breathing. His vital signs
       were all stable and normal when he was admitted.
                 He was admitted for polysubstance abuse. He was admitted
       for . . . his diagnosis for his dehydration. He was admitted for motor
       vehicle accident. Then, when he was admitted into the jail, by his
       self-report, he was put into a detox program, but he tells you all he
       wasn’t under the influence of anything.

Cf. McElroy v. State, 637 N.W.2d 488, 502 (Iowa 2001) (noting even if hearsay

evidence is admitted to show responsive conduct and not for its truth, “the court

must limit its scope to that needed to achieve its purpose”). Looking next to the

exception the district court cited, we are also unable to affirm on that ground

because it only applies when the statement is about the declarant’s then-existing

10 This overstates Peterson’s actual testimony—Peterson testified the defendant’s

oxygen level was 98%, but he never gave a time period for when that vital was
taken so there was no evidence whether it was during Jackson’s hospital stay or
when his vitals were taken at the jail.
                                         18

mental, emotional, or physical condition—but, while the statements objected to

here are about Jackson’s diagnosis and observed condition, Jackson is not the

declarant, and so the exception cannot apply. See Iowa R. Evid. 5.803(3).

       Still, “[w]e may affirm admission of evidence if it was properly admissible on

any ground.” State v. Fontenot, 958 N.W.2d 549, 556 (Iowa 2021). The records

are admissible under rule 5.803(6), the business record exception, which allows:

       A record of an act, event, condition, opinion, or diagnosis if:
               (A) The record was made at or near the time by—or from
       information transmitted by—someone with knowledge;
               (B) The record was kept in the course of a regularly conducted
       activity of a business, organization, occupation, or calling, whether
       or not for profit;
               (C) Making the record was a regular practice of that activity;
               (D) All these conditions are shown by the testimony of the
       custodian or another qualified witness, or by a certification that
       complies with rule 5.902(11) or rule 5.902(12) or with a statute
       permitting certification; and
               (E) The opponent does not show that the source of
       information or the method or circumstances of preparation indicate a
       lack of trustworthiness.

       And here, Peterson testified that he is the custodian of the jail’s medical

records. He also testified that the medical records he reviewed were transmitted

from the hospital to the jail at the time of Jackson’s hospital discharge containing

information about Jackson’s condition at that time and the records from the initial

medical screening conducted by jail staff at the time of Jackson’s intake at the jail.

According to Peterson’s testimony, the records are kept as a part of the regular

business of the jail and the record was made as a regular practice of the jail for

those who need medical care after an arrest. With the appropriate foundation laid,

the exception to hearsay found in rule 5.803(6) applies. See State v. Musser, 721

N.W.2d 734, 750-52 (Iowa 2006) (addressing the proper foundation to admit lab
                                          19

reports under the business record exception). Because the evidence was properly

admissible under this ground, we find no error.

III. Conclusion.

       The district court correctly allowed the results of Jackson’s toxicology report

into evidence.     And because Peterson’s testimony about Jackson’s medical

records was not prohibited by Iowa Code section 622.10 once Jackson opened the

door and was admissible as an exception to the rule against hearsay, we affirm

the district court’s admission of both.

       AFFIRMED.