Court Opinion

ID: 9716574
Source: CourtListenerOpinion
Date Created: 2023-08-26 06:44:24.326428+00
Date Added: 2024-06-11T18:23:46.905518
License: Public Domain

Liacos, C.J.
(dissenting). The hospital record at issue contains second-level hearsay for which no exception to the rule against hearsay exists. It therefore should not have been admitted in evidence. I dissent.
General Laws c. 233, § 79 (1990 ed.), provides an exception to the hearsay rule for certain hospital records.1 In *690Bouchie v. Murray, 376 Mass. 524, 531 (1978), the court established a four-part test to determine when hospital records are admissible under § 79:
“First, the document must be the type of record contemplated by G. L. c. 233, § 79. Second, the information must be germane to the patient’s treatment or medical history. Third, the information must be recorded from the personal knowledge of the entrant or from a compilation of the personal knowledge of those who are under a medical obligation to transmit such information. Fourth, voluntary statements of third persons appearing in the record are not admissible unless they are offered for reasons other than to prove the truth of the matter contained therein or, if offered for their truth, come within another exception to the hearsay rule or the general principles discussed [earlier in the opinion].” (Citation omitted.)2
Parts three and four of the Bouchie test recognize that hospital records may raise problems of “totempole” or multiple hearsay. See P.J. Liacos, Massachusetts Evidence 334 (5th ed. 1981 & Supp. 1985). If the record contains the personal knowledge of the recorder, it is simply hearsay — an out-of-court statement by the recorder offered to prove the truth of the matter asserted. If the record contains information that someone conveyed to the recorder, it contains two *691levels of hearsay: the first level is the recorder’s out-of-court statement (i.e., the record), and the second level is the content of the record, that is, the out-of-court statement made to the recorder by the person who conveyed the information. Under parts three and four of the test, Bouchie, supra at 531, information in the record that was conveyed to the recorder by a third party is inadmissible unless: (1) the information consists of “personal knowledge of those who are under a medical obligation to transmit such information” to the recorder;3 (2) the third party’s statement falls within some other exception to the hearsay rule; or (3) the statement is not offered for its truth.4
The record in the instant case contains both first and second-level hearsay: Dr. Rubin recorded that someone told him that the child’s epiglottal culture was normal at Symmes Hospital.5 The court holds that the record is admissible be*692cause it meets the first of the three conditions for the admissibility of second-level hearsay:6 “Dr. Rubin received the Symmes Hospital information from someone, or from a report prepared by someone, on Symmes Hospital’s medical staff who either personally treated the child . . . , and therefore had an obligation to transmit that information to Dr. Rubin, the recorder - at Children’s Hospital, when the child was transferred.” Ante at 686. The court notes that the record was made contemporaneously with the transfer of the patient, when a transferring hospital routinely transmits patient information to a receiving hospital, and that the record contains large amounts of technical medical history that would be available (and comprehensible) only to someone familiar with patient treatment. Furthermore, the court notes that Children’s Hospital itself relied on the information provided. While the identity of the person who gave the information to Dr. Rubin is unknown,7 the court holds that this lack of identification goes to the weight, not to the admissibility, of the record.
The court has understated the importance of ascertaining the identity of the person who supplied the information to Dr. Rubin. In this respect, the court’s reliance on Commonwealth v. Franks, 359 Mass. 577 (1971), is misplaced. In Franks, the identity of the recorder was unknown, but because there was evidence that the record in question was a routine hospital report, it was held admissible. See id. at 580. In the instant case, however, the identity of the recorder is known (Dr. Rubin), but the identity of the person who reported to him is not. That is, we know the identity of the declarant of first-level hearsay, but we do not know the iden*693tity of the declarant of second-level hearsay. Franks is therefore inapplicable to the instant case.8 At the second level of hearsay, unlike the first, some knowledge of identity is essential to determine admissibility.9 In the instant case, the court must determine whether the person who reported to Dr. Rubin had personal knowledge of the epiglottal culture and whether he or she had an obligation to report to Children’s Hospital.
The defendant did not meet his burden of proving that the information recorded by Dr. Rubin came from a reliable source, namely a person under an obligation to record truthfully what was personally known to that person. It is reasonable to assume, as the court does, that the information in the record came from a Symmes Hospital employee, and that the information was transferred during the routine transportation of a patient. Nevertheless, it remains unclear how the person at Symmes Hospital obtained the information.10 The defendant, as the proponent of this evidence, had the burden of proving that the individual at Symmes Hospital either had personal knowledge of the epiglottal culture or received information from those “under a medical obligation to transmit such information,” Bouchie, supra at 531. See Commonwealth v. Dunne, 394 Mass. 10, 16 (1985). The defendant did not have to identify each individual in the chain of communication, see Wingate v. Emery Air Freight Corp., 385 *694Mass. 402, 406 (1982), but he had to show that the chain was routine and reliable. See Dolan v. Commonwealth, 25 Mass. App. Ct. 564, 567 (1988) (hospital record inadmissible because source of information therein not proven reliable).11 Given the mystery surrounding the origins of the epiglottal culture results, see note 9, supra, the defendant did not meet his burden. The hospital record was not admissible as evidence. I dissent.12

"Records kept by hospitals . . . under [G. L. c. 111, § 70] shall be admissible, and records which the court finds are required to be kept by the laws of any other state [or the United States], by hospitals . . . may be admitted by the court, in its discretion, as evidence ... so far as such records relate to the treatment and medical history of such cases . . . but *690nothing therein contained shall be admissible as evidence which has reference to the question of liability.” G. L. c. 233, § 79.
“[T]he purpose of the statute [is] to admit presumptively reliable evidence without the necessity of calling numerous hospital personnel as witnesses.” Bouchie v. Murray, 376 Mass. 524, 528 (1978). “This presumption of reliability of the information contained in hospital records arises primarily from the fact that entries in these records are routinely made by those charged with the responsibility of making accurate entries and are relied on in the course of treating patients.” Id.
Unless the records are so technical as to be unintelligible without further explanation, they are admissible without testimonial corroboration. Commonwealth v. Copeland, 375 Mass. 438, 442 (1978).

The fulfilment of the first and second parts of the test is not at issue.

The court has drawn an analogy to the business records exception to the hearsay rule. See G. L. c. 233, § 78 (1990 ed.). “The [recorder’s] hearsay sources must carry the same indicia of reliability, arising from regularity and business motives, that bring his own act of recording the information within the statutory exception. Thus, unless statements on which the [recorder] relies fall within some other exception to the hearsay rule, the proponent must show that all persons in the chain of communication, from the observer to the [recorder], reported the information as a matter of business duty or business routine. . . . Ordinarily this can, of course, be accomplished by presenting evidence of normal business practice, with no need to produce each speaker.” (Citations omitted.) Wingate v. Emery Air Freight Corp., 385 Mass. 402, 406 (1982) (§ 78 case). See Commonwealth v. McDonough, 400 Mass. 639, 643 n.8 (1987) (§ 79 case referring to Wingate).

The fourth part of the Bouchie test is that “voluntary statements of third persons appearing in the record are not admissible unless they . . . come within another exception to the hearsay rule or the general principles discussed supra” (emphasis added). Bouchie, supra at 531. While this language might seem to open other avenues for the admission of second-level hearsay, the Bouchie test has been read to require an exception to the hearsay rule for each level of hearsay contained in the record. See, e.g., P.J. Liacos, Massachusetts Evidence 334 (5th ed. 1981 & Supp. 1985); see also the views expressed by Justice Greaney in Comment, Evidence — Hospital Records Exception to the Hearsay Rule — Medical History and Treatment — Second Level Hearsay, 64 Mass. L. Rev. 33, 34-35 (1979). See also Bouchie, supra at 528-529.

“At Symmes Hosp. ER . . . epiglottal Cx. . . . imp was nl. epiglottis.”

The information within the record does not fall under any other exception to the hearsay rule, and it was offered to prove the truth of the matter asserted.

As the Appeals Court noted, the source of Dr. Rubin’s note was never explained. See Doyle v. Dong, 30 Mass. App. Ct. 743, 747 (1991). The attending physician at Symmes Hospital testified that he had not given the information to anyone at Children’s Hospital, and the physician who helped resuscitate the child could not recall his observations of the epiglottis. Id. at 747 n.8.

Similarly, the court’s quotation from P.J. Liacos, supra at 334, see ante at 687, refers to a passage discussing the identity of the “maker of the record.”

That is, knowledge of identity is essential unless the recorder received information from hospital records meeting the Bouchie requirements. In such a case, as in Franks, supra, the second-level hearsay would fall under an established exception to the hearsay rule, namely § 79, and would be admissible. The defendant in the instant case offered no evidence that Dr. Rubin received his information from a Symmes Hospital record. See Commonwealth v. Dunne, 394 Mass. 10, 16 (1985) (proponent of evidence bears burden of proving admissibility). He therefore cannot rely on a Franks argument.

That is, it is not established that the “information [came] from someone . . . who . . . personally treated the child” (emphasis added). See ante at 686.

I believe that the United States Court of Appeals for the First Circuit has interpreted § 79 correctly. In Ricciardi v. Children’s Hosp. Medical Ctr., 811 F.2d 18 (1st Cir. 1987), the plaintiff sought to introduce a note from his medical record suggesting the occurrence of a problem during his surgery. The information was written in medical shorthand and clearly came from someone familiar with the surgery, but the recorder did not have personal knowledge of the incident and the person who conveyed the information to the recorder was unidentified. The court held that the note contained inadmissible hearsay. See id. at 22.

The defendant has argued that, even if the record was inadmissible, its admission in evidence was harmless error. The court does not reach this issue. I would hold that the admission of the record was not harmless error, for essentially the reasons offered in the opinion of the Appeals Court. See Doyle, 30 Mass. App. Ct. at 749, and cases cited (“Because the note [in the hospital records] was the only evidence that the epiglottis was normal and not red and swollen, and because the defense employed the damaging notation often and to effect, we cannot say that its admission was harmless”).