Court Opinion

ID: 9488385
Source: CourtListenerOpinion
Date Created: 2023-08-05 12:43:33.959654+00
Date Added: 2024-06-11T17:52:51.078863
License: Public Domain

HOLLOWAY, Circuit Judge,
concurring and dissenting:
I concur fully in the majority’s well-reasoned analysis of the testimony of Kae Eck-lebarger, Lisa Rocha, and Beverly Padilla and agree that the out-of-court statements made by A.T. to these witnesses were inadmissible hearsay. I also agree that the erroneous admission of these statements through the testimony of Ecklebarger, Rocha, and Padilla was not harmless and that therefore defendant Tome is entitled to a new trial.
However, I disagree with the majority’s conclusion that A.T.’s out-of-court statements *1456to Drs. Kuper, Reich, and Spiegel were admissible under Fed.R.Evid. 803(4). In United States v. Joe, 8 F.3d 1488, 1493 (10th Cir.1993), cert. denied, — U.S. -, 114 S.Ct. 1236, 127 L.Ed.2d 579 (1994), we said “[t]he Rule 803(4) exception to the hearsay rule is founded on a theory of reliability that emanates from the patient’s own selfish motive — her understanding ‘that the effectiveness of the treatment received will depend upon the accuracy of the information provided to the physician.’ 2 McCormick on Evidence, § 277, at 246-47 (John W. Strong ed., 4th ed. 1992).” (Emphasis added.) It is the patient’s self-interest in furnishing accurate information which provides the guarantee of trustworthiness which justifies excepting these types of out-of-court statements from the general bar on the admission of hearsay. See White v. Illinois, 502 U.S. 346, 356, 112 S.Ct. 736, 743, 116 L.Ed.2d 848 (1992) (“a statement made in the course of procuring medical services, where the declarant knows that a false statement may cause misdiagnosis or mistreatment, carries special guarantees of credibility that a trier of fact may not think replicated by courtroom testimony.” (Emphasis added.)). Thus, unless the declar-ant appreciates the fact that giving truthful information is necessary to ensure proper treatment or diagnosis, there is no guarantee of trustworthiness justifying the admission of the statement under Rule 803(4).
In United States v. White, 11 F.3d 1446 (8th Cir.1993), the defendant was convicted of sexually abusing his wife’s two grandsons, R.H. and L.H., who were nine and seven years old respectively at the time of defendant’s trial. On appeal, the defendant argued that statements made by R.H. to a social worker were not admissible under 803(4). The court noted that in order for the statements to be admitted under 803(4) the government “must show that R.H. understood that he was speaking to a trained professional for the purposes of obtaining diagnosis of, or providing treatment for, emotional or psychological injuries.” 11 F.3d at 1449. The court concluded “[tjhere is nothing in the record to suggest that R.H. appreciated that it was in his best interests to tell the truth and was therefore unlikely to lie.” Id. at 1450. “How [the social worker] explained her role and purpose to R.H., how she asked him questions, and how and where she conducted the interview are matters that can provide evidence ‘that the child understood the physician’s [or therapist’s] role in order to trigger the motivation to provide truthful information.’ ” Id., quoting United States v. Barrett, 8 F.3d 1296, 1300 (8th Cir.1993).1
The court in White also relied on Ring v. Erickson, 983 F.2d 818 (8th Cir.1992), a ha-beas case which held that the admission at trial, under Minn.R.Evid. 803(4),2 of out-of-court statements made by a three year old child, C.R., to a physician violated the petitioner’s confrontation rights. In so holding, the Eighth Circuit said:
C.R.’s mother, not C.R., sought the “medical treatment,” and there was no evidence suggesting that at the time of the interview C.R. even knew Dr. Levitt was a doctor. C.R. was three years old at the time. The principal reason why 803(4) is a traditional hearsay exception automatically carrying the indieia-of-reliability label is because of the selfish-motive doctrine. This exception is based on the belief that a person seeking medical treatment is unlikely to he to a doctor she wants to treat her, since it is in her best interest to tell the truth. White [v. Illinois], [502] U.S. at [354]—[58], 112 S.Ct. at 742-43.
983 F.2d at 820.3
Here the majority opinion correctly notes that the exception of Rule 803(4) “is prem*1457ised on the theory that a patient’s statements to her physician are likely to be particularly reliable because the patient has a self-interested motive to be truthful: She knows that the efficacy of her medical treatment depends upon the accuracy of the information provided to the doctor.” Majority Opinion at 1449, citing Joe. The majority thus appropriately recognizes the selfish treatment interest rationale supporting the exception. However, without proof that A.T. had such knowledge, the guarantee of trustworthiness disappears, and the statement then stands on no more rehable grounds than any other hearsay statement.
Turning to the trial record, there is no showing which demonstrates that A.T., who was four years old at the time of the alleged abuse, five at the time she saw Drs. Kuper and Reich, and six when she saw Dr. Spiegel, had the necessary understanding that “the efficacy of her medical treatment depend[ed] upon the accuracy of the information she provide[d] to the doctor.” Majority Opinion at 1449. A.T.’s own testimony did not establish that she appreciated the importance of being truthful with the doctors. The government did not explore this area on direct examination. On cross-examination, defense counsel attempted to ask A.T. about the doctors she saw:
Q What you talked with Tara [Neda, the prosecutor,] about Matthew, [the defendant,] that’s what I’m asking you about, what you told Tara about Matthew, whatever it was, did you tell that to any doctor? And you can say yes or no or you don’t remember.
A (No audible response.)
Q Do you remember, [A.T.]?
A No.
Q Do you know any doctors, [A.T.]?
A (No audible response.)
Q Do you know the names of any doctors that you went to see?
A (No audible response.)
Q Do you know the name of Dr. Ku-per?
A Yes.
Q Is that doctor’s job to help kids too?
A Yes.
Q Do you know the name of Dr. Spie-gel?
A No.
Q How about Dr. Kuper, did she hurt you in any way?
A No.
Q -When you talked to Dr. Kuper, do you remember telling her the truth or not the truth, do you remember?
A No.
*1458VII R. at 152, 154-56. On re-direct, the prosecutor asked
Q Did you tell Dr. Kuper that Matthew did bad things to you, Dr. Kuper, the lady doctor?
A (No audible response.)
Q Do you remember?
A (No audible response.)
Id. at 159.
Thus, A.T.’s testimony is insufficient to establish that she knew the importance of telling the truth to Drs. Kuper, Reich, and Spiegel, and is therefore insufficient to satisfy the selfish interest rationale under Rule 803(4). Likewise, the testimony of the doctors themselves and of Beverly Padilla, A.T.’s mother, shows no such proof. See Appendix to this opinion. Because the record does not show that A.T. appreciated the importance of telling the truth to the doctors, I must conclude that A.T.’s out-of-court statements to the doctors are not admissible under Rule 803(4). I therefore respectfully dissent from the majority’s conclusion that those statements are admissible under Rule 803(4).
The government argues in the alternative that the testimony of the three examining physicians concerning A.T.’s statements to them was admissible under Rule 803(24). I am persuaded that the testimony was not properly admissible under that rule. The majority opinion carefully applies the proper analysis under this provision to the testimony of Kae Ecklebarger, and I agree with the majority’s conclusion that the out-of-court statements made by A.T. to her were inadmissible hearsay. For the same reasons, I am convinced that the statements made by A.T. to the three physicians were not admissible under Rule 803(24).4
Finally, I am impressed with the importance of care in the application of the hearsay exceptions because of the caveat in the Supreme Court’s opinion in this case, where Justice Kennedy stated:
Courts must be sensitive to the difficulties attendant upon the prosecution of alleged child abusers. In almost all eases a youth is the prosecution’s only eye witness. But “[t]his court cannot alter evidentiary rules merely because litigants might prefer different rules in a particular class of cases.” United States v. Salerno, 505 U.S. [317], [322], 112 S.Ct. 2503, 2507, 120 L.Ed.2d 255 (1992).
Tome v. United States, — U.S. -, -, 115 S.Ct. 696, 705, 130 L.Ed.2d 574 (1995) (emphasis added).
In sum, while I concur in the other eviden-tiary conclusions the majority reaches and in the remand for a new trial, I respectfully dissent from the majority’s holding that the statements by A.T. introduced through the testimony of the doctors were admissible.
APPENDIX
Dr. Kuper, a pediatrician, testified that she saw A.T. on two occasions, once in September 1990 and then again in October 1990. VII R. at 251. During the September 1990 visit, Dr. Kuper interviewed A.T. “in order to ascertain exactly what injuries had occurred.” Id. at 251-52. Dr. Kuper said that A.T.’s mother was in the room at the time of the interview. The doctor explained that the purpose for that was that “[A.T.] had just turned five at that point. And with young *1459children I always have parents in the room. Id. at 267.
On cross-examination, defense counsel asked “Do you let [patients] know that you’re there to help kids?” to which Dr. Kuper replied “I don’t believe I use that term exactly, no.” VII R. at 265. Defense counsel then asked “Do you ever talk with a child about truth telling?” Id. Dr. Kuper answered “No, I don’t because that is part of Protective Services.” Id. Later, defense counsel asked “[a]nd you had no discussion with [A.T.] about truth telling? ” Id. at 267 (emphasis added). Dr. Kuper replied “No, I did not.” Id. (emphasis added). Nor did Dr. Kuper have any discussion with A.T.’s mother about truth telling. Id. It is clear from this and from the rest of Dr. Kuper’s testimony that Dr. Kuper did not convey to A.T. the importance of telling the truth. Thus, Dr. Kuper’s testimony does nothing to satisfy the preliminary requirement that the declarant understand the importance of candor with the doctor.
Dr. Laura Reich, another pediatrician, testified about an examination of A.T. on September 21, 1990. VII R. at 289-90. In questioning the child about personal history, the doctor said A.T. “was extremely calm during the examination and very friendly and said her father had put his thing in her.” Id. at 292. The doctor concluded from her examination that the vaginal opening was definitely larger than normal and the hymen was not intact. Id. at 293. The doctor said the child was approximately five years old when she saw her. Her conclusion was that she had “definitely had penile penetration in her vaginal area.” Id. at 294.
Dr. Reich was asked about whether she had discussed with A.T. the importance of giving truthful answers:
Q Did you talk to her at all about the importance of truth telling with you?
A No, I didn’t talk to her about that.
Q Did you get any sense that she — if anyone else had talked with her about that, that it was important to tell you the truth?
A No, that particular issue didn’t come up. I didn’t get any sense of that.
Q Did you talk with her at all about what might happen if she didn’t — wasn’t completely honest with you about things?
A No, I didn’t.
VII R. at 299.
Another pediatrician, Dr. Jean Spiegel, testified about examining A.T. on September 3, 1991. A.T. was six years old then. IX R. at 472. Dr. Spiegel said her findings from the examination were consistent with hyme-nal penetration or vaginal penetration which was “chronic” in nature or had occurred more than one time. Id. at 473. She testified that while it was difficult to time such penetrations, nothing would have likely happened to the child within the prior four to six months, and that “the findings are old.” Id. There was no testimony by Dr. Spiegel about any statements by A.T. that the defendant had committed any of these acts. The doctor did say that A.T. was very shy and quiet and the doctor asked A.T. where her body was touched. She said that “her breasts were touched and her front privates were touched, and she also told [Dr. Spiegel] that her bottom where her poop comes out was touched.” Id. at 509. There was no testimony by Dr. Spiegel about any discussion with A.T. concerning truth telling or its importance in the examination of the child.

. The court in White upheld the defendant's conviction on the grounds that the erroneous admission of the statements was harmless error. 11 F.3d at 1451.

. Minn.R.Evid. 803(4) is identical to the federal rule.

. See also People of Territory of Guam v. Ignacio, 10 F.3d 608, 613 n. 3 (9th Cir.1993) (“whether a statement is admissible under the medical treatment exception does not depend solely on the intent of the person asking the questions, but also on whether the respondent understands herself to be providing information for purposes of medical treatment." (Emphasis added.)); Morgan v. Foretich, 846 F.2d 941, 951-52 (4th Cir.1988) (Powell, J. (ret.), concurring in part and dissenting in part) (“[tjhere is no evidence in the record *1457that [the girl's] frame of mind was comparable to a patient seeking treatment.... [Tjhere is no evidence that Dr. Harrison ever explained to [the child] that his questions and relationship with her arose, at least in part, from a desire to treat her.... Absent a finding that [the child] made her statements believing they would be used by Dr. Harrison to help her, I am reluctant to rest my decision on the cases relied on by the court.”); Oldsen v. People, 732 P.2d 1132, 1135—36 (Colo.1986) (holding statements inadmissible under Colo.R.Evid. 803(4) (which is identical to the federal rule) because there was no evidence that the five-year old child "was capable of recognizing, at the time the challenged statements were made, the need to provide accurate information for purposes of medical diagnosis or treatment within the meaning of CRE 803(4).”). Oldsen holds that the prosecution, as proponent of the hearsay statements, has the burden of establishing the foundation for admitting them under an exception to the hearsay rule. 732 P.2d at 1135 n. 7. The court in Oldsen did uphold the conviction because the challenged testimony was admitted properly on the alternative ground of being circumstantially trustworthy. Id. at 1137.
But see United States v. George, 960 F.2d 97, 100 (9th Cir.1992) ("As a general matter, the age of the child and her other personal characteristics go to the weight of the hearsay statements rather than their admissibility."); cf. State v. Robinson, 153 Ariz. 191, 735 P.2d 801, 809 (1987) (upholding admission of statements under Ariz.R.Evid. 803(4) (also identical to the federal rule), concluding "[t]he record is not as clear regarding [the child’s] motive in making the challenged statements. The record does indicate, however, that [the] statements were elicited in the course of treatment. And nothing in the record indicates that [the child victim's] ‘motive in making these statements was other than as a patient seeking [or at least needing] treatment.' [Citation omitted.]”).

. As with Ecklebarger’s testimony, three circumstances surrounding A.T.’s statements to the physicians indicate trustworthiness: the experience and training of the physicians in interviewing child abuse victims; the use of non-leading questions; and the specificity of the statements. On the other hand, as with the statements made to Ecklebarger, the statements were not spontaneous, were not close in time to the abuse, and were made at a time when the child arguably had a motive to fabricate.
Thus, on balance, it is far from clear that A.T. "was particularly likely to be telling the truth when [her] statements] [were] made.” Idaho v. Wright, 497 U.S. 805, 822, 110 S.Ct. 3139, 3150, 111 L.Ed.2d 638 (1990). Consequently, it could not be said that, at the time the statements were made, A.T.'s "truthfulness [was] so clear from the surrounding circumstances that the test of cross-examination would be of marginal utility...." Id. at 820, 110 S.Ct. at 3149. As the majority opinion correctly notes, although Wright involved a challenge to the admission of hearsay testimony under the Confrontation Clause, "its discussion of the reliability of hearsay statements by child victims of sexual abuse is equally pertinent to both Confrontation Clause cases and Rule 803(24) cases." Majority Opinion at 1452 n. 5.