Court Opinion

ID: 9448848
Source: CourtListenerOpinion
Date Created: 2023-08-03 23:46:22.662294+00
Date Added: 2024-06-11T17:31:34.427722
License: Public Domain

ALBERT V. BRYAN, Circuit Judge
(dissenting).
The Federal Shop Book rule in my understanding of it is now expanded by the 'Court far beyond its intendment. As the effect will be to deprive a party- — -in criminal as well as civil cases — of the right to confrontation by his accuser and the safeguards of cross-examination in other than routine matters, I feel compelled to state my reasons for not joining in the ■opinion.
Frankhouser and Kissinger were taken by ambulance to the dispensary at the Station. The doctor on duty there noted as to Frankhouser “the odor of alcohol ■on his breath”, and “suspected that he was intoxicated”. He testified further that Frankhouser though not unconscious was “in a semi-stuporous condition”, and had sustained a blow on the top of his head. This doctor ordered the blood test, and for this purpose as well as for general attention, sent him to the United States Naval Hospital at Portsmouth, Virginia.
The crucial evidence in this case on the intoxication of Frankhouser was the Naval Hospital record. On the “Clinical Record Physical Examination” under -date of October 16, 1959 (the day he was admitted) is the entry “alcohol odor to breath”. Upon the same sheet under ■“Initial Impression” is written “simple drunkenness”. This record is signed by a Dr. J. M. Marlowe. In the same record ■of that day in “Doctor’s Progress Notes” is entered “Borgans 2.5 mgm at 0315. J. M. Marlowe”. The “alcohol odor to breath” entry the District Court ruled to be inadequate in itself to prove intoxication.
Dr. Marlowe was not called as a witness. In fact he did not ask for, make or receive the Bogen test. Although it appeared in another part of the hospital record and may have been seen by the jury, neither Court nor counsel noticed until after the trial that a Dr. Heldt had requested, received and evaluated the test. He did not testify. Only the hos-pitalman at the Naval Hospital who had extracted the blood and run the test testified to it. A toxicologist took the stand for the plaintiff and explained to the jury the mechanics and meaning of the Bogen method. He stated, “Well, obviously 2.5 is a marked degree of intoxication and there is no question that the person could not properly operate a motor vehicle”.
Admission of the hospital record as well as the testimony of the hospitalman and the toxicologist was opposed by defendant Frankhouser. The ground of the objection was that the entries could not be received under the Federal Shop Book law, 28 U.S.C. § 1732- — -the only basis urged for their admission — because they embodied an opinion, rather than reflecting a regular event in hospital routine.
Error, I think, was committed in the reception of the hospital record. The issue on which it was adduced could not be proved by the entries alone. The first— “simple drunkenness” — was, as the record declares, only a conditional finding. Both this and “Bogans 2.5 mgm” were expressions of opinion derived through professional judgment. The recordation was not simply of the habitual or commonplace incidents of a patient’s hospital stay as the statute contemplates. Without the aid and exposition of the author — he was not a witness in the trial —these notations in my judgment were not provable.
I. As previously suggested, the notation of “simple drunkenness” was merely “Initial Impression”. Obviously the physician did not accord it definitiveness; *353on its face it was but tentative. He intentionally indicated a reluctance to express himself categorically. An impression is merely an immediate, and often only passing, idea. “Initial” in the circumstances is a primary, “first-blush” or first-glance thought — one at the outset. The vagueness of “simple” points up the wholly provisional nature of the conception. The examiner here registered an unsureness, and was frank about his uncertainty. It was a diagnosis which the diagnostician would not and could not vouch as a final opinion.
The doctor’s wisdom is evident. Here was a patient suffering from severe trauma to the head. The examining physician at the Station dispensary had merely “suspected” intoxication. Marlowe too detected the odor of alcohol, but the patient’s actual condition certainly could not be fairly appraised in the circumstances. “Symptoms which are characteristic of drunkenness may result also from many different causes (e. g. epilepsy, brain injury, diabetic or kidney disease) * * *.” 7 Encyclopaedia Britannica 792 (1961 ed.) Apparently, the doctor was only noting a possibility, based on his immediate observations, to guide and expedite later diagnosis and treatment. He never confirmed it.
This evidence, I think, should not have gone to the jury, primarily because it was only an impression. A jury is not permitted to hear a diagnosis which the doctor will advance only tentatively; unless final, its probative value is nil. In re Buck’s Dependents Case, 342 Mass. 766, 175 N.E.2d 369 (1961); Lyons v. Chicago City Ry., 253 Ill. 75, 101 N.E. 211 (1913). Moreover, for the same reasons I note in a moment for believing the Bogen test entry inadmissible, I would also reject the “simple drunkenness” memorandum.
II. The Bogen’s method of determination of the alcohol content of human blood is not a simple reading, such as a temperature taking, which a literate layman can make. Two stages are involved: the running of the test and then its evaluation. The testimony provides a somewhat complete description of the process. The necessary apparatus consists of two vertical test tubes, side by side, “with inlet tubes to the bottom of each and outlet tubes to each side”. In the first tube are placed 4 ccs. of the blood specimen together with what is known as a Scott-Wilson reagent (to eliminate “acetone bodies in case of diabetics”). A defoam-ing element is also included. In the next or second tube — the receiving tube — are put 9 ccs. of Anstie’s reagent, consisting of potassium dichromate and sulfuric acid. The tubes are then immersed in boiling water.
To the second tube is attached an aspirator, which is activated to reduce the pressure in the system. The alcohol in the blood in the first tube is volatilized by the heat of the water bath, and passes over into the second tube containing the Anstie’s reagent. The “boiling and aspirating” in the distilling process must continue for a half hour. As the alcohol distills over, it condenses into a green chemical-chromic sulphate. By comparison of its hue with results of tests of known alcoholic content through the use of a colorimeter, the amount of alcohol in the specimen is assessed by the evaluator.* Thus, the first stage calls for an expert execution of a prescribed technique and the second a professional appraisal of the results of the first. Instantly, the toxicologist called to evaluate the test report, as I read his testimony, completely destroyed the acceptability of that test. The use of 2 ccs. of blood by the technician for the test, as noted in the majority opinion, instead of 4 does not excuse the care, knowledge and attention the run requires for reliability.
The aim and history of the Shop Book rule deny it, to my mind, the scope the *354majority gives it. Never was the statute intended of its own force alone to authenticate opinion. Never was it design-' ed to enable mere opinion to stand by itself for what it speaks in judgment. Never could it qualify an entry to testify —untried' by cross-examination — to a diagnosis or prognosis. Not even the expert himself who was responsible for the entry would have such testimonial stature and immunity. An expert ascertainment is not “any act, transaction, occurrence, or event” as the statute contemplates. These refer to bare happenings, e. g., the presence of the patient in the room, whether abed or ambulatory, if on or off a diet, in a cast or not, treatments received, medicines prescribed and administered, and similar matters of course, routinely and regularly recorded. The majority opinion combats the expressions of the Supreme Court in Palmer v. Hoffman, 318 U.S. 109, 113-115, 63 S.Ct. 477, 87 L.Ed. 645 (1943).
Intoxication is commonly known to be quite a debatable state. Juries have wrestled with it on instructions formulated only after difficulty by both court and counsel. To say that a hospital entry may be taken as a declaration of the patient’s condition in this respect is to accord it an evidentiary position wholly unjustified, indeed, offensive to our system of search for truth. Moreover, the Bogen test is of so grave consequence and has such vast import both in civil litigation and criminal prosecutions that I think it should be treated only for what it actually is — an expert ascertainment and not a mere mechanical exercise. This is peculiarly true when the result is to be given effect extramurally, not simply retained for the general reference of the hospital’s physicians who know how much credence it should receive in the circumstances of its procurement and their use of it.
The gravity of the danger of admitting such hospital entries without the doctor’s verifying testimony is starkly drawn by reference to its use in criminal cases. One could be convicted of a felony upon these entries alone, if guilt or innocence depended on sobriety or inebriety. Alarming and unthinkable there, it is little less so in a civil action of importance.
Slight consolation is provided the affected party by the statute’s invitation to him to assail the record. The assault would be directed at the responsible doctor. But rarely would he be at the trial— the Shop Book authentication takes his place. In this the proponent is highly advantaged to the prejudice of his adversary, for he would neither have to produce the doctor, nor qualify him. Indeed, no qualification at all of any expert —medical or technical — would be required. The opponent would be deprived even of the right to inquire into the doctor’s knowledge of what he had recorded, or the medical basis for his opinion. All this again but demonstrates the unfairness of the Shop Book entry as proof of an opinion. This inequity becomes the more manifest in the instant situation where the opinion is of an evanescent condition — -it cannot be confirmed'in any way. This alone would seem to destroy its “probability of trustworthiness”; the statute was not intended to “opens wide the door to avoidance of cross-examination.” Palmer v. Hoffman, supra, 318 U.S. at 114, 63 S.Ct. at 481.
New York Life Insurance Co. v. Taylor, 79 U.S.App.D.C. 66, 147 F.2d 297, 301 (1945) firmly establishes the inadmissibility of an opinionative entry in a hospital record. Admittedly, the Court mentions in obiter the eligibility under the statute of a notation in the record of a physician’s observation of drunkenness. It is inapposite here because the instant entries are far more than observations: first a tentative finding and then a chemical analysis.
But admittedly there are decisions actually or apparently contra. See, for example, Reed v. Order of United Commercial Travelers, 123 F.2d 252 (2 Cir. 1941). In most instances, however, upon scrutiny it will be seen that the hospital records received in evidence related only to factual matters, or the doctor was in court to corroborate them. This is why *355the District of Columbia decision Wheeler v. United States, 93 U.S.App.D.C. 159, 211 F.2d 19, 22 (D.C.Cir.), cert. denied 347 U.S. 1019, 74 S.Ct. 876, 98 L.Ed. 1140 (1954) cannot be said to overrule the view expressed in New York Life Insurance Co. v. Taylor, supra. In the later case the Shop Book statute was used merely to identify certain slides of smears as a genuine record of the latter. Other cases are inapplicable since they involved statements in his history made by the patient himself, doctors’ recitals of what was seen on autopsy, birth dates and parentage, or observations of foreign substances found in the body. in
Cited as contrary authority is our decision in United States v. Wescoat, 49 F.2d 193 (4 Cir. 1931). But the circumstances there were quite different. To begin with, the only objection raised was the cry of hearsay, and the right to admit an opinion under the Shop Book rule was nowhere involved. The evidence consisted of a soldier’s field medical record fastened to his clothing. A diagnosis of “choroiditis” — an eye inflammation— was included. Foremost, however, in difference is that the record was signed successively by medical officers of the United States, the defendant, and was thus binding on the defendant.
True, this court has said that “The alcoholic content of the blood * * * is an objective fact, not a mere expression of opinion * * Kay v. United States, 255 F.2d 476, 481 (4 Cir. 1958). But there the reference was directed to a certificate of content which was by fiat of statute, now 1950 Code of Va. 18.1-55 et seq., made an evidential fact. This fact in turn gives rise to certain presumptions. The expert whose determination is acceptable is named by statute. His qualification is conclusively established thereby. But, paramount, the blood test can be made only at the request of the accused and with his implied consent that it may be used in evidence against him in a criminal prosecution.
I do not mean to say that hospital record entries of a preliminary diagnosis or result of a Bogen test are not pertinent to an inquiry upon intoxication. I do mean to say the entries do not by themselves prove their truth.
I would set aside the verdict and the judgment thereon and order a new trial for error in the admission of the hospital record entries.
Judge Boreman has authorized me to state that he joins in this dissent.

 For a lucid, graphic and scholarly exposition of the entire process, see: Determination of Ethyl Alcohol in Blood, by Sidney Kaye, M.SC. and Harvey B. Haag, M.D., Journal of Forensic Medicine (October-December 1954) 373; and Emergency Toxicology (2d ed. 1961) by Sidney Kaye, M.SC.Ph.D., of Richmond, Va.