Court Opinion

ID: 9617458
Source: CourtListenerOpinion
Date Created: 2023-08-22 04:55:36.698505+00
Date Added: 2024-06-11T09:18:48.220339
License: Public Domain

Sognier, Judge,
concurring specially in part and dissenting in part.
I respectfully dissent from the majority’s holding in Division 1 that the admission of a nurse practitioner’s testimony stating her opinion the victim had been sexually abused was not error. I do not agree that the witness was qualified to testify on a matter requiring an expert medical opinion.
The nurse practitioner, Laurie McAfee, first testified regarding the medical history she took from the victim. Although evidence of statements made by a patient describing medical history is admissible under OCGA § 23-3-4 insofar as such statements were “reasonably pertinent to diagnosis or treatment,” medical diagnosis is the exclu*731sive province of physicians, OCGA § 43-34-20 (3); see Penn. &c. Ins. Co. v. Gilliam, 88 Ga. App. 451, 453 (76 SE2d 834) (1953), and registered nurses such as McAfee may administer medical treatments only as prescribed by a practicing physician. OCGA § 43-26-1 (3). However, I find no error in the admission of McAfee’s testimony regarding the victim’s medical history in view of McAfee’s statement that she acted under the authority of Dr. Brad Ward at the time she examined the victim. See Sparks v. State, 172 Ga. App. 891, 892 (2) (324 SE2d 824) (1984).
McAfee next testified as to the victim’s out-of-court statement to McAfee that appellant was the abuser of the victim. Although admission of such testimony was error because it was not reasonably related to the taking of medical history, Roberson v. State, 187 Ga. App. 485, 486 (370 SE2d 661) (1988), this error was harmless here because the testimony was cumulative of the victim’s testimony, Johnson v. State, 149 Ga. App. 544, 545 (5) (254 SE2d 757) (1979), and also was admissible pursuant to OCGA § 24-3-16, which provides that “[a] statement made by a child under the age of 14 years describing any act of sexual contact or physical abuse performed with or on the child by another is admissible in evidence by the testimony of the person or persons to whom made if the child is available to testify in the proceedings and the court finds that the circumstances of the statement provide sufficient indicia of reliability.” The victim in the instant case was available to testify at trial and did so testify. Although the record does not expressly show that the trial court found that “sufficient indicia of reliability” were present, the evidence adduced at trial did reveal that McAfee was trained to evaluate child molestation victims, and that she was a detached professional with no personal interest in the outcome of the case. There was no evidence the victim’s statement was obtained under coercion or duress. Thus, the trial court was authorized to find that the victim’s statement was made voluntarily to a trustworthy witness, and accordingly that the circumstances of the statement provided sufficient indicia of reliability. See Newberry v. State, 184 Ga. App. 356, 357-358 (2) (361 SE2d 499) (1987).
However, I find that reversible error was committed by admission of the nurse practitioner’s opinion testimony that the victim had been sexually abused. The nurse practitioner, who examined the victim approximately four years after the alleged sexual abuse occurred, testified that upon examining the victim she observed scarring of the victim’s hymenal membrane, and then stated, over proper objection, that in her opinion this finding was consistent with the history of sexual abuse related to her by the victim. McAfee further testified that in her opinion the scarring was caused by penetration of the vagina by a blunt object.
“The diagnosis and the causes and effects of diseases and other *732kindred matters of medical practice form an important field of expert testimony. Except to the extent that the physical condition of a person is open to ordinary observation by persons of common experience, opinion evidence in this field is limited to the opinions of experts — that is, of physicians.” 31 AmJur2d Expert & Opinion Evidence § 103 (1967); see Cherokee County Hosp. Auth. v. Beaver, 179 Ga. App. 200, 204 (345 SE2d 904) (1986). Nurses, who are not authorized by law to diagnose injuries or diseases or to prescribe treatments, are not qualified to testify as expert witnesses regarding “decisions and treatment that [are] exclusively within the professional skills of medical doctors.” Smith v. Hospital Auth., 161 Ga. App. 657, 660 (3) (288 SE2d 715) (1982). Interpretation of the cause and significance of vaginal scarring is such a matter and thus must be presented by expert medical opinion. Pegg v. State, 183 Ga. App. 668, 669 (359 SE2d 678) (1987); Russell v. State, 181 Ga. App. 624, 626 (3) (353 SE2d 820) (1987). Because no one other than a licensed medical doctor was qualified to state the opinion at issue here, and because McAfee, a nurse practitioner, is not a licensed medical doctor, the trial court erred by allowing her to testify. See Fountain v. Cobb Gen. Hosp., 167 Ga. App. 36, 37 (306 SE2d 37) (1983); see generally Moore v. State, 221 Ga. 636 (5) (146 SE2d 895) (1966).
The medical malpractice cases cited by the majority on this issue, Bethea v. Smith, 176 Ga. App. 467 (336 SE2d 295) (1985), and McCormick v. Avret, 154 Ga. App. 178 (267 SE2d 759) (1980), aff’d sub nom., 246 Ga. 401 (271 SE2d 832), are inapposite. In Bethea, we found that, although pursuant to statutory authorization the podiatrist-witness was capable of rendering the same treatment as the defendant orthopedic surgeon for the condition at issue, there was no evidence the same standard of care for that condition was recognized by both schools of practice, and thus the podiatrist was not competent to present expert medical testimony against the orthopedic surgeon. In McCormick, this court authorized the testimony of a nurse on an issue not within the exclusive province of physicians. These cases do not authorize the admission of the opinion testimony at issue here.
Having concluded that the opinion testimony was improperly admitted, the remaining question is whether the error necessitates reversal of the conviction. “The test for determining whether error not of constitutional dimension is prejudicial is, of course, a familiar one. Regardless of whether there was other independently sufficient evidence to convict appellant, [the court] can find the error harmless only if it is ‘highly probable that the error did not contribute to the judgment.’ [Cits.]” Parker v. State, 162 Ga. App. 271, 275 (5) (290 SE2d 518) (1982). Because of the importance juries attach to medical testimony, I cannot find “that it was highly probable that the consid*733eration of the erroneously admitted [opinion testimony] of the state’s [witness] did not influence the jury’s verdict,” Estes v. State, 165 Ga. App. 453, 456 (301 SE2d 504) (1983), and accordingly I would reverse.
Decided November 30, 1988 —
Rehearing denied December 20, 1988
Ronald L. Davis, for appellant.
Darrell E. Wilson, District Attorney, William F. Riley, Jr., Assistant District Attorney, for appellee.
I am authorized to state that Judge Carley and Judge Benham join in this special concurrence and dissent.