Supreme Court of Idaho Finds the State Failed to Present Proof Sexual Assault Victim’s Statements to Nurse Were Made for Purposes of Diagnosis/Treatment

A big recurring question under evidence law is whether dual medical and forensic examinations of sexual assault victims satisfy the hearsay exception contained in Federal Rule of Evidence 803(4) and state counterparts. The latest example can be found in the recent opinion of the Supreme Court of Idaho in State v. Al Muthafar, 2024 WL 4997111 (Idaho 2024).

In Al Muthafar, 

Jameel Fakhri Al Muthafar (“Al Muthafar”) appeals[ed] his convictions for aggravated assault and attempted strangulation [against K.S.]. Al Muthafar contend[ed] that the district court erred by denying his motion to dismiss the Information after the magistrate allowed hearsay statements at the preliminary hearing over his objection. The statements at issue were made to a nurse at the Family Advocacy Center and Education Services, commonly known as FACES of Hope (“FACES”), during a dual medical and forensic examination.

In addressing the issue, the Supreme Court of Idaho noted that the hearsay exception at play was Idaho Rule of Evidence 803(4), which provides an exception to the rule against hearsay for:

A statement that:

(A) is made for – and is reasonably pertinent to – medical diagnosis or treatment; and

(B) describes medical history; past or present symptoms or sensations; or their source.

In finding this hearsay exception was not satisfied, the court ruled as follows:

We first note that K.S. was capable of making statements for the purpose of medical diagnosis. Even though she may function as a 13-year-old, we have previously explained that children as young as six or four can make statements for purposes of medical diagnosis or treatment….The issue here is that Donahue’s testimony at the preliminary hearing failed to demonstrate that K.S.’s statements at FACES were for the purposes of receiving a medical diagnosis or treatment.

The full appellate record indicates that the State had access to evidence that likely would have supported its position, but it failed to develop those facts at the preliminary hearing. For example, the State had medical records from K.S.’s visit to St. Alphonsus and additional records from FACES. There was even an audio recording of the FACES interview and police reports, all of which suggest K.S.’s statements were made, at least in part, for the purpose of receiving a medical diagnosis or treatment. K.S. first called the police that night because she was feeling suicidal, and K.S. recounted the physical, mental, and sexual abuses committed against her to Donahue at FACES. K.S. described her pain, as well as injuries resulting from being beaten, punched, bitten, kicked, and then strangled with a pillow. Donahue conducted an examination and questioning that could arguably be said to have both medical and forensic purposes, similar to the CARES recordings we have previously considered and determined were admissible under Rule 803(4)….

However, when the State presented its case before the magistrate court at the preliminary hearing, it relied on Donahue’s testimony to establish the purpose of the interview. Donahue testified that K.S.’s examination had a dual purpose—to gather “medical” and “forensic evidence on a stated assault”—but her testimony focused almost entirely on the forensic components of the examination. Donahue explained that K.S. was photographed and examined as part of the “forensic exam,” and that K.S. was asked “interview” questions so Donahue could know “what happened from the start.” Donahue stated that these questions were asked only for “clarification.” Aside from briefly noting K.S.’s symptoms of pain, Donahue’s testimony under the State’s questioning only described the physical exam she typically conducts at FACES. Donahue did not testify about the actual physical assessment she performed on K.S., the health and medical history she completed, her diagnosis of K.S.’s injuries, any treatment she rendered or prescribed, or the content of K.S.’s medical records. In sum, there was no evidence offered that demonstrated how the statements K.S. made during the FACES interview pertained to a medical purpose. Such testimony was necessary to meet the foundational requirements of Rule 803(4)(A) and (B).

While the trial and appellate record contain various medical records that offer more insights into the scope of the FACES interview, none of this evidence was presented at the preliminary hearing. The State could have supported Donahue’s testimony by offering K.S.’s physical assessment, the audio recording of Donahue’s questioning, and more specific testimony from Donahue, but it failed to do so. Because the preliminary hearing transcript on its own does not demonstrate a dual medical purpose for the interview, the State failed to establish that the hearsay statements attributed to K.S. were made for the purpose of receiving a medical diagnosis and treatment from FACES. Therefore, the State also failed to meet its burden to demonstrate that the Rule 803(4) exception applied. As a result, the magistrate court’s decision to bind Al Muthafar over to the district court for trial was based on inadmissible hearsay evidence.

Accordingly, we conclude that the district court erred in determining that there was no abuse of discretion by the magistrate court in admitting the hearsay statements.

-CM