U.S. v. Cucuzzella, 66 M.J. 57

Military Justice Personnel: Military Judge: Duties and Responsibilities

1. in determining whether a statement was made with some expectation of receiving medical benefit or treatment, a military judge’s finding as to the declarant’s state of mind in making a statement is a preliminary question of fact under MRE 104(a); as such, it will be set aside only if clearly erroneous; in making this determination, the military judge should look to the circumstances surrounding the proffered testimony to determine that the appropriate indicia of reliability are present
2. when statements made by a patient to a psychiatrist are offered under medical exception to the hearsay rule, the military judge must determine that the statements were elicited under circumstances which made it apparent to the patient that the psychiatrist desired truthful information and that only by speaking truthfully would he receive the desired benefits from the psychiatric consultation; where the mental health diagnosis and treatment is offered in the context of marital counseling, declarants may well have mixed motives as well as ulterior motives behind their words; so too, the reliability of the statements at issue may be clouded by emotional distress
3. in this case, the military judge did not abuse his discretion in admitting, under the medical exception to the hearsay rule, statements that the accused’s wife made to a family advocacy nurse regarding sexual and physical abuse she suffered at the hands of the accused, where the family advocacy nurse was engaged in mental health diagnosis and referral, the statements were made with some expectation of receiving medical benefit or treatment, and the nurse did not play the role of a law enforcement agent and there was no indication of an established relationship between the nurse and law enforcement authorities; here, the nurse’s notes taken during the disclosure of the abuse appear typical to the nursing practice, suggesting diagnoses and treatment, the wife’s unnerved demeanor during her discussion of the abuse corroborates her motivation for seeking treatment, and the detailed discussion of the history and progression of abuse resembles statements made to a psychiatrist for diagnosis or treatment through counseling

Core Criminal Law Subjects: Evidence: Hearsay › Generally

1. hearsay is not admissible except as provided by the rules of evidence or an act of Congress

Core Criminal Law Subjects: Evidence: Hearsay › Medical exception

1. the hearsay rules permit admission of statements made for purposes of medical diagnosis or treatment and describing medical history, or past or present symptoms, pain, or sensations, or the inception or general character of the cause or external source thereof insofar as reasonably pertinent to diagnosis or treatment
2. for statements to be admissible under the medical exception to the hearsay rule, the statements must first be made for the purposes of medical diagnosis or treatment, and second, the patient must make the statements with some expectation of receiving medical benefit for the medical diagnosis or treatment that is being sought
3. the medical exception to the hearsay rule is premised on the theory that the declarant has an incentive to be truthful because he or she believes that disclosure will enable a medical professional to provide treatment or promote the declarant’s own well-being
4. the medical exception to the hearsay rule has been broadened to include persons outside the medical profession, who perform health care functions and receive statements for the purpose of medical diagnosis; for instance, the rule includes statements made to nonmedical personnel as long as they are made for the purpose of seeking treatment; as a result, the reach of the medical hearsay exception is potentially extremely broad
5. in determining whether a statement was made with some expectation of receiving medical benefit or treatment, a military judge’s finding as to the declarant’s state of mind in making a statement is a preliminary question of fact under MRE 104(a); as such, it will be set aside only if clearly erroneous; in making this determination, the military judge should look to the circumstances surrounding the proffered testimony to determine that the appropriate indicia of reliability are present
6. in contexts where the medical purpose and benefit may be less apparent, the medical exception to the hearsay rule should not be applied in a rote or mechanical manner; rather, its application should depend on the identification of indicia that the elements and the purposes of the exception are met; for example, in cases involving statements by young children, where the medical purpose behind a visit might well be apparent to an adult, an appellate court has looked to see if the military judge has found indicia that the child herself was cognizant of the medical purpose of the visit
7. when statements made by a patient to a psychiatrist are offered under medical exception to the hearsay rule, the military judge must determine that the statements were elicited under circumstances which made it apparent to the patient that the psychiatrist desired truthful information and that only by speaking truthfully would he receive the desired benefits from the psychiatric consultation; where the mental health diagnosis and treatment is offered in the context of marital counseling, declarants may well have mixed motives as well as ulterior motives behind their words; so too, the reliability of the statements at issue may be clouded by emotional distress
8. in this case, statements that the accused’s wife made to a family advocacy nurse regarding sexual and physical abuse she suffered at the hands of the accused were admissible under the medical exception to the hearsay rule, where the family advocacy nurse was engaged in mental health diagnosis and referral, the statements were made with some expectation of receiving medical benefit or treatment, and the nurse did not play the role of a law enforcement agent and there was no indication of an established relationship between the nurse and law enforcement authorities; here, the nurse’s notes taken during the disclosure of the abuse appear typical to the nursing practice, suggesting diagnoses and treatment, the wife’s unnerved demeanor during her discussion of the abuse corroborates her motivation for seeking treatment, and the detailed discussion of the history and progression of abuse resembles statements made to a psychiatrist for diagnosis or treatment through counseling

Trial Stages: Appeals: Standards of Review, Burdens, etc.

1. an appellate court reviews a military judge’s decision to admit evidence for an abuse of discretion; an abuse of discretion occurs when a military judge either erroneously applies the law or clearly errs in making his or her findings of fact
2. in determining whether a statement was made with some expectation of receiving medical benefit or treatment, a military judge’s finding as to the declarant’s state of mind in making a statement is a preliminary question of fact under MRE 104(a); as such, it will be set aside only if clearly erroneous; in making this determination, the military judge should look to the circumstances surrounding the proffered testimony to determine that the appropriate indicia of reliability are present