State v. Smith (2016)

Supreme Court of Iowa · 2016 · Evidence

876 N.W.2d 180 (Iowa 2016)

Updated August 22, 2026

EvidenceHearsayMedical diagnosis or treatment exceptionIowa R. Evid. 5.803(4)medical diagnosis or treatmentidentity of perpetratordomestic abusefoundation

Facts

After an assault, M.D. went to the emergency room, where a nurse asked what happened and M.D. said she was assaulted by her baby's father; she also answered domestic-abuse screening questions indicating fear and abuse by someone close to her. A doctor likewise asked how she sustained her injuries, and M.D. said she had been assaulted by her child's father. The medical evidence showed treatment and diagnosis focused on physical injuries, including a closed head injury, cervical strain, facial contusion, and arm contusions, and there was no evidence the assailant's identity was used in diagnosis or treatment. At trial, after the State learned M.D. would recant, the State offered the nurse's and doctor's testimony repeating M.D.'s identification of Smith under Iowa Rule of Evidence 5.803(4).

Issue

Whether hearsay statements made by a domestic-abuse victim to an emergency room nurse and doctor identifying the perpetrator were admissible under Iowa Rule of Evidence 5.803(4) as statements made for purposes of medical diagnosis or treatment. More specifically, the question was whether the State laid sufficient foundation showing the identity of the assailant was reasonably pertinent to diagnosis or treatment.

Rule

Under Iowa Rule of Evidence 5.803(4), statements are admissible only if they are made for purposes of medical diagnosis or treatment and describe medical history, symptoms, pain, sensations, or the inception or general character of the cause or external source insofar as reasonably pertinent to diagnosis or treatment. For statements identifying a perpetrator, the proponent must satisfy the Tracy two-part test in the particular case: (1) the declarant's motive in making the statement must be consistent with promoting treatment, and (2) the content of the statement must be such as is reasonably relied on by a physician in treatment or diagnosis. There is no categorical rule making identity statements by domestic-abuse victims admissible under rule 5.803(4).

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One of 10 multiple-choice questions for this case. Pick an answer to see why.

In Des Moines, Alicia Warren arrived at an emergency department with bruising around her eye and a sprained wrist. When the triage nurse asked what happened, Alicia said, “My boyfriend Eric did this,” and the physician later ordered X-rays and pain medication; no witness testified that Eric’s identity affected diagnosis, treatment, or discharge planning.

At Eric’s assault trial, the prosecution offers the nurse’s and physician’s testimony repeating Alicia’s identification under the medical-diagnosis-or-treatment exception. Should the identity portion be admitted?

Explanation. The exception requires more than the fact that the patient was seeking medical care. Under the majority rule, the proponent must satisfy the two-part foundation: the declarant’s motive must be consistent with promoting treatment, and the content must be reasonably relied on in diagnosis or treatment. Identity is usually different from “what happened,” and without case-specific evidence that the assailant’s identity mattered to treatment or diagnosis, the identity portion is inadmissible.