from the Iowa District Court for Floyd County, Christopher C.
defendant appeals his conviction of third-degree sexual abuse
following a jury trial, asserting the district court erred in
allowing the sexual-assault nurse examiner to testify as to
the victim's statements over the defendant's
C. Smith, State Appellate Defender, and Theresa R. Wilson,
Assistant Appellate Defender, for appellant.
J. Miller, Attorney General, and Louis S. Sloven, Assistant
Attorney General, for appellee.
Considered by Vaitheswaran, P.J., and Doyle and Bower, JJ.
a jury trial, Stephen Brodersen Jr. was found guilty of
third-degree sexual abuse. He now appeals his conviction,
arguing the district court erred or abused its discretion
when it permitted the victim's examining nurse to
testify, over Brodersen's objection, to statements made
by the victim to the nurse during the nurse's examination
of the victim. Brodersen argues the district court erred in
finding the hearsay exception concerning medical treatment
applied to permit the nurse's hearsay testimony, because,
he alleges, the victim's statements to the examining
nurse were not made for the purposes of medical diagnosis or
treatment but rather given in response to the nurse's
questions as part of the nurse's forensic examination.
Our review is for correction of errors at law. See State
v. Smith, 876 N.W.2d 180, 184 (Iowa 2016).
is an out-of-court statement offered in evidence to prove the
truth of the matter asserted. See Iowa R. Evid.
5.801(c); Smith, 876 N.W.2d at 185. The general rule
is that hearsay is not admissible at trial unless an
exception or exclusion to the rule applies. See Iowa
Rs. Evid. 5.802-.807; Smith, 876 N.W.2d at 185.
Here, the parties do not dispute the nurse's testimony
detailing the victim's statements and answers given
during her examination is hearsay. Rather, the fighting issue
is whether the exception, set out in Iowa Rule of Evidence
5.803(4), applies to permit the hearsay testimony.
5.803(4) excepts from the hearsay prohibition
"[s]tatements 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."
See Iowa R. Evid. 5.803(4). Breaking the rule down
into its parts, the medical diagnosis or treatment exception
to the hearsay rule applies if two criteria are met: (1) the
statements were "made for purposes of medical diagnosis
or treatment, " and (2) the statements describe
"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." Id.;
see also Smith, 876 N.W.2d at 185.
The rationale for the exception is that statements made by a
patient to a doctor for purposes of medical diagnosis or
treatment are "likely to be reliable because the patient
has a selfish motive to be truthful." This motive exists
because the effectiveness of the medical treatment rests on
the accuracy of the information imparted to the doctor. A
patient understands that a false statement in a diagnostic
context could result in misdiagnosis. Thus, the circumstances
of statements made for diagnosis and treatment provide
"special guarantees of credibility" and justify the
exception to the rule against hearsay.
Smith, 876 N.W.2d at 185 (citations omitted).
essentially contends that because the victim did not initiate
medical treatment on her own, but rather only sought
treatment after law enforcement officials encouraged her to
do so, the statements made by the victim to her examining
nurse were not made for the purposes of medical diagnosis or
treatment. Additionally, Brodersen points out the nurse
testified she obtained information from the victim to
determine what forensic evidence to obtain and that some of
the information related to her by the victim was not
pertinent to the victim's medical treatment. He also
notes the examining nurse was not asked at trial if she
explained to the victim "that the purpose of the exam
was for medical treatment or that truthful answers were
needed to ensure appropriate treatment." Brodersen
claims the testimony of the nurse recounting the victim's
statements, including those he contends were not relevant to
her treatment, served to bolster the victim's credibility
to his detriment, "tipp[ing] the scales toward
Brodersen's guilt" and resulting in prejudice to
him. We disagree.
true the victim did not initiate treatment; nevertheless, it
was the victim that-on her own-told the 9-1-1 dispatcher she
had been sexually abused by Brodersen, in addition to
relating Brodersen's medical emergency that day. The
victim told the responding officers she had been sexually
abused by Brodersen, and it was the victim that ultimately
chose to go to the hospital for an examination, told the
emergency room staff she had been sexually abused, waited to
be examined by the sexual-assault nurse examiner, and then
told the nurse what happened. We believe these circumstances
are evidence of the victim's motivation to be truthful.
While the statements made by the victim to the nurse were
used to determine what forensic evidence to obtain, we
believe all of the statements were made for purposes of
medical diagnosis, if not for medical treatment. That the
matters overlap is due to the nature of the crime. The
medical professionals ask questions to determine what
happened and what treatment is required. In making those
assessments, evidence related to a crime is collected, if
available and appropriate. The victim did not have to submit
to the sexual-abuse examination or answer the examining
nurse's questions; she chose to do so. The victim told
the nurse the actions Brodersen took related to the sexual
abuse, beginning to end. Though some minor details provided
by the victim were not directly required for treatment, those
details were all given with information about and in
reference to Brodersen's actions. We find no error in the
district court's determination that the medical diagnosis
or treatment exception to the hearsay rule in rule 5.803(4)
applied to permit the nurse's testimony of the
victim's statements made during the examination.
even assuming arguendo that some of the statements were
admitted erroneously, we believe the record affirmatively
establishes, under the facts of this case, that the admission
of hearsay evidence over proper objection was not
prejudicial. See State v. Plain, __ N.W.2d __, __,
2017 WL 2822482, at *4 (Iowa 2017). "The burden to
affirmatively establish lack of prejudice is met 'if the
record shows the hearsay evidence did not affect the
jury's finding of guilt.' Tainted evidence that is
merely cumulative does not affect the jury's finding of
guilt." Id. (quoting State v. Elliott,
806 N.W.2d 660, 669 (Iowa 2011)). Here, the testimony of the
nurse concerning the victim's statements was merely
cumulative of evidence already in the record-namely the
victim's testimony. More significantly, there was other
evidence in the record that bolstered the victim's
testimony-the messages sent by Brodersen to the victim via
social media after the sexual abuse. One message stated
Brodersen was "very sorry that things went further than
[she] wanted." After many more messages to the victim,
the victim responded, "Even when I said no you continued
to try last night . . . . I told you that I didn't want
to be with you not like that . . . . [W]hat you did last
night was rape . . . . I said no on more than one
occasion." Brodersen replied that he was "so
sorry" and that he hurt her and it was messing him ...