## Facts

- Margaret Gaffey executed a will that was admitted to probate after her death.
- Anna Knapp filed a statutory will contest in circuit court, alleging Gaffey lacked testamentary capacity and executed the will under undue influence.
- Before Gaffey’s death, Dr. McWilliams treated her and kept an account book recording visit dates, charges and payments, and brief medical notations (including “hyperaemia,” “brain softening,” and “paralysis”).
- Dr. McWilliams died before trial.
- Knapp offered the account book at trial to show Gaffey’s medical condition near the time the will was executed.
- The trial court admitted the book only to prove visits and charges, excluding the medical notations as evidence of Gaffey’s condition.
- The jury returned a verdict for the defendants upholding the will, and judgment was entered accordingly.
- Knapp appealed, arguing the limitation on the account book’s evidentiary use was error.

## Issues

1. Whether a deceased physician’s account book, kept in the regular course of medical practice and contemporaneously with treatment, is admissible to prove the nature of the patient’s illness and condition, not merely the fact of visits and charges, in a will contest.

## Decision

- The Supreme Court of Missouri reversed and remanded for a new trial.
- The trial court erred by limiting the account book to proof of visits and payments.
- The diagnostic/condition entries, if properly authenticated, were competent evidence of Gaffey’s illness and physical/mental condition.
- Excluding the medical notations was prejudicial because the entries were relevant to testamentary capacity and susceptibility to undue influence.

## Legal Principles

- Contemporaneous records made by a physician in the ordinary course of professional practice may be admitted as substantive evidence of the patient’s condition when the physician is unavailable (including by death).
- Such professional records may be admitted for more than financial accounting; they can include and prove medical observations and diagnoses recorded in the course of treatment.
- Where reliability is supported by routine, systematic, contemporaneous recordkeeping and necessity arises from the recorder’s unavailability, the entries may fall within a recognized exception to the hearsay rule.
- In will contests, exclusion of competent medical record evidence bearing on capacity and undue influence can constitute reversible error when it materially limits proof of the decedent’s condition.

## Conclusion

The Missouri Supreme Court held that a deceased physician’s regularly kept practice account book could be used to prove the patient’s recorded medical condition as well as attendance and charges, and it ordered a new trial because the improper limitation likely affected the verdict sustaining the will.


Knapp v. St. Louis Tr. Co., 98 S.W. 70 (Mo. 1906)