## Facts

- After a late-night 911 call and a related report from the victim’s mother, officers found M.D. outside her residence with her child and dog.
- M.D. reported she was struck while investigating a noise in the dark, lost consciousness after being kicked in the head, and believed the assailant entered through a locked door.
- M.D. later identified “Trent Daniel,” later determined to be Trent Smith, as the assailant and described a long history of abuse.
- Officers transported M.D. to a hospital emergency room, where an ER nurse and physician treated her physical injuries and observed she was distressed and shaken.
- In response to questions about what happened, M.D. told the nurse and physician she was assaulted by her child’s father and identified Smith as the attacker; she also reported being kicked in the head and arm and having loose teeth.
- The medical personnel limited diagnosis and treatment to physical injuries; neither witness testified that the assailant’s identity was needed or used for diagnosis or treatment, and no domestic-abuse-related psychological condition was diagnosed.
- M.D. later refused to sign a written statement identifying Smith; at trial, the State relied heavily on M.D.’s identification statements to medical staff.
- Over a hearsay objection, the trial court admitted the identification statements under Iowa Rule of Evidence 5.803(4), and the jury convicted Smith of domestic abuse assault.

## Issues

1. Whether a domestic-abuse victim’s hearsay identification of the alleged assailant to ER medical personnel is admissible under Iowa Rule of Evidence 5.803(4) without a sufficient foundation that the statement was made for, and was reasonably pertinent to, medical diagnosis or treatment.

## Decision

- The Iowa Supreme Court held M.D.’s statements identifying Smith to the ER nurse and physician were not admissible under Iowa Rule of Evidence 5.803(4) because the required foundation was not established.
- The Court declined to treat domestic-abuse cases as categorically permitting perpetrator-identification statements under the medical-diagnosis-or-treatment exception.
- The Court affirmed the court of appeals in part and vacated in part, reversed the district court judgment, and remanded for further proceedings.

## Legal Principles

- Iowa Rule of Evidence 5.803(4) applies only when (1) the declarant’s purpose in making the statement is consistent with obtaining medical diagnosis or treatment, and (2) the statement is of a type reasonably relied on by medical providers for diagnosis or treatment.
- A perpetrator’s identity is not automatically “reasonably pertinent” to medical diagnosis or treatment in adult domestic-assault cases; admissibility turns on a case-specific foundation.
- The proponent must present evidence that the patient understood the medical purpose of providing the identity information and that medical personnel actually needed or used it for diagnosis, treatment, or related medical decisionmaking.
- Where medical treatment is confined to physical injuries and there is no evidence that identity affected care, admitting identity-bearing hearsay under Rule 5.803(4) is error.

## Conclusion

The court required a specific evidentiary foundation before admitting a domestic-abuse victim’s identification of an assailant to medical personnel under Rule 5.803(4), and it reversed the conviction because that foundation was not shown on this record.


State v. Smith, 876 N.W.2d 180 (Iowa 2016)