## Facts

- Iraephraim X. Underwood was accused of sexually assaulting his minor step‑granddaughter (“Jane”) during an interstate trucking trip.
- Jane reported that she traveled with Underwood and another child (“John”) on a work trip; after John was taken home, Underwood continued with Jane and, after arriving in Michigan, sexually assaulted her.
- After Jane disclosed the assault, her mother took her to a hospital and then to a Children’s Advocacy Center.
- Jane underwent a sexual‑assault evaluation conducted by a Sexual Assault Nurse Examiner (SANE), Nurse Gorsuch. Underwood was not present during the exam.
- During the evaluation, Nurse Gorsuch asked Jane about what happened and who assaulted her; Jane identified Underwood and described the assault.
- A superseding federal indictment charged Underwood with one count of crossing state lines with intent to engage in a sexual act with a child (18 U.S.C. § 2241(c)) and two counts of transporting a minor with intent that the minor engage in unlawful sexual activity (18 U.S.C. § 2423(a))—one count involving Jane and one involving John.
- At trial, the government offered (among other evidence): (1) testimony from Underwood’s wife (“Cora”), including her observations and certain texts/voicemails; (2) testimony from Underwood’s adult daughter that Underwood sexually abused her in 1992 (conduct for which he had pleaded guilty); and (3) Nurse Gorsuch’s testimony recounting Jane’s statements during the medical evaluation.
- The jury convicted Underwood on the counts involving Jane and acquitted him on the count involving John. The district court imposed concurrent life sentences.

## Issues

1. Did admitting Cora Underwood’s testimony violate the adverse spousal testimony privilege or the confidential marital communications privilege?
2. Did the district court abuse its discretion under Federal Rule of Evidence 403 by admitting testimony from Underwood’s adult daughter about prior sexual abuse in 1992?
3. Did the district court err by allowing Nurse Gorsuch to recount Jane’s statements under Federal Rule of Evidence 803(4), and did Rule 403 require exclusion of that testimony?

## Decision

- The Sixth Circuit affirmed the convictions and sentences.
- The court held that spousal privileges did not bar Cora’s testimony as admitted at trial.
- The court held the district court did not abuse its discretion under Rule 403 by admitting the adult daughter’s testimony about the 1992 abuse.
- The court held Jane’s statements to Nurse Gorsuch were admissible under Rule 803(4), and the district court did not abuse its discretion in declining to exclude the testimony under Rule 403.

## Legal Principles

- The adverse spousal testimony privilege belongs to the witness‑spouse; a defendant generally cannot stop a spouse from testifying when the spouse chooses to testify.
- The confidential marital communications privilege protects only communications intended to be confidential; it does not generally cover a spouse’s observations of conduct, and it can be defeated where confidentiality is not shown.
- Rule 403 permits exclusion of relevant evidence only when the danger of unfair prejudice substantially outweighs its probative value; trial courts have broad discretion, and limiting instructions may reduce unfair prejudice.
- Rule 803(4) allows admission of statements made for medical diagnosis or treatment; in a sexual‑assault exam, a child’s description of the assault and identification of the assailant may fall within the exception when tied to medical care, including physical and psychological assessment and safety planning.
- Appellate review of these evidentiary rulings is for abuse of discretion.

## Conclusion

United States v. Underwood, 859 F.3d 386 (2017), affirmed Underwood’s convictions and concurrent life sentences for aggravated sexual abuse of a child and transporting a minor, concluding that the district court did not err in admitting (1) the wife’s testimony over spousal‑privilege objections, (2) the adult daughter’s prior‑abuse testimony under Rule 403, and (3) the child’s statements to a SANE under Rule 803(4) and Rule 403.
