ÿWPC\3 …# VUNa %¯ 0 —µw@L 4Œ   0Û¯ 0DŠ UFÎ  UH 0Jd 0T® 0^ 0h` 0rÈ 0|: 0†¶ 0< 1uÌ 0dA B¥ D3ÂU>õ 0@3U6s AK©U*ô=}[ŒØâdiFد߇(v~f*vÓä+ AO·1Æ2 0DÌ2 D/3 B?3˜HP LaserJet 4Si/4SiMX PS 600dpiPSCRIPTÀÌÀääÀÀÌ0 (ÈhH  Z ‹6Times New Roman RegularX(o…:$¡¡ÑŒ Œ ÑÑXÑÒ°ÒÒX°ÒÔ€XwXXXÔÑ  ÑÓ  Ó íîïðñòDóDôõÓ€ÿDÒ k3|xÿ(‹(3ví$¤¤Ý ƒ…:!ÝÑŒ °ÑѰÑÒ°ÒÒX°ÒÔ€X:XXXÔÑ  ÑÓ  ÓÝ  Ýà ` àòòÚ  Ú0Ú  Úóó(#Ã$òòÚ  Ú0Ú  Úóó´.Courier New Regular<à09Z 0Courier (W1) Regular2 ÿÿ0Indent1Ô2ÔÔ3  Ô2" ÿÿ0Indent2à0 àÔ2ÔÔ3  Ô2, ÿÿ0Indent3à0 àà0 àÔ2ÔÔ3  Ô26 ÿÿ0Indent4à0 àà0 àà0 àÔ2ÔÔ3  Ô2@ ÿÿ0Indent5à0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2J ÿÿ0Indent6à0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2T ÿÿ0Indent7à0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2^ ÿÿ0Indent8à0 àà0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô ÿÿ?AGMSYaioIndent0I.A.1.a.(1)(a)i)a)P ÿÿ8Mac DefaultMac DefaultÓ ` °šXÓ d$$$$'ÿÿdxd< Œ 9p`(&Times New Roman("ÿÿ$££Ò  ÒÒ  Ò< Œ 9p`(Courier New€-Cþÿ << Gÿÿ< Œ 9p`(Arial 3Ý ƒ!ÝÔ€,ÔÑ Œ ÑÑ  ÑÒ  ÒÒ X ÒÔ€.ÔÑ  ÑÓ  ÓÝ  ÝÔ€0ÔÔ€0ÔÓ  Óò òÔ YYY ÔFILEDÔ€0XÔÌÌOctoberÏ14,Ï1996ÌÌCecilÏW.ÏCrowsonÌAppellateÏCourtÏClerkÔ  Ôó ó sÝ ƒ!ÝÑ#€d#ÑÔ€,ÔÑ Œ ÑÑ  ÑÒ  ÒÒ X ÒÔ€.ÔÑ  ÑÓ  ÓÝ  ÝÝ ƒ $Ýà àòòÚ  ÚÚ  ÚóóÝ  ÝTennessee€Rule€Evidence€803(4)€differs€significantly€from€itsÏfederal€counterpart,€Fed.€R.€Evid.€803(4),€in€one€respect.€€TheÏfederal€rule€allows€ð ð[s]tatements€made€for€purposes€of€medicalÏdiagnosis€òòoróó€treatment,ðð€while€the€Tennessee€version€of€the€ruleÏrequires€that€the€physician€be€consulted€ð ðfor€purposes€of€medicalÏdiagnosis€òòandóó€treatment.ðð€(emphasis€added).Ìà à€We€further€observe€that€although€Rule€803(4)€ordinarilyÏinvolves€statements€made€to€physicians,€the€scope€of€the€ruleÏapplies€to€any€person€to€whom€a€statement€is€made€for€purposes€ofÏor€pertinent€to€medical€diagnosis€and€treatment.€€òòSee,€e.g.,€StateÏv.€Ruckeróó,€847€S.W.2d€512€(Tenn.€Crim.€App.€1992)(statements€madeÏto€nurse).€€Commentators€have€also€suggested€that€the€Rule€extendsÏto€other€medical€professionals€and€employees€such€as€ambulanceÏattendants,€orderlies,€hospital€attendants,€clerks,€andÏadministrative€personnel.€€Neil€P.€Cohen€òòet€al.óó,€òòTennessee€Law€onÏEvidenceóó€ðð€803(4).6€(3d€ed.€1995).€€However,€in€òòState€v.€Baroneóó,Ï852€S.W.2d€216€(Tenn.€1993),€we€declined€to€apply€Rule€803(4)€toÏstatements€made€to€psychologists.Ì ‚Ý ƒ!ÝÑ#€d#ÑÔ€,ÔÑ Œ ÑÑ  ÑÒ  ÒÒ X ÒÔ€.ÔÑ  ÑÓ  ÓÝ  ÝÝ ƒ $Ýà àòòÚ  ÚÚ  ÚóóÝ  ÝWe€are€aware€that€òòRuckeróó€construes€Rule€803(4)€differently€byÏsuggesting€that€there€are€three€requirements€that€must€beÏsatisfied€before€a€statement€can€be€admitted€under€803(4):€ð ðItÏmust€be€established€that€the€statement€(a)€was€made€for€theÏpurpose€of€medical€diagnosis€and€treatment,€(b)€described€theÏmedical€history€of€the€declarant,€i.e.,€past€or€present€symptoms,Ïpain,€sensations,€and€the€general€character€of€the€cause€or€sourceÏthereof,€òòand€(c)€was€reasonably€pertinent€to€diagnosis€andÏtreatmentóó.ðð€847€S.W.2d€at€516€(emphasis€added).€€We€construeÏ803(4)€as€having€only€two€requirements:€(1)€the€statement€must€beÏmade€for€the€purpose€of€diagnosis€or€treatment:€(a)€describingÏmedical€history,€or€(b)€past€or€present€symptoms,€or€(c)€pain€orÏsensation;€or€(2)€the€statement€may€address€the€inception,€cause,Ïor€source€of€the€problem€if€it€is€reasonably€pertinent€toÏdiagnosis€or€treatment.Ì ØÝ ƒ!ÝÑ#€d#ÑÔ€,ÔÑ Œ ÑÑ  ÑÒ  ÒÒ X ÒÔ€.ÔÑ  ÑÓ  ÓÝ  ÝÝ ƒ $Ýà àòòÚ  ÚÚ  ÚóóÝ  ÝWe€note€that€other€jurisdictions€follow€the€federal€rule€andÏadmit€statements€made€for€either€diagnosis€or€treatment;€our€ruleÏwhich€requires€that€the€statement€be€made€for€diagnosis€andòòÏóótreatment.€€Thus,€ours€is€a€stricter€rule.Ì _Ý ƒ!ÝÑ#€d#ÑÔ€,ÔÑ Œ ÑÑ  ÑÒ  ÒÒ X ÒÔ€.ÔÑ  ÑÓ  ÓÝ  ÝÝ ƒ $Ýà àòòÚ  ÚÚ  ÚóóÝ  ÝIn€cases€involving€sexually€oriented€crimes,€the€CourtÏwithholds€the€identities€of€young€victims€when€appropriate.Ì ÎÝ ƒ!ÝÑ#€d#ÑÔ€,ÔÑ Œ ÑÑ  ÑÒ  ÒÒ X ÒÔ€.ÔÑ  ÑÓ  ÓÝ  ÝÝ ƒ $Ýà àòòÚ  ÚÚ  ÚóóÝ  ÝWe€recognize€that€many€states€include€emotional,Ïpsychological,€or€psychiatric€injuries€within€the€803(4)Ïdefinition€of€ð ðmedical€diagnosis€and€treatment.ðð€The€United€StatesÏCourt€of€Appeals€has€acknowledged€that€hearsay€evidence€can€beÏadmitted€under€the€medical€treatment€exception€when€the€statementÏis€made€for€the€treatment€of€a€nonphysical€injury.€òòGuam€v.ÏIgnacioóó,€10€F.3d€608€(9th€Cir.€1993).€òòGuamóó€involved€the€sexualÏabuse€of€a€three„year„old€child€by€her€uncle.€òòId.óó€at€610.€In€thatÏcase€the€court€stated€that€ð ð[s]exual€abuse€involves€more€thanÏphysical€injury;€the€physician€must€[also]€be€attentive€toÏtreating€the€victimððs€emotional€and€psychological€injuries€....ððÏòòId.óó€at€613;€òòSee€alsoóó€òòMoore€v.€C.F.óó,€165€B.R.€495,€498€(Bankr.€M.D.ÏAla.€1993)(extending€Fed.€R.€Evd.€803(4)€to€mental€healthÏprofessionals;€quoting€the€advisory€committeeððs€note€that€theÏððstatement€need€not€have€been€made€to€a€physician.ðð);€òòMorgan€v.ÏForetichóó,€846€F.2d€941,€949€(4th€Cir.€1988)€(holding€thatÏstatements€to€psychiatrists€or€psychologists€are€admissible€underÏ803(4)€the€same€as€statements€to€physicians);€òòUnited€States€v.ÏRenvilleóó,€779€F.2d€430€(8th€Cir.€1985)(€holding€that€physical€andÏpsychological€injuries€accompany€the€crime€of€child€abuse,€and€aÏphysician€must€be€able€to€treat€both€injuries);€òòUnited€States€v.ÏLechocoóó,€542€F.2d€84€(D.C.€Cir.€1976)(applying€the€medicalÏtreatment€exception€to€comments€made€to€a€psychiatrist);€òòPeople€v.ÏWilkinsóó,€349€N.W.2d€815€(Mich.€Ct.€App.€1984)(holding€that€sexualÏabuse€includes€medical,€physical,€and€psychological€components,Ïthe€court€held€that€the€childððs€statements€were€reasonablyÏnecessary€for€diagnosis€and€treatment€under€803(4));€òòState€v.ÏNelsonóó,€406€N.W.2d€385€(Wis.€1987)€(applying€803(4),€the€courtÏstated€that€child€abuse€cases€involve€emotional€and€psychologicalÏinjuries€and€that€a€child€is€equally€as€aware€of€the€existence€ofÏemotional€pain€as€he€is€of€physical€pain).Ì ÕÝ ƒ!ÝÑ#€d#ÑÔ€,ÔÑ Œ ÑÑ  ÑÒ  ÒÒ X ÒÔ€.ÔÑ  ÑÓ  ÓÝ  ÝÝ ƒ $Ýà àòòÚ  ÚÚ  ÚóóÝ  Ý"Aggravated€sexual€batteryðð€is€defined€as€the€unlawful€sexualÏcontact€with€a€victim€by€the€defendant€or€the€defendant€by€aÏvictim€who€is€less€than€thirteen€years€old.€€Tenn.€Code€Ann.€ððððÏ39„13„504(a),€39„13„502(a)(4)(1991).ÌPtPtHHÚ(ÿáÿâùFG(üHHÚ(d'@Styl{WP}01•ÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃà Ãà Ãà Ãà Ãà ÃÃÃÃÃÃÃÃÃÃÃÐ ÐÐHHÐÐ  ÐÐ2ÐÐÿÿ¸æ$ÿÐÐHHÐÐÐÐÐÐÐÐ  ÐÐ ÐÐ ÐÑÑÑGenevaÑÑ ÑÑ € ÑÑ<Px–ÈÑÒÒÒ443!#4ÒÒ$ *$ÒÒ$*$ÒÒ ÿKK ÒÒ  Geneva ÒÒ  Geneva ÒÓ.,ÓÓÓÓ6ÓÓ ÓßßßßßßßßßßßßßßßßßßÑGenevaÑÑ ÑÒ  BA Op Geneva ÒÒ  BA Op Geneva Ò€-‚ƒCþÿ<< CÿÿƒLevel 1Level 2Level 3Level 4Level 5($$””ò òÚ  Ú1Ú  Úó ó„„'÷ÿ dxdüÿP PdÝ ƒ!ÝÔ . ÔÔ€,ÔÑ Œ ÑÑ  ÑÒ  ÒÒ X ÒÔ€.ÔÑ  ÑÓ  ÓÝ  ÝÓ  ÓÑ ° ÑÑ X ÑÓ` °‚X˜XÓÑ\R AØ'\ÑIN€THE€SUPREME€COURT€OF€TENNESSEEÌÌAT€NASHVILLEÌÓ  ÓÌÌSTATE€OF€TENNESSEEà àà àà à)à àFor€PublicationÌà àà àà àà àà à)Ìà àAppelleeà àà àà à)à àFiled:€€October€14,Ï1996Ìà àà àà àà àà à)à àÌv.à àà àà àà àà à)à àDavidson€CriminalÌà àà àà àà àà à)à àÌCARL€LEE€MCLEODà àà àà à)à àHon.€Walter€C.ÏKurtz,€JudgeÌà àà àà àà àà à)Ìà àAppellantà àà àà à)à àNo.€01„S„01„9509„CR„00170ÌÌÌÌSTATE€OF€TENNESSEEà àà àà à)Ìà àà àà àà àà à)Ìà àAppelleeà àà àà à)Ìà àà àà àà àà à)Ìv.à àà àà àà àà à)à àMaury€CircuitÌà àà àà àà àà à)ÌJAMES€YOUNGà àà àà àà à)à àHon.€Jim€T.ÏHamilton,€JudgeÌà àà àà àà àà à)Ìà àAppellantà àà àà à)à àNo.€01„S„01„9509„CC„00171ÌÌÌòòÌAttorney€for€Appellant€McLeodóó:à àòòAttorney€forÏthe€Stateóó:ÌÌJEFFREY€A.€DEVASHERà àà àà àà àCHARLES€W.ÏBURSONÌSenior€Assistant€Public€Defenderà àAttorneyÏGeneral€&€ReporterÌNashville,€Tennesseeà àà àà àÌ(On€appeal)à àà àà àà àà àMICHAEL€E.ÏMOOREÌà àà àà àà àà àà àSolicitor€GeneralÌPAT€MCNALLYà àà àà àà àà àÌAssistant€Public€Defenderà àà àGORDON€W.€SMITHÌNashville,€Tennesseeà àà àà àAssociateÏSolicitor€GeneralÌ(At€trial)à àà àà àà àà àNashville,ÏTennesseeÌÌòòAttorney€for€Appellant€Youngóóà àà àNICHOLAS€D.ÏBAILEYÌà àà àà àà àà àà àAssistant€DistrictÏAttorneyÌßD€/15%!`|¯éw` 81 `€DßJAMES€YOUNG€à àà àà àà àà à€GeneralÌ(Pro€se€on€appeal)à àà àà àà àNashville,€TennesseeÌà àà àà àà àà àà à(In€McLeodððs€case€only)ÌMARK€J.€FISHBURNà àà àà àà àÌNashville,€Tennesseeà àà àà àT.€MICHAEL€BOTTOMSÌ(At€trial)à àà àà àà àà àDistrict€Attorney€GeneralÌÙ€€Ùà àà àà àà àà àà àLawrenceburg,€TennesseeÌÌà àà àà àà àà àà àROBERT€C.€SANDERSÌà àà àà àà àà àà àAssistant€District€Attorney€Ìà àà àà àà àà àà à€GeneralÌà àà àà àà àà àà àColumbia,€TennesseeÌà àà àà àà àà àà à(In€Youngððs€case€only)ÌÌÌà@ àòòO€P€I€N€I€O€NóóÌÌÌAFFIRMEDà àà àà àà àà àà àà àà àà àà àBIRCH,ÏC.J.ÇÑ Œ ÑÑ  ÑÓÓ›Ñ7€ t— XdÖXXdÈ7Ñà àThis€consolidated€appeal€centers€our€attention€on€theÏbroad,€growing€problem€in€child€abuse€cases€of€the€admissibilityÏof€statements€made€by€children€during€the€course€of€a€medicalÏexamination.€€The€precise€difficulty€arises€in€attempting€to€applyÏevidentiary€rules€drafted€with€adults€in€mind€to€cases€involvingÏchildren.€€€Problems€notwithstanding,€we€must€achieve€a€balanceÏthat€fosters€the€important€governmental€interest€in€protectingÏchildren€while€maintaining€fundamental€fairness.Ìà àÌà àIn€each€case€before€us,€the€trial€court,€pursuant€toÏTenn.€R.€Evid.€803(4),€permitted€a€physician€to€testify€concerningÏout„of„court€statements€made€by€a€child„declarant.€€At€issue€isÏwhether€each€trial€court€erred€in€admitting€the€respectiveÏstatements.€€We€consolidated€the€cases€and€granted€review€in€orderÏto€clarify€the€criteria€for€determining,€in€cases€involvingÏallegedly€abused€child„declarants,€whether€a€statement€qualifiesÏfor€admission€into€evidence€under€the€exception€to€the€hearsayÏrule€as€provided€in€Rule€803(4).ÌÌà àFor€the€reasons€discussed€below,€we€hold€today€that€inÏorder€to€determine€the€admissibility€under€Rule€803(4)€of€aÍstatement€made€by€a€child„declarant,€the€trial€court€shall€conductÏan€evidentiary€hearing€outside€the€juryððs€presence.€€AfterÏconsidering€all€of€the€relevant€evidence€offered€pertaining€to€theÏmaking€of€the€statement,€the€trial€judge€shall€admit€the€statementÏinto€evidence€upon€an€affirmative€finding€that€the€conditionsÏdescribed€in€the€rule€have€been€satisfied.€€Ìà àò òÌà@ àó óIÌÌà àStatements€made€for€the€purpose€of€medical€diagnosis€andÏtreatment€are€admissible€as€an€exception€to€the€hearsay€rule€underÏTenn.€R.€Evid.€803(4).€€The€exception€€provides:ÌÓÓÌà8 àà8 àStatements€made€for€purposes€ofÏmedical€diagnosis€and€treatmentÏdescribing€medical€history;€past€orÏpresent€symptoms,€pain,€orÏsensations;€or€the€inception€orÏgeneral€character€of€the€cause€orÏexternal€source€thereof€insofar€asÏreasonably€pertinent€to€diagnosisÍand€treatment.œ× ƒ4 ××  ×›ÌÓÓÌà àThe€language€of€Rule€803(4)€sets€forth€the€requirementsÏto€be€met€before€such€statements€may€be€admitted€under€thisÏexception.€€First,€the€statement€must€have€been€made€for€theÏpurpose€of€medical€diagnosis€and€treatment,€describing€the€medicalÏhistory,€which€includes€past€or€present€symptoms,€œpain,›€orÏsensations;€òòoróó,€second,€if€the€statement€addresses€the€inceptionÏor€€general€character€of€the€cause€or€external€source€of€theÍproblem,€then€the€information€in€the€statement€must€be€reasonablyÏpertinent€to€diagnosis€and€treatment.òòœ× ƒ5 ××  ×›óóà àÌÌà àRule€803(4)€is€based€upon€the€notion€that€statementsÏmade€under€conditions€prescribed€by€the€rule€are€presumptivelyÏtrustworthy.€€Courts€have€reasoned€that€patients€seeking€medicalÏassistance€are€strongly€motivated€to€be€truthful€because€accurateÏdiagnosis€and€effective€treatment€often€depend,€in€part,€upon€whatÏpatients€tell€health€care€providers.€€òòUnited€States€v.€Renvilleóó,Ï779€F.2d€430,€436€(8th€Cir.€1985);€òòUnited€States€v.€Iron€Shellóó,Ï633€F.2d€77,€84€(1980).€€ð ð[T]hus[,]€the€declarant€has€a€self„interested€motive€to€tell€the€truth.ðð€€òòState€v.€Baroneóó,€852€S.W.2dÏ216,€220€(Tenn.€1993)(òòciting€óóNeil€P.€Cohen€òò€et€al.,óó€òòTennessee€LawÍof€Evidenceóó€ðð€803(4).1€at€425€(2d€ed.€1990)).€€Moreover,€ifÏphysicians€or€other€medical€personnel€rely€upon€the€statement€inÏdiagnosing€and€treating€the€patient,€then€the€statement€should€beÏsufficiently€trustworthy€to€be€admissible€in€a€court€of€law.€€òòId.Ïóóat€220;€òòState€v.€Edwardsóó,€868€S.W.2d€682,€699€(Tenn.€Crim.€App.Ï1993).€€The€patientððs€strong€motivation€to€be€truthful€constitutesÏthe€basis€for€similar€evidentiary€rules€in€other€jurisdictions€asÏwe€will€discuss€below.ÌÌà àThis€rationale,€however,€becomes€questionable€when€theÏpatient€is€a€child€because€children€may€not€be€able€to€understandÏthe€need€to€be€truthful€in€the€medical€setting.€€Nevertheless,Ïcourts€must€adhere€to€the€evidentiary€rules€to€ensure,€to€theÏextent€possible,€that€only€those€out„of„court€statements€whichÏsatisfy€the€œrequirements›€of€the€rule€are€admitted€into€evidence.€ÌÌà àFor€guidance€on€this€issue,€we€turn€to€otherÏjurisdictions€to€consider€their€treatment€of€Rule€803(4)€in€casesÏinvolving€statements€made€by€a€child€to€medical€personnel.œ× ƒ6 ××  ×›€€SomeÍjurisdictions€require€the€child„declarant€to€show€knowledge€of€theÏmotive€for€the€treatment.€€òòSee,€e.g.,€United€States€v.€Barrettóó,€8ÏF.3d€1296,€1300€(8th€Cir.€1993)(requiring€ð ðevidence€that€the€childÏunderstood€the€physicianððs€role€in€order€to€trigger€the€motivationÏto€provide€truthful€informationðð);€òòRing€v.€Ericksonóó,€983€F.2d€818,Ï820€n.2€(8th€Cir.€1993)(finding€that€three„year„old€victim€who€didÏnot€know€she€was€talking€to€physician€did€not€have€the€ð ðselfishÏmotiveðð€to€tell€the€truth;€the€court€indicated,€however,€that€ifÏthere€had€been€some€other€indicia€of€reliability,€the€statementsÏmay€have€been€admissible);€òòState€v.€Maldonadoóó,€536€A.2d€600,€602„03€(Conn.€App.€Ct.€1988)(holding€statement€admissible€whereÏsecurity€guard€enlisted€to€translate€statement€of€three„year„oldÏdeclarant€told€child€he€was€questioning€her€to€aid€in€doctorððsÏtreatment);€òòState€v.€Jonesóó,€625€So.€2d€821,€823„24€(Fla.Ï1993)(requiring€some€evidence€that€declarant€was€motivated€toÏspeak€the€truth€for€purposes€of€obtaining€medical€treatment);ÏòòJohnson€v.€Stateóó,€666€So.€2d€784,€795€(Miss.€1995)(requiringÏaffirmative€finding€that€declarantððs€motive€in€making€statementÏwas€consistent€with€purpose€of€promoting€treatment).ÌÌà àOther€jurisdictions€require€that€the€declarant€have€aÏmotive€for€making€the€statement€surrounding€the€œtreatment›€butÏallow€such€motive€to€be€inferred€or€presumed.€€òòSee,€e.g.,€UnitedÏStates€v.€Iron€Shellóó,€633€F.2d€77,€84€œ(1980)(holding›€that€nothingÏin€the€content€of€the€statements€suggested€that€declarant€wasÏresponding€to€the€doctorððs€questions€for€any€reason€other€thanÏpromoting€treatment),€òòcert.€deniedóó,€450€U.S.€1001€(1981);€òòDana€v.ÏDepartment€of€Correctionsóó,€958€F.2d€237,€239€(8th€œCir.)(despite›Ïlack€of€direct€evidence€on€the€issue€of€declarantððs€motivation€inÏgiving€statements,€court€considered€declarantððs€age,€lack€ofÏinconsistencies,€and€graphic€descriptions€of€abuse€as€weighing€inÏfavor€of€trustworthiness€of€œstatements),òò€cert.€deniedóó,€505€U.S.Ï1225€(1992);›€òòMorgan€v.€Foretichóó,€846€F.2d€941,€949€(4th€Cir.Ï1988)(young€child€has€same€motive€to€make€true€statements€forÏpurposes€of€diagnosis€or€treatment€as€an€adult).ÌÌà àA€third€group€of€jurisdictions€does€not€require€aÏspecific€showing€of€motive;€rather,€they€inquire€whether€theÏsubject„matter€of€the€declarantððs€statement€was€reasonablyÏpertinent€to€diagnosis€or€treatment.€€òòSee,€e.g.,€Clausen€v.€Stateóó,Ï901€S.W.2d€35,€37€(Ark.€Ct.€App.€1995)(court€ignored€question€ofÍtreatment€motive€of€three„year„old€declarant€and€focused€insteadÏupon€question€whether€subject„matter€of€statements€was€reasonablyÏpertinent€to€diagnosis€or€treatment).ÌÌà àIt€is€well€established€that€trial€courts€have€broadÏdiscretion€in€determining€the€admissibility€of€evidence,€and€theirÏrulings€will€not€be€reversed€absent€an€abuse€of€that€discretion.€€ÏòòState€v.€Campbell,€óó904€S.W.2d€608,€œ616›€(Tenn.€1995);€òòState€v.ÏBaker,óó€785€S.W.2d€132,€134€(Tenn.€Crim.€App.€1989);€òòsee€alsoóó€Tenn.ÏR.€Evid.€104.€€In€making€the€determination€under€Rule€803(4),Ïtrial€courts€must€consider€criteria€such€as€the€circumstancesÏsurrounding€the€making€of€the€statement,€which€would€include€theÏtiming€of€the€statement€and€its€contents.€€If€the€trial€courtÏfinds€that€the€statement€was€inappropriately€influenced€byÏanother,€the€court€should€exclude€it€as€not€having€been€made€forÏthe€purpose€of€diagnosis€and€treatment.€€The€inquiry,€however,Ïwill€vary€depending€on€the€facts€of€each€case.€€To€œillustrate:€Ï(1)›€the€trial€court€may€consider€whether€the€childððs€statement€wasÏin€response€to€suggestive€or€leading€œquestions;€and/or€(2)€the›Ïtrial€court€may€consider€any€other€factor€that€may€affectÏtrustworthiness,€such€as€a€bitter€custody€battle€or€family€feud.ÌÌà àCourts€should€not€presume€that€statements€by€a€child€toÏa€medical€services€provider€are€untrustworthy€merely€because€thereÏis€disputable€evidence€of€the€childððs€motivation€to€be€truthful.ÏRather,€the€admissibility€decision€should€be€based€upon€a€thoroughÏexamination€of€all€of€the€circumstances€surrounding€the€statement.€ÏAlthough€it€is€the€responsibility€of€the€trial€court€to€determine,Ïin€the€first€instance,€whether€the€statement€will€ever€reach€theÏjury,€we€must€remember€that€the€jury,€in€the€final€analysis,€Ïdetermines€œcredibility.›€€We€now€apply€these€principles€to€theÏcases€before€us.ÌœÌÌÓ  Ó›IIÌÓ  ÓÌà àIn€May€1990,€a€Davidson€County€jury€convicted€appellantÏCarl€Lee€œMcLeod›€of€seven€counts€of€aggravated€rape€involving€hisÏson,€his€daughter€TM,× ƒ7 ××  ×€and€TMððs€friend.€€Because€the€issue€underÏconsideration€concerns€the€statements€made€by€TM€to€a€physician,Íwe€need€not€address€the€convictions€for€the€counts€involving€theÏother€victims.ÌÌà àAt€trial,€TM,€then€age€eleven,€testified€that€œMcLeod›Ïused€his€finger€to€penetrate€her€ð ðprivate€parts,ðð€and€on€oneÏœoccasion›€he€penetrated€her€with€his€ð ðprivate€part.ððÌÌà àPaul€Heil,€M.D.,€a€pediatric€resident€at€a€DavidsonÏCounty€medical€facility,€examined€TM€a€few€days€after€the€abuseÏhad€been€reported.€€At€trial,€he€testified€that€he€obtained€aÏmedical€history€from€TM€before€performing€the€physicalÏexamination.€€Following€an€objection€by€the€defendantððs€counsel€toÏthe€testimony€surrounding€the€history,€the€court€conducted€a€jury„out€evidentiary€hearing.€€During€the€hearing,€Heil€testified€thatÏTM€had€sustained€trauma€to€her€genitalia€consistent€with€havingÏbeen€penetrated€just€inside€her€vagina.€€In€response€to€questionsÏabout€the€purpose€of€the€examination€and€the€significance€ofÏobtaining€the€patientððs€medical€history,€Heil€testified€that€bothÍwere€important€in€ascertaining€whether€the€child€needed€immediateÏtreatment€for€physical€problems.œ× ƒ8 ××  ×›ÌÌà àRelevant€points€of€his€testimony€are€summarized€asÏfollows:à àœHeil›€testified€that€he€examined€TM€when€she€was€nineÍyears€old.€The€examination€was€performed€within€a€few€days€of€theÏinitial€complaint.€This€procedure€included€taking€a€history€fromÏthe€child€as€well€as€conducting€a€physical€examination.€€HeilÏdenied€that€the€purpose€of€the€examination€was€to€gather€evidenceÏof€abuse,€œrather›€he€testified€that€both€the€history€and€theÏphysical€examination€were€necessary€to€aid€him€in€diagnosis€andÏtreatment.€œ€TM›€was€examined€out€of€the€presence€of€her€mother,€andÏupon€questioning,€she€told€him€about€her€medical€history€and€theÏcircumstances€of€the€alleged€offense€that€occurred€when€she€wasÏsix.€€Heil€testified€that€the€physical€findings€of€the€medicalÏexamination€were€consistent€with€the€history€of€sexual€abuse€givenÏby€TM.Ìœ€òò€€€€€€€€€€€€€óó€€€€€€€€€€€€€€€€€€€€€€›Ìœà àThe›€court€ruled€this€testimony€admissible€pursuant€toÏRule€803(4),€and€Heil€was€allowed€to€relate€the€statements€to€theÏjury.€€On€direct€appeal,€the€intermediate€court€affirmed€the€trialÏcourtððs€judgment.€€Considering€the€circumstances€and€the€entireÏrecord€in€light€of€the€rule€just€established,€we€are€unable€toÏfind€that€the€trial€judge€abused€his€discretion€in€admitting€theÏstatements.€€Accordingly,€we€affirm€the€judgments€of€convictionÏand€the€sentences€thereupon€imposed.ÌÓ  ÓÓÓÌÌIIIÌÓ  ÓÓÓÌà àAppellant€James€Young€was€convicted€of€aggravated€sexualÏbattery× ƒ9 ××  ×€for€fondling€his€stepdaughter,€JD.€€At€trial,€JD€testifiedÏthat€Young€had€on€numerous€occasions€fondled€her€breasts€andÏgenital€area.€€According€to€JD,€Young€fondled€her€on€an€almost„daily€basis€from€May€1990€to€mid„March€œ1991›€when€she€reportedÏYoungððs€conduct€to€her€father.ÌÌà àJDððs€father€testified€that€he€had€confronted€Young€aboutÏJDððs€allegations€and€that€Young€admitted€having€fondled€JD,Ïapologized€for€the€conduct,€and€promised€never€to€do€it€again.€ÏOther€witnesses€established€that€Young€had€made€similarÏadmissions,€apologies,€and€promises€to€other€adult€family€members.€ÏAdditionally,€Young€gave€a€written€statement€to€a€Department€ofÏHuman€Services€(DHS)€investigator€in€the€presence€of€a€sheriffððsÏdeputy.€€In€this€statement,€Young€admitted€having€ð ðtouchedðð€JDððsÏbreasts€and€vaginal€area.ÌÌà àMary€Overton,€M.D.,€a€board„certified€pediatrician,Ïexamined€JD€approximately€one€month€after€the€allegationsÏsurfaced.€€Despite€objection€from€defendantððs€counsel,€the€trialÏcourt,€without€either€a€jury„out€evidentiary€hearing€or€a€properÏfoundation€having€been€laid,€permitted€Overton€to€testify,€underÏthe€authority€of€Rule€803(4),€about€statements€JD€made€during€theÏmedical€examination.€€JDððs€statements€to€Overton€were€consistentÏwith€her€testimony€at€trial€concerning€the€events€œat›€issue.€€ÌÌà àOverton€testified€that€she€ð ðevaluated€[JD]€for€possibleÏsexual€abuse.ðð€€During€the€evaluation,€JD€told€Overton:€(1)€thatÏher€stepfather€had€fondled€œher;›€(2)€that€the€abuse€was€notÏœpainful;›€and€(3)€that€she€attempted€to€persuade€Young€to€stop€theÏsexual€abuse€but€was€unsuccessful.€€Perhaps€the€most€salientÏportions€of€Overtonððs€testimony€were€her€statements€that€theÏexamination€was€for€evaluative€œpurposes;›€and€because€fondling€wasÏthe€alleged€abuse,€she€did€not€expect€to€find€any€physicalÏevidence.ÌÌà àœFrom€the€scant€record,€we›€have€œgleaned€other€pertinentÏcircumstances€surrounding€JDððs€statements€to€Overton.€€DHSÏarranged€the€examination€approximately€one€month€after€the€abuseÏwas€reported.€€JD€was€eight„years„old€at€this€time,€and€her€motherÏwas€present€during€the€examination€by€Overton.€€The€nature€of€theÏabuse€made€it€unlikely€that€a€physical€examination€would€uncoverÏtrauma€or€other€evidence€of€sexual€abuse.€€Consequently,€whenÏOverton€examined€eight„year„old€JD€she€observed€no€trauma€in€theÏgenital€area.Ìà àÌà àIn€light€of€all€the€circumstances€surrounding€the€makingÏof€the€statements,€we€are€hard„pressed€to€find€a€basis€sufficientÏto€support€the€admission€of€JDððs€statements€to€Overton€under€RuleÏ803(4).€€These€circumstances€seem€strongly€to€indicate€that€theÏstatements€were€not€made€for€the€purpose€of€medical€diagnosis€andÏtreatment€as€explicitly€required€by€Rule€803(4).€€ÌÌà àIn€the€context€of€Rule€803(4),€diagnosis€ð ðrefers€to€aÏdiagnosis€made€for€the€purpose€of€determining€what€course€ofÏtreatment€should€be€prescribed€for€the€patient.ðð€€òòRuckeróó,€847ÏS.W.2d€at€517.€€By€definition,€a€distinction€exists€betweenÍstatements€made€for€diagnosis€and€treatment€and€those€made€forÏevaluation.€€Statements€made€for€purposes€of€evaluation€are€lessÏlikely€to€be€viewed€as€reliable€in€the€sense€that€they€may€haveÏbeen€affected€by€the€prospect€of€litigation.€€òòSeeóó€Cohen,€òòsupra,€óóððÏ803(4).2.€€Thus,€we€conclude€that€admission€of€the€statements€wasÏan€abuse€of€discretion€and€constitutes€error.ÌÌà àThe€trial€courtððs€error,€however,›€œdoes›€not€justifyÏreversal€of€the€judgment.€€JDððs€testimony€was€clear,€cogent,€andÏunwavering.€€Moreover,€Young€admitted€his€misconduct€to€threeÏpersons€and€also€provided€a€written€statement€to€investigators.€ÏIn€light€of€such€compelling€evidence,€it€is€hardly€conceivableÏthat€the€outcome€of€the€trial€would€have€been€different€had€theÏstatements€not€been€presented€to€the€jury.€€Accordingly,€we€findÏthe€error€harmless.€€Tenn.€R.€App.€P.€36(b);€Tenn.€R.€Crim.€P.Ï52(a).€€The€judgment€of€the€Court€of€Criminal€Appeals€is€affirmed.ÌÌÌÓÓà àà àà àà àà à___________________________________Ìà àà àà àà àà àADOLPHO€A.€BIRCH,€JR.,€Chief€Justice̛̜̜CONCUR:ÌDrowota,›€Anderson,€Reid,€White,€JJ.