ÿWPC#? Å# ÖUNá %/ 0 45U:ib£U:«w@å4%9 0@H 0Dˆ 1mÌ 0c9œ 0J¶ 0T 0^T 0h² 0r 0|Œ 0† 0Ž B 1u; 0d° 0B! AQV!Ƨ! 0Dm" 0@±" 0Dñ" D/5# Bd# D3#U >´#U*ò#U*$B)F$DCo$ AM²$7ÿ$w6&>­')ë(L,þ`.l^3Ê4v~Þ6vÓ\8 0ô/>˜HP LaserJet 4SiHPPCL5MS,ü,,,,,ü0nLhÎ(ÖÃ9 Z ‹6Times New Roman RegularX( ¤U$¡¡Ó  Ó,c½¬AZ‹"Arial Regular- ù-,c½¬AZ‹"Arial Regular x$Ey$z$D{$|$}$D~$-e$D€$Ó€Š$Ýu:#쉮"3|xŠ$2 ÿÿ$Squareð ðà0 à(#Ã$òòÚ  Ú0Ú  Úóó#.e37=CIQYag­­1.a.i.(1)(a)(i)1)a)(;³»$´´Ô2.eÔÚ  Ú0Ú  Ú.Ô3  Ôà0  àMcLeod2 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 d ÿÿ?AGMSYaioIndent0I.A.1.a.(1)(a)i)a)P ÿÿ8Mac DefaultMac DefaultÓ ` °šXÓ2-¦$Squareð ðà0  à!"#$&Cþÿ<< CÿÿƒLevel 1Level 2Level 3Level 4Level 5(3¯$¢¢Ý ƒ!ÝÝ  Ý("ÿÿ$££Ò  ÒÒ  Ò($$””ò òÚ  Ú1Ú  Úó ó(('÷ÿ dxdüÿP Pd'ÿÿdxd< Œ 9p`(&Times New Roman< Œ 9p`(Arial< Œ 9p`(Times% Line 7 d11117Border 1dd!#2Cþÿ << Gÿÿ -Ý ƒ!ÝÑ  ÑÑ#€d#ÑÔ€.ÔÓ  ÓÝ  ÝÝ ƒ""ÝÝ  ÝÔ€/ÔÔ€/ÔÓ  Óò òÔ YYY ÔFILEDÔ€/XÔÌÌSeptember€29,€1997ÌÌCecil€W.€CrowsonÌAppellate€Court€ClerkÔ  Ôó ó mÝ ƒ!ÝÑ#€d#ÑÔ€.ÔÓ  ÓÝ  ÝÝ ƒÄ$ÝÑ À ÑÑ Ì ÑÒ 4 ÒÒ „ ÒÔ€/ÔÔ€/ôÔò òà àòòÚ  ÚÚ  Úóóó óÝ  Ý€€A€visiting€cousin€was€also€watching€television€in€the€defendantððs€bedroom€for€at€leastÏpart€of€the€evening.Ì 4Ý ƒ!ÝÑ#€d#ÑÔ€.ÔÓ  ÓÝ  ÝÝ ƒÄ$ÝÑ À ÑÑ Ì ÑÒ 4 ÒÒ „ ÒÔ€/ÔÔ€/ôÔò òà àòòÚ  ÚÚ  Úóóó óÝ  Ý€€The€history€itself€was€also€introduced€as€an€exhibit.Ì Ý ƒ!ÝÑ#€d#ÑÔ€.ÔÓ  ÓÝ  ÝÝ ƒÄ$ÝÑ À ÑÑ Ì ÑÒ 4 ÒÒ „ ÒÔ€/ÔÔ€/ôÔò òà àòòÚ  ÚÚ  Úóóó óÝ  Ý€€Nearly€every€jurisdiction€has€likewise€held€that€the€time€interval€is€not€dispositive€and€thatÏother€factors€must€be€considered.€€òòSeeóó€òòe.g.óó,€€òòUnited€States€v.€Riveraóó,€43€F.3d€1291,€1296€(9thÏCir.€1995);€òòMorgan€v.€Foretichóó,€846€F.2d€941,€947€(4th€Cir.€1988);€òòGross€v.€Greeróó,€773€F.2d€116,Ï120€(7th€Cir.€1985);€òòUnited€States€v.€Goldenóó,€671€F.2d€369€(10th€Cir.),€òòcertóó.€òòdeniedóó,€456€U.S.€919Ï(1982);€€òòUnited€States€v.€Boydóó,€620€F.2d€129€(6th€Cir.),€òòcertóó.€òòdeniedóó,€449€U.S.€855€(1980).€Ì BÝ ƒ!ÝÑ#€d#ÑÔ€.ÔÓ  ÓÝ  ÝÝ ƒÄ$ÝÑ À ÑÑ Ì ÑÒ 4 ÒÒ „ ÒÔ€/ÔÔ€/ôÔò òà àòòÚ  ÚÚ  Úóóó óÝ  Ý€€The€issue€in€this€case€involves€primarily€the€first€prong€of€the€rule.€€We€have€held,€andÏthe€defendant€does€not€contest,€that€a€childððs€statement€identifying€the€perpetrator€of€a€sexualÏoffense€may€be€ð ðreasonably€pertinent€to€diagnosis€and€treatment.ðð€òòState€v.€Livingstonóó,€907ÏS.W.2d€392,€397€(Tenn.€1995).€Ì ôÝ ƒ!ÝÑ#€d#ÑÔ€.ÔÓ  ÓÝ  ÝÝ ƒÄ$ÝÑ À ÑÑ Ì ÑÒ 4 ÒÒ „ ÒÔ€/ÔÔ€/ôÔò òà àòòÚ  ÚÚ  Úóóó óÝ  Ý€€This€approach€is€consistent€with€other€jurisdictions€which€allow€the€child€declarantððsÏmotive€to€be€inferred€from€circumstances.€€òòUnited€States€v.€Iron€Shellóó,€633€F.2d€77,€84€(8th€Cir.Ï1980),€òòcertóó.€òòdeniedóó,€450€U.S.€1001€(1981);€òòDana€v.€Dept.€of€Correctionóó,€958€F.2d€237,€239€(8thÏCir.),€òòcertóó.€òòdeniedóó,€505€U.S.€1225€(1992);€òòMorgan€v.€Foretichóó,€846€F.2d€941,€949€(4th€Cir.€1988).€ÏIn€contrast,€some€jurisdictions€have€required€that€the€child€have€knowledge€of€the€motive.€€òòSeeóó,Ïòòe.g.óó,€òòUnited€States€v.€Barrettóó,€8€F.3d€1296€(8th€Cir.€1993)(ð ðthere€must€be€evidence€that€the€childÏunderstood€the€physicianððs€role€in€order€to€trigger€the€motivation€to€provide€truthful€informationðð);ÏòòState€v.€Wadeóó,€622€A.2d€832,€835„36€(N.H.€1993)(ð ðThe€medical€treatment€exception€appliesÏwhether€the€declarant€is€a€child€or€an€adult,€and€the€foundation€for€admissibility€must€include€aÏshowing€that€the€child€possessed€the€requisite€state€of€mind.ðð).€Ì bÝ ƒ!ÝÑ#€d#ÑÔ€.ÔÓ  ÓÝ  ÝÝ ƒÄ$ÝÑ À ÑÑ Ì ÑÒ 4 ÒÒ „ ÒÔ€/ÔÔ€/ôÔò òà àòòÚ  ÚÚ  Úóóó óÝ  Ý€€The€State€refers€to€evidence€that€the€victim€had€refrained€from€urinating€due€to€theÏphysical€pain.Ì Ý ƒ!ÝÑ#€d#ÑÔ€.ÔÓ  ÓÝ  ÝÝ ƒÄ$ÝÑ À ÑÑ Ì ÑÒ 4 ÒÒ „ ÒÔ€/ÔÔ€/ôÔò òà àòòÚ  ÚÚ  Úóóó óÝ  Ý€€The€State€also€argues€in€support€of€a€ð ðpragmaticðð€approach€that€would€remove€theÏdeclarantððs€motive€from€the€analysis€and€focus€solely€on€whether€the€statements€were€relied€uponÏby€the€medical€personnel.€€We€rejected€this€in€òòMcLeodóó,€937€S.W.2d€at€871.€ÌPtPtHHÚ(ÿáÿâùFG(üHHÚ(d'hStyl{WP}01•ÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃà Ãà Ãà Ãà Ãà ÃÃÃÃÃÃÃÃÃÃÃÐ ÐÐHHÐÐ  ÐÐ2ÐÐÿÿ¸æ$ÿÐÐHHÐÐÐÐÐÐÐÐ  ÐÐ ÐÐ ÐÑÑÑGenevaÑÑ ÑÑ € ÑÑ<Px–ÈÑÒÒÒ443!#4ÒÒ$ *$ÒÒ$*$ÒÒ ÿKK ÒÒ  Geneva ÒÒ  Geneva ÒÓ.,ÓÓÓÓ6ÓÓ ÓßßßßßßßßßßßßßßßßßßÑGenevaÑÑ ÑÒ  h HD: Geneva ÒÒ  h HD: Geneva Ò(¡+2Pu$¤¤Ý ƒ¤U!ÝÓ  ÓÝ  ÝÑÀ°ÑÑ̰ÑÒ„°ÒÒ4°ÒÔ€XÏ®XXXÔÔ€òðÚòXXÏ®Ôò òà Œ àòòÚ  Ú0Ú  Úóóó óÝ ƒ!ÝÔ . ÔÔ€.ÔÓ  ÓÝ  ÝÒ ° ÒÒ „ ÒÑ  ÑÒ 4 ÒÒ „ ÒÑ\R AØ'\ÑÑ€ÑÑ  ÑÓ  ÓÔ€/ÔÑ\R AØ'\ÑÑ7€Ï®XXdædÈ7ÑØ ØÓ&€00XÐd&ÓÞ ÞÌ€›à@ àIN€THE€SUPREME€COURT€OF€TENNESSEEÌÌà@ àAT€NASHVILLEÌÌÌÌÌÌà àà àà àà àà àà àà àœ€€€ò òòòFOR›€PUBLICATIONÌÌó óóóà àà àà àà àà àà àà àò òòòFiled:œ€€September€29,€1997ó ó€óóÌà àà àà àà àà àà àà àÌSTATE€OF€TENNESSEE,à àà àà à)Ìà àà àà àà àà àà à)Ìà àà àAppellee,à àà àà à)à à€€DAVIDSON€CRIMINALÌà àà àà àà àà àà à)à àà àà àà àà àà àà àà àà àà àà à)à àÌ€Vs.à àà àà àà àà àà à)à àHON.€WALTER€C.€KURTZ,Ìà àà àà àà àà àà à)à àà à€€€€JUDGEÌà àà àà àà àà àà à)ÌMAURICE€GORDON,à àà àà à)Ìà àà àà àà àà àà à)ÌÙ€!ÙßR€342A1-j|oÝ` ç `€€@ÿRßà àà àAppellant.à àà àà à)à àNo.€€01„S„01„9605„CC„00084ÌÌÌÌÌÌÌò òòòFor€Appellant:à àà àà àà àFor€Appellee:ó óóóÌÌJeffrey€A.€DeVasherà àà àà àCharles€BursonÌSenior€Assistant€Public€Defenderà àà àAttorney€General€&€ReporterÌÌJoan€A.€Lawsonà àà àà àà àMichael€E.€MooreÌSenior€Assistant€Public€Defenderà àà àSolicitor€GeneralÌÌRoss€Aldermanà àà àà àà àElizabeth€T.€RyanÌDeputy€Public€Defenderà àà àà àAssistant€Attorney€GeneralÌNashville,€Tennesseeà àà àà àNashville,€TennesseeÌÌà àà àà àà àà àà àVictor€S.€Johnson,€IIIÌà àà àà àà àà àà àDistrict€Attorney€GeneralÌÌà àà àà àà àà àà àRenee€ErbÌà àà àà àà àà àà àBill€ReedÌà àà àà àà àà àà àAssistant€District€Attorneys€GeneralÌà àà àà àà àà àà àNashville,€TennesseeÌÌÌÌò òÔ€/„Ôà@ àO€P€I€N€I€O€Nó óÌÔ€/XÔÌÌÌAFFIRMED.›à àœà àà àà à›à àà àà àà àANDERSON,€œC.J.›ÇÓÓÑ  Ñà àWe€granted€this€appeal€to€review€two€familiar€exceptions€to€the€ruleÏwhich€excludes€hearsay€statements€from€a€trial:€statements€relating€to€a€startlingÏevent€or€condition€made€while€under€the€stress€of€excitement€from€the€event€orÏcondition;€and€statements€made€for€the€purpose€of€medical€diagnosis€andÏtreatment.€€ÌÌà àThe€defendant€was€convicted€of€aggravated€rape.€€The€trial€court€ruledÏthat€statements€made€by€the€victim€to€her€mother€were€excited€utterances€and,Ïtherefore,€admissible€under€Tenn.€R.€Evid.€803(2).€€The€trial€court€also€ruled€thatÏthe€victimððs€statements€to€a€psychologist,€which€were€contained€in€a€report€laterÏrelied€upon€by€a€nurse€practitioner,€had€been€made€for€the€purpose€of€medicalÏdiagnosis€and€treatment€and€were,€therefore,€admissible€under€Tenn.€R.€Evid.Ï803(4).€€The€Court€of€Criminal€Appeals€affirmed.ÌÌà àWe€have€concluded€that€the€trial€court€did€not€abuse€its€discretion€inÏadmitting€the€victimððs€statements€to€her€mother€as€excited€utterances.€€We€haveÏalso€concluded€that€the€State€established€the€required€foundation€for€theÏadmission€of€the€victimððs€statements€to€the€psychologist€pursuant€to€the€medicalÏtreatment€and€diagnosis€exception.€€We,€therefore,€affirm€the€Court€of€CriminalÏAppeals.Ìà àÌà@ àò òòòBACKGROUNDó óóóÌà àOn€May€13,€1991,€the€three„year„old€victim€was€visiting€with€her€maternal€Ïgrandparents,€her€sister,€and€the€defendant€(her€uncle)€at€her€grandparentsððÏhouse.€€Her€grandparents€and€sister€were€watching€television€in€the€living€room,Ïand€the€defendant€was€watching€television€in€his€bedroom.× ƒ5 ××  ×€€The€victim€hadÏbeen€in€and€out€of€the€defendantððs€room.€€At€one€point,€the€victim€went€into€theÏbathroom€and€cried€out,€apparently€from€pain€she€experienced€when€trying€toÏurinate.€€Her€sister€and€grandmother€attended€to€her;€they€looked€at€the€victimððsÏgenitalia€but€saw€nothing€unusual.€€ÌÌà àThe€victimððs€mother€(the€defendantððs€sister)€was€called€and€she€arrived€toÏtake€the€victim€and€her€sister€home.€€After€getting€a€bath,€the€victim€again€tried€toÏuse€the€bathroom,€and€she€again€cried€out€from€pain.€€Her€mother€wrapped€herÏin€a€towel,€placed€her€on€a€bed,€and€saw€ð ðbits€and€tears€and€dried€bloodðð€on€theÏinside€of€the€victimððs€vaginal€area.€€She€asked€the€victim,€ð ðWho€made€you€hurtÏlike€this?ðð€€The€victim€initially€lowered€her€head,€but€after€further€reassurance,Ïshe€named€the€defendant.ÌÌà à€The€victim€was€taken€to€two€hospitals€that€same€night,€but€she€refused€toÏbe€examined.€€She€was€referred€to€Our€Kids€Clinic,€a€facility€that€evaluatesÏcases€of€suspected€child€sexual€abuse,€and€was€taken€there€the€next€morning.€ÍAt€the€clinic,€the€victim€was€interviewed€by€a€psychologist€who€took€a€historyÏcontaining€the€victimððs€statements.€€The€history€was€used€by€a€nurse€practitionerÏwho€conducted€a€physical€examination€of€the€victim.€€Although€the€psychologistÏdid€not€testify€at€trial,€the€nurse€practitioner€was€permitted€to€read€the€interview× ƒ6 ××  ×Ïinto€evidence.ÌÌà àThe€nurse€practitioner€testified€that€the€victim€had€two€ð ðbreaks€in€the€skinÏinside€the€labia€major€but€outside€the€vagina,ðð€which€were€ð ðvery€superficial.ðð€ÏShe€said€that€the€injuries€were€consistent€with€having€been€caused€by€the€touchÏor€scrape€of€a€finger,€and€that€they€appeared€to€have€been€caused€within€theÏpast€twenty„four€hours.€€She€conceded€that€the€injuries€could€have€been€causedÏin€some€other€manner.ÌÌà àThe€victim€testified€that€she€had€been€in€the€defendantððs€room€when€heÏpulled€down€her€pants€and€touched€her€with€his€finger.€€The€defendant€testifiedÏand€denied€the€allegation.€€The€defendantððs€father€(the€victimððs€grandfather)Ïtestified€that€he,€his€wife,€and€the€victimððs€sister€had€been€watching€television€inÏthe€living€room,€and€the€defendant€had€been€watching€television€in€hisÏbedroom.€€The€house€was€a€small,€single„story€home€with€two€bedrooms,€aÏliving€room,€kitchen,€and€bathroom.€€The€victim€was€in€and€out€of€the€living€roomÍand€the€defendantððs€bedroom.€€The€victim€did€not€at€first€tell€anyone€that€theÏdefendant€had€hurt€her,€and€no€one€knew€anything€was€wrong€until€the€victimÏexperienced€pain€while€trying€to€urinate.ÌÌò òà àó óThe€trial€court€admitted€the€victimððs€statement€to€her€mother€as€an€excitedÏutterance€under€Tenn.€R.€Evid.€803(2),€and€the€victimððs€statements€to€the€childÏpsychologist€as€statements€for€medical€diagnosis€and€treatment€under€Tenn.€R.ÏEvid.€803(4).€€The€jury€convicted€the€defendant€and€the€judgment€was€affirmedÏby€the€Court€of€Criminal€Appeals.€€We€granted€this€appeal€and€now€affirm.ò òÌÌà@ àòòEXCITED€UTTERANCEó óóóÌà àPursuant€to€Tenn.€R.€Evid.€803(2),€statements€ð ðrelating€to€a€startling€eventÏor€condition€made€while€the€declarant€is€under€the€stress€of€excitement€causedÏby€the€event€or€conditionðð€are€admissible€as€an€exception€to€the€hearsay€rule.€ÏThe€rationale€for€admitting€such€statements,€known€as€ð ðexcited€utterances,ðð€isÏtwofold:ÌÓÓÌà8 àFirst,€since€this€exception€applies€to€statements€where€it€is€likelyÏthere€was€a€lack€of€reflection„„€and€potential€fabrication„„€by€aÏdeclarant€who€spontaneously€exclaims€a€statement€in€response€toÏan€exciting€event,€there€is€little€likelihood,€in€theory€at€least,€ofÏinsincerity.€€.€.€.€€Second,€ordinarily€the€statement€is€made€while€theÏmemory€of€the€event€is€still€fresh€in€the€declarantððs€mind.€€ThisÏmeans€that€the€out„of„court€statement€about€an€event€may€be€moreÏaccurate€than€a€much€later€in„court€description€of€it.€€ÌÌÌÓÓCohen,€Paine€&€Sheppeard,€òòTennessee€Law€of€Evidenceóó,€ðð€803(2).1€at€532€(3dÏed.€1995).€€Thus,€we€review€the€requirements€of€the€rule€with€this€rationale€inÏmind.ÌÌà àFirst,€there€must€be€a€startling€event€or€condition.€€As€noted€in€òòTennesseeÏLaw€of€Evidenceóó,€the€ð ðpossibilities€are€endlessðð€because€ð ðany€event€deemedÏstartling€is€sufficient.ðð€€òòIdóó.,€ðð803(2).2€at€533.€€As€another€treatise€has€stated,€theÏð ðevent€must€be€sufficiently€startling€to€suspend€the€normal,€reflective€thoughtÏprocesses€of€the€declarant.ðð€€òòMcCormick€on€Evidenceóó,€ðð297€at€854€(3d€ed.Ï1984).€€Although€the€ð ðstartling€eventðð€is€usually€the€act€or€transaction€uponÏwhich€the€legal€controversy€is€based,€such€as€an€assault€or€accident,€theÏexception€is€not€limited€to€statements€arising€directly€from€such€events;€rather,€aÏsubsequent€startling€event€or€condition€which€is€related€to€the€prior€event€canÏproduce€an€excited€utterance.€€òòSeeóó€òòBayne€v.€Stateóó,€632€A.2d€476€(Md.€App.Ï1993)(and€cases€cited€therein).ÌÌà àIn€òòUnited€States€v.€Napieróó,€518€F.2d€316€(9th€Cir.),€òòcertóó.€òòdeniedóó,€423€U.S.Ï895€(1975),€the€victim€was€beaten€and€hospitalized.€€Upon€returning€home,€sheÏsaw€a€photograph€of€the€defendant€and€said,€ð ðHe€killed€me.ðð€€The€Court€heldÏthat€the€statement€was€an€excited€utterance€related€to€the€startling€event€ofÏseeing€the€defendantððs€picture.€€òòIdóó.€at€318.€€Similarly,€in€òòState€v.€Carpenteróó,€773ÍS.W.2d€1€(Tenn.€Crim.€App.€1989),€the€victimððs€statement€occurred€not€when€sheÏdiscovered€a€theft€of€money,€but€rather€when€the€defendant€returned€to€theÏscene€of€the€offense.€€The€Court€of€Criminal€Appeals€determined€that€theÏvictimððs€ð ðcomments€resulted€from€the€suspectððs€return€to€the€scene€rather€thanÏthe€theft€itselfðð€and€that€the€statements€were€ð ðso€spontaneous€as€to€embody€allÏthe€required€elements€of€reliability.ðð€€òòIdóó.€at€9;€òòseeóó€òòalsoóó€òòState€v.€Owensóó,€899€P.2dÏ833€(Wash.€App.€1995),€òòaffððdóó,€913€P.2d€366€(Wash.€1996);€òòState€v.€Meyeróó,€694ÏS.W.2d€853€(Mo.€App.€1985).ÌÌà àThe€second€requirement,€that€the€statement€ð ðrelate€toðð€the€startling€eventÏor€condition,€is€likewise€broad.€€As€stated€in€òòTennessee€Law€of€Evidenceóó,€òòsupraóó,Ïð ðconsiderable€leeway€is€available,ðð€because€the€statement€ð ðmay€describe€all€orÏpart€of€the€event€or€condition,€or€deal€with€the€effect€or€impact€of€that€event€orÏcondition.ðð€€òòIdóó.,€ðð803(2).2€at€534.ÌÌà àThe€third€requirement,€that€the€statement€be€made€while€the€declarant€isÏunder€the€stress€or€excitement€from€the€event€or€condition,€relates€most€directlyÏto€the€underlying€rationale€for€the€exception.€€In€òòState€v.€Smithóó,€857€S.W.2d€1,€9Ï(Tenn.),€òòcertóó.€òòdeniedóó,€510€U.S.€96€(1993),€we€said€that€ð ð[t]he€ultimate€test€isÏspontaneity€and€logical€relation€to€the€main€event€and€where€an€act€orÏdeclaration€springs€out€of€the€transaction€while€the€parties€are€still€laboringÏunder€the€excitement€and€strain€of€the€circumstances€and€at€a€time€so€near€it€asÍto€preclude€the€idea€of€deliberation€and€fabrication.ðð€€The€time€interval€is€but€oneÏconsideration€in€determining€whether€a€statement€was€made€under€stress€orÏexcitement:ÌÓÓÌà8 àOther€relevant€circumstances€include€the€nature€and€seriousnessÏof€the€event€or€condition;€the€appearance,€behavior,€outlook,€andÏcircumstances€of€the€declarant,€including€such€characteristics€asÏage€and€physical€or€mental€condition;€and€the€contents€of€theÏstatement€itself,€which€may€indicate€the€presence€or€absence€ofÏstress.ÌÌÌÓÓòòTennessee€Law€of€Evidenceóó,€òòsupraóó,€ðð803(2).2€at€534;€òòseeóó€òòalsoóó€òòState€v.€Smithóó,Ï868€S.W.2d€561,€574€(Tenn.€1993),€òòcertóó.€òòdeniedóó,€513€U.S.€960€(1994).× ƒ7 ××  ×€€TheÏdeclarant€does€not€have€to€be€a€participant€in€the€startling€event€or€condition,Ïand€statements€made€in€response€to€questions€may€still€be€admissible€if€theÏdeclarant€is€under€the€excitement€or€stress€of€the€event.€€òòSeeóóòòState€v.€Smithóó,Ï857€S.W.2d€at€9.ÌÌ€à àHere,€the€trial€court€held€a€jury€out€hearing€on€the€issue.€€The€victimððsÏmother€testified€that€she€gave€the€victim€a€bath€shortly€after€arriving€home€fromÏher€parentsðð€home.€€She€left€the€victim€to€answer€the€phone€and€a€moment€laterÏheard€the€victim€ð ðhollering€real€loud.ðð€€She€returned€to€the€bathroom€where€sheÍfound€the€victim€on€the€toilet€in€ð ða€lot€of€pain.ðð€€After€placing€the€victim€on€the€bedÏand€leaning€her€back,€she€saw€ð ðtears€and€dried€blood€up€in€the€vagina.ðð€€SheÏasked€the€victim,€ð ðWho€made€you€hurt€like€that?ðð€€The€victim€lowered€her€head,Ïbut€after€being€reassured,€identified€the€defendant.€€This€was€approximately€twoÏminutes€after€the€victim€had€started€hollering.€€€ÌÌà àThe€trial€court€concluded€that€the€statements€were€admissible€underÏTenn.€R.€Evid.€803(2),€after€making€the€following€findings:ÌÓÓà8 àÌà8 àI€think€itððs€admissible€.€.€.€as€an€excited€utterance.€€And€I€think€theÏstartling€event,€really,€is€the€injury€to€the€child€on€the€commodeÏwhen€she€was€urinating€at€her€motherððs€house.€.€.€.€€When€the€littleÏgirl€urinated,€as€her€mother€said,€she€was€very€upset,€she€holleredÏand€she€cried.€€According€to€her€motherððs€testimony,€she€made€theÏstatement€[€]€in€the€bedroom€two€minutes€after€that.€[A]lthough€herÏmother€said€sheððd€stopped€crying,€I€think€the€two€minute€intervalÏbetween€her€crying€on€the€commode€and€her€statement€was€aÏmatter€that€still€leads€me€to€believe€she€was€under€the€stress€ofÏexcitement.€.€.€.€€I€acknowledge€itððs€a€close€call€here,€but€I€believeÏitððs€admissible€under€803(2).ÌÌÌÓÓà àThe€State€contends,€and€the€defendant€concedes,€that€the€painÏexperienced€by€the€victim€while€urinating,€as€opposed€to€the€sexual€offenseÏitself,€constituted€a€startling€event.€€The€parties€also€agree€that€the€victimððsÏstatement€naming€the€defendant€as€the€one€who€had€hurt€her€was€related€to€theÏstartling€event.€€The€parties€dispute€whether€the€victim€was€under€the€stress€orÏstrain€of€this€event€when€she€identified€the€defendant.€€The€defendant€contendsÍthat€the€victimððs€statements€were€not€made€spontaneously,€but€rather,€wereÏmade€only€after€a€period€of€reticence,€reflection€and€considerable€prompting€byÏher€parents.ÌÌà àWe€agree€that€the€victimððs€painful€urination€was€a€sufficiently€serious€andÏstartling€event€under€the€rule.€€It€was€related€to€the€sexual€offense,€and€itÏproduced€a€separate€cry€of€anguish€from€the€victim,€which,€in€turn,€caused€stressÏor€strain€to€the€victim.€€Contrary€to€the€defendantððs€assertion,€the€recordÏindicates€that€the€victimððs€statements€were€made€just€a€few€minutes€after€theÏevent,€while€she€was€in€obvious€discomfort.€€Although€the€victimððs€parentsÏoffered€reassurance€and€asked€what€had€happened,€the€stress€of€the€event€hadÏnot€diminished€and€the€time€was€short.€€In€sum,€we€conclude€that€the€trial€courtÏdid€not€abuse€its€discretion€in€finding€that€the€statements€were€made€after€aÏstartling€event,€while€the€victim€was€under€the€stress€of€that€event.€€ÌÌà@ àòòò òMEDICAL€TREATMENT€AND€DIAGNOSISó óóóÌà àStatements€made€for€the€purpose€of€medical€diagnosis€and€treatmentÏmay€be€admissible€as€an€exception€to€the€hearsay€rule€under€Tenn.€R.€Evid.Ï803(4):ÌÓÓÌà8 àStatements€made€for€purposes€of€medical€diagnosis€and€treatmentÏdescribing€medical€history;€past€or€present€symptoms,€pain,€orÏsensations;€or€the€inception€or€general€character€of€the€cause€orÍexternal€source€thereof€insofar€as€reasonably€pertinent€toÏdiagnosis€and€treatment.ÌÌÌÓÓTo€be€admissible,€the€statement€must€have€been€made€for€purpose€of€medicalÏdiagnosis€òòandóó€treatment,€describing€medical€history€such€as€past€or€presentÏsymptoms,€pain,€or€sensation;€and€if€the€statement€addresses€the€inception€orÏgeneral€character€of€the€cause€or€external€source€of€the€problem,€it€must€beÏð ðreasonably€pertinent€to€diagnosis€and€treatment.ðð€€òòState€v.€McLeodóó,€937ÏS.W.2d€867,€870€(Tenn.€1996).× ƒ8 ××  ×€€€ÌÌà àThe€exception€is€predicated€on€the€perception€that€statements€made€forÏthe€purpose€of€medical€diagnosis€and€treatment€are€reliable€and€trustworthy:€ÌÓÓÌà8 àThe€rationale€underlying€the€hearsay€exception€for€statementsÏmade€for€purposes€of€medical€diagnosis€and€treatment€is€that€theÏdeclarantððs€motive€of€obtaining€improved€health€increases€theÏstatementsððs€reliability€and€trustworthiness.€€This€motivation€isÏconsidered€stronger€than€the€motivation€to€lie€or€shade€the€truth.€ÏPatients€generally€go€to€doctors€to€receive€treatment,€andÏtreatment€usually€depends,€in€part,€on€what€is€said;€thus€theÏdeclarant€has€a€self„interested€motive€to€tell€the€truth.ÌÌÌòòÓÓState€v.€Baroneóó,€852€S.W.2d€216,€220€(Tenn.€1993);€òòseeóó€òòalsoóó€òòState€v.ÏLivingstonóó,€907€S.W.2d€at€396€(ð ðthe€declarant€makes€the€statements€for€theÏultimate€purpose€of€receiving€proper€diagnosis€and€treatmentðð).€€ÌÌà àAs€we€recognized€in€òòMcLeodóó,€òòsupraóó,€however,€the€rationale€for€theÏexception€and€its€application€become€more€troublesome€when€the€declarant€isÏa€child€who,€due€to€his€or€her€age,€may€be€unable€to€comprehend€the€medicalÏsetting€or€to€understand€the€need€to€provide€accurate€information.€€òòIdóó.€at€870.€ÏOur€task€in€such€cases€is€to€ð ðachieve€a€balance€that€fosters€the€importantÏgovernmental€interest€in€protecting€children€while€maintaining€fundamentalÏfairness.ðð€€òòIdóó.€at€869.€€Thus,€rather€than€hold€the€exception€inapplicable€in€childÏsexual€abuse€cases,€we€said:ÌÓÓÌà8 àCourts€should€not€presume€that€statements€by€a€child€to€a€medicalÏservices€provider€are€untrustworthy€merely€because€there€isÏdisputable€evidence€of€the€childððs€motivation€to€be€truthful.€€òòRather,Ïthe€admissibility€decision€should€be€based€upon€a€thoroughÏexamination€of€all€of€the€circumstances€surrounding€the€statementóó.ÌÌÌòòIdóó.€at€871.€€€(Emphasis€added).× ƒ9 ××  ×€€€ÌÌÌÌÓÓà àAccordingly,€in€cases€where€the€declarant€is€a€child,€numerousÏconsiderations€are€relevant€to€determining€the€motivation€for€the€statements,Ïincluding€the€timing€and€content€of€the€statement,€the€presence€or€absence€ofÏany€improper€influences€placed€on€the€child,€whether€the€childððs€statement€wasÏmade€in€response€to€leading€or€suggestive€questioning,€and€any€other€factorÏthat€may€affect€the€trustworthiness€of€the€statement.€€Upon€an€affirmative€findingÏfrom€evidence€in€the€record€that€the€conditions€of€the€rule€are€met,€the€statementÏis€admissible.€€òòIdóó.€at€871.ÌÌà àIn€òòMcLeodóó,€the€victim,€age€nine,€was€examined€by€a€physician€just€a€fewÏdays€after€she€had€been€abused.€€The€physician€testified€that€she€took€aÏmedical€history€for€the€purpose€of€her€medical€diagnosis€and€treatment,€and€theÏmedical€history€included€the€victimððs€statement€that€she€had€been€sexuallyÏpenetrated€by€the€defendant.€€No€one€else€was€present€during€the€examination,Íwhich€revealed€that€the€victim€had€sustained€injuries€to€her€genitalia€that€wereÏconsistent€with€vaginal€penetration.€€We€concluded€from€these€circumstancesÏthat€the€victimððs€statements€had€been€made€for€the€purpose€of€medicalÏdiagnosis€and€treatment.€€òòIdóó.€at€872.ÌÌà àBy€contrast,€in€òòState€v.€Youngóó,€the€companion€case€to€òòMcLeodóó,€the€eight„Ïyear„old€victim€was€examined€by€a€physician€over€one€month€after€allegationsÏsurfaced€that€the€defendant€had€fondled€the€victim.€€Although€the€doctor€testifiedÏthat€she€evaluated€the€victim€ð ðfor€possible€sexual€abuse,ðð€she€conceded€thatÏshe€did€not€expect€to€find€physical€evidence€of€fondling.€€The€victimððs€motherÏwas€present€during€the€examination,€which€had€been€arranged€by€theÏDepartment€of€Human€Services.€€We€held€that€ð ðthese€circumstances€seemÏstrongly€to€indicate€that€the€statements€were€not€made€for€the€purpose€ofÏmedical€diagnosis€and€treatment€as€explicitly€required€by€Rule€803(4).ðð€€òòIdóó.€atÏ873.ÌÌà àHere,€in€a€jury€out€proceeding,€the€nurse€practitioner,€Sue€Ross,€testifiedÏthat€the€clinicððs€standard€procedure€is€for€a€psychologist,€social€worker,€or€theÏnurse€practitioner€to€interview€the€child€and€obtain€a€history€which€is€used€in€theÏexamination.€€The€victim€in€this€case€was€interviewed€by€a€child€psychologist.€€ÏAlthough€Ross€was€not€present€during€the€interview€and€did€not€take€a€separateÍmedical€history€of€her€own,€she€relied€upon€the€history€taken€by€theÏpsychologist.€€The€trial€court€found:ÌÓÓÌà8 à[T]he€proof€is€that€this€young€lady€was€taken€to€Memorial€HospitalÏalmost€immediately.€€She€was€then€transported€to€...€theÏemergency€room€at€General€Hospital,€where€she€spent€severalÏhours,€but€couldnððt€be€examined,€and€then€came€back€to€Our€KidsÏClinic€the€very€next€day.€€I€think€under€the€circumstances€that€I€canÏcertainly€draw€an€inference€that€this€situation€and€her€appearanceÏat€Our€Kids€Clinic€was€for€the€purpose€of€medical€diagnosis€andÏtreatment,€and€that€the€[victim]€wouldnððt€think€otherwise.ÌÌÌÓÓà àThe€defendant€argues€that€there€was€no€evidence€to€show€that€the€victimÏknew€she€was€being€interviewed€for€the€purpose€of€medical€diagnosis€andÏtreatment€or€that€she€was€aware€of€the€need€to€provide€truthful€and€accurateÏinformation.€€The€State€maintains€that€the€circumstances,€specifically,€that€theÏvictim€was€injured,€taken€to€the€clinic€less€than€a€day€after€the€incident,€and€stillÏin€discomfort× ƒ: ××  ×€at€the€time€of€the€interview,€supported€the€trial€courtððs€finding€theÏvictimððs€statement€was€made€for€medical€diagnosis€and€treatment.× ƒ; ××  ×Ì€€Ìà àWe€conclude€that€the€evidence€was€sufficient€to€warrant€an€inference€thatÏthe€conditions€of€Tenn.€R.€Evid.€803(4)€were€met.€€First,€the€victim€cried€out€at€herÍgrandparentsðð€home€with€pain€on€urination€shortly€after€being€alone€with€theÏdefendant.€€The€victimððs€mother€was€called;€the€victim€was€taken€home€andÏbathed€and€again€cried€out€from€pain€while€trying€to€urinate.€€Her€motherÏexamined€her€and€observed€evidence€of€injury€inside€the€vagina.€€The€victimÏidentified€the€defendant€as€the€cause€of€the€injury.€€The€child€was€thenÏimmediately€taken€about€9:00€p.m.€to€a€hospital€for€treatment,€then€referred€toÏanother€hospital€where€she€stayed€until€3:00€a.m.€€She€refused€to€be€treatedÏbecause€of€the€pain.€€She€was€referred€for€treatment€to€Our€Kids€Clinic,€whereÏshe€went€the€next€morning€at€8:00€a.m.€for€examination.€€The€victim€gave€aÏhistory€and€was€examined€within€twelve€hours€of€the€initial€incident.€ÌÌà àThe€nurse€practitioner€testified€the€purpose€of€the€history€was€for€properÏdiagnosis€and€treatment,€and€that€she€relied€on€the€history€for€that€purpose.€€TheÏquestioning€by€the€psychologist€was€not€suggestive€or€leading.€€The€content€ofÏthe€victimððs€statement€suggests€no€motive€by€the€victim€other€than€that€ofÏseeking€medical€treatment.€€The€physical€examination€revealed€injury€to€theÏvagina€within€the€previous€twenty„four€hours.€€There€was€no€evidence€ofÏimproper€influence€on€the€child,€nor€evidence€of€a€motive€inconsistent€withÏseeking€medical€treatment,€nor€evidence€of€any€other€factor€affecting€the€victimððsÏtrustworthiness.€€No€investigative€agency€had€been€involved€to€that€point,€andÏno€investigative€referral€had€been€made.€€The€motive€was€to€seek€medicalÍtreatment.€€Half€the€night€was€consumed€in€this€continuing€quest,€which€wasÏresumed€early€the€following€day.€€ÌÌà àAs€in€òòMcLeodóó,€òòsupraóó,€the€totality€of€these€circumstances€support€anÏinference€that€the€victimððs€motive€in€making€the€statements€was€for€the€purposeÏof€medical€diagnosis€and€treatment.€€The€trial€court€did€not€err€in€admitting€theÏstatements€into€evidence.ÌÌà@ àòòò òCONCLUSIONó óóóÌà àWe€have€determined€that€the€trial€court€did€not€abuse€its€discretion€inÏruling€that€the€victimððs€statements€to€her€mother€were€ð ðexcited€utterancesðð€andÏadmissible€under€Tenn.€R.€Evid.€803(2).€€We€have€further€concluded,€however,Ïthat€there€was€a€sufficient€foundation€to€show€that€the€victimððs€statements€to€theÏchild€psychologist€were€made€for€the€purpose€of€medical€diagnosis€andÏtreatment€under€Tenn.€R.€Evid.€803(4).€€Costs€of€appeal€shall€be€paid€by€theÏdefendant.ÌÌÓÓ€à àà àà àà àà àœ____________________________________›Ìà àà àà àà àà àE.€RILEY€ANDERSON,€CHIEF€JUSTICEÌÌò òÌÌConcur:ó ó€€ÌÌDrowota,€Reid,€Birch,€and€Holder,€JJ.