The theory behind a medical exception to the hearsay rule is that anyone seeking medical treatment has an incentive to be truthful and hence those statements should be trusted. This exception to the hearsay rule is often used in the case of young children in the context of custody cases or criminal cases where the child is too scared or nervous to testify.
In the custody case of Williams vs. Williams 91 NCApp 469, 372 SE2d 310 (1988) the North Carolina Court of Appeals upheld the use of statements made for medical diagnosis and treatment because of their inherent reliability with the caveat that statements made to a physician in preparation for trial are less reliable and hence are inadmissible hearsay. In other family court custody cases this could potentially allow a therapist or counselor to testify that a young child was too anxious or scared to visit a parent because the child was exposed to mental or emotional abuse in their care.
A medical provider could potentially testify about specific instances or facts told to them by a child without the child ever getting on the witness stand. This is meant to allow evidence to be presented where a child may be rendered unable to testify in some instances due to legitimate emotional trauma. The danger of allowing even a medical professional to testify about what a child “told” them is it creates the potential for the fabrications of a “brainwashed” or “coached” child to be introduced into evidence without being subject to the normal process of cross examination.
In the sexual abuse case of State vs. Hinnant, 351 NC 277, 523 SE2d 663, (2000) the State sought to introduce the hearsay of a young child that the Defendant had allegedly molested her via a clinical psychologist specializing in child sexual abuse and the examining physician who examined the child for signs of abuse. In its analysis the North Carolina Supreme Court created a two part test to determine when hearsay was admissible under NC General Statute § 8C-1, Rule 803(4):
The Court went on the elaborate that “some factors to consider in determining whether a child had the requisite intent are whether an adult explained to the child the need for treatment and the importance of truthfulness; with whom and under what circumstances the declarant was speaking; the setting of the interview; and the nature of the questions.” Although the Court certainly created a good starting point to determine whether hearsay may be reliable this is far from an objective standard. In the end the Judge has the tremendous responsibility to decide whether to allow testimony that would otherwise be inadmissible. Often this decision of whether to allow or exclude the contested statements determines the eventual outcome of a case.