Laying the Proper Foundation for Medical Evidence
In general, medical records are considered hearsay. However, they are admissible as an exception to the hearsay rule if they meet certain conditions under FRE 803(6), sometimes called the business records exception. This recognizes that hearsay evidence is more likely to be reliable when it is created in the course of regular business. To qualify for this exception, medical records must first be authenticated and accompanied by a proper foundation. The types of records admitted under this exception include hospital and billing records, medical notes, medical tests, test results, and imaging, and exams and reports prepared for litigation.
Authentication is the process of proving that the document is what it purports to be. This can be accomplished by introducing testimony from the custodian of the records or by using a certification from a qualified third-party (this is often defined by state statute). Laying the foundation involves demonstrating further that the records were created in the course of regular business activity and that they were made at or near the time of the events they describe.
Admitting Expert Testimony
In addition to medical records, expert testimony is also commonly used in personal injury trials. Expert witnesses are individuals who possess specialized knowledge, skill, experience, or training that qualifies them to testify as an expert in a particular field. In a personal injury trial, an expert witness can help to explain complex medical issues to the jury and provide opinions on the cause and extent of the plaintiff's injuries.
The admissibility of expert testimony is subject to certain requirements. Under FRE 702, an expert witness must be qualified to testify based on their education, training, or experience in the relevant field. They must also provide opinions that are based on reliable methods and principles that are widely accepted within the scientific community. Additionally, their opinions must be relevant to the issues in the case and must assist the jury in understanding the evidence or determining a fact in dispute.
Admitting Statements Made for Medical Diagnosis and Treatment under FRE 803(4)
FRE 803(4) is an exception to the hearsay rule that allows statements made by a patient to a healthcare provider, or by a healthcare provider to a patient, for the purpose of medical diagnosis or treatment to be admissible as evidence of the truth of the matter asserted.
For example, if a plaintiff told an ER doctor that they were experiencing chest pain following a car accident, the doctor's record of that statement may be admissible under FRE 803(4) as evidence that the patient was experiencing chest pain at that time. Similarly, if the doctor told the plaintiff that they fractured several ribs, the plaintiff’s testimony may be admissible under FRE 803(4) as evidence of their injury.
The statements must have been made for the purpose of obtaining medical diagnosis or treatment, and must be relevant to the patient's diagnosis or treatment. Additionally, the statements must have been made by the patient or a healthcare provider who was involved in the patient's medical care, and must be shown to be trustworthy.
This exception is limited to statements made for the purpose of medical diagnosis or treatment and does not apply to statements made for other purposes, such as for use in litigation.
Out of Court Materials
Another issue that may arise is the admissibility of out of court materials relied upon by experts. These materials may include medical literature, research studies, or other documents that the expert used to form their opinions. Under FRE 703, an expert may base their opinion on facts or data that are not admissible in evidence if they are of a type reasonably relied upon by experts in the field.
The expert must disclose the underlying facts or data to the opposing party, and the court may exclude the testimony if it finds that the probative value of the opinion is substantially outweighed by the risk of unfair prejudice, confusion of the issues, or misleading the jury. Of course, if an attorney suspects the expert is relying on out of court records to shield information that should be in evidence, that absence may be the basis for cross-examination.
One exception to this rule is the "learned treatise" exception under FRE 803(18). This rule allows an expert to read from or refer to authoritative texts or treatises in the field, even if the texts are not admissible in evidence. However, the expert may not introduce the text itself as evidence.
Medical evidence is a critical component of personal injury trials. Medical records, statements made for medical diagnosis and treatment, expert testimony, and out of court materials are all sources of evidence when proving or challenging causation and damages. Attorneys must be very comfortable navigating the FRE, state statutes, and case law in order to offer and challenge various types of medical evidence. Experts should also become familiar with these rules and hearsay exceptions to provide critical litigation support.