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State v. Cookson12/1/2003
s long as the expert is qualified, the extent of the qualifications goes to the weight of the expert's testimony. In re Erika R., 563 A.2d 369, 373 (Me. 1989). The deferential standard of review leads us to conclude that the court did not abuse its discretion in determining that the nurse practitioner was an expert for purposes of testifying about Gould's diagnosis and treatment.
Cookson also argues that the nurse practitioner was not qualified to give a diagnosis because 32 M.R.S.A. ยง 2205-B(3) (1999) allows a nurse practitioner, who is certified and approved by the State Board of Nursing, to "perform medical diagnosis . . . when these services are delegated by a licensed physician." He points out that there was no evidence that she was certified and approved by the Board and, because she testified that she acts independently and without the supervision of a physician, she does not strictly adhere to the statutory requirements for making diagnoses. However, she testified that she was "licensed," which may be a short-hand term for "certified." The failure to demonstrate that she complies with section 2205-B(3) goes more to the weight of her opinion, rather than its admissibility. See State v. Gammon, 529 A.2d 813, 815 (Me. 1987).
Cookson further objects to the admission of the nurse practitioner's diagnosis on the grounds of relevance. We review a determination of relevance under a clear error standard. Kaechele v. Kenyon Oil Co., Inc., 2000 ME 39, 6, 747 A.2d 167, 170. The court did not clearly err in admitting Gould's diagnosis of "depression, anxiety and situational stress secondary to emotional abuse by boyfriend." It served as background for the jury to understand other testimony from the nurse practitioner regarding the medication and referral to Womancare. Even if the diagnosis was not relevant and it was error to admit it, the error was harmless. There was a great deal of evidence by other witnesses as to Gould's mental state in the days and months preceding her death as well as the stress that she was under because of her relationship with Cookson. Also, as discussed below, Gould's own statements to the nurse practitioner about her depression and her relationship with Cookson were properly admitted. Therefore, even if it was not relevant that Gould had been given an actual diagnosis of depression, it is highly probable that the admission of the diagnosis did not affect the jury's decision, and therefore, any error was harmless. See State v. White, 2002 ME 122, 16, 804 A. 2d 1146, 1150.
Cookson's next contention is that the nurse practitioner should not have been permitted to state the cause of Gould's mental health diagnosis. The nurse practitioner testified that Gould herself had said that she was depressed because of her relationship with Cookson. Thus, whether the court erred in permitting the nurse to testify about the cause of Gould's depression is inextricably linked to Cookson's additional argument that the nurse practitioner's recitation of Gould's history was hearsay and was improperly admitted as a hearsay exception under M.R. Evid. 803(4).
Rule 803(4) allows hearsay statements "made for purposes of medical diagnosis or treatment and describing . . . general character of the cause or external source thereof insofar as reasonably pertinent to diagnosis or treatment." M.R. Evid. 803(4). The rationale behind the rule is "the patient's strong motivation to be truthful." M.R. Evid. 803(4) advisers' note. Here, Gould went to the nurse practitioner to receive treatment for her self-diagnosed depression. Presumably, Gould was interested in accurately relating her symptoms and the cause for them in order to receive the appropriate treatment. Gould's
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