IN THE SUPREME COURT OF IOWA
No. 13–0588
Filed June 30, 2015
STATE OF IOWA,
Appellee,
vs.
HILLARY LEE TYLER,
Appellant.
On review from the Iowa Court of Appeals.
Appeal from the Iowa District Court for Webster County, Thomas J.
Bice, Judge.
Defendant appeals her conviction for murder in the second degree
for the death of her newborn son. DECISION OF COURT OF APPEALS
VACATED; DISTRICT COURT JUDGMENT AFFIRMED IN PART AND
REVERSED IN PART AND CASE REMANDED.
Mark C. Smith, State Appellate Defender, and Maria Ruhtenberg,
Assistant Appellate Defender, for appellant.
Thomas J. Miller, Attorney General, Tyler J. Buller and Laura
Roan, Assistant Attorneys General, and Ricki Osborn and Cori Kuhn
Coleman, County Attorneys, for appellee.
2
Randall D. Armentrout and Ryan G. Koopmans of Nyemaster
Goode, P.C., Des Moines, for amicus curiae Iowa Association of County
Medical Examiners.
3
ZAGER, Justice.
Hillary Tyler appeals her conviction for murder in the second
degree for the death of her newborn son (Baby Tyler). See Iowa Code
§§ 707.1, .3 (2011). She maintains the district court erred in denying
several of her trial motions, including: a motion in limine to exclude a
medical examiner’s testimony and autopsy report opining to the cause
and manner of Baby Tyler’s death, a motion to suppress evidence
obtained by police during the search of Tyler’s hotel room, and a motion
to suppress statements Tyler made to police. She also maintains there
was insufficient evidence to support her conviction. The court of appeals
held the district court abused its discretion in allowing the medical
examiner to testify to the cause and manner of Baby Tyler’s death and in
admitting the unredacted autopsy report into evidence. Accordingly, it
reversed the judgment of the district court and remanded the case for a
new trial. The court of appeals did not address the remaining issues
raised in the appeal.
The State applied for further review, which we granted. On further
review, we conclude the district court abused its discretion in allowing
the medical examiner to testify to the cause and manner of Baby Tyler’s
death because the medical examiner based his opinions primarily, if not
exclusively, on Tyler’s inconsistent and uncorroborated statements to
the police as opposed to objective, scientific, or medical evidence. For the
same reason, the district court should have redacted any reference to
cause and manner of death in the autopsy report. Additionally, we
conclude the district court erred in denying Tyler’s motion to suppress
evidence obtained by the police during the search of the hotel room
based solely on the legal conclusion that Tyler had no reasonable
expectation of privacy in the room because she obtained it for the
4
purpose of committing a crime. Thus, we reverse this motion and
remand the issue for further hearing and ruling by the district court
concerning the applicability of exceptions to the warrant requirement or
exclusionary rule. We affirm the district court’s denial of Tyler’s motion
to suppress statements she made to police. We vacate the decision of the
court of appeals, affirm the judgment of the district court in part and
reverse in part, and remand the case for additional proceedings
consistent with this opinion and a new trial.
I. Background Facts and Proceedings.
Tyler and Rodney Cyphers began dating in 2010. In early 2011,
Cyphers noticed Tyler was beginning to exhibit signs of pregnancy and
asked her if she was pregnant. Tyler denied being pregnant. She told
Cyphers she was suffering from a medical condition that caused her to
exhibit signs typically associated with pregnancy. Tyler was in fact
pregnant. Over time, Tyler exhibited increased signs of pregnancy and
began wearing looser fitting clothing. Even so, Tyler continued to deny
she was pregnant to anyone who asked and refused to allow Cyphers to
touch her abdomen.
In the summer of 2011, Cyphers’s employer assigned him to a job
at a plant located in Fort Dodge, Iowa. At the end of August, Tyler and
Cyphers temporarily relocated to Coalville, Iowa, which is approximately
ten miles south of Fort Dodge. While there, Tyler and Cyphers lived in a
fifth-wheel trailer in a trailer park.
At approximately 3:00 a.m. on September 19, Tyler began
experiencing mild contractions. At approximately 6:30 a.m., she called
the Super 8 Hotel in Fort Dodge to inquire about a room. She spoke with
the hotel manager who advised her that a room was available. Tyler
arrived at the hotel approximately twenty minutes later and checked into
5
room 225. Tyler occupied room 225 from approximately 6:50 a.m. until
4:30 p.m. At approximately 12:00 p.m., she gave birth to Baby Tyler in
the bathroom of room 225. She then “laid around for a little bit” and
“cleaned the bathroom floor” before returning to the trailer in Coalville.
Cyphers was home when she arrived. Shortly before 7:00 p.m., Cyphers
left to work a night shift. Tyler stayed alone at the trailer for the night.
After working the night shift, Cyphers returned to the trailer at
approximately 7:15 a.m. on September 20. Tyler was present when he
arrived. The couple ate breakfast and ran a few errands before returning
to the trailer so that Cyphers could sleep. At approximately 10:15 a.m.,
Tyler returned to the hotel to check out of room 225. Upon Tyler’s
arrival, the hotel manager informed Tyler there had been a cancellation
and room 225 was available for an additional night. Another member of
the hotel staff had previously informed Tyler room 225 was not available
for an additional night. Tyler rented room 225 for the night of September
20. Shortly thereafter, she left the hotel and returned to the trailer in
Coalville. She intended to return to the room later that evening to clean
it further.
At approximately 11:00 a.m., a housekeeper at the hotel entered
room 225 to clean it. Because Tyler had not rerented the room until late
that morning, the sheet informing the housekeeper of the room’s rental
status had not been updated to reflect that the room was a “stayover” as
opposed to a “checkout.” The doorknob to the room had a “Do Not
Disturb” sign hanging from it. Upon entering the room, the housekeeper
observed the carpet was saturated with blood. Upon entering the
bathroom, she further discovered “a lot of blood smear[ed] . . . on the
floor.” The housekeeper then exited the bathroom and discovered a
“hoodie coat.” She picked it up and observed the inside of the coat was
6
saturated with blood. Additionally, she observed two discarded vodka
bottles and “$8 . . . on the dresser by the TV,” which she thought was a
tip. She also observed a garbage can in the room, which contained a
“white towel bundled up” among other trash. She “slid the garbage can”
across the room and discovered it was “heavy.” She did not empty the
garbage can or further examine its contents. In a panicked state, she left
the room and reported her findings to the hotel manager. The manager
and the housekeeper returned to the room. Another housekeeper also
entered the room “because she could tell there was something going on
in the room.” The other housekeeper “pulled the can liner out of the
garbage can” and the group observed the towel in the garbage can had
some blood on it and the bottom of the garbage bag contained “fluid and
some blood.” Although they did not see Baby Tyler’s body, they were
very concerned about the contents of the garbage can. The manager
then called the police to report these findings.
Police were dispatched to the hotel at approximately 11:36 a.m.
According to the responding officer, the original complaint “was for . . .
criminal mischief . . . or . . . vandalism[,] . . . so that’s what [he] was
thinking going into it.” Upon arrival at the hotel, the responding officer
spoke with the hotel manager who advised him what the hotel staff had
observed. Accompanied by hotel staff, the officer entered room 225 to
investigate. Thereafter, he contacted his supervisor who arrived within
approximately ten minutes. Over the next twenty to fifty minutes, the
officers looked around the room as several additional officers arrived at
the scene. In the course of their investigation, officers observed that, in
addition to the blood, there appeared to be other bodily fluids present in
the room. Eventually, one of the officers moved the towel and other
items in the garbage can. Beneath these items, he discovered Baby
7
Tyler’s body. At that point, it “didn’t appear that there was any need to
render any aid,” so the officers secured the room until they could obtain
a search warrant.
After officers discovered Baby Tyler’s body, Fort Dodge police
contacted the Iowa Division of Criminal Investigation (DCI). Detectives
from the Fort Dodge Police Department, in cooperation with the DCI,
were subsequently able to identify and locate Tyler. At approximately
2:08 p.m., Special Agent Michael Roehrkasse of the DCI, Special Agent
Ray Fiedler of the DCI, and Detective Jody Chansler of the Fort Dodge
Police Department went to the trailer in Coalville. 1 The officers were
dressed in plain clothes as opposed to police uniforms. The officers
approached the trailer and knocked on the door. Tyler answered. The
officers’ encounter with Tyler was audio recorded.
After making contact with Tyler, the officers told her they needed to
speak with her. She told them she understood that she needed to speak
with them. Detective Chansler asked Tyler if she needed any medical
attention. She replied, “No.” He then stated, “I want to have you go with
this guy right here,” and pointed to Special Agent Roehrkasse. He
further stated, “We need to get to the bottom of what’s going on.” He
then asked Tyler, “Are you okay with that?” Tyler responded, “Yea.”
Tyler followed the officers to Special Agent Roehrkasse’s vehicle
and entered it. Outside of Tyler’s presence, the officers discussed how
Special Agent Roehrkasse should ask Tyler if the baby was born alive.
Special Agent Roehrkasse then entered the vehicle and proceeded to
drive to the Fort Dodge police station. He did not read Tyler her Miranda
rights at this time. During the ride, Special Agent Roehrkasse asked
1We will refer to the special agents of the DCI and the officers of the Fort Dodge
Police Department as “officers” when referred to collectively.
8
Tyler if the baby had moved. She responded, “No.” He also asked her if
the baby had cried. She responded, “No.” Special Agent Roehrkasse and
Tyler did not discuss anything else of significance during the ride to the
police station.
After arriving at the police station, Tyler was escorted to an
interview room in the basement. Thereafter, Special Agent Roehrkasse,
along with Special Agent Jim Thiele of the DCI, questioned Tyler over a
period of approximately three hours. The interview was video recorded.
Both officers were wearing guns on their hips. During the interview, the
door to the room was closed; however, it was unlocked and Tyler’s path
to it was unobstructed.
Special Agent Roehrkasse began the interview by asking Tyler if
she needed any medical attention. She responded, “No.” He then
informed her that although she had ridden with him to the police station,
she was free to leave at any time. He also informed her that if she
desired, he would drive her back to the trailer. He told her that although
the door was shut, that should not deter her from leaving. During the
interview, the special agents again reminded Tyler she was not in
custody and was free to leave. The special agents twice suggested that
Tyler seek medical treatment.
During the first half of the interview, the special agents asked Tyler
open-ended questions about her background and the events surrounding
Baby Tyler’s birth. During this period, Tyler told the special agents that
after Baby Tyler was born he was silent, he did not move, and she
immediately placed him in the garbage can. After approximately forty-
five minutes, the special agents took a forty-three minute break. Before
they left the room, Special Agent Thiele reminded Tyler the door was
unlocked and informed her that she was free to “get up and roam
9
around” if she wanted. After the break, Special Agent Roehrkasse
returned alone, began asking Tyler more pointed questions about the
birth, and posited several hypothetical questions about what the autopsy
would show. Tyler eventually stated that after Baby Tyler was born he
moved and cried and she placed him in the bathtub and turned the
water on for the purpose of drowning him. Special Agent Roehrkasse
then took another thirty-minute break before returning to ask Tyler
several follow-up questions. Special Agent Roehrkasse then took another
fifteen-minute break. Upon his return, he informed Tyler she would be
“charged today” and read Tyler her Miranda rights. After waiving her
Miranda rights by signing a written waiver form, Special Agent
Roehrkasse reviewed Tyler’s statements with her. Tyler confirmed that
after Baby Tyler was born he moved and cried and she placed him in the
bathtub and turned on the water for the purpose of drowning him. At
the conclusion of the interview, the special agents took Tyler to the
hospital for medical treatment.
Although the exact time is not clear from the record, officers filed
an application for search warrant after they completed the interview at
the police station. Through the warrant application, officers sought
authorization to search for and seize items from room 225, a pickup
truck registered to Cyphers, and the trailer in Coalville. Officers also
sought to obtain DNA samples from both Tyler and Cyphers for analysis.
In the warrant application, Detective Cory Husske wrote that at
approximately 11:00 a.m. the Super 8 cleaning staff “found . . . room
[225] in disarray,” “saw what looked like blood in multiple locations
around the room and bathroom,” “observed a garbage can in the room
containing towels soaked in blood and female menstruation pads,”
noticed the garbage can “had a heav[y] weight about it,” and contacted
10
police. The warrant application noted that after officers confirmed the
information provided by the hotel staff and found Baby Tyler’s body in
the garbage can, they decided to “get as much information extracted from
[the] room as [was] possible through the use of a search warrant.” The
warrant application explained the officers then sought to locate Tyler
and, in cooperation with the DCI, were successful in doing so. Finally,
the warrant application noted that officers had “obtained audio/video
recorded statements from [Tyler] in which she . . . admitted to giving
birth to a baby and discarding it.” Officers subsequently seized a
number of items from room 225, including Baby Tyler’s body and a piece
of the umbilical cord. Officers also seized a number of items from the
trailer in Coalville, including the placenta.
After Tyler arrived at the hospital on September 20, Dr. Daniel Cole
treated her and ordered several lab tests. He testified at the suppression
hearing and at trial that Tyler was alert and aware of her surroundings
when he was treating her. Thereafter, Tyler received surgical repair for a
tear from childbirth. She had lost a large amount of blood and her blood
pressure was high. She received a blood transfusion and several
medications. 2 Tyler was also suffering from a condition called
preeclampsia. This is a condition that occurs in pregnancy and causes
the patient to become hypersensitive and leads to increased blood
pressure.
2Some of the medications Tyler received include Labetol, magnesium sulfate,
and codeine. At the suppression hearing, Dr. Cole testified that Labetol is used to treat
high blood pressure, magnesium sulfate is used to treat high blood pressure in
pregnancy, and codeine is a narcotic. He testified that because Tyler was taking several
medications to reduce high blood pressure, it was possible these medications caused
her blood pressure to drop too low, which could potentially affect her mental status.
Additionally, he testified that codeine could affect a person’s mental status if given in a
“high enough dose.” However, no evidence was presented suggesting these medications
in fact affected Tyler’s mental status.
11
The next day, September 21, Special Agent Roehrkasse and Special
Agent in Charge Larry Hedlund of the DCI went to Tyler’s hospital room
to question Tyler again. This interview was audio recorded and lasted for
approximately fifty minutes. At the start of the interview, Special Agent
in Charge Hedlund read Tyler her Miranda rights. “[H]e went through
each of [her rights] and had her explain what each of the rights meant to
her.” Tyler explained each of her rights back to the special agents in her
own words. She acknowledged that she understood her rights and
signed another written waiver form. Tyler told the special agents she was
“really out of it.” However, she remembered speaking with Special Agent
Roehrkasse the previous day and that his name was “Mike.” She also
knew that she was at the hospital. 3 Additionally, when the special
agents asked Tyler if she would prefer “[they] come back later,” Tyler
responded, “You can talk to me.” The special agents told Tyler that if she
got too tired or upset, they would stop the questioning. During the
questioning Tyler never appeared confused and was alert and tracking
with the special agents’ questions. During this follow-up interview, Tyler
again stated that after Baby Tyler was born he moved and cried and she
placed him in the bathtub and turned on the water for the purpose of
drowning him.
Baby Tyler’s body, a piece of the umbilical cord, and the placenta
were taken to the offices of the State Medical Examiner. Thereafter, Dr.
Jonathan Thompson, an Associate State Medical Examiner trained in the
field of forensic pathology, performed an autopsy on Baby Tyler’s body
and a pathology examination on the body and related items. Dr.
3Apsychiatric evaluation conducted on September 21 stated that at the time of
the examination, Tyler was oriented to time and place.
12
Thompson subsequently issued a “Report of Autopsy” summarizing his
findings.
After performing the autopsy and pathology examination, Dr.
Thompson’s opinions on both the cause and manner of Baby Tyler’s
death were “Undetermined.” In his final report, however, Dr. Thompson
concluded the cause of death was “Bathtub drowning” and the manner of
death was “Homicide.” His final report indicated that in reaching these
conclusions he performed both an external and internal examination of
Baby Tyler’s body. His report further indicated that in forming his
opinions he relied on Tyler’s statements to police. The report stated:
“The mother claimed she had given birth the previous day in the motel
room and then placed the infant in a bathtub partially filled with water
shortly after the birth. The baby reportedly moved and cried after birth.”
Based on Tyler’s statements to police and other evidence obtained
during the investigation, the State charged Tyler with murder in the first
degree for the death of Baby Tyler on September 28. See Iowa Code
§§ 707.1, .2(1), .2(5). Tyler entered a plea of not guilty.
Prior to trial, Tyler filed several motions relevant to this appeal,
including: a motion in limine to exclude Dr. Thompson’s testimony and
autopsy report opining to the cause and manner of Baby Tyler’s death; a
motion to suppress evidence obtained by police during the search of
room 225 in violation of the Fourth Amendment to the United States
Constitution and article I, section 8 of the Iowa Constitution; and a
motion to suppress Tyler’s statements to police in violation of the Fifth
and Fourteenth Amendments to the United States Constitution and
article I, section 9 of the Iowa Constitution.
After hearings on the motions, the district court denied both of
Tyler’s motions to suppress. On the motion to suppress evidence
13
obtained by police during the search of room 225, the district court
concluded Tyler did not have a reasonable expectation of privacy in the
room because she had not intended to use the room as a residence, but
instead as a venue for the commission of an alleged crime. Thus, the
district court concluded Tyler’s Fourth Amendment rights were not
implicated. On the motion to suppress Tyler’s statements to police, the
district court concluded Tyler was not in custody at the trailer, during
the ride to the police station, or during the questioning at the police
station on September 20. As a result, the district court concluded her
Fifth Amendment rights were not violated. The district court also
concluded the special agents’ follow-up questioning of Tyler at the
hospital did not violate her rights because the special agents informed
her of her Miranda rights and she executed a knowing, intelligent, and
voluntary waiver.
On January 15, 2013, the district court held a hearing on Tyler’s
motion in limine to address the admissibility of Dr. Thompson’s expert
opinion on the cause and manner of Baby Tyler’s death. Tyler’s motion
requested that the district court “prohibit[] the State . . . from soliciting
or introducing any evidence from [Dr. Thompson] on his conclusions of
the truthfulness of [Tyler’s] statements that were provided to him by law
enforcement.” Tyler maintained this evidence impermissibly “passe[d] on
[her] guilt or innocence” and constituted an improper comment on her
credibility. Tyler’s motion also requested that the district court
“prohibit[] the State . . . from soliciting or introducing any evidence from
[Dr. Thompson] as to scientific or medical opinions on the cause or
manner of death.” Tyler maintained Dr. Thompson’s opinion on these
matters “would not be based on any scientific or medical knowledge,
14
scientific standards, or technical training, but merely from the witness
adopting the statements and conclusions of law enforcement.”
At the hearing, Tyler’s counsel questioned Dr. Thompson about the
autopsy he performed and the foundation for his conclusions of the
cause and manner of Baby Tyler’s death. The following exchange
occurred:
Q. Okay. So the examination includes your visual
examination, both inside and outside of the body that you’re
examining, correct? A. Yes, sir.
Q. And then it also includes various . . . scientific
tests? A. Yes, it does.
....
Q. In this case, if you based your opinions speaking
strictly on medical or scientific evidence, you were unable to
give a conclusion as to whether or not this was a homicide,
correct? A. Just on the autopsy findings, that would be
correct, yes.
Q. Okay. And also based just on the autopsy
findings, you would be unable to determine whether or not
this was a drowning, correct? A. That would be correct, yes.
Q. The autopsy findings were consistent with
intrauterine fetal demise,[4] correct? A. They could be, yes.
Q. They could also be consistent with a baby that died
immediately after birth, correct? A. It could be, yes.
....
Q. Okay. So the specific autopsy, the testing that you
did, the toxicology test, the examination of the lungs, all of
the things you did, the examination of the stomach contents,
all of that led you to an inconclusive determination,
correct? A. That’s correct, yes.
Q. And the only way that you reached the conclusion
of homicide as the manner of death, as drowning as a cause
of death, is through observing and watching the videotapes
that the law enforcement officers supplied to you,
correct? A. Yes, it is.
Q. So that would be of Miss Tyler’s interview with the
police, correct? A. That’s correct.[5]
4Intrauterine fetal demise, commonly referred to as a “stillbirth,” occurs when a
fetus dies in utero.
15
....
Q. Okay. So from that standpoint, ultimately your
opinion as to whether or not this was a homicide . . . and
what the cause of death was, is based entirely on your belief
of her statements, correct? A. That’s correct, yes.
....
Q. Okay. . . . [E]ssentially what you’re saying is that
since the autopsy didn’t disprove her statement, you’re going
to believe her statement? A. That’s correct, yes. There’s
nothing inconsistent between what she said and what I saw
at the autopsy.
Q. Hypothetically speaking, if her statement to the
police was the baby was a stillborn, your conclusion then
would have had to have been stillborn birth, natural cause of
death, correct? A. . . . I would probably classify as
[stillbirth].
....
Q. And that’s just because the actual medical
examination, medical testing, scientific testing is
inconclusive? A. That’s correct, yes.
The district court overruled Tyler’s motion in limine. In its ruling,
it noted that “in Iowa, the courts are committed to a liberal rule on the
admission of expert testimony” and that Dr. Thompson’s reliance on
Tyler’s statements to police was “no different than a physician relying on
a patient’s history in reaching a diagnosis.” Consequently, the district
court overruled Tyler’s motion in limine, “subject to [her] right to
vigorously and thoroughly cross-examine” Dr. Thompson.
Trial in this matter commenced on February 11. The central issue
in the case was the cause of Baby Tyler’s death. Specifically, whether
Baby Tyler was born alive and survived for a sufficient period for Tyler to
drown him, or whether he was stillborn or died immediately after birth
_________________________________
5Based on the record, it is unclear whether Dr. Thompson listened to the audio
recording of the ride from the trailer to the police station. Testimony given by Dr.
Thompson at a deposition taken prior to the hearing on the motion in limine, at the
hearing on the motion in limine, and at trial confirms that he both viewed the video of
the interview at the police station and listened to the audio recording of the follow-up
interview at the hospital.
16
such that Tyler could not drown him. The State presented, among other
evidence, testimony from Cyphers, members of the hotel staff, officers
who investigated room 225, and the special agents who interviewed Tyler.
The State also presented Tyler’s interviews at both the police station and
the hospital by way of video and audio recordings, respectively. 6
Dr. Thompson also testified on behalf of the State. On direct
examination, he explained to the jury that the autopsy he conducted on
Baby Tyler involved both an external and internal examination of the
body. He explained that he found fluid in Baby Tyler’s lungs. However,
he also explained that this fluid was, at least in part, amniotic fluid. Dr.
Thompson testified that because amniotic fluid is in part composed of
water, there was no scientific basis for determining whether some of the
fluid was bathwater. Dr. Thompson further testified that there were
indications Baby Tyler may have taken a breath because the alveoli in
the lungs were partially, although not entirely, expanded. He then
testified that based on this finding, and “[g]iven the history that Baby
Tyler cried and moved, . . . Baby Tyler probably took a few breaths.” Dr.
Thompson further testified that based on his findings, he was able to
rule out several possible alternative causes of death. He then opined
that Baby Tyler’s cause of death was “drowning,” and that his manner of
death was “homicide”—meaning “death at the hands of another
individual.” Finally, Dr. Thompson testified that his opinions on the
cause and manner of Baby Tyler’s death were based on “a combination of
history, which includes scene findings, it includes witness statements;
it’s also based on a combination of physical exam, which is [the] autopsy
findings; and then supplemental testing.”
6The jury did not listen to the audio recording of the officers’ initial contact with
Tyler or the ride from the trailer to the police station.
17
On cross-examination, defense counsel called attention to the
inconclusive nature of Dr. Thompson’s autopsy findings. Counsel asked
Dr. Thompson if there was an alternative explanation for the partially
expanded alveoli in Baby Tyler’s lungs. Dr. Thompson explained that
partially expanded alveoli would also be consistent with the production of
methane gas by bacteria found in the body after death, which “will
diffuse up into the lungs and can expand those a[l]veolar spaces.”
Counsel also questioned Dr. Thompson as to whether it was possible,
based on the autopsy, that Baby Tyler was stillborn or died immediately
after birth. Dr. Thompson testified there were several other possible
causes of death he could not rule out based on the autopsy findings
alone. He agreed with defense counsel that it was possible Baby Tyler
died either in utero or immediately after birth. Defense counsel and Dr.
Thompson also had an exchange in which counsel pressed Dr.
Thompson on the basis for his conclusion of the cause and manner of
Baby Tyler’s death. The following exchange occurred:
Q. Okay. It is true that you cannot say from your
autopsy alone that the child in this case ever took a breath,
correct? A. That’s correct, yes.
Q. . . . For that opinion, you are entirely relying on the
review of the interview in this case; is that correct? A. Uh,
not necessarily, because there’s nothing inconsistent with
what the witness statement said with the autopsy findings.
Q. Well -- A. But without the witness statements, I
could not have diagnosed drowning in this case.
Q. You had conducted your autopsy, correct? A. Yes.
Q. Your opinion was undetermined at that
time? A. That’s correct, yes.
Q. And then the only way you came up with your
decision in this case was based on the interview you
watched? A. Yes, sir, that’s correct.
Q. Now, you’re relying on the fact that [Tyler] said
prior to putting the baby in the tub, the baby moved and
cried, correct? A. Yes, sir.
18
Tyler’s defense was that her statements to police were not credible
and the product of coercion. Counsel noted that during the first half of
the interview at the police station, Tyler denied the baby cried or moved
after the birth. It was only after being interviewed for forty-five minutes
and a forty-three minute break that Tyler stated the baby cried and
moved. Tyler maintained these statements were not credible due to the
length of the interview and her need for medical care. As to her second
interview at the hospital, Tyler’s defense was that these statements were
also not credible due to her medicated and vulnerable state. Tyler also
presented a medical expert who testified in her defense. This pathologist
testified that there was not sufficient information to determine the cause
or manner of death.
The jury found Tyler guilty of the lesser included offense of murder
in the second degree. See Iowa Code §§ 707.1, .3. Tyler appealed and we
transferred the case to the court of appeals. The court of appeals held
the district court abused its discretion in allowing Dr. Thompson to
testify to the cause and manner of Baby Tyler’s death and in admitting
the unredacted autopsy report into evidence. The court of appeals
reasoned Dr. Thompson’s reliance on Tyler’s statements in forming his
opinions on the cause and manner of death amounted to an improper
comment on Tyler’s credibility. It also concluded Dr. Thompson’s
opinions could not fairly be characterized as expert medical opinions.
The court of appeals further determined the erroneous admission of
Dr. Thompson’s testimony and autopsy report into evidence was
reversible error because Tyler’s credibility was the central issue in the
case. The court of appeals reversed the conviction and remanded the
case for a new trial. It did not address the remaining issues raised in the
appeal.
19
The State applied for further review, which we granted. We will
provide additional facts in the discussion of specific issues below.
II. Standard of Review.
Evidentiary rulings are reviewed for an abuse of discretion. State
v. Elliott, 806 N.W.2d 660, 667 (Iowa 2011). “ ‘An abuse of discretion
occurs “when the district court exercises its discretion on grounds or for
reasons clearly untenable or to an extent clearly unreasonable.” ’ ” State
v. Miller, 841 N.W.2d 583, 586 (Iowa 2014) (quoting Rowedder v.
Anderson, 814 N.W.2d 585, 589 (Iowa 2012)). “ ‘A ground or reason is
untenable when it is not supported by substantial evidence or when it is
based on an erroneous application of the law.’ ” State v. Redmond, 803
N.W.2d 112, 117 (Iowa 2011) (quoting Graber v. City of Ankeny, 616
N.W.2d 633, 638 (Iowa 2000)). “Thus, under our abuse-of-discretion
standard, ‘we will correct an erroneous application of the law.’ ” Miller,
841 N.W.2d at 586 (quoting Rowedder, 814 N.W.2d at 589). “ ‘ “When
the error is not of constitutional magnitude, the test of prejudice is
whether it sufficiently appears that the rights of the complaining party
have been injuriously affected or that the party has suffered a
miscarriage of justice.” ’ ” Id. (quoting State v. Marin, 788 N.W.2d 833,
836 (Iowa 2010)).
We review determinations of whether to suppress both evidence
obtained and statements made in violation of constitutional guarantees
de novo. State v. Watts, 801 N.W.2d 845, 850 (Iowa 2011); State v.
Palmer, 791 N.W.2d 840, 844 (Iowa 2010). “[W]e make ‘ “an independent
evaluation of the totality of the circumstances as shown by the entire
record,” ’ ” considering “both the evidence introduced at the suppression
hearing as well as the evidence introduced at trial.” Palmer, 791 N.W.2d
at 844 (quoting State v. Turner, 630 N.W.2d 601, 606 (Iowa 2001)); see
20
also Watts, 801 N.W.2d at 850. “ ‘We give deference to the district
court’s fact findings due to its opportunity to assess the credibility of
witnesses, but we are not bound by those findings.’ ” Palmer, 791
N.W.2d at 844 (quoting Turner, 630 N.W.2d at 606). In considering
whether a defendant’s statements were voluntarily given, we give
considerable weight to the district court’s findings. State v. Payton, 481
N.W.2d 325, 328 (Iowa 1992). When the alleged error concerns the
erroneous admission of evidence in violation of a defendant’s
constitutional rights, such error is typically subject to harmless-error
analysis. See State v. Peterson, 663 N.W.2d 417, 430 (Iowa 2003).
III. Discussion of Medical Examiner Testimony.
In our analysis of this case, we must determine when medical
examiners may rely on witness statements and the results of police
investigations, in addition to their medical examination and findings, in
forming their opinions on cause or manner of death. We begin by setting
forth the role of expert testimony within our system of justice. Next, we
consider the duties and responsibilities of our state medical examiners.
We then consider whether medical examiners may rely on witness
statements and information obtained through police investigations in
forming their opinions on cause or manner of death. Finally, we consider
whether under the unique circumstances of this case, it was appropriate
for Dr. Thompson to opine on the cause and manner of Baby Tyler’s
death.
A. The Role of Expert Testimony in Iowa. Iowa is generally
“committed to a liberal view on the admissibility of expert testimony.”
Ranes v. Adams Labs., Inc., 778 N.W.2d 677, 685 (Iowa 2010). Iowa Rule
of Evidence 5.702 allows expert opinion testimony “[i]f scientific,
technical, or other specialized knowledge will assist the trier of fact to
21
understand the evidence or to determine a fact in issue.” Iowa Rule of
Evidence 5.703 provides further insight into the information experts may
rely on in forming their opinions. This rule provides:
The facts or data in the particular case upon which an
expert bases an opinion or inference may be those perceived
by or made known to the expert at or before the trial or
hearing. If of a type reasonably relied upon by experts in the
particular field in forming opinions or inferences upon the
subject, the facts or data need not be admissible in evidence.
Iowa R. Evid. 5.703.
“[T]here is no requirement that the expert be able to express an
opinion with absolute certainty. A lack of absolute certainty goes to the
weight of the expert’s testimony, not to its admissibility.” Johnson v.
Knoxville Cmty. Sch. Dist., 570 N.W.2d 633, 637 (Iowa 1997) (citation
omitted). In the context of cause of death determinations, in order to be
considered by the trier of fact “ ‘it is only necessary that the witness
entertain a “reasonable degree of medical certainty” for his conclusions.’ ”
State v. Webb, 309 N.W.2d 404, 413 (Iowa 1981) (quoting Commonwealth
v. Stoltzfus, 337 A.2d 873, 879 (Pa. 1975)). “ ‘ “Whether the . . . evidence
is sufficient to warrant a finding of causal connection is initially a legal
question for the court, but whether it is persuasive beyond a reasonable
doubt is for the jury to say.” ’ ” Id. at 413–14 (quoting Stoltzfus, 337 A.2d
at 879).
“[O]therwise admissible [opinion testimony] is not objectionable
because it embraces an ultimate issue to be decided by the trier of fact.”
Iowa R. Evid. 5.704. However, an expert may not opine as to whether a
particular legal standard has been satisfied or to “the defendant’s guilt or
innocence.” State v. Smith, 522 N.W.2d 591, 593–94 (Iowa 1994).
Further, we have continually held that expert testimony is not admissible
merely to bolster a witness’s credibility. See State v. Dudley, 856 N.W.2d
22
668, 676 (Iowa 2014) (“[W]e continue to hold expert testimony is not
admissible merely to bolster credibility.”); State v. Myers, 382 N.W.2d 91,
97 (Iowa 1986) (“[M]ost courts reject expert testimony that either directly
or indirectly renders an opinion on the credibility or truthfulness of a
witness.”). As we recently explained with respect to this rule:
Our system of justice vests the jury with the function of
evaluating a witness’s credibility. The reason for not
allowing this testimony is that a witness’s credibility “is not a
‘fact in issue’ subject to expert opinion.” Such opinions not
only replace the jury’s function in determining credibility,
but the jury can employ this type of testimony as a direct
comment on defendant’s guilt or innocence. Moreover, when
an expert comments, directly or indirectly, on a witness’s
credibility, the expert is giving his or her scientific certainty
stamp of approval on the testimony even though an expert
cannot accurately opine when a witness is telling the truth.
In our system of justice, it is the jury’s function to determine
the credibility of a witness. An abuse of discretion occurs
when a court allows such testimony.
Dudley, 856 N.W.2d at 676–77 (citations omitted) (quoting State v.
Hulbert, 481 N.W.2d 329, 332 (Iowa 1992)). Notwithstanding, “[w]e
recognize there is a very thin line between testimony that assists the jury
in reaching its verdict and testimony that conveys to the jury that [a
witness’s] out-of-court statements and testimony are credible.” Id. at
677.
B. The Role of the Medical Examiner. A state medical examiner
must be “a physician and surgeon or osteopathic physician and surgeon,
. . . licensed to practice medicine in the state of Iowa, and . . . board
certified or eligible to be board certified in anatomic and forensic
pathology by the American board of pathology.” Iowa Code § 691.5.
Forensic pathologists are physicians who specialize in forensic pathology,
meaning they received a Doctor of Medicine or a Doctor of Osteopathy,
spent at least four years in a residency program, and then spent another
23
year in a forensic pathology fellowship. See Iowa Code § 331.801(2)
(outlining requirements to serve as a county medical examiner); id.
§ 691.5 (outlining requirements to serve as a state medical examiner);
David Dolinak et al., Forensic Pathology: Principles and Practice, at xxiii
(Mark Listewnik et al. eds., 2005) [hereinafter Dolinak] (outlining
qualifications of forensic pathologists). In certain cases, state law
requires medical examiners to investigate the cause and manner of a
death, conduct an autopsy, and prepare a written report of their findings.
See Iowa Code § 331.802(2)(a) (requiring county medical examiners to
“conduct a preliminary investigation of the cause and manner of death
[and] prepare a written report of the findings” when “a person’s death
affects the public interest”); id. § 691.6(7)–(8) (requiring the state medical
examiner to “perform an autopsy or order that an autopsy be performed”
if required by law and to “retain tissues, organs, and bodily fluids as
necessary to determine the cause and manner of death”); Iowa Admin.
Code r. 641—127.3(1), (5) (requiring county medical examiners to
“perform an autopsy or order that an autopsy be performed” in specified
cases and submit a “complete record of the findings of the autopsy . . . to
the state medical examiner’s office”).
The administrative code defines “Cause of death” as “the disease or
injury which sets in motion the chain of events which eventually result in
the death of a person.” Iowa Admin. Code r. 641—127.1. The
administrative code defines “Manner of death” as “the circumstances
under which the cause of death occurred.” Id. The manner of death
“may be specified as . . . natural, accident, suicide, homicide,
undetermined, or pending.” Id. In this context, and as explained by Dr.
Thompson at trial, the term “homicide” means “[t]he killing of one human
being by . . . another.” Black’s Law Dictionary 734 (6th ed. 1990). The
24
term “homicide” expresses no opinion as to the criminality of the killing
or the culpability of the killer. 7 See id.
In making cause and manner of death determinations, medical
examiners conduct an autopsy, defined as “the external and internal
postmortem examination of a deceased person.” Iowa Admin. Code
r. 641—127.1; see Iowa Code § 691.6(7); Iowa Admin. Code r. 641—
127.3(1). Further, in making these determinations, medical examiners
routinely rely on the circumstances that surround the death, as revealed
by independent investigation, police investigation, and eyewitness
accounts. See Iowa Code § 691.6(5) (“The duties of the state medical
examiner shall be: To conduct an inquiry, investigation, or hearing and
administer oaths and receive testimony under oath relative to the matter
of inquiry, investigation, or hearing, and to subpoena witnesses and
require the production of records, papers, and documents pertinent to
the death investigation.”); Dolinak at 4 (“Before the autopsy is
interpreted, circumstances prior to death must be considered.”); Michael
J. Shkrum & David A. Ramsay, Forensic Pathology of Trauma: Common
7As Black’s Law Dictionary explains:
Homicide is not necessarily a crime. It is a necessary ingredient
of the crimes of murder and manslaughter, but there are other cases in
which homicide may be committed without criminal intent and without
criminal consequences, as, where it is done in the lawful execution of a
judicial sentence, in self-defense, or as the only possible means of
arresting an escaping felon.
Black’s Law Dictionary at 734. Our statutes reflect this same concept. See, e.g., Iowa
Code § 707.1 (defining murder as “kill[ing] another person with malice aforethought”
(emphasis added)); id. § 707.5(1)–(2) (defining involuntary manslaughter as
“unintentionally caus[ing] the death of another person by the commission of a public
offense other than a forcible felony or escape [or] . . . by the commission of an act in a
manner likely to cause death or serious injury” (emphasis added)); id. § 707.6A(1)
(defining homicide by vehicle as “unintentionally caus[ing] the death of another by
operating a motor vehicle while intoxicated” (emphasis added)).
25
Problems for the Pathologist 2 (2007) (“A complete autopsy requires the
integration of information from various investigative sources . . . .”).
C. Reliance on Witness Statements and Information Obtained
Through Police Investigation. Whether a medical examiner may opine
on cause or manner of death when his or her opinions are based largely
on uncorroborated witness statements or information obtained through
police investigation is an issue of first impression in Iowa. Other
jurisdictions that have considered the issue have failed to reach a
consensus. State v. Sosnowicz, 270 P.3d 917, 923–24 (Ariz. Ct. App.
2012) (collecting cases and noting that “[t]o the extent that there is a
common thread amongst these cases, it is that the admissibility in a
criminal case of a medical examiner’s opinion regarding the manner of
death depends on the particular facts and circumstances of each case”).
We turn now to survey the authority on the issue.
As discussed above, expert opinion testimony is admissible “[i]f
scientific, technical, or other specialized knowledge will assist the trier of
fact to understand the evidence or to determine a fact in issue.” Iowa R.
Evid. 5.702. Thus, we must determine whether a medical examiner’s
opinion on cause or manner of death assists the trier of fact. Clearly,
such opinions can assist the trier of fact in certain circumstances.
Specifically, a medical examiner’s opinion on cause or manner of death
can help the jury determine whether the medical and scientific evidence
is consistent with a particular view of the evidence. See State v. Dao
Xiong, 829 N.W.2d 391, 397 (Minn. 2013) (noting that medical
examiner’s opinion that the victim’s manner of death was homicide
“assisted the jury’s understanding of the medical evidence offered at trial
by explaining that the autopsy results were consistent with homicide”).
26
Notwithstanding, when a medical examiner over-relies on witness
statements or information obtained through police investigation in
forming his or her opinions on cause or manner of death, such opinions
may not assist the trier of fact. Numerous jurisdictions have held that
when a medical examiner bases his or her opinions on cause or manner
of death largely on statements of lay witnesses or information obtained
through police investigation, such opinions are inadmissible under rules
similar to our rule 5.702. Iowa R. Evid. 5.702; see, e.g., Sosnowicz, 270
P.3d at 922 (noting that “it does not appear that [the medical examiner]
relied on any ‘specialized knowledge’ to classify the death as a ‘homicide’
rather than an ‘accident’ ” when the medical examiner “based his
conclusion that the death was a homicide on the circumstances reported
to him by the police”); Maxwell v. State, 414 S.E.2d 470, 473–74 (Ga.
1992) (holding “[t]he medical examiner should not have been permitted to
testify as to his conclusion or opinion of the manner of death” when “his
opinion that the manner of death was due to homicide was based entirely
upon the circumstances surrounding [the victim’s] demise as related to
him by a detective working on the case” because “his expertise as a
forensic pathologist was not needed or used in reaching that
conclusion”), overruled on other grounds by Wall v. State, 500 S.E.2d 904,
907 (Ga. 1998); People v. Perry, 593 N.E.2d 712, 716 (Ill. App. Ct. 1992)
(noting “[the pathologist’s] opinion as to homicide, caused by the
defendant’s body being positioned on top of her sleeping son, did not in
any way add to the evidence already presented to the jury or assist them
in reaching their own conclusions,” but upholding the conviction because
error was harmless); State v. Vining, 645 A.2d 20, 20–21 (Me.
1994) (concluding “the medical examiner’s opinion that [the victim’s]
death was a homicide was not a product of her expertise” and “amounted
27
to an assessment of the credibility and investigatory acumen of the
police” when “[she] conceded that there was no physical evidence that
[the victim’s] death had been caused by a human agent as opposed to an
accidental fall”); State v. Jamerson, 708 A.2d 1183, 1189, 1195 (N.J.
1998) (holding a forensic pathologist’s opinion that a car crash was a
homicide as opposed to an accident was inadmissible because his
opinion was based on “circumstances leading up to the accident that
were within the understanding of the average juror,” such that his
opinion “could not be of assistance to the jury”); People v. Eberle, 697
N.Y.S.2d 218, 219 (App. Div. 1999) (holding a medical expert’s opinion
that an infant’s death was caused by “homicidal suffocation” as opposed
to sudden infant death syndrome was inadmissible when “the results of
the autopsy equally supported two possible causes of death” because her
opinion was not based on the medical evidence, but rather on her review
of “statements by defendant and other individuals” (internal quotation
marks omitted)); Bond v. Commonwealth, 311 S.E.2d 769, 772 (Va.
1984) (“The ultimate question was whether the decedent jumped
intentionally, fell accidentally, or was thrown to her death. The facts and
circumstances shown by the testimony of lay witnesses were sufficient to
enable a jury to decide that question. The expert’s opinion was based
largely, if not entirely, upon the same facts and circumstances.”). These
cases generally stand for the proposition that when a medical examiner’s
opinion on cause or manner of death is based largely on statements of
lay witnesses or information obtained through police investigation, such
opinions are not sufficiently based on scientific, technical, or specialized
knowledge that would assist the jury in weighing the evidence.
For example, in Sosnowicz, the defendant was accused of running
over the victim with his Hummer. 270 P.3d at 919. At trial, the medical
28
examiner testified that based on his autopsy of the victim’s body, the
cause of death was “blunt force trauma.” Id. at 921. He also testified
that based on the autopsy and information he received from police
regarding the circumstances surrounding the victim’s death, the manner
of death was “homicide.” Id. He explained that in reaching his
conclusion on the manner of death he determined the circumstances of
the victim’s death as reported to him by police were consistent with his
autopsy findings and that those circumstances were consistent with
homicide. Id.
In concluding the medical examiner’s testimony was inadmissible
under Arizona Rule of Evidence 702, the Court of Appeals of Arizona
reasoned:
[I]t does not appear that [the medical examiner] relied on any
“specialized knowledge” to classify the death as a “homicide”
rather than an “accident.” Under cross-examination, [he]
agreed with defense counsel that he based his conclusion
that the death was a homicide on the circumstances
reported to him by the police. Indeed, [he] was in no better
position to determine the manner of death than was the jury
who heard the actual trial testimony of witnesses and had
the opportunity to evaluate their credibility.
Id. at 922–23.
In Vining, the victim “died after falling over backwards and hitting
his head on a cement floor.” 645 A.2d at 20. The victim was intoxicated
at the time. Id. At trial, an eyewitness who was also intoxicated at the
time of the incident testified that the defendant and the victim were in a
fight at the time of the fall and that the defendant was standing in front
of the victim when the victim fell. Id. However, the eyewitness did not
actually see the defendant push the victim. Id. “The State Medical
Examiner testified that although there was no physical evidence from
[the victim’s] body that would allow her to determine whether [the victim]
29
fell or was pushed, she concluded based on her conversations with the
police investigators that [the victim’s] death was a homicide.” Id.
In concluding the medical examiner’s opinion that the victim’s
death was a homicide was inadmissible, the Supreme Court of Maine
reasoned:
[T]he medical examiner’s opinion . . . was not a product of
her expertise. The medical examiner conceded that there
was no physical evidence that [the victim’s] death had been
caused by a human agent as opposed to an accidental fall.
Her opinion was based solely on her discussions with the
police investigators and therefore amounted to an
assessment of the credibility and investigatory acumen of the
police. The credibility of witnesses is the exclusive province
of the jury.
. . . [T]he State argues that “[the medical examiner’s]
opinion assisted the jury in determining whether [the victim’s]
fatal injuries resulted from accidentally falling backwards off
his chair onto the floor or from the severe force applied by
another person.” That argument begs the issue. It is
appropriate for the medical examiner to testify, as she did,
that the damage to the skull shows that severe force was
applied. It is another thing entirely, however, to testify that
although the physical evidence was insufficient for her to
distinguish whether [the victim] fell or was pushed, the police
investigators have convinced her that [the victim’s] death was
a homicide. That is not an expert medical opinion.
Id. at 20–21 (footnote omitted)(citation omitted).
In Eberle, a case closely analogous to the present case, a medical
examiner testified that an infant victim’s cause of death was “homicidal
suffocation.” 297 N.Y.S.2d at 219 (internal quotation marks omitted).
However, she admitted “there were no medical findings to explain the
death of the infant” and that “the results of the autopsy equally
supported two possible causes of death, i.e., suffocation and Sudden
Infant Death Syndrome (SIDS).” Id. Additionally, she stated that “her
opinion that the death was caused by homicidal suffocation rather than
30
SIDS was not based on medical evidence but rather . . . on her review of
statements by defendant and other individuals.” Id.
In concluding the medical examiner’s opinion concerning cause
and manner of death was inadmissible, the Supreme Court, Appellate
Division, of New York reasoned:
[T]he opinion of the . . . expert was not based on professional
or medical knowledge but rather was based on inferences
and conclusions drawn from various statements presented to
her by the police. It is, however, for the jury to determine
whether to credit such statements and to determine the
inferences to be drawn therefrom. . . . Because the jury was
able to comprehend the issues and evaluate the evidence,
the expert’s opinion, which intruded on the province of the
jury to draw inferences and conclusions from that evidence,
was improperly admitted.
Id. (citation omitted).
The State asserts the weight of out-of-state authority supports a
more liberal approach regarding the admissibility of medical examiner
opinions on cause or manner of death under rule 5.702. Iowa R. Evid.
5.702; see, e.g., Baraka v. Commonwealth, 194 S.W.3d 313, 314–16 (Ky.
2006) (holding the trial court did not abuse its discretion in admitting a
medical examiner’s opinion that the victim’s manner of death was
homicide when the medical examiner’s opinion was “based, in part, on
disputed information regarding the circumstances of the victim’s death
that was provided to her by police”); Rollins v. State, 897 A.2d 821, 849,
851–52 (Md. 2006) (holding a medical examiner’s opinion that the victim
was “smothered” was admissible when her opinion was based, in part, on
witness statements and information provided by police), abrogated on
other grounds as recognized by Derr v. State, 29 A.3d 533, 548–49 (Md.
2011); Dao Xiong, 829 N.W.2d at 397–98 (holding the trial court did not
err in admitting a medical examiner’s testimony that the victim’s manner
of death was “homicide” when the medical examiner’s opinion “was based
31
on [his] examination of [the victim’s] body”); State v. Bradford, 618
N.W.2d 782, 790, 793 (Minn. 2000) (holding a medical examiner’s
testimony that the victim’s death was a “homicide” was admissible
because the “testimony was helpful to the jury” and assisted it in
“differentiat[ing] between a self-inflicted intraoral gunshot wound and
one inflicted by another”); State v. Wilson, 248 P.3d 315, 323–25 (N.M.
2010) (holding the trial court did not abuse its discretion in admitting a
medical expert’s testimony that the victim’s death was “consistent with
smothering” when the expert “considered several sources of information
when forming his opinion, including the medical record and the autopsy
report, as well as Defendant’s confession and the police report”),
overruled on other grounds by State v. Tollardo, 275 P.3d 110, 121 (N.M.
2012); State v. Commander, 721 S.E.2d 413, 420 (S.C. 2011) (“Because
the anecdotal history is an essential component of any autopsy, we find
testimony concerning findings based on this information falls within the
umbrella of the expert’s specialized knowledge.”); State v. Boyer, 741
N.W.2d 749, 757 (S.D. 2007) (holding a forensic pathologist’s testimony
that the victim’s manner of death was “homicide” was admissible when
his conclusion was “based on [his] interview with the law enforcement
officers that were investigating the death and . . . the autopsy findings”);
State v. Richardson, 603 A.2d 378, 379 (Vt. 1992) (holding, in a case
where the defendant did not raise a rule 702 argument, a medical
examiner’s testimony that the victim’s death was a “homicide” did not
impermissibly state a legal conclusion concerning the defendant’s guilt
because the jury “still had to decide the ultimate question of whether
defendant was at all involved in the homicide”); State v. Scott, 522 S.E.2d
626, 632 (W. Va. 1999) (holding, in a case where the defendant did not
raise a rule 702 argument, a medical examiner’s testimony that the
32
victim’s death was a “homicide” did not impermissibly state a legal
conclusion concerning the defendant’s guilt). However, unlike the cases
discussed above, in many of the cases cited by the State the medical
experts based their opinions primarily on the autopsy results, as
opposed to witness statements or other information provided by police.
For example, in Dao Xiong, the Supreme Court of Minnesota
approved the admission of a medical examiner’s testimony that the
manner of death of a victim of a gunshot wound to the abdomen was
homicide. 829 N.W.2d at 394–95, 98. In concluding the testimony
would assist the jury, the court noted that the medical examiner based
his opinion on his “examination of [the victim’s] body.” 8 Id. at 397.
8The extent to which the medical examiner in Dao Xiong relied on witness
statements or information provided by police in forming his opinion on manner of death
is somewhat unclear. However, in approving the medical examiner’s testimony, the Dao
Xiong court compared the case to its earlier Bradford decision in which the medical
examiner based his manner-of-death opinion primarily on his examination of the
victim’s body. See Dao Xiong, 829 N.W.2d at 397 (“[I]n . . . Bradford, we concluded that
no error was committed when the district court admitted a medical examiner’s expert
testimony that, based on his autopsy of the victim’s body, the victim’s manner of death
was homicide rather than suicide.”). This suggests the medical examiner in Dao Xiong
based his opinion largely on his examination of the victim’s body.
The court further noted that Dao Xiong was unlike its prior decision Hestad v.
Pennsylvania Life Insurance Co., 204 N.W.2d 433, 436 (Minn. 1973). See Dao Xiong,
829 N.W.2d at 397. There, the trial court excluded testimony from a coroner who
would have testified on behalf of the defendant that an individual’s cause of death was
carbon monoxide poisoning and manner of death was accident, as opposed to suicide.
Hestad, 204 N.W.2d at 435. In concluding the coroner’s opinion was inadmissible, the
Minnesota Supreme Court noted the coroner based his opinion largely “on information
received from the sheriff.” Id. at 436. As a result, “the medical expert did not . . .
possess[] any peculiar knowledge or ability to assist the jury in the determination of
whether the death was accidental or suicide.” Id. Thus, the Dao Xiong court’s effort to
distinguish Hestad further suggests the medical examiner in Dao Xiong based his
opinion largely on his examination of the victim’s body.
The Dao Xiong court did note that subsequent decisions of the court
“establish[ing] that expert testimony regarding the victim’s manner of death can be
helpful to the jury” have somewhat limited the scope of Hestad’s holding. Dao Xiong,
829 N.W.2d at 397. However, the court did not overrule Hestad or hold medical
examiners may testify to cause or manner of death irrespective of the extent to which
they base such opinions on witness statements or information provided by police. Id.
33
Bradford similarly involved a medical examiner’s opinion that appears to
have been primarily based on the autopsy. 9 See 618 N.W.2d at 790; see
also Sosnowicz, 270 P.3d at 923 (“Bradford, however, is inapposite
because the pathologist’s opinion . . . appears to have been based on his
external and internal examination of the victim rather than a history
provided to him by law enforcement investigators.”); Dao Xiong, 829
N.W.2d at 397 (“[I]n . . . Bradford, we concluded that no error was
committed when the district court admitted a medical examiner’s expert
testimony that, based on his autopsy of the victim’s body, the victim’s
manner of death was homicide rather than suicide.” (emphasis added)).
Likewise, the expert in Rollins relied largely on the autopsy in concluding
the victim’s cause of death was “asphyxiation” and manner of death was
“smothering.” 10 See 897 A.2d at 849–50.
9The Bradford court described the basis of the medical examiner’s opinion as
follows:
The medical examiner who performed an autopsy on [the victim’s]
body noted a single intraoral gunshot wound with an exit wound on the
back of her neck. The examiner concluded that [the victim] died from the
gunshot wound. He also observed numerous bruises on [the victim’s]
scalp, left eye, ear, face, abdomen, hands, feet, arms, and legs and
abrasions on her left eye, back, shoulders, buttocks, and knees. The
examiner concluded that the injury to [the victim’s] left eye was
consistent with her having been struck with a fist.
618 N.W.2d at 790.
10The expert in Rollins did not base her opinion primarily on witness statements
or information provided by police, but also relied on evidence of physical injuries on the
victim indicating there had been an altercation and other physical findings consistent
with smothering. See 897 A.2d at 848. Specifically, she noted:
There was a hemorrhage in her mouth where it shouldn’t be, indicating
pressure on the mouth, hemorrhage, bleeding. That is indicative of
smothering, pressure to the mouth in some manner from an external
force, be it a hand, be it a pillow, something pushing on her mouth. . . .
In addition, there are other injuries on her that you can’t ignore
also. They might not be part of the exact smothering but it is part of the
injury that you have to take into consideration. Of course smothering is
holding something over the mouth. Just because I have bruises in my
34
In Baraka, a fight between the defendant and the victim allegedly
caused the victim to have a fatal heart attack. 194 S.W.3d at 314. A
medical examiner testified the victim’s cause of death was heart attack
and manner of death was “homicide.” Id. The defendant asserted the
medical examiner’s testimony regarding manner of death did not assist
the jury because it was “based, in part, on disputed information
regarding the circumstances of the victim’s death that was provided to
her by police.” Id. In concluding the testimony was admissible, the
Supreme Court of Kentucky observed that “it is axiomatic that a
determination of the cause and manner which led to a person’s death is
generally scientific in origin and outside the common knowledge of
layperson jurors.” Id. Accordingly, the court concluded the testimony,
based in part on information provided by police, assisted the jury. Id.
Three of seven justices concurred. Id. at 320 (Cooper, J.,
concurring). In summarizing the state of the law concerning medical
examiner opinions on manner of death, the concurrence noted,
[M]ost jurisdictions that have addressed the issue hold that
a qualified expert can express an opinion that the manner of
a disputed death was homicide, i.e., that the death of one
person was due to an act or omission of another, as opposed
to natural causes or suicide, though not that the homicide
was intentional, wanton, reckless, or accidental, which
would constitute an opinion as to the guilt or innocence of
the defendant.
Id. at 318. However, the concurrence also noted,
_________________________________
arms doesn’t mean that I’m smothered. But she does have bruises on
her arms as I stated. So she has additional injuries.
Id.
The expert also relied on witness statements and other information provided by
police, namely that the house in which the incident occurred was recently ransacked;
however, she expressly noted her physical findings indicated asphyxiation and
smothering. Id. at 849.
35
The consensus of these cases is that an expert medical
examiner or forensic pathologist can express an opinion not
only as to the cause of death, but also that the manner of
death was homicide . . . where such would not be readily
ascertainable by a layperson, thus would assist that trier of
fact in determining a fact in issue. However, the expert
cannot express an opinion as to the mental state of the
accused which would constitute an expression as to guilt or
innocence, and cannot base the opinion solely on facts that
are just as easily understood by a layperson.
Id. at 319 (emphasis added).
Two of seven justices dissented. Id. at 324 (Johnstone, J.,
dissenting). The dissent concluded the medical examiner exceeded the
scope of her expertise and that her testimony did not assist the jury. Id.
at 321. The dissent explained,
The jury did not require expert testimony to determine
whether the altercation between [the victim] and [the
defendant] was highly emotional; testimony from the
investigating officers and the 911 recording would have been
sufficient evidence upon which the jury could base an
informed decision. Likewise, [the medical examiner’s] expert
opinion was unnecessary to an intelligent determination as
to whether [the victim] did or did not perceive a physical
threat that would induce stress. This question does not
require specialized knowledge beyond the understanding of
the average juror.
Id. at 321. Ultimately, five of seven justices agreed that, depending on
the extent to which experts base their opinions on facts just as easily
understood by laypersons, there is a point when such opinions do not
assist the jury. The justices disagreed on when the line is crossed.
In Boyer, “[t]he issue . . . was whether [a nineteen-month-old
victim’s] injuries were either accidental from falling down the stairs or
the subject of homicide from being thrown to the floor.” 741 N.W.2d at
751–52, 756. A forensic pathologist testified the manner of death was
homicide because the likelihood the victim’s “injuries occurred as a
result of falling down a flight of stairs was extremely small.” Id. at 756–
36
57. While the pathologist in that case did base his opinion in part on
information provided to him by police, there is no indication the
information formed a substantial basis of his opinion. See id. at 757.
Instead, the pathologist’s opinion appears to have been primarily based
on the fact that the victim’s injuries were simply not consistent with an
accident or suicide. See id. (“[T]he autopsy findings . . . suggested that
natural disease certainly was not an option in this case nor was suicide
an option in this case”).
One of the State’s strongest cases is Commander. 721 S.E.2d 413.
There, a victim’s “family members discovered [her] mummified and
partially decomposed body covered by a blanket and lying on a sofa
inside her home.” Id. at 415 (footnote omitted). Despite the fact that
“the autopsy did not uncover any evidence of violence or trauma to [the]
[v]ictim’s body,” a medical examiner opined the cause of death was
asphyxiation and the manner of death was homicide “due to the
suspicious nature of [the] [v]ictim’s death.” Id. He based his opinion in
part on anecdotal evidence provided to him by police concerning the
scene of the incident, coupled with the absence of typical indicators of
physical violence. 11 Id.
In concluding the medical examiner’s opinion was admissible, the
Supreme Court of South Carolina concluded that “[b]ecause the
anecdotal history is an essential component of any autopsy, . . .
11In explaining the basis for his opinion, the medical examiner stated,
“I believe [the] [v]ictim died of unnatural causes. And as a result of
elimination [of other manners of death], and like you mentioned, the
interpolation of the facts of the case, that being her purse is gone, her
car is gone, the house is locked up and somebody went through an awful
lot of effort to cover up this death, that I feel that [the] v[ictim] died as a
result of homicide due to asphyxiation.”
Commander, 721 S.E.2d at 416 (third alteration in original) (footnote omitted).
37
testimony concerning findings based on this information falls within the
umbrella of the expert’s specialized knowledge.” Id. at 420. However, the
court also acknowledged that “in certain circumstances, expert medical
testimony of this type has the potential to invade the province of the
jury” and distinguished the facts of the case from cases in which the
expert “base[d] his opinion exclusively on the circumstantial information
provided by the police officers at the scene.” Id. at 420 & n.11.
Having surveyed the authority on the issue, we conclude there are
circumstances when a medical examiner’s opinions on cause or manner
of death may assist the jury, even when such opinions are based in part
on witness statements or information obtained through police
investigation. 12 However, our review of the caselaw confirms there is no
bright-line rule for determining whether a medical examiner may opine
on cause or manner of death when his or her opinions are based, in
whole or in part, on such information. Instead, whether a medical
examiner’s opinion on cause or manner of death is admissible depends
on the particular circumstances of each case. For example, when a
medical examiner bases his or her opinion of cause or manner of death
largely on witness statements or information obtained through police
investigation, such opinions would ordinarily be inadmissible under rule
5.702 because they would not assist the trier of fact. See Iowa R. Evid.
5.702; see also, e.g., Sosnowicz, 270 P.3d at 922; Maxwell, 414 S.E.2d at
473–74; Perry, 593 N.E.2d at 716; Vining, 645 A.2d at 20–21; Jamerson,
708 A.2d at 1195; Eberle, 297 N.Y.S.2d at 219; Bond, 311 S.E.2d at 771–
12We note that this case does not present an issue of whether an expert witness
may rely on facts or data not in evidence under rule 5.703. See Iowa R. Evid. 5.703.
Here, the facts and data relied on by Dr. Thompson were ultimately admitted into
evidence. Thus, insofar as rule 5.703 is concerned, Dr. Thompson could rely on such
information. See id.
38
72. In contrast, when a medical examiner bases his or her opinion on
cause or manner of death primarily on the autopsy, such opinions will
likely assist the jury in understanding the evidence and would ordinarily
be admissible. See Iowa R. Evid. 5.702; see also, e.g., Rollins, 897 A.2d
at 848–49, 851–52; Dao Xiong, 829 N.W.2d at 397–98; Bradford, 618
N.W.2d at 790, 793; Boyer, 741 N.W.2d at 757.
D. Dr. Thompson’s Testimony. We turn now to consider
whether it was appropriate for Dr. Thompson to opine on the cause and
manner of Baby Tyler’s death. First, we consider whether Dr.
Thompson’s opinions were sufficiently based on “scientific, technical, or
other specialized knowledge” so as to “assist the trier of fact to
understand the evidence or to determine a fact in issue.” Iowa R. Evid.
5.702. Second, we consider whether under the unique facts of this case,
Dr. Thompson’s opinions amounted to an impermissible comment on
Tyler’s credibility. See Dudley, 856 N.W.2d at 676. We address each of
these points in turn.
First, we conclude Dr. Thompson’s opinions on the cause and
manner of Baby Tyler’s death were not sufficiently based on scientific,
technical, or other specialized knowledge so as to assist the jury. Rather,
Dr. Thompson admitted that his opinions on the cause and manner of
Baby Tyler’s death were based primarily, if not exclusively, on Tyler’s
inconsistent and uncorroborated statements to police, as opposed to
objective medical findings. The central issue in this case was whether
Baby Tyler was born alive and survived for a sufficient period of time for
Tyler to drown him, or whether he was stillborn or died immediately after
birth such that Tyler could not have drowned him. Without the benefit
of objective medical findings, Dr. Thompson testified to the ultimate
issues of fact questions for the jury to determine. Clearly, a medical
39
examiner could testify concerning the medical signs of drowning,
whether the autopsy findings were consistent with drowning, whether
there were other possible causes of death, whether he or she could rule
out other possible causes of death, and whether he or she could
legitimately render definitive opinions on cause or manner of death.
Much of Dr. Thompson’s testimony assisted the jury in these respects.
However, the record in this case does not support the conclusion that Dr.
Thompson relied on scientific, technical, or other specialized knowledge
to classify the cause of Baby Tyler’s death as bathtub drowning or the
manner of his death as homicide, rather than undetermined. Instead,
the record established Dr. Thompson’s opinions were based primarily, if
not exclusively, on Tyler’s inconsistent and uncorroborated statements to
police.
After performing the autopsy and pathology examination, Dr.
Thompson’s opinions on the cause and manner of Baby Tyler’s death
were undetermined. In his final report, however, Dr. Thompson
concluded the cause of death was bathtub drowning and the manner of
death was homicide. His final report clearly indicated that in forming his
opinions he relied on Tyler’s statements to police. His report stated: “The
mother claimed she had given birth the previous day in the motel room
and then placed the infant in a bathtub partially filled with water shortly
after the birth. The baby reportedly moved and cried after birth.” At the
hearing on the motion in limine, Dr. Thompson agreed with defense
counsel that based on the autopsy, he was unable to reach a conclusion
on both the cause and manner of Baby Tyler’s death. He admitted the
only way he reached his final opinions was by reference to Tyler’s
statements to police during her interview at the police station.
40
At trial, Dr. Thompson testified on direct examination that there
was nothing inconsistent with his autopsy findings and the State’s theory
that Baby Tyler was born alive and survived for a sufficient period for
Tyler to drown him. Based on his physical examination of Baby Tyler’s
body, he ruled out several possible alternative causes of death. He
further testified that there were indications Baby Tyler may have taken a
breath because the alveoli in the lungs were partially, although not
entirely, expanded. He then opined, “given the history that Baby Tyler
cried and moved . . . Baby Tyler probably took a few breaths.” He further
opined the cause of death was drowning and the manner of death was
homicide. On cross-examination, defense counsel pressed Dr. Thompson
on the basis for his conclusions. Ultimately, Dr. Thompson testified
there were several other possible causes of death he could not rule out
based on the autopsy. He explained that partially expanded alveoli
would also be consistent with the production of methane gas by bacteria
found in the body after death, which “will diffuse up into the lungs and
can expand those a[l]veolar spaces.” He agreed with defense counsel that
it was possible Baby Tyler died either in utero or immediately after birth.
He then stated, “without the witness statements, I could not have
diagnosed drowning in this case.”
Thus, the record shows Dr. Thompson’s opinions that the cause of
death was drowning and manner of death was homicide were not based
on scientific, technical, or other specialized knowledge. Iowa R. Evid.
5.702. Instead, the record shows that absent Tyler’s statements, Dr.
Thompson would have been unable to render definitive opinions on both
cause of death and manner of death. Further, the record does not
support the conclusion that Dr. Thompson relied on any other
corroborating evidence, aside from Tyler’s statements, in reaching his
41
opinions on cause or manner of death. Dr. Thompson did testify that his
opinions were based on “a combination of history, which includes scene
findings [and] witness statements,” in addition to “[the] autopsy findings .
. . and . . . supplemental testing.” However, he did not explain how the
scene findings or other objective information factored into his opinions.
In fact, the record is devoid of any such objective evidence. Instead, he
admitted Tyler’s statements to police were the but-for factor in rendering
his opinion. Consequently, Dr. Thompson’s opinions on the cause and
manner of death were not sufficiently based on scientific, technical, or
other specialized knowledge as required by our rules. Iowa R. Evid.
5.702. He was in no better position to determine the cause or manner of
death than were the members of the jury who watched and listened to
Tyler’s interviews with the special agents and had the opportunity to
evaluate her credibility. His opinions on cause and manner of death did
not assist the trier of fact and were therefore inadmissible under rule
5.702.
This case closely resembles cases from other jurisdictions in which
courts have excluded medical examiner testimony for similar reasons.
As discussed above, in those cases the medical examiner performed an
autopsy, was unable to render an opinion on cause or manner of death,
and then after review of witness statements or information obtained
through police investigation, rendered an opinion based largely on that
information. See, e.g., Sosnowicz, 270 P.3d at 922; Maxwell, 414 S.E.2d
at 473–74; Perry, 593 N.E.2d at 714; Vining, 645 A.2d at 20–21;
Jamerson, 708 A.2d at 1189–90, 1195; Eberle, 297 N.Y.S.2d at 219;
Bond, 311 S.E.2d at 772. This is not a case where the medical examiner
simply considered witness statements or information obtained from
police, but based his or her opinions primarily on the physical evidence.
42
See, e.g., Rollins, 897 A.2d at 848–49, 851–52; Dao Xiong, 829 N.W.2d at
397–98; Bradford, 618 N.W.2d at 790, 793; Boyer, 741 N.W.2d at 757.
Nor is it a case where the medical examiner relied on information fairly
characterized as “anecdotal.” See, e.g., Commander, 721 S.E.2d at 415.
Instead, Dr. Thompson’s opinions on the cause and manner of Baby
Tyler’s death were based primarily, if not exclusively, on Tyler’s
inconsistent and uncorroborated statements to police.
We also conclude that under the unique facts of this case, Dr.
Thompson’s opinions were inadmissible because they amounted to an
impermissible comment on Tyler’s credibility. As discussed above, an
expert witness cannot comment, directly or indirectly, on a witness’s
credibility. See Dudley, 856 N.W.2d at 676–77. We prohibit such
opinions because they “not only replace the jury’s function in
determining credibility, but the jury can employ this type of testimony as
a direct comment on defendant’s guilt or innocence.” Id. We recently
addressed the application of this rule in three child sex-abuse cases.
In Dudley, we held an expert who opined that a child victim’s
“physical manifestations and symptoms were consistent with a child
dealing with and suffering from sexual abuse trauma” impermissibly
commented on the child’s credibility. Id. at 677–78. We reasoned that
when an expert testifies that the child’s physical manifestations or
symptoms are consistent with sexual abuse trauma, “the expert is saying
these symptoms mean the child suffered a sexual abuse trauma;
therefore, the child must be telling the truth when he or she relates his
or her story to the jury.” Id. at 677. In Dudley, we also held another
expert impermissibly commented on the child’s credibility in
communicating to the jury that she recommended the child receive
therapy and stay away from the defendant. Id. at 678. Because she
43
based these recommendations on her belief that the defendant had
sexually abused the victim as was related to her by the victim, we
concluded the expert necessarily communicated to the jury that she
believed the victim’s story. Id. at 673, 678.
In State v. Brown, 856 N.W.2d 685, 688–89 (Iowa 2014), we held
an expert impermissibly opined on a child victim’s credibility when the
expert’s report stated the victim communicated to the expert that the
defendant had inappropriately touched her and the expert believed “ ‘this
disclosure [to be] significant and that an investigation [was] clearly
warranted.’ ” We reasoned this final statement “indirectly convey[ed] to
the jury that [the victim was] telling the truth about the alleged abuse
because the authorities should conduct a further investigation into the
matter.” Id. at 689.
Finally, in State v. Jaquez, 856 N.W.2d 663, 665 (Iowa 2014), we
held an expert crossed the line in testifying that a child victim’s
demeanor was “ ‘completely consistent with a child who has been
traumatized, particularly multiple times.’ ” We concluded this testimony
indirectly vouched for the child’s credibility because the expert was in
effect saying the child’s “demeanor means the child suffered a sexual
abuse trauma, therefore, the child must be telling the truth.” Id.
An analogous situation occurred here. Tyler made various
inconsistent statements to the special agents regarding whether Baby
Tyler was born alive. During the ride from the trailer to the police station
and for the first half of the three-hour interview at the police station, she
told the special agents that after Baby Tyler was born he was silent, he
did not move, and she immediately placed him in the garbage can. After
the special agents interviewed her for over an hour and a half, Tyler then
stated that after Baby Tyler was born he moved and cried and she placed
44
him in the bathtub and turned the water on for the purpose of drowning
him. There is no additional objective evidence indicating Baby Tyler was
born alive. Therefore, aside from Dr. Thompson’s opinions, Tyler’s
statements to police were the only evidence presented to the jury
showing whether Baby Tyler was born alive. Dr. Thompson’s opinions
that the cause of death was bathtub drowning and the manner of death
was homicide were based primarily, if not exclusively, on Tyler’s
statements. Significantly, Dr. Thompson did not credit Tyler’s initial
statements to police that after Baby Tyler was born he was silent and did
not move. 13 Instead, he selectively credited her statements during the
second half of the interview when she stated Baby Tyler was born alive
and described her actions after the birth. It is clear that if Tyler never
stated Baby Tyler was born alive, Dr. Thompson could not have opined
that the cause of death was drowning or that the manner of death was
homicide. Thus, in opining on cause and manner of death, Dr.
Thompson necessarily credited one version of Tyler’s story over another.
He at least indirectly communicated to the jury that he believed Tyler’s
statements when he stated on direct examination, “given the history that
Baby Tyler cried and moved . . . Baby Tyler probably took a few breaths.”
As a result, Dr. Thompson’s opinions on the cause and manner of death
crossed that very thin line between testimony that assists the trier of fact
and testimony that vouches for a witness’s credibility.
Finally, for similar reasons, we have serious doubts as to whether
Dr. Thompson possessed a reasonable degree of medical certainty with
respect to his opinions on the cause and manner of Baby Tyler’s death.
13In fairness to Dr. Thompson, police may not have provided him with the audio
recording of the ride from the trailer to the police station in which Tyler stated Baby
Tyler did not cry or move after the birth.
45
Again, the record showed that after conducting the autopsy, Dr.
Thompson was unable to reach an opinion on cause or manner of death.
He then watched Tyler’s interview with police and changed his opinion.
By his own admission, he was only able to determine to a reasonable
degree of forensic or medical certainty that Baby Tyler’s cause and
manner of death were undetermined. For all of these reasons, the
district court abused its discretion in allowing Dr. Thompson to
communicate his opinions concerning the cause and manner of Baby
Tyler’s death to the jury. 14
E. Summary. In reaching the above conclusion, we do not create
a bright-line rule to govern every criminal case in which a medical
examiner is called to testify to a victim’s cause or manner of death. Nor
do we conclude medical examiners may never rely in part on witness
statements or information obtained from police in forming their opinions.
In this case, however, Dr. Thompson conceded he was unable to form an
opinion on the cause or manner of Baby Tyler’s death based on the
autopsy and his investigation. Instead, he based his opinions primarily,
if not exclusively, on Tyler’s inconsistent and uncorroborated statements
to police. Without her statements, crediting some and discounting
14“Error may not be predicated upon a ruling which admits or excludes evidence
unless a substantial right of the party is affected . . . .” Iowa R. Evid. 5.103. “In cases
of nonconstitutional error, we start with the presumption that the substantial rights of
the defendant have been affected. The State has the burden to affirmatively establish
the substantial rights of the defendant were not affected.” Dudley, 856 N.W.2d at 678
(citation omitted); accord State v. Howard, 825 N.W.2d 32, 41–42 (Iowa 2012). While
the State makes a passing reference to harmless error in its brief, in context, it is clear
the State is not arguing harmless error in this case. The State failed to cite any
authority in support of this issue and did not argue this in its application for further
review or at oral argument. Therefore, the State has waived the issue of harmless error
on appeal. See Iowa R. App. P. 6.903(2)(g)(3) (“Failure to cite authority in support of an
issue may be deemed waiver of that issue.”); Dudley, 856 N.W.2d at 678 (finding the
State waived a harmless-error argument by failing to raise it on appeal); In re Det. of
Blaise, 830 N.W.2d 310, 320–21 (Iowa 2013) (acknowledging that the State waives a
harmless-error argument by failing to raise it on appeal).
46
others, Dr. Thompson could not have offered an opinion on the critical
issue in this case: whether Baby Tyler was born alive. His opinions were
not sufficiently based on scientific, technical, or other specialized
knowledge and therefore did not assist the trier of fact. Iowa R. Evid.
5.702. Further, under the unique facts of this case, Dr. Thompson
indirectly vouched for Tyler’s credibility. Because Dr. Thompson’s
opinions on these matters failed to comply with our evidentiary rules, we
vacate the decision of the court of appeals, reverse the conviction, and
remand the case for a new trial.
IV. Other Issues on Appeal.
Tyler raised other issues in this appeal. While not dispositive,
these issues may form the basis for a subsequent appeal. Therefore, we
elect to address them as part of this appeal. Specifically, we address
whether the search of room 225 violated the Fourth Amendment to the
United States Constitution and whether the special agents’ various
questionings of Tyler violated the Fifth and Fourteenth Amendments to
the United States Constitution. 15
A. Search of the Hotel Room. The Fourth Amendment to the
United States Constitution provides: “The right of the people to be secure
in their persons, houses, papers, and effects, against unreasonable
15In district court, Tyler cited the Federal Constitution and the Iowa Constitution
in both her motion to suppress evidence obtained during the search of room 225 and
her motion to suppress her statements to the special agents. As it relates to both
motions, Tyler did not make a specific argument based on the Iowa Constitution.
Further, the district court’s rulings on both of these motions were based entirely on the
Federal Constitution. Tyler did not file a motion to enlarge the trial court’s ruling. See
State v. Mitchell, 757 N.W.2d 431, 435 (Iowa 2008). Thus, because Tyler’s state
constitutional claims were not sufficiently raised or ruled on by the district court, any
such claims she has raised in this appeal were not adequately preserved. See id.; Meier
v. Senecaut, 641 N.W.2d 532, 537 (Iowa 2002) (“It is a fundamental doctrine of appellate
review that issues must ordinarily be both raised and decided by the district court
before we will decide them on appeal.”). Accordingly, we consider Tyler’s claims only
under federal constitutional standards.
47
searches and seizures, shall not be violated . . . .” U.S. Const. amend.
IV. In assessing whether a search resulted in a Fourth Amendment
violation, we apply a two-step approach. State v. Brooks, 760 N.W.2d
197, 204 (Iowa 2009). “First, the defendant must show that he or she
has a legitimate expectation of privacy in the area searched. ‘Second, if
the defendant had a legitimate expectation of privacy, we must then
decide whether the State unreasonably invaded the protected interest.’ ”
Id. (citations omitted) (quoting State v. Halliburton, 539 N.W.2d 339, 342
(Iowa 1995)).
1. Expectation of privacy. To establish a legitimate expectation of
privacy in the area searched, “a defendant challenging a search must
show (1) a subjective expectation of privacy and (2) this expectation of
privacy was reasonable.” State v. Ortiz, 618 N.W.2d 556, 559 (Iowa
2000); accord State v. Lowe, 812 N.W.2d 554, 567 (Iowa 2012). “ ‘The
determination of whether a person has a legitimate expectation of privacy
with respect to a certain area is made on a case-by-case basis,
considering the unique facts of each particular situation.’ ” State v.
Fleming, 790 N.W.2d 560, 564 (Iowa 2010) (quoting State v. Breuer, 577
N.W.2d 41, 46 (Iowa 1998)). Whether a defendant’s expectation of
privacy is reasonable “is determined by examining property laws as well
as society’s generally recognized and permitted expectations about
privacy.” Id. We first analyze whether Tyler has demonstrated a
subjective expectation of privacy in room 225.
Tyler originally rented room 225 in the early morning hours of
September 19. She paid for the room at that time. Based on the record,
it is reasonable to conclude she was having contractions and was looking
for a private location in anticipation of the birth of Baby Tyler. Tyler
brought nothing with her for an overnight stay. Further, after giving
48
birth to Baby Tyler, Tyler left the room and returned to the trailer in
Coalville where she stayed for the night. However, when Tyler returned
to the hotel the next morning to check out, the hotel manager informed
her that she could rent room 225 for an additional night. She did so and
paid for the second night at that time. It is undisputed that at all times
during this period, the room was registered to Tyler. Shortly thereafter,
she left the hotel and returned to the trailer. Upon her departure, she
left a “Do Not Disturb” sign hanging from the doorknob of room 225. See
United States v. Lanier, 636 F.3d 228, 231 (6th Cir. 2011) (concluding a
“Do Not Disturb” sign hanging from a hotel room’s doorknob supported
the conclusion that the defendant had a subjective expectation of privacy
in his hotel room). She left her bloody hoodie coat, two vodka bottles,
eight dollars, and Baby Tyler’s body in the room. See id. (suggesting a
defendant’s decision to leave clothing and “a lot of cocaine” in his hotel
room supported the conclusion that the defendant had a subjective
expectation of privacy in his hotel room). The record further established
that Tyler intended to return to the room later to clean up. Thus, while
Tyler was not present when police entered the room, the record supports
the conclusion that after she departed from the hotel on September 20,
she maintained a subjective expectation of privacy in room 225.
Having concluded Tyler had a subjective expectation of privacy in
room 225, we turn now to consider whether this expectation of privacy
was one “ ‘that society is prepared to recognize as reasonable.’ ” Fleming,
790 N.W.2d at 565 (quoting Minnesota v. Olson, 495 U.S. 91, 96–97, 110
S. Ct. 1684, 1688, 109 L. Ed. 2d 85, 93 (1990)). The Fourth Amendment
clearly establishes a reasonable expectation of privacy in the home.
Payton v. New York, 445 U.S. 573, 585, 100 S. Ct. 1371, 1379, 63
L. Ed. 2d 639, 650 (1980). “The case law extends this protection to hotel
49
or motel rooms.” Brooks, 760 N.W.2d at 205; accord Stoner v. California,
376 U.S. 483, 486, 84 S. Ct. 889, 891, 11 L. Ed. 2d 856, 859 (1964);
Fleming, 790 N.W.2d at 565; State v. Smith, 178 N.W.2d 329, 332 (Iowa
1970). However, as we have previously explained:
The mere fact that a premise[s] may be characterized
as a residence or a motel room does not, by itself, establish
that a particular person has a reasonable expectation of
privacy in the premises. For example, the use of a hotel or
motel room as a center for drug transactions and not as a
residence does not give rise to legitimate expectations of
privacy within the ambit of the Fourth Amendment. A
defendant does not have a reasonable expectation of privacy
when the motel or hotel room is nothing more than “a
convenient processing station” for the packaging and
distribution of drugs.
Brooks, 760 N.W.2d at 205 (quoting Minnesota v. Carter, 525 U.S. 83,
102, 119 S. Ct. 469, 479, 142 L. Ed. 2d 373, 388 (1998) (Kennedy, J.,
concurring)).
Ultimately, a defendant must establish that he or she was using a
hotel or motel room as a residence, or for some other purpose for which
he or she had a legitimate expectation of privacy. See Brooks, 760
N.W.2d at 205. “A bald assertion that one has been staying in a hotel,
without further proof, is generally insufficient; as is the defendant’s mere
presence in the motel room at the time of the search.” Id. Whether the
guest checked into and paid for the room is one factor we consider in
assessing whether an individual had a reasonable expectation of privacy
in the room. United States v. Cooper, 203 F.3d 1279, 1284 (11th Cir.
2000); United States v. Carter, 854 F.2d 1102, 1105–06 (8th Cir. 1988).
We also consider whether the room is rented to the defendant at the time
of the search. See United States v. Huffhines, 967 F.2d 314, 318 (9th Cir.
1992) (“A guest in a motel has no reasonable expectation of privacy in a
room after the rental period has expired.”); United States v. Parizo, 514
50
F.2d 52, 54 (2d Cir. 1975) (“[W]hen the term of a guest’s occupancy of a
room expires, the guest loses his exclusive right to privacy in the room.”).
Another relevant factor is “the presence of the defendant’s belongings.”
Brooks, 760 N.W.2d at 205; accord Cooper, 203 F.3d at 1284.
We turn now to apply these principles to the unique facts of this
case. We must decide, based upon the record developed, whether Tyler
was using room 225 as an overnight guest, thereby giving rise to a
reasonable expectation of privacy, or whether she was using the room for
a purpose for which she had no reasonable expectation of privacy. Upon
our de novo review of the record, we conclude Tyler’s expectation of
privacy in room 225 was reasonable. Tyler rented room 225 in her own
name. She paid for the room on both September 19 and September 20.
The room was rented to her at the time of the search. She brought
personal property with her to the room, albeit a minimal amount. She
placed a “Do Not Disturb” sign on the door indicating she expected
privacy. As stated earlier, it is reasonable to assume she checked into
the room believing she was about to give birth. These actions are
consistent with her continuing efforts to conceal the pregnancy from her
friends and family. The mere fact that she gave birth to a child in the
room does not, alone, diminish her otherwise reasonable expectation of
privacy in the room. On this record, we cannot conclude Tyler’s sole
purpose for renting room 225 was to commit a criminal offense.
Considering the totality of the circumstances, Tyler had a reasonable
expectation of privacy in room 225.
2. Invasion of protected interest and the exclusionary rule.
“ ‘Warrantless searches are per se unreasonable if they do not fall within
one of the well-recognized exceptions to the warrant requirement.’ ”
Lowe, 812 N.W.2d at 568 (quoting State v. Naujoks, 637 N.W.2d 101, 107
51
(Iowa 2001)). Further, if a defendant had a legitimate expectation of
privacy in the searched area, and the search does not fall within an
exception to the warrant requirement, “[t]he exclusionary rule requires
the suppression of evidence discovered as a result of [the] illegal
government activity.” State v. McGrane, 733 N.W.2d 671, 680 (Iowa
2007). “However, there are exceptions to the exclusionary rule.” Id. at
681. There is no dispute that police initially entered room 225 without a
warrant. Therefore, any analysis should include whether an exception to
the warrant requirement or exclusionary rule applies in this case.
In its ruling on the motion to suppress evidence obtained by police
during the search of room 225, the district court concluded Tyler did not
have a reasonable expectation of privacy in the room because “as was the
case in Brooks, the motel room was not intended to be used as a
‘residence’ but rather a venue for the commission of an alleged crime.”
As discussed above, the district court erred in denying Tyler’s motion on
that basis alone because the conclusion that Tyler rented room 225 for
the sole purpose of committing a criminal offense is not supported by the
record. Because of the district court’s specific ruling on that issue, it did
not address whether any exceptions to the warrant requirement or
exclusionary rule may apply to law enforcement’s search of room 225.
One potentially applicable exception to the warrant requirement in
this case is the community caretaking exception. See State v. Kern, 831
N.W.2d 149, 172 (Iowa 2013). “A core notion of the community
caretaking exception is that . . . it is ‘totally divorced from the detection,
investigation, or acquisition of evidence relating to the violation of a
criminal statute.’ ” Id. (quoting Cady v. Dombrowski, 413 U.S. 433, 441,
93 S. Ct. 2523, 2528, 37 L. Ed. 2d 706, 715 (1973)). “ ‘The community
caretaking function involves the duty of police officers to help citizens an
52
officer reasonably believes may be in need of assistance.’ ” Id. at 172–73
(quoting State v. Mireles, 991 P.2d 878, 880 (Idaho Ct. App. 1999)).
We have recognized that “ ‘the community caretaking exception
encompasses three separate doctrines: (1) the emergency aid doctrine, (2)
the automobile impoundment/inventory doctrine, and (3) the “public
servant” exception.’ ” State v. Kurth, 813 N.W.2d 270, 274 (Iowa 2012)
(quoting State v. Crawford, 659 N.W.2d 537, 541 (Iowa 2003)). The
emergency aid doctrine and the public servant exception are closely
related. Crawford, 659 N.W.2d at 541. As we have previously
recognized:
Under the emergency aid doctrine, the officer has an
immediate, reasonable belief that a serious, dangerous event
is occurring. . . . [I]n contrast, the officer in a public servant
situation might or might not believe that there is a difficulty
requiring his general assistance. For example, an officer
assists a motorist with a flat tire under the public servant
doctrine, but an officer providing first aid to a person
slumped over the steering wheel with a bleeding gash on his
head acts pursuant to the emergency aid doctrine.
Id. at 541–42 (alterations in original) (quoting Mary Elisabeth Naumann,
Note, The Community Caretaker Doctrine: Yet Another Fourth Amendment
Exception, 26 Am. J. Crim. L. 325, 333–34 (1999)).
The determination of whether the community caretaking exception
applies
require[s] a three-step analysis: (1) was there a seizure
within the meaning of the Fourth Amendment?; (2) if so, was
the police conduct bona fide community caretaker activity?;
and (3) if so, did the public need and interest outweigh the
intrusion upon the privacy of the citizen?
Crawford, 659 N.W.2d at 543; accord Kern, 831 N.W.2d at 173. While
the test “does not primarily focus on searches,” we have previously
53
applied the community caretaking exception to justify searches in several
cases. Kern, 831 N.W.2d at 173 (collecting cases).
One potentially applicable exception to the exclusionary rule in
this case is the inevitable discovery doctrine. See McGrane, 733 N.W.2d
at 681. Under the inevitable discovery doctrine, “relevant, probative
evidence gathered despite Fourth Amendment violations is not
constitutionally excluded when the police would have inevitably
discovered the same evidence acting properly.” State v. Christianson, 627
N.W.2d 910, 912 (Iowa 2001).
Unfortunately, the State did not develop an adequate a record on
these issues in the district court. While it was error for the district court
to conclude Tyler had no reasonable expectation of privacy in room 225,
we will allow the State to develop an additional record on whether these
or any other potential exceptions to the warrant requirement or
exclusionary rule apply. On this record, we reverse the district court’s
denial of the motion to suppress and remand this issue for further
hearing and ruling by the district court.
B. Tyler’s Statements to Police. In Miranda v. Arizona, 384 U.S.
436, 471, 478–79, 86 S. Ct. 1602, 1626, 1630, 16 L. Ed. 2d 694, 722,
726 (1966), the Supreme Court of the United States required police to
advise suspects of their rights under the Fifth Amendment to the United
States Constitution before a custodial interrogation. The Court required
that police tell the suspect
he has the right to remain silent, that anything he says can
be used against him in a court of law, that he has the right
to the presence of an attorney, and that if he cannot afford
an attorney one will be appointed for him prior to any
questioning if he so desires.
Id. at 479, 86 S. Ct. at 1630, 16 L. Ed. 2d at 726.
54
In determining the admissibility of a defendant’s inculpatory
statements over a Fifth Amendment challenge we apply a two-part test.
State v. Countryman, 572 N.W.2d 553, 557 (Iowa 1997). “We first
determine whether Miranda warnings were required and, if so, whether
they were properly given. Second, we ascertain whether the statement is
voluntary and satisfies due process.” Id. Miranda warnings are only
required if, at the time of police questioning, the suspect is both: 1) in
custody, and 2) subject to interrogation. Berkemer v. McCarty, 468 U.S.
420, 429, 104 S. Ct. 3138, 3144, 82 L. Ed. 2d 317, 328 (1984); accord
Countryman, 572 N.W.2d at 557. Once police give a suspect the
requisite warning, the “[s]uspect[] may waive [his or her] Miranda rights
as long as the suspect has done so knowingly, intelligently, and
voluntarily.” State v. Ortiz, 766 N.W.2d 244, 251 (Iowa 2009). We turn
now to address Tyler’s specific arguments.
1. Custodial interrogation. Tyler asserts she was in custody when
the special agents questioned her at the police station, prior to giving her
Miranda warnings, in violation of her Fifth Amendment rights. For
purposes of the Fifth Amendment, a suspect is in custody “as soon as a
suspect’s freedom of action is curtailed to a ‘degree associated with
formal arrest.’ ” Berkemer, 468 U.S. at 440, 104 S. Ct. at 3150, 82 L. Ed.
2d at 335 (quoting California v. Beheler, 463 U.S. 1121, 1125, 103 S. Ct.
3517, 3520, 77 L. Ed. 2d 1275, 1279 (1983) (per curiam)). “ ‘[A] court
must examine all of the circumstances surrounding the interrogation,
but “the ultimate inquiry is simply whether there was ‘a formal arrest or
restraint on freedom of movement’ of the degree associated with a formal
arrest.” ’ ” Countryman, 572 N.W.2d at 557–58 (quoting Stansbury v.
California, 511 U.S. 318, 322, 114 S. Ct. 1526, 1528–29, 128 L. Ed. 2d
293, 298 (1994) (per curiam)). In deciding whether a suspect is in
55
custody at a given time, “we examine the extent of the restraints placed
on the suspect during the interrogation in light of whether ‘a reasonable
man in the suspect’s position would have understood his situation’ to be
one of custody.’ ” Ortiz, 766 N.W.2d at 251 (quoting Berkemer, 468 U.S.
at 442, 104 S. Ct. at 3151, 82 L. Ed. 2d at 336). We consider four
factors in making this determination:
(1) the language used to summon the individual; (2) the
purpose, place, and manner of interrogation; (3) the extent to
which the defendant is confronted with evidence of her guilt;
and (4) whether the defendant is free to leave the place of
questioning.
Countryman, 572 N.W.2d at 558. We turn now to determine whether
Tyler was in custody at the Fort Dodge police station on September 20
when she stated she drowned Baby Tyler.
First, we must assess the language the officers used to summon
Tyler. When the officers approached Tyler at the trailer, they did not
demand that she go with them. They knocked on the door to the trailer,
told her they needed to speak with her, and asked her if she needed
medical attention. Tyler agreed to speak with them and said she did not
need medical attention. Detective Chansler asked Tyler if she was “okay”
with going with Special Agent Roehrkasse and speaking with the officers.
Tyler responded, “Yea.” Tyler was neither handcuffed nor forcibly placed
in the back of Special Agent Roehrkasse’s vehicle. See State v. Miranda,
672 N.W.2d 753, 760 (Iowa 2003) (considering the fact that the suspect
was handcuffed as weighing in favor of custody). The record shows that
Tyler voluntarily accompanied Special Agent Roehrkasse to the police
station. See State v. Smith, 546 N.W.2d 916, 923 (Iowa 1996) (“Although
coming to the center voluntarily is not alone enough to negate a finding
of custody, it is indicative of the state of mind of a reasonable person in
56
the situation.”); State v. Brown, 341 N.W.2d 10, 16 (Iowa 1983) (“He
accompanied officers to the police station voluntarily and was at no time
subjected to either physical or verbal restraint.”); see also Purvis v.
Dugger, 932 F.2d 1413, 1415, 1419 (11th Cir. 1991) (considering
suspect’s voluntary decision to accompany officers to the police station in
a police vehicle as weighing against custody); State v. Atkinson, 670 A.2d
276, 285 (Conn. 1996) (considering a suspect’s voluntary decision to
accompany “two plainclothes detectives in an unmarked vehicle” to the
police station as weighing against custody). This factor weighs against
custody.
Second, we must examine the purpose, place, and manner of the
interrogation. As we have previously recognized, while a three-hour
interview may seem like a long time, this does not necessarily mean the
suspect was in custody. See Countryman, 572 N.W.2d at 558 (“The
three-hour length of the conversation did not render it custodial.”);
Brown, 341 N.W.2d at 16 (finding no custody despite two and one-half
hours of questioning). Further, that an interview takes place at the
police station does not, itself, render the suspect in custody. See
Countryman, 572 N.W.2d at 558 (finding no custody when interview
occurred at the sheriff’s office). In examining the purpose, place, and
manner of an interrogation, we examine factors including the number of
persons conducting the questioning, the number of breaks taken during
the questioning, the availability of restroom breaks or other breaks, and
the type of questioning in which those conducting the interview engage.
See id; see also Smith, 546 N.W.2d at 924.
Here, although the interrogation took place over the course of a
three-hour period, the room in which it occurred was carpeted and well
lit. See Smith, 546 N.W.2d at 924 (considering building’s furnishings in
57
assessing custody). Although the special agents who questioned Tyler
were armed, they were dressed in plain clothes. Id. (finding the fact that
officers were casually dressed weighed against custody). During the
questioning, only two special agents were present at any given time. See
id. (noting “[o]ne fact of particular significance is the number of law
enforcement officers taking part in the interview process” and finding no
custody when two officers conducted the interview). In fact, for the
majority of the questioning only Special Agent Roehrkasse was present.
See id. (considering the fact that only one officer was present for a
majority of the questioning as weighing against custody). At the start of
the interview, Special Agent Thiele asked Tyler if she needed to go to the
restroom and told her that if she needed anything to drink, to let them
know. The special agents again asked Tyler if she needed medical
treatment. She responded, “No.” The special agents did not engage in
confrontational or aggressive questioning, but rather asked Tyler open-
ended questions about the events that transpired at the hotel. See
Countryman, 572 N.W.2d at 558 (finding nonconfrontational nature of
questioning weighed against custody). During the course of the
interview, the special agents did not raise their voices, but conducted
themselves in a calm, respectful manner, often times prefacing questions
with statements such as “[we] are not here to judge you.” Finally, while
“[a] policeman’s unarticulated plan has no bearing on the question
whether a suspect was ‘in custody’ at a particular time,” Berkemer, 468
U.S. at 442, 104 S. Ct. at 3151, 82 L. Ed. 2d at 336, the record revealed
the special agents were not attempting to get Tyler to confess to a crime.
Rather, their discussion outside of Special Agent Roehrkasse’s vehicle
before transporting Tyler to the police station suggests they did not know
what had happened at the hotel. Specifically, one of the officers stated,
58
“We don’t know what we got.” Thus, the purpose of the questioning was
to ascertain what had happened, as opposed to getting Tyler to confess to
a murder. Importantly, the special agents intentions manifested in the
manner of their questioning, as they repeatedly informed Tyler that they
were only trying to gather information. Their demeanor, tone, and line of
questioning do not suggest a reasonable person would have understood
him or herself to be in custody. This factor weighs against custody.
Third, we must examine the extent to which the special agents
confronted Tyler with evidence of her guilt. Again, the record revealed
that when the special agents began questioning Tyler they did not know
whether Baby Tyler was born alive. While Special Agent Roehrkasse did
ask Tyler if the autopsy would show that there had been air in the baby’s
lungs or that the baby was born alive, he did not suggest the autopsy
would in fact show that Baby Tyler ever took a breath or was born alive.
These questions were not accusatory in nature, but rather intended to
encourage her to tell the truth. See Smith, 546 N.W.2d at 925 (finding
officers decision to tell the defendants their stories did not match was a
“tool with which to urge the defendants to provide more information,” as
opposed to an accusation of guilt). Prior to her confession, the special
agents did not confront Tyler with any other evidence that she drowned
Baby Tyler. This factor weighs against custody.
Finally, we must consider whether Tyler was free to leave the
place of questioning. At the start of the interview, Special Agent
Roehrkasse informed Tyler that, although she had ridden with him to the
police station, she was free to leave at any time and that he would give
her a ride back to Coalville if she desired. See Miranda, 672 N.W.2d at
760 (“ ‘The most obvious and effective means of demonstrating that a
suspect has not been taken into custody or otherwise deprived of
59
freedom of action is for the police to inform the suspect that an arrest is
not being made and that the suspect may terminate the interview at
will.’ ” (quoting United States v. Griffin, 922 F.2d 1343, 1349 (8th Cir.
1990))). Although the door to the interview room was closed, it was
unlocked and Tyler’s path to it was unobstructed. Special Agent
Roehrkasse told Tyler that the fact that the door was shut should not
deter her from leaving. During the interview, the special agents told
Tyler she was free to leave one additional time. Immediately before the
forty-three minute break, Special Agent Thiele reminded Tyler that the
door was unlocked and informed her that she was free to “get up and
roam around” if she wanted.
We recognize that Tyler had given birth the day before the
interview and possibly remained under the stress of that event.
Notwithstanding, the record revealed her physical state did not affect her
ability to leave. Specifically, the afternoon of the birth Tyler drove herself
from the hotel to the trailer and spent the night there. The following
morning, she ate breakfast with Cyphers, ran errands, and returned to
the hotel to check out. After renting room 225 for an additional night,
she drove herself back to the trailer. Thus, Tyler’s own conduct following
Baby Tyler’s birth undermines any claim that her medical condition
precluded her from leaving the interview. Further, the special agents
asked Tyler if she needed any medical attention prior to transporting her
to the police station and several more times during the interview. Tyler
coherently answered the special agents’ questions and told them she did
not need medical attention. We do not find that her medical state
precluded her from leaving. This factor weighs against custody.
Upon our de novo review, we conclude Tyler was not in custody at
any time prior to when she confessed to drowning Baby Tyler. Because
60
Tyler was not in custody when she initially confessed to drowning Baby
Tyler, her initial confession was not obtained in violation of the Fifth
Amendment.
2. Waiver. Tyler next argues that she did not execute a valid
waiver of her Miranda rights at the police station before her confirmation
confession or later at the hospital when she again admitted to drowning
Baby Tyler. She maintains that she did not voluntarily waive her
Miranda rights during these police encounters. In order to execute a
valid waiver of one’s Miranda rights, the waiver must be made
“knowingly, intelligently, and voluntarily.” Ortiz, 766 N.W.2d at 251.
“ ‘[V]oluntariness’ for . . . due process purposes and Miranda purposes
are identical.” Countryman, 572 N.W.2d at 559. Therefore, “a Miranda
waiver is involuntary only when it is shown to be the product of police
misconduct or overreaching.” Id. “For a waiver to be made voluntarily,
the relinquishment of the right must have been voluntary, meaning it
was the product of the suspect’s free and deliberate choice rather than
intimidation, coercion, or deception.” Ortiz, 766 N.W.2d at 251. The
question of whether a suspect voluntarily waived his or her Miranda
rights “is to be made by inquiring into the totality of the circumstances
surrounding the interrogation, to ascertain whether the suspect in fact
‘decided to forgo his rights to remain silent and to have the assistance of
counsel.’ ” Id. (quoting Fare v. Michael C., 442 U.S. 707, 724–25, 99 S.
Ct. 2560, 2571–72, 61 L. Ed. 2d 197, 212 (1979)). The State has the
burden to prove by a preponderance of the evidence that Tyler voluntarily
waived her Miranda rights. Payton, 481 N.W.2d at 328.
A number of factors are helpful in determining whether a
defendant voluntarily waived their Miranda rights. These factors include:
61
defendant’s age; whether defendant had prior experience in
the criminal justice system; whether defendant was under
the influence of drugs; . . . whether defendant was mentally
“subnormal”; whether deception was used; whether
defendant showed an ability to understand the questions
and respond; the length of time defendant was detained and
interrogated; defendant’s physical and emotional reaction to
interrogation; whether physical punishment, including
deprivation of food and sleep, was used.
Id. at 328–29 (citations omitted). Further, while “[a] written waiver of
constitutional rights is not alone sufficient to establish the waiver as . . .
voluntary[,] [i]t is . . . strong proof of its validity.” Countryman, 572
N.W.2d at 559 (citation omitted). We now turn to consider whether Tyler
voluntarily waived her Miranda rights, both at the police station after
Special Agent Roehrkasse informed her she was going to be charged, and
the next day at the hospital during the special agents’ follow-up
questioning.
After Tyler initially confessed at the police station, Special Agent
Roehrkasse took two breaks before telling Tyler she would be “charged
today.” He then read Tyler her Miranda rights aloud, and she signed a
written waiver form. This is strong proof that Tyler executed a voluntary
waiver. Id. Further, prior to reading Tyler her Miranda rights, Special
Agent Roehrkasse asked Tyler if she was forced to make any of the
statements she had previously made. She responded, “No.” At the time
of the questioning, Tyler was thirty-one years old. She had prior
experience with the criminal justice system from a prior theft
prosecution. She had graduated from high school and had taken several
college courses. The record reflects that prior to the interview, Tyler had
taken some cold medicine and felt “spacey” as a result. She also gave
birth the day before the interview and was questioned for a long period.
However, the record shows that the special agents took several breaks
during the questioning and offered Tyler food, drink, and the opportunity
62
to use the bathroom. She was readily capable of understanding and
answering the special agents’ questions. Further, she voluntarily stayed
at the police station and answered questions despite Special Agent
Roehrkasse’s offer to take her home. While on several occasions she
began to cry, she never lost control or had a breakdown. The special
agents never threatened Tyler, nor did they make any promises of
leniency in exchange for her cooperation. Finally, the special agents did
not engage in any deceptive tactics during the questioning. Tyler
voluntarily answered the special agents’ questions and then, after Special
Agent Roehrkasse read Tyler her Miranda rights, she voluntarily waived
her rights and confirmed her prior confession. Considering the totality of
the circumstances, Tyler voluntarily waived her Miranda rights at the
police station on September 20.
Many of the same factors also support the conclusion that Tyler
voluntarily waived her Miranda rights at the hospital on September 21.
Before this follow-up interview, Special Agent in Charge Hedlund again
read Tyler her Miranda rights. Tyler explained what each of her rights
meant to her, acknowledged that she understood her rights, and signed
another written waiver form. Prior to this second interview, Tyler
received a surgical repair for a tear from childbirth, she had lost a large
amount of blood, her blood pressure was high, and she was taking
several medications. Further, she initially told the officers she was
“really out of it.” However, she remembered speaking with Special Agent
Roehrkasse the previous day and that his name was “Mike,” knew she
was at the hospital, never appeared confused, and was alert and tracking
with the special agents’ questions. See Countryman, 572 N.W.2d at 559
(finding a defendant’s statements were voluntarily given despite the fact
that the defendant was “under the influence of drugs and was confused”
63
because “she was easy to understand”); State v. Edman, 452 N.W.2d 169,
170 (Iowa 1990) (“Being ‘under the influence’ does not, standing alone,
render inculpatory statements involuntary.”). Additionally, when the
special agents asked Tyler if she would prefer “[they] come back later,”
Tyler responded, “You can talk to me.” Considering the totality of the
circumstances, Tyler voluntarily waived her Miranda rights at the
hospital on September 21.
3. Voluntariness of confessions. Finally, Tyler maintains that all of
her confessions to the special agents were involuntary and therefore in
violation of her due process rights under the Fourteenth Amendment to
the United States Constitution. As noted above, “ ‘voluntariness’ for . . .
due process purposes and Miranda purposes are identical.” Countryman,
572 N.W.2d at 559. Thus, the same factors outlined in the preceding
subsection are relevant in determining whether Tyler’s confessions were
voluntarily given.
For many of the same reasons noted above, our de novo review of
the record reveals that each of Tyler’s confessions was voluntarily given.
During the first interview, Special Agent Roehrkasse told Tyler that she
was free to leave and that he would give her a ride home if she desired.
The special agents asked her if she needed medical treatment. She
responded, “No.” While she had just given birth and had taken cold
medicine, her own actions that morning suggest that she was capable of
leaving if she desired. She voluntarily remained at the police station and
answered questions. Her responses to the questioning clearly indicated
she was capable of both understanding and answering the special agents’
questions. The special agents made no threats or any promises of
leniency in exchange for her cooperation. Neither did they engage in
deceptive tactics. Tyler voluntarily answered the special agents’
64
questions, and then after being informed both that she would be
“charged today” and of her Miranda rights, she told the special agents
she had not been forced to confess previously. She then proceeded to
confirm her initial confession.
At the hospital, although Tyler was tired, medicated, and had
undergone surgery recently, she again agreed to speak with the special
agents despite their offer to return later. She never appeared confused
and was alert and tracked with the special agents’ questions. While she
had previously confessed, making it difficult for her to change her story,
her prior confession was not the product of coercion. Although Special
Agent Roehrkasse again participated in the follow-up interview, the
interview took place at an entirely different location and a day later. The
record does not reflect a woman whose will was overborne. Considering
the totality of the circumstances, Tyler’s confessions both at the police
station and later at the hospital were voluntarily given and therefore not
in violation of her due process rights.
Tyler was not in custody during her initial confession to the special
agents at the police station. She voluntarily waived her Miranda rights
both at the police station and later at the hospital. Each of her
confessions was voluntarily given. The district court properly denied
Tyler’s motion to suppress her statements to police.
V. Conclusion.
The district court abused its discretion in allowing Dr. Thompson
to opine on the cause and manner of Baby Tyler’s death because he
based his opinions primarily, if not exclusively, on Tyler’s inconsistent
and uncorroborated statements to police as opposed to objective,
scientific, or medical evidence. On retrial, should the State attempt to
use Dr. Thompson as an expert witness, the district court should
65
prohibit him from testifying that the cause of death was “drowning” and
the manner of death was “homicide.” Likewise, it should redact the
portions of the autopsy report stating his ultimate opinions on cause and
manner of death.
With respect to Tyler’s motion to suppress evidence obtained by
police during the search of room 225, we conclude the district court
erred in denying this motion based solely on the legal conclusion that
Tyler had no reasonable expectation of privacy in room 225 because she
obtained it for the purpose of committing a crime. We reverse this
motion and remand the issue for further hearing and ruling by the
district court concerning the applicability of exceptions to the warrant
requirement or exclusionary rule. With respect to Tyler’s motion to
suppress statements made to police during her initial contact with law
enforcement, at the police station, and at the hospital, we affirm the
district court’s ruling. We vacate the decision of the court of appeals,
affirm the judgment of the district court in part and reverse in part, and
remand the case for additional proceedings consistent with this opinion
and a new trial.
DECISION OF COURT OF APPEALS VACATED; DISTRICT
COURT JUDGMENT AFFIRMED IN PART AND REVERSED IN PART
AND CASE REMANDED.
Hecht, J., files a concurrence in part and dissent in part in which
Wiggins and Appel, JJ., join. Appel, J., files a concurrence in part and
dissent in part in which Wiggins and Hecht, JJ., join. Waterman, J., files
a concurrence in part and dissent in part in which Cady, C.J., and
Mansfield, J., join.
66
#13–0588, State v. Tyler
HECHT, Justice (concurring in part and dissenting in part).
I agree the district court erred in allowing the medical examiner to
rely primarily upon Tyler’s uncorroborated statements in forming an
opinion as to the cause of Baby Tyler’s death. I also agree the district
court erred in concluding Tyler had no reasonable expectation of privacy
in the hotel room. However, I dissent in part because I conclude all of
Tyler’s statements to the police are inadmissible. The circumstances—
especially the officers’ repeated verbal assurances that Tyler was not in
custody and their subsequent decision to administer warnings only after
Tyler made all of the inculpatory statements they sought—demonstrate a
calculated strategy to circumvent Miranda. In my view, the police
questioning in this case constitutes a “midstream recitation of warnings
after interrogation and unwarned confession” in violation of Missouri v.
Seibert, 542 U.S. 600, 604, 124 S. Ct. 2601, 2605, 159 L. Ed. 2d 643,
650 (2004) (plurality opinion), and all of Tyler’s statements made during
the police station and hospital interrogations should have been
suppressed.
Our court has not had occasion to apply Seibert. Thus, this case
presents the first opportunity to consider the problem of midstream
Miranda warnings in successive interrogations. Seibert was a split 4–1–4
decision, so courts applying it must determine whether the plurality
opinion or Justice Kennedy’s concurring opinion provides the controlling
rule. See Kuhne v. Commonwealth, 733 S.E.2d 667, 673 (Va. Ct. App.
2012) (“The Seibert plurality would review all two-step interrogations
under a multi-factor test . . . . Justice Kennedy’s opinion would apply a
form of heightened scrutiny only to those two-step cases in which law
enforcement officers deliberately employed a two-step procedure designed
67
to weaken Miranda’s protections.”). A majority of federal Circuit Courts
of Appeals have adopted Justice Kennedy’s standard, and so have several
state courts. See generally id. at 672 & nn. 5–6 (collecting cases); see
also State v. Nightingale, 58 A.3d 1057, 1066–67 (Me. 2012); State v.
Fleurie, 968 A.2d 326, 332–33 (Vt. 2008).
I would not expressly adopt either standard in this case because I
conclude the officers violated both. See United States v. Aguilar, 384
F.3d 520, 525 (8th Cir. 2004) (finding a Miranda violation under both the
Seibert plurality opinion and Justice Kennedy’s concurring opinion in the
same case); see also United States v. Pacheco-Lopez, 531 F.3d 420, 427
n.11 (6th Cir. 2008) (same). The officers’ strategy and technique in this
case clearly exemplify the use of a “question-first tactic” that subverts
Miranda’s rationale, see Seibert, 542 U.S. at 617, 124 S. Ct. at 2613, 159
L. Ed. 2d at 658, and epitomizes a “deliberate two-step strategy,” id. at
622, 124 S. Ct. at 2616, 159 L. Ed. 2d at 661 (Kennedy, J., concurring in
the judgment).
This case involves two successive interrogations: one beginning in
the police car and continuing at the police station, and another at the
hospital. Tyler received Miranda warnings toward the end of the three-
hour police station interrogation only after she made incriminating
statements regarding Baby Tyler’s death. After receiving Miranda
warnings at the police station, Tyler did not repeat her incriminating
statements anew, but simply answered “Yes” as the officers confirmed
what she had previously said. 16 She also received additional Miranda
16The transcript of the police station interview in the record fills sixty-eight
pages. Miranda warnings precede only the final six pages, which span the final sixteen
minutes of the three-hour interrogation. During that time, Tyler overwhelmingly
provided one-word answers, likely because the officers asked almost exclusively yes-or-
no questions—for example, “You gave birth at approximately 12:00 p.m., okay?”; “[Y]ou
said you filled up the bathtub with approximately two to three inches of water?”; and
68
warnings at the hospital the next day where she repeated her
incriminating statements.
I. Custody Principles.
As a threshold matter, Tyler brings claims under both the Federal
and State Constitutions. Because I conclude Seibert is dispositive, I
would not reach the question whether the Iowa Constitution provides
different standards. Cf. State v. Kooima, 833 N.W.2d 202, 212 (Iowa
2013) (“We do not decide this case under the Iowa Constitution because
we resolve this issue based upon the Fourth Amendment of the United
States Constitution.”).
Custody for Miranda purposes is ordinarily an objective test that
considers the totality of the circumstances. Stansbury v. California, 511
U.S. 318, 323, 114 S. Ct. 1526, 1529, 128 L. Ed. 2d 293, 298 (1994) (per
curiam). “[T]he ultimate inquiry is . . . whether there is a ‘formal arrest
or restraint on freedom of movement’ of the degree associated with a
formal arrest.” California v. Beheler, 463 U.S 1121, 1125, 103 S. Ct.
3517, 3520, 77 L. Ed. 2d 1275, 1279 (1983) (per curiam) (quoting Oregon
v. Mathiason, 429 U.S. 492, 495, 97 S. Ct. 711, 714, 50 L. Ed. 2d 714,
719 (1977) (per curiam)). When making this inquiry, courts must keep
in mind the purpose of the Miranda rule: to protect individuals from
coerced or involuntary self-incrimination. See Seibert, 542 U.S. at 608,
124 S. Ct. at 2608, 159 L. Ed. 2d at 652–53 (plurality opinion); Berkemer
v. McCarty, 468 U.S. 420, 433, 104 S. Ct. 3138, 3146–47, 82 L. Ed. 2d
317, 330 (1984).
_________________________________
“[Y]ou brought the baby out of the tub and placed him in a trash can, correct?” In the
few instances in which the officers did not ask a yes-or-no question, Tyler still answered
very briefly. For example, to answer a question about where she gave birth, Tyler used
just five words: “I was in the bathroom.”
69
Our cases generally examine four factors in determining whether a
suspect is in custody:
“(1) the language used to summon the individual;
(2) the purpose, place, and manner of interrogation;
(3) the extent to which the defendant is confronted with
evidence of her guilt; and
(4) whether the defendant is free to leave the place of
questioning.”
State v. Bogan, 774 N.W.2d 676, 680 (Iowa 2009) (quoting State v.
Miranda, 672 N.W.2d 753, 759 (Iowa 2003)). These factors, however, are
not exclusive, and no one fact or factor is determinative. State v. Smith,
546 N.W.2d 916, 922 (Iowa 1996) (en banc).
II. Applying Custody Principles to This Case.
Recognizing their primary purpose was to obtain admissions of
criminal conduct from the only suspect in their investigation, and
understanding the circumstances surrounding the transaction had
characteristics of interrogation raising Miranda implications, the officers
told Tyler she was free to leave soon after she arrived at the police station
and as the questioning began. They told Tyler she was free to leave
because they knew a suspect’s freedom to leave the interrogation room is
a relevant factor in determining whether that suspect is in custody. See
Bogan, 774 N.W.2d at 680; State v. Ortiz, 766 N.W.2d 244, 251–52 (Iowa
2009); accord United States v. Griffin, 922 F.2d 1343, 1349 (8th Cir.
1990). But telling Tyler she was free to leave “is not ‘talismanic’ or
sufficient in and of itself to show a lack of custody.” United States v.
Hargrove, 625 F.3d 170, 180 (4th Cir. 2010). Actions speak louder than
words in this context, and several other factors convince me that Tyler
was in custody from the time the officers took her from her residence and
70
should have received Miranda warnings before the questioning began.
See People v. Minjarez, 81 P.3d 348, 357 (Colo. 2003) (en banc) (declining
to credit officers’ assurances the defendant was free to leave “when all
external circumstances appear[ed] to the contrary”); Buck v. State, 956
A.2d 884, 908 (Md. Ct. Spec. App. 2008) (finding custody despite “what
the detectives said about . . . not being under arrest and being free to
leave,” in part because the detectives used “catchphrases” in an effort “to
create an interrogation that could be labeled non-custodial”); see also 2
Wayne R. LaFave et al., Criminal Procedure § 6.6(d), at 737 n.57 (3d ed.
2007 & Supp. 2014) [hereinafter LaFave] (noting an assurance the
suspect is free to leave “will not carry the day where it is, in effect,
nullified by other police conduct”).
First, Tyler did not voluntarily contact the police to offer a
statement. See Griffin, 922 F.2d at 1351 (“[W]hen the confrontation
between the suspect and the criminal justice system is instigated at the
direction of law enforcement authorities, rather than the suspect,
custody is more likely to exist.”).
Second, the words the three officers used when they arrived at
Tyler’s residence did not constitute a mere invitation for Tyler to come
with them to the police station. Within fifteen seconds of Tyler opening
the door, one officer told Tyler, “What we’re going to do . . . I want to have
you go with . . . this guy right here. OK. We need to get to the bottom of
what’s going on. OK.” The officers discussed waking Cyphers, asking,
“He knows what’s going on?” Tyler responded that he did not. One
officer stated, “May I ask you why not?” Tyler gave an inaudible
response and the officer stated, “There’s no way around this right now,
he’s going to know.” Another officer stated, “We need to talk to him” and
“We might as well get this over with.” Thereafter, the officer told Tyler,
71
“why don’t you ride with Mike,” another officer. A DCI agent then
directed Tyler to a police vehicle.
“If the so-called ‘invitation’ involves the person going to the station
in the company of the police, then a finding of custody is much more
likely.” 2 LaFave § 6.6(d), at 735. Here, the words spoken at Tyler’s
residence communicated the notion that the officers insisted upon
speaking with her at the police station about Baby Tyler. See Bogan, 774
N.W.2d at 680 (noting we consider “the language used to summon the
individual” when determining whether a suspect was in custody); Ortiz,
766 N.W.2d at 251–52 (same); State v. Werner, 9 S.W.3d 590, 596 (Mo.
2000) (en banc) (finding custody when a detective “requested” that a
suspect accompany him to the police station and did not tell the suspect
he could refuse to do so).
Third, the questions posed to Tyler during the car ride to the police
station and soon thereafter at the police station lasted more than three
hours. While the duration of three hours certainly is not dispositive on
the question whether Tyler was in custody, it is nonetheless a relevant
consideration. See United States v. Wright, 777 F.3d 769, 775 (5th Cir.
2015) (noting length of questioning is an important factor); Bogan, 774
N.W.2d at 680 (noting we consider “the purpose, place, and manner of
interrogation” (emphasis added)); see also Aguilar, 384 F.3d at 527
(suppressing a confession in part because the “questioning was not
brief”); Payne v. State, 854 N.E.2d 7, 15 (Ind. Ct. App. 2006) (finding a
Seibert violation when pre-Miranda questioning lasted seven hours).
Fourth, the officers took numerous lengthy breaks during the
questioning at the police station and, after each of them, refocused their
questions or asked specific follow-up questions about Baby Tyler’s death.
They did not accept Tyler’s explanation that Baby Tyler was stillborn.
72
These breaks in the action and accusatory follow-up questions were
obviously in furtherance of the officers’ strategy for eliciting admissions
establishing Tyler’s guilt on each of the elements of a first-degree murder
charge prior to giving the Miranda warnings. See Bogan, 774 N.W.2d at
680 (noting we consider the extent to which a suspect is confronted with
evidence of guilt).
To be sure, the lengthy prewarnings session at the police station
cannot reasonably be characterized as merely gathering nonsubstantive
background facts. Compare State v. Lewis, 326 P.3d 387, 398 (Kan.
2014) (finding no Seibert violation because “[t]he pre-warning interview
lasted only 10 minutes with nothing of substance revealed”), and State v.
Juranek, 844 N.W.2d 791, 803–04 (Neb. 2014) (finding no Seibert
violation when the prewarnings questions “did not touch upon key points
in the investigation”), with Payne, 854 N.E.2d at 15 (finding a Seibert
violation because police “waited to advise [the defendant] of her Miranda
warnings until she essentially had divulged her entire involvement”).
Notably, it was not until after Tyler stated she placed Baby Tyler face
down in a bathtub containing water that Agent Roehrkasse left the room
and returned with a written Miranda waiver form. 17 He then thoroughly
reviewed with Tyler each of the Miranda warnings before eliciting with
leading questions all of the details of Tyler’s confession that had
previously been methodically extracted from her.
17Tyler had previously revealed that Baby Tyler cried briefly after he was born. I
find it significant that the officer did not stop posing questions and administer the
Miranda warnings at that point. Instead, the officer forged ahead with the interrogation
and didn’t stop until Tyler had admitted she had placed the baby face down in water in
the bathtub. See Seibert, 542 U.S. at 616, 124 S. Ct. at 2612, 159 L. Ed. 2d at 657
(“When the police were finished there was little, if anything, of incriminating potential
left unsaid.”).
73
Further, although Tyler was not informed of her arrest on the
murder charge before she was taken from the police station to the
hospital for medical attention, the record reveals a law enforcement
officer was posted outside her hospital room while she was there. See
Griffin, 922 F.3d at 1355 (concluding when a suspect was arrested at the
end of an interview, the arrest was objective evidence weighing in favor of
custody “from the inception of the encounter”); Buck, 956 A.2d at 908
(finding custody even though officers repeatedly told the defendant he
was free to leave and did not formally arrest him until after they drove
him back home). On these facts, I would conclude Tyler was not free to
leave the police station and therefore was in custody.
My conclusion that Tyler was in custody at all times en route to
the police station and during the three hours of interrogation conducted
after they arrived there is strongly influenced by the circumstances
surrounding her physical and mental health. The officers knew from the
outset of the questioning that Tyler had given birth at a hotel without
medical assistance—indeed, without assistance from anyone—during the
previous forty-eight hours. Although Tyler denied a need for medical
assistance when the officers inquired, the officers either knew or
certainly should have known that she had received no medical care
during or after the delivery, and she therefore needed it promptly. There
was clearly no urgent need for the interrogation to occur before a
physical examination and postnatal medical treatment. Yet, the agents
decided to interrogate Tyler as a suspect in a crime first, knowing that
she had gone through a very traumatic event the night before.
III. The Seibert Standard.
Because I conclude Tyler was in custody during the entire time she
was en route to the police station and during the interrogations
74
conducted there and at the hospital, I would apply Seibert. In Seibert,
the Supreme Court’s plurality opinion set forth a number
of relevant facts that bear on whether Miranda warnings
delivered midstream could be effective enough to accomplish
their object: the completeness and detail of the questions
and answers in the first round of interrogation, the
overlapping content of the two statements, the timing and
setting of the first and second, the continuity of police
personnel, and the degree to which the interrogator’s
questions treated the second round as continuous with the
first.
Seibert, 542 U.S. at 615, 124 S. Ct. at 2612, 159 L. Ed. 2d at 657. The
police interrogation in this case meets each of those factors. The first
round of interrogation was extremely detailed and complete and, as I
have noted, the officers did not stop to administer Miranda warnings at
the first sign Tyler might be culpable—her admission that Baby Tyler
cried. The two statements fully overlap; indeed, the officers simply
repeated Tyler’s statements back to her and asked for an
acknowledgement that they were correct. As in Seibert, “[t]he warned
phase of questioning proceeded after a pause of only 15 to 20 minutes, in
the same place as the unwarned segment.” Id. The same officers
conducted both interrogations. Finally, the officers expressly referred to
previous statements using phrases such as “you told me” and “you said.”
With every one of these factors satisfied, just as in Seibert, this
interrogation “by any objective measure reveal[s] a police strategy . . . to
undermine the Miranda warnings.” Id. at 616, 124 S. Ct. at 2612, 159 L.
Ed. 2d at 657.
Additionally, the officers took no curative measures once they
finally administered warnings. See Seibert, 542 U.S. at 622, 124 S. Ct.
at 2616, 159 L. Ed. 2d at 661 (Kennedy, J., concurring in the judgment)
(“If the deliberate two-step strategy has been used, postwarning
75
statements that are related to the substance of prewarning statements
must be excluded unless curative measures are taken before the
postwarning statement is made.”). Only fifteen minutes passed between
the prewarning statements and the first Miranda warning at the police
station, leaving Tyler insufficient time “to distinguish the two contexts
and appreciate that the interrogation ha[d] taken a new turn.” See id.;
see also Aguilar, 384 F.3d at 525 (suppressing a confession when the
“two interrogations were not separated in time, occurred in the same
interrogation room, and the same officers participated in the
questioning”). Compare Vasquez v. State, 453 S.W.3d 555, 574–75 (Tex.
App. 2015) (concluding officers did not undertake curative measures
when they provided Miranda warnings after just a short bathroom
break), with United States v. Courtney, 463 F.3d 333, 339 (5th Cir. 2006)
(concluding a properly Mirandized confession made “more than one year”
after an unwarned confession need not be suppressed).
Further, the officers interrogating Tyler did not augment the
Miranda warning with an additional disclosure that her previous
unwarned statements might be inadmissible against her. See Seibert,
542 U.S. at 622, 124 S. Ct. at 2616, 159 L. Ed. 2d at 661. Instead, after
administering the Miranda warnings at the police station and at the
hospital, the officers expressly brought to Tyler’s attention and actively
used the inculpatory statements she had made before the warnings. See
Martinez v. State, 272 S.W.3d 615, 626–27 (Tex. Crim. App. 2008)
(including abstention from reference to the prior statement among a list
of nonexhaustive curative measures gleaned from the Seibert plurality
and concurring opinions). Thus, no matter which opinion sets forth the
controlling Seibert rule, the officers violated it and Tyler’s statements
should be suppressed.
76
IV. Voluntariness.
After watching the video of the police station interrogation in this
case, I find Tyler’s physical condition and her emotional state
substantially augment the factors mentioned above in creating a
custodial environment during all of the questioning. The video
establishes beyond dispute that Tyler’s depleted physical condition was
accompanied and aggravated by utter emotional despondency.
Notwithstanding her obvious physical and extreme emotional
vulnerability, however, the officers forged ahead with more than three
hours of interrogation. They stopped and took her to the hospital, where
she underwent surgery and was treated for blood loss, 18 only after they
were confident they had secured admissions supporting the essential
elements of first-degree murder. Thus, under the circumstances
presented here, I am persuaded that, apart from the Seibert issue, Tyler’s
depleted physical and emotional state rendered all of her statements to
the officers involuntary. See State v. Alspach, 524 N.W.2d 665, 667
(Iowa 1994) (“A contention that a defendant’s statements were taken in
violation of his [or her] Miranda rights and a contention that the
statements were not voluntary are separate issues.”).
In determining whether statements are voluntary, we consider
“[m]any factors,” including “the defendant’s physical and emotional
condition.” State v. Hodges, 326 N.W.2d 345, 348 (Iowa 1982). In this
case, Tyler’s depleted physical condition and despondent emotional
condition carry significant weight. Several cases from other courts
confirm that a highly vulnerable defendant’s statements are more likely
18Tyler’s repeated denials when asked at her residence and again at the police
station whether she needed medical attention informs and confirms my overall
assessment of how poorly she was functioning physically and emotionally during the
interrogation.
77
to be involuntary, and I find them instructive here. See, e.g., Effland v.
People, 240 P.3d 868, 878 (Colo. 2010) (en banc) (concluding statements
were involuntary when the defendant was suffering from extreme
depression and had recently attempted suicide, and the “officers were
fully aware of [his] mental condition and the failed suicide attempt at the
time of the interrogation”); People v. Humphrey, 132 P.3d 352, 362–63
(Colo. 2006) (affirming a trial court’s determination that a detective’s
interrogation was coercive “given [the defendant]’s weak and vulnerable
state”); State v. Marshall, 642 N.W.2d 48, 55–56 (Minn. Ct. App. 2002)
(finding statements involuntary in part because the defendant “became
so emotionally upset that she cried . . . and had difficulty breathing” and
officers expressed concern about a need for medical assistance but did
not cease questioning); Xu v. State, 100 S.W.3d 408, 414–15 (Tex. App.
2002) (suppressing statements made after a defendant accused of killing
his wife had been at the police station for hours, “was intermittently
crying and clutching [his wife]’s picture,” and became “so distraught[] it
took almost twenty minutes to calm him down”).
V. The Hospital Interrogation.
Tyler’s confession at the hospital did not cure the infirmity of the
earlier police station confession and, in my view, should also be
suppressed. The same officers conducted the serial interrogations less
than twenty-four hours apart. The substance of the hospital
interrogation reveals the officers’ purpose was to have Tyler again repeat
the inculpatory statements she made before she received the Miranda
warnings. Both officers repeatedly referenced the previous day’s
conversations, asking Tyler if she remembered their names, if she
remembered receiving Miranda warnings the day before, and even
expressly referencing Tyler’s previous statements with phrases such as
78
“At some point I think you said . . . .” Early in Iowa’s history, this court
concluded an invalid first confession rendered a second confession
invalid even though ten months separated them. State v. Chambers, 39
Iowa 179, 183 (1874) (“[B]elieving the first confession admissible, the
strong probability is that [the defendant] concluded a repetition could
make the case no worse, and the last confession was made under the
influence of the preceding one.”). We reversed the defendant’s conviction
despite that long temporal divide between the interrogation sessions. See
id. I would apply the same principle here where the sessions were
separated by less than twenty-four hours.
VI. Conclusion.
The interrogating officer in Seibert candidly admitted a strategy to
“question first, then give the warnings.” Seibert, 542 U.S. at 606, 124 S.
Ct. at 2606, 159 L. Ed. 2d at 651 (plurality opinion). Although the
interrogating officers in this case did not expressly acknowledge an
identical strategy, their failure to do so cannot be dispositive.19 See id. at
616 n.6, 124 S. Ct. at 2612 n.6, 159 L. Ed. 2d at 657 n.6 (recognizing
that officers’ subjective intent to delay Miranda warnings until after
inculpatory statements are made will “rarely be . . . candidly admitted”
and recommending a “focus . . . on facts apart from intent that show the
question-first tactic at work”). If express acknowledgement of such a
strategy were dispositive, Seibert would provide an implausibly narrow
fact-specific rule and officers could avoid the mandate of Miranda
19Notwithstanding the absence of such an explicit admission by the officers in
this case, their strategy of questioning Tyler first and warning her later is unmistakable
on this record. Just prior to transporting Tyler to the police station, the officers are
overheard conferring among themselves about the word choices they would use in
questioning Tyler about whether Baby Tyler was born alive. They decided the
interrogating officer driving Tyler to the station should not ask whether the baby was
born alive, but whether it cried or moved.
79
without consequence as long as they did not admit their strategy.
Rather, I agree with the Supreme Court’s observation that it is
“unrealistic to treat two spates of integrated and proximately conducted
questioning as independent interrogations subject to independent
evaluation simply because Miranda warnings formally punctuate them in
the middle.” Id. at 614, 124 S. Ct. at 2611, 159 L. Ed. 2d at 656.
The same should be said in this case for obvious reasons. If police
can cure Miranda violations by simply taking a break in the interrogation
and giving the required warnings after securing a confession, law
enforcement officers will always be powerfully encouraged to question
first and warn later. As the plurality opinion explained in Seibert, that
kind of strategy actively avoids fulfilling Miranda’s prophylactic objective:
Upon hearing warnings only in the aftermath of interrogation
and just after making a confession, a suspect would hardly
think he had a genuine right to remain silent, let alone
persist in so believing once the police began to lead him over
the same ground again. A more likely reaction on the
suspect’s part would be perplexity about the reason for
discussing rights at that point, bewilderment being an
unpromising frame of mind for knowledgeable decision.
What is worse, telling a suspect that “anything you say can
and will be used against you,” without expressly excepting
the statement just given, could lead to an entirely reasonable
inference that what he has just said will be used, with
subsequent silence being of no avail.
Id. at 613, 124 S. Ct. at 2611, 159 L. Ed. 2d at 655–56 (footnote
omitted). This quotation from Seibert succinctly explains why the
question-first-warn-later approach utilized by the officers in interrogating
Tyler does violence to the Miranda rule and should not be condoned here.
I respectfully dissent in part because I conclude Tyler was in
custody at all times after she was taken from her residence. Her motion
to suppress should have been granted because all of her statements to
the officers in the car, at the police station, and at the hospital were the
80
product of a violation of the Miranda rule and because they were
involuntarily made.
Wiggins and Appel, JJ., join this concurrence in part and dissent
in part.
81
#13–0588, State v. Tyler
APPEL, Justice (concurring in part and dissenting in part).
I concur in the majority’s resolution of the expert opinion issue and
the search and seizure issue. I dissent in the court’s treatment of issues
surrounding the custodial interrogation of Tyler.
By a 4–3 margin, a majority of this court has concluded Tyler was
not in custody during the ride to the police station and during her
interview at the police station. For the reasons expressed by Justice
Hecht, three justices, including myself, reach a different conclusion. A
slight variation in the facts could well have led to a different result.
Whether a person is in custody will turn on the facts of a particular case,
but I trust it clear this court will not tolerate a two-step confession
process in which law enforcement seeks to evade the requirements of
Miranda. 20
In light of its conclusion Tyler was not in custody, the majority
does not reach the question of proper remedy in the event of unlawful
successive interviews. While I agree with Justice Hecht’s application of
Seibert under federal law, I write separately to emphasize that in my
view, when law enforcement improperly engages in a two-step
interrogation to defeat Miranda, the Iowa Constitution requires any
improperly obtained inculpatory statements be suppressed unless the
state meets the “fruit of the poisonous tree” test of Wong Sun v. United
States, 371 U.S. 471, 485–86, 83 S. Ct. 407, 416, 9 L. Ed. 2d 441, 454
(1963).
20I note Tyler did not claim a different test should be utilized for determining
custody under the Iowa Constitution. Cf. State v. Kittredge, 97 A.3d 106, 111 (Me.
2014) (applying ten-factor test and noting the state bears the burden of proof of
showing lack of custody).
82
While the United States Supreme Court in Oregon v. Elstad took a
different approach, I find the dissents in that case much more persuasive
than the majority opinion. Compare 470 U.S. 298, 307–08, 105 S. Ct.
1285, 1292–93, 84 L. Ed. 2d 222, 231 (1985) (majority opinion) (finding
“[i]t is an unwarranted extension of Miranda to hold that a simple failure
to administer the warnings, unaccompanied by any actual coercion or
other circumstances calculated to undermine the suspect’s ability to
exercise his free will, so taints the investigatory process that a
subsequent voluntary and informed waiver is ineffective for some
indeterminate period”), with id. at 335, 105 S. Ct. at 1306–07, 84 L. Ed.
2d at 249 (Brennan, J., dissenting) (“The correct approach . . . is to
presume that an admission or confession obtained in violation of
Miranda taints a subsequent confession unless the prosecution can show
that the taint is so attenuated as to justify admission of the subsequent
confession.”), and id. at 364–72, 105 S. Ct. at 1321–26, 84 L. Ed. 2d at
268–73 (Stevens, J., dissenting). As noted by Justice Brennan in Elstad,
the linkage between the unlawful confession and subsequent post-
Miranda confession will ordinarily be clearly established. Id. at 321–24,
105 S. Ct. at 1299–1301, 84 L. Ed. 2d at 240–42 (Brennan, J.,
dissenting). Further, under Miranda, there is a presumption that the
product of unwarned custodial interrogation is coerced. See id. If so,
Wong Sun provides the proper standard for admission of inculpatory
statements made after unwarned statements. To hold otherwise is to
remove the strength of Miranda and encourage law enforcement to
engage in quasi-custodial interrogations in the hope that a confession
may be extracted without allowing the suspect to have the usual Miranda
warnings.
83
Further, history demonstrates the voluntariness test is
extraordinarily difficult to apply and leads to inconsistent results. See
Dickerson v. United States, 530 U.S. 428, 444, 120 S. Ct. 2326, 2336,
147 L. Ed. 2d 405, 420 (2000) (noting that the totality of the
circumstances test for voluntariness “is more difficult . . . for law
enforcement officers to conform to, and for courts to apply in a
consistent manner”); Louis Michael Seidman, Brown and Miranda, 80
Calif. L. Rev. 673, 729–30 (1992) (describing Justice Frankfurter’s
unsuccessful attempt to put spine into voluntariness). Indeed, that is
one of the reasons why the Miranda rule was adopted in the first place.
While not perfect, I view Miranda as an important protection to help
ensure interrogations are truly voluntary.
My views are consistent with decisions from a number of other
state jurisdictions. For example, in Commonwealth v. Smith, the
Supreme Judicial Court of Massachusetts rejected the Elstad approach.
593 N.E.2d 1288, 1295–96 (Mass. 1992). According to the Smith court, a
statement obtained in violation of Miranda is presumed to be tainted. Id.
at 1295. As stated in Smith:
The presumption of taint was intended to deter law
enforcement officials from circumventing the Miranda
requirements by using the warnings strategically—first
questioning the suspect without benefit of warnings, and
then, having obtained an incriminating response or having
otherwise benefitted from the coercive atmosphere, by giving
the Miranda warnings and questioning the suspect again in
order to obtain an admissible statement.
Id. at 1292. Further, the Smith court found, “This presumption [of taint]
supports one of the purposes of the ‘bright-line’ Miranda rule: to avoid
fact-bound inquiries into the voluntariness of confessions.” Id. at 1295–
96. As a result, the Smith court held the prosecution has the burden of
84
showing a break in the stream of events in order to gain admission of the
subsequent incriminating statements. Id. at 1292, 1295.
Appellate courts in Hawaii, New York, Tennessee, and Vermont
have reached a similar conclusion based on similar reasons. See State v.
Pebria, 938 P.2d 1190, 1196 (Haw. Ct. App. 1997) (rejecting Elstad under
Hawaii Bill of Rights); People v. Bethea, 493 N.E.2d 937, 938–39 (N.Y.
1986) (per curiam) (rejecting Elstad under state constitution); State v.
Smith, 834 S.W.2d 915, 919 (Tenn. 1992) (adopting approach of Justice
Brennan under state constitution); State v. Barron, 16 A.3d 620, 626–27
(Vt. 2011) (endorsing the “fruit of the poisonous tree” analysis under
state constitution).
I agree with the approach of these state authorities. On the record,
I would find there was no “break in the stream of events” sufficient to
allow for the admission of subsequent interrogation under Wong Sun.
See Elstad, 470 U.S. at 326, 345–46, 105 S. Ct. at 1302, 1312, 84 L. Ed.
2d at 243, 255 (Brennan, J., dissenting) (internal quotation marks
omitted).
Wiggins and Hecht, JJ., join this concurrence in part and dissent
in part.
85
#13–0588, State v. Tyler
WATERMAN, Justice (concurring in part and dissenting in part).
I respectfully concur in part IV and dissent from part III of the
majority opinion. The majority correctly concludes the district court
properly denied Tyler’s motion to suppress her confessions that she
drowned her baby in the bathtub. Yet, the majority erroneously
concludes the district court abused its discretion by allowing the medical
examiner to testify as to the cause and manner of death because he
relied on the same voluntary confessions the jury was allowed to hear.
Medical experts testifying in our courts routinely rely on patient
histories. Medical examiners such as Dr. Thompson are no different.
The medical examiner has a statutory duty to investigate and determine
the cause and manner of the suspicious death of a child. Iowa Code
§ 331.802(2)(a) (2015). Why fault Dr. Thompson for considering the
mother’s own incriminating statements as to how she killed her baby?
The majority breaks from long-standing Iowa law liberally allowing
expert testimony, including testimony based on witness statements or
patient histories. The majority acknowledges that “we have been
committed to a liberal view on the admissibility of expert testimony.”
Ranes v. Adams Labs., Inc., 778 N.W.2d 677, 685 (Iowa 2010). Indeed,
Iowa courts have been committed to a liberal standard for over seventy
years. See Grismore v. Consol. Prods. Co., 232 Iowa 328, 343, 5 N.W.2d
646, 655 (1942) (“The modern tendency of the courts everywhere is to
take a more liberal and rational view respecting the admissibility and
scope of [expert] testimony.”); see also Leaf v. Goodyear Tire & Rubber
Co., 590 N.W.2d 525, 530–31 (Iowa 1999) (noting the “expansive scope”
of expert testimony under Iowa R. Evid. 5.702). In my view, we should
continue to trust our adversary system to expose weaknesses in an
86
expert’s opinions and trust our juries to give appropriate weight to expert
testimony in this case and generally. The majority’s opinion will
inevitably lead to the exclusion of a wide variety of expert opinion
testimony based on witness accounts.
The majority opinion rests on a false premise—that Dr. Thompson
based his opinion as to the cause (drowning) and manner (homicide) of
death solely on Tyler’s statements to the police. To the contrary, his
testimony confirms he based his opinions on his autopsy findings, lab
reports, and the physical evidence at the crime scene as well as Tyler’s
confession. Dr. Thompson conducted a thorough physical examination
of the deceased infant and sent organs to three outside specialists for
testing. Through his own investigation, he was able to rule out
congenital defects, substance abuse, infections, and skeletal trauma as
alternate causes of death. He explained what he relied on to determine
the infant’s cause of death was drowning:
Q. Do you have an opinion as to a reasonable degree
of medical certainty regarding the cause of death in this
case? A. Yes, I do.
Q. And what is it? A. The cause of death is drowning.
Q. And what do you base your opinion on? A. My
opinion is based on a combination of history, which includes
scene findings, it includes witness statements; it’s also based
on a combination of physical exam, which is my autopsy
findings; and then supplemental testing.
Q. Supplemental testing, for example, when you sent
certain organs to a specialist to examine; is that correct? A.
Supplemental lab testing would be x-rays, microbiology,
metabolic studies.
Q. Okay. Toxicology? A. Toxicology.
Dr. Thompson also explained how he determined the manner of death
was homicide:
87
Q. What is your opinion based on? A. Just like cause
of death, my manner of death opinion is based on history,
again, scene findings, witness statements; it’s based on a
physical exam, or the autopsy; and then supplemental lab
testing.
Dr. Thompson’s autopsy findings corroborated Tyler’s confession
that her baby was born alive, moved, cried, and took some breaths before
being drowned in bathwater. Dr. Thompson testified that there was fluid
that could be bathwater in the baby’s lungs consistent with drowning.
Secondly, he testified that the expanded alveoli in Baby Tyler’s lungs
indicate the infant was probably born alive:
Q. In this case, is there any evidence that this baby
took a breath? A. There could be, yes.
Q. Explain that, please. A. When I looked under the
microscope, the – there’s a structure in the lungs called
alveoli, which are a grape-like structure. Some of those
structures were expanded, which could be consistent with
Baby Tyler taking a few breaths.
....
Q. Do you have an opinion to a reasonable degree of
medical certainty as to what that [partially expanded alveoli]
indicates to you? A. Given the history that Baby Tyler cried
and moved, to me that suggests that Baby Tyler probably
took a few breaths.
The majority recognizes that “in making these determinations
[about cause and manner of death], medical examiners routinely rely on
the circumstances that surround the death, as revealed by independent
investigation, police investigation, and eyewitness accounts.” (Emphasis
added.) I agree. As Dr. Thompson testified:
Q. In your role as a medical examiner, how do these
witness statements and your knowledge of the scene, how
important is that in determining a diagnosis of manner and
cause of death? A. Uh, it’s vital.
Q. And explain that, please. A. Um, so I’m a
physician first. Um, as I’ve been saying, my diagnosis,
which we call cause of death, is based on history, physical
88
exam, and then supplemental lab testing. Um, if I just did
the physical exam, I would miss a significant number of
cause and manner of death. It would be similar to you going
to your primary care physician, sitting down on his exam
table and just having -- have him start listening to your
lungs, looking in your ears, checking your eyes without him
asking you what’s wrong. I can’t obviously ask my patients
what’s wrong with them, so I have to ask other people what’s
wrong. I have to ask police what’s wrong. Sometimes
witnesses will come forward and say what’s wrong or what
happened. So that part of my diagnosis or cause of death,
the history, is absolutely essential.
....
So in every single case that I do, it’s always history,
physical exam, and lab tests, just like when you go see your
physician.
It is well established that physicians may rely on self-reported
patient histories. See, e.g., Walker v. Soo Line R.R., 208 F.3d 581, 586
(7th Cir. 2000) (“Medical professionals reasonably may be expected to
rely on self-reported patient histories. Such histories provide
information upon which physicians may, and at times must, rely in their
diagnostic work.” (Citation omitted.)). This applies equally to medical
examiners who must determine the cause and manner of death. See
Baraka v. Commonwealth, 194 S.W.3d 313, 315 (Ky. 2006) (“Indeed, the
facts and data in this case, information regarding the circumstances of
the victim’s death provided by investigating officers, is exactly the kind of
information customarily relied upon in the day-to-day decisions
attendant to a medical examiner’s profession.”); Rollins v. State, 897 A.2d
821, 851 (Md. 2006) (“[W]e disagree with [the] contention that [an expert]
relied upon improper information to render her expert opinion. [The
expert’s] consideration of the medical examiner’s file in its entirety was
proper. She testified that a review of all aspects of the file, including the
criminal investigation, was necessary to form her opinion and was the
accepted practice in her field.”), abrogated on other grounds as recognized
89
by Derr v. State, 29 A.3d 533, 549 (Md. 2011); State v. Wilson, 248 P.3d
315, 324–25 (N.M. 2010) (allowing a forensic pathologist to “consider
evidence beyond the medical record” in forming his medical opinion),
overruled on other grounds by State v. Tollardo, 275 P.3d 110, 121 (N.M.
2012); State v. Commander, 721 S.E.2d 413, 420 (S.C. 2011) (“Because
the anecdotal history is an essential component of any autopsy, we find
testimony concerning findings based on this information falls within the
umbrella of the expert’s specialized knowledge.”); State v. Boyer, 741
N.W.2d 749, 757 (S.D. 2007) (“Although [the medical examiner]
considered extrinsic information in reaching his opinion, he further
explained that receiving extrinsic evidence was widely accepted in the
medical field . . . .”); State v. Tucker, 96 P.3d 368, 371 (Utah Ct. App.
2004) (“[The expert] testified that medical examiners regularly rely upon
investigative information when forming their opinions. This practice is
also supported in case law throughout the United States that examines
this issue.”).
These courts agree that medical examiners may rely on disputed
witness testimony, with cross-examination as the proper tool to explore
weaknesses in the opinions. See Walker, 208 F.3d at 586 (“In situations
in which a medical expert has relied upon a patient’s self-reported
history and that history is found to be inaccurate, district courts usually
should allow those inaccuracies in that history to be explored through
cross-examination.”); Baraka, 194 S.W.3d at 315 (“It has been long held
that such underlying factual assumptions are properly left for scrutiny
during cross-examination.”); Rollins, 897 A.2d at 853 (“All experts . . .
were subject to cross-examination about their findings; once the experts’
opinions were admitted, it was within the province of the trier of fact to
determine which expert should be believed.”); Wilson, 248 P.3d at 325
90
(“Defendant was free to persuade the jury that [the expert’s] opinion
relied too much on a questionable confession and not enough on hard
science. The jury remained the ultimate arbiter of [the expert’s]
credibility, and it was free to reject his opinion and conclude that [the
victim’s] death was caused by natural causes.”).
Dr. Thompson was vigorously cross-examined and conceded his
autopsy findings could also be consistent with a stillborn child with
amniotic fluid in the lungs and alveoli expanded by gases released after
death. He acknowledged he was unable to determine the cause and
manner of death until viewing Tyler’s confession. These weaknesses go
to the weight of his opinion testimony, not its admissibility. See Williams
v. Hedican, 561 N.W.2d 817, 823 (Iowa 1997) (“ ‘ “[A]n expert’s lack of
absolute certainty goes to the weight of this testimony, not to its
admissibility.” ’ ” (alteration in original) (quoting State v. Buller, 517
N.W.2d 711, 713 (Iowa 1994))); Hutchison v. Am. Family Mut. Ins. Co.,
514 N.W.2d 882, 888 (Iowa 1994) (“[W]e believe with the aid of vigorous
cross examination, the jury is fully capable of detecting the most
plausible explanation of events.”).
The cases the majority relies on are distinguishable. In People v.
Eberle, an appellate court held the trial court erred by denying the
defendant’s motions to suppress the statements relied on by the medical
examiner. 697 N.Y.S.2d 218, 219–20 (App. Div. 1999). The medical
examiner’s opinion that an infant’s death was “homicidal suffocation”
rather than Sudden Infant Death Syndrome (SIDS) was based on the
statements alone, not any “medical evidence.” Id. at 219. The
statements, obtained in violation of defendant’s right to counsel, were the
fruit of the poisonous tree. Id. at 219–20. The suppression remedy
would be empty if the jury nevertheless heard the inadmissible
91
statements through the medical examiner. By contrast, the majority
correctly holds Tyler’s confessions were properly admitted into evidence.
Dr. Thompson was entitled to rely on the same confessions the jury
heard, in addition to the medical evidence (his autopsy findings) that
corroborated Tyler’s self-incriminating statements to police.
The majority relies on other cases that did not involve a medical
examiner relying on the defendant’s confession. In State v. Vining, the
medical examiner testified that “none” of the physical evidence supported
her opinion that the fatal head injury “was caused at the hands of
another as opposed to an accidental fall.” 645 A.2d 20, 21 n.1 (Me.
1994). Dr. Thompson, however, testified that his opinion was supported
by the physical findings of his autopsy, lab tests, and physical evidence
at the crime scene, as well as Tyler’s confessions, and explained how the
forensic evidence corroborated her history of the drowning death. In
Maxwell v. State, the medical examiner was unable to determine the
cause of death from his autopsy, and his opinion that the manner of
death was homicide “was based entirely upon the circumstances
surrounding Gina Maxwell’s demise as related to him by a detective
working on the case.” 414 S.E.2d 470, 473–74 (Ga. 1992), overruled on
other grounds by Wall v. State, 500 S.E.2d 904, 907 (Ga. 1998). The
medical examiner “admitted that his opinion as to the manner of death
‘[was] based on things the jury could determine themselves.’ ” Id. at 474
(alteration in original). That is not so in this case. The jury needed
expert medical testimony to explain the significance of the fluid found in
the infant’s lungs and the partially expanded alveoli. Nor does State v.
Jamerson help the majority. 708 A.2d 1183 (N.J. 1998). The medical
examiner in that case strayed outside his zone of medical competence by
acting as an accident reconstructionist in determining the defendant
92
drove recklessly. See id. at 1194–95. By contrast, Dr. Thompson simply
did what medical examiners are trained to do.
Other cases cited by the majority conclude the use of the word
“homicide” implies criminal guilt or intent, and prohibit medical
examiners from testifying on that basis. State v. Sosnowicz, 270 P.3d
917, 922 (Ariz. Ct. App. 2012) (“[The expert]’s testimony that the victim
died as the result of a ‘homicide’ went to the key issue in the case: Did
defendant intentionally, knowingly or recklessly cause the victim’s death
by a criminal act or was the victim’s death the result of a non-criminal
accident?”); People v. Perry, 593 N.E.2d 712, 716 (Ill. App. Ct. 1992) (“In
fact, it might be construed as prejudicial, since a layperson might equate
the word homicide with murder.”); Eberle, 697 N.Y.S.2d at 219
(“Moreover, the expert’s statement that the infant died from ‘homicidal’
suffocation improperly states a conclusion regarding defendant’s
intent.”); Bond v. Commonwealth, 311 S.E.2d 769, 771–72 (Va. 1984)
(finding medical examiner impermissibly testified to an ultimate issue of
fact—death by homicide). These cases are inapposite, because
Dr. Thompson testified that “homicide,” as used in his report, is a
neutral medical term:
Q. And in this case, did you form an opinion to a
reasonable degree of medical certainty regarding manner of
death? A. Yes, I did.
Q. And what is your opinion? A. In the manner of
death is homicide.
Q. And what does that mean? Homicide. A.
Homicide is a medical term. It’s a neutral term. It doesn’t
signify right or wrong. It simply means death at the hands of
another individual.
Such explanatory testimony is lacking in the foregoing cases relied upon
by the majority. Tyler does not challenge the jury instructions given in
this case, which correctly set forth the elements of the crimes charged.
93
The district court properly allowed Dr. Thompson to testify regarding the
medical definition of homicide.
The majority inaccurately refers to Tyler’s confessions as
“uncorroborated.” To the contrary, the police investigation and
Dr. Thompson’s medical investigation corroborate key factual statements
in her confessions. During Tyler’s first police interview, she described
giving birth while standing up, which is corroborated by a bruise noted
in the autopsy on Baby Tyler’s forehead where he hit the floor of the
bathroom. The police found key physical evidence—the placenta and the
scissors used to cut the exposed umbilical cord—exactly where Tyler said
she put them. Most importantly, Dr. Thompson’s autopsy findings of
fluid in the infant’s lungs and expanded alveoli corroborate her
description of how she filled the tub with water and placed Baby Tyler,
born alive, face down in the bathwater to drown. Dr. Thompson’s
medical evaluation of Baby Tyler corroborated Tyler’s confession. See
State v. Polly, 657 N.W.2d 462, 467 (Iowa 2003) (“ ‘Corroboration need
not be strong nor need it go to the whole case so long as it confirms some
material fact connecting the defendant with the crime.’ ” (quoting State v.
Liggins, 524 N.W.2d 181, 187 (Iowa 1994))).
Dr. Thompson did not merely parrot Tyler’s confession to the jury;
he considered her account in the context of his medical conclusions from
the autopsy and lab tests. Dr. Thompson admittedly could not
determine the cause and manner of death without Tyler’s confession.
That does not mean his opinion rests on her confession alone. As
medical examiners routinely do, he relied on his autopsy findings, lab
test results, and physical evidence as well as the history provided by the
only person present at the time of the baby’s death. I would not exclude
94
testimony of medical witnesses because they necessarily rely on the
history provided by family members present at the time of death.
I disagree with the majority’s conclusion that “Dr. Thompson’s
opinions were inadmissible because they amounted to an impermissible
comment on Tyler’s credibility.” The majority relies on State v. Dudley in
which we concluded the prosecution’s expert improperly vouched for the
credibility of the child sex-abuse victim, not the defendant. 856 N.W.2d
668, 676–77 (Iowa 2014). Such precedent is inapplicable to expert
testimony relying in part on an adult defendant’s voluntary confession to
establish the factual cause and manner of death. None of our court’s
precedent that culminated in Dudley involved a defendant arguing the
State’s expert improperly vouched for the defendant’s credibility. Tyler,
who did not testify at trial, is complaining Dr. Thompson “vouched for”
what Tyler herself told police. This is a far cry from Dudley, which
involved a “he-said, she-said” swearing contest that turned on whether
the jury believed Dudley (who denied abusing the victim), or the child
victim (who said Dudley abused her). The State could gain an unfair
advantage through expert testimony introduced to bolster the credibility
of a victim testifying against the defendant. See id. That concern is not
implicated when an expert relies on the defendant’s own words as to
what happened. 21
Significantly, Dr. Thompson never commented on Tyler’s
credibility, state of mind, or guilt in the presence of the jury. He gave no
opinion as to her motive or intent. He simply relied, in part, on her
21Itis true Tyler initially denied her baby was born alive before confessing, twice,
that it moved and cried and she drowned the infant in the bathwater. Yet, as the
majority and district court correctly found, Tyler’s confessions were voluntary. Why
would she make up the story? There is no evidence Tyler was coerced or duped into
confessing through a promise of leniency. Why preclude a medical expert from relying
on confessions deemed reliable enough for the jury to hear?
95
confessions for determining the physical cause and manner of death. As
the majority recognizes, the term “homicide” as used by medical
examiners such as Dr. Thompson “expresses no opinion as to the
criminality of the killing or the culpability of the killer.” A medical
examiner testifying that the manner of death is homicide is rendering a
neutral medical opinion, one required by statute. See Iowa Code
§ 331.802(2)(a) (“[T]he county medical examiner shall conduct a
preliminary investigation of the cause and manner of death, prepare a
written report of the findings, . . . and submit a copy of the report to the
county attorney.”). For a killing to be a crime, the requisite intent must
be present. See id. §§ 707.1–.5. Intent, and therefore guilt or innocence,
is for the jury to determine.
Most courts agree the expert medical examiner only crosses the
line by testifying to the intent or guilt of the defendant. See Commander,
721 S.E.2d at 420 (“Of the many courts in other jurisdictions that have
considered where to draw the line in these cases, we tend to agree with
those courts that have found that expert testimony addressing the state
of mind or guilt of the accused is inadmissible.”). Dr. Thompson did not
cross this line. See id.; Willis v. State, 558 S.E.2d 393, 395 (Ga. 2002)
(“Because this testimony did not improperly invade the province of the
jury on the ultimate issue of whether the death was an intentional killing
or an accident, the trial court did not err . . . .”); Baraka, 194 S.W.3d at
318 (“Accordingly, most jurisdictions . . . hold that a qualified expert can
express an opinion that the manner of a disputed death was
homicide, . . . though not that the homicide was intentional, wanton,
reckless, or accidental, which would constitute an opinion as to the guilt
or innocence of the defendant.”); Rollins, 897 A.2d at 851–52 (discussing
how all expert testimony is designed to bolster one view of the facts,
96
which does not invade the province of the jury); State v. Dao Xiong, 829
N.W.2d 391, 397 (Minn. 2013) (“Here, the district court properly
admitted [the expert’s] testimony that the manner of [the victim’s] death
was homicide. . . . [I]t did not constitute improper expert testimony
regarding [the defendant’s] intent. [The expert’s] testimony assisted the
jury’s understanding of the medical evidence offered at trial by explaining
that the autopsy results were consistent with homicide. . . . [The
expert’s] testimony as to [the victim’s] manner of death was based on [the
expert’s] examination of [the victim’s] body.”); State v. Bradford, 618
N.W.2d 782, 793 (Minn. 2000) (holding an examiner could testify to
homicide as a manner of death, but not offer an opinion regarding
intent); Boyer, 741 N.W.2d at 758 (“We finally note that neither expert
usurped the function of the jury by testifying that [the victim] actually
died as a result of being shaken or thrown down. Nor did the experts
opine whether they thought [the defendant] was guilty.”); Tucker, 96 P.3d
at 371 (“In light of [the expert’s] testimony that intent was not a factor in
classifying [the victim’s] death, and that intent is a question for the jury,
we see no error in the trial court’s rulings.”); State v. Richardson, 603
A.2d 378, 379 (Vt. 1992) (“The testimony [that the manner of death was
homicide] was not a comment on defendant’s guilt or innocence.”); State
v. Scott, 522 S.E.2d 626, 632 (W. Va. 1999) (“Because the term ‘homicide’
is neutral and pronounces no judgment, we do not find that [the expert]
testifying that [the victim’s] manner of death was homicide removed any
defense available to [the defendant]. In fact, [the expert] testified that his
opinion was not a legal conclusion—that he was neither trained nor
qualified to render a legal conclusion concerning [the victim’s] death.”). I
would follow these well-reasoned decisions. Medical examiners should
be allowed to rely on witness accounts, including a defendant’s
97
confession, in testifying the manner of death was homicide so long as
they do not testify that the defendant is “guilty” or has criminal intent.
I fear today’s majority opinion will have unintended consequences.
Going forward, will an accident reconstructionist be allowed to give
opinions based on witness statements? May a forensic accountant rely
on a defendant’s confession to embezzlement or consider deposition
testimony to determine a spouse dissipated marital assets? May a
human-factors expert rely on disputed testimony as to how an accident
happened when opining on the efficacy of a warning or safety of a
product design? May a hydrologist rely on disputed testimony or a
party’s admissions to determine the source of groundwater
contamination? May medical witnesses continue to rely on patient
histories? After today’s decision, it appears such testimony could be
excluded from evidence any time the expert admits his opinion depends
on the witness’s account of what happened. This is an unwarranted and
ill-advised sea change in our heretofore liberal approach to the
admissibility of expert testimony.
We have routinely allowed expert testimony based on witness
testimony or statements. Is the expert thereby indirectly vouching that
the witness is telling the truth? Do these cases remain good law? See,
e.g., In re Det. of Stenzel, 827 N.W.2d 690, 702 (Iowa 2013) (concluding
expert testimony based on an interview with defendant and defendant’s
criminal history was sufficient to show that defendant had “a mental
abnormality and had serious difficulty controlling his behavior”); Leaf,
590 N.W.2d at 530 (affirming admissibility of expert’s opinion on product
defect that depended on plaintiff’s recollection of events); Olson v.
Nieman’s, Ltd., 579 N.W.2d 299, 308 (Iowa 1998) (discussing how expert
considered statements of a third party when determining if an invention
98
meets the nonobvious requirement of a patent); Johnson v. Knoxville
Cmty. Sch. Dist., 570 N.W.2d 633, 639–40 (Iowa 1997) (discussing how
expert relied on a two-hour interview, case documentation, and a family
member’s journal detailing plaintiff’s symptoms to support opinion that
plaintiff suffered from obsessive compulsive disorder); State ex rel. Leas
in re O’Neal, 303 N.W.2d 414, 417 (Iowa 1981) (permitting clinical
psychologist acting as an expert witness to use psychological testing and
interviews to determine that parents were psychologically unfit to care for
a child). 22 These are just a few of the cases that could have gone the
other way, had the majority’s opinion been the rule of law when they
were decided.
Finally, I note the State failed to argue on appeal that any error in
the admission of Dr. Thompson’s testimony was harmless. The court of
appeals concluded the error was not harmless. Given Tyler’s confession,
I am not so sure. Several decisions cited by the majority held it was
harmless or nonprejudicial error to allow a medical examiner to testify
that the death was a homicide. Sosnowicz, 270 P.3d at 925–26; Perry,
593 N.E.2d at 717. The dissent in Dudley concluded that the admission
of the expert testimony in that case was harmless. 856 N.W.2d at 684–
85 (Cady, C.J., dissenting). I would trust our juries to give the expert
testimony proper weight. But, because the State failed to argue harmless
22Decisions of the court of appeals would likewise be called into question by the
majority’s decision. See, e.g., State v. Gilmore, No. 11–0858, 2012 WL 3589810, at *5–6
(Iowa Ct. App. Aug. 22, 2012) (allowing psychologist to consider defendant’s interview to
determine that defendant could form the specific intent to kill); State v. Favara, No. 02–
1311, 2003 WL 21920959, at *1–2 (Iowa Ct. App. Aug. 13, 2003) (allowing sheriff’s
deputy to testify as an expert witness as to how he believed a burglary took place after
he “investigated the crime scene, photographed and weighed the items, and conducted
interviews”); In re Det. of Rafferty, No. 01-0397, 2002 WL 31113930, at *1 (Iowa Ct. App.
Sept. 25, 2002) (concluding that expert could base his opinion that a person is a
sexually violent predator and likely to reoffend on a clinical interview, official records,
and actuarial assessment tools).
99
error in its appellate brief or application for further review, the majority
could properly find it waived that issue. See Iowa R. App. P.
6.903(2)(g)(3) (“Failure to cite authority in support of an issue may be
deemed waiver of that issue.”).
The district court, relying on our traditional liberal approach to the
admissibility of expert testimony, correctly denied Tyler’s motion to
suppress Dr. Thompson’s testimony and autopsy report stating the cause
and manner of Baby Tyler’s death. The district court properly equated
Dr. Thompson’s reliance on Tyler’s confessions to “a physician relying on
a patient’s history in reaching a diagnosis.” I would affirm Tyler’s
conviction.
Cady, C.J., and Mansfield, J., join this concurrence in part and
dissent in part.