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Eleventh Circuit tightens Rule 803(4) purpose requirement in recent case

2/6/26

By: Robert Scavone Jr.

In United States v. Keegan (Dec. 17, 2025), the Eleventh Circuit addressed a defense attempt to use Federal Rule of Evidence 803(4)—the hearsay exception for statements “made for—and … reasonably pertinent to—medical diagnosis or treatment”—to introduce a defendant’s abuse allegations through an expert witness rather than through the defendant’s own testimony.

Keegan’s duress theory depended on claims that her husband abused her, but she sought to present those allegations via a psychologist so she could “get her story out without also getting on the stand.” The district court excluded the abuse narrative as hearsay (while allowing the expert to rely on it as a basis under Rule 703), and the Eleventh Circuit affirmed.

The panel’s analysis is explicitly textual. It begins with the “plain text” of Rule 803(4) and focuses on the word “for,” explaining that it “connotes intent” and denotes “the object, aim, or purpose” of an action. On the court’s reading, Rule 803(4) creates a tight link between purpose (“for”) and end (“medical diagnosis or treatment”), preventing litigants from converting medical experts into conduits for otherwise inadmissible hearsay—an “end-run” around cross-examination that the hearsay rules are designed to prevent. The court also ties that textual reading to the traditional rationale for the exception: statements made to obtain treatment are thought reliable because a patient has a “selfish treatment motivation” to be accurate.

Applying that framework, the court found no clear error in the district court’s determination that Keegan’s abuse statements were not made for diagnosis or treatment but to prepare trial testimony. The district court found her “purpose . . . was to prepare the witness to testify to a jury” and to feed the expert “her story” so the expert could repeat it to the jury.

Several case-specific facts supported that conclusion: Keegan sought the expert “principally in anticipation of litigation”; her lawyer asked the expert to evaluate impacts “as they relate to her current legal charges”; the psychologist had not done clinical work in about a decade; and Keegan already had the same diagnosis in earlier medical records that did not include her abuse allegations.

The panel distilled the point in a line that will likely be quoted in future briefing: “It is not enough that Keegan asked for a medical diagnosis and got one”—the diagnosis must be the “object, aim, or purpose” of the statements.

A concurrence by Judge Newsom underscores the interpretive theme: even if Keegan’s reading is “linguistically plausible,” “proper textualism” is not “wooden literalism”; context matters because it shapes how real-world readers understand the phrase “statement … made for … medical diagnosis” within a body of hearsay rules built around reliability.

Keegan is a cautionary decision. When opposing “medical hearsay,” press the “for” requirement, highlight litigation-driven circumstances, and emphasize the cross-examination concerns the panel called the “heart” of the hearsay rules.

For more information, please contact Robert Scavone Jr.at robert.scavone@fmglaw.com or your local FMG attorney.

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