State v. Sanchez-Alfonso, 293 P.3d 1011

C child sustained multiple injuries including a skull fracture; defendant admitted forehead injury but claimed it was accidental or aunt-caused; CARES Northwest physician Skinner diagnosed C as physically abused and that defendant caused injuries; Court of Appeals held the abuse diagnosis could be scientifically valid but not its attribution to defendant; Oregon Supreme Court reversed and remanded, holding Skinner's perpetrator conclusion not admissible under OEC 702/403 and that its admission was not harmless as to certain convictions; trial court admitted Skinner's diagnosis over defense objections; the case involved charges including second- and third-degree assault and criminal mistreatment.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether Skinner's conclusion that defendant caused the injuries is admissible	Skinner's diagnosis is a medical conclusion admissible under OEC 702	Conclusion to identify perpetrator lacks scientific basis under Brown/O'Key/Southard	Not admissible under OEC 702; reversible error
Whether admission of Skinner's perpetrator conclusion was harmless	Error affected the verdict given it addressed key disputed issue	Error was harmless as jury could rely on other evidence	Not harmless as to second-degree assault and not harmless for first-degree mistreatment and third-degree assault; remand warranted
Whether Skinner's diagnosis of abuse, separate from perpetrator identity, satisfies Southard/702 criteria	Diagnosis considered clinically valid and helpful to jury	Diagnosis failed to meet standard validity and methodology	Skinner's broader abuse diagnosis did not satisfy admissibility under 702; not relied upon
Effect of ruling on remaining convictions	Diagnosis influenced multiple counts tied to injury causation	Some counts not dependent on perpetrator identity	Remand for proceedings; reversal of convictions warranted

State v. Brown, 297 Or 404 (1984) (tests for admissibility of expert medical opinions under 702)
State v. O'Key, 321 Or 285 (1995) (Brown-O'Key framework for admissibility; 702 factors)
State v. Southard, 347 Or 127 (2009) (assessing child-abuse diagnosis under 702, 401, 403; risk of prejudice)
Marcum v. Adventist Health System/West, 345 Or 237 (2008) (differential diagnosis admissibility; need for basis and explanation)
State v. Davis, 351 Or 35 (2011) (harmless-error framework for evidentiary errors)
State v. Willis, 348 Or 566 (2010) (scientific report admissibility; importance of core proof)