OPINION
Aрpellant Anthony Phillip Scacchetti was convicted of first-degree criminal sexual conduct, malicious punishment of a child, and third-degree assault against his girlfriend’s three-and-one-half-year-old daughter, R.J. At trial, the court determined that the child victim was incompetent to testify and, as a result, the state was allowed to introduce into evidence statements the victim made during medical assessments conducted by a pediatric nurse practitioner for Midwest Children’s Resource Center (MCRC). Scacchetti appealed his conviction, and the court of appeals affirmed. On appeal to this court, we remanded to the court of appeals for a determination of whether the statements the victim made to the pediatric nurse practitioner during the assessments werе admissible under
Crawford v. Washington,
In May 2002, Scacchetti began living with his girlfriend, K.J., and her daughter, R.J. Before Scacchetti moved in, K.J.’s mother or K.J.’s ex-boyfriend cared for R.J. while K.J. was at work. After Scac-chetti had lived with K. J. for a few weeks, Scacchetti began caring for R.J. while K.J. was working.
Soon thereafter, K.J. started noticing physical changes in R.J. On one occasion, R.J. told K.J. that Scacchetti had spanked her with a belt, which Scacchetti admitted doing. Shortly after that, K.J. noticed R.J. had marks on her face, which Scac-chetti claimed were from R.J. falling down the stairs. R.J. could not explain how the injuries occurred. During May and June of 2002, K.J. noticed that R.J. had become clingy to her and distant toward Scacchet-ti. In fact, R.J. began to tell K.J. she did not want to be left alone with Scacchetti.
*511 On June 24, 2002, K.J. returned from work to find that R.J.’s body had multiple bruises and burn marks. In addition, her face and one ear were swollen. Scacchetti told K.J. that R.J. had fallen in the bathtub. K.J. also found a number of bloody items, including underwear and a pillowcase belonging to R.J., and a washcloth: R.J. could not explain what had happened to her. K.J. did not go to work the next two days because she did not want to leave R.J. alone with Scacchetti.
On June 26, 2002, K.J. brought R.J. to a Saint Paul woman’s shelter, where shelter employees suggested K.J. take R.J. to the hospital to be examined. On June 27, K.J. took R.J. to Minneapolis Children’s Hospital, where R.J. told K.J. that Scacchetti had touched her “down there” and that it hurt when she urinated. The doctor who examined R.J. was concerned that her gen: ital exam had indicated an abnormal hymen and called a pediatric nurse practitioner, Laurel Edinburgh, from MCRC to еxamine R.J.
MCRC is a clinic that assesses children for possible physical abuse, sexual abuse, and neglect. Their assessment consists of an interview and physical examination of the child. After an assessment, Edinburgh links the family with appropriate services. Edinburgh testified that she has seen over 500 patients and has testified in court about 15 to 20 times. She uses a particular protocol when assessing children, which shе used when assessing R.J. Dr. Carolyn Levitt, the founder of MCRC, testified at trial regarding the protocol Edinburgh used. Dr. Levitt explained that the protocol is “pretty much based on what I would be doing if I were evaluating a child * * * who had abdominal pain and appendicitis, but it’s a medical protocol and it specializes in getting specific details from the child.” According to Dr. Levitt, the protocol consists of a verbal interview, an external exam, and a colposcopic exam of the child’s genitalia. In explaining why the assessments are videotaped, Levitt stated, “There are many children seen at our center who have videotaped interviews so that the evaluations are then reviewed. The videotape is reviewed by me, the videotape colposcopic exаmination is reviewed by me.”
Edinburgh assessed R.J. two times. At the first assessment, which took place at the hospital on June 27 and was not videotaped, Edinburgh first met with K.J. to gather background information and then met with R.J. to ask questions regarding her injuries. She then did a physical exam, during which K.J. was present. While examining R.J.’s anal and vaginal area, Edinburgh asked R.J., “did anything ever happen to this area right here?” to which R.J. responded “yes.” Edinburgh asked ‘What touched there?” and R.J. responded “Tony’s pee-pee.” As part of the exam, Edinburgh found an oblong-shaped bruise next to R.J.’s anal opening.
Edinburgh conducted a follow-up assessment of R.J. the next day. That assessment took place in the MCRC office in Saint Paul. The office has a typical doctor’s office layout, with a waiting area and two exam rooms. The assessment took placе in one of the exam rooms and was videotaped. At one point during the assessment, R.J. became distraught-and asked for her mother.
Edinburgh’s follow-up assessment followed the standard protocol. Incidentally, during the assessment, R.J. described how Scacchetti had slapped her on her cheek and spanked her with a big belt and a brush. After further questioning, R.J. indicated that Scacchetti had touched her аnus (where she “goes poop”) with his hands. R.J. stated, “he put his hands right in there” while pointing up with one *512 of her fingers. The following questions and answers ensued:
Q: Did Tony touch here with his pee-pee?
A: Yeah.
Q: Yeah. What did his pee-pee do there?
A: Him — when he was mad in there.
Q: When he was mad there?
A: Yeah. When he was mad at me.
Q: When he was mad at you?
A: Yeah.
Q: What did he do with his pee-pee there?
A: I don’t know.
Q: You don’t know?
A: Him put in the corner.
Q: What happened to your clothes? What did he do with your clothes?
A: He take them off.
Q: He took them off?
A: Uh-huh.
Q: Okay. What did Tony do with his clothes?
A: Um, he took them — his off too.
Q: He took his off too?
A: Uh-huh.
The court conducted a hearing to determine whether R.J. was competent to testify. The hearing took place with the judge in normal attire. During the hearing, R.J. was unwilling to orally answer questions asked of her. As a result, the court found that R.J. was incompеtent to testify and was therefore unavailable. Because R.J. was unavailable, Scacchetti had no opportunity to cross-examine her.
Edinburgh testified at trial regarding both of her assessments of R.J. and statements R.J. made during those assessments, and the videotape of the second assessment was shown to the jury. 1 She also testified that R.J., as a three-and-one-half-year-old, had sexual knowledge thаt was beyond her age,- and that based on Edinburgh’s experience R.J. was both physically and sexually abused. In explaining the basis for that conclusion, Edinburgh stated:
I use all of my knowledge of how children disclose, out of the statements that they made during [the] interview, out of what a parent tells me about a medical history, about any histories of trauma, and my physical exam, and I put those, all of those sort of factors go together when I’m making a diagnosis that a child was sexually abused.
Scacchetti testified and admitted spanking R.J. with a belt, but denied sexually abusing her.
On December 12, 2002, a jury found Scacchetti guilty of criminal sexual conduct in the first degree in violation of Minn. Stat. § 609.342, subd. 1 (2004), malicious punishment of a child in violation of Minn. Stat. § 609.377, subd. 4 (2004), and assault in the third degree in violation of Minn. Stat. § 609.223, subd. 3 (2004). Scacchetti appealed his conviction and the court of appeals affirmed on June 1, 2004.
State v. Scacchetti,
No. A03-301,
We granted the petition and remanded to the court of appeals for reconsideration in light of
Crawford.
On remand, the court of appeals affirmed, determining that
*513
the statеments R.J. made to Edinburgh were not testimonial for purposes of
Crawford. State v. Scacchetti
The Sixth Amendment to the United States Constitution ensures a criminal defendant’s right “to be confronted with the witnesses against him.” Until
Crawford
was decided, Confrontation Clause issues were determined according to
Ohio v. Roberts,
Our first
post-Craioford
Confrontation Clause case was
State v. Wright,
We set forth eight considerations relevant to determining whether a declarant’s statements are testimonial:
(1) whether the declarant was a victim or an observer; (2) the declarant’s purpose in speaking with the officer (e.g., to obtаin assistance); (3) whether it was the police or the declarant who initiated the conversation; (4) the location where the statements were made (e.g., the de-clarant’s home, a squad car, or the police station); (5) the declarant’s emotional state when the statements were made; (6) the level of formality and structure of the conversation between the officer and declarant; (7) the officers’ purpose in speaking with the declarant (e.g., to secure the scene, determine what happened, or collect evidence); and (8) if and how the statements were recorded.
Id. at 812-13.
In
State v. Bobadilla,
we again applied the eight factors considered in
Wright
for determining whether a declarant’s statement is testimonial.
In
Bobadilla,
we held that statements made by a three-year-old child sexual abuse victim in an interview with a county child protection worker with a law enforcement officer present in accordance with MinmStat. § 626.556, subd. 10(a) (2004), were not testimonial.
Bobadilla,
In addition, we stated that the intent of the questioner, the seventh
Wright
factor, is one of the most important factors in determining whether statements are testimonial.
Id.
at 250. We also consider the identity of the questioner to be an indication of the questioner’s intent. As the Supreme Court stated in
Crawford,
“Involvement of
government officers
in the production of testimony with an eye toward trial presents unique potential for prosecutorial abuse.”
Crawford,
We begin our analysis by examining the identity of and the purpose of the questioner. It is significant in this case that no government actor initiated, participated, or was involved in any way with the assessments of R.J. that resulted in the statements at issue. In
Bobadilla,
even though police were involved in organizing the child’s interview, were present at the interview, the interview was conducted at the police station, and the interviewer was a government questioner, we held that the child’s statements were not testimonial.
Even if we had concluded that Edinburgh was acting in concert with or as an agent of the government, our conclusion that R.J.’s statements to Edinburgh are not testimonial would not change. The record here indicates that Edinburgh’s purpose in interviewing and examining R.J. was to assess her medical condition. Both Edinburgh and Dr. Levitt testified that their purpose in evaluating children such as R.J. is to determine whether the child has been abused and, if necessary, to connect the child and family to appropriate services. There is no evidence or other testimony in the record to the contrary. The fact that MCRC generally does not have оngoing contact with the child after the assessment does not minimize the medical purpose for which the assessment is conducted.
Scacchetti argues that, even if the court focuses on the medical purpose for the assessments, the fact that Edinburgh has testified in past child sexual abuse cases with relative frequency indicates that she is acting for the purpose of collecting statements for use in a later prosecution. First, we note that Scacchetti’s contention that Edinburgh testifies in child sexual abuse cases with relative frequency is belied by the only evidence in the record on this subject. According to Edinburgh’s testimony, she has examined over 500 patients and of those she testified in 15 to 20 eases. We do not believe, on these facts, that testifying 15 to 20 times constitutes relatively frequent testimony.
Moreover, the mere fact that Edinburgh may be called to testify in court regarding sexual abuse cases does not transform the medical purpose of the assessments into a prosecutorial purpose, nor is there any evidence that Edinburgh had a proseeuto-rial purpose here. Further, in
Bobadilla
we specifically held that the fact that the interview of the child may have had the secondary purpose of preserving testimony does not make a statement testimonial if that purpose is incidental to a broader purpose of protecting the child’s welfare.
Bobadilla,
At least three other courts have held that statements made by children are not testimonial when taken for medical assessment purposes without the involvement of government actors.
See United States v. Peneaux,
Further, we also note that the first five Wright factors support the conclusion that R.J.’s statements to Edinburgh are not *516 testimonial. R.J. was the victim in this case, and not a mere observer. Given R.J.’s age at the time Edinburgh assessed her, it is not clear that R.J. knew or understood the purpose of the statements she made to Edinburgh. We do know, however, that R.J. made the statements in response to questions asked during Edinburgh’s medical assessments and that the statements were made at a hospital and in a doctor’s office. R.J.’s mother initiated R.J.’s medical assessment when she brought R.J. to the hospital and requested that R.J. be examined. And, like the de-clarants in Wright, R.J. was emotionally distraught when discussing the alleged abuse with Edinburgh.
Finally, we note that the sixth and eighth Wright factors do not clearly support a cоnclusion one way or the other as to whether the statements are testimonial. Although the questions that Edinburgh asked R.J. followed a particular protocol and were structured to elicit responses from a young child, the questions were designed to elicit answers related to the child’s medical health and not responses that would necessarily be useful in prosecuting an offender. Dr. Levitt specifically testified that the structure of the questioning is necessary to elicit useful responses and obtain specific medical details from the child. No evidence to the contrary was presented. Therefore, while the questioning was structured, we conclude that it was not structured for the purpose of creating useful prosecutorial • statements. Similarly, although the statements R.J. made during the second assessment were recorded by Edinburgh, the trial record indicates only that the recording was made to allow Dr. Levitt to review the assessment.
Taken separately or together, the absence of government involvement in the questioning of R.J. and the Wright factors, viewed against the backdrop of the record presented, lead us to the conclusion that the statements R.J. made during Edinburgh’s assessments are not testimonial. We therefore hold that admission of the statements at trial did not offend Scaechet-ti’s Sixth Amendment right to confront the witnesses against him.
Affirmed.
Notes
. While the videotape was shown to the jury, the jurors were not shown the physical examination portion of the tape.