OPINION
Albert J. Kappell appeals from his jury conviction and sentence on multiple counts of child sexual abuse in violation of 18 U.S.C. §§ 2241(c) and 2244. He contends that his trial violated his Sixth Amendment right to confront the witnesses against him (the victims of the abuse), that the district court erroneously admitted the testimony of a licensed psychotherapist reporting what the victims had said in interviews with her, and that the evidence was insufficient to support his convictions. He also challenges his sentence of life imprisonment under § 2241(c) based on his prior state conviction for child sexual abuse. We reject all of his contentions, and AFFIRM his conviction and sentence.
I
A. Kappell was convicted by a jury in the United States District Court for the Western District of Michigan of nine counts of child sexual abuse in violation of 18 U.S.C. §§ 2241(c) and 2244, based on his abuse of two minor female children (“the children”), who are members of the Keweenaw Bay Indian Community. When the abuse began, the children were six and three years old and were living on an Indian reservation with their mother and grandmother. In early 2001, Kappell began a relationship with the mother and moved into the family’s home on the reservation. He lived there until April 2002, when he was compelled to leave after the children’s mother learned that he had been convicted of felony child sexual abuse by the state of Wisconsin in 1982. The vie-tims in that ease were the nine- and ten-year-old daughters of his former fiancee.
In the spring of 2002, state and tribal social workers learned of Kappell’s Wisconsin conviction and became concerned because he had been living with the children for some time. A medical clinic nurse who had spoken with the children’s mother made a mandatory child sexual abuse referral to the social services department. As a result, the children were interviewed several times by tribal and state social workers. The children gave verbal and nonverbal interview responses indicating that Kappell might have sexually abused them.
In May 2002, the tribe and the state agency referred the children to Fran Waters for further evaluation. Waters is a licensed psychotherapist and state-certified clinical social worker specializing in child sexual abuse. Waters interviewed each child several times, following a “forensic interview” protocol of the State of Michigan for interviewing children who may have been sexually abused. Waters testified that these interviews were needed to obtain the information necessary for an accurate medical diagnosis before seeking mental health treatment for the children.
According to Waters, both children made verbal disclosures of various incidents of sexual abuse by Kappell, and also reacted nonverbally in ways suggesting that they had been sexually abused. Waters also testified that the older child had described seeing Kappell sexually abuse the younger one. Waters testified that, based on her interviews, she concluded that both children were suffering from post-traumatic stress disorder, and recommended to the tribal social worker that both children receive mental health thera *553 py. Waters herself did not provide therapy to the children.
During 2002, the children were examined by two pediatric physicians. Both doctors testified about the children’s verbal and nonverbal responses to questions about sexual abuse. According to the doctors’ testimony, the older girl described incidents of sexual abuse by Kappell to one doctor, confirmed abuse by Kappell to the other doctor by nodding, and became emotional in the presence of each doctor when the subject was discussed.
B. The indictment charged Kappell with seven counts of aggravated sexual abuse of minor children, in violation of 18 U.S.C. § 2241(c), and two counts of abusive sexual contact against minor children, in violation of 18 U.S.C. § 2244. Prior to trial, Kappell moved to exclude Waters’s testimony regarding statements that the children made during the interviews. The district court denied Kappell’s motion, ruling that such statements would be admissible under Federal Rule of Evidence 803(4), the hearsay exception for “statements for purposes of medical diagnosis or treatment,” and also under Rule 807, the hearsay “residual exception” for statements not specifically covered by Rules 803 or 804, but having “equivalent circumstantial guarantees of trustworthiness.” Waters and the two physicians who had examined the children testified for the prosecution at trial.
The two children, who were eight and five years old at the time of the trial, also testified. The court determined that they feared Kappell and “would suffer emotional trauma from testifying in open court in the presence of [Kappell].” Therefore, they testified in a room outside the courtroom and the jury viewed their testimony over closed-circuit television monitors. Kappell did not object to this procedure. Each child answered many questions on both direct and cross-examination, but they often answered without providing details and were unresponsive to some questions.
At the conclusion of the government’s case and again at the conclusion of trial, Kappell moved for judgment of acquittal on six of the nine counts. The district court stated that “there is little or no evidence as to what Mr. Kappell specifically did on or about certain dates with respect to these two girls individually, absent the testimony of Ms. Waters .... So what we’re down to is can the defendant be convicted of [the six counts] based upon the testimony of Ms. Waters.” The court denied Kappell’s motion, ruling that “a reasonable juror could convict the defendant of these charges based upon the testimony of Ms. Waters, if it is believed by the jury.”
C. After the jury verdict, the district court instructed the parties to brief the issue whether the mandatory life sentence provision of 18 U.S.C. § 2241(c) covers this case. That provision states, in pertinent part:
If the defendant has previously been convicted of another Federal offense under this subsection, or of a State offense that would have been an offense under either such provision had the offense occurred in a Federal prison, unless the death penalty is imposed, the defendant shall be sentenced to life in prison.
Id.
The presentence report recommended that Kappell receive a life sentence under section 2241(c), based on his 1982 Wisconsin state conviction for child sexual abuse. Kappell objected to the report, arguing, among other things, that his Wisconsin conviction was not for an offense that section 2241(c) covered. The district court *554 rejected Kappell’s contention, and sentenced him to life imprisonment.
II
A. Kappell contends that the introduction into evidence of the two children's statements about what Kappell had done to them violated his right to confrontation under the Sixth Amendment. His challenge relates both to the children's testimony and the testimony of the psychotherapist and the two physicians regarding what the children told them. Since Kap-pell did not raise a Confrontation Clause argument in the district court, we review the issue (even though it is constitutional) for plain error. See United States v. Cromer,
The Confrontation Clause provides that, “[i]n all criminal prosecutions, the accused shall enjoy the right ... to be confronted with the witnesses against him.” The “principal evil at which the Confrontation Clause was directed was the civil-law mode of criminal procedure, and particularly its use of
ex parte
examinations as evidence against the accused .... The Sixth Amendment must be interpreted with this focus in mind.”
Crawford v. Washington,
Nothing in Kappell’s trial violated his rights under the Confrontation Clause. He was able to, and did, confront all of the witnesses against him. The children gave direct testimony and he cross-examined them. Although the children testified not in the courtroom but in another room and their testimony was viewed on closed circuit television, Kappell acquiesced in that arrangement.
Cf. Maryland v. Craig,
Kappell argues, however, that under the Supreme Court’s recent decision in Crawford, the trial in his case denied him his right to confrontation. That argument rests upon a misinterpretation of Crawford.
Crawford
involved a Washington state conviction for stabbing a man, Lee, who allegedly had tried to rape Crawford’s wife. The wife was present at the stabbing and gave a tape-recorded statement to the police. Her statement was damaging to Crawford’s defense that he stabbed Lee in self-defense because he believed that Lee was about to assault him. At Crawford’s trial, his wife did not testify because the state marital privilege prevented such testimony without the other spouse’s consent. The prosecution introduced the wife’s tape-recorded statement at Crawford’s trial. The Washington Supreme Court upheld its introduction because it was trustworthy.
Crawford,
*555
The United States Supreme Court reversed, holding that the introduction of the tape violated the Confrontation Clause. The Court stated and applied the following standard governing the requirements of the Confrontation Clause: “Testimonial statements of witnesses absent from trial have been admitted only where the declar-ant is unavailable, and only where the defendant has had a prior opportunity to cross-examine.”
Id.
at 59,
Crawford thus involved the admissibility under the Confrontation Clause of recorded testimonial statements of a person who did not testify at the trial. The holding in Crawford was that such statements, regardless of their reliability, are not admissible unless the defendant was able to cross-examine their maker. In the present ease, in sharp contrast, the two witnesses (the children) did testify and were cross-examined. Kappell argues, however, that because the two children were unresponsive or inarticulate at some points during their trial testimony, they should be viewed as “unavailable” witnesses, whom the defendant could not effectively cross-examine. In substance, this is an argument that the children should be treated as if they had not, in fact, testified or been cross-examined. Kappell, however, did not challenge the District Court’s ruling that the children could testify.
The Supreme Court addressed this issue in
United States v. Owens,
This Court followed
Owens
in
Bugh v. Mitchell,
This Court held that, under Owens, Robin’s testimony did not violate Bugh’s rights under the Confrontation Clause. This Court stated that
in Owens the [Supreme] Court clearly held that the Confrontation Clause guarantees only the opportunity for cross examination, and that the Clause is not violated by the admission of hearsay evidence when the witness’s memory fails at trial.... While counsel’s cross-examination of Robin may not have yielded the desired answers, and Robin may not have recalled the circumstances surrounding her previous statements, counsel clearly had the opportunity to expose such infirmities, by pointing out Robin’s youth and lack of memory. The jury had the opportunity to observe Robin’s demeanor, thus permitting the jury to draw its own conclusions regarding her credibility as a witness.
Id. at 508. All of these considerations are equally applicable in the present case, and lead to the conclusion that the two children’s testimony did not violate the Confrontation Clause.
B. Kappell next argues that the district court erred by admitting, under the Federal Rules of Evidence, psychotherapist Waters’s hearsay testimony about the children’s out-of-court statements. The district court admitted this testimony pursuant to Rule 803(4), the hearsay exception for “[statements made for purposes of medical diagnosis or treatment,” and Rule 807, permitting admission of hearsay statements “not specifically covered by Rule 803 or 804 but having equivalent circumstantial guarantees of trustworthiness[.]”
This Court apparently has not previously decided whether Rule 803(4) covers statements made to a psychotherapist and social worker, rather than to a physician or nurse. The advisory committee note to Rule 803(4) states, however: “Under the exception, the statement need not have been made to a physician. Statements to hospital attendants, ambulance drivers, or even members of the family might be included.” FED. R. EVID. 803, n. to ¶ 4. Several other circuits have recognized that the provision covers statements made to non-physicians.
See United States v. Running Horse,
The critical inquiry under Rule 803(4) in this ease is whether Waters undertook her interviews for the primary purpose of medical diagnosis, rather than for some other purpose, such as determin
*557
ing whether to notify state authorities of suspected abuse as in
Territory of Guam v. Ignacio,
Waters testified that she was hired to evaluate the children’s mental health and provide a diagnosis, that she conducted her interviews for that diagnostic purpose, and that she diagnosed both children as suffering from post-traumatic stress disorder and anxiety. In response to the district court’s questioning whether she told the children that she was meeting with them for “any sort of medical purpose,” Waters testified that she informed them “that it’s important to tell the truth, [so] that if something happened, then you can get help for that.” Although Waters’s interviews produced evidence that was introduced against Kappell, the record (which includes a hearing before the district court on whether to admit Waters’s testimony) does not show that developing evidence was the primary, or even a major, purpose of Waters’s interviews with the girls, nor does the record undermine her testimony that the purpose of the interviews was diagnostic.
Waters testified that she emphasized to the children the importance of telling the truth, and took steps consistent with the state interviewing protocol to make sure that they understood that fact. Furthermore, as the Fourth Circuit has recognized, a young child — even one who was four years old and incompetent to testify in a sexual abuse case — has a strong motive to “make true statements for the purposes of diagnosis or treatment^]”
Morgan,
In sum, the record supports the district court’s admission of the children’s out-of-court statements to Waters under the hearsay exception of Rule 803(4) because those statements were made for the purpose of medical diagnosis. Because we conclude that the children’s statements to Waters were properly admitted under Rule 803(4), it is unnecessary to consider the district court’s alternative holding that they also were admissible under Rule 807.
Cf. United States v. Laster,
C. Kappell’s contention that the evidence is insufficient to support his convictions is based on the assumption that Waters’s testimony would be excluded. Our holding that her testimony was properly admitted thus eliminates the basis of Kap-pell’s challenge to the sufficiency of the evidence. As he conceded at oral argument, if Waters’s testimony was properly admitted, there were no grounds on which *558 to challenge the sufficiency of the evidence.
Ill
The remaining question is whether the district court properly sentenced Kappell to life imprisonment under 18 U.S.C. § 2241(c), based on his prior state conviction for child sex abuse. Section 2241(c) covers “knowingly engaging] in a sexual act with another person who has not attained the age of 12 years, or attempting] to do so[.]” “Sexual act” is defined under 18 U.S.C. § 2246(2) as various forms of skin-to-skin sexual contact that are explicitly described in the statute, but need not be repeated here. Section 2241(c) also contains a sentence enhancement provision that triggers a mandatory life sentence (unless the death penalty is imposed) “if the defendant has previously been convicted of another Federal offense under this subsection, or of a State offense that would have been an offense under either such provision had the offense occurred in a Federal prison[.]” Id.
Kappell previously had been convicted, on his plea of no contest in a Wisconsin state court, of child sexual abuse. The district court, relying on the judicial records of Kappell’s state conviction, held that Kappell’s conduct reflected in those records would have constituted an offense under section 2241(c). Those state judicial records included the criminal complaint, which contained facts reported by investigating officers, and the transcript of the plea hearing at which Kappell, speaking through his lawyer, stipulated that the facts recited in the complaint were correct for purposes of entering his plea. The record in this case also includes the district court trial testimony of the two victims of Kappell’s Wisconsin crime, now in their early thirties, describing what he had done to them when they were children.
Kappell argues that the court’s consideration of the plea transcript and the criminal complaint was impermissible under
Taylor v. United States,
The question therefore arose as to what state burglary crimes constituted burglary under section 924(e). The Eighth Circuit in
Taylor
construed “burglary” under the federal statute to mean “ ‘burglary’ however a state chooses to define it[.]”
Id.
at 579,
The Court then considered “the problem of applying this conclusion to cases in which the state statute under which a defendant is convicted varies from the generic definition of ‘burglary.’”
Id.
It “h[e]ld that an offense constitutes ‘burglary’ for purposes of a § 924(e) sentence enhancement if either its statutory definition substantially corresponds to ‘generic’ burglary, or the charging paper and jury instructions actually required the jury to find all the elements of generic burglary in order to convict the defendant.”
Id.
at 602,
Shepard,
decided two days before we heard oral argument in the present case, involved the same situation as
Taylor
except that the enhancing state burglary conviction resulted from the defendant’s guilty plea rather than a conviction after trial. The Supreme Court held that “guilty pleas may establish ACCA predicate offenses and that
Taylor’s
reasoning controls the identification of generic convictions following pleas, as well as convictions on verdicts, in States with nongeneric offenses.”
Shepard,
The inquiry under
Taylor,
regarding whether the state crime of burglary of which the defendant previously had been convicted constituted generic burglary, is straightforward and rather simple: whether the crime involved “unlawful or unprivileged entry into, or remaining in, a building or structure, with intent to commit a crime.”
Taylor,
We need not here determine the precise limits to the materials a sentencing court may consider in child sexual abuse cases, *560 since we conclude that the materials that the district court relied upon in enhancing Kappell’s sentence to life imprisonment were permissible and appropriate even under Taylor and Shepard. In determining that the state offense of which Kappell was convicted also would have been an offense under the federal statute, the district court had before it the state criminal complaint, a transcript of the state plea proceedings, and Kappell’s acceptance in those proceedings of the factual statements in the complaint. We know of no convincing reason why the district court could not properly rely on those records in making its predicate offense determination. Indeed, the materials would satisfy the standards of Taylor and Shepard for determining whether a state burglary conviction constitutes generic burglary under the federal Act.
At oral argument, Kappell suggested that he, like Shepard, did not know, understand or accept the facts on which the state criminal complaint was based when he pleaded no contest to the state charge.
See Shepard,
In
Shepard,
the Supreme Court noted that “[i]n this particular pleaded case, the record is silent on the generic [burglary] element [which was in dispute], there being no plea agreement or recorded colloquy in which Shepard admitted the generic fact.”
Shepard,
In contrast, in Kappell’s ease the “prior judicial record” is anything but silent. The “facts contained in the complaint” not only were mentioned at Kappell’s plea hearing, but Kappell agreed to them. The only reason the facts were not read into the record was that Kappell waived their reading. The relevant portion of the plea colloquy was as follows:
The Court: Are you convinced, Mr. Haacke [Kappell’s attorney], that [Kap-pell] understands this process today?
Mr. Haacke: I believe he does.
The Court: Do you want to read further the charge that he is going to be pleading to then and the facts of it?
Mr. Haacke: We are probably willing to stipulate that the facts contained in the Complaint could act as a basis for the finding in this case.
The Court: And he understands those facts?
Mr. Haacke: I believe he does.
The Court: Based upon his understanding, then the Court will accept the waiver of the reading and will then accept the change of plea from not guilty on count one to no contest.
Kappell, who was present and had previously directly answered several of the judge’s questions, raised no issue about his lawyer’s statements to the court or about the factual basis of the criminal charge against him. “Where a defendant is represented by competent counsel, the court usually may rely on that counsel’s assurance that the defendant has been properly informed of the nature and elements of the charge to which he is pleading guilty.”
Bradshaw v. Stumpf,
— U.S. -,
United States v. Etimani,
The district court refused to impose a life sentence because it could not tell from the material before it whether the California conviction was for conduct that violated § 2241(c). The Ninth Circuit affirmed that ruling on the ground that “it is not possible to tell, solely by reading the Information in tandem with the judgment of conviction, whether Etimani was convicted of the ‘sexual act’ [skin-to-skin contact] or ‘sexual contact’ [through clothing] species of the offense.” Id. at 504. It then stated:
Had the Information charged skin-to-skin contact, a no-contest or guilty plea to the crime as charged would have removed the ambiguity, but that is not the case here. Likewise, if Etimani’s conviction had derived from a jury verdict, it might have been possible to discern what acts Etimani was found to have committed by examining the form-of-verdict along with the jury instructions. Read together, the verdict and the instructions might have shown what the jury necessarily found, but that is. not the situation here, either. Sometimes, plea agreements contain a written statement of the factual basis for the plea, but that, too, is not what we have. As the district judge noted, a transcript of Etimani’s plea of no-contest might have clarified the exact nature of his prior conviction, but none was provided. Under these circumstances, the district court correctly ruled that the government failed to establish that the California prior conviction qualified as predicate offense for purposes of § 2241(c).
Id. (emphasis omitted). As this statement indicates, there is little doubt that the Etimani court, if it had before it the record in the present case, would uphold the district court’s imposition of a life sentence on Kappell.
CONCLUSION
Kappell’s conviction and sentence are affirmed.
