Subject: No. 90-6113 - Syllabus


NOTE: Where it is feasible, a syllabus (headnote) will be released, as is
being done in connection with this case, at the time the opinion is issued.
The syllabus constitutes no part of the opinion of the Court but has been
prepared by the Reporter of Decisions for the convenience of the reader.
See United States v. Detroit Lumber Co., 200 U. S. 321, 337.

SUPREME COURT OF THE UNITED STATES

                 Syllabus

WHITE v. ILLINOIS
certiorari to the appellate court of illinois,
fourth district
No. 90-6113.   Argued November 5, 1991-Decided January 15, 1992

At petitioner White's trial on charges related to a sexual assault upon
 S. G., a 4-year-old girl, the trial court ruled that testimony recount-
 ing S. G.'s statements describing the crime that was offered by her
 babysitter, her mother, an investigating officer, an emergency room
 nurse, and a doctor was admissible under state-law hearsay excep-
 tions for spontaneous declarations and for statements made in the
 course of securing medical treatment.  The trial court also denied
 White's motion for a mistrial based on S. G.'s presence at trial and
 failure to testify.  White was found guilty by a jury, and the Illinois
 Appellate Court affirmed his conviction, rejecting his Sixth Amend-
 ment Confrontation Clause challenge that was based on Ohio v.
 Roberts, 448 U.S. 56.  The court concluded that this Court's later
 decision in United States v. Inadi, 475 U.S. 387, foreclosed any rule
 requiring that, as a necessary antecedent to the introduction of
 hearsay testimony, the prosecution must either produce the declarant
 at trial or show that the declarant is unavailable.
Held:The Confrontation Clause does not require that, before a trial
 court admits testimony under the spontaneous declaration and
 medical examination exceptions to the hearsay rule, either the
 prosecution must produce the declarant at trial or the trial court
 must find that the declarant is unavailable.  Pp.4-11.
   (a)This Court rejects the argument of the United States as amicus
 curiae that the Confrontation Clause's limited purpose is to prevent
 the abusive practice of prosecuting a defendant through the presenta-
 tion of ex parte affidavits, without the affiants ever being produced
 at trial, that the only situation in which the Clause would apply to
 the introduction of out-of-court statements admitted under an accept-
 ed hearsay exception would be those few cases where the statement
 was in the character of such an ex parte affidavit, and that S. G. was
 not a ``witness against'' White within the meaning of the Clause
 because her statements did not fit this description.  Such a narrow
 reading of the Clause, which would virtually eliminate its role in
 restricting the admission of hearsay testimony, is foreclosed by this
 Court's decisions, see, e. g., Mattox v. United States, 156 U.S. 237,
 and comes too late in the day to warrant reexamination.  Pp.4-5.
   (b)Although Roberts contains language that might suggest that the
 Confrontation Clause generally requires that a declarant be produced
 at trial or be found unavailable before his out-of-court statement may
 be admitted into evidence, such an expansive reading was negated by
 the Court's decision in Inadi, supra, at 392-400.  As Inadi recognized
 with respect to co-conspirator statements, the evidentiary rationale
 for admitting testimony regarding such hearsay as spontaneous
 declarations and statements made in the course of receiving medical
 care is that such out-of-court declarations are made in contexts that
 provide substantial guarantees of their trustworthiness.  But those
 same factors that contribute to the statements' reliability cannot be
 recaptured by later in-court testimony.  A statement that has been
 offered in a moment of excitement-without the opportunity to reflect
 on the consequences of one's exclamation-may justifiably carry more
 weight with a trier of fact than a similar statement offered in the
 relative calm of a courtroom.  Similarly, a statement made in the
 course of procuring medical services, where the declarant knows that
 a false statement may cause misdiagnosis or mistreatment, carries
 special guarantees of credibility that a trier of fact may not think
 replicated by courtroom testimony.  Where proffered hearsay has
 sufficient guarantees of reliability to come within a firmly rooted
 exception to the hearsay rule, the Confrontation Clause is satisfied.
 Establishing a generally applicable unavailability rule would have
 few practical benefits while imposing pointless litigation costs.
 Pp.6-10.
   (c)White misplaces his reliance on Coy v. Iowa, 487 U.S. 1012,
 and Maryland v. Craig, 497 U.S. ___, from which he draws a
 general rule that hearsay testimony offered by a child should be
 permitted only upon a showing of necessity-i. e., in cases where
 necessary to protect the child's physical and psychological well-being.
 Those cases involved only the question of what in-court procedures
 are constitutionally required to guarantee a defendant's confrontation
 rights once a child witness is testifying, and there is no basis for
 importing their ``necessity requirement'' into the much different
 context of out-of-court declarations admitted under established
 exceptions to the hearsay rule.  Pp.10-11.
198 Ill. App. 3d 641, 555 N. E. 2d 1241, affirmed.

 Rehnquist, C. J., delivered the opinion of the Court, in which White,
Blackmun, Stevens, O'Connor, Kennedy, and Souter, JJ., joined,
and in which Scalia and Thomas, JJ., joined except for the discussion
rejecting the United States' proposed reading of the ``witness against''
Confrontation Clause phrase.  Thomas, J., filed an opinion concurring
in part and concurring in the judgment, in which Scalia, J., joined.
Const., Amdt. 6.  It is plain that the critical phrase within
the Clause for purposes of this case is -witnesses against
him.-  Any attempt at unraveling and understanding the
relationship between the Clause and the hearsay rules
must begin with an analysis of the meaning of that phrase.
Unfortunately, in recent cases in this area, the Court has
assumed that all hearsay declarants are -witnesses against-
a defendant within the meaning of the Clause, see, e. g.,
Ohio v. Roberts, 448 U. S. 56 (1980); Lee v. Illinois, 476
U. S. 530 (1986); Idaho v. Wright, 497 U. S. -- (1990), an
assumption that is neither warranted nor supported by the
history or text of the Confrontation Clause.
     There is virtually no evidence of what the drafters of the
Confrontation Clause intended it to mean.  See California
v. Green, 399 U. S. 149, 176, n. 8 (1970) (Harlan, J., concur-
ring); Dutton v. Evans, 400 U. S. 74, 95 (1970) (Harlan, J.,
concurring in result); Baker, The Right to Confrontation,
The Hearsay Rules, and Due Process-A Proposal for
Determining When Hearsay May be Used in Criminal
Trials, 6 Conn. Law Rev. 529, 532 (1974).  The strictest
reading would be to construe the phrase -witnesses against
him- to confer on a defendant the right to confront and
cross-examine only those witnesses who actually appear
and testify at trial.  This was Wigmore's view:
     -The net result, then, under the constitutional rule,
is that, so far as testimony is required under the
hearsay rule to be taken infrajudicially, it shall be
taken in a certain way, namely, subject to cross-exami-
nation-not secretly or ex parte away from the accused.
The Constitution does not prescribe what kinds of
testimonial statements (dying declarations or the like)
shall be given infrajudicially-this depends on the law
of evidence for the time being-but only what mode of
procedure shall be followed-i.e., a cross-examining
procedure-in the case of such testimony as is required
by the ordinary law of evidence to be given
infrajudicially.-  5 J. Wigmore, Evidence 1397, p. 159
(J. Chadbourn rev. 1974) (footnote omitted) (emphasis
modified).
The Wigmore view was endorsed by Justice Harlan in his
opinion concurring in the result in Dutton v. Evans, supra,
at 94.  It also finds support in the plain language of the
Clause.  As Justice Scalia recently observed:
-The Sixth Amendment does not literally contain a
prohibition upon [hearsay] evidence, since it guarantees
the defendant only the right to confront the `witnesses
against him.'  As applied in the Sixth Amendment's
context of a prosecution, the noun `witness'-in 1791 as
today-could mean either (a) one `who knows or sees
any thing; one personally present' or (b) `one who gives
testimony' or who `testifies,' i.e., `[i]n judicial proceed-
ings, [one who] make[s] a solemn declaration under
oath, for the purpose of establishing or making proof of
some fact to a court.'  2 N. Webster, An American
Dictionary of the English Language (1828) (emphasis
added).  See also J. Buchanan, Linguae Britannicae
Vernunciatio (1757).  The former meaning (one
`who knows or sees') would cover hearsay evidence, but
is excluded in the Sixth Amendment by the words
following the noun: `witnesses against him.'  The
phrase obviously refers to those who give testimony
against the defendant at trial.-  Maryland v. Craig, 497
U. S. --, -- (1990) (dissenting opinion).
The difficulty with the Wigmore-Harlan view in its purest
form is its tension with much of the apparent history
surrounding the evolution of the right of confrontation at
common law and with a long line of this Court's precedent,
discussed below.  For those reasons, the pure Wigmore-
Harlan reading may be an improper construction of the
Confrontation Clause.
  Relevant historical sources and our own earlier decisions,
nonetheless, suggest that a narrower reading of the Clause
than the one given to it since 1980 may well be correct.  In
16th-century England, magistrates interrogated the
prisoner, accomplices, and others prior to trial.  These
interrogations were -intended only for the information of
the court.  The prisoner had no right to be, and probably
never was, present.-  1 J. Stephen, A History of the Crimi-
nal Law of England 221 (1883).  At the trial itself, -proof
was usually given by reading depositions, confessions of
accomplices, letters, and the like; and this occasioned
frequent demands by the prisoner to have his `accusers,' i.e.,
the witnesses against him, brought before him face to face
. . . .-  Id., at 326.  See also 5 Wigmore, supra, 1364, at 13
(-there was . . . no appreciation at all of the necessity of
calling a person to the stand as a witness-; rather, it was
common practice to obtain -information by consulting
informed persons not called into court-); 9 W. Holdsworth,
History of English Law 227-229 (3d ed. 1944).  The infa-
mous trial of Sir Walter Raleigh on charges of treason in
1603 in which the Crown's primary evidence against him
was the confession of an alleged co-conspirator (the confes-
sion was repudiated before trial and probably had been
obtained by torture) is a well-known example of this feature
of English criminal procedure.  See Pollitt, The Right of
Confrontation: Its History and Modern Dress, 8 J. Pub. L.
381, 388-389 (1959); 1 Stephen, supra, at 333-336; 9
Holdsworth, supra, at 216-217, 226-228.
     Apparently in response to such abuses, a common-law
right of confrontation began to develop in England during
the late 16th and early 17th centuries.  5 Wigmore, supra,
1364, at 23; Pollitt, supra, at 389-390.  Justice Story
believed that the Sixth Amendment codified some of this
common law, 3 J. Story, Commentaries on the Constitution
of the United States 662 (1833), and this Court previously
has recognized the common-law origins of the right.  See
Salinger v. United States, 272 U. S. 542, 548 (1926) (-The
right of confrontation did not originate with the provision
in the Sixth Amendment, but was a common-law right
having recognized exceptions-).  The Court consistently has
indicated that the primary purpose of the Clause was to
prevent the abuses which had occurred in England.  See
Mattox v. United States, 156 U. S. 237, 242 (1895) (-The
primary object of the [Confrontation Clause] was to prevent
depositions or ex parte affidavits, such as were sometimes
admitted in civil cases, being used against the prisoner in
lieu of a personal examination and cross-examination of the
witness . . .-); California v. Green, 399 U. S., at 156 (-It is
sufficient to note that the particular vice that gave impetus
to the confrontation claim was the practice of trying
defendants on `evidence' which consisted solely of ex parte
affidavits or depositions secured by the examining magis-
trates, thus denying the defendant the opportunity to
challenge his accuser in a face-to-face encounter in front of
the trier of fact-); id., at 179 (Harlan, J., concurring) (-From
the scant information available it may tentatively be
concluded that the Confrontation Clause was meant to
constitutionalize a barrier against flagrant abuses, trials by
anonymous accusers, and absentee witnesses-); Dutton v.
Evans, 400 U. S., at 94 (Harlan, J., concurring in result)
(the -paradigmatic evil the Confrontation Clause was aimed
at- was -trial by affidavit-).
     There appears to be little if any indication in the
historical record that the exceptions to the hearsay rule
were understood to be limited by the simultaneously
evolving common-law right of confrontation.  The Court has
never explored the historical evidence on this point.  As a
matter of plain language, however, it is difficult to see how
or why the Clause should apply to hearsay evidence as a
general proposition.  As Justice Harlan observed:
     -If one were to translate the Confrontation Clause
into language in more common use today, it would
read: `In all criminal prosecutions, the accused shall
enjoy the right to be present and to cross-examine the
witnesses against him.'  Nothing in this language or in
its 18th-century equivalent would connote a purpose to
control the scope of the rules of evidence.  The lan-
guage is particularly ill-chosen if what was intended
was a prohibition on the use of any hearsay . . . .-  Id.,
at 95 (opinion concurring in result).
     The standards that the Court has developed to imple-
ment its assumption that the Confrontation Clause limits
admission of hearsay evidence have no basis in the text of
the Sixth Amendment.  Ever since Ohio v. Roberts, 448
U. S. 56 (1980), the Court has interpreted the Clause to
mean that hearsay may be admitted only under a -firmly
rooted- exception, id., at 66, or if it otherwise bears -partic-
ularized guarantees of trustworthiness,- ibid. See, e. g.,
Idaho v. Wright, 497 U. S., at --; Bourjaily v. United
States, 483 U. S. 171, 183 (1987).  This analysis implies
that the Confrontation Clause bars only unreliable hearsay.
Although the historical concern with trial by affidavit and
anonymous accusers does reflect concern with the reliability
of the evidence against a defendant, the Clause makes no
distinction based on the reliability of the evidence present-
ed.  Nor does it seem likely that the drafters of the Sixth
Amendment intended to permit a defendant to be tried on
the basis of ex parte affidavits found to be reliable.  Cf.
U. S. Const., Art. III,  3 (-No person shall be convicted of
Treason unless on the Testimony of two Witnesses to the
same overt Act, or on Confession in open Court-).  Reliabili-
ty is more properly a due process concern.  There is no
reason to strain the text of the Confrontation Clause to
provide criminal defendants with a protection that due
process already provides them.
     The United States, as amicus curiae, has suggested that
the Confrontation Clause should apply only to those persons
who provide in-court testimony or the functional equivalent,
such as affidavits, depositions, or confessions that are made
in contemplation of legal proceedings.  This interpretation
is in some ways more consistent with the text and history
of the Clause than our current jurisprudence, and it is
largely consistent with our cases.  If not carefully formulat-
ed, however, this approach might be difficult to apply, and
might develop in a manner not entirely consistent with the
crucial -witnesses against him- phrase.
     In this case, for example, the victim's statements to the
investigating police officer might be considered the function-
al equivalent of in-court testimony because the statements
arguably were made in contemplation of legal proceedings.
Attempts to draw a line between statements made in
contemplation of legal proceedings and those not so made
would entangle the courts in a multitude of difficulties.
Few types of statements could be categorically characterized
as within or without the reach of a defendant's confronta-
tion rights.  Not even statements made to the police or
government officials could be deemed automatically subject
to the right of confrontation (imagine a victim who blurts
out an accusation to a passing police officer, or the unsus-
pecting social-services worker who is told of possible child
abuse).  It is also not clear under the United States'
approach whether the declarant or the listener (or both)
must be contemplating legal proceedings.  The United
States devotes little attention to the application of its
proposed standard in this case.
     Thus, we are faced with a situation in which the text of
the Sixth Amendment supports the Wigmore-Harlan view
but history and our earlier cases point away from that
strictest reading of the text.  Despite this tension, I believe
it is possible to interpret the Confrontation Clause along
the lines suggested by the United States in a manner that
is faithful to both the provision's text and history.  One
possible formulation is as follows:  The federal constitution-
al right of confrontation extends to any witness who
actually testifies at trial, but the Confrontation Clause is
implicated by extrajudicial statements only insofar as they
are contained in formalized testimonial materials, such as
affidavits, depositions, prior testimony, or confessions.  It
was this discrete category of testimonial materials that was
historically abused by prosecutors as a means of depriving
criminal defendants of the benefit of the adversary process,
see, e. g., Mattox v. United States, 156 U. S. 237, 242-243
(1895), and under this approach, the Confrontation Clause
would not be construed to extend beyond the historical evil
to which it was directed.
     Such an approach would be consistent with the vast
majority of our cases, since virtually all of them decided
before Ohio v. Roberts involved prior testimony or confes-
sions, exactly the type of formalized testimonial evidence
that lies at the core of the Confrontation Clause's concern.
This narrower reading of the Confrontation Clause would
greatly simplify the inquiry in the hearsay context.
Furthermore, this interpretation would avoid the problem
posed by the Court's current focus on hearsay exceptions
that are -firmly rooted- in the common law.  See ante, at 8,
n.8.  The Court has never explained the Confrontation
Clause implications of a State's decision to adopt an
exception not recognized at common law or one not recog-
nized by a majority of the States.  Our current jurispru-
dence suggests that, in order to satisfy the Sixth Amend-
ment, the State would have to establish in each individual
case that hearsay admitted pursuant to the newly created
exception bears -particularized guarantees of trustworthi-
ness,- and would have to continue doing so until the
exception became -firmly rooted- in the common law, if that
is even possible under the Court's standard.  This result is
difficult to square with the Clause itself.  Neither the
language of the Clause nor the historical evidence appears
to support the notion that the Confrontation Clause was
intended to constitutionalize the hearsay rule and its
exceptions.  Although the Court repeatedly has disavowed
any intent to cause that result, see, e. g., ante, at 5; Idaho
v. Wright, 497 U. S., at --; United States v. Inadi, 475
U. S. 387, 393, n.5 (1986); Dutton v. Evans, 400 U. S., at 86;
California v. Green, 399 U. S., at 155, I fear that our
decisions have edged ever further in that direction.
     For the foregoing reasons, I respectfully suggest that, in
an appropriate case, we reconsider how the phrase -witness
against- in the Confrontation Clause pertains to the
admission of hearsay.  I join the Court's opinion except for
its discussion of the narrow reading of this phrase proposed
by the United States.
-------------------------------

SUPREME COURT OF THE UNITED STATES
--------
No. 90-6113
--------
RANDALL D. WHITE, PETITIONER v. ILLINOIS
on writ of certiorari to the appellate court of
illinois, fourth district
[January 15, 1992]

  Justice Thomas, with whom Justice Scalia joins,
concurring in part and concurring in the judgment.
  The Court reaches the correct result under our prece-
dents.  I write separately only to suggest that our Confron-
tation Clause jurisprudence has evolved in a manner that
is perhaps inconsistent with the text and history of the
Clause itself.  The Court unnecessarily rejects, in dicta, the
United States' suggestion that the Confrontation Clause in
general may not regulate the admission of hearsay evi-
dence.  See ante, at 4-5.  The truth may be that this Court's
cases unnecessarily have complicated and confused the
relationship between the constitutional right of confronta-
tion and the hearsay rules of evidence.
     The Confrontation Clause provides simply that -[i]n all
criminal prosecutions, the accused shall enjoy the right . . .
to be confronted with the witnesses against him . . . .-  U. S.

NOTICE: This opinion is subject to formal revision before publication in the
preliminary print of the United States Reports.  Readers are requested to
notify the Reporter of Decisions, Supreme Court of the United States, Wash-
ington, D.C. 20543, of any typographical or other formal errors, in order that
corrections may be made before the preliminary print goes to press.

SUPREME COURT OF THE UNITED STATES
--------
No. 90-6113
--------
RANDALL D. WHITE, PETITIONER v. ILLINOIS
on writ of certiorari to the appellate court of
illinois, fourth district
[January 15, 1992]

  The Chief Justice delivered the opinion of the Court.
  In this case we consider whether the Confrontation
Clause of the Sixth Amendment requires that, before a trial
court admits testimony under the -spontaneous declaration-
and -medical examination- exceptions to the hearsay rule,
the prosecution must either produce the declarant at trial
or the trial court must find that the declarant is unavail-
able.  The Illinois Appellate Court concluded that such
procedures are not constitutionally required.  We agree with
that conclusion.
  Petitioner was convicted by a jury of aggravated criminal
sexual assault, residential burglary, and unlawful restraint.
Ill. Rev. Stat., ch.38,  12-14, 19-3, 10-3, (1989).  The
events giving rise to the charges related to the sexual
assault of S. G., then four years old.  Testimony at the trial
established that in the early morning hours of April 16,
1988, S. G.'s babysitter, Tony DeVore, was awakened by
S. G.'s scream.  DeVore went to S. G.'s bedroom and wit-
nessed petitioner leaving the room and petitioner then left
the house.  6 Tr. 10-11.  DeVore knew petitioner because
petitioner was a friend of S. G.'s mother, Tammy Grigsby.
Id., at 27.  DeVore asked S. G. what had happened.
According to DeVore's trial testimony, S. G. stated that
petitioner had put his hand over her mouth, choked her,
threatened to whip her if she screamed and had -touch[ed]
her in the wrong places.-  Asked by DeVore to point to
where she had been touched, S. G. identified the vaginal
area.  Id., at 12-17.
  Tammy Grigsby, S. G.'s mother, returned home about 30
minutes later.  Grigsby testified that her daughter appeared
-scared- and a -little hyper.-  Id., at 77-78.  Grigsby pro-
ceeded to question her daughter about what had happened.
At trial, Grigsby testified that S. G. repeated her claims
that petitioner choked and threatened her.  Grigsby also
testified that S. G. stated that petitioner -put his mouth on
her front part.-  Id., at 79.  Grigsby also noticed that S. G.
had bruises and red marks on her neck that had not been
there previously.  Id., at 81.  Grigsby called the police.
  Officer Terry Lewis arrived a few minutes later, roughly
45 minutes after S. G.'s scream had first awakened DeVore.
Lewis questioned S. G. alone in the kitchen.  At trial,
Lewis' summary of S. G.'s statement indicated that she had
offered essentially the same story as she had first reported
to DeVore and to Grigsby, including a statement that
petitioner had -used his tongue on her in her private parts.-
Id., at 110-112.
  After Lewis concluded his investigation, and approximate-
ly four hours after DeVore first heard S. G.'s scream, S. G.
was taken to the hospital.  She was examined first by
Cheryl Reents, an emergency room nurse, and then by Dr.
Michael Meinzen.  Each testified at trial and their testimo-
ny indicated that, in response to questioning, S. G. again
provided an account of events that was essentially identical
to the one she had given to DeVore, Grigsby, and Lewis.
  S. G. never testified at petitioner's trial.  The State
attempted on two occasions to call her as a witness but she
apparently experienced emotional difficulty on being
brought to the courtroom and in each instance left without
testifying.  App. at 14.  The defense made no attempt to call
S. G. as a witness and the trial court neither made, nor was
it asked to make, a finding that S. G. was unavailable to
testify.  6 Tr. 105-106.
  Petitioner objected on hearsay grounds to DeVore,
Grigsby, Lewis, Reents, and Meinzen being permitted to
testify regarding S. G.'s statements describing the assault.
The trial court overruled each objection.  With respect to
DeVore, Grigsby, and Lewis the trial court concluded that
the testimony could be permitted pursuant to an Illinois
hearsay exception for spontaneous declarations.  Peti-
tioner's objections to Reents' and Meinzen's testimony was
similarly overruled, based on both the spontaneous declara-
tion exception and an exception for statements made in the
course of securing medical treatment.  The trial court also
denied petitioner's motion for a mistrial based on S. G.'s
-presence [and] failure to testify.-  App. 14.
  Petitioner was found guilty by a jury, and the Illinois
Appellate Court affirmed his conviction.  It held that the
trial court operated within the discretion accorded it under
state law in ruling that the statements offered by DeVore,
Grigsby and Lewis qualified for the spontaneous declaration
exception and in ruling that the statements offered by
Reents and Meinzen qualified for the medical examination
exception.  198 Ill. App. 3d 641, --- - ---, 555 N. E. 2d
1241, 1246-1251 (1990).  The court then went on to reject
petitioner's Confrontation Clause challenge, a challenge
based principally on language contained in this Court's
decision in Ohio v. Roberts, 448 U. S. 56 (1980).  It conclud-
ed that our later decision in United States v. Inadi, 475
U. S. 387 (1986), foreclosed any rule requiring that, as a
necessary antecedent to the introduction of hearsay
testimony, the prosecution must either produce the declar-
ant at trial or show that the declarant is unavailable.  The
Illinois Supreme Court denied discretionary review, and we
granted certiorari, 500 U. S. --- 1991), limited to the
constitutional question whether permitting the challenged
testimony violated petitioner's Sixth Amendment Confronta-
tion Clause right.
  We consider as a preliminary matter an argument not
considered below but urged by the United States as amicus
curiae in support of respondent.  The United States con-
tends that petitioner's Confrontation Clause claim should be
rejected because the Confrontation Clause's limited purpose
is to prevent a particular abuse common in 16th and 17th
century England: prosecuting a defendant through the
presentation of ex parte affidavits, without the affiants ever
being produced at trial.  Because S. G.'s out-of-court state-
ments do not fit this description, the United States suggests
that S. G. was not a -witness against- petitioner within the
meaning of the Clause. The United States urges this
position, apparently in order that we might further conclude
that the Confrontation Clause generally does not apply to
the introduction of out-of-court statements admitted under
an accepted hearsay exception.  The only situation in which
the Confrontation Clause would apply to such an exception,
it argues, would be those few cases where the statement
sought to be admitted was in the character of an ex parte
affidavit, i.e., where the circumstances surrounding the out-
of-court statement's utterance suggest that the statement
has been made for the principal purpose of accusing or
incriminating the defendant.
  Such a narrow reading of the Confrontation Clause,
which would virtually eliminate its role in restricting the
admission of hearsay testimony, is foreclosed by our prior
cases.  The discussions in these cases, going back at least
as far as Mattox v. United States, 156 U. S. 237 (1895),
have included historical examination of the origins of the
Confrontation Clause, and of the state of the law of evi-
dence existing at the time the Sixth Amendment was
adopted and later.  We have been careful -not to equate the
Confrontation Clause's prohibitions with the general rule
prohibiting the admission of hearsay statements,- Idaho v.
Wright, (1990) 497 U. S. ---, --- (slip op. 6-7) (citations
omitted).  Nonetheless we have consistently sought to
-stee[r] a middle course,- Roberts, supra, at 68, n.9, that
recognizes that -hearsay rules and the Confrontation
Clause are generally designed to protect similar values,-
California v. Green, 399 U. S. 149, 155 (1970), and -stem
from the same roots.-  Dutton v. Evans, 400 U. S. 74, 86
(1970).  In Mattox itself, upon which the Government relies,
the Court allowed the recorded testimony of a witness at a
prior trial to be admitted.  But, in the Court's view, the
result was justified not because the hearsay testimony was
unlike an ex parte affidavit, but because it came within an
established exception to the hearsay rule.  We think that
the argument presented by the Government comes too late
in the day to warrant reexamination of this approach.
     We therefore now turn to petitioner's principal conten-
tion that our prior decision in Roberts requires that his
conviction be vacated.  In Roberts we considered a Confron-
tation Clause challenge to the introduction at trial of a
transcript containing testimony from a probable-cause
hearing, where the transcript included testimony from a
witness not produced at trial but who had been subject to
examination by defendant's counsel at the probable-cause
hearing.  In the course of rejecting the Confrontation
Clause claim in that case, we used language that might
suggest that the Confrontation Clause generally requires
that a declarant either be produced at trial or be found
unavailable before his out-of-court statement may be
admitted into evidence.  However, we think such an
expansive reading of the Clause is negated by our subse-
quent decision in Inadi, supra.
  In Inadi we considered the admission of out-of-court
statements made by a co-conspirator in the course of the
conspiracy.  As an initial matter, we rejected the proposi-
tion that Roberts established a rule that -no out-of-court
statement would be admissible without a showing of
unavailability.-  475 U. S., at 392.  To the contrary, rather
than establishing -a wholesale revision of the law of
evidence- under the guise of the Confrontation Clause,
ibid., we concluded that -Roberts must be read consistently
with the question it answered, the authority it cited, and its
own facts.-  Id., at 394.  So understood, Roberts stands for
the proposition that unavailability analysis is a necessary
part of the Confrontation Clause inquiry only when the
challenged out-of-court statements were made in the course
of a prior judicial proceeding.  Ibid.
  Having clarified the scope of Roberts, the Court in Inadi
then went on to reject the Confrontation Clause challenge
presented there. In particular, we refused to extend the
unavailability requirement established in Roberts to all out-
of-court statements.  Our decision rested on two factors.
First, unlike former in-court testimony, co-conspirator
statements -provide evidence of the conspiracy's context
that cannot be replicated, even if the declarant testifies to
the same matters in court,- Inadi, 475 U. S., at 395.  Also,
given a declarant's likely change in status by the time the
trial occurs, simply calling the declarant in the hope of
having him repeat his prior out-of-court statements is a
poor substitute for the full evidentiary significance that
flows from statements made when the conspiracy is
operating in full force.  Ibid.
  Second, we observed that there is little benefit, if any, to
be accomplished by imposing an -unavailability rule.-
Such a rule will not work to bar absolutely the introduction
of the out-of-court statements; if the declarant either is
unavailable, or is available and produced for trial, the
statements can be introduced.  Id., at 396.  Nor is an
unavailability rule likely to produce much testimony that
adds meaningfully to the trial's truth-determining process.
Ibid.  Many declarants will be subpoenaed by the prosecu-
tion or defense, regardless of any Confrontation Clause
requirement, while the Compulsory Process Clause and
evidentiary rules permitting a defendant to treat witnesses
as hostile will aid defendants in obtaining a declarant's live
testimony.  Id., at 396-398.  And while an unavailability
rule would therefore do little to improve the accuracy of
factfinding, it is likely to impose substantial additional
burdens on the factfinding process.  The prosecution would
be required to repeatedly locate and keep continuously
available each declarant, even when neither the prosecution
nor the defense has any interest in calling the witness to
the stand.  An additional inquiry would be injected into the
question of admissibility of evidence, to be litigated both at
trial and on appeal.  Id., at 398-399.
  These observations, although expressed in the context of
evaluating co-conspirator statements, apply with full force
to the case at hand.  We note first that the evidentiary
rationale for permitting hearsay testimony regarding
spontaneous declarations and statements made in the
course of receiving medical care is that such out-of-court
declarations are made in contexts that provide substantial
guarantees of their trustworthiness.  But those same
factors that contribute to the statements' reliability cannot
be recaptured even by later in-court testimony.  A state-
ment that has been offered in a moment of excitement -
without the opportunity to reflect on the consequences of
one's exclamation - may justifiably carry more weight with
a trier of fact than a similar statement offered in the
relative calm of the courtroom.  Similarly, a statement
made in the course of procuring ml services, where the
declarant knows that a false statement may cause misdiag-
nosis or mistreatment, carries special guarantees of
credibility that a trier of fact may not think replicated by
courtroom testimony.  They are thus materially different
from the statements at issue in Roberts, where the out-of-
court statements sought to be introduced were themselves
made in the course of a judicial proceeding, and where
there was consequently no threat of lost evidentiary value
if the out-of-court statements were replaced with live
testimony.
  The preference for live testimony in the case of state-
ments like those offered in Roberts is because of the
importance of cross examination, -the greatest legal engine
ever invented for the discovery of truth.-  Green, 399 U. S.,
at 158.  Thus courts have adopted the general rule prohibit-
ing the receipt of hearsay evidence.  But where proffered
hearsay has sufficient guarantees of reliability to come
within a firmly rooted exception to the hearsay rule, the
Confrontation Clause is satisfied.
  We therefore think it clear that the out-of-court state-
ments admitted in this case had substantial probative
value, value that could not be duplicated simply by the
declarant later testifying in court.  To exclude such proba-
tive statements under the strictures of the Confrontation
Clause would be the height of wrong-headedness, given that
the Confrontation Clause has as a basic purpose the
promotion of the - `integrity of the factfinding process.' -
Coy v. Iowa, 487 U. S. 1012, 1020 (1988) (quoting Kentucky
v. Stincer, 482 U. S. 730, 736 (1987).  And as we have also
noted, a statement that qualifies for admission under a
-firmly rooted- hearsay exception is so trustworthy that
adversarial testing can be expected to add little to its
reliability.  Wright, 497 U. S., at --- (slip op. 13).  Given
the evidentiary value of such statements, their reliability,
and that establishing a generally applicable unavailability
rule would have few practical benefits while imposing
pointless litigation costs, we see no reason to treat the out-
of-court statements in this case differently from those we
found admissible in Inadi.  A contrary rule would result in
exactly the kind of -wholesale revision- of the laws of
evidence that we expressly disavowed in Inadi.  We
therefore see no basis in Roberts or Inadi for excluding from
trial, under the aegis of the Confrontation Clause, evidence
embraced within such exceptions to the hearsay rule as
those for spontaneous declarations and statements made for
medical treatment.
     As a second line of argument, petitioner presses upon us
two recent decisions involving child-testimony in child-
sexual assault cases, Coy v. Iowa, supra, and Maryland v.
Craig, 497 U. S. --- (1990).  Both Coy and Craig required
us to consider the constitutionality of courtroom procedures
designed to prevent a child witness from having to face
across an open courtroom a defendant charged with
sexually assaulting the child.  In Coy we vacated a convic-
tion that resulted from a trial in which a child witness
testified from behind a screen, and in which there had been
no particularized showing that such a procedure was
necessary to avert a risk of harm to the child.  In Craig we
upheld a conviction that resulted from a trial in which a
child witness testified via closed circuit television after such
a showing of necessity.  Petitioner draws from these two
cases a general rule that hearsay testimony offered by a
child should be permitted only upon a showing of necessity
- i.e., in cases where necessary to protect the child's
physical and psychological well-being.
  Petitioner's reliance is misplaced.  Coy and Craig involved
only the question of what in-court procedures are constitu-
tionally required to guarantee a defendant's confrontation
right once a witness is testifying.  Such a question is quite
separate from that of what requirements the Confrontation
Clause imposes as a predicate for the introduction of out-of-
court declarations.  Coy and Craig did not speak to the
latter question.  As we recognized in Coy, the admissibility
of hearsay statements raises concerns lying at the periphery
of those that the Confrontation Clause is designed to
address, 487 U. S., at 1016.  There is thus no basis for
importing the -necessity requirement- announced in those
cases into the much different context of out-of-court
declarations admitted under established exceptions to the
hearsay rule.
  For the foregoing reasons, the judgment of the Illinois
Appellate Court is
                                    Affirmed.
