State of Iowa v. Karen Sue Huston , 2013 Iowa Sup. LEXIS 7 ( 2013 )


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  •                IN THE SUPREME COURT OF IOWA
    No. 11–1262
    Filed January 25, 2013
    STATE OF IOWA,
    Appellee,
    vs.
    KAREN SUE HUSTON,
    Appellant.
    On review from the Iowa Court of Appeals.
    Appeal from the Iowa District Court for Lee (North) County,
    John G. Linn, Judge.
    Defendant appeals the judgment and sentence following her
    conviction for child endangerment causing serious injury. COURT OF
    APPEALS DECISION AFFIRMED IN PART AND VACATED IN PART;
    DISTRICT COURT JUDGMENT AND SENTENCE REVERSED, AND
    CASE REMANDED FOR NEW TRIAL.
    Mark C. Smith, State Appellate Defender, Samuel S. Berbano,
    Student Legal Intern, and Shellie L. Knipfer, Assistant State Appellate
    Defender, for appellant.
    Thomas J. Miller,       Attorney General, Bridget A. Chambers,
    Assistant Attorney General, Michael P. Short, County Attorney, and
    Clinton R. Boddicker, Assistant County Attorney, for appellee.
    2
    WATERMAN, Justice.
    Defendant, Karen Sue Huston, was one of several adult caregivers
    for a five-year-old girl suffering from malnutrition. This appeal presents
    the question whether the district court committed reversible error in
    Huston’s criminal jury trial by allowing a caseworker for the Iowa
    Department of Human Services (DHS) to testify that a child abuse report
    against Huston was administratively determined to be “founded.”
    Huston objected to this testimony as irrelevant and unfairly prejudicial.
    The jury found Huston guilty of child endangerment causing
    serious injury. The district court sentenced Huston to a term of fifteen
    years in prison.       Huston appealed, contending the evidence was
    insufficient to prove a “serious injury” and that the district court erred by
    allowing testimony on the DHS administrative finding.          The court of
    appeals affirmed, and we granted Huston’s application for further review.
    We exercise our discretion to limit our review to the evidentiary
    ruling on the founded child abuse report. See State v. Marin, 
    788 N.W.2d 833
    , 836 (Iowa 2010). Division III of the court of appeals decision shall
    stand as the final opinion in this appeal on the sufficiency of the
    evidence to support Huston’s conviction.    For   the   reasons   explained
    below, we hold it was reversible error to allow testimony that DHS had
    determined the child abuse complaint against Huston was founded.
    Accordingly, we vacate Division II of the decision of the court of appeals,
    reverse the judgment of the district court, and remand the case for a new
    trial.
    3
    I. Background Facts and Proceedings.
    The victim, T.H., was born in January 2005 to Brandon Holmes
    and Christie Polhans. Brandon is now married to Mandy Holmes, who
    has four children. Mandy is the daughter of Karen and Fred Huston. 1
    In November 2008, T.H. began living with Brandon and his wife,
    Mandy, in Fort Madison, Iowa, after DHS removed T.H. from the care of
    her mother. Approximately one month later, Brandon, Mandy, T.H., and
    Mandy’s four children moved into the Hustons’ two-bedroom home,
    where they all stayed until April or May 2010. Mandy was T.H.’s primary
    caregiver during this time. In April of that year, shortly before Brandon
    and Mandy moved out, Huston returned home from serving a ten-month
    federal prison sentence in Texas for passing money orders in violation of
    18 U.S.C. § 500.
    Although Karen and Fred initially denied that T.H. lived with them,
    Huston admitted at trial that when Brandon and Mandy moved out T.H.
    remained at the Hustons’ home. During this eight-month period, Karen,
    Fred, and Mandy were all involved in caring for T.H.                    Fred would
    occasionally make breakfast or dinner for T.H., but was otherwise gone
    most of the day.       Mandy would come over daily and sometimes would
    prepare T.H.’s breakfast or lunch. Mandy was also the one who would
    bathe T.H.
    Huston is disabled and confined to a wheelchair. She weighs 395
    pounds, and her right hip socket is “broke off.” She suffers from COPD
    and asthma. She is unable to climb stairs and, for that reason, sleeps
    on a bed in the dining room.           In light of her limited mobility, Huston
    could only prepare sandwiches and other quick meals for T.H.
    1References   to “Huston” throughout this opinion are to Karen Huston.
    4
    Dr. Frank Artinian, T.H.’s pediatrician, first became concerned
    about T.H.’s weight in November 2009. T.H. had lost approximately five
    pounds or twelve percent of her body weight since her last doctor’s visit
    in May.   Dr. Artinian tested T.H. for various medical conditions that
    could be at the root of her failure to thrive, but all the tests came back
    negative. Dr. Artinian wished to have T.H. admitted to the hospital at
    that time for further testing and evaluation, but Mandy lacked authority
    to consent to T.H.’s hospitalization, and DHS declined to force T.H.’s
    hospitalization.   In lieu of hospitalization, Mandy brought T.H. in for
    weekly weight checks for the next month. T.H.’s weight remained stable
    during this time period.
    Dr. Artinian did not see T.H. again until ten months later when
    Mandy brought T.H. in at the request of DHS. DHS caseworker, Sharon
    Andrusyk, had received a report that T.H. was not wearing the glasses
    prescribed for her to correct her crossed eyes.        Andrusyk contacted
    Mandy, and she brought T.H. into the DHS office a day later on
    October 20, 2010. During this meeting, Andrusyk immediately noticed
    that something was wrong with T.H.       Andrusyk noted that T.H.’s skin
    was “pale and gray,” her affect was flat, and the hair on the top of her
    head was extremely thin. Andrusyk asked Mandy to take T.H. to see a
    doctor.
    Mandy took T.H. in to see Dr. Artinian. Dr. Artinian determined
    T.H. was failing to thrive. Failure to thrive is not a diagnosis but, rather,
    “a description of what’s going on with a child.”      There are numerous
    potential causes for failure to thrive. Dr. Artinian described T.H.’s failure
    to thrive as “very serious” and noted that he “was actually worried about
    her life at that point in time” because T.H. had not gained any weight in
    5
    nearly a year. Dr. Artinian was unable to identify an illness or disease
    that could account for T.H.’s condition.
    After examining T.H., Dr. Artinian wrote Andrusyk a letter
    expressing his concerns regarding T.H.’s condition. Dr. Artinian wrote:
    “[T.H.] had not grown or gained any weight in 10 months. Her hair is
    thinning, she is emaciated and has a wasted appearance. [T.H.]’s skin is
    dry and loose. Her affect is flat.” Dr. Artinian told Mandy that he was
    “profoundly concerned about [T.H.]’s medical and psychological health.”
    Nevertheless, Mandy remained unconcerned.          Dr. Artinian, therefore,
    urged DHS to compel T.H.’s hospitalization. He noted: “As a pediatrician,
    I have grave concerns regarding the physical and mental health of [T.H.].
    I am very concerned that she is undergoing abuse/neglect in her home.
    DHS absolutely needs to take action to help this child.”
    After   receiving   Dr.   Artinian’s   letter,   Andrusyk   obtained
    authorization to remove T.H. from the Hustons’ home, to admit her to the
    hospital, and to place her in foster care thereafter.      On November 2,
    Andrusyk went to Brandon and Mandy’s home to remove T.H., but she
    was not there. Brandon told Andrusyk that T.H. was with Mandy at an
    appointment, but refused to tell Andrusyk where they were. Eventually,
    Andrusyk found Mandy, but T.H. was not with her.              Mandy took
    Andrusyk to the Hustons’ home and went inside the home and removed
    T.H. Andrusyk noted the following about T.H.’s condition that day:
    She was very dirty. Her clothing was dirty. Her hair
    was matted. She, again, would not make eye contact, would
    not talk, except to repeat some things. She did state she
    was hungry. Her skin was very gray and loose appearing,
    again, very flat affect. She just didn’t talk hardly.
    Andrusyk took T.H. to the hospital, where she was admitted by
    Dr. Christopher Youngman.       T.H. stayed in the hospital for five days.
    6
    Andrusyk returned to the hospital the day after T.H. was admitted and
    took photographs of T.H, including some bruising that appeared after
    she was rehydrated.       Andrusyk noted T.H.’s skin tone and affect had
    improved markedly since her admission to the hospital the previous day.
    During T.H.’s hospitalization, Dr. Artinian and Dr. Youngman
    ruled out a number of medical causes for T.H.’s failure to thrive. While
    in the hospital, T.H. ate everything presented to her and sometimes
    asked for more to eat. On the last day of her hospitalization, T.H. ate a
    lot of food and vomited. By the time T.H. was released from the hospital,
    she had gained nine pounds.
    Dr. Artinian testified it was his opinion, to a reasonable degree of
    medical certainty, that
    the reason why [T.H.] was failing to grow properly and gain
    weight over time was that she was not receiving an adequate
    amount of calories, meaning she was not getting enough
    food. This was—this was determined by ruling out the other
    problems that could cause it, but more than that, by
    hospitalizing her for five days, we were able to control her
    environment and control her caloric intake, and when given
    calories, she gained weight. We did no other intervention for
    her. We gave her no other medicine or therapies that would
    cause weight gain, and during that five days, [T.H.] came
    into the hospital at 34 pounds and was discharged at 43
    pounds, which is a nine pound weight gain in five days,
    which is—just speaks to the fact that when given calories,
    she was able to grow.
    Dr. Youngman similarly concluded, to a reasonable degree of medical
    certainty, that the cause of T.H.’s failure to thrive was “inadequate
    caloric intake . . . she just was not receiving enough calories to grow.”
    Dr. Youngman also noted that if left untreated, “people can die of
    malnutrition,” and even short of death, they can suffer “[n]eurological
    consequences . . . and other organ damage as well.”
    7
    After T.H.’s release from the hospital, she was placed in foster care.
    Apart from another episode of vomiting, T.H. has thrived in her new
    environment. T.H. has continued to gain weight since her release from
    the hospital and, as of her last appointment, was between the 50 and 75
    percentiles on the growth chart for weight.         In addition to these
    improvements, the hair on the top of T.H.’s head has filled in, and she
    has grown two inches.
    Leslie Boyer, a caseworker with DHS, was assigned to investigate
    the allegations brought against Karen and Fred regarding T.H.’s care.
    Boyer interviewed Karen and Fred at their home as part of this
    investigation. During both interviews, Karen and Fred denied that T.H.
    was living with them at the time DHS intervened. They later admitted at
    trial that, after Brandon and Mandy moved from their home, T.H. stayed
    behind with them.
    During these interviews, Huston also reported that she had seen
    T.H. overeat and vomit several times. At trial, Fred and Mandy testified
    to similar behavior.   Huston also told Boyer that T.H. would eat more
    than any of the other children and that she believed T.H. had an eating
    disorder. Moreover, Huston and Mandy testified that they thought T.H.’s
    failure to thrive may have resulted from the stress she experienced when
    Brandon cut ties with his own mother and prevented T.H. from seeing
    her siblings and maternal grandparents.
    On December 27, 2010, the State charged Karen and Fred each
    with two counts of child endangerment. Count I alleged they knowingly
    acted in a manner creating a substantial risk to T.H. or willfully
    depriving T.H. of food, causing serious injury in violation of Iowa Code
    sections 726.6(1)(a), 726.6(1)(d), and 726.6(5) (2009).   Count II alleged
    Karen and Fred intentionally used unreasonable force, torture, or cruelty
    8
    on T.H. causing bodily injury in violation of Iowa Code sections
    726.6(1)(b) and 726.6(6).      The cases against Karen and Fred were
    consolidated for trial.
    The three-day trial began on June 20, 2011.         Nine witnesses
    testified, including Karen and Fred, who were the defendants’ only
    witnesses. One of the State’s witnesses, DHS caseworker Boyer, testified
    regarding her investigation of the child abuse allegations against Karen
    and Fred and her conclusions following that investigation. Boyer and the
    county attorney had the following exchange:
    Q. As a result of your investigation, were you, as part
    of your work, able to reach a conclusion—you talked earlier
    about founded, not confirmed, so forth. Did you reach a
    conclusion with respect to that? A. Yes.
    ....
    Q. And what was your conclusion?
    MR. DIAL: Objection. Relevancy and lower burden of
    proof, Your Honor.
    MR. ORT: Same objection.
    THE COURT: Overruled. You may answer.
    [BOYER]: My outcome of my report was a founded
    child abuse report, two separate, actually, reports: One on
    Karen Huston and one on Fred Huston. It was founded on
    denial of critical care, failure to provide adequate
    supervision, also on physical abuse, and failure to provide
    adequate food.
    Boyer had previously testified that a report would be founded if there was
    a preponderance of evidence.      The county attorney then asked Boyer
    whether there was a process for appealing a founded child abuse report.
    The court, over defense counsel’s objection, permitted Boyer to explain
    the appeal process.       The county attorney next asked Boyer whether
    either Karen or Fred had appealed the founded reports against them.
    Before Boyer was allowed to answer, the court sustained the objections
    of defense counsel.
    9
    At the close of the State’s case, defense counsel for Karen and Fred
    moved for a judgment of acquittal on both counts. The court granted the
    motions for both defendants as to count II, but denied the motions as to
    count I.
    At the close of the defendants’ case, the court denied defendants’
    renewed motions for judgment of acquittal on count I.           The court
    submitted the case to the jury.     The jury found Huston guilty on the
    felony charge of child endangerment causing serious injury. Fred was
    found guilty of a lesser included misdemeanor—child endangerment
    causing no injury, in violation of Iowa Code sections 726.6(1) and
    726.6(7). Huston admitted she had at least two prior felonies, making
    her a habitual offender eligible for an enhanced sentence under Iowa
    Code sections 902.8 and 902.9(3).        The court denied the defendants’
    motions for a new trial on August 5. The court sentenced Huston to a
    term not to exceed fifteen years.
    Huston appealed, alleging the district court erred in admitting DHS
    caseworker Boyer’s testimony that the child abuse report against Huston
    was founded and describing the process for appealing an administrative
    finding of child abuse.    Huston also contends her trial counsel was
    ineffective when he failed to move for judgment of acquittal after the
    State failed to prove T.H. suffered serious injury. Fred did not appeal the
    judgment or sentence entered against him. We transferred the case to
    the court of appeals.
    A three-judge panel of the court of appeals affirmed Huston’s
    conviction and sentence for child endangerment causing serious injury.
    The court of appeals concluded the district court acted within its
    discretion by admitting Boyer’s testimony as relevant:
    10
    Boyer’s testimony regarding the report described T.H.’s
    weight loss, failure to grow, and poor condition—evidence
    consistent with intentional abuse or neglect, an essential
    element the State needed to prove. The testimony explained
    the investigatory and protective steps taken by DHS to
    determine whether evidence supported the initial information
    DHS received, and how the investigation resulted in a
    “founded” report.     The testimony explained why further
    action was taken against Huston and what measures were
    taken to protect T.H.
    The court of appeals further held Boyer’s testimony was not unfairly
    prejudicial:
    [T]he probative value of the evidence outweighed any danger
    of unfair prejudice to Huston [because] . . . [u]nder these
    facts, evidence of a founded child abuse report is hardly the
    type of information that would arouse horror or surprise in
    the jury or lure the jury into declaring guilt on a ground
    different from proof specific to the offense charged.
    The court of appeals also found that any error in admitting Boyer’s
    testimony was harmless.
    We granted Huston’s application for further review.
    II. Scope of Review.
    We review evidentiary rulings for abuse of discretion.      State v.
    Rodriquez, 
    636 N.W.2d 234
    , 239 (Iowa 2001); McClure v. Walgreen Co.,
    
    613 N.W.2d 225
    , 235 (Iowa 2000) (“We reverse a ruling that the district
    court makes in the balancing process under rule 403 only if the district
    court has abused its discretion.”).
    III. Analysis.
    We must decide whether the district court committed reversible
    error by allowing the DHS caseworker to testify that the child abuse
    report against Huston was determined to be founded.         Huston argues
    “the danger here was that the jury would find [her] guilty because DHS
    found her to have committed child abuse.” The State contends testimony
    that the abuse report was deemed founded was admissible to explain the
    11
    actions taken by DHS to remove T.H. from Huston’s care and that any
    error in admitting this testimony was harmless.
    We recognize that a DHS caseworker may need to provide some
    context when she testifies in a child endangerment case as to her
    personal observations of the victim or home environment and when she
    recounts the statements made by the defendant during interviews. But,
    we have also cautioned “ ‘the line of inadmissibility’ ” may be crossed
    when an investigator’s testimony goes “ ‘beyond the point of merely
    explaining why certain responsive actions were taken.’ ” State v. Elliot,
    
    806 N.W.2d 660
    , 668 (Iowa 2011) (quoting State v. Doughty, 
    359 N.W.2d 439
    , 442 (Iowa 1984)). Here, T.H.’s removal for hospitalization and the
    interviews of Karen and Fred Huston all occurred before the DHS’s
    determination that the child abuse allegations were founded.           Boyer
    could have simply testified that she acted in response to a report of child
    abuse to provide the context necessary for this testimony, without telling
    the jury that DHS determined the abuse report to be founded.
    Huston argues any probative value of the fact DHS deemed the
    abuse report against Huston to be founded was substantially outweighed
    by the danger of unfair prejudice. We agree. Even relevant evidence is
    inadmissible “ ‘if its probative value is substantially outweighed by the
    danger of unfair prejudice.’ ” McClure, 613 N.W.2d at 235 (quoting Iowa
    R. Evid. 5.403). Rule 5.403 provides:
    Although relevant, evidence may be excluded if its probative
    value is substantially outweighed by the danger of unfair
    prejudice, confusion of the issues, or misleading the jury, or
    by considerations of undue delay, waste of time, or needless
    presentation of cumulative evidence.
    We employ a two-part test to decide whether evidence should be excluded
    under rule 5.403.   See State v. Cromer, 
    765 N.W.2d 1
    , 8 (Iowa 2009).
    12
    First, we “consider the probative value of the evidence.” Id. Second, we
    balance the probative value “ ‘against the danger of its prejudicial or
    wrongful effect upon the triers of fact.’ ” Id. (quoting State v. Harmon,
    
    238 N.W.2d 139
    , 145 (Iowa 1976)).
    “[T]he purpose of all evidence is to sway the fact finder.” State v.
    Mitchell, 
    633 N.W.2d 295
    , 301 (Iowa 2001) (Neuman, J., dissenting). In
    child abuse cases, much evidence will be “at least somewhat prejudicial.
    Exclusion is required only when evidence is unfairly prejudicial [in a way
    that] substantially outweighs its probative value.” Id. “ ‘Unfair prejudice’
    is the ‘ “undue tendency to suggest decisions on an improper basis,
    commonly though not necessarily, an emotional one.” ’ ” McClure, 613
    N.W.2d at 235 (quoting State v. Plaster, 
    424 N.W.2d 226
    , 231 (Iowa
    1988)).
    We see no probative value to the DHS determination the abuse
    report against Huston was founded.       Whether or not the abuse report
    was deemed founded is irrelevant to any issue for the jury to decide.
    Additionally, we see a real danger the jury will be unfairly influenced by
    that agency finding, which gives the “imprimatur” of a purportedly
    unbiased state agency on a conclusion that Huston was guilty of child
    abuse. A federal court recently applied the same balancing test under
    Federal Rule of Evidence 403 to exclude from evidence a fire department
    report on the cause of a fire.     EMK, Inc. v. Fed. Pac. Elec. Co., 
    677 F. Supp. 2d 334
    , 338 (D. Me. 2010). The court concluded,
    Because . . . the report . . . carries the imprimatur of
    municipal government, the jury could well place undue
    emphasis on its summary causation conclusion on the
    assumption that it reflects the considered opinion of a fire
    investigator, who is cloaked with governmental objectivity
    and expertise.
    Id. We see the same danger here.
    13
    Other courts have recognized the danger a jury will be unfairly
    influenced by an administrative agency finding.              In Rambus, Inc. v.
    Infineon Technologies, AG, 
    222 F.R.D. 101
    , 110 (E.D. Va. 2004), the court
    held that Rule 403 required exclusion of a decision by an administrative
    law judge. The court surveyed the authorities as follows:
    First, the jury, when confronted with the Initial
    Decision, likely would give undue weight to the findings of
    the ALJ. See Martin v. Cavalier Hotel Corp., 
    48 F.3d 1343
    ,
    1358 (4th Cir. 1995) (upholding trial court’s decision under
    Fed. R. Evid. 403 to exclude report of state agency because
    “jury would have placed undue weight on such evidence”)
    (internal citations and quotations omitted); accord Williams
    v. Nashville Network, 
    132 F.3d 1123
    , 1129 (6th Cir. 1997) (“A
    strong argument can made that a jury would attach undue
    weight to this . . . agency determination.”). Similarly, the
    jurors’ ability to reach their own determinations respecting
    the facts at issue in this case would be undermined by the
    admission of the Initial Decision.         United States v.
    MacDonald, 
    688 F.2d 224
    , 230 (4th Cir. 1982) (upholding
    trial court’s decision under Fed. R. Evid. 403 to exclude
    executive branch investigator’s findings and conclusions
    because report “tend[ed] to undermine the exclusive province
    of the jury”); see also Steven P. Grossman & Stephen J.
    Shapiro, The Admission of Government Fact Findings Under
    Federal Rule of Evidence 803(8)(C): Limiting the Dangers of
    Unreliable Hearsay, 38 U. Kan. L. Rev. 767, 778–779 (1990)
    (“Jurors learning that a presumably objective public official
    has reached a certain conclusion after hearing evidence
    similar to what they have heard may have difficulty reaching
    an opposite conclusion.       Further, the jury is likely to
    deliberate on the correctness of the previous fact finding,
    rather than retaining the open-minded, first impression
    approach to the issues our system prefers.”).
    Rambus, Inc., 222 F.R.D. at 110.
    Other courts have applied the Rule 403 balancing test to exclude
    evidence   of   administrative     agency    determinations      in      employment
    discrimination cases.     One such court pointedly observed, “presenting
    the   administrative    findings   with     respect   to   plaintiff’s    charge   of
    discrimination is ‘tantamount to saying “this has already been decided
    and here is the decision.” ’ ” Brom v. Bozell, Jacobs, Kenyon & Eckhardt,
    14
    Inc., 
    867 F. Supp. 686
    , 692 (N.D. Ill. 1994) (quoting Tulloss v. Near N.
    Montessori Sch., Inc., 
    776 F.2d 150
    , 154 (7th Cir. 1985)). The Eighth
    Circuit affirmed the trial court’s ruling to exclude from evidence in a jury
    trial the EEOC’s administrative determination of racial discrimination.
    Johnson v. Yellow Freight Sys., Inc., 
    734 F.2d 1304
    , 1309–10 (8th Cir.
    1984). The Johnson court observed that to allow the agency finding into
    evidence
    would amount to admitting the opinion of an expert witness
    as to what conclusions the jury should draw, even though
    the jury had the opportunity and the ability to draw its own
    conclusions from the evidence presented regarding disparate
    treatment.
    Id. at 1309; see also Jones v. Cargill, Inc., 
    490 F. Supp. 2d 989
    , 992–93
    (N.D. Iowa 2007) (excluding evidence of finding by Cedar Rapids Civil
    Rights Commission of no probable cause as to race discrimination).
    These cases are persuasive. Telling the jury the DHS determined
    the child abuse complaint against Huston was founded was unfairly
    prejudicial due to the risk the jury would substitute the DHS
    determination for its own finding of guilt or would give the determination
    undue weight.
    The State argues the risk of prejudice was mitigated by testimony
    from the DHS caseworker as to the lower burden of proof to establish a
    child abuse complaint as founded by the agency. The district court gave
    no curative or limiting instruction to the jury regarding the DHS
    determination. Other courts have allowed testimony as to administrative
    findings with a curative or limiting instruction. See, e.g., United States v.
    W.R. Grace, 
    455 F. Supp. 2d 1203
    , 1207 (D. Mont. 2006) (allowing
    evidence of EPA environmental risk assessment because the jury is
    capable of “[d]ifferentiating between the different standards” with the
    15
    help of a limiting jury instruction); Commonwealth v. Hernandez, 
    615 A.2d 1337
    , 1341 (Pa. Super. Ct. 1992) (affirming conviction for sexual
    abuse of minor when trial court gave cautionary instruction “that only
    the jury was the factfinder . . . and [that] it ‘must not and may not accept
    any standard adopted by DHS’ ”). We do not believe it would have been
    proper in this case to allow testimony that the child abuse report was
    determined to be founded even with a limiting instruction. In any event,
    we conclude Boyer’s testimony as to the lower burden of proof was
    insufficient to cure the unfair prejudice.
    The risk of unfair prejudice to Huston was exacerbated by further
    testimony as to the right to appeal the DHS determination, followed by
    the district court’s evidentiary ruling preventing testimony as to whether
    Huston appealed. The jury could improperly infer Huston’s guilt from
    the absence of a successful appeal overturning the DHS finding that the
    child abuse complaint against her was founded.
    For all these reasons, we hold the district court abused its
    discretion by allowing the jury to hear testimony the child abuse
    complaint against Huston was founded. Nor are we persuaded the error
    was harmless. Prejudice is presumed, and the State bears the burden of
    showing lack of prejudice.    State v. Howard, ___N.W.2d ___, ___ (Iowa
    2012). The evidence against Huston was strong, but not overwhelming.
    Huston shared responsibility for feeding T.H. with several other
    caregivers.   Huston’s own mobility was limited.     The child–victim had
    problems vomiting in the hospital and with her new foster parents. The
    seriousness of the child’s injury from malnutrition and Huston’s intent
    and role in the victim’s endangerment were disputed issues. We cannot
    conclude the record affirmatively establishes that Huston was not
    16
    prejudiced by the erroneous admission of evidence that the child abuse
    complaint against her was founded. She is entitled to a new trial.
    IV. Conclusion.
    We hold the district court abused its discretion by allowing the
    DHS caseworker to testify the child abuse report against Huston was
    founded.   That evidentiary error was not harmless, and accordingly,
    Huston is entitled to a new trial. We therefore vacate Division II of the
    court of appeals decision and reverse the judgment and sentence of the
    district court. We remand the case for a new trial.
    COURT OF APPEALS DECISION AFFIRMED IN PART AND
    VACATED IN PART; DISTRICT COURT JUDGMENT AND SENTENCE
    REVERSED, AND CASE REMANDED FOR NEW TRIAL.