Opinion filed August 31, 2023

In The

Eleventh Court of Appeals __________

No. 11-22-00089-CR

__________

JAMES HARVEY TROLLINGER, Appellant

V.

THE STATE OF TEXAS, Appellee

On Appeal from the 29th District Court

Palo Pinto County, Texas

Trial Court Cause No. 16940

M E M O R A N D U M O P I N I O N

James Harvey Trollinger, Appellant, challenges his convictions for sexual 

assault of a child and indecency with a child by contact. See TEX. PENAL CODE ANN. 

§ 22.011(a)(2) (West Supp. 2022), § 21.11(a)(1) (West 2019). The jury found 

Appellant guilty of both offenses. For the sexual-assault conviction, the jury 

assessed Appellant’s punishment at fifteen years’ imprisonment in the Institutional 
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Division of the Texas Department of Criminal Justice (TDCJ) and a $5,000 fine. For 

the indecency-with-a-child conviction, the jury assessed Appellant’s punishment at 

twelve years’ imprisonment in TDCJ and a $2,500 fine. The trial court sentenced 

Appellant in accordance with the jury’s verdicts, and, on the State’s motion, ordered 

Appellant’s sentences to run consecutively. Appellant raises two issues for our 

review that relate to the admission of the testimony and written report of a sexual 

assault nurse examiner (SANE). We affirm.

Factual and Procedural History

Appellant lived with K.R. and her family; Appellant was K.R.’s stepfather. In 

early 2018, when K.R. was sixteen, her mother took a job working nights. When 

Appellant was home alone with K.R. he began to touch her inappropriately. As 

Appellant’s actions against K.R. progressed, he would come into K.R.’s room and 

touch her breasts. Appellant continued his abuse by repeatedly contacting K.R.’s 

sexual organ, including digital penetration.

After nine months of escalating abuse, K.R. outcried to her aunt and K.R. 

reported the abuse to the police. K.R. underwent a forensic interview at the 

Children’s Alliance Center. The Mineral Wells Police Department requested that

K.R. undergo a sexual assault examination at Cook Children’s Hospital. Bren 

Ledbetter, a certified SANE, conducted the examination. After discussing with K.R. 

and her mother, K.R.’s medical history and Appellant’s actions, Ledbetter evaluated 

K.R. for injuries and sexually transmitted infections. Following their investigation, 

the police obtained a warrant and arrested Appellant. After waiving his Miranda

rights, Appellant talked with police and eventually confessed that he had touched

K.R. underneath her clothes.

At trial, K.R. testified regarding when the sexual assaults started, where

Appellant touched her, and Appellant’s statements made to her about the assaults.
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Following K.R.’s testimony, the State called Ledbetter as a witness. Appellant 

objected to any testimony by Ledbetter regarding K.R.’s statements to her during the

examination as inadmissible hearsay. The State argued that the statements were 

admissible under Rule 801(e)(1)(B) of the Texas Rules of Evidence to rebut 

Appellant’s challenges to the statements and memory of K.R. and under Rule 803(4) 

as statements reasonably pertinent to medical diagnosis or treatment. Appellant 

argued that the statements were cumulative of K.R.’s other consistent statements 

and, because K.R. underwent an examination at the request of law enforcement, her 

statements to a SANE would not have been made for her diagnosis and medical 

treatment. The trial court overruled Appellant’s objections and granted a running 

objection to testimony from Ledbetter regarding K.R.’s statements to her during the 

examination. During Ledbetter’s testimony, the State offered the SANE report in its 

entirety. Appellant loosely objected to “the hearsay statements that are contained 

within the report.” The trial court overruled this objection as well. On appeal, 

Appellant contends that both of the trial court’s hearsay rulings were an abuse of 

discretion.

Analysis

In Appellant’s first issue, he argues that the trial court erred when it permitted 

Ledbetter to testify as to the statements K.R. made during the sexual assault 

examination. Appellant cites no case law in support of his position.

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1

Appellant provides minimal authority for his assertion that the trial court abused its discretion 

when it overruled Appellant’s objection to Ledbetter’s “hearsay statements made to her from the victim.” 

In fact, Appellant does not cite a single case in his brief to support his argument. Furthermore, Appellant’s 

brief makes no further effort to identify the specific statements at issue. As a result, Appellant’s first 

argument narrowly avoids waiver. See TEX. R. APP. P. 38.1(i). Accordingly, we confine our analysis of 

this issue to Rule 803(4) of the Texas Rules of Evidence.
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We review the trial court’s exclusion of evidence under an abuse of discretion 

standard. Rhomer v. State, 569 S.W.3d 664, 669 (Tex. Crim. App. 2019). A trial 

court abuses its discretion when it acts without reference to any guiding rules and 

principles or when it acts arbitrarily or unreasonably. Id. (citing Montgomery v. 

State, 810 S.W.2d 372, 380 (Tex. Crim. App. 1990)). Therefore, we will uphold a 

trial court’s ruling on admissibility if it is within the “zone of reasonable 

disagreement.” Inthalangsy v. State, 634 S.W.3d 749, 754 (Tex. Crim. App. 2021)

(quoting Powell v. State, 63 S.W.3d 435, 438 (Tex. Crim. App. 2001)).

Hearsay is an out-of-court statement made for the truth of the matter asserted. 

TEX. R. EVID. 801(d). A statement made for medical diagnosis or treatment is 

considered an exception to Rule 802, the rule against hearsay. TEX. R. EVID. 803(4). 

The admissibility of statements under Rule 803(4), depend upon the proponent of 

the evidence showing that (1) the declarant was aware that the statement was made 

for the purposes of medical diagnosis or treatment and that proper diagnosis or 

treatment was dependent upon the veracity of the statement, and (2) the statement 

offered is pertinent to treatment. Taylor v. State, 268 S.W.3d 571, 589, 591 (Tex.

Crim. App. 2008); Prieto v. State, 337 S.W.3d 918, 921 (Tex. App.—Amarillo 2011, 

pet. ref’d).

Here, Ledbetter testified to her education, experience, duties, and 

responsibilities as a SANE. She also testified that, as a part of the sexual assault 

examination process, she asks the parent for a background of the child’s medical 

history. Ledbetter states in her report that K.R. understood that she was “here today 

for a medical exam for the purpose of diagnosis and treatment.” Ledbetter also 

explained the medical purposes of the examination. She stated that, “the reason that 

kids are referred is because we may need to do testing for sexually transmitted 

infections.” She stated that part of the examination “also involves an anal/genital 
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exam . . . to make sure that [there are no] signs of infection or injury or healed injury 

or anything like that.” Ledbetter further testified that children referred to her when

“there’s been skin-to-skin contact between genitals or touching of genitals or oral 

contact . . . may need to be evaluated for injury.” She testified that, “a lot of times 

it’s a healing process for kids . . . knowing that their bodies are okay after what 

happened and what happened to them doesn’t mark them for the rest of their lives.” 

The State confirmed the medical nature of the visit with Ledbetter as follows:

Q. Okay. And so that process you were talking about going through 

with the child and getting medical history from a parent or adult who’s 

with the child and then from the child, is that done for the purpose of 

carrying out that medical diagnosis and treatment?

A. Yes. I’m trying to get as much information as I can so that I know 

what I need to be doing.

Ledbetter’s testimony laid out, in context, the careful and methodical taking 

of the medical history of a patient who has experienced sexual trauma. The 

responses then of K.R. were made for and were reasonably pertinent to her medical 

diagnosis or treatment. See TEX. R. EVID. 803(4)(A). Further, K.R.’s statements

described her relevant “medical history; past or present symptoms or sensations;

their inception; or their general cause” for Ledbetter. Id. R. 803(4)(B). This 

testimony is admissible as an exception to the hearsay rule because it establishes that 

children like K.R. understand that they are offering statements for the purpose of 

medical treatment, and their statements, like those made by K.R. to Ledbetter during 

the examination, are reasonably pertinent to diagnosis or treatment. See Taylor, 268 

S.W.3d at 589 (discussing the tacit presumption that patients understand that medical 

professionals’ “questions are designed to elicit accurate information and that 

veracity will serve their best interest”); see also Sharp v. State, 210 S.W.3d 835, 839

(Tex. App.—Amarillo 2006, no pet.); Beheler v. State, 3 S.W.3d 182, 188–89 (Tex.
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App.—Fort Worth 1999, pet. ref’d); Fleming v. State, 819 S.W.2d 237, 247 (Tex.

App.—Austin 1991, pet. ref’d).

Ledbetter’s subsequent recitation of K.R.’s statements made during her 

examination related to K.R.’s medical diagnosis. These various statements,

transcribed within eight pages of the court reporter’s record, are all statements 

reasonably pertinent to the examination of a trauma patient like K.R. See

Westbrook v. State, No. 10-19-00119-CR, 2021 WL 3773474, at *9–10 (Tex. 

App.—Waco Aug. 25, 2021, pet. ref’d) (mem. op., not designated for publication) 

(concluding that nothing in the record supported the conclusion that the eight-yearold child was unaware that the purpose of the SANE’s questions was to provide 

medical treatment or diagnosis, or was unaware of the necessity to be truthful where 

the child described incidents of sexual abuse after SANE explained who SANE was 

and the purpose of the visit (a medical examination), obtained a medical history from 

the child, and asked the child if she knew why she was there). That K.R. underwent 

a sexual assault examination at the referral of law enforcement does not change the 

medical nature of the examination. See Prieto, 337 S.W.3d at 920 n. 2; Torres v. 

State, 807 S.W.2d 884, 886–87 (Tex. App.—Corpus Christi–Edinburg 1991, pet. 

ref’d). 

Some of our sister courts of appeals have concluded that, consistent with 

Rule 803(4), when a patient gives a verbal history to a SANE or other medical 

professional during a sexual assault examination for the purpose of receiving 

medical treatment, that history is admissible. See Kirkman v. State, No. 01-18-

00978-CR, 2020 WL 2026372, at *3 n.3 (Tex. App.—Houston [1st Dist.] Apr. 28, 

2020, pet. ref’d) (mem. op., not designated for publication); see also Metoyer v. 

State, No. 13-18-00573-CR, 2019 WL 3331634, at *2 (Tex. App.—Corpus Christi–

Edinburg July 25, 2019, pet. ref’d) (mem. op., not designated for publication); 
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Garrett v. State, No. 12-15-00208-CR, 2017 WL 1075710, at *3 (Tex. App.—Tyler 

Mar. 22, 2017, no pet.) (mem. op., not designated for publication); see generally

Beheler v. State, 3 S.W.3d 182, 189 (Tex. App.—Fort Worth 1999, pet. ref’d) 

(noting that the object of a sexual assault examination is to ascertain whether the 

victim has been sexually abused and to determine whether further medical attention 

is needed, and therefore, the victim’s statements describing acts of sexual abuse are 

pertinent to the victim’s medical diagnosis and treatment). The trial court properly 

admitted Ledbetter’s testimony regarding K.R.’s statements to her. Appellant’s first 

issue is overruled.

Appellant’s second issue, that the trial court erred in admitting the SANE 

report itself, is inadequately briefed.2 The Texas Rules of Appellate Procedure 

require an appellant to “state concisely all issues or points presented for review” and 

to make “a clear and concise argument” for each issue raised, “with appropriate 

citations to authorities and to the record.” TEX. R. APP. P. 38.1(f), (i). Rule 38.1(i) 

requires both citations to legal authority and a clear and concise argument for the 

contentions made in the appellant’s substantive analysis in regard to the issues

raised. See TEX. R. APP. P. 38.1(i). Failure to either cite legal authority or advance 

arguments for the contentions made in an appellant’s substantive analysis waives the 

issue on appeal. See Gonzalez v. State, 616 S.W.3d 585, 587 (Tex. Crim. App. 

2020); Wolfe v. State, 509 S.W.3d 325, 343–45 (Tex. Crim. App. 2017); 

Edmondson v. State, 399 S.W.3d 607, 612 (Tex. App.—Eastland 2013, no pet.).

Appellant does not cite any case law or other legal authority in his argument

for his second issue. He does not point out with specificity the objectionable 

2

We reviewed Appellant’s trial objections in an effort to obtain a specific complaint relative to

Appellant’s second issue. The full objection made at trial to the admission of Ledbetter’s twelve-page report

was only: “Your Honor, I’m going to object to the hearsay statements that are contained within the report.”
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statements contained in the twelve-page report. The entirety of his appellate 

argument is reprinted below:

The trial court abused its discretion in overruling Appellant’s objection 

to the hearsay testimony of Nurse Ledbetter [sic] written report. The 

State offered State’s Exhibit 3, the written Physical and Sexual Abuse 

Medical Protocol report of Nurse Ledbetter’s report. Appellant 

objected and the Court overruled the objection. (7 RR 129, 130). No 

exception to the hearsay rule was even offered by the State in support 

of admitting the written report.

His argument, which is devoid of citations to legal authorities and the record, 

is inadequately briefed. See Wolfe, 509 S.W.3d at 345. Appellant also fails to 

address any harm or provide authority that would suggest that the result would have 

been different if the SANE report had been excluded.

3 See Walker v. State, No. 01-

21-00323-CR, 2022 WL 17981670 at *5 (Tex. App.—Houston [1st Dist.] 2022, pet.

ref’d) (admission of outcry witness hearsay regarding the sexual assault of a child is 

subject to a harm analysis and, without same, appellant therefore inadequately 

briefed the erroneous admission of hearsay evidence issue). We are not obligated to 

make Appellant’s arguments for him. See Mendoza v. State, No. 11-15-00232-CR, 

2017 WL 4545280, at *7 (Tex. App.—Eastland Oct. 12, 2017, pet. ref’d) (mem. op., 

not designated for publication).

We note that the appellant in Westbrook v. State also argued that the trial court 

erred in admitting the testimony of the SANE nurse regarding her report and in 

admitting the report itself. Westbrook v. State, No. 10-19-00119-CR, 2021 WL 

3773474, at *7 (Tex. App.—Waco Aug. 25, 2021, pet. ref’d) (mem. op., not 

designated for publication). The court in Westbrook held that the trial court did not 

abuse its discretion in admitting the report. Id. at *10. In light of the fact that the 

3

We note that Appellant does not include any briefing or argument regarding harm with regard to

to his first appellate issue either.
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basis of the contents of the SANE report had already been testified to by Ledbetter,

the information therein being obtained as “a part of [her] regularly conducted

business activities in the CARE Team,” trial counsel’s overbroad objection, and 

Appellant’s inadequate briefing on the issue before us, we agree with the court’s 

reasoning in Westbrook and hold that the trial court did not abuse its discretion when 

it admitted the SANE report. Appellant’s second issue is overruled.

This Court’s Ruling

We affirm the judgment of the trial court. 

W. BRUCE WILLIAMS

JUSTICE

August 31, 2023

Do not publish. See TEX. R. APP. P. 47.2(b).

Panel consists of: Bailey, C.J., 

Trotter, J., and Williams, J.