### NUM BER 13-05- 457- CR 

## COURT OF A PP EA LS T H I R T E E N T H D I S T R I C T O F T E X AS C OR P U S C H R I S T I - E D I N B U R G
JEA NIN E H A NN A H, A pp ellan t,
v . TH E STA

TE OF T EXAS, A pp ellee.
On ap pe al f rom th e 9 3rd Dist rict C ou rt o f H ida lgo C ou nty , T exas .



## ME MOR A ND UM OP IN ION Be fo re Ju stice s Y añ ez, R od rigu ez, an d Be na v ide s M emo rand um Opin ion b y Ju stice B en av ide s Ma rg a re tB ra d le y d ie d f ro m a n in s u li n o ve rd o s e o n Ma y 3 0 , 2 0 0 2

. Ata ge si xt yeig ht, w hil e Bradl ey

su ff er ed from s ev eral maladi es— she w as confine d to a w heel chai r due to pa rt ial paraly si s and suffered from mult ipl e sc lerosi s— she w as not dia beti c. The St ate of Tex as charg ed appel lan t, Jeani ne H annah, w it h c ausi ng Bradl ey 's deat h by i nje cti ng her
w it h a mass iv e amountof ins uli n. See T EX
. P EN AL C OD E A NN
. § 19 .02 (b) (Vernon 2 003 ). A jur y conv ic ted Han nah, and the tr ial cour t ass ess ed a nin ety -n ine y ear se ntenc e. Id. §2

12.32( a) ( Ver non 200 3)

. Han nah now appeal s, arg uin g that( 1) the tr ial co urt abu sed it s discretion b y a ll owi ng the Sta te to presen t evi den ce of extrane ous b ad a cts to w hich Han nah w as li nked; (2 ) the e v ide nce suppo rt ing her co nv ic ti on i s l eg all y

i nsuffici ent; and ( 3) t he e v i de nc e s up po rti ng h er c on v i c ti on i s fac tu al l y

i ns uffi c i en t. W e affi r m. I. Back ground Hann ah's trial too k place bet w een May 16th and May

27th in 2005 . Ov er the co urse of eig ht da y s a nd approx imat ely tw enty w it ness es, the follo w ing nar ra ti v e emerg ed. A . Bradley 's Dea th In ea rl y 2002, Bradl ey

w as li v ing i n M cAl len , Tex as, w it h her daught er , Rhonda, and Rho nda' s c ommon-l aw hus band, Mi chael N eig er
. Beca use o f h e r inf ir miti es, Bradl ey needed domest icas si sta nce. R honda h ired Kel ly H eal th C ar e, I nc. ( "Kel ly H eal th") to prov ide a c ar etak er
. In F ebr uar y of 2002, Kel ly

H ealth s ent a reg is tered nurse, Je ani ne Han nah, to ass is t Bradl ey
. H annah v is it ed Bradl ey tw ic e a d ay , onc e i n the mor nin g and
o n ce in th e afte rn o o n , t o he lp Bra d le y w it h rou ti n e ta sk s su ch as fe e d in g an d ba th i n g. Medicare covered the morn ing v isits, and Bradley paid Hann ah for the a f terno on visi ts v ia perso nal che ck. Altho ugh Bradle y

nee ded Hanna h's help w ith som e thin gs, she did notnee d he lp tak ing her

medi cat ion

. Bradl ey

took medi cat ion for her many ail ments, but she took them on her ow n. The medic ine s hung from a bag on the handl e of B ra dle y 's sc ooter w here s he coul d ac ces s t hem eas il y . Ins uli n w as not a mong her medi ci nes. In f a ct , n o n e of her medic ine s w er e tak en by i nje cti on as i nsul in is g enerall y tak en. Bradl ey di d, ho w ev er , l ik e to re cei v e oc cas ion al inj ect ion s of v it amin B- 12. Becau se she trust ed Hann ah's crede ntials as a registered nurse, sh e aske d Hann ah to inject her.T he doct or s f i r st l i st ed seconda r y adr enal i nsuff i ci ency as t he cause of deat h. As w e e x pl ai n, 1 h o w e v e r, th e c a u s e o f d e a th w a s l a te r c h a n g e d to a n e x o g e n o u s i n s u l i n o v e rd o s e
. S ee infr a P a r t I , C. 3 The B- 12 s y ri ng es, w hic h Bradl ey stored under the b athroom si nk, w er e much l arg er than
ordin ar y i nsul in sy ri ng es. Bradl ey ’s daug hter, R h onda, w as a reg is tered nurse, and she testif ied th at th e sy ringes could ho ld app rox ima tely three time s t h e i n sulin do sage for a nor mal dia beti c p erson. On M ay 29, 2002, Mi chael re tur ned home from w or k at about 5:40 p.m. a nd found Bradle y non -res p o n s iv e, m um bling, and "look[ ing] real clamm y and dazed." He also noti ced that her

m obi li ty w as re str ic ted b ecaus e s he w as str ug g li ng to g ra sp a c up th at s he
ordin ar il y

g ra sped easi ly

. Mi chael ca ll ed R honda a t w or k t o al ert h e r, reason ing that becau se Rho nda w as a nurse at McAl len Hea rt Hos pit al, she "had more know led g e" about such th ings. Acc ordin g to Rho nda' s t est imony and cel l phone rec ords, sh e had already sp oken to he r mother

ov er the phone a t 3: 35 p.m. that day and to Han nah at 3: 36 p. m. H ospi tal employ ment records and a sto re recei pt s how thatR honda c loc ked out o f w or k a t 3: 23 p
. m
. thataf

terno on a nd m ade a purcha se at th e J.C. Pen ney store at La Plaza M all in sout h M cAl len

. She re tur ned to w or k at 4:20 p.m., and s he recei v ed th e phone ca ll from M i c ha el a bo utB r ad l ey ' s c on di ti on a t 5: 43 p .m
. Rho nda r ushed home an d s at w it h her mother for a b o u t forty

min utes

. She g re w c on c er ne d ab ou t Brad l ey ' s de te r i orat i ng c on di ti on an d c al l ed a n am bu l an c e at6 :2 6 p. m. The ambul ance crew

co n d u ct e d b loo d tes ts and det er mined that Bradl ey w as sufferin g from unus ual ly

l ow blo od- sug ar lev els

. At the hospi tal , her blo od- sug ar lev els fluc tuate d fo r t h e n e xttwe n t y-fo u r h o u rs , a n d d o c t o rs co u ld n o td e t e rm in e t h e c a u s e o f t h e in s t a b il it y. Sh e di e d th e fo llo wing e ven in g. 1Br adl ey had t wo such st am ps whi ch she nor m al l y kept i n he r m edi ci ne b ag. Rhonda t est i f i ed t hat 2 one oft hem was m i ssi ng. 4 B. Bradl ey 's C heck s At t he ti me of her

deat h, B ra dle y

had acc ounts at tw o bank s, W ell s F arg o and Tex as St a te Bank. W hen R honda w ent t o the bank s t o s ee how much money

Bradl ey had for funeral ex pense s, she noti ced dis crepanc ies betw een t he ledg ers in Bradl ey 's ch eck book and the ba nk's records. T his prom pte d he r to i nvestigate recentactiv ity in both accou nts, and she un covered som e un usua l transactio ns. Fi rs t, Bradl ey 's l edg er

l is te d c h e ck #5038 as hav ing been w ri tten for $566 for g ro cer ies , butac cordin g to the b ank, the chec k h ad ac tual ly been w ri tten to AIG Ins urance. Rho nda di sc ov er ed th at t he chec k pai d for an aut o i nsurance pol icy for W il li am and A loh a S h u e ll o f Mi s s io n , T e xa s
. Ha n n a h wa s a co ve re d d ri ve r o n t h e p o li c y. Seco nd, R honda found c heck #5051 in her

mother 's p a p e r shredder

. W hen s he taped itbac k t og ether , s he not ic ed that it w as a v oid ed chec k for $160 w ri tten to H annah and s tamped w it h Bradl ey 's sign a tu re st amp. Rho nda l ater di sc ov er ed th at t he $160 2 chec k h ad been v oid ed w hen H annah t ri ed to ca sh it

. T w o em ployees of

Coasta l Bank, Yadira Reyna, a teller who received the check, and Sa ndra Vec chi o, he r super v is or , t est ified thatH annah h ad c ome throug h the dr iv e- throug h in May

2002 seek ing to cas h w hat appeared to be an al tered c heck w ri tten on Bradl ey 's W ell s F arg o ac count

. Or ig ina ll y , the chec k had been w ri tten for $60, but t he number "1" ha d been added i n a d ifferent col or ed i nk, al ter ing the chec k to read "$16 0." On th e instructio n of

Vecchio , Rey na voide d i t

. Reyna recalled Hanna h be com ing v ery upsetaboutthe bank’ s refusal to cash the chec k and insi sti ng that i t w as Bradl ey w ho had altere d the num ber.5

T hird, che ck # 502 9 had b een liste d in Bradle y 's ledger as w ritten to Rhond a's sister, Paul a Tv eit

. Tv eittes ti fied th at he r mother often s ent h er

ch e ck s o f

b etw een $50 and $100. She sta ted t hat B ra dle y recent ly promis ed to se nd a chec k, but she nev er recei v ed it

. Rho nda dis cov er ed that check #5029 w as actu all y

cashed by

H annah for

$1,3 00, a nd Han nah' s n ame i s w ri tten ov er Tv eit 's name on the chec k. Tv eitfurth er tes ti fied th at he r mother w oul d nothav e sent her $1,300, and a $300 chec k w as far more l ik ely

. The $1,300 chec k and tw o other chec ks —a $21.59 re fund from Southw est er n Bel l a n d a $ 4 1 2 .82 annui ty from Al ls tate—

w er e al l depos it ed in Han nah' s bank acc ount on Ma y 31, 2002, the day after Bradl ey 's deat h. A Tex as Stat e Banktel ler , An it a M unoz , t est ified at tr ial thatsh e k new H annah t o be a regular bank custo me r a n d t h a t s h e no ticed o n May 31, 200 2 tha t a $1, 300 check Han nah s oug ht to cash had been altered. Mu nozw as rel uct ant to cash the chec k, but she sai d H annah i nsi ste d tha t she at lea st depos it it , and "charg e itto her [H annahs 's ] ac count " if any probl ems arose. M unoztes ti fied th at he r super iors at the bank w er e "furi ous" about the i nci dent and t hat s he near ly l osther j ob ov er i t. Fi nal ly , R honda w as per ple x ed to see that a bal ance of onl y $200 re mained i n her mother 's Tex as Stat e Bank ac countdue to s ix re centATM w it hdraw als rang ing from $20 0 to $3 00. Acc ordin g to Rho nda, thi s w as odd bec ause Bradl ey di d nothav e the abi li ty to
use an ATM herself

. Mo re ov er , s he had tradi ti onal ly onl y w anted about $50 i n c ash per month, w hic h s he us ed to pl ay bi ng o. Al l of these dubi ous transac ti ons caus ed R honda to remember that approx imat ely one month before her death, Bradl ey had c omplai ned t hat Hann ah a sked to o ma ny f inan cial q uest ions an d w ant ed to w rite checks on Bradley's behal f.A c -p e p ti d e te s t re v e a l s h o w m u c h n a tu ra l l y -p ro d u c e d i n s u l i n s h o u l d b e i n th e b o d y . See W e b
- MD, 3 D iabet es Heal t h Cent er , a v a i l a b l e a t h ttp :// d i a b e te s .w e b m d .c o m /c -p e p ti d e (L a s t V i s i te d A u g . 5 , 2 0 0 8 ).

6 C. Bradl ey 's I nsu lin L ev els Rho nda t est if ie d thather su spi ci ons w er e ov er

w hel ming at thi s p oin t. She ask ed Lui s P adul a, M .D ., to ex amine lab re sul ts from a c -p epti de te st g iv en to Bradl ey dur ing her stay at the ho spital, th e results of wh ic h we re n ot received un til af ter Bradle y 's fu nera l. 3 Dr . Pa dul a t o l d h e r t h a t t h e t e s t i n d i c a t e d t h a t B r a d l e y , a t t h e t i me o f h e r d e a t h , had a mass iv e ex ces s of ins uli n in her b ody

. Fur ther more, the c- pepti de te st conc lus iv ely r ule d outboth pan creatic can cer and end ogeno us hyperinsulinsim . Dr . Pad ula f urthe r told Rho nda, and l ater

tes ti fied i n c our

t, that alt houg h he coul d notdete rmine h o w m uch or
w hat ty pe of i nsul in had been inj ect ed, i t w as cl ear thatthe amount w as v ast ly g re ater than
w ould be ne cessary to treat an y patie nt, e v en a diabe tic. These op ini ons w er e ec hoed by Mer cy Bay ot- Mo or e, M.D ., an endocr ino log is t w ho
ex amined Bradl ey 's i nsul in lev els before her deat h and obser

v ed th at B ra dle y

had an insulin read ing of

4 00, well ab ove th e norm al read ing of aroun d 27 . Th e att end ing doctors then filed an a mended dea th c erti ficat e, l is ti ng Bradl ey 's ca use of death as an ex og enous ins uli n ov erdose. Rho nda not ified the pol ic e aboutthes e dev elo pments on J u n e 6 th , butby then , Bra d le y's funeral had already tak en pl ace, and she had bee n c re mated. In 2004, tw o-an d-a -h a lf

ye a rs a f t e r B ra d le y' s d e a t h , Ha n n a h wa s a rr e s t e d a n d in d ic t e d fo r know ingly
a n d in t e n t io n a ll y ca u s in g d e a t h a n d se ri o u s b o d il y in ju ry t o B ra d le y. D. Han nah ’s Hi st or y At Hanna h's tri al, testi mony rev eal ed th at be fore s he ar ri v ed i n M cAl len to w or k for Kel ly Heal th, Han nah had an unusu al emplo y ment his tor y , charact er iz ed by

ch ang ing j obs7

freq uentl y , us ing al ias es (s he has been know n at di f ferent ti mes as Je ani ne H annah, Jean nie Miata, and Julie Kocian ), and b ein g c o n n ecte d to a su spicious—p ossibly
cr imi nal —i nci dent in Oreg on. W e disc uss this hist or y herein , bec ause Han nah obj ect ed to t he foll ow ing tes ti mony under Tex as Ru le s o f

E vi dence 104, 404( b) , and 403 and beca use th e evidentia ry relev ance of

the histo ry

is the principal issue on ap pea l. Fi rs t, Troy a Brow n, an Oreg on resi dent, tes ti fied th at H annah w or ked w it h her at a
re hab ili ta ti on faci li ty

i n Beav erton, Oreg on, i n 2001. Atthatti me, ac cordin g to Brow n, Han nah w as know n as Jeanni e Mi ata. Brow n tes ti fied abou t an inc ide nt t hat o cc ur re d on September

10, 2000. On that day , s he c ame to w or k a t 6 :3 0 a.m. and encou ntered Hann ah co mp leting her night shif t and mo nitoring an eld erly patie nt na me d Ann e Jon es. Hann ah a sked Bro w n, in an unu suallyadamantfashi on, n ot t o w alk int o J ones' s room to check o n he r becau se the patie nt ha d "h ad a rough night." Brown foun d he r co-w orker's ins is tenc e to be odd, and she ig nore d the r eq uest

. Han nah foll ow ed Brow n i nto t he pati ent' s room and beg an i nsi sti ng t hat B ro w n v er ify the ins uli n amountw hic h s he had admini ste re d to Jones

. Brow n tes ti fied th at s he found th is to be odd behav ior al so. Jani ce Nez beda, the n ursi ng di re cto r at t he Beavert o n f aci li ty , w ho al so knew Han nah as Je anni e M iat a at the t ime, ar ri v ed th at da y at 9:00 a.m. She found Jones
uncon sc iou s i n her ro om and w it h a v er y low blo od- sug ar lev el of 13

. She tes ti fied that a norm al readin g w ould have been bet we e n 60 an d 80 . Moreover, j ust two hours b e fo re h a n d , Jo n e s ' s b lo o d -s u ga r l e ve ls h a d b e e n a t1 0 0

. Jo n e s d ie d la t e r t h a td a y. Jones appeared to hav e s ig ned a "do notre su sc itate" for m ( "DN R") , butJa mes Green, an ex per

t in for ensi c documentex aminat ion , testi fied that he did not bel iev e tha t Jones ’s D NRhad act ual ly been si g ned by

Jo nes. In f act , he compl etel y ex cl uded t he8

possib ility . Green also ex am ined Hanna h's han dwr iting, and he a pplied a sy stem in w hich the l ik eli hood of forg er

y i s a ss ig ned a number

on a one- to- nin e sc ale , w it h ni ne bei ng the most li kel y . On t h is scale , G re en te sti fied th at t he l ik eli hood t hat H annah h ad forg ed Jones 's si g nature on the D NRw as a s ev en. Jones 's daug hter , M ar

jor ie W ool iv er , testi fied th at after Jo nes' s d eath, a di amond ri ng w as mis si ng from her f in ger
. Nurses and others w ho had atten ded t o J ones re membered the ri ng , but they did not know w hat happened to i t. W ool iv er doubt ed th at the r ing w oul d s impl y

hav e sl ipp ed off becau se Jones 's fing ers h ad bec ome sw oll en w it h illne ss , m a ki ng the ri ng v er y di ff ic ultto re mov e. Nez beda an nounc ed th at s he w oul d be laun ching an investigation into th e l o s s o f the ring, but two days later—b efore the police
w er e not ified —th e r ing appeare d i n N e zbeda 's off ic e mai lbo x . It w as pla ced in an env elo pe and left anony mousl y . No charg es w er e filed ov er the br ief di sappe arance of the rin g. After thi s i nci dent, H annah mov ed to Tex as a n d t o o k a j o b i n the ci ty of Mi ss ion und er the n am e "Ju lie Kocian ." At trial, Minerv a Ruiz , the dire c t o r o f Missi on Hosp ital, ide nti fied Hannah as the reg is tered nurs e w ho w or ked at the hospi tal under t hat n ame from June to S eptember

of 2001. Rui zg av e s peci fic t est imony aboutthe par

ti cul ars o f ins uli n. She tes ti fied th at i t c an re main eff ect iv e for sev er al months , and i t doe s n ot ha v e an ex pirati on dat e of ju st a matt er of days, "like milk." Ruizt estif ied tha t Hann ah was know ledgeab le abo ut th ese p articulars and had ac ces s t o the hos pit al' s ins uli n cac he. H annah w or ked in an area of the hospi tal
w here ov er seventy percen t of the pa tient s w ere in ne ed o f regular i nsulin inje ctions. Mission Hospital, Ruiz ex plaine d, kep t its insulin stored in a locked ref rig e ra t or to w hich9

Han nah and al l the o th e r nurses had a k ey
. Acc ordin g to Rui z , t here i s n o ac count ing
s y s t e m fo r t h e i n s u l i n , a n d i f s o me o f i t w e r e mi s s i n g o r s t o l e n , i t w o u l d b e d i ffi cul t t o detec t. Rui ztes ti fied th at H annah left the hospi tal due to a w or k- re lat ed i nju ry
. It w as after le a vin g Mi s s io n Ho s p it a l t h a tH a n n a h j o in e d K e ll y He a lt h a n d b e ga n wo rk in g wit h B ra d le y. E. Han nah 's D ef

ense St rat egi es Han nah app ears to hav e had tw o defensi v e strateg ies at tr ial

. Fi rs t, she q uest ion ed
w hether an i nsul in ov erdose w as the tru e cause of Bradl ey 's death. Secon d, s he s oug ht to rais e reason abl e d oubt by su g g est ing thatBradl ey 's daug hter , R honda, had t he oppor tuni ty and the mot iv e t o k ill B radley by i nje cti ng her

w it h ex og enous i nsul in. F or ex ample, dur ing R honda' s c ro ss -e x aminat ion , H annah' s defense couns el led Rho nda t o tes ti fy that , as a nurse, sh e had re g ula r acc ess to ins uli n and, i n fact, sh e had once broug ht insulin ho me f rom th e ho spital: Q: At your place of

emp loymenty ou h ave access—as a registered nu rse y ou hav e ac ces s t o i nsul in? A: Yes, sir

. Q: And , in fact, do y ou recall back on June 30t h, 2002 w hen y ou sp oke to Dete ctiv e Ralph Ramirez— A: Yes, sir

. Q:

—th ata pp rox i ma te l y fi v e y ea rs a g o y ou h ad a c c i de nt al l y t ak en s om e ins uli n home? D o y ou recal l that? A: Yes, sir

.

. . . . A: I retur ned t he medi cat ion to the hospi tal , and I threw it in the t ra sh— Q : O k a y.10

A: —b e ca u se it h a d be e n ou t o f th e ref rige ra to r fo r so lo n g. Q: Oka y . Do y ou hav e a re col lec ti on as to w hy y ou w oul d hav e had that ins uli n, ag ain bac k fiv e y ears a g o, an d mi sta kenl y tak en i t home? A: I had admi nis tered i t t o a p ati ent a nd putit in mypocketin a hur ry and jus t nev er

ch eck ed my

poc ket s b efore I l eft home. Af ter this question ing, Hanna h's coun sel asked Rh o nda w hy, during her direct examina tion, she felt the n eed t o of fer t ime reco rds f rom McAllen Heart Hospita l and a J.C. Penney recei pt t o prov e her w hereabouts on the apparent afternoo n of Brad ley 's ov erdose. Rhon da rep lied tha t af

ter spea king w ith the d ete ctiv e w ho w as investig ating the dea th, it beca me a "con cern" o f h ers to provide evi den ce of her w here abo uts. Finally, H ann ah's defense c ounse l forced R honda t o di sc los e tha t s he w as a "compul si v e g ambler " and t hat, in the p ast , Bradl ey had hel ped Rho nda pay off g ambli ng debt s. R honda a ls o tes ti fied th at Bradle y had borrow ed $ 10, 000 on a credit ca rd to he lp Rhon da p urcha se a car. At t he c oncl usi on of the tr ial , H ann a h wa s f o und g uil ty of ki ll ing Bradl ey

and sent ence d to nin ety-nine y ears in prison. She no w app eals. II. St and ard s o f Rev iew T he f irst issue in this case, comp rised of three su b-issues, conce rns the trial cou rt's
ru li ng on t he admi ss ibi li ty of ev ide nce; su ch is sues are rev iew ed for abuse of dis creti on. Sauc eda v. S tate, 129 S.W .3d 116, 120 (Tex

. Cr im. App. 2004)

. “The tr ial cour t abu ses it s d is creti on w hen t he dec is ion l ies outs ide the z one of reason abl e di sag re eme n t.” Mc Car ty v. State, N o. P D- 1139- 07, 2 008 W L 251281 8 , at *1 (Tex . C ri m. App. Ju ne 25, 2 0 0 8 ) (ci ti n g Can tu v

. St ate , 842 S.W .2d 6 67, 6 82 ( Tex . C ri m. App. 1992) ). The tw o remaini ng i ss ues conc er n s uff ic ien cy of the ev ide nce. To ass ess w hether the e v ide nce suppo rt ing a v erdic t is leg all y suffici ent, w e cons ide r all the ev ide nce in the11

record in the lig ht m ost favorable to th e jury v erdict an d de term ine w het her a ration al jury could have fo und the de fend antg uilty of all the elem ent s of

the crime beyond a rea sona ble doubt. Hoop e r v. State , 2 1 4 S. W .3 d 9, 13 (T e x. Crim . A p p . 2 0 0 7 ) (ci ti n g Jackson v. Virginia , 443 U .S. 307, 318- 19 ( 1979) ); S we a r i n g e n v . Sta te , 1 0 1 S

. W

. 3 d 8 9 , 9 5 (T e x. Cr im. App. 2003)

. “I n rev iew ing the suffici ency of the e v ide nce, w e shoul d l ook at ‘ ev ents
occ ur ri ng before, dur ing and after the c ommis si on of the off ense and mayrely on a cti ons of the defendant w hic h s how an u ndersta ndi ng and common de si g n to do th e prohi bit ed act.’” Hooper

, 2 1 4 S .W .3 d at13 (quo ti n g Cor dova v. State , 6 9 8 S

. W

. 2 d 1 0 7 , 1 1 1 (T e x. Cr im. App.19 85) ). W hil e e a ch f a ct maynot poi nt di re ctl y and ind ependent ly

to the appel lan t’ s g uil t, w e may aff ir m “ as lon g as the cumul ati v e forc e of al l the i ncr imi nati ng circumsta nces is suf

f icient to supp ort the conviction.” Id. Ci rc umstan ti al ev ide nce alo ne maybe e noug h to est abl is h g uil t. Id. To ass ess w hether the ev ide nce behi nd a v erdic t i s fact ual ly su ff ic ien t, w e rev iew the e v i d e n c e i n a n e u t r a l l i g h t t o d e t e r mi n e w h e t h e r ( 1 ) t h e e v i d e n c e i s s o w e a k a s t o re n d e r the jury

v erdict clearly w rong and m anif estly unju st or (2) w het her the ev iden ce suppo rt ing the v erdic t i s s o outw eig hed by the g rea t weigh t and preponderance of the cont ra ry ev ide nce as to render the verd ic t c lea rl y

w ro ng and manifest ly

unj ust

. Grotti v. State , N o. P D- 134- 07, 2 008 Tex . C ri m. App. LEXI S 761, at *22- 23 ( Tex . C ri m. App. Ju ne 25, 2008)

. W e must show great deferenc e to a j ur y v erdic t. W

ats on v . St ate , 204 S.W .3d 404, 417 ( Tex . C ri m. Ap p
. 2 0 0 6 ). "An appel lat e c our t j udg e c annot conc lud e tha t a
conv ic ti on i s ‘ cl ear ly

w ro ng ’ or

‘ manifest ly

unj ust ’ si mply

bec a u se, on t he q uantum o f
ev ide nce admit ted, h e wo u ld h av e v oted to ac q uithad he been on t he j ur y . Nor ca n an app ellate court judge de clare tha t a conf lict in the evidence justif ie s a new trial simply12

becau se he di sag re es w it h the j ur y 's resol uti on of thatco nflic t." Id. at 41 7. III . Adm issib ili ty

o f Ext ran eou s Of

fe nse Ev id ence It is a fundamental pr inci p le of l aw i n al l Eng li sh- speak ing j ur is dic ti ons that defendants must onl y

be t ri ed for the c ri mes for w hic h theyhav e been charg ed, n ot ot her dis conne cte d c ri mes. Tur ner v. Sta te , 754 S.W .2d 668, 671 ( Tex . C ri m. App. 1988) ( ci ti ng Young v. State , 261 S.W 2d 836, 837 (Tex . C ri m. App. 1953) ). Therefor e, to av oid undue pr eju dic e to defendants, the ci rc umstan ces under w hic h w e per mit ev ide nce of extraneous of f e n se s a t tria l ar e l imi ted. See T EX
. R. E V ID
. 404( b) ( li sti ng j ust ific ati ons for per mitt ing
extraneous offense ev ide nce) ; see als o T am ez v. Sta te , 4 8 S

. W

. 3 d 2 9 5 , 2 9 6 (T e x. App .–S an An ton io 200 1, no p e t

. ) (ho lding that pro hibition on use of extrane ous o f

fense e vide n ce is a “ba sicte n e t o f ou r cri m in a l j u s t i c e s yste m ”) (qu o ti n g Sm it h v . St ate , 12 S.W .3d 149 , 152 (Tex. App. –El Pa so 20 00, pet. ref ’d)). Han nah arg ues that the j ur y heard ev ide nce of tw o pr ior of fenses for w hic h s he w as not c harg ed or

co nv ic ted: (1 ) theft of i nsul in from Mi ss ion Hos pit al; and (2 ) Jones ’s deat h by i nsul in ov erdose and t he appa re nt t heft of her ri ng i n Orego n
. She arg ues that the admis si on of thi s ev ide nce v iol ated Tex as Rul es of Ev ide nce 104, 404( b) , and 403. T EX
. R. E V ID
. 104 , 404 (b), 403 . W e mu st assess whethe r the trial co urt abu sed its d iscretion in adm itti ng thi s e v ide nce. To do thi s, w e need to de ter mine w hether ( 1) the Stat e prov ed tha t Hann ah's involv em entin the extraneo us of fense s w as prob able beyond a rea sona ble doubt, id. at R . 104 ; ( 2) the ev ide nce w as proper ly admi tted under

an e x cept ion to the g eneral prohi bit ion ag ain st ev ide nce of extraneous bad act s, id. at R

. 404( b) ; and ( 3) the probati v e v alu e of t he ev ide nce outw eig hed the unfair preju dic e to Han nah. Id. at R. 403. A . Texa s Rule of Ev idence 104 (b)13

For ev ide nce of Han nah' s extraneous of fenses to be per mitt ed attr ial , t he St ate w as re q uired to demons trate bey ond a re asona ble doubtthatH annah h ad c ommitt ed th e off enses
. See i

d. at R. 104( b) ( "W hen t he rele v ancy o f e vide n ce depends upon the fulfill ment of a condi ti on of fact , the cour t shal l admiti t upo n, or

su bje ct to, the i ntroduct ion of ev iden ce s uff ic ien t t o s uppor t a findi ng of the ful fill ment of the condi ti on.") ; Ex par te Var ela s , 45 S. W .3d 627 , 630 -31 (Te x . Crim. App . 200 1). I n this case, t he Sta te me t this
re q uirement. 1. A Reasona ble Jury

could hav e Determine d Bey ond a Reasonable Doubt th atH ann ah had K no w led ge of an d Access t o In sul in atM issio n Ho spi ta l. Hann ah arg ues that the trial court erred in adm itting ev iden ce tha t she sto le insulin from M is si on H ospi tal bec ause there w as no ev ide nce t h at s he admi nis tered i nsul in to pati ents there or

thati nsul in had ev er

been mis si ng from t he hos pit al. W e di sag re e. It is tr ue th at no di re ct ev ide nce w as pr esent ed th at H annah h ad s tol en i nsul in from Mi ss ion H ospi tal , butthe is sue in thi s c ase is w hether a reason abl e j ur

y co uld hav e found tha t she had know ledge of insulin and access to i t w ithin a reaso nab le t im e b e f o re Bradl ey 's deat h. The evide n ce o n thi s p oin t i s s tar k. H annah h ad a key to a l ock ed
me d icati on room. Rui ztes ti fied th at H annah h ad "w or ki ng kn ow led g e" of in sul in and i ts ef fe c t s
. Ha n n a h w orked in an area w here ov er seventy perce nt of the pa tient s w ere in need of reg ula r ins uli n i nje cti ons. A jur y co uld hav e found bey ond a reason abl e doubtthat she had ac ces s t o i nsul in and k now led g e of it s u se. 2. A R easo nab le Ju ry

co ul d hav e D et erm in ed th atH ann ah w as C ul pab le i n Jones 's Dea th and t he Theft of her Ring The ev ide nce pr esent ed of H annah' s l ink to Jones 's deat h and th e t h e ft of her ri ng —te sti mony

by fiv e w it ness es—

w as subs tanti al. To beg in, tw o w it ness es, Brow n and14

Nez beda, from Be av erton R ehabi li tati on i n Oreg on te sti fied that Han nah w as the w oman
w it h w hom they

onc e w orke d and w ho th ey kn ew as Je anni e M iat a. Their tes ti mony re v eal ed th at H annah b ehav ed i n an aw kw ard and sus pic iou s mann er on the mor nin g of Septem b e r

1 0 t h , w h e n s h e u rg e d B ro w n t o s t a y a w a y fro m J o n e s
. B ro w n a l s o tes ti fied that she found itodd that Ha nnah w oul d req uestv er ific ati on of the ins uli n dos ag e s he had admini ste re d to Jones , but n ot v er ific ati on for her othe r pati ents

. In fact , Brow n tes ti fied that itw as odd th at H annah w oul d ev en be pr esenti n the rehabi li tati on faci li ty , g iv en th at her sh ift had al re ady

ended. Brow n and Nez beda both ex pla ine d that lat er thatday , and
soon af ter exhibiting an e xt re m ely low blood -sugar l evel, Jones die d f rom a n insulin
ov erdose. Jones 's D NRhad been si g ned, but Gre en, a forens icdoc ument ex aminer , t est ified that he di d n o tb e l i e v e t h a tJ o n e s ' s s i g n a t u r e w a s o n t h e d o c u me n t

. H e fu rt h e r t e s t i fied that, after

he rev iew e d H a n n a h's handw ri ti ng , he bel iev ed i t w as "probabl e" tha t t he si g nature w as Han nah' s. H e as si g ned t he preci se pro b a b ili ty that Han nah had forg ed Jone s ' s s i g n a t u r e a s a " s e v e n " o n a o n e - t o - n i n e s c a l e ( o n e b e i n g l e a s t l i k e l y , and ni ne bein g mo st likely ). Fi nal ly , ev ide nce w as pr esent ed t h a t a d i a mo nd r ing di sappe ar ed from J ones' s h and and w as lat er

anony mousl y re tur ned onl y after the faci li ty di re cto r threatened to re fer th e inc ide nt t o the pol ic e. After the i nci dent, H annah l eft Oreg on and chang ed her name. W e bel iev e thi s e v ide nce, cu mulat iv ely , co u ld hav e l ed a re asona ble j ur y to conclu de b eyond a rea sona ble d o u b t t h a t Hann ah was culpable in this inciden t. A jury could infer thatHanna h mo st likely killed Jone s by injecting her w ith an ov erdo se of insulin and t hen ex pedi ted h er pl an by forg ing Jo nes' s s ig nature on the DN R and urg ing othe r15

nurses to sta y

aw ay
. See Hooper

, 214 S.W .3d a t 13 (p er mitt ing i nferenc es by j ur ies as lo n g a s e a c h in fe re n c e is s u p p o rt e d b y t h e e vid e n c e a tt ri a l)

. A r e a s o n a b le ju ry c o u ld h a ve further i nferr e d t h at H annah s tol e the di amond r ing but became w or ri ed w hen N ez beda
announc ed an inv est ig ati on and furti v ely repl aced the r ing

. Id. B. Rule 404 (b) Al thoug h the extraneous o f f ense ev ide nce ag ain st Han nah met the req uirements of rul e 1 0 4 ( b ) , i t mu s t a l s o me e t t h e r e q u i r e me n t s o f r u l e 4 0 4 ( b ) o r i t mu s t r e but a defensi v e the or

y in order to be admis si ble

. See T EX
. R. E V ID
. 404 (b) (extrane ous o f fense
ev ide nce must demonst ra te proof of "motiv e, op por tuni ty , i ntent , preparati o n, pl an, know led g e, i denti ty , or

abs ence of mi sta ke or

ac ci dent" ra ther

than merely

g oin g tow ards the defendant' s c haract er ); Cas ey v. State , 215 S.W .3d 8 70, 8 79 ( Tex . C ri m. App. 2007) ("E xtraneous -o ff ense ev ide nce is not ina dmis si ble under Rul e 404(b) w hen it is offer ed to
re but a n af

firmat iv e defense or

a de fensiv e i ss ue th at ne g ates one of the el ements of the crime." ). W e be liev e tha t bot h t h e e xtrane ous o f fense s in this case m eetthese requireme nts. T he e v iden ce of Hanna h's the f

t of insulin f rom Mission Hos p it a l is admis si ble as rebutt al ev ide nce; the ev ide nce of her inv olv e m e n t in t he Oreg on i nci dent is adm issible for provi ng mod us op eran di. 1. Ev id ence o f Han nah 's P ossi bl e T hef t of In sul in f ro m M issio n Ho spi ta l T he e v iden ce of

Hanna h's knowledge of and access to insulin at Mi ssion Hosp ital, sug g est ing a po ss ibl e the ft, w as admis si ble in thi s tr ial becau se it w as used to re but a ke y defensi v e the or

y proff er ed by

H annah. See C asey, 215 S.W .3d a t 879 ; Powell v. Sta te , 63 S. W .3d 4 35, 4 38- 40 ( Tex . C ri m. App. 2001) ( hol din g thatthe Stat e i s e nti tl ed to rebut def ensive theo ries raised by the def ense in the op enin g state me nt).16

In his op enin g s tate me nt, Han nah 's counse l ex plaine d to th e jury thatone of

his defensi v e s tr a te g ies i n the tr ial w oul d be to de ny thatH annah w as the s our ce of the
ex og enous i nsul in thatki ll ed Bradl ey
. In fact , he tol d the j ur y thatthe ev ide nce in the t ri al
w oul d demons trate t hat H annah d id not e v en hav e ac ces s t o i nsul in:

Fi rs t, [the ev ide nce] w il l not e sta bli sh that Jeani ne H annah, the Defendant , w as the s our ce of the i nsul in ov erdose. There is not g oin g to be any e v iden ce abo ut tha t. Nu mb er t w o, the re is notgoing t o be any ev iden ce that Jeani ne H annah h ad ac ces s e it her at w or k or at he r pla ce of w or k o r at the h ospi tal of acc ess [s ic ] or pos ses si on of i nsul in. In order to re but t his arg ument, the Stat e w as per mitt ed to show that Han nah had
acc ess to ins uli n dur ing her employ ment as a nurse at M is si on H ospi tal

. See C asey, 215 S.W .3d a t 879 ; Powell , 63 S.W .3d a t 438 -4 0. Han nah as ser ts that thi s i s a n i nsuffici ent justif ication beca use sh e w as no t w orking at Missi on Hosp ital at the tim e of Bradley's death, and thus , she did not hav e ac ces s t o i nsul in at t he rele v ant t ime. Thi s a rg ument, how ev er , i s c ountered by R uiz 's tes ti mony

thati nsul in ca n r e main eff ect iv e for sev eral
mo nth s, and it does no t have an expiration d ate of just a ma tter of

days. T hus, according to test imo ny add uced at tr ial, Hann ah h ad a ccess to use able insulin
w ithin a rea sona b le t im e f rame before Brad ley' s dea th, a nd th e Sta te prese nte d this
ev ide nce in directrespon se to a defensi v e the or y proff er ed by

H annah' s c ounse l. I t w as not, therefore, an abus e of di sc re ti on to al low i t i nto e v ide nce. 2. Ev idence of Hannah's Culpability for Jones 's Dea th and t he Ring W e al so bel iev e the ev ide nce of the i nci dent in Oreg on w as p ro per ly i ntroduce d becau se itdemons trated modus operandi , w hic h refers to " a defendant' s d is ti nct iv e and idi osy ncrati c mann er of c ommitt ing cr imi nal ac ts. " C asey, 215 S.W .3d a t 880 -8 1 ( q uoti ng Owens v. State , 827 S.W .2d 911 , 915 (Tex. Cr im. Ap p. 19 92)). “Ev iden ce of a def end ant 's17

par ti cul ar modus operandi i s a recog niz ed ex cept ion to the g eneral r ule precl udi ng extraneous offense ev ide nce, i f the modus operandi ev ide nce tends to prov e a mat e rial fact atissue, oth er than prope nsity.” Owens , 827 S.W .2d a t 915

. W e do not recog niz e the modus operandi ex cept ion here merel y because mult ipl e murders a re i nv olv ed; t he St ate must show

not onl y repeated cr imes , but "p arti cul ar iz ed det ail s o r uni q ue q ual it ies of the tw o ac ts. " Ma rt

in v. State , 173 S.W .3d 4 63, 4 67- 68 ( Tex . C ri m App. 2005) ; Owens , 827 S.W .2d a t 915

. The modus operandi ex cept ion i s a ls o i mport ant b ecaus e i t c a n i mpli cat e the "doct ri ne of cha nces ," w hic h holds thatev ide nce of the repeti ti on of si mil ar unus ual ev ents
ov er time demons trates a de creasi ng probabi li ty thatthe ev ents oc cur re d merely by chanc e. Daggett v. State , 187 S.W 3d 444, 453 n.18 (Tex . Cr im. App. 2005) ; Martin , 173 S.W .3d a t 467 ; Pl

ante v. State , 692 S.W 2d 487, 491- 92 ( Tex. Cri m. App. 1985)

. The doct ri ne reflect s t he pr inc ipl e tha t ev ide nce of str ik ing si mil ar it ies betw een tw o rather idi o s y n c r a t i c c r i me s i s e v i d e n c e t h a t t h e s a me p e r p e t r a t o r w a s b e h i n d b o t h c r imes , and such ev i de nc e i s a dm i s s i bl e un de r 4 04 ( b) for

i ts p rob at i v e v al ue — no t me r el y t o un fai rly attemptto tr

y the defendant for an extraneous offense. See T EX
. R. E V ID
. 404 (b). Here, th e tr i al c ou rt s pe c i fi c al l y c om me nt ed on th e i ns ul i n ov erdo s e dea ths in Oreg on and Tex as bei ng a "di stinc ti v e and idi osy ncrati c mann er of commi tti ng cr imi nal act s." W e ag re e. Ex og enous i nsul in, unli ke firea rms or kniv es, is not commonly us ed as
a murder w eapon. Mo re ov er , Hannah' s defensiv e theory appears t o hav e been to i mpli cat e R honda, Bradle y 's daughte r, in the ad min istration of the excess insulin. T he d efense spen t mu ch of its cross- e xa m in a t io n of Rhond a focusin g on th e fact th at she w as a registered nu rse18

wh o h a d t a k e n in s u li n h o m e f ro m t h e h o s p it a l b e fo re a n d t h a tsh e wa s a co m p u ls i ve g ambler w ho reli ed upon Bradl ey to hel p pay

her gambl ing debts. The St ate o ff er ed th e ev ide nce of Jones 's deat h i n Oreg on i n order to show

t hat e v en i f both R honda a nd Han nah had eq ual ac ces s t o i nsul in, onl y H annah c oul d be con n e ct e d t o a modu s ope rand i. This pa rticular mod u s o p e ra n di w as to m urde r elderly patie nts vi a insulin
ov erdose and s teal from t hem. The tr ial co urt ex pla ine d thi s reason ing i n c lea r ter ms, and
w e c annot say

that i ts deci si on to al low

the ev ide nce w as an abus e of di sc re ti on. C. Texa s R ul e o f Ev id ence 403 Fi nal ly , w e do not b eli ev e the tr ial co urt abu sed it s d is creti on by dete rmi nin g thatthe probati v e v alu e of the extraneous offense ev ide nce subs tanti all y outw eig hed t he dang er of un fair pr eju dic e to Han nah. See i d. at R. 403. "Unfair

prej udi ce" does not ari se from the
mere fact th at ev ide nce inj ur es a par ty 's ca se, bec ause v ir

tual ly all ev ide nce that a par ty off ers w il l be preju dic ial to the o pponent 's ca se. Cas ey , 215 S.W .3d at 883 . Ev iden ce is

" u n fa i r l y p r ej u d i c i a l " w h e n i t t e n d s t o h a v e s o me a d v e rs e e ffe c t o n a d e fe n d a n tbey ond tendi ng to prov e the fact o r is sue that jus ti fies it s a dmis si on. Id.

[A] tr ial co urt, w hen under tak ing a Rul e 403 anal y si s, must bal ance (1 ) the i nherent p ro bati v e forc e of the proff er ed i tem of ev ide nce alo ng w it h ( 2) the p ro ponent' s n eed for that ev ide n ce a g ain st (3 ) any tend ency

of the ev ide nce to s ug g estdec is ion on a n i mprop er bas is , ( 4) any

tend ency

of the ev ide nce to c onfuse or di stractthe jur

y from t he mai n iss u e s, ( 5) any tendency

of the e vide n ce t o be g iv en undu e w eig ht by a j ur y thathas not been eq uip ped to ev alu ate the probati v e force of t he ev ide nce, and (6 ) the li kel iho od th at present ati on of the ev id e n ce w il l cons ume an i nordin ate amount o f time o r merel y repeat ev ide nce already admi tted. Gi gli obi anco v. State, 210 S.W .3d 637 , 641 -42 (Te x . Crim. App . 200 6). T he fa ctors in this bal anci ng tes t freq uentl y bl end t og ether

i n pract ic e. Id.19

Appl y ing thes e factors, w e first note thatthe inh er ent p ro bati v e forc e of both
extraneous offenses w as si g nific ant b ecaus e i t t ended t o prov e H a n n a h's oppor tuni ty to
a c c e s s in s u li n a n d h e r p o s s ib le m o d u s o p e ra n d i, wh ic h H a n n a h d is p u t e d ve h e m e n t ly. Cas ey , 215 S.W .3d at 882 (e xtraneous offense ev ide nce probati v e to dis pute cent ra l is sue at t ri al as ra is ed by

defense)

. Seco nd, the Stat e's need for the ev ide nce w as si g nific ant becau se it w as the onl y ev ide nce av ail abl e to the S tate to rebut the d efensiv e the or y that Bradl ey 's daug hter Rho nda w as a more pla usi ble so ur ce of the i nsul in than Han nah. Id. at 88 3- 84 ( probati v e forc e of ev ide nce cent er ed i n St ate’ s i nherent i n a b ili ty to rebut defensi v e arg uments ). The ev ide n ce is c ertai nly preju dic ial , butw e c annot say thatsu ch pr eju dic e w as unfair . Th e r e i s n o i n d i c a t i o n i n t h e re c o rd t h a tt h e j u r y w a s u n e q u i p p e d t o e v a l u a t e the prob ative fo rce of

the evidence

. Beca use the ev iden ce w as significa nt, b ut no t repet itious, itdi d notco nsume an i nordin ate a mount of ti me. There i s n othi ng i n the record to show tha t the ev iden ce conf used the jury or sugg este d a de cision ba sed o n an improp er basis (i.e., a verdict based on the extrane ous o f fense s rather tha n the instan t of fense ). The tr ial cour

t is pr esumed to ha v e appl ied the same a nal y si s i n dec idi ng to all ow t h e e v i d e n c e a g a i n s t Han nah. Se e Will iam s v . St ate , 95 8 S. W .2 d 18 6, 1 95 ( Tex

. C r i m. App. 1997) ( hol din g thatthe bal anci ng tes t is pr esumed to hav e been condu cte d if the tr ial
re cord i s s il ent o n the tes t)

. W e g iv e g re at de ferenc e to the t ri al cour t' s c onduc t of the tes t, and w e do not beli ev e it w as an abus e of di sc re ti on to dete rmi ne th at t he probati v e v alu e of the ev ide nce outw eig hed i ts pr eju dic ial natu re
. IV. L egal Su ff icien cy Hann ah n ext arg ues th at even if the trial cour t d id n ot ab use its discretio n in20

adm itting the extraneo us of fense e v i de nce, the cum ulative ev iden ce is nevertheless legally i n s u f f i c i e n tt o s u p p o rta g u i l t y v e rd i c t b e c a u s e t h e r e i s n o d i r e c t e v i d e n c e o f h e r g u i l t

. We dis ag re e w it h H annah' s framing of the leg al suffici ency iss ue, and w e f urther

bel iev e tha t the ev iden ce in the record—con sidered in th e lig ht m ost favorable to th e v erdict—is legally suffici ent t o s uppor

t a g uil ty v erdic t bec ause itco uld hav e l ed a ra ti onal j ur y to find H annah g uil ty of al l the e lement s o f murder bey ond a re asona ble doubt

. See Swear ing en , 101 S.W .3d a t 95. T h e T e xa s Co u rt o f Cr im in a l Ap p e a ls re c e n t ly cl a ri f ie d t h e t e s tfo r l e ga l s u f f ic ie n c y. See Hooper

v. Sta te , 214 S.W .3d 9, 13 (T ex. C rim. App . 200 7 ). Ev en a bsen t direct evidence , the court explained thatjuries are "pe rmitte d to dra w multip le reason able inferences as l ong as each inferenc e is suppor ted bythe ev ide nce pr esent ed at tr ial ." Id. at 15

. Therefor e, c ontrar y to Han nah' s a rg ume n t, c irc u m sta nti al ev ide nce alo ne c an be suffici ent t o es tabl is h g uil t. Id. In th is case, w e be liev e the cumu lative ev id e n c e — e ven if it is prima rily circumsta ntial—is overw helm ingly against Hann ah becau se the inferen ces w hich th e jury
w as re q uired to draw

about her motiv e and oppor tuni ty w er e reason abl y

su ppor ted b y the facts adduc ed at tr ial

. F or ex ample, a j ur

y co uld hav e made a reason abl e i nferenc e about Han nah' s motiv e to murde r Bradl ey
. In its clos ing arg ument, the State tol d the j ur y thati ts theor y of moti ve in thi s c ase w as "that Jeani ne H annah w as ste ali ng from M arg ar et Bradl ey
. And then she w anted to cov er up thes e the fts bec ause [sh e] w as about

. . . to g et
ca u ght ." Th e St a te su p p o rt e d th is t h e o ry of m o ti ve wit h e xt e n s i ve fa ct s a b o u t s tr a n ge transac ti ons in Bradl ey 's bank ac count s: (1) a chec k w hic h Bradl ey 's l edg er had mark ed as "groceries," but which i n r e a lity , had paid for an insu rance policyfor Hanna h; (2) a21

shred ded check Coast al Ban k v o id e d b ecau se it app eare d f raud ulen t; (3) a check, origi nally tho ught by a bank teller to be f raud ulen t, w ritten in Hann ah's led ger to Bradley's daug hter Tv eit for an unusu all y larg e amount— but w hic h w as act ual ly ca shed by

H annah; (4 ) re fund and annu ity ch eck s t o Bradl ey d e p o sited in Han nah' s a cc ount the d ay of Bradl ey 's deat h; an d ( 5) freq uent ATM w it hdraw als from Bradl ey 's acc ount for amount s far larg er than sh e had ordin ar il y w it hdraw n. Fi nal ly , t he St ate p re sent ed ev ide nce that Bradl ey had beg un to g ro w

su spi ci ous about Han nah' s q uest ion s a bout her financ es. A
re asona ble j ur

y co uld hav e heard thi s e v ide nce and i nf e rre d that H annah w as sy stem atically stea ling f rom Bradley, feare d be ing caught, and had the m otive to kill her. A reason abl e j ur

y co uld als o hav e found bey ond a re asona ble doubt that Han nah had t he oppo rt uni ty

to ki ll Bradl ey , g iv en th at ( 1) she had w or ki ng know led g e of i nsul in from her train ing as a nu rs e and her pr ior ac ces s t o i t at Mis si on Hosp it al; (2) she w as entr ust ed to ad mini ste r inj ect ion s t o Bradl ey ; ( 3) sh e w as the l astperson know n to be w it h Bradl ey before the onse t of

her cond ition; a nd, moststriking ly, ( 4) Hanna h's link to a rem arkab ly si mil ar i nci dent in Oreg on. In s hor t, the State present ed a full nar ra ti v e w hic h, in its cumulat iv e effect , made a leg all y suffici ent cas e that Han nah ki ll ed Bradl ey
. Beca use a jur y coul d have m a de
re asona ble i nferenc es based on the ev ide nce pr esent ed to r each thi s c oncl usi on, w e may not o v ertur n the j ur

y 's v erdic t. See Hooper , 214 S.W .3d at 13. W e overrule Han n a h ’s
sec ond i ss ue. V. Fact ual Su ff icien cy Hann ah's f inal argume nt on app eal is thatthe evidence prese nte d at tri al is fa ctua lly ins uff ic ien t t o s uppor

t t he g uil ty

ve rd ic t. Ev alu ati ng the ev ide nce in a neut ra l li g ht, fav or ing22

nei ther par ty , w e c annot say

thatthe g uil ty

v erdic t i s c lea rl y

w ro ng and manifest ly

unj ust , or that t h e e v i d e n c e i n s u p p o rt o f t h e j u d g me n t i s o u tw e i g h e d b y t h e g r e a t w e i g ht an d pr eponderance of the contrar y ev ide nce. See G ro tti , 2008 Tex

. Cr im. App. LEX IS 7 61, a t *22- 23. As w e no ted abo v e, th e evidence linking Ha n n a h t o Brad ley' s dea th is
ov er w hel ming : the unusu al bank acc ount act iv ity ; her know led g e of and ac ces s t o i nsul in; her co nnect ion to Jones 's deat h and the theft of he r ri ng in Oreg on; a nd th e fact that she
w as the l astperson know n to be w it h Bradl ey befor e the onset of

the condi ti on that l ed to her deat h. This ev ide nce is far too subs tanti al for us to be abl e to desc ri be th e v erdic t as cl ear ly w ro ng and manifest ly

unj ust

. See Watson , 204 S.W .3d a t 414 -1 5. Mo re ov er , w hil e i t i s t ru e tha t t here i s s ome ev ide nce in the rec ord tha t c onfli cts w it h the j ur y 's v erdic t, iti s h ardly

enoug h to desc ri be th e gu ilt y v erdic t as ag ain st the "g re at
w eig ht an d preponderance o f t he ev ide nce. " To beg in, w e recog niz e tha t t he c ause of dea th in this case is i nde f inite be cause no au top sy w as pe rforme d , b u t t h e l o gic of this poi nt i s l imi ted. After

al l, n o a u to psy

w as per formed bec ause the rev ela ti ons about the
c- pepti de te st emerg ed onl y after the cremati on had already been per

formed. At t hat p oin t,
w hil e an autops y

w oul d hav e been hel pful, i t w as not neces sar y because mult ipl e medi cal
ex per ts ex amined the c- pepti de te st re sul ts and ag re ed on the c ause of death. The doct ors w er e, i n fact, so co nv inc ed th at B ra dle y had die d of an i nsul in ov erdose that they ch a n ged he r de a th ce rt if ica te to ref le ctth is f in d in g. Han nah al so soug ht t o i mpli cat e R honda i n Bradl e y's death. Thi s e x pla nati on, howev er, is implau sible giv en th at w e ha v e a v irtually min ute -by -minu te record of Rhond a's
w here abo uts on the da y before Brad ley's d e a th. Acco rding to emp loymentrecords,23

Rho nda s pent most of the day at w or k. Phone records show thatsh e c all ed and spok e to both Bradl ey

and Han nah. F ina ll y , for the o ne ti me of day that s h e did s tep a w ay from
wo rk

— b e twe e n 3 : 2 3 a n d 4 : 3 0

— s h e ca n p ro vid e a t im e -s t a m p e d re c e ip tf ro m J. C. P e n n e y, proving thatshe ha d be en sh opp ing there. A s t he St ate emp hasized, Rho nda 's hom e is in north eastMcAllen, butthe J.C. Pe nne y at w hich she w as sho pp in g is in the sou the rn par t of the ci ty . It w oul d hav e been ex ceedi ng ly diff ic ult—i f poss ibl e at all —for Rho nda t o leave w ork, go to the m all, go hom e to injure Bradley, and f inal ly d ri ve b a c kt o w ork, all
w ithin th e spa n of

less than an ho ur. T his cont rary

ev iden ce is n o t subst ant ial eno ugh to overw helm the evidence
s u p p o rt in g t h e ve rd ic t

. T h e e vid e n c e im p li c a t in g Ha n n a h wa s fa c t u a ll y s u f f ic ie n t , a n d we ov er ru le Han nah' s t hird i ss ue. VI. Conclus ion For the re a so n s o u tl ine d abov e, w e bel iev e tha t t he tr ial co urt di d notabus e i ts dis creti on by

al low ing the Stat e to pr esent ev ide nce of H annah' s e xtraneous bad act s a t Mi ss ion H ospit a l o r in Oreg on. Mo re ov er , w e bel iev e tha t t he ev ide nce suppo rt ing her conviction is legally and factu ally suf f icient. T he judgmen t of the district court is therefore AFFIRMED.

GIN A M . BE NA VID ES J u s t i c e Do not p ubl is h. T EX
. R. A PP
. P. 47 .2(b). Me moran dum Opi nio n del iv er ed and filed thi s t he 21s t day

of Aug ust , 200 8.