Court Opinion

ID: 9407708
Source: CourtListenerOpinion
Date Created: 2023-07-08 06:09:49.794519+00
Date Added: 2024-06-11T17:20:39.751737
License: Public Domain

Opinion filed July 7, 2023

                                       In The

        Eleventh Court of Appeals
                                    __________

                  Nos. 11-22-00045-CR & 11-22-00048-CR
                                __________

                     TRISTAN DUANE BELL, Appellant
                                          V.
                      THE STATE OF TEXAS, Appellee

                     On Appeal from the 35th District Court
                              Brown County, Texas
                   Trial Court Cause Nos. CR28491 & CR28282

                      MEMORANDUM OPINION
       Appellant, Tristan Duane Bell, was indicted under separate cause numbers for
the offenses of aggravated assault with a deadly weapon against a family member, a
first-degree felony, and injury to a disabled individual, a third-degree felony. See
TEX. PENAL CODE ANN. §§ 22.02(b)(1), 22.04 (West Supp. 2022). The cases were
consolidated for trial and, after Appellant waived his right to a jury trial, the trial
court heard both cases in a unified bench trial. The trial court found Appellant guilty
of both offenses and assessed his punishment at thirty years’ imprisonment for the
aggravated assault with a deadly weapon conviction and ten years’ imprisonment for
the injury to a disabled individual conviction; the sentences were ordered to be
served concurrently.
      Appellant challenges his convictions in two issues: (1) the evidence is
insufficient to support his conviction for aggravated assault with a deadly weapon—
family violence—because evidence of serious bodily injury is lacking, and (2) the
trial court erred when it admitted hearsay testimony under Rule 803(4) of the Texas
Rules of Evidence. We affirm.
                               I. Factual Background
      Appellant assaulted his girlfriend, Macie Paige, during an argument they had
in the apartment that they shared. Appellant struck Paige with his hands, dragged
her by her hair from the bedroom to the living room, and choked her. He proceeded
to hit Paige with various objects: plant pots, a wooden stand, and a jukebox. Finally,
he smashed the living room television on her left foot, causing a fracture to her left
foot. After doing so, Appellant stated that he was going to get a knife to cut her
throat and claimed that he “didn’t care about getting a life sentence.”
      As Appellant left the room to retrieve the knife, Paige, battered and bleeding,
fled the apartment and ran to a neighbor’s house. Paige and the neighbor called the
police. Eventually, an ambulance transported Paige to the hospital in Brownwood.
      Appellant inflicted numerous injuries upon Paige, including deep cuts and
lacerations on her limbs, which required stitches, and a broken bone in her left foot.
Most significantly, during the assault Appellant ripped off a medical pump that was
attached to Paige’s body, which administered a constant flow of medication to her.
According to Paige’s treating pulmonologist, Dr. Sonja Bartolome, this medication
(Treprostinil) treats Paige’s pulmonary arterial hypertension, a chronic illness for
which Paige requires constant around-the-clock treatment. Paige’s condition, if
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untreated, creates a significant risk of death for her, and her medication mitigates
that risk. However, because it has a short terminal half-life, any disruption in the
administration of the medication to Paige’s body resurrects the severe risk of death
that is posed by her illness. Her medication pump is the mechanism by which her
ongoing treatment is achieved.
      When Paige fled the apartment, she was forced to leave behind both her
medicine pump—which Appellant had physically ripped from her body—and her
medication. Unfortunately, the hospital in Brownwood lacked a supply of this
medication to administer to Paige. Because even a short lapse in Paige’s treatment
could result in her death, Paige’s father retrieved her medication that same night
from the apartment she shared with Appellant, with the assistance of a civil standby
conducted by local law enforcement officers. Appellant’s assault was the latest in
an extensive history of violent, abusive incidents, including previous occurrences in
which Paige was hospitalized because Appellant had ripped her medicine pump from
her body.
      While at the hospital, Paige was given fentanyl for her pain. Her broken left
foot was placed in a stabilizing boot; she was given crutches to assist her in walking
and was instructed not to put any weight on her left foot for six to eight weeks. She
was also scheduled for two follow-up appointments with an orthopedic surgeon to
ensure that the fracture to her left foot healed properly.
      Paige testified that she left the hospital that night in a wheelchair, and that she
was wheelchair-bound for several weeks, during which time she required assistance
in bathing, eating, and getting to bed. When she regained her ability to walk, she
needed to use crutches for about two months. At the time of the trial, over a year
later, Paige testified that her left foot was still swollen and did not fit in the same
sized shoe as the shoe that she wore on her right foot. She further testified that her

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left foot hurts when the weather changes and that the mobility in her left foot is
limited in comparison to her uninjured right foot.
        Amy Murphy, the nurse practitioner who treated Paige in the hospital
emergency department, testified that this type of injury can cause prolonged
impairment of the use of a foot if not properly treated and rehabilitated. Dr. Marlen
Strefling, the orthopedic surgeon who examined and treated Paige, testified that lack
of treatment can result in the displacement of the fracture, which can cause more
serious complications. Dr. Strefling further explained that even after a bone fracture
heals, scar tissue that develops around the fracture can cause a loss of mobility and
pain.
        While on bond for having assaulted Paige, Appellant worked as a caregiver
for disabled persons who lived in group homes in Brownwood. Logan Bishop also
worked as a caregiver in the same group home as Appellant. Before Bishop began
working as a caregiver, he met Appellant at a party; while there, Bishop overheard
Appellant drunkenly brag about hitting someone who had a colostomy bag. Soon
thereafter, when Bishop became employed at the same group home where Appellant
worked, he realized that Appellant’s boasts concerned a resident at the home:
Charles Robinson.
        Robinson, an elderly man with severe intellectual disabilities, was a resident
at the group home during the time that Appellant worked there, and received care
from both Appellant and Bishop. Bishop noticed that Robinson bore a large bruise
on his chest. Although his disabilities limited his ability to speak, Robinson was
able to communicate to Bishop that Appellant had caused the bruise.
                               II. Standards of Review
        A. Sufficiency of the Evidence
        We review a challenge to the sufficiency of the evidence, regardless of
whether it is denominated as a legal or factual sufficiency challenge, under the
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standard of review set forth in Jackson v. Virginia, 443 U.S. 307 (1979). Brooks v.
State, 323 S.W.3d 893, 912 (Tex. Crim. App. 2010); Polk v. State, 337 S.W.3d 286,
288–89 (Tex. App.—Eastland 2010, pet. ref’d). Under the Jackson standard, we
review all of the evidence in the light most favorable to the verdict and determine
whether any rational trier of fact could have found the essential elements of the
charged offense beyond a reasonable doubt. Jackson, 443 U.S. at 319; Isassi v. State,
330 S.W.3d 633, 638 (Tex. Crim. App. 2010).
      When conducting a sufficiency review, we consider all of the evidence
admitted at trial, including improperly admitted evidence, and defer to the
factfinder’s role as the sole judge of the witnesses’ credibility and the weight their
testimony is to be afforded. Winfrey v. State, 393 S.W.3d 763, 768 (Tex. Crim. App.
2013); Brooks, 323 S.W.3d at 899; Clayton v. State, 235 S.W.3d 772, 778 (Tex.
Crim. App. 2007). This standard accounts for the factfinder’s duty to resolve
conflicts in the testimony, to weigh the evidence, and to draw reasonable inferences
from basic facts to ultimate facts. Jackson, 443 U.S. at 319; Clayton, 235 S.W.3d at
778. We may not reevaluate the weight and credibility of the evidence to substitute
our judgment for that of the factfinder. Dewberry v. State, 4 S.W.3d 735, 740 (Tex.
Crim. App. 1999). Therefore, if the record supports conflicting inferences, we
presume that the factfinder resolved the conflicts in favor of the verdict, and we defer
to that determination. Jackson, 443 U.S. at 326; Merritt v. State, 368 S.W.3d 516,
525–26 (Tex. Crim. App. 2012); Clayton, 235 S.W.3d at 778.
      Because the standard of review is the same, we treat direct and circumstantial
evidence equally. Isassi, 330 S.W.3d at 638; Clayton, 235 S.W.3d at 778; Hooper v.
State, 214 S.W.3d 9, 13 (Tex. Crim. App. 2007). The evidence need not directly
prove the defendant’s guilt. Rather, circumstantial evidence is as probative as direct
evidence in establishing the guilt of an actor and can, without more, be sufficient to
establish his guilt. Carrizales v. State, 414 S.W.3d 737, 742 (Tex. Crim. App. 2013)
                                           5
(citing Hooper, 214 S.W.3d at 13). A guilty verdict does not require that every fact
must directly and independently prove a defendant’s guilt. Hooper, 214 S.W.3d at
13. Instead, the cumulative force of all the incriminating circumstances is sufficient
to support the conviction. Id. Therefore, in evaluating the sufficiency of the
evidence, we must consider the cumulative force of the evidence. Villa v. State, 514
S.W.3d 227, 232 (Tex. Crim. App. 2017); Murray v. State, 457 S.W.3d 446, 448
(Tex. Crim. App. 2015).
      B. Admission of Evidence
      We review for an abuse of discretion whether an out-of-court statement was
properly admitted pursuant to an exception to the general hearsay rule. Templeton v.
State, 629 S.W.3d 616, 625 (Tex. App.—Eastland 2021, no pet.) (citing Taylor v.
State, 268 S.W.3d 571, 579 (Tex. Crim. App. 2008); McCarty v. State, 257 S.W.3d
238, 239 (Tex. Crim. App. 2008)). We will not reverse a trial court’s decision to
admit evidence, and the trial court does not abuse its discretion, unless its decision
lies outside the zone of reasonable disagreement. Beham v. State, 559 S.W.3d 474,
478 (Tex. Crim. App. 2018); Taylor, 268 S.W.3d at 579. Furthermore, we will not
disturb a trial court’s evidentiary ruling, even if the trial court’s reasoning was
flawed, if it is correct on any theory of law that reasonably finds support in the record
and is applicable to that ruling. Henley v. State, 493 S.W.3d 77, 93 (Tex. Crim. App.
2016); De La Paz v. State, 279 S.W.3d 336, 344 (Tex. Crim. App. 2009).
                                     III. Analysis
      A. The Evidence is Sufficient to Establish Serious Bodily Injury
      A person commits the offense of assault if he “intentionally, knowingly, or
recklessly causes bodily injury to another.” PENAL § 22.01(a)(1). “The offense is
elevated to first-degree aggravated assault if ‘the actor uses a deadly weapon during
the commission of the assault and causes serious bodily injury to a person whose
relationship to or association with the defendant is described by Section 71.0021(b),
                                           6
71.003, or 71.005, Family Code’—i.e., a family member, a member of the
defendant’s household, or a person with whom the defendant has a ‘dating
relationship.’” Garcia v. State, 667 S.W.3d 756, 762 (Tex. Crim. App. 2023) (citing
PENAL § 22.02(b)(1)).
      Thus, based on the statutory language as modified by the indictment, the State
was required to prove beyond a reasonable doubt that (1) Appellant; (2) intentionally
or knowingly; (3) caused serious bodily injury to Paige; (4) who was a member of
Appellant’s household or a person with whom he had a “dating relationship”; and
(5) in doing so, he used a deadly weapon. Because Appellant only challenges the
third element, our review focuses there—whether a rational factfinder could have
found, beyond a reasonable doubt, that Paige suffered serious bodily injury as a
result of Appellant’s conduct.
      The Penal Code defines “bodily injury” as “physical pain, illness, or any
impairment of physical condition.” PENAL § 1.07(a)(8) (West 2021). It further
defines “serious bodily injury” as “bodily injury that creates a substantial risk of
death or that causes death, serious permanent disfigurement, or protracted loss or
impairment of the function of any bodily member or organ.” Id. § 1.07(a)(46).
      The Court of Criminal Appeals has held that, in examining sufficiency
challenges that pertain to the element of serious bodily injury, the degree of risk
created by the injury, or the disfiguring or impairing qualities of the injury, should
be evaluated based on the magnitude of the injury when inflicted, rather than after
the ameliorating effects of medical treatment. Pruett v. State, 510 S.W.3d 925, 929
(Tex. Crim. App. 2017). Specifically, in Blea v. State, the Court of Criminal Appeals
noted that the definition of serious bodily injury plainly “refers to the injury caused
by the offender, and it does not require consideration of any medical treatment that
may have lessened the impact of the injury.” 483 S.W.3d 29, 34 (Tex. Crim. App.
2016). Thus, in determining whether a bodily injury creates a substantial risk of
                                          7
death, we should consider “the disfiguring and impairing quality of the bodily injury
as it was inflicted on a complainant by an offender,” and should “not consider the
amelioration or exacerbation of an injury by actions not attributable to the offender,
such as medical treatment.” Id. at 34–35.
      Moreover, expert medical testimony is not required to establish serious bodily
injury. Id. at 35 (observing that “serious bodily injury may be established without a
physician’s testimony when the injury and its effects are obvious”). Indeed, an
injured person’s lay testimony about the seriousness of her injuries may support a
finding of serious bodily injury. See Wade v. State, 663 S.W.3d 175, 185 (Tex. Crim.
App. 2022) (“We have previously held that a lay witness’s opinion testimony
supported a finding of serious bodily injury. . . . ‘[A] person who has received
injuries is qualified to express an opinion on the seriousness of those injuries.’”)
(citing and quoting Hart v. State, 581 S.W.2d 675, 677 (Tex. Crim. App. [Panel Op.]
1979)). And, the factfinder is permitted “to apply common sense, knowledge, and
experience gained in the ordinary affairs of life in drawing reasonable inferences
from the evidence presented to it in order to conclude that a particular injury
constitutes ‘serious bodily injury.’” Id.
             1. Paige’s Left Foot Injury Constitutes a Serious Bodily Injury
      During his assault on Paige, Appellant smashed a television on her left foot,
which caused a fracture. At the hospital, Paige was diagnosed with a fractured
metatarsal in her left foot, as well as surface lacerations to her left foot and both
hands. She was given fentanyl for the pain. Her fractured left foot was placed in a
stabilizing boot; she was also provided crutches to assist her in walking and was
instructed not to put any weight on her left foot for six to eight weeks. She was also
scheduled for two follow-up appointments with an orthopedic surgeon to ensure that
the fracture healed properly.

                                            8
      Paige testified that she left the hospital that night in a wheelchair, and she was
wheelchair-bound for several weeks, during which time she required assistance in
bathing, eating, and getting to bed. When she regained her ability to walk, she
needed to use crutches for about two months. At the time of the trial, over a year
later, Paige testified that her left foot was still swollen and would not fit into the
same sized shoe as the shoe that she wore on her right foot. She also experiences
pain in her left foot when the weather changes and she has limited mobility in her
left foot in comparison to her uninjured right foot.
      Murphy testified that this type of injury can cause prolonged impairment of
the use of a foot if the injury is not properly treated and rehabilitated. Dr. Strefling
testified that lack of treatment can result in displacement of the fracture, which can
cause more serious complications. Dr. Strefling further explained that even after a
fracture heals, scar tissue that develops around the fracture can cause pain and a loss
of mobility in the injured joint.
      Injuries that cause prolonged impairment can support a finding of serious
bodily injury. See, e.g., Brown v. State, 605 S.W.2d 572, 574–75 (Tex. Crim. App.
[Panel Op.] 1980) (holding that a broken nose, which would have caused
disfigurement and dysfunction of the nose if not set, was a serious bodily injury);
Omoleme v. State, No. 14-20-00226-CR, 2021 WL 4956924, at *1 (Tex. App.—
Houston [14th Dist.] 2021, no pet.) (mem. op., not designated for publication)
(holding that a concussion resulting in two days’ hospitalization and several months
of dizziness, headaches, loss of balance, and loss of vision was a serious bodily
injury); Madden v. State, 911 S.W.2d 236, 244 (Tex. App.—Waco 1995, no pet.)
(holding that a gunshot wound was a serious bodily injury when it resulted in the
victim being hospitalized for one day, prevented him from walking for three to four
weeks, and left permanent scar tissue).

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      The testimony established that Paige’s fractured left foot prevented her from
walking for two months and that she continued to experience pain and reduced
mobility in her left foot over a year later. The medical testimony of Murphy and
Dr. Strefling, although not required, further established that absent medical
treatment, the fracture to Paige’s left foot could have become displaced, which
would have resulted in further impairment. Based on this record, we conclude that
the evidence is sufficient to support the trial court’s verdict that Appellant’s conduct
caused Paige to suffer a serious bodily injury, namely when his actions during the
assault caused the fracture to Paige’s left foot.
              2. Displacement of Paige’s Medicine Pump Constitutes Serious
                 Bodily Injury
      When Appellant assaulted Paige, he ripped her medicine pump from the port
that was inserted in her stomach. When Paige fled the apartment, the medicine pump
and medication remained there, and she was unable to bring any of her medication
with her. When she arrived at the hospital in Brownwood, it was determined that
the hospital did not have available the prescription medication that she was required
to take. Paige’s father, assisted by local law enforcement officers, went to the
apartment, where Appellant remained after the assault, and retrieved Paige’s
medication.
      Dr. Bartolome testified that Paige’s chronic pulmonary arterial hypertension
was severe; in her circumstance, Paige required the constant, around-the-clock
administration of her prescribed medication, Treprostinil, through her medicine
pump. Dr. Bartolome testified that Paige’s medication had a terminal half-life of
five hours and that an interruption in the administration of the medication to Paige
created a high risk of death that could result in five hours or less. Dr. Bartolome
further stated that she had patients who had died due to a sudden interruption in the
administration of this medication.

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        We assess the evidence of serious bodily injury according to the risk created
by the injury as it was inflicted, not after the harm or risk is ameliorated by medical
intervention. Pruett, 510 S.W.3d at 929. The evidence supports the argument that
Appellant’s conduct created a serious risk of death for Paige when he ripped her
medicine pump from her body during his assault on her. Therefore, we conclude
that the evidence is sufficient to support the trial court’s verdict that Appellant’s
conduct during the assault caused serious bodily injury to Paige. Accordingly, we
overrule Appellant’s first issue.
        B. Bishop’s Statement is Admissible Under Rule 803(4).
        In his second issue, Appellant complains that the trial court abused its
discretion when it admitted hearsay testimony under the exception for statements
made for the purpose of a medical diagnosis or treatment. TEX. R. EVID. 803(4). In
order for a statement to be admissible under Rule 803(4), it must be pertinent to a
medical diagnosis or treatment. Gutierrez v. State, 630 S.W.3d 270, 278 (Tex.
App.—Eastland 2020, pet. ref’d) (citing Taylor, 268 S.W.3d at 591). The State
contends that Appellant did not preserve his hearsay complaint for appellate review
because his objection was not timely. We agree.1
        To preserve error for appellate review, an appellant is ordinarily required
to make a timely request, objection, or motion to the trial court.                            TEX. R.
APP. P. 33.1(a)(1)(A). An objection is timely if it is raised as soon as the ground for
the objection becomes apparent; otherwise, the matter is forfeited. Johnson v. State,
878 S.W.2d 164, 167 (Tex. Crim. App. 1994); see Yazdchi v. State, 428 S.W.3d 831,
844 (Tex. Crim. App. 2014) (“[A] party must make the complaint at the earliest
possible opportunity.”).

        1
         The challenge raised by Appellant in his second issue concerns the admission of certain evidence
in Cause No. 11-22-00045-CR—the indicted offense of injury to a disabled individual. Despite Appellant’s
isolated evidentiary challenge, he does not challenge the sufficiency of the evidence to support his
conviction for this offense.
                                                   11
      Bishop testified that the elderly and disabled victim, Robinson, explained that
Appellant had injured him. During Bishop’s testimony, Appellant’s trial counsel
raised a hearsay objection, but only after Bishop had already answered, without
objection, several of the State’s questions about Robinson’s statements:
              Q: Did you talk to Mr. Robinson about his bruises?
           A: Yes, ma’am. I actually – I was trying to ask him what
      happened, and for the most part, he wouldn’t answer until the very end.
              Q: And what did he eventually say to you?
              A: Eventually said that Tristan did it – with the officer in the
      room.
           Q: When you talked about Mr. Bell to Mr. Robinson, what was
      Mr. Robinson like?
              A: Say that again.
              Q: What was Mr. Robinson like whenever you mentioned Mr.
      Bell?
             A: He was just very quiet. He never really said anything. He
      didn’t want to say nothing. I did ask him at one point if he was one of
      the ones that was hitting him, and he told me, no, for the longest time.
            [DEFENSE COUNSEL]: Objection, your honor. I’m going to
      object to hearsay.
      The basis for the hearsay objection was apparent as soon as the State asked:
“And what did he eventually say to you?” However, Appellant did not object to that
question, and he did not make any hearsay objection until after the State had asked
and received answers to two subsequent questions. See Juarez v. State, 461 S.W.3d
283, 300 (Tex. App.—Texarkana 2015, no pet.) (“If a party ‘fails to object until after
an objectionable question has been asked and answered, and he can show no
legitimate reason to justify the delay, his objection is untimely and error is waived.’”)
(quoting Grant v. State, 345 S.W.3d 509, 512 (Tex. App—Waco 2011, pet. ref’d).
Appellant does not explain the delay in asserting his untimely hearsay objection. See

                                           12
id. Therefore, we hold that Appellant’s objection was untimely and the claimed
error, if any, is waived. See id.
      Nevertheless, even if Appellant had preserved this issue for our review,
Bishop’s statements were admissible under Rule 803(4). To be admissible under
this rule, a statement must be: (1) made to a medical professional or someone who
would be likely to obtain medical help for the declarant; (2) made for the purpose of
diagnosis or treatment; and (3) pertinent to such diagnosis or treatment. Taylor, 268
S.W.3d at 586–87. The testifying witness need not have any medical qualifications
under the rule. Id. at 587. Rather, “[t]he essential ‘qualification’ expressed in the
rule is that the declarant believe that the information he conveys will ultimately be
utilized in [the] diagnosis or treatment of a condition from which the declarant is
suffering.” Id.
      While not a physician or other type of degreed medical professional, Bishop
was a full-time caregiver at the group home where Robinson resided. Bishop was
personally responsible for feeding Robinson, washing him, changing his clothes,
administering his medications, and changing his colostomy bag. In essence, Bishop
was Robinson’s primary source of care while he was on duty. One could reasonably
conclude that Robinson had every reason to believe that any information that he
expressed to Bishop about the injuries he sustained while a resident at the group
home, including their cause, would be used to diagnose or treat his injuries.
      The Court of Criminal Appeals, in addressing the purpose of Rule 803(4), has
suggested that the removal of a child from an abusive environment is a legitimate
extension of “medical treatment” under the rule. See, e.g., Taylor, 268 S.W.3d at
591. This rationale supports the application of Rule 803(4) here, where a vulnerable,
disabled adult requires protection from an abusive caregiver in a care facility. It is
reasonable to conclude that when Robinson told Bishop about Appellant’s abusive

                                         13
conduct, he most likely believed that doing so would result in “treatment” that
included the prevention of any further abuse by Appellant.
      Because the trial court could have determined that Robinson made his
statement to Bishop for the purpose of improving his care and the treatment of his
injuries, we conclude that the statement was pertinent to Robinson’s medical
situation and that Bishop was qualified under Rule 803(4) to express the statement
that Robinson made to him concerning Appellant’s abusive conduct. Therefore, the
trial court did not abuse its discretion when it admitted Bishop’s testimony regarding
Robinson’s statement under Rule 803(4). Accordingly, Appellant’s second issue is
overruled.
                               IV. This Court’s Ruling
      We affirm the judgments of the trial court.

                                               W. STACY TROTTER
                                               JUSTICE

July 7, 2023
Do not publish. See TEX. R. APP. P. 47.2(b).
Panel consists of: Bailey, C.J.,
Trotter, J., and Williams, J.

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