Court Opinion

ID: 9385837
Source: CourtListenerOpinion
Date Created: 2023-04-10 08:09:05.067934+00
Date Added: 2024-06-11T17:17:47.444187
License: Public Domain

In the
        Court of Appeals
Second Appellate District of Texas
         at Fort Worth
    ___________________________

         No. 02-21-00171-CR
    ___________________________

    CHARLES RAY GARY, Appellant

                    V.

         THE STATE OF TEXAS

  On Appeal from the 271st District Court
           Wise County, Texas
        Trial Court No. CR22323

   Before Kerr, Bassel, and Womack, JJ.
   Memorandum Opinion by Justice Kerr
                           MEMORANDUM OPINION

      A jury found Appellant Charles Ray Gary guilty of continuous sexual abuse of a

young child and assessed his punishment at life in prison. See Tex. Penal Code Ann.

§ 21.02(b), (h). Gary appeals his conviction, arguing in seven issues that the trial court

reversibly erred by submitting a jury charge that did not properly instruct the jury on

extraneous-offense evidence (issues 1–3); by admitting extraneous-offense evidence

(issues 4–5); and by admitting hearsay testimony from a sexual-assault nurse examiner

(issues 6–7). Because Gary forfeited his extraneous-offense evidence complaints and

because the trial court did not otherwise err, we will affirm.

                                     I. Background

      In late May 2020, sisters M.C. (Mae), who was seven years old, and J.C. (Joy),

who was eight years old, made outcries to their mother E.C. (Mother) that Gary had

touched and licked their genitals.

      Mother took both girls to Cook Children’s Medical Center in Fort Worth

where Teresa Fugate, a certified sexual-assault nurse examiner (SANE), examined

them on June 15, 2020. Nurse Fugate took a medical history from Mother and took a

patient history from each girl separately without Mother present. During Mae’s patient

history, she told Nurse Fugate that starting when she “was like maybe three or four

years old,” Gary had “rubbed [her] front privates” “mostly under” her clothes and

that he had “licked [her] private[s]” once. Joy pointed to her genital area and reported

to Nurse Fugate that Gary had rubbed “down there” mostly under her clothes and

                                            2
that “he would lick down there . . . a bunch.” Because more than 120 hours had

passed since the alleged abuse, the girls were considered “nonacute,” which means

that DNA could not be collected and that the girls were tested but not treated with

medications to prevent infection. Nurse Fugate examined the girls, tested them for

sexually transmitted infections, and found no infections or physical injuries.

       In July 2020, a grand jury indicted Gary under two separate cause numbers for

continuous sexual abuse of a young child. In CR22323, the victim was Mae. In

CR22322, the victim was Joy. The case involving Mae proceeded to trial and is the

subject of this appeal.

                            II. Relevant Pretrial Matters

       The State filed a notice of its intent to offer evidence of extraneous offenses

and bad acts under Articles 37.07 and 38.37 of the Texas Code of Criminal Procedure

and Texas Rules of Evidence 404(b) and 609 in which it listed, among other things, its

intent to offer evidence of Gary’s alleged sexual abuse of Joy. In response, Gary filed

a written objection to the State’s extraneous-offense evidence under Rules of

Evidence 401, 402, 403, and 404(b). Gary also filed (1) a “Motion for Limiting

Instruction (Rule 404b Evidence),” which asked the trial court to give the jury his

proposed limiting instruction each time extraneous-offense evidence was admitted,

and (2) “Defendant’s Requested Jury Instruction[:] Limiting Instruction on 404(b)

Evidence,” which asked the trial court to include his proposed limiting instruction in

the charge. The trial court never ruled on Gary’s written objection to the State’s

                                            3
extraneous-offense evidence, but it granted both of Gary’s limiting-instruction

motions.

      Gary also filed a motion in limine, seeking to exclude the following evidence

and to prevent the State from referring to it until a hearing could be held outside the

jury’s presence to determine the evidence’s admissibility:

      [A]ll extraneous crime or misconduct evidence, which is not alleged in
      the indictment, unless it can be shown by sufficient proof that [Gary]
      perpetrated such conduct, that this evidence is relevant to a material
      issue in the case, other than character conformity, and that its probative
      value outweighs its potential for prejudice.

             . . . [A]ll extraneous crime or misconduct evidence, notice of
      which was requested by [Gary], but not provided by the [S]tate as
      required by Rules 404(b) and 609(f) of the Texas Rules of Evidence, and
      Art[icle] 37.07(g) of the Texas Code of Criminal Procedure.
      Alternatively, any purported acts would not be admissible under Texas
      Rules of Evidence 403, 404(a),(1),(b), or 608.

The trial court granted Gary’s limine motion.

                                    III. The Trial

      After the jury was empaneled and sworn but before opening statements, the

parties discussed the extraneous-offense evidence outside the jury’s presence:

      [THE STATE]: Judge, in an effort not to violate any type of motions in
      limine, we have had some discussion and I have given the Defense
      counsel notice of our intent to call an extraneous victim. The Court is
      aware we’re proceeding on the case that involves [Mae], and we intend --
      we believe that it is permissible under 38.37 to bring up and discuss the
      abuse by the Defendant of her sister, [Joy], which is the subject matter of
      Indictment CR3222 -- I don’t think that’s the cause number. I’m sorry.

             THE COURT: 22322?

                                           4
            [THE STATE]: Yes, sir. Thank you.

             [DEFENSE COUNSEL]: Your Honor, I think 38.37 does
      purport to allow that. However, we’re going to object to that testimony
      in that I believe it violates the Equal Protection Clause of both the
      United States constitution and the State constitution. What 38.37 does,
      basically it was -- creates a subclass of citizens. It gives people who are
      accused of sexual cases involving children less protection and less rights
      in a criminal trial than it does a person, say, who is accused of a burglary
      of a habitation.

             In a burglary of a habitation, the State’s not allowed to bring in
      during the guilt-innocence phase other burglary victims. This statute --
      and that’s so that the State can have a -- the defense can have a fair trial.
      This statute specifically takes away rights that any other citizen would
      have if they were on trial for a crime in the state of Texas. So we make
      that objection.

            THE COURT: All right. Your objection is overruled at this time.

            [THE STATE]: Thank you.

            THE COURT: Are we ready to go?

             [DEFENSE COUNSEL]: Can we have a running objection on
      that so we don’t have to keep interrupting the process?

            THE COURT: Yes, I understand your objection. You do not
      have to object in front of the jury. That -- that would be if --

            [DEFENSE COUNSEL]: When they get to the extraneous
      witness?

             THE COURT: Yes, the sister of the alleged victim in this case.

             [DEFENSE COUNSEL]: Thank you, sir.

      After the jury was called into the courtroom, the trial court instructed the jury

in relevant part as follows: “Some testimony or exhibits may be introduced for a

                                           5
limited purpose. If that occurs, I will instruct you to consider the evidence only for

that express limited purpose, and that is, again, what you would be obligated to do.”

       During the guilt–innocence phase, the State offered testimony from Mother,

the girls’ father, Nurse Fugate, Mae, Joy, and the girls’ therapists. Through these

witnesses, the jury heard about Gary’s abuse of both Mae and Joy. Gary did not object

to testimony regarding his conduct toward Joy on Rule 403 or 404 grounds, nor did

he ask for a limiting instruction on that evidence.

       Nurse Fugate testified that as part of her examinations, she took the girls’

patient histories from them. When Nurse Fugate started testifying about what Mae

had told her, Gary objected on hearsay grounds and argued that Rule 803(4)’s hearsay

exception did not apply because Mae’s statements to Nurse Fugate were not made for

medical diagnosis or treatment:

       [Rule] 803(4) is an exception to the hearsay; however, it does not apply
       to this case. Our position is that these statements were elicited by the
       witness for the purpose of being used as evidence in a criminal case,
       which is exactly what they’re trying to do here now. This witness testified
       this morning that this was a nonacute case and that she was there to test
       this child and not to treat this child.

             Therefore, since these statements were elicited not for the
       purposes of medical diagnosis and treatment, they are not -- it is hearsay.

The trial court overruled Gary’s objection but gave him a running objection as to both

girls’ statements to Nurse Fugate. Nurse Fugate then testified about how Mae and Joy

described for her Gary’s abuse and about her subsequent examination and testing of

the girls.

                                            6
       The jury charge did not include Gary’s requested limiting instruction. During

the charge conference, Gary objected only to the submission of aggravated sexual

assault—a person intentionally or knowingly causing a child’s sexual organ to contact

another person’s mouth—on the grounds that the evidence was insufficient to

support its submission to the jury.1 The trial court overruled the objection.

       The jury found Gary guilty of continuous sexual abuse of a young child as

charged in the indictment and, after hearing punishment evidence, assessed his

punishment at life in prison. Gary has appealed.

                                    IV. Gary’s Issues

       On appeal, Gary raises seven issues:

       1. The trial court erred by submitting a jury charge that failed to give a proper

limiting instruction on extraneous-offense evidence.

       2. The trial court erred by failing to include Gary’s requested limiting

instruction in the jury charge.

       3. The incorrect jury charge egregiously harmed Gary.

       4. The trial court erred by admitting inadmissible extraneous-offense evidence

to the jury without first conducting the requisite Article 38.37 hearing.

       1
        Here, the indictment alleged aggravated sexual assault and indecency with a
child as component offenses of the continuous-sexual-abuse-of-a-child charge. See
Tex. Penal Code Ann. §§ 21.02(b), (c)(2), (c)(4), 21.11(a)(1), (c)(1), 22.021(a)(1)(B)(iii).
The jury charge instructed and charged the jury accordingly and submitted indecency
with a child as a lesser included offense of continuous sexual abuse of a child.

                                             7
        5. The trial court erred by admitting extraneous-offense evidence because the

danger of unfair prejudice substantially outweighed the evidence’s probative value.

        6. The trial court erred by admitting Nurse Fugate’s hearsay testimony under

Rule 803(4)’s hearsay exception for statements made for medical diagnosis or

treatment.

        7. The admission of Nurse Fugate’s hearsay testimony egregiously harmed

Gary.

        We will address Gary’s fourth and fifth issues first because doing so aids in our

disposition of this appeal.

                   V. Admission of Extraneous-Offense Evidence

        Gary’s fourth and fifth issues challenge the trial court’s admission of

extraneous-offense evidence regarding his sexually abusing Joy under Code of

Criminal Procedure Article 38.37. Within these two issues, he argues that the trial

court abused its discretion by admitting evidence concerning his abusing Joy because

(1) the trial court failed to hold the required Article 38.37 hearing to determine

whether the evidence was adequate to support a jury finding that he committed the

separate offenses beyond a reasonable doubt; (2) the evidence’s probative value was

substantially outweighed by the danger of unfair prejudice; and (3) the trial court

failed to give a contemporaneous limiting instruction when the evidence was

admitted. We address each of these arguments in turn.

                                            8
       Rule 404(b)(1) disallows evidence of crimes, wrongs, or other acts solely to

prove a person’s character to show that the person acted in conformity with that

character on a particular occasion.2 Tex. R. Evid. 404(b)(1). Such extraneous-offense

evidence is statutorily admissible, however, in continuous-abuse-of-a-young-child and

indecency-with-a-child cases. See Tex. Code Crim. Proc. Ann. art. 38.37. In such cases,

“[n]otwithstanding Rules 404 and 405,” evidence that a defendant has committed a

separate such sexual offense against a child may be admitted “for any bearing the

evidence has on relevant matters, including the character of the defendant and acts

performed in conformity with the character of the defendant.” Id. § 2(b). But before

such evidence may be introduced, the trial judge must conduct a hearing outside the

jury’s presence to determine whether the evidence is adequate to support a jury

finding that the defendant committed the separate offense beyond a reasonable doubt.

Id. § 2-a.

       Although the trial court here did not conduct the required hearing, Article

38.37’s hearing requirement is subject to general preservation requirements and can

thus be forfeited. See, e.g., Corporon v. State, 586 S.W.3d 550, 560 (Tex. App.—Austin

2019, no pet.); Stephens v. State, Nos. 02-15-00046-CR, 02-15-00047-CR,

2016 WL 2586639, at *7 (Tex. App.—Fort Worth May 5, 2016, pet. ref’d) (mem. op.,

       But this evidence may be admissible for other purposes, “such as proving
       2

motive, opportunity, intent, preparation, plan, knowledge, identity, absence of
mistake, or lack of accident.” Tex. R. Evid. 404(b)(2).

                                          9
not designated for publication). To preserve a complaint for our review, a party must

have presented to the trial court a timely request, objection, or motion sufficiently

stating the specific grounds, if not apparent from the context, for the desired ruling.

Tex. R. App. P. 33.1(a)(1); Montelongo v. State, 623 S.W.3d 819, 822 (Tex. Crim. App.

2021). Further, the party must obtain an express or implicit adverse trial-court ruling

or object to the trial court’s refusal to rule. Tex. R. App. P. 33.1(a)(2); Dixon v. State,

595 S.W.3d 216, 223 (Tex. Crim. App. 2020).

      Here, Gary failed to object to the lack of an Article 38.37 hearing. He has thus

failed to preserve that complaint for our review. See, e.g., Corporon, 586 S.W.3d at 560;

Stephens, 2016 WL 2586639, at *7.

      Next, Gary complains that the trial court abused its discretion by admitting the

extraneous-offense evidence because the danger of unfair prejudice substantially

outweighed the evidence’s probative value. See Tex. R. Evid. 403. Even if extraneous-

offense evidence is relevant and admissible under Article 38.37, that evidence can be

excluded under Rule 403 if the danger of unfair prejudice substantially outweighs the

evidence’s probative value. See Wells v. State, 558 S.W.3d 661, 669 (Tex. App.—Fort

Worth 2017, pet. ref’d); Martin v. State, 176 S.W.3d 887, 895 (Tex. App.—Fort Worth

2005, no pet.); see also Tex. R. Evid. 403. A trial court must conduct a Rule

403 balancing test upon a proper objection or request. See Belcher v. State, 474 S.W.3d

840, 847 (Tex. App.—Tyler 2015, no pet.); Sanders v. State, 255 S.W.3d 754, 760 (Tex.

App.—Fort Worth 2008, pet. ref’d). But, as the State notes, Gary failed to preserve

                                            10
this complaint by not objecting to the extraneous-offense evidence on Rule

403 grounds.

      To preserve error in the admission of evidence, a party generally must object

each time the objectionable evidence is offered. Geuder v. State, 115 S.W.3d 11,

13 (Tex. Crim. App. 2003); Martinez v. State, 98 S.W.3d 189, 193 (Tex. Crim. App.

2003); Clay v. State, 361 S.W.3d 762, 766 (Tex. App.—Fort Worth 2012, no pet.). Gary

contends that although he did not object to the extraneous-offense evidence on Rule

403 grounds when that evidence was offered at trial, he nevertheless preserved his

403 complaint through (1) his written objection to the admission of the State’s

extraneous-offense evidence; (2) his motion in limine; and (3) his objection to

evidence admitted under Article 38.37 as violative of his Equal Protection rights. We

disagree.

      Neither Gary’s written objection nor his motion in limine sufficed to preserve

his Rule 403 complaint. First, the trial court never ruled expressly or implicitly on his

written objection—which was based in part on Rule 403—so he was required to

renew that objection when the extraneous-offense evidence was offered. Cf. Tex. R.

Evid. 103(b) (“When the court hears a party’s objections outside the presence of the

jury and rules that evidence is admissible, a party need not renew an objection to

preserve a claim of error for appeal.”). Gary did not do so. Second, motions in limine

do not preserve error. See Fuller v. State, 253 S.W.3d 220, 232 (Tex. Crim. App. 2008)

(“A motion in limine . . . is a preliminary matter and normally preserves nothing for

                                           11
appellate review. For error to be preserved with regard to the subject of a motion in

limine, an objection must be made at the time the subject is raised during trial.”

(citation and emphasis omitted)); Roberts v. State, 220 S.W.3d 521, 533 (Tex. Crim.

App. 2007). This is true whether the motion is granted or denied, see Griggs v. State,

213 S.W.3d 923, 926 n.1 (Tex. Crim. App. 2007); Swilley v. State, 465 S.W.3d 789,

795 (Tex. App.—Fort Worth 2015, no pet.), and the party must object when the

evidence is offered at trial, Fuller, 253 S.W.3d at 232; Roberts, 220 S.W.3d at 533. Here,

although the trial court granted Gary’s motion in limine, he did not object when the

extraneous-offense evidence was offered at trial.

      Like Gary’s written objection and limine motion, Gary’s objection to the State’s

Article 38.37 evidence on Equal Protection grounds (and his running objection3 on

that basis) was insufficient to preserve his Rule 403 complaint. An objection must be

sufficiently specific to preserve a complaint for appellate review. See Tex. R. App. P.

33.1(a)(1)(A). “The two main purposes of requiring a specific objection are to inform

the trial judge of the basis of the objection so that he has an opportunity to rule on it

and to allow opposing counsel to remedy the error.” Clark v. State, 365 S.W.3d 333,

339 (Tex. Crim. App. 2012); see Resendez v. State, 306 S.W.3d 308, 312 (Tex. Crim. App.

2009). Preservation does not require “magic language,” however, but turns only on

      3
       A defendant’s obtaining a running objection is an exception to the
contemporaneous-objection rule. Geuder, 115 S.W.3d at 13; Ethington v. State,
819 S.W.2d 854, 858–59 (Tex. Crim. App. 1991).

                                           12
whether the trial court understood the basis of the objection. Vasquez v. State,

483 S.W.3d 550, 554 (Tex. Crim. App. 2016); State v. Rosseau, 396 S.W.3d 550,

555 (Tex. Crim. App. 2013).

      Furthermore, an objection preserves only the specific ground cited. Tex. R.

App. P. 33.1(a)(1)(A); Tex. R. Evid. 103(a)(1)(B); Mosley v. State, 983 S.W.2d 249,

265 (Tex. Crim. App. 1998) (op. on reh’g); see also Fierro v. State, 706 S.W.2d 310, 317–

18 (Tex. Crim. App. 1986) (holding that general objection is insufficient to apprise

trial court of complaint urged and thus preserves nothing for review). And the

complaint made on appeal must comport with the complaint made in the trial court

or the error is forfeited. Clark, 365 S.W.3d at 339; Lovill v. State, 319 S.W.3d 687, 691–

92 (Tex. Crim. App. 2009) (“A complaint will not be preserved if the legal basis of the

complaint raised on appeal varies from the complaint made at trial.”); Pena v. State,

285 S.W.3d 459, 464 (Tex. Crim. App. 2009) (“Whether a party’s particular complaint

is preserved depends on whether the complaint on appeal comports with the

complaint made at trial.”).

      Here, Gary objected to the State’s Article 38.37 evidence regarding Joy as

follows:

      Your Honor, I think 38.37 does purport to allow that [evidence].
      However, we’re going to object to that testimony in that I believe it
      violates the Equal Protection Clause of both the United States
      constitution and the State constitution. What 38.37 does, basically it was
      -- creates a subclass of citizens. It gives people who are accused of sexual
      cases involving children less protection and less rights in a criminal trial
      than it does a person, say, who is accused of a burglary of a habitation.

                                           13
             In a burglary of a habitation, the State’s not allowed to bring in
      during the guilt-innocence phase other burglary victims. This statute --
      and that’s so that the State can have a -- the defense can have a fair trial.
      This statute specifically takes away rights that any other citizen would
      have if they were on trial for a crime in the state of Texas. So we make
      that objection.
      Gary’s objection was that Article 38.37 violated his Equal Protection rights

under the United States and Texas Constitutions, not that the State’s Article

38.37 evidence’s probative value was substantially outweighed by the danger of unfair

prejudice. Even so, Gary argues that given that (1) the objection was made in the

context of the State’s bringing up his limine motion—which raised Rule 403—and

(2) his written Rule 403 objection stated that it was made to preserve his Equal

Protection rights under the United States and Texas Constitutions, his objection

sufficed to preserve his Rule 403 complaint. We cannot agree. The basis for Gary’s

objection was the constitutionality of Article 38.37, which was insufficient to apprise

the trial court that he was objecting on Rule 403 grounds. And he has not raised his

Equal Protection argument on appeal. Gary thus failed to preserve his Rule

403 complaint for our review.

      Finally, Gary notes that “[t]he relevant and substantive testimony of five out of

seven of the State’s witnesses introduced and emphasized highly prejudicial testimony

of the extraneous offense” and complains that the trial court thus erred by failing to

give a contemporaneous limiting instruction each time the extraneous-offense

evidence was admitted. Rule 105 provides that, when the trial court admits evidence

                                           14
that is admissible for one purpose but not for another, “the court, on request, must

restrict the evidence to its proper scope and instruct the jury accordingly.” Tex. R.

Evid. 105(a). A defendant must request an extraneous-offense limiting instruction

under Rule 105 when the evidence is admitted during the guilt–innocence phase.

Delgado v. State, 235 S.W.3d 244, 251 (Tex. Crim. App. 2007); Hammock v. State,

46 S.W.3d 889, 893–94 (Tex. Crim. App. 2001). If a defendant does not, the evidence

is admitted for all purposes. Delgado, 235 S.W.3d at 251; Hammock, 46 S.W.3d at 892,

895; see also Tex. R. Evid. 105(a).

       Any error in the admission of evidence that is admissible for one purpose, but

not for the other, is preserved “only if the party requests the court to restrict the

evidence to its proper scope and instruct the jury accordingly.” Tex. R. Evid.

105(b)(1). A pretrial request for a limiting instruction is insufficient to preserve a

complaint that the trial court failed to give a limiting instruction. See Taylor v. State,

No. 06-22-00063-CR, 2022 WL 16704396, at *4 n.8 (Tex. App.—Texarkana Nov. 4,

2022, no pet.) (mem. op., not designated for publication); see also Reeves v. State,

99 S.W.3d 657, 658–59 (Tex. App.—Waco 2003, pet. ref’d) (“There is nothing in the

plain language of Rule 105 or the case law that requires the trial court, upon a pre-trial

request, to recognize each instance of extraneous[-]offense evidence and deliver a

limiting instruction at each instance.”). Because Gary did not ask for a limiting

instruction when the extraneous-offense evidence was admitted, he cannot complain

                                           15
on appeal about the trial court’s not giving that instruction. See Tex. R. Evid.

105(b)(1).

       Because Gary failed to preserve his complaints regarding the trial court’s

admission of extraneous-offense evidence regarding his abusing Joy, we overrule his

fourth and fifth issues.

                                 VI. The Jury Charge

       Gary’s first, second, and third issues challenge the trial court’s jury charge. In

his first issue, Gary asserts that the trial court erred by submitting a jury charge that

failed to give a proper limiting instruction on the extraneous-offense evidence. Gary

complains in his second issue that the trial court erred by failing to include his

requested limiting instruction in the charge. And finally, Gary contends in his third

issue these errors caused him egregious harm.

       We must review “all alleged jury-charge error . . . regardless of preservation in

the trial court.” Kirsch v. State, 357 S.W.3d 645, 649 (Tex. Crim. App. 2012). In

reviewing a jury charge, we first determine whether error occurred; if not, our analysis

ends. Id. We address Gary’s first and second issues in turn, and because we conclude

that no error occurred, we do not reach his third issue. See id.

       Gary asserts in his first issue that, because indictments involving both girls were

discussed at trial and because there was considerable evidence concerning his abusing

Joy, the following abstract paragraphs of the jury charge misstated the law and created

confusion:

                                            16
                                         II.

             A person commits the offense of Continuous Sexual Assault of a
      Young Child if, during a period that is 30 days or more in duration, the
      person commits two or more acts of sexual abuse, regardless of whether
      the acts of sexual abuse are committed against one or more victims . . . .

             ....

                                         V.

             ....

              You are further instructed that in order to find the defendant
      guilty of the offense of continuous sexual abuse of a young child, you are
      not required to agree unanimously on which specific acts of sexual abuse
      were committed by the defendant or the exact date when those acts were
      committed. However, in order to find the defendant guilty of the offense of
      continuous abuse of a young child, you must unanimously agree that the defendant,
      during a period that is 30 or more days in duration, on or about [the] 15th
      day of April, 2016 through and including the 28th day of May, 2020 as
      charged in the indictment, committed two or more acts of sexual abuse.

             ....

             You are instructed that if there is any testimony before you in this
      case regarding the defendant having committed offenses, if any, other
      than the offenses alleged against him in the indictment in this case, you
      cannot consider said testimony for any purpose unless you find and
      believe beyond a reasonable doubt that the defendant committed such
      other offenses, if any were committed. [Emphases added.]

      Gary argues that the instruction in section II “creates confusion, in particular

because there was no instruction about how the jury could consider the extraneous

offense.” He further argues that the jury could have interpreted the instruction in

section V to mean that it “could rely on one or more of the discussed offense[s]

against [Joy] to convict [him],” and that “[b]ecause there were no charges in the

                                               17
indictment for any victim other than [Mae], [the instruction] misstates the applicable

law for these facts.”

       But Gary’s argument ignores the application paragraphs, which provided:

       Now bearing in mind the foregoing instructions, if you find and believe
       from the evidence, beyond a reasonable doubt, that the defendant,
       CHARLES RAY GARY, on or about the 15th day of April,
       2016 through and including the 28th day of May, 2020, in the County of
       Wise and State of Texas, did then and there, during [a] period that was
       30 or more days in duration, when the defendant was at least 17 years of
       age or older, knowingly commit two or more acts of sexual abuse against
       [Mae], child younger than 14 years of age, said acts of sexual abuse being
       more fully described as follows:

             1. Aggravated sexual assault of child by knowingly caus[ing] the
       sexual organ of [Mae], a child who was then and there younger than
       14 years of age and not the spouse of the defendant, to contact the
       mouth of the defendant.

             2. Indecency with child by sexual contact with the intent to arouse
       or gratify the sexual desire of said defendant [by] engag[ing] in sexual
       contact with [Mae], a child younger than 17 years of age and not the
       spouse of the defendant, by touching the genitals of said [Mae] with his
       hand.

              Unless you so find beyond a reasonable doubt. or if you have a
       reasonable doubt thereof, you will acquit the Defendant of the offense
       of Continuous Sexual Abuse of a Young Child and say by your verdict
       not guilty of Continuous Sexual Abuse of a Young Child. If you do not
       so find, or if you have a reasonable doubt thereof, you will next consider
       whether the Defendant is guilty of the lesser included offense of
       Indecency with a Child.

              Now bearing in mind the foregoing instructions, if you find and
       believe from the evidence, beyond a reasonable doubt, that the
       defendant, CHARLES RAY GARY, on or about the 15th day of April,
       2016 through and including the 28th day of May, 2020, in the County of
       Wise and State of Texas, did then and there, with the intent to arouse or
       gratify the sexual desire of said defendant, knowingly engage in sexual

                                          18
       contact with [Mae] by touching the genitals of [Mae], a child younger
       than 17 years of age and not the spouse of the defendant then you will
       find the defendant guilty of the offense of Indecency With a Child
       Sexual Contact.

       The application paragraphs make clear that the jury could find Gary guilty of

only the offenses involving Mae. We thus conclude that the abstract paragraphs—

when considered in conjunction with the application paragraphs—do not misstate the

law and are not confusing. See Dinkins v. State, 894 S.W.2d 330, 340 (Tex. Crim. App.

1995) (“When we review a charge for alleged error, we must examine the charge as a

whole instead of a series of isolated and unrelated statements.”). We overrule Gary’s

first issue.

       Gary argues in his second issue that the trial court erred by failing to include his

requested Rule 404 limiting instruction. 4 He alternatively asserts that although Article

38.37 allows extraneous-offense evidence to be admitted for character and character-

       Gary requested that the following Rule 404 limiting instruction be included in
       4

the charge:

       The Defendant is on trial solely on the charge contained in the
       indictment. The State has introduced in evidence an act or acts other
       than the one charged in the indictment. With reference to those other
       acts, you are instructed that said evidence was admitted only for the
       purpose of showing, if it does, (the specific purpose advocated by the
       State) of the Defendant. You cannot consider said testimony for any
       purpose unless you find beyond a reasonable doubt that the Defendant
       committed such other act or acts, if any were committed. If you so find
       beyond a reasonable doubt, you can consider the evidence only for the
       purpose allowed. The evidence may not be considered to prove the
       character of the Defendant in order to show that he acted in conformity
       therewith on the occasion in question.

                                            19
conformity purposes, the charge, (1) “at a minimum, should have emphasized to the

jury that the evidence about the extraneous offense[s] could not itself be a basis for

conviction, but only the indicted offenses” and (2) “should have tracked the language

of [Article 38.37] and limited the jury to only consider[ing] the extraneous offense for

its bearing on relevant matters and clarified that the only offenses that could form the

basis of the verdict were those in the indictment.”

      When, as here, the defendant does not timely request a limiting instruction, the

evidence is admitted for all purposes. See Delgado, 235 S.W.3d at 251 (explaining that

to hold otherwise would allow the jury to sit through most of the trial under the

mistaken belief that certain evidence is admissible for all purposes when, in fact, it is

not). A trial court does not err by failing or refusing to give a limiting instruction on

extraneous-offense evidence in the jury charge during the guilt–innocence phase if the

defendant did not request a limiting instruction when the trial court admitted the

evidence. See id. (“[A] limiting instruction concerning the use of extraneous[-]offense

evidence should be requested, and given, in the guilt-stage jury charge only if the

defendant requested a limiting instruction at the time the evidence was first

admitted.”); Gunter v. State, 327 S.W.3d 797, 802 (Tex. App.—Fort Worth 2010, no

pet.) (applying Delgado to hold that appellant forfeited his complaint on appeal).

      As noted, Gary did not request a limiting instruction on the extraneous-offense

evidence regarding Joy when it was admitted. The evidence was thus admitted for all

purposes, and the trial court was not obligated to include any limiting instruction in

                                           20
the guilt–innocence charge. See Delgado, 235 S.W.3d at 251; see also Williams v. State,

273 S.W.3d 200, 230 (Tex. Crim. App. 2008) (“A failure to request a limiting

instruction at the time evidence is presented renders the evidence admissible for all

purposes and relieves the trial judge of any obligation to include a limiting instruction

in the jury charge.”). Accordingly, we conclude that the trial court did not err by not

including Gary’s requested limiting instruction or any instruction limiting the purposes

for which the jury could consider the evidence. We thus overrule Gary’s second issue.

       Because we have concluded that there was no charge error, we need not

address Gary’s third issue. See Kirsch, 357 S.W.3d at 649; see also Tex. R. App. P. 47.1.

              VII. Admission of Nurse Fugate’s Hearsay Testimony

       Gary’s sixth and seventh issues challenge the trial court’s admission of Nurse

Fugate’s hearsay testimony regarding Mae’s and Joy’s patient histories, which the State

argued was admissible under Rule 803(4)’s medical-diagnosis-or-treatment exception

to the hearsay rule. Gary argues in his sixth issue that because these statements were

inadmissible under this hearsay exception, the trial court erred by overruling his

hearsay objection and by allowing Nurse Fugate, a SANE, to testify about what Mae

and Joy had told her. Gary complains in his seventh issue that the trial court’s

admission of this inadmissible evidence caused him egregious harm.

A. Standard of review

       We review a trial court’s evidentiary ruling on a hearsay objection for an abuse

of discretion. See, e.g., Zuliani v. State, 97 S.W.3d 589, 595 (Tex. Crim. App. 2003);

                                            21
Coffin v. State, 885 S.W.2d 140, 149 (Tex. Crim. App. 1994). We will not reverse an

evidentiary ruling unless it is outside the zone of reasonable disagreement. Tillman v.

State, 354 S.W.3d 425, 435 (Tex. Crim. App. 2011). If the ruling is correct under any

applicable theory of law, we will affirm it regardless of the trial court’s reason for the

ruling. Johnson v. State, 490 S.W.3d 895, 908 (Tex. Crim. App. 2016).

B. Admissibility of a child’s hearsay statements to a SANE

      Rule 803(4) allows statements “made for—and . . . reasonably pertinent to—

medical diagnosis or treatment” that “describe[ ] medical history; past or present

symptoms or sensations; their inception; or their general cause” to be admitted into

evidence even though they are hearsay. Tex. R. Evid. 803(4). For evidence to be

admissible under this exception, the proponent must show (1) that the declarant “was

aware that the statements were made for purposes of medical diagnosis or treatment

and that proper diagnosis or treatment depended upon the veracity of the statements”

and (2) “that the statements are pertinent to diagnosis or treatment, i.e., that it was

reasonable for the care provider to rely on the statements in diagnosing or treating the

declarant.” Lumsden v. State, 564 S.W.3d 858, 883 (Tex. App.—Fort Worth 2018, pet.

ref’d) (citing Taylor v. State, 268 S.W.3d 571, 588–89, 591 (Tex. Crim. App. 2008)).

      In cases involving medical diagnosis and treatment—as opposed to mental-

health treatment and therapy—courts generally presume that “children of a sufficient

age or apparent maturity” will understand that the medical provider’s questions are

designed to elicit accurate information and that veracity will serve their best interest.

                                           22
Taylor, 268 S.W.3d at 589. In applying the test, courts thus generally review the record

for “evidence that would negate such an awareness, even while recognizing that the

burden is on the proponent of the hearsay to show that the Rule 803(4) exception

applies.” Id. Absent such negative evidence, the Texas Court of Criminal Appeals

does “not require[ ] the proponent of statements to a SANE to affirmatively

demonstrate that the declarant was aware of the purpose of the statements and the

need for veracity.” Lumsden, 564 S.W.3d at 884; see Taylor, 268 S.W.3d at 589.

C. Analysis

      Gary attacks both of Rule 803(4)’s admissibility requirements. First, he asserts

that the record negates the presumption that the girls understood the need for

truthfulness because of Mae’s and Joy’s ages (seven and eight years old, respectively);

because the girls may have been repeating the description of events that Mother gave

to Nurse Fugate; and because there is no evidence that Nurse Fugate told the girls

“the purpose of the examination or impressed upon them the importance to tell the

truth.” Second, he contends that the girls’ statements were not pertinent to medical

diagnosis or treatment and were “solicited for the purposes of testifying at trial”

because Nurse Fugate’s testing and treatment did not rely on the girls’ statements.

      At trial, Nurse Fugate explained the sexual-assault-examination procedure.

When a child and parent come into the clinic, Nurse Fugate “usually show[s] them

around.” She talks to the parent first to get the child’s medical history and to “go over

what they know about what’s happened.” She then meets with the child alone to get a

                                           23
patient history, during which time she talks to the child and “go[es] into

what’s . . . gone on” and “why they’re here today.” According to Nurse Fugate, the

patient history’s purpose is for medical diagnosis and proper treatment, regardless of

whether the child is acute or nonacute, and the history “helps [her] determine what

[she’s] looking for, what [she] needs to test, [and] what to do, basically.” Nurse Fugate

then explains to the child that she is going to do a checkup; performs a “head-to-toe

checkup” on the child; examines the child’s anal and genital areas looking for any

signs of infection, injury, or healed injury; and performs any necessary testing.

      The record here does not reflect whether the girls were present when Nurse

Fugate talked to Mother. Nurse Fugate testified that when she talked to the girls

alone, she explained to both of them that they were there for a medical checkup and

diagnosis and treatment. When Nurse Fugate asked Mae why Mae was there, she

responded, “because of the inappropriate things that happened” and “inappropriate

touching,” and then, after additional questioning from Nurse Fugate, Mae described

Gary’s abuse and where and when it had happened. Joy similarly responded to Nurse

Fugate’s questions: Joy was there “because of [Gary], but we don’t see him anymore,”

and when asked what happened, Joy recounted Gary’s abuse. Nothing in the record

negates Mae’s or Joy’s understanding that the purpose of their statements was for

medical diagnosis or treatment and that they needed to be truthful. See Beheler v. State,

3 S.W.3d 182, 188–89 (Tex. App.—Fort Worth 1999, pet. ref’d) (stating that “there is

no requirement that a witness expressly state that the hearsay declarant recognized the

                                           24
need to be truthful in her statements for the medical[-]treatment exception to apply”

and holding that evidence was sufficient to support conclusion that seven-year-old

child understood the need for veracity during SANE exam where process was

explained and child was interviewed alone, child knew why she was there, and SANE

testified that she interviewed child for purposes of medical exam); see also 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 conclusion that eight-year-old child was unaware that the

purpose of SANE’s questions was to provide medical treatment or diagnosis or was

unaware of the necessity to be truthful where 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). We therefore conclude that the girls’ statements to Nurse

Fugate satisfy the admissibility test’s first requirement.

       We similarly conclude that the girl’s statements satisfy the second requirement:

the statements were pertinent to medical diagnosis or treatment. See Lumsden,

564 S.W.3d at 883. We disagree with Gary’s assertion that the girls’ histories were

taken solely for use in court and weren’t pertinent for treatment or diagnosis. Nurse

Fugate agreed that the “core principle” for a medical provider was to take a patient

history and testified that “[w]ithout a history, we don’t know what we’re dealing

with.” Although Nurse Fugate testified about her general exam procedures, she

                                             25
testified as follows about the purpose of taking a patient history from both girls in this

case:

              [State]: Specifically, what was the purpose of taking a history from
        both of those young ladies?

              [Nurse Fugate]: So that I would be able to figure out what I
        needed to do and come up with a game plan for diagnosis and treatment.

              Q. All right. So your purpose in asking for a history was to obtain
        the proper treatment or course of treatment for both children?

              A. Yes.

        When the trial court indicated that it wanted to know what Nurse Fugate did in

this case, the following exchange occurred:

               Q. [By the State] So in this particular case, then, you took a
        history; is that correct?

              A. I did.

              Q. After you took a history, then what did you do next?

              A. So after the history, then I formulate what I’m going to do.

              Q. And what did you do?

               A. So I do the checkup based on the contact that they describe. I
        did testing for gonorrhea and chlamydia.

              ....

              Q. . . . And so based on their disclosures, that’s where you
        looked?

              A. Yes.

              Q. All right. And so specifically were you looking for a sexually
        transmitted disease -- gonorrhea and chlamydia?

                                           26
              A. I was.

              ....

              Q. All right. Did you do any other testing, any other blood work
        on these particular girls?

              A. No. Based on the contact that they told me, that was the one
        that we needed to do.

        Nurse Fugate additionally testified that she performed a “head-to-toe checkup”

on each girl and then examined and photographed each girl’s genital and anal areas.

Neither girl had any physical injuries, healed injuries, or obvious infections. The lack

of physical injuries did not surprise Nurse Fugate because of the contact the girls had

described. And because the girls did not test positive for gonorrhea or chlamydia,

there was no reason to treat them with medication. On this record, we conclude that

it was reasonable for the trial court to conclude that the girls’ statements to Nurse

Fugate were “pertinent to diagnosis or treatment, i.e., that it was reasonable for the

care provider to rely on the statements in diagnosing or treating the declarant.”

Lumsden, 564 S.W.3d at 883.

        Having concluded that the trial court could have reasonably concluded that the

challenged hearsay statements fall within Rule 803(4)’s hearsay exception, we hold that

the trial court did not abuse its discretion by admitting them. Accordingly, we overrule

Gary’s sixth issue, and we thus do not address his seventh issue. See Tex. R. App. P.

47.1.

                                          27
                                 VIII. Conclusion

      Having overruled Gary’s dispositive issues, we affirm the trial court’s judgment.

                                                     /s/ Elizabeth Kerr
                                                     Elizabeth Kerr
                                                     Justice

Do Not Publish
Tex. R. App. P. 47.2(b)

Delivered: April 6, 2023

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