State of Tennessee v. Christopher Earl Watts ( 2012 )


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  •         IN THE COURT OF CRIMINAL APPEALS OF TENNESSEE
    AT NASHVILLE
    September 14, 2011 Session
    STATE OF TENNESSEE v. CHRISTOPHER EARL WATTS
    Direct Appeal from the Criminal Court for Davidson County
    No. 2007-D-3224     Cheryl Blackburn, Judge
    No. M2009-02570-CCA-R3-CD - Filed May 3, 2012
    A Davidson County Criminal Court Jury convicted the appellant, Christopher Earl Watts, of
    four counts of aggravated child abuse, two counts of aggravated child neglect, and one count
    of child neglect. After a sentencing hearing, the appellant received an effective sentence of
    seventy-five years to be served at one hundred percent. On appeal, the appellant contends
    that (1) the trial court erred by denying his motion to sever the offenses; (2) the trial court
    erred by instructing the jury that the appellant’s co-defendant was an accomplice; (3) the
    evidence is insufficient to support the convictions; (4) the trial court erred by failing to merge
    the appellant’s aggravated child neglect convictions; and (5) his effective sentence is
    excessive. The State concedes that the trial court erred by failing to merge the appellant’s
    aggravated child neglect convictions. We conclude that the trial court erred by failing to
    grant the appellant’s motion to sever but that the error was harmless. We also conclude that
    the evidence is insufficient to support one of the appellant’s convictions for aggravated child
    abuse, one of his convictions for aggravated child neglect, and his conviction for child
    neglect. The appellant’s remaining convictions and effective seventy-five-year sentence are
    affirmed.
    Tenn. R. App. P. 3 Appeal as of Right; Judgments of the Criminal Court are
    Affirmed in Part and Reversed in Part.
    N ORMA M CG EE O GLE, J., delivered the opinion of the Court, in which J AMES C URWOOD
    W ITT, J R., J., joined. J ERRY L. S MITH is not participating.
    Emma Rae Tennent (on appeal), J. Michael Engle (at trial), and Aisha McWeay (at trial),
    Nashville, Tennessee, for the appellant, Christopher Earl Watts.
    Robert E. Cooper, Jr., Attorney General and Reporter; Lindsy Paduch Stempel, Assistant
    Attorney General; Victor S. Johnson, III, District Attorney General; and Brian Holmgren,
    Assistant District Attorney General, for the appellee, State of Tennessee.
    OPINION
    I. Factual Background
    The record reflects that in October 2007, the Davidson County Grand Jury indicted
    the appellant for the following crimes: count 1, aggravated child abuse; count 2, child
    neglect; count 3, aggravated child abuse; counts 4 and 5, aggravated child neglect; and counts
    6 and 7, aggravated child abuse. According to the indictment, counts 1 and 2 occurred on
    or about April 16, 2007; counts 3 and 4 occurred on or about June 15, 2007; count 5 occurred
    between June 13 and 14, 2007; and counts 6 and 7 occurred between May 29 and June 15,
    2007. In counts 2 though 7, the appellant was indicted jointly with the victim’s mother,
    Lakeisha Watkins.1 However, the appellant was tried separately from Watkins.
    At the appellant’s trial, Janelle Driver, a paramedic with the Nashville Fire
    Department, testified that about 6:30 p.m. on April 16, 2007, she was dispatched to Watkins’
    home in response to a 911 call placed by Watkins. When paramedics arrived, Watkins was
    outside carrying the fifteen-month-old victim. Driver said the victim was breathing and had
    “no obvious apparent injury.” Watkins told Driver that the victim fell about 11:00 a.m., may
    have hit his head, and was fine all day but began acting sleepy about 6:00 p.m. Watkins also
    told Driver that she did not call 911 earlier because the victim was acting normal.
    Driver testified that the victim appeared “a little bit sleepy.” In assessing the victim,
    Driver asked Watkins about seizures, and Watkins said the victim did not have a history of
    seizures. Driver noticed the victim had a bruise above the top of his nose that was consistent
    with a fall or blunt injury. When she lifted the victim’s shirt to check his airway and listen
    to his heart, she noticed small scratches on both sides of his neck. Driver said Watkins told
    her the scratches were due to the victim’s “rough playing.” Driver did not see any other
    injuries on the victim, and paramedics transported him to the Vanderbilt Pediatric Emergency
    Room (ER). Driver never talked with the appellant.
    Bryan Jones, a paramedic with the Nashville Fire Department, testified that on the
    night of June 15, 2007, paramedics were dispatched to Watkins’ home in response to a 911
    call about an unconscious child. When they arrived at 10:18 p.m., firemen were carrying the
    victim to an ambulance and were using a bag mask over the victim’s face to ventilate him.
    The victim was having seizures and was unable to control his airway or breath efficiently.
    The victim had a pulse, but his heart rate was very low and irregular. Paramedics continued
    to ventilate the victim with the bag mask and gave him Valium rectally to control the
    1
    Watkins also was charged in count 8 of the indictment with aggravated child abuse for striking the
    victim with a belt between May 29, 2007, and June 15, 2007.
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    seizures. Jones said Watkins “described seizure activity” that occurred about eighteen hours
    before the 911 call. However, Watkins denied any recent trauma to the victim. Jones said
    there was no evidence of any food in the victim’s airway that would have prohibited the
    victim from breathing and that Watkins did not say the victim choked on anything. Watkins
    told Jones that the victim did not have a history of seizures. Jones noticed the victim’s pupils
    were small and were not at a normal level, indicating a neurological injury or a drug
    overdose. The victim’s condition was critical, and paramedics transported him to the
    hospital. Jones never spoke with the appellant.
    On cross-examination, Jones testified that the Valium caused the victim’s condition
    to improve temporarily. However, the victim’s seizures returned while en route to the
    hospital.
    Falonda Tolston, a case manager for Child Protective Services, testified that she
    became involved with the victim’s case on April 17, 2007. The victim spent one day in the
    hospital, and Tolston spoke with his mother and maternal grandparents. Tolston said that as
    part of the victim’s “safety plan,” he was to live with his maternal grandmother for thirty
    days so that Tolston could complete her investigation. On April 18, 2007, Tolston went to
    Lakeisha Watkins’ apartment, but no one was there. About May 22, 2007, Tolston received
    a telephone call from the victim’s maternal grandfather, telling her that Watkins and the
    appellant had taken the victim home. On May 29, Tolston went to Watkins’ apartment and
    spoke with her. Tolston said that the victim “still had some marks from the [April 16]
    incident” but that he “seemed fine.” The appellant was not present, and Tolston did not see
    any evidence he was living with Watkins. Tolston said that if she had received information
    about the appellant’s living there, she would have “[p]robably re-enacted the safety
    placement.” Tolston needed to interview the appellant in order to complete her investigation
    but never spoke with him. In June 2007, she learned the victim was in the hospital again.
    At that point, the police got involved with the victim’s case.
    On cross-examination, Tolston acknowledged that nothing legally prevented Watkins
    from removing the victim from his grandparents’ care. Tolston also acknowledged that the
    appellant’s living with Watkins would have been a violation of Watkins’ lease agreement,
    which allowed only family members to live in Watkins’ apartment.
    On redirect examination, Tolston testified that when she saw the victim in the hospital
    in April 2007, he had bruises on his face and a few marks on his right eye. She said that
    when she saw him on May 29, 2007, he still had “old marks from April. . . . They appeared
    to be scratches and old scars.”
    Detective Woodrow Ledford of the Metropolitan Nashville Police Department
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    (MNPD) testified that about 10:00 p.m. on June 15, 2007, he was on patrol and was
    dispatched to Watkins’ apartment. When he arrived at the apartment, the victim was in an
    ambulance, and Watkins was sitting in the cab of the ambulance. Detective Ledford went
    inside Watkins’ apartment, but no one was there. He went upstairs and noticed a puddle of
    water on the bathroom floor.
    On cross-examination, Detective Ledford testified that he did not see a telephone in
    the apartment. He acknowledged that he spoke with Watkins and that she told him she fed
    the victim bologna and bread that night.
    John Watkins, Lakeisha Watkins’ father, testified that he currently had custody of the
    three-year-old victim. On April 16, 2007, he and his ex-wife learned the victim was in the
    hospital and went to see the victim. The victim had a bruise on his forehead, and his eyes
    were swollen shut. He also had a small knot on the side of his head and a small knot on the
    back of his head. Mr. Watkins spoke with the appellant at the hospital. The appellant
    claimed that the victim pulled away from the appellant’s hand, ran down a hill, fell, and hit
    his face. Mr. Watkins had seen the victim run previously, and the victim did not run very
    well. While the victim was in the hospital, the appellant told some nurses that he was the
    victim’s father. Mr. Watkins told the appellant that he was not the victim’s father or
    stepfather, and the appellant got upset. The appellant claimed he cared for the victim, but
    Mr. Watkins did not believe him. When doctors discharged the victim from the hospital, he
    lived with Mr. Watkins for about three weeks. The victim was alert and did not have any
    seizures during that time. Then the victim went to live with his grandmother for three weeks.
    At some point, the victim’s mother and the appellant took the victim home. Mr. Watkins
    notified Falonda Tolston.
    Mr. Watkins testified that in June 2007, the appellant telephoned Mr. Watkins’ ex-
    wife and told her that the victim was in the hospital. Later, the appellant telephoned her
    again and asked how the victim was doing. Mr. Watkins said he told the appellant to “come
    down here and see for yourself.” The victim was in the hospital for a couple of weeks, but
    Mr. Watkins never saw the appellant. After the victim was discharged, the victim went to
    a hospital in Atlanta for rehabilitation. He was there for one month, and Mr. Watkins stayed
    with him. The victim was blind and had to learn to walk again and use his arms and hands.
    After he left the Atlanta hospital, his eyesight returned. Mr. Watkins said that since the
    victim had regained his eyesight, his recovery “has been like leaps and bounds.” The victim
    still had limited use of his left leg and arm and appeared to have some double vision.
    On cross-examination, Mr. Watkins denied telling the appellant to leave the hospital
    in April 2007. He explained that the hospital staff asked the appellant to leave because the
    appellant made a commotion when Mr. Watkins objected to the appellant’s saying he was
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    the victim’s father. Mr. Watkins said there was a slight slope near the dumpsters in his
    daughter’s apartment complex.
    Pamela Watkins, Lakeisha Watkins’ mother, testified that on April 16, 2007, she
    learned the victim was in the hospital. She said that the victim had bruises “all about his
    face” and that the appellant claimed the victim fell down a hill near the dumpsters. The
    victim stayed in the hospital overnight. The next day, he went to live with his grandfather
    for three weeks. Then he lived with Pamela Watkins for three weeks. She said she never
    saw the victim exhibit unusual behavior or have any seizures during that time. After the
    victim had been with his grandparents for six weeks, his mother took him home. In June
    2007, the appellant telephoned Pamela Watkins and told her that the victim had stopped
    breathing and was in the hospital. She went to the hospital but never saw the appellant.
    About two days before the victim went to the hospital, Lakeisha Watkins told her mother that
    she thought the victim had had a seizure.
    On cross-examination, Pamela Watkins testified that she did not see the victim from
    the time he left her care until he returned to the hospital in June. She acknowledged that
    there was a slope at the dumpsters near her daughter’s apartment and said that the slope was
    dangerous. She denied telling someone from the Department of Children’s Services (DCS)
    that she fell near the dumpsters.
    Detective Faye Okert of the MNPD testified that on June 15, 2007, she went to
    Vanderbilt Hospital to investigate a report of an injured seventeen-month-old child. She
    arrived just before midnight and photographed the victim. She also spoke with the victim’s
    mother, grandparents, and a social worker. At that time, doctors did not know what was
    causing the victim’s seizures, and Detective Okert did not have any reason to believe a crime
    had been committed. She interviewed the victim’s mother two additional times, and all three
    interviews were recorded. Detective Okert never saw the appellant at the hospital. On June
    18, Detective Okert visited the victim in the hospital, where she witnessed and video-
    recorded him having a seizure. She interviewed the appellant in person on June 20, recorded
    the interview, and played the video of the victim’s seizure for the appellant. During the
    interview, the appellant mentioned someone named Michael who had spent the night at
    Lakeisha Watkins’ apartment. Detective Okert said the police “tried to identify who he could
    be and never could figure out whether there was a Michael.” On June 21, Detective Okert
    went to Watkins’ apartment and photographed the dumpsters where the victim allegedly fell
    in April 2007. Detective Okert said that a neighbor telephoned 911 on April 16 and that the
    911 call on June 15 was placed from Nicole Riley’s telephone.
    The State played the videos of the victim’s seizure and the appellant’s June 20
    interview for the jury. During the appellant’s interview, he told Detective Okert the
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    following: The appellant had been living with Lakeisha Watkins for nine or ten months. On
    the morning of April 16, 2007, Watkins went to the dentist, and the appellant babysat the
    victim. While Watkins was gone, the appellant took out the trash. The victim went with
    him, ran down a hill, and fell. The victim was “alright at first,” but his lip was “busted.”
    Later, a knot appeared on his head, and the appellant told Watkins to call an ambulance. The
    victim fell near the dumpster about 11:00 a.m., but the appellant and Watkins did not call for
    help until 7:00 p.m. because Watkins did not want to take the victim to the hospital. The
    appellant did not know anything about the bruises on the victim’s face. He said that he had
    seen Watkins “pop” the victim previously for misbehaving and that he had “popped” the
    victim’s hand one time.
    On the morning of Wednesday, June 13, the victim had his first seizure while the
    appellant was changing his diaper. The victim’s eyes rolled back into his head, but he did
    not “lock up.” At the time, the appellant and Watkins did not know the victim was having
    a seizure; the appellant thought the victim was having a heat stroke because it was hot in the
    apartment. The appellant put the victim in front of a fan, and the victim “snapped out of it.”
    The victim was “okay” and “running around.” On Friday morning, June 15, the appellant
    awoke and noticed the victim was not in his playpen. Watkins and the appellant had a baby
    gate to prevent the victim from going downstairs, but they had failed to put the gate up. The
    appellant went downstairs and found the victim leaning on the couch. At some point, the
    victim started screaming, which was unusual, and Watkins gave him some Tylenol. Later
    that day, Watkins fed the victim bologna and bread. Then she handed the victim to the
    appellant and left the apartment to get something to eat. The appellant put the victim down,
    noticed his lips were blue, and noticed he was lifeless. The appellant panicked and yelled
    for someone to call the police. The appellant did not know cardio pulmonary resuscitation
    (CPR) but blew into the victim’s mouth and “pressed” on the victim. A female neighbor
    performed CPR and got the victim to breathe.
    About forty-five minutes into the interview, the victim told Detective Okert for the
    first time that someone named Michael spent Thursday night, June 14, in the apartment.
    However, the appellant did not think Michael hurt the victim. The appellant denied
    “thumping” the victim or pushing him down. He also denied ever going into a room with the
    victim, shutting the door, and causing a “thud” in the room. The appellant said he had seen
    Watkins “thump” and “pop” the victim previously. However, he said that Watkins was a
    wonderful mother and that he did not think she hurt the victim.
    Dr. Lawrence Stack, an ER physician at Vanderbilt Hospital, testified as an expert in
    emergency medicine that he and a resident physician examined the victim on April 16, 2007.
    According to the victim’s medical records, the victim’s “stepfather” said that about 11:00
    a.m., the victim fell “flat on his face” while they were walking down a hill to take out the
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    trash. The victim developed bruises on his forehead and multiple abrasions on his upper
    extremities and face. He also had been sleeping since the fall. Dr. Stack noticed the victim
    was fussy and had no response when Dr. Stack tried to open his eyes. The victim had
    multiple bruises on his forehead, face, upper arms, and shoulders, and a fall did not
    adequately explain the victim’s injuries. Dr. Stack initiated a non-accidental trauma plan that
    included a skeletal survey, a CT scan, social services, and DCS. Although the CT scan
    showed no evidence of trauma to the brain, Dr. Stack diagnosed the victim with a
    concussion, which Dr. Stack explained was a disruption of brain function caused by
    significant force. The victim was admitted to the hospital in order for a Care Team to
    evaluate his bruises and home environment.
    On cross-examination, Dr. Stack testified that the radiologist who read the victim’s
    CT scan found an arachnoid cyst in the victim’s brain. However, the radiologist considered
    the cyst to be benign. Therefore, Dr. Stack saw no connection between the cyst and the
    victim’s injuries. Although the victim was cleared for discharge from the ER at 10:20 p.m.,
    he was admitted to the hospital for the Care Team evaluation. Dr. Stack acknowledged that
    the victim’s grandfather did not want the victim to be around the appellant. The
    grandfather’s concern raised Dr. Stack’s suspicion. Dr. Stack said that he did not see the
    victim lose consciousness but that the victim was fussy, which was abnormal behavior.
    On redirect examination, Dr. Stack testified that a physician could not see a
    concussion on a CT scan and that a concussion was a clinical diagnosis. The resident
    physician who treated the victim wrote in her report that the victim had three linear petechiae
    in a slap pattern on his left cheek and that he had abrasions and swelling on his lower lip.
    Jessica Mitchell testified that in April 2007, she was Watkins’ next door neighbor.
    The appellant was Watkins’ boyfriend. Mitchell saw him go in and out of Watkins’
    apartment every day, and the appellant told Mitchell that the victim was his son. About 4:00
    p.m. on April 16, Watkins asked Mitchell to drive her and the victim to the hospital. Mitchell
    said the appellant “was going looking for a ride -- another ride, I guess, on his own terms.”
    Mitchell told Watkins that she would take Watkins and the victim to the hospital after her
    children got home from daycare. The victim kept going to sleep. Mitchell thought he needed
    medical attention and called 911.
    On cross-examination, Mitchell testified that sometime later, she saw the victim at a
    birthday party for Nicole Riley’s child. She said the victim was awake and alert but “looked
    like he was sick or something.”
    On redirect examination, Mitchell acknowledged that a “blow-up bouncy” toy for
    children to jump in was at the party. However, Mitchell did not see the victim jump or
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    interact with other children. She said the victim “wasn’t involved with nothing,” so she
    thought something was wrong with him.
    Nicole Riley, the appellant’s cousin, testified that in June 2007, she was Watkins’
    neighbor. The appellant was Watkins’ boyfriend, bought food for Watkins and the victim,
    and seemed to like the victim. On the afternoon of Wednesday, June 13, Riley had a birthday
    party for her son and invited the victim. The appellant brought the victim to the party. Riley
    said the victim “didn’t ever move, he didn’t ever talk, he didn’t ever play. . . . He just stood
    there.” Riley gave the victim a popsicle, and he ate it. She said that when Watkins arrived
    at the party, the victim “busted into tears.” Riley said Watkins grabbed the victim by the arm
    or wrist, “jerked him up off the porch,” and took him home. Watkins and the victim later
    returned to the party, and Watkins got into the bounce-toy with him. However, the victim
    would not play. Riley did not see the victim have any seizures.
    On cross-examination, Riley testified that Watkins often got mad when the appellant
    left the apartment and that Watkins “slammed the door and stuff like that.” The State showed
    Riley a photograph of the victim’s bedroom, and she identified a baby gate. She said that she
    gave the baby gate to the appellant so that the victim would not fall down the stairs in
    Watkins’ apartment.
    Latoya Starks testified that in June 2007, she lived in an apartment across from
    Lakeisha Watkins’ apartment but did not know Watkins or the appellant. One night, Starks
    was on her porch when she saw the appellant run out of Watkins’ apartment. The appellant
    yelled for help, said his son was not breathing, and was in a panic. Starks and some other
    people ran to Watkins’ apartment and went upstairs. The victim was lying on the floor, was
    purple, and was not breathing. Someone tried to give the victim CPR, but it did not help, so
    Starks left and got her friend, Barbara Miller, to go to Watkins’ apartment. Starks said Miller
    performed CPR on the victim and “brought him back.” The victim was coughing, and Starks
    asked what was in his mouth. The appellant told her it was bread and bologna. Starks said
    that the bologna “never came up” but that she saw bread in the corner of the victim’s mouth.
    They carried the victim downstairs just as Watkins walked into the apartment. Watkins
    pulled the bread out of the corner of the victim’s mouth, shook the victim, and smacked the
    victim’s face. Starks said Watkins told the victim to “stay with me, stay with me.” Starks
    said that the victim “went out again,” that Miller performed CPR again, and that the victim
    “came back.” Starks said it was hot in the apartment.
    Dr. Sandra Moutsios, a pediatrician and internist at Vanderbilt Hospital, testified as
    an expert in pediatric medicine and child abuse evaluation. When the victim came to the ER
    on June 15, 2007, he received treatment for continuous seizures and was stabilized. He
    continued to have seizures intermittently for one and one-half hours and received multiple
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    intravenous medications to stop them. He also had a CT scan, an MRI, a skeletal survey, and
    an opthamologic exam. On June 17, Dr. Moutsios was a member of the Care Team that
    evaluated the victim in the hospital’s intensive care unit. Dr. Moutsios said that the Care
    Team was the consultation service responsible for evaluating children suspected of being
    abused and that she conducted a “head to toe” examination of the victim. The victim was not
    very responsive and would not open his eyes in response to voice. The victim moved all of
    his extremities minimally, but spontaneously, and moved his right side more than his left.
    The victim made sounds with his mouth and gritted his teeth. Dr. Moutsios said that his
    heart, lungs, and abdomen were normal and that “[i]t was his mental status that was most
    concerning.”
    Dr. Moutsious spoke with Lakeisha Watkins. She said Watkins told her the following:
    About noon on Wednesday, June 13, the victim had an episode of crying, gritting his teeth,
    and locking his joints. His eyes also rolled backed into his head. The episode lasted five
    minutes and resolved on its own, and the victim behaved normally for the rest of the day. On
    Thursday, June 14, the victim attended a birthday party. He and his mother jumped in a
    “bounce factory type attraction,” and the victim used his arms and legs normally. On Friday,
    June 15, Watkins awoke about 8:00 a.m. and discovered that the victim had crawled out of
    his playpen. She found him downstairs, standing by the couch with his head and arms resting
    on the couch. Watkins thought the victim was tired and put him into bed. He had an episode
    of screaming, crying, clenching his hands, and extending all four extremities, but the episode
    resolved in a few minutes. The victim would not walk, so Watkins carried him to a seat for
    breakfast. The victim ate cereal and drank milk. Watkins thought he was in pain, gave him
    Tylenol, and put him in his playpen with a fan. The victim did not want to walk and was
    sleepy for the rest of the day. About 10:00 p.m., Watkins left the victim with the appellant
    and went to get something to eat. When she returned to the apartment, the appellant was
    standing at the door, yelling for help, and saying that the victim was not breathing. Watkins
    found the victim upstairs, lying on the floor and gasping for breath. The appellant had tried
    to give the victim CPR, but the victim was not breathing. A neighbor gave the victim CPR,
    and the victim began breathing. Paramedics arrived at 10:15 p.m. Dr. Moutsious said that
    Watkins demonstrated the victim’s episodes from Wednesday, Friday morning, and Friday
    night. From the demonstrations, Dr. Moutsious thought victim was having “tonic clonic”
    seizures. Dr. Moutsious said she was “concerned” that the victim had sustained a head injury
    prior to the seizures.
    Dr. Moutsious testified about the victim’s skeletal survey, opthalmologic exam, CT
    scan, and MRI. The victim’s skeletal survey revealed a fracture to his left arm bone near the
    wrist. She described the fracture as a “buckle fracture,” meaning “there was some course
    that caused the outside layer of the bone to actually buckle.” Significant force caused the
    fracture, which had started to heal. Dr. Moutsious estimated that the victim’s arm was
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    broken one to two weeks before he was brought to the hospital on June 15; the fracture did
    not occur within one or two days of June 15. She said that the fracture could have resulted
    from the “bending of the bone” and that “[w]e see that sometimes in older athletes that end
    up on an outstretched wrist and the bone buckles.” She said the fracture also could have
    resulted from a “twisting mechanism.” She said that the arm would have been painful, that
    she would have expected the victim to cry and not use the arm, and that some swelling could
    have appeared over the fracture.
    Dr. Moutsious testified that the victim had extensive bilateral retinal hemorrhages in
    his eyes, showing a severe brain injury caused by significant and severe force. For the first
    two weeks the victim was in the hospital, Dr. Moutsious could not get him to track light or
    sound. She said that if the victim’s brain was injured on June 15, she would have expected
    the victim’s caregiver to have noticed he was not acting normal. In the ER, the victim’s CT
    scan was quickly read as normal. However, when it was re-read in the Pediatric Intensive
    Care Unit, the victim was found to have a subdural hematoma. The victim’s MRI revealed
    subdural and subarachnoid hemorrhages, also known as bleeding in the brain, on the right
    side. The bleeding was caused by a lateral force or shake. The victim went for some period
    of time without breathing, which deprived the central part of his brain of oxygen. She said
    the victim could have easily died on Friday night.
    Dr. Moutsious testified that the victim’s MRI showed some of the “bleeds” in his
    brain were acute, meaning they occurred within a couple of days from the time the victim
    stopped breathing. Although Dr. Moutsious could not say exactly when the bleeds occurred,
    she stated that “there’s great concern that something happened just before this child stopped
    breathing” and that “when we see children present with such severe episodes of stopping
    breathing and seizure, that oftentimes, there’s an injury that happened within minutes.” The
    victim’s most severe bleeding caused him to have the Friday-night seizure and trouble
    breathing. The victim’s brain was permanently injured, and Dr. Moutsious did not think he
    would have been able to eat after he sustained the injury. She stated that if care had been
    sought for the victim prior to the Friday-night seizure, the victim “may not have progressed
    to that point and we could have potentially prevented that.” She said that based on the
    victim’s MRI, it was “certainly possible” that the victim also sustained prior, less-severe
    brain bleeds. In her opinion, the victim had a brain injury prior to the Wednesday seizure.
    She stated that in her opinion, the victim sustained multiple injuries to his brain, that he
    sustained non-accidental trauma to his brain, and that his wrist injury was non-accidental.
    On cross-examination, Dr. Moutsious testified that if the victim ate bologna and bread
    on Friday night, then the brain injury likely happened afterward because it would have been
    unusual for a child to have eaten right after a seizure. She said she did not know bread and
    bologna was found in the victim’s mouth, and she acknowledged that food in the victim’s
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    mouth could have affected his breathing. She said she found it “curious” that the victim
    reportedly had a seizure on Wednesday but played and jumped at the birthday party on
    Thursday. She also said that the victim’s being in the hospital in April 2007 “raised [her]
    level of concern” about the injuries he sustained in June 2007. She acknowledged that the
    victim’s CT scans in April and June showed an arachnoid cyst within the outside layers of
    his brain. However, she described the cyst as an “incidental finding” because the victim’s
    radiologist and neurologist did not think the cyst was significant or related to his injuries. She
    acknowledged that the bleeding in the victim’s brain was due to injuries at different times.
    She reiterated that one bleed was acute, meaning it occurred within a couple of days, but that
    some of the bleeds “were called consistent with possible old subdurals [and] would have
    been older than two weeks.” Lakeisha Watkins never told her that the victim had a history
    of falling down the apartment stairs.
    On redirect examination, Dr. Moutsious testified that in her opinion, a fall down the
    stairs did not cause the victim’s injuries because the injuries were of different ages and
    locations. She stated, “I don’t think this is a one event trauma for this child.” She
    acknowledged that given what happened to the victim in June, his injuries in April were more
    likely the result of non-accidental trauma. She stated that the victim’s choking did not
    explain his June injuries. She acknowledged that the likely sequence of events for the
    victim’s June injuries was as follows: Trauma to the victim’s brain, subdural and
    subarachnoid hemorrhages, and difficulty breathing. She stated that “it’s difficult to say
    whether [the] brain injury caused him to stop breathing or [the] seizure caused him to stop
    breathing. But with that addition, I believe that’s the sequence of events.”
    Lakeisha Watkins, the victim’s mother, acknowledged that she was the appellant’s co-
    defendant in seven of the eight counts and testified that she had not been promised anything
    in exchange for her testimony.2 Watkins said she attended special education classes in high
    school and did not graduate but received a certificate of attendance. The victim was born in
    January 2006, and Watkins did not work after he was born. She supported herself and the
    victim with assistance from the Families First program, food stamps, and help from her
    parents. Watkins met the appellant in 2007 and was pregnant with his child at the time of
    the events in question. The appellant played with the victim sometimes and changed his
    diaper. She said that the appellant did not pay for food and that he was “not really” the
    victim’s caretaker. However, Watkins would leave the victim in the appellant’s care about
    once per week for two or three hours.
    2
    At the time of the appellant’s trial, a jury already had convicted Watkins of attempted child neglect
    as a lesser-included offense of child neglect in count 2 of the indictment; aggravated child abuse in counts
    3, 6, 7, and 8; and aggravated child neglect in count 4. See State v. Lakeisha Margaret Watkins,
    No. M2009-02607-CCA-R3-CD, 2011 Tenn. Crim. App. LEXIS 523, at *1 (Nashville, July 8, 2011).
    -11-
    Watkins testified that on April 16, 2007, she went to the dentist about 9:00 a.m. The
    victim stayed with the appellant. When Watkins returned home about noon, she saw that the
    victim had a large knot on his forehead and that he could not open his eyes. The appellant
    told Watkins that he and the victim were behind a dumpster, that the victim began running,
    that the victim let go of the appellant’s finger, and that the victim fell. Watkins said that the
    victim had just started learning to run and that he could not run very fast. She did not see any
    other injuries on the victim and accepted the appellant’s explanation. However, about thirty
    minutes later, the victim was still sleepy. The appellant did not want Watkins to call an
    ambulance, so Watkins went to Jessica Mitchell’s house. Mitchell had a car, and Watkins
    asked Mitchell to drive her and the victim to the hospital. Mitchell said she would drive
    them. However, about one hour later, Mitchell told Watkins that something was wrong with
    the car. About 6:00 p.m., Mitchell called an ambulance, and paramedics took the victim and
    Watkins to the hospital. The appellant arrived at the hospital about twenty or thirty minutes
    later, and he and Watkins spoke with doctors. The appellant told the doctors that he was the
    victim’s stepfather. Watkins got upset with the doctors because they said they were going
    to take the victim away from her. They questioned her about other bruises on the victim, but
    she did not have an explanation for the bruises. She said she could not explain why she
    waited to call an ambulance for the victim.
    Watkins testified that when the victim got out of the hospital, he stayed with her
    parents. At some point, the victim’s parents asked Falonda Tolston if the victim could go
    back to Watkins. Tolston told them yes but that she first had to check Watkins’ apartment.
    Tolston visited Watkins’ apartment after the victim returned to live with Watkins. Watkins
    lied to Tolston by telling Tolston that she and the appellant had ended their relationship, and
    Tolston allowed the victim to remain with Watkins. Watkins said her parents did not approve
    of her relationship with the appellant but approved of the appellant’s being around the victim.
    Watkins testified that about two days before the victim’s June admission to the
    hospital, she and the victim went to a birthday party hosted by Nicole Riley. Watkins said
    Riley had a “bounce machine” at the party. Watkins said that she tried to get the victim to
    play in the machine but that he “was just sitting there.” About noon on Wednesday, June 13,
    the victim had his first seizure while Watkins was taking out the trash. She said that she did
    not see the seizure but that the appellant told her the victim was “locking up” his left arm and
    grinding his teeth. Watkins did not get medical help for the victim at that time because she
    was scared. The victim acted normal for the rest of the day, and the appellant told her not
    to call an ambulance because the appellant did not think the victim’s condition was serious.
    Watkins testified that on Friday, June 15, she awoke about 9:00 a.m. The appellant
    and the victim were in the victim’s bedroom, and the appellant was cleaning the room.
    Watkins heard the victim screaming and crying, got out of bed, and went into the victim’s
    -12-
    bedroom. The appellant was holding the victim. She said the appellant told her that he found
    the victim downstairs, “asleep standing up.” About five minutes later, the victim had a
    seizure. The seizure lasted five to ten minutes, and the victim was weak and sleepy
    afterward. Watkins was worried, but the appellant told her not to call an ambulance. Watkins
    gave the victim Tylenol and let him sleep for about one hour. Then she gave him Fruit Loops
    and milk. Watkins still wanted to call an ambulance for the victim, but the appellant told her
    not to call. For the rest of the day, the victim acted weak and sleepy. Watkins said she
    wanted to get help for the victim but was scared he would be taken away from her.
    Watkins testified that about 9:45 p.m., the appellant suggested that she leave the
    apartment to get something to eat. He offered to watch the victim. Watkins had just fed the
    victim pieces of bologna and bread. The victim did not have any trouble eating and did not
    choke. The victim was not having trouble breathing, and he was awake in his room when
    Watkins left the apartment. She said she was gone from the apartment about five minutes.
    When she returned, the appellant was outside. He yelled her name and said the victim was
    not breathing. Watkins ran inside and upstairs to the victim’s bedroom. The victim was
    lying on the floor, and Watkins picked him up. A neighbor came in and performed CPR. One
    of the appellant’s cousin’s telephoned 911, and Watkins told the operator that the victim was
    not breathing. Watkins said that she shook the victim and told him to wake up but that she
    did not shake him back and forth or slap his face.
    Watkins testified that she had seen the appellant use his fingers to “thump” the
    victim’s head previously. One time, she saw the appellant pull the victim’s shirt up over the
    victim’s head and let the victim run into a wall. She also saw the appellant push the victim,
    causing him to fall on his buttocks and cry. Watkins spoke with the police and told them that
    the appellant would take the victim into the victim’s bedroom and “[fuss] or [holler]” at the
    victim. She acknowledged that she asked the appellant to discipline the victim because she
    could not “handle it.” She said that the appellant would take the victim into another room
    to discipline him and that she assumed the appellant just talked to the victim. She said she
    lied to the police and the assistant district attorney general by telling them that the appellant
    would close the door and that she would hear loud thumps in the room. Although she
    acknowledged lying to the police, she maintained that she saw the appellant shove the victim
    and thump his forehead.
    Watkins testified that the appellant must have caused the bruises on the victim’s head,
    face, and upper arms in April 2007 because “he was the only one that was taking care of him
    at the time.” She said that the victim’s June 2007 injuries resulted “[f]rom not calling the
    ambulance when I was supposed to.” The victim never complained about his wrist, and
    Watkins did not know how he broke his wrist. She said she truthfully told the police that she
    saw the appellant “jerk” the victim’s arm one time. She said that the appellant jerked the
    -13-
    victim’s arm during the week of June 15, 2007, and that the victim started crying.
    On cross-examination, Watkins acknowledged that from April to June 2007, the
    appellant spent a lot of time at her apartment but also was gone a lot. The appellant was not
    very helpful and did not do a lot of activities with the victim. She acknowledged that the
    appellant took the victim for walks. She also acknowledged that a man named Michael spent
    the night of Thursday, June 14, in the apartment. She thought Michael left the apartment
    about 5:00 a.m. on Friday morning because that is what time he told her he was going to
    leave. She acknowledged that she would get frustrated with the victim and said that she
    would let the appellant discipline him because she was “afraid that [she] would go
    overboard.” She said she spoke with the police three times in June 2007 but did not tell them
    she pushed the victim or caused some of his injuries. At first, Watkins denied telling the
    police that she hit the victim with a belt. However, she acknowledged demonstrating for the
    police how she used a belt to hit the victim. She then acknowledged using a belt to discipline
    the victim but said she used a belt only one time. She denied telling the police that she hit
    the victim with a belt every day. She said she never went overboard in disciplining the
    victim.
    On redirect examination, Watkins acknowledged telling the police that she heard the
    appellant force the victim “up against the wall” four times and “against the floor” twice.
    However, she said she lied to the police. She said she truthfully told the police that the
    appellant yelled at the victim, told him to stop crying, and called him a “momma’s boy.” She
    said Michael slept downstairs on the night of June 14, that the victim slept upstairs, and that
    Michael never had contact with the victim.
    At the close of the State’s proof, the State made the following election of offenses:
    Count 1, the appellant committed aggravated child abuse on or about April 16, 2007, by
    causing severe head injuries to the victim, including a concussion, inability to open his eyes,
    and multiple facial bruises; count 2, the appellant committed child neglect by failing to seek
    timely medical treatment for head injuries the victim sustained on April 16, 2007; count 3,
    the appellant committed aggravated child abuse on or about June 15, 2007, by causing severe
    head injuries to the victim, including anoxic brain damage, acute subdural and subarachnoid
    hemorrhages, retinal hemorrhages, and severe seizures; count 4, the appellant committed
    aggravated child neglect by neglecting the victim’s welfare and failing to seek timely medical
    treatment for seizures the victim experienced on the morning of June 15, 2007, and his
    “decreased physical abilities throughout that day”; count 5, the appellant committed
    aggravated child neglect by neglecting the victim’s welfare and failing to seek timely medical
    treatment for the seizures the victim experienced on or about Wednesday, June 13, 2007;
    count 6, the appellant committed aggravated child abuse by causing a subdural hematoma
    and other brain trauma to the victim between May 29 and June 15, 2007; and count 7, the
    -14-
    appellant committed aggravated child abuse by causing a fracture to the victim’s left ulna
    between May 29 and June 15, 2007. The jury convicted the appellant as charged.
    II. Analysis
    A. Motion to Sever
    The appellant contends that the trial court erred by failing to grant his motion to sever
    counts 1 and 2, which occurred in April 2007, from the remaining counts, which occurred
    in June 2007. The State acknowledges that the trial court erred by failing to grant the
    severance motion but argues that the error was harmless. We agree with the State.
    Before trial, the appellant filed a motion to sever the offenses allegedly committed in
    April 2007 from the offenses allegedly committed in June 2007. In the motion, the appellant
    argued that severance was necessary because one trial would “threaten the unanimity of any
    verdicts” and because the proof was going to be complex and require the jury “to make an
    immense number of legal and factual distinctions.” In a written response, the State argued
    that the trial court should deny the motion because “the defendants evidenced a common
    scheme or plan to abuse and neglect the victim” and because the offenses were part of the
    same criminal transaction. The State also argued that one trial was necessary to establish
    identity and absence of mistake or accident and to provide a contextual background. In a
    written order, the trial court concluded that the April and June episodes were part of a
    common scheme or plan and that evidence from one trial would be admissible in a second
    trial to establish identity, intent, and lack of mistake or accident.
    Tennessee Rule of Criminal Procedure 8(b) states that two or more offenses may be
    joined in the same indictment if the offenses constitute parts of a common scheme or plan
    or if they are of the same or similar character. Tenn. R. Crim. P. 8(b)(1), (2). Tennessee
    Rule of Criminal Procedure 13(b) provides that the trial court may order severance of
    offenses prior to trial if such severance could be obtained on motion of a defendant or the
    State pursuant to Rule 14. Rule 14(b)(1) provides that “[i]f two or more offenses are joined
    or consolidated for trial pursuant to Rule 8(b), the defendant has the right to a severance of
    the offenses unless the offenses are part of a common scheme or plan and the evidence of one
    would be admissible in the trial of the others.”
    Our supreme court has held that “decisions to consolidate or sever offenses pursuant
    to Rules 8(b) and 14(b)(1) are to be reviewed for an abuse of discretion.” State v. Shirley,
    
    6 S.W.3d 243
    , 247 (Tenn. 1999). “A holding of abuse of discretion reflects that the trial
    court’s logic and reasoning was improper when viewed in light of the factual circumstances
    and relevant legal principles involved in a particular case.” State v. Moore, 
    6 S.W.3d 235
    ,
    -15-
    242 (Tenn. 1999).
    In examining a trial court’s ruling on a severance issue, the primary consideration is
    whether the evidence of one offense would be admissible in the trial of the other if the
    offenses remained severed. See Spicer v. State, 
    12 S.W.3d 438
    , 445 (Tenn. 2000).
    Essentially, “any question as to whether offenses should be tried separately pursuant to Rule
    14(b)(1) is ‘really a question of evidentiary relevance.’” Id. (quoting Moore, 6 S.W.3d at
    239). As such, the trial court must determine from the evidence presented that
    (1) the multiple offenses constitute parts of a common scheme
    or plan, (2) evidence of each offense is relevant to some material
    issue in the trial of all the other offenses, and (3) the probative
    value of the evidence of other offenses is not outweighed by the
    prejudicial effect that admission of the evidence would have on
    the defendant.
    Id. (citations omitted).
    This court previously has concluded, “A common scheme or plan for severance
    purposes is the same as a common scheme or plan for evidentiary purposes.” State v. Hoyt,
    
    928 S.W.2d 935
    , 943 (Tenn. Crim. App. 1995), overruled on other grounds by Spicer, 12
    S.W.3d at 447. Typically, common scheme or plan evidence tends to fall into one of the
    following three categories:
    (1) offenses that reveal a distinctive design or are so similar as
    to constitute “signature” crimes; (2) offenses that are part of a
    larger, continuing plan or conspiracy; and (3) offenses that are
    all part of the same criminal transaction.
    Moore, 6 S.W.3d at 240.
    Turning to the instant case, the offenses did not reveal a distinctive design and were
    not so similar as to constitute “signature” crimes. Moreover, the April offenses alleged in
    counts 1 and 2 were not part of the same criminal transaction as the June offenses alleged in
    counts 3 through 7. Regarding whether the offenses were part of a larger, continuing plan
    or conspiracy, our supreme court has explained that “a larger plan or conspiracy in this
    context contemplates crimes committed in furtherance of a plan that has a readily
    distinguishable goal, not simply a string of similar offenses.” State v. Denton, 
    149 S.W.3d 1
    , 15 (Tenn. 2004). Therefore, we conclude that the April and June offenses were not part
    of a continuing plan or conspiracy, and the first prong of Rule 14(b)(1), that the offenses
    -16-
    were part of a common scheme or plan, was not met. The trial court should have granted the
    appellant’s severance motion.
    The State argues that the trial court’s error was harmless because the evidence against
    the appellant was overwhelming.
    Whether a trial court should grant a severance under Tennessee
    Rule of Criminal Procedure 14(b)(1) involves primarily an
    evidentiary question, therefore, “the effect of a denial of that
    right is weighed by the same standard as other
    non-constitutional evidentiary errors: the defendant must show
    that the error probably affected the judgment before reversal is
    appropriate.”
    Id. at 15 (quoting Moore, 6 S.W.3d at 242).
    We agree with the State that the trial court’s failure to grant a severance in this case
    was harmless error. Regarding count 1, the evidence established that the appellant was the
    victim’s sole caregiver on the morning of April 16; that the victim suffered a concussion,
    bruises, and knots while he was in the appellant’s care; and that a fall did not explain the
    victim’s injuries. Regarding the appellant’s remaining convictions, the evidence established
    that the victim was in the exclusive care of his mother and the appellant from May 29 to June
    15 and that he suffered numerous brain bleeds during that time. At trial, the defense
    suggested to the jury that the victim was injured by falling down the stairs. However, Dr.
    Moutsious testified that a fall down the stairs did not account for the number, location, and
    severity of the victim’s injuries. Therefore, we agree with the State that the trial court’s
    failure to grant the appellant’s severance motion was harmless. See Tenn. R. App. P. 36(b);
    State v. Rodriguez, 
    254 S.W.3d 361
    , 372 (Tenn. 2008).
    B. Accomplice Instruction
    The appellant argues that the trial court erred by instructing the jury that Lakeisha
    Watkins was an accomplice as a matter of law because the instruction amounted to a judicial
    comment on the evidence. The State argues that the trial court properly instructed the jury.
    We conclude that the appellant is not entitled to relief on this issue.
    At the conclusion of Watkins’ testimony, the trial court informed the parties that “I
    have added about Lakeisha Watkins being an accomplice.” Defense counsel answered,
    “Okay. Fine.” The trial court continued, “And I am instructing that she is an accomplice and
    that her testimony would have to be corroborated.” Defense counsel stated, “Fine.” During
    -17-
    the jury charge, the trial court instructed the jury as follows:
    In this case, the Court charges you that the witness,
    Lakeisha Watkins, was an accomplice in the alleged offenses,
    and before the defendant can be convicted, you must find that
    this accomplice testimony has been sufficiently corroborated.
    An accomplice is a person who knowingly, voluntarily
    and with common intent with a defendant, unites with him or
    her in the commission of an offense.
    After the trial court finished instructing the jury, defense counsel asked for a bench
    conference. During the conference, counsel stated,
    I apologize for not mentioning this earlier, but I ran into this. My
    problem is with the first sentence of the accomplice charge here,
    saying, the Court charges you that she was an accomplice. . . .
    The Court doesn’t mean that. But it might infer to the Jurors
    that you’re finding that she was an accomplice. I mean, as a
    matter of fact[.]
    The trial court stated, “She is. I have to tell them. This is the law in this case. It’s not
    whether they find her as an accomplice. She was.”
    A defendant has a “constitutional right to a correct and complete charge of the law.”
    State v. Teel, 
    793 S.W.2d 236
    , 249 (Tenn. 1990). A charge resulting in prejudicial error is
    one that fails to fairly submit the legal issues to the jury or misleads the jury about the
    applicable law. State v. Hodges, 
    944 S.W.2d 346
    , 352 (Tenn. 1997).
    An accomplice is someone who “knowingly, voluntarily, and with common intent
    participates with the principal offender in the commission of the crime alleged in the
    charging instrument.” State v. Griffis, 
    964 S.W.2d 577
    , 588 (Tenn. Crim. App. 1997).
    Generally, the question of a witness’s status as an accomplice is answered by determining
    whether that person could have been indicted for the charged offense. State v. Boxley, 
    76 S.W.3d 381
    , 386 (Tenn. Crim. App. 2001). If the facts about the witness’s participation in
    the crime are clear and undisputed, the trial court must declare the witness to be an
    accomplice as a matter of law and instruct the jury that the accomplice’s testimony must be
    corroborated. State v. Eric Ricardo Middleton, No. W2010-01427-CCA-R3-CD, 2011 Tenn.
    Crim. App. LEXIS 833, *47 (Tenn. Crim. App. Nov. 14, 2011) (citing State v. Lawson, 
    794 S.W.2d 363
    , 369 (Tenn. Crim. App. 1990)). However, if the facts are disputed or subject to
    -18-
    different inferences, the jury should determine as a question of fact whether the witness was
    an accomplice. State v. Anderson, 
    985 S.W.2d 9
    , 16 (Tenn. Crim. App. 1997).
    Initially, we note that the appellant failed to object when the trial court stated that it
    was going to give the accomplice as a matter of law instruction and failed to make a
    contemporaneous objection during the jury charge. See Tenn. R. App. P. 36(a). In any
    event, Watkins was indicted as a co-defendant in all but one of the counts, and a jury found
    her guilty prior to the appellant’s trial. Therefore, Watkins was an accomplice as a matter
    of law with regard to counts 2 through 7, and the trial court properly instructed the jury. As
    to count 1, Watkins testified that she was not present when the victim’s injuries occurred on
    April 16, and she was not charged with causing his injuries. Therefore, she was not an
    accomplice as a matter of law with regard to that count. However, as noted by the State, the
    trial court’s instruction held the State to a higher burden, requiring the jury to find that her
    testimony was corroborated. Therefore, the State has demonstrated that any error regarding
    the trial court’s instruction was harmless. See Rodriguez, 254 S.W.3d at 371.
    C. Sufficiency of the Evidence
    The appellant argues that the evidence is insufficient to support the convictions. When
    an appellant challenges the sufficiency of the convicting evidence, the standard for review
    by an appellate court is “whether, after viewing the evidence in the light most favorable to
    the prosecution, any rational trier of fact could have found the essential elements of the crime
    beyond a reasonable doubt.” Jackson v. Virginia, 
    443 U.S. 307
    , 319 (1979); see also Tenn.
    R. App. P. 13(e). The State is entitled to the strongest legitimate view of the evidence and
    all reasonable or legitimate inferences which may be drawn therefrom. See State v. Cabbage,
    
    571 S.W.2d 832
    , 835 (Tenn. 1978). Questions concerning the credibility of witnesses and
    the weight and value to be afforded the evidence, as well as all factual issues raised by the
    evidence, are resolved by the trier of fact. See State v. Bland, 
    958 S.W.2d 651
    , 659 (Tenn.
    1997). This court will not reweigh or reevaluate the evidence, nor will this court substitute
    its inferences drawn from the circumstantial evidence for those inferences drawn by the jury.
    See id. Because a jury conviction removes the presumption of innocence with which a
    defendant is initially cloaked at trial and replaces it on appeal with one of guilt, a convicted
    defendant has the burden of demonstrating to this court that the evidence is insufficient. See
    State v. Tuggle, 
    639 S.W.2d 913
    , 914 (Tenn. 1982).
    A guilty verdict can be based upon direct evidence, circumstantial evidence, or a
    combination of direct and circumstantial evidence. State v. Hall, 
    976 S.W.2d 121
    , 140
    (Tenn. 1998). “The jury decides the weight to be given to circumstantial evidence, and ‘[t]he
    inferences to be drawn from such evidence, and the extent to which the circumstances are
    consistent with guilt and inconsistent with innocence, are questions primarily for the jury.’”
    -19-
    State v. Rice, 
    184 S.W.3d 646
    , 662 (Tenn. 2006) (quoting State v. Marable, 
    313 S.W.2d 451
    ,
    457 (Tenn. 1958)). “The standard of review ‘is the same whether the conviction is based
    upon direct or circumstantial evidence.’” State v. Dorantes, 
    331 S.W.3d 370
    , 379 (Tenn.
    2011) (quoting State v. Hanson, 
    279 S.W.3d 265
    , 275 (Tenn. 2009)).
    1. Aggravated Child Abuse - Counts 1, 3, 6, & 7
    The appellant contends that the evidence is insufficient to support his aggravated child
    abuse convictions. A defendant is guilty of aggravated child abuse when the defendant
    commits the offense of child abuse and the conduct results in serious bodily injury to the
    child. Tenn. Code Ann. § 39-15-402(a)(1). Child abuse occurs when a person “knowingly,
    other than by accidental means, treats a child under eighteen (18) years of age in such a
    manner as to inflict injury.” Tenn. Code Ann. § 39-15-401(a). “A person acts knowingly
    with respect to a result of the person’s conduct when the person is aware that the conduct is
    reasonably certain to cause the result.” Tenn. Code Ann. § 39-11-302(b). Bodily injury
    “includes a cut, abrasion, bruise, burn or disfigurement, and physical pain or temporary
    illness or impairment of the function of a bodily member, organ, or mental faculty[.]” Tenn.
    Code Ann. § 39-11-106(a)(2). At the time of the appellant’s trial, serious bodily injury was
    defined as bodily injury that involved
    (A) a substantial risk of death;
    (B) Protracted unconsciousness;
    (C) Extreme physical pain;
    (D) Protracted or obvious disfigurement; or
    (E) Protracted loss or substantial impairment of a
    function of a bodily member, organ or mental faculty.
    Tenn. Code Ann. § 39-11-106(a)(34)(A)-(E).3
    3
    We note that in July 2009, two months before the appellant’s trial, our state code was amended to
    define “serious bodily injury to the child” in Tennessee Code Annotated Section 39-15-402(d) as
    includ[ing], but . . . not limited to, second-or third-degree burns, a fracture
    of any bone, a concussion, subdural or subarachnoid bleeding, retinal
    hemorrhage, cerebral edema, brain contusion, injuries to the skin that
    involve severe bruising or the likelihood of permanent or protracted
    (continued...)
    -20-
    The trial court instructed the jury on criminal responsibility. A defendant is criminally
    responsible for an offense committed by another if, “[a]cting with intent to promote or assist
    the commission of the offense, or to benefit in the proceeds or results of the offense, the
    [defendant] solicits, directs, aids, or attempts to aid another person to commit the offense.”
    Tenn. Code Ann. § 39-11-402(2). “‘[U]nder the theory of criminal responsibility, presence
    and companionship with the perpetrator of a felony before and after the commission of the
    crime are circumstances from which an individual's participation may be inferred.’” State
    v. Dorantes, 
    331 S.W.3d 370
    , 386 (Tenn. 2011) (quoting State v. Phillips, 
    76 S.W.3d 1
    , 9
    (Tenn. Crim. App. 2001)). In addition, “no specific act or deed need be demonstrated.” Id.
    (citing State v. Ball, 
    973 S.W.2d 288
    , 293 (Tenn. Crim. App. 1998)). A defendant also is
    criminally responsible for an offense committed by another if,
    [h]aving a duty imposed by law or voluntarily undertaken to
    prevent commission of the offense and acting with intent to
    benefit in the proceeds or results of the offense, or to promote or
    assist its commission, the person fails to take a reasonable effort
    to prevent commission of the offense.
    A step-parent and caretaker has a duty to protect a child from harm and provide the child
    with emergency attention. State v. Hodges, 
    7 S.W.3d 609
    , 623 (Tenn. Crim. App. 1998).
    For count 1, the State alleged that the appellant committed aggravated child abuse on
    or about April 16, 2007, by causing severe head injuries to the victim, including a
    concussion, inability to open his eyes, and multiple facial bruises. The appellant asserts that
    the evidence is insufficient to support the conviction because it failed to establish that the
    victim suffered serious bodily injury. The evidence shows that the victim’s eyes were
    swollen shut, that he had numerous bruises and abrasions on his face and upper body, and
    that he had knots on his head. He also had a concussion, which Dr. Stack explained was a
    disruption in brain function, and would not open his eyes. In our view, such injuries,
    particularly in a seventeen-month-old child, qualify as serious bodily injury. Therefore, the
    evidence is sufficient to support the conviction.
    For count 3, the State alleged that the appellant committed aggravated child abuse on
    or about June 15, 2007, by causing severe head injuries to the victim, including anoxic brain
    damage, acute subdural and subarachnoid hemorrhages, retinal hemorrhages, and severe
    3
    (...continued)
    disfigurement, including those sustained by whipping children with objects.
    Moreover, “[a] broken bone of a child who is eight (8) years of age or less” was added to the list for serious
    bodily injury in Tennessee Code Annotated section 39-11-106(a)(34).
    -21-
    seizures. The appellant asserts that the evidence is insufficient to support the conviction
    because the evidence is entirely circumstantial and indicates the victim’s mother caused the
    injuries. Dr. Moutsious testified that the victim had bleeds in his brain and that one of the
    bleeds occurred within a couple of days of June 15. Although Dr. Moutsious could not say
    precisely when the bleed occurred, she was concerned that the victim had sustained a brain
    injury within minutes of the time he stopped breathing. The evidence demonstrated that the
    appellant and Watkins were the victim’s sole caregivers in the days leading up to the victim’s
    June hospitalization. Watkins told the police that she allowed the appellant to discipline the
    victim, that he took the victim into a room and shut the door, and that she heard thuds in the
    room. Moreover, the evidence showed that the appellant was alone with the victim just
    before the victim experienced the seizure that caused him to stop breathing. Therefore, the
    evidence is sufficient to show that the appellant caused the anoxic brain damage, acute
    subdural and subarachnoid hemorrhages, retinal hemorrhages, and severe seizures that the
    victim suffered on or about June 15.
    For count 6, the State alleged that the appellant committed aggravated child abuse by
    causing a subdural hematoma and other brain trauma to the victim between May 29 and June
    15, 2007. The appellant argues that the evidence is insufficient to support the conviction
    because (1) the State failed to show that the victim suffered a subdural hematoma and brain
    trauma other than the subdural hematoma and brain trauma related to count 3, (2) the State
    failed to show that the victim suffered serious bodily injury, and (3) the evidence does not
    ensure juror unanimity. Dr. Moutsious testified that the victim suffered multiple brain
    injuries that were caused by significant force. She said that while one of the victim’s brain
    bleeds occurred within a couple of days of June 15, other bleeds were older than two weeks.
    In her opinion, the victim had a brain injury before the Wednesday, June 13, seizure. As
    stated above, Watkins and the appellant were the victim’s sole caregivers, and Watkins
    testified that the appellant pushed the victim and “would thump” the victim when the
    appellant disciplined the victim. Also, in her statement to police Watkins said that she heard
    thuds when the appellant disciplined the victim. Therefore, the evidence is sufficient to show
    that the appellant caused prior brain trauma to the victim, which resulted in older brain
    bleeds. Moreover, we are unpersuaded by the appellant’s claim that the victim did not suffer
    serious bodily injury. Bleeding in the brain, particularly bleeding that causes a seizure such
    as the one the victim experienced on Wednesday, June 13, involves substantial impairment
    of a function of a bodily organ. The evidence is sufficient to support the conviction for
    aggravated child abuse in count 6.
    For count 7, the State alleged that the appellant committed aggravated child abuse by
    causing a fracture to the victim’s left ulna between May 29 and June 15, 2007. The appellant
    argues that the evidence is insufficient to show he committed aggravated child abuse because
    the evidence fails to show that the victim suffered serious bodily injury. Dr. Moutsious
    -22-
    testified that the victim’s broken ulna would have been painful, that she would have expected
    him not to use the arm, and that some swelling could have appeared over the fracture.
    However, her testimony is insufficient to establish that the victim suffered extreme physical
    pain, that he sustained substantial impairment of his arm, or that he sustained protracted or
    obvious disfigurement. Therefore, we conclude that the evidence is insufficient to support
    the appellant’s conviction for aggravated child abuse in count 7.
    2. Child Neglect and Aggravated Child Neglect - Counts 2, 4, & 5
    The appellant contends that the evidence is insufficient to support his child neglect
    and aggravated child neglect convictions. As charged in the indictment, a defendant is guilty
    of child neglect when the defendant knowingly, other than by accidental means, neglects a
    child under six years of age, so as to adversely affect the child’s health and welfare. Tenn.
    Code Ann. § 39-15-401(a) (2006). Aggravated child neglect occurs when the act of child
    neglect results in serious bodily injury to the child. Tenn. Code Ann. § 39-15-402(a)(1).
    For count 2, the State alleged that the appellant committed child neglect by failing to
    seek timely medical treatment for head injuries the victim sustained on April 16, 2007. The
    appellant contends that the evidence is insufficient to support the conviction because the
    State failed to prove that the appellant’s failure to seek timely medical attention for the victim
    affected the victim’s health and welfare. The State does not address the merits of issue. We
    agree with the appellant that the evidence is insufficient to support his conviction for child
    neglect. In order to sustain a conviction for child neglect, the proof must establish “an actual,
    deleterious effect upon the child’s health and welfare.” State v. Mateyko, 
    53 S.W.3d 666
    ,
    669 (Tenn. 2001). The victim allegedly fell at 11:00 a.m., and paramedics transported him
    to the ER about 6:30 p.m. Dr. Stack diagnosed the victim with a concussion but medically
    cleared him for discharge at 10:20 p.m. Although the State proved that the appellant delayed
    seeking medical treatment for the victim, the State failed to show that the delay itself
    adversely affected the victim’s health and welfare. Therefore, the evidence is insufficient
    to support the conviction for child neglect in count 2.
    For count 4, the State alleged that the appellant committed aggravated child neglect
    by neglecting the victim’s welfare and failing to seek timely medical treatment for seizures
    the victim experienced on the morning of June 15, 2007, and his “decreased physical abilities
    throughout that day.” The appellant contends that the State failed to prove that his failure
    to seek timely medical attention for the victim resulted in serious bodily injury. Taken in the
    light most favorable to the State, the evidence shows that the victim suffered a seizure on the
    morning of June 15 and that Watkins gave him Tylenol because she thought he was in pain.
    The victim was sleepy and weak for the rest of the day. Watkins was worried about the
    victim, but the appellant told her not to call an ambulance. The appellant and Watkins did
    -23-
    not seek medical attention for him until he stopped breathing on the night of June 15, which
    resulted in the victim’s permanent brain injury. The evidence is sufficient to support the
    appellant’s conviction for aggravated child neglect in count 4.
    For count 5, the State alleged that the appellant committed aggravated child neglect
    by neglecting the victim’s welfare and failing to seek timely medical treatment for the
    seizures the victim experienced on Wednesday, June 13, 2007. Again, the appellant contends
    that the State failed to prove that his failure to seek timely medical attention for the victim
    resulted in serious bodily injury. We agree with the appellant. We have already determined
    that the appellant’s failure to get medical help for the victim after the Friday-morning seizure
    sustains the appellant’s conviction for aggravated child neglect in count 4. However, the
    State presented no evidence to demonstrate that the appellant’s failure to seek treatment for
    the victim after the Wednesday-morning seizure resulted in serious bodily injury separate and
    apart from the serious bodily injury established for count 4.
    In sum, the evidence is insufficient to support the appellant’s convictions for child
    neglect in count 2 and aggravated child abuse in counts 5 and 7. The evidence is sufficient
    to support his convictions for aggravated child abuse in counts 1, 3, and 6 and aggravated
    child neglect in count 4.
    D. Merger
    Next, the appellant contends that the trial court erred by failing to merge his
    aggravated child neglect convictions in counts 4 and 5. The State concedes that the trial
    court should have merged the convictions. We have already determined that the evidence
    is insufficient to support the appellant’s conviction in count 5. In any event, as correctly
    noted by the State, aggravated child neglect is a continuing course of conduct “beginning
    with the first act or omission that causes adverse effects to a child’s health or welfare.” State
    v. Adams, 
    24 S.W.3d 289
    , 296 (Tenn. 2000). The crime “continues until the person
    responsible for the neglect takes reasonable steps to remedy the adverse effects to the child’s
    health and welfare caused by the neglect.” Id. The State argued that the appellant should
    have sought medical treatment for the victim after the victim’s first seizure on Wednesday.
    Given that the appellant’s neglect was “continuous and without interruption” from the time
    of the victim’s first seizure on Wednesday until the victim’s Friday-night seizure, his dual
    convictions for aggravated child abuse in count 4 and 5 could not stand. Id. at 297.
    E. Sentencing
    Finally, the appellant contends that his effective sentence is excessive because the trial
    court misapplied an enhancement factor and erred by ordering consecutive sentencing. The
    -24-
    State contends that the appellant’s effective seventy-five-year sentence is proper. We agree
    with the State.
    No witnesses testified at the appellant’s sentencing hearing, but the State introduced
    the appellant’s presentence report into evidence. According to the report, the then twenty-
    eight-year-old appellant was expelled from high school in the eleventh grade, never earned
    a GED, and had a one-year-old daughter. In the report, the appellant denied having any
    physical or mental disabilities but admitted using marijuana since he was thirteen years old.
    The report shows that the appellant worked as a laborer for Industrial Staffing from July
    2006 to September 2007. According to the report, the appellant has two prior convictions
    for criminal trespassing and one prior conviction each for kidnapping, sexual battery, and
    casual exchange.
    The trial court found that the following enhancement factors applied to all of the
    appellant’s convictions: (1), that the appellant “has a previous history of criminal convictions
    or criminal behavior, in addition to those necessary to establish the appropriate range”; (4),
    that the victim “was particularly vulnerable because of age or physical or mental disability”;
    and (14), that the appellant abused a position of private trust. Tenn. Code Ann. § 40-
    35-114(1), (4), (14). The trial court gave great weight to the factors. The trial court also
    applied enhancement factor (5), that the appellant “treated, or allowed a victim to be treated,
    with exceptional cruelty during the commission of the offense,” to the appellant’s convictions
    in counts 3 through 7, but did not give the factor much weight. Tenn. Code Ann. § 40-
    35-114(5). The trial court noted that the range of punishment for the appellant’s aggravated
    child abuse and aggravated child neglect convictions, Class A felonies, was fifteen to twenty-
    five years and that his range of punishment for the child neglect conviction, a Class E felony,
    was one to two years. See Tenn. Code Ann. § 40-35-112(a)(1), (5). The trial court sentenced
    the appellant as a Range I, standard offender to the maximum punishment in the range for
    all seven convictions.
    Regarding consecutive sentencing, the trial court found the appellant to be a
    dangerous offender “whose behavior indicates little or no regard for human life and no
    hesitation about committing a crime in which the risk to human life is high.” Tenn. Code
    Ann. § 40-35-115(b)(4). The trial court explained,
    This was a very young child who was severely abused. The
    defendant has been convicted of that. Now, the mere fact that
    I have found that factor four applies does not stop the inquiry
    because pursuant to Wilkerson I have to find that there’s an
    aggregate term reasonably related to the severity of the offenses,
    and it’s necessary to protect the public from further serious
    -25-
    criminal conduct by the defendant. He has previously been
    convicted of some very serious offenses involving sexual battery
    and kidnapping. He then -- on this particular series of events
    there’s like three separate things that are going on. You’ve got
    the first incident in April, then you’ve got the broken arm, and
    then you’ve got the other. So I think that there is some need to
    -- for consecutive sentences in this particular case.
    The trial court merged count 2 into count 1. The trial court ordered that the appellant’s
    twenty-five year sentences in counts 3, 4, and 5 be served concurrently with each other and
    that his twenty-five year sentences in counts 6 and 7 be served concurrently with each other.
    However, the trial court ordered that the two effective twenty-five year sentences be served
    consecutively to each other and consecutively to his twenty-five year sentence in count 1 for
    a total effective sentence of seventy-five years in confinement.
    Appellate review of the length, range or manner of service of a sentence is de novo.
    See Tenn. Code Ann. § 40-35-401(d). In conducting its de novo review, this court considers
    the following factors: (1) the evidence, if any, received at the trial and the sentencing
    hearing; (2) the presentence report; (3) the principles of sentencing and arguments as to
    sentencing alternatives; (4) the nature and characteristics of the criminal conduct involved;
    (5) evidence and information offered by the parties on enhancement and mitigating factors;
    (6) any statistical information provided by the administrative office of the courts as to
    sentencing practices for similar offenses in Tennessee; (7) any statement by the appellant in
    his own behalf; and (8) the potential for rehabilitation or treatment. See Tenn. Code Ann.
    §§ 40-35-102, -103, -210; see also State v. Ashby, 
    823 S.W.2d 166
    , 168 (Tenn. 1991). The
    burden is on the appellant to demonstrate the impropriety of his sentence. See Tenn. Code
    Ann. § 40-35-401, Sentencing Comm’n Cmts. Moreover, if the record reveals that the trial
    court adequately considered sentencing principles and all relevant facts and circumstances,
    this court will accord the trial court's determinations a presumption of correctness. Id. at (d);
    Ashby, 823 S.W.2d at 169.
    The appellant asserts that the trial court misapplied enhancement factor (5) regarding
    the victim’s being treated with exceptional cruelty. In State v. Arnett, 
    49 S.W.3d 250
    , 258
    (Tenn. 2001), our supreme court concluded that the exceptional cruelty factor is applicable
    in cases of “extensive physical abuse or torture.” In this case, the appellant’s acts of abuse
    and neglect in April and June caused the victim to have a concussion, bleeding in the brain,
    retinal hemorrhages, and seizures. The trial court did not err by applying factor (5). In any
    event, the trial court gave great weight to enhancement factors (1), (4), and (14) but little
    weight to factor (5). Therefore, even if the court had misapplied enhancement factor (5), it
    would not have justified reducing the appellant’s sentences.
    -26-
    The appellant also argues that the trial court erred by ordering consecutive sentencing.
    Specifically, the appellant contends that the State failed to establish that his effective
    seventy-five-year sentence is reasonably related to the severity of the offenses or necessary
    to protect the public.
    In order to find that a defendant is a dangerous offender, a court must also find that
    (1) the sentences are necessary in order to protect the public from further misconduct by the
    defendant and that (2) the terms are reasonably related to the severity of the offenses. State
    v. Wilkerson, 
    905 S.W.2d 933
    , 938 (Tenn. 1995); see also State v. Lane, 
    3 S.W.3d 456
    , 461
    (Tenn. 1999). In the instant case, the trial court found that the appellant had been previously
    convicted of serious offenses. The court also noted that the victim was severely abused in
    this case. The court properly addressed the Wilkerson factors. Accordingly, the appellant
    is not entitled to relief on this issue.
    III. Conclusion
    Based upon the oral arguments, the record, and the parties’ briefs, we conclude that
    the appellant’s convictions of child neglect in count 2, aggravated child neglect in count 5,
    and aggravated child abuse in count 7 should be reversed and those charges dismissed. The
    appellant’s convictions of aggravated child abuse in counts 1, 3, and 6; aggravated child
    neglect in count 4; and effective seventy-five-year sentence are affirmed.
    _________________________________
    NORMA McGEE OGLE, JUDGE
    -27-