in Re: the Commitment of Leonard Flores ( 2018 )


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  •                               NUMBER 13-17-00258-CV
    COURT OF APPEALS
    THIRTEENTH DISTRICT OF TEXAS
    CORPUS CHRISTI – EDINBURG
    In Re: Commitment of Leonard Flores
    On appeal from the 214th District Court
    of Nueces County, Texas.
    MEMORANDUM OPINION
    Before Justices Rodriguez, Contreras, and Hinojosa
    Memorandum Opinion by Justice Contreras
    On March 1, 2017, a jury found beyond a reasonable doubt that appellant Leonard
    Flores is a sexually violent predator (SVP). See TEX. HEALTH & SAFETY CODE ANN. §
    841.003(a) (West, Westlaw through 2017 1st C.S.). The trial court adjudged Flores as a
    SVP and civilly committed him for sex-offender treatment and supervision. See 
    id. § 841.081
    (West, Westlaw through 2017 1st C.S.). By two issues, Flores contends that the
    trial court erred by: (1) admitting into evidence a voluntary written statement he gave to
    police during a previous criminal investigation, and (2) allowing the State’s expert to testify
    as to the details underlying Flores’s past convictions and other alleged bad acts. We
    affirm.
    I.    BACKGROUND
    On October 29, 2010, Flores was convicted and sentenced to ten years’
    imprisonment for aggravated sexual assault of a child1 and sexual assault.2 See TEX.
    PENAL CODE ANN. §§ 22.011, 22.021 (West, Westlaw through 2017 1st C.S.).                                  On
    February 16, 2016, as Flores approached the end of his sentence for the aforementioned
    crimes, the State filed its petition for civil commitment alleging that Flores is a SVP. See
    TEX. HEALTH & SAFETY CODE ANN. § 841.041 (West, Westlaw through 2017 1st C.S.).
    For the purpose of the civil commitment proceeding, there were three other
    incidents in Flores’s past that were of interest to the State: (1) Flores’s 2003 juvenile
    conviction for indecency with a child,3 see TEX. PENAL CODE ANN. § 21.11 (West, Westlaw
    through 2017 1st C.S.); (2) Flores’s arrest in 2003 for having sex with two fourteen-year-
    old boys while he was living in a foster home, although the charges were ultimately
    dismissed; and (3) Flores’s expulsion from a youth wilderness camp sometime in 2003 or
    2004 due to allegations that Flores had sex with a staff member and with another camper
    who was a child.4
    1 The victim in Flores’s 2010 conviction for aggravated sexual assault of a child was a four-year-
    old girl who was the daughter of Flores’s girlfriend at the time of the offense. Evidence at trial showed that
    Flores failed to inform the victim’s mother that he was a registered sex offender when they began dating.
    2   The victim in Flores’s 2010 conviction for sexual assault was his adult sister.
    The victim in Flores’s 2003 conviction for indecency with a child was a four-year-old girl who was
    3
    the daughter of Flores’s foster parents. Flores was sixteen years old at the time of this offense.
    4 Flores stated at trial that he could not remember whether he was kicked out of the youth
    wilderness camp for having sex with a child or for having sex with a staff member. Regardless of the reason
    why Flores was kicked out, the State’s expert, Michael Arambula, M.D., testified that the records he
    reviewed alleged Flores engaged in some sexual activity with both a staff member and another camper
    who was a child.
    2
    Trial began on February 28, 2017, and the State called Flores as its first witness.
    Flores testified as to the events surrounding his convictions for indecency with a child,
    aggravated sexual assault of a child, and sexual assault. He also testified as to the events
    surrounding his expulsion from the youth wilderness camp. However, Flores denied
    having sex with two fourteen-year-old boys at the foster home, and he denied giving a
    statement to police after being arrested for this. To refresh his memory, the State
    presented Flores with a written statement he gave to police when he was arrested for
    having sex with the two fourteen-year-old boys from the foster home.
    The State then moved to admit the statement into evidence, and Flores objected
    because the statement was cumulative and substantially more prejudicial than probative.
    See TEX. R. EVID. 403. The State argued that Flores’s statement directly addressed the
    sexual offending behavior at issue, and that the State’s expert witness considered the
    statement and surrounding circumstances in forming the basis for his opinion. The trial
    court overruled Flores’s objections, admitted Flores’s statement into evidence, and Flores
    then testified as to having sex with both fourteen-year-old boys.
    After Flores’s testimony, the State called a board-certified forensic psychiatrist,
    Michael Arambula, M.D., as its expert witness. Dr. Arambula explained he had been
    asked by the State to determine whether Flores has a behavioral abnormality that made
    him likely to engage in a predatory act of sexual violence. See TEX. HEALTH & SAFETY
    CODE ANN. §§ 841.002(2), .003(a) (West, Westlaw through 2017 1st C.S.).
    Dr. Arambula testified that he receives mental health records, legal records,
    investigative records, victim statements, administrative records, and medical records
    3
    when asked to conduct a behavioral abnormality evaluation, and that he reviews and
    relies on these records in forming his opinion. Dr. Arambula also testified that he reviewed
    and considered Flores’s three sexual criminal convictions, as well as other allegations
    that did not reach the level of a criminal conviction, such as Flores’s arrest for having sex
    with the two fourteen-year-old boys at the foster home and his expulsion from the youth
    camp. In doing his evaluation, Dr. Arambula interviewed Flores for “probably two-and-a-
    half hours.” Dr. Arambula explained that experts in his field typically review and rely on
    these types of records in formulating their opinion.
    Dr. Arambula testified that he found that Flores has a behavioral abnormality that
    makes him likely to engage in a predatory act of sexual violence.           Specifically, he
    diagnosed Flores as having a sexual deviance with pedophilic features, antisocial
    personality disorder, and polysubstance dependence.
    As the State began to question Dr. Arambula concerning how and why he
    formulated his diagnosis, Flores objected to Dr. Arambula’s testimony because it was
    based on hearsay, and because it was substantially more prejudicial than probative. See
    TEX. R. EVID. 403, 705, 801, 802. The court overruled Flores’s objections and granted
    him running objections to Dr. Arambula’s testimony on these grounds. The court then
    gave the jury limiting instructions, and Dr. Arambula proceeded to testify as to the details
    of Flores’s convictions and alleged bad acts that played a role in formulating his diagnosis.
    Dr. Arambula’s explanation divulged to the jury underlying facts and data from each of
    Flores’s criminal convictions and from the alleged incidents of sexual misconduct at the
    foster home and at the youth camp.
    4
    After the parties rested, the State moved for a directed verdict on the issue of
    whether Flores is a repeat sexually violent offender—the first requirement for civil
    commitment under the Texas SVP statute—and the court granted it. See TEX. HEALTH &
    SAFETY CODE ANN. § 841.003 (“A person is a repeat sexually violent offender for the
    purposes of this chapter if the person is convicted of more than one sexually violent
    offense and a sentence is imposed for at least one of those offenses . . . .”). The case
    then went to the jury for the determination of whether Flores “suffers from a behavioral
    abnormality that makes [him] likely to engage in a predatory act of sexual violence.” See
    
    id. 841.003(a)(2). The
    jury returned a unanimous verdict finding Flores a SVP, thereby, implicitly
    finding the remaining required element—that he suffers from said behavioral abnormality.
    See 
    id. § 841.002(2).
    The trial court rendered a final judgment reflecting the jury’s verdict
    and ordered that Flores be civilly committed. Flores filed a motion for a new trial, which
    was overruled as a matter of law, and this appeal followed.
    II.   STANDARD OF REVIEW
    We review a trial court’s ruling admitting or excluding evidence in a civil
    commitment proceeding for an abuse of discretion. In re Commitment of Mares, 
    521 S.W.3d 64
    , 69 (Tex. App.—San Antonio, 2017, pet. denied) (citing In re Commitment of
    Browning, 
    113 S.W.3d 851
    , 865 (Tex. App.—Austin 2003, pet. denied)); see Bay Area
    Healthcare Grp., Ltd. v. McShane, 
    239 S.W.3d 231
    , 234 (Tex. 2007) (per curiam). A trial
    court abuses its discretion when it acts without regard for guiding rules or principles.
    Owens-Corning Fiberglas Corp. v. Malone, 
    972 S.W.2d 35
    , 43 (Tex. 1998). “A successful
    challenge to evidentiary rulings usually requires the complaining party to show that the
    5
    judgment turns on the particular evidence excluded or admitted.” City of Brownsville v.
    Alvarado, 
    897 S.W.2d 750
    , 753–54 (Tex. 1995). “We determine whether the case turns
    on the challenged evidence by reviewing the entire record.” See 
    id. at 754
    (citing Boothe
    v. Hausler, 
    766 S.W.2d 788
    , 789 (Tex. 1989) (per curiam)); see also In re Commitment
    of Haines, No. 09-15-00526-CV, 
    2016 WL 3356571
    , at *3 (Tex. App.—Beaumont June
    16, 2016, no pet.) (mem. op.).
    We will not reverse a judgment on the admission or exclusion of evidence unless
    the appellant establishes that the trial court’s ruling was in error, and that the error
    probably did cause the rendition of an improper judgment. State v. Cent. Expressways
    Sign Assocs., 
    302 S.W.3d 866
    , 870 (Tex. 2009); see also TEX. R. APP. P. 44.1(a)(1);
    Haines, 
    2016 WL 3356571
    at *4. “[T]he exclusion or admission of evidence is likely
    harmless if the evidence was cumulative, or the rest of the evidence was so one-sided
    that the error likely made no difference in the judgment.”        Cent. Expressways Sign
    
    Assocs., 302 S.W.3d at 870
    .
    III.   APPLICABLE LAW
    A person is a “sexually violent predator” subject to civil commitment if the person:
    (1) is a repeat sexually violent offender; and (2) suffers from a behavioral abnormality that
    makes the person likely to engage in a predatory act of sexual violence. TEX. HEALTH &
    SAFETY CODE ANN. § 841.003(a). A behavioral abnormality is “a congenital or acquired
    condition that, by affecting a person’s emotional or volitional capacity, predisposes the
    person to commit a sexually violent offense, to the extent that the person becomes a
    menace to the health and safety of another person.” 
    Id. § 841.002(2).
    6
    The State can file a petition alleging that a person is a SVP, see 
    id. 841.041, which
    will require a trial on the issue and, if the person is found to be a SVP, subsequent civil
    commitment for treatment. See 
    id. §§ 841.061–.065,
    .081(a) (West, Westlaw through
    2017 1st C.S.). Usually, an expert will examine the defendant and testify as to his opinion
    on whether that person suffers from a behavioral abnormality that makes him likely to
    engage in a predatory act of sexual violence. See 
    id. §§ 841.003(a),
    .061(c), (f) (West,
    Westlaw through 2017 1st C.S.); see also, e.g., In re Commitment of Talley, 
    522 S.W.3d 742
    , 748 (Tex. App.—Houston [1st Dist.] 2017, no pet.); In re Commitment of Stuteville,
    
    463 S.W.3d 543
    , 554–55 (Tex. App.—Houston [1st Dist.] 2015, pet. denied); In re
    Commitment of Anderson, 
    392 S.W.3d 878
    , 882–83 (Tex. App.—Beaumont, 2013, pet.
    denied).
    When testifying, an expert may disclose the underlying facts or data upon which
    the expert based his or her opinion if they are of the type relied upon by experts in the
    field in forming opinions on the subject. 
    Talley, 522 S.W.3d at 748
    ; 
    Stuteville, 463 S.W.3d at 554
    –55; see TEX. R. EVID. 703 (“If experts in the particular field would reasonably rely
    on those kinds of facts or data in forming an opinion on the subject, they need not be
    admissible for the [expert’s] opinion to be admitted.”); 
    id. R. 705
    (stating that an “expert
    may . . . disclose on direct examination, or be required to disclose on cross-examination,
    the underlying facts or data”); In re Commitment of Day, 
    342 S.W.3d 193
    , 198–99 (Tex.
    App.—Beaumont 2011, pet. denied) (explaining why, in SVP cases, evidence regarding
    the details of an alleged SVP’s prior offense has probative value to help the jury
    understand the expert’s opinion). Accordingly, in SVP civil commitment cases, the facts
    or data underlying previous sexual assaults and other alleged bad acts are admissible
    7
    when they assist the jury in understanding the expert’s testimony that a person has a
    behavioral abnormality, so long as experts in the field rely on that type of facts or data in
    forming their opinions on the subject. 
    Talley, 522 S.W.3d at 748
    –49; 
    Stuteville, 463 S.W.3d at 555
    –56; 
    Day, 342 S.W.3d at 198
    –99; see TEX. R. EVID. 703, 705.
    However, the admission of the underlying facts or data is still subject to the same
    relevancy constraints that govern the admission of other kinds of evidence. 
    Talley, 522 S.W.3d at 748
    ; see TEX. R. EVID. 705(d). Thus, a court may exclude relevant evidence if
    its probative value is substantially outweighed by a danger of unfair prejudice. TEX. R.
    EVID. 403.
    “Evidence is unfairly prejudicial when it has an undue tendency to suggest that a
    decision be made on an improper basis, commonly, but not necessarily, an emotional
    one.” 
    Anderson, 392 S.W.3d at 882
    . Factors that should be considered include the
    probative value of the evidence, the potential of the evidence to impress the jury in some
    irrational way, the time needed to develop the evidence, and the proponent’s need for the
    evidence.    
    Stuteville, 463 S.W.3d at 555
    ; 
    Anderson, 392 S.W.3d at 882
    (citing
    Montgomery v. State, 
    810 S.W.2d 372
    , 389–90 (Tex. Crim. App. 1991) (op. on reh’g));
    see also In re Commitment of Dockery, No. 09-14-00236-CV, 
    2015 WL 2124995
    , at *1–
    2 (Tex. App.—Beaumont, May 7, 2015, no pet.) (mem. op.).
    IV.    DISCUSSION
    A.     Admission of Voluntary Statement
    By his first issue, Flores challenges the admission of the voluntary written
    statement he gave to police in 2003. Flores gave the statement after being arrested for
    having sex with two fourteen-year-old boys at the foster home where he was living, and
    8
    the statement details some of his sexual misconduct with both boys. Here, the State used
    the statement to refresh Flores’s memory on the stand after he initially denied having sex
    with both boys and making a statement to police. Afterward, the State introduced the
    statement into evidence. See TEX. R. EVID. 612.
    Flores first challenges the admission of the statement because Texas Rule of
    Evidence 612 “does not state that the producing party that used the statement to refresh
    their own witness’ memory has the right to have the statement admitted, even if they also
    happen to be the adverse party.” See 
    id. Flores also
    argues that even if the statement
    was properly admitted under Texas Rule of Evidence 612, the court should have redacted
    the statement before introducing it into evidence.5 See 
    id. R. 612(b).
    However, Flores
    neither objected at trial to the introduction of the statement on the basis of rule 612, nor
    asked the trial court to redact the statement. Therefore, this complaint has been waived.
    See TEX. R. APP. P. 33.1.
    Next, Flores argues that the trial court erred in admitting the statement because it
    was substantially more prejudicial than probative.                    See TEX. R. EVID. 403, 705.
    Specifically, Flores points to two instances of explicit language in the statement used to
    describe the sexual misconduct between him and the two fourteen-year-old boys.6
    5   Texas Rule of Evidence 612 governs writings used to refresh a witness’ memory. It states in part
    that:
    [a]n adverse party is entitled to have the writing produced at the hearing, to inspect it, to
    cross-examine the witness about it, and to introduce in evidence any portion that relates to
    the witness’s testimony. If the producing party claims that the writing includes unrelated
    matter, the court must examine the writing in camera, delete any unrelated portion, and
    order that the rest be delivered to the adverse party. Any portion deleted over objection
    must be preserved for the record.
    TEX. R. EVID. 612(b).
    6Flores complains about the following sentences in his 2003 statement to police: (1) “I told [A.] the
    next day that [M.] had sucked my dick”; and (2) “The next night, it was like a couple of days later or
    something, [A.] started fucking [M.] in the ass. It was me after that and then [F.]”
    9
    As to the statement’s probative value and the State’s need for the statement, see
    
    Anderson, 392 S.W.3d at 882
    , Flores’s statement goes to the central issue at trial of
    whether Flores suffers from a behavioral abnormality, and Dr. Arambula’s testimony
    indicated that he considered Flores’s arrest and subsequent statement in forming his
    opinion. Furthermore, when questioned at trial, Flores denied having sex with the two
    boys and giving the statement to police. Therefore, the probative value of the statement
    and the State’s need for the statement were high. See, e.g., 
    Talley, 522 S.W.3d at 749
    (concluding that trial court did not abuse its discretion in admitting Talley’s written
    confession because it “assisted the jury in understanding [the expert’s] testimony that
    Talley had a behavioral abnormality, and Talley placed the veracity of [the facts in the
    confession] at issue during [his testimony at] trial . . . .”); 
    Stuteville, 463 S.W.3d at 556
    (“[T]he trial court could have reasonably concluded that the facts and details related to
    Stuteville’s offenses would be helpful to the jury in weighing [Stuteville’s] testimony and
    [the expert’s] testimony, and in explaining the basis for [the expert’s] opinion that Stuteville
    suffers from a behavioral abnormality.”); see also In re Commitment of Bath, No. 09-11-
    00559-CV, 
    2012 WL 3860631
    , at *3 (Tex. App.—Beaumont Sept. 6, 2012, no pet.) (mem.
    op.) (“The probative value of the statements includes their tendency to show that at one
    time Bath had admitted to matters that he would no longer admit during the proceedings
    that led to his commitment.”).
    Regarding the potential of the statement to irrationally impress the jury, we note
    that the alleged sexual misconduct with the fourteen-year-old boys described in the
    statement is no more sordid than Flores’s convictions for his other sexual crimes.
    Furthermore, any prejudicial effect of the statement lies in its probative value rather than
    10
    an unrelated matter. See 
    Talley, 522 S.W.3d at 749
    ; Robbins v. State, 
    27 S.W.3d 245
    ,
    251 (Tex. App.—Beaumont 2000) (applying rule 403 in a criminal case), aff’d, 
    88 S.W.3d 256
    (Tex. Crim. App. 2002); see also Bath, 
    2012 WL 3860631
    at *3. Thus, the potential
    of the statement to irrationally impress the jury was low. See 
    Anderson, 392 S.W.3d at 882
    ; see also Dockery, 
    2015 WL 2124995
    at *2. Finally, as to the time needed to develop
    the evidence, the record reflects that the State spent minimal time in developing the
    statement.
    We conclude that the probative value of the statement, the State’s need for the
    statement, the potential of the statement to impress the jury in some irrational way, and
    the time needed to develop the statement all weigh in favor of admissibility. See 
    Talley, 522 S.W.3d at 749
    ; 
    Anderson, 392 S.W.3d at 882
    ; see also Dockery, 
    2015 WL 2124995
    at *2; Bath, 
    2012 WL 3860631
    at *3–4. Therefore, the trial judge could reasonably have
    concluded that Flores’s statement was not unfairly prejudicial, and the trial court did not
    abuse its discretion in admitting the statement into evidence. See Anderson, at 882–83;
    
    Talley, 522 S.W.3d at 749
    ; 
    Day, 342 S.W.3d at 199
    .
    We overrule Flores’s first issue.
    B.     Dr. Arambula’s Testimony
    By his second issue, Flores argues that details revealed by Dr. Arambula during
    his testimony were substantially more prejudicial than probative and were based on
    hearsay. Flores points to statements made by Arambula concerning Flores’s first victim,
    the events surrounding the two fourteen-year-old boys, and the allegation of sexual
    misconduct with a staff member at the youth wilderness camp. Finally, Flores argues that
    the fact that the trial court gave the jury a limiting instruction is irrelevant.
    11
    As noted, an expert may disclose the underlying facts or data upon which the
    expert based his or her opinion if it is of a type relied upon by experts in the field in forming
    opinions on the subject. 
    Talley, 522 S.W.3d at 748
    ; 
    Stuteville, 463 S.W.3d at 554
    –55;
    see TEX. R. EVID. 703, 705; 
    Day, 342 S.W.3d at 198
    –99. In a SVP civil commitment
    proceeding, the accused’s history of sexually violent conduct and other alleged sexual
    bad acts are “highly relevant to whether he suffers from a behavioral abnormality making
    it difficult for him to control his impulses to commit sexually violent offenses.” 
    Mares, 521 S.W.3d at 71
    (quoting 
    Browning, 113 S.W.3d at 860
    , 866) (internal quotations omitted).
    Thus, to assist the jury in weighing the expert’s opinion on the ultimate issue of whether
    the accused suffers from a behavioral abnormality, the expert can explain the facts
    considered, including past sexual offenses and alleged bad acts, and how those facts
    influenced his evaluation. 
    Stuteville, 463 S.W.3d at 555
    ; see In re Commitment of Young,
    
    410 S.W.3d 542
    , 557 (Tex. App.—Beaumont 2013, no pet.).
    Here, Dr. Arambula explained that he considered multiple types of records in
    formulating his opinion that Flores suffers from a behavioral abnormality that makes him
    likely to re-offend with a predatory act of sexual violence. Dr. Arambula explained that
    experts in his field typically review and rely on the type of records he reviewed in
    formulating their opinion. Dr. Arambula elaborated that, in forming his diagnosis, he
    considers factors associated with an offender’s risk to re-offend with a predatory act of
    sexual violence, and he explained that these risk factors come from medical literature and
    research. During his testimony, Dr. Arambula thoroughly went through Flores’s history
    and records, and he explained the risk factors presented and associated with his behavior
    in each incident.
    12
    Flores points to:    Dr. Arambula’s statements that there were other alleged
    instances of sexual misconduct with the first victim, although Dr. Arambula only
    considered the one instance that led to Flores’s conviction in his diagnosis;
    Dr. Arambula’s statements describing the alleged sexual misconduct that took place at
    the foster home, including his opinion on the significance of the age difference between
    Flores and the victims; and Dr. Arambula’s comments regarding the alleged sexual
    misconduct between Flores and a staff member at the youth wilderness camp. We
    disagree with Flores that these statements were substantially more prejudicial than
    probative.
    As to Flores’s first offense, Dr. Arambula explained that he considered the age of
    Flores and the victim, the reports of the offense, and the surrounding circumstances.
    Dr. Arambula explained that the ages of the victim (four) and Flores (sixteen) were risk
    factors considered in his diagnosis of Flores’s behavioral abnormality. Dr. Arambula
    elaborated that “starting at [the age of sixteen] raises the risk for more serious disease
    and higher rates of recidivism.” Thus, Dr. Arambula’s statements at issue assisted the
    jury in understanding his diagnosis that Flores has a behavioral abnormality with
    pedophilic tendencies, the scope of Flores’s behavioral abnormality, and the first reported
    occurrence of Flores’s sexual deviancy. See 
    Anderson, 392 S.W.3d at 882
    –83; see also
    In re Commitment of Robinson, No. 09-14-00162-CV, 
    2015 WL 1736754
    , at * 2 (Tex.
    App.—Beaumont Apr. 16, 2015, no pet.) (mem. op.) (citing 
    Day, 342 S.W.3d at 199
    )
    (“Having an expert explain which facts were considered and how those facts influenced
    the expert’s evaluation assisted the jury in weighing the expert’s testimony and the
    opinion offered regarding the ultimate issue in the case.”).
    13
    As to Flores’s sexual misconduct while living at the foster home, Dr. Arambula
    explained that he looked at the arrest, Flores’s statement to police, investigative records,
    and statements taken from both boys. Dr. Arambula explained that when he interviewed
    Flores about these events, “it was as if it didn’t occur.” Dr. Arambula elaborated that
    denial is a high-risk factor for reoffending and breaking denial “is the first step in sex
    offender treatment.” Furthermore, Dr. Arambula testified about the surrounding events,
    and he explained that there were several other risk factors: that young boys were
    involved; that there were threats made to keep victims quiet; and that there was an
    exchange of money, which is like grooming and “usually associated with sexual
    victimization of children.” Thus, Dr. Arambula’s statements at issue were important in
    explaining to the jury his diagnosis of Flores’s behavioral abnormality, and the depth and
    breadth of the acts Flores committed while acting out on his sexual deviancy. See
    
    Anderson, 392 S.W.3d at 882
    –83; 
    Stuteville, 463 S.W.3d at 556
    ; see also Haines, 
    2016 WL 3356571
    , at *6.
    As to Dr. Arambula’s testimony regarding Flores’s expulsion from the youth
    wilderness camp, Dr. Arambula explained that sexual preoccupation is a risk factor.
    Dr. Arambula explained that, regardless of whether Flores engaged in sexual misconduct
    with a child or a staff member, he considered the events from the youth camp as an
    indication of Flores’s sexual preoccupation. Dr. Arambula also explained that Flores was
    under probation at the time of the incident at the youth wilderness camp and offending
    while under supervision is another risk factor.      Dr. Arambula elaborated as to the
    significance of this event in his evaluation and diagnosis of Flores:
    [D]espite having gotten in trouble for what he was doing, being under a
    closer supervision, it didn’t detract him, in other words, it didn’t slow him
    14
    down. But what [stuck] out to me more so is that it was very apparent that
    he was preoccupied with sexual activity. It was just — it followed from one
    place, to another, to another. It didn’t really matter the gender. And he
    even remarked that he — that sex was an outlet for him, so that — that was
    the undercurrent or the backdrop behind all of this, and so I looked at his
    sexual preoccupation on his part.
    Thus, Dr. Arambula’s statements at issue helped the jury understand his diagnosis that
    Flores has a behavioral abnormality that makes him likely to re-offend with a predatory
    act of sexual violence. See 
    Anderson, 392 S.W.3d at 882
    –83; 
    Stuteville, 463 S.W.3d at 556
    ; see also Dockery, 
    2015 WL 2124995
    , at *3.
    While the statements by Dr. Arambula that Flores complains of may be prejudicial,
    they are also probative, and Flores has failed to demonstrate how they are substantially
    more prejudicial than probative. See TEX. R. EVID. 403. Therefore, the trial court could
    have reasonably found that the prejudicial value of Dr. Arambula’s statements did not
    substantially outweigh their probative value. See Talley, 748–49; 
    Stuteville, 463 S.W.3d at 556
    ; 
    Anderson, 392 S.W.3d at 882
    –83; 
    Day, 342 S.W.3d at 199
    .
    As to the hearsay basis of Dr. Arambula’s testimony, the trial judge gave the jury
    the following limiting instruction in open court:
    Ladies and gentlemen, hearsay is a statement other than one made by the
    declarant while testifying at the trial or hearing offered to prove the truth of
    the matter asserted. Certain hearsay information contained in the records,
    which have been reviewed by experts, is admitted before you through
    expert testimony. Such hearsay is admitted only for the purpose of showing
    the basis of the expert’s opinion and cannot be considered as evidence to
    prove the truth of the matter asserted.
    The jury charge contained a similar limiting instruction on hearsay, and, absent record
    evidence to the contrary, we must assume the jury followed the instruction. See 
    Mares, 521 S.W.3d at 71
    ; 
    Stuteville, 463 S.W.3d at 555
    .            Flores has failed to rebut the
    presumption that the jury followed the trial court’s instructions; therefore, any potential
    15
    harm arising from Dr. Arambula’s testimony concerning the factual details of the sexual
    assaults was cured. See 
    Mares, 521 S.W.3d at 71
    ; 
    Day, 342 S.W.3d at 199
    . We reject
    as speculative Flores’s argument that the limiting instructions were irrelevant.
    Finally, the record, including Flores’s own testimony and Dr. Arambula’s complete
    testimony, does not support the argument that any of Dr. Arambula’s statements caused
    an improper result in the trial. Thus, any error in allowing the admission of Dr. Arambula’s
    statements does not require reversal of the judgment in this case. See TEX. R. APP. P.
    44.1; Cent. Expressways Sign 
    Assocs., 302 S.W.3d at 870
    ; 
    Anderson, 392 S.W.3d at 883
    .
    We overrule Flores’s second issue.
    V.    CONCLUSION
    We affirm the trial court’s judgment.
    DORI CONTRERAS
    Justice
    Delivered and filed the
    12th day of April, 2018.
    16