Christopher Douglas Cornett v. State ( 2018 )


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  • Opinion filed May 31, 2018
    In The
    Eleventh Court of Appeals
    __________
    No. 11-16-00124-CR
    __________
    CHRISTOPHER DOUGLAS CORNETT, Appellant
    V.
    THE STATE OF TEXAS, Appellee
    On Appeal from the 35th District Court
    Brown County, Texas
    Trial Court Cause No. CR23048
    MEMORANDUM OPINION
    The jury convicted Christopher Douglas Cornett of continuous sexual abuse
    of a young child. The trial court assessed his punishment at confinement for thirty-
    five years in the Institutional Division of the Texas Department of Criminal Justice.
    Appellant brings four issues on appeal. In his first and second issues, Appellant
    contends that the trial court erred in admitting evidence of Appellant’s extraneous
    bad acts. In his third issue, Appellant contends that the trial court erred when it
    allowed the State’s expert to testify that rapid dilatation of the complainant’s anus
    was consistent with sexual abuse. In his fourth issue, Appellant contends that the
    cumulative effect of his first three issues requires a reversal of his conviction. We
    affirm.
    Background Facts
    The victim in this case, ZC, is the adopted daughter of Appellant. Prior to
    being adopted, Child Protective Services removed ZC and her younger sister from
    their home due to neglectful supervision and physical neglect. The removal occurred
    when ZC was four years old. ZC suffered from developmental and behavioral issues,
    and she was placed in a residential treatment center.
    Appellant and his wife, Amanda Sharp, adopted ZC and her sister when ZC
    was five years old. ZC continued to suffer from developmental and behavioral
    problems, making it difficult for Sharp to manage her alone while Appellant worked.
    Consequently, Appellant left his job in order to help care for ZC. This led to
    financial difficulties, which placed a strain on Appellant’s marriage to Sharp.
    Appellant and his family had to leave their “dream house” and move into a smaller
    home.
    To bring in extra income, Sharp opened a thrift store and began cleaning
    houses. Beginning in May 2013, when ZC was nine years old, Appellant began
    encouraging Sharp to spend Friday nights at her friend’s house out of town so that
    she could clean. This continued nearly every week until the end of 2013. During
    this time, Appellant, Sharp, and their daughters lived in May, Texas.
    Appellant had a history of violent behavior toward Sharp and the children. On
    one occasion, approximately four years before they separated, Appellant and Sharp
    got into a physical altercation that ended with Appellant pinning Sharp to the floor
    and holding a knife to her throat. ZC and her sister witnessed this incident.
    Additionally, Sharp testified that Appellant excessively disciplined the children and
    2
    “thoroughly enjoyed whooping [ZC].”            On another occasion, Sharp overheard
    Appellant telling someone that he would kill her and the children. A few days after
    this incident, Sharp left the home with the children and applied for a protective order.
    On February 24, 2014, Appellant and Sharp attended a hearing on the
    application for a protective order. The judge lifted the protective order, as it applied
    to the children, and awarded Appellant supervised visitation with ZC and her sister
    on the following weekend. That night, Sharp told the girls that they would be going
    to see Appellant. Upon hearing this news, ZC became upset.
    Sharp later found ZC crying in the shower. ZC told Sharp that she “couldn’t
    take the bad touches anymore” and that Appellant had been sexually assaulting her
    every Friday night when Sharp was with Sharp’s friend. According to ZC, Appellant
    would use his hands and his penis to penetrate her vagina, her anus, and her mouth.
    Debbie Coats, a sexual assault nurse examiner (SANE), conducted an
    examination of ZC. Coats noted a full thickness notch at the one o’clock position of
    ZC’s hymen. She further noted a scar at the seven o’clock position of ZC’s posterior
    fourchette or perineum area. Coats opined that these injuries were consistent with
    the sexual assault reported by ZC. Appellant offered the testimony of Sonja
    Eddelman, a SANE nurse from Corpus Christi. Eddelman disagreed that the notch
    found at the one o’clock position was indicative of trauma and opined that it was
    most likely congenital.
    Coats also examined ZC’s anus. In order to check for anal injuries, Coats
    applied pressure to both sides of the buttocks to allow the muscles to relax. Coats
    testified that, generally, it takes a child’s anus between fifteen and forty-five seconds
    to relax. However, ZC’s anus relaxed in only five seconds. Coats opined that this
    was consistent with chronic anal penetration. Eddelman agreed that rapid anal
    dilatation could indicate anal penetration, but she opined that Coats’s report did not
    provide a sufficient amount of detail related to ZC’s anal exam.
    3
    Analysis
    In his first issue, Appellant contends that the trial court erred in admitting
    Sharp’s testimony describing the incident where Appellant allegedly held a knife to
    Sharp’s throat. Appellant first contends that Sharp’s testimony was irrelevant. We
    review a trial court’s ruling on admissibility of evidence for an abuse of discretion.
    Coble v. State, 
    330 S.W.3d 253
    , 272 (Tex. Crim. App. 2010). We will uphold the
    trial court’s decision unless it lies outside the zone of reasonable disagreement.
    Salazar v. State, 
    38 S.W.3d 141
    , 153–54 (Tex. Crim. App. 2001). Under Rule 402
    of the Texas Rules of Evidence, “[i]rrelevant evidence is not admissible.” TEX. R.
    EVID. 402. “Evidence is relevant if: (a) it has any tendency to make a fact more or
    less probable than it would be without the evidence; and (b) the fact is of
    consequence in determining the action.” TEX. R. EVID. 401.
    The State contends that Sharp’s testimony was relevant to rebut Appellant’s
    defensive theories. We agree. At trial, Appellant’s defensive theory was that Sharp
    coached ZC to make a false allegation of sexual abuse. Appellant’s trial counsel
    described Sharp’s motivation to falsely accuse Appellant during his opening
    statement: “[Sharp] resented the fact that . . . [Appellant] never went back to work .
    . . . So she starts trying to figure out a way of how she is going to leave [Appellant]
    and keep the girls, considering the fact [that] he basically had been raising them for
    the past year.” Evidence that Appellant was physically abusive toward Sharp during
    their marriage is relevant to rebut the defensive theory that Sharp was motivated by
    financial gain to leave the marriage and falsely accuse Appellant of sexually abusing
    their daughter.
    Appellant contends that the four-year gap in time between the alleged incident
    with the knife and the alleged sexual abuse makes the latter irrelevant because it
    “played [no] role in [Sharp’s] decision to separate [from Appellant].” We disagree.
    Sharp testified that this incident, and others like it, happened after Appellant had
    4
    been drinking. Similarly, ZC testified that Appellant would sexually assault her after
    drinking heavily. Sharp testified that, although Appellant had stopped drinking for
    some time, Appellant had begun drinking again immediately prior to their
    separation, which placed an additional strain on the marriage. Therefore, the trial
    court could have reasonably concluded that this incident was relevant to paint a full
    picture of the family dynamic and to place Appellant’s alleged threat to kill Sharp
    and the children a few days before the separation into context.
    Appellant next contends that the unfairly prejudicial nature of Sharp’s
    testimony outweighed its probative value. Under Rule 403, relevant evidence may
    be excluded if its “probative value is substantially outweighed by a danger of . . .
    unfair prejudice.” TEX. R. EVID. 403. Rule 403 favors the admission of relevant
    evidence and carries a presumption that relevant evidence is more probative than
    prejudicial.   Hayes v. State, 
    85 S.W.3d 809
    , 815 (Tex. Crim. App. 2002);
    Montgomery v. State, 
    810 S.W.2d 372
    , 389 (Tex. Crim. App. 1991). Evidence is
    unfairly prejudicial when it has an undue tendency to suggest an improper basis for
    reaching a decision. Reese v. State, 
    33 S.W.3d 238
    , 240 (Tex. Crim. App. 2000);
    Render v. State, 
    347 S.W.3d 905
    , 921 (Tex. App.—Eastland 2011, pet. ref’d). When
    we review a trial court’s determination under Rule 403, we reverse the trial court’s
    judgment “rarely and only after a clear abuse of discretion.” Mozon v. State, 
    991 S.W.2d 841
    , 847 (Tex. Crim. App. 1999) (quoting 
    Montgomery, 810 S.W.2d at 392
    ).
    An analysis under Rule 403 includes, but is not limited to, the following factors:
    (1) the probative value of the evidence; (2) the potential to impress the jury in some
    irrational, yet indelible, way; (3) the time needed to develop the evidence; and (4)
    the proponent’s need for the evidence. Hernandez v. State, 
    390 S.W.3d 310
    , 324
    (Tex. Crim. App. 2012); Shuffield v. State, 
    189 S.W.3d 782
    , 787 (Tex. Crim. App.
    2006).
    5
    The trial court conducted a Rule 403 balancing test. The trial court found that
    the evidence was unlikely either to lead to a confusion of the issues or to be too time-
    consuming and held that the probative value of the evidence outweighed its
    prejudicial nature. We agree. Sharp’s testimony regarding this incident was short,
    accounting for no more than five pages out of the four volumes of trial testimony.
    Further, Appellant’s defensive theories strengthened the need for this evidence.
    Appellant’s defensive theories were that Sharp made up the allegations against
    Appellant and coached ZC, who was easily manipulated, into making a false outcry.
    We, therefore, conclude that the trial court did not clearly abuse its discretion when
    it allowed the jury to hear Sharp’s account of this incident. We overrule Appellant’s
    first issue.
    In his second issue, Appellant contends that the trial court erred in admitting
    Sharp’s testimony that Appellant used excessive corporal punishment on ZC and her
    sister. Appellant first argues that the trial court erred in holding that excessive
    corporal punishment is not an extraneous offense. However, Appellant’s objection
    at trial was limited to the admissibility of this evidence under Rules 401, 402, and
    403. Therefore, we will limit our analysis to those rules. See TEX. R. APP. P. 33.1(a);
    Berry v. State, 
    233 S.W.3d 847
    , 857 (Tex. Crim. App. 2007) (to preserve a
    Rule 404(b) complaint on appeal, Appellant must make a timely objection at trial).
    Appellant asserts that evidence that Appellant excessively disciplined his
    children was irrelevant. For the same reasons given in our discussion of Appellant’s
    first issue, we find that this evidence was relevant to rebut the defensive theory that
    Sharp was motivated by financial reasons to make up the allegations against
    Appellant and coach ZC to lie. Further, this evidence is relevant to explain ZC’s
    state of mind and the relationship between ZC and Appellant. See McCulloch v.
    State, 
    39 S.W.3d 678
    , 680–81 (Tex. App.—Beaumont 2001, pet. ref’d) (discussing
    6
    the relevancy of extraneous acts in the context of Article 38.37 of the Texas Code of
    Criminal Procedure).
    Appellant further asserts that the trial court failed to conduct a balancing test
    as required by Rule 403. “There is no requirement that the trial court place on the
    record that it has conducted and completed the balancing test in its own mind.”
    Reyes v. State, 
    480 S.W.3d 70
    , 77 (Tex. App.—Fort Worth 2015, pet. ref’d). Since
    the trial court overruled Appellant’s Rule 403 objection, we will presume that it
    performed the necessary balancing test. See Hung Phuoc Le v. State, 
    479 S.W.3d 462
    , 469 (Tex. App.—Houston [14th Dist.] 2015, no pet.).
    Appellant contends that admitting this evidence might have led the jury to
    believe that convicting Appellant was necessary in order to protect his children from
    his excessive discipline. However, the trial court instructed the jury that this
    evidence may only be considered in rebutting a defensive theory. We will presume
    that the jury followed the trial court’s instructions and considered this evidence only
    for the purpose of rebutting Appellant’s defensive theories. See Colburn v. State,
    
    966 S.W.2d 511
    , 520 (Tex. Crim. App. 1998). We cannot conclude that the trial
    court clearly abused its discretion in overruling Appellant’s Rule 403 objection. We
    overrule Appellant’s second issue.
    In his third issue, Appellant contends that the trial court erred in admitting
    expert testimony regarding rapid anal dilatation because it was unreliable. “A trial
    judge’s ruling on the admissibility of expert testimony is reviewed under an abuse-
    of-discretion standard and will not be disturbed if it is within the zone of reasonable
    disagreement.” Wolfe v. State, 
    509 S.W.3d 325
    , 335 (Tex. Crim. App. 2017) (citing
    Russeau v. State, 
    291 S.W.3d 426
    , 438 (Tex. Crim. App. 2009)). “Absent a clear
    abuse of that discretion,” we will not disturb the trial court’s decision to admit or
    exclude testimony. Wyatt v. State, 
    23 S.W.3d 18
    , 27 (Tex. Crim. App. 2000). We
    review the trial court’s ruling in light of the evidence before the court at the time of
    7
    the ruling. Rodgers v. State, 
    205 S.W.3d 525
    , 528–29 (Tex. Crim. App. 2006) (citing
    Weatherred v. State, 
    15 S.W.3d 540
    , 542 (Tex. Crim. App. 2000)).
    If scientific, technical, or other specialized knowledge will assist the trier of
    fact to understand the evidence or to determine a fact in issue, a witness qualified as
    an expert by knowledge, skill, experience, training, or education may testify thereto
    in the form of an opinion or otherwise. TEX. R. EVID. 702; see 
    Wolfe, 509 S.W.3d at 335
    . For expert testimony to be admissible, the proponent of the expert scientific
    evidence must demonstrate by clear and convincing evidence that the testimony is
    “sufficiently reliable and relevant to help the jury in reaching accurate results.”
    Kelly v. State, 
    824 S.W.2d 568
    , 572 (Tex. Crim. App. 1992). “In other words, the
    proponent must prove two prongs: (1) the testimony is based on a reliable scientific
    foundation, and (2) it is relevant to the issues in the case.” Tillman v. State, 
    354 S.W.3d 425
    , 435 (Tex. Crim. App. 2011). Here, we limit our analysis to the prong
    addressing reliability because Appellant has not challenged the prong addressing the
    relevancy of the testimony to the issues in the case. It is a trial court’s responsibility
    under Rule 702 to determine whether proffered scientific evidence is sufficiently
    reliable. Jackson v. State, 
    17 S.W.3d 664
    , 670 (Tex. Crim. App. 2000).
    Evidence derived from a scientific theory must satisfy three criteria to be
    considered reliable: (1) the underlying scientific theory must be valid; (2) the
    technique applying the theory must be valid; and (3) the technique must be properly
    applied. 
    Id. (citing Kelly,
    824 S.W.2d at 573). The proponent of the evidence has
    the burden to show, by clear and convincing evidence, that the evidence is reliable.
    
    Id. In Kelly,
    the Court of Criminal Appeals suggested “a nonexclusive list of factors
    that might influence a finding of reliability.” 
    Wolfe, 509 S.W.3d at 336
    . These
    factors include, but are not limited to, the following: (1) the extent to which the
    underlying scientific theory and technique are accepted as valid in the relevant
    scientific community; (2) the qualifications of the expert testifying; (3) the existence
    8
    of literature supporting or rejecting the underlying scientific theory or technique;
    (4) the potential rate of error of the technique; (5) the availability of other experts to
    test and evaluate the technique; (6) the clarity with which the underlying scientific
    theory and technique can be explained to the court; and (7) the experience and skill
    of the person who applied the technique on the occasion in question. 
    Kelly, 824 S.W.2d at 573
    . An appellate court applies the Kelly factors to the evidence presented
    in the case. See 
    Wolfe, 509 S.W.3d at 336
    .
    Coats first testified outside the presence of the jury. The parties stipulated at
    the outset of her testimony to Coats’s qualifications to testify as an expert in the field
    of sexual assault examinations. In this regard, “[q]ualification is distinct from
    reliability,” and each are evaluated independently. Vela v. State, 
    209 S.W.3d 128
    ,
    131 (Tex. Crim. App. 2006). We note, however, that Coats testified that she had
    been a SANE nurse for about twenty-two years and that she was certified as such by
    the Texas Attorney General’s office. In her career, she had performed approximately
    400 adult SANE exams and approximately 600 pediatric SANE exams.
    Coats begins each exam by collecting a history from the patient. Next, she
    performs a head-to-toe assessment of the patient. Finally, she performs a detailed
    genital exam and collects any forensic evidence found on the patient. As part of the
    genital exam, Coats conducts a detailed examination of the patient’s anus. She
    applies pressure to the buttocks in order to relax the muscles and allow her to
    examine the anus for injuries. Coats then notes how quickly the anus dilates and
    whether or not there is stool in the vault, which could cause rapid dilatation.
    Coats examined ZC’s anus as a part of the SANE exam. Coats testified that,
    typically, the anus will begin to dilate within between fifteen and thirty seconds and
    will be fully dilated within one minute. She also testified that this examination could
    be difficult to perform on a younger child because of the time usually required to
    9
    cause the anus to dilate. However, Coats did not note any difficulty performing this
    examination on ZC.
    Coats testified that ZC’s anus dilated very rapidly, within five seconds. Coats
    also noted that there was no stool present in the vault of ZC. Coats testified that, in
    the absence of stool present in the vault, this was an unusual finding in a child and
    was consistent with a reported history of anal penetration. Coats also testified about
    other potential causes of rapid anal dilatation, including sedation, chronic
    constipation, or neurological deficits. However, ZC did not report a history of any
    of these conditions, unlike her report of anal penetration.
    Coats initially testified that her opinion of a finding consistent with anal
    penetration was not based on any literature but, rather, on her training as a SANE
    nurse. Specifically, Coats attended the annual Crimes Against Children Conference
    in Dallas, where physicians discussed rapid anal dilatation.            Although she
    remembered doing “some reading” on rapid anal dilatation, she could not remember
    any specific articles or journals addressing the subject. Coats was initially unable to
    provide a rate of error in either the application of this technique or its usefulness as
    an indicator of sexual abuse. She testified that there was “some controversy”
    surrounding the technique and that other things, such as the presence of stool in the
    vault or the patient’s position during the exam, could affect the results. Nevertheless,
    Coats testified that rapid anal dilatation is accepted in the scientific community as a
    valid symptom of chronic anal penetration. Additionally, Coats testified that her
    opinion is one recognized by the scientific community that deals with investigating
    child sexual abuse. Specifically, she agreed with the following excerpt read by the
    prosecutor from a book entitled “Investigation and Prosecution of Child Sexual
    Assault,” which was written by Teresa M. Buess and Michael E. Trent:
    Immediate dilatation of the anus with no stool visible or palpable in the
    rectal vault when the child is examined in the knee-chest position and
    10
    where there is no history of chronic constipation, neurological deficits,
    or sedation are considered definite evidence of blunt force penetrating
    trauma to the anus.
    Appellant responded to Coats’s initial testimony regarding rapid anal
    dilatation by arguing that it was inadmissible under Escamilla v. State, 
    334 S.W.3d 263
    (Tex. App.—San Antonio 2010 pet. ref’d). The trial court initially took the
    matter under advisement. Later that day, Coats again testified outside the presence
    of the jury. On this subsequent occasion, she testified that an article written by “a
    man by the name of Hobbs” described a study on anal dilatation. Coats testified that
    this study concluded that 36% of known sexually abused children exhibited rapid
    anal dilatation, compared to only 4% of the children in the control group.1 The trial
    court subsequently overruled Appellant’s objection.                       Coats then repeated her
    testimony for the jury.
    Eddelman, Appellant’s expert witness, was also a SANE nurse. She testified
    that she had performed approximately 2,000 adult SANE exams and 6,500 pediatric
    SANE exams. Eddelman reviewed Coats’s report that summarized Coats’s SANE
    exam of ZC. Eddelman agreed that a SANE exam should include an examination of
    the patient’s anus. She explained that, if the patient’s anus dilated to two centimeters
    in less than thirty seconds, she would make a note of that finding. Further, she would
    note whether only the “external” sphincter dilated or whether both the “external”
    and “internal” sphincters dilated. Coats’s report did not contain these details.
    Eddelman further testified that there is some controversy surrounding this technique
    because “the anus has not been studied as much as other parts of the body have.”
    Nevertheless, Eddelman testified that rapid anal dilatation could be consistent with
    sexual abuse.
    1
    The article by Hobbs was not offered into evidence. Accordingly, its contents are not a part of our
    analysis other than Coats’s description of the article. See 
    Rodgers, 205 S.W.3d at 528
    –29.
    11
    On appeal, Appellant again relies on Escamilla to support his contention that
    evidence of rapid anal dilatation is inadmissible. In Escamilla, the defendant was
    convicted of sexually assaulting his two-year-old daughter. 
    Escamilla, 334 S.W.3d at 265
    (majority opinion). America Garza, a SANE nurse, testified that the rapid
    dilatation of the victim’s anus was consistent with sexual abuse. 
    Id. at 267.
    The San
    Antonio Court of Appeals analyzed the reliability of Garza’s testimony using the
    Kelly factors. 
    Id. at 267–70.
    Garza testified that she had conducted approximately
    100 SANE exams. 
    Id. at 269.
    In conducting the SANE exam of the victim in that
    case, Garza used a procedure that is identical to the one used by Coats. See 
    id. at 271
    (Hilbig, J., dissenting and concurring). Garza testified that a “normal” anus
    takes at least one minute to dilate but that the victim’s anus dilated in only seven
    seconds. 
    Id. at 269
    (majority opinion). Garza opined that this was consistent with
    sexual abuse. 
    Id. Much like
    Coats, Garza could not remember any literature or specific
    scientific studies related to rapid anal dilatation, relying on her training and
    experience to form her opinion. 
    Id. She briefly
    mentioned Dr. Nancy Kellogg and
    Dr. John McCann but “could only reference a magazine article possibly written in
    2008.” 
    Id. Finally, Garza
    testified that the technique was accepted in the medical
    community. 
    Id. The majority
    concluded that the State had not met its burden to establish that
    Garza’s testimony was reliable because (1) Garza could not elaborate on the extent
    to which the technique was reliable in the scientific community, (2) she could make
    only vague references to supporting literature, and (3) she did not appear to
    understand the term “potential rate of error.” 
    Id. However, due
    to other evidence
    pointing toward the defendant’s guilt, the court affirmed his conviction. 
    Id. at 269
    –
    70.
    12
    Justice Hilbig dissented and concurred, agreeing with the majority that the
    conviction should be affirmed but believing that Garza’s testimony was properly
    admitted. 
    Id. at 270
    (Hilbig, J., dissenting and concurring). Justice Hilbig noted
    that, although Garza could not identify either specific literature or a potential rate of
    error for the technique, these are only two of seven factors that can be considered
    under Kelly. 
    Id. at 274.
    Justice Hilbig applied the “sliding scale” discussed in
    Rodgers. 
    Id. at 275
    (citing 
    Rodgers, 205 S.W.3d at 528
    ). Under Rodgers, an
    appellate court is to evaluate whether a trial court abused its discretion in
    determining that a witness is qualified using three criteria: (1) the complexity of the
    area of expertise; (2) whether or not the expert’s opinion was conclusive; and
    (3) whether or not the expert’s testimony is dispositive of the disputed issues.
    
    Rodgers, 205 S.W.3d at 528
    . Justice Hilbig believed that Garza’s testimony was
    similar to the expert opinion in Rodgers, and he would have held that the trial court
    did not abuse its discretion in allowing it. 
    Escamilla, 334 S.W.3d at 275
    .
    In this case, the trial court adopted a similar line of reasoning as that employed
    by Justice Hilbig by stating that “not every one of the various litany of Kelly factors
    have to be established, but there is a sliding scale that is utilized as the Court of
    Criminal Appeals has applied in matters such as this.” The trial court found that
    Coats was qualified as an expert, that the subject matter was not complex like DNA
    evidence, that Coats’s opinion was not conclusive that sexual abuse had occurred as
    alleged but rather her findings were consistent with sexual abuse, and that it was not
    “junk science” because the methodology had been accepted. See 
    Wolfe, 509 S.W.3d at 336
    (noting that the trial court’s gatekeeper function is to weed out junk science
    from evidence that has its basis in sound scientific methodology).
    Relying upon Escamilla, Appellant contends on appeal that, because
    (1) Garza was able to provide more information on rapid anal dilatation in Escamilla
    than Coats was able to provide in this case and (2) Garza’s testimony did not satisfy
    13
    the State’s burden of proving reliability in Escamilla, it follows that Coats’s
    testimony could not have satisfied the State’s burden to prove reliability in this case.
    We disagree. In this regard, the applicable inquiry is whether the trial court abused
    its discretion in admitting Coats’s expert opinion based upon the evidence presented
    to the trial court in light of the nonexclusive Kelly factors. 
    Wolfe, 509 S.W.3d at 336
    .
    It is true that, in some respects, Garza was able to provide some information
    about the technique that Coats could not provide. For example, Garza was able to
    name two doctors who had studied the technique, whereas Coats could only
    reference a study by “a man by the name of Hobbs.” See 
    Escamilla, 334 S.W.3d at 269
    . However, this approach relies too heavily on attempting to meet all seven of
    the Kelly factors. “The reliability inquiry is . . . a flexible one.” 
    Vela, 209 S.W.3d at 134
    ; see 
    Wolfe, 509 S.W.3d at 336
    (explaining that the Kelly factors are a
    nonexclusive list of factors to consider).
    Coats had more experience than Garza. Garza had conducted approximately
    100 SANE exams at the time of her testimony in Escamilla. 
    Escamilla, 334 S.W.3d at 269
    . Conversely, Coats had performed approximately 1,000 SANE exams,
    consisting of 400 adult and 600 pediatric exams. Further, Garza did not understand
    what a potential rate of error was. 
    Id. Coats, in
    contrast, was able to explain the
    second time that she testified that 36% of children known to have suffered from
    sexual abuse displayed rapid anal dilatation, while only 4% of children in the control
    group displayed this same symptom. She referred to the article by Hobbs in
    presenting this testimony. She had previously testified that the rate of error was
    “very low” for this finding.
    Although Coats initially was not able to provide a specific reference to an
    article or medical journal, she later provided a reference to the article by Hobbs.
    This is some evidence of the third Kelly factor—the factor that Appellant primarily
    14
    relies upon on appeal. Coats testified that other doctors and nurses in the medical
    community that investigate sexual abuse of children utilize this technique as part of
    their sexual assault examinations. This is evidence of the first Kelly factor because
    it indicates that the underlying scientific theory and technique are accepted as valid
    by the relevant scientific community. Additionally, the trial court received evidence
    concerning Coats’s qualifications and experience as a SANE nurse, which are
    relevant to the second and seventh Kelly factors. Furthermore, the trial court also
    received evidence pertaining to the potential rate of error, which is the fourth Kelly
    factor. Finally, Coats was able to testify with clarity on the subject of rapid anal
    dilatation, which is related to the sixth Kelly factor. The only Kelly factor that was
    not directly addressed before the trial court was the fifth factor pertaining to
    availability of other experts to test and evaluate the technique. However, this factor
    was indirectly addressed by the references to the use of the technique by other sexual
    abuse investigators. In summary, we conclude that the trial court was presented with
    sufficient evidence to determine that Coats’s opinion met the reliability requirement
    of Rule 702. Accordingly, the trial court did not abuse its discretion by admitting
    Coats’s testimony regarding rapid anal dilatation. We overrule Appellant’s third
    issue.
    In his fourth issue, Appellant contends that the errors he has alleged in his
    previous three issues constitute cumulative error requiring reversal of the trial
    court’s judgment. The Court of Criminal Appeals has long recognized that the
    cumulative effect of errors at trial may result in harmful error. Collier v. State, 
    528 S.W.3d 544
    , 548–49 (Tex. App.—Eastland 2016, pet. ref’d) (citing Linney v. State,
    
    413 S.W.3d 766
    , 767 (Tex. Crim. App. 2013) (Cochran, J., concurring in refusal of
    pet.)). However, we have held that the trial court did not commit error in any of the
    issues raised by Appellant.        Therefore, the cumulative-error doctrine is not
    15
    applicable to this appeal. See Chamberlain v. State, 
    998 S.W.2d 230
    , 238 (Tex.
    Crim. App. 1999). We overrule Appellant’s fourth issue.
    This Court’s Ruling
    We affirm the judgment of the trial court.
    JOHN M. BAILEY
    JUSTICE
    May 31, 2018
    Do not publish. See TEX. R. APP. P. 47.2(b).
    Panel consists of: Willson, J.,
    Bailey, J., and Wright, S.C.J.2
    2
    Jim R. Wright, Senior Chief Justice (Retired), Court of Appeals, 11th District of Texas at Eastland,
    sitting by assignment.
    16