Urias, Javier ( 2015 )


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  •                                                                                  PD-0883-15
    PD-0883-15                        COURT OF CRIMINAL APPEALS
    AUSTIN, TEXAS
    Transmitted 7/15/2015 3:06:42 PM
    Accepted 7/17/2015 2:03:35 PM
    ABEL ACOSTA
    NO.__________________________                                     CLERK
    ═══════════════════════════════════════════════
    IN THE COURT OF CRIMINAL APPEALS OF TEXAS
    ═══════════════════════════════════════════════
    JAVIER URIAS,
    Appellant
    July 17, 2015
    v.
    THE STATE OF TEXAS,
    Appellee
    ═══════════════════════════════════════════════
    From the Eighth Court of Appeals
    No. 08-12-00090-CR
    Affirming Conviction in Cause Number 20090D03338
    ═══════════════════════════════════════════════
    APPELLANT’S PETITION FOR DISCRETIONARY REVIEW
    ═══════════════════════════════════════════════
    JAIME GÁNDARA
    El Paso County Chief Public Defender
    William Robinson Cox                               Benjamin Joseph Gutiérrez
    First Assistant                                    Solo Practitioner
    State Bar No. 00792933                             State Bar No. 24094693
    500 E. San Antonio, Room 501                       Post Office Box 41
    El Paso, Texas 79901                               El Paso, Texas 79940
    Tel. No. 915.546.8185                              Tel. No. 915.239.0793
    Fax 915.546.8186                                   Fax No. 866.399.5268
    wcox@epcounty.com                                  bjgutierrez@miners.utep.edu
    ORAL ARGUMENT REQUESTED
    ORAL ARGUMENT REQUESTED
    The Appellant submits that oral argument would aid this Court in its
    decisions with the issue presented of sufficiency of evidence for serious injury to a
    child when evidence amounts to mere presence and strong suspicion or mere
    probability to prove corpus delicit. This Court’s holdings in Plunkett v. State, 
    580 S.W.2d 815
    (Tex. Crim. App. 1978) and Johnson v. State, 
    673 S.W.2d 190
    (Tex.
    Crim. App. 1984) remain good law and provide precedence in these matters. The
    El Paso Courts of Appeals’ holding below declines to follow this Court.
    i
    IDENTITIES OF PARTIES AND COUNSEL
    Pursuant to Texas Rules of Appellate Procedure, Rule 38.1(a), Appellant
    offers the following names of all parties, trial and appellate counsel:
    Appellant:                              Javier Urias
    Counsel:                                Jamie Gándara
    El Paso County Public Defender
    William Robinson Cox
    First Assistant
    State Bar No. 00792933
    500 East San Antonio, Room 501
    El Paso, Texas 79901
    Benjamin Joseph Gutiérrez
    Solo Practitioner
    State Bar No. 24094693
    Post Office Box 41
    El Paso, Texas 79940
    Appellee:                           State of Texas
    Counsel:                            Jaime Esparza
    El Paso County District Attorney
    500 East San Antonio, Suite 201
    El Paso, Texas 79901
    Trial Court Defendant:              Javier Urias
    Counsel:                            Joseph D. Vasquez
    300 East Main, Suite 700
    El Paso, Texas 79901
    (Counsel in Eighth Court of Appeals)
    State’s Trial Court Prosecutor:     El Paso County District Attorney
    Counsel:                            Alyssa Perez and Humberto Acosta
    Assistant District Attorneys
    State’s Court of Appeals Counsel:   Joe Monsivais
    Appellant Division Chief of El Paso County
    District Attorney Office
    Trial Court:                        243rd Judicial District Court
    Honorable Bill Hicks Presiding
    ii
    TABLE OF CONTENTS
    ORAL ARGUMENT REQUESTED..........................................................................i
    IDENTITY OF PARTIES AND COUNSEL ........................................................... ii
    TABLE OF CONTENTS ......................................................................................... iii
    INDEX OF AUTHORITIES.................................................................................... iii
    STATEMENT OF THE CASE .................................................................................iv
    GROUNDS FOR REVIEW ....................................................................................... v
    ISSUES PRESENTED..............................................................................................vi
    STATEMENT OF THE FACTS ............................................................................... 1
    ARGUMENT ............................................................................................................. 3
    Issue No. 1: It is an error to affirm conviction of injury to a child as
    legally sufficient when evidence amounts to mere presence and strong
    suspicion or mere probability to prove corpus delicit? Yes. ................ 3
    CONCLUSION ........................................................................................................ 16
    PRAYER .................................................................................................................. 18
    CERTIFICATE OF SERVICE ................................................................................ 18
    CERTIFICATE OF COMPLIANCE ....................................................................... 19
    COURT OF APPEAL’S OPINION ............................................................ Appendix
    INDEX OF AUTHORITIES
    Cases
    Bryant v. State, 
    909 S.W.2d 579
    (Tex. App.— Tyler 1995) .....................8, 9, 10, 14
    Butts v. State, 
    835 S.W.2d 147
    (Tex. App. – Corpus Christi 1992) ..........6, 7, 10, 13
    Crawford v. State, 
    2014 WL 5878112
    (Tex. App.– Ft. Worth 2014). .......10, 11, 14
    Elledge v. State, 
    890 S.W.2d 843
    (Tex. App.– Austin 1994). ............7, 8, 10, 13, 14
    Garcia v. State, 
    16 S.W.3d 401
    (Tex. App. — El Paso 2000) ................9, 10, 12, 14
    Hooper v. State, 
    214 S.W.3d 9
    (Tex. Crim. App. 2007) ........................................... 4
    Jackson v. Virginia, 
    443 U.S. 307
    (1979) ................................................................. 3
    Johnson v. State,
    
    673 S.W.2d 190
    (Tex. Crim. App. 1984) ......... 3, 4, 5, 6, 7, 11, 13, 14, 15, 16
    Plunkett v. State,
    
    580 S.W.2d 815
    (Tex. Crim. App. 1978) ..... 3, 5, 6, 7, 8, 9, 10, 13, 14, 15, 16
    Urias v. State,
    
    2014 WL 1259397
    (Tex. App.-- El Paso, Mar. 26, 2014).............v, 11, 12, 16
    iii
    ═══════════════════════════════════════════════
    IN THE COURT OF CRIMINAL APPEALS OF TEXAS
    ═══════════════════════════════════════════════
    JAVIER URIAS,
    Appellant
    v.
    THE STATE OF TEXAS,
    Appellee
    ═══════════════════════════════════════════════
    APPELLANT’S PETITION FOR DISCRETIONARY REVIEW
    ═══════════════════════════════════════════════
    TO THE HONORABLE COURT OF CRIMINAL APPEALS:
    COME NOW, Javier Urias, appellant herein, and respectfully moves this
    Court to grant discretionary review, pursuant to Texas Rules of Appellate
    Procedure 66 et. seq., and would show the Court as follows:
    STATEMENT OF THE CASE
    On July 21 2009, Javier Urias was indicted for one count of allegedly
    intentionally and knowingly causing serious bodily injury to a child younger than
    fifteen years of age, J. A.1, on or about March 25, 2009. Mr. Urias’ indictment
    stated three paragraphs by which he could have caused serious injury to J.A.: (1)
    striking J.A. about the head with an unknown object, (2) striking J.A.’s head
    1
    As per the spirit of TRAPP 9.8, children will be referred to by initials only.
    iv
    against an unknown object, or (3) shaking J. A.’s body. (CR 2-3)2. At trial, a jury
    convicted Mr. Urias without specifying which paragraph of the indictment their
    decision was held. RR 6 at 6-8. The same jury assessed punishment to be
    confinement for 45 years and a $10,000 fine. (6 RR 112-116) (2 CR 656)
    STATEMENT OF PROCEDURAL HISTORY
    In January 2012, Javier Urias was convicted by a Jury for first degree felony
    of serious injury to a child in the 243rd Judicial District Court, the Honorable Bill
    Hicks Presiding. Mr. Urias timely filed notice of appeal. (2 CR 680) The Eighth
    Court of Appeals affirmed his conviction in an unpublished opinion on March 26,
    2014. Urias v. State, 
    2014 WL 1259397
    (Tex. App.-- El Paso, Mar. 26, 2014).
    A petition for discretionary review was not previously filed. A mandate
    issued from the Eighth Court of Appeals on September 12, 2014. Mr. Urias filed a
    pro se writ under § 11.07 of the Texas Code of Criminal Procedure requesting the
    opportunity to file an out of time petition for discretionary review. This court
    granted that request on May 20, 2015. The mandate issued from that holding on
    June 15, 2015. This petition follows.
    GROUNDS FOR REVIEW
    2
    Citations to the clerk’s record will be denominated as CR and the page number, to the
    reporter’s record as RR, volume and page number. State’s exhibits will be described as SX and
    number, defense exhibits as DX and number.
    v
    This Court should grant discretionary review, because the Eighth Court of
    Appeals decision below conflicts with applicable decisions by this Court’s on an
    important question of law. Tex. R. App. Proc. 66.3(c)
    ISSUES PRESENTED
    1. It is an error to affirm conviction of injury to a child as legally sufficient when
    evidence amounts to mere presence and strong suspicion or mere probability to
    prove corpus delicit? ......................................................................................................................... Yes
    vi
    STATEMENT OF FACTS
    On March 25, 2009, Appellant, Javier Urias, called 911 to report an
    emergency concerning his fifteen month old stepson J.A.. (CR 210) (SX 1) (SX 3)
    A team lead by Dr. Alan Tyroch treated J.A. at R.E. Thomason General Hospital in
    El Paso, Texas. J. A. was diagnosed with acute subdural hematoma, a head injury.
    (3 RR 105) Fortunately, J.A. had neither neck injuries nor any internal injuries. (3
    RR 154-155) J.A. received prompt medical attention that lead to a prognosis of
    J.A. being able to live a normal life. (3 RR 116-117) However, there was evidence
    that J. A. also had another older brain injury. (3 RR 114) Accordingly, Dr. Tyroch
    and his team have “a very low threshold to look for child abuse in any child that
    comes in, especially a child that comes in with a head injury.” (4 RR 139) On Dr.
    Tyroch’s direction, an ophthalmology expert days later assessed J.A.’s eyes for
    retinal hemorrhages or bleeding in the retinal fields. 
    Id. In a
    one page medical
    report Dr. Adams noted the presence of retinal bleeding to which Dr. Tyroch cited
    as evidencing abuse.
    Another physician, Dr. Fadi Hanbali, assessed J.A.’s prior injury to be three
    weeks to four months old. (4 RR 105, 120) Dr. Hanbali believed the latest trauma
    occurred within 72 hours prior to J.A.’s admission to the hospital and conceded it
    was possible the symptoms manifested then even though Mr. Urias “did not lay a
    hand on [J.A.].” (4 RR 123-125) Other witnesses testified Mr. Urias was never
    1
    violent with the children, never hit them, and never spanked them. (4 RR 172) No
    one saw anyone hit J.A., strike J.A., or hit J.A.’s head against something. (4 RR 58,
    135)
    On the day of J.A. sustained an acute subdural hematoma Mr. Urias reported
    on the 911 call that J. A. fell off the bed. All of Mr. Urias’ subsequent statements
    consistently recounted his initial statements. (CR 210) (SX 1) (SX 3) (3 RR 45-46)
    Mr. Urias explained that J.A. had woken up from a nap and was sat up on a bed
    whereupon Mr. Urias left the room to get diaper wipes. When Mr. Urias returned,
    J.A. was on the floor screaming and crying, then J.A.’s mouth locked whereupon
    breathing became shallower and J.A unresponsive. Mr. Urias called an ambulance
    and attempted to “blow into his mouth” but could not because the baby’s jaw was
    clenched and his mouth was closed. (CR 210) (SX 1) (SX 3) (3 RR 45-46) Mr.
    Urias met emergency personal with J.A. unconscious in Urias’ arms. (3 RR 23)
    The trier of fact found Mr. Urias guilty of serious injury to a child as per the
    indictment containing three alternative means of causation3 and assessed a
    punishment of 45 years imprisonment and a $10,000,000 fine. Mr. Urias timely
    appealed where the Eighth Court of Appeals denied Mr. Urias any relief.
    Accordingly, Mr. Urias now presents this petition for discretionary review to the
    Texas Court of Criminal Appeals.
    3
    Paragraph a, striking J.A. about the head; paragraph b, striking J.A.’s head against an unknown
    object; and paragraph c, shaking J.A.’s body. (CR 2-3)
    2
    ARGUMENT
    I.    Mr. Urias’ Mere Presence when J.A. was admitted to the Hospital and
    Evidence Amounting Only to Strong Suspicion or Mere Probability of
    Mr. Urias’ Culpability is Legally Insufficient to Prove Corpus Delicit.
    The critical inquiry on review of the sufficiency of the evidence to support a
    criminal conviction must be to determine whether the record evidence could
    reasonably support a finding of guilt beyond a reasonable doubt. Jackson v.
    Virginia, 
    443 U.S. 307
    , 318 (1979). A mere modicum of evidence cannot rationally
    support a conviction beyond a reasonable doubt. 
    Id. at 320.
    Each fact need not point directly and independently to the guilt of the
    accused, however, as the cumulative effect of all the incriminating facts may be
    sufficient to support the conviction. Plunkett v. State, 
    580 S.W.2d 815
    (Tex. Crim.
    App. 1978). Complicity in an offense is not show by mere presence alone when the
    proof shown amounts to only strong or mere probability and there is not showing
    that the act was committed intentionally and knowingly. Johnson v. State, 
    673 S.W.2d 190
    , 197 (Tex. Crim. App. 1984). There must be legal and competent
    evidence pertinently identifying the defendant with the transaction constituting the
    offense charged against him. 
    Id. at 196.
    The fact that the trier of fact is entitled to
    disregard the defendant’s version of events does not mean that the missing
    elements of the offense are supplied by rejection. 
    Id. Juries are
    not permitted to
    come to conclusions based on mere speculation or factually unsupported inferences
    3
    or presumptions. Hooper v. State, 
    214 S.W.3d 9
    , 15-16 (Tex. Crim. App. 2007);
    also see Johnson at 196. In Hooper this Court further explained:
    [A]n inference is a conclusion reached by considering other facts and
    deducing a logical consequence from them. Speculation is mere theorizing
    or guessing about the possible meaning of facts and evidence presented. A
    conclusion reached by speculation may not be completely unreasonable, but
    it is not sufficiently based on facts or evidence to support a finding beyond a
    reasonable doubt.
    
    Id. at 16.
    The record shows Mr. Urias was in sole possession of J.A. for about thirty-
    five minutes prior to J.A. being admitted to a hospital. (3 RR 159-60) J.A. did not
    sustain permanent injuries and will live a normal life. (3 RR 116-17) The State
    charged Mr. Urias by indictment with serious bodily injury to J.A. by three
    alternative means. (CR 2-3) Mr. Urias’ guilt was found without denoting the
    specific means of his culpability. 
    Id. Mr. Urias
    received a prison sentence of forty-
    five years. (6 RR 112) El Paso’s Court of Appeals held evidence was sufficient to
    support a finding of guilt beyond a reasonable doubt based on the two inferences
    that Mr. Urias was present at time of injury and characteristics of the injury were
    dispositive that an accident did not occur. See Urias v. State, 
    2014 WL 1259397
    (Tex. App.-- El Paso, Mar. 26, 2014).
    4
    A review of associated case law provides a greater appreciation for the
    Courts of Appeals divergence and circumvention of this Court precedential
    holding:
    A. This Court has Held in Cases Involving Serious Injuries to Children
    Cumulative Incriminating Evidence Supports Conviction, but Mere
    Presence with Only Strong Suspicion or Mere Probability of Culpability
    is Insufficient.
    In Plunkett v. State the cumulative effect of incriminating evidence
    supported conviction of murder when defendant’s actions were injurious despite
    his supposed benevolent intent. Plunkett v. 
    State, 580 S.W.2d at 821
    . Larry
    Plunkett described finding A.D.P. lying on the floor in her bedroom when he
    attempted to resuscitate her and may have used too much force. 
    Id. at 820.
    Upon
    A.D.P.’s death, the autopsy showed injuries such as some forty bruises all over her
    body, skull fractures, and tears to organs: heart, liver, spleen, pancreas, and
    intestinal tissues. 
    Id. at 818-19.
    Mr. Plunkett argued the evidence was only
    sufficient to demonstrate he attempted to help A.D.P. but was insufficient to show
    A.D.P.’s death was intentionally or knowingly caused. 
    Id. at 823.
    Texas’ Court of
    Criminal Appeals of Texas affirmed conviction. 
    Id. at 825.
    This Court reasoned
    that the law of accident focuses on actions, not causation. 
    Id. at 823.
    Each fact need
    not point directly and independently to guilt, the cumulative effect of all the
    incriminating facts was sufficient to support Mr. Plunkett’s conviction. 
    Id. at 821.
    5
    In Johnson v. State this Court reversed conviction holding corpus delicti is
    insufficiently meet when defendant’s version of child’s death and serious injuries
    were negated facilitating conviction by default without showing defendant
    committed any criminal act. Johnson v. 
    State, 673 S.W.2d at 196
    . Karl Johnson
    explained how he found B.F. under his vehicle when the car accidently fell off the
    jack. 
    Id. at 192.
    Several states’ witnesses, including experts, described their
    investigation showed the injuries in conjunction with the scene were not consistent
    with Mr. Johnson’s story. 
    Id. at 192-93.
    A forensic pathologist stated with
    reasonable medical certainty the trauma was caused by a blow with a very blunt
    object. 
    Id. at 192.
    The extent of Mr. Johnson’s relationship with B.F. was unclear,
    but there was no showing of any prior child abuse or hostility. 
    Id. at 194.
    Texas’
    Court of Criminal Appeals reversed conviction. 
    Id. at 197.
    This Court reasoned
    mere presence alone is not sufficient proof, even when coupled with strong or mere
    probability of culpability. 
    Id. The trier
    of fact was entitled to disregard Mr.
    Johnson’s explanation but that did not mean that the missing elements of the crime
    were supplied by showing that Mr. Johnson was complicit in the crime alleged. 
    Id. at 196-97
    B. Texas’ Courts of Appeals have Held Mere Presence is Sufficient in
    Many Circumstances.
    6
    In Butts v. State the court found Plunkett permitted finding corpus delicit
    when characteristics of the injuries established culpability and declined following
    Johnson holding inapplicability. Butts v. State, 
    835 S.W.2d 147
    , 151 (Tex. App. –
    Corpus Christi 1992). Baby sitter Patty Butts had no explanation for J.A.’s knot on
    his head, skull fracture, and the resulting permanent injuries of paralysis, blindness,
    and severe learning disabilities. 
    Id. at 148.
    Ms. Butts and the state contested when
    the injuries could have occurred. 
    Id. State expert
    concluded that the severity of
    J.A.’s injuries and the characteristics were caused by either being picked up,
    slammed, or thrown, and were equivalent to falling on concrete from a two-story
    window. 
    Id. at 149-50.
    Corpus Christi Court of Appeals affirmed conviction. 
    Id. at 152.
    The court reasoned that, unlike Johnson, the jury’s conclusion was supported
    by state’s witnesses’ testimony regarding characteristics of injuries sustained while
    in the exclusive possession of Ms. Butts supported the jury’s prerogative of
    holding that Ms. Butts intentionally caused the injuries. 
    Id. at 151.
    The court citing
    to Plunkett found a rational juror may find from the circumstances that an offense
    was committed by Ms. Butts. 
    Id. In Elledge
    v. State the court held expert testimony noting implausibility of
    injuries occurring other than when defendant was in sole custody of child
    established he was the perpetrator. Elledge v. State, 
    890 S.W.2d 843
    , 846 (Tex.
    App.– Austin 1994). Richard Elledge, father of R.G.E., described to R.G.E.’s
    7
    mother that their five week old baby had fallen between the pillow of the bed and
    the railing managing to wrap his arm around one of the bars. 
    Id. at 845.
    Shortly
    after the parents decided it was necessary to bring R.G.E. to the hospital: R.G.E.
    died two days later. 
    Id. The autopsy
    and other medical testimony showed R.G.E.
    suffered massive trauma to his brain and right side skull fracturing caused by a
    considerable blow to the head. 
    Id. A physician
    further testified that injuries were
    very acute that it was not plausible for the injuries to have occurred more than hour
    prior to hospital admittance. 
    Id. at 848.
    The record undisputedly placed Mr.
    Elledge as the only person alone with the baby when the fatal injury was sustained.
    
    Id. at 847.
    Among the three points of error Mr. Elledge appealed, sufficiency of
    evidence was not one of them. Austin’s Court of Appeals affirmed conviction. 
    Id. at 849.
    The court while addressing the weight of newly discovered evidence
    reasoned that the circumstances permitted culpability when undisputed medical
    testimony placed Mr. Elledge as the only person alone with R.G.E. when the fatal
    injury was inflicted. 
    Id. at 847.
    Like Plunkett, in Bryant v. State the defendant claims he intentionally acted
    with benevolence but did not intend the injurious results to a child under his care.
    Bryant v. State, 
    909 S.W.2d 579
    , 583 (Tex. App.— Tyler 1995). Robert E. Bryant
    had sole possession of C.L. for about four hours before her admittance to the
    hospital where his account of events was little more than unexplained seizure. 
    Id. 8 at
    581. C.L. suffered from fractured legs, bruises, and brain injuries sustained from
    severe skull fractures and hemorrhaging. 
    Id. at 580.
    One physician noted Mr.
    Bryant smelled of alcohol the night in question and another physician ruled out
    infections or any natural phenomenon as potential causes. 
    Id. at 581.
    Both
    physicians agreed the brain injuries occurred within thirty minutes prior to
    admittance and various other fractures occurred within days or a couple weeks
    thereof. Id at 580-81. Mr. Bryant claimed C.L.’s injuries occurred prior to his sole
    possession, but C.L.’s mother denied that C.L. was sick on the day in question. 
    Id. at 582-83.
    As information became available as to C.L.’s injuries, Mr. Bryant’s
    version of events varied as he described at points in time C.L. had fallen of the
    couch and hit the back of her head on the floor, he also remembered hitting C.L. on
    the back of the head and pushing C.L.’s stomach to dislodge a penny C.L. was
    choking on, and Mr. Bryant even admitted to shaking C.L. at some point. 
    Id. at 582.
    During trial, Mr. Bryant said he held back on his disclosure of events since he
    was afraid it would be thought he intentionally hurt C.L.. 
    Id. Tyler’s Court
    of
    Appeals affirmed conviction. 
    Id. at 583.
    The court reasoned the evidence showed
    C.L. was in relatively healthy condition when Mr. Bryant took possession of C.L.
    and the acute nature of injuries demonstrated the trauma occurred thirty minutes
    prior to admittance. 
    Id. Therefore, it
    was undisputedly that injuries were sustained
    9
    when C.L. was in the sole possession of Mr. Bryant and the state did not need to
    disprove other reasonable hypotheses, such as Mr. Bryant’s account(s). 
    Id. Like Plunkett,
    the defendant in Garcia v. State admitted to acts that would
    directly result in injuries as the child was found to sustain when the adult defendant
    had sole access to child and evidence was upheld as sufficient. Garcia v. State, 
    16 S.W.3d 401
    , 406 (Tex. App.- El Paso 2000). Miguel A. Garcia admitted while
    taking care of his three month old daughter C.G. he shook her, punched her in the
    stomach, and karate chopped her nose the day C.G. was pronounced dead. 
    Id. at 405.
    Mr. Garcia provided a plethora of illustrations of his intentional infliction of
    injuries to C.G. over the course of two months, explaining he would “lose it” when
    she cried and caused most of C.G.’s injuries by shaking her “real hard” but rarely
    hit C.G. with his fist. 
    Id. The indictment
    alleged death by shaking and Mr. Garcia
    challenged the sufficiency of evidence to support his conviction, El Paso’s Court of
    Appeals affirmed. 
    Id. at 404.
    El Paso’s Court of Appeals began its analysis with
    “Texas case law is replete with holdings that when an adult defendant has had sole
    access to a child at the time its injuries are sustained, the evidence is sufficient to
    support a conviction for injury to a child, or murder if the child dies” citing Bryant,
    Elledge, and Butts. 
    Id. at 405.
    The court went on to reason that in regards to Mr.
    Garcia’s case a rational trier of fact could conclude the cause of death, and Mr.
    10
    Garcia’s culpability therein, since he admitted to being alone with C.G. when she
    sustained injuries and his related intentional actions. 
    Id. at 406.
    Like Plunkett, the defendant in Crawford v. State admitted to acts that would
    directly result in injuries as the child was found to sustain and evidence was upheld
    as sufficient. Crawford v. State, 
    2014 WL 5878112
    (Tex. App.– Ft. Worth 2014).
    Austin Crawford was saying ten month old K.M. was blue as K.M.’s mother woke
    up the day her daughter was pronounced dead. 
    Id. at 2.
    The jury heard from several
    witnesses that Mr. Crawford admitted to shaking K.M. and were played a
    recording taped while Mr. Crawford was in custody attesting to that effect. 
    Id. at 2-
    3. A Detective further stated Mr. Crawford also admitted to throwing K.M. on the
    couch where Mr. Crawford later found K.M. not breathing. 
    Id. at 3.
    K.M.’s treating
    physician characterized the injuries as non-accidental as they were consistent with
    someone violently shaking K.M. or striking her. 
    Id. at 2.
    K.M.’s medical examiner
    found evidence of blunt head trauma concluding K.M. was struck or caused strike
    something. 
    Id. at 3.
    Mr. Crawford contested the sufficiency of the evidence since
    he was not in exclusive possession of K.M. at the time her injuries were sustained.
    
    Id. Fort Worth’s
    Court of Appeals affirmed conviction. 
    Id. at 5.
    The court reasoned
    that necessary inferences are reasonable when based upon the cumulative force of
    the evidence and sole possession was simply a factor for incrimination, not a
    perquisite of culpability. 
    Id. at 3-4.
    11
    C. El Paso Court of Appeals holding in Urias.
    Like Johnson, here the evidence presented at trial amounts to only strong
    suspicion or mere probability that Javier Urias is culpable of serious injury to a
    child. Urias v. State, 
    2014 WL 1259397
    (Tex. App.— El Paso 2014). Mr. Urias,
    while dating J.A.’s mother, was taking care of J.A. and called emergency services
    to report J.A. sustained injuries when J.A. fell off a bed. 
    Id. at 1.
    J.A. had minor
    old bruises, but visibly, little more. 
    Id. A computerized
    tomography scan revealed
    building cranial pressure from two separate hematomas. 
    Id. One hematoma
    was
    sustained no more than seven-two hours prior, and the other one anywhere from
    three weeks to four months old. 
    Id. J.A. immediately
    underwent surgery. 
    Id. The only
    other caretakers of J.A. testified Mr. Urias treated J.A. appropriately. 
    Id. There were
    no notable averse actions of Mr. Urias evidenced otherwise, with
    exception of Mr. Urias explaining he “tried to slap [J.A.] around a little bit to wake
    him up” when J.A. lost consciousness. 
    Id. One of
    J.A.’s treating physicians
    testified that J.A.’s injuries could have been sustained at the time from falling off a
    bed due to the past hematoma. 
    Id. at 2.
    The physician went on to say while
    referring to findings of another physician, who did not testify, that J.A.’s retinal
    bleeding suggested the injuries were intentionally caused and not accidentally. 
    Id. El Paso’s
    Court of Appeals affirmed conviction. 
    Id. at 5.
    The court reasoned a jury
    could infer that J.A.’s injuries were sustained when in the sole possession of Mr.
    12
    Urias4 (citing Garcia) and could also infer that that injury was intentionally caused
    and not a result of accident5 or natural effect. 
    Id. at 3.
    Stare Decisis of Johnson is Applicable to Urias.
    The court of Butts focusing on dicta in Johnson found the evidentiary burden
    to be met by an expert witness’ belief that J.A.’s injuries occurred as an intentional
    act perpetrated by an adult during the time J.A. was in Ms. Butts’ exclusive care.
    
    Butts, 835 S.W.2d at 150
    . The court went on to state that it was the jury’s
    prerogative to determine the cause of J.A.’s injury to be Ms. Butts. 
    Id. at 151.
    In
    order to reach this conclusion the court of Butts cites Plunkett. 
    Id. However, as
    detailed above this Court explained in Plunkett evidence supports affirming
    conviction when its cumulative effects sufficiently incriminate the defendant. This
    Court in Johnson specifically stated that its holding was contingent upon Wright:
    it is not within the prerogative of jurors to find guilt simply by negative
    disjunction. Johnson v. 
    State, 673 S.W.2d at 197
    ; see Wright v. State, 
    603 S.W.2d 838
    (Tex. Crim. App. 1980). Moreover, in Johnson this Court held complicity is
    not demonstrated by mere presence and proof amounting to strong or mere
    4
    To establish Mr. Urias was present the court found injuries occurred shortly before J.A.
    exhibited symptoms for three reasons: (1) children’s larger brains hastens the onset of
    neurological symptoms, (2) prior injury reduced the space inside the cranium even further before
    the second bleed began, and (3) a shift in a child’s brain from those injuries would cause total
    comatose towards the seventy-two-hour widow limit.
    5
    The court noted that the lack of any discernable trauma on J.A.’s body combined with the
    presence of retinal bleeding indicated J.A.’s injuries stemmed from being shaken vigorously.
    13
    probability when there is no showing that the related act was committed
    intentionally and knowingly. 
    Id. Unlike Butts,
    the court of Elledge does not even mention Johnson. This is
    likely do the fact that Mr. Elledge did not appeal on the issue of sufficiency of
    evidence. In Elledge the assessment of the weight of the evidence was in regards to
    the effects new evidence would have upon a new trial. Elledge v. 
    State, 890 S.W.2d at 847
    . There was not discussion of Plunkett or Johnson and the standards
    therein.
    Whereas, Bryant, Garcia, and Crawford all satisfy the evidentiary standard
    in Plunkett, in that the cumulative effect of incriminating evidence points to an
    intentional action(s) on the part of the defendant that directly caused serious
    injuries or death to a child. Therefore, it is in meeting the standard in Plunkett that
    there was more than mere presence and evidence amounting to only strong
    suspicion or mere probability of culpability. Crawford was correct in that exclusive
    possession held in Garcia is simply factor for incriminating evidence, not a
    perquisite of culpability. Crawford, 
    2014 WL 5878112
    , 3.
    Accordingly, El Paso’s Court of Appeals below erred when it cited Garcia is
    determinative on this matter that evidence is sufficient for injury to a child
    conviction where it shows an adult defendant has had sole access to a child at the
    time the child sustained her injuries. This Court held in Johnson and Plunkett the
    14
    State must demonstrate more against Mr. Urias than has been shown, mere
    presence and resulting strong suspicion or mere probability of culpability is not
    sufficient to uphold Mr. Urias’ conviction.
    To establish Mr. Urias was present at the time of injuries, and the false
    inference of Mr. Urias’ complicity, the court below denoted dispositive reasons as
    follows:
    (1) children’s larger brains hastens the onset of neurological symptoms,
    (2) prior injury reduced the space inside the cranium even further before the
    second bleed began,
    (3) a shift in a child’s brain from those injuries would cause total comatose
    towards the seventy-two-hour widow limit, and
    (4) the lack of any discernable trauma on J.A.’s body combined with the
    presence of retinal bleeding indicated J.A.’s injuries stemmed from being
    shaken vigorously.
    Urias v. State, 
    2014 WL 1259397
    at 3. None of the reasons supplied by the court
    supply proof beyond strong suspicion or mere probability that Mr. Urias may have
    or may not have been complicit in any related act resulting in the crime alleged.
    Furthermore, it is presumptive for the court to find causation for the jury when the
    Jury was presented three alternative means and did not specific which method
    alleged they found culpability upon.
    During the time medical testimony said J.A. could have sustained his
    injuries, the record definitely shows J.A. had multiple care takers: Guadalupe
    15
    Salas, J.A.’s great aunt, watched J.A. the day before the onset of his symptoms (3
    RR 56), Yolanda Salas, J.A.’s other great aunt also had access to J.A. that day ( RR
    58), and J.A.’s mother, Roxanne Alvarado, also had access to J.A.. (3 RR 132).
    The proof required under Plunkett and Johnson is only further complicated by the
    fact that J.A. had a chronic or pre-existing subdural hematoma at the time he fell
    off of his bed that no evidence attributes to Mr. Urias. (3 RR 119) The record
    shows that even benign circumstances could have triggered a re-bleed. (3 RR 45-
    46) (CR 210) (SX 1) (SX 3) Moreover, there was no evidence from any source of
    anyone seeing Mr. Urias or someone else hitting J. A., striking J.A. against
    something, or shaking J.A.. These facts demonstrate that only mere probability or
    strong suspicion exists for Mr. Urias’ culpability and severely undermine a finding
    that Mr. Urias’ was even present at the time the injuries occurred.
    CONCLUSION
    This Court has provided Texas’ Courts of Appeals the standards to assess
    sufficiency of evidence in cases involving serious injury or death to children: in
    Plunkett this Court held cumulative incriminating evidence may support a
    conviction, and as per Johnson mere presence with only strong suspicion or mere
    probability of culpability is insufficient. Both holdings remain precedential law
    that the El Paso’s Court of Appeals declines to follow when it holds that evidence
    is sufficient for injury to a child conviction where it shows, without more, an adult
    16
    defendant has had sole access to a child at the time the child sustained her injuries.
    Urias v. State, 
    2014 WL 1259397
    at 3. Therefore, Mr. Urias is entitled to the relief
    of reversal of his conviction of injury to a child since the evidence did not prove
    corpus delicit of the crime alleged and thus is legally insufficient.
    17
    PRAYER
    Wherefore, appellant prays that this petition for discretionary review be
    granted, that this court review the opinion of the Eighth Court of Appeals, and
    requests all relief to which he may show himself justly entitled.
    Respectfully Submitted,
    JAIME GÁNDARA
    El Paso County Chief Public Defender
    /s/ William Robinson Cox
    William Robinson Cox                                   Benjamin Joseph Gutiérrez
    First Assistant                                        Solo Practitioner
    State Bar No. 00792933                                 State Bar No. 24094693
    500 E. San Antonio, Room 501                           Post Office Box 41
    El Paso, Texas 79901                                   El Paso, Texas 79940
    Tel. No. 915.546.8185                                  Tel. No. 915.239.0793
    Fax 915.546.8186                                       Fax No. 866.399.5268
    wcox@epcounty.com                                      bjgutierrez@miners.utep.edu
    CERTIFICATE OF SERVICE
    Pursuant to Tex. R. App. P. 9.5(d), copies of the foregoing petition were
    served on opposing counsel, and the State Prosecuting Attorney, P.O. Box 12405,
    Capital Station, Austin, Texas 78711, by placing copies in the United States mail,
    postage prepaid, on July 15th, 2015.
    /s/ William Robinson Cox
    William Robinson Cox
    18
    CERTIFICATE OF COMPLIANCE
    Undersigned counsel herein states that the computer generated word count is
    3,611 and as such this document is in compliance with the Texas Rules of
    Appellate Procedure.
    /s/ William Robinson Cox
    William Robinson Cox
    Benjamin Joseph Gutiérrez
    19
    APPENDIX
    JAVIER URIAS v. THE STATE OF TEXAS
    COURT OF APPEALS
    EIGHTH DISTRICT OF TEXAS
    EL PASO, TEXAS
    §
    JAVIER URIAS,                                                     No. 08-12-00090-CR
    §
    Appellant,                                            Appeal from the
    §
    243rd District Court
    §
    STATE OF TEXAS,                                                 of El Paso County, Texas
    §
    Appellee.                                            (TC# 20090D03338)
    OPINION
    Javier Urias appeals his conviction of injury to a child causing serious bodily injury. In
    two issues, Appellant challenges the legal sufficiency of the evidence and the admission of a
    medical doctor's expert testimony over his Daubert' and Confrontation Clause objections. We
    affirm.
    BACKGROUND
    Prior to the incident in question in 2009, Appellant had been dating Roxanne Alvarado
    ("Roxanne"), mother of a four-year-old boy, a two-week-old boy, and fifteen-month-old
    Dominic Jacob Alvarado ("Jacob"), for about eight months. None of Roxanne's sons were
    Appellant's biological children. Appellant and Roxanne resided together in a studio
    apartment that was part of a three-apartment building. Roxanne's two aunts resided in the
    other units.
    _________________________
    'Daubert v. Merrell Dow Pharmaceuticals, Inc., 
    509 U.S. 579
    , 
    113 S. Ct. 2786
    , 
    125 L. Ed. 2d 469
         (1993).
    -1-
    Roxanne's youngest son was born premature, so Roxanne went to the hospital twice a day
    following his birth to feed him and learn appropriate care methods. Appellant usually
    accompanied Roxanne to the hospital during these visits. During this time, Roxanne,
    Appellant, and Roxanne's two aunts were the only people who took care of Roxanne's sons.
    Roxanne testified that she trusted Appellant with her children, and Roxanne' s aunt
    Guadalupe S alas testified that Appellant usually treated Roxanne's children appropriately.
    On Mach 25, 2009, Roxanne left Appellant in charge of Jacob while she went to the hospital.
    Salas had watched Jacob the prior day. Salas testified that Jacob had been in good health that
    day, and neither she nor her sister Yolanda had hit Jacob or caused him any injury. Roxanne
    also denied hitting Jacob and denied any knowledge of any prior head injuries. Appellant did
    not testify in his own defense. His account as relayed through a 911 call recording and his
    statements to police indicates that Appellant claimed he had placed Jacob on a bed while
    changing his diaper. While Appellant left the room to get supplies, he heard Jacob screaming,
    and when he returned, the baby was on the floor. When Appellant picked him up, Jacob was
    clenching his jaw and breathing irregularly. At some point, Jacob lost consciousness, and
    Appellant "tried to slap him around a little bit to wake him up." Appellant called 911.
    When paramedics arrived, Jacob was breathing but unconscious and unresponsive.
    Appellant told them that Jacob had fallen off the bed and that he had cried before becoming
    unconscious. One paramedic testified that Jacob had no apparent physical injuries beyond a
    bruise on his forehead and a small cut on his chin, both of which were "old." Paramedics
    subsequently took Jacob by ambulance to R.E. Thomason General Hospital, now known as
    University Medical Center ("UMC"), in El Paso.
    Jacob arrived at the hospital semi-conscious and nearly in a coma. A team of medical
    -2-
    personnel led by Dr. Alan Tyroch treated Jacob at UMC. The hospital admitted Jacob as a
    Level I trauma patient. An X-ray bone scan showed that Jacob had no visible bone fractures.
    A CT scan of Jacob's head indicated the presence of blood from two separate subdural
    hematomas, one chronic - i.e., between three weeks and four months old - and one acute,
    taking place within 72 hours of the scan. Dr. Fadi Hanbali, a neurosurgeon on Jacob's
    treatment team, testified that subdural hematomas occur when blood vessels in the skull
    rupture as a result of trauma and blood begins to accumulate between the brain and the dura,
    a hard membrane encasing the brain inside the cranium. In Jacob's case, the subdural
    hematoma had caused a 9-millimeter midline shift of the brain, meaning that accumulating
    blood had forced Jacob's brain to one side of the skull. Dr. Hanbali characterized the 9-mm
    midline shift as a serious medical emergency that could result in death. He testified that he
    performed surgery to stem the bleeding and evacuate blood from inside the dura, thereby
    relieving pressure on the brain.
    Following surgery, Dr. Tyroch asked Dr. Neil Adams, an ophthalmologist, to perform
    an eye exam on Jacob. Dr. Adams, who did not testify at trial, noted the presence of retinal
    bleeding in Jacob's medical file. Both Dr. Hanbali and Dr. Tyroch testified that retinal
    hemorrhaging was not consistent with a fall from the bed and suggested instead that Jacob
    had been shaken fairly vigorously. Dr. Tyroch further testified that although it was possible
    that the previous subdural hematoma made Jacob more susceptible to getting the acute
    hematoma from a short fall from the bed, the presence of retinal bleeding and absence of
    recent visible trauma suggested that the injury stemmed from a caretaker's intentional
    shaking of the child and not an accidental fall.
    The jury returned a guilty verdict against Appellant. He was sentenced to forty-five years' in
    prison.
    -3-
    I.
    In Issue One, Appellant contends that the evidence is legally insufficient to support a
    jury finding that he caused Jacob's serious injuries. We disagree.2
    Standard of Review
    In assessing the legal sufficiency of a verdict, we review all the evidence in the record,
    both "properly and improperly admitted[,]" in "the light most favorable to the prosecution" to
    determine whether "any rational trier of fact could have found the essential elements of the
    crime beyond a reasonable doubt." Clayton v. State, 
    235 S.W.3d 772
    , 778 (Tex.Crim.App.
    2007), citing Jackson v. Virginia, 
    443 U.S. 307
    , 319, 
    99 S. Ct. 2781
    , 2789, 
    61 L. Ed. 2d 560
    (1979)[Emphasis omitted]. "Circumstantial evidence is as probative as direct evidence in
    establishing the guilt of an actor, and circumstantial evidence alone can be sufficient to
    establish guilt." 
    Id., citing Hooper
    v. State, 
    214 S.W.3d 9
    , 13 (Tex.Crim.App. 2007). Our role
    on legal sufficiency review is not to usurp the jury and replace its verdict with our own;
    instead, we serve as a procedural safeguard, ensuring that whatever verdict the jury rendered
    comports with due process. King v. State, 
    29 S.W.3d 556
    , 562 (Tex.Crim.App. 2000);
    Johnson v. State, 
    967 S.W.2d 410
    , 412 (Tex.Crim.App. 1998). "In conducting this review, we
    must defer to the jury's role as the sole judge of the credibility and weight that testimony is to
    be afforded." Castaneda v. State, 08-10-00050-CR, 
    2011 WL 4490960
    , at *4 (Tex.App.--E1
    Paso Sept. 28, 2011, pet, ref'd)(not designated for publication).
    Analysis
    Appellant complains that the State, at best, merely presented the jury with conflicting,
    equally plausible guilt and innocence scenarios that cannot establish proof of guilt beyond a
    __________________________
    2 As a threshold matter, the State objects to Appellant's briefing of Issue One, arguing that it is deficient under
    TEx.R.APP.P. 38.1 and thus presents nothing for our review. We overrule the State's objection and find that Issue One
    of Appellant's brief complies with the Rules of Appellate Procedure.
    -4-
    reasonable doubt as a matter of law. See Clark v. Procunier, 
    755 F.2d 394
    , 396 (5th Cir.
    1985)(where evidence gives near-equal weight to theories of guilt and innocence, reasonable
    doubt precluding a guilty verdict exists and a defendant is entitled to acquittal). However, the
    "introduction of conflicting evidence does not render evidence insufficient." Castaneda, 
    2011 WL 4490960
    , at N. The Court of Criminal Appeals has instructed the courts of appeals to
    presume that "[w]hen the record supports conflicting inferences . . . the factfinder resolved
    the conflicts in favor of the prosecution[.]" 
    Clayton, 235 S.W.3d at 778
    . The ultimate
    question we answer in Issue One is whether any rational trier of fact could find that the State
    has proved every element of an offense beyond a reasonable doubt. 
    Clayton, 235 S.W.3d at 778
    . Here, we find the State met its burden.
    Appellant complains specifically that the State failed to provide evidence that Jacob's injuries
    were non-accidental, or that the injuries occurred while Appellant had sole care, custody, and
    control of Jacob, which would give rise to a permissible inference that he caused the injury.
    See Castaneda, 
    2011 WL 4490960
    , at *5 (evidence is sufficient for injury to a child
    conviction where it shows "an adult defendant has had sole access to a child at the time the
    child sustained her injuries . . . ."); Garcia v. State, 
    16 S.W.3d 401
    , 405 (Tex.App.--El Paso
    2000, pet. ref d)(listing cases holding same).
    The medical testimony is dispositive on these issues. The medical experts testified that
    although the CT scan could only establish that the blood began pooling between the brain and
    the dura at some point within seventy-two hours of the scan, the bleeding likely began shortly
    before Jacob exhibited symptoms, given that (1) a child's brain is larger in relation to the
    skull than an adult's brain, which hastens the onset of a subdural hematoma's neurological
    symptoms in children; (2) the presence of old blood from the second, undetected subdural
    hematoma would
    -5-
    have reduced the space inside the cranium even further before the second bleed began; and
    (3) Jacob arrived at the hospital semi-conscious in spite of his brain having shifted nine
    millimeters off-center, whereas a subdural hematoma that serious in a child that age likely
    would have rendered him totally comatose as he approached the seventy-two-hour window
    limit. Dr. Tyroch further testified that while the first healed-over subdural hematoma could
    have made Jacob more susceptible to a bleed from accidentally falling off the bed, the lack of
    any discernable trauma on Jacob's body combined with the presence of retinal bleeding
    indicated to him that Jacob's injuries stemmed from being shaken vigorously.
    Based on this testimony, a rational juror could infer that Jacob sustained a
    subdural hematoma at the time he was in Appellant's sole care, custody, and control. A
    rational juror could also infer based on the presence of retinal hemorrhaging that the injury
    was caused by vigorous shaking and not by accident, some prior injury, or a congenital
    defect. Taking those two factors together, a rational juror could find guilt beyond a
    reasonable doubt on the charge levied in the indictment. The evidence is legally sufficient.
    Issue One is overruled.
    II.
    In Issue Two, Appellant maintains that the trial court erred by admitting, over his
    objections on Daubert and Confrontation Clause grounds, portions of Dr. Tyroch's testimony.
    Specifically, Appellant complains that Dr. Tyroch's testimony about Jacob's retinal
    hemorrhaging stemmed from the medical report of Dr. Adams, the ophthalmologist with
    whom Dr. Tyroch consulted during treatment who did not testify at trial. Because Appellant
    could not cross-examine Dr. Adams regarding his medical findings, Appellant contends his
    confrontation rights were violated under Bullicoming v. New Mexico, - U.S. -, 
    131 S. Ct. 2705
    , 180 L.Ed.2d
    -6-
    610 (2011). The State raises a bevy of briefing and preservation of error issues before
    arguing alternatively that Dr. Adams' medical report was not "testimonial" under the Sixth
    Amendment. We address each issue in turn.
    Inadequate Briefing on Daubert Issue
    In its response, the State contends that Appellant failed to adequately brief the Daubert
    issue. We agree. Although the Court is mindful of its duty to liberally construct briefs in
    assessing compliance with the Rules of Appellate Procedure, see TEx.R.APP.P. 38.9; White
    v. State, 
    50 S.W.3d 31
    , 45 (Tex.App.--Waco 2001, pet. ref d), Appellant has failed to comply
    with TEx.R.APP.P. 38.1(i). His argument section sets out the standard of review for Daubert
    challenges before Appellant states that "[b]ased on the totality of the evidence it is appellant's
    position that State [sic] failed to establish the etiology of the injury and therefore to prove its
    causal link to the defendant." Even under the most liberal construction of his brief, Appellant
    failed to challenge Dr. Tyroch's credential or methodology, nor did he apply the law to any
    facts beyond this conclusory assertion. As such, we find that nothing has been presented for
    appellate review on this issue.
    The Daubert sub-point of Issue Two is overruled on inadequate briefing grounds.
    Preservation of Error
    The State further argues that Appellant failed to preserve error on the admission of Dr.
    Adams' retinal bleeding diagnosis because he failed to timely object to testimony and because
    his argument on appeal fails to comport with the objection made at trial. We agree that
    Appellant failed to preserve error.
    "To be timely, a request, objection, or motion must be made at the earliest opportunity."
    Casey v. State, 
    349 S.W.3d 825
    , 834 (Tex.App.--El Paso 2011, pet. ref d). "An objection
    must
    -7-
    be made each time inadmissible evidence is offered unless the complaining party obtains a
    running objection or obtains a ruling on his complaint in a hearing outside the presence of the
    jury." Garza v. State, No. 08-11-00035-CR, 
    2012 WL 1883118
    , at *2 (Tex.App.--El Paso
    May 23, 2012, pet. rerd)(not designated for publication). Further, an objection does not
    preserve error unless the trial court rules on the objection or the complaining party objects to
    the trial court's refusal to rule. TEx.R.APP.P. 33.1(a)(2).
    Here, Appellant failed to preserve error for two reasons. First, Appellant failed to
    obtain a ruling on the confrontation objection. Instead, the record shows that Appellant
    lodged an objection arguably on confrontation grounds, among other grounds, before the
    court allowed him to take Dr. Tyroch on voir dire at a Daubert hearing. Following that
    hearing, Appellant objected to Dr. Tyroch's testimony on the basis that it was cumulative.
    The trial court overruled the objection and noted that it found Dr. Tyroch to be qualified to
    testify as an expert. Appellant then requested miming objections on the issues of relevance,
    cumulative presentation of evidence, improper bolstering, "asked and answered," and on Dr.
    Tyroch's qualifications. The trial court granted running objections only on the issues of
    relevance and cumulative presentation. The record does not indicate that the trial court ever
    ruled on the confrontation grounds Appellant advanced in his pre-Daubert hearing objection.
    As such, no error is preserved.
    Second, Appellant waived his objection on the basis of timeliness. Appellant's counsel failed
    to object to the discussion of retinal bleeding during Dr. Hanbali's testimony prior to Dr.
    Tyroch relaying the same information to the jury. Appellant's counsel claims he refrained
    from objection during Dr. Hanbali's testimony because Dr. Adams was designated as a
    possible witness on the State's witness list for trial, and it was his understanding that Dr.
    Adams would
    -8-
    testify. When counsel realized that Dr. Adams would not testify, he maintains he objected,
    informed the trial court of the situation, and requested a limiting instruction from the court.
    However, this is not enough to preserve error on confrontation grounds. Counsel should have
    objected at the first mention of the retinal bleeding if he wished to preserve the issue for
    appeal. 
    Casey, 349 S.W.3d at 843
    .
    Finally, even if error was properly preserved, the Sixth Amendment prohibits the
    introduction only of testimonial statements from unavailable declarants not previously
    subjected to cross-examination. Crawford v. Washington, 
    541 U.S. 36
    , 59, 
    124 S. Ct. 1354
    ,
    1369, 
    158 L. Ed. 2d 177
    (2004). Dr. Adams statements were not "testimonial" for Crawford
    purposes, given that they were made for the primary purpose of rendering medical treatment
    and obtaining a differential diagnosis between accidental injury and intentional trauma. See
    Melendez-Diaz v. Massachusetts, 
    557 U.S. 305
    , 312 n.2, 
    129 S. Ct. 2527
    , 2533 n.2, 
    174 L. Ed. 2d 314
    (2009); Berkley v. State, 
    298 S.W.3d 712
    , 715 (Tex.App.--San Antonio 2009,
    pet. ref'd)(admission of unavailable sexual assault nurse examiner's report through a
    surrogate did not violate Crawford because report compiled for non-testimonial medical
    treatment purposes); Perez v. State, No. 1411-01102-CR, 
    2013 WL 655714
    , at *7..*8
    (Tex.App.--Houston [14th Dist.] Feb. 21, 2013, no pet.)(mem. op., not designated for
    publication)(absent direct evidence of physician's purpose in questioning patient, trial court
    does not abuse its discretion in ruling physician's report is non-testimonial and made for
    medical purposes).
    Issue Two is overruled. We affirm Appellant's conviction.
    March 26, 2014
    YVONNE T. RODRIGUEZ, Justice
    Before McClure, C.J., Rivera, and Rodriguez, JJ.
    (Do Not Publish)
    -9-