Ryka Telan Hopper v. State ( 2013 )


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  •                          COURT OF APPEALS
    SECOND DISTRICT OF TEXAS
    FORT WORTH
    NO. 02-11-00492-CR
    RYKA TELAN HOPPER                                                   APPELLANT
    V.
    THE STATE OF TEXAS                                                        STATE
    ----------
    FROM THE 213TH DISTRICT COURT OF TARRANT COUNTY
    ----------
    MEMORANDUM OPINION 1
    ----------
    A jury convicted Appellant Ryka Telan Hopper of injury to a child causing
    serious bodily injury and assessed her punishment at forty years’ confinement.
    See Tex. Penal Code Ann. § 22.04(a)(1) (West Supp. 2012). In two issues,
    Appellant argues that the evidence was insufficient and that the trial court erred
    1
    See Tex. R. App. P. 47.4.
    by allowing the State to lower its burden of proof during closing jury arguments.
    We affirm the trial court’s judgment.
    I. BACKGROUND
    A. PROLOGUE
    On July 12, 2010, Ahnnahka White (“Annie”), who was almost three years
    old, was rushed to a hospital after having a seizure. When she arrived, she had
    no detectable heart rate, was in a coma, could not breathe on her own, and
    “appeared to be critically ill.” In short, she was clinically dead. Her body was
    covered in bruises that appeared to have occurred at different times.          The
    doctors were able to resuscitate Annie, but she tragically never recovered and
    now is in a persistent vegetative state in an East Texas long-term care facility.
    After the hospital alerted the authorities, an investigation was begun to determine
    what happened to Annie.
    B. FACTS LEADING TO JULY 12, 2010
    Appellant is Annie’s mother. By all accounts, including her own, Appellant
    is an accomplished liar with a vivid imagination. At the time of Annie’s seizure
    that led to her hospitalization, Appellant was living with her boyfriend, Adam
    Palmer, and her two daughters, Annie and five-year-old Mahkayla. Palmer, who
    was charming but had a bad temper, liked to tell people he was a fireman,
    although he was not. Indeed, Palmer and Appellant lived next door to a fire
    station. He had a fireman’s uniform and kept a stethoscope on the rearview
    mirror of his truck. Appellant apparently believed Palmer was a fireman even
    2
    though she never knew him to have a job as a firefighter. Palmer had been
    convicted of injury to a child before Appellant met him. While Palmer was living
    with Appellant and her children, he was on parole for this prior offense and was
    not allowed to live with children.
    Appellant had met Palmer in September 2009 and apparently moved in
    with him shortly thereafter. Their home had internet access, and Appellant was
    well versed in how to contact people electronically. The relationship was rocky,
    leading Appellant, Annie, and Mahkayla to move back in with Appellant’s mother
    in early 2010 after Palmer gave Appellant a black eye. Appellant was also aware
    at this time that Palmer was “under the influence of drugs.”         Palmer and
    Appellant continued to see each other, however.
    Beginning in January 2010 and continuing through February 2010,
    Appellant began going to multiple hospitals in search of pain medications for
    Palmer and muscle relaxers for herself. In February 2010, Appellant called her
    sister, Tia Miller, and told her to pick her up at Palmer’s grandmother’s house in
    Grand Prairie because Appellant had “had enough [and] it was time to go get
    her.”     Appellant sounded upset.   Miller and Appellant’s other sister, Rhonda
    Rubio, immediately drove from Houston to Grand Prairie because they were
    concerned for the safety of Appellant, Annie, and Mahkayla. 2 After Miller and
    2
    Appellant denied that Annie and Mahkayla were with her when she called
    Miller.
    3
    Rubio arrived, they couldn’t find Appellant.         Appellant called Miller, and
    Appellant’s “attitude at that time” was “different,” leading Miller to believe
    Appellant and Palmer had “worked it out.” Miller and Rubio did not want to leave
    without seeing Appellant, but they eventually did based on Appellant’s wishes.
    At some point between January and March of 2010, Appellant also left a voice
    message for her step-brother, Shaun Holmberg, in which she was crying.
    Holmberg tried to locate Appellant but could not.
    On May 23, 2010, 3 Appellant, her mother, Annie, Mahkayla, Rubio, and
    Rubio’s three sons were driving home after attending a family reunion in
    Nacogdoches when their car broke down near Marlin. They flagged down a
    police officer who called a tow truck to tow them to Marlin. After attempting to
    call several people to come help them, including Appellant’s two step-brothers,
    Appellant called Palmer because “he would be dumb enough to actually come
    out there and work on the car for cheap.” Palmer came to fix the car, and once
    the car was fixed, Appellant, Annie, and Mahkayla left with Palmer in Palmer’s
    truck. Palmer apparently threatened Appellant and told her that if she didn’t
    move back in with him, he would “make sure your family pays for it.” By the time
    Appellant’s mother, sister, and nephews arrived home, Palmer was loading his
    truck with Appellant’s, Annie’s, and Mahkayla’s possessions. Appellant acted
    3
    From this point forward, all dates will refer to incidents occurring in 2010.
    4
    “normal,” however. Appellant moved back in with Palmer and brought Annie and
    Mahkayla with her. 4
    In June, Appellant sent Holmberg a text message stating that Annie could
    not walk. A few hours later, Appellant sent a second text to Holmberg saying that
    “the problems were cleared up.”        Also in June, Carla Hamilton, Palmer’s ex-
    girlfriend, was at Appellant and Palmer’s house for a play date with Appellant’s
    daughters and Alyssa, a two-year-old girl Hamilton was baby-sitting. Appellant
    told Hamilton that Annie recently had a seizure and she was taking Annie to a
    neurologist to determine the cause. A few weeks later, Hamilton and Alyssa
    again were at Appellant and Palmer’s home. Hamilton noticed that Annie “was
    just laying [sic] on the couch” and was “real sluggish and lethargic.”     When
    Hamilton questioned Appellant about Annie, Appellant stated that she had been
    sedated earlier that day for an epilepsy diagnostic test. Hamilton later learned
    that Appellant had lied and Annie had never been taken to a doctor. Appellant
    previously had told Hamilton that she knew Palmer was on parole for injury to a
    child.       Indeed, Appellant told Hamilton that she had to leave with Annie and
    Mahkayla when Palmer’s parole officer visited because Palmer was not allowed
    to live with children.
    4
    Appellant later told police officers that she voluntarily moved back into
    Palmer’s home so she could find a job. Appellant stated Palmer was not living in
    the home at the time she moved back in, but that he moved in shortly thereafter.
    5
    Beginning on June 25, Appellant resumed her hospital hopping, visiting six
    different hospitals over a two-week period and claiming back injuries to get pain
    pills. On June 27, Appellant saw Palmer “backhand[]” Annie with his open hand
    so hard Annie fell into the refrigerator. Appellant stated she tried to leave after
    this incident but stayed after Palmer promised he would not do it again. On July
    10, Appellant saw Palmer grab Annie by the shoulders and violently shake her,
    making her head “bob[] back and forth.” Appellant stated that Annie was “fine”
    the next day.
    C. JULY 12
    On July 12, Appellant, Palmer, Annie, and Mahkayla were on their way to
    see an orthopedic surgeon “for [Palmer] to have his hand evaluated for [an]
    accident he sustained at work.” Annie began to have a seizure with her “right
    arm extended straight up, the feet extended,” which lasted approximately one
    minute. Annie then went limp and stopped breathing. Palmer drove Annie to the
    closest emergency room.
    The doctors determined that Annie had a “very large subdural hematoma”
    covering both sides of her brain along with bruising on her brain. The amount of
    blood on Annie’s brain would have caused Annie to not behave normally such
    that a parent would know Annie “had a problem and they should seek medical
    attention.” One of her eyes had a detached retina caused by “severe trauma.”
    These injuries were not a result of the seizure.     Indeed, Annie’s spinal fluid
    contained blood caused by at least two prior traumatic brain injuries, occurring
    6
    both recently and as far back as “several weeks.” The bleeding and bruising on
    her brain caused “the seizures, which then caused her not to breathe, which then
    caused the heart to stop.” Because Annie’s brain was “disastrously injured,” her
    strength “had drained away trying to sustain itself,” and “the seizure finished it.”
    Annie’s condition was “cumulative” in that multiple episodes of “substantial
    injury” led to the tragic consequences. Indeed, if she had received all of her
    injuries at once, she would have died from them. If Annie had received medical
    attention after prior traumatic events and been removed from further trauma, she
    could have recovered. But because Annie was still recovering from prior traumas
    to her brain, she was more susceptible to additional and tragic injury.
    D. ANNIE’S REPRESENTED MEDICAL HISTORY
    Annie’s attending physician, Dr. James R. Matson, talked to Appellant and
    Holmberg (who Appellant had called once she arrived at the hospital) to get
    Annie’s medical history. Appellant told Matson that Annie had had a fever of
    102°–103° for the past three days and had been sleepy and “cold to [the] touch.”
    Holmberg told Matson that Annie had not been able to walk since late June.
    Holmberg denied he told Matson that but did admit that he told Matson about
    Appellant’s text in late June telling him that Annie could not walk because
    Appellant had failed to tell Matson about Annie’s inability to walk. Holmberg told
    Matson that Annie began to have seizures in late May.
    Appellant told Matson that Annie’s first seizure occurred when she was
    eighteen months of age and lasted about one minute and that Annie had a 103°
    7
    fever, extended her right arm upward, extended her left leg, and foamed at the
    mouth. Annie returned to normal after the seizure. Appellant claimed she took
    Annie to her primary-care physician the next day but that he told Appellant the
    seizure was a result of the fever and that “no further evaluation or treatment was
    needed.” 5 Appellant did not know the name of Annie’s primary-care physician or
    where his office was located. Annie continued to have seizures every four days,
    but Appellant did not seek any medical help.
    After arriving at the hospital, Palmer took Mahkayla. Palmer later brought
    Mahkayla back, and Mahkayla had a black eye.
    E. THE INVESTIGATION
    During the ensuing investigation, Appellant shared more details about
    Palmer’s violence toward Annie. Corporal Justin Graves interviewed Appellant
    on July 12 at the hospital. Appellant told Graves that Palmer had abused Annie
    on several occasions. On May 30, Annie was bounced to the floor off of a
    pedestal waterbed after Palmer moved “violently.”         Annie’s head and neck
    “popped backwards” when she hit the floor, and Annie appeared “unbalanced
    and dizzy” when she got up. Appellant did not seek medical help for Annie
    because she was afraid Palmer would “do something” to Appellant. In mid-June,
    Palmer and Annie came out of the bathroom after Palmer gave Annie a bath, and
    5
    During a later police interview, Appellant stated that the diagnosis actually
    occurred during a phone call with the unnamed doctor.
    8
    Appellant saw a cut on Annie’s foot with a BB lodged in the cut.         Appellant
    confronted Palmer but did not take Annie to the doctor because she was scared
    of Palmer. On July 10, after Palmer gave Annie a bath, Appellant saw Palmer
    “forcefully slam” Annie’s head into the door frame as they were leaving the
    bathroom. Annie again was unbalanced and dizzy. Appellant repeatedly told
    Graves that Palmer broke her arm on July 11 when he jerked her arm. Appellant
    told Graves that she had gone to a doctor to have her arm checked, which he
    believed because she was wearing a cast on her arm at the time of the interview.
    In fact, Graves noticed that Appellant “was worried about her injuries and not so
    much about what was going on in the other room [to Annie].”
    Detective Barry Moore spoke with Palmer at the police station on July 12.
    Palmer told Moore that he was a “monster” because of how he treats children.
    Palmer told Moore that he hit Annie on the head with a belt. When Palmer
    demonstrated how he hit Annie, “it shook [the] table and the walls in [the]
    interview room.” Palmer also discussed the BB in Annie’s foot but stated that
    Appellant held Annie down while he dug the BB out.
    Moore arrested Palmer and then brought Appellant to the police station to
    be interviewed. 6 As she had with Graves, Appellant “talk[ed] a lot about herself,”
    did not “go right into the details of what happened to Annie,” and focused on what
    6
    The videotape of this interview was played for the jury during the guilt-
    innocence portion of Appellant’s trial.
    9
    happened to her at Palmer’s hands. Appellant mentioned the BB incident to
    Moore, but said that Palmer told her to take Annie to the hospital and then
    changed his mind. Appellant remembered that the BB Palmer dug out of Annie’s
    foot while Appellant held Annie down was gold.
    Appellant discussed the June seizure Annie had that left her unconscious
    for sixteen hours. Appellant stated that when Annie woke up, she had problems
    speaking, could not understand much of what was said to her, could not walk,
    and indicated that her head hurt. Although Appellant admitted she had chances
    after this seizure to get help for Annie, she did nothing because she was scared
    and she was worried about “our clothes and stuff.” Annie could not walk on her
    own after this seizure and never recovered her ability to walk according to
    Appellant.   Annie’s “comprehension was a little slow,” she would throw up
    occasionally, and was able to use only one arm after the mid-June seizure.
    Appellant admitted that she knew Annie had a head injury and that something
    was “seriously wrong” when Annie started having seizures in early June. In fact,
    Appellant stated that every time Annie had a seizure, she knew there was
    “something wrong” and she was “hoping and praying this wouldn’t be the end.”
    Even though Palmer would tell Appellant there was nothing wrong with Annie,
    Appellant stated she knew something was wrong.
    Appellant either did not know why she failed to get help for Annie, even
    though she knew Annie needed medical attention, or blamed Palmer’s efforts in
    stopping her from leaving, including taking the battery out of her cell phone and
    10
    screwing the house windows shut. Additionally, she wanted to get away from
    Palmer “without having the whole world in on it.” At the end of the interview,
    Appellant said she could call Palmer’s father to bring some clothes to her at the
    police station because she was upset she didn’t have any clothes.
    On July 22, an investigator with the Texas Department of Family and
    Protective Services (DFPS), Sky Gaeta, went to the hospital to talk to Appellant.
    Appellant, as before, could not give Gaeta any information on who Annie’s
    primary-care physician was. Appellant told Gaeta that Palmer had abused her
    and that she “liked [Palmer], but he got on her nerves sometimes.” Appellant
    also recounted for Gaeta that, on June 26, she had seen Annie lying on the bed
    “unconscious” and that Palmer told her Annie would be unconscious for sixteen
    hours. Appellant tried to wake Annie up, but she would not respond. Appellant
    and Palmer “went about their day, went to sleep that night.” At 2:00 a.m. on June
    27, Annie woke up, but “could not talk, . . . she could not walk[,] and . . . she
    could not use her right arm.” On July 1, Annie could stand on her own but told
    Appellant “it would hurt whenever she would go to sit down.” Appellant reported
    that Annie previously had daily seizures on June 16 through 19 and that after
    Annie woke up on June 27, “she would have seizures daily and many days she
    was having multiple seizures a day.” Appellant reported that during the night of
    July 10, Annie began crying due to a nightmare. Appellant did not get up to
    comfort her daughter because she was “too tired,” so Palmer went to check on
    her when Annie continued to cry. Appellant opened her eyes to witness Palmer
    11
    “violently shaking” Annie. Appellant told Palmer he was going to hurt Annie and
    that he needed to come back to bed. Appellant did not get up to check on Annie
    after this incident because she was “too sleepy.” Appellant told Gaeta that she
    did not leave Palmer because she was afraid. Based upon her discussion with
    Appellant, Gaeta believed Appellant was smart.
    F. APPELLANT ARRESTED
    On July 22, Detective Moore arrested Appellant. One of her cellmates was
    Melissa Rivera. Appellant told Rivera that she saw Palmer swing Annie by the
    ankles until her head hit the television; however, Appellant did nothing because
    Palmer had drugged her. Appellant said she couldn’t get away from Palmer
    because she did not have a phone, Palmer jammed the bedroom door “to where
    he could get in but [Appellant] couldn’t get out,” and the windows were made of
    fiberglass. Appellant also told Rivera that she held Annie down when Palmer
    used a knife to get a BB out of Annie’s foot. Appellant never called the police
    about Palmer’s abuse because she did not want to lose custody of Annie and
    Mahkayla. Rivera was struck by the fact that Appellant seemed concerned only
    about herself. Rivera finally confronted Appellant about her attitude and the fact
    that many of Appellant’s stories seemed embellished.          Appellant said “she
    wanted to play the system like the system was playing her.”
    Another cellmate of Appellant’s, April Pollefeyt, recounted that Appellant
    stated Palmer drugged her, hit Annie in the head with a belt, and had thrown
    Annie into the television. Pollefeyt did not believe Appellant’s assertion that she
    12
    had been drugged because the “needle mark” Appellant showed Pollefeyt “was
    really just like a spot or something, maybe a rash.”
    G. APPELLANT’S TRIAL TESTIMONY
    At trial, Appellant asserted that many of her statements to the police and
    the doctors were not true. For example, she stated that she and Palmer made
    up the BB story when Annie injured her foot on a piece of glass. 7 When asked
    why she “would [] make up a story that makes you sound like a horrible person
    for a baby that’s just had an accidental injury,” Appellant stated, “A friend of mine
    is writing a book, sir.” She further testified that she and Palmer “cooked . . .
    many things up together” because they “think quite a bit alike at some times”
    based on the fact that their “birthdays are one day apart.”
    Appellant testified that Annie was never unconscious for sixteen hours and
    that she had never seen Annie have a seizure before July 12. Appellant also
    testified, however, that she was told Annie had a seizure in June. Appellant was
    firm that Annie was fine after Palmer backhanded and shook her and that Palmer
    told Appellant Annie did not need medical attention. Appellant admitted lying to
    Gaeta about how Palmer hurt her arm and clarified she broke her finger hitting
    Palmer after Palmer shook Annie on July 10. She further denied that she knew
    7
    Interestingly, Appellant’s nephews similarly had cut themselves on pieces
    of glass, which Appellant averred she stitched up without medical intervention.
    The subsequent investigation by DFPS into this incident was still pending at the
    time of the investigation into Annie’s injuries.
    13
    Palmer had been convicted of injury to a child and was on parole. Appellant
    contended that Hamilton’s testimony to the contrary was a lie.             Appellant
    conceded that it “could [have been] an act” when she told Detective Moore that
    she knew that Annie had a head injury, that Annie was hurt, and that she needed
    to do something.
    II. SUFFICIENCY OF THE EVIDENCE
    In her first issue, Appellant contends that the evidence is insufficient to
    show that her failure to seek medical attention for Annie caused serious bodily
    injury to Annie. In other words, there was no evidence “that Appellant’s failure to
    treat Annie’s injuries created a substantial risk of death or serious bodily injury
    above and beyond that sustained in any of the initial injuries at the hands of
    Palmer.”
    A. STANDARD OF REVIEW
    In our due-process review of the sufficiency of the evidence to support a
    conviction, we view all of the evidence in the light most favorable to the verdict to
    determine whether any rational trier of fact could have found the essential
    elements of the crime beyond a reasonable doubt. Jackson v. Virginia, 
    443 U.S. 307
    , 319, 
    99 S. Ct. 2781
    , 2789 (1979); Wise v. State, 
    364 S.W.3d 900
    , 903 (Tex.
    Crim. App. 2012). The trier of fact is the sole judge of the weight and credibility
    of the evidence. See Tex. Code Crim. Proc. Ann. art. 38.04 (West 1979); 
    Wise, 364 S.W.3d at 903
    . Thus, when performing an evidentiary sufficiency review, we
    may not re-evaluate the weight and credibility of the evidence and substitute our
    14
    judgment for that of the fact finder. Isassi v. State, 
    330 S.W.3d 633
    , 638 (Tex.
    Crim. App. 2010). Instead, we determine whether the necessary inferences are
    reasonable based upon the cumulative force of the evidence when viewed in the
    light most favorable to the verdict. Sorrells v. State, 
    343 S.W.3d 152
    , 155 (Tex.
    Crim. App. 2011). We must presume that the fact finder resolved any conflicting
    inferences in favor of the verdict and defer to that resolution. 
    Jackson, 443 U.S. at 326
    , 99 S. Ct. at 2793; 
    Wise, 364 S.W.3d at 903
    . The standard of review is
    the same for direct and circumstantial evidence cases; circumstantial evidence is
    as probative as direct evidence in establishing the guilt of an actor. 
    Isassi, 330 S.W.3d at 638
    ; Hooper v. State, 
    214 S.W.3d 9
    , 13 (Tex. Crim. App. 2007).
    B. INJURY TO A CHILD
    Appellant was indicted for a knowing injury to a child by omission.          A
    person commits this offense if she knowingly causes injury to a child by omission
    and has a duty to act. 8 Tex. Penal Code Ann. § 22.04(a). Parents have a duty to
    care for, to control, to protect, and to provide medical care to their children. Tex.
    Fam. Code Ann. § 151.001(a)(2), (3) (West 2008). Injury to a child is a “result of
    conduct” offense; thus, the State had to prove not only that Appellant knowingly
    failed to provide medical care to Annie, but also that she knowingly caused
    8
    The statute allows conviction upon evidence of any one of three culpable
    mental states: intentional, knowing, or reckless. See Tex. Penal Code Ann.
    § 22.04(a). The State only charged Appellant with knowingly causing serious
    bodily injury.
    15
    Annie’s injuries. See Alvarado v. State, 
    704 S.W.2d 36
    , 39 (Tex. Crim. App.
    1985); see also Johnston v. State, 
    150 S.W.3d 630
    , 634–35 (Tex. App.—Austin
    2004, no pet.). A person acts knowingly with respect to a result of her conduct
    when she “is aware that [her] conduct is reasonably certain to cause the result.”
    Tex. Penal Code Ann. § 6.03(b) (West 2011). The requisite culpable mental
    state may be inferred from a person’s acts, words, and conduct. See Robledo v.
    State, 126 S.W.3d 150,155 (Tex. App.—Houston [1st Dist.] 2003, no pet.).
    A person is criminally responsible for the result of conduct if the result
    would not have occurred “but for” the actor’s conduct, operating either alone or
    concurrently with another cause, unless the concurrent cause was clearly
    sufficient to produce the result and the conduct of the actor clearly insufficient.
    Tex. Penal Code Ann. § 6.04(a) (West 2011). Thus, the result must be within the
    scope of risk of which the defendant is aware, which is met if an intervening
    cause is reasonably foreseeable. See Williams v. State, 
    235 S.W.3d 742
    , 764–
    65 (Tex. Crim. App. 2007). When the challenged conduct is an omission, proof
    that a defendant knowingly caused the result requires evidence that she was
    aware with reasonable certainty that the injury would have been prevented had
    she performed the act that was omitted. Byrd v. State, 
    112 S.W.3d 675
    , 677
    (Tex. App.—Fort Worth 2003, pet. ref’d).
    C. APPLICATION
    The jury heard evidence that Appellant had seen Palmer seriously injure
    Annie several times.    During this time of abuse, Annie had suffered multiple
    16
    seizures with no medical attention. One of these seizures left Annie unconscious
    and later unable to walk or talk. Further, after some of the hits she absorbed,
    Annie would be dizzy and unstable. Hamilton testified that she saw Annie in late
    June, and she was lethargic, sluggish, and not her normal self. Appellant lied
    and told Hamilton that she sought medical care for Annie’s seizures after
    Hamilton questioned Annie’s condition. Though Appellant lived next door to a
    fire station and repeatedly went to hospitals herself seeking prescriptions for pain
    medications, Appellant did not seek medical care for Annie.          The evidence
    established Appellant had the knowledge and ability to seek medical attention as
    she did so for Palmer, herself, and her mother.
    Although Appellant testified that Annie was completely normal before she
    had the seizure in the car, this was contrary to what she stated in her videotaped
    statement, and her admitted habit of lying and exaggerating was well known.
    The jury weighed the credibility of the witnesses, including Appellant, and
    reasonably concluded that Appellant knew of Annie’s injuries but failed to seek
    medical help. Appellant offered multiple excuses for that failure, including that
    she relied on Palmer to tell her when to do so, that she was physically restrained
    by Palmer from doing so, that she simply was too tired, or that she did not want
    to lose custody of her children. When confronted with her lack of concern for
    Annie, the jury heard that Appellant said she “wanted to play the system like the
    system was playing her.”
    17
    As the sole judges of the credibility of the witnesses, the jury could have
    believed Matson and Moore and concluded with reasonable certainty that the
    ultimate injuries Annie suffered would have been prevented had Appellant
    performed the act that was omitted—obtaining medical attention over the time
    period she was being abused. Matson described bruises distributed over Annie’s
    torso and limbs that were from three, different traumatic episodes. He further
    described blood visible in Annie’s spinal fluid that indicated both recent trauma
    and trauma that occurred as much as four weeks before July 12. The CT scan
    and MRI both revealed old and new blood over Annie’s brain, which indicated a
    more recent and an older event of trauma. Matson further explained that when
    there is a blow to the brain, the brain itself will typically look normal on day one.
    Annie’s MRI, performed when she was admitted to the hospital, showed
    contusions to her brain leading Matson to conclude that “there had been
    significant trauma a few to several days or more prior to her presentation.”
    Matson concluded that “there had been some substantial traumatic events
    repeated over time that had been very damaging to this child’s brain.”          The
    repeated damage to Annie’s brain resulted in contusions and blood on her brain,
    which set up a scenario where seizures were extremely likely. The seizure most
    likely caused Annie’s cardiac arrest.     Matson was clear in how this scenario
    culminated: “I believe that the reason Annie went down and had the [cardiac]
    arrest, as a result of the seizure, which wouldn’t ordinarily do that, is because her
    18
    brain was disastrously injured and her bodily strength had drained away trying to
    sustain itself. And the seizure finished it.”
    The jury viewed Appellant’s videotaped interview and heard Moore’s
    testimony.    The statements Appellant made to Moore confirmed Matson’s
    conclusions. Appellant told Moore that Annie was unconscious for sixteen hours
    after her seizure in June and never regained her ability to walk thereafter. Annie
    told Appellant that her head hurt.        Appellant acknowledged that she knew
    something was “seriously wrong” with Annie and that she felt like each
    subsequent seizure could be “the end” for Annie. Yet she did not seek medical
    attention for Annie.
    Matson was asked if the outcome for Annie would have been different if
    Appellant had sought medical attention for Annie. He responded, “Presumably
    there was some first event and had Annie been taken to get medical attention
    and that included getting her away from further trauma, it is likely she would have
    made a complete or nearly complete recovery.” Matson recognized two separate
    actions that were needed to change the outcome of this tragedy, both of which
    were independently necessary:          (1) take Annie for medical attention that
    Appellant knew was needed and (2) not return her to the circumstances where
    she was subjected to the physical abuse. The first act to save Annie is the
    allegation of this indictment. The evidence is sufficient that Appellant did neither.
    See Thompson v. State, 
    227 S.W.3d 153
    , 160–61 (Tex. App.—Houston [1st
    Dist.] 2006, pet. ref’d); 
    Johnston, 150 S.W.3d at 636
    –37; 
    Byrd, 112 S.W.3d at 19
    678; Payton v. State, 
    106 S.W.3d 326
    , 330 (Tex. App. —Fort Worth 2003, pet.
    ref’d); Hill v. State, 
    881 S.W.2d 897
    , 903 (Tex. App.—Fort Worth 1994), aff’d on
    other grounds, 
    913 S.W.2d 581
    (Tex. Crim. App. 1996); cf. Dusek v. State, 
    978 S.W.2d 129
    , 133 (Tex. App.—Austin 1998, pet. ref’d) (holding evidence
    insufficient to support injury-to-child conviction because child’s broken leg treated
    same day as injury and no evidence treatment was delayed or recovery hindered
    by treatment timing).
    The law does not require that Appellant have specialized and specific
    medical knowledge that Annie would suffer a heart attack leading to a coma as a
    result of significant and repeated head injuries followed by seizures. Cf. Vasquez
    v. State, 
    272 S.W.3d 667
    , 672 (Tex. App.—Eastland 2008, no pet.) (recognizing
    issue in injury-to-child case not whether defendant aware with reasonable
    certainty that injury to child would have been prevented but whether defendant
    knowingly caused injury by failing to provide adequate medical care). The law
    only requires that Appellant be reasonably certain that failing to get medical care
    for Annie would result in serious bodily injury to Annie. This the evidence does.
    Based on the cumulative force of the evidence recited above, the State
    sufficiently proved through circumstantial evidence that Appellant was reasonably
    certain that Annie would suffer severe medical consequences if Annie did not
    receive appropriate medical attention. See Luna v. State, 
    264 S.W.3d 821
    , 825–
    28 (Tex. App.—Eastland 2008, no pet.).              Indeed, the severe medical
    consequences Annie suffered were within the scope of medical risk Appellant
    20
    could have reasonably foreseen based on the circumstantial evidence of Annie’s
    prior medical condition before she was rushed to the hospital.           See, e.g.,
    
    Williams, 235 S.W.3d at 764
    –65 (discussing criminal responsibility for result of
    conduct).
    We overrule issue one.
    III. JURY ARGUMENT
    Appellant argues in her second issue that the trial court erred by allowing
    the State to lower its burden of proof during closing jury arguments. As with her
    sufficiency argument, Appellant protests that the State argued it only had to
    prove Appellant knew Annie needed medical attention:
    And Annie did not get in that [boxing] ring knowingly. She got in that
    ring because her mother placed her in it until the final knockout punch was
    delivered. And we don’t have to prove to you that [Appellant] knew that
    this is - - this was going to be the end result of Annie.
    [Defense Counsel]: Objection, Your Honor. I believe that is the law.
    [The State]: No, the law is - -
    THE COURT: I’ll overrule the objection.
    [The State]: The law is we had to prove to you that she knew that
    Annie needed to seek medical attention. She needed to seek medical
    attention for Annie. And expert after expert told you that Annie’s going to
    be showing signs and symptoms of what that man did to her, while her
    mother sat by and did nothing.
    Appellant asserts that this argument lowered the State’s burden of proof because
    the State failed to clarify that it also had to show that “Appellant knew or should
    have known that failure to get medical treatment could result in Annie’s
    21
    debilitating heart attack or that Appellant’s failure to seek medical attention
    caused any injury to Annie beyond what Palmer did to her.” 9 Appellant concedes
    that the jury charge correctly stated the applicable law.
    To be permissible, the State’s jury argument must fall within one of the
    following four general areas: (1) summation of the evidence; (2) reasonable
    deduction from the evidence; (3) answer to argument of opposing counsel; or
    (4) plea for law enforcement. Felder v. State, 
    848 S.W.2d 85
    , 94–95 (Tex. Crim.
    App. 1992), cert. denied, 
    510 U.S. 829
    (1993).          Here, Appellant’s counsel
    previously had argued that knowingly meant “your conduct is reasonably certain
    to cause the result. . . . But which one of you can tell me looking here you can be
    reasonably certain [Annie’s current medical condition was] going to happen eight
    days later?” Counsel then emphasized that Appellant is “not a doctor. She
    doesn’t know what seizures are.” The State was responding to this argument
    and reinforcing the idea that Appellant did not have to know the exact medical
    consequences of her omission; she only needed to be reasonably certain that an
    injury would result if Annie was not taken to a doctor. Thus, this argument was
    permissible as a response to opposing counsel’s argument that Appellant had to
    be aware of the exact medical consequences of her omission.
    9
    Appellant also complains of nine other jury arguments made by the State
    that she asserts similarly lowered the State’s burden of proof. Appellant failed to
    object to these jury arguments on the grounds now raised; thus, she has forfeited
    these complaints, and we will not address them. See Tex. R. App. P. 33.1(a)(1);
    Wilson v. State, 
    311 S.W.3d 452
    , 473 (Tex. Crim. App. 2010) (op. on reh’g).
    22
    We overrule issue two.
    IV. CONCLUSION
    Having overruled both of Appellant’s issues, we affirm the trial court’s
    judgment.
    LEE GABRIEL
    JUSTICE
    PANEL: WALKER, MCCOY, and GABRIEL, JJ.
    DO NOT PUBLISH
    Tex. R. App. P. 47.2(b)
    DELIVERED: August 29, 2013
    23