OPINION
Appellant, Moisés Molina, pleaded not guilty before a jury to the offense of aggravated sexual assault. He was convicted, and the trial judge assessed punishment, enhanced, at 60 years imprisonment in the Texas Department of Criminal Justice, Institutional Division, and a $10,000 fine. In nine points of error, he contends the trial court erred in (1) ordering him bound and gagged during the trial; (2) denying his motion for mistrial based on the binding and gagging; (3) denying his motion to quash the jury panel based on the binding and gagging; and (4) admitting hearsay testimony.
Background
In January of 1995, appellant was alone at home with his eight year-old stepdaughter, the complainant. While thеy were watching television on the couch, appellant fondled complainant’s vaginal area and pulled her off the couch on top of him. He undressed her, fondled her again, and took her to the kitchen. There, he sat her on the counter and attempted sexual penetration. He stopped when he heard the complainant’s mother, Cecilia Quintanilla, coming home. Appellant told the complainant to get dressed, and he put on his shorts. Quintanilla entered the apartment and saw appellant’s reflection in a mirror as he was tying the drawstrings of his shorts and threatening the complainant. Suspicious of her husband’s behavior, Quin-tanilla called some friends from church (the Millers) and asked them to come over so she could question her daughter regarding what had happened.
When the Millers arrived, appellant was nervous and the complainant was upset. The complainant, afraid her mother would punish her, simply told her mother that appellant had pulled down his shorts and his underwear; however, she told Mrs. Miller about the attempted penetration. Quintanilla did not report the incident for over eight months, when she told authorities at the Children’s Assessment Center. The complainant then told the Center’s interviewer about the entire incident. Dr. Robin Williams examined her and found injuries consistent with penetrating trauma.
Prior to voir dire but before the jury panel was present, appellant complained to the court about his attorney’s handling of his case. While the court addressed appellant’s complaints, appellant interrupted several times, and the court admonished him not to raise his voice or interrupt. The last thing the judge said to appellant before bringing the panel back in was, “I don’t want you screaming at your lawyer or talking out of turn.”
*678 Appellant was silent throughout the State’s voir dire, but as his attorney was about to begin voir dire, appellant interrupted, restating his request that counsel not be allowed to represent him. In the panel’s presence, he accused his attorney of tampering with witnesses and threatening witnesses to dissuade them from testifying. The judge told appellant he was out of order and asked him to be seated. When appellant continued to object, the judge asked the bailiff to take appellant out of the courtroom. Defense counsel approached the bench and moved for a mistrial and- to quash the jury panel. The court denied both motions. The court then recessed the jury, brought appellant back into the courtroom, and admonished him to “act like a gentleman,” speak to the court outside the panel’s presence, and refrain from outbursts. The judge expláined he would give appellant another chance to control his behavior and asked appellant to promise to conduct himself appropriately and to direct his requests through his attorneys. Appellant agreed.
Moments after the panel was brought back in, aрpellant interrupted his attorney, stating, “I cannot allow this attorney to continue, your honor. I’m sorry, I can’t do it.” The judge told appellant to sit down, but he continued to complain that his attorney and the district attorney had “done too much already.” The panel was excused, and appellant’s attorney renewed his previous motions. When the court denied them, appellant argued, “You won’t even do that?” At this point, the court ordered the bailiff to get some tape and stated he wanted appellant shackled to the chair and taped. The judge told appellant he had lied to the court, and he repeated his order to bind and gag appellant. Appellant’s attorney objected and again moved for a mistrial. The court reiterated its reasons for denying the motion and shackling appellant, and appellant again interrupted the court, complaining he could not breathe. Appellant removed the gag before the jury returned and interrupted as soon as his attorney’s voir dire began, saying, “I fight for my freedom, your honor. My hands are a little numb, your Honor.” The court again admonished appellant, this time before the jury, that he was out of order and instructed counsel to continue, but appellant interrupted, stating the court was indicating his guilt because the tape looked like handcuffs. The court gave appellant another warning in the jury panel’s presence, instructing him to speak only outside their presence. As counsel was about to resume voir dire, appellant interrupted, stating, “[t]he Court has just physically assaulted me outside the panel’s presence, sir.” The court warned appellant he would have to excuse the panel unless appellant controlled himself but told appellant he could leave the gag off if he behaved. As his attorney again attempted to continue, appellant said, “I cannot sit here, sir, because of what this court has just done.” The court excused the panel and admonished appellant, who continued to object that he had been assaulted and complained about the tape on his hands. The court ordered appellant gagged again, brought the panel back in, and continued the voir dire. Although appellant was bound and gagged during the remainder of voir dire, he was not restrained during opening argument or any other portion of the trial. Appellant made no further interruptions.
The Propriety of the Court’s Action
In his first five points of error, appellant complains the court’s actions violated (1) article one, section 19 of the Texas Constitution and article 1.05 of the Texas Code of Criminal Procedure, ensuring a right to due course of the law; (2) article one, sections 10 and 15 of the Texas Constitution and the Sixth and Fourteenth Amendments to the United States Constitution, ensuring a fair trial and effective counsel; and (3) the Fifth and Fourteenth Amendments to the United States Constitution, ensuring due process.
We review the trial court’s decision to shackle the defendant during a trial proceeding for an abuse of discretion.
See Culverhouse v. State,
*679
The seminal case on this issue is
Illinois v. Allen,
Appellant correctly asserts that shackling is a “last resort.”
See Shaw v. State,
The Sixth Circuit requires a court to pursue less restrictive alternatives before shackling a disruptive defendant.
See Kennedy,
Appellant also argues the restraints seriously impacted his constitutional rights. He further asserts that: (1) certain jurors expressed concern about appellant’s behavior and appearance, and that thе sight of appellant in this state affected his credibility when he later testified; (2) the measure disrupted his ability to communicate with his attorney; and (3) the actions violated his right to due process. However, the jurors who expressed concern about appellant being bound and gagged were struck during voir dire. Further, appellant spoke clearly enough that the court reporter was able to take down appellant’s remarks; there is no indication in the record of any statement by the appellant which was unintelligible. Appellant anticipates this matter in his brief but notes that “the fаct remains that he was bound and gagged during a large portion of voir dire” and that his counsel timely objected. We fail to see the relevance of appellant’s arguments in light of the fact that the record establishes his ability to communicate. Regarding appellant’s due process rights, he contends the court’s order to “shut up” and efforts to bind him were an affront to “the public’s interest in the just administration of the law.” Appellant offers no authority for this argument, and therefore, we need not address it.
See
Tex.R.App. P. 38.1(h);
Smith v. State,
Appellant cites a number of cases to support his argument that the trial court’s аctions violated the constitutional provisions set forth above. However, of the ten cases appellant cites, only two of them held the trial court abused its discretion in employing one of the measures suggested by the Supreme Court to quell a disruptive defendant. First, in
United States ex rel. Boothe v. Superintendent, Woodboume Correctional Facility,
Appellant also cites
Gammage v. State,
*681
The Court of Criminal Appeals has addressed the circumstances in which a court is justified in binding and shackling a defendant. In
Kimithi v. State,
In
Shaw v. State,
Federal cases are also instructive. In a case appellant cites,
Woodard v. Perrin,
In the present ease, appellant’s trial behavior at the time he was gagged is far more egregious than that of the defendants in
Shaw
or
Woodard,
although it does not rise to the level of the conduct in
Allen
or
Kimi-thi.
As the Supreme Court stated in
Allen,
“[W]e find nothing unconstitutional about [removing defendant from the proceeding], Allen’s behavior was clearly of such extreme and aggravated nature as to justify either his
*682
removal from the courtroom or his total physical restraint.”
We overrule points of error one through five.
The Court’s Denial of Appellant’s Motion to Quash and for a Mistrial
In his sixth and seventh points of error, appellant contends the court erred in denying his motion for a mistrial and motion to quash the jury based on the binding and gagging. Appellant argues that being handcuffed to counsel table hindered his- appeаrance, dignity, and self-respect, conveying to the jury that he was dangerous. He contends the action was not supported by the record because appellant was not physically violent or resistant.
First, appellant’s motion to quash occurred after appellant’s first and second outbursts in front of the jury, not at any time after he ivas bound and gagged. Appellant failed to preserve this matter. See Tex.R.App. P. 83.1(a)(1)(A). We note that appellant’s attorney did move to withdraw and for a mistrial after appellant was shackled; therefore, he had the opportunity to movе to quash the panel but did not do so.
We review error regarding a court’s ruling on a motion for mistrial for an abuse of discretion.
See Kipp v. State,
Obviously, if the trial court had granted the motion for mistrial, the parties would have begun the proceeding anew, and the trial would be delayed. The record indicates that this is exactly the result appellant intended from the moment of his first outburst, as indicated by his highly inflammatory accusations against his counsel and the judge, as well as his attempts to capitalize on the consequences of his own opprobrious conduct, by asserting (only after the judge suggested it) that he had asthma and that his hands were numb because of the shackles. Holding that the trial court erred in overruling appellant’s motion for a mistrial would be directly contrary to precedent from the Supreme Court, which wrote in
Allen,
“Nor can the accused be permitted by his disruptive conduct indefinitely to avoid being tried on the charges brought against him. It would degrade our country and our judicial system to permit our cоurts to be bullied, insulted, and humiliated and their orderly progress thwarted and obstructed by defendants brought before them charged with crimes.”
Points of error six and seven are overruled.
The Outcry Witness Rule
In his eighth point of error, appellant asserts the trial court erred in admitting the testimony of Lisa Holcombe, the interviewer with the Children’s Assessment Center, as an “outcry witness.” Generally, an out of court statement is not admissible to prove, of the truth of the matter asserted.
See
Tex.R.CRIM. Evid. 801(d), 802. The legislature has created an exception, however, for statements of child abuse victims made by the victim to the first person over the age of eighteen to whom the victim made a statement about the offense.
See
Tex.Code CRiM. Proc. Ann. art. 38.072 (Vernon Supp.1998). The statement made “must be more- than words which give a general allusion that something in the area of child abuse.was going on.”
Garcia v. State,
As noted above, Holcombe interviewed the complainant eight months after the incident. On the day of the incident, however, the *683 complainant answered two of her mother’s questions about the incident and told Mrs. Miller about the attempted penetration. Appellant asserts Holcombe therefore was not an “outcry witness” because she was not the first person with whom the complainant discussed the incident.
First, appellant never urged at trial that Mrs. Miller was the first person to whom the complainant made a statement regarding the offense. As such, this contention is not properly preserved. See Tex.RApp. P. 33.1(a)(1)(A). Appellant did contend, however, that Quintanilla was the first person to whom the complаinant reported the incident. Therefore, we only consider whether Quin-tanilla, rather than Holcombe, was the outcry witness.
The complainant testified that she did not tell her mother appellant tried to put his penis inside her vagina. Holcombe testified the complainant told her appellant “put his private into her vaginal area” and that the complainant identified the meaning of “private” by pointing to the genital area of an anatomically correct doll. The complainant reiterated this testimony during trial. Quin-tanilla testified that, following the incident, she asked her daughtеr if appellant pulled his pants down. Quintanilla also asked the complainant if appellant pulled his underwear down. The complainant responded “yes” to both questions but did not respond to further questioning by Quintanilla.
In
Hayden v. State,
In the present ease, appellant was charged with causing his sexual organ to contact the complainant’s sexual organ. The record is clear that the complainant’s mother did not ask the complainant whether penetration oc-eured and that the complainant did not tell her mother sexual penetration occurred. The complainant did, however, tell Holcombe that appellant caused his penis to contаct her vagina. As such, Holcombe was the first person the complainant told about the offense as alleged in the indictment. As such, the court correctly found Holcombe to be the outcry witness pursuant to Texas Code of Criminal Procedure § 38.072.
Point of error eight is overruled.
Statement of Identity as a Hearsay Exception
In his ninth and final point of error, appellant contends the testimony of Dr. Williams was hearsay and should not have been admitted pursuant to Texas Rule of Criminal Evidence 803(4). As noted above, Dr. Williams was the physician who examined the complainant after her interview with Holcombe. Dr. Williams testified she has examined and treated many sexually abused childrеn. She asked the complainant questions about sexual contact while she took the complainant’s history and physical. The complainant told Williams her stepfather touched her “private” and breasts with his finger and hand and that he put his finger and “private” into her private part. Williams also testified the history and physical is the most important part of an examination and is crucial in arriving at an appropriate diagnosis.
Rule 803(4) provides an exception to the hearsay exclusion for statements made for
*684
purposes of medical diagnosis or treatment and describing medical history, past or present symptoms, pain, or sensations, or the inception or general character of the cause or external source thereof insofar as reasonably pertinent to diagnosis or treatment.
See
Tex.R.Crim. Evid. 803(4). Surprisingly, few cases discuss this rule’s application in the context of sexual abuse of a child. Those which do, however, have found that a child’s statement of identity of the abuser is admissible.
See Fleming v. State,
Appellant contends
Renville
and the Texas cases relying upon it require the statement identifying the perpetrator be reasonably pertinent to the treatment and that the child understand the need to tell the truth. He contends that the record is devoid of evidence establishing the complainant’s understanding of the physician’s role, and that this understanding motivates the child to tell the truth. Appellant is correct that the
Renville
opinion stressed that the child needed to appreciate the importance of giving correct information to the caregiver,
see id.
at 438, and that Dr. Williams did not testify that she discussed the importance of this matter with the complainant. However, such proof was absent in
Fleming,
in which the court noted the trial judge made no specific inquiry to determine whether the child appreciated the need to be truthful but that, nonetheless, the record was sufficient to support this conclusion.
See Fleming,
Point of error nine is overruled. We affirm the trial court’s judgment.
Notes
. This Rule is identical to Texas Rule of Criminal Evidence 803(4).
