Joseph E. Hancock v. Easwaran P. Variyam ( 2011 )


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  •                                         NO. 07-09-0277-CV
    IN THE COURT OF APPEALS
    FOR THE SEVENTH DISTRICT OF TEXAS
    AT AMARILLO
    PANEL C
    JUNE 16, 2011
    JOSEPH E. HANCOCK, APPELLANT
    v.
    EASWARAN P. VARIYAM, APPELLEE
    FROM THE 99TH DISTRICT COURT OF LUBBOCK COUNTY;
    NO. 2006-537,571; HONORABLE WILLIAM C. SOWDER, JUDGE
    Before QUINN, C.J., HANCOCK and PIRTLE, JJ.1
    OPINION
    Appellant, Joseph E. Hancock, appeals from a judgment entered in a defamation
    action in favor of Appellee, Easwaran P. Variyam, following a jury trial. In support,
    Hancock presents three issues: (1) whether the trial court erred in finding as a matter of
    law that Hancock's written statements were libel per se; (2) whether Variyam's evidence
    1
    For purposes of disclosure, we note that Justice Hancock is not related to Appellant.
    of damages is legally and factually insufficient; and (3) whether the trial court erred in
    admitting an anonymous letter at trial. We affirm.
    Background
    At all relevant times, Hancock and Variyam were physicians practicing internal
    medicine and gastroenterology at the Texas Tech University Medical Center in
    Lubbock, Texas. Both men were on the faculty of Texas Tech. Variyam was formerly
    the Chief of the Gastroenterology Division from September 2000 until January 2006,
    and as such, he was Hancock's supervisor when the following events occurred.
    On the morning of January 2, 2006, a dispute arose between the two physicians
    related to the transfer of patients from Hancock's care to Variyam's care. After Variyam
    wrote a letter to Hancock alleging he had disregarded patient care, Hancock responded
    with a letter of resignation wherein he stated, in pertinent part, as follows:
    Please find a copy of letter from Dr Variyam letter (sic) which I received
    today. Due to Dr Variyam's reputation for lack of veracity, a majority of my
    communications and interactions is (sic) recorded or witnessed and
    subsequently verified as in this case.
    My telephone conversation was over the speakerphone and witnessed by
    a third party who will dispute Dr. Variyam's position. The interaction by
    and through the Department of Internal Medicine this morning is again
    refutable.
    Dr Variyam deals in half truths, which legally is the same as a lie.
    It is Dr. Variyam's ethical behavior that should be challenged.
    Hancock addressed his letter to Bernhard Mittemeyer, Dean of the School of
    Medicine, and copied Donald Wesson, Chair of Internal Medicine, David Hodges,
    Associate Professor and Director of the UMC Endoscopy Center, Variyam and the
    2
    Accreditation Council for Graduate Medical Education (ACGME) in Chicago, Illinois.2 In
    February of 2006, Variyam was removed as Chief of the Gastroenterology Division.
    In December 2006, Variyam filed an original petition alleging that Hancock's letter
    had defamed him. Variyam sought special damages for loss of past and future income
    as well as general damages for injury to his reputation and mental anguish. He also
    sought exemplary damages. In November 2008, Variyam and Hancock filed an agreed
    order wherein Variyam agreed to forego special damages arising out of his removal as
    Chief of the Gastroenterology Division, but retained his defamation claim under a per se
    theory. Hancock continued to assert truth as an affirmative defense.
    In May 2009, a three day jury trial was held. At its conclusion, the trial court
    found that the statements in Hancock's letter were libel per se.                  The jury rejected
    Hancock's affirmative defense by finding that his statements3 regarding Variyam were
    not substantially true at the time they were made and that, by clear and convincing
    evidence, the harm to Variyam resulted from malice on Hancock's part.                       The jury
    2
    At all times relevant to this case, Hancock knew that ACGME was an independent organization that
    accredits institutions where medical training takes place nationwide. When Hancock wrote his letter, he
    was aware that an application for reinstatement of Texas Tech's Gastroenterology Fellowship was
    pending with ACGME and that Texas Tech and ACGME were scheduled to meet toward the end of
    January 2006 to decide the fate of Texas Tech's Fellowship Program of which Variyam was the Program
    Director. Hancock was also aware that the letter would be received by ACGME's Residency Review
    Committee, a committee comprised of physicians who were national experts in the field of
    gastroenterology or internal medicine. In addition to Hancock's letter, ACGME received an anonymous
    letter dated January 19 complaining about two doctors, Farooq and Parupudi, participants in the
    gastroenterology training program.
    3
    From the Charge of the Court, question 1 addressed the statement "reputation for lack of veracity";
    whereas, question 2 addressed the statement "deals in half truths, which is legally the same as a lie."
    3
    awarded Variyam actual damages of $90,0004 and exemplary damages of $85,000.
    Variyam was also awarded prejudgment interest of $6,455.68 and court costs. This
    appeal followed.
    Discussion
    Hancock contends the trial court erred by finding, as a matter of law, that his
    statements were libel per se because the statements were ambiguous and did not injure
    Variyam in his office or occupation as a physician. He also asserts that the evidence is
    legally and factually insufficient to justify any award for mental anguish or injury to
    reputation. He contends Variyam failed to prove that Hancock's statements caused him
    any damage and, alternatively, that the trial court erred by not issuing a jury instruction
    on proximate cause. Lastly, he asserts the trial court erred by admitting an anonymous
    letter at trial.
    Issue One - Libel per se
    Defamation is generally defined as the invasion of a person's interest in his or her
    reputation and good name. Prosser & Keeton on Torts § 111, at 771 (5th ed. 1984 &
    Supp. 1988). Defamation claims are divided into two categories depending on how the
    defamatory statement was communicated: libel for written communications and slander
    for oral communications.5
    4
    The jury awarded Variyam $30,000 for loss of reputation in the past, $30,000 for future loss of reputation,
    $15,000 for past mental anguish and $15,000 for future mental anguish.
    5
    Libel is defined by statute as "defamation expressed in written or other graphic form that tends to . . .
    injure a living person's reputation and thereby expose the person to . . . financial injury or to impeach any
    person's honesty, integrity, virtue, or reputation . . . ." Tex. Civ. Prac. & Rem. Code Ann. § 73.001 (West
    4
    Defamation claims are also divided into two categories, defamation per se and
    defamation per quod, according to the level of proof required in order to make them
    actionable.    Texas Disposal Sys. Landfill, Inc. v. Waste Mgmt. Holdings, Inc., 
    219 S.W.3d 563
    , 580 (Tex.App.--Austin 2007, pet. denied); Moore v. Waldrop, 
    166 S.W.3d 380
    , 384 (Tex.App.--Waco 2005, no pet.). Statements that are defamatory per quod are
    actionable only upon allegation and proof of damages. Texas 
    Disposal, 219 S.W.3d at 580
    ; Alaniz v. Hoyt, 
    105 S.W.3d 330
    , 345 (Tex.App.--Corpus Christi 2003, no pet.).
    That is, before a plaintiff can recover for defamation per quod, he must carry his burden
    of proof as to both the defamatory nature of the statement and the amount of damages
    caused by the publication of that statement. Texas 
    Disposal, 219 S.W.3d at 580
    ; See
    also Leyendecker & Assocs., Inc. v. Wechter, 
    683 S.W.2d 369
    , 374 (Tex. 1984);
    Peshak v. Greer, 
    13 S.W.3d 421
    , 426 (Tex.App.--Corpus Christi 2000, no pet.). By
    contrast, in cases involving defamation per se, damages are presumed to flow from the
    nature of the defamation itself and, in most situations, a plaintiff injured by a defamatory
    per se communication is entitled to recover general damages without specific proof of
    the existence of harm. Bentley v. Bunton, 
    94 S.W.3d 561
    , 604 (Tex. 2002) ("Our law
    presumes that statements that are defamatory per se injure the victim's reputation and
    entitle him to recover general damages, including damages for loss of reputation and
    mental anguish."); Exxon Mobil Corp. v. Hines, 
    252 S.W.3d 496
    , 501 (Tex.App--
    Houston [14th Dist.] 2008, pet. denied); but see Gertz v. Robert Welch, Inc., 
    418 U.S. 323
    , 347-48, 
    94 S. Ct. 2997
    , 
    41 L. Ed. 2d 789
    (1974) (holding that, so long as they do not
    2005). Although slander is not statutorily defined, at common law a slanderous statement is one that is
    orally communicated or published to a third person without legal excuse. Randall's Food Markets v.
    Johnson, 
    891 S.W.2d 640
    , 646 (Tex. 1995).
    5
    impose liability without fault, States are free to define for themselves the appropriate
    standard of liability in defamation suits where a private plaintiff sues a media defendant
    for speech involving a public issue). The United States Supreme Court later clarified
    that the constitutional requirements of Gertz do not prohibit the application of strict
    liability to defamation suits involving private-figure plaintiffs who sue nonmedia
    defendants for speech involving nonpublic issues. Dun & Bradstreet, Inc. v. Greenmoss
    Builders, Inc., 
    472 U.S. 749
    , 760-61, 
    105 S. Ct. 2939
    , 
    86 L. Ed. 2d 593
    (1985). In suits
    involving such situations, courts applying Texas law have applied strict liability in
    defamation per se causes of action. See Thomas-Smith v. Mackin, 
    238 S.W.3d 503
    ,
    509 (Tex.App.--Houston [14th Dist.] 2007, no pet.); Peshak v. Greer, 
    13 S.W.3d 421
    ,
    425-26 (Tex.App.--Corpus Christi 2000, no pet.); Snead v. Redland Aggregates Ltd.,
    
    998 F.2d 1325
    , 1334 (5th Cir. 1993).         Because the decision whether an alleged
    defamatory statement is defamatory per se or per quod affects the level of proof
    required, that question is initially determined by the trial court as a matter of law. Turner
    v. KTRK TV, Inc., 
    38 S.W.3d 103
    , 114 (Tex. 2000); Musser v. Smith Protective Servs.,
    Inc., 
    723 S.W.2d 653
    , 654-55 (Tex. 1987).
    A communication is considered libel per se when it is so obviously hurtful to the
    person aggrieved that no proof of its injurious character is required to make it
    actionable.   Clark v. Jenkins, 
    248 S.W.3d 418
    , 437 (Tex.App.--Amarillo 2009, pet.
    denied), cert. denied, __ U.S. __, 
    130 S. Ct. 52
    , 
    175 L. Ed. 2d 21
    (2009); Houseman v.
    Publicaciones Paso Del Norte, S.A. de C.V., 
    242 S.W.3d 518
    , 524 (Tex.App.--El Paso
    2007, no pet.). A false statement will typically be classified as defamatory per se if it
    injures a person in his office, profession, or occupation; Morrill v. Cisek, 
    226 S.W.3d 6
    545, 549 (Tex.App.--Houston [1st Dist.] 2006, no pet.); charges a person with the
    commission of a crime; 
    Leyendecker, 683 S.W.2d at 374
    ; or imputes to him a
    loathsome disease. Bolling v. Baker, 
    671 S.W.2d 559
    , 570 (Tex.App.--San Antonio
    1984, no writ).
    Whether a given statement is reasonably capable of a defamatory meaning is a
    question to be decided by the trial court as matter of law. See 
    Musser, 723 S.W.2d at 654-55
    . The trial court should construe the alleged defamatory communication as a
    whole in light of the surrounding circumstances based upon how a reasonable person of
    ordinary intelligence would perceive it, considering the surrounding circumstances and
    the context of the statement. New Times, Inc. v. Isaacks, 
    146 S.W.3d 144
    , 153 (Tex.
    2003), cert. denied, 
    545 U.S. 1105
    , 
    125 S. Ct. 2557
    , 
    162 L. Ed. 2d 276
    (2005); 
    Turner, 38 S.W.3d at 114
    . This is an objective test, not a subjective one. New Times, 
    Inc., 146 S.W.3d at 157
    . Thus, the parties' opinion of the statements, Musser v. Smith, 
    690 S.W.2d 56
    , 58 (Tex.App.--Houston [14th Dist.] 1985), aff'd, 
    723 S.W.2d 653
    (Tex.
    1987), or the defendant's intent in making the statements have no bearing on whether
    they are defamatory. 
    Peshak, 13 S.W.3d at 426
    ("We assume the words were intended
    because they were used.")       "Common sense requires courts to understand the
    statement as ordinary men and women would"; 
    Moore, 166 S.W.3d at 385
    , and the
    question whether a statement is defamatory per se is only submitted to the jury if the
    contested language is ambiguous or of doubtful import. See Denton Pub. Co. v. Boyd,
    
    460 S.W.2d 881
    , 884 (Tex. 1970). Otherwise, it is an issue of law for the trial court to
    decide. 
    Musser, 723 S.W.2d at 655
    . Therefore, according to this body of law, a written
    communication, made by a nonmedia defendant, concerning a private-figure individual
    7
    and pertaining to a nonpublic issue, which is obviously hurtful to the aggrieved party in
    his profession or occupation, is libel per se.
    Standard of Review
    The standard of review applicable to alleged error concerning a question of law is
    de novo. El Paso Natural Gas Co. v. Minco Oil & Gas, 
    8 S.W.3d 309
    , 312 (Tex. 1999);
    Block v. Mora, 
    314 S.W.3d 440
    , 444-45 (Tex.App.--Amarillo 2009, pet. dism'd).
    Therefore, in reviewing a trial court's determination of libel per se, this Court must
    conduct a de novo review. In doing so, this Court must exercise its own judgment and
    redetermine each legal issue, according no deference to the lower court's decision.
    Quick v. City of Austin, 
    7 S.W.3d 109
    , 116 (Tex. 1998); 
    Block, 314 S.W.3d at 445
    .
    Analysis
    Hancock contends the statements at issue were not libelous per se because they
    were ambiguous and extrinsic evidence was required to interpret them. Alternatively,
    he contends the statements did not injure Variyam in his office or occupation as a
    physician.6 We disagree.
    The trial court found that Hancock's written statements that Variyam had a
    "reputation for lack of veracity" and "deal[t] in half truths, which legally is the same as a
    lie" were libelous per se. See Lartigue v. Southern Mut. Ben. Ass'n, 
    265 S.W. 742
    , 743
    (Tex.Civ.App.--Beaumont 1924, no writ) (printed circular held libelous per se where it
    6
    Hancock does not challenge whether the evidence was sufficient to establish that his statements were
    false, published, or made with malice.
    8
    "unquestionably charged appellant with untruthfulness--with being a liar--that he was
    telling lies"); Hibdon v. Moyer, 
    197 S.W. 1117
    , 1118 (Tex.Civ.App.--El Paso 1917, no
    writ) (article held libelous per se where it unquestionably charged appellant with
    "untruthfulness"); Fleming v. Mattinson, 
    114 S.W. 650
    , 652 (Tex.Civ.App.--Texarkana
    1908, no writ) (newspaper article held libelous per se where statement "clearly imputes
    to [plaintiff] a lack of veracity");7 Mitchell v. Spradley, 
    56 S.W. 134
    , 135 (Tex.Civ.App.--
    Houston 1900, no writ ) (article held libelous per se where statement denounced plaintiff
    as "a liar").
    The trial court's determination is supported by the fact that Hancock imputes
    dishonesty to Variyam in his profession or occupation by addressing the letter to
    Variyam's superiors at Texas Tech and ACGME. See Bradbury v. Scott, 
    788 S.W.2d 31
    , 38 (Tex.App.--Houston [1st Dist.] 1990, writ denied) (letter libelous per se where
    writing accused employee of a lack of fidelity and honesty in her dealings with her
    employer). See also 
    Bolling, 671 S.W.2d at 571
    ("Generally, spoken words imputing
    that a person is dishonest or unethical in the practice of his employment have been held
    to be actionable per se.") Hancock's open-ended statements affirmatively questioned
    Variyam's ethical behavior as well as his reputation for being truthful and honest to his
    co-workers and employers at Texas Tech and ACGME, where he had submitted an
    application requesting that Texas Tech's fellowship program be reinstated. Hancock
    agreed with Variyam's counsel at trial that, if his statements about Variyam having a
    7
    "There can be no doubt that, at common law, to publish of a person in writing that he was mendacious,
    or that he had uttered a falsehood, was libelous per se." 
    Fleming, 114 S.W. at 652
    . "Such a publication
    is a direct impeachment of the honesty and integrity of the person against whom it is directed, and its
    tendency necessarily is to injure him by exposing him to public hatred and contempt." 
    Id. 9 reputation
    for untruthfulness were not true, then his statements "could have a very, very
    serious affect on [Variyam's] character" and would represent "character assassination."
    At trial, Variyam attested to the importance of his professional reputation for telling the
    truth in dealing with patients and other doctors, patient care, and research when
    publishing abstracts and book chapters. He also testified that "being untruthful would
    [also] affect his relationship with other physicians that might send him business or
    work." Like lawyers and bankers, a physician such as Variyam, by definition, depends
    greatly on his reputation. See generally First Bank of Corpus Christi v. Ake, 
    606 S.W.2d 696
    , 702 (Tex.Civ.App.--Corpus Christi 1980, writ ref'd) (citing Eidinoff v. Andress, 
    321 S.W.2d 368
    , 372-73 (Tex.Civ.App.--El Paso 1959, writ ref'd n.r.e.)).
    Hancock asserts that the term "veracity" is ambiguous because it is subject to
    two interpretations. In support he cites the parties' testimony, i.e., Hancock testified
    "veracity" means accuracy while Variyam testified "veracity" means truthfulness. It is
    well settled that "the meaning of a publication, and thus whether it is false and
    defamatory, depends on a reasonable person's perception of the entirety of the
    publication and not merely on individual statements."       
    Bentley, 94 S.W.3d at 584
    .
    Moreover, as we stated earlier, the test applied by the court to interpret the meaning of
    the publication is objective; New Times, 
    Inc., 146 S.W.3d at 157
    , and the parties'
    interpretations and intentions are irrelevant. 
    Peshak, 13 S.W.3d at 426
    ; 
    Musser, 690 S.W.2d at 58
    . Having duly considered the entirety of the publication, the surrounding
    circumstances and the context of the statement, we find that a reasonable person of
    ordinary intelligence would perceive the statements in Hancock's letter as defamatory
    per se. See State Medical Ass'n of Texas v. Committee for Chiropractic Education, Inc.,
    10
    
    236 S.W.2d 632
    , 634 (Tex.Civ.App.--Galveston 1951, no pet.) ("It has been uniformly
    held by the courts of this state that to impugn the veracity of a person is to defame
    him.")
    Hancock next asserts that he was merely expressing an opinion8 when he stated
    that Variyam had a "reputation for lack of veracity." We disagree. However, even
    where statements may be characterized as opinions, the statements may be
    defamatory nonetheless if they clearly imply the existence of undisclosed facts that the
    person engaged in conduct which would adversely reflect on his reputation. Shearson
    Lehman Hutton, Inc., v. Tucker, 
    806 S.W.2d 914
    , 920 (Tex.App.--Corpus Christi 1991,
    writ dism'd w.o.j.).      True, as Hancock suggests, the only way to gauge a person's
    reputation is through an examination of the opinions expressed by others, however,
    Hancock's affirmative statements imply that he had already undertaken that task and
    made his conclusion. In other words, his statement implies the existence of undisclosed
    facts known to Hancock indicating that Variyam had been untruthful in the past with
    others. See Milkovich v. Lorain Journal Co., 
    497 U.S. 1
    , 18-19, 
    110 S. Ct. 2695
    , 
    111 L. Ed. 2d 1
    (1990).9 See also 
    Bentley, 94 S.W.3d at 584
    .
    8
    If Hancock's statements were constitutionally protected opinion speech, his statements would not be
    actionable. See Pisharodi v. Barrash, 
    116 S.W.3d 858
    , 862 (Tex.App.--Corpus Christi 2003, pet. denied).
    9
    In Milkovich, the United States Supreme Court stated as follows:
    If a speaker says, "In my opinion John Jones is a liar," he implies knowledge of facts
    which lead to the conclusion that Jones told an untruth. Even if the speaker states the
    facts upon which he bases his opinion, if those facts are either incorrect or incomplete, or
    if his assessment of them is erroneous, the statement may still imply a false assertion of
    fact. Simply couching such statements in terms of opinion does not dispel these
    implications; and the statement, "In my opinion Jones is a liar," can cause as much
    damage to reputation as the statement, "Jones is a liar." As Judge Friendly aptly stated:
    11
    Hancock also contends that his statement "deals in half truths" is ambiguous
    because of the phrase "deals in." The entirety of Hancock's statement is "Dr. Variyam
    deals in half truths, which legally is the same as a lie." (Emphasis added). Considering
    the entire publication objectively, we believe a reasonable person of ordinary
    intelligence would understand that Hancock is using the terms "half truths" and "lies"
    interchangeably and the phrase "deals in" means that Variyam "tells" half-truths or
    lies.10    This is particularly so given Hancock's prior statement that Variyam has a
    "reputation for lack of veracity." In addition the phrase, Variyam "deals in half truths,
    which legally is the same as a lie," also implies knowledge of facts that lead to
    Hancock's conclusion. See 
    Milkovich, 491 U.S. at 18-19
    . See also 
    Bentley, 94 S.W.3d at 584
    .
    Lastly, Hancock cites a string of slander cases for the proposition that merely
    calling someone a "liar," "thief," or "crook," by itself, is not defamatory. See Gateway
    Logistics Group, Inc. v. Dangerous Goods Management Australia PTY, LTD, No. H-05-
    2742, 
    2008 U.S. Dist. LEXIS 34246
    (S.D. Houston Apr. 25, 2008) (statements in
    question were oral statements even though the litigation involved both libel and slander
    "[It] would be destructive of the law of libel if a writer could escape liability for accusations
    of [defamatory conduct] simply by using, explicitly or implicitly, the words 'I think.'" See
    Cianci v. New Times Publishing Co., 
    639 F.2d 54
    , 64 (2d Cir. 1980).
    
    Milkovich, 497 U.S. at 18-19
    .
    10
    Other courts have not found the term "dealing" ambiguous or troubling in the defamation context. For
    example, see 
    Bradbury, 788 S.W.2d at 38
    (letters that accused employee of "a lack of fidelity and honesty
    in her dealings with her employer" were actionable per se); Butler v. Central Bank & Trust Co., 
    458 S.W.2d 510
    , 514 (Tex.Civ.App.--Dallas 1970, writ dism'd) ("[t]o charge an employee with dishonesty in his
    dealing with his employer" is actionable per se).
    12
    allegations); Moore, 
    166 S.W.3d 380
    ; Billington v. Houston Fire & Casualty Ins. Co., 
    226 S.W.2d 494
    (Tex.Civ.App.--Fort Worth 1950, no writ).
    The law has long recognized a difference between written charges of falsehood
    or lack of veracity and oral charges in the area of per se liability. 
    Billington, 226 S.W.2d at 497
    (quoting 53 C.J.S. LIBEL AND SLANDER § 18, at 63) ("Written charges of
    falsehood or want of veracity generally are libelous per se; but oral charges of this
    character ordinarily are not slanderous per se"); Arant v. Jaffe, 
    436 S.W.2d 169
    , 176
    (Tex.Civ.App.--Dallas 1968, no writ) (in the area of per se defamation,"[t]he law
    recognizes the distinction between oral and written imputations").11 Because the cases
    cited by Hancock are slander cases, we find these cases to be distinguishable and
    inapposite.
    Therefore, applying a de novo review, we find the trial court did not err in finding
    that the defamatory statements in question were libel per se. Accordingly, issue one is
    overruled.
    Issue Two - Damages
    Hancock next asserts there is no evidence supporting the jury's award of
    damages for mental anguish or injury to reputation.               He also asserts there is no
    evidence his statements proximately caused Variyam any injury and the trial court erred
    11
    “In general, oral words, however opprobrious, are not actionable without proof of specific damages,
    unless they impute to another the commission of a crime or affect a person injuriously in his office,
    profession or occupation. Written or printed words charging dishonesty, fraud, rascality, or general
    depravity are generally libelous per se, but not so when spoken orally." 
    Arant, 436 S.W.2d at 176
    (quoting 36 Tex.Jur.2d, Libel and Slander, § 3, pp. 282-83).
    13
    by failing to instruct the jury on proximate cause.            Further, he contends Variyam's
    damages should be denied because Variyam self-published Hancock's letter when he
    was aware it was defamatory.
    Legal and Factual Sufficiency
    In conducting a legal sufficiency review, we must consider the evidence in the
    light most favorable to the challenged finding, indulge every reasonable inference to
    support it; City of Keller v. Wilson, 
    168 S.W.3d 802
    , 822 (Tex. 2005), and credit
    favorable evidence if reasonable jurors could while disregarding contrary evidence
    unless reasonable jurors could not. 
    Id. at 827.
    A challenge to legal sufficiency will be
    sustained when, among other things, the evidence offered to establish a vital fact does
    not exceed a scintilla.12 
    Id. at 810.
    In addition, so long as the evidence falls within the
    zone of reasonable disagreement, we may not invade the fact-finding role of the jurors,
    who alone determine the credibility of witnesses, the weight to be given their testimony,
    and whether to accept or reject all or a part of their testimony. City of 
    Keller, 168 S.W.3d at 822
    .
    In reviewing a factual sufficiency challenge, we consider all the evidence and set
    aside a finding only if it is so against the great weight and preponderance of the
    evidence as to be clearly wrong or unjust. Ortiz v. Jones, 
    917 S.W.2d 770
    , 772 (Tex.
    1996). If, as here, the appellant is challenging the factual sufficiency of the evidence to
    support a finding on an issue on which the other party had the burden of proof, we must
    12
    Less than a scintilla of evidence exists when the evidence is so weak as to do no more than create a
    mere surmise or suspicion of fact. King Ranch, Inc. v. Chapman, 
    118 S.W.3d 742
    , 751 (Tex. 2003), cert.
    denied, 
    541 U.S. 1030
    , 
    124 S. Ct. 2097
    , 
    158 L. Ed. 2d 711
    (2004).
    14
    overrule the complaint unless, considering all the evidence, the finding is clearly wrong
    and manifestly unjust. See Santa Fe Petroleum, L.L.C. v. Star Canyon Corp., 
    156 S.W.3d 630
    , 637 (Tex.App.--Tyler 2004, no pet.) (citing Garza v. Alviar, 
    395 S.W.2d 821
    , 823 (Tex. 1965)). Inferences may support a judgment only if they are reasonable
    in light of all the evidence, 
    id., and, again,
    the trier of fact is the sole judge of the
    credibility of the witnesses and the weight to be given their testimony. GTE Mobilnet of
    S. Tex. Ltd. P'ship v. Pascouet, 
    61 S.W.3d 599
    , 615-16 (Tex.App.--Houston [14th Dist.]
    2001, pet. denied).
    General Damages--Defamation
    Compensatory damages allowable for defamation are divided into two
    categories: general and special. 
    Pershak, 13 S.W.3d at 427
    . General damages include
    mental anguish, loss of reputation, and like damages that naturally flow from the
    defamation and are not easily susceptible to monetary valuation. 
    Id. General damages
    are those conclusively presumed to have been foreseen by the defamer as a necessary
    and usual result of his or her wrongful act.      Fox v. Parker, 
    98 S.W.3d 713
    , 726
    (Tex.App.--Waco 2003, pet. denied) (citing Arthur Anderson & Co. v. Parker Equip. Co.,
    
    945 S.W.2d 812
    , 816 (Tex. 1997)).       As noted earlier, Variyam chose not to seek
    "special" damages, i.e., damages which must be specifically stated and proved, such as
    loss of earning capacity, which are foreseeable to the defendant but are not the
    necessary and usual result of the wrong. 
    Id. Because Hancock's
    statements were determined by the trial court to be
    defamatory per se, Variyam is entitled to recover general damages without proof of
    15
    other injury. 
    Leyendecker, 683 S.W.2d at 374
    . "The law presumes a statement which
    is libelous per se defames a person, injures his reputation"; 
    id., and causes
    mental
    anguish. Ryder Truck Rentals, Inc. v. Latham, 
    593 S.W.2d 334
    , 337 (Tex.Civ.App.--El
    Paso 1979, writ ref'd n.r.e.) (general damages for injury to character, reputation,
    feelings, mental suffering or anguish, or other wrongs not susceptible to monetary
    valuation are presumed); 
    Peshak, 13 S.W.3d at 427
    ("In actions of libel per se, the law
    presumes the existence of some actual damages, requiring no independent proof of
    general damages.") Because the damages are presumed, "there need be no inquiry in
    the [jury] charge about whether there was a defamation or about 'proximate cause' and
    injury (or the jury may be instructed to so find.”) 
    Fox, 98 S.W.3d at 726
    .
    Further, because the damages are purely personal and cannot be measured by
    any fixed rule or standard, the amount of general damages suffered in a defamation
    case is difficult to determine. First State Bank of Corpus Christi v. Ake, 
    606 S.W.2d 696
    , 702 (Tex.Civ.App.--Corpus Christi 1980, writ ref'd n.r.e.) (citing Bayoud v. Sigler,
    
    555 S.W.2d 913
    (Tex.Civ.App.--Beaumont 1977, writ dis'md)). Thus, because of their
    uncertain nature, their measurement is generally left to the discretion of the finder of
    fact, subject only to a determination that the award was clearly excessive or the result of
    "passion, prejudice, or other improper influences."     See 
    Morrill, 226 S.W.3d at 550
    (citing 
    Bolling, 671 S.W.2d at 549
    ). See also Tranum v. Broadway, 
    283 S.W.3d 403
    ,
    422 (Tex.App.--Waco 2008, pet. denied).
    16
    Mental Anguish
    An award of mental anguish damages will survive a legal sufficiency challenge
    when the plaintiff has introduced (1) "direct evidence of the nature, duration, or severity
    of [plaintiff's] anguish, thus establishing a substantial disruption in the plaintiff's daily
    routine"; or (2) other evidence of "a high degree of mental pain and distress that is more
    than mere worry, anxiety, vexation, embarrassment, or anger."              Parkway Co. v.
    Woodruff, 
    901 S.W.2d 434
    , 444 (Tex. 1995). Direct evidence may be in the form of the
    parties' own testimony, that of third parties, or experts. 
    Id. "There must
    also be some
    evidence to justify the amount awarded"; Saenz v. Fid. & Guar. Ins. Underwriters, 
    925 S.W.2d 607
    , 614 (Tex. 1996), and the amount awarded must be fair and reasonable.
    
    Id. Hancock relies
    on two cases in asserting that Variyam's testimony portrays
    nothing more than common anxiety, embarrassment and anger. See Parkway 
    Co., 901 S.W.2d at 444
    ; Exxon Mobil 
    Corp., 252 S.W.3d at 505
    . In Parkway, the Texas Supreme
    Court found plaintiff's proof of damages for mental anguish lacking where he addressed
    his mental state in only two passages of testimony saying he "was hot" and "was very
    disturbed about that." 
    Parkway, 901 S.W.2d at 444
    . His wife testified that "[their] life
    changed," "just upsetting," "her husband was very quiet," and she was "just upset it
    changed their lifestyle." 
    Id. The Exxon
    Mobil Court found plaintiff's proof of damages
    for mental anguish lacking where the plaintiff testified that he found being terminated
    from his employment "devastating," "life changing," and "horrible." Exxon Mobil 
    Corp., 252 S.W.3d at 505
    . His wife testified that her husband was "devastated" when he had
    17
    to tell his children that he lost his job. 
    Id. A co-worker
    of the plaintiff also testified that,
    when plaintiff was told of his termination, he was "devastated," reacted with an
    "emotional outburst," was in a "state of disbelief and shock," "extremely upset," and
    "could not sleep that night." 
    Id. (emphasis added).
    Here, Variyam testified to mental anguish that substantially affected his mental
    state at home and at work. He testified that he was devastated, very distraught, and
    disappointed. The defamation disrupted his family and distracted him at home. He
    acted differently at home and was more introspective---spending time looking at the
    information. He considered moving his family from Lubbock. Work was also disrupted
    and stressful. He was distracted, uncomfortable returning to work, embarrassed when
    he saw his colleagues, and paranoid that people might be talking behind his back. He
    still thinks about the defamatory statements---the accusations "are still stuck in his
    mind." He fears that others who saw the letter will communicate the statements further,
    worries how the letter will affect his future ability to practice medicine, fears how the
    communication to ACGME will affect him in the future practice of his profession, and
    continues to suffer from sleeplessness. Because of Hancock's statements, he testified
    he has suffered emotional difficulties and has seen "an institutional person who has
    supported [him]."
    We agree with Variyam that his circumstances are more like the plaintiff's
    circumstances in Bentley where the Texas Supreme Court held that the plaintiff satisfied
    his burden of proof in proving mental anguish. In Bentley, the plaintiff testified at trial
    that the defamation cost him time, deprived him of sleep, embarrassed him in the
    18
    community, disrupted his family life, distressed his children at school, depressed him,
    impugned his honor and integrity, was the worst experience in his life and caused his
    family to suffer. 
    Bentley, 94 S.W.3d at 606
    .
    Having reviewed all the evidence, we find that the record in this case does not
    indicate that the jury's award of past and future mental anguish damages in the amount
    of $30,000 is either excessive, or the result of passion, prejudice, or other improper
    influence. The amount was within the jury's discretion and we will not substitute our
    judgment for that of the jury. See 
    Peshak, 13 S.W.3d at 427
    ("amount of general
    damages is very difficult to determine, and the jury is given wide discretion in its
    estimation of them"). Accordingly, we find Variyam's evidence is legally and factually
    sufficient to support the jury's determination that $30,000 is "fair and reasonable"
    compensation for past and future mental anguish Variyam suffered because of
    Hancock's libel per se.
    Loss of Reputation
    In support of his contention that the evidence supporting Variyam's award for
    past and future injury to his reputation, $60,000, is legally and factually insufficient,
    Hancock again cites Exxon Mobil 
    Corp., supra
    . Hancock asserts that, although Variyam
    felt paranoid, there is no evidence his colleagues believed Hancock's statements and
    Dr. Wesson, who demoted Variyam, did not receive Hancock's letter and had no opinion
    about Variyam's reputation for truthfulness.
    Because the trial court correctly determined that Hancock's statements were libel
    per se, "the law presumes that [Variyam's] reputation has been injured thereby."
    19
    
    Leyendecker, 683 S.W.2d at 374
    ; see Mustang Athletic Corp. v. Monroe, 
    137 S.W.3d 336
    , 339 (Tex.App.--Beaumont 2004, no pet.); ("In Leyendecker and Bentley, the
    Supreme Court of Texas held statements which are defamatory per se entitle a plaintiff,
    as a matter of law, to recover actual damages for injury to reputation."); 
    Peshak, 13 S.W.3d at 427
    ("In actions of libel per se, the law presumes the existence of some
    actual damages, requiring no independent proof of general damages."); Ryder Truck
    Rentals, 
    Inc., 593 S.W.2d at 337
    (defamation per se entitles a plaintiff to presumed
    general damages for injury to character, reputation, feelings, mental suffering or
    anguish, and other wrongs not susceptible to monetary valuation). As such, Variyam
    was not required to present independent evidence that his reputation was harmed or
    that his colleagues believed Hancock's statements. 
    Peshak, 13 S.W.3d at 427
    .13 That
    said, having reviewed the entire record, there is sufficient evidence from which the jury
    could have inferred that Variyam's demotion from his position as Chief of the
    Gastroenterology Division and ACGME's denial of his application to reinstate the
    Fellowship Program were due, at least in part, to the statements in Hancock's letter
    which was published only weeks before these events took place.
    Furthermore, contrary to Hancock's argument that Dr. Wesson did not receive
    Hancock's letter and had no opinion about Variyam's reputation for truthfulness, the
    record indicates that Dr. Wesson testified that he did "not remember receiving the letter"
    13
    "A third party is deemed to have understood the defamatory nature of a statement if a reasonable
    person would have understood the statement under the circumstances." In re Perry, 
    423 B.R. 215
    , 267
    (Bankr. S.D. Tex. 2010) (citing Marshall Fields Stores, Inc. v. Gardiner, 
    859 S.W.2d 391
    , 396 (Tex.App.--
    Houston [1st Dist.] 1993, writ dism'd w.o.j.)). A finding that a statement is defamatory per se subsumes
    the need for such a determination. See 
    Leyendecker, 683 S.W.2d at 374
    .
    20
    although he "remembered the issues." Further, in addition to being listed as a recipient
    of Hancock's letter on its second page, Dr. Wesson appeared very familiar with the
    letter's contents in subsequent e-mails between Dr. Wesson, Variyam, and other Texas
    Tech officials in January 2006 and testified that he recalled consulting with Variyam on
    Hancock's letter and its potential harm to the application for reinstatement.14 Although
    Dr. Wesson may not have had an opinion on Variyam's reputation for truthfulness, he
    testified that, from his personal interactions with Variyam, he found Variyam to be a
    truthful person and disagreed with Hancock's statements that Variyam had a "reputation
    for lack of veracity," "deals in half truths," and his "ethical behavior should be
    challenged." He indicated that anyone from the University Medical Center, Physician
    Network Services or any physician who complained of having personality issues with
    Variyam never complained that Variyam was untruthful or dishonest.
    Hancock's citation to Exxon Mobil 
    Corp., supra
    , is also unavailing. The portions
    of Exxon Mobil Corp. cited by Hancock were relevant only to the Exxon Mobil Court's
    analysis of whether there was sufficient evidence to support the plaintiff's award of
    damages for mental anguish, not injury to reputation. Exxon Mobil 
    Corp., 252 S.W.3d at 505
    n.10. Moreover, Hancock fails to cite a single case in support of his assertion that,
    where libel per se is found by the trial court, the plaintiff must present independent
    evidence of injury to his or her reputation.
    14
    Dr. Wesson testified that the effect of Hancock's letter on the pending reinstatement application with
    ACGME to reinstate the Fellowship Program would have been negative.
    21
    Accordingly, we find the evidence is legally and factually sufficient to support the
    jury's award of $60,000 in damages for past and future injury to Variyam's reputation as
    a result of Hancock's letter.
    Causation--Self-Publication
    Hancock next asserts that, because Variyam self-published Hancock's
    statements a week after Hancock published the statements,15 Variyam can recover no
    damages because he suffered no harm or the trial court should have issued a charge
    that sought a jury determination of proportionate fault, i.e., did Variyam cause some of
    his damages due to self-publication. In support he cites the cases of Doe v. SmithKline
    Beecham Corp., 
    855 S.W.2d 248
    (Tex.App.--Austin 1993), aff'd as modified, 
    903 S.W.2d 347
    (Tex. 1995) and Glenn v. Gidel, 
    496 S.W.2d 692
    , 698 (Tex.Civ.App.--
    Amarillo 1973, no writ).
    In Doe, an employment applicant, Doe, asserted that SmithKline libeled or
    slandered her by placing her in a situation in which she felt obligated to disclose to other
    prospective employers the circumstances of a drug test and the revocation of
    SmithKline's offer of employment. 
    Doe, 855 S.W.2d at 259-260
    . She did not allege that
    SmithKline published the defamatory statement. 
    Id. The Doe
    Court affirmed summary
    judgment in favor of the defendant on the defamation claim because there was no
    15
    Hancock refers to a letter sent January 9, 2006, by Variyam to Hancock wherein Variyam references the
    defamatory statements made in Hancock's letter and requests that he make a retraction in the form of a
    written letter addressed to all the recipients of Hancock's January 2nd letter. With the exception of
    ACGME, Variyam's letter copied only the recipients of Hancock's letter, Dean Bernard Mittemeyer, Dr.
    Donald Wesson, and Dr. David Hodges. Thus, Hancock had already published his libelous statements to
    the recipients of Variyam's letter at least a week before they received a copy of Variyam's letter.
    22
    indication that Doe was compelled by law or other authority to report the alleged
    defamatory statement made by SmithKline. 
    Id. at 259.
    In so doing, the Doe Court
    relied on the rule of law espoused in Lyle v. Waddle, 
    144 Tex. 90
    , 
    188 S.W.2d 770
    (Tex.
    1944), that "if the publication of which plaintiff complains was consented to, authorized,
    invited or procured by plaintiff, he cannot recover for injuries sustained by reason of the
    publication." 
    Id. at 772.
    Here, the circumstances are quite dissimilar. First, the trial court determined that
    Hancock's statements represented libel per se. Hence, there was no need to show
    Hancock's statements proximately caused the injury to Variyam's reputation or mental
    anguish. See 
    Fox, 98 S.W.3d at 726
    . Secondly, the jury was specifically asked to limit
    his damages to those damages "caused by the January 2, 2006 letter" from Hancock to
    Variyam's superiors and ACGME. Finally, there was no evidence at trial that Variyam
    "consented to, authorized, invited or procured" Hancock's publication.
    Neither does Glenn v. 
    Gidel, supra
    , have any application here. On appeal it was
    determined that the trial court properly instructed a verdict favorable to all defendants
    where the record was devoid of any evidence that the alleged defamatory statement
    was overheard or communicated to a third party. 
    Glenn, 496 S.W.2d at 698
    . In the
    absence of evidence of publication, the Glenn Court held the alleged defamation is not
    actionable citing the rule in 
    Lyle, supra
    .            Here, there was ample evidence of the
    publication of Hancock's letter before Variyam sought a retraction.16
    16
    The evidence at trial showed that, in addition to the addressees of Hancock's letter, some form of
    publication of the letter's contents was made to Dr. Eugene Dabezies, then Chairman of the Orthopedic
    Surgery Department at Texas Tech. He testified at trial that he heard of a controversy in the
    23
    To resolve what Hancock asserts to be equal inferences that Variyam's injury
    resulted from his own self-publication rather than Hancock's publication, he asserts the
    trial court should have issued a jury instruction which proportioned fault between
    Variyam and Hancock, i.e., asked the jury whether Variyam's injuries were caused by
    Hancock's publication or Variyam's publication. A party objecting to a charge must point
    out distinctly the objectionable matter and the grounds of the objection to the trial court.
    See Wilgus v. Bond, 
    730 S.W.2d 670
    , 672 (Tex. 1990). Here, the trial court was given
    no opportunity to correct the error Hancock now asserts. Hancock failed to state such
    an objection clearly designating the error and explaining the grounds for the complaint.
    See 
    Wilgus, 730 S.W.2d at 672
    . As a result, any complaint as to a question, definition,
    or instruction, on account of the alleged defect or omission concerning submission of
    the issue to the jury was waived. See Tex. R. Civ. P. 275; Kirkpatrick v. Memorial
    Hosp., 
    862 S.W.2d 762
    , 769 (Tex.App.--Dallas 1993, writ denied); Borden, Inc. v. Rios,
    
    850 S.W.2d 821
    , 826 (Tex.App.--Corpus Christi 1993, no writ).
    Exemplary Damages
    In reviewing whether an exemplary damages award is constitutional, we consider
    three "guideposts": (1) the nature of the defendant's conduct, (2) the ratio between
    exemplary and compensatory damages, and (3) the size of civil penalties in comparable
    cases. Tony Gullo Motors I. L.P. v. Chapa, 
    212 S.W.3d 299
    , 308 (Tex. 2006) (citing
    Gastroenterology Department involving an allegation that Variyam had a reputation for not being truthful,
    but it didn't make sense to him. To the contrary, Dr. Dabezies testified at trial that Variyam "was a truthful
    person," "well respected in the medical community as a person to take care of patients" and "a scholar."
    24
    State Farm Mut. Auto. Ins. Co. v. Campbell, 
    538 U.S. 408
    , 418, 
    123 S. Ct. 1513
    , 
    155 L. Ed. 2d 585
    (2003)). The reprehensibility of Hancock's conduct (the most important of
    these guideposts); 
    id. (quoting BMW
    of North America, Inc. v. Gore, 
    517 U.S. 559
    , 575,
    
    116 S. Ct. 1589
    , 
    134 L. Ed. 2d 809
    (1996)), depends in turn on five more factors, i.e.,
    whether Hancock's conduct (1) caused physical rather than economic harm, (2)
    threatened the health or safety of others, (3) threatened someone who had financial
    vulnerability (4) involved repeated action rather than an isolated incident, and (5) the
    harm resulted from intentional malice, trickery, or deceit as opposed to mere accident.
    Bennett v. Reynolds, 
    315 S.W.3d 867
    , 874 (Tex. 2010) (citing State 
    Farm, 538 U.S. at 419
    ).17
    We find that the exemplary damages awarded to Variyam were not excessive
    because the ratio of general damages to exemplary damages was less than 1 to 1; see
    
    Bennett, 315 S.W.3d at 877
    ("an award of more than four times the amount of
    compensatory damages might be close to the line of constitutional impropriety")
    (quoting State 
    Farm, 538 U.S. at 425
    ), and we have two Bennett factors present that
    establish the reprehensibility of Hancock's conduct, i.e., his defamatory statements were
    sent to multiple recipients, and his conduct was the result of intentional malice.
    Compare Tony Gullo Motors I. 
    L.P., 212 S.W.3d at 308-09
    (exemplary damages push
    the constitutional limits where the ratio between general/economic and exemplary
    17
    Because we have determined Variyam is entitled to recover damages for injury to reputation and mental
    anguish, we need not consider Hancock's argument that Variyam is entitled to no exemplary damages
    because he did not recover actual damages. Under Texas law, generally, the recovery of actual
    damages is a prerequisite to the receipt of exemplary damages. Nabours v. Longview Savings & Loan
    Association, 
    700 S.W.2d 901
    , 903 (Tex. 1985).
    25
    damages is 4.33 to 1 and only one factor of five factors analyzed in BMW of North
    America, Inc., 
    517 U.S. 559
    , is present).
    Hancock's wrongful conduct involved the simultaneous publication of his
    defamatory statements to two of Variyam's superiors, a colleague and ACGME. His
    conduct was also "the result of intentional malice rather than mere accident." 
    Bennett, 315 S.W.3d at 878
    . Hancock testified at trial that he wrote the letter when he was
    extremely angry about his dispute with Variyam related to patient transfers. He knew
    the status of the ACGME application and was aware that his letter would be seen by
    people at ACGME including physicians from across the country. His letter violated the
    established protocol at Texas Tech for communication with ACGME18 and he was
    aware his statements that Variyam had "a reputation for lack of truthfulness" could have
    a "very, very serious effect on [Variyam's] character." If the letters were not true, as
    subsequently found by the jury, he testified he was "basically assassinating Variyam's
    character." From this evidence, the jury could infer that Hancock not only intended to
    injure Variyam's prospects with his present employer, Texas Tech, but possible future
    prospects of employment by sending the letter to ACGME, an independent organization
    that accredits all institutions where medical training takes place nationwide.19
    18
    Dr. Surendra Varma, Associate Dean for Graduate Medical Education and Chair of the Graduate
    Medical Education Committee at Texas Tech, testified that it was inappropriate for anyone to
    communicate directly with ACGME unless they were the Program Director, Variyam, or the Designated
    Information Officer, Jim Watters. In addition, he testified it was an ACGME requirement that all
    correspondence with ACGME go through the Graduate Medical Education Committee.
    19
    The fact that Hancock unnecessarily mailed an additional copy of the letter to ACGME reflects a
    malicious intent. 
    Leyendecker, 683 S.W.2d at 375
    .
    26
    In addition, the exemplary damages award is comparable in size to other
    defamation cases. See 
    Clark, 248 S.W.3d at 427
    (jury awarded $100,000 in exemplary
    damages each against two defendants for libel per se); Bunton v. Bentley, 
    176 S.W.3d 21
    , 23 (Tex.App.--Tyler 2005, pet. denied), cert. denied, 
    547 U.S. 1013
    , 
    126 S. Ct. 1476
    ,
    
    164 L. Ed. 2d 266
    (2006) ($1,000,000 exemplary damages award reasonable in
    defamation case); 
    Bradbury, 788 S.W.2d at 39
    ($50,000 punitive damages award in
    libel per se case not excessive); 
    Bolling, 671 S.W.2d at 572
    ($60,000 punitive damages
    award in slander per se case not excessive). Accordingly, issue two is overruled.
    Issue Three - Anonymous Letter
    Hancock next asserts the trial court erred in admitting testimony of the existence
    of an anonymous letter mailed nearly two weeks after Hancock's January 2nd letter that
    complained to ACGME about the Fellowship Program. Hancock asserts the testimony
    was irrelevant; see Tex. R. Evid. 402, and the original writing was required to prove the
    content of the anonymous letter. See Tex. R. Evid. 1002.
    Evidentiary rulings admitting or excluding evidence are committed to the trial
    court's sound discretion; Bay Area Healthcare Group, LTD. v. McShane, 
    239 S.W.3d 231
    , 234 (Tex. 2007); American Protection Ins. Co. v. Johnson, 
    171 S.W.3d 921
    , 923
    (Tex.App.--Amarillo 2005, no pet.), and, even if a trial court errs by improperly admitting
    evidence, reversal is warranted only if the error probably caused the rendition of an
    improper judgment.     See Tex. R. App. P. 44.1; Owens-Corning Fiberglas Corp. v.
    Malone, 
    972 S.W.2d 35
    , 43 (Tex. 1998). Further, we review the entire record and
    require the complaining party to demonstrate that the judgment turns on the particular
    27
    evidence admitted. Bay Area Healthcare Group, 
    LTD., 239 S.W.3d at 234
    . See Allen v.
    Creditwatch Services, LLC, 
    236 S.W.3d 315
    , 324 (Tex.App.--Corpus Christi 2007, pet.
    denied ) ("complaining party must usually show that the whole case turned on the
    evidence at issue").
    Hancock asserts the trial court should have excluded any and all evidence of the
    anonymous letter sent to ACGME.20 At trial, Variyam acknowledged, when testifying
    about the continuing process related to the ACGME reinstatement application, that
    ACGME had received a letter "from an anonymous source" and he wrote a letter
    "basically [responding] to the anonymous complaints" received by ACGME against Drs.
    Farooq and Parupudi. Variyam's letter to ACGME, admitted as an exhibit, referenced
    an "unnamed complainant" and summarized the anonymous complaints made against
    Drs. Farooq and Parupudi in a single paragraph. The remainder of Variyam's five-page
    letter addressed the qualifications and actions of Drs. Farooq and Parupudi, and
    Variyam's efforts to assure ACGME that the Fellowship Program had sufficient key
    clinical faculty to maintain the program. In the second to last paragraph, the letter
    stated that "[w]e suspect that the complaint came from a disgruntled person who has
    some, but incomplete knowledge of our division."                  Dr. Hancock's name was not
    mentioned in connection with Variyam's testimony regarding the anonymous letter sent
    to ACGME.
    20
    We note that record references to an anonymous letter represented isolated statements contained in
    four pages out of over five hundred thirty pages of testimony over a three day trial. Further, Variyam's
    counsel did not mention the anonymous letter in either his opening or closing statements.
    28
    Without specifically stating how the case, or any material issue, turned on this
    particular evidence, Hancock simply asserts that this testimony caused the rendition of
    an improper judgment because the jury was permitted to speculate whether Hancock
    authored the anonymous letter. Because Hancock's statements in his January 2nd
    letter were found by the trial court to be libel per se, the anonymous letter was wholly
    irrelevant to the issue of whether Hancock's prior letter defamed Variyam. See 
    Allen, 236 S.W.3d at 324
    .        Furthermore, Variyam's responsive letter indicates that the
    anonymous complainant was someone other than Hancock who, from the record,
    appeared to have complete knowledge of the Gastroenterology Division. Accordingly,
    we find that, even if the trial court erred in admitting evidence of the anonymous letter,
    any error was harmless. See Shearson 
    Lehman, 806 S.W.2d at 927
    (admission of
    anonymous letter harmless error in defamation case where letter did not refer to a
    matter dispositive of the case and did not establish that the defendant was attempting to
    damage the plaintiff's reputation). Hancock's third issue is overruled.
    Conclusion
    The trial court’s judgment is affirmed.
    Patrick A. Pirtle
    Justice
    Quinn, C.J., not participating.
    29