Nexion Health at Beechnut, Inc., D/B/A Beechnut Manor v. Maria Moreno, Individually and as Representative of the Estate of Mario Moreno

ACCEPTED 01-05-00793-CV FIRST COURT OF APPEALS HOUSTON, TEXAS 11/10/2015 3:30:30 PM CHRISTOPHER PRINE CLERK

01-15-00793-CV

In the Court of Appeals FILED IN 1st COURT OF APPEALS For the First District of Texas at Houston HOUSTON, TEXAS 11/10/2015 3:30:30 PM CHRISTOPHER A. PRINE Nexion Health at Beechnut, Inc. d/b/a Beechnut Manor, Clerk Appellant,

v.

Maria Moreno, Individually and as Representative of the Estate of Mario Moreno, Appellee.

On Appeal from the 133rd Judicial District Court of Harris County, Texas Cause Number: 2015-01975 The Honorable Jaclanel McFarland, Presiding Judge

APPELLANT’S BRIEF

Attorneys for Appellant

MACDONALD DEVIN, PC Gregory N. Ziegler 3800 Renaissance Tower Texas Bar No. 00791985 Dallas, Texas 75270 GZiegler@MacdonaldDevin.com 214.744.3300 telephone Weston M. Davis 214.747.0942 facsimile Texas Bar No. 24065126 WDavis@MacdonaldDevin.com ORAL ARGUMENT REQUESTED

IDENTITY OF PARTIES AND COUNSEL

Defendant/Appellant

Nexion Health at Beechnut, Inc. d/b/a Beechnut Manor Counsel for Defendant/Appellant

Gregory N. Ziegler Texas Bar No. 00791985 Weston M. Davis Texas Bar No. 24065126 MACDONALD DEVIN, PC 1201 Elm Street 3800 Renaissance Tower Dallas, Texas 75270 214.744.3300 Telephone 214.747.0942 Facsimile

Counsel for Plaintiff/Appellee

Maria Moreno, Individually and as Representative of the Estate of Mario Moreno, represented by Jason A. Gibson THE GIBSON LAW FIRM 440 Louisiana, Suite 2400 Houston, Texas 77002 713.650.1010 Telephone 713.650.1011 Facsimile

i

STATEMENT REGARDING ORAL ARGUMENT

Pursuant to Texas Rule of Appellate Procedure 39.1, Appellant requests oral argument in this case. This case presents an issue regarding the expert report requirement of Civil Practice and Remedies Code Chapter 74, which is a developing area of the law. For this reason, Appellant respectfully submits that argument would significantly aid the Court in determining the legal and factual issues presented in this appeal.1 1 See TEX. R. APP. P. 39.8.

ii

TABLE OF CONTENTS

Identity of Parties and Counsel ............................................................. i Statement on Oral Argument ................................................................ ii Table of Contents .................................................................................... iii Index of Authorities ................................................................................ v Statement of the Case ............................................................................ 2 Statement of Jurisdiction ...................................................................... 3 Issues Presented ..................................................................................... 3 Statement of Facts ................................................................................. 4 Summary of the Argument .................................................................... 5 Argument .................................................................................................... 6

I. Standard of Review ............................................................... 6

II. First Issue: Trial court abused its discretion in denying Appellant’s motion to dismiss because Dr. Marks’ report does not sufficiently identify causation. ............ 7

III. Second issue: Trial court abused its discretion in denying Appellant’s motion to dismiss because Dr. Marks’ report and CV do not evidence adequate qualifications ............................................................................. 9

IV. Third Issue: The trial court abused its discretion in failing to dismiss Appellee’s claims. ....................................... 10

Prayer ....................................................................................................... 11 Certificate of Service ............................................................................. 12

iii Certificate of Compliance .................................................................... 13 Appendix Contents ................................................................................ 13

iv

INDEX OF AUTHORITIES

Cases

Baker v. Gomez, 276 S.W.3d 1, 8 (Tex. App.–El Paso 2008, pet. denied) .................... 6

Bowie Memorial Hosp. v. Wright, 79 S.W.3d 48, 53 (Tex. 2002) ......................................................... 6, 9

Buck v. Blum, 130 S.W.3d 285 (Tex. App.–Houston [14th Dist.] 2004, no pet.) ..... 6

Cayton v. Moore, 224 S.W.3d 440 (Tex. App.–Dallas 2007, no pet.). .......................... 10

Columbia N. Hills Hosp. Subsidiary, L.P. v. Tucker, No. 05-14-00056-CV, 2014 Tex. App. LEXIS 13685 (Tex. App.— Dallas Dec. 22, 2014, no pet.) ......................................................... 7, 8

Fortner v. Hosp. of the Sw., LLP, 399 S.W.3d 373 (Tex. App.—Dallas 2013, no pet.) ............................. 9

Foster v. Zavala, 214 S.W.3d 106 (Tex. App.—Eastland 2006, pet. denied) ................. 11

Hollingsworth v. Springs, 353 S.W.3d 506 (Tex. App.–Dallas 2011, no pet.) ......................... 6, 10

Jones v. Ark-La-Tex Visiting Nurses, Inc., 128 S.W.3d 393 (Tex. App.—Texarkana 2004, no pet.) .................... 10

Ortiz v. Patterson, 378 S.W.3d 667 (Tex. App.—Dallas 2012, no pet.) ............................. 7

Rittmer v. Garza, 65 S.W.3d 718 (Tex. App.–Houston [14th Dist.] 2001, no pet.) ........ 6

Simonson v. Keppard, 225 S.W.3d 868 (Tex. App.–Dallas, 2007, no pet.). ......................... 10

v

Windsor v. Maxwell, 121 S.W.3d 42 (Tex. App.–Fort Worth 2003, pet. denied) ................. 6

Statutes Tex. Civ. Prac. & Rem. Code § 51.014(a)(9) ............................................. 3, 6 Tex. Civ. Prac. & Rem. Code § 74.351 ............................................. 1, 3, 9, 13 Tex. Civ. Prac. & Rem. Code § 74.402 ......................................................... 9 Rules TEX. R. APP. P. 39.1 ...................................................................................... ii TEX. R. APP. P. 39.8 ..................................................................................... ii TEX. R. APP. P. 9.4 ....................................................................................... 13

vi

01-15-00793-CV

In the Court of Appeals For the First District of Texas at Houston

Nexion Health at Beechnut, Inc. d/b/a Beechnut Manor, Appellant,

v.

Maria Moreno, Individually and as Representative of the Estate of Mario Moreno, Appellee.

On Appeal from the 133rd Judicial District Court of Harris County, Texas Cause Number: 2015-01975 The Honorable Jaclanel McFarland, Presiding Judge

TO THE HONORABLE COURT OF APPEALS:

Appellant Nexion Health at Beechnut, Inc. d/b/a Beechnut Manor complains of the trial court’s Order denying its motion to dismiss Appellee’s lawsuit for failure to serve an expert report that complied with Texas Civil Practice and Remedies Code Chapter 74.351, and shows:

STATEMENT OF THE CASE

This is an interlocutory appeal from a health care liability claim filed under the Texas Medical Liability Act. Mario Moreno was a resident at Beechnut Manor (“Beechnut”) between April and May 2013, and passed away on May 30, 2013. CR:22. In January 2015, Maria Moreno (“Plaintiff” or “Appellee”), the underlying plaintiff, filed suit against Beechnut, alleging claims for medical negligence stemming from Mr. Moreno’s residency at the Beechnut facility in 2013. CR:20-26.

On February 23, 2015, Appellee served Beechnut with the purported expert reports and CVs of (1) Dr. Donald H. Marks (“Dr. Marks”) and (2) Nurse Rhonda Rotterman (“Nurse Rotterman”). CR:27-63. On June 29, 2015, Beechnut filed objections to both reports and a Motion to Dismiss the complaint based on deficiencies in the reports. CR:⁶-19. Appellee filed a response to the motion to dismiss on August 21, 2015. CR:81-88. The trial court heard Beechnut’s Motion to Dismiss on August 24, 2015 and signed an order denying the motion. CR:143. On September 14, 2015, Beechnut timely filed its Notice of Accelerated Appeal.

STATEMENT OF JURISDICTION

This Court has jurisdiction over this accelerated appeal pursuant to Texas Civil Practice and Remedies Code section 51.014(a)(9), because Beechnut seeks interlocutory relief from an order denying the relief sought by a dismissal motion under Section 74.351(b).

ISSUES PRESENTED

FIRST ISSUE

Did the trial court abuse its discretion when it denied Appellant’s motion to dismiss because Dr. Marks’ report fails to establish the causal relationship between the alleged harm and Beechnut’s conduct?

SECOND ISSUE

Did the trial court abuse its discretion when it denied Appellant’s motion to dismiss because Dr. Marks’ report and CV show that he lacks the requisite qualifications?

THIRD ISSUE

Did the trial court abuse its discretion when it failed to dismiss Appellee’s claims?

STATEMENT OF FACTS

Appellee’s complaint alleges that Beechnut breached its duties and was negligent in “one or more of the following ways:

a. Failing to exercise ordinary care while treating a patient; b. Failing to adequately diagnose and treat a patient;

c. Failing to provide adequate supervision to a patient;

d. Failing to provide adequate supervision when the patient returned to the facility; e. Failing to act as a reasonable and prudent medical care facility would under the same or similar circumstances; and

f. Failing to adequately assess medical condition.” CR:23. Appellee alleges that “Defendant’s acts and omissions were a proximate cause of Plaintiff’s injuries.” Id.

Dr. Marks’ report states that Mr. Moreno fell outside of the Beechnut facility on May 23, 2013 and was found lying in the hallway of the Beechnut facility on May 29, 2013. CR:41. Dr. Marks states that Mr. Moreno’s death certificate indicates that he died of “blunt head trauma” on May 30, 2013. Id. Dr. Marks incorporates Nurse Rotterman’s opinion on the applicable standard of care and states that “based on reasonable medical probability, bruises, lacerations, blunt head trauma and death are all reasonably foreseeable injuries when a cognitively *5 impaired patient prescribed six different mind altering medications is improperly supervised and falls repeatedly.” Id. Dr. Marks’ opinion on causation consists of the following:

Mr. Moreno was prescribed and administered six different antipsychotic medications, was improperly supervised and fell on his head on two separate occasions, the latter of which directly preceded his death.”

Id.

Beechnut objected to both reports report and moved to dismiss Appellee’s complaint because Dr. Marks failed to causally link Beechnut’s alleged conduct to the injuries that led to Mr. Moreno’s falls or death. CR:15-17. Beechnut also objected that neither Dr. Marks’ nor Nurse Rotterman’s reports evidenced sufficient qualifications to opine on the standards of care and causation issues in this case. CR:9-12. The trial court denied Beechnut’s motion on August 24, 2015 and this appeal followed. CR:143.

SUMMARY OF THE ARGUMENT

The trial court abused its discretion because Dr. Marks’ report failed to causally link Beechnut’s alleged negligence to Mr. Moreno’s falls or death. Additionally, neither Dr. Marks’ report nor his CV shows that he is qualified to provide opinions concerning the alleged negligent activity in this case.

ARGUMENT

I. Standard of Review

An abuse of discretion standard of review is applicable to this case. Hollingsworth v. Springs, 353 S.W.3d 506, 512 (Tex. App.–Dallas 2011, no pet.). An abuse of discretion occurs when a trial court acts in an unreasonable and arbitrary manner, or when it acts without reference to any guiding principles. Rittmer v. Garza, 65 S.W.3d 718, 721-22 (Tex. App.–Houston [14th Dist.] 2001, no pet.). To the extent resolution of the issue before the trial court requires interpretation of a statute, a de novo standard is applicable. Id. at 722; Buck v. Blum, 130 S.W.3d 285, 290 (Tex. App.–Houston [14th Dist.] 2004, no pet.).

When reviewing the sufficiency of an expert report in a health care liability case, this Court is confined to the four corners of the expert’s report. Baker v. Gomez, 276 S.W.3d 1, 8 (Tex. App.–El Paso 2008, pet. denied). This Court may not draw inferences to supply necessary information missing from the expert’s report, nor construe a report in Appellee’s favor. Bowie Memorial Hosp. v. Wright, 79 S.W.3d 48, 53 (Tex. 2002); Windsor v. Maxwell, 121 S.W.3d 42, 50 (Tex. App.–Fort Worth 2003, pet. denied).

II. First Issue: Trial court abused its discretion in denying Appellant’s motion to dismiss because Dr. Marks’ report does not sufficiently identify causation.

To adequately address causation, an expert report under Chapter 74 must “explain, to a reasonable degree, how and why the breach [of the standard of care] caused the injury based on the facts presented.” Columbia N. Hills Hosp. Subsidiary, L.P. v. Tucker, No. 05-14-00056-CV, 2014 Tex. App. LEXIS 13685, *5-6 (Tex. App.—Dallas Dec. 22, 2014, no pet.) (citing Ortiz v. Patterson, 378 S.W.3d 667, 671 (Tex. App.—Dallas 2012, no pet.). The Court “may not ‘fill gaps’ in an expert report by drawing inferences or guessing what the expert likely meant or intended.” Id. at *6 (citation omitted).

A Chapter 74 expert report may not simply identify a breach and imprecisely state that the breach caused an injury. The report must explain the causal connection between the breach and the injury. That causal connection is missing in this case.

Dr. Marks’ report states that upon admission, Beechnut staff observed that Mr. Moreno “suffered from an impaired level of consciousness, impaired balance, schizophrenia, seizures and a tendency to wander” and that a physician’s examination shortly after his admission “indicated Moreno required long term residential nursing home care and close supervision and assistance.” CR:40. Dr. *8 Marks’ report notes that Mr. Moreno was prescribed six “mind altering medications” by the physician. CR:40-41.

Dr. Marks refers to Nurse Rotterman’s report and states:

Causation in this case is extremely straightforward. Mario Moreno was prescribed and administered six different antipsychotic medications, was improperly supervised and fell on his head on two separate occasions, the latter of which directly preceded his death.

CR:41. Dr. Marks concludes “that Beechnut Manor and its staff were negligent in the care and supervision of Moreno” which was “the proximate cause of Mario Moreno’s fall and subsequent death caused by blunt force trauma Moreno suffered during that fall.” Id.

Dr. Marks’ report does not contain any factual explanation of the causal connection between Beechnut’s alleged failure to supervise Mr. Moreno and Mr. Moreno’s falls on May 23 and May 29. Instead, he simply states that Mr. Moreno was “improperly supervised.” CR:41. This statement is conclusory and is legally insufficient to satisfy the Chapter 74 causation requirement. See Columbia N. Hills, 2014 Tex. App. LEXIS 13685, *12-13. Chapter 74 required Dr. Marks to explain how and why there would be a different result if Beechnut complied with the standard of care. Id. at *14-15. Although the court may read Nurse Rotterman’s report in conjunction with Dr. Marks’, Nurse Rotterman cannot *9 provide a causation opinion because she is not a physician and cannot cure Dr. Marks’ conclusory causation statements. Id. at *15-16.

The expert report must contain sufficiently specific information to demonstrate causation beyond conjecture—the mere provision of some insight into the plaintiff’s claims does not address causation adequately. See Bowie Mem'l Hosp., 79 S.W.3d at 52; Fortner v. Hosp. of the Sw., LLP, 399 S.W.3d 373, 379 (Tex. App.—Dallas 2013, no pet.). Dr. Marks was required to explain how the alleged negligence of Beechnut caused the conditions that led to Mr. Moreno’s death. Because Dr. Marks’ report did not do that, it failed to adequately address causation and the trial court erred in failing to dismiss Appellee’s complaint.

III. Second Issue: Trial court abused its discretion in denying Appellant’s motion to dismiss because Dr. Marks’ report and CV do not evidence adequate qualifications.

Dr. Marks’ report and C.V. failed to satisfy the expert qualification requirements of Chapter 74 because (1) he is not actively practicing health care in a nursing home—Beechnut’s healthcare field, and (2) he has no training or experience working in a nursing home or supervising nurses. Tex. Civ. Prac. & Rem. Code §§ 74.351(r)(5)(B) and 74.402. Chapter 74 requires that the expert be actively practicing health care in the “same field as the defendant health care provider.” Tex. Civ. Prac. & Rem. Code § 74.402(a)(2). When assessing the qualifications of a purported expert under Chapter 74, the trial court “may not draw *10 any inferences” and “must rely exclusively on the information contained within the four corners of the report.” Cayton v. Moore, 224 S.W.3d 440, 445 (Tex. App.– Dallas 2007, no pet.).

In this case neither Dr. Marks’ report nor his CV shows that he has any qualification or experience in a nursing home setting or supervising a nursing staff. Indeed, Dr. Marks’ report describes the “reasonable standard of care required of a hospital when treating patients similar to Mario Moreno.” CR:41 (emphasis added). The absence of any qualification relating to nursing supervision or nursing homes precludes the report from satisfying the requisites of Chapter 74. Simonson v. Keppard, 225 S.W.3d 868, 873 (Tex. App.–Dallas, 2007, no pet.); Jones v. Ark-La-Tex Visiting Nurses, Inc., 128 S.W.3d 393, 397 (Tex. App.—Texarkana 2004, no pet.). Accordingly, the trial court abused its discretion in denying Appellant’s motion to dismiss.

IV. Third issue: The trial court abused its discretion in failing to dismiss Appellee’s claims.

Dr. Marks’ report omits necessary causation information and does not reflect any qualifications to provide an expert opinion in this case. While the statute allows for a discretionary 30 day period to cure deficiencies where a deficient report is timely served, “[a] court may not provide opportunities to cure, however, when an expert report is ‘absent’ as opposed to deficient,” such as when a report “fails to address all required elements of a claim.” Hollingsworth, 353 S.W.3d at *11 524 (denying a health care liability claimant an opportunity to cure when the expert report “omitted any discussion of the element of causation,” so the “report could not qualify as a good faith effort to meet Chapter 74’s requirements”). Beechnut asks that this Court deny any opportunity to cure and require dismissal based on Dr. Marks’ lack of adequate qualifications. See e.g., Foster v. Zavala, 214 S.W.3d 106, 116 (Tex. App.—Eastland 2006, pet. denied) (An expert report by a person not qualified to testify does not represent a good-faith effort to comply with the definition of an expert report.). Alternatively, Beechnut requests that this Court remand the case to the trial court to determine whether to dismiss or grant Appellee an opportunity to cure.

PRAYER FOR RELIEF

WHEREFORE, PREMISES CONSIDERED, Appellant Nexion Health at Beechnut, Inc. d/b/a Beechnut Manor prays: that this Court reverse the trial court’s August 24, 2015 Order denying Appellant’s dismissal motion; that this Court render judgment holding Appellant is entitled to dismissal of Appellee’s claims with prejudice, and that this Court remand to the trial court to award Appellant its attorney’s fees and costs in the trial court and in this Court; and for general relief.

Respectfully submitted,

MACDONALD DEVIN, PC

By: /s/ Weston M. Davis Gregory N. Ziegler Texas Bar No. 00791985 GZiegler@MacdonaldDevin.com Weston M. Davis Texas Bar No. 24065126 WDavis@MacdonaldDevin.com

1201 Elm Street 3800 Renaissance Tower Dallas, Texas 75270 214.744.3300 telephone 214.747.0942 facsimile

Attorneys for Appellant

CERTIFICATE OF SERVICE

The undersigned attorney certifies that a true and correct copy of the foregoing Appellant’s Brief was served on all counsel of record in accordance with the Texas Rules of Appellate Procedure via e-Filing, on November 10, 2015.

/s/ Weston M. Davis Weston M. Davis

CERTIFICATE OF COMPLIANCE

Pursuant to TEX. R. APP. P. 9.4, I hereby certify that this petition contains 2,938 words, including those not required to be counted in the word limits. This is a computer-generated document created in Microsoft Word, using 14-point typeface for all text, except for footnotes which are in 12-point typeface. In making this certificate of compliance, I am relying upon the word count provided by the software used to prepare the document.

/s/ Weston M. Davis Weston M. Davis

APPENDIX CONTENTS

A. CR 143, Order denying Appellant’s Motion to Dismiss, signed August 24, 2015

B. CR 27-34; 40-42, Expert Report and C.V. of Dr. Donald H. Marks

C. Texas Civil Practice and Remedies Code § 74.351

Chris Daniel -District Clerk Harris County Envelope No: 6909288 By: WASHINGTON, PHYLLIS Filed: 9/14/20151:13:17 PM

( Cause No 2015-01975-133 j)t~ MARIO MORENO, lndMdually § IN THE DISTRICT COURT OF '/ and as Representabve of the ESTATE§ OF MARIO MORENO § § § v § HARRIS COUNlY, TEXA § § . NEXION HEALTH AT BEECHNUT, INC , § i 'G dfb/a BEECHNUT MANOR § 133m JUDICIAL DISTRI

ORDER DENYING DEFENDANT NEXION AT BEECHNUT, INC D/B/A BEECHNUT MANOR'S CHAPTER 74 MODON TO DISMISS

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ietri:faniillar with thØterrns ‘ nesIIGenice7 otxlinaiycaW and proximate cause. 4 TM Based upon my review of the medical records and death certificate of Mario Moreno a is my opinion that Beechnut Manor and its staff were negbgent in iho care and supervision of Mereno The negligent acts outlined above ware the proximate cause of Mario Morono”s tall and subsequent death caused by blunt force trauma Moreno eufr d dWing theft 1.

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Page 1 1 of 1 DOCUMENT

LexisNexis (R) Texas Annotated Statutes Copyright © 2013 by Matthew Bender & Company, Inc. a member of the LexisNexis Group All rights reserved.

*** This document is current through the 2013 3rd Called Session *** *** Federal case annotations: July 9, 2013 postings on Lexis *** *** State case annotations: July 31, 2013 postings on Lexis ***

CIVIL PRACTICE AND REMEDIES CODE TITLE 4. LIABILITY IN TORT CHAPTER 74. MEDICAL LIABILITY SUBCHAPTER H. PROCEDURAL PROVISIONS

GO TO TEXAS CODE ARCHIVE DIRECTORY

Tex. Civ. Prac. & Rem. Code § 74.351 (2013) § 74.351. Expert Report

(a) In a health care liability claim, a claimant shall, not later than the 120th day after the date each defendant's original answer is filed, serve on that party or the party's attorney one or more expert reports, with a curriculum vitae of each expert listed in the report for each physician or health care provider against whom a liability claim is asserted. The date for serving the report may be extended by written agreement of the affected parties. Each defendant physician or health care provider whose conduct is implicated in a report must file and serve any objection to the sufficiency of the report not later than the later of the 21st day after the date the report is served or the 21st day after the date the defendant's answer is filed, failing which all objections are waived.

(b) If, as to a defendant physician or health care provider, an expert report has not been served within the period specified by Subsection (a), the court, on the motion of the affected physician or health care provider, shall, subject to Subsection (c), enter an order that:

(1) awards to the affected physician or health care provider reasonable attorney's fees and costs of court incurred by the physician or health care provider; and

(2) dismisses the claim with respect to the physician or health care provider, with prejudice to the refiling of the claim.

(c) If an expert report has not been served within the period specified by Subsection (a) because elements of the report are found deficient, the court may grant one 30-day extension to the claimant in order to cure the deficiency. If the claimant does not receive notice of the court's ruling granting the extension until after the 120-day deadline has passed, then the 30-day extension shall run from the date the plaintiff first received the notice.

Page 2 Tex. Civ. Prac. & Rem. Code § 74.351

(d) to (h) [Reserved].

(i) Notwithstanding any other provision of this section, a claimant may satisfy any requirement of this section for serving an expert report by serving reports of separate experts regarding different physicians or health care providers or regarding different issues arising from the conduct of a physician or health care provider, such as issues of liability and causation. Nothing in this section shall be construed to mean that a single expert must address all liability and causation issues with respect to all physicians or health care providers or with respect to both liability and causation issues for a physician or health care provider.

(j) Nothing in this section shall be construed to require the serving of an expert report regarding any issue other than an issue relating to liability or causation.

(k) Subject to Subsection (t), an expert report served under this section:

(1) is not admissible in evidence by any party;

(2) shall not be used in a deposition, trial, or other proceeding; and

(3) shall not be referred to by any party during the course of the action for any purpose.

(l) A court shall grant a motion challenging the adequacy of an expert report only if it appears to the court, after hearing, that the report does not represent an objective good faith effort to comply with the definition of an expert report in Subsection (r)(6).

(m) to (q) [Reserved].

(r) In this section:

(1) "Affected parties" means the claimant and the physician or health care provider who are directly affected by an act or agreement required or permitted by this section and does not include other parties to an action who are not directly affected by that particular act or agreement.

(2) "Claim" means a health care liability claim.

(3) [Reserved].

(4) "Defendant" means a physician or health care provider against whom a health care liability claim is asserted. The term includes a third-party defendant, cross-defendant, or counterdefendant.

(5) "Expert" means:

(A) with respect to a person giving opinion testimony regarding whether a physician departed from accepted standards of medical care, an expert qualified to testify under the requirements of Section 74.401;

(B) with respect to a person giving opinion testimony regarding whether a health care provider departed from accepted standards of health care, an expert qualified to testify under the requirements of Section 74.402;

(C) with respect to a person giving opinion testimony about the causal relationship between the injury, harm, or damages claimed and the alleged departure from the applicable standard of care in any health care liability claim, a physician who is otherwise qualified to render opinions on such causal relationship under the Texas Rules of Evidence;

(D) with respect to a person giving opinion testimony about the causal relationship between the injury, harm, or damages claimed and the alleged departure from the applicable standard of care for a dentist, a dentist or physician who

Page 3 Tex. Civ. Prac. & Rem. Code § 74.351

is otherwise qualified to render opinions on such causal relationship under the Texas Rules of Evidence; or

(E) with respect to a person giving opinion testimony about the causal relationship between the injury, harm, or damages claimed and the alleged departure from the applicable standard of care for a podiatrist, a podiatrist or physician who is otherwise qualified to render opinions on such causal relationship under the Texas Rules of Evidence.

(6) "Expert report" means a written report by an expert that provides a fair summary of the expert's opinions as of the date of the report regarding applicable standards of care, the manner in which the care rendered by the physician or health care provider failed to meet the standards, and the causal relationship between that failure and the injury, harm, or damages claimed.

(s) Until a claimant has served the expert report and curriculum vitae as required by Subsection (a), all discovery in a health care liability claim is stayed except for the acquisition by the claimant of information, including medical or hospital records or other documents or tangible things, related to the patient's health care through:

(1) written discovery as defined in Rule 192.7, Texas Rules of Civil Procedure;

(2) depositions on written questions under Rule 200, Texas Rules of Civil Procedure; and

(3) discovery from nonparties under Rule 205, Texas Rules of Civil Procedure.

(t) If an expert report is used by the claimant in the course of the action for any purpose other than to meet the service requirement of Subsection (a), the restrictions imposed by Subsection (k) on use of the expert report by any party are waived.

(u) Notwithstanding any other provision of this section, after a claim is filed all claimants, collectively, may take not more than two depositions before the expert report is served as required by Subsection (a).

HISTORY: Enacted by Acts 2003, 78th Leg., ch. 204 (H.B. 4), § 10.01, effective September 1, 2003; am. Acts 2005, 79th Leg., ch. 635 (H.B. 2645), § 1, effective September 1, 2005; am. Acts 2013, 83rd Leg., ch. 870 (H.B. 658), § 2, effective September 1, 2013.

NOTES:

Applicability. -- Acts 2005, 79th Leg., ch. 635 (HB. 2645), § 2 provides: "This Act applies only to a cause of action that accrues on or after the effective date of this Act. An action that accrued before the effective date of this Act is governed by the law applicable to the action immediately before the effective date of this Act, and that law is continued in effect for that purpose." Acts 2013, 83rd Leg., ch. 870 (S.B. 658), § 3(b) provides: "Section 74.351(a), Civil Practice and Remedies Code, as amended by this Act, applies only to an action commenced on or after the effective date of this Act [September 1, 2013]. An action commenced before the effective date of this Act is governed by the law in effect immediately before that date, and that law is continued in effect for that purpose." 2005 amendment, substituted "original petition" for "claim" in the first sentence in (a). 2013 amendment, in (a), substituted "each defendant's original answer is" for "the original petition was" in the first sentence and in the third sentence, added "the later of" and substituted "report is served or the 21st day after the date the defendant's answer is filed" for "it was served"; and made a stylistic change.

LexisNexis (R) Notes:

Footnotes

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