### NUM BER 13-08- 0011 3-CV 

## COURT OF A PP EA LS T H I R T E E N T H D I S T R I C T O F T E X AS CORPUS CHRI ST I - 

## E D I N B U R G
RGV HEA LTHCA RE ASSO CIATES, INC. & LEGEND RGV M cA LLEN LP D/B/A LEGEND TR A NSIT IONA L CA RE-M cA LL EN, A pp ellan ts,
v. OF EL IA E ST EV IS , O D EL IA

MA R R OQ U IN , OREFELI NDA

CA RDENAS, DELIA

FLORES, M IKE M A R R OQ U IN , B A L D EMA RMA R R OQ U IN , O F EL IA M . EST EVIS, AS PE RSO NA L REP RES ENTA TIVE OF TH E ES TA

TE OF SA NT OS MA RR OQU IN, A pp ellees . On ap pe al f rom th e 3 32n d Dist rict C ou rt of H ida lgo C ou nty , T exas . 

## O P I N I O N B efo re C h ie f Ju st ic e Va ld ez a n d J u st ic es R o d rig u ez a n d V el a

Op inio n by

C hie f J us tice Vald ez Appel lan ts, R GV H eal thc ar e As soc iat es, Inc . & L e gen d RGV M cAl len LP d/b/a2

Leg e n d T ra nsi ti onal C ar e- McAl len ( col lec ti v ely “ RG V H eal thc ar e” ), appeal the deni al of thei r moti on to d ism is s t he heal thc ar e l iab il it y cl aims broug ht by

Odel ia Ma rroq uin , Orfelinda Cardena s Delia Flores, M ike Marroq uin, Ba ldem ar Marroq uin, a nd Of elia M. Este v is , indiv idua lly

and as person al represe nta tiv e of the Est ate of

Sant os Marroquin (collectiv ely “t h e M arroquins”) fo r the w rongf ul dea th of Sant os Marroquin. By a single is sue, R GV H eal thc ar e arg ues that the ex per t repor t submit ted bythe Ma rroq uin s does not
cons ti tute a g ood- faith e ff ort t o c omply w it h the ex per

t repor t req uirements

. See T EX
. C IV
. P R AC
. & R EM
. C OD E A NN . § 74.351( b) , (l ), (r )( 6) (Ver non Supp. 2008)

. W e af firm in par

t and
re v erse and remand i n par t. I. B A CKGRO UND On J une 1, 2005, Sant os, a ni nety -t hr ee y ear ol d w oman, w as admit ted t o R GV He a lt h ca re fo r re h a b ili tati on of a p o st -st ro ke co n d it io n . S a n to s su f fe re d f ro m di a b e te s, hi gh blo od press ur e, c oronar y ar ter y di seas e, and cong est iv e heart fail ur e. On the morni ng of J u n e 4 , 2 0 0 5 , n u rs e s d is c o ve re d t h a tS a n t o s ’s lo we r r ig h tle g wa s co o l a n d d id n o th a ve a pul se. Atnoon, Sant os w as transfer re d to the emerg ency ro om at Ri o Grande R eg ion al Hos pit al, and she under w ent a n embol ect omyto re mov e an emboli sm t hat h ad dev elo ped in her r ig ht leg

. Dur ing the procedu re , the surg eon dis cov er ed that Santos ’s r ig ht l eg w as p r e - g a n g r e n o u s a n d a mp u t a t e d i t a b o v e - t h e - k n e e . O n J u n e 1 0 , 2 0 0 5 , S a n t o s ’ s l o w e r l e ft leg w as noted to be co ol, but no furt her su rg ic al int er

v enti on w as order ed. Santos then dev elo ped at ri al fibr il lat ion , a fev er , and a ur ina ry tracti nfecti on. She di ed on June 13, 2005.M i c hael Koch, M

. D

. , was Sant os’ s at t endi ng p hy si ci an a t R G V H eal t hcar e. T he M ar r oqui ns 1 s u b s e q u e n tly n o n s u ite d h im , a n d h e is n o t a p a r ty t o th is a p p e a l.

T h e M a rr o q u i n s d i d n o t k n o w P a b l o ’ s a n d G ra c i e ’ s l a s t n a m e s w h e n th e y fi le d s u it, a n d d e s p i te 2 di scov er y , t he f am i l y has not ascer t ai ned t hei r l ast nam es. T o dat e, P abl o and G r aci e ha v e no t bee n ser v ed in th e u n d e r lyin g s u it, a n d th e y a r e n o t p a r tie s to th is a p p e a l. 3 On M ar ch 26, 2 007, the M ar ro q uin s sued RG V Heal thc ar e, J. M ic hael Koc h, M .D ., 1 Pabl o, a re g is tered nurs e, an d Graci e, a cer ti fied nurse’ s a ide

. The M ar ro q uin s a ll eg ed 2 that RG V H eal thc ar e w as: (1 ) direct ly l iab le for San tos ’s deat h, ( 2) v ic ar iou sl y l iab le under the d oct ri ne of respon deat super ior f or Pablo’ s and Graci e’s neg li g ence, and (3 ) li abl e for neg li g ent h ir ing and super v is io n ( co llecti v ely

“ the M ar ro q uin s’ s l iab il it y theo ri es” ). R GV Hea lt hcare ans w er ed w it h a g eneral deni al, pleaded for limi tati ons under chapter 74 of the ci v il pract ic e and re medies co de, see T EX
. C IV
. P R AC
. & R EM
. C OD E A NN
. §§ 74.301, 74.3 02, 74.303 (V er non 200 5) , and as ser ted v ar iou s a ff ir mati v e defenses

. On Ju ly 24 , 2 0 0 7 , t h e Mar ro qui n s t e n d e r e d a n e xpe rtrep o rtby Li ge B . Ru sh in g, M. D. , w ho, a fter rev iew ing Santos’ s medi cal r ecords from R GV H eal thc ar e and Ri o Grande Reg ion al Hos pit al, opi ned t hat: T he sta nda rds o f

ca re f or a lo ng-term care facility a nd its n ursing staf

f such as [R GV Hea lt h ca re ] req uires that they prov ide thatl ev el of car e and treatment that a re asona ble , pr udent, and s imi lar faci li ty w oul d prov ide under the same or similar circum stan ces. Each residentmustreceiv e an d the facility mu st provide the n ecessa ry care and serv ices to atta in or ma intain the highest practicab le, ph y sical, me nta l, and ps y chos oci al w ell bei ng , as d e f in e d by and in acc ordance w it h the comprehens iv e as ses sment and pl an of care. In orde r to mee t the stand ards of care in t h is c ase, Mrs. Marroquin should hav e had a dai ly

body ch e ck

. T his means ex aminat ion of the u pper extremit ies and the l ow er extr emit ies and her body for ev ide nce of edema, skin integrity, a n d wheth er the skin was dry , evi den ce of abrasion s, tea rs, ulc ers, and t he te mpera ture of the sk in. In t his ca se w hen t he c old r ig ht l eg w as noted, her phy si ci an w as noti fied.4

The probl em i s t hat t he ar ter ial oc cl usi on of the r ig ht l eg mor e l ik ely than not occ ur re d 24- 36 hours pri or to it s dis cov er

y . This is ev ide nced by

the fact th at her leg w as be y ond salv age w hen she f irst arri v ed a t the hosp ital. By the ti me M rs . M ar ro q uin ar ri v ed atR io Grande M edi cal C enter , her l eg was b e yon d sa lvage an d th e re w a s n o op ti o n , b u t t o am p u ta te he r le g. If the ar ter ial occ lus ion had been dis cov er ed ear li er then more li kel y then not h e r l e g c o u ld h a ve b e e n sa lva ge d b y t h e p e rf o rm a n c e o f a n e m b o le c t o m y. Th e failu re o f the n urses t o app ro pr iat ely mo ni to r M rs. Ma rro qu in res ulted in their failure to detect the arteri al t hrombosis a t or near the ti me i t occu rre d. As a res ul t, mo r e l i k el y t ha n no t, of t he s tres s a nd t r au ma she d eveloped co n ge s t iv e he art failure, at rial fibrillation , and subse quently mult iorg an fail ur e i .e. ki dney , l iv er and hear

t, w hic h resul ted i n her deat h. It shoul d be noted that Mrs. Ma rroq uin w as sta ble unti l the ti m e sh e dev elo ped her

ac ute a rt er ial oc cl usi on. Had the acut e ar ter ial oc cl usi on been diag nosed in a ti mely f ashi on th[e]n more li kel y than not the t hrombus coul d hav e been re mov ed and she w oul d hav e s ur v iv ed. (E mphasi s a dded.) On A ug ust13, 2007, RG V H eal thc ar e f iled obj ect ion s t o R ushi ng ’s repor t on the g rou nd s th at i t di d no t de fi ne th e s ta nd ard of c are, brea c h, an d c au s at i on as to ea ch defendant. R eg ardin g the caus ati on el ement, the o bje ct io n referenc ed w hat a ppears t o be a med ical report ab outa dif feren t pat ient’s injuries be cause it asserts: He re , P laintif [s]’s sole stat em ent s w ith regard to cau sation are: “[t]his com bina tion o f

proced ures po ten tially altered blood f low

to the nipple resulting in ev ent ua l n e c re osis;” and “[t]he cu mu lative ef fect of these proce dure s ap p e a rs t o ha v e cau sed n ipple ische mia and ev ent ual nip ple necrosi s a nd l oss of ti ss ue.” Simil ar to Costello , the se stat em ent s are co n clu sory

bec ause they

do n ot ex pla in how

or w hy the all eg ed fail ur e to meet t he s tandard of care c aused press ur e ul cer dev elo pment. F urther , t he sta tements do not ex pla in the medic al basi s or r eason ing for t he c oncl usi on t hatDefend ant ’s alleged breach “appe ars to ha v e cau sed n ipple ische mia and ev ent ual ne crosis and loss of tissue.” As a result, th e stat em ent s are conclu soryand thus f ail to satisf y the Cha pte r 74 requiremen ts.A r ev i ew oft he r ecor d do es no t r ev eal t hat t he M ar r oqui ns’ s cl ai m s i nv ol v e ni ppl e ne cr osi s or 3 p re s s u re u l c e rs . R G V H e a l th c a re ’ s o b je c ti o n s w e r e n e v e r a m e n d e d w i th i n th e tw e n ty -o n e d a y p e rio d to re fe re n c e R u s h i n g ’ s re p o rt a s to c a u s a ti o n . See T EX
. C IV
. P RAC
. & R EM
. C OD E A NN
. § 74. 351( a) (Ver non Supp. 20 08 ). 5 (c it ati ons omit ted.) RG V H eal thc ar e al so mov ed to di smi ss the sui t. See id. § 74.3 51(b ). 3 The M ar ro quins respon ded by cl aimi ng thatR ushi ng ’s r epor t w as adeq uate as to t he sta ndard of care, breach, and caus ati on and that itr epr esent e d a go o d- faith e ffort t o compl y w it h C hapter

74. In the e v ent t h a t t he tr ial co urt found t he repor t defic ien t, the Ma rroq uin s req uest ed a thi rt y -d ay extens ion to file a n a mended repor t. See id . § 74. 351 (c). On O cto ber

3, 2007, a hear ing on R GV H eal thc ar e’s obje ct io n s and moti on to dis mis s w as hel d, and the tr ial cour t acc epted post -h ear ing l etter br iefs. O n F ebr uar

y 12, 200 8, t h e t rial court overr uled the objection s and den ied th e mo tion to dismiss. T his int er loc utor

y appeal ens ued. See id . § 51. 014 (a)(9) ( Verno n 20 08). II. D I S CUS S I ON In a si ng le is sue, R GV H ealthca re arg ues that the t ri al cour t abu sed it s d is creti on in den y ing th e mo tion to dism iss b ecau se the Marroq uins failed to serv e a prop er expert
re por t. A . St and ard o f Rev iew an d A pp licab le L aw W e rev iew

the tr ial co urt’ s d eci si on to deny a mot ion to dis mis s u nder an a buse of dis creti on s tandard. Am . T ra nsiti onal C ar e C tr s. of Tex., Inc

. v. Pal

aci os , 46 S.W .3d 8 73, 877- 78 ( Tex . 200 1)

. The tr ial co urt is lim it ed to r ev iew ing the infor mati on w it hin the four
cor ners o f the repor

t. Id . at 87 8. “An ab use o f discretion o ccurs w hen a t rial cou rt a cts in
an arbitrary or u nrea sona ble ma nne r or w ithou t referen ce to an y g uiding principles.” Moore
v. Suther

lan d , 107 S.W .3d 7 86, 7 89 ( Tex . Ap p.–Tex ar kana 2003, pet. deni e d ) ( ci ti ng6

Gar ci a v . M ar ti nez , 988 S.W .2d 219 , 222 (Te x . 199 9)). An appe llate court ma y not reverse fo r a b u s e o f

d is c re t io n si m p ly b e c a u s e i t w o u l d h a ve d e c id e d t h e m a t t e r d if fe re n t ly. Downer v. Aquam ar

ine Oper ator s, Inc ., 70 1 S.W .2d 238 , 242 (Tex.198 5). “W ith respe ct to resolu tion of factu al issues or ma tters com mitt ed to the trial court’s dis creti on, for

ex ample, the re v iew ing co urt may not subs ti tute it s judg ment for that of the trial court.” W

alk er v. Packer

, 827 S.W .2d 833 , 839 (Tex.1 9 9 2 ). T h e a ppe llant m ust “estab lish thatthe tri al court could reaso nab ly have reache d on ly

one decision .” Id . at840. Con v ersel y , a tr ial courthas no dis creti on in deter mini ng w hat the l aw i s o r in appl y ing the law to the facts. “[A] clea r fa ilure by the trial court to ana lyz e or app ly the law correctly w ill const itute an ab use o f

discretion. ” Id

. Sect ion 74 .35 1 requires that a plaintif f serv e on each party “one or m o re ex pert
re por ts, w it h a c ur ri cul um v it ae of eac h e xpe rt l is ted i n the r epor t for each phy si ci an or hea lth care provider against w hom a liability c la im i s asserted .” T EX
. C IV
. P R AC
. & R EM
. C OD E A NN . § 74.351( a)

. An “ ex per t repor t” i s d efined as
a w ritten rep ort by an e xp e rt t hatprovi des a fair summ aryof the expert’s opi nio ns as of the d ate o f the repor t reg ardin g appl ic abl e s tandards of car e, the man ner in w hich th e ca re rende red by the physician or hea lth care prov ide r faile d to meet t he s tandards, and the c ausal r ela ti onshi p betw e en that failu re and the i nju ry , har m, or damag es cl aimed. Id. § 74. 351( r) (6 ). A cour t must grant a m oti on to dismi ss under sec ti on 74. 351( b) i f, after the 120- day deadl ine has pass ed, it appears to the c our t t hat t he repor

t doe s n ot repr esent an obj ect ive, g ood- faith e ff ort t o c omply w it h the defini ti on of an ex per t repor t. Id . § 74. 351 (l). To q ual ify

as a “ g ood- faith e ffort,” the re por t must “ prov ide enoug h i nformati on to fu l fi l l tw o p u r p o s e s ” : ( 1 ) i tm u s t“ i n fo r m t h e d e fe n d a n to f t h e s p e c i fi cc o n d u c tt h e p l a i n t i ffR G V H eal t hcar e nev er am ended i t s obj ect i on t o R ushi ng' s r epor t wi t hi n t he t went y - one day per i od 4 af t er R ushi ng' s r epor t was ser v ed. Adm i t t edl y , R G V H eal t hcar e f i l ed a l et t er br i ef on Sept em ber 20, 200 7. H o w e v e r, b y th a t d a te th e tri a l c o u rt c o u l d h a v e o n l y c o n s i d e re d th e A u g u s t 1 3 , 2 0 0 7 o b je c ti o n s . See T EX
. C IV
. P RAC
. & R EM
. C OD E A NN
. § 74

. 351( a) ( “ Each def endan t phy si ci an o r heal t h car e pr ov i der whose conduct i s i m pl i cat ed i n a r epor t m ust f i l e an d ser v e an y obj ect i on t o t he suff i ci ency oft he r epor t not l at er t han t he 2 1st d a y a fte r th e d a te i t w a s s e rv e d , f ai ling whi ch al

l objecti ons a re wai ved

. ”) (em ph as i s ad de d). 7 has cal led i nto q uest ion ,” and (2 ) itmust“ prov ide a basi s for the tr ial cour t t o c oncl ude t hat th e c la im s h a v e me rit.” Pal aci os , 46 S.W .3d a t 879

. “A r epor t t hat merely

st ates the expert’s conclusion s abo ut th e stan dard of c a re , b re ach, and causa tion d oes n ot f ulf ill thes e tw o pur poses . Nor ca n a re por

t meetthes e pur poses and thus co nst it ute a good-faith e f

fort if it omits an y

of the sta tuto ry

requirem ent s.” Id

. B. Waiv er At t he outset, w e address w hether R GV H eal thc ar e w aiv ed i ts chal len g e to the
cau s at i on el em en t be c au s e i ts ob j ec ti on do es no t r efe r en c e R us hi ng ’ s r ep or t at all. Inste ad, RGV Healthca re assails the ade quacy of Rushing’s repo rt b y

referring to an ex pert
re por t on a di ff er ent p ati ent’ s mal adi es. At o ra l arg ument, the M ar ro q uin s s ug g est ed th at 4 the object ion w as insuff icient an d did no t preserve the issue for our rev iew beca use it
er ro neous ly

referenc ed a different ex pert re por t. R GV H eal thc ar e c ontende d tha t i ts obj ect ion w as proper ly pr eser v ed becau se the Ma rroq uin s, by re spond ing to t he obj ect ion , app aren tly

comp rehe nde d it. I n the ir w ritten respo nse, the Marroquins did no t referen ce RGV Health care’s causa tion a rg um ent ; the y sim ply urged the t rial cou rt to f ind Rush ing’s
re por t s uff ic ien t on all of the e lement s. RG V Hea lt hcare’s “a pparentl y it w as pr eser v ed” arg ument bel ies the fact th at i t had the b urden t o ar

ti cul ate a n obj ect ion and ass umes t hat, b y re sponding to w hat t hey
cons ide re d a g ener ic , boi ler pla te ob jec ti on, t he M ar ro q uins conv erted a n i ncohe re nt obj ect ion i nto a s u f

f ici ent o ne. See T EX
. R. A PP
. P. 33.1 (p ro v idi ng the pr er eq uis it es to8

pr eser v ing a c omplai nt for

appel lat e rev iew ); Esta te of Veale v. Teled

yne Indu s., Inc. , 899 S.W .2d 2 39, 2 42 ( Tex . Ap p.–H oust on [1 4th D is t.] 1995, w ri t den ied ) (p ro v iding that the burden is on the compl ain ing par ty to pr esent a suffici ent re cord to the a ppel lat e c our t t o show error requiri n g re versal). Accordingly , RGV Health care’s obje ction to “Rushing’s repo rt” on the ground thatit wa s c o n c lu soryin opining on th e cau se of Sant os’s “nipple
necrosi s” and “p re ss ur e ul cer dev elo pment” is ins uff ic ien t becau se it is not re lat ed to the facts of this ca se, present s n othi ng for o ur r ev iew , and i s w aiv ed. C. Direc t Liability The M ar ro q uin s p lea ded, inter alia , that RG V Hea lt hcare w as direct ly li abl e for the all eg ed l y n eg l i g en t c are th atS an to s rec ei v ed

. B efo r e th e tr i al c ou rt, R GVHealthca re obj ect ed to R ushi ng ’s opi nio n on it s d ev iat ion from t he s tandard of care on the g ro und t hat his repor t di d “ not expla in what [ RG V H eal thc ar e] s houl d hav e done differentl y and d[i d] notput [RGVHealthca re on] n otice o f the com plaine d o f

c ond uct.” On inte rlocuto ry appeal , R GV H eal thc ar e arg ues that the repor t di d not spec ific all y ide nti fy it by name w it h to reg ard to how

i t breache d the st andard of care. W e ag re e. Al thoug h R ushi ng opi nes that RG V H eal thc ar e w as req uired to “ prov ide thatl ev el of care and tr eatment that a reason abl e, pr udent, and si mil ar f aci li ty w oul d prov ide under the same or si mil ar ci rc umstan ces ,” his re por t impl ic ates onl y the condu ct o f Pa b lo and Graci e, RGVHeal thc ar e employ ees. See Gar dner v. U .S. Im agi

ng, Inc ., 274 S. W .3d 6 69, 671- 72 ( Tex

. 2008) (p er cu ri am) (h old ing that“ [w]hen a par ty ’s al leg ed heal th c ar e l iab il it y is purely v ic ar iou s, a repor

t t hat adeq uatel y impl ic ates the act ion s o f that pa rty 's ag ents or em ployees is suf

f icient. ”)

. Rushing’s repo rt did notspea k as to ho w RGV Healthca re’s d ir e c tco n d u c t , su c h a s t h e im p le m e n t a t io n o f p ro c e d u re s , p o li c ie s , o r r u le s t h a tco u ld h a ve9

ensured v ig il ant c ar e, de v iat ed from t he appl ic abl e s tanda rd o f c a re . See C tr

. f or Neu ro logic al Di

sor der s v . G eor ge , 261 S.W .3d 285, 294 (Tex . App.–F ort W orth 20 08, p et. deni ed) ( op. o n re mand) (fin din g an ex per t re por t defici ent as to a cl aim for directl iab il it y ag ain st a professi onal as soc iat ion bec ause itonl y di sc uss ed th e as soc iat ion ’s v ic ar iou s liability and not its spe cif ic condu ct). Accordingly , the re is not hing in t he reco rd to sup port the t ri al cour

t’ s d ecision, and w e hol d tha t i t abu sed it s d is creti on by deny ing R GV Hea lt h c a r e ’ s o bj e c t i o n t o R u s h i n g ’ s r e p o rta s i tr e l a t e d t o t h e M a r ro q u i n s ’ s d i r e c tl i a b i l i ty claims. D. Vic arious Liability 1. The Taylor Case RG V H eal thc ar e c ontends Ru shi ng ’s r epor t i s d efici ent b ecaus e i t doe s n ot de l i ne at e th e s ta nd ard of c are an d brea c h for P ab l o’ s a nd G r ac i e’ s i nd i v i du al c on du c t. To suppo rti ts cont enti on, R GV Hea lt hcare re li es on th is C our t’ s o pin ion i n Tay

lor v. C hr is tus Spohn Hea lt

h Sy s. Cor p. , 169 S.W .3d 2 41 ( T ex . Ap p.–C or pus Chr is ti 2004, no p et.)

. In Tay lor , a h e a lt h c a re li a b il it y cl a im a n tsu e d a n e m e rg e n c y ro o m p h ys ic ia n , a h o s p it a l, two card io lo gists, an d a c ardio log y as soc iat ion under

C hapter 74' s p re deces sor . Id . at242. The cl aimanttend er ed an ex per t repor t t hat p re sent ed onl y

a s ing le sta ndard of care and
ass erted t hat it w as eq ual ly appl ic abl e to all par ti es inv olv ed. Id . at246. The de fendants
mo v ed for dismissa l on the g roun ds tha t the report w as con clusory and thatit imprope rly g ro uped al l the d efendants tog ether , thereby faili ng to s peci fical ly address the sta ndard of
care and br each of duty w it h respec t t o eac h defendant. Id . at243. The t ri al cour t g ra nted the d efendant’ s mot ion and dis mis sed the s uit

. Id . a t 242. W e aff ir med and noted that “[c]ollective assertion s of neglig ence against v arious de fend ant s are inad equate .” Id . atI n Jim enez , hea l t hcar e l i abi l i t y cl ai m ant s sue d a s urg i c al f aci l i t y , t he su r geon, t wo nur ses, and a 5 c e rti fie d re g i s te re d n u rs e a n e s th e ti s ts (“C R N A ”)

. R enaissance Sur gi cal C ent er s- Sout h Texas, L. L. P. v. Jim enez , N o. 13- 07- 00121
- C V, 200 8 T ex. App. LEX I S 685 7, a t * * 2- 3 ( T ex. App. –C or pus Chr i st i Aug. 28, 2008, no pet

. ) ( m em o op. )

. T he cl ai m s agai nst t he sur gi cal f aci l i t y wer e br ought und er t heor i es of di r ect and v i c a rio u s l i a b i l i ty

. Id . a t **1 2 -2 5 . A s to th e vic a rio u s l i a b i l i ty th e o ry a g a i n s t t h e s u rg i c a l fa c i l i ty , t h e c l a i m a n ts te n d e re d a re p o rt b y a n a n e s th e s i o l o g i s t th a t o u tl i n e d a l l e g e d o m i s s i o n s m a d e b y th e C R N A

. Id

. at * * 12- 14. T he sur gi cal f aci l i t y obj ect ed o n t he g r ounds t hat t he r epor t di d no t speci f i cal l y i dent i f y i t norexpl ai n ho w i t was v i c a rio u s l y li a b l e , a n d i t m o v e d fo r d i s m i s s a l

. Id . a t *1 5

. T h e C N R A a l s o m o v e d fo r d i s m i s s a l

. Id

. at * 2, n3. T h e tria l c o u rt d e n i e d b o th m o ti o n s to d i s m i s s . Id

. at * 5. O nl y t he su r gi cal f aci l i t y app eal ed, and we aff i r m ed. Id

. at * 21. 10 2 4 4 (cit in g Doa des v. Syed , 94 S.W .3d 6 64, 6 71- 72 ( Tex . Ap p.–San Ant oni o 2002, no pet.) ). Tay

lor i s d i s ti ng ui s ha bl e be c au s e i t di d no t de al w i th h ea l th c ar e l i ab i l i ty c l ai ms ass erted u nder

a t heor y of v ic ar iou s l iab il it y . The defendants i n Tay lor w er e uni q ue heal thc ar e prov ide rs w ho had all been s e rved , appear ed befor e the tr ial co urt, and obj ect ed to the ex per

t re por t off er ed by the cl aimant

. No w her e i n Tay lor di d w e menti on
v ic ar iou s li abi li ty cl aims

. In thi s c ase, the Ma rroq uin s s ued R GV H eal thc ar e, P abl o, an d Graci e. Pabl o and Graci e hav e notbeen ser v ed and ar e notpar

ti es to t his appeal. As to RG V H eal thc ar e, t he M ar ro q uin s a ss e rted t hr ee l iab il it y theo ri es ag ain st it , and they prese nte d a repo rt th at singled outa lleged om issions ma de b y RGV Healthca re’s nurses. RGV Health care, respo ndin g to only the v icarious l iability the ory , obje cted to t h e rep ort beca use it did n ot de lineat e the ex pert rep ort requireme nts as to Pablo , Gracie, an d itself and reli ed on Tay

lor a s o n p o in ta u t h o ri t y. Tay lor , howev er, d o e s n o t re qui re t h a t an ex per t repor t del ine ate a nd define allegedly negligent cond uct as be tw een an agent a nd a principa l b ecau se it implicitly dea lt
w it h di re ct li abi li ty

cl aims

. Fur

ther more, i n a memorand um opi nio n i ss ued four y ears a fter Tay lor , w e decli ned to draft the ru le thatRGV Heal thc ar e urg es on us. See J im enez , 200 8 Tex . Ap p. LE X IS 6 857, at * *12- 21. 511

Th e d i s s e n t p o s i t s t h a t o u r h o l d i n g i n t h i s c a s e c o n fl i c ts w it h Tay lor bec ause that
cas e sta n d s f o r the p ro posi ti on th at an ex per t repor t mus t ex pla in how

eac h defendant brea ched the sta nda rd of ca re. I t doe s, w hen e ach def end antis sued o n a the oryof direct li abi li ty , i s s er

v ed w it h c it ati on, a nsw ers the sui t, and chal len g es the ex per t re por t. Butthat i s n o tt h e c a s e h e r e . I n es s e n c e , th e di s s e n ti g n o r e s th e pro c e d u r a l p o s t u r e o f Tay lor to read into the case its own un prece den ted requirem entthatan expert repo rt deta il specif ic and discrete con ductof indiv idua l emp loyee s — in t his case Pa blo an d Gracie—whose sta ndard of c ar e has already been defined as a cl ass . W e w il l not c ontor t our precede nt to resul t s uch a resul t. 2. The Railsback Case T he Marroquins argue tha t Rushing’s rep ort prop erly set forth th e stan dard of care for nu rs es—the p osi ti ons that Pabl o and Graci e hel d w hil e empl oy ed by R GV Hea lt hcare—and how

they breache d tha t s tandard of care. Theydir ectus to the Railsback
cas e as su ppor

ti ng auth or it y . In University of Texas Med ical B ra n ch v. Railsback , a heal thc ar e l iab il it y

cl aimantsu ed th e hos pit al w her e she had an all eg edl y neg li g ent k nee s u rg e rya n d t h e su rg e o n s wh o p e rf o rm e d t h e p ro c e d u re . 25 9 S

. W

. 3 d 8 6 0 , 8 6 2 (T e x. App.–H oust on [1 st Di st. ] 2 0 0 8 , n o pet. ). The c lai mant as ser ted t hat t he hos pit al w as direct ly l iab le and v ic ar iou sl y

l iab le for th e s urg eon’ s a nd nursi ng st a f f’s n eg li g ence. Id

. She t endered an ex per t medica l re por

t that detai led the sta ndard of care for t he s urg eon and the “o per ati ng ro om nursi ng sta ff ,” but it nev er re ferenc ed any nurse by name. Id . at 866 -6 7 . Th e ho spital objected to the report an d mo v ed for dismissa l, but th e trial court deni ed th e hos pit al’ s o bje cti on and moti on. Id . at864. On i nter loc utor

y appeal , t he hospi tal arg ued that the repor t c oul d notsu ppor

t, inter12

alia , the claims for di re c t liab ility and v icarious liability base d up on th e nu rsing staf f ’s all eg ed neg li g ence. Id . at864- 66. The Hou sto n Fi rs t Di str ic t C our t of Appea ls hel d tha t the t ri al cour

t abu sed it s d is creti on by not dis mis si ng the directl iab il it y cl aims

. Id . at866. It als o hel d tha t t he tr ial co urt di d notabus e i ts dis creti on in deny ing the hospi tal ’s moti on to di smi ss as to the v ic ar iou s l iab il it y cl aims bec ause the c lai mant had not named any
nurse as a defendant. Id . a t 8 6 8 (cit in g Kett le v. Bayl

or Me d. Ct

r. at Gar lan d , 232 S.W .3d 832, 841 ( Tex . Ap p.–D all as 2007, pet. deni ed) ; Tov ar v. Methodi

st Hea lt hcar e Sy s. of S an Antoni o, Ltd. , 185 S.W .3d 65, 70 (Tex. App. –Sa n Ant onio 200 5, pe t. de nied )). RG V H eal thc ar e focus es on th e c lau se noti ng thatthe cl aimanthad not named any
nurse as a defendant and c ontends that Railsb a ck is distinguishable f rom th is case becau se the M ar ro q uin s n amed Pabl o and Graci e a s d efendants. Bu t, nei ther the Railsback

C our t nor the tw o c our

ts that itcite s e xpla in why an e x per

t repor t may g ro up nurses tog ether

i f a hospi tal i s a ll eg ed to be v ic ar iou sl y l iab il it y f o r thei r act ion s a nd th e nurse s are notsued . Furtherm ore, RGV Health care ha s not pro v ided us w ith a ration ale for th e “ not s ued” req uirement. Gi v en th e l ack of suppo rt ing rati ona le f or the “n ot s ued” requireme nt, th at Pa blo an d Gracie ha v e no t bee n served and are notparties to this appeal , and thatR ushi ng ’s repor t det ail s t he c onduc t of v ic ar iou sl y l iab le par

ti es, w e s ee no reason to appl y

i t i n the i nst ant c ase. 3. An alysis Sect ion 74 .35 1 requires that the p laintif f se rv e on each d ef end antwhose con duct is i mpli cat ed by

a he alt hcare l iab il it y

cl aim an ex per

t repor t that s ets forth the sta ndard of
care, breach of that s tandard, an d c ausat ion

. T EX
. C IV
. P R AC
. & R EM
. C O D E A NN . § 74.351( a) , ( r) (6 ). W hen a pla int iff’s cl aim ag ain st a hospi tal is not for directneg li g ence, but13

is based on t he c onduc t of an e mploy ee th ro ug h the doc tr ine of re spond eat s uper ior , t he
ex per t repor t nee d noti denti fy the h ospi tal by name or inc lud e an opi nio n abouthow the employ ee w as act ing i n the co urse and s cope of employ ment for the h o sp it a l. Uni v. of Tex. Sw. Med. Cente r v. D ale , 188 S.W .3d 8 77, 8 79 ( Tex . Ap p.–D all as 2006, no pet .)

. In fact, a medi cal ex per

t w oul d notbe q ual ified to re nder such an opini on on the l eg al is sue of v ic ar iou s l iab il ity . Id

. at 879 n. 1; see als o In reC HC A C onr oe, L .P. , N o. 09 -0 4- 453- CV , 2 0 0 4 T e x. Ap p . L EXI S 1 0 4 8 1 , at*3 (T e x. Ap p .– Be a u m o n t No v. 23 , 2 0 0 4 , o rig. pro ce e d in g) (mem. op.) ( “The condu ct by the hospi tal on w hic h the a g ency r ela ti onshi p depen ds is not
measured by

a medi cal st andard of care. These ar e pr inc ipl es of ag ency l aw on w hic h no
ex per t repor t i s req uired.” ). If the repor

t i denti fies condu ct by

the hospi tal ’s empl oy ee, t he hos pit al is i mpli cat ed, and as l ong as the re por t ade q uatel y

ad d re ss e s th e st andard of care appl ic abl e to the employ ee, h ow

the employ ee breache d the st andard of care, an d tha t t he breach caus ed the plaintif

f 's injury , it is suf

f icient as against t h e h o spital to satisf y the expert repo rt
re q uirement for

the v ic ar iou s l iab il it y

cl aims

. Dale , 188 S.W .3d a t 879 ; see als o C asado s
v. Harris Metho dist H-E-B , No. 02-0 5-08 0-CV, 20 06 T ex. App. LE XIS 6357 , at *12 (T e x. App .–Fo rt W orth 20 06, no pe t.) (mem . op. ) ( hold ing plaintif f s a t is f ied expert repo rt
re qui rements w it h respec t t o v ic ar iou s l iab il it y cl aims by

fil ing ex per

t repor t det ail ing negligence of

docto rs, fo r w hose action s hosp ital w as liable). Rus hin g ’s repor

t prov ide d tha t t he s tandard of ca re for n urses at re habi li tati on facilities such as RGV Hea lthcare was to p erform daily bod y checks of

the extremitie s for, among othe r thi ng s, body temperature. A s t o breach, the re por t not es that Rus hin g re v iew ed R GV H eal thc a re ’s medi cal r ecords, and the repor t doe s n ot ment ion w hetherT he di s s en t s u m m a ril y s t ates t ha t be c au s e “t he M arroq ui ns fai l ed t o s erve an ex pe rt repo rt 6 ad dre s s i ng t he i r cl ai m s f o r n eg l i ge nt hi ri ng , su pe rvi s i on , t rai ni ng , an d reten t i on , I be l i eve t ha t t he t ri al co urt w a s r e q u ir e d to d is m is s th e c o m p la in e d
- o f c la im s u p o n a p p e lla n ts ’ r e q u e s t. ” T h e p r o b le m w ith th e d is s e n t’s posi t i on i s t hat R G V H eal t hcar e ne v er l odged an obj ect i on agai nst R ushi ng’ s r epor t as t o t he a f or em ent i oned c l a i m a n d n e v e r m o v e d to d i s m i s s th a t c l a i m . 14 daily bod y

checks w ere no ted in the record s. Accordingly , w e ho ld tha t the trial court did notabu se its discret io n b y r elyi ng on Rushing’s report to sa tisf y the expert repo rt
re q uirements on t he M ar ro q uin s’ s v ic ar iou s l iab il it y cl aims ag ain st RG V H eal thc ar e. E. Negligent Hiring and Superv ision T he Marroquins’s third l iability the ory against R GV H ealth care i s thatit neglig ent ly hired and super

v is ed empl oy ees. The c ontext of Rushi ng ’s r epor

t c lea rl y i mpli cat es RG V Hea lt hcare’s ro le as Pabl o’s and Graci e’s su per v is or . How ev er , nei ther before the t ri al
cour t nor on i nter loc utor

y appeal has R GV H eal thc ar e ar ti cul ated a n o bje cti on, i ss ue, o r argume nt in w hich it asserts th at Rush ing’s repo rt w as de f icient a s t o the Marroquins’s neg li g ent hir ing and super v is ion theo ry . Acc ordin g ly , t he i ss ue i s w aiv ed. See T EX
. R. A PP
. P. 33.1. Cf

. Obste tr ic al & Gy

necol ogical As socs., P.A . v

. McC oy, N o. 14 -0 8- 00762- CV , 2009 Tex . Ap p. LE X IS 2 410, at * 14 ( Tex . Ap p.–H oust on [1 4th Di st. ] Apr

. 9, 2009, pet. filed ) (holdin g tha t a prof ession al associa tion’s objection regarding the suf f iciency of

an expert
re por t’ s o pin ion on a cl aimant ’s vic a rious l iab il it y cl aim ag ain st the a ss oci ati on i s w aiv ed
w hen a proff er ed repor t det ail ing the ass oci ati on’ s d oct or ’s co nductsu ff ic ien tl y i mpli cat ed the a ss oci ati on and the a ss oci ati on di d notobj ect ). 6 RG V H eal thc ar e’s first is sue sus tai ned i n par t, and ov er ru led i n par

t. III . C ONCL US I ON W e aff ir m the tr ial court ’s order deny ing R GV H eal thc ar e’s obj ect ion s a s i t rela tes t o t h e M a r ro q u i n s ’ s c l a i m s fo r v i c a r i o u s l i a b i l i t y

a n d n e g l i g e n th i r i n g a n d s u p e r v i s i o n . W e15

re v er se t h e t r i a l c o u rt ’ s o r d e r a s i t r e l a t e s t o t h e M a r ro q u i n s ’ s d i r e c t l i a b i l i t y c l a i m. The
cas e i s remanded s o tha t t he tr ial co u rt m ay co nsi der

w hether

to g ra nt a thi rty -d ay extens ion to cure defects i n t h e r e p o rt

. T EX
. C IV
. P R AC
. & R EM
. C OD E A NN . § 74. 351 (c); Lel and v . Br andal , 257 S.W .3d 2 04, 2 07 ( Tex . 200 8)

.

RO GELI O VA LDE Z Chief Justice
Di ss enti ng In Par

t and C oncur ri ng In Par t O pin ion by Ju sti ce Ros e Vel a. Opi nio n del iv er ed and filed on thi s t he 2nd day

of Jul y , 200 9.