Affirmed and Memorandum Opinion filed February 9, 2012.

In The

Fourteenth Court of Appeals

NO. 14-11-00392-CV

REBECCA MAXWELL, M.D., Appellant

V.

DONNA T. MARTIN, INDIVIDUALLY AND AS INDEPENDENT 

ADMINISTRATRIX OF THE ESTATE OF DAVID R. MARTIN, SR.

AND AS NEXT FRIEND OF DEVIN T. MARTIN 

AS SURVIVOR OF DAVID R. MARTIN, SR., Appellee

On Appeal from the 164th District Court

Harris County, Texas

Trial Court Cause No. 2010-37659

M E M O R A N D U M O P I N I O N

In this health-care-liability suit, appellant, Rebecca Maxwell, M.D., appeals the 

trial court‘s order denying Dr. Maxwell‘s motion challenging sufficiency of the amended 

expert report served by appellee, Donna T. Martin, Individually and as Independent 

Administratrix of the Estate of David R. Martin, Sr. and as Next Friend of Devin T. 

Martin As Survivor of David R. Martin, Sr.1 In her sole issue, Dr. Maxwell contends the 

 

1 We will refer to appellee as ―Martin‖ and her late husband, the subject patient, as ―David.‖
2

expert failed to sufficiently describe the applicable standard of care, Dr. Maxwell‘s 

alleged breach of such standard, and a causal relationship between any breach and the 

damages claimed. We affirm.

I. BACKGROUND2

After David was discharged from the United States Army in the 1990s, he was 

diagnosed with several psychiatric disorders, including Post Traumatic Stress Disorder

(―PTSD‖), Bipolar Disease, and ―ADHD.‖ On April 14, 2008, David, who was then 

forty-five years old, requested admission to Intracare Hospital for detoxification from 

addiction to Benzodiazepine and opiate narcotics. When admitted, David said he was 

taking twenty to thirty pills per day each of Valium (a brand of Benzodiazepine) and 

Vicodin (a brand of opiate narcotic) and ten other prescription medications, including 

Buproprion, Trazodone, and Depakote (which contains Volproic acid).

3 David also 

reported he was experiencing ―intermittent visual hallucinations.‖ It was noted in the 

hospital records that he was ―actively hallucinating during assessment . . . patient having 

more frequent verbal hallucinations and aggression . . . grandiose and hypersexual.‖

Dr. Maxwell treated David during his hospitalization and diagnosed ―Substance 

Dependence‖ in addition to the previously-diagnosed psychiatric disorders. Dr. Maxwell 

continued David on the medications he was taking when admitted although she ultimately 

eliminated one such medication, Ambien, and lowered the dosage of Depakote. At the 

outset of admission, Dr. Maxwell also placed David on ―Dr. Jason Baron‘s Opiate 

Withdrawal Protocol‖ (―the protocol‖), which consisted of Trazodone and six 

medications additional to those he was taking when admitted. A urinalysis subsequently 

performed during the hospitalization revealed that David either was not addicted to 

Benzodiazepine or opiates or had not recently taken those drugs. However, Dr. Maxwell 

 

2

In her live petition, Martin does not detail any factual background and instead pleads only 

various acts of negligence allegedly committed by the defendants, including Dr. Maxwell. Therefore, we

have gleaned from the expert report the factual background that appears undisputed at least for purposes 

of Dr. Maxwell‘s motion and this appeal.

3 At one point in his report, the expert referred to ―nine‖ prescription medications but later listed 

ten such medications. Nevertheless, this discrepancy is immaterial to our disposition.
3

did not discontinue the protocol. At some point, David was also given an anti-psychotic 

medication.

The hospital records note David was ―shakey [sic] . . . anxious . . . nausea . . . 

racing thoughts at night . . . hallucinating . . . very confused and irritable‖ on April 16, 

2008 and ―exhibiting an unsteady gait . . . sedated state‖ by that night. On the morning of 

April 17, 2008, medical personnel found David dead in his hospital bed. The autopsy 

report reflected that David died from ―Polydrug toxicity due to Buproprion, Trazodone 

and Valproic acid.‖

Martin filed this health-care-liability claim on behalf of herself, David‘s estate, 

and his son against Dr. Maxwell and several other defendants. In her live petition, 

Martin‘s sole allegation against Dr. Maxwell is a contention that she ―negligently 

order[ed] a dangerous detox drug protocol unnecessarily causing severe drug toxicity and 

death.‖

Martin timely served all parties with an expert report of George S. Glass, M.D., 

P.A., a psychiatrist. Only Dr. Maxwell filed a motion challenging sufficiency of the 

report relative to Dr. Glass‘s opinions on the applicable standard of care, Dr. Maxwell‘s 

alleged breach of such standard, and the causal relationship between any breach and 

David‘s death. The trial court conducted a hearing on Dr. Maxwell‘s motion. However, 

there is no reporter‘s record of the hearing or written order on the motion in the appellate 

record. In her appellate brief, Martin asserts the trial court orally overruled all objections 

to the report yet ―improperly‖ ordered Martin to serve an amended report to make the 

report ―idiot proof.‖ In Dr. Maxwell‘s appellate brief, she does not directly dispute this 

assertion. However, in trial court proceedings relative to the amended report, Dr. 

Maxwell suggested that the court had found the original report was deficient but, instead 

of dismissing the claim, ordered Martin to file an amended report.4

 

4 At a hearing (which was recorded) relative to the amended report, Dr. Maxwell reminded the 

trial court that it had found the original report was deficient but ordered Martin to serve an amended 

report to make the report ―idiot proof.‖ The trial court merely responded, ―I do remember saying idiot-
4

In any event, Martin served an amended report (hereinafter ―the report‖). Dr. 

Maxwell filed a motion challenging sufficiency of this report relative to the same 

elements he challenged with respect to the original report. In her response, Martin argued 

that Dr. Maxwell‘s motion was untimely. After a hearing, the trial court signed orders 

ruling Dr. Maxwell‘s motion was timely but denying the motion. Dr. Maxwell now 

presents this interlocutory appeal. See Tex. Civ. Prac. & Rem. Code Ann. § 51.014(a)(9) 

(West Supp. 2011) (authorizing interlocutory appeal from order denying motion to 

dismiss health-care-liability claim on ground that expert report was inadequate).

II. ANALYSIS

Chapter 74 of the Texas Civil Practice and Remedies Code governs Martin‘s 

health-care-liability claim. See generally Tex. Civ. Prac. & Rem. Code Ann. §§ 74.001–

.507 (West 2011 & Supp. 2011). Under this chapter, ―a claimant shall, not later than the 

120th day after the date the original petition was filed,‖ serve on a defendant physician 

―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.‖ Id. § 

74.351(a). If ―an expert report has not been served within‖ the 120-day period, on the 

defendant‘s motion, the trial court ―shall,‖ subject to section 74.351(c), dismiss the claim 

with prejudice. Id. § 74.351(b). If a report is served, a defendant physician must file and 

serve any objections to the sufficiency of the report ―not later than the 21st day after the 

date it was served. . . .‖ Id. § 74.351(a). If an expert report has not been served within 

the 120-day period ―because elements of the report are found deficient,‖ the trial court 

may grant one thirty-day extension for the plaintiff to cure the deficiency. Id. § 

74.351(c).

An ―expert report‖ is defined as ―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 . . . failed to 

 

proof. Yes.‖ Therefore, the trial court‘s comment does not clarify whether it previously made an oral 

ruling that the original report was deficient.
5

meet the standards, and the causal relationship between that failure and the injury, harm, 

or damages claimed.‖ Id. § 74.351(r)(6). The expert may not merely state his 

conclusions about these elements but instead must explain the basis for his statements 

and link his conclusions to the facts. Am. Transitional Care Ctrs. of Tex., Inc. v. 

Palacios, 46 S.W.3d 873, 879 (Tex. 2001); Baylor Coll. of Med. v. Pokluda, 283 S.W.3d 

110, 117 (Tex. App.—Houston [14th Dist.] 2009, no pet.). The trial court should grant a 

motion challenging adequacy of an expert report only if it appears to the court, after a 

hearing, that the report does not represent an objective good-faith effort to comply with 

the statutory definition of an expert report. Tex. Civ. Prac. & Rem. Code Ann. § 

74.351(l). When determining if a good-faith effort has been made, the trial court is 

limited to the four corners of the report and may not consider extrinsic evidence. See

Palacios, 46 S.W.3d at 878; Pokluda, 283 S.W.3d at 117.

We employ an abuse-of-discretion standard to review a trial court‘s determinations 

regarding adequacy of an expert report in a health-care-liability suit. Palacios, 46 

S.W.3d at 875; San Jacinto Methodist Hosp. v. Bennett, 256 S.W.3d 806, 811 (Tex.

App.—Houston [14th Dist.] 2008, no pet.). A trial court abuses its discretion if it acts in 

an arbitrary or unreasonable manner or without reference to any guiding rules or 

principles. Bowie Mem’l Hosp. v. Wright, 79 S.W.3d 48, 52 (Tex. 2002) (per curiam); 

Bennett, 256 S.W.3d at 811.5

 

5 As we have mentioned, the record does not reflect that the trial court ruled the original report 

was deficient, and, during proceedings relative to the amended report, the parties disputed whether the 

court made such a ruling on the original report; yet the court ordered Martin to serve an amended report. 

See Tex. Civ. Prac. & Rem. Code Ann. § 74.351(c) (authorizing trial court to grant extension for plaintiff 

to cure deficiencies if elements of the report are found deficient). However on appeal, neither party 

directly raises an issue regarding the order that Martin serve an amended report, and both parties seem to 

treat the amended report as the operative report. Nonetheless, even if Dr. Maxwell had obtained an order 

that the original report was deficient (either from the trial court or on appeal of a trial-court order 

overruling Dr. Maxwell‘s objections), the trial court would have been vested with discretion to order an 

amended report. See id. As explained below, we uphold the trial court‘s order that the amended report is 

sufficient. Consequently, we need not decide the effect, if any, of the court‘s ordering Martin to serve the 

amended report absent a ruling that the original report was deficient, and Martin has satisfied her statutory 

obligation at least via the amended report.
6

A. Dr. Glass’s Opinions

In the report, Dr. Glass explained his opinions regarding the applicable standard of 

care, Dr. Maxwell‘s breach thereof, and the causal connection between the breach and 

David‘s death. Dr. Glass stated that he relied on his own knowledge, training, and 

experience and reviewed the following to formulate his opinions: David‘s certificate of 

discharge from active duty; David‘s military records; medical records from Intracare 

Hospital concerning the relevant hospitalization; autopsy results; David‘s death 

certificate; Physicians‘ Desk Reference; Dr. Glass‘s interview of the medical examiner 

who performed the autopsy; and ―Epocrates Online.‖

Relative to the standard of care, Dr. Glass opined that a reasonable and prudent 

psychiatrist should have recognized three factors pertinent to the circumstances of 

David‘s admission. First, there is a ―very high probability‖ a ―drug dependent‖ or ―drug 

seeking‖ patient will ―distort[] upwards‖ when reporting the amount of drugs, such as 

Benzodiazepine or narcotics, he is taking or falsely claim a dependency to obtain more of 

such drugs as part of a detoxification protocol. Second, a patient who is dependent on 

Benzodiazepine or narcotics rarely experiences ―verbal‖ or ―hyper-sexual‖ hallucinations 

(as David was experiencing when admitted); rather, such hallucinations are primarily 

symptomatic of Psychosis and occasionally PTSD, although a Benzodiazepine-dependent 

patient may experience ―visual‖ hallucinations (which David also reported when 

admitted). Third, some medications in the protocol have known risks for negative 

interaction with some prescription medications that David said he was taking when 

admitted; in certain combinations, one medication may slow metabolism of another 

medication, effectively rendering the latter more potent or causing ―dangerous toxic 

 

As another preliminary matter, Martin requests that we uphold the trial court‘s order denying Dr. 

Maxwell‘s challenge to sufficiency of the amended report because her motion was not timely served on 

Martin. Because we uphold the trial court‘s finding that the report was sufficient, we need not address the 

issue regarding timeliness of service.
7

levels‖ in the blood.6 For example, Dr. Glass stated that Trazodone is known to inhibit 

metabolism of Buproprion (a medication David said he was taking when admitted).

Dr. Glass opined that, in light of the above factors, a reasonable and prudent 

psychiatrist should not have immediately placed David on the protocol before confirming 

the claimed addiction; rather, the psychiatrist should have taken a more conservative 

approach of admitting and monitoring David without administering the protocol and 

placing him on one or more of the following while awaiting urinalysis results: (1) a 

medication containing a low dosage of Benzodiazepine, such as Ativan, to facilitate 

detoxification without threat of seizures if David were actually experiencing 

Benzodiazepine withdrawal and alleviate symptoms of narcotic withdrawal if he were 

actually experiencing such withdrawal; (2) Imodium for diarrhea; and/or (3) a low dosage 

of Catapres to ease muscle and bone pain of any narcotic withdrawal. Dr. Glass stated 

that there is a low risk of side effects from Ativan or Catapres and they generally do not 

interfere with the medications David said he was taking when admitted. Dr. Glass further 

opined that, although the protocol was negligently started, a reasonable and prudent 

psychiatrist should have at least discontinued the protocol once the urinalysis revealed 

David was not addicted to Benzodiazepine or narcotic opiates and treated him for 

Psychosis and/or PTSD.

With respect to the alleged breach, Dr. Glass acknowledged that Dr. Maxwell 

placed David on Ativan and Imodium (part of the approach that Dr. Glass described as 

―conservative‖ if it had been the only course of treatment exercised by Dr. Glass at the 

outset of admission) and prescribed an anti-psychotic medication. However, Dr. Glass 

opined that Dr. Maxwell breached the above-described standard of care by also 

 

6 Dr. Glass quoted Epocrates Online when he outlined potential negative interactions between 

various combinations of certain medications in the protocol and certain medications David was taking 

when admitted. Based on his recitation of excerpts from Epocrates Online, these combinations are 

apparently listed in that guide under various headings based on the degree of risk, such as ―Avoid/Use 

Alternatives,‖ ―Monitor/Modify Tx,‖ and ―Caution Advised.‖
8

immediately administering the protocol and then failing to discontinue it when the 

urinalysis revealed David was not addicted to Benzodiazepine or narcotic opiates.

Relative to the causation element, Dr. Glass seemed to rely on several alleged 

facts: (1) the autopsy report showed the cause of death as ―Polydrug toxicity due to 

Buproprion, Trazodone, and Valproic Acid‖; (2) the medical examiner told Dr. Glass that 

the autopsy revealed a ―lethal‖ level of Buproprion and ―toxic‖ yet ―therapeutic‖ levels of 

Trazodone and Valproic Acid in David‘s system; and (3) on the day after admission, Dr. 

Maxwell increased the dosage of Trazodone, as part of the protocol, to a higher dosage 

than David said he was taking when admitted.

Dr. Glass then opined that the protocol inhibited metabolism of Buproprion, 

causing it to reach the lethal level. At one point, Dr. Glass further opined that the lethal 

level of Buproprion ―more likely than not, in reasonable medical probability, led to a 

decrease in [David‘s] respiratory effort and hypoventilation that resulted in his becoming 

increasingly hypoxic to the extent that he had a respiratory and subsequent cardiac arrest 

from which he could not recover and, more likely than not, caused his death.‖ Dr. Glass 

seemed to use interchangeably the concepts of a lethal Buproprion level due to inhibiting 

effects of the protocol and ―acute drug toxicity‖ because at another point, he opined 

―acute drug toxicity‖ led to the respiratory and cardiac arrest. Regardless, in sum, Dr. 

Glass concluded that David‘s death resulted from Dr. Maxwell‘s alleged negligence in 

prescribing the protocol and then failing to discontinue it when testing revealed David 

was not addicted to Benzodiazepine or opiate narcotics.

Dr. Glass‘s opinion on causation is unclear relative to his conclusion that the 

protocol inhibited metabolism of the Buproprion. At one point, Dr. Glass suggested the 

increased dosage of Trazodone alone could have caused the inhibited metabolism of 

Buproprion. At other points, he suggested that the increased dosage of Trazodone, along 

with one or more other medications in the protocol, caused the inhibited metabolism. At 

yet another point, his statement is unclear on whether other medications in the protocol 

also contributed to the inhibited metabolism. Nevertheless, as explained below, the 
9

significant point relative to Dr. Maxwell‘s appellate complaint concerning the causation 

element is that an increased dosage of Trazodone was a common denominator in each of 

Dr. Glass‘s conclusions that the protocol inhibited metabolism of Buproprion, 

irrespective of whether he believed other medications in the protocol also contributed to 

this effect.7

B. Dr. Maxwell’s Contentions

1. Standard-of-Care and Breach Elements

On appeal, Dr. Maxwell advances only one reason that the report was purportedly 

inadequate with respect to the standard-of-care and breach elements. Specifically, Dr. 

Maxwell emphasizes that Dr. Glass opined David‘s death was caused by a negative 

interaction between Trazodone and Buproprion, but David was already taking both 

medications when admitted to the hospital. Thus, Dr. Maxwell argues that Dr. Glass‘s 

opinions were based on a false assumption: Dr. Maxwell‘s administration of the protocol 

and failure to discontinue it once the urinalysis revealed no addiction was the source of 

both Trazodone and Buproprion in David‘s system. Accordingly, Dr. Maxwell suggests 

that Dr. Glass failed to describe the standard of care applicable to a psychiatrist treating a 

patient who is already taking Trazodone and Buproprion; thus, he also failed to describe 

the manner in which Dr. Maxwell breached any such standard.

As discussed above, Dr. Glass opined that an increased dosage of Trazodone 

administered as part of the protocol inhibited metabolism of Buproprion. As we will 

further discuss, Dr. Maxwell contends on appeal, relative to the causation element, that 

Dr. Glass incorrectly concluded the Trazodone dosage was increased, although Dr. 

Maxwell did not raise this contention in her motion. Nonetheless, this contention, if 

properly raised, would pertain to sufficiency of Dr. Glass‘s causation opinion—not his 

standard-of-care and breach opinions.

 

7 At least, as we construe the report, Dr. Glass did not clearly render any conclusion that one or 

more other medications in the protocol, exclusive of an increased dosage of Trazodone, inhibited

metabolism of the Buproprion.
10

In particular, Dr. Glass‘s opinion that Dr. Maxwell was negligent by 

administering, and then failing to discontinue, the protocol was not based solely on a 

potential negative interaction between Trazodone and Buproprion. Rather, in addition to 

the advisory concerning the Trazodone-Buproprion combination, Dr. Glass outlined risks 

inherent in other combinations of various medications in the protocol and various 

medications David said he was taking when admitted. Accordingly, the trial court did not 

abuse its discretion by determining Dr. Glass provided a sufficient opinion on the 

standard-of-care and breach elements by articulating the potential for negative interaction 

between various medications in the protocol and various medications David said he was 

taking when admitted. Again, whether administration of the protocol could have actually 

caused David‘s death because of, more specifically, a negative interaction between 

Trazodone and Buproprion is a different issue, pertaining to whether Dr. Glass 

sufficiently described a causal relationship between the alleged breach and David‘s death.

2. Causation Element

Dr. Maxwell presents two appellate complaints relative to Dr. Glass‘s causation 

opinion. First, Dr. Maxwell contends that Dr. Glass incorrectly concluded the protocol 

included an increased Trazodone dosage. Specifically, in the report, Dr. Glass stated that 

David was taking 300 mg per day of Trazodone when admitted and the dosage initially 

given in the hospital was 100 mg per day. Dr. Glass then apparently quoted the hospital 

records when making the following statement:

The day after admission, ―. . . Trazodone was increased to 200mg hs, then 

may give 150 more if he wakes up.‖ (Total Trazodone dose, 350 mg/day, or 

at least 50 mg/day more than he had been taking as an outpatient).

Dr. Maxwell suggests the instruction that an additional 150 mg ―may‖ be given if David 

―wakes up,‖ as noted in the hospital records, did not establish that an additional 150 mg 

was actually given, for a total of 350 mg per day, as Dr. Glass adds in the parenthetical; 

thus, the medical records indicate, at most, that the highest Trazodone dosage in the 

protocol (200 mg per day) was actually less than David was purportedly taking when 

admitted (300 mg per day). Second, Dr. Maxwell argues that, even if the Trazodone 
11

dosage administered in the protocol was 50 mg higher than David was purportedly taking 

when admitted, Dr. Glass failed to explain how this increase, which Dr. Maxwell seems 

to characterize as negligible, inhibited metabolism of the Buproprion.

However, in her motion, Dr. Maxwell did not object to sufficiency of Dr. Glass‘s 

causation opinion on either of the two grounds raised on appeal. See Tex. Civ. Prac. & 

Rem. Code § 74.351(a) (requiring that defendant must ―file and serve‖ objections to 

expert report); Holland v. Hayden, 901 S.W.2d 763, 765 (Tex. App.—Houston [14th 

Dist.] 1995, writ denied) (recognizing that, in order to preserve error for appellate review, 

objection at trial must comport with complaint raised on appeal). In the motion, Dr. 

Maxwell did not mention Dr. Glass‘s assertion that the Trazodone dosage was increased, 

much less attack Dr. Glass‘s opinion on the ground he made an incorrect factual 

conclusion that the Trazodone dosage was increased. Moreover, in the motion, Dr. 

Maxwell did not argue that any increased Trazodone dosage of 50 mg per day was too 

insignificant a change to affect metabolism of Buproprion.

Rather, Dr. Maxwell objected that Dr. Glass‘s conclusion regarding the cause of 

death was unsupported by, and contrary to, the facts for the following reasons: (1) his 

opinion that David died from ―acute drug toxicity which led to a decrease in his 

respiratory effort and hypoventilation that resulted in his becoming increasingly hypoxic 

to the extent that he had a respiratory and subsequent cardiac arrest from which he could 

not recover . . .‖ was pure conjecture because the autopsy report reflected David died of 

―Polydrug toxicity due to Buproprion, Trazodone, and Valproic Acid‖ and never 

mentioned respiratory or cardiac arrest; (2) none of the medications in the protocol, 

except Trazodone, were listed as a cause of death in the autopsy report; and (3) the 

autopsy report never mentioned that David‘s Buproprion level was ―lethal,‖ as asserted 

by Dr. Glass.

In the portion of her motion challenging Dr. Glass‘s causation opinion, Dr. 

Maxwell did mention twice that David was already taking Trazodone when admitted to 

the hospital. However, these assertions were effectively parentheticals to Dr. Maxwell‘s 
12

above-cited contentions challenging Dr. Glass‘s conclusion regarding the cause of death. 

Specifically, when arguing that the cause of death was not respiratory and cardiac arrest, 

Dr. Maxwell asserted, ―The autopsy report states clearly, and Dr. Glass quotes it in his 

report, that the cause of death was  ̳[p]olydrug toxicity due to Buproprion, Trazodone, 

and Valproic Acid‘ . . . all of which [David] had been taking prior to his admission to [the 

hospital].‖ Subsequently, Dr. Maxwell asserted, ―none of the medications in the detox 

protocol, except for the Trazodone [David] was taking before admission to [the hospital], 

are stated as the cause of death in the autopsy report.‖

To the extent these assertions may be construed as objections that the protocol 

could not have caused David‘s death because he was already taking Trazodone when 

admitted, Dr. Maxwell nonetheless did not apprise the trial court of the contention she 

asserts for the first time on appeal. In particular, Dr. Glass acknowledged that David was 

taking Trazodone when admitted. Integral to Dr. Glass‘s opinion was his conclusion that 

an increased dosage of Trazodone administered in the protocol caused, or contributed to, 

the inhibited metabolism of Buproprion. Therefore, Dr. Maxwell‘s note that David was 

already taking Trazodone when admitted did not constitute an attack on Dr. Glass‘s 

opinion that an increased Trazodone dosage inhibited metabolism of Buproprion.

To constitute a good-faith effort at providing a fair summary of an expert‘s 

opinions, the report must contain sufficient information to fulfill two purposes: (1) inform 

the defendant of the specific conduct the plaintiff has called into question; (2) and 

provide a basis for the trial court to conclude the claims have merit. Palacios, 46 S.W.3d 

at 875. With respect to the causation element, Dr. Maxwell contends the report failed to 

satisfy the second purpose; i.e., she acknowledges that Dr. Glass provided an opinion (the 

increased Trazodone dosage, alone or in conjunction with other medications in the 

protocol, inhibited metabolism of Buproprion) but argues his opinion is wrong because 

there was no such increased dosage or any increased dosage could not have caused, or 

contributed to, the inhibited metabolism.
13

We cannot hold the trial court abused its discretion by determining Dr. Glass 

adequately demonstrated that Martin‘s claims have merit despite the purported 

deficiencies in his report cited by Dr. Maxwell on appeal when Dr. Maxwell did not 

specifically inform the court of those deficiencies. Accordingly, we uphold the trial 

court‘s ruling that Dr. Glass sufficiently provided an opinion on the causation element. 

See Ibrahim v. Gildbride, No. 14-09-00938-CV, 2010 WL 5064430, at *11 n.2 (Tex. 

App.—Houston [14th Dist.] Dec. 9, 2010, no pet.) (mem. op.) (refusing to consider one 

ground for defendant‘s appellate challenge to causation opinion in expert report served in 

health-care-liability claim because ground was not presented to trial court in defendant‘s 

motion); Williams v. Mora, 264 S.W.3d 888, 890–91 (Tex. App.—Waco 2008, no pet.) 

(considering only defendant‘s appellate contention that health-care-liability expert report 

was speculative based on expert‘s using ―could have‖ in two places to describe causation 

opinion because such contention was defendant‘s only timely objection in trial court; and 

holding defendant waived other complaints raised on appeal—that report was conclusory

and failed to identify ―deviation from the standard of care and negligence‖ and provide 

sufficient information on causation).

We overrule Dr. Maxwell‘s sole issue and affirm the trial court‘s order denying 

Dr. Maxwell‘s motion challenging sufficiency of Martin‘s amended expert report.

/s/ Charles W. Seymore

Justice

Panel consists of Justices Frost, Seymore, and Jamison.