## COURT OFAPPEALS SECOND DISTRICTOF TEXAS FORT WORTH NO. 2 - 0 8 - 3 2 5 - CV SHA NN O N POLON E, P. A.
- C. AN D APPE L L AN TS F R ANC I S R . L ONE R GAN , M . D. V . M O N I C A SH EA RER A PPELL EE

----- ----- -- FR O M THE 17TH DI STRI CT CO URT O F TARRA NT CO UN TY

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### OPI NI ON

----- ----- -- I. I NTR ODUCTI ON I n t hese accel er at ed, i nt er l ocutory appeal s, A ppel l ant s Shan non Pol one, P. A.
- C. a n d F r a n c i s R. L o n e r g a n , M . D. a p p e a l t h e t r i a l c o u rt ’ s o r d e r s d e n y i ng t hei rm ot i ons t o di sm i ss t he h e al t h car e l i abi l i t y cl ai m s ofA ppel l ee M oni ca S h e a re r. S ee T e x . C i v . P ra c . & R e m . C o d e A n n . § 5 1 .0 1 4 (9 ) (V e rn o n 2 0 0 8 ). I n t w o i ss ues, Pol one ar gues t hatSh ear erf ai l ed t o com pl y w i t h ci vi l pr act i ce2

and r em edi esco de se ct i on 74. 351 be ca us e t he m edi ca l expertr epo rt s t hats he fi l e d are i n a d e q u a te a n d fai l to s h o w tha t th e au th o ri n g ex p e rt s a re q u a l i fi e d to of f eran expe r to pi ni on r ega r di ng t he st and ar d ofca r e a ppl i ca bl e t o a ph ys i ci an ’ s ass i stant. S e eid . § 7 4 .3 5 1 (b ), ( l) (V e rn o n S u p p . 2 0 0 8 ). D r. L o n e r g a n a ls o a r g u e s t h a tS h e a r e rf a ile d t o f i l e a n a d e q u a t e e x p e rtre p o rtin com pl i anc e w i t h c i vi l pr ac t i cean d r em edi esco de se ct i on 74. 3 5 1 , buthe c o n te n d s i n tw o i s s u e s th a t th e o p i n i o n s o f th e a u t h o ri n g e x p e rts a re specul at i ve and con cl usory and t hatt he expert s f ai l ed t o adequ at el y addr ess S h e a re r’ss p e c if ic c l a i m s . S e eid . W e a f f i r m i n pa rtan d r eve r sean d r em and i n p a rt . II . F ACTUA LAN DP ROCEDURALB AC KG ROUND Shear erf i l ed a m edi ca l m al pr ac t i cel aw sui ta ga i ns tD r . Lo ner gan an d Pol one i n Janu ar y 20 08 . S he al l eged t hatshe exper i enced sym pt om at i c br east pr ob l e m s , i nc l ud i ng a s ym m e t r i c b r e a s t s a nd b r e a s tp a i n, a tt heen d of2004 . I n Novem be r2 005 , Pol oneex am i ned Shea r eraft erShea r erco m pl ai ned of b r e a s t p a i n a n d d i m p l i n g o f th e s k i n . A m a m m o g ra m a n d s o n o g ra m w e re per f or m ed, butt he r esul t s di d not show a def i nabl e m ass. The r adi ol ogi st cl as si f i ed t he f i ndi ngsas“ BI RA D S 2” a nd r ec om m end ed a f ol l ow up1 ... A ccor di ng t o Po l one, t he r esul t s of t he di agno st i c tes t s i ndi cat ed t hat

t he m as s w asbe ni gn. 3 m a m m o g ra m i n o n e y e a r. 1 She are rs aw D r . Lo ner gan t hr ough 200 7, dur i ng w h i c h ti m e s h e a l l e g e d l yc o n ti n u e d t o c o m p l a i n o f “ b re a s t p ro b l e m s .” D r. A dr i enn e M art i n e val uat ed Shear eri n l at e 2007, an d t i ssue exc i se d f r om S hear er ’ s l ef tbr eastw as di agno sed as l obu l arcar ci nom a. Shearert hen unde r w enta bi l at er al m as t ec t om y. S h e a rer al l e g e d i n h e r ori g i n a l p e ti ti o n tha t P o l o n e n e g l i g e n tl yfa il e d “to c l o s e l y fo l l o w u p th e fi n d i n g s a fte r th e m a m m o g ra m i n 2 0 0 5 ” a n d “ to t im e ly re c o g n i z e th e p o s s i b i l i tyo f m a l i g n a n c yi n [S h e a re r].” S h e a re r a l l e g e d th a t D r. Lon er gan w asne gl i gen ti n f ai l i ng “ t o c l os el y f ol l ow up t he f i ndi ngsaft ert he m a m m o g r a m in 2 0 0 5 ,” “ t o p e r f o r m a f in e n e e d l e a s p i r a t io n o n t h e m a s s in q u e s t i o n , ” “ t o re f e r[S h e a r e r ] t o a s u r g e o n f o rf o llo w u p ,” a n d “ t o t im e ly re c o g n i z e th e p o s s i b i l i tyo f m a l i g n a n c yi n [S h e a re r].” S h e a r e ra t t a c h e d t o h e rp e t i t i o n t he m e d i c a l e x p e rtr e p o rto fM a r kD. A k in , M .D . S h e la t e rf ile d a s e c o n d e x p e rt r e p o rt p r e p a r e d b yG e r a ld H . S o k o l, M . D . Bot h Pol one an d D r . Lo ner gan f i l ed obj ec t i onst o t he ade qua cy oft he exp ertr epo rt s and m ove d t o di sm i ssShea r er ’ s hea l t h c ar e l i abi l i t y c l ai m s. The2 ... S e eL e wi sv. F un derb urk , 253 S. W . 3d 204, 208 ( Te x. 2008 ) ( aut hor i zi ng app eal f r om t r i al courtor derdet er m i ni ng thatexpertr eportw as a d e q u a te a n d d e n y i n g m o ti o n to d i s m i s s ). 4 tri a l c o u rt o v e rru l e d th e o bj e c ti o n s a n d d e n i e d th e m o ti o n s to d i s m i s s . T h is i nt er l ocu t ory a ppe al f ol l ow ed. 2 II I. S TA NDA RD OFR EVI EW W e r evi ew a t r i al co urt ’ s den i al of a m ot i on t o di sm i ssf oran ab us e o f d i s c re ti o n . Jer

ni g a n v. L angley , 1 9 5 S .W .3 d 9 1 , 9 3 (T e x . 2 0 0 6 ); Mar i s v. Hendr i cks , 2 6 2 S .W .3 d 3 7 9 , 3 8 3 (T e x . A p p .— F o rt W o rth 2 0 0 8 , p e t. d e n i e d ). A t r ia l c o u rta b u s e s it s d is c r e t io n w h e n ita c t s in a n a r b it r a r yo ru n r e a s o n a b le m a n n e r o r w i th o u t re fe re n c e to a n yg u i d i n g ru l e s a n d p ri n c i p l e s . D owner v. A quam ar

i ne Operators, I

nc. , 7 0 1 S .W .2 d 2 3 8 , 2 4 1

– 4 2 (T e x . 1 9 8 5 ), cert. denied, 47 6 U . S . 11 59 ( 19 86 ) . M er el y because a t r i al courtm ay d eci de a m a t t e rw it h in it s d is c r e t io n in a d if f e r e n tm a n n e rt h a n a n a p p e lla t e c o u rtw o u ld i n a si m i l ar ci r cum st ance does not dem onst r at e t hat an abuse ofdi scr et i on has o c c u rre d . Id . But a t r i al co urthas no di scr et i on i n det er m i ni ng w hatt he l aw i so r i n a p p l y i n g th e l a w to th e fa c ts , a n d th u s “ a c l e a r fa i l u re b yth e tri a l c o u rt to a n a l y z e o r a p p l y th e l a w c o rre c tl y w i l l c o n s ti tu te a n a b u s e o fd is c re ti o n .” W al ker v. Packer, 8 2 7 S .W .2 d 8 3 3 , 8 4 0 (T e x . 1 9 9 2 ).5 IV . C HALLE NGES TOE XPE RTR EPORTS Ci vi l p r a c t i c e a nd r e m e di e s c od e s e c t i on 74. 351 p r ov i de s t ha t , w i t hi n 120 day s off i l i ng s ui t , a pl ai nt i f fm us ts erve exp ertr epo rt s f orea ch physi ci an or heal t h car e pr ovi deragai nstw hom a l i abi l i t y cl ai m i s assert ed. Tex . C i v. Pr ac. & Rem . C ode A nn. § 7 4. 35 1( a) . A n expertr eporti s a w r i t t en r eportby an exp ertt hatpr ovi desa f ai rs um m ary oft he exp ert ’ s opi ni onsr ega r di ng t he app l i ca bl e s t and ar d ofca r e, t he m an ne ri n w hi ch t he ca r e r end er ed by t he physi ci an orheal t h car e pr ovi derf ai l ed t o m eett he st andar d , a n d t he causal re l a ti o n s h i p b e tw e e n t h a t fa i l u re a n d t h e in j u ry , h a rm , o r d a m a g e s c l a i m e d . Id . § 7 4. 35 1( r ) ( 6) . I fa cl ai m antti m el y f ur ni shes an expertreport , a d ef endan tm ay fi l e a m o t i o n c h a l l e n g i n g th e re p o rt’sa d e q u a c y . S e eid . § 7 4 .3 5 1 (a ), (b ), ( l). A t r i al co u rtm u st gr anta m ot i on t o di sm i ss based on t he al l eged i nadeq uacy ofan ex pertr epo rtonl y i fi tf i nds , aft era hea r i ng , “ t hatt he r epo rtdoe s not repr esentan obj ect i ve goo d f ai t h ef f ortt o com pl y w i t h t he def i ni t i on of an e x p e rt re p o rt” i n th e s ta tu te . Id . § 74 . 351( l). T h e i n f o r ma t i o n i n t h e r e p o rtd o e s n o th a v e t o me e tt h e s a me r e q u ir e m e n t s a s e v id e n c e o f f e r e d in a s u m m a r yju d g m e n tp r o c e e d in g o r a tt r ia l, and t he r epo rtne ed notm ar sh al al l t he pl ai nt i f f ’ s pr oof , buti tm us ti ncl udet he exp ert ’ s opi ni onson ea ch oft he el em ent s i den t i f i ed i n t he st at ut e— st and ar d of c a re , b re a c h , a n d c a u s a ti o n . See Am . Transiti ona l Care Ctr

s. v. Pal

aci os , 466

S .W .3 d 8 7 3 , 8 7 8

– 7 9 (T e x . 2 0 0 1 ); T h o m a sv. A lfo rd, 230 S . W . 3d 853, 856 ( Tex . A pp. — H oust on [ 14 t h D i st . ] 20 07 , no pet . ) . I n det ai l i ng t hese el em ent s, th e rep o rtm u st p rov i d e en o u g h i n fo rm a tio n to fu l fi l l tw o p u rpo se s i f i t i s to con st i t ut e a good
- f ai t h e f f ort : ( 1) t he r epo rtm us ti nf or m t he def end antoft he speci f i c condu ctt he pl ai nt i f fhas cal l ed i nt o quest i on and ( 2) th e re p o rtm ust p rov i d e a b a sis for the tr i a l co u rtto c o n c l u d e tha t t h e clai m s h a v e m e ri t. Pal aci os , 4 6 S .W .3 d a t 8 7 9 ; Gray v. CH CA Bayshore L . P. , 189 S. W . 3d 855, 8 5 9 (T e x . A p p .— H o u s t o n [1 s tD is t .] 2 0 0 6 , n o p e t .) . A re p o rtd o e s n o tf u lf ill t hes e t w o pur pos es i f i t m er el y st at es t he exp ert ’ s con cl us i onsori fi tom i t s any o f th e s ta tu to ryre q u i re m e n ts . Pa l a ci os , 4 6 S . W .3 d a t8 7 9 . A c la im a n tis al l ow ed t o ut i l i z e s epa r at e e xpe rtr epo rt s t o sat i sf y any r equ i r em entofs ec t i on 7 4 .3 5 1 . T e x . C i v . P ra c . & R e m . C o d e A n n . § 7 4 .3 5 1 (i ). I n a ss es si ng t he r epo rt ’ s su f f i ci enc y, t he t r i al c ou r tm ay notdr aw an y i nf er enc es ; i tm us tr el y e xcl us i vel y on t he i nf or m at i on c ont ai ned w i t hi n t he re p o rt’sfo u r c o rn e rs . Bowi e Mem ’ l Hosp. v. W

r i ght, 79 S. W . 3d 48, 52 ( Tex. 2 0 0 2 ); Pal

aci os , 46 S. W . 3d at878. How eve r , s ec t i on 74. 351 doe s not pr eve ntex pert s, asoppo se d t o c ourt s, fr om m ak i ng i nf er enc esba se d on m e d i c a l h i s to ry . Ben ishv. Gro ttie , N o. 02- 08- 00148

- CV , 2009 W L4172 64, a t * 6 (T e x . A p p .— F o rt W o rth F e b . 1 9 , 2 0 0 9 , n o p e t. h .); se e al so Tex. R. Evi d. 703 ( pr ovi di ng t hatan ex pertm ay dr aw i nf er enc es i n a part i cul arca se ) ; Tex.7

R. Evi d. 705 ( pr ovi di ng t hatan e xp ertm ay t es t i f y i n t er m s ofopi ni onsan d i n fe re n c e s ). A . S t andar d ofC ar e and B r each In p a rt o f h e r fi rs t i s s u e , P o l o n e a rg u e s th a t D r . A k in ’sa n d D r. S o k o l ’s r eport s ar e i nadeq uat e because t he r eport s f ai l t o set f ort h th e sp e c i f i c, a p p l i ca bl e stan da r d o fcare f or a ph ys i ci an ’ s ass i stant. S he argue s t ha tD r. A ki n’ s r epo rtset s f ort h one “uni ver sa l ” st and ar d ofcar e f orbot h phy si ci ansan d phys i ci an’ s as si st ant s butt hati tf ai l s t o s t at e w hy t hi s i s app r opr i at e. She c o n te n d s th a t D r. S o k o l ’sre p o rt a l s o tre a ts th e s ta n d a rd o f c a re f o r a physi ci an’ s ass i st antand a physi ci an as one and t he sam e. A n expe rtr epo rtm ay notass ertt hatm ul t i pl e def end ant s ar e al l ne gl i gen t f orf ai l i ng t o m ee tt he st and ar d ofca r e w i t houtpr ovi di ng a n e xpl ana t i on ofhow each def endan t speci f i cal l y br eached t he st andar d and how t hatbr each caused orco nt r i but ed t o t he ca us e o fi nj ury. Taylor v. Chr i stus Sp ohn Health S ys. Cor p. , 1 6 9 S .W .3 d 2 4 1 , 2 4 4(T e x . A p p .— C o rp u s C h ri s ti 2 0 0 4 , n o p e t.); see Woo d v. Ti

ce , 9 8 8 S .W .2 d 8 2 9 , 8 3 1 ( T e x . A p p .— S a n A n to n i o 1 9 9 9 , p e t. den i ed) ( st at i ng t hatt he r epo rtm us ts pec i f i ca l l y r ef ert o t he def end antan d di scuss how t hat def endan t br eached t he appl i cabl e st andar d of car e) . Justas a n e x p e rtre p o rtm u s tp r o v id e a n e x p la n a t io n o fh o w e a c h d e f e n d a n ts p e c if ic a lly b r e a c h e d t h e s t a n d a r d o fc a r e , t h e e x p e rtr e p o rtm u s ts e tf o rt h t h e a p p lic a b le8

s ta n d a rd o fc a r e f o r e a c h d e fe n d a n t. S ee D oades v. Syed, 94 S . W . 3d 664, 6 7 1

– 7 2 (T e x . A p p .— S a n A n to n io 2 0 0 2 , n o p e t.) (h o l d i n g e x p e rt re p o rt i nad equ at e b ec aus e i tf ai l ed t o s etf ort h t he st and ar d ofcar e f orea ch def end ant i n d i v i d u a l l ya n d c o n ta i n e d m e re c o n c l u s i o n s re g a rd i n g b re a c h a n d c a u s a ti o n ); Rittm er v. G a r

za , 6 5 S .W .3 d 7 1 8 , 7 2 2

– 2 3 (T e x . A p p .— H o u s to n [1 4 th D i s t.] 20 01 , no pet . ) ( r easoni ng t hatexpertreportw as i nadeq uat e b ecause i tl acked sp ec i f i ci t y a s t o t he st and ar dsofca r e a ppl i ca bl e t o t he su r ger i espe r f or m ed on p l a i n ti ff). D r . Aki n’ s r e po rti de nt i f i e d t he“ Spe c i f i c Act s o rOm i s s i on s o fM edi cal C ar e” com m i t t ed by Pol one as ( 1) f ai l i ng t o adequ at el y eval uat e and m anage a br eastm ass and ( 2) f ai l i ng t o r ecogn i ze t hatm am m o g raph y and br east so nogr aph y a r e n otco ncl us i ve t es t s f orbr ea stca nce r . U ndert he f i r stac tor om i ssi on, D r . A ki n st at ed i n r el evantpartas f ol l ow s: T h e s tan d a rd o f ca re fo r t h e ev a l u a ti o n o f a b rea st m a ss i s to obt ai n a t hor ough hi st ory, pe r f or m an ad eq uat e b r ea stex am , an d o b t a in a p p r o p r ia t e d ia g n o s t ic im a g in g p r o c e d u r e s . W h e n t h is eval uat i on y i e l d s f i ndi ngs t hatcoul d be consi st entw i t h a br east ca nce r , ei t her cl os e f ol l ow - up ors ur gi ca l ev al uat i on i s m and at ory. U ndert he second actorom i ssi on, D r . A ki n st at ed as f ol l ow s: Th e st andar d ofcar e f ori nt er pr et at i on of m am m ogr aphy an d br east so nogr aph y i s t o r ec ogni z e t hatt hes e t es t s ar e n otco ncl us i ve, an d t hatpat i entm anagem ent canno t be based excl usi vel y upo n t hese r adi ol ogi c f i ndi ngs. PA Pa[ l ] one r el i ed on t he negati ve m am m ogr am and sonog r am fi ndi ngs as evi dence t hatM oni ca’ s br eastm ass w as9

not cancer , even i n spi t e ofpr ogr essi ve gr ow t h oft he br eastm ass and a s s oc i a t e d s k i n c ha ng e s . I n l i gh to ft hew e l l
- pu bl i s hed evi dence t hatnotal l br eastcancer s can b e ide nt i f i ed by t hese r adi ol ogi c p r oce dur es , t hi s f al l s bel ow t he st and ar d ofcar e f ort he i nt er pr et at i on ofm am m ogr aph y a nd br ea sts onogr aph y. Regar di ng Dr . Lo ner gan , D r . A ki n’ s r epo rt i den t i f i ed t he “Spe ci f i c Act s or O m i ss i o n s o f M e d i c a l C a re” co m m i tted b yD r. L o n e rg a n as the sa m e tw o “Spe ci f i c Act s orO m i ss i ons of M edi ca l C ar e” com m i t t ed by Pol one . A nd ashe d i d w i th P o l o n e , u n d e r th e f i rs t a c t o r o m i s s i o n , D r. A k i n s ta te d i n re l e v a n t p a rt as f ol l ow s: T h e sta n d a rd o f ca re fo r t h e ev a l u a ti o n o f a b rea st m a s s is to obt ai n a t hor ough hi st ory, pe r f or m an ad equ at e b r ea ste xam , an d o b t a i n a p p r o p r ia t e d ia g n o s t ic im a g in g p r o c e d u r e s . W h e n t h is e v a l u a ti on yi el ds f i ndi ngs t hatcoul d be consi st entw i t h a br east ca nce r , ei t hercl os e f ol l ow - up or su r gi ca l eva l uat i on i s m and at ory. A nd un dert he second actorom i ssi on, D r . A ki n st at ed as f ol l ow s: Th e st andar d ofcar e f ori nt er pr et at i on of m am m ogr aphy an d br east so nogr aph y i s t o r ec ogni z e t hatt hes e t es t s ar e n otco ncl us i ve, an d t hatp at i entm anagem entcan not be based excl usi vel y upo n t hese r adi ol ogi c f i nd i ngs . Dr . Lo ner gan r el i ed on t he neg at i ve m a m m o g ra m a n d s o n o g ra m fi n d i n g s a s e v i d e n c e th a t M o n i c a ’s b rea st m a ss w a s n o t ca n c e r, ev e n i n sp i te o f pro g re s s ive g row th oft he br ea stm as s and as so ci at ed ski n change s. I n l i ghtoft he w el l
- pub l i shed evi dence t hatnotal l br eastcancer s can be i denti f i ed b yth e s e ra d i o l o g i c p ro c e d u re s , th i s fa l l s b e l o w t h e s ta n d a rd o f c a re f ort he i nt er pr et at i on ofm am m ogr aph y a nd br ea sts onogr aph y. A lt h o u g h D r . A k in ’s re p o rts e t s f o rt h w h a th e o p in e s t o b e t h e a p p lic a b le sta n d a rds of car e f or both Pol one and D r . Loner gan r egar di ng eval uat i on of a10

br ea stm as s and i nt er pr et at i on ofm am m ogr aph y a nd br ea sts onogr aph y, t he st and ar dsofca r e t hathei den t i f i ed ar e i den t i ca l . Beca us e t he r epo rt doe s not del i nea t e b et w ee n t he st and ar d of ca r e app l i ca bl e t o a phys i ci an’ s as si st antan d t he st and ar d of ca r e app l i ca bl e t o a phy si ci an, t he r epo rts et s f ort h butone s t a n d a r d o f c a r e a p p lic a b le t o b o t h P o lo n e a n d D r . L o n e r g a n . A n d b e c a u s e o n ly one s t andar d of car e i s set f ort h, t he r eport does not— as Polon e p o i n ts out
— exp l ai n how orw hy i ti s t he r es pons i bi l i t y ofPol onean d notD r . Lo ner gan , t he t r ea t i ng ph ys i ci an, t o or derdi agn os t i c t es t s orm ak e a r ef er r al ; atw hatpoi nt t he dut y t o or derad di t i ona l t es t i ng beco m est he dut y oft he phys i ci an; orw hy o r w h e th e r i t i s n o t a l w a y s th e d u tyo f th e p h y s ic i a n a n d n o t th e p h y s i c i a n ’s a s s is t a n t t o p e r f o r m s u c h t a s k s . In o t h e r w o r d s , th e re p o rtd o e sn o ts p e c if ic a lly i den t i f y the p art i cul ars t and ar d ofca r e a ppl i ca bl e t o Pol one . Al t hough t he st and ar d s o fc a r e m i g h tb e t h e s a m e f o rb o t h P o l o n e a n d Dr . L o n e r g a n , t he r epo rtdoe s nots pec i f i ca l l y s t at e as m uch . Bec aus e t he r epo rtdoe s not art i cul at e thatthe st andar ds o fcare ar e the sam e, t he r eportr equi r ed t he t r i al courtt o i m per m i ssi bl y i nf ert hatPol one and D r . Loner gan s h a red i denti cal st and ar dsofca r e a ppl i ca bl e t o e val uat i on ofa br ea st m as s and i nt er pr et at i on o f m a m m o g rap h yan d b re a s t so n o g rap h y , w h i c h m a yo r m a yn o t be co rr e c t, c o n side ri n g the i n fo rm a ti o n co n tai n e d o n l yw i th i n the fou r co rne rs o f t h e rep o rt .11

See W r i ght, 79 S. W . 3d at52 ( st at i ng t hat t r i al court m ay not dr aw i nf er ences re g a rd i n g i n fo rm a ti o n c o n ta i n e d i n e x p e rt re p o rt). D r . Sokol ’ s r epo rts et s f ort h i n a s i ngl e p ar agr aph w hatheopi nest o be t he st andar d ofcar e f or t he di agno si s and t r eat m ent of w om en w i t h suspect ed br eastcancer , st at i ng as f ol l ow s: STAN DA RD O F CA RE A s a re s u lto fm yb a c k g r o u n d , t r a in in g , a n d c l in ic a l e x p e r ie n c e in t he tr e a t m entofw om en w i t h suspect ed br eastcancer , I am f am i l i ar w i t h t he st and ar ds of ca r e f ort he di agn os i s and t r ea t m ent o fs u c h p a t ie n t s . T h e s t a n d a r d o fc a r e f o ra p a t ie n tw it h a p a lp a b le m as s and s ki n di m pl i ng i s t o pe r f or m a f i ne nee dl e a sp i r at i on oft he l um p a nd t o r ef ert o a br ea sts ur geo n. D r. S o k o l ’sre p o rt s e ts fo rth a s i n g l e s ta n d a rd o f c a re fo r b o th P o l o n e a n d D r. Lon er gan i ns t ea d ofi den t i f yi ng t he sp ec i f i c st and ar d ofcar e appl i ca bl e t o e ac h. S eePal aci os , 46 S. W . 3d at88 0 ( “W het hera def endan tbr eached hi s orher duty t o a pat i entcannot be det er m i ned absent speci f i c i nf or m at i on abo utw hat th e d e fe n d a n t s h o u l d h a v e d o n e d i ffe re n tl y .” ); see al so D oades , 94 S. W . 3d at 6 7 1

– 7 2 . D r. S o k o l ’sre p o rt i s d e fi c i e n t e v e n w h e n c o n s i d e re d w i th D r. A k i n ’s rep o rt . W e h o l d th a t th e tri a l c o u rt a b u s e d it s d i s c re ti o n b yd e n y i n g P o l o n e ’s m o ti o n to d i sm i ss o n th e g rou n d th a t D r. A k i n ’s an d D r. S o k o l ’s ex p e rtrep o rt s w er e d ef i ci entf orf ai l i ng t o a deq uat el y s etf ort h t he app l i ca bl e s t andar dsof12

c a re . S ee T e x . C i v . P ra c . & R e m . C o d e A n n . § 7 4 .3 5 1 (a ), (b ), ( l), (r )(6 ). W e sust ai n t hi s partofPol one’ s f i r sti ssue. In a n o th e r p a rt o f h e r firs t i s s u e , P o l o n e c o n te n d s th a t D r. A k i n ’sre p o rt i sin a d e q u a te re g a rd i n g t h e e l e m e n t o f b re a c h . S h e s p e c i fi c a l l ya rg u e s th a t D r. A ki n’ s r epo rtdoes notex pl ai n why i t i s a b re a c h o f th e s ta n d a rd o f c a re fo r a physi ci an’ s ass i st antt o di sr egar d t he di agno st i c t est s per f or m ed (becau se, accor di ng t o Po l one, t he r esul t s i ndi cat ed t hatt he m ass w as beni gn ). U nder t he f ai l ur e t o a deq uat el y e val uat e a nd m ana ge a br ea stm as s “Spe ci f i c Act [ ] or O m i ssi on[ ] ofM edi cal C ar e, ” D r . A ki n el abor at ed on t he m andatory “cl ose fo l l o w -u p o r s u rg i c a l e v a l u a ti o n ” s ta n d a rd o f c a re a n d s ta te d , “ Even though a d i a g n o s t i c ma mm o g r a m a n d s o n o g r a m we r e p e r f o r me d a n d r e p o rt e d a s B I R ADS 2 , app rop ri

a te m a n ag em en t o fa p a lp a b le b r e a s tm a s s w it h s k in d im p lin g w o u ld have i ncl uded ei t herf i ne n e edl e aspi r at i on of t he m ass orr ef er r al t o a br east sur geon . ” [ Em phasi s added. ] Thu s, D r . A ki n expl ai ns exact l y w hy i ti s a br each o f t h e sta n d a rd o f ca re fo r a p h y sici a n ’s as sistan t t o d i sre g a rd d i a g n o sti c tes ts r esul t i ng i n B I R A D S 2: because “appr opr i at e m anagem ent ” ofa pal pabl e br east m ass w i t h ski n di m pl i ng cal l s f orf i ne needl e aspi r at i on or refe rr a l t o a br east sur geon . W e over r ul e t hi s partofPol one’ s f i r sti ssue.13

B. C aus at i on In a n o th e r p a rt o f h e r fi rs t i s s u e , P o lo n e a rg u e s th a t D r. A k i n ’sa n d D r. Sokol ’ s r epo rt s ar e d ef i ci entw i t h r ega r d t o c aus at i on. She con t end s t hatt he re p o rts fa i l to s e t f o r th h o w h e r a l l e g e d b re a c h e s o f th e s ta n d a rd o f c a re re s u l te d i n a d e l a yo f th e d i a g n o s i s a n d tre a tm e n t o f S h e a re r’sb re a s t c a n c e r, how t he al l ege d de l ay ca us ed m or e da m ag es and i nj ury t han w oul d ha ve occ ur r ed abs entt he al l ege d br ea che s of t he st and ar d of ca r e, and how butf or t h e al l eged br eaches oft he st andar d ofcar e, Sh ear erw oul d not have been i nj ur ed. Dr . Lo ner gan ar gue s i n hi s f i r st i ss ue t hatt he r epo rt s ar e s pec ul at i ve and co ncl us ory. In f u lf illin g t h e d u a l p u r p o s e s o ft h e e x p e rtre p o rt , t h e e x p e rtm u s te x p la in th e b a s i s o f h i s s ta te m e n ts a n d l i n kh i s c o n c l u s i o n s to th e fa c ts . W r i ght, 79 S. W . 3d at52. The r epo rtm us tnotbeco nc l us ory i n i t s exp l ana t i on of c a u s a ti o n . Id . a t 5 3 ; Pal aci os , 46 S . W . 3d a t879. D r . A ki n’ s r eportst at es i n partas f ol l ow s: I ti s m y pr of essi onal opi ni on t hatM o n i ca Sh ear er ’ s br eastcancer w aspr es entf oratl ea st22 m ont hspr i ort o bi ops y c onf i r m at i on, and t he d e l a yi n d i a g n o s i s w a s a d i r e c tc o n s e q u e n c e o ft he f ol l ow i ng i ndi vi dual s f ai l i ng t o m eetthe st andar ds o fm edi cal car e:

. . . . It i s m yp ro fe s s i o n a l m e d i c a l o p i n i o n th a t th e d i a g n o s i s o f M o n i c a ’s br eastcancerw as del ayed f or2 2 m onths. D ur i ng t hi s t i m e f r am e14

t her e i s doc um ent ed evi den ceofpr ogr es si ve gr ow t h a nd d e v e l o p m e n t o f h e r b re a s t c a n c e r. W ithi n re a s on a bl

em e di cal p ro b a b ility, Mo n ic a ’sb re a s tc a n c er wo uld h a veb e entim ely di agn os ed if

PA Pol onean d Dr. Lo ner

ganhad m et

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ua ti o n a n dm a n ag em en t o f ab rea s t m a ss . T h is f ai lure to m ee tthe standard of ca re h asi

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c b rea st cancer an d s ubs equ ent

m or bi dity and m ortal ity, and con stitutes m edical negl i gence . [E m p h a s i s a d d e d .] D r. S o k o l ’s rep o rtsta tes i n rel e v a n t pa rt : Itism yo p in io n t h a t , m o r e p r o b a b lyt h a n n o t , t h e d e la yin d ia g n o s is o f t h e b re a s t c a n c e r re s u lte d in in ju ryo r d a m a g e to th isp a tie n t. It i s m yo p i n i o n , to a d e g re e o f m e d i c a l p ro b a b i l i ty , th a t M s . S h e a re r’s br ea stca nce rco ul d hav e bee n t r ea t ed, i ft i m el y di agn os ed, w i t hout t he necessi t y ofm ast ect om i es and as l i kel y herpr ogn osi s w as w o rs e n [e d ] b yd e l a yo f d i a g n o s i sa s w e l l . Th e r ecor d dem onst r at es t hatSh ear eri s sui ng P ol one and D r . Loner gan f ordam ages r esul t i ng f r om t hei ral l eged neg l i gence i n f ai l i ng t o t i m el y di agno se Shear er ’ s br ea stca nce r . Dr . A ki n a ddr es se s ca us at i on i n hi s r epo rtw hen he opi nes t hatt her e has been an i ncr ease i n S hear er ’ s ( 1) r i sk ofm et ast at i c br east c a n c e r a n d (2 ) su b s e q u e n t m o rb i d i tya n d m o rta l i ty a s a re s u l t o f P o l o n e a n d D r. Loner gan’ s al l eged f ai l ur e t o m eetthe appl i cabl e st andar ds ofcar e. St at ed ot her w i se, butf orPol one and D r . Loner gan’ s f ai l ur e to m eett he accept ed st and ar dsofca r e r ega r di ng eva l uat i on and m ana gem entofa br ea stm as s and i nt er pr et at i on ofm am m ogr aph y a nd br ea sts onogr aph y, Shea r erw o u l d notha ve e x p e ri e n c e d an i n c re a se i n the ri sko f m e tas tati c b rea st c a n c e r an d m o rbidi ty and m ort al i t y. Accor di ng t o t he pl ai n l ang uag e oft he r epo rt , D r . A ki n doe s not15

opi ne t hatShea r erw oul d n o t hav e a r i skofm et as t at i c can ce r , m or bi di t y, an d m ort al i t y i n t he abs enc e o fPol one ’ s and D r . Lo ner gan ’ s br ea che s oft he s ta n d a rd o f c a re ; h e o n l yo p i n e s t h a t th e i r fa i l u re t o m e e t th e s ta n d a rd s o f c a re i ncrea se d th o s e ri s k s . T h i s i s n o t a c o n c l u s o ryo p i n i o n . C f . W r i ght, 79 S . W . 3d at53 ( r ea so ni ng t hatex pertr epo rtw asco ncl us ory w hen i ts t ated thatt he pl ai nt i f fm i ghtha ve had “t he pos si bi l i t y ofa bett erout com e”w i t houtex pl ai ni ng h o w d e fe n d a n t’s c o n d u c t c a u s e d i n j u ryto p l a i n ti ff). D r . So kol si m i l arl yc ontends t hati ft i m el y di agno sed, Sh ear er ’ s br east c a n c e r c o u ld h a v e b e e n tre a te d w ith o u t t h e n e c e s s it yo f m a s te c to m ie s . In ot her w or ds, but f or Pol one and D r . Loner gan’ s f ai l ur e t o m eet t h e ac c ept ed st andar ds of car e f or a pat i ent w i t h a pal pabl e m ass and ski n di m pl i ng, Sh ear er w oul d notha ve had t o und er go t r ea t m entf orhe rco ndi t i on t hr ough i m pl em ent at i on of m ast ect om i es. D r . A ki n’ s r epo rtan d D r . Sokol ’ s r epo rtt huss how a ca us al co nne ct i on bet w ee n t he com pl ai ned
- ofnegl i gen tact s orom i ss i onsan d t he r es ul t i ng i nj ury: butf orPol onean d Dr . Lo ner gan ’ s neg l i gen tac t s orom i ss i onsi nv ol vi ng t he f ai l ur e t o t i m el y di agno seShea r er ’ s br ea stca nce r , Shea r erw oul d notha ve i n c u rre d th e a l l e g e d i n j u ri e s o f a n i n c re a s e d ri s ko f m e ta s ta ti c b re a s t c a n c e r, m or bi di t y, and m ort al i t y and t r eat m entof her cancer by w ay ofm ast ect om i es. Th e r eport s accor di ngl y i nf or m Pol one and D r . Loner gan of t he speci f i c condu ct3 ... D r . Lo ner gan ad di t i ona l l y m ak essom e t ype ofco m par at i ve

re s p o n s i b i l i tya rg u m e n t. I t i s u n p e rs u a s i v e . S ee T e x . R . A p p . P . 3 8 .1 (h ). 16 th a t S h e a rer h a s c a l l e d i n to q u e s tio n an d p rov i d e a b a sis for the tr i a l co u rtto c o n c l u d e th a t t h e c l a i m s h a v e m e ri t. S ee Tex. Ci v. Pr ac . & Rem . Code Ann. § 7 4 .3 5 1 (r)(6 ); Pal

aci os , 46 S. W . 3d at 8 7 9 . Thi s i s al l t hati s r equ i r ed; t he i nf orm a ti o n i n t he r eportdoes nothave t o m eett he sam e r equi r em ent s as e v i d e n c e o ffe re d i n a s u m m a ryj u d g m e n t p ro c e e d i n g o r a t tri a l . See Pal aci os , 46 S. W . 3d at8 78– 79. C ons equ ent l y, i n t he cont extofex am i ni ng c aus at i on, t h e re p o rt s a r e s u f f ic ie n tt o re p r e s e n ta n o bje c t iv e g o o d -f a it h e f f o rtt o c o m p ly
w i t h t he def i ni t i on of an exp ert r epo rt i n ci vi l pr ac t i ce and r em ed i es code s e c ti o n 7 4 .3 5 1 (r)(6 ). S ee Te x. Ci v. Pr a c . & Rem . Cod e Ann . § 74 . 351( l), (r)(6 ). 3W e h ol d t hatt he t r i al co urtdi d notab us e i t s di sc r et i on byde nyi ng P o lo n e ’s a n d D r . L o n e r g a n ’s m o t i o n s t o d is m is s o n t h is g r o u n d . W e o v e r r u le t hi s partofPol one’ s f i r sti ssue and D r . Loner gan’ s f i r sti ssue. C . Q ual i f i ca t i ons I n h e r se c o n d i ss u e , P o l o n e a rgu e s th a t D r. A k i n ’s an d D r. S o k o l ’s rep o rt s

“ fa i l to s h o w th a t th e ya re q u a l i fi e d to te s ti fyre g a rd i n g th e s ta n d a rd o f c a re a p p l i c a b l e to a p h y s i c i a n ’sa s s i s ta n t.” A n e x p e rt p ro v i d i n g o p i n i o n te s ti m o n yre g a rd i n g w h e th e r a h e a l th c a re pr ovi derde part ed f r om t he ac ce pt ed st and ar dsofheal t h c ar e m us ts at i sf y t he17

re q u i re m e n ts s e t fo rth i n s e c ti o n 7 4 .4 0 2 . Id . § 7 4 . 3 5 1( r ) ( 5) ( B) . Sec t i on 74 . 40 2 p r ovi des i n partas f ol l ow s: (b) I n a s u it in v o l v i n g a h e a l th ca re l i a b i l i ty c l a i m ag a i n st a h e a l th ca r e p r ovi der , a per so n m ay qua l i f y a s an exp ertw i t nes s on t he i ssue of w het herthe heal t h car e p r ovi derd epart ed f r om accept ed st and ar dsofca r e o nl y i ft he per so n: ( 1) i s pract i ci ng heal t h car e i n a fi el d ofp r act i ce thati nvol ves t he sa m e t ypeofca r e o rt r ea t m en tast hatde l i ver ed by t he d e fe n d a n t h e a l th c a re p ro v i d e r, i f th e d e fe n d a n t h e a l th c a re pr ovi deri s an i ndi vi dual , atthe t i m e the t est i m ony i s gi ven orw as pr act i ci ng t hatt ype of heal t h car e att he t i m e t he cl ai m ar ose; (2 ) h a s k n o w l e d g e o f ac c e p te d s tan d a rds o f ca re fo r he a l th car e pr ovi der s f ort he di agno si s, c a r e, ort r eat m entoft he i l l ness, i nj ury, orco ndi t i on i nvol ved i n t he cl ai m ; an d ( 3) i s qual i f i ed on t he basi s oft r ai ni ng orexper i ence t o of f er a n ex p e rto p i n i o n reg a rding tho se ac c e p ted sta n d a rds o f he a l th car e. Id . § 7 4. 40 2( b) ( V er non 2 00 5) . I n det er m i ni ng w het hera w i t ness i s qual i f i ed on t he bas i s oft r ai ni ng or exp er i enc e, t he cou rts hal l co ns i derw het her , att he t im e t h e c l a i m a r o s e o ra tt h e t im e t h e t e s t im o n yisg iv e n , t h e w it n e s s (1 ) is c e rti fi e d b ya l i c e n s i n g a g e n c yo f o n e o r m o re s ta te s o f th e U n i te d S ta te s o r a nat i ona l pr of es si ona l ce rt i f yi ng a gen cy, orha s ot hersub st ant i al t r ai ni ng or e x p e r ie n c e , in t h e a r e a o f h e a lt h c a r e r e le v a n tt o t h e c la im ; a n d (2 ) is a c t iv e ly p r a c t ic in g h e a lt h c a r e in re n d e r in g h e a lt h c a r e s e r v ic e s re le v a n tt o t h e c la im . Id . § 7 4. 40 2( c) ( 1) –( 2) . O uranal ysi s oft he qual i f i cat i ons ofan expertunder18

se ct i on 74. 3 51 i s l i m i t ed t o t he f ourco r ner s oft he exp ert ’ s r epo rtan d c u rri c u l u m v i ta e . Mem ’l Her m a nnHe a lth c a reS ys . v. Bur rell, 230 S. W . 3d 755, 7 5 8 (T e x . A p p .— H o u s to n [1 4 th D i s t.] 2 0 0 7 , n o p e t.). D r . A ki n’ s r epo rtan d cu r r i cul um vi t aede m ons t r at e t hatheha s bee n a l i censed phy si ci an i n t he S t at e of Tex as si nce 19 79 , t hathe i s boar d cert i f i ed by t he A m er i can C ol l ege ofO bst et r i ci ans and G ynecol ogi st s, and t hathe has bee n i n pr i vat e p r ac t i ces i nce1983 . D r . A ki n w ast r ai ned i n br ea stev al uat i on dur i ng a f our - year r esi dency at Par kl and H ospi t al i n D al l as, Texas, and he has t w ent y- f ourye ar s of“ of f i cepr ac t i ceex per i enc e”i n Aust i n, T ex as, w her e h e has“ perf or m ed br ea st ex am i nat i onson a r egu l arda i l y ba si s. ” H e s t at est he f ol l ow i ng: I am qual i f i ed t o r enderan opi ni on o n th e physi ci an and nu r se pr ac t i t i one rca r e p r ovi ded i n t hi s ca sebe ca us e I am an exp erti n t he di agn os i s ofbr ea stdi se as e. I ha ve exa m i ned thousands ofw om en w i t h f i br ocy st i c b r ea st di se as e a nd hun dred[ s]o f w o m e n w i th br ea stcan ce r . T hi s i ncl ude s t he r out i ne pr ac t i ceofobt ai ni ng a hi st ory ofthe pat i ent ’ s br ea stco m pl ai nt s and pe r f or m i ng a t h o r o u g h p h y s i c a l e x a m i n a t i o n , a n d w h e n n e c e s s a r yo r d e r i ng m am m ogr aph y, s ono gr aph y, an d/orf i ne nee dl e a sp i r at i on. M or eov er , asa pr i m ary c ar e p hys i ci an, I am r es ponsi bl e f or asses si ng al l oft he abov e i nf or m at i on and det er m i ni ng w hi ch pat i ent s sh oul d ber ef er r ed f orf urt hers ur gi ca l ev al uat i on a nd t r e a t m e n t . M y2 4y e a r s o fc lin ic a l e x p e r ie n c e m a k e m e in t im a t e ly f a m ilia rw it h t h e a c c e p t e d s t a n d a r d s o fc a r e a s a p p l ie s t o a ll a s p e c ts o f th i s c a s e . [E m p h a s i s a d d e d .]19

D r . S o k o l’s r e p o rta n d c u r r ic u lu m v it a e d e m o n s t r a t e t h a th e islic e n s e d in Fl or i da and W ashi ngton, D . C . , and t hathe i s board c e rt i fi ed by t he A m er i can B o a rds o f I n tern a l M e d i c i n e , R a d i o l o g y , I n tern a l M e d i c i n e S u b -sp e c i a l ty O nco l ogy, Cl i ni ca l Pha r m ac ol ogy, an d Q ual i t y Ass ur anc e. He st at est he f ol l ow i ng: I am qua l i f i ed t o a t t es tt o s t and ar dsofm ed i cal t r ea t m entf ort he di agn os i s and t r ea t m entofa pat i entpr es ent i ng a s M s. Shear erdi d. I am qual i fi e d t o do so by vi rt ue oft he f actt hatI am a l i censed p h y s ic ia n p r a c t ic in g in t h e S t a t e o fF lo r id a , s p e c ia liz in g in O n c o lo g ic M e d i c i n e . I

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pa ti ents with the presen ti ng si gnsan d s ymptom s si m i l a r to th o s eth a t Ms . Sh e a rer p res en te d with a t th e o fficeo f D r. Lon er gan i n t he appr oxi m at e t w o yearper i od pr i ort o herbr east s u rg e ry . I

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n thi s pat i ent, an d as a res ul tofm y t r ai ni ng and exper i ence i n such t r eat m ent , I am f am i l i arw i t h t he ef f ec t s of ear l y di agn os i s and t r ea t m entof pat i ent s w i t h t hes e p r obl em s, an d t he ef f ec t s ofl at e d i agn os i s and tre a tm e n t o f s u c h p a ti e n ts . I h a vetre a ted

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n vo lve d i nthec a re o f m a n ysu chp a ti en ts who di d not rec eive the ben ef itof ti m ely di agn osi s and trea tm ent . [E m p h a s i s a d d e d .] P o lo n e d o e s n o t s p e c ific a ll yc h a ll e n g e a n ys e c tio n 7 4 .4 0 2 (b ) re q u ire m e n t. C f . Bur rell, 2 3 0 S .W .3 d a t7 5 9

– 6 2 (a d d r e s s in g e a c h o fa p p e lla n t ’s s p e c if ic s e c ti o n 7 4 .4 0 2 c h a l l e n g e s ). S h e c o n te n d s th a t D r. A k i n ’sre p o rt a n d D r. Sokol ’ s r epo rtf ai l t o s t at e w het hert heyar e q ual i f i ed t o t es t i f y r ega r di ng t he s t a n d a r d o fc a r e f o ra p h y s ic ia n ’s a s s is t a n t . T h is d e t e r m in a t io n , h o w e v e r , is20

m a d e b yc o n s i d e ri n g th e i n fo r m a t io n c o n ta i n e d w i th i n D r. A k i n ’sa n d D r. S o k o l’s re p o rt s a n d c u r r ic u la v it a e in lig h to ft h e q u a lif ic a t io n re q u is it e s in c iv il p ra c ti c e a n d re m e d i e s c o d e s e c ti o n 7 4 .4 0 2 (b ) a n d (c ). S e eid . at 758 . Pol one a l so arg u e s th a t ne i th e r D r. A k i n n o r D r. S o k o l is q u a l i fi e d b e c a u se th e i r r e p o rt s do no ts t at e w het her t he st and ar ds of ca r e des cr i bed i n t he r epo rt s app l y t o a p h y sici a n , a p h y sici a n ’s as sistan t, o r bo th . T h is i s n o t an i ss u e rel e v a n t t o w het herD r . A ki n and D r . So kol ar e qua l if i ed t o o f f e ra n e x p e rto p in io n in t h is ca se ; i ti s an i ss ue app r opr i at el y a ddr es se d w hen co ns i der i ng t he ade qua cy of t he r eport s r egar di n g s tandar ds ofcar e, w hi ch w e have al r eady add r essed above. W e h ol d t hatt he t r i al co urtdi d notab us e i t s di scr et i on byde nyi ng Pol one ’ s m ot i on t o di sm i ss t he exp ert r epo rt s of D r . A ki n and D r . Sokolon t he g ro u n d s th a t th e ya re n o t q u a l i fi e d t o o ffe r a n e x p e rt o p i n i o n i n th i s c a s e . W e over r ul e Pol one’ s second i ssue. D . S p e c i fi c ity I n hi s se con d i ss ue, D r . Lo ner gan ar gue s t hatne i t herD r . A ki n’ s r epo rtnor D r . Sokol ’ s r epo rtr epr es ent s a g ood- f ai t h e f f ort t o com pl y w i t h t he def i ni t i on o f a n e x p e rtrep o rtb e c a u se the clai m s a l l e g e d i n S h e a rer’ s p e ti ti o n ( fai l i n g to c l o s e l yfo l l o w u p th e fi n d i n g s a fte r th e m a m m o g ra m in 2 0 0 5 , fa i l i n g to p e rfo rm a f i ne nee dl e a sp i r at i on on t he m as s i n que sti on, f ai l i ng t o r ef erShea r ert o a21

su r geo n f orfol l ow up, an d f ai l i ng t o t i m el y r ec ogni z e t he pos si bi l i t y of m a l i g n a n c yi n S h e a re r) d o n o t m a tc h th e c l a i m s a d d re s s e d i n th e re p o rts . W e h a v e t h o r o u g h lyr e v ie w e d S h e a r e r ’s o r ig in a l p e t it io n a n d t h e re p o rt s o fD r . A k in and D r . Sokol . I n t he con t ext of w het her t he t heo r i es of neg l i gen cem at ch t he c l a i m s a d d re s s e d i n th e re p o rts , w i th th e e x c e p ti o n o f th e s ta n d a rd o f c a re i s s u e a d d re s s e d i n p a rt o f P o l o n e ’sfi rs t i s s u e , th e re p o rts o f D r. A k i n a n d D r. S o k o l c o n s id e r e d t o g e t h e rre p r e s e n ta n o bje c t iv e g o o d -f a it h e f f o rtt o c o m p ly
w i t h t he de f i ni t i on of an ex pe rt r ep ort i n secti on 7 4 . 3 5 1 ( r )(6 ). S ee Tex. Ci v. P ra c . & R e m . C o d e A n n . § 7 4 .3 5 1 (i ), ( l) . W e over r ul e D r . Lo ner gan ’ s se con d i ssue. V . R E MAND O RD I SMI SS ? P o lo n e c o n t e n d s t h a tS h e a r e risn o te n t it le d t o a re m a n d o ft h e c a s e if t h is c o u rtd e t e r m in e s t h a tt h e e x p e rtre p o rt s a r e d e f ic ie n t . W e d is a g r e e . C iv il pr ac t i cean d r em edi escode se ct i on 74 . 351 ( c) al l ow s t he t r i al co urtt o gr antone th i rt y -da yex ten sion to th e clai m a n t i n o rde r to g i v e th e c l a i m a n t an o p p o rt u n i ty to c u re a re p o rt fo u n d to b e d e fi c i e n t. Id . § 7 4 .3 5 1 (c). H e re, i t i s th i s c o u rt , not t he t r i al court , t h a t has sust ai ned partofPol one’ s m ot i on t o di sm i ss ch al l eng i ng t he ade qua cy ofD r . A ki n’ s and D r . Sokol ’ s r epo rt s. Sec t i on 74. 351 ( c) i s notr end er ed m ea ni ngl es s si m pl y be ca us e t hi s cou rt , i ns t ea d oft he tri a l c o u rt, d e te rm i n e s t h a t a n e x p e rt re p o rt i s d e fi c i e n t. S ee Lel and v. Brandal,22

2 5 7 S .W .3 d 2 0 4 , 2 0 5 , 2 0 7

– 0 8 ( T e x . 2 0 0 8 ) (“ In t h is h e a lt h c a r e lia b ilit yc la im , w e m u st d e c i d e w h e th e r a p l a i n ti ff m a yb e affo rde d a thirty-d a yex ten sion to c u r e a n e x p e rtre p o rta f t e ra t r ia l c o u rt ’s ru lin g t h a tt h e re p o rtisa d e q u a t e is re v e rs e d o n a p p e a l . W e h o l d t h a t w h e n e l e m e n ts o f a ti m e l yfi l e d e x p e rt re p o rt ar e f oun d def i ci ent , ei t herby t he t r i al courtoron appeal , one t hi rt y- day e x te n s i o n to c u re th e re p o rt m a yb e g ra n te d .” ) (c i ta ti o n o m i tte d ); see al so Mi randa v. Marti

nez , N o. 1 3- 06- 003 86- C V , 2 007 W L 68 700 1, at*3–4 ( Tex. A pp. — C or pus C hr i st i M ar . 8, 20 07 , pet . deni ed) ( m em . op. ) . The r ecor d does notde m o n s t r a t e t h a tt h e t r i a l c o u rth a s a l r e a d yg r a n t e d Sh e a r e ra s e c t i on 7 4 .3 5 1 (c) ex ten sion . A c c o rding l y , rem a n d i s ap p rop ri a te fo r t h e tr i a l co u rtto m ake i t s ci vi l pr act i ce and r em edi es code sect i on 74 . 35 1( b)

— w hi ch i s subj ect to s e c ti o n 7 4 .3 5 1 (c )— d e te rm i n a ti o n . S ee Tex. C i v. Pr ac . & Rem . Code Ann. § 7 4 .3 5 1 (b ), (c). V I. C ONC L USI ON W e affi rm the tr i a l co u rt ’s o rde r de n y i n g D r. Lo n e rga n ’s m o ti o n to d i sm i ss . H avi ng sust ai ned partofPol one’ s f i r sti ssue, w e r ever se t he t r i al cou rt ’ s or derde nyi ng Pol on e’s m ot i on t o di sm i ssan d r em and t he ca set o t he tr i a l c o u rt to d e term i n e w h e th e r to d i sm i ss S h e a rer’ s cl a i m ag a i n st P o l o n e o r t o23

gr antShea r era se ct i on 74. 351 ( c) t hi rt y- dayex t ens i on t o cur e t he def i ci enc y. S e eid .

W I L L I AM B R I GHA M J U S T I C E PA N EL: LI V I N G STO N an d M C C O Y, JJ. ; an d W I LL I A M BRI G H A M ( Seni or J u s ti c e , R e ti re d , S i ttin g b yA s s i g n m e n t). DEL I VERE D: Apr i l 2, 2009