### TEXA S C OU R T OF A PPEAL S, THIR D DIST R ICT , AT AU STIN

NO. 03-0 6 -00 607 -CV
Austin Heart, P .A. and David J. Ke ssler, M.D . , Appellan ts
v. Christian L. Webb and Marilou Webb , Appellees

F ROM THE DISTRICT CO URT OF TRAVIS COUNTY , 98TH JUDICIAL DISTRICT NO. D-1- GN-06- 0003 76 , HO NORAB LE P AUL DAVIS , JUDGE PRESIDI NG

O P I N I O N
Aus ti nH e art, P. A
. a n d

D a v id J. K e s s le r , M
. D
. a

p p e a l t h e d is tr ic t c o u rt’ s order de nyingthe ir

mot ion to d ism iss Chr ist ian a

nd Mari lou Web b’ s me dic a l ma lpr a c tic e c la ims . A us tin Hea rt and Dr. Kessler contend that the ex pert report served on them pursuant to civil prac tice and
reme dies code section 74.351 did not comply with the statute beca use it did not sufficiently

identify either Austin Heart or

Dr. Ke ssler as the parties responsible for the alleg ed bre ach of

the standar d of ca re or t h e ca u s e o f t h e all eg ed injury to Mr. Webb. See Tex. Ci v. Prac. & Rem. Code Ann. § 74.351 (West 2005 & Supp. 2006). We a g ree that the plaintiffs’ expert repor t w as defic ient and that the district court e rre d in denying the motion to di smiss. However, w e ar e of the view that the
c ur e pr ov isi on s of se c tio n 74 .3 51 (c ) are de sig ne d to a llo w the pla int if fs an op po rt

un ity to addre ss
an d c o r r e c t t h e d e f

e c t
. C o n s e qu e n t l y , w e r e v e r s e t h e d i s t r i c t c o u rt ’ s o r d e r d e n y i n g t h e m o tio n to d i s m i s s an d re m and this cause to the district court to consider whether a 30-da y extension of the deadline f or ser ving the repor

t to allow the plaintiffs to addre ss the defic iency is appropriate.2 The W ebbs sued Austin He art a nd Dr. Ke ssler in J anuar y of 2006 alleg ing that Dr. Ke ssler fa iled to “diag nose and tre at the medica l condition which cause d [Mr. W ebb’s] sever e pa lpi ta tio ns and

re su lti nga sso c ia te d h e a lthc on dit ion s. ” Th e pa lpi ta tio ns and oth e r s y mpt oms descr ibed by

the Webbs were related to Mr. W ebb’s pacemaker. On M ay 31, 2006, the Webbs filed and ser ved the e x pert re port and c urricu l u m v i t ae of Dr. A lan E. Cororve pursuant to the require ments of sec tion 74.351 of the civil pr actice and reme dies code se tting for th Dr. Cororve ’s opinions reg ardingMr. Webb’s treatment for his problems with his pace maker . Austin Hear t and Dr. Ke ssler filed a

motion to di smiss on J une 21, 2006, cla iming that Dr . Cororve’ s repor t did not identify either Dr. Ke ssler or Austin He art a s the parties r esponsible for br eac hing the standard of
c a r e o r cau s i n g M r. W eb b i n j u ry an d , t h er ef

o re , t h e re p o rt wa s n o t a ti m el y re p o rt as t o t h e m . In response , the Webbs claimed that the r eport was sufficie nt a s written and, in the alternative, filed a mot ion fo r a 30 -d ay e xten sio n to c ur e in t

he e ve nt t he c ourt fo un d th e re po rt

de fi c ie nt. Th e dis tr ic t c ourt ini tia lly g ra nte d the mot ion to dis mis s on Augus t 22 , 2 00 6, and did not gr ant a 30- day

extension t o allow the plaintiffs t o attempt to cure the def iciency . The Webbs filed a motion for r ehea

ring and a motion for ne w trial on September 15, 2006, arguing that the court had misinterpre ted ca se law r elating to w hat constitutes a sufficie nt r eport under section 74.351 and that D r. Cor or

ve ’s re po rt

wa s su ff ic ie nt. Th e y a lso re -u

rg e d the ir re qu e st fo r a 30- da y e xten sio n to
c ur e in the e ve nt t

he c ourt de nie d th e ir

mot ion fo r r e he ari ng . T he dis tr ic t c ourt the n r e ve rs e d it s
or ig ina l r uli ng , g ra nte d th e mot ion

fo r r e he ari ng , a

nd e nte re d an o rd e r d e nyingthe mot ion to d ism iss
. This appea l followed.

Section 74.351 require s a cla imant pursuing a health car e liability claim to serve one
or more e x pert re ports on eac h party no lat er t h an t h e 1 20th day afte r the filing of the orig inal3

petition. Id. § 74.351(a) . The e x pert re port must provide “a fair summar

y of the e x pert’s opinions as of the date of the r eport re g arding applicable standards of

car e, the mann er i n which the c are rende red by

the phy sician or he alth car e provide r fa iled to meet the standa rds, and the c ausal relationship between that fa ilure and the injury , harm, or da mag es cla imed.” Id. § 74.351(r) (6). A court shall g rant a motion challeng ing the adequa cy of a repor t only if the re port “doe s not repre sent an objec tive g ood faith ef fort to comply ” with the def inition of “expert report” in the statute. Id. § 74.351( l ). To c on sti tut e a g oo d f a ithe ff or t, t he re po rt mus t pr ov ide e no ug h in fo rm a tio n to fu lf ill tw o p ur po se s: (1 ) it must

inf or m th e de fe nd ant o f t

he sp e c if ic c on du c t th e pla int if

f h a s c a lle d in to qu e sti on , a

nd (2 ) i t mu st p ro vid e a

ba sis fo r t

he trial cou rt to c on c lud e that th e c la ims have me ri t. Bowie Mem orial Hosp. v. W right , 79 S.W .3d 48, 52 (Tex. 2002) ( c iti ng Am e ric an Tra ns iti on al C ar e Ctrs, Inc. v. Palacios , 46 S.W .3d 873, 879 (Tex. 2001)).

The T ex as Supreme Court has a lso stated that a re port nee d not marshal all of the plaintiff’s proof

, but it mus t include the expert’s opinion on ea ch of the elements identified in se ction 74.351. Palacios , 46 S.W .3d at 878. A repor t c annot mere ly

state the e x pert’s c onclusions about the statutory

elements. Id. a t 87 9. “ Ra the r, the e xp ert mu st e xpla in t he ba sis of

his state me nts to link his conclusions to t he fa cts.” Bowie Mem orial , 79 S.W .3d at 52 ( qu oti ng Ea rlev . R atl iff , 998 S.W .2d 882, 890 (Tex. 1999)). In addition, since the statute f ocuses on wha

t i s re q u i re d in the
re po rt , th e on ly inf

or ma tio n r e le va

nt t o d e te rm ini ngwh e the r a re po rt c omp lie s w iththe statut e is “within the four corne rs of the document.” Palacios , 46 S.W .3d at 878. This require ment prec ludes
a c ourt fr om fi lli ng g a

ps in a r e po rt

by dr awi nginf

e re nc e s o r gue ssi nga s to wh a t th e e xpe rt lik e ly meant or intende d. See B owie Memorial , 79 S.W .3d at 53 (“The repor t must include the r equire d inf or ma tio n wi thi n its fo ur

c or ne rs .” ); see also Gray v. CHCA Bayshore L.P. , 189 S.W .3d 855, 859These inc luded re cords of five phy sicians, three hospitals, and a clinic. 1 4 (Tex. App.—Houston [1s t Dist.] 2006, no pet.).

We reviewa district cour t’s ruling on a motion to dismiss under section 74.351 for
an abuse of discre tion. Palacios , 46 S.W.3 d at 8 77 -7 8. A tri a l c ourt a bu se s it s d isc re tio n w he n it
a c ts i n a n a rb itr ary or un re a so na

ble mann e r or

wi tho ut r e fe re nc e to a

ny g uid ingru le s o r p ri nc ipl e s. Downer v. Aquam arine Operators, Inc

. , 701 S.W .2d 238, 241-42 (Te x . 1985). A trial c ourt does not abuse its discre tion sim ply beca use it may

decide a matter

within its discretion differ ently than an appellate court. Id. a t 42 . H ow e ve r, a tr ia l c ourt ha s no dis c re tio n in de te rm ini ngwh a t th e law i s or apply ing the law to the facts. W alker v. Pac ker , 827 S.W .2d 833, 840 (Tex. 1992). A cle ar f ailure by the trial cour

t to analy ze or apply

the law c orre ctly

will constitut e an a

buse of discr etion. Id. I n a sing le issue, Aust in Hea rt and Dr. Kessler argue that section 74.351(b) mandates dismiss al of the Webbs’ la wsuit. Their ar g ument is straig htforwa rd : Read litera lly , without any infere nces or

relianc e on information outsi de of its four c orner s, Dr. Cororve ’s re port does not identify either D r. Ke ssler or Austin He art a s having brea ched the standard of car e or having cause d Mr. Webb injury . The Webbs re spond that, while t he sections of Dr. Cororve ’s re port relating to the brea ch of the standard of

car e and causation do not ide ntify any specific phy sicians, the meaningof the re port rea d as a w hole is appar ent and re v ea l s that Dr. Cororve is refe rringto Mr. Webb’s treatment by

Dr. Ke ssler. Dr. Cororve ’s t wo and one-half pa g e re port is divided into five sections—“Qua lifications,” “Materials Reviewed and Ba ckg round,” “Standard of Care,” “Standar d of car e not me t,” and “Causation.” I n the section titled Materials Reviewed an d Ba ckg round, Dr. Cororve lists t he var ious medical re co rd s h e reviewe d. He then se ts out selected por tions of 1I n their brief , the Webbs state that the email re sponse was a ctually by Dr. Ke ssler rather 2 than Dr. Rodg ers a

nd the re fer ence in the repor t i s a ty pog raphic al er

ror. How ever , there is no e vid e nc e in t

he re c or d o n th is p oin t ot he r t ha n D r. Cor or

ve ’s re po rt
. Th e re po rt

do e s n ot m e nti on

wh o was res po ns ible fo r t he dia g no sis of

dia ph ra g ma tic 3 stimul ation or plac ing a

new r ight ve ntricular le ad.

5 these re cords de tailing the releva nt aspec ts of Mr. Webb’s history of treatment for atr ial fibrillation and palpitations ove r a per iod of nea rly four y ear s beg inning with the plac ement of his pac emake r in November

2001. This reviewof Mr. Webb’s tre atment history includes a numbe r of r efe renc es to Dr. Ke ssler’s off

ice notes, c omments by

Dr. Ke s s l er in those notes, complaints by Mr. Webb contained in the note s, a re fer ence to the office notes of a D r. Ge org e Rodg er s , an email from Mr. Webb to Dr. Ke ssler, a r esponse e mail from Dr. Rodg ers, and a g eneral s t at em en t that 2 “[Mr. Webb] was seen by various phy sicians, including se vera l electr ophy siologica l consultations.” Th e ba c kg ro un d s e c tio n c on c lud e s w it h the o bs e rv a tio n th a t “ [f]urt he r e va luatio n e ve ntu a lly documented dia

phrag matic stimulation and a new right ventricular lead was place d on September 7, 2005. The patient was subsequently discharg ed in e x cellent condition.” The ba ckg round sec tion 3 of the re port offe rs no opinions reg ardingthe appr opriatene ss of the treatment or the re sp o n s es of the phy sicians to Mr. Webb’s complaints. I t is strictly a rec itation of historical mater ial contained in the medical r ecor ds review ed by Dr. Cororve
. Th e re po rt

the n c on c lud e s w iththe fo llo wi ngthr e e se c tio ns :
Stand ard of Care The standa

rd of c are in a patient such a s this require s more intensive investig ation as to t he so ur c e of

a patie nt’ s sy

mpt oms and

su bs e qu e nt c or

re c tiv e a c tio ns to a

me lio ra te the pr ob le m. Atte mpt s a t a dju sti ng the ve ntr ic ula r pa c ing ou tputs sh ou ld r ou tin e ly be a tte mpt e d a

nd wo uld mos t li ke ly

have pin po int e d th e pr ob le m mu c h e arl ie r. Th is sta nd ard of c are wa s n ot m e t.Austin Hear t, P.A. is allege d to be vicar iously liable for the con d u ct of Dr. K essler. 4 Dr. Cororve ’s re port notes at the outset that “[a]ny ref ere nce in this repor

t to David J . Kessler , M.D. ref ers to Dr . Kessler

individually , and his em p l o y er, Austin Heart, P.A.” Conseque ntly , for the purposes of this appe al, the re port must link Dr. Cororve’s opinions to the ac tions of Dr. Ke ssler. The Webbs s ug g est that a tally of t he number of times a phy sician is mentioned in a re port 5 is significa

nt. They note that Dr. K essler’ s name a ppear s eleve n times i n Dr
. C o rorve ’s re port (a s o pp os e d to thr e e tim e s f or Dr . Ro dg e rs and on c e fo r “ va ri ou s p hy sic ians ” ). Th e y

argue that th is c ou ld l e a d to a

re a so na ble c on c lus ion

that th e re po rt

mus t be a

bo ut D r. Ke ssl e r a

nd his a c tio ns . Howeve r, we are not persuade d that such a ta lly is releva nt to the analy s i s . A phy sician may be name d in a re port any number of times simply beca use he w as intimately i n v o l ved in the treatment of a patient, y et the complaint may be with the conduct of a phy sician who saw

the patient only once and i s mentioned i n the report only once. The number of times a phy sician is mentioned in a report, by

itself, has little bearingon whether the opinions ex presse d in the repor t conce rn that phy sician. W h at matters, of c ourse, is how the phy sician is mentioned and wha t the repor

t communicates a

bout that phy sician. 6 Stand ard of care not m et The diag nostic and corr ective action eventua lly taken, specific ally the incre ase in the ventricula r pac ing output, should have been implemente d much sooner. Causation Had the c orre ctive ac tion described oc curr ed, Mr. Webb would not have underg one the phy sical and me ntal problem(s) he had and c ould have c ontinued his normal lifesty le much ea

rlier than he did.
Dr. Ke ssler and Austin Hea rt point to these sections and argue that, while they may articulate an opinion on the bre ach of t h e st andar d of ca re a nd on causation, the sections do not identify Dr. Ke ssler as br eac hing the standard of car e or causing injury
. The W ebbs conc ede that 4 these sec tions do not ex pressly ment i o n Dr
. Kessler. They argue, howe ver, that the backg round
se c tio n o f t

he re po rt make s it c le ar D r. Cor orv e’s op ini on s r e la te to D r. Ke ssl e r b e c a us e it i s primarily Dr. Ke ssler’s a ctions that are noted in the re l ev an t h i story
. Thus, they argue the r eport 5I t is not c lear what the ref ere nce to “ various phy sicians” and “e l ectr ophy siologica l 6 consultations” in the re port means or is intended to communicate.

7 should be rea d to mean that the opinions in the s tandar d of care and causation sections refer to the
a c tio ns and

c on du c t of

Dr . K e ssl e r s e t out in

the ba c kg ro un d s e c tio n o f t he re po rt
. The proble m with this argument is that it requires the r eade r to i n fe r o r m ake a n educated g uess that Dr. Coror ve is identifying D r. Ke ssler as the phy si ci an who br eac hed the standard of

car e and c aused injury . Had Dr. Cororve refe renc ed only actions by

Dr. Ke ssler in the ba c kg ro un d s e c tio n o f h is r e po rt , th e lin k b e tw e e n D r. Coro rve’ s op ini on s and the re sp on sib le phy sician mig ht be more a ppare nt. Howeve r, Dr. Cororve also ref ers to a ctions taken by

Dr. Rodg ers and make s a vague re fer ence to Mr. Webb having been “ seen by various p h y sicians, including
se ve ra l e le c tr op hy sio log ic a l c on su ltatio ns ” a ft e r h e wa s tr e a te d b y Dr . K e ssl e r but befo re h is
co n d i t i o ni mp ro v ed
. T h er e i s n o t h i n g in t he re po rt that links Dr. Kessler to Dr. Cororve ’s opinions 6 reg ardingthe bre ach of

the standar d of car e and causation a ny more than Dr. Rodge rs or the other “var ious phy sicians” r efe renc ed.

The Webbs point out that (1) Dr. Kessler is the only defe ndant phy sician and ( 2) the
essenc e o f Dr
. C o ro rv e’s opinions is that the brea ch of the standard of car e wa s the failure of the treating phy sicians, implicitly including D r. Ke ssler, to proper ly adjust the ventricular pac ing outputs. However , that Dr. Ke ssler is the only defe ndant phy sician is not rele vant to an ana ly sis of whethe r ane xp e rt r e p o rt c o mp li e s w it h s e c ti o n7 4
. 3 5 1
. T h e f

a c t t h a t h e is th e o n ly

d e f endant phy sician and, the ref

ore, ve ry likely to be the subject of the report is outside the four c orner s of the repor t. See Palacios , 46 S.W .3d at 878. I t also does nothing to c larify to whom the opinions of the expert supply ing the repor t a pply
. The expert’s opinions a re, of course , confine d to the repor t and8

must tell t he re ader n o t only what conduc t brea ched the standard of car e, but whose c onduct brea ched the standard of

car e. The plaintiffs’ alleg ation that a particula r phy sician was at fault does
no t su bs tit ute fo r t he re qu ir e me nt t

hat th e y su pp ly an e xpe rt re po rt de mon str a tin g that the e xpe rt is of the same opinion.

We also do not ag ree that t h e substance of Dr. Coror ve’s opinions could only be associate d with the conduct of Dr. Ke ssler. The e ssence o f Dr
. C o ro rve’s opinion is t hat the phy sicians who tre ated Mr. Webb should have adjusted his ventricula r pac ing outp u t s s ooner a nd the fa ilure to d o s o w a s a br e a c h o f t he st and ard of care . T his op ini on c ou ld a pp ly or no t a pp ly
e qu a lly to D r. Ke ssl e r, Dr . Ro dg e rs , or the va ri ou s un name d ph y sic ians . Th e re po rt mus t st a te , in
some manner , who bre ache d the standar d of ca re a nd who ca used the alleg ed injury , and whe ther that includes Dr. K essler. In the words of the supreme court in P a la c ios , “t h e re p ort must inform the defe ndant of the spec ific conduc t the plaintiff has c alled into question.” Palacios , 46 S.W .3d at 879. This includes informing the def endant of the spec ific conduct in question of that defendant
. See Palacios , 46 S.W .3d at 878 (The statute requir es, as to each de fendant , a fa ir summary of the expert’s opinions about the applicable standard of ca re, the manner

in which the ca

re f ailed to meet that standard, a

nd the ca usal relationship between the f ailure a nd the claimed injury

). We are mindful t h at a re p ort’s ade quacy under se ction 74.351 does not depe nd on whether the expert uses any

particula r mag ic words suc h as “the standard of car e wa s brea ched by Dr. Kessler .” S

e e B o wie Mem orial , 79 S.W. 3d a t 53 . H ow e ve r, the re po rt mus t c omm

un ic a te in some fashion—within its four cor ners—how the car e rende red by the phy sician fa iled to meet the applicable standard of

car e and the causa l relationship betwee n that failure and the injury suffe red by the c la ima

nt. Te x. Civ . Pr a c . & Re m. C od e Ann
. § 7 4. 35 1( r) (6 ). We r e c og nize that th is9

information could be c ommunicated in a number of way s and it c ould be communicate d in sections of a repor t othe r than sections titled “ Standard of Care” or “Causation.” The for m of the re port and the location of the information in the re port are not dispositi ve. Howeve r, i n this case , Dr. Cororve ’s
re po rt is s ile nt a s to wh e the r a

sin g le ph y sic ian, mul tip le ph y sic ians , o r a ll p hy sic ians me nti on e d in the re po rt fa ile d to me e t th e sta

nd ard of c are and c a

us e d injury to Mr . Webb
. I t simpl y do e s n ot s ta te t h a tt h e c ar e r e n d e r e d

b y D r . K e s s l e r

f a i l e d t o m e e ta p p l i c a b l e s t an d ar d s an d

c a u s e d i n j u r y. Whil e we are of t he view that Dr. Cororve’s re port is deficie nt under sec tion 74.351 be c a us e it r e qu ir e s the re a de r t o ma ke an e du c a te d gue ss r e g ard ingan e sse nti a l e le me nt, we are a lso
awa re that the defe ct might we ll be cura ble. The tenor of Dr. Cororve’ s repor t, coupled with the fa ct that there is only

one phy sician def

endant, make s it quit e likely that Dr. Cororve intended to opine that Dr. Ke ssler bre ache d the standar d of ca re an d ca u sed injury

even thoug h the re port did not contain that opinion. The re port’s fa ilure on this point is the kind of def ect that the c ure pr ovisions of sec tion 74.351(c) wer e desig ned to addr ess. Since the district cour t ultim ately

found the re port to be suffic ient, the cour

t did not consider whethe r a 30- day extension of the repor t de adline to allow the Webbs to attempt to cure a defe ct would be appropriate. I n light of our ruling t hat t he re port does contain a defe ct, we be lieve conside ration by the trial cour

t of the Webbs’ re quest for a n extension to attempt to cure the defe ct is warr anted.

Au sti n H e art

and Dr . K e ssl e r a

rgue that Garcia v. M

arichalar , 185 S.W .3d 70 (Tex. App.—San Antonio 2006, no pet.), supports the pr o p o s i t i o n that an expert re port that ref ere nces mult iple health care providers but fa ils to delineate the standa rd of c are , brea ch and c ausal
c on ne c tio n a s to sp e c if

ic , in div idu a l de fe nd ants is t anta mou nt t o n o r e po rt

a t a ll with re sp e c t to tho se defe ndants. They then pos it that since Dr. Cororve’ s repor t should be conside red no r eport at all as10

to Dr. Ke ssler, the court has no discretion but to dismiss the plaintiffs’ cla ims with prejudice. See Je r n i g a n v. Langley , 1 95 S.W. 3d 91 , 9 4 ( Te x. 20 06 ); Marichalar , 1 85 S.W. 3d a t 73 -7 4. Th is
over s t at es t he holding in Ga rc ia . The phy sician in Garcia wa s n ot m e nti on e d in the re po rt

a t a ll. There was litera lly

nothing in the r eport that re lated to the phy sician in any way . Thus, the re port
was no re port as to him. The Ga rc ia court then held that this was a situation wher e no ex pert re port was ti mely filed wit h respe ct t o the phy sician i n question, prec luding the trial court from considering an extension to cure be cause there was no timely repor t to cure. 185 S.W .3d at 74 (trial c ourt had no authority

to allow a cur e per iod for a none x istent report). A c los e r c a se is Jernigan v . Langley , 195 S.W .3d 91 (Tex. 2006). I n Jernigan , the supreme c ourt noted t hat a mere “passing ref ere nce” to a phy sician i n a report, without expl anation of how the phy sician bre ache d the standar d of ca re or cause d the injury , would not constitute a sufficie nt report. 195 S.W .3d at 94. The only ref ere nce to Dr . J ernig an in the re port was “ [a] t 4:30 p.m. [ J ohn L ang ley ’s] case wa s discussed wit h Dr. J ernig an and at 4: 50 p.m. a lactulose enema was
or de re d. ” T h e e xp e rt ’ s o p i n i o n o n b r e a c h o f t h e s t an d ar d o f c ar e h a d t o d o w i t h t h e f a ilu re to
e xami ne c e rt a in x- ra

y s. Th e re po rt

did no t li nk

Dr . Jer nig an o r t

he re fe re nc e d d isc us sio n w ith D r . J e r n i g ant o a b r e a c h o f

t h e s t a n d a r d o f c a r e o r

t o t h e f a i l u r e t o e x a m i n e x - r ay s i nan y w a y . It
ma de no other

me nti on of him or wh a t he did

a t a ll. Th e su

pr e me c ourt

no te d th a t th e sin g le ref ere nce to Dr . J ernig an in the report was so oblique that there was no connec tion at all betwee n the ref ere nce to him and the e x pert’s opinions reg arding the standard of car e and causation. I t affir med the trial cour

t’s dismiss al of the la

wsuit based on the insufficiency of t he report, s tating that “the trial court ha d no discretion but to conclude , as it did here, that L ang ley ’s claims aga inst Dr. J ernig an must be dismis sed.” Id.Jernigan interpre ted a pr ior version of the statute that had a dif fer ent standar d for g ranting 7 an ex t en s i on to cure . Under the pre vious iteration of the statute, the tr ial court c ould gr ant an e xten sio n o nly

if it f ound tha t th e fa ilure to c omp ly

wi th t he statut e wa s “ no t int e nti on a l or the re su lt of consc ious indiffer ence but was the result of an acc ident or mistake.” See former Tex. Rev. Ci v. Stat. An n . ar t . 4590i, § 13.01(g ) repeale d by Acts 2003, 78th L eg ., ch. 204, § 10.09, ef f. Sept. 1, 2003. The Jernigan opinion does not discuss the a pplication of this standa

rd, the trial court’ s failure to gr ant an e x tension under this standard, or whether the t rial court could have considere d such an extension if it had made such finding s. Thus, the Jernigan op ini on is d ist inguis ha

ble fr om t his c a se on this basis alone. Howe ver, e ven if the trial co u rt ’s d i s cretion to dism iss claims under either version of the statute is viewed a s the same, the e x pert re port in Jernigan would still constitute “no repor t” for the purposes of dismissal under e ither ver sion of the statute. 11 The re port in Jernigan , as in Ga rc ia , amounted to no re port at all as to Dr. J ernig an and warra nted di smissal for failure to serve a ti mely repor t. There was no discr etion for the c ourt to g ra nt a n e xten sio n to c ur e be c a

us e the re wa s n o time ly re po rt —w ithre sp e c t to Dr . Jer

nig a n— to
cure . Any

attempt by

the plaintiffs to “c ure” the re ports in Jernigan and Ga rc ia wo uld , in e ff e c t, 7 have be en to cr eate and ser ve new repor ts—that did not ex ist at all within t he time per iod for ser ving repor ts—with re spect to the phy sicians in que stion in eac h case . This is conce ptually no differ ent fr om t he sit uatio n w he re a

pla int if f s imp ly mis se d th e de a dli ne fo r s e rv inga re po rt
. Jernigan and Ga rc ia dif fe r f ro m th is c a se in c ru c ia l r e sp e c ts. Her e , a tim e ly repor t plainly discusses the conduc t of t he phy sician i n question and the re port discusses opinions
on the sta nd ard of c are and c a us a tio n th a t c ou ld b e lin ke d to the c on du c t of the ph y sic ian s e t out in the re port, but simply

are not. The re port is not deficient be cause it does not relat e to Dr. K essler
a t a ll. I t is de fi c ie nt b e c a

us e the lin k b e tw e e n D r. Ke ssl e r’ s c on du c t and the e xpe rt ’s c on c lus ion s is not express l y s t ated. The repor t in this case is, theref

ore, some r eport a s to Dr. Kessler (among oth e rs ), bu t it

is n ot s uf

fi c ie nt t o me e t a ll o f t

he re qu ir e me nts of

se c tio n 7 4. 53 1. I t is an e xamp le of what section 74.351(c) ref ers to as a repor

t that “has not bee n serve d within the [ 120-day period for se rving repor

ts] beca use ele ments of the re port ar e found deficient.” Tex. Ci v. Prac. &The dissent ar g ues that by rema nding to a llow the trial court to conside r whe ther a section 8 74.351(c) extension i s appropr iate we are g ranting Dr. Ke ssler and Austin Heart more relief than they reque sted or ar e entitled to. The dissent’s theory is that the re is a distinction under se ction 74.351 betwee n (1) se eking dismiss al on the basis that no repor t was ser ved and ( 2) see king dismissal on the ba sis that a

re po rt wa s se rv e d, bu t it

do e s n ot m e e t th e re qu ir e me nts of the statut e and

is d e fi c ie nt. Acc ording to the dissent, if a defe ndant seeks dismiss al only on the basis that no re port was se rved, then dismissal is not a

ppropriate if the cour

t finds that a re port, no matter how de ficient, wa s serve d. T h e r e ar e t w o p r o b l e m s w i t h t h i s t h e o r y. Fir s t, th e d is mi s s a l m e c h an is m o f s e c ti o n7 4
. 3 5 1 d o e s n o t w o r k th e w ay th e d is sent sug g ests. Under section 74.351, a cla imant must serve an “ expert repor t,” as de fined in the statute, or be subjec t to dism issal. I f a c laimant does not serve a re port that co m p l i es wi th the statutory require ments, then the cla imant has not serve d an “expert repor t” as define d in the s tatute. Whether a cla imant actually fails t o serve a report at all or serves a defic ient repor t the effec t under sec tion 74.351(b) is the same—the claimant has failed to se rve the require d “expert repor t” and dismissal is the remedy . Ho we v er, se ction 74.351(c) provides a pote ntial cure period for situations where the c la ima

nt h a s se rv e d a

re po rt , b ut t

he re po rt do e s n ot c on sti tut e the re qu ir ed “ex pe rt re po rt ” be c a us e “ e le me nts of

the re po rt

are fo un d d e fi cie nt. ” Th e c la ima nt t he n h a s a n o pp or tun ity to f ix the def ec t i n t h e re p o rt t hat was se rved. I f there is a failure to cure the def ect by the extended deadline, the n dismiss al is mandatory beca use t he claimant has fa iled to serve a n “expert re port” a s define d in the statute. Whil e sec tion 74.351(b) does not distinguish betwee n a complete failure to se rve a repor t and the f ai l u re t o serve a complying r eport, ther e is a distinction betwee n the two for the purposes of 74 .3 51 (c ). Whe n a

c la ima nt f a ils to s e rv e a

re po rt a t a ll, se c tio n 7 4. 35 1( c ) d oe s n ot p ro vid e a ba sis 12 Rem. Code Ann. § 74.351(c)
. I n such a circ umstance, section 74.351(c) g rants the trial co urt discretion to a llow a 30-day extension of the deadline “in order to cure the def

iciency .” Id. Jernigan and Ga rc ia cannot be rea d to mean that a n y d ef i ci en cy in a re port requir es dismissal without t he po ssi bil ity

of an e xten sio n to c ur e be c a us e that wou ld mea n se c tio n 7 4. 35 1( c ) h a s n o p os sib le application and is super fluous. Section 74.351(c) contemplates that there a re c ircumstance s where a timely repor t will be deficie nt, but the deficie ncy can be cure d. To be c onsistent with the statute, Jernigan and Ga rc ia mus t be re a d to a llo w f or a t least so me sit

uatio ns wh e re a

tim e ly re po rt is defic ient, but the trial court should consider w hether the def iciency is such that it warra

nts allowing
a cur e per iod. Id.

8for the tr ial court to g rant a ny extension of the deadline f or serving a repor

t. Conseque ntly , dismiss al is mandatory

without any

cure period. When a c laimant serve s a repor t, but it is def

icient, sec tion 74.351(c) g ives the t rial court the di scre tion to g rant an ext ension to cure . Reg ardle ss of whethe r a claimant has f

ailed to serve a re port at all or has serve d a defic ient repor t, the statutory

basis of the motion to di smiss by

a def endant is the same—the claimant has f ailed to serve an “e x pert re port” a s re qu ir e d b y

se c tio n 7 4. 35 1( b) . T he fa c t th a t th e c la ima nt w ho fi le s a

de fi c ie nt rep or

t ma y re qu e st and re ceive an extension of time to cure the def iciencie s does not alter the nature of the de fenda nt’s motion to di smiss. The motion to dismiss is on the ground that the pl aintiff has failed to ser ve an “expert re port.” Second, the de fenda

nts in thi s case did r equest dismiss al on the basis that, while the Webbs had s e r v e d a r e p o rt th a t me n ti o n e d D r . K e s s le r , th e r e p o rt “ f a il s to a d dr e s s th e s ta

ndard of car e applicable to Dr. Kessler, the brea ch of the standard or any alleg ed ca

usal link.” This is an alleg ation that the report serve d was deficient. The defenda nts acknow ledg e that a report was se rved a nd that the re po rt a dd re sse s c on du c t of

Dr . K e ssl e r, bu t they cla im i t is de fi c ie nt i n f a ili ngto a dd

re ss the statut or ily

re qu ir e d e le me nts . T he y are awa re that se c tio n 74 .3 51 (c ) g ra nts the tr ia l c ourt

so me discretion in allowing an extension to cure cer tain defic ient repor

ts. But, they argue that the report in this case is so defic ient that it should be viewed a s “no re port,” requiringdismiss al rather than re mand for c onsideration of a n extension period. By

alleg ing that the defic iency is s ever e enoug h to c onstitut e “no repor t” the defe ndants are trying to a void the possibili ty

of a c ure pe riod. They are not altering their cla im that the re port they rec eived is def

icient and will re quire dismissal if not corr ecte d. We ha ve conclude d that the repor t is defic ient, but not so defic ient as t o co n s t i t u t e “no re po rt .” Th e re fo re , our op tio ns are (1 ) re ve rs e the tr ia l c ourt or de r de ny ing the mot io n t o dism iss and re nder judg ment of dismiss al or (2) reve rse the tr ial court orde r and r emand f or consider ation of whe ther a

n extension shoul d be g rante d to give the plaintiffs an oppor tunity to at tempt to cure. Remanding for the case to pr ocee d on its mer its, e ven though we ag ree with the appellants that the repor t is deficient, is not an option. 13 We are of the opinion that the re port in this case fa lls int o that cate g ory . I t was ser ved timely , it makes more than a passing ref ere nce to Dr. Kessler, and it notes conduct by Dr. Ke ssler that could be linked t o t h e expert’s conc lusions reg ardingthe bre ach of the standar d of ca

re a nd
causation. I t is deficient only beca use it does not expressly m ak e t h e li nk betwee n the expert’s conclusions and the r efe renc ed c o n d u ct by Dr. Ke ssler. I f the e x pert is of the opinion that Dr . K e ssl e r’ s c on du c t bre a c he d the sta nd ard of c are and c a

us e d injury , h e wi ll n ot h a ve to g e ne rate
a new , previously

nonexis tent repor

t. He will simply have to a dd the link betwee n his alrea dy stated14

conclusions and the a lrea dy ref ere nced c onduct of Dr . Kessler . There fore , the circ umstances he re
are not similar to the situation where a plaintiff simply

has missed the dea dline for se rving a re port with respec t to the conduct of a phy sician. We re ve rs e the dis tr ic t court ’s or de r de nying the mot ion to dis mis s file d by Au sti n He art , P. A. a nd

Dr . K e ssl e r a

nd re mand thi s c a us e fo r f ur the r p ro c e e din g s.

__________________________________________ G. Alan Waldrop, Just ice Be fore J ustices Patterson, Pember ton and Waldrop; Dissenting O pinion by

J ustice Patterson Reverse d and Remande d Filed: May

9, 2007