NO.

NO. 12-14-00357-CV

IN THE COURT OF APPEALS

TWELFTH COURT OF APPEALS DISTRICT

TYLER, TEXAS

PINECREST SNF, LLC D/B/A 

PINECREST NURSING & 

REHABILITATION CENTER, 

APPELLANTS

V.

TASCO BAILEY, NATHAN BAILEY, 

CARLIE BAILEY, ROY BAILEY, BILL 

BAILEY, JAMES BAILEY, EARL 

BAILEY, MARY DUNLAP AND 

LICILLE MARTIN, AS HEIRS OF 

ARCHIE BAILEY,

APPELLEES

§

§

§

APPEAL FROM THE 114TH 

JUDICIAL DISTRICT COURT

SMITH COUNTY, TEXAS

MEMORANDUM OPINION

Pinecrest SNF, LLC d/b/a Pinecrest Nursing & Rehabilitation Center appeals the trial 

court’s order denying its motion to dismiss the claims against it in a suit filed by Tasco Bailey, 

Nathan Bailey, Carlie Bailey, Roy Bailey, Bill Bailey, James Bailey, Earl Bailey, Mary Dunlap 

and Licille Martin, as heirs of Archie Bailey (the Baileys). In its sole issue, Pinecrest argues that 

the trial court abused its discretion when it overruled Pinecrest’s objections to the Baileys’ suit 

for failure to comply with the expert report requirements under Chapter 74 of the Texas Civil 

Practice and Remedies Code.1 We affirm.

BACKGROUND

On June 12, 2010, Archie Bailey was admitted to Pinecrest for long-term care related to 

her Alzheimer’s disease. She was eighty-eight years old and had a history of hypertension, 

 

1 See TEX. CIV. PRAC. & REM. CODE ANN. § 74.351 (West Supp. 2015).
2

congestive heart failure, diabetes mellitus, and asthma. Bailey required total assistance with all 

activities of daily living. 

In August 2013, Bailey developed a pressure ulcer on her sacrum.2 The ulcer continued 

to worsen, and on September 19, 2013, Bailey was discharged from Pinecrest and transferred to 

Trinity Mother Frances Hospital (TMF). Upon admission, Bailey was diagnosed with a Stage IV 

decubitus ulcer on her sacrum, a Stage II pressure ulcer on her left buttock, leukocytosis, and a 

urinary tract infection. Bailey’s nutritional status was described as “severely compromised,” 

resulting in malnourishment. TMF transferred Bailey to Tyler ContinueCARE Hospital for 

further treatment and management of her wounds, where she developed another Stage II pressure 

ulcer on her right buttock. Bailey had several surgical debridements, and other treatments such 

as placement of a “wound VAC” and aggressive antibiotic therapy, from late September until her 

discharge on October 22, 2013, to Colonial Tyler Care Center. There, Bailey continued to 

receive negative pressure therapy and a therapeutic diet to promote wound healing. Her 

condition did not improve, and she was placed on hospice care. Bailey died on December 4, 

2013. Her death certificate indicates that she died from cardiopulmonary arrest.

The Baileys filed suit against Pinecrest, alleging that it was negligent in allowing the 

development and progression of Bailey’s pressure ulcers. The Baileys attempted to comply with 

the statutory expert report requirements under Chapter 74 of the Texas Civil Practice and 

Remedies Code by filing the report of their expert, Christopher M. Davey, M.D. Pinecrest filed 

written objections to the report. The trial court ruled that Dr. Davey’s report was insufficient, 

but allowed the Baileys time to amend the report and cure its deficiencies. Dr. Davey amended 

his report, and Pinecrest again filed written objections to Dr. Davey’s report on the grounds that

his opinions regarding causation were conclusory. The trial court overruled Pinecrest’s 

objections, and this interlocutory appeal followed.3

EXPERT REPORT

In its sole issue, Pinecrest argues that Dr. Davey’s report on causation is conclusory.

 

2 Bailey had previously developed a pressure ulcer in March 2013, but the ulcer resolved by early April 

2013.

3 See TEX. CIV. PRAC. & REM. CODE ANN. § 51.014(a)(9) (West Supp. 2015).
3

Standard of Review

A trial court’s ruling on the sufficiency of an expert’s report is reviewed for an abuse of 

discretion. Van Ness v. ETMC First Physicians, 461 S.W.3d 140, 142 (Tex. 2015). A trial 

court abuses its discretion if it acts without reference to guiding rules or principles. Id. 

However, in exercising its discretion, it is incumbent upon the trial court to review the report, 

sort out its content, resolve any inconsistencies, and decide whether the report demonstrated a 

good faith effort to show that the plaintiff’s claims have merit. See id. at 144. When reviewing 

factual matters committed to the trial court’s discretion, an appellate court may not substitute its 

judgment for that of the trial court. Id. 

Applicable Law

Chapter 74 of the civil practice and remedies code governs health care liability claims. 

Brewster v. Columbia Med. Ctr. of McKinney Subsidiary, L.P., 269 S.W.3d 314, 316 n.3 (Tex.

App.–Dallas 2008, no pet.). Any person who brings suit asserting a health care liability claim 

must provide an expert report for each physician or health care provider against whom a health 

care liability claim is asserted. See TEX. CIV. PRAC. & REM. CODE ANN. § 74.351(a) (West Supp. 

2015).

 An “expert report” is defined as a written report that provides a fair summary of the 

expert’s opinions as of the date of the report regarding applicable standards of care, the manner 

in which the care rendered by the physician or health care provider failed to meet the standards 

of care, and the causal relationship between that failure and the injury, harm, or damages 

claimed. Id. § 74.351(r)(6); Bowie Mem’l Hosp. v. Wright, 79 S.W.3d 48, 51 (Tex. 2002) (per 

curiam). Although a claimant must timely file an adequate expert report as to each defendant in 

a health care liability suit, Chapter 74 does not require an expert report as to each liability theory 

alleged against that defendant. TTHR Ltd. P’ship v. Moreno, 401 S.W.3d 41, 45 (Tex. 2013); 

Certified EMS, Inc. v. Potts, 392 S.W.3d 625, 632 (Tex. 2013). Rather, a single liability theory 

meeting the statutory requirements is sufficient to defeat a motion challenging the adequacy of 

an expert report. Certified EMS, 392 S.W.3d at 632. 

A trial court shall grant such a motion only if it appears to the court, after hearing, that 

the report does not represent an objective good faith effort to comply with the definition of 

“expert report” in section 74.351(r)(6). TEX. CIV. PRAC. & REM. CODE ANN. § 74.351(l); see 

also Loaisiga v. Cerda, 379 S.W.3d 248, 260 (Tex. 2012). To represent an objective good faith 

effort to comply with statutory requirements, the expert report must (1) inform the defendant of 
4

the specific conduct the plaintiff has called into question, and (2) provide a basis for the trial 

court to conclude that the claims have merit. Loaisiga, 379 S.W.3d at 260; Am. Transitional 

Care Ctrs. of Tex., Inc. v. Palacios, 46 S.W.3d 873, 879 (Tex. 2001). 

A causal relationship is established by proof that the negligent act or omission was a 

substantial factor in bringing about the harm, and that, absent this act or omission, the harm 

would not have occurred. Costello v. Christus Santa Rosa Health Care Corp., 141 S.W.3d 245, 

249 (Tex. App.–San Antonio 2004, no pet.). Causation is often established in medical 

malpractice cases through evidence of a “reasonable medical probability” or “reasonable 

probability” that the alleged injuries were caused by the negligence of one or more defendants. 

Jelinek v. Casas, 328 S.W.3d 526, 532–33 (Tex. 2010). In other words, the plaintiff must 

present evidence “that it is ‘more likely than not’ that the ultimate harm or condition resulted 

from such negligence.” Id. (quoting Kramer v. Lewisville Mem’l Hosp., 858 S.W.2d 397, 399–

400 (Tex. 1993)). An expert may show causation by explaining a chain of events that begins 

with a defendant doctor’s negligence and ends in injury to the plaintiff. See McKellar v. 

Cervantes, 367 S.W.3d 478, 485 (Tex. App.–Texarkana 2012, no pet.). 

A report is deficient if it states only the expert’s conclusions about the standard of care, 

breach of the standard of care, or causation. See Ortiz v. Patterson, 378 S.W.3d 667, 671 (Tex.

App.–Dallas 2012, no pet.). An expert cannot simply opine that the breach caused the injury.

Van Ness, 461 S.W.3d at 142; Jelinek, 328 S.W.3d at 539. Rather, the report must explain, to a 

reasonable degree, how and why the breach of the standard of care caused the injury based on the 

facts presented. Van Ness, 461 S.W.3d at 142; Jelinek, 328 S.W.3d at 539–40. The report must

explain the basis of the expert’s statements to link his conclusions to the facts. Bowie Mem’l 

Hosp., 79 S.W.3d at 52; see also Taylor v. Fossett, 320 S.W.3d 570, 575 (Tex. App.–Dallas 

2010, no pet.) (expert report must contain sufficiently specific information to demonstrate 

causation beyond conjecture).

In determining whether the expert report represents a good faith effort to comply with the 

statutory requirements, the court’s inquiry is limited to the four corners of the report. Christian 

Care Ctrs., Inc. v. Golenko, 328 S.W.3d 637, 641 (Tex. App.–Dallas 2010, pet. denied) (citing 

Palacios, 46 S.W.3d at 878). “We may not ‘fill gaps’ in an expert report by drawing inferences 

or guessing what the expert likely meant or intended.” Hollingsworth v. Springs, 353 S.W.3d 
5

506, 513 (Tex. App.–Dallas 2011, no pet.). “We determine whether a causation opinion is 

sufficient by considering it in the context of the entire report.” Ortiz, 378 S.W.3d at 671.

Discussion

Dr. Davey opined that Pinecrest failed to prevent Bailey’s pressure ulcer, treat it once it 

developed, maintain sufficient staffing levels, and implement policies to prevent Bailey’s 

injuries. With regard to his theory that Pinecrest failed to prevent Bailey’s pressure ulcer, Dr. 

Davey explained in his report that Bailey suffered from several preexisting conditions such as 

hypertension, congestive heart failure, diabetes mellitus, and asthma. Dr. Davey also stated in 

his report as follows: 

[A] facility and its nurses [should] ensure that a resident who is admitted without pressure sores 

does not develop pressure sores unless the individual’s clinical condition demonstrates that the 

sores were unavoidable and that a resident who develops pressure sores receives necessary 

treatment and services to promote healing, prevent infection, and prevent new sores from 

developing. 

Pinecrest correctly argues that Dr. Davey did not discuss whether Bailey’s preexisting 

conditions made her development of a pressure ulcer unavoidable. Therefore, he has not 

adequately demonstrated causation on this theory. See, e.g., Christus Spohn Health Sys. Corp. 

v. Castro, No. 13-13-00302-CV, 2013 WL 6576041, at *6 (Tex. App.—Corpus Christi Dec. 12, 

2013, no pet.) (mem. op.) (holding that although allegation that nurse’s failure to assess skin was 

sufficient in report, expert failed to explain role of patient’s other complex medical conditions in 

developing pressure ulcer); Nexion Health at Southwood, Inc. v. Judalet, No. 12-08-00464-CV, 

2009 WL 3019717, at *4 (Tex. App.—Tyler Sept. 23, 2009, no pet.) (mem. op.) (holding expert 

report was insufficient on causation because expert failed to link conclusion that patient’s earlier 

fall resulting in broken leg contributed to congestive heart failure and death and did not discuss 

role of other conditions in death). However, as we have noted, an expert report need only allege 

one viable theory to be sufficient under Chapter 74. See Certified EMS, 392 S.W.3d at 632.

Dr. Davey separately opined that Pinecrest breached the standard of care by not only 

allowing the ulcer to develop, but also in “allowing the pressure ulcer to progress to a Stage IV,” 

which caused Bailey’s “soft tissues to become distorted and die.” Dr. Davey stated that Bailey 

suffered injuries as a result. In other words, even if the pressure ulcer was unavoidable, Dr. 

Davey directly concluded that it was treatable once it appeared. He specifically tracked the 
6

development of Bailey’s ulcer while she was in Pinecrest’s care, stating in relevant part as 

follows:

On 8-12-13, the nursing staff at Pinecrest Nursing noted a 0.3 x 0.2 cm macerated area on Ms, 

Bailey's gluteal fold. The area of skin breakdown on Ms. Bailey’s sacral area had developed a 

scant amount of serous exudate by 8-19-13, and nurses noted the area had “deteriorated.”

Several days later, on 8-22-13, a Stage II pressure ulcer was discovered on Ms. Bailey’s sacral 

area that measured 1.0 x 0.3 cm and had a small amount of serous exudate present. Ms. Bailey 

began to experience a “continuous” and “aching” pain from her sacral ulcer on 9-3-13, and at this 

time, her Stage II pressure ulcer had increased in size to 0.8 x 1.0 x 0.2 cm. On 9-12-13, the 

nursing staff failed to stage the wound, but they noted measurements of 2.0 x 2.0 x 2.0 cm and the 

presence of serosanguineous drainage. By 9-17-13, Ms. Bailey had an unstageable pressure ulcer 

on her sacrum that measured 8.0 x 15.0 x >2.0 cm. According to the documentation in the weekly 

pressure ulcer record, the wound had a moderate amount of serosanguineous exudate and was 

causing Ms. Bailey a significant amount of pain.

On September 19, 2013, Bailey was transferred to TMF, and later to other care providers, in 

order to treat her pressure ulcers. Upon admission at TMF, she was diagnosed with a Stage IV 

sacral pressure ulcer. Hospital staff also determined that Bailey was malnourished. 

In the standard of care section of Dr. Davey’s report related to Pinecrest’s failure to 

properly treat Bailey’s pressure ulcer, he stated that Pinecrest should position the patient so that 

pressure on the ulcer is relieved, provide pressure relieving devices, keep the patient clean and 

dry, and properly nourish the patient through a diet that will encourage healing. Dr. Davey also 

stated that the pressure ulcer and surrounding skin should be cleansed at the time of each 

dressing change, or it is unlikely to heal. Finally, he stated that regular and complete 

assessments must be performed and documented so that the necessary interventions can be 

implemented. 

In the breach section, Dr. Davey opined that Pinecrest failed to comply with these 

standards. He stated that once the skin breakdown was discovered on Bailey’s sacrum, the 

nursing staff at Pinecrest should have been frequently monitoring the area, documenting any 

changes, and describing the progression of the wound. Instead, he continued, the nurses waited a 

week to reassess the area of skin breakdown, and by that time, it had deteriorated into a Stage II 

pressure ulcer. On September 12, 2013, the nurses assessed the ulcer as measuring 2.0 x 2.0 x 

2.0 cm, but failed to stage it. Five days later, Bailey’s ulcer had increased in size from 8.0 x 15.0 

x >2.0 cm, and became unstageable. Dr. Davey explained that once an ulcer is unstageable, it 

means that the ulcer is at least Stage III or Stage IV. But since the ulcer is heavily covered in 
7

necrotic tissue at that point, the healthcare providers cannot determine how deep the injury 

extends under the skin. Later that same day, according to Dr. Davey, the wound was assessed 

for the first time in the nursing notes, and the entry described the wound as “deteriorated,” 100 

percent necrotic, with measurements of 18.0 x 10.0 cm. According to the entry, the wound’s 

depth could not be measured. 

Dr. Davey explained further that proper assessment is necessary to treat the ulcer, and 

that measurement and accurate description of wounds is crucial to track a wound’s progress and 

response to treatment. Proper assessment and prompt, accurate documentation and reporting 

inform the treating physicians and dieticians of the condition so that they can timely order and 

implement the proper interventions to treat the ulcer. According to Dr. Davey, based on his 

review of Bailey’s medical records, Pinecrest’s staff failed to regularly assess and accurately and 

consistently document the status and progression of the wound. Consequently, the attending 

physician was not timely notified of Bailey’s worsening condition. Dr. Davey stated that a 

wound care consultation and treatments were not ordered until after Bailey’s ulcer had developed 

a depth of 0.2 cm, which was indicative of a Stage III pressure ulcer. Aside from these orders, 

Dr. Davey explained, Bailey’s pressure ulcer was never mentioned in any of the physician’s 

progress notes or consultations. Dr. Davey opined that the nurses should have brought the 

wound and the fact that it was becoming necrotic to her physician’s attention. The failure to do 

so, he stated, prevented the physician from determining the necessity of interventions such as a 

low air mattress or a wound consult. 

Finally, in relation to Pinecrest’s alleged failure to properly treat the ulcer, Dr. Davey 

opined that Pinecrest failed to adequately monitor Bailey’s nutritional status and monitor her 

laboratory tests. Dr. Davey stated that there is an increased metabolic demand in healing a 

pressure ulcer, and that without monitoring her lab values, nursing staff were unaware of 

worsening albumin and pre-albumin levels. Dr. Davey stated that Bailey’s lab values were not 

taken until September 19, 2013, the date of her discharge. Those values indicated that Bailey 

was malnourished. He acknowledged that a multivitamin was administered, but Pinecrest failed 

to provide other interventions such as snacks, fortified meals, or providing more frequent, 

smaller meals to address the increased metabolic demand and promote healing.

At the end of the breach section, Dr. Davey opined on causation and concluded that had 

Pinecrest’s nurses complied with these standards of care, the proper interventions could have 
8

been implemented before Bailey’s pressure ulcer became unstageable, and ultimately progressed 

to a Stage IV ulcer when Bailey was discharged from Pinecrest and admitted at TMF. In the 

causation section of his report, Dr. Davey explained the nature of pressure ulcers and how they 

develop in the clinical setting. He stated that they develop when a patient has sustained pressure, 

often in combination with shear or friction, on soft tissues located over bony prominences. The 

pressure causes distortion in the soft tissues, which will result in a loss of blood flow through the 

vessels. Consequently, without nutrients, the tissue will become ischemic, and if sustained for a 

long enough period of time, necrosis of the tissue occurs. 

Dr. Davey stated that the standards of care related to treatment are intended to prevent 

ulcers from progressing from a Stage I or Stage II wound to a Stage III or Stage IV wound. 

When allowed to progress to those stages, he continued, the patient will suffer a number of 

complications directly caused by the failure to assess and treat the ulcer. Specifically, he noted 

that the ulcer at those stages will cause skin loss with extensive destruction, necrosis, and 

damage to muscle, bone, tendons, and other supporting structures. He noted that such severe 

ulcers will make the patient become more susceptible to infection and other complications 

related to the wound and its treatment, including increased morbidity and a higher mortality rate. 

Finally, he stated that the patient will have problems with pain and loss of dignity associated 

with the wound and its treatment, particularly due to fluid leakage, smell, discomfort, difficulties 

with mobility, and a decrease in appetite. Based on the medical records, Dr. Davey opined that 

Bailey suffered all of these complications. He also stated that she was required to endure 

multiple surgical debridements, placement of a “wound VAC,” and aggressive IV antibiotic 

therapy due to osteomyelitis and an infection with Proteus mirabillis. 

Dr. Davey concluded that “to a reasonable degree of medical probability, the breaches of 

the standard of care identified above proximately caused Ms. Bailey’s injuries, including the 

development of a Stage IV pressure ulcer.” He separately stated as follows:

In my opinion, to a reasonable degree of medical probability, the breaches of the standard of care 

discussed above related to the assessment, prevention, and treatment of severe pressure ulcers 

were the proximate cause of Ms. Bailey’s severe pressure ulcer. As stated above, Pinecrest 

Nursing and its nursing staff failed to reposition Ms. Bailey every two hours, keep her skin clean 

and dry, and implement other appropriate interventions to relieve pressure and promote skin 

integrity. Pinecrest Nursing and its nursing staff also failed to properly treat the pressure ulcer and 

encourage its healing once it developed. Because Pinecrest Nursing failed to reposition her every 

two hours and failed to implement effective interventions, Ms. Bailey had sustained pressure on 

her sacral area, which caused the blood to stop flowing to that part of the body and the skin to 
9

distort. Because of the lack of blood flow, the tissue died, causing Ms. Bailey to develop an 

infected Stage IV pressure ulcer.

Pinecrest argues that Dr. Davey failed to explain that absent Pinecrest’s acts or 

omissions, the harm would not have occurred. It argues that Dr. Davey did not specifically 

identify the “interventions” or demonstrate how the failure to provide them caused harm to 

Bailey. Pinecrest also argues that Dr. Davey’s reasoning is based on speculation or conjecture. 

We disagree.

We note that we review the entire report to determine the adequacy of the expert’s 

opinion on causation. See Ortiz, 378 S.W.3d at 671. In reviewing the entire report, Dr. Davey 

explained the nature of pressure ulcers, that once they develop, the standard of care shifts from 

prevention to treatment, and that Pinecrest’s nurses should timely and accurately assess, 

document, and report the progression of the pressure ulcer. The purpose of this standard of care 

is to notify the patient’s care team so that the proper interventions can be timely provided to 

prevent progression to a Stage III or Stage IV pressure ulcer. As we have detailed above, Dr. 

Davey explained how Pinecrest failed in this regard. He also identified the “interventions” 

elsewhere in his report. For example, he stated that Pinecrest’s staff should keep Bailey’s skin 

clean and dry, reposition her every two hours, provide pressure relieving devices such as a low 

air mattress, and provide an appropriate diet. Dr. Davey concluded that these failures, in 

reasonable medical probability, caused Bailey’s pressure ulcer to progress to a Stage IV wound. 

Dr. Davey adequately linked the facts alleged in his report to his conclusions.

Pinecrest claims that Bailey’s medical records reflect no entries that she had been 

repositioned in her three years as a resident prior to the incident, yet Bailey did not develop a 

pressure ulcer until 2013. It contends that had she not been repositioned during that time period, 

she would have developed pressure ulcers much sooner. Thus, its argument continues, Dr. 

Davey speculated when he opined that the lack of entries related to repositioning meant she was 

not in fact repositioned. Pinecrest relies on authority stating that a medical expert’s opinion 

cannot be based on speculation or conjecture, and must show more than the conduct possibly 

caused the harm. See, e.g., Hutchinson v. Montemayor, 144 S.W.3d 614, 618 (Tex. App.—San 

Antonio 2004, no pet.). While we agree with that statement of the law, the court in Hutchinson

held that the expert’s opinion that “[i]f an arteriogram had been done, there would have been a 

possibility that [the patient] may have had bypassable lesions and that the amputation may have 
10

been avoided[,]” was insufficient. See id. at 617 (emphasis added). The court further held that 

his conclusion that there was a possibility of a better outcome was speculative. See id. Here, Dr. 

Davey opined that Pinecrest’s nursing staff’s failure to assess, document, and report the 

progression of the pressure ulcer directly caused her harm, because the interventions were not 

timely provided. Moreover, we are confined to the four corners of the report, and defer to the 

trial court’s determination of the facts alleged in the report. See Van Ness, 461 S.W.3d at 144;

Palacios, 46 S.W.3d at 878. 

Dr. Davey explained that the basis for his opinion as to preventing the ulcer’s 

advancement is the lack of entries in Bailey’s records, because this prevented her treating 

physician and nutritionist from timely providing interventions. He explained that the standard of 

care requires that Pinecrest’s staff track its progression and document it in the patient’s records. 

Those entries were plainly absent according to Dr. Davey. To corroborate the lack of 

communication to the physician, Dr. Davey also explained that Bailey did not receive a wound 

care consultation or treatments until after the ulcer had progressed to Stage III, and that other 

than those orders, Bailey’s ulcer was not mentioned in any of the physician’s progress notes. By 

cross referencing these documents, and relying on his experience in practice treating pressure 

ulcers, he explained that “it is clear that the assessments, treatments, and interventions described 

above were not performed here.” Bailey is not required to marshal all her evidence at this stage 

of the proceeding. See Palacios, 46 S.W.3d at 878-79. Pinecrest’s theory that the interventions 

were in fact timely performed is an issue for trial. 

Pinecrest also argues that Dr. Davey failed to discuss the fact that ulcers may develop and 

deteriorate very quickly in patients despite adequate care, and that Bailey continued to develop 

pressure ulcers even after she left Pinecrest. As we have discussed, we examine only the four 

corners of the report, giving deference to the trial court’s resolution of the factual allegations in 

the report. See Van Ness, 461 S.W.3d at 144; Palacios, 46 S.W.3d at 878. As we have 

explained, Dr. Davey adequately linked his discussion of the facts in his report to the conclusion 

that Pinecrest’s breach of the standard of care proximately caused Bailey’s harm on at least one 

theory. Furthermore, by the time the other hospitals began treating it, the ulcer had already 

progressed to a Stage IV ulcer with necrosis. He explained that the basis for this theory was that 

Pinecrest failed to prevent it from becoming a Stage III or Stage IV. The other health care 
11

providers’ treatment of the wound after it had advanced to Stage IV is irrelevant at this stage of 

the proceeding to this particular theory asserted by the Baileys.

Finally, Pinecrest argues that although Dr. Davey contended that Bailey’s Stage IV 

pressure ulcer contributed to her death, he did not opine, under the correct legal standard, that the 

ulcer was a “substantial factor” in her death. The Baileys sued Pinecrest only in their capacity as 

heirs, not in their individual capacities. Their petition specifically identifies only a survival 

cause of action. However, in the damages section, the Baileys averred that not only did Bailey 

suffer damages, but they did as well. The Baileys concede in their brief that they are seeking 

damages only under a survival cause of action for Bailey’s damages, not their own damages 

under a wrongful death cause of action. In other words, the Baileys make no contention that 

Pinecrest’s actions caused Bailey’s death, even though Dr. Davey attempted to opine on that 

issue. 

We hold that the trial court correctly concluded that Dr. Davey’s report satisfies Chapter 

74’s requirements on at least one theory.4 Consequently, Pinecrest’s sole issue is overruled.

DISPOSITION

Having overruled Pinecrest’s sole issue, we affirm the trial court’s order denying its 

motion to dismiss.

BRIAN HOYLE

Justice

Opinion delivered May 27, 2016.

Panel consisted of Worthen, C.J., Hoyle, J., and Neeley, J.

(PUBLISH)

 

4 Since we have held that the failure to treat theory was sufficiently alleged, we need not address the 

Baileys’ remaining theories. See Certified EMS, 392 S.W.3d at 632.
COURT OF APPEALS

TWELFTH COURT OF APPEALS DISTRICT OF TEXAS

JUDGMENT

MAY 27, 2016

NO. 12-14-00357-CV

PINECREST SNF, LLC D/B/A PINECREST NURSING & REHABILITATION 

CENTER,

Appellants

V.

TASCO BAILEY, NATHAN BAILEY, CARLIE BAILEY, ROY BAILEY, BILL BAILEY, 

JAMES BAILEY, EARL BAILEY, MARY DUNLAP AND LICILLE MARTIN, AS 

HEIRS OF ARCHIE BAILEY,

Appellees

Appeal from the 114th District Court 

of Smith County, Texas (Tr.Ct.No. 14-0856-B)

THIS CAUSE came to be heard on the oral arguments, appellate record 

and briefs filed herein, and the same being considered, it is the opinion of this court that there 

was no error in the trial court’s order.

It is therefore ORDERED, ADJUDGED and DECREED that the order 

denying Appellants’ motion to dismiss of the court below be in all things affirmed, and that all 

costs of this appeal are hereby adjudged against the Appellants, PINECREST SNF, LLC D/B/A 

PINECREST NURSING & REHABILITATION CENTER, for which execution may issue, 

and that this decision be certified to the court below for observance.

Brian Hoyle, Justice.

Panel consisted of Worthen, C.J., Hoyle, J., and Neeley, J.