Opinion issued November 19, 2020

In The

Court of Appeals 

For The 

First District of Texas 

————————————

NO. 01-20-00146-CV

———————————

TEXAS CHILDREN’S HOSPITAL, Appellant

V.

AVIV BARR AND ELA BARR, INDIVIDALLY AND AS NEXT FRIENDS 

OF M.B., A MINOR CHILD, Appellees

On Appeal from the 189th District Court

Harris County, Texas

Trial Court Case No. 2019-12365

MEMORANDUM OPINION

Appellees, Aviv Barr and Ela Barr, individually and as next friends of M.B., 

a minor child, sued Texas Children’s Hospital (TCH) and others for negligence in 
2

connection with a brain surgery performed on M.B.1 After several objections and 

subsequent amendments to the Barrs’ expert report, TCH moved to dismiss the 

Barrs’ claims, arguing that their amended expert report was insufficient as to 

causation. The trial court denied the motion to dismiss. In its sole issue, TCH argues 

that the trial court abused its discretion in denying TCH’s objections to the amended 

expert report and motion to dismiss. Because we conclude that the expert affidavit 

was sufficient, we affirm.

Background

The Barrs’ minor daughter, M.B., underwent a minimally-invasive brain 

surgery to treat her epilepsy at TCH in Houston.

2 On July 20, 2018, Dr. Daniel Curry 

performed the surgery at TCH using the NeuroBlate system, which is an MRIguided3

laser ablation device that had been subject to a recall by the Food and Drug 

Administration (FDA), prior to M.B.’s surgery, in October 2017. M.B. was 

discharged from TCH on July 22, 2018, but she later experienced symptoms such as

1 The Barrs also sued Dr. Daniel Curry, the surgeon, and Monteris, the manufacturer 

of the ablation laser that allegedly malfunctioned, but they are not parties to this

appeal.

2 We accept the facts included in Dr. Avellino’s report for the limited purpose of this 

appeal. See Marino v. Wilkins, 393 S.W.3d 318, 320 n.1 (Tex. App.—Houston [1st 

Dist.] 2012, pet. denied); see also Bowie Mem’l Hosp. v. Wright, 79 S.W.3d 48, 53 

(Tex. 2002) (review of Chapter 74 report is limited to four corners of report).

3 The NeuroBlate system used Magnetic Resonance Imaging to guide the surgeon’s 

use of the laser probe.
3

dizziness, vomiting, and loss of consciousness and was admitted to St. Mary’s 

Medical Center in Florida for further treatment. Doctors at St. Mary’s concluded that 

M.B. had a ruptured pseudoaneurysm and treated her with additional surgery, and 

M.B. was then moved to a hospital in Tel Aviv, Israel for further rehabilitation. The 

Barrs allege that M.B. has suffered permanent brain damage.

The Barrs filed suit against TCH, Dr. Curry, and Monteris, the manufacturer 

of the NeuroBlate system. The Barrs alleged product-liability claims against 

Monteris, and they alleged that Dr. Curry was negligent in several ways, including 

that he failed to disclose to the Barrs that the NeuroBlate system had been recalled 

by the FDA when he obtained their consent for the surgery and that he failed to order 

vascular studies after M.B. first experienced a brain bleed during her surgery in July 

2018 that would have identified the pseudoaneurysm before its rupture. Finally, the 

Barrs alleged that TCH was negligent in permitting Dr. Curry to use its recalled 

NeuroBlate laser probe to perform M.B.’s surgery. The Barrs supported their 

pleadings with the expert report of Dr. Anthony Avellino, a pediatric and adult 

neurosurgeon.4

Dr. Avellino’s report, as amended to address deficiencies pointed out by TCH,

provided details regarding the FDA’s recall of the NeuroBlate laser probe. Dr. 

4 The Barrs also provided an additional expert report from an engineer regarding the 

malfunctioning of the laser probe, but that report is not relevant to this appeal.
4

Avellino stated in his report that this recall was due to “unexpected heating and probe 

damage, which ‘could cause unanticipated heating of surrounding brain tissue, or 

damage the tip of the probe, and allow the CO2 cooling gas inside the probe to leak 

into the brain.’” He stated that, on October 5, 2017, the device was the subject of a 

Class I recall by the FDA, which recommended that health care providers “should 

strongly consider treating patients using alternative procedures if available.” He also 

indicated that a Class I recall meant “by definition [the malfunctioning device] can 

cause death or serious injury.” Monteris likewise sent notices to healthcare providers 

between October and December 2017 about the unintentional heating and advised 

doctors to “take certain precautionary steps to mitigate the risk to patients, including 

limiting MRI scans while the probe is in the patient.” However, on March 22, 2018, 

the FDA subsequently provided a “Safety Alert,” informing health care providers 

that the steps recommended by Monteris were “not sufficient to mitigate the risk of 

unintended laser probe heating.”

On April 24, 2018, the FDA warned health care providers “that the MR 

thermometry, which is used to monitor the changes in temperature at the laser 

ablation site, was potentially inaccurate and may not account for continued spread 

of energy to the surrounding brain tissue.” Dr. Avellino further stated that the FDA 

stated in its notice that several adverse events were associated with use of the 

NeuroBlate system: “neurological deficits, increased intracerebral edema or 
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pressure, intracranial bleeding, and/or visual changes.” Monteris continued to work 

on designing a new laser probe for the NeuroBlate system that replaced the metal 

thermocouple with a new, non-metallic fiber optic sensor, “thus eliminating any risk 

of unintended probe heating.” This design was submitted to the FDA on July 30, 

2018, ten days after M.B.’s surgery. On November 8, 2018, the FDA notified 

healthcare providers that Monteris had received FDA clearance for the new probe 

and stated that the safety risks associated with the old probe remained.

Regarding M.B.’s surgery specifically, Dr. Avellino reviewed M.B.’s medical 

records from TCH and noted that “[p]ostoperative head CT imaging on 7/21/2018 

revealed a small amount of acute hemorrhage at the lesion site, intraventricular 

hemorrhage, and subarachnoid hemorrhage in the ambient cistern with an abnormal 

irregular rounded shaped focal lesion lateral to the ambient cistern suspicious for an 

aneurysm.” He noted that, despite this head CT, “the cranial vasculature was not 

evaluated with a head CT angiogram to rule out an aneurysm and no explanation 

was given for the hemorrhages outside the lesion bed.” Rather, Dr. Curry relied on 

imaging that showed the bleeding appeared to be resolving, and M.B. was 

discharged. She later sought further treatment at St. Mary’s Medical Center after she 

“became comatose.”

When M.B. was admitted to St. Mary’s on August 7, 2018, “head CT imaging 

showed a large acute right temporal intracerebral hematoma with diffuse 
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intraventricular hemorrhage, acute hydrocephalus, and uncal herniation.” She 

underwent emergency surgery to reduce the swelling in her brain, and further 

imaging revealed that she had a pseudoaneurysm, which was treated at St. Mary’s. 

M.B. was then released for “further rehabilitation” to a hospital in Tel Aviv “with 

permanent neurologic sequelae.”

Regarding the standard of care and breach with regard to TCH, Dr. Avellino 

stated in his report that a hospital like TCH “requires formulation and enforcement 

of adequate policies regarding the use of recalled medical devices in surgical 

procedures performed at its facility.” He stated the TCH breached the standard of 

care by permitting Dr. Curry to use the NeuroBlate system because “the device is 

subject to a Class I recall (which by definition can cause death or serious injury)” 

against FDA warnings and advice that “health care providers strongly consider 

treating patients with alternative procedures if available.” Dr. Avellino stated that 

alternative procedures were available at the hospital.

Regarding the causal connection between the outlined breaches and M.B.’s 

injuries and damages, Dr. Avellino opined: “The NeuroBlate laser probe used in 

[M.B.’s] surgery can cause unintended heating to surrounding brain tissue, 

damaging blood vessels in the brain and creating pseudoaneurysms. A 

pseudoaneurysm occurs when a blood vessel wall is injured, and the leaking blood 

collects in the surrounding tissue.” He recounted the above-listed facts regarding the 
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FDA’s recall of the NeuroBlate laser probe as facts relevant to the “General 

Causation” of M.B.’s injuries.

He further stated, “The NeuroBlate laser probe used in [M.B.’s] surgery 

caused unintended heating to surrounding brain tissue, damaging a blood vessel in 

her brain and creating a pseudoaneurysm” that eventually ruptured. In addition to 

the information from the FDA that the NeuroBlate probe was recalled because it was 

prone to overheating and the FDA notices that such overheating had been associated 

with brain bleeds in other patients, Dr. Avellino specifically identified Dr. Curry’s 

operative report. This report noted that during surgery, “there was an element of 

abnormal MR thermography at this point, which scanning revealed to be a small 

intraventricular and cisternal hemorrhage.” Dr. Avellino stated, “Therefore, 

according to his operative report, Dr. Curry noticed an abnormal heating pattern 

during [M.B.’s] surgery and discovered a bleed in her brain. Therefore, the recalled 

laser probe caused unintended overheating and blood vessel damage, resulting in a 

bleed during the surgery.” Dr. Avellino’s expert report further observed that “sixteen 

days after her discharge, [M.B.] suffered a massive right temporal bleed, the same 

region of the brain as her intraoperative bleed.” He stated, “Based on the defective 

nature of the recalled laser probe and the location of the second bleed, the ruptured 

pseudoaneurysm was caused by the unintended overheating of the laser probe during 

the laser ablation surgery.”
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Finally, Dr. Avellino opined, 

If [TCH] had prevented Dr. Curry from using the recalled NeuroBlate 

laser probe at its facility during [M.B.’s] surgery, her resulting injuries 

and damages would not have occurred. As previously discussed, the 

recalled NeuroBlate laser probe used in [M.B.’s] surgery caused 

unintended heating to surrounding brain tissue, damaging a blood

vessel in the brain and creating a pseudoaneurysm that eventually 

ruptured. Thus, had [TCH] properly prevented Dr. Curry from using the 

NeuroBlate laser probe, [M.B.] would not have suffered her resulting 

injuries. It was foreseeable that permitting a physician to utilize a 

medical device subject to a Class I Recall would cause injury to 

patients, including [M.B.] Moreover, [M.B.’s] injury was foreseeable 

to [TCH], as the NeuroBlate laser probe had been recalled months 

earlier for unintended overheating of surrounding brain tissue, which 

could (and did) result in intracranial hemorrhage.

TCH objected to Dr. Avellino’s amended expert report on the basis that it did 

not provide an adequate opinion as to causation, and it moved to dismiss the Barrs’ 

suit against it for failure to provide an adequate expert report. The trial court denied 

the motion to dismiss, and this appeal followed.

Expert Report

In its sole issue, TCH argues that the trial court erred in overruling its 

objection to Dr. Avellino’s expert report as to causation and denying its motion to 

dismiss.

A. Standard of Review and Relevant Law

Section 74.351 of the Texas Medical Liability Act (TMLA) provides that no 

medical negligence cause of action may proceed until the plaintiff has made a goodfaith effort to demonstrate that a qualified medical expert believes that a defendant’s 
9

conduct breached the applicable standard of care and caused the claimed injury. See

TEX.CIV. PRAC. &REM.CODE § 74.351(l), (r)(6). “[T]he purpose of the expert report 

requirement is to weed out frivolous malpractice claims in the early stages of 

litigation, not to dispose of potentially meritorious claims.” Abshire v. Christus 

Health Se. Tex., 563 S.W.3d 219, 223 (Tex. 2018) (per curiam). 

An expert report is sufficient under the TMLA if it “provides a fair summary 

of the expert’s opinions . . . regarding applicable standards of care, the manner in 

which the care rendered . . . failed to meet the standards, and the causal relationship 

between the failure and the injury.” TEX. CIV. PRAC. & REM. CODE § 74.351(r)(6); 

Abshire, 563 S.W.3d at 223. “Importantly, the trial court need only find that the 

report constitutes a ‘good faith effort’ to comply with the statutory requirements.” 

Abshire, 563 S.W.3d at 223 (citing TEX. CIV. PRAC. & REM. CODE § 74.351(l)); see 

also Am. Transitional Care Ctrs. of Tex., Inc. v. Palacios, 46 S.W.3d 873, 878 (Tex. 

2001) (holding that courts look to report itself to determine whether it “represents a 

good-faith effort to comply with the statutory definition of an expert report”). An 

expert report demonstrates a “good faith effort” when it “(1) inform[s] the defendant 

of the specific conduct called into question and (2) provid[es] a basis for the trial 

court to conclude the claims have merit.” Abshire, 563 S.W.3d at 223 (citing Baty v. 

Futrell, 543 S.W.3d 689, 693–94 (Tex. 2018)). A report “need not marshal all the 

claimant’s proof,” but “a report that merely states the expert’s conclusions about the 
10

standard of care, breach, and causation” is insufficient. Id. (quoting Palacios, 46 

S.W.3d at 878–79); see also Miller v. JSC Lake Highlands Operations, LP, 536 

S.W.3d 510, 517 (Tex. 2017) (per curiam) (holding that expert report does not have 

to meet same requirements as evidence in summary judgment proceeding or at trial).

The expert must explain the basis for his statements and link his conclusions to the 

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

“We review a trial court’s decision to grant or deny a motion to dismiss based 

on the adequacy of an expert report for an abuse of discretion.” Abshire, 563 S.W.3d 

at 223. “A trial court abuses its discretion if it acts in an arbitrary or unreasonable 

manner without reference to any guiding rules or principles.” Wright, 79 S.W.3d at 

52. As a court reviewing matters committed to the trial court’s discretion, we may 

not substitute our own judgment for that of the trial court merely because we would 

have ruled differently. Id.; see also Larson v. Downing, 197 S.W.3d 303, 304 (Tex. 

2006) (per curiam) (holding that, when reviewing decisions that fall within trial 

court’s discretion, “[c]lose calls must go to the trial court”). In analyzing a report’s 

sufficiency under this standard, we consider only the information contained within 

the four corners of the report. Wright, 79 S.W.3d at 52. We are also mindful that 

expert-report challenges are made at an early, pre-discovery stage in the litigation.

See Baty, 543 S.W.3d at 697 & n.10 (rejecting argument that expert report was 

inadequate, concluding that expert report sufficed “particularly in light of the 
11

purposes the report is intended to serve” at early stage in litigation, and stating 

“additional detail is simply not required at this stage of the proceeding”).

TCH argues that Dr. Avellino’s expert report is insufficient as to causation.

An expert report must set out “the causal relationship between the failure and the 

injury.” TEX. CIV. PRAC. & REM. CODE § 74.351(r)(6); Abshire, 563 S.W.3d at 223. 

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

constituted a substantial factor in bringing about the harm and that, absent the act or 

omission, the harm would not have occurred.” Kline v. Leonard, No. 01-19-00323-

CV, 2019 WL 6904720, at *9 (Tex. App.—Houston [1st Dist.] Dec. 19, 2019, pet. 

denied) (mem. op.); Costello v. Christus Santa Rosa Health Care Corp., 141 S.W.3d 

245, 249 (Tex. App.—San Antonio 2004, no pet.). 

For causation, the expert report must explain “how and why” the physician’s 

or healthcare provider’s breach proximately caused the plaintiff’s injury. Columbia 

Valley Healthcare Sys., L.P. v. Zamarripa, 526 S.W.3d 453, 459–60 (Tex. 2017);

Jelinek v. Casas, 328 S.W.3d 526, 536 (Tex. 2010) (“It is not enough for an expert 

simply to opine that the defendant’s negligence caused the plaintiff’s injury. The 

expert must also, to a reasonable degree of medical probability, explain how and 

why the negligence caused the injury.”). “In satisfying this ‘how and why’ 

requirement, the expert need not prove the entire case or account for every known 

fact; the report is sufficient if it makes ‘a good-faith effort to explain, factually, how 
12

proximate cause is going to be proven.’” Abshire, 563 S.W.3d at 224 (quoting 

Zamarripa, 526 S.W.3d at 460). 

Proximate cause has two components: (1) foreseeability and (2) cause-in-fact.

Zamarripa, 526 S.W.3d at 460; Kelly v. Ford, 543 S.W.3d 383, 390 (Tex. App.—

Houston [14th Dist.] 2018, pet. denied). A causation opinion must explain both 

foreseeability and cause-in-fact and provide a “straightforward link” between the 

alleged breach of the standard of care and the claimed injury. See Abshire, 563 

S.W.3d at 225; Miller, 536 S.W.3d at 515; Zamarripa, 526 S.W.3d at 460. The 

court’s role is to determine whether the expert has explained how the negligent 

conduct caused the injury. Abshire, 563 S.W.3d at 226.

B. Analysis

Dr. Avellino’s expert report states that TCH was negligent in permitting Dr. 

Curry to use the recalled laser probe during M.B.’s laser ablation surgery. Dr. 

Avellino opined that the laser probe—which the FDA had indicated was prone to 

overheating and damaging tissue in the area around the probe—overheated during 

M.B.’s surgery. To support this opinion, Dr. Avellino cited Dr. Curry’s operative 

report that “there was an element of abnormal MR thermography” during the 

surgery, and he generally cited the FDA’s warning that “the MR thermometry which 

is used to monitor the changes in temperature at the laser ablation site, was 

potentially inaccurate and may not account for continued spread of energy to the 
13

surrounding brain tissue.” He opined that the overheated probe damaged a nearby 

blood vessel, causing bleeding during surgery, as the FDA noted had happened in 

other cases when the probe overheated. This damage caused a pseudoaneurysm—a 

type of weakness in a blood vessel’s wall that “occurs when a blood vessel wall is 

injured, and the leaking blood collects in the surrounding tissue.”

Dr. Avellino further opined that, although M.B.’s initial brain imagining after 

surgery was “suspicious for an aneurysm,” Dr. Curry relied on follow up scans that

showed that the hemorrhages were resolving before he discharged M.B. Dr. Curry 

did not evaluate the vessels with a “head CT angiogram” to rule out an aneurysm 

and “no explanation was given for the hemorrhages outside the lesion bed.” Thus, 

the pseudoaneurysm went undetected until it ruptured—which Dr. Avellino noted 

was a “vascular emergency”—and M.B. suffered neurological damage.

Dr. Avellino’s expert report sets out a chain of events that links TCH’s alleged 

negligence in allowing Dr. Curry to use the recalled NeuroBlate laser probe with 

damage that occurred during her surgery, which subsequently caused further damage 

when the pseudoaneurysm ruptured. See Abshire, 563 S.W.3d at 225. The expert 

report indicates that the injury to M.B. was foreseeable to TCH. See Zamarripa, 526 

S.W.3d at 460. The FDA had recalled the NeuroBlate laser probe because it was 

prone to overheating and causing brain bleeds, and this was precisely the injury 

sustained by M.B. Dr. Avellino also set out facts necessary to establish the cause-in-
14

fact element of proximate cause by asserting that, but for TCH’s negligence in 

permitting Dr. Curry to use the recalled laser probe, it could not have overheated 

during M.B.’s surgery, damaging her blood vessels and causing the development of 

the pseudoaneurysm that later ruptured. See id. 

The trial court could reasonably have concluded that the report sets out “to a 

reasonable degree of medical probability . . . how and why” TCH’s alleged 

negligence in allowing Dr. Curry to use the recalled device to perform surgery 

caused an injury to the vessel in M.B.’s brain, which in turn caused the remainder of 

her injuries. See Jelinek, 328 S.W.3d at 536; Kline, 2019 WL 6904720, at *9 

(providing that causal relationship is established by proof that alleged negligence 

was substantial factor in bringing about harm).

TCH asserts that Dr. Avellino’s expert report is conclusory and merely states 

his unsupported opinion, and it argues that his conclusions are impermissibly vague.

Specifically, it argues that Dr. Avellino’s opinion fails to link his conclusion that the 

probe overheated to the underlying facts and fails to explain how the overheating 

caused the bleed. TCH argues that Dr. Avellino “improperly extrapolates” from Dr. 

Curry’s operative report—noting abnormal MR thermography and an area of 

bleeding—to support the conclusion that the NeuroBlate laser probe overheated and 

damaged surrounding brain tissue. TCH asserts, “Dr. Curry’s operative report does 

not say that the probe overheated; nor does it say that the abnormal MR 
15

thermography is evidence that the probe overheated.” TCH argues that Dr. Curry’s 

report stated that the abnormal temperature reading was caused by the brain bleed, 

which was “a known complication of laser ablation surgery, irrespective of any 

overheating of the medical device.” 

This argument, however, misconstrues the requirements for expert reports. Dr. 

Avellino’s expert report was required to make “‘a good-faith effort to explain, 

factually, how proximate cause is going to be proven.’” Abshire, 563 S.W.3d at 224 

(quoting Zamarripa, 526 S.W.3d at 460). He did that by stating that abnormal 

thermography indicated that the laser probe overheated, damaging surrounding brain 

tissue, which eventually caused the remainder of M.B.’s injuries. The fact that Dr. 

Curry’s operative report does not expressly state that the laser probe overheated does 

not render Dr. Avellino’s conclusions insufficient. Nor does the fact that Dr. Curry 

attributed the abnormal thermography to a different cause render Dr. Avellino’s 

report conclusory. “An expert report need not marshal all of the plaintiff’s proof 

necessary to establish causation at trial, and it need not anticipate or rebut all possible 

defensive theories that may ultimately be presented to the trial court.” Kline, 2019 

WL 6904720, at *9; see Wright, 79 S.W.3d at 52; Cornejo v. Hilgers, 446 S.W.3d 

113, 123 (Tex. App.—Houston [1st Dist.] 2014, pet. denied).

TCH further argues that Dr. Avellino’s report does not explain why the 

abnormal thermography is an indication that the probe overheated or how this fact 
16

supports his conclusion that the overheated probe caused the interoperative bleed. 

But Dr. Avellino’s expert report states that the probe was recalled because it had 

been known to overheat, and the FDA had specifically warned healthcare providers 

that the MR thermography was potentially unreliable because it “may not account 

for continued spread of energy to the surrounding brain tissue.” He opined that 

thermography during M.B.’s surgery showed “an abnormal heating pattern” in the 

region where the laser probe was being used, leading Dr. Curry to discover a bleed 

in M.B.’s brain. Rather than ruling out the possibility of a pseudoaneurysm, which 

is caused when blood vessels are injured, Dr. Curry discharged M.B., and the 

pseudoaneurysm subsequently ruptured. These facts from the expert report allowed 

the trial court to determine that Dr. Avellino had explained how TCH’s negligent 

conduct caused M.B.’s injury. See Abshire, 563 S.W.3d at 226.

TCH further argues that Dr. Avellino’s expert report fails to explain how 

M.B.’s brain bleed caused a ruptured pseudoaneurysm eighteen days after surgery, 

asserting that he bases his opinion solely on the fact that the pseudoaneurysm was 

located in the same region of M.B.’s brain as the intraoperative bleed, which “is pure 

ipse dixit.” Contrary to this assertion, however, Dr. Avellino’s report provides not 

only that the pseudoaneurysm was located in the same region of M.B.’s brain as the 

intraoperative bleed, but also that pseudoaneurysms are caused by injury to blood 
17

vessel walls. He then explained that the laser probe overheated, damaged the 

surrounding blood vessels, causing a bleed. 

Dr. Avellino’s expert report was required to provide some basis for proving 

that TCH’s act or omission proximately caused M.B.’s injury. See Wright, 79 

S.W.3d at 53; Scoresby v. Santillan, 346 S.W.3d 546, 556 (Tex. 2011) (“No 

particular words or formality are required [in the expert report], but bare conclusions 

will not suffice.”). With respect to causation, our role “is to determine whether the 

expert has explained how the negligent conduct caused the injury. Whether this 

explanation is believable should be litigated at a later stage of the proceedings.” 

Abshire, 563 S.W.3d at 226; see also Miller, 536 S.W.3d at 516–17 (stating that 

“whether [an expert’s opinion of applicable] standards appear reasonable is not 

relevant to the analysis of whether the expert’s opinion constitutes a good-faith 

effort” and that adequate expert reports need not “meet the same requirements as the 

evidence offered at summary judgment or trial).

Because Dr. Avellino explained how the alleged negligent conduct—TCH’s 

providing a recalled device with which it allowed Dr. Curry to perform M.B.’s 

surgery—caused the damage to the blood vessel in M.B.’s brain that resulted in the 

remainder of her injuries, we cannot conclude that the trial court abused its discretion 

in determining that the expert report satisfied the TMLA’s requirement to provide
18

“the causal relationship between the failure and the injury.” See TEX. CIV. PRAC. &

REM. CODE § 74.351(r)(6); Abshire, 563 S.W.3d at 223. 

We overrule TCH’s sole issue. 

Conclusion

We affirm the trial court’s order denying TCH’s motion to dismiss.

Richard Hightower

Justice

Panel consists of Chief Justice Radack and Justices Hightower and Adams.