COURT OF APPEALS

SECOND DISTRICT OF TEXAS

FORT WORTH

NO. 02-10-00313-CV

GERALD ROBERT STEPHENSON, 

M.D.

APPELLANT

V.

NATASHA MILLER, INDIVIDUALLY 

AND AS THE SURVIVING SPOUSE, 

HEIR AT LAW, COMMUNITY 

SURVIVOR, AND PERSONAL 

REPRESENTATIVE OF STEVE 

MILLER, DECEASED, AND AS 

MOTHER, NEXT FRIEND AND JOINT 

MANAGING CONSERVATOR OF 

JAYLYNN DENIQUE MILLER, 

DEYLIN RAESHAWN MILLER, AND 

JACOBE ANTONIO MILLER, 

MINORS, AND AS COMMUNITY 

SURVIVOR AND BENEFICIARY OF 

THE ESTATE OF STEVE MILLER, 

DECEASED, AND AS BENEFICIARY, 

PURSUANT TO THE TEXAS 

WRONGFUL DEATH STATUTE AND 

TEXAS SURVIVAL STATUTE; AND 

CYNTHIA MILLER, INDIVIDUALLY 

AND AS THE SURVIVOR, HEIR AT 

LAW, AND BENEFICIARY

PURSUANT TO THE TEXAS 

WRONGFUL DEATH STATUTE AND 

TEXAS SURVIVAL STATUTE, AND 

AS JOINT MANAGING 

CONSERVATOR OF JAYLYNN

DENIQUE MILLER, DEYLIN 

APPELLEES
2

RAESHAWN MILLER, AND JACOBE 

ANTONIO MILLER, MINORS

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FROM THE 236TH DISTRICT COURT OF TARRANT COUNTY

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MEMORANDUM OPINION1

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Gerald Robert Stephenson, M.D. appeals from the trial court‟s interlocutory 

order refusing to dismiss the health care liability claims of appellees Natasha 

Miller, in her individual and other capacities, and Cynthia Miller, individually and 

in her other capacities. In two issues, appellant challenges the expert reports 

proffered by appellees as to standard of care and causation. We affirm.

Procedural Background

Appellees sued appellant, a surgeon who transplanted a kidney into Steve 

Miller, alleging that Miller died after appellant failed to recognize signs of 

postoperative bleeding, failed to timely order labs that would have purportedly 

diagnosed the bleeding at an earlier time, and failed to institute timely and 

appropriate therapies that would have prevented Miller‟s death from cardiac 

arrest. Appellant filed a motion to dismiss for failure to file an adequate expert 

report, which the trial court denied.

Standard of Review

 

1See Tex. R. App. P. 47.4.
3

A trial court=s decision on a motion to dismiss under section 74.351 is 

subject to an abuse of discretion standard. See, e.g., Am. Transitional Care Ctrs. 

of Tex., Inc. v. Palacios, 46 S.W.3d 873, 875 (Tex. 2001). To determine whether 

a trial court abused its discretion, we must decide whether the trial court acted 

without reference to any guiding rules or principles; in other words, we must 

decide whether the act was arbitrary or unreasonable. Downer v. Aquamarine 

Operators, Inc., 701 S.W.2d 238, 241–42 (Tex. 1985), cert. denied, 476 U.S. 

1159 (1986). Merely because a trial court may decide a matter within its 

discretion in a different manner than an appellate court would in a similar 

circumstance does not demonstrate that an abuse of discretion has occurred. Id. 

at 242. A trial court does not abuse its discretion if it commits a mere error in 

judgment. See E.I. du Pont de Nemours & Co. v. Robinson, 923 S.W.2d 549, 

558 (Tex. 1995).

Expert Report Requirements

In a health care liability claim, a claimant must serve on each defendant an 

expert report that addresses standard of care, liability, and causation no later 

than the 120th day after the claim is filed. Tex. Civ. Prac. & Rem. Code Ann. '

74.351(a), (j) (West 2011); Barber v. Mercer, 303 S.W.3d 786, 790 (Tex. App.––

Fort Worth 2009, no pet.). If an expert report has not been served on a 

defendant within the 120-day period, then on the motion of the affected 

defendant, the trial court must dismiss the claim with prejudice and award the 

defendant reasonable attorney=s fees and costs. Tex. Civ. Prac. & Rem. Code 
4

Ann. ' 74.351(b); Barber, 303 S.W.3d at 790. A report Ahas not been served@

under the statute when it has been physically served but it is found deficient by 

the trial court. Lewis v. Funderburk, 253 S.W.3d 204, 207–08 (Tex. 2008); 

Barber, 303 S.W.3d at 790B91. When no report has been served because the 

report that was served was found to be deficient, the trial court has discretion to 

grant one thirty-day extension to allow the claimant the opportunity to cure the 

deficiency. Tex. Civ. Prac. & Rem. Code Ann. ' 74.351(c); Barber, 303 S.W.3d 

at 791.

A report is deficient (therefore subjecting a claim to dismissal) when it 

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

an expert report@ in the statute. Tex. Civ. Prac. & Rem. Code Ann. ' 74.351(l); 

Barber, 303 S.W.3d at 791. While the expert report Aneed not marshal all the 

plaintiff‟s proof,@ Palacios, 46 S.W.3d at 878, it must provide a fair summary of 

the expert=s opinions as to the Aapplicable standards of care, the manner in which 

the care rendered by the physician or health care provider failed to meet the 

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

or damages claimed.@ Tex. Civ. Prac. & Rem. Code Ann. ' 74.351(r)(6); Barber, 

303 S.W.3d at 791.

To qualify as a good faith effort, the report must Adiscuss the standard of 

care, breach, and causation with sufficient specificity to inform the defendant of 

the conduct the plaintiff has called into question and to provide a basis for the 

trial court to conclude that the claims have merit.@ Palacios, 46 S.W.3d at 875; 
5

Barber, 303 S.W.3d at 791. A report does not fulfill this requirement if it merely 

states the expert=s conclusions or if it omits any of the statutory requirements. 

Palacios, 46 S.W.3d at 879; Barber, 303 S.W.3d at 791. The information in the 

report Adoes not have to meet the same requirements as the evidence offered in 

a summary-judgment proceeding or at trial.@ Palacios, 46 S.W.3d at 879; Barber, 

303 S.W.3d at 791. When reviewing the adequacy of a report, the only 

information relevant to the inquiry is the information contained within the four 

corners of the document alone. Palacios, 46 S.W.3d at 878; Barber, 303 S.W.3d 

at 791; see Bowie Mem‟l Hosp. v. Wright, 79 S.W.3d 48, 52 (Tex. 2002). This 

requirement precludes a court from filling gaps in a report by drawing inferences 

or guessing as to what the expert likely meant or intended. Barber, 303 S.W.3d 

at 791; see Austin Heart, P.A. v. Webb, 228 S.W.3d 276, 279 (Tex. App.––Austin 

2007, no pet.) (citing Bowie Mem=l Hosp., 79 S.W.3d at 53).

“[I]t is not enough that the expert report „provided insight‟ about the 

plaintiff‟s claims. Rather, to constitute a good-faith effort to establish the causalrelationship element, the expert report must fulfill Palacios‟s two-part test.” 

Bowie Mem’l Hosp., 79 S.W.3d at 52 (citation omitted); Farishta v. Tenet 

Healthsystem Hosps. Dallas, Inc., 224 S.W.3d 448, 453 (Tex. App.––Fort Worth 

2007, no pet.). The expert “must explain the bases of the statements [made 

regarding causation] and link his or her conclusions to the facts.” Farishta, 224 

S.W.3d at 453–54 (quoting Longino v. Crosswhite, 183 S.W.3d 913, 917–18 

(Tex. App.––Texarkana 2006, no pet.)). The report must provide enough 
6

information within the document to both inform the defendant of the specific 

conduct at issue and to allow the trial court to conclude that the suit has merit. 

Bowie Mem’l Hosp., 79 S.W.3d. at 52.

Analysis

In two issues, appellant challenges the adequacy of the expert reports 

provided by appellees because (1) the standard of care and breach opinions 

lump all the doctors together collectively and (2) the causation opinions lump all 

the doctors together and fail to specify how the breaches caused Miller‟s death or 

specifically link those breaches to the cause of death.

Standard of Care

Dr. Ronald Ferguson, appellee‟s first expert, had over thirty years‟ 

experience in the “practice of transplant surgery and the care of kidney transplant 

patients.” He opined that appellant was aware of Miller‟s postoperative 

hematocrit drop to 21.72and elevated potassium of 8.8; a note from appellant the 

morning after surgery notes the potassium of 8.8 “and the delayed graft function 

(DGF) of the transplanted kidney.” It also notes that Miller “would be scheduled 

to be hemodialyzed „today.‟” At 8:03 a.m. the morning after surgery, appellant 

made a requisition for 1 gram of calcium gluconate by IV for Miller.

 

2

In some parts of the report, Dr. Ferguson refers to the hematocrit drop as 

being to 21.7, and in others, he refers to it as being 22.7. For purposes of this 

opinion, the difference is not significant. 
7

Dr. Ferguson noted that appellant was an independent contractor of Harris 

Methodist Hospital and that he was bound by their Renal Transplant Program 

2006 Protocol guidelines. According to Dr. Ferguson,

The transplant surgeon is to be available post-operatively for 

the usual post-operative care, [and] for consultation with the Medical 

Director, including the occurrence of possible surgical problems. 

Concurrently, the nephrologists are responsible for the management 

of the transplant patients post-operatively. In the case of Steve 

Miller, nephrologists Linh Le, M.D., Rubina Khan, M.D., Shane 

Kennedy, M.D., and Charles Andrews, M.D., all part of Dialysis 

Associates, were to be responsible for the care of Steve Miller.

In addition to the above operational guidelines set by the 

Protocol for the Kidney Transplant Program and Unit, the Protocol 

set had established guidelines for the Post Operative Management 

of the Transplant Recipient. The protocol is their standard of care 

for the post-operative care and management of a kidney transplant 

recipient.

According to the Harris Methodist Hospital – Fort Worth Renal 

Transplant Program 2006 Protocol, applicable to the care of Steve 

Miller on April 2nd and 3rd, 2007, . . . Gerald R. Stephenson, M.D. . . . 

failed to implement this Protocol in the care of Steve Miller by failing 

to assess, monitor, and/or communicate Steve Miller‟s fractional 

urine output that was significantly lower than the 500 cc per four 

hours set as the standard quantitative guideline of the Protocol.

Steve Miller, whose urine output post-operatively, was less 

than 20cc per hour since surgery, necessitated laboratory monitoring 

every four hours. Accordingly, the Protocol dictated that a complete 

blood count (CBC) and basic metabolic panel (BMP) were to be 

analyzed every four hours until routine labs the following morning. 

This Protocol, had it been implemented as dictated, would have 

provided a CBC, including a hemoglobin and hematocrit, and a 

BMP, which included a potassium level, at 9:30 p.m., 1:30 a.m., and 

5:30 a.m. This pattern of monitoring was critical in the care denied 

Steve Miller.

. . . .
8

. . . Gerald Robert Stephenson, M.D., failed to implement 

Harris Methodist Hospital – Fort Worth – Renal Transplant Program 

2006 Protocol and obtain on Steve Miller a complete blood count 

and basic metabolic panel every four hours post-operatively until 

morning, necessitated by his oliguric status. The protocol 

recognizes the minimal standard set forth in the community for 

kidney transplant patients. The standard approach recognized for 

laboratory monitoring in the first 24 hours post renal transplant would 

be to obtain testing for hemoglobin, hematocrit, and electrolytes (at 

least) every six hours for the first twenty four hours post 

transplant. . . .

Had their own Protocol been implemented, or the community 

standard cited above, Steve Miller‟s post-operative bleeding and 

hyperkalemia[

3

] would have been detected at a much earlier time 

allowing much earlier treatment.

. . . .

● Dr. Stephenson is documented in the nursing records to 

be at Steve Miller‟s bedside at 7:30 a.m. on April 3, 

2007.

. . . .

● Christina Collier, R.N. reports that “Dr. Stephenson was 

actually in the unit making rounds, so I provided him 

with a copy of the morning labs. This was 

approximately 7:30 a.m. on April 3, 2007. . . .[”]

● Christina Collier, R.N., reports that Dr. Stephenson was 

at Steve Miller‟s bedside at 7:30 a.m., and documents it 

in the nurse‟s notes. Further documentation by Nurse 

Collier notes that “Dr. Kahn and Dr. Stephenson aware” 

of Steve Miller‟s laboratory values, including his 

potassium of 8.8 and his hematocrit of 22.7.

. . . .

 

3Hyperkalemia is “[a] greater than normal concentration of potassium ions 

in the circulating blood.” Stedman‟s Med. Dictionary 921 (28th ed. 2006).
9

In addition to having the critical, life threatening potassium 

level, indicating his severe hyperkalemia, Steve Miller was also 

hypovolemic,[

4

] having critically low hematocrit and hemoglobin 

values that were made known to Drs. Stephenson and Khan at 7:25 

a.m., on 4/3/07. At this time, Steve Miller‟s condition was extremely 

critical and life threatening. Mr. Miller‟s kidney had produced very 

little urine (oliguria) and the hematocrit and hemoglobin values 

indicated an internal hemorrhage. As indicated before, the accepted 

standard for medical care for such a patient in critical condition 

would require urgent therapy with intravenous Calcium Gluconate or 

an insulin and glucose combination. . . .

. . . .

Furthermore, [although Dr. Khan ordered 1 gram of calcium 

gluconate “now”] neither Dr. Khan nor Dr. Stephenson took 

responsibility to assure that the Calcium Gluconate was immediately 

processed and administered. In fact, Dr. Stephenson testifies that 

he left the entire clinical emergency management of Steve Miller up 

to Dr. Khan, absent the ordering [of] an advancement of Steve 

Miller‟s diet to „clear liquids‟.

Drs. Khan and Stephenson, Nurses Laureano, Collier, and 

Dickerson, Harris Methodist Fort Worth Hospital and its health care 

providers, each had a duty, as respective medical doctors, 

registered nurses and health care providers of Harris Methodist 

Hospital – Fort Worth, to Steve Miller, in an emergency situation, to 

see that the „Now‟ order was immediately communicated to the 

pharmacy, [and] processed and administered to Steve Miller within 

one hour. Steve Miller was administered the Calcium Gluconate 

over two hours later. This is below the standard of care for medical 

doctors, specifically Rubina Khan, M.D. and Gerald Stephenson, 

M.D. . . .

. . . .

1. The standard of care for a post-operative kidney 

transplant patient is to have a blood assessment, at the 

very minimum, every six hours, post-operatively, which 

 

4Hypovolemic means having “a decreased amount of blood in the body.” 

Id. at 939.
10

would include a basic metabolic panel. The standard of 

care would require that both the surgeon, in this case, 

Dr. Gerald Stephenson, M.D., and the nephrologist 

group (Dialysis Associates), and the individual 

nephrologist, in this case, Linh Le, M.D., Shane 

Kennedy, M.D. and Rubina Khan, M.D., would be 

responsible for seeing that such order was entered. . . .

. . . .

3. The medical records do not indicate that either Drs. 

Stephenson or Khan properly diagnosed the fact that 

Steve Miller was hypovolemic as a result of an internal 

hemorrhage, which was causing his low hematocrit and 

hemoglobin levels (as well as the critical potassium 

value of 8.8). The calcium gluconate, together with the 

insulin glucose combination should have been given 

intravenously and immediately. The accepted standard 

of care would require the proper diagnosis be made of 

Steve Miller‟s critical condition that he was bleeding 

internally, and thus, hyperkalemic, and the standard of 

care would require that he be administered the above 

therapy intravenously and that both Drs. Khan and 

Stephenson should have made certain that this order 

was carried out and that therapy was given immediately. 

It was a violation of the standard of care for them not to 

do so. . . .

4. It was a violation of the standard of care to not order the 

intravenous timely administration of Calcium Gluconate 

or the insulin glucose combination as well as dialysis, 

without ultrafiltration. . . .

. . . Both Drs. Stephenson and Khan failed to treat the 

primary cause of Steve Miller’s hyperkalemia, the postoperative bleeding. The accepted standard of care for a 

post-operative kidney patient, such as Steve Miller, 

would have been not to decrease his fluid volume, 

created quite possibly by surgical post-operative 

bleeding, and to treat medically his hyperkalemia. 

Rubina Khan, M.D. and Gerald Robert Stephenson, 

M.D. failed to perform any of these that were required 

by the accepted standards of care, for a patient of Mr. 
11

Miller‟s condition. Furthermore, it is a violation of the 

standard of care by both Rubina Khan, M.D. and Gerald 

Robert Stephenson, M.D., both of whom had the 

responsibility for Steve Miller upon examining him at 

7:25 a.m., on 4/03/07, to order and/or permit him to 

receive ultrafiltration . . . . The standard of care for the 

nephrologist on duty in the early morning hours of 

4/03/07, . . . as well as . . . Dr. Stephenson, the kidney 

transplant surgeon, was to diagnose Steve Miller as 

suffering from post-operative bleeding which required 

immediate treatment . . . . Rubina Khan, M.D. and 

Gerald Robert Stephenson, M.D. failed to take any of 

the appropriate actions necessary to treat the extremely 

critical conditions caused by Steve Miller‟s postoperative bleeding. [Emphasis added.]

Dr. Gallon, appellees‟ second expert, had over ten years‟ experience in the 

practice of transplant surgery and the care of transplant patients. He states in his 

report that the nephrologists were responsible for postoperative management of 

transplant patients and that “[t]he transplant surgeon, Gerald Robert Stephenson, 

M.D., was concurrently responsible for Steve Miller‟s post-operative monitoring, 

care and intervention as it related to the surgical procedure and potential 

complications and/or issues related to the kidney allograft.”

“Concurrent” is defined as “[o]perating at the same time[,]... covering the 

same matters.” Black‟s Law Dictionary 331 (9th ed. 2009). A reasonable 

construction of Dr. Ferguson‟s and Dr. Gallon‟s use of the word “concurrently” in 

their reports is that Dr. Stephenson was to be available for the usual postoperative care of Miller and that he was to be responsible for the post-operative 

management of Miller along with the nephrologists. Thus, any references in the 

report to a joint standard of care involving the post-operative management of 
12

Miller would be appropriate. See, e.g., Barber v. Dean, 303 S.W.3d 819, 831 

(Tex. App.––Fort Worth 2009, no pet.). The excerpts above show that both Dr. 

Ferguson and Dr. Gallon concluded and opined that under Harris‟s Protocol, as 

well as prevailing standards of care for post-operative care and management of a 

patient, the transplant surgeon was responsible for both post-operative care and 

management of a patient like Miller. Both reports clearly state that the articulated 

standards of care are applicable to both Dr. Stephenson and the nephrologists; 

Dr. Ferguson‟s report also states how Dr. Stephenson as well as the 

nephrologists breached that standard. Thus, the expert reports proffered by 

appellees fulfill their statutory purpose: to provide enough information within the 

document to both inform the defendant of the specific conduct at issue and to 

allow the trial court to conclude that the suit has merit. See Bowie Mem’l Hosp., 

79 S.W.3d. at 52.

We overrule appellant‟s first issue.

Causation

Appellant further contends that Dr. Ferguson‟s and Dr. Gallon‟s reports are 

deficient because they are conclusory and “also lump all physicians and 

defendants together for causation.”

Appellant contends that appellees‟ experts failed to explain how he is 

linked to Miller‟s cardiac arrest, which occurred during ultrafiltration by Dr. Khan, 

the nephrologist. According to appellant, the court must make improper 

inferences to “glean precisely how it is that the care of Appellant Dr. Stephenson 
13

himself . . . caused the death of the patient.” He contends Dr. Gallon‟s report 

fails for the same reason because it is “not surprisingly identical to [that] of Dr. 

Ferguson.”

Dr. Ferguson opined as follows:

Had their own Protocol been implemented, or the community 

standard cited above, Steve Miller‟s post-operative bleeding and 

hyperkalemia would have been detected at a much earlier time 

allowing much earlier treatment.

. . . .

3. The critical potassium value indicating the hyperkalemia 

condition that could immediately cause a patient to develop lifethreatening arrhythmia required aggressive treatment as soon as 

that condition was diagnosed by the blood sample that was drawn at 

3:40 a.m. . . . [A]t 7:25 a.m., on 4/3/07 . . . Steve Miller‟s condition 

was extremely critical and life-threatening. Mr. Miller‟s kidney had 

produced very little urine (oliguria) and the hematocrit and 

hemoglobin values indicated an internal hemorrhage. . . .

4. . . . The ultrafiltration removed fluid volume from Steve Miller 

who was already presenting with a compromised hypovolemic 

condition, and was the finishing catalyst in Steve Miller‟s 

hemodynamic[

5

] collapse and a contributing cause to his death at 

11:27 a.m. on 4/3/07.

. . . . Due to the cumulative effect of the negligent care, aggressive 

medical management of the hyperkalemia, followed by an operation 

to control bleeding or intraoperative dialysis, with life-support 

measures, accompanied by surgical repair of the postoperative 

bleeding, were at the time, (7:25 a.m.), the only heroic and plausible 

interventions to save the life of this 24 year-old young man.

. . . .

 

5Hemodynamic means “[r]elating to the physical aspects of the blood 

circulation.” Id. at 868.
14

. . . [Miller] died of a cardiac arrest while in dialysis in a state of 

uncontrovertible ventricular tachycardia. . . . He experienced 

postoperative bleeding that caused dangerous hyperkalemia. A 

decision to use dialysis to treat the life threatening hyperkalemia, 

rather than, or in addition to, aggressive medical management, was

made. While on dialysis, ultrafiltration led to hypotension as it 

frequently does in the early post-transplant dialysis setting and 

definitely does in a compromised hypovolemic post-surgical state. 

This was not recognized, but in fact, more fluid volume was removed 

by ultrafiltration that exacerbated rather than improved the 

hypotension and hypovolemic, thus setting up an environment of 

uncorrected hyperkalemia (repeat potassium in dialysis of 7.9), 

acidosis (arterial pH of 7.166), hypotension, hypovolemic, hypoxia, 

and ventricular tachycardia. Given this setting and environment, it is 

not surprising that the ventricular tachycardia could not be 

successfully reversed and became the ultimate cause of death.

. . . .

Each of the standards of care as I have indicated above was a 

proximate cause of the death of Steve Miller. . . . Earlier, had he 

received the proper treatment, Steve Miller, in all reasonable medical 

probability, would have resulted in his being able to survive the postoperative bleeding. . . . The failure to properly treat Steve Miller‟s 

condition by Rubina Khan, M.D., Shane Kennedy, M.D., Gerald 

Robert Stephenson, M.D. and Patricia Fenderson, M.D. [the Director 

of Harris Methodist Hospital – Fort Worth], combined with the failure 

of the nurses and health care providers . . . all of which . . . caused 

Steve Miller to ultimately go into cardiac arrest from which he could 

not be resuscitated, thus, causing his death. Each of the above 

violations of the standard of care was a proximate cause of Steve 

Miller‟s death.

Earlier in his report, Dr. Ferguson faults Dr. Stephenson for breaching the 

following standards of care: failing to ensure the Protocol was implemented as to 

timely CBC and BMP laboratory tests, failing to ensure that Dr. Khan‟s “now” 

order for calcium gluconate was immediately processed, failing to diagnose and 

treat the primary cause of Miller‟s hyperkalemia, which was the postoperative 
15

bleeding, and allowing Dr. Khan to order ultrafiltration when it was not indicated. 

In his report, he states that had the Protocol been implemented, Miller‟s 

hyperkalemic condition would have been evident earlier and would not have 

eventually progressed to ventricular tachycardia. According to Dr. Ferguson, Dr. 

Stephenson‟s failure to diagnose the underlying cause of Miller‟s hyperkalemia 

and his allowing the ultrafiltration exacerbated that continuing hyperkalemic 

condition, which eventually led to irreversible ventricular tachycardia. Dr. 

Ferguson‟s report describes a chain of omissions that each had the effect of 

further exacerbating Miller‟s condition until it became irreversible. See, e.g., 

Menefee v. Ohman, 323 S.W.3d 509, 519–20 (Tex. App.––Fort Worth 2010, no 

pet.); Presbyterian Cmty. Hosp. of Denton v. Smith, 314 S.W.3d 508, 518–19

(Tex. App.––Fort Worth 2010, no pet.); see also Del Lago Partners, Inc. v. Smith, 

307 S.W.3d 762, 774 (Tex. 2010) (holding that there may be more than one 

proximate cause of an event).

Accordingly, we conclude and hold that Dr. Ferguson‟s opinions on 

causation are not conclusory, nor do they fail for lack of specificity as to Dr. 

Stephenson, with respect to each of the alleged standard of care violations 

except for the failure to ensure the timely administration of calcium gluconate or 

insulin. Dr. Ferguson does not explain how that failure was a proximate cause of 

Miller‟s death. However, Dr. Gallon states in his report that intravenous calcium 

gluconate would “stabilize the myocardium” and an insulin/glucose combination 

would “treat the hyperkalemia.” Thus, reading both reports together, the alleged 
16

failure to ensure the timely administration of the proper medication was another 

omission in the chain that led to the exacerbation of Miller‟s hyperkalemia and 

ultimate cardiac arrest. See Tex. Civ. Prac. & Rem. Code Ann. § 74.351(i); 

Davisson v. Nicholson, 310 S.W.3d 543, 558 (Tex. App.––Fort Worth 2010, no 

pet.) (op. on reh‟g); Packard v. Guerra, 252 S.W.3d 511, 526–27 (Tex. App.––

Houston [14th Dist.] 2008, pet. denied) (holding that we must review multiple 

reports “in the aggregate” to determine if they are adequate as to liability and 

causation).

We conclude and hold that the trial court did not abuse its discretion by 

determining that the expert reports proffered by appellees constituted a good 

faith effort to comply with the statute. We overrule appellant‟s second issue.

Conclusion

Having overruled both of appellant‟s issues, we affirm the trial court‟s 

order.

TERRIE LIVINGSTON

CHIEF JUSTICE

PANEL: LIVINGSTON, C.J.; MEIER, J.; and DIXON W. HOLMAN (Senior 

Justice, Retired, Sitting by Assignment).

DELIVERED: July 28, 2011