Affirmed and Memorandum Opinion filed August 18, 2016.

In The

Fourteenth Court of Appeals

NO. 14-15-00829-CV

PAUL STAMATIS, JR., AS INDEPENDENT EXECUTOR OF THE 

ESTATE OF PAUL STAMATIS, DECEASED, Appellant

V.

METHODIST WILLOWBROOK HOSPITAL, THE METHODIST 

HEALTH CARE SYSTEM, DANIEL MAO, M.D., AND NEPTUNE 

EMERGENCY SERVICES, P.A., Appellees

On Appeal from the 190th District Court

Harris County, Texas

Trial Court Cause No. 2010-34910

M E M O R A N D U M O P I N I O N

In this appeal following remand, appellant Paul Stamatis, Jr., as Independent 

Executor of the Estate of Paul Stamatis, contends that the trial court erroneously 

granted a no-evidence summary judgment in favor of appellees, Methodist 

Willowbrook Hospital; the Methodist Health Care System; Daniel Mao, M.D.; and 

Neptune Emergency Services, P.A. (collectively, appellees). Stamatis also alleges 
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that the trial court erred in excluding his expert’s causation opinion. We affirm. 

FACTUAL AND PROCEDURAL BACKGROUND

Stamatis sued appellees for negligence arising out of the medical care that he

received while at the hospital. The underlying facts and proceedings that followed 

are recounted in this court’s opinion in Stamatis v. Methodist Willowbrook 

Hospital, No. 14-14-00492-CV, 2015 WL 3485734 (Tex. App.—Houston [14th 

Dist.] June 2, 2015, no pet.) (mem. op.) (“Stamatis I”). As explained in Stamatis I, 

on the day trial was to begin, the trial court allowed the parties to argue various 

issues, including: (1) whether Stamatis’s expert was qualified to opine on the issue

of causation; and (2) which standard of proof should apply at trial. We summarized

the underlying dispute concerning the standard of proof follows: 

The parties disagreed as to whether Stamatis received “emergency 

medical care” under section 74.153 of the Texas Civil Practice and 

Remedies Code, and thus disagreed as to whether the willful and 

wanton standard applied. See [Tex. Civ. Prac. & Rem. Code § 

74.153]. Under this statute, the claimant in a health care liability case 

involving “emergency medical care” must prove that the health care 

providers acted with willful and wanton negligence, as opposed to the 

traditional ordinary negligence standard. See id.

Stamatis I, 2015 WL 3485734, at *2. After hearing argument from both parties, but 

without admitting any evidence, the trial court determined as a matter of law that 

the willful and wanton standard applied because appellees provided emergency 

medical care. Id. The court also concluded that Stamatis’s expert could not testify 

regarding causation. Id. Appellees then moved for entry of judgment, and the trial 

court ultimately signed a final judgment ordering that Stamatis take nothing on all 

of his claims against appellees. Id.

On appeal, this court held that the trial court erred by disposing of Stamatis’s 

case in a manner not authorized by the Texas Rules of Civil Procedure. Id. at *6. 
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We reversed the trial court’s judgment and remanded the case for a new trial 

without reaching Stamatis’s issue regarding the admissibility of his expert’s 

deposition testimony. Id.

On remand, appellees filed a joint no-evidence motion for summary 

judgment, arguing that: (1) Stamatis’s claim involved emergency medical care, but 

Stamatis presented no evidence of willful or wanton conduct; and (2) Stamatis 

presented no evidence that appellees’ conduct proximately caused his injuries and 

damages. 

In response, Stamatis argued that because he only pleaded ordinary 

negligence, and never alleged that he received emergency medical care, a noevidence motion for summary judgment was improper. Stamatis also claimed that 

appellees’ no-evidence motion was improper because it was appellees’ burden to 

prove that Stamatis received emergency medical care. Lastly, Stamatis argued that 

the summary judgment evidence established that he did not receive emergency 

medical care and that appellees’ actions proximately caused his injuries. 

The trial court granted appellees’ no-evidence motion without specifying the 

grounds upon which it was granting summary judgment. The trial court also 

sustained appellees’ objections to the previously-excluded causation opinion of Dr. 

Paynter, Stamatis’s expert. The trial court did not specify the grounds upon which 

it was granting summary judgment. 

ANALYSIS OF STAMATIS’S ISSUES

Stamatis raises numerous issues on appeal, the majority of which concern 

whether Stamatis received emergency care. Because we conclude that Stamatis’s 

complaints regarding the trial court’s exclusion of his expert’s causation opinion 

and Stamatis’s evidence of causation are dispositive, we need not reach Stamatis’s 
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other issues.1

Stamatis contends that the trial court erred in granting appellees’ noevidence summary judgment motion because he presented more than a scintilla of 

probative evidence that appellees’ negligence caused Stamatis’s injuries. In 

support of his contention, Stamatis points to Dr. Paynter’s affidavit and deposition 

testimony, deposition testimony of appellees’ experts, and Stamatis’s medical 

records. However, the trial court sustained appellees’ motion to exclude Dr. 

Paynter’s testimony as to causation and sustained appellees’ objections to “any 

opinion testimony by Dr. Paynter on the issue of causation.” Therefore, in order to 

determine whether the trial court properly granted summary judgment, we must 

first determine whether the trial court properly excluded Dr. Paynter’s causation 

opinion. We thus turn to a discussion of the trial court’s evidentiary rulings.

I. The Trial Court’s Exclusion of Dr. Paynter’s Causation Opinion

Stamatis argues that the trial court erroneously excluded Dr. Paynter’s 

causation opinion because, contrary to appellees’ contentions, Dr. Paynter is 

qualified by his “knowledge, skill, experience, training, [and] education.” See Tex. 

R. Evid. 702. However, appellees also objected to Dr. Paynter’s causation opinion 

on the grounds that it was unreliable. When an appellee objects to evidence on 

several independent grounds and, on appeal, the appellant complains of the 

 

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In his first six issues, Stamatis contends that the trial court erred in granting summary 

judgment because: (1) appellees moved for summary judgment on claims and causes of action 

that Stamatis never pleaded; (2) appellees improperly moved for no-evidence summary judgment 

without any determination as a matter of law that Stamatis received emergency medical care; (3) 

neither relevant case law nor appellees’ summary judgment evidence supports a finding of 

emergency medical care; (4) there is more than a scintilla of evidence to raise a fact issue as to 

whether Stamatis received emergency medical care; (5) the trial court erred in determining 

Stamatis received emergency medical care because Stamatis was in a medically stable condition; 

and (6) Stamatis presented more than a scintilla of evidence that appellees’ negligence caused 

injury to Stamatis. In his seventh issue, Stamatis argues that the trial court erred in granting the 

joint motion to exclude Dr. Paynter’s deposition testimony.
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exclusion of the evidence on only one of those grounds, the appellant waives any 

error by failing to challenge all possible grounds for the trial court’s ruling that 

sustained the objection. Gulley v. Davis, 321 S.W.3d 213, 218 (Tex. App.—

Houston [1st Dist.] 2010, pet. denied); Najera v. Recana Sol., LLC., No. 14-14-

00332-CV, 2015 WL 4985085, at *8 (Tex. App.—Houston [14th Dist.] Aug. 20, 

2015, no pet.) (mem. op.). Therefore, by failing to attack all possible grounds for 

the trial court’s ruling, Stamatis has waived his challenge on appeal. See Gulley, 

321 S.W.3d at 218; Najera, 2015 WL 4985085, at *8. We overrule Stamatis’s sixth 

issue. 

II. The Trial Court’s Grant of Summary Judgment 

Having determined that Stamatis waived his challenge to the trial court’s 

exclusion of Dr. Paynter’s causation opinion, we now turn to Stamatis’s contention 

that he presented more than a scintilla of evidence of causation. 

A. Standard of Review

A trial court must grant a no-evidence motion for summary judgment if: (1) 

the moving party asserts that there is no evidence of one or more specified 

elements of a claim or defense on which the adverse party would have the burden 

of proof at trial; and (2) the respondent produces no summary judgment evidence 

raising a genuine issue of material fact on each of the challenged elements. See 

Tex. R. Civ. P. 166a(i). We sustain a no-evidence summary judgment when (a) 

there is a complete absence of evidence of a vital fact; (b) the court is barred by 

rules of law or of evidence from giving weight to the only evidence offered to 

prove a vital fact; (c) the evidence offered to prove a vital fact is no more than a 

mere scintilla; or (d) the evidence conclusively establishes the opposite of the vital 

fact. King Ranch, Inc. v. Chapman, 118 S.W.3d 742, 751 (Tex. 2003).
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Less than a scintilla of evidence exists when the evidence is so weak as to do 

no more than create a mere surmise or suspicion of a fact. Id. Conversely, more 

than a scintilla of evidence exists when reasonable and fair-minded people could 

differ in their conclusions based on the evidence. Id. To raise a genuine issue of 

material fact, the evidence must exceed mere suspicion. Ford Motor Co. v. 

Ridgway, 135 S.W.3d 598, 601 (Tex. 2004). “Evidence that is so slight as to make 

any inference a guess is in legal effect no evidence.” Id. In reviewing a noevidence summary judgment, we review the evidence in the light most favorable to 

the non-movant against whom the summary judgment was rendered. Id.

When a trial court’s order granting summary judgment does not specify the 

ground or grounds relied on for its ruling, we must affirm summary judgment if 

any of the grounds advanced is meritorious. Carr v. Brasher, 776 S.W.2d 567, 569 

(Tex. 1989); Oliphint v. Richards, 167 S.W.3d 513, 516 (Tex. App.—Houston 

[14th Dist.] 2005, pet. denied) (citing FM Props. Operating Co. v. City of Austin, 

22 S.W.3d 868, 872 (Tex. 2000)).

Stamatis argues that “the Affidavit of Dr. Paynter, the deposition testimony 

of Dr. Paynter and Appellees’ experts, and the medical records of [Stamatis] 

constitute more than a scintilla of probative evidence that the alleged negligence of 

the Appellees cause[d] injury to [Stamatis].” However, we have already 

determined that Stamatis waived his challenge to the exclusion of Dr. Paynter’s 

causation opinion. Therefore, we must determine whether the cited testimony of 

appellees’ experts or Stamatis’s medical records amount to more than a scintilla of

evidence of causation.

B. Analysis

Stamatis points to various statements from appellees’ experts, claiming that 

these excerpts demonstrate that appellees’ actions caused his injuries. However, 
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contrary to Stamatis’s contention, none of appellees’ experts opined that appellees’ 

conduct caused Stamatis’s bladder injury. The cited testimony includes general 

statements concerning the anatomy of the bladder and Stamatis’s condition before 

and during his stay in the emergency room. For example, Dr. McDonald testified 

regarding a urinary condition called nephrosis and stated that in his opinion, 

Stamatis’s bladder contained approximately 1600 ccs of urine at the time of his CT 

scan. Dr. Varon testified as to Stamatis’s urine output and opined that an output of 

400 milliliters “would not necessarily be abnormal.” Dr. Varon also stated that if 

the detrusor muscle was stretched too far, injury could result. In the referenced

excerpts from Dr. Fishman, the doctor testified that he did not see anything in 

Stamatis’s medical records regarding a prior detrusor injury or a history of urinary 

tract infections. None of the above-referenced testimony supports Stamatis’s 

contention that appellees caused his injury. 

Similarly, Stamatis’s medical records do not provide evidence of causation. 

According to Stamatis, the attached portions of Stamatis’s records indicate the 

results of the CT scan, the amount of time that passed before a catheter was 

inserted, the condition of Stamatis’s bladder after catheterization, and Stamatis’s 

inability to void on his own following his discharge from the hospital. Stamatis 

also points to records from Dr. Westney, a urologist who examined Stamatis 

following a referral. Dr. Westney noted that Stamatis was “referred to the Urology 

Department for evaluation of urinary retention which began during an emergency 

room visit on 06/15/08.” Additionally, testing by Dr. Westney concluded that 

Stamatis “was suffering from an injured, atonic Detrusor muscle of the bladder.”

Although these notes and records describe various aspects of Stamatis’s condition, 

they do not contain any opinions or conclusions regarding the cause of Stamatis’s 

condition.
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Furthermore, as Dr. Paynter’s causation opinion was properly excluded, 

Stamatis has no expert testimony to interpret these records and explain how the 

records support Stamatis’s contention that appellees caused his injury. Generally, 

expert testimony is required to establish causation in a medical malpractice case. 

See Jelinek v. Casas, 328 S.W.3d 526, 533 (Tex. 2010); Kimbrell v. Mem’l 

Hermann Hosp. Sys., 407 S.W.3d 871, 879 (Tex. App.—Houston [14th Dist.] 

2013, no pet.). “An expert witness must ‘explain how and why the negligence 

caused the injury.’” Kimbrell, 407 S.W.3d at 879 (quoting Jelinek, 328 S.W.3d at 

536). Stamatis has not satisfied his burden to produce evidence of causation.

Stamatis attempts to argue that because a bladder injury was not diagnosed 

or recognized before his visit to the hospital, but was diagnosed after, appellees’ 

conduct during his hospital stay must have caused the injury. But the Texas 

Supreme Court has repeatedly rejected such an argument. In Guevara v. Ferrer, 

the court noted that although “[e]vidence of an event followed closely by 

manifestation of or treatment for conditions which did not appear before the 

evident raises suspicion that the event at issue caused the conditions[,] . . . 

suspicion has not been and is not legally sufficient to support a finding of 

causation.” 247 S.W.3d 662, 668 (Tex. 2007); see also Jelinek v. Casas, 328 

S.W.3d 526, 533 (Tex. 2010) (“Care must be taken to avoid the post hoc ergo 

propter hoc fallacy, that is, finding an earlier event caused a later even merely 

because it occurred first. Stated simply, correlation does not necessarily imply 

causation.”). We conclude that Stamatis has not produced legally sufficient 

evidence of causation, and we overrule his sixth issue. 

Having determined that Stamatis has not presented more than a scintilla of 

evidence on the element of causation, we affirm the trial court’s grant of appellees’ 

no-evidence summary judgment motion on that basis. We need not, and do not, 
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address Stamatis’s remaining issues. See Tex. R. App. P. 47.1.

CONCLUSION

We affirm the judgment of the trial court.

/s/ Ken Wise

Justice

Panel consists of Justices Boyce, Brown, and Wise.