## COURT OF APPEALS SECOND DISTRICTOFTEXAS FORT WORTH NO. 2 - 0 6 -4 4 2 - CV
P HI L I PA. M OOR E , M . D. AP P E L L ANT V . KR I STY G A TI C A A PPELL EE

----- ----- -- FR O M THE 236TH DI STRI CT CO URT O F TARRA NT CO UN TY

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### OP I NI ON ON R E M AND

----- ----- -- I nt r oduc t i on A p p e l l a n t P h i l i p A . M o o re , M .D . (D r. M o o re ) a p p e a l sth e tri a l c o u rt’s d e n i a l o f his m o ti o n to d i sm i ss th e h e a l th c a re l i a b i l i ty c l a i m o f ap p e l l e e K ri sty G at i ca ( G at i ca ) . W e or i gi nal l y di sm i ss ed t hi s i nt er l ocu t ory a ppe alf orw antof j u ri s d i c ti o n . Mo o rev. Ga ti c a, 253 S. W . 3d 291 ( Te x. App.

— Fo rt W ort h 2007) (m e m . o p .), re v ’d, 2 5 3 S . W . 3 d 2 1 9 ( T e x . 2 0 0 8 ) . B e c a u s e t h e T e x a sS u p r e me C ourtha s hel d t hatw e h avej ur i sd i ct i on, w e n ow co ns i der th e a p p e a l on t he2

m e ri ts . Mo o re , 253 S . W . 3d at 220 . I n onei ss ue, D r . M oor e c ont end s t hatt he t r i al co urtab us ed i t s di sc r et i on i n de nyi ng hi s m ot i on t o di sm i ssby con cl udi ng t h a tt h e e x p e rtre p o rts e rv e d u p o n h im s a t is f ie d t h e re q u ir e m e n t so ft h e c iv il p ra c ti c e a n d re m e d i e sc o d e . S ee Te x. Ci v. Pr a c . & Rem . Cod e Ann. § 74. 351 (V e rn o n S u p p . 2 0 0 8 ) (se c ti o n 7 4 .3 5 1 ). W e a ffir m . B a c k g rou n d F a c ts In 2 0 0 5 , G a t ic a e n g a g e d D r . M o o r e t o p e r f o r m a la p a r o s c o p ic appen dect om y. G at i ca al l eges t hat f ol l ow i ng hersur ger y, she began t o suf f er s u b s t a n t ia l p a in , w h ic h re q u ir e d h e rt o h a v e f u rt h e ro p e r a t io n sre s u lt in g in
s c a rs , d i s fi g u re m e n t, a n d i m p a i rm e n t i n h e r u p p e r b o d y . G a ti c a c l a i m sth a t D r. M oor e c aus ed t hes e p r obl em s by f ai l i ng t o pe r f or m t he app end ec t om y w i t h t he
or di na ry car e and di l i gence used byot herphysi ci ans. Speci f i cal l y, G at i ca al l ege s t hatD r . M oor e f ai l ed t o cor r ec t l y cl os e t he ce cum and i l eum f ol l ow i ng t he appen dect om y and f ai l ed t o det er m i ne t hatt he cecum and i l eum had been i m pr oper l y cl osed. G at i ca assert s t hat D r . M oor e’ s negl i gence caused her over $ 5 0 0 ,0 0 0 i n d a m a g e s . O n A pr i l 18 , 20 06 , G at i ca f i l e d h e r or i gi nal pet i t i on agai nstD r . M oor e, al l egi ng t hathe negl i gentl y per f or m ed t he appen dect om y. A ft er D r . M oor e f i l ed
a n a n s w e r c o n ta i n i n g a g e n e ra l d e n i a l , G a ti c a s e rv e d o n D r. M o o re a n e x p e rt
r eportpr epar ed by Loui s F. S i l ver m an, M . D . ( D r . S i l ver m an) , a boar d- cert i f i ed3

gen er al an d t hor ac i c s ur geo n, w hi ch con t ai ned f ac t s and con cl us i onsr ega r di ng D r. M o o re ’sa l l e g e d n e g l i g e n c e , a sre q u i re d b yth e s ta tu te . Sp eci f i cal l y, D r . Si l ver m an’ s r eportdet ai l ed hi s educat i on and c a r eer backgr oun ds and st at ed t hathe “car e[ s] f or pat i ent s w i t h appen di ci t i s” and w as t her ef or e qu a li fi ed t o “r enderan expertopi ni on r egar di ng t he qual i t y oft hat
c a re .”F o rm e d fro m a re v i e w o f G a ti c a ’sh o s p i ta l re c o rd s , D r. S i l v e rm a n ’s rep o rtthe n all e g e d the foll o w i n g su m m a ri ze d fac ts. D r. M o o re c o n su l ted w i th G at i ca on Apr i l 10, 2005 aft er G at i ca had exp er i enc ed t hr ee w ee ks ofev ol vi ng a b d o m in a l p a in . T h e n e x t d a y , D r . M o o r e p e r f o r m e d a la p a r o s c o p ic appen dect om y. A ft e rD r . M oor e r em oved the appendi x, a “s t apl erw as f i r ed
a c ro s s th e b a s e o f th e a p p e n d i x ” to c l o s e th e c e c u m , a n d v a s c u l a r s ta p l e sw e re a p p l i e d to th e m e s o a p p e n d i x . H o w e v e r, fo l l o w i n g th e s e p ro c e d u re s , G a ti c a ’s t e m p e r a t u r e ro s e , s h e b e g a n t o v o m ita n d h a v e d ia r r h e a , h e rw h it e b lo o d c e ll
coun ti ncr eased, and f l ui d col l ecte d i n heri nt est i nes. Because oft hese
c o n d i ti o n s , G a ti c a w a s re tu rn e d to s u rg e ry , w h i c h re v e a l e d l e a k a g e fro m w h e re D r. M o o re h a d s ta p l e d h e r. T o tre a t G a ti c a ’sc o m p l i c a ti o n s , D r. M o o re su ct i one d t he dr ai nag e a nd s ut ur ed t he pr evi ous l y s t apl ed app end i ce als t um p. H o w e v e r, a fte r D r. M o o re a tte m p te d th e s e c o rre c ti v e a c ti o n s , G a ti c a ’s t em per at ur e r ose agai n, and a c ol l ect i on of f l ui d w as di scover ed behi nd her
s m a ll in t e s t in e . O n M a y4 , 2 0 0 5 , G a t ic a w a sd is c h a r g e d f r o m t h e h o s p it a l;4

how eve r , on M ay 11, 2005 , s he w asr ea dm i t t ed w i t h “ pur ul ent , f oul

- sm el l i ng dr ai nage f r om herabdom i nal i nci si on. ” G at i ca w a s a g a i n di schar ged on M ay 2 3 , 2 0 0 5 . B u t a fte r h a v i n g fu rth e r d i fficu l ti e s , G a ti c a w a sa d m i tte d i n J a n u a ry 20 06 t o a di f f er enthospi t al w i t h com pl ai nt s ofsever e abdom i nal pai n. A new su r geo n di sc ove r ed t hatG at i ca ha d “ con gl om er at i on ofs oftgr anu l at i on t i ss ue and m ul t i pl e heavy si l k sut ur es . . . sur r oun di ng t he per cut aneou s dr ai n. ” A ft er
m o re tre a tm e n t, G a ti c a w a sd i s c h a rg e d a g a i n l a te r th a t m o n th . B a s e d o n th e s e fa c ts , D r. S i l v e rm a n ’sre p o rt c o n c l u d e d th a t D r . M o o re f ai l ed t o s at i sf y hi s dut y ofca r e b ec aus e h e ( 1) f ai l ed t o s ec ur el y c l o s e a nd
r ei nf or cet he app e n d i c e a l s t um p, r es ul t i ng i n l ea ka ge and co nt am i nat i on, an d ( 2) used si l k sut ur es w hi l e know i ng t hat l eakage exi st ed, r esul t i ng i n bact er i al
c o n tam i n a ti o n . D r. S i l v e rm a n as se rt e d tha t th e se c o n d i ti o n s re q u i red G a ti c a to hav e f urt her abd om i nal su r ger i es . D r . Si l ver m an al so pr ovi ded a c u rr i cul um vi t ae , w hi ch det ai l ed m or e t han f ort y yea r s of su r gi ca l exp er i enc e, w i t h t w ent yf i ve yea r s i n pr i vat e p r ac t i cean d “ br oad pr ac t i ceen com pas si ng a l l as pec t s of G ener al , Th or aci c and C ar di ovascul arSu r ger y .” H i s vi t ae det ai l ed sever al
c e rti fi c a ti o n s , fe l l o w s h i p s , a n d re s e a rc h a c ti v i ti e s . O n A ugu st29 , 20 06 , D r . M oor e f i l ed a M ot i on t o D i sm i ss w i t h Pr ej udi ce, con t end i ng t hatG at i ca f ai l ed t o f i l e a n a deq uat e e xpe rtr epo rtas re q u i re d by
s e c ti o n 7 4 .3 5 1 . S p e c i fi c a l l y , D r. M o o re a s s e rte d th a t D r. S i l v e rm a n ’se x p e rt1 ... T h o u g h the tr i a l co u rtj u d g e rul e d tha t G a ti c a h a d m a d e a g o o d fai th

ef f ortt o c om pl y w i t h t he st at ut e ( and t her ef or e den i ed D r . M oor e’ s m ot i on) , he n o n e th e l e s so ffe re d G a t i c a th i rtyd a y sto “ i m p ro v e u p o n ” D r. S i l v e rm a n ’s re p o rt, o p i n i n g th a t “ a p p e l l a te c o u rt s s e e m to b e re q u i ri n g a l i ttle b i t m o re pr ec i si on”i n r evi ew i ng e xpe rt r epo rt s. G at i ca ’ s cou ns elde cl i ned t hi s of f er , an d D r. M o o re a p p e a l e d . 5 rep o rtd i d n o t co n sti tu te a g o o d fai th e ffort a t co m p l i a n c e w i th the req u i rem e n ts
o fs e c t io n 7 4 .3 5 1 b e c a u s e D r . S ilv e r m a n h a d n o ta d e q u a t e lyq u a lif ie d h im s e lf
as a n e x p e rti n t h e s u r g i c a l ma n a g e me n to fl a p a r o s c o p i c a p p e n d e c t om i es. A f t erG at i ca r espond ed t o D r . M oor e’ s m ot i on and t he t r i al court hear d coun sel
a rg u e , th e c o u rt d e n i e d D r. M o o re ’sm o ti o n , c o n c l u d i n g th a t D r. S i l v e rm a n ’s
r e po rtw a s “ s uf f i c i e nt t o c om pl y w i t h t her e qu i r e m e nt s ”o fs e c t i on 74. 351. 1 S t andar d ofRev i ew T e x a s c o u rt s a g r e e t h a t r e v i e w o f a tri a l co u rt ’s d e n i a l o f a m o ti o n to di sm i ss unde r se ct i on 74. 351 i s su bj ec t t o an abu se of di sc re ti o n s t and ar d. S e e, e .g ., Sa nJa ci

n to Me th o d

i s t Ho sp . v. Benn e tt, 256 S . W . 3d 806, 811 (T e x . A p p .— H o u s to n [1 4 th D i s t.] 2 0 0 8 , n o p e t.) ; Cra i g v. D e a rb o n n e, 259 S .W .3 d 3 0 8 , 3 1 0 (T e x . A p p . — B e a u m o n t 2 0 0 8 , n o p e t.) ; L a l v. Ha r r is Me th o d i st F o rt Wo rth , 230 S. W . 3d 468 , 471 ( Tex. A pp. — Fort W ort h 2007, no pet . ) . A l so, a t r i al court ’ s deci si on on w het hera physi ci an i s qual i f i ed t o of f er an exp ert opi ni on i n a hea l t h ca r e l i abi l i t y cl ai m i s r evi ew ed unde ran ab us e o f6

d i s c re ti o n s ta n d a r d . S e eMem ’l Her m a nnHea lth c a reS ys . v. Bur rell, 230 S .W .3 d 7 5 5 , 7 5 7 (T e x . A p p .— H o u s to n [1 4 th D i s t.] 2 0 0 7 , n o p e t.). To det er m i ne w het her a t r i al cou rt abu se d i t s di sc r et i on, w e m us tde ci de
w het hert he t r i alco urtac t ed w i t houtr ef er enc e t o a ny g u i d i n g ru l esor pr i nci pl es ; i n ot herw or ds , w e m us tde ci de w het hert he ac t w a s a r bi t r ary or
u n re a s o n a b l e . D owner v. A quam ar i ne Oper ator s, I nc . , 701 S . W . 2d 238, 241– 4 2 (T e x . 1 9 8 5 ), cert. denied, 47 6 U . S . 11 59 ( 19 86 ) . M er el y because a t r i al
courtm ay deci de a m at t erw i t hi n i t s d is c re tio n in a di f f er entm annert han an appel l at e courtw oul d i n a si m i l ar ci r cum st ance does not dem onst r at e t hatan a b u s e o f d i s c re ti o n h a so c c u rre d . Id. A t r i alco urtdoe s not abu sei t s di sc r et i on i f i t c o m m i ts a m e re e rro r i n j u d g m e n t. See E. I. du Pont deNem our

s & Co. v. Robi ns on , 9 2 3 S .W .2 d 5 4 9 , 5 5 8 (T e x . 1 9 9 5 ).

S u fficie n c yo f D r. S i l v e rm a n ’sE x p e rt R e p o rt I n hi s s ol e i s s ue , Dr . M oo r e a s s e rt s t ha t t he t r i a l c ou rtab u se d i ts di sc r et i on byde c i d i n g t hatD r . Si l ver m an’ s exp ertr epo rts at i sf i ed t he
re q u i re m e n t s o f s e c ti o n 7 4 .3 5 1 . S eeT e x . C i v . P ra c . &R e m . C o d e A n n . § 7 4 .3 5 1 . A ppl i cabl e Law In a h e a l th c a re l i a b i l i tyc l a i m , a c l a i m a n t m u s t s e rv e a n e x p e rt re p o rt ( w hi c h a d dr es se s l i abi l i t y a nd c aus at i on) on e ac h de f end antno l at ert han t he7

1 2 0 th d a y a fte r th e c l a i m i s fi l e d . Id . § 7 4. 35 1( a) , (j ) . I fan expertr eporthas notbe en se rved on a def end antw i t hi n t he 120

- daype r i od, t hen on t he m ot i on oft he af f ect ed def endan t , t he t r i al courtm ustdi sm i ss t he cl ai m w i t h pr ej udi ce a n d aw ar d t he def end ant r ea so nab l e att or ney ’ s f ee s and cos t s . Id . § 74 . 35 1( b ) . A r e p o rt“ h a sn o tb e e n s e rv e d ” u n d e rt h e s t a t u t e wh e n i thas phys i ca l l y bee n se rved but i t i s f ound def i ci ent by t he t r i al cou rt. L e wi s v. F un derb urk , 25 3 S . W . 3d 20 4, 20 7– 08 ( Tex . 20 08 ) . W hen “no r eporthas been
served” because t he r eportt hat w as served w as f oun d t o be def i ci ent , t he t r i al
c o u rth a s d i sc reti o n to g ran t on e th i rt y -da y e x ten sion to a l l o w th e c l a i m a n t t o c u re th e d e fi c i e n c y . T e x . C i v . P ra c . &R e m . C o d e A n n . § 7 4 .3 5 1 (c ). A r e p o rt i s“ d e fi c i e n t” (th e re fo re s u bj e c ti n g a c l a i m to d i s m i s s a l ) w h e re i t“ doe s notr epr es entan obj ec t i ve good f ai t h e f f ortt o c om pl y w i t h t he def i ni t i on ofan exp ert r epo rt ” i n t he st at ut e. Tex. C i v. Pr ac . & Rem . Code Ann. § 7 4 .3 5 1 (l ). W h i l e th e e x p e rt re p o rt “ n e e d n o t m a rs h a l a l l th e p l a i n ti ff’sp ro o f,” A m . Transiti

onal Care Ctr

s. of Tex. , I nc. v. Pal

aci os , 46 S. W . 3d 873, 878 ( Tex. 200 1) , i tm us tpr ovi de a f ai rs um m ary ofth e ex pert ’ s opi ni onsast o t he “a p p l i c a b l e s t a n d a r d s o f c a r e , t h e ma n n e r i n wh i c h t h e c a r e r e n d e r ed by t he physi ci an orheal t h car e pr ovi derf ai l ed t o m eet t he st andar ds, and t he causal
re l a ti o n s h i p b e tw e e n th a t fa i l u re a n d th e i n j u ry , h a rm , o r d a m a g e s c l a i m e d .” T e x . C i v . P ra c . &R e m . C o d e A n n . § 7 4 .3 5 1 (r)(6 ).8

T o q u a l i fya sa g o o d fa i th e ffo rt, th e re p o rt m u s t “ d i s c u s sth e s ta n d a rd of c a r e , b r e a c h , a n d c a u s a t i o n wi t h s u f f i c i e n t s p e c i f i c i t y t o i n f or m t he def end antoft he con duc tt he pl ai nt i f fha s ca l l ed i nt o que sti o n a nd t o pr ovi de a basi s f ort he t r i al courtt o concl ude t hatt he cl ai m s have m er i t . ” Pal aci os , 46 S. W . 3d at875. A r epo rtdoe s notf ul f i l l t hi s r equ i r em enti fi tm er el y s t at est he
e x p e rt’s c o n c l u s i o n s o r i f i t o m i ts a n yo f th e s ta tu to ryre q u i re m e n ts . Id . a t879. Th e i nf or m at i on i n t he r eport“does nothave t o m eett he sam e r equi r em ent s as t he evi dence off er ed i n a sum m ary-j udg m entpr oceedi ng oratt r i al . ” Id . The cl ai m ant ’ s expertm usti ncor por at e enoug h i nf or m at i on t o f ul f i l l t w o pur poses: (1 ) i n fo rm the d e fen d a n t of th e sp e c i fi c co n d u c t t h e p l a i n ti ff h a s c a l l e d i n to q u e s ti o n , a n d (2 ) p ro v i d e a b a s i s fo r th e tri a l c o u rt to c o n c l u d e th e c l a i m sa re
m e ri to ri o u s . Id . W hen r evi ew i ng t he ade qua cy of a r epo rt , t he onl y i nf or m at i on
r el eva ntt o t he i nqui ry i s t he i nf or m at i on c ont ai ned w i t hi n t he f ourco r ner s of th e d o c u m e n t. Id . a t 8 7 8 ; se e Bowi e Mem ’ l Hosp. v. W

r i ght, 79 S. W . 3d 48, 5 2 (T e x . 2 0 0 2 ). T h i s re q u i re m e n t p re c l u d e s a c o u rt fro m fi l l i n g g a p si n a re p o rt by d r aw i n g i n fer enc esorgue ss i ng a s t o w hatt he exp ertl i ke l y m ea ntor i n te n d e d . See Austi n Heart , P. A . v. Webb , 228 S .W .3 d 2 76, 279 ( Tex. A pp. — A us t i n 2007, no p et . ) ( ci t i ng Bo wi eMem ’l

Ho sp ., 7 9 S .W .3 d a t 5 3 ). A n expertr eport concer ni ng st andar ds ofcar e f orphysi ci ans “aut hor ed b ya p e rso n w h o i s n o t q u a l i fi e d to tes ti fy . . . c a n n o t co n sti tu te a n ad e q u a te9

r eport . ” I

n re W i ndi sch , 138 S. W . 3d 507 , 511 ( Tex. A pp. — A m ar i l l o 2004, no p e t.); see Ehr

l i ch v. Mi

les , 1 4 4 S .W .3 d 6 2 0 , 6 2 4

– 2 5 (T e x . A p p .— F o rtW o rt h 2 0 0 4 , p e t. d e n i e d ). T o b e a n “ e x p e r t ” o n th e d e p a rtu re fro m a p h y s i c i a n ’s
s ta n d a rd o f c a re (th e re fo re q u a l i fy i n g th e s u b m i s s i o n o f a n e x p e rt re p o rt), a per so n m us tbea phys i ci an w ho ( 1) i s pr ac t i c i n g m edi ci ne att he t i m e s uch t es t i m ony i s gi ven or w as pr act i ci ng m edi ci ne att he t i m e t he cl ai m ar ose; (2) ha s kno w l edg e o fac ce pt ed st and ar dsofm edi ca l ca r e f ort he di agn os i s, c ar e, ort r ea t m entoft he i l l nes s, i nj ury, orco ndi t i on i nvol ved i n t he cl ai m ; an d ( 3) i s qual i f i ed on t he basi s oftra in in g o rexper i ence t o of f eran expert opi ni on r egar di ng t hose accept ed st andar ds of m edi cal car e. Te x. Ci v. Pr a c . & Rem . Cod e Ann . §§ 7 4. 351( 5) ( A) , 74. 401( a ) ( Ver no n 2005
a n d S u p p . 2 0 0 8 ) . I n d e term i n i n g the thir d elem e n t of th i s s tan d a rd, co u rt s
m u s t c o n s i d e r w h e th e r th e p h y s i c i a n w h o c o m p l e te d t h e re p o rt (1 ) i sb o a rd
c e rt ifie d orhas ot hersubst ant i al t r ai ni ng orexper i ence i n an ar ea ofm edi cal pr act i ce r e le v a n tt o t h e c la im , a n d (2 ) is a c t iv e lyp r a c t ic i n g m e d ic in e in
re n d e ri n g m e d i c a l c a re s e rv i c e s re l e v a n t to th e c l a i m . Id . § 7 4. 40 1( c) . I n ot her
w o rd s , th e re i sn o v a l i d i ty , i f th e re e v e r w a s , t o t h e n o ti o n th a t e v e ry l i c e n se d m e d i c a l d o c to r sh o u l d b e au to m a ti c a l l yq u a l i fi e d to te sti fy asan ex perton e very m edi ca l que st i on . . . [ T] he pr opone ntoft he t es t i mo n yh a st h e b u r d e n t o s h o w t h a tt h e e x p e rtp o s s e s ses10

sp e c i a l k n o w l e d g e as to th e v e ry m a tter on w h i c h h e p rop o se s to gi ve an opi ni on. Ehr l i ch , 144 S . W . 3d at6 2 5 ( quot i ng Broder s v. Hei

se , 924 S. W . 2d 148, 1 5 2

– 5 3 (T e x . 1 9 9 6 )) . F o rt h isre a s o n , t h e o f f e r e d r e p o rtm u s tg e n e r a lly dem ons t r at e t hatt he exp ertha s “k now l edg e, s ki l l , ex per i enc e, t r a i n i n g , or edu ca t i on r ega r di ng t he sp ec i f i c i ss ue bef or e t he cou rtw hi ch w oul d qua l i f y t he expertt o gi ve an opi ni on on t hatpart i cul ar subj ect . ” Ehr l i ch , 14 4 S . W . 3d at 625 ( quot i ng Roberts v. W i l l i am son , 1 1 1 S .W .3 d 1 1 3 , 1 2 1 (T e x . 2 0 0 3 )). H o w e v e r, “th e re a re c e rt a i n sta n d a rd s o f m e d i c a l ca re th a t ap p l yto
m u l ti p l e s c h o o l so f p ra c ti c e a n d a n ym e d i c a l d o c to r.” S e e Bla n v. A li, 7 S. W . 3d 7 4 1 , 7 4 6 (T e x . A p p . — H o u s t o n [1 4 th D i s t.] 1 9 9 9 , n o p e t.). T h e re fo re , a p h y s ic ia n “ w h o isn o to ft h e s a m e s c h o o l o f m e d i c i n e [a st h e d e f e n d a n t ] is
com pet entt o t es t i f y i fheha s pr ac t i ca l kn ow l edg e o fw h a ti s us ual l y a nd cust om ar i l y don e by a pr act i t i on e r u n d e rci r cum st ances si m i l art o t hose confr onti ng t he def endan t . ” Ehr l i ch , 1 4 4 S .W .3 d a t 6 2 5 ; se e al so Mar l i ng v. Ma i l l a rd , 826 S. W . 2d 735, 740 ( Tex. A pp. — H ous t on [ 14t h D i st . ] 199 2, no
w ri t). D r . Si l ver m an’ s Q ual i f i ca t i ons D r . M oor e h asnotch al l eng ed D r . Si l ver m a n ’ s exp ertr epo rton t he gr oundst hati tf ai l s t o pr ovi de a f ai rs um m ary ofhi s opi ni onson l i abi l i t y or11

ca us at i on. I ns te a d , D r . M oor e o nl y c ont end s t hatD r . Si l ver m an w asnot st at ut or i l y qu al i f i ed t o s ubm i tt he r epo rt . Ther ef or e, w e m us tde t er m i ne
w het hert he t r i al cou rt abu se d i t s di sc r et i on i n de t er m i ni ng t hatt he i nf or m at i on contai ned w i t hi n D r . S i l ver m an’ s r eport est abl i shed hi s cr edenti al s as a qual i f i ed

“ e x p e rt” o n G a ti c a ’sc l a i m u n d e r th e c i v i l p ra c ti c e a n d re m e d i e sc o d e . S eeTex. C i v . P ra c . &R e m . C o d e A n n . § 7 4 .4 0 1 (a ). D r . Si l ver m an’ s Pr act i ce ofM edi ci ne att he T i m e t he C l ai m A r ose T o q u a l i fy h i m a s a n e x p e rt fo r th e p u rp o s e so f th i sc a s e , D r. S i l v e rm a n ’s
r epo rtm us tf i r stes t abl i sh t hathe i s a p hys i ci an w ho w aspr ac t i ci ng m edi ci ne a t th e ti m e h e w r o te th e re p o rt o r a t th e ti m e G a ti c a ’sc l a i m a ro s e . Id. § 7 4 .4 0 1 (a )(1 ). D r. M o o re h a sn o t c o n te s te d th a t D r. S i l v e rm a n ’sre p o rt est abl i shes t hi s el em ent . Furt her , D r . S i l ver m an’ s r eporti ndi cat es t hathe i s a “b oar d- ce rt i f i ed gen er alan d t hor a c i c s u rgeo n i n a ct i ve pr ac t i cei n Houst on, T e x a s,” a n d h i s c u rr i c u l u m v i tae d e m o n strate s th a t h e h a s a c t iv e s t a ff
re s p o n s i b i l i ti e sa t fi v e h o s p i ta l si n T e x a s . T h e re fo r e , D r. S i l v e rm a n ’se x p e rt
r e p o rts u f f ic ie n t lye s t a b lis h e st h a t h e w a s p r a c t ic in g m e d ic in e d u r in g t h e t im e G a ti c a ’sc l a i m a ro s e a n d w h e n h e w ro te h i sre p o rt. See i d. § 7 4 .4 0 1 (a )(1 ).2 ... A t tri a l a n d o n a p p e a l , D r. M o o re h a sc o n fl a te d th e s e tw o s ta tu to ry

p r o v is io n sin c o n t e n d in g t h a tD r . S ilv e r m a n w a sn o t q u a lif ie d t o s u b m ith is e x p e rt re p o rt. F o r th i s re a s o n , a n d b e c a u s e th e s ta te m e n t s m a d e in D r. S i l ver m an’ s r eportar e dual l y appl i cabl e t o both pr ovi si ons, w e w i l l anal yze t hem to g e th e r. 12 D r . Si l ver m an’ s Know l edg e o fA cc ept ed St and ardsof M e d i ca lCar e for th eD i a g n o sis, C a re, o r T rea tm e n t o f G a ti c a ’s A p p e n d e c to m y a n d P o stO perat i ve Pr oce dures ,an d Hi s Q ual i f i ca t i onst o O ff eran Exp ertO pi ni on Regardi ng Thos e St and ards N ext , D r . Si l ver m a n ’s re portm us tes t abl i sh t hatheha s “k now l edg e o f
ac ce pt ed st and ar dsofm edi ca l ca r e f ort he di agn os i s, ca r e, ort r ea t m ent oft he i l l nes s, i nj ury, or con di t i on i nvol ved i n t he cl ai m ” and t hat he i s “q ual i f i ed on t he basi s oft r ai ni ng orexper i enc e t o of f eran expertopi ni on” r egar di ng t hose
s ta n d a rd s . Id. § 7 4 .4 0 1 (a )(2 ), (3 ). 2In d e t e r m in in g w h e t h e rD r . S ilv e r m a n is q u a l i fi e d o n the b a sis o f t rai n i n g o r e x p e ri e n c e , th e tr i a l co u rtw a s re q u i red to
con si derw het herhew as“ boa r d ce rt i f i ed orha [ d] ot hers ubs t ant i alt r ai ni ng or exper i ence” and w het herhe w as “act i vel y pr act i ci ng m edi ci ne” i n t he ar ea re l a te d to G a ti c a ’sc l a i m . Id . § 7 4 .4 0 1 (c ). D r. M o o re c o n te n d s th a tD r. S ilv e r m a n ’s re p o rtd id n o ts p e c if ic a llys t a t e t h a th e h a se x p e r ie n c e in per f or m i ng l apar oscopi c append ect om i es and t h athe w as t her ef or e notqual i f i ed t o subm i tt he expertr eportsupport i ng G at i ca’ s cl ai m . W e di sagr ee. D r . Si l ver m an’ s exp ertr epo rtan d c ur r i cul um vi t aede m ons t r at e t hathe h a s e x t e n s iv e e x p e r ie n c e in a b r o a d r a n g e o f s u r g ic a l p r a c t ic e sa n d t h a th e is13

a b o a rd-c e rt i fi e d g e n e ral an d th o rac i c su rge o n . S p e c i fi c a l l y , th e se d o c u m e n ts in d ic a t e t h a tD r . S ilv e r m a n p a rt ic ip a t e d in e ig h ty e a r so fre s id e n c ie sin g e n e r a l, t hor ac i c, an d c ar di ova sc ul ars ur gery; t hat h e ha s ce rt i f i ca t i onsf r om t he A m er i ca n Boar d ofSur gery, A m e r i ca n Boar d ofThor ac i c Sur gery, an d Fe l l ow A m er i ca n Col l egeofSur geo ns ; t hatheco m pl et ed su bs t ant i alf el l ow sh i psan d
r e s e a r c h t a s k s ; a n d t h a t h e c u r r e n t lye n g a g e sin a p r a c t ic e b r o a d lyc o v e r in g “ a ll
a s p e c ts ” o f g e n e ra l , th o ra c i c , a n d c a rd i o v a s c u l a r s u rg e ry . I n to ta l , D r. S il v e r m a n ’s c u r r ic u lu m v it a e d e t a ilso v e rf o rt y -f iv e y e a r so fe x p e r ie n c e in
v a ri o u s s u rg i c a l p ra c ti c e s . M or e s pec i f i ca l l y, D r . S i l v e rm an’ s r epo rts t at ed t hatheha s an ac t i ve su r g ic a l p rac ti c e i n H o u sto n , T e x a s, i n w h i c h h e ca res “fo r pa ti e n ts w i th appen di ci t i s such as M s. G at i ca had suf f er ed” and t hathe i s t her ef or e “qual i f i ed by e d u c a t i on, t r ai ni ng, an d e xpe r i enc e t o a ss es s t he qua l i t y ofs uch ca r e a nd
re n d e r a n e x p e rt o p i n i o n re g a rd i n g th e q u a l i tyo f th a t c a re .”H i sre p o rt
c o n ti n u e d b yd e tai l i n g h i s k n o w l e d g e reg a rding the sta n d a rds o f ca re rel a ted to appen dect om i es. A f t er di scussi ng t he f act s aboutG at i ca’ s m edi cal car e t hat
w e re g a th e red fr o m h e r m e d i c a l rec o rds , D r. S i l v e rm a n ex p l a i n e d tha t [t ]he s t a n d a rd o f ca re a p p l i c a b l e to a p p e n d e c to m yfor a c u te app e n di ci t i s m and at ess ec ur e c l os ur e o ft he app end i ce als t um p w hi ch r equi r es cl osur e t o non i nf l am ed t i ssue, even i ft hi s r equi r es pl a c i ng t hes t a pl e l i nea c r os sa s m a l l p ort i on o f th e c e c um . By f ai l i ng t o m ee tt hi s st and ar d, D r . M oor e f ai l ed t o a chi eves ec u re14

cl os ur e o ft he app end i ce al st um p. Thatf ai l ur e r es ul t ed i n m as si ve fe c a l c o n ta m i n a ti o n o f M s . G a ti c a ’s p e ri to n e a l c a v i ty . T h e s ta n d a rd ofca r e, gi ven t he pr es e n c e o fs eve r e i nf l am m at i on i n t he per i app end i ce alar ea , r equ i r ed app r opr i at e r ei nf or ce m ent o f t he i n v o l v e d a re a , a si n fa c t D r. M o o re a tte m p te d a t M s . G a ti c a ’s s u b s e q u e n t o p e ra ti o n . W e c onc l udet hat t hes e st at em ent s, w hen co ns i der ed i n t he con t extof t h e re m a in d e ro fD r . S ilv e r m a n ’s re p o rt , e n a b le d t h e t r ia l c o u rtt o p r o p e r ly
con cl udet hatheha d k now l edg e o ft he ac ce pt ed st and ar ds of m edi ca l ca r e f or t he t r ea t m entofG at i ca ’ s app end i ci t i s and t hat he w as qua l i f i ed on t he bas i s of tra i n i n g o r e x p e ri e n c e to o ffe r a n e x p e rt o p i n i o n re g a rd i n g th o s e s ta n d a rd s . S ee i d. § 74. 401 ( a) ( 2) , ( 3) . Pa rti cul ar l y, by i ndi ca t i ng t hr ough hi s r epo rtan d
cur r i culu m v ita e th athi s pr act i ce i s sol el y f ocused on sur ger y, and by t hen expl ai ni ng t hathe car es “f orpat i ent s w i t h appen di ci t i s such as M s. G at i ca had
s u f f e r e d ,” D r . S ilv e r m a n a d e q u a t e ly d e m o n s t r a t e d t h a t h e h a sk n o w le d g e , s k ill, exper i ence, t r ai ni ng, oreducat i on r egar di ng t he speci f i c i ssue bef or e t he t r i al
c o u rt— th e p ro p e r c o n c l u s i o n o f a n a p p e n d e c to m y . S ee Ehr l i ch , 144 S . W . 3d
a t624– 25; Kel

ly v. Ren do n, 2 5 5 S .W .3 d 6 6 5 , 6 7 3 (T e x . A p p .— H o u sto n [ 1 4 th D i s t.] 2 0 0 8 , n o p e t.) (d e c i d i n g th a t a d o c to r w a sq u a l i fi e d to s u b m i t a n e x p e rt
r epo rti n pa rt bec aus e t he r epo rti ndi ca t ed t he doc t orha d “ exp er i enc e t r ea t i ng p a ti e n ts w i th th e s a m e c o n d i ti o n ” a sth ec l a i m a n t); Casti l lo v. A ugust, 248 S .W .3 d 8 7 4 , 882 ( Tex. A pp. — El Pas o 2008, no p et . ) ( hol di ng t hata doc t or3 ... A l apa r os cop i c p r oce dur e d i f f er s f r om a l apa r ot om i c pr oce dur e i n t he

m e a n s u s e d t o g a in a c c e s st o t h e a p p e n d ix . S p e c i f i c a lly , la p a r o s c o p ic app end ec t om i e s i n v o l ve an exa m i nat i on oft he app end i x t hr ough a s cop e p a s s e d th ro u g h th e a b d o m i n a l w a l l , w h i l e l a p a ro to m i c a p p e n d e c to m i e sre q u i re a n i n c i s i o n i n t o th e l o i n . St edm an’ s M edi ca l D i ct i ona ry 840, 1170 ( 25t h Ed. 1 9 9 0 ); s e e a l

s o A lva ra do v. Co nm e d Co rp . , No. E P- 06- CV

- 0198- KC, 200 8 W L 27 83 51 0, at*1 ( W . D . Tex . M ar . 13 , 20 08 ) ( expl ai ni ng t he di f f er ence bet w een l a p a ro s c o p i c a n d l a p a ro to m i c s u rg e ri e s ). 15 w asqua l i f i ed t o s ubm i t an exp ertr epo rtab outpos t - ope r at i ve st aph i nf ec t i ons
w hen hi s r eporti ndi cat ed t hathe had been “cal l ed upo n t o i denti f y, di agno se, and t r eatpost - sur gi cal and hospi t al

- bor ne i nf ect i ons”) . M or eover , t he f act ual det ai l i n Dr . Si l ver m an’ s r epo rtr ega r di ng t h e p ro perco ncl us i on of
a p p e n d e c t o m ie sin d ic a t e s t h a t h e h a s p r a c t ic a l k n o w le d g e o f w h a t is“ u s u a lly
a n d c u s to m a ri l yd o n e b y o t h e r p ra c ti ti o n e rs ” i n s u c h s u rg e ri e s . S ee Bl an , 7 S .W .3 d a t 7 4 5 . D r . M oor e cont ends t hatbecause G at i ca’s a p pend ect om y w as l apar oscopi c, and because D r . S i l ver m an’ s r eportdi d not i ndi cat e t hathe had exper i ence i n l apa roscop i c pr ocedu r es, he i s di squal i f i ed f r om subm i t t i ng an e x p e rtre p o rtf o rG a t ic a ’s c la im . 3 H o w e v e r, D r. M o o re h a s fa i l e d to a rt i c u l a te h o w t h e la p a r o s c o p ic n a t u r e o fG a t ic a ’s a p p e n d e c t o m y r e la t e st o t h e s p e c if ic cl ai m s f orne gl i gen ce con t ai ned i n G at i ca ’ s pl ea di ngs ( w hi ch al l co nce r ned t he f ai l ur e t o c l os e t he ce cum an d i l eum f ol l ow i ng t he su r gi ca l d i s s e c ti o n oft he app end i x, r at hert han t he m ea nsD r . M oor e u se d t o a c c e s s orr em ovet he16

a p p e n d ix ). In f a c t , D r . M o o r e c o n c e d e d in h is r e p ly b r ie f t o t h is c o u rtt h a tit“ is D r . M oor e’ s su r gi ca l t ec hni queonc e add r es si ng t he app end i x, nott he t ypeof i nci si on orap pr oac h i nvol ved i n ge t t i ng t o t he app end i x, t h a t i s th e ba si s of G at i ca ’ s com pl ai nt . ” Bec aus e Gat i ca ’ s com pl ai nt s abo utD r . M oor e d o not dep end upon s t and ar dsr el at i ng to l a p a r os cop y bu tr at herde pen d upo n t he p ro p e r c o n c l u s i o n o f a n a p p e n d e c to m y(w h e th e r l a p a ro s c o p i c o r n o t), w e c o n c lu d e t h a tD r . S ilv e r m a n ’s re p o rtw a sn o tr e q u ir e d t o e s t a b lis h h is exper i ence w i t h l apar oscopi c pr ocedu r es. F i n a l l y , D r. M o o re h a sc i te d s e v e ra l c a s e sw h i c h h o l d th a t a n e x p e rt
re p o rt i s i n a d e q u a t e w h e re i t d o e sn o t d e m o n s tra te th e re p o rti n g d o c to r’s
e x p e r ie n c e w it h t h e m e d ic a l p r o c e d u r e in v o lv e d in t h e u n d e r ly in g c la im . See,
e. g. , W i ndi sch , 13 8 S .W .3 d at513– 14 ( hol di ng t hata r adi ol ogi stw asnot qua l i f i ed t o s ubm i tan ex pertr epo rt b e c a u s e h i s r epo rtdi d noti ndi ca t e a ny e x p e ri e n c e w i th th e e m b o l i z a ti o n p ro c e d u re a t i s s u e ); To m asi v. Li ao , 63 S . W . 3d 62 , 65 –6 6 ( Tex . A pp. — S an A nt oni o 20 01 , no pet . ) ( det er m i ni ng t hat a p sy chi at r i s t w a s notqua l i f i ed t o s ubm i tan ex pertr epo rtr ega r di ng p o s t o p e r a t iv e c a r e f o llo w in g n e u r o s u r g e ry w h e n h is r e p o rt d id n o te x p la in
w h e th e r h e h a d a n y e x p e r i e n c e w i th s u c h c a re ); For res tv. D ani

el son , 77 S. W . 3d 842, 848 ( Tex. A pp. — Tyl er 200 2, no pet . ) ( dec i di ng t hat t he r epo rt i ng doc t orw asdi sq ual i f i ed bec aus e h i s r epo rt f ai l ed t o s how f am i l i ar i t y w i t h t he17

c a re o f a d i s c p ro tru s i o n , w h i c h fo rm e d t h e b a s i so f th e p l a i n ti ff’sc l a i m s ). C ontr ar y t o t he hol di ngs oft hese case s , D r . Si l ver m an’ s r eportdoes d e m o n s tra te th a t heh a se x p e ri e n c e w i th p e rfo rm i n g a n a p p e n d e c to m y – th e v e ry p ro c e d u re i n v o l v e d i n G a ti c a ’sc l a i m . For t hes e r ea so ns , w e hol d t hat t he t r i al cou rt di d not abu sei t s di sc r et i on b yd e te rm i n i n g th a t D r. S i l v e rm a n ’se x p e rt re p o rt q u a l i fi e d a s a g o o d fa i th e ffo rt to s a ti s fyth e re q u i re m e n ts o f s e c ti o n 7 4 . 3 5 1 . See T e x . C i v . P r a c . & R e m. C o d e A n n . § 7 4 .3 5 1 (l ). T h e re fo re , w e o v e rru l e D r. M o o re ’ss o l e i s s u e . C onc l us i on H avi ng over r ul ed D r . M oor e’ s onl y i ssue, w e af f i r m t he t r i al court ’ s or der d e n y i n g h i sm o ti o n to d i s m i s s .

T E R R I E L I VI NGS T ON J U S T I C E
PA N EL: L I V I N G STO N , D A U PH I N O T, A N D H O LM A N , JJ. DEL I VERE D: Oct ob e r9, 2008