Fourth Court of Appeals

San Antonio, Texas

MEMORANDUM OPINION

No. 04-15-00136-CV

Gerald HARRINGTON, M.D.,

Appellant

v.

Sandra Schroeder and Duane J. Ramos, Individually and as All Heirs to the Estate of Sylvia 

Sandra SCHROEDER and Duane J. Ramos, Individually and as All Heirs to the Estate of 

Sylvia Ramos, Deceased,

Appellees

From the 288th Judicial District Court, Bexar County, Texas

Trial Court No. 2014-CI-06284

Honorable John D. Gabriel, Jr., Judge Presiding

Opinion by: Rebeca C. Martinez, Justice

Sitting: Karen Angelini, Justice

Rebeca C. Martinez, Justice

Jason Pulliam, Justice

Delivered and Filed: December 16, 2015

AFFIRMED

Gerald Harrington, M.D. appeals an order denying his motion to dismiss the healthcare 

liability lawsuit filed against him by Sandra Schroeder and Duane J. Ramos, individually and as 

all heirs to the estate of Sylvia Ramos, deceased. We affirm the judgment of the trial court.

BACKGROUND

Sylvia Ramos was a resident of Trisun Care Center Windcrest when she died as a result of 

an assault by a fellow nursing home resident; her death was ruled a homicide. Appellees sued the 

following for negligence: Trisun Care Center; Setters Medical Group, P.A.; Rudolfo Zarate, M.D.; 
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Zarate Medical Group, P.A.; and Dr. Harrington. Pursuant to Section 74.351, appellees filed the 

expert report of Loren G. Lipson, M.D. According to this report, Dr. Harrington was negligent in 

failing to: (1) provide appropriate input as to Ms. Ramos’s care plan; (2) perform timely and 

adequate assessments of Ms. Ramos; (3) document Ms. Ramos’s medical care accurately; and (4) 

coordinate discharge of Ms. Ramos to another facility that could meet her needs.

Dr. Harrington filed objections to the expert report filed by appellees. Dr. Harrington 

objected to Dr. Lipson’s report on the basis that it fails to (1) establish that Dr. Lipson is competent 

to testify as an expert witness and (2) adequately identify and explain any causal link between the 

alleged breaches of the standard of care by Dr. Harrington and Ms. Ramos’s injuries and damages. 

Dr. Harrington subsequently filed a motion to dismiss pursuant to section 74.351, arguing that Dr. 

Lipson’s report failed to meet all the requirements of section 74.351. See TEX. CIV. PRAC. & REM.

CODE ANN. § 74.351(a) (West Supp. 2015). 

After holding a hearing on the motion to dismiss, the trial court denied Dr. Harrington’s 

motion to dismiss, and he appealed. On appeal, Dr. Harrington seeks a reversal of the trial court’s 

order denying the motion to dismiss, and a remand to the trial court for a determination of statutory 

attorney’s fees.

STANDARD OF REVIEW

We review a trial court’s ruling on the sufficiency of an expert’s report for an abuse of 

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

Al–Lahiq, 331 S.W.3d 764, 766 (Tex. 2011); Am. Transitional Care Ctrs. of Tex., Inc. v. Palacios,

46 S.W.3d 873, 877 (Tex. 2001). A trial court abuses its discretion if it rules without reference to 

guiding rules or principles. Samlowski v. Wooten, 332 S.W.3d 404, 410 (Tex. 2011). “When 

reviewing matters committed to the trial court’s discretion, a court of appeals may not substitute 
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its own judgment for the trial court’s judgment.” Bowie Mem’l Hosp. v. Wright, 79 S.W.3d 48, 52 

(Tex. 2002) (citing Flores v. Fourth Court of Appeals, 777 S.W.2d 38, 41 (Tex. 1989)).

DISCUSSION

Section 74.351(a) of the Texas Civil Practice and Remedies Code mandates that in a 

“health care liability claim,” a claimant must serve on each party or his attorney one or more expert 

reports. TEX. CIV. PRAC. & REM. CODE ANN. § 74.351(a). If a claimant fails to serve the required 

report, the trial court must—upon the motion of the affected physician or health care provider—

dismiss the claim with prejudice and award attorney’s fees and costs. Id. 

§ 74.351(b) (West Supp. 2015). 

When presented with a motion to dismiss a healthcare liability claim, the trial court must 

determine whether the expert report represents a good faith effort to comply with the statutory 

definition of an expert report. See Wright, 79 S.W.3d at 52; Palacios, 46 S.W.3d at 878; see also

TEX. CIV. PRAC. & REM. CODE ANN. § 74.351(l) (West Supp. 2015). The statute defines an expert 

report as “a written report by an expert that provides a fair summary of the expert’s opinions as of 

the date of the report regarding the applicable standards of care, the manner in which the care 

rendered by the physician . . . 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) (West Supp. 2015). 

In evaluating an expert report, the trial court looks only to the information within the four 

corners of the report and is prohibited from making any inferences. Wright, 79 S.W.3d at 52-53; 

Palacios, 46 S.W.3d at 878. Although the expert report need not marshal all the plaintiff’s proof, 

it must include the expert’s opinion on each of the three elements identified in the statute: standard 

of care, breach, and causal relationship. Wright, 79 S.W.3d at 52; Palacios, 46 S.W.3d at 878. 

The expert cannot merely state his conclusions about these elements in his report. Wright, 79 
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S.W.3d at 52; Palacios, 46 S.W.3d at 879. The expert must explain the basis of his statements to 

link his conclusions to the facts. Jelinek v. Casas, 328 S.W.3d 526, 539-40 (Tex. 2010); Wright,

79 S.W.3d at 52 (citing Earle v. Ratliff, 998 S.W.2d 882, 890 (Tex. 1999)). To constitute a goodfaith effort to comply with the statutory definition, the expert’s report must provide enough 

information to fulfill two purposes: (1) it must inform the defendant of the specific conduct the 

plaintiff has called into question, and (2) it must provide a basis for the trial court to conclude that 

the claims have merit. Palacios, 46 S.W.3d at 879. “A report that merely states the expert’s 

conclusions about the standard of care, breach, and causation does not fulfill these two purposes.” 

Id.; Jelinek, 328 S.W.3d at 539. 

On appeal, Dr. Harrington argues the trial court abused its discretion in denying his motion 

to dismiss because Dr. Lipson’s report is deficient in that it fails to (1) establish that Dr. Lipson is 

competent to testify as an expert witness and (2) set forth the causal relationship between Dr. 

Harrington’s alleged breaches of the standard of care and the alleged injuries suffered by Ms. 

Ramos. 

Service of Defendant’s Objections to Expert Report

At the outset, we must address appellees’ contention that Dr. Harrington waived his 

objections to Dr. Lipson’s expert report by failing to serve said objections on counsel for appellees 

within 21 days of receipt of the expert report. See TEX.CIV. PRAC. &REM.CODE ANN. § 74.351(a). 

At the hearing on the motion to dismiss, appellees argued that although Dr. Harrington’s objections 

were timely filed, they were not served on plaintiffs’ attorneys until four months after the deadline 

to do so had passed. See TEX. R. CIV. P. 21a. After much discussion over whether electronic 

service was properly effected, and after the court contemplated resetting the hearing to permit 

evidence to be presented by the service provider for Dr. Harrington’s counsel, plaintiffs’ counsel 

informed the court as follows:
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Judge, I have no problem going forward on the substance of the Chapter 74 report. 

I feel that we would win on the service issue; however, I feel that the Chapter 74 

report is more inadequate [sic] for what the rules require. So I’m prepared to talk 

about that, if you would like.

After reviewing the record, we conclude that appellees have waived consideration of this 

issue. See TEX.R. APP. P. 33.1(a). At the hearing on the motion to dismiss, the trial court indicated 

it would reset the hearing to consider evidence regarding the electronic service. At that time, 

counsel for appellees abandoned the objection and affirmatively informed the trial court that he 

had “no problem going forward on the substance of the Chapter 74 report.” The parties then 

proceeded to discuss the substance of Dr. Harrington’s motion to dismiss, including his complaints 

related to Dr. Lipson’s qualifications and his statements regarding causation, without any further 

mention of the service issue. Accordingly, appellees have failed to preserve any complaint related 

to service of the objections. 

Qualifications

Dr. Harrington contends Dr. Lipson’s report is deficient because it fails to establish that 

Dr. Lipson is competent to testify as an expert witness. As to Dr. Lipson’s standard of care 

opinions, he maintains that there is no affirmative showing that Dr. Lipson was board certified and 

was actively practicing medicine in rendering medical care relevant to the claim against Dr. 

Harrington at the time the claim arose or at the time the report was authored. As to Dr. Lipson’s

causation opinions, he maintains Dr. Lipson is not qualified to testify because he is not licensed to 

practice medicine in Texas.

An expert must establish that he is qualified to provide an acceptable report. TEX. CIV.

PRAC. & REM. CODE ANN. § 74.351(r)(5)(B) (West Supp. 2015). Qualifications of an expert must 

appear in the expert report and curriculum vitae and cannot be inferred. See Olveda v. Sepulveda,

141 S.W.3d 679, 683 (Tex. App.—San Antonio 2004, pet. denied). Analysis of the expert’s 
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qualifications under section 74.351 is limited to the four corners of the expert report and the 

expert’s curriculum vitae. See TEX. CIV. PRAC. & REM. CODE ANN. § 74.351(a); In re McAllen 

Med. Ctr., Inc., 275 S.W.3d 458, 463 (Tex. 2008) (orig. proceeding). 

A) Qualifications to Render Standard of Care Opinions 

To be qualified to provide opinion testimony regarding whether a physician departed from 

the accepted standard of medical care, the expert must satisfy section 74.401. See TEX. CIV. PRAC.

& REM. CODE §§ 74.351(r)(5)(A), 74.401(a) (West Supp. 2015 & West 2011). Under section 

74.401, the expert must be a physician who: (1) is practicing medicine at the time such testimony 

is given or was practicing medicine at the time the claim arose; (2) has knowledge of accepted 

standards of medical care for the diagnosis, care, or treatment of the illness, injury, or condition 

involved in the claim; and (3) is qualified on the basis of training or experience to offer an expert 

opinion regarding those accepted standards of medical care. Id. § 74.401(a). “Practicing 

medicine” includes, but is not limited to, “training residents or students at an accredited school of 

medicine or osteopathy.” Id. § 74.401(b) (West 2011). “In determining whether a witness is 

qualified on the basis of training or experience” to offer an expert opinion regarding the applicable 

standards of medical care, the court shall consider whether, at the time the claim arose or at the 

time the testimony is given, the witness: (1) is board certified or has other substantial training or 

experience in an area of medical practice relevant to the claim; and (2) is actively practicing 

medicine in rendering medical care services relevant to the claim. Id. § 74.401(c) (West 2011); 

Bailey v. Amaya Clinic, Inc., 402 S.W.3d 355, 362-63 (Tex. App.—Houston [14th Dist.] 2013, no 

pet.).

In his report, Dr. Lipson states:

During the course of my career, I have been Board Certified in Internal Medicine, 

Geriatric Medicine, and Utilization Review and Quality Assurance. I have served 

as Director of the University of California (‘USC’) Teaching Nursing Home 
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Program and Co-Director of the Los Angeles County USC Medical Center Adult 

Protection Team-Geriatric Assessment Clinic. I have worked with the Keck School 

of Medicine at USC for over 29 years, having served as the Chief of the Section of 

Geriatric Medicine and Associate Professor of Medicine, Gerontology, Clinical 

Pharmacy, Medical Dentistry and Public Health, and Occupation Science and 

Occupational Therapy. I am currently Professor Emeritus of Medicine. I also 

currently serve as Co-Director in Geriatric Education and as Affiliate Professor at 

the University of Alaska, Anchorage in the College of Health and in the WWAMI 

Program for Alaskan Medical Students. I am also Adjunct Professor at the School 

of Community and Global Health, Claremont Graduate University.

Additionally, I am a consultant to the Department of Justice, State of California and 

New Mexico, and U.S. Department of Justice in areas of geriatric care and elder 

abuse. I have served as a Consultant to the Departments of Administration, Health 

and Social Services and Law, State of Alaska, in the areas of geriatric medicine and 

long term care. I also have been the Physician Advisor to USC University Hospital 

in areas of utilization management and quality assurance.

I have extensive personal experience in primary medical care as well as in 

subspecialty consultation and long-term care. In addition to my academic teaching, 

research, and administrative responsibilities, I am currently practicing medicine 

and was doing so at the time the claims described below occurred.

As a result of my education, training, and experience, I am qualified to render a 

relevant and reliable expert opinion on the standard of care applicable to the treating 

physician, Dr. Harrington...Through my extensive personal experience in primary 

medical care and the various positions I have occupied during the course of my 

career, I am familiar with the accepted standards of medical care applicable to 

treating physicians at nursing home facilities.

Dr. Harrington argues that there is no affirmative showing that Dr. Lipson was board 

certified and was actively practicing medicine or rendering medical care relevant to the claim 

against Dr. Harrington at the time the claim arose or at the time the report was authored, and thus 

Dr. Lipson is not qualified to testify as to the standard of care. We disagree. Board certification 

is just one of the considerations the trial court may evaluate when determining whether an expert 

qualifies as an expert on the issue of whether the defendant departed from accepted standards of 

medical care. Id. § 74.401(c)(1). The trial court may also consider the physician’s training or 

experience in the area of medical practice relevant to the claim. Id. Even though Dr. Lipson’s 

board certifications may have lapsed, his training and experience make him sufficiently qualified 
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in this case. According to the expert report, Dr. Lipson has extensive experience in the areas of 

geriatric medicine and long term care; he is also the author of several articles relating to those 

subjects. His resume reflects post-graduate training in the area of geriatrics and care of the elderly. 

Dr. Lipson’s experience in geriatric medicine, as set forth in his 47-page curriculum vitae, is 

significant and he continues to be on staff at the University of Alaska, Anchorage and at the School 

of Community and Global Health, Claremont Graduate University. In addition, he is Professor 

Emeritus of Medicine at the University of Southern California. He also currently serves as a

consultant to various governing bodies in the areas of geriatric care and elder abuse. Accordingly, 

the fact that Dr. Lipson’s board certifications have lapsed does not alone render him unqualified 

as an expert in this case. 

Dr. Harrington similarly complains that the report does not reflect that Dr. Lipson is 

actively practicing medicine. However, Dr. Lipson affirmatively states in the report that, “I am 

currently practicing medicine and was doing so at the time the claims described below occurred,” 

and the report demonstrates that, as the Co-Director in Geriatric Education at the University of 

Alaska, Anchorage, Dr. Lipson trains students at an accredited school of medicine. See id. 

§ 74.401(b) (“practicing medicine” includes, but is not limited to, “training residents or students 

at an accredited school of medicine or osteopathy”). As a consequence, the statement in his report 

that he is familiar with the accepted standards of medical care applicable to treating physicians at 

nursing home facilities is supported by his curriculum vitae and report. Given his experience in 

the field of geriatrics and long-term care, Dr. Lipson has the requisite skill and knowledge to opine 

that Dr. Harrington had a duty to assist Trisun in providing input into Ms. Ramos’s care plan, to 

perform timely and adequate assessments of Ms. Ramos, and to coordinate discharge of Ms. 

Ramos to a facility that could meet her health needs. We, therefore, conclude that the trial court 

did not abuse its discretion in finding Dr. Lipson sufficiently qualified, as set forth in his report 
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and curriculum vitae, to opine on the accepted standards of medical care applicable to Dr. 

Harrington. See id. § 74.401(c); PM Mgmt.-Wurzbach NC, LLC v. Jones, No. 04-09-00506-CV, 

2010 WL 374406, at *2 (Tex. App.—San Antonio Feb. 3, 2010, no pet.) (mem. op.).

B) Qualifications to Render Causation Opinions 

A person is qualified to give opinion testimony concerning the causal relationship between 

the alleged injury and the alleged departure from the applicable standard of care only if the person 

is a physician and is otherwise qualified to render opinions on that causal relationship under the 

Texas Rules of Evidence. See TEX. CIV. PRAC. & REM. CODE ANN. §§ 74.351(r)(5)(C), 74.403(a) 

(West Supp. 2015 & West 2011). Dr. Harrington argues that Dr. Lipson is not qualified to testify 

as to causation because he is not licensed to practice medicine in the state of Texas and is only 

licensed to practice medicine in the state of California. See id. § 74.001(a)(23)(A) (West Supp. 

2015) (defining, in part, “physician” as “an individual licensed to practice medicine in this state”). 

We disagree. Dr. Harrington ignores a subsequent provision of the statute, section 74.401, which 

provides that in a suit against a physician, an expert witness must be a physician who is “licensed 

to practice medicine in one or more states in the United States.” Id. § 74.401(g)(1) (West 2011)

(emphasis added). Thus, a physician need not be licensed to practice medicine in the state of Texas 

to be qualified to provide an expert opinion on causation in an expert report. See TTHR, L.P. v. 

Guyden, 326 S.W.3d 316, 321-22 (Tex. App.—Houston [1st Dist.] 2010, no pet.); Tenet Hospitals 

Ltd. v. Boada, 304 S.W.3d 528, 536-39 (Tex. App.—El Paso 2009, pet. denied); Springer v. 

Johnson, 280 S.W.3d 322, 327-28 (Tex. App.—Amarillo 2008, no pet.); Kelly v. Rendon, 255 

S.W.3d 665, 675 (Tex. App.—Houston [14th Dist.] 2008, no pet.). We therefore conclude that the 

trial court did not abuse its discretion in finding Dr. Lipson sufficiently qualified to opine on the 

cause of Ms. Ramos’s injuries. See TEX. CIV. PRAC. & REM. CODE ANN. § 74.401(c); Jones, 2010 

WL 374406, at *2.
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Causation

Next, we address Dr. Harrington’s complaint that the report fails to set out the causal 

relationship between Dr. Harrington’s breaches and the injuries suffered by Ms. Ramos. An 

expert’s report must address the causal relationship between the breach and the injury, harm, or 

damages. See TEX. CIV. PRAC. & REM. CODE ANN. § 74.351(r)(6). The expert must “explain the 

basis of his statements to link his conclusions to the facts.” See Wright, 79 S.W.3d at 52. Thus, 

in the present case, Dr. Lipson was required to link Dr. Harrington’s alleged negligence to Ms. 

Ramos’s alleged injuries, including the falls she suffered on November 20, 2009 and March 20, 

2010, an attack by a fellow resident on February 19, 2011, and ultimately, her death, which resulted 

from an assault by a fellow resident on July 16, 2012. 

Causation is generally established in medical malpractice cases through evidence of a 

“reasonable medical probability” or “reasonable probability” that the alleged injuries were caused 

by the negligence of one or more defendants; in other words, the plaintiff must present evidence 

“that it is ‘more likely than not’ that the ultimate harm or condition resulted from such negligence.” 

Jelinek, 328 S.W.3d at 532-33 (quoting Kramer v. Lewisville Mem’l Hosp., 858 S.W.2d 397, 399-

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

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

367 S.W.3d 478, 485 (Tex. App.—Texarkana 2012, no pet.). An expert report must explain “to a 

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

the facts presented.” Jelinek, 328 S.W.3d at 539-40; see also Van Ness, 461 S.W.3d at 142 (“An 

expert must explain, based on facts set out in the report, how and why the breach caused the 

injury.”). The report must not be conclusory in its explanation of causation; it “must explain the 

basis of [the expert’s] statements to link his conclusions to the facts. Wright, 79 S.W.3d at 52; see 

also Taylor v. Fossett, 320 S.W.3d 570, 575 (Tex. App.—Dallas 2010, no pet.) (expert report must 
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contain sufficiently specific information to demonstrate causation beyond conjecture). An expert’s 

mere conclusion that “in medical probability” one event caused another differs little, without an 

explanation tying the conclusion to the facts, from an ipse dixit, which the supreme court has 

consistently criticized. Jelinek, 328 S.W.3d at 539.

In his report, Dr. Lipson states that Ms. Ramos endured numerous injuries and problems 

during her six-year stay at Trisun, including repeated falls, hematomas, a pelvic fracture, a fracture 

of the left 5th metacarpal, repeated head trauma, continuous threats to her safety by residents, 

physical altercations with other residents, attacks by other residents, overall physical and mental 

decline, pain and suffering, mental anguish, and ultimately, intracranial hemorrhage. Ms. Ramos 

was involved in as many as a dozen physical altercations with other residents during her stay at 

Trisun. On July 16, 2012, she was pushed by another resident, causing her to fall and suffer a head 

injury which ultimately resulted in her death two weeks later. 

According to Dr. Lipson’s report, Dr. Harrington had a duty to assist the facility in 

providing input into Ms. Ramos’s care plan. “When faced with a resident who repeatedly wanders 

and falls at a facility and a resident who is involved in numerous altercations with other residents 

and the subject of attacks by other residents, the standard of care requires the physician supervising 

the medical care of the resident to assist the facility in providing input into the resident’s care plan 

to address these problems.” Such input may have included: implementing timed toileting 

programs, regularly orienting Ms. Ramos with her environment to prevent wandering and 

confusion, monitoring and readjusting medications, investigating the cause of injuries, lowering 

her bed, instituting bed rails, maintenance of proper hydration and nutrition, instituting bed alarms, 

and ordering additional supervision and assistance. In regard to the physical altercations with other 

residents, Dr. Lipson states that Dr. Harrington should have: “identif[ied] triggers for threats and 

attacks by other residents, investigat[ed] the cause of the injury/threat and implement[ed] a care 
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plan to address the cause, remov[ed] Ms. Ramos from close proximity to aggressive residents, and 

monitor[ed] and modifi[ed] the environment as needed.” Dr. Lipson goes on to state that Dr. 

Harrington breached the standard of care by failing to perform timely and adequate assessments 

of Ms. Ramos, by failing to document her mental and physical status, and by failing to discharge 

her from Trisun to another facility when it became clear that Trisun could not meet her needs. Dr. 

Harrington does not dispute that Dr. Lipson’s report adequately sets out the statutory requirements 

for standard of care and breach, but maintains that the report fails to set forth the causal relationship 

between Dr. Harrington’s alleged breaches of the standard of care and Ms. Ramos’s alleged 

injuries.

In the causation section of his report related to fall injuries sustained by Ms. Ramos, Dr. 

Lipson states that:

Ms. Ramos’ falls and resulting fractures, and specifically including the 11-20-09 

and 3-20-10 falls, were proximately caused in part by the aforementioned breaches 

of the standard of care by Dr. Harrington. Dr. Harrington failed to properly assess 

Ms. Ramos, including an assessment of her fall risks, and failed to provide proper 

input into Ms. Ramos’ care plan to address falls and fall risks. If Dr. Harrington 

had properly assessed Ms. Ramos and provided proper input into Ms. Ramos’ care 

plan to address falls, in some of the ways enumerated above, in reasonable medical 

probability, Ms. Ramos would not have continued to suffer repeated falls and 

injuries and would not have suffered the 11-20-09 and 3-20-10 falls.

As to the attacks by fellow nursing home residents, Dr. Lipson states that:

It is my medical opinion that had . . . Dr. Harrington met the aforementioned 

standard of care, in all reasonable probability Ms. Ramos would not have suffered 

continual threats, altercations, and attacks by other residents. Additionally, Ms. 

Ramos would not have suffered the assault on 2-19-11 that resulted in a large 

occipital hematoma and she would not have suffered the assault on 7-16-12 that 

resulted in her death.

If Dr. Harrington had provided appropriate input in regard to the deficiencies in 

Ms. Ramos’ care plan concerning the physical altercations she was involved in with 

other residents, as required by the standard of care, the care plan for Ms. Ramos 

would have addressed the issue of resident on resident attacks and measures would 

have been taken to protect Ms. Ramos from future attacks, such as the measures 

discussed above. If Ms. Ramos continued to suffer attacks and threats by other 
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residents and Trisun was unable to keep Ms. Ramos safe, Dr. Harrington should 

have discharged Ms. Ramos to a facility that could meet her needs. If such 

measures had been taken, in reasonable medical probability Ms. Ramos would not 

have been pushed by residents on either 2-9-11 or 7-16-12, and she would not have

suffered a large occipital hematoma and intracranial hemorrhage that resulted in 

her death. 

Dr. Lipson’s report, when read in its entirety, explains how Ms. Ramos’s injuries could 

have been prevented had Dr. Harrington adhered to the standard of care for a nursing home 

physician, including instituting bed rails and bed alarms to avoid falls, removing her from close 

proximity to aggressive residents to avoid being assaulted by fellow residents, and discharging her 

from Trisun to another facility when it became clear that Trisun could not meet her needs. We are 

mindful that at this preliminary stage of the proceeding, all that is required is that Dr. Lipson’s

expert report inform Dr. Harrington of the specific conduct the appellees have called into question 

and provide a basis for the trial court to conclude that the claims have merit. See Palacios, 46 

S.W.3d at 879. We conclude the information in Dr. Lipson’s report adequately discusses causation 

so as to inform Dr. Harrington of the conduct that appellees have called into question and to 

provide a basis for the trial court to conclude that appellees’ claims have merit. See id.; see also 

Jelinek, 328 S.W.3d at 539. Applying, as we must, the deferential abuse-of-discretion standard of 

review, we cannot conclude that the trial court acted arbitrarily, unreasonably, and without guiding 

rules and principles in determining that Dr. Lipson’s report provided sufficient information 

regarding his opinions concerning standard of care, breach, and causation as they relate to the 

underlying facts, to enable it to determine whether the appellees’ claims had merit. See Hebert v. 

Hopkins, 395 S.W.3d 884, 891 (Tex. App.—Austin 2013, no pet.). Therefore, the trial court did 

not err in denying the motion to dismiss.1

 

 1 Appellees’ request for damages for frivolous appeal is denied. See TEX. R. APP. P. 45.
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CONCLUSION

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

Rebeca C. Martinez, Justice