1 ... S eeTe x. R. App . P. 47. 4. 

## COURT OF APPEALS SECOND DISTRICTOFTEXAS FORT WORTH
NO. 2 - 0 8 - 3 2 6 - CV
R AL P H P L E M ONS , M . D. AP P E L L ANT V . PA TRI C I A H A RRI S, I N D I V I D U A LL Y APPELLEE A N D A S PERSO N A L REPRESEN TA TI V E OF T HE E ST ATE OF HARVE Y H A RRI S, D ECEA SED

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FR O M THE 48TH DI STRI CT CO URT O F TARRA NT CO UN TY

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### M E M ORANDU M OP I NI ON 1

----- ----- -- I . I nt r oduc t i on In o n e i s s u e , A p p e l l a n t R a l p h P l e m o n s , M .D . a s s e rts th a t th e tri a l c o u rt
a b u s e d i t s d i s c re ti o n b y o v e rru l i n g h i s o b j e c ti o n s to A p p e l l e e P a tri c i a H a rri s ’s2

chapter74 exper tr epor tand al so by deny i ng D r . Pl em ons’ s m ot i on t o di sm i ss. W e a f f i r m. II . F a c tu a l a n d P ro c e d u ra l H i s to ry O n S e p te m b e r 7 , 2 0 0 5 , a fte r p e rfo rm i n g a n E K G o n H a r v e y H a rri s , D r. T r a c y e Or rr ef e r r e d Ha r v e y t o a s u r g e o n f o rr e p a i ro fa n u mb i l i c a l h e r n i a . On O c t o b e r 2 1 , 2 0 0 5 , D r. A u g u s tu s L y o n s , a l o n g w i th th e a n e s th e s i o l o g i s t D r. Pl em ons , pe r f or m ed t he su r ger y. Appr oxi m a te l y t w ent y- f ourhour s af t ert he
su r ger y, H ar vey re t ur ned t o t he hos pi t al w i t h c hes tpa i ns . He di ed t he fo l l o w i n g d a y fro m a n a p p a re n t m y o c a rd i a l i n fa rc ti o n , a .k .a . “h e a rt a tta c k .” Har r i s , Har ve y’ s s ur vi vi ng s po us e , f i l e d t hi s s ui t on Dec e m be r17, 2007 , a l l e g i n g th a t D r. P l e m o n s fa i l e d to u ti l i z e a p p ro p ri a te a n e s th e s i a g i v e n H a rv e y ’s h e a lt h . P u r s u a n tt o c h a p t e r7 4 o ft h e c iv il p r a c t ic e a n d r e m e d ie s c o d e , H a r r is
se r ved a t i m el y e xpe r tr epo r tf r om D r . Jos eph A . St i r t , an ane st hes i ol ogi stf r om C har l ot t es vi l l e, V i r gi ni a. He opi ned t hatD r . Pl em ons br ea che d t he st and ar d of
car e by not obtai ni ng a pr eoper at i ve EK G w i t hi n t hi r t y d a y s o f a pl anned
su rgica l p roc e d u re a s re q u i red for a n y p a ti e n t ov e r sixty y e a rs o l d w h o w a s to
r ec ei ve gen er al an es t hes i a. Dr . St i r tf ur t hers t at ed t hatt he dev i at i ons f r om t he
s ta n d a rd o f c a r e re p re s e n te d n e g l i g e n c e , w h i c h p ro x i m a te l y c a u s e d H a rv e y ’s dea t h.3

O n A p ri l 2 9 , 2 0 0 8 , D r. P l e m o n s fi l e d o b j e c ti o n s to H a rr i s’s e x p e rtrep o rt , and h e a me n d e d t h o s e o b j e c t i o n s o n M a y 6 , 2 0 0 8 . S u b s e q u e n t l y , t h e t r i al
cou r tove r r ul ed D r . Pl em ons ’ s obj ec t i ons , an d t hi s i nt er l ocu t or y app ea l f ol l ow ed. I I I . Pr es ervat i on ofEr r or A . Rev i ew To pr eser ve a com pl ai nt f orappel l at e r evi ew , a par t y m usthave pr esent ed t o t h e t r ia l c o u r t a t im e ly re q u e s t , o b je c t io n , o rm o t io n t h a ts t a t e s t h e s p e c if ic gr ounds f ort he des i r ed r ul i ng, i ft heyar e n ot app ar entf r om t he con t extoft he
re q u e s t, o b j e c ti o n , o r m o ti o n . T e x . R . A p p . P . 3 3 .1 (a ); see al so Tex. R. Evi d. 103 ( a) ( 1) . I fa par t y f ai l s t o do t hi s, er r or i s notpr es er ved , an d t he com pl ai nt i s w a i v e d . Bu shel

l v. D ean , 8 0 3 S .W .2 d 7 1 1 , 7 1 2 (T e x . 1 9 9 1 ) (o p . o n re h ’g ). The ob j ec t i ng pa r t y m us tge ta r ul i ng f r om t he t r i al c o u rt. T hi s r ul i ng c an be
e i t h e r e x p re s s o r i m p l i e d . F ra zi e r v. Yu , 9 8 7 S
. W . 2 d 6 0 7 , 6 1 0 ( Tex. A pp. — For tW or t h 1999, pe t . den i ed) . I f t r i al j udge r ef us es t o r ul e, an obj ec t i on to th e re fu s a l to ru l e i s s u fficie n t to p re s e rv e e rro r. T e x . R . A p p . P . 3 3 .1 (a )(2 ). Fur t her , t he com pl ai nt on appeal m ust be t he sam e as t hat pr esent ed i n t he t r i al
c o u rt. S e eBa n da v. G a rc ia , 9 5 5 S .W .2 d 2 7 0 , 2 7 2 (T e x . 1 9 9 7 ). A n ap p e l l a te
c o u rt c a n n o t re v e rs e b a s e d o n a c o m p l a i n t n o t ra i s e d i n th e tri a l c o u rt. Id.4

B . A n a ly s is In “ D e fe n d a n t R a l p h P l e m o n s , M .D .’s A m e n d e d O b j e c ti o n s to P l a i n ti ff’s C h a p ter 7 4 E x p e rtR e p o rtan d M o ti o n to D i sm i ss ,” P l e m o n s a sk e d the co u rtto d i s m i s s H a rri s ’s s u i t d u e to th e i n a d e q u a c y o f D r. S ti rt’s re p o rt a s fo l l o w s :

I n hi s r epor tD r . Sti rt suggest s “one st andar d of car e w as br eached by D r . Ral ph P l em ons”. D r . S t i r tgoes on t o st at e, “a pr eoper at i ve EK G obt ai ned w i t hi n 3 0 d ays ofa pl ann e d sur gi cal pr oce dur e i s r equ i r ed pr i ort o ge ner al an es t hes i a f oran y pa t i ent ove r60 yea r s ol d. No EKG w as per f or m ed on M r . H ar r i s and subsequen t l y exam i ned as r equi r ed by D r . Pl em ons. ” See at t ached r e po r to fDr . St i r ta s E xh i bi t2. D r . Sti r t ’ s sol e cr i t i ci sm of D r . Pl em ons w as t hat no EK G w as p e r f o r m e d o n M r . H a r r is p r io r t o t h e s u r g e r y a n d s u b s e q u e n t ly e x a m i n e d a s re q u i re d b y D r. P l e m o n s . T h iss o lec r

itic is m isen tire ly fa c tu a l lyi n a c c ura te . S ee at t ached as Exhi bi t3, EK G dat ed S e p te m b e r 7 , 2 0 0 5 p e rfo rm e d a n d re c e i v e d p ri o r to th e p ro c e d u re a t i s s u e . A s su ch, thi s repo rti

s con cl us ory and doe s notr epr es ent a good f ai t h ef f or t to f ul f i l l t he st at ut e as w el l as cas e l aw i n te rp re ti n g s a m e . . . . The repo rtof D r. Sti rti s con cl us ory a nd based upo n assumpti ons which are notsupported by the f acts w i th r e s p e c tt o s t a n d a r d o f c a r e , b r e a c h a n d c a u s a t io n a n d a c c o r d in g ly f ai l s t o m eett he r equi si t es ofC hap te r 7 4 as w el l as cas e l aw i n te rp re ti n g s a m e . [E m p h a s i s a d d e d .] O n a ppe al , Pl em ons ar gue s t hus l y: It i s s i g n i fi c a n t to n o te th a t o n th e fi rs t p a g e o f D r. S ti rt’s r epo r t , he s t at es t hathe ha d r evi ew ed t he r ec or ds f r om D r . Tr ac ye O r rf r o m S e p t e m b e r7 , 2 0 0 5 , t h r o u g h O c t o b e r1 9 , 2 0 0 5 . It is undi sp ut ed t hatD r. O r rpe r f or m ed an EKG on M r . H ar r i s on S ept em ber7, 20 05 . A f t er D r. O r robt ai ned t hi s EK G , he r ef er r ed M r . H ar r i s f ora su r gi ca l co ns ul t f ort he um bi l i ca l he r ni a, w i t hout r equ es t i ng ors ee ki ng a ny t ype off ur t herca r di ac ev al uat i on or fo l l o w -u p .5 S i nce D r . Sti r tr evi ew ed D r . O r r ’ s r ecor ds, he w oul d have had access t o t he EK G per f or m ed on S ept em ber7, 20 05 , yet conspicuou sly m i

ssi ng f rom hi s reporti

s any m enti

on or ref erence to a ny a bnor

m al iti esi n the Septem ber

7 EKGthat

w ould ha ve c a us e d th es urg e ryto b ec a n c e l le d ; m o re o v e r, he doe s noti den tify, de s c ri b e, o r exp l

a i n wh y a n EK Gdo n e1 4da ysl a te r ( i . e. , 30 days b e fo re s u rg e ry ) wo uld ha veb e e n d if f e re n to r de mo n s tra te d

s o me t ypeof ab nor m al it y that w ould ha ve res ulted i n the sur

gery bei

ng c a n c e l le d
. T o th e cont r ar y, D r . Sti r tonl y specul at es t hat a pr eo p e rati v e E K G “c o u l d w e l l h a v e sh o w n m a rke d ca rdiac ab n o rm a l i ty

. . . ” D r. S tirt is o b vio us ly sp e c ula tingo n wh a ta s e c o n d EK Gc o uld have sh own; how it m i ght have cha nge d f

rom the oneobtai

ned on S ep te m b e r 7; w het heri tw oul d have r esul t ed i n f ur t hercar di ac fo l l o w -u p ; and whether it w ould have res ulted i n a de f er ral of the s ur g e ry. D r. S ti

rt ’ sa t te mp tsa tc a us a ti o n a rec o n c lus or y and w oul d r equ i r e a n i nf er enc e o n c aus at i on w hi ch, unde rt he “f our cor ner s r ul e ,” a c o u r ti s notpe r m i t t ed t o do. [ Em pha si s su ppl i ed; i n te rn a l c i ta ti o n s o m i tte d .] A p l a i n re a d i n g o f D r. P l e m o n s ’s a rg u m e n t to th e tri a l c o u rt i s th a t th e re
w as t he a f act ual i naccur acy i n D r . S t i r t ’ s r epor t , w hi ch D r . Pl em ons asser t ed
cau s e d t h e r e p o r tt o b e c o n c l u s o r y i n n a t u r e . T h i s i s p l a i n l y d e mo n s t r at ed

w h e n h e s t a t e s t h a t , r e f e r r i n g t o Dr . St i r t ’ s cri t i c i s m t h a tn o p r e s u r g e r y E KG

w a s p e rfo rm e d o n H a rv e y , “[t]h i s s o l e c ri ti c i s m i s e n ti re l y i n a c c u ra te . . . [a ]s such, t hi s r epor ti s concl usor y. ” I n c ont r as t , on app ea l , D r . Pl em ons ac kno w l edg es t hathe i s notar gui ng f ac t ual i nac cur ac y. Rat her , a pl ai n r ea di ng ofD r . Pl em on s ’s ar gum enton app ea l i s t hatbe ca us e t her e w as an EKG pe r f or m ed f or t y- f our day s bef or e t he
su rge ry, D r. S ti rt ’s rep o rtfai l e d to s h o w h o w a s e c o n d E K G p e rf o rm e d thir ty6

days orl ess bef or e t he sur ger y w oul d have r esul t ed i n a di f f er ent sur gi cal
o u tco m e . S p e c i fi c a l l y , h e a rgu e s th a t D r. S ti rt ’s rep o rto n l y sp e c u l a ted tha t a pr e- ope r at i ve EKG “c oul d w el l hav e sh ow n m ar ke d ca r di ac abn or m al i t i es ” and
s p e c u l a te d “ w h e th e r i t w o u l d h a v e re s u l te d i n th e d e fe rra l o f th e s u rg e ry . D r. St i r t ’ s at t em pt s atca us at i on a r e con cl us or y and w oul d r equ i r e an i nf er enc e o n causat i on . . . . ” D u ri n g o ral arg u m e n t t o this c o u rt , c o u n se l for D r. P l e m o n s a ttem p ted to exp l ai n t he l ac k o fco ngr ui t y bet w ee n t he ar gum ent s at t r i al an d on app ea l by
a s s e rti n g th a t h e o n l y n e e d e d to u rg e t h a t D r. S ti rt’s re p o rt w a s c o n c l u s o ry
w i t houtan y e xpl ana t i on t o t he t r i al co ur t o f w her e, w hen , how , orw hy, an d t hathe ha d i n hi s su m m at i on at t he end ofhi s am end ed m ot i on s t at ed t hatt he
r epo r tw as co ncl us or y and f ac t ual l y un su ppor t ed, t her ebydi sc onne ct i ng t he t w o t hough t s. W e obs er ve t hat t he onl y exp l ana t i on gi ven t o t he t r i al co ur tof how t he r epor tw as concl usor y w as t hati tw as f act ual l y i naccur at e, as pr evi ous l y di sc us se d. W e d ec l i ne t o hol d t hat t r i al j udge s ar e r equ i r ed t o a dopt t he m et hod s ofSh er l ock H ol m es and di vi ne w i t hou tw r i t t en oror al gui dance as to w h e re , w h e n , w h y , a n d h o w a n e x p e rt’s re p o rt i s c o n c l u s o ry . W e th e re fo re hol d t hatt he com pl ai ntt o t he t r i al co ur tdoe s notco m por t w i t h t he com pl ai nt
o n a p p e a l a n d a s s u c h i s n o t p re s e rv e d fo r o u r re v i e w . See Ba nda , 955 S
. W . 2d
a t 2 7 2 ; s e ea l

s o Wo h lf

a h rtv. Ho l

low ay , 172 S. W . 3d 630, 639– 40 ( Tex.7

A pp. — H ous t on [ 14t h D i st . ] 200 5, pet . den i ed) ( “To hav e pr es er ved er r or, a p a rty ’s a rg u m e n t o n a p p e a l m u s t c o m p o rt w i th i ts a rg u m e n t i n th e tri a l c o u rt.” ),
cert. denied, 549 U . S. 1052 ( 2 0 0 6 ); Ho x ie I mplem entC o. , I

nc. v. Baker, 65 S. W . 3d 140, 151 ( Tex. A pp. — A m ar i l l o 2001, pe t . de ni ed) ( “[ G ] i ven t hatt he content i on befor e us does not com por tw i t h t he obj ect i on ra i sed bel ow , t hat b e fo re u s w a s a n d i s w a i v e d .” ). I V . Concl us i on H avi ng f oun d t hatD r . Pl em ons’ s com pl ai nt o n a ppeal has not been p re s e rv e d , w e o v e rru l e h i s s o l e i s s u e o n a p p e a l a n d a ffir m th e tri a l c o u rt’s j u d g m e n t.

B OB M CC OY J U S T I C E PA N EL: LI V I N G STO N an d M C C O Y, J J .; an d W I LL I A M BRI G H A M , J. ( Seni or J u s ti c e , R e ti re d , S i ttin g b y A s s i g n m e n t). LI V I N G STO N , J. co ncu r s w i t houtopi ni on. DEL I VERE D: J a nu a r y 8, 2009