C o v e n a n t a l s o s o u g h t d i s m i s s a l o f th e l a w s u i t. 1 NO. 07-09 -010 4-CV

IN THE CO UR T OF APPEA LS FO R THE S EVEN TH D ISTRI CT O F TEXAS

AT AM AR ILLO PAN EL C SEPTEM BER29, 2009

_________

_________

_________

___ ME THOD IST H OSPI TAL LEVE LLAN D d/b/a C OVEN AN T HO SPITAL LEVELL AN D, Appel lan t

v. JEF FR EY

KIM BR ELL, Appel lee

_________

_________

_________

______ FRO M T HE 28 6 DIS T RI CT COU RT OF HO CK L EY CO UNT Y; TH NO. 08-06 -21,3 55; HON. PAT PHELAN, PRE SIDING

_________

_________

_________

____ Memorandum Opinion

_________

_________

_________

____ Bef ore QUINN, C.J., and HANCOCK and PIRT LE, JJ. In t his ac cel er ated appeal , M ethodi st Hos pit al Lev ell and d/ b/a C ov enant Hos pit al Lev ell and ( Cov enant) appeals f ro m an order of the tr ial co urt den y ing i ts obj ect ion s t o the suffici ency

of a medic al ex per

t repor t ser v ed byJeff re y

Kimbr ell (Ki mbrel l) in his law sui t for
me dical ma lpractice against Covenant

. Kimbrell suf fered respiratory arrest after allegedly 1 bein g giv en too m uch n arcotic pa in me dicatio n followi ng surg eryto remo v e his gall blad der.2

In see king reversal of the orde r, Covenant asserts that the expert repo rt of Dr. Roland o H. Sae nz (Saen z ) fa iled to 1) show he w as qualif ied to rend er an op inion a s to the stand ard of car e for nurses , 2) sta te the sta ndard of c ar e appl ic abl e to a nurse, and 3) i denti fy the
caus al re la ti onshi p betw een t he al leg ed breach of the s tandard of care and the c lai med dam ages. W e reverse the orde r. Back gr ound Af t e r s u c c e s s f u l s u rg e ry o n K im b re ll , Dr

. W e e ra c h a i W ir i ( W ir i) wro t e p o s t -o p e ra t ive orde rs for intravenou s Dem erol to be giv en ev ery tw o hou rs “as nee ded ” fo r pain as w ell
as a F entany l tr ansdermal patc h. The nurse appl ied the patc h at 3:05 p.m. a nd te n min ute s l a t e r gave Kimbrell a dose of Deme rol. Two addition al dose s of Deme rol w ere admini ste re d at 5:25 p.m. and at 11:35 p.m. The next morni ng , Ki mbrel l w as found to be in re spi ra tor

y ar re st. Ki mbrel l filed suiton June 17, 2008, pursuantto Cha pter 74 o f the C iv il Pract ic e and Remedi es Cod e. As re qui re d by §74. 351, he s er

v ed hi s e x per

t repor t on Oct ober

13, 2008. See T EX
. C IV
. P R AC
. & R EM
. C OD E A NN
. § 7 4

. 3 5 1 ( a ) ( V e r n o n Supp. 2008)

. In that
re por t, Saenzopined about the neg li g ence of W ir i and t he nurse admini ste ri ng medi ci ne to Kim brell. Co v ena nt doe s n ot challen ge th e ade quacy of t he repo rt with respect to W iri. How ev er , i t doe s c ontend that Saenzfail ed to i ll ust ra te t hat h e w as q ual ified t o o f f er an opin ion as to the sta nda rd of care app licabl e to nu rses, failed to state the ap plicable sta ndard of care i mposed on nurses , and fail ed to es tabl is h a c ausal l ink betw een t he
nurse ’s actions an d the dam ages suf fered byKimb rell.3

Di sc uss ion An ex per

t w it ness on t he iss ue of w hether the heal th car e prov ide r depar ted from acc epted sta ndards of car e may q ual ify as one onl y

i f he: ( 1 ) i s p r a c t i c i n g h e a l t h c a r e i n a fi e l d o f p r a c t i c e t h a t i n v o l v e s t h e s am e ty pe of care or

treatm e n t as that del iv er ed by the defendant hea lt h care prov ide r, . . . ; ( 2) has k no w l ed g e of ac c ep te d stan dard s of care f or hea lth care prov ide rs for t he di ag nosi s, care, or tr eatment of t he il lne ss , inj ur y , or condi ti on i nv olv ed i n the cl aim; and 3) is qualif ied on the basis of trainin g o r e xperien ce to of fer an e x pert opi nio n r eg ar din g thos e ac cept ed s tandards of healt h c ar e.
Id. §74.402 (b ) (V er non 200 5) . Here, S aenzst ated that he w as board c erti fied i n g ener al
as w ell as colon and rec tal surg er y , did a six -y ear

surg ic al rotati on w hic h i ncl uded on e y ear of in te n sive ca re medi ci ne, d id a fell ow shi p i n c olo n and re cta l surg er y , had been an ass is tant pr ofessor of c li nic al surg er y , and mai ntai ned a pr iv ate p ra cti ce compr is ed of 60% g e n e r a l s u r g e r

y a n d 4 0 % c o l o n a n d r e c t a l s u rg e r y . H e fu rt h e r r e p r e s e n t e d t hat h e per formed 500- 600 s urg er ies a y ear , 25 to 35 per centof w hic h enc ompass the re mov al of ga ll bl adders. So too did he opine that the nurs e w ho admi nis ter ed th e pai n medi cat ion “w as neg li g ent i n notq uest ion ing thattw o nar cot ic s w er e bei ng order ed atthe same t ime, and in adm inistering the types of narcotics in the dosa ge lev els as prescribed without f irst det ermin ing the pat ient’s pa in toleran ce.” Y et, nothi ng i s s aid i n the r epor t abo ut ho w

Saenzcame to know

the sta ndards of care ap plicable to nurse s, as opp osed to physicians, in like circumsta nces. Tha t is pr obl emati c. Admi ttedl y , bei ng a phy si ci an mayqual ify someone to off er

an o pin ion on t he stan dard of care applicable to nurses or oth er me dical perso nne l me rely beca use he is a4

phy si ci an. In r

e Sta cy K. Boone, P .A., 223 S. W .3d 3 98, 4 04 ( Tex . Ap p.–Amar il lo 2006,
or ig . proceed ing ); Hal

l v. Huf f, 957 S. W .2d 9 0, 10 0 ( Tex . Ap p.–Tex ar kana 1997, pet. d e n i e d )

. Y e t , t h e c o n v e rs e i s e q u a l l y t r u e ; b e i n g t i t l e d a p h y s i c i a n d o e s n o ta l o n e q u a l i fy
a d o c t o r t o o p in e a b o u t t h e s t a n d a rd s a n u rs e m u s tfo ll o w. An d , wh il e va ri o u s co u rt s h a ve foun d ph y sicians so qualif ied, th e y d id so w hen the ph y sicians stat ed th at th ey w ere famili ar w ith the st andard of care appl ic abl e to nurses w hen prev enti ng or treati ng the il lne ss , i nju ry

or co ndi ti on i nv olv ed or

thatthey w er e famili ar w it h the st andard of care and
re spons ibi li ti es of nurs es becau se they had w or ked a n d i n te ra cte d w it h the m. Bayl or Me dic al Cen ter

v. Wallac e, 278 S. W .3 d 5 5 2 , 558 ( Tex . Ap p.–D all as 2009, no pet .) ; see als o San Jaci

nto Methodi

st Hos pit al v. Bennett, 256 S.W .3d 806, 813 (Tex . Ap p.–H oust on [14 Dist.] 2008 , no pet .) (no ting th at the e x pert state d he w as fam iliar w ith the stand ard th of car e f o r n u rse s i n the treatment of decubi tus ul cers) ; In r e St acy K. Boone, P.A ., 223 S.W .3d a t 404 (n oti ng that the ex per t sta ted he w as famili ar

w it h the st andards of car e and regularly provi ded an d s up er

v ised care in con nect ion w ith the treatm ent of patie nts similarly si tuate d i n ter ms of ph y si ci ans, phy si ci an’ s a ss is tants , nurses , and hos pit als ); Hal l v. Huf f, 957 S.W

. 2 d a t9 9
- 1 0 0 ( n o t i n g t h a tt h e e x p e rts t a t e d h e t a u g h tn u rs i n g c o u rs e s a n d had testif ied ab out the sta nda rds of nursing care). No such allegations ap pea r in Saenz’ repo rt
or curr i c u l u m v i t a e , t h o u g h

. T h a ti s , n e i t h e r i l l u s t r a t e t h a th e w a s fa mi l i a r w i t h the sta ndards of nurs ing ca re as they r ela te t o pos t- operat ive p a in manag ement, that he super v is ed or w or ked w it h nurses i n tha t area, o r thathe had taug ht cl ass es to nu rs es on the s ubj ect

.5

In s hor t, Saenzmay

w ell be hig hly q ual ified to re nder an opi nio n on the s tandards of car e a n urse must follo w . Y et, w e cannot si mply co ncl ude t hat h e i s. Inde ed, s tandards of care may w ell di ff er

betw een phy si ci ans and nurses . See e.g. , Sim onso n v. Kep pard , 225 S.W .3d 8 68, 8 73-7 4 (Te x . App .–Dallas 200 7, no pet .) (so not ing th ere). And before we ca n d e e m su f

f ic ie n th is o p in io n s re ga r d i n g t h e ca re p ro vid e d b y t h e n u rs e a tb a r, we must know

not onl y w hat t he nurse w as obl ig ated to do but als o how the ex per

t k new that

. Unl ik e s it uati ons w h e re in p a rents ar e tal ki ng to thei r chi ldren, s ay ing or as sumi ng “b ecaus e” i s n ot en oug h. Giv en o ur dispositio n of the f irst arg um ent , w e ne ed n ot ad dr e ss the ot hers prof fered b y Co v ena nt. I nste ad, we rev erse the trial court’s order and rema nd th e cau se for furt her

proceed ing s.

Br ian Qui nn C hie f Just ic e