1 ... SeeTe x. R. App . P. 47. 4. 

## COURT OFAPPEALS SECOND DISTRICTOF TEXAS FORT WORTH NO. 0 2 - 0 8 -4 3 7 - CV
R O BE R T G . RA N ELLE, D . O . APP EL LANT V . HERSCHELE DW ARD BE AV ERS APPE L L EE S AN D PAM EL A BEAV ERS

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FR O M THE 9 6 TH DI STRI CT CO URT O F TARRA NT CO UN TY

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### MEMORANDU M OPI NI ON 1

----- ----- -- I . I nt r oduc t i on I n t hi s i nt er l ocutory appeal , A ppel l antR obertG . Ran el l e, D . O . chal l enges t he t r i alco urt ’ s orde rd eny i ng hi s m ot i on t o di sm i ssA ppe l l ee s H er sc helan d P a m e l a B e a v e rse s’ h e a l th c a re l i a b i l i ty cl a i m s f o r th e fai l u re to fi l e an ad e q u a te e x p e rtr e p o rt . We a f f i r m.2 II . F a c tu a la n d P ro c e d u ra lH i s to ry O n M ay 29 , 20 08 , t he B eaver ses f i l ed heal t h car e l i abi l i t y cl ai m s agai nst D r. R a n e l l e tha t aro se fr o m m e d ic a l a n d su rgica l ca re h e h a d p rov i d e d to H e rsc h e l . A c c o rding to the i r f o u rt h am e n d e d p e ti ti o n , th e B e a v e rse s s o u g h t t o r ec ove rda m age s f r om D r . Rane l l e f ort he f ol l ow i ng: O n orab outM arch 1 8 , 2003 , [ D r . ] Rane l l e p erf or m ed su r gery on H e r s c h e l E d w a r d B e a v e r s ’s b a c k . B e f o r e s u r g e ry , [ D r .] R a n e lle r epr esent ed t o [ H er schel ] t hatt he sur ger y w as i ndi cat ed because [ H er sc hel ] ha d a r upt ur ed d i sc , he r ni at ed nuc l euspul pos i s, or her ni at ed di sc att he L5
- S 1 l evel ofhi s spi ne. Thi s w as a f al se st at em entby D r . R ane l l e and t he t r ut h t hat[ H er sc hel ] di d notha ve t h isc o n d i t io n w a sn e v e rd is c lo s e d u n t il D r . R a n e lle c o n f e s s e d h is d is h o n e s t yin h isd e p o s it io n o n M a r c h 2 8 , 2 0 0 8 . [ H e r s c h e l] w o u ld not h a v e c o n s e n t e d t o t h e s u r g e ry h a d h e k n o w n t h a t h e d i d not h a v e a ru p t u re d /h e rn i a te d d i s c . A sa re s u l t o f D r. R a n e l l e ’s dec ept i on a nd t he r es ul t ant su r gery, [ H er sc hel ] s uf f er ed i nj ur i esan d t he [ Beav er s] have suf f er ed dam ages. [ D r . Ran el l e] vi ol at ed t he dutyh e o w ed t o [ H er schel ] t o exer ci se or di nary c ar e a nd di l i gen ceex erci sed by ot hers ur geo nsan d heal t hcar e pr ovi der s i n t he sam e orsi m i l arci r cum st ances and w as n e g l i g e n t i n th a t h e : ( 1) Perf or m ed unne ce ss ary s ur gery; ( 2) Fai l ed t o accur at el y i nt er pr etr adi ol ogy st udi es; ( 3) N egl i gen t l y pe r f or m ed su r gery; an d ( 4) O ver so l d t he nee d f ors ur gery. O ne orm or e oft he abo ve- m ent i one d a ct s and /orom i ss i ons , am ong ot her s, by [ D r . Rane l l e] , w asa pr oxi m at e c aus e o fi nj ury a nd d a m a g e s. . . . [ D r . R an el l e’ s] co nduc tasde sc r i bed ab ovei ncl ude d m ak i ng m i s re p re s e n ta t io n sa sw e l l a sc o n c e a l i n g i n fo rm a ti o n th a t [D r.3

Ranel l e] had a dut y t o di sc l os e. Such co nduc tco ns t i t ut esf r aud and /or con st r uct i ve f r aud an d r es ul t ed i n i nj ur i est o [ H er sc hel ] an d d a m a g e sto th e [B e a v e rs ] . . . . As ar e s ul to ft hes ur ge ry pe r f or m e d by [ Dr . Ra ne l l e ] o n M a r c h 18, 20 03 , [ H er schel ] suf f er ed an assaul tand bat t ery by [ D r . ] Ran el l e, si nce any con sentw as based on decepti on by[ D r . ] Ran el l e. The Bea ver se s t i m el y s erved D r . Rane l l e w i t h t he cur r i cul um vi t aean d e x p e rt r e p o rt o f D u n c a n M c B r id e , M .D ., a b o a r d c e rt if ie d n e u r o s u r g e o n . In h is
r epo rt , D r . M cBr i de st at ed t hatD r . Rane l l e’ s ca r e o fH er sc helw asbe l ow t he s ta n d a rd o f c a rei n tw o w a y s : (1 ) D r. R a n e l l e w a s d i s h o n e s t a b o u t H e rs c h e l ’s c o n d i ti o n a n d (2 ) D r. R a n e l l e fa i l e d to a d e q u a te lyp a d a n d p o s i ti o n H e rs c h e l ’s s h o u l d e r fo r s u rg e ry . H e f u rth e r s ta te d t h a t i t w a sh i so p i n i o n th a t th e fa i l u re ofD r . Rane l l e t o obs erve t he st and ar d ofca r e w asa pr oxi m at e c aus e o f H er sc hel ’ s ongoi ng bac k pr obl em s, H er sc hel ’ s t or n r ot at or cuf f , and al l oft he c o n s e q u e n c e st h a t n a t u r a lly f lo w f r o m t h e b a c ks u r g e rya n d s u r g e ryt o re p a ir th e torn rota to r cu ff. D r. R a n e l l e ti m e l y fi l e d h i s m o ti o n to d i sm i ss w i th p rej u d i c e , o bj e c ti n g to D r . M cBr i de’ s r epo rton t he gr oundst hati tf ai l ed t o s etf ort h t he st and ar d of car e, b r each, an d causat i on el em ent s of t he heal t h car e l i abi l i t y cl ai m s al l eged aga i ns thi m , i ncl udi ng t he t heo r i esofne gl i gen ce , ba tt ery, f r aud , co ns t r uct i ve f r aud, and l ack o f i n fo rm e d consent. A ft era hear i ng on t he m at t er , t he t r i al cou rtde ni ed D r . Rane l l e’ s m ot i on. Thi s app ea lf ol l ow ed.4 II I. A d e q u a c yo f E x p e rt R e p o rt I n h i s s o l e i ss u e , D r. R a n e l l e arg u e s th a t t h e tr i a l c o u rtab u se d i ts di sc r et i on byco ncl udi ng t hatD r . M cBr i de’ s exp ertr epo rtw asl ega l l y s uf f i ci ent because t he r eport( 1) f ai l ed t o a d d res s t he el em ent s oft he com m on l aw bat t ery cl ai m al l eged by t he Beav er ses agai nst D r . R anel l e; ( 2) f ai l ed t o addr ess H er schel ’ s pr e sur ger y sym p to m s, thei rdegr ee ofsever i t y, orw hy such sy m pt om s di d notm er i t , pe rt he st and ar d ofca r e, goi ng f or w ar d w i t h t he s u r g e ry ; a n d (3 ) fa ile d t o p r o v id e in f o r m a t io n o n h o w H e r s c h e l w a s a c t u a l ly padd ed orposi t i oned dur i ng t he sur ger y, orany causal r el at i onshi p bet w een su ch pad di ng a nd po si t i oni ng a nd Her sc hel ’ s r ot at orcu f fi nj ury. A . St andar d ofRev i ew A t r i alco urt ’ s r ul i ng c onc er ni ng a n e xpe rtr epo rtf i l ed unde rs ec t i on 74. 351 ( f or m er l y a rt i cl e 45 9 0 i , s ec t i on 13. 01) oft he M edi ca l Li abi l i t y a nd In s u ra n c e A c t i sre v i e w a b l e u n d e rt h e a b u s e o f d i s c re ti o n s ta n d a rd . A m. Transiti onal Care Ctr

s. of Tex. , I

nc. v. Pal

aci os , 46 S. W . 3d 873, 875 ( Tex. 2 0 0 1 ); seeT e x . C i v . P ra c . & R e m . C o d e A n n . § 7 4 .3 5 1 (V e rn o n S u p p . 2 0 0 8 ). To det er m i ne w het hera t r i al c ourtab us ed i t s di sc r et i on, w e m us tde ci de
w het hert he tr i al courtac t ed w i t houtr ef er enc e t o a ny g ui di ng r ul esor pr i nci pl es ; i n ot herw ords, w e m us tde ci de w het hert he ac tw asar bi t r ary or u n re a s o n a b l e . Ci

re v. Cum m i

ngs , 13 4S. W . 3 d 83 5 , 83 8

– 3 9 ( T e x . 2 0 0 4 ) . An5

a p p e lla t e c o u rt c a n n o t c o n c lu d e t h a t a t r ia l c o u rt a b u s e d it sd is c r e t io n m e r e ly because t he appel l at e courtw oul d have r ul ed di f f er ent l y i n t he sam e c i rc u m s ta n c e s . E. I. du PontdeNem our s & Co. v. Robi

ns on , 923 S. W . 2d 549, 5 5 8 (T e x . 1 9 9 5 ). B. A ppl i cabl e Law I n a he al t h c ar e l i abi l i t y c l ai m , a cl ai m antm us ts erve an exp ertr epo rton e a c h d e fe n d a n t n o l a te r th a n th e 1 2 0 th d a ya fte r th e c l a i m i sfi l e d . S eeTex. C i v. Pr ac. &Rem . C ode A nn. § 7 4. 35 1. I ft he cl ai m antdoes notserve an exp ertr epo rton ade f end antphy si ci an orhe al t h c ar e p r ovi derw i t hi n t he 1 2 0 -d a yp e ri o d , th e n o n th e m o ti o n o f th e a ffe c te d p h y s i c i a n o r h e a lt h c a re p ro v i d e r, th e tri a l c o u rt m u s t d i s m i s s th e c l a i m w i th p rej u d i c e . Id . § 7 4 .3 5 1 (b ). A d e fen d a n t m a y c h a l l e n g e th e a d e q u a c y o f a rep o rt b yfi l i n g a m o ti o n to d i s m i s s . Id . § 7 4 .3 5 1 (l) . T h e t r ia l c o u rt m u s t g r a n t t h e m o t io n t o d is m is sifit f i nds , aft era hea r i ng, t hat“ t he r epo rtdoe s notr epr es entan obj ec t i ve good fa i th e ffo rt to c o m p l yw i th th e d e fi n i ti o n o f a n e x p e rt re p o rt” i n th e s ta tu te . Id. W hi l e t he expertr eport“need notm ar shal al l t he pl ai nt i f f ’ s pr oof, ” i tm ust pr ovi de a f ai r su m m ary of t he exp ert ’ s opi ni onsast o t he “a ppl i ca bl e s t and ar ds o f c a re , th e m a n n e r in w h i c h t h e c a rere n d e re d b yth e p h y s i c i a n o r h e a l th c a re pr ovi derfai l ed t o m eetthe st andar ds, and t he causal r el at i onshi p bet w een t hat f ai l ur e and t he i nj ury, har m , ordam age s cl ai m ed. ” T ex. C i v. Pr ac . & Rem . Code6

A n n . § 7 4 .3 5 1 (r)(6 ); Pal aci os , 4 6 S .W .3 d a t8 7 8 ( c o n s t r u in g f o r m e ra rt . 4 5 9 0 i, § 1 3 .0 1 ). T o c o n s ti tu te a 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 ofcar e, b r ea ch, an d c aus at i on w i t h s uf f i ci ents pec i f i ci t y t o i nf or m t he def end antoft he c on duc tt he pl ai nt i f fha s ca l l ed i nt o que st i on a nd t o pr ovi de a basi s f ort he t r i al co urtto 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’sc o n c l u s i o n so r if it 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. B u t t h e i n fo rm a ti o n i n the rep o rt“d o e s n o t ha v e to m e e t th e sa m e req u i rem e n ts as t he evi dence off er ed i n a sum m ary-j udg m entpr oceedi ng orat t 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 ) to i n fo rm th e d e fen d a n t o f th e sp e c i fi c c o n d u c t th 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 ) to p ro v i d e a b a s i sfo 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 ofa r epo rt , t he onl y i nf or m at i on r el eva nt t 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 ou rcor ner s oft he d o c u m e n t. Id . a t8 7 8 . T h isr e q u ir e m e n tp r e c lu d e sa c o u rtf r o m f illin g g a p sin a r epo rtby dr aw i ng i nf er enc esorgue ss i ng a s t o w hatt he exp ertl i ke l y m ea nt o r i n te n d e d . See id. H ow ever , sect i on 7 4. 35 1 d oes notpr ohi bi texpert s, as o p p o s e d to c o u rts , fro m m a k i n g in fe re n c e sb a s e d o n m e d i c a l h i s to ry . Ma rvin7

v. Fithi

an , N o. 14- 07- 009 96- C V , 2008 W L 257982 4 , a t* 4 ( Tex. A p p .— H o u s to n [1 4 th D i s t.] J u l y1 , 2 0 0 8 , n o p e t.) (m e m . o p .); se e al so Te x. R. E v i d . 7 0 3 ( p rov i d i n g tha t an ex p e rtm a yd raw i n fere n c e s from th e fac ts o r da ta in a p a rt ic u la rc a s e ); T e x . R . E v id . 7 0 5 (p r o v id in g t h a te x p e rtm a yt e s t if yin te rm so f o p i n i o n sa n d i n fe re n c e s ). 1 . B a tt e ryC la im In re s p o n s e to D r. R a n e l l e ’sa rg u m e n t th a t D r. M c B ri d e ’se x p e rt re p o rt f ai l ed t o a ddr es s t he el em ent s oft he Beav er se s’ cl ai m f orba tt ery, t he B e a v e r s e sa rg u e th a t D r. M c B ri d e ’se x p e rt re p o rt m e e tsth e s ta tu to ry r e q u ir e m e n t sa n d t h a tr e q u ir in g a n y t h in g m o r e w o u ld g o t o t h e m e r it so ft h e ir case. W e agr ee. The t ortofba tt ery ha s bee n r ec ogni z ed w hen a phys i ci an, w i t h no j ust i f i cat i on orexcuse, per f or m s an oper at i on w i t hou tt he exp res s ori m pl i ed c o n s e n to ft h e p a ti e n t. Gravi s v. Physici

ans & Sur

geon s Hosp. of

A l i ce , 427 S. W . 2d 310, 311 ( Tex. 1 968 ) . H ow eve r , i n Mur phy , th e T e x a ss u p re m e c o u rt h e l d th a t th e fa i l u reto o b ta i n c o n s e n t d o e sn o t a u to m a ti c a l l yre s u l t i n a b a tte ry b e c a u s e “ [t ]h e r e m a yb e re a s o n sf o rp r o v id in g t r e a t m e n tw it h o u ts p e c if ic consent t hat do not br each any appl i cabl e st andar d of car e. ” S eeM ur phy v. Russ ell, 16 7 S . W . 3d 83 5, 83 8 ( Tex . 20 05 ) . “The exi st ence ornonex i st ence ofsuch r easons i s necessar i l y t he subj ectofexpertt est i m ony. ” Id .8

H er e, D r . M cBr i de st at esi n hi s exp ertr epo rtt hatoneoft he st and ar dsof c a re fo r a sp i n e s u rg e o n i n this typ eo f ca se i s “ [b]e i n g tr u th fu l ab o u t a pat i ent ’ s co nd i t i on. ” H e f urt hers t at est hat“ [ b] ec aus e t he r i sk s and con se que nce s ofs pi nal su r gery ar e se r i ous , i t i s i m port antt o a voi d pe r f or m i ng su r gery w hen t he r ea so n f ort he su r gery i s di sh one st l y s t at ed. ” D r . M cBr i de o p i n e d i n h i sre p o rt th a t D r. R a n e l l e ’s c a re o f H e rs c h e l fe l l b e l o w th e s ta n d a rd ofca r e b as ed on t he f ol l ow i ng: 1) D r . R ane l l e t ol d [ H er sc hel ] an d hi s i ns ur anc e c om pan y t hathe n e e d e d s u r g e ryb e c a u s e [H e r s c h e l] h a d a h e r n i a t e d d is c , w h e n in f a c t[H e r s c h e l] d id n o th a v e a h e r n ia t e d d is c . D r . R a n e lle a d m it sin hi s deposi t i on t hathe t ol d [ H er schel ] t hathe had a her ni at ed di sc or her ni at ed nuc l eus pul pos i s w hen he kne w t hi s i n f ac t w as no t t h e c a s e . P a t ie n t s r e ly o n t h e ir s u r g e o n st o b e t r u t h f u l a b o u tt h e ir cond i t i on and need f or sur ger y. Tel l i ng a pat i entand hi s i nsur ance c o m p a n yt h a th e h a sa h e r n ia t e d d is c t h a tn e e d ss u r g e ryis ove r st at i ng t he pat i ent s con di t i on a nd i s m i sl ea di ng be ca us e t he success r at e f orl eg pai n r el i efaft erspi ne sur ger y f oran annu l ar t eari s m uch l ow ert han spi ne sur ger y f ora her ni at ed di sc. H e concl uded hi s r eportby st at i ng t hatthe sur ger y “w oul d not have been p e rfo rm e d ifD r . R a n e ll e h a d b e e n h o n e s t” a n d i t w a sh i so p i n i o n th a t D r. Ranel l e’ s f ai l ur e t o obs erve t he st and ar d ofca r e w asa pr oxi m at e c aus e o f H er schel ’ s i nj ur i es. Speci f i cal l y, D r . Ran el l e’ s act i ons w er e t he pr oxi m at e cause of [ H er schel ’s ] ongo i ng back probl em s and al l oft he consequ ences t hatna t ur al l y f l ow f r om perf or m i ng a su r gery t hat w oul d notha ve been per f or m e d i fD r . Ran el l e had been h onest . These9

c o n s e q u e n c e si n c l u d eh o s p i ta l i z a tio n , p a in a s s o c ia t e d w it h re c o v e ry f r om t he t r aum a ofsur ger y, l i m i t at i on i n act i vi t i es and addi t i onal m edi cal car e i ncl udi ng i n t hi s case, physi cal t her apy and addi t i onal s u r g e ryt o re m o v e t h e b o n e s t im u la t o r . A d d it io n a lly , [ H e r s c h e l] su ffered a s h o u l d e r i n j u ry a s a res u l t of D r. R a n e l l e ’s fai l u re to p ro p e rl yp o s i ti o n a n d p a d [H e rs c h e l ] re q u i ri n g s u rg e r yfo r a to rn rota to r cu ff. D r . M cBr i de’ s exp ertr epo rti s notr equ i r ed t o m ee tt he sa m e s t and ar ds a se v i d e n c e o ffe re d in s u m m a ryj u d g m e n t p ro c e e d i n g so r i n a tri a l . S e eBo wie Mem or i al Hosp. v. W

r i ght, 7 9 S . W . 3 d 4 8 , 5 2 ( T e x . 2 0 0 2 ) . T h e r e f o r e , we agr ee w i t h t he B eaver ses t hatt he t r i al courtcoul d have r easonabl y f oun d t hat D r . M cBri de’ s expertr eport di scussest he st andar d ofcar e, br each, and causal l i nk w i t h s uf f i ci ents pec i f i ci t y t o f ul f i l l t he t w o r equ i r ed pur po ses ofs ec t i on 74 . 35 1: ( 1) t o i nf or m D r . Ran el l e oft he speci f i c co n d u c t t hatt he B eaver ses h a v e ca l l e d i n to q u e sti o n an d ( 2 ) to p rov i d e a b a sis for the tr ia l c o u rtto c o n c l u d e th a t th e c l a i m h a sm e ri t. S ee i d. a t 5 2 ; Pal

aci os , 46 S . W . 3d a t879. T o re q u i rea n y th i n g m o rew o u l d g o to th e m e ri tso f th e i r c a s e . See Ham i lton v. D ur gin , N o. 10

- 08

- 00 14 6- C V , 20 08 W L 48 16 62 4, at*2 ( Tex . A pp. — W aco N ov. 5, 2008 , no p et . ) ( m em . op. ) ( hol di ng t hatt he exp ertr epo rtw ass uf f i ci ent and t hatt he def end ant s w er e a r gui ng t he m er i t s oft he cl ai m by r el yi ng on d o c u m e n tsa n d i n fo rm a t io n o u ts i d e o f th ere p o rts ); A r boretum Nur

si ng & Rehab. C tr. of

W i nnie, I nc. v. I

saacks , No. 14- 07- 00895

- CV , 2 008 W L 2 1 3 0 4 4 6 , a t * 6 (T e x . A p p .— H o u s to n [1 4 th D i s t.] M a y2 2 , 2 0 0 8 , n o p e t.)10

( m em . op. ) (h o l d i ng t hatan expertr eportt hatf ai l ed t o addr ess s ever al content i o n s i n appel l ee’ s pet i t i on w as suf f i ci entf orpur poses oft he r equi r ed s t a t u t o rye le m e n t s ). A c c o r d in g ly , w e o v e r r u le t h a tp o rt io n o fD r . R a n e lle ’s s o le is s u e p e rt a in in g t o t h e B e a v e r s e s ’ b a tt e ryc la im . 2 . N e g l i g e n c e : U n n e c e s s a ryS u rg e ry In re s p o n s e to D r. R a n e l l e ’sa rg u m e n t th a t D r. M c B ri d e ’se x p e rt re p o rt f ai l ed t o s t at e, ores t abl i sh, thatt he su r gery i t se l fw asunne ce ss ary, t he Beav er ses as sertt hatD r . Ran el l e w ai ved t hi s com pl ai ntor , in t he al t er nat i ve, t hatt he r epo rtw ass uf f i ci entt o pr ovi de a b as i s f ort he t r i alco urtt o c onc l ude t hatt he su r gery w asunne ce ss ary. W e di sa gr eeon t he m att erofw ai verbut agr eeon t he i ss ue ofs uf f i ci enc y. Fi r st , t he Beav er se s as se rtt hatD r . R ane l l e neve rcom pl ai ned i n hi s m ot i on to d i s m i s s th a t D r. M c B ri d e ’s re p o rt fa i l e d to s ta te o r e s ta b lis h u n n e c e s s a ry s u r g e rya n d t h e r e f o r e D r . R a n e lle h a sf a ile d t o p r e s e r v e t h isis s u e f o ra p p e a l. I n s upportoft hei rar gum ent , t he Beav er se s di r ec touratt ent i on t o Plem ons , in
w hi ch w e r ecent l y r ei t er at ed t hata com pl ai nton appeal m ustbe t he sam e as th a t p re s e n te d i n th e t r ia l c o u rt. Plem o n sv. Ha r r is , No . 0 2

- 0 8

- 0 0 3 2 6

- CV , 2 0 0 9 WL 5 1 2 9 0 , a t * 3 ( T e x . A p p . — F o rt W o rt h J a n . 8 , 2 0 0 9 , n o p e t . ) ( me m. o p .) . H e r e , h o w e v e r , a lt h o u g h D r . R a n e lle ’s m o t io n t o d is m is sd id n o tc o n t a in th e w o rds “u n n e c e ss a ry s u rge ry,” i t did c o n tai n the foll o w i n g co m p l a i n t:11

[ T] her e i s no di sc us si on w hat so eve r of [ H er sc hel ] pr es ent i ng sy m pt om s, t hei rde gr eeors ever i t y, an d w hy s uch s ym pt om s, of th e m s e l v e s , d i d n o t m e ri t, p e r th e s ta n d a rd o f c a re , g o i n g fo rw a rd w i t h t hi s part i cul ars ur gi ca l pr oce dur e. M or eov er , t her e i s no di scussi on of t he r esul t s oft h e s u rgery i n t er m s ofw het her [H e rs c h e l ] fo u n d re l i e f fro m t h e s y m p to m st h a t l e d t o t h e s u rg e ry i n t he f i r stpl ace. D r. R a n e l l e ’sm o ti o n a s s e rtsth a t th e B e a v e rs e sfa i l e d to a d d re s si n th e e x p e rt re p o rt th a t H e rs c h e l ’ss y m p to m sd i d n o t re q u i reg o i n g t h ro u g h w i th th e s u rg e ry a n d a l s o th a t th e s u rg e ryd i d n o t b e n e fi t H e rs c h e l . In o th e r w o rd s , D r. R a n e l l e ’s com pl ai ntassert s t hatt he B eaver ses f ai l ed t o addr ess i n t he expertr eportt hat H er s c h e l ’ s s u r g e ry w a s u n n e c e s s a ry . Th e r e f o r e , b e c a u s e t h e a r g u m entof
u n n e c e ss a ry s u rge ryis ap p a ren t f rom the co n tex t of D r. R a n e l l e ’s co m p l a i n t,
w e h o l d th a t h e h a sp re s e rv e d th i si s s u e fo r a p p e a l . T e x . R . A p p . P . 3 3 .1 (a ). The Bea ver se s al so ar guet hatD r . M cBr i de’ s exp ertr epo rtw ass uf f i ci ent t o pr ovi de t he t r i al court w i t h t he basi s t o concl ude t hatH er schel ’ s sur ger y w as unne ce ss ary. In th e re p o rt, D r. M c B ri d e s ta te st h a t o n e o f th e s ta n d a rd so f c a refo r a s p i n e s u rg e o n i n th i sty p e o f c a s e i s“ [b ]e i n g tru th fu l a b o u t a p a ti e n t’s c o n d i ti o n ”a n d t h a t “ [b ]e c a u s e t h e ris k sa n d c o n s e q u e n c e so f s p i n a l s u rg e rya re se r i ous , i ti s i m port antt o a voi d pe r f or m i ng s ur gery w hen t he r ea so n f ort he s u r g e ryis d is h o n e s t lys t a t e d .” H e f u rt h e ro p in e d t h a t“ [p ]a t ie n t sr e lyo n t h e ir s u rg e o n sto b e tru th fu l a b o u t th e i r c o n d i ti o n a n d n e e d fo r s u rg e ry .”2 ... B ecause w e p r evi ousl y l i st ed t he speci f i c i nj ur i es suf f er ed by H er schel

asa r es ul toft he su r gery, w e n ee d notl i stt hem ag ai n. 12 D r. M c B ri d e ’sre p o rt th e n s ta t e sh i so p i n i o n o f th em a n n e r i n w h i c h D r. R a n e lle b r e a c h e d t h e s t a n d a r d o fc a r e . H e s t a t e s t h a tD r . R a n e lle a d m it t e d , in hi s dep osi t i on, thath e h ad t ol d H er schel thath e h ad a r uptur ed di sc and needed sur ger y but t hen adm i tt ed t hatH er schel di d not, i n f act , h ave a rupt ur ed di sc. F i n a l l y , D r. M c B ri d e ’s rep o rt d e tai l s h o w D r. R a n e l l e ’s d i sh o n e styl e d to H er schel havi ng a sur ger y t hatw as unnecessary and t he i nj ur i es t hatr esul t ed fro m th e u n n e c e s s a rys u rg e ry . D r. M c B ri d e s ta te s , I ti s m y op i ni on ba sed on r ea so nab l e m edi ca l pr oba bi l i t y t hatt he f ai l ur e ofD r . Ran el l e t o obser ve t he st andar ds ofcar e i n H er schel Beav er s’ case w as a pr oxi m at e cause oft he [si c ] M r . Beavers ’ o n g o in g b a c kp r o b le m sa n d a ll o ft h e c o n s e q u e n c e st h a tn a t u r a lly f l ow fr om pe r f or m i ng a s ur gery t hatw oul d not have been perf or m ed i f D r. R a n e l l e h a d b e e n h o n e s t. [E m p h a s i sa d d e d .] 2 T h e re fo re , a fte r v i e w i n g th e in fo rm a ti o n s e t fo rth w i th i n th e fo u r c o rn e rs ofD r . M cBr i de’ s r epo rt , w e h ol d t hatt he t r i al cou rt di d not abu se i t s di sc r et i on b yd e te rm i n i n g t h a t D r. M c B ri d e ’sre p o rt p ro v i d e sa f a i r s u m m a ryo f h i se x p e rt o p i n i o n sa sto th e “ a p p l i c a b l e s ta n d a rd so f c a re , th e m a n n e r i n w h i c h th e c a re r ender ed by t he phy si ci an orheal t h car e pr ovi derf ai l ed t o m eett he st andar ds, and t he ca us alr el at i ons hi p be t w ee n t hatfai l ure and t he i nj ury, ha r m or d a m a g e sc l a i m e d ” a s to th e B e a v e rs e s ’ u n n e c e s s a ry s u rg e ry c l a i m . S eeTex.13

C i v . P ra c . & R e m . C o d e A n n . § 7 4 .3 5 1 (r)(6 ); Pal aci os , 46 S . W . 3d a t878. F u rth e rm o re , th e tri a l c o u rt d i d n o t a b u s e i tsd i s c re ti o n b y d e te rm i n i n g th a t D r. M c B ri d e ’s rep o rtco n sti tu tes an o bj e c tiv e g o o d fai th effo rtto s a ti sfythe tw o p u rp o s e s o f s e c ti o n 7 4 .3 5 1 . S eeTex . Ci v. Pr a c . & Rem . Cod e Ann . § 74 . 351. A c c o rding l y , w e o v e rr u l e tha t po rt i o n o f D r. R a n e l l e ’s so l e i ss u e p e rt a i n i n g to t he Beav er se s’ cl ai m f orunne ce ss ary s ur gery. 3 . N e g l i g e n c e : R o ta to r C u ff Inj u ry In re s p o n s e to D r. R a n e l l e ’sa rg u m e n t th a t D r. M c B ri d e ’se x p e rt re p o rt
w as concl usor y as t o H er schel ’ s r ot at orcu f fi nj ur y, t he B eaver ses as sertt hat D r . Rane l l e’ s adm i ss i on, i n hi s dep os i t i on, t hat H er sc hel su f f er ed a t or n r ot at or cuf fasa r es ul tofhi s pos i t i oni ng du r i ng the su r gery, i s su f f i ci entt o c onc l ude t hatt he B eaver ses’ cl ai m has m er i t . W e agr ee. In h i se x p e rt re p o rt, D r. M c B ri d e s ta te sth a t o n e o f th e s ta n d a rd so f c a re i n t hi s t ypeofca sei s “[ p] os i t i oni ng and pad di ng t he pat i entdur i ng l um bars pi ne s u rg e rys o h i ss h o u l d e rsa rep ro te c te d f ro m in j u ry .”H e fu rth e r s ta te sth a t D r. R anel l e coul d have pr event ed H er schel ’ s r ot at orcuf fi n j ur y w i t h pr oper posi t i oni ng and paddi ng. H e t hen pr ovi des hi s opi ni on on D r . Ran el l e’ s br each of t he st andar d of car e by r ef er r i ng t o D r . R anel l e’ s adm i ssi on “ t h a t H e r schel Beav er s su f f er ed a t or n r ot at or cuf f as a r es ul t of t he pos i t i oni ng f ort he sp i ne sur ger y. ” Fi nal l y, D r . M cBri de’ s r eportpr ovi de s ass ert i ons as t o t he causal14

rel a ti o n sh i p b e tw e e n D r. R a n e l l e ’s n e g l i g e n c e a n d H e rsc h e l ’s to rn ro tato r cu ff t hatar e not m e rel y concl usor y i n l i ght ofD r . Ran el l e’ s adm i ssi on. H e st at es th a t H e rsc h e l “s u ffered a s h o u l d e r i n j u ry a s a res u l t o f D r. R a n e l l e ’s fai l u re to p ro p e rl yp o s i ti o n a n d p a d [H e rs c h e l ] re q u i ri n g s u rg e ryfo r a to rn ro ta to r c u ff.” T h u s , D r . M c B r id e ’s re p o rts u m m a r iz e sh iso p in io n sa st o t h e a p p lic a b le st and ar d ofca r e, t he m ann eri n w hi ch D r . Rane l l e f ai l ed t o m ee tt he st and ar d, a n d th e c a u s a l re l a ti o n s h i p b e t w e e n D r. R a n e l l e ’sn e g l i g e n c e a n d H e rs c h e l ’s to rn ro ta to r c u ff. SeeT 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 ). W e t her ef or e h ol d t ha tt he t r i alco urtdi d notab us e i t s di sc r et i on byde t er m i ni ng t hat D r . M cBri de’ s r eport com pl i ed w i t h sect i on 74 . 35 1 as t o t he B eaver ses’ cl ai m f or H er sc hel ’ s t or n r ot at orcu f f , an d a cc or di ngl y w e o ver r ul e t hatport i on ofD r . Rane l l e’ s so l e i ss ue pert ai ni ng t o Her sc hel ’ s r ot at orcu f fi nj ury. I V . Concl us i on H avi ng ov er r ul ed D r . Ran el l e’ s sol e i ssue i n i t s ent i r et y, w e af f i r m t he t r i al court ’ s or derdenyi ng hi s m ot i on t o di sm i ss.

B OBM CC OY J U S T I C E P A N E L : C A Y C E , C .J .; M C C O Ya n d M E IE R , J J . C A YC E, C. J. di ss ent s w i t houtopi ni on. DEL I VERE D: Apr i l 30, 2009