### NUM BER 13-08- 0022 2-CV 

## COURT OF A PP EA LS T H I R T E E N T H D I S T R I C T O F T E X AS CORPUS CHRI ST I - 

## E D I N B U R G
JOSE R. CA RR ERAS, M .D., A pp ellan t,
v. JU LIA N TR EVIN O, A pp ellee.

On ap pe al f rom th e C ou nty C ou rt atL aw N o. 5 of H ida lgo C ou nty , T exas . 

## O P I N I O N Be fo re C hie f J us tice Vald ez an d Ju stice s Y añ ez an d Be na v ide s

Opin ion b y

C hie f J us tice Vald ez App ellant , Jose R. Carreras, M.D., a p p e a ls the de nial of his mot ion to dismiss a heal thc ar e li abi li ty cl aim br oug ht by appel lee , J uli an Tr ev ino

. See T EX
. C IV
. P R AC
. & R EM
. C OD E A NN
. § 51. 014( a) (9 ) (V er non 200 8)

. In a si ng le is sue, Car re ra s conte nds that the t ri al
cour t abu sed it s d is cr eti on by findi ng thatthe st atuto ri ly req uired ex per

t medica l re por

t w as2

ade quate b ecau se it wa s ren dere d by a phy sician w ho d id not dem onst rate his q ual ific ati on. Id . § 74.351 (V er non Su pp. 2 008) , § 74.401 (V er non 200 5)

. W e r ev erse and
re mand. I. B A CKGRO UND On A pr il 17, 2006, Car re ra s, a n o rt h opedi c s urg eon, per formed a total r ig ht k nee replace me nt surg ery on T rev ino. At several post-o pera tiv e follow- up visi ts w ith Carreras, T rev ino com plaine d of

sev ere an d disab ling pain , but Ca rreras a llegedly ignored Trevino’s
conc er ns. Tr ev ino w as then tr eated by a different orthopedi c s urg eon, w ho per formed a
sec ond t otal r ig ht k nee repl acement

. On A ug ust28, 2007, Trev ino fil ed a heal thc ar e l iab il it y cl aim ag ain st Car re ra s all eg ing that : 1. The su rg er

y w as inc omplet e or

i nadeq uate in that the t otal kn ee re pla cementw as not p ro per ly al ig ned, re sul ti ng i n extr eme pai n. 2. The surg er

y w as inc omplet e or

i n adeq uate in that the femor al componen t of the prost hesi s w as loo se. 3. The su rgery

w as inc omplet e or

i nadeq uate in that the t ibi al componen t of the prost h[es is ] w as undersi z ed. 4. The surg er

y w as inc omplet e or inadeq uate in that ther e w er e pi eces of methy l methac ry lat e r emaini ng i n the j oin t. 5. W hen [ Trev ino ] retur ned to Dr . C ar re ra s o n mul ti ple oc cas ion s compl ain ing of sev er e and dis abl ing pain i n the r ig ht k nee, the D oct or faile d [t o] i nq uire, t est , and ev alu ate t he s urg er y to deter mine that the total kn ee repl acementw as inc omplet e or i nadeq uate. 6. Dr. Carreras relied up on p ain m e d ica tion a nd a nti-inf lam ma tory medic ati on for pati ent c ontrol ra ther than dis cov er ing the probl em w it h the s urg er

y and cor re cti ng i t.3

Car re ra s a nsw er ed w it h a g ener al deni al. O n D ecember 21, 2007, Trev ino , i n an eff ort t o compl y w it h s ect ion 74.3 51’ s e x per t repor t req uire ment, tendered th e aff ida v itand
cur ri cu lu m vit ae of W il li am R . M arti n, M .D

. See id

. Ma rt in, an i nter v enti onal r adi olo g is t, p ro vid e d t h e fo ll o win g p e rt in e n ta f f id a vit t e s t im o n y: I hav e k now led g e of the acc epted standards of medic al care for the dia g nosi s, pr ev enti on, c ar e, t re atment and c ur e of knee deg ener a ti o n and the d iag nosi s, pr ev enti on, c ar e, t re atment and c ur e of knee re pla cementby v ir tue o f myeduc ati on, t ra ini ng and ex per ien ces i n treati ng pati ents w ho sus tai ned k nee i nju ri es and w ho had knee deg ener ati on ei ther due to na tur al proce sses such as osteo arthritis, or due to the ef fect of their injuries. I hav e re v iew ed medic al re cords prov ide [d] from D r. C ar re ra s a nd D r. M ar ina [the orthopedi c s urg eon w ho per formed th e s e cond total r ig ht k nee re pla cement ], inc lud ing the oper ati v e r epor ts. I hav e not been prov ide d w it h x -ray s t aken before o r after the r ig ht k nee repl acement

.

. . . . Base d on [a rev iew

of the] re cord, an d my ow n ex per ien ce and ex per ti se, I conclu de tha t Dr. Carreras w as belo w the relevant sta nda rd of care in [his] care and tr eatment of Jul ian Trev ino on Apr il 17, 2006 i n tha t 1) he d id not prop erly alig n an d secu re t h e j ig f o r cut ting the tibia a nd f em ur in Mr

. T rev ino’s rig ht kne e, 2) he did not prop erly align and secure th e prosth esis for th e k n e e , a n d 3 ) h e d i d n o t p e r fo r m a fi n a l fl e x i o n t e s t i n g o f the k nee before c los ing the surg ic al w ound and after cement ing the prost hesi s t o the knee bones

. It is furth er my opi nio n tha t D r. C ar re ra s w as bel ow the re lev ant sta ndard of care i n hi s c ar e and tr eatm e n t o f Juli an Tr ev ino from Ap ri l 17, 2006 t o Aug ust30, 2006 i n dis re g ar din g Mr

. Trev ino ’s compl ain t of abnor mal pa i n, a nd n otd i s c ov er i ng t he mi s al i g nmen t of the k ne e. I t i s fur

th er my opi nio n tha t t he neg lect b y Dr. Car re ra s w as a c ause of the addi ti onal surg ic al pr ocedu re s .
. . . On Jan uary 9, 2008 , Carreras object ed to Martin’s repo rt on the g roun d s t h a t (1) M artin
w as not q ual ified to off er an ex per

t medic al opi nio n, and (2 ) the re por t w as conc lus or

y as to c ausat ion

. Car re ra s mov ed for dis mis sal and an aw ar d of at to rn e y’s fees. Trev ino responde d by

arg uin g thatM arti n w as q ual ified on t he g ro und t hat “ iti s c ommon knowledge that orthop edic surgeons an d radiolo gists w ork closely togeth er.” See Si lv as4

v. Ghi atas , 954 S .W .2d 5 0, 54 (Te x . App .–S an Ant onio 1 997 , pet

. den ied) (conclud ing, in the rev iew

of a sum ma ry

judgmen t, tha t an orth ope dic surgeon w ho has w ritten scho larly articles abo ut skeleta l rad iology is com pet ent to testif

y in a hea lthcare liability

suit against
a r adi olo g is t)

. In t he al ter nati v e, Tr ev ino so ug ht a thi rt y -d ay extens ion to c ur e any defects that the t ri al cour

t mi g ht f ind in Mar

ti n’s repor

t. T he tri al cour

t den ied C ar re ra s’ s mot ion to dis mis s. This i nter loc utor y appeal foll ow ed.

II. D I S CUS S I ON In a si n gle iss u e , Ca rre ra s a rgu e s t h a t t h e tri a l co u rte rre d i n o verru lin g h is c h a lle n ge to th e ad equacy of

Martin’s repo rt on the g roun d tha t Martin did no t dem onst rate his q ual ific ati on to r ender

an e x per

t opi nio n i n thi s c ase. Tr ev ino r e sp o n ds by arg uin g that int er v enti onal r adi olo g y

i s a su rg ic al spec ial it y , and therefore, Ma rt in is q ual ified under
sec ti on 74. 401( a) ’s “ tr ain ing or ex per ien ce” el ement. W e di sag re e. A . St and ard o f Rev iew W e r ev iew

a t ri al cour

t’ s d eter minat ion as to the q ual ific ati on of a wit n e ss as an
ex per t for an abus e of di sc re ti on. Lar son v. Downi

ng , 197 S.W .3d 3 03, 3 04- 05 ( Tex . 200 6) (ci ti n g Brode rs v. Heise , 924 S.W .2d 1 4 8 , 1 5 1 (Tex . 199 6) ); Str omv. Mem ’

l Her m ann Hosp. Sys. , 110 S.W .3d 216, 220 (Tex . App.–H oust on [1st Di st. ] 2003, pet. denied ). A tr ial
cour t abu ses i ts dis cr eti on i f it act s a rb it ra ri ly , unreason abl y , or w it hout re ferenc e to g uid ing
ru les or pr inc ipl es. See Lo oks hin v. F eld m an , 127 S.W .3d 1 00, 1 03 ( Tex . Ap p.–H oust on [1s t D is t.] 2003 , p e t. d eni ed)

. W e do not d is tur b the tr ial co urt’ s d is creti on abs ent c lea r abuse

. Lar

son , 1 9 7 S. W .3 d at 30 4 (cit in g Br oder s, 924 S.W .2d at 151 ). B. A pp licab le L aw To be q ual ified to prov ide opi nio n tes ti mony re g ardin g w hether a phy si ci an depa rt ed5

f rom th e acce pte d stan dard of hea lth care, a n expert mu st satisf y section 74.4 01 o f

the civi l pr act ic e and re medies co de. See T EX
. C IV
. P R AC
. & R EM
. C OD E A NN . § 74. 351 (r) (5)(A). Sect ion 74.4 01 prov ide s i n per ti nent par

t: (a ) In a sui t inv olv ing a heal th c ar e l iab il it y cl aim ag ain st a phy si ci an for injuryto or dea th of

a p a t ie n t , a person may q ualif y as an expert w it ness on t he iss ue of

w hether the phy si ci an depart ed from a cc epted sta ndards of medic al care onl y i f the person is a ph y si ci an w ho: (1 ) is pract ic ing medi ci ne atthe ti me suc h te st imony i s g iv en or w as pr act ic ing medi ci ne atthe ti me the cl aim arose; (2 ) has know led g e of ac cept ed sta ndards of medi cal care for th e dia g nosi s, care, or

treatment of the il lne ss , i nju ry , or co ndi ti on inv olv ed i n the cl aim; and (3 ) is q ual ified on t he bas is of tr ain ing or ex p e rie n ce to off er an ex per t opi nio n r eg ar din g thos e acc epted sta ndards of medic al care.

. . . . (c ) In deter mini ng w hether a w it ness is q ual ified on t he bas is of tr ain ing or experience, the cou rt shall conside r w het her, at the time the claim arose or at the tim e the testim ony is giv en, the wi tne ss: (1) is board ce rtif ied or has o the r substan tial training or experience in an area of medi cal pr act ic e r ele v ant t o the cl aim; and ( 2) is activ ely practicing me di c i ne i n r en de ring me dical care s er v i c es r el ev an t to t he c l ai m. Id . § 74.401( a) , ( c)

. A tr ial co urt may “ depar t from [thes e] cri te ri a i f, under the circumsta nces, the cou rt dete rmine s that there is a good rea s on to adm it the expert’s tes ti mo n y,” b u t, if the c our t doe s s o, i t mus t s tate the reason for t he depa rt ur e on the
re cord. Id . § 74. 401 (d). In ad dition to section 74.4 01, the trial court’s de cision o n a m e d ic al expert’s q ual ific ati on i s a ls o g uid ed by a w eal th of c ommon-l aw pr inc ipl es. See , e.g ., Philipp v.6

Mc Cr eedy , N o. 04 -0 8- 00922- CV , 200 9 W L 23429 19, a t * 1 ( Tex . App.–San Antoni o J ul. 29, 2009, no pet . h. ) (“ There is no d oubt that Cha pter 74 h as spaw ned a cot tage indu str y of expert report litigation; th is court alone has add ressed issues relatin g to prelim inary expert
re por ts

. . . mult ipl e ti mes w it hin the pasty ear .” ). I n Brode rs v. Heise , t he l eadi ng case o n
me dical expert qualif ication , the suprem e cou rt held th at no t every licensed docto r is automati cal ly

q ual ified to tes ti fy on ev er y medi cal q uest ion

. 924 S. W .2 d a t 1 52. The
s up r em e c ou rt ha s a l s o he ld tha t a proffered e x pe rt ne ed n otp r ac ti c e i n th e s am e spec ial it y as the defendant phy si ci an to q ual ify as an ex per t for that cas e. See Ro berts v. W il li am son , 111 S.W .3d 1 13, 1 22 ( Tex . 200 3)

. Acc or din g to Rob er

ts , the tr ial cour

t’ s inq uir y shoul d not focus on t he s peci alt y of the phy si ci an defendant or medi cal ex per

t. See id . Instea d, as Brode rs holds, the trial court sh o u ld de te rm in e w h e th e r th e pro f fe re d exp e rtha s “k n o wled ge, ski ll, exp e rie n ce , t ra in in g, or edu cation ” regarding the spe cif ic issue bef ore the court w hich w ould qua lify the expert to gi v e an opin ion on t hat p arti cul ar su bje ct. Brode rs , 924 S.W .2d 1 53- 54 ( appl y ing Tex as Rul e of Ev ide nce 702) ; Blan v. Ali , 7 S.W .3d 7 41, 7 46 ( Tex . Ap p.–H oust o n [14th D is t.] 1999, no pet .) ( hol din g , i n an int er pr etati on of c hapter 74’ s pr edece ss or , that the focus of a tri al cour

t’ s inq uir y reg ar din g m edi cal ex per t qua li ficat ion s shoul d not be on the defendant phy si ci an’ s a re a of exp e rt ise, but o n the co ndi ti on i nv olv ed i n the cl aim)

. Therefor e, a
m e d ica l e xpe rtf ro m on e sp e cia lt y ma y be qua lif ie d to te st if y if he ha s p ra ct ica l kn o wled ge of w hat i s c ust omari ly

done by pr act it ion ers o f a different spec ial it y under ci rc umstan ces
s i mi l a r t o t h o s e a t i s s u e in the c ase. See K eo v . Vu , 7 6 S

. W

. 3 d 7 2 5 , 7 3 2 (T e x. App.–H oust on [1 st Di st. ] 200 2, pe t. deni ed)

. If the s ubje ct m atter i s c ommon to and eq ual ly r ecog niz ed and dev elo ped i n al l field s of pr act ic e, anyphy si ci an famil iar w it h the7

subj ectmay

tes ti fy as to t he s tandard of care. Id .; Bl an , 7 S.W .3d at 745 (n oti ng that “[ t]he T exas Suprem e Court ha s mad e it clear that if a su bject o f i n qu ir y is sub stan tially develope d in mo re than one f ield, a qualif ied expert in any of those f ields ma y

testif y ”). C. A nal ysis Acc or din g to his cu rr ic ulu m v it ae, M arti n w as board ce rt ified i n radi olo g y i n 1980. He has train ing and experience in the followi ng “i nte rv ent iona l procedu res”: per cut aneous ang iop las ty , embol iz ati ons, IVC fil ter pl acement , retri ev al of foreign bod ies, CT/ US guide d biop sies, pe rcutan eou s absce ss drainages, per c. anteg ra de bi li ar y dr ain ag e, di lat ion of bil iar y and ur eteral sten osis/ob struction s, perc. ne phro stom ies, throm bolysis, etc. In his af f idavit, Martin asserts that he ha s: . . . kn owl edge of

t he accep ted stand ards of med ical care for the d iagnosis, pr ev enti on, c ar e, t re atment and c ur e of knee deg ener ati on and t he dia g nosi s, p re v enti on, c ar e, t re atment and c ur e of knee r epl acementby v ir tue o f myeduc ati on, t raini ng and ex per ien ces i n treati ng pati ents w ho sus tai ned knee inj ur ies and w ho had knee deg ener ati on ei ther due to na tur al proce sses such as osteo arthritis, or due to the ef fect of their injuries. Car re ra s a rg ues that Ma rt in’ s c ur ri cul um v it ae “ bla tantl y co ntr adi cts ” his repor

t’ s a ss erti on that he has “ know led g e” of the a cc epted sta ndard of medic al care for knee re pla cement pr ocedu re s a nd th at M arti n’s r epor t i s c oncl usor

y i n i ts ass erti on of “ know ledge ” o f the subj ectmatte r in q uest ion

. W e ag re e. T h e s p e ci fic i ss ues ra is ed i n Tre v ino ’s su itce nter on t he s urg ic al sk il l and pos toper ati v e c ar e tha t C ar re ra s render ed. In order to sat is fy sec ti on 74. 401( c) ’s medi cal
ex per t q ual ific ati on req uirement, and ther eby cons ti tute an adeq uate re por t, Trev ino had to de monstrate t hat M arti n had “s ubst anti al tr ain ing or ex per ien ce” i n tot al knee
re pla cementsurg er

y and the po st- oper ati v e c ar e of suc h a p ro cedure. See T EX
. C IV
. P R AC
. & R EM
. C OD E A NN . § 74. 401 (c). Besid es sum ma rily asserting such “knowledge,” Martin’s8

repo rt and cu rriculum vi tae doe s not de mo nstrat e ho w he gained the requisite experience
or train ing to sat is fy the s tatut e’s r eq uirement. See E hr lich v. Mi les , 144 S.W .3d 6 20, 6 25- 26 (T ex. App.– Fort W orth 20 04, pet. d enie d) (a f f irming, u nde r chapte r 74’s prede cessor, a trial court’s ruling tha t an ex pert repo rt drafted by a neu rologist did no t dem onst rate his qualif ication to opin e on the st and ard of ca re re nde red by a plast ic surg eon during a fa ce li ft and c heek implan t procedu re ); see a lso Gar ci a v . R odr igu ez , N o. 13 -0 5- 00747- CV , 2007 W L 24423 49, at **3 -4 (Tex

. App.–C or pus Chr is ti Aug . 30, 2007, pet. deni ed) ( memo. op. ) ( af f irming, u nde r cha pte r 74 ’s p rede cessor, a trial co urt’s ru ling tha t an e x pert rep ort draft ed b y

a p l as ti ca nd r ec on s tr uc ti v e s urg eo n w ho s ta te d th ath e ha d trea te d bu r n v i c ti ms d id n o td e m o n s t ra t e h is qu a li f ic a t io n t o o p in e o n t h e st a n d a rd o f ca re re n d e re d b y a pulm ono logist to a burn vi ctim); Mi ra nda v. Ma rtin ez , N o
. 1 3
- 0 6
- 0 0 3 8 6
- C V , 2 0 0 7 WL 687001, at *3 ( Tex . Ap p.–C or pus Chr is ti M ar . 8, 2007, pet. denied) ( memo. op. ) (rev ersi ng a trial court’s ruling th a t a n e xp e rt report drafted byan ob stetrician and g y neco logist dem onst rated that he w as qualif ied to opin e on anot her OBGYN ’s allegedly negligent act of leavin g a spo nge in a pat ient a f ter a C-section b ecau se the prof fered ex pert “simp ly infor m[ e d ] t h e t r i a l c o u rt t h a t [ h e ] w a s a d o c t o r w i t h a s p e c i a l t y i n e i t h e r g y n e c o l og yor obst etr ic s ( or

both ) [and] di d not a d d re ss any of the fact ors t hat u lt imat ely dete rmi ne
w hether one is a q ual ified ex per t—i .e., kn ow led g e, s ki ll , ex per ien ce, traini ng , and edu cation .”). W e hol d that Ma rt in’ s re por t is ina deq uate becau se itdoes not demonst ra te t hat h e is q ual ified to re nder

an e x per

t medi cal opi nio n in this case and the tr ial co urt abu sed it s dis cr eti on bynot g ra nti ng Car re ra s’ s motion to dis mis s. Ac cordin g ly , C ar re ra s’ s s ole i ss ue is su sta ine d.T he supr em e cour t has hel d t hat sect i on “ 74. 351’ s pl ai n l angua ge per m i t s one t hi r t y - day ext ensi on 1 w he n t he c ou rt of ap pe al s fi nd s de fi c i en t a rep ort t ha t t he t ri al co urt co ns i de red ad eq ua t e.” Leland v. Br andal , 257 S. W

. 3d 2 04, 207 ( T ex. 200 8)

. Accor di ngl y , t he t r i al cour t shou l d ha v e an opp or t uni t y t o con si der gr ant i ng T r ev i no a n ext ensi on t o cur e t he d ef i ci enci es de t ai l ed i n t hi s opi ni on. 9 III . C ONCL US I ON W e r ev erse the tr ial cour t’ s or der deny ing Car re ra s’ s moti on to dis mis s and remand this case to the trial court to consid er w het her to grant T rev ino a thirty -day exten sion to f ile an adeq uate ex per

t repor t. 1
RO GELI O VA LDE Z

Chief Justice Opinio n de liv ered and f iled this 25th day of Aug ust , 200 9.