Affirmed and Memorandum Opinion filed August 10, 2023

.

In The 

## Fourteenth Court of Appeals

NO. 14

- 22

- 00301

- CV

RAWNEY CHARLES MCVANEY , Appellant
V.
BAYLOR SCOTT & WHITE MEDICAL CENTER

– LAKEWAY; KIRBY DALE REED, N.P.; KRISTIE LEE MILLER, M

. D.; AND EP LRMC, P.A. , A ppellee s
On Appeal from the 353rd District Court Travis County, Texas Trial Court Cause No. D

- 1

- GN

- 19

- 001953

MEMORANDUM OPINION Appellant Rawney Charles McVaney presented to the Baylor Scott & White Medic al Center

– Lakeway ( the hospital ) in Tr a vis Cou n ty with un e xplained weakness and tingling in his extr emities. After several hours , McVaney requested a discharge from the hospital because he believed had not received proper care and had not received a satisfactory explanation for his worsening s y mptoms

. McVaney

wa s later diagnosed at another area medical facility with Guillain

- Barr é Syndro me2 (GBS) , a relati v ely rare ne urolo gi cal condition

. In this appea l, we must determine whether th e trial court erred in rendering summary judgment on the groun d that McV a ney p ro duced no ev idenc e of t he causation required for his me dic al

- malpractice c laims against appelle e s the hospital , Kirby Dale R eed, N.P., Kristie Lee Miller, M.D. and EPLRMC, P.A

. Concluding the trial court did not err , we affirm the judgment of the tr i al cour t. 1

I. B ACKGROUND McVaney , now a 64

- year
- old man with a previously unremar kable medical history , woke up with tin g ling in his extremi ti es and weakness in his legs on the morning of February 20 , 2018

. After his s ymptoms worsen ed through the m ornin g , Mc V aney ’ s wi fe drove him to the emergency department at the hospital arou nd
1 1: 30 a

. m

. The hospital ’ s m e dical records ref lect that McVaney w as able to walk and stand without assistance at the time of his admission. Despite the fact no docto r ever s poke with o r physic ally ex amined McVaney , the hospital ’ s medical r ecords recite the fo llowing diagnoses: “ R53.1 Weakness; R20.2 Paresthes ia of both hands; R 20.2 Paresthesia of both feet; R42 Dizziness; and Z56.6 Work Stress. ” McVaney ’ s condition con tinued to worsen

a fter his admission, and he became frustrated that the hospital ’ s st aff had not diagnosed o r treated his condition. Nurse practitioner Kirby Dale Reed discussed the possibility of sleep apnea , suggested a sleep study , as well as an MRI for fu rthe r diagnosti c s

. McVan ey requested a discharge five and a half ho urs af ter his

1 Th e S upre me Cou r t of T exa s ordere d the C ou r t of Ap peals for the Third Distr i ct of T exas to transf er thi s appeal (N o. 03

- 22

- 00 132

- C V ) to thi s cour t

. M i sc. Doc ket No. 22

- 9025 ( Tex. March 29 , 20 22 ); s ee T ex . G o v ’ t Cod e Ann. §§ 73.001, .002. Be ca use o f th e tr an sfer, we d ecid e t he case in acco r d an c e wi th t he preceden t of the transf er or c o urt und er prin cipl es of st a re de cis is if our deci sion o the rwis e wo u ld hav e be e n i n consiste n t with th e t ra nsfe ror court ’ s p re ced e nt. See Tex. R. App. 41.3.3 a dmission in what McVane y describe d in his petition as a quadriplegi c state , bei ng unable to walk or stand. McVaney ’s wife contacted a friend who was married to Dr. Richard V an B o ven, a loca l neurol ogist unaffiliated with the hospital

. Dr. Van Bov e n cam e to McVaney ’s h om e shortly after his discharge from the hospital , examined him, suspect ed he ha d GBS , and called an ambulanc e. McVaney was then transported to
S eton Medical Center i n Austin wh ere he b egan receiving intravenous immunoglobulin treatment af ter medical staf f at S eton suspected that he was suffering fr om GBS

. Though the parties dispute th e leng th o f the delay in treatment, it is undisputed that McVane y began rec eiv ing tre atment for his GBS less than 24 hours after the onset of his symptoms

. GBS is an acu te neurological condition that g enerally begins with symptoms of numbness, tingling sensation in extremities, weakness, p ain in the limbs o r some combi nation of these sy mpt oms

. See No bu hiro Y uki , M. D

. and Hans

- Peter Hartung, M. D ., Gu i llain

- Bar r é Syndrome , N. Eng. J. Med. 2012 , 366:2295

. 2 “ The main feature is progressive bilateral and relatively symmetric weakness of the limbs, and the weaknes s progresses over a period of 1 2 hours to 28 d ays be fore a plateau is reached. ” Id . Unfor tunat ely, the di s ease has a poor and often severe
prog nosis: In the majority of patients, the Guillain

– Barré syndrome continues to progress for up to 1 to 3 weeks afte r the onset of sym p toms. Two t h ir ds of patie nt s are unable to walk independently when max imum weakness is reached. Re spiratory insufficiency occurs in 25% of patients, and major complications, including pneumonia, sepsis, pulmonary embolism, and gastrointe stinal bleed ing, d e velop in 60 %
o f intubated p atient s. Among severely affected p atients, 20% r emain

2 This article was r elied on by Mc Vaney ’ s expert, Dr. V an Bo ven and a tta ched t o the expert report.4 unable to w alk 6 months after the onset of symptoms. The variations in the rate and extent of recovery in the Guillain

– Barré syndrome make prognostication d ifficult.
Id . at 2 2 96. D espite im munotherapy , “ up to 20% of patients remain severely disab led a nd approximately 5% die

. ” Id . at 2294. After his admission to Seton, McVaney continued to deteriorate reach ing his plate au some weeks later. F ollowing his hospita lization s , M cVaney experienced

s o me recovery and imp rovement

. In 2021, McVaney gave h is deposi tion and testified he w as then a ble to walk independently for short distances, walk with the aid of a can e for longer distances, and drive a vehicle withou t m odificat ions. Th ou gh h e returned to w ork part ti m e , G BS ha s left him with physical li mitations

an d constant pain in his l egs.
I n April 2019, McV aney filed a medical

- mal p ractice claim subject to Civil Practice and Reme d ies Code chapter 74 against the hosp ital , Kri s ti e Lee Miller, M.D., Kir by D ale Reed, N .P ., and E P LRMC, P.A. 3 for fail ure to timely di agnose his GBS and b egin appropriat e treatment

. 4 McVaney ’ s pe tition states th at this failure to diagnose and treat le d to an increased severity of his GBS and result ed i n

“ perm anent paralysis resul t ing in perm an ent disa bility, disfigurement and [e]conom ic l oss. ” Krist i e Lee M iller , M .D. w as McVaney ’ s attending ph ysician at the hospi tal, who elect ronically signed his medical records. 5 Reed , a nurse

3 EPL RMC, P.A . is t he prof e ssional association whi ch employed Dr. Kr isti e Miller.

4 Tex. Civ. Pra c. & Rem . Code Ann. § § 74.0 01

– .50 7 ( popul ar l y know n as Texas Medic al Liabili ty Act (TMLA) )

. 5 Dr. Mi ller, the attending physician, elect ronica lly si gned McVaney ’ s medica l records agre eing to the following statement : “ I have see n an d examined the above patient. ” A lth ough not p e rtinen t to t he causation is sue b efore us, thi s attestati o n w as investigated by the Texas Departmen t of State Health Se rvi ces (D SHS) after Dr. Van Bo ven lodged a c omplaint on behalf of McVaney b ecause Dr. Mi ller al legedly never physically ex am ine d McVaney or spo k e with him

.5 practitioner at the hospital , also s igned Mc Vaney ’ s m edical reco rd s and ag reed t o McVaney ’ s t reatment plan

. McVaney su bsequently amended his petition to add

c laims against all defendants for violations of the Eme rgency Med ical Trea tment & Labor Act, a feder al sta tute. S ee 42 U.S.C. § 1 395dd(a). 6

I n 2021 , t he d efendants collecti v ely filed a traditional and no

- evidenc e motion for s u m mary jud gment on the issue of causation. McVaney , in response , argued that his neurology expert Dr. Van Boven established that defenda nt s ’ violation s of the standard of care proxi mate ly caus ed the incr eased severity of his
GBS

. After he ar ing the summary

- j u dgment m otions, t he t rial c ourt g ranted t he defend ants ’ no
- evidence motion as to McVaney ’ s clai ms against the defendants

. McVaney now appeals from the final judgment of the trial cour t. 7

II. A NALYSIS On ap peal, McVaney argues that the trial court erred in re n d ering su mmary jud gment beca use reasona ble minds co uld differ as to wh ether immunotherapy treatment earlier in the day woul d have slowed the progression of his disease. Therefore, he a sserts a fact issu e p recluded summary judgment

.

6 P opul ar l y know n as the Em ergency Medical Treatment and Labo r Act ( EMTALA)

. In his peti tion, McVaney incorrectly cites to 42 U .S.C. § 19395dd(a )

. 7 The f inal judgment of the tr ial cou rt co ntai ns the foll owing uneq uivo cal “ fin ality ” language : [ T] he D ef end ants ’ No

- Ev idence Motion for Summary Judgme nt should be GRANTE D as to all claims an d causes of action by Plaintiff against the Defendants and that said cl aims and causes of acti on pled agai nst the Defenda nts are hereby DISMISS ED WITH PREJUDICE

. IT I S FU RTH ER ORDERED, ADJUDGE D AND DEC REED by the C ou rt that Plaintiff t ake nothing by this s uit for his claim s and causes of action against the Def endants

. S

ee L ehmann v

. Har

- Con Corp. , 3 9 S.W.3 d 1 9 1, 1 92

– 93 , 20 0 ( Tex. 2001) ( “ [A] judg ment issued without a c onv en tio nal trial is final for purp os e s o f appeal i f and only if eith er it actually dispos es of all claims a nd parties then before the court, rega rdless of its l anguage, or it states

w ith unmist akable clarity th at it is a fin al judgm ent as to all claims a n d a ll pa rties [.] ”)

.6 A. A ppl icable l aw To preva i l on a cl aim for medical neg lig ence, a plaintiff is required to prove “(1) a duty by the healthcare provider to act acc ording to a certain standard, (2) a breach of the applicable stan dard of care, (3) an injury, and (4) a suff icient causal

co nnection bet w e en the b reach of care and t he injury.” Dunnick v. Marsillo , 654 S.W.3d 224, 228 (Tex. App.

— Austin 2022, pet. granted ) ; see Tex. Civ. Prac. & Rem. Code Ann. § 74.004 (a) (13) ; see al so W indrum v. Kareh , 581 S.W.3d 761,
7 68 ( Tex. 2019) ( “ To prevail in a wrongf u l

- death s uit alleging medica l

m alpractice, a plaint iff must establish the ele ments of negligence

. ”). A claimant bringing a medical

- negligence claim must se rve each defend ant
aga i nst whom a liability cla im is asser ted with one or more expert report s

. See T e x

. Civ. P rac. & Rem. Code § 74.351 (a)

. T h e expert must explain the basis of his statements to link hi s conclusio ns to the facts. See Columb ia V alley Healt h c are Sys. , L.P. v. Zama rrip a , 526 S.W.3d 453, 460 ( Tex. 2017 ) ; HMIH Cedar Crest, LLC v. Bue ntello , No. 03

- 20

- 00377

- CV, 20 22 WL 62722 6, at *6 (Tex. App

. — Austin Mar. 4, 2022, no pet.)

. B. Standard of review Although the defendants filed a combined traditional and no

- evidence
summary jud gment motion, the trial court granted only the no

- evid en ce motion. Therefore, we consider only the standards applicable to no

- evidence motion s.
A no

- evidence summary judgment is essentially a pretrial directed verdict, and we apply the same legal suffi cien cy standard in reviewing a no

- evidence summary judgmen t as we apply in reviewing a directed verdict. King Ranch, Inc. v. Chapman , 118 S. W.3d 742, 750

– 51 (Tex. 2003)

. “ A fter adequa te time for discovery, a pa rty without presenting summary judgment eviden ce m ay move fo r7 summary judgment on the gro und that there is no ev idence of one or more e ssential elements of a claim or defense on which the [ nonmovan t ] would have the burden of proof at trial. ” Tex. R. C iv. P. 1 66a(i). O nce the mo tion is filed, the burd e n sh ifts to the nonmov ant to pr oduce summary
- judgment evid en ce raising a ge nuine issue of material fact on the challenged element. See B.C. v. Steak N Sha ke Operatio ns, Inc. , 598 S.W.3d 256, 2 59 (Tex. 2020). A trial c ourt properly grant s a

no
- evidence summ ary
- judgment motion if the nonmov an t produces no more than a scintilla of probative ev idence

— that is, if the nonmovant ’ s evidence does not rise to a level that w ould enable reasonable and fair

- minded people to diff er in thei r conclusions. Dall as Morning Ne ws, Inc. v . Tatum , 554 S.W.3d 614 , 625 (Tex. 2018).

C. The ex pe rt repo rt
Plaintiff produced an expert report from Dr

. Van Bo v en , dat ed March 27,
2019 , descr ib ing how defendants devi ated f rom the appropriate standard of care by
not properly scre en ing and exami n ing McVaney . The se failures resulted in the hos pital ’ s fa i l ure to appropriately d iagnose McVaney and provide the ne cessary and standard treatment for GBS

. Dr. Van Boven opined that the se violations in the standard of care had a “ sig ni f ic ant delete rious ef fect [on] the patient ’ s lo ng
- term
out com e. ” Spe cific ally a dd ressing causation, Dr

. Van Bov en e xplains that the hos pital
grea tl y increased McVaney ’ s chances for a poor outcome by delaying the administration of immunotherapy :
Wea kness at ho spital admission h as b een recently found to be a main pre dict or o f l ong
- te rm o utcomes in pa tients with GBS . In the la rgest study of its kind of prognos tic indicators, nearly 400 patients with GBS followed prospectively, Walg aard et al. found that weakness at hospital admiss ion, as measured and quantified by the Medi cal8 Res ear ch Co un cil (“MRC”) s umscore , is a m ajor predic tor of poor pro gnosis, i.e. being unable to walk independently, at 4 weeks and 6 months , the latter being a time

- frame wherei n a plateau in recovery may reas onab ly be expected. These data are of r elev ance to th e c as e of Mr. McVane y. Hi s risk of poor outcom e was predicted to have more than doubled by the delay in treatment caused by [ the hospital’s ] violations in the stand a rd of
care . Co mparison of his MRC sums core at initial hospital presentation
a t B ay lor Scott & Wh it e
- Lakew ay versus his sumsco re upon admi ssion at Se ton Main not only boded poorly , but has been brought to f ruition

. More than one year after the delayed diagn osis and delay ed treatment of GBS, Mr. McV aney remains wheel

- chair or walker depen den t. The
cons eq uences of failure to timely treat GBS parallels the se quela of failure to treat other acute, monophasic attacks, e .g. stroke , traumatic brain injury , or heart attacks. [ ] B ased on these and pr evio us s tudies, I maintain that the delay in ac ute treatment ( IV Immun oglobulin) for GBS resultant from Defendants’ br eaches in the standards of care contributed significantly and negatively to Mr. McVaney’s long

- term out c ome. 8
In his report, Dr. Van Boven cit e s th ree medical journa l artic les, t wo of wh ich were includ ed with his expert report

. Although Dr. Van Boven supple ment ed his expert report , his opinion on caus ation and the basis for his opinion remained unchanged

. D. T he trial court ’ s jud gment
The d efendant s ’ su mmary
- judgment motion discusses t he stand a rds for admi ss ibilit y o f evidence und er Rule 702 and asks the trial court to exclude Dr.
Van Bov en ’ s opinion because his opinions are not reliable an d inadmissible for

es tabl ishing causation

. 9 The d efendants a l so f iled , on the same day , a

8 The f ootnotes in Dr. Van Boven ’ s report have be en omitted

. 9 The record bef ore this court does not reflect that any Da u b ert/Ro binson motions to exclude were filed or considered by the trial court. S ee E. I. du Pont de Nemours & Co ., I nc. v.9 Da u b ert / Ro binson motion to ex cl ude the opinion of Dr. Van Boven

. S ee E. I. du Pont de Nemours & Co ., Inc. v. Robinson , 923 S.W.2d 549, 55 8 (Tex. 1995) ( trial
court determine s whether expert ’ s opinion i s based on reliable method s and research ).

T he trial court r eviewed Dr. Van Boven ’ s o pi nion s by performing its own analysis of the medical literature relied on by Dr. Van Boven. 10 , 11 Ultimately, the trial court conclude d that McVaney did not provide evidence that the delay in

treatm e nt c on tributed to his injuries. Alt hough t he trial court ’s j udgment appear s to

e nco mpas s both a summ ary
- judgment analysis as well as a R ule 702 analysis , the trial court never ma de a ruling in the record ex c luding or striking the opinions of
Dr. Van Bo ve n

. T hi s court h as previously concluded that a similar ru ling f rom a trial court
const ituted an implied ruling. See Praytor v. Ford Motor Co. , 97 S.W.3d 237, 242 (Tex. App.

— Houston [14th D ist.] 2002, no pet.) ( “ The trial court, in holding that [plaintif f] ha d fai l ed to pr esent ‘ legally competent evidence, ’ effective ly concluded that the exp ert testimony was either inadmissible or insufficient. ” ). The Austin Court of Appeals has also held that a no
- evidence summary judgment is proper if the only evidence offer e d by the nonm ovant to prove an essential element of the cl ai m cannot be given weigh t by the court. See Jacob v. Int ’ l Cellulose Corp., Inc. ,

Rob inson , 923 S.W.2d 549, 5 5 8 (Tex. 1995) ( trial court de t erm i ne s whether expert ’ s opinion i s based on reliable methods and research ).

10 While judge s act as gatekeepers in determining the admissibility of evidence, judg es are not scient ists o r d octo rs and do not decide whether an op i nion is c orrect. See Gammill v. J a ck Williams Chevrolet, Inc

. , 972 S.W.2d 713, 728 (Tex. 1998) ( “ The trial court is not to d etermine wheth er an expert ’ s conclusions are correct, but only whether the analysis us ed to re ach the m is relia ble. ”).

11 The trial c ourt ’s final judgment is six pa ge s long and is in effect a four

- page opinion combined with a two

- page judgment. For purposes of our review, we only consider the por tion of the writing t ha t constitutes the judgment

.10 No. 03

- 06

- 0021 0

- CV, 2007 WL 1237963, at *4 (Tex. App.

— Austin Apr. 27, 2007, no pet.) (citing with ap proval Praytor , 97 S .W.3d at 24 0 )

. Here, the evidence supporti ng McVaney ’ s c ausation argument was a n affidavit from Dr. Van Boven and Dr . Van Boven ’ s expert rep ort. Given that the trial court concluded that it had not been provided with suff icient evidence that any dela y in treat me nt c ontributed to McVaney ’ s injuries , the trial co urt effectively addressed the competency of the expert opinions

. E. Causation Proximate cause is an essential element of a medical

- neg ligence claim and consists o f (1) cause in fact an d (2) fo rese e a bili ty. Windrum , 581 S.W.3d at 777 (citing Bustamante v. Po nt e , 5 2 9 S .W.3d 447, 456 (Tex. 20 17) ). Foreseeability requires only that the defendant s should have anticipat ed that their negligent act s or omission s would cre ate danger or harm for ot hers; it d o e s no t require the defendant s to have actually anticipated t he prec ise m anner in which the in jur y would have occurred. Travis v. City of Mesquite , 830 S.W.2d 94, 98 (Tex . 1992). To establish cause in fact, the plaintiff must show by a preponde ra nce of the

e vide nce that the defendant ’ s negligent conduct “was a subst an tial fac to r in bringing about t he injuries, and without it, the harm would not have occurred.”
Bustamante , 529 S.W.3d at 456 (citation omitted). Con sequently, the plaintiff must “ad du ce evi denc e of a ‘reasonable medical pro bability’ or ‘reasonable probab il ity’ ” th a t the defendant ’ s negl ige nce caused the plaintiff ’ s injury

— that is, it must be “ ‘more likely than not’ that the ultimate harm or condition resulted from such negligence.” I d . (quot ing J e line k v. Casas , 328 S.W.3d 526. 532

– 33 (Tex. 2010)). The pr og ressi on and treatment of GBS i s not within the common knowledge and exp erience of jurors , and therefore requires expert testimony to establish11 caus at ion

. See JLG Trucking, LLC v. G a r za , 466 S.W. 3 d 15 7, 162 (Tex. 2015). “A

con clusory statement of causatio n is in ad equate; instead, the ex pert must explain the basis of his statements and link conclusio ns to specific facts.” Abshire v. Christus He alth Se. Tex. , 563 S.W.3d 219, 224 (Tex. 2 0 18). In addi t ion, “when the facts su pport s everal possible conclusions, on ly so me of which establish tha t th e defendant ’ s negligence caused the plaintiff ’ s injury, the expert must explain to the fact finder why th ose conc lusions are superior based on ver i f iable m edica l evi dence, not simply t he expe rt ’ s opinion.” Jelinek , 328 S .W .3d a t 536.

The specific causa tion question in this case is whether t he delay in immunotherapy treatment due to defendants ’ fa ilure to diagnose McV aney ’ s GBS while he was a t the h o s pital ca used M cVan ey ’ s GBS to progress faster and/ or with more severity t h an it would have with m ore rapid treatment

. F. Did the trial cou rt err ?
1. A r gument s of the parties

In their no
- evidence motion , the def endants argued that Dr. Van Boven ’s opinio ns “pr o vide no evidence whic h establishes pr oximate cause between any alleged neg li ge nce a ttributable to Def end ants and the injuries sustaine d by Plaintif f and o r the compen sable damages sought by the Plaintiff. ” The y also highli ght that
Dr. Van Boven neve r disc u ssed or explaine d the medical literature on which he relied

. Th en anal yzin g th e med ical literatur e on which Dr. Van Bo ven specif ically bases his op i nion, defendants conclude th at Dr. Van Boven ’ s opinion is not reliable bec ause the medical literature does n ot suppo rt or co rrob o rate his opinion. In response, McVaney a rgued that Dr

. Van Bov en ’s opinion w as reliable and was based on pe er
- reviewed medical literature. McVaney c ountered defen dants ’ argument that the medic al litera ture did not support Dr. V an Bove n ’ s opini on and

a s sert ed that it “is naive to assert/assume that because th er e is no t a study show ing12 the results of tre atment delay at exact particular points in time there is no evidence of causation when clearly there is evidence that im mediate tr eat men t prior t o deteri o rati on nearly doubled the improved prognosis. ”

2. Dr. Van B oven ’ s opinions

Dr. Van Boven ’ s report extensively addresses the ho s pital ’ s breach of the
st andard of care, wh ich was n ot c hallenged by the hospital on summary judgment. With res pe ct to causation, D r. Van Boven ultimately concludes in his report that “the delay in acute treatment (IV Immun oglobulin) for GBS resultant from Defen dants’ breaches in the stand a rds of c are contr ibut ed significantly and negatively to Mr. McVaney’s long

- t er m out c ome. ” Howeve r, an exper t must explain the basis of his statements and link his conclusions to specific facts

. See Abshire , 563 S.W.3d at 224.

Dr. Van Boven begins his cau s ation di scussion b y st ating that weakness at hospital admission , “ as measured a nd qu antified by t he Medical Researc h Council ( “ MRC ” ) sumscore , ” is found to be a m ain predictor of poor prognosi s

. 12 Dr. Van
Boven never provide d McV a ney ’ s sumscor e at the time of his a d mission t o th e h ospital , nor does he discuss McVaney ’ s s umsco r e at a ny late r point in ti me

. Dr.
Van Boven ’ s expert report offers no insight into how a sumscore is calculated o r

w h ether or when it was calculated for McVa ney

. It is also unknown whe t h er McVa ney ’ s sums core was ca l culated by his medical provide rs and contained wi thin h is medical r ecords or w hether it is a measure calculated after the fact

. In his affidavit, Dr. V an Boven quantifies the delay in treatment as “ nearly 12 hours delay. ” Bu t , d espit e t hi s case tur n ing on a d elay in medical treatment , Dr.

12 T he q uote is a t tribute d to a Dutch s tudy hea v ily relied on by Dr. V an Bo v en. See C. Walgaard, H.F. Lingsma, L. Ruts, P.A. van Doorn, E.W. Steyerberg & B.C. Jacobs , Early Recognition o f Poor Prognosis In Guillain

- Barr é Syndrome , N EUROLOGY , 76:968

- 975 ( 2 011 )

.13 Van Boven off er ed no opinion or d iscussion regarding the appropriate window of opportunity for treatment , consistent with the standard of care, in which GBS should have been di ag n osed to avoid more serious illn ess. Instead, Dr. Van B oven cit ed to a study that followed 40 0 pat ients with GB S and concluded that weakness

at hospital admission is a major predictor of poor progn osis. It is undi sputed that when McVaney pres ented to th e hospita l he was already experi enci ng weakness, difficulty walking , and tingling in his ex tr em iti es. Although t he record make s clear that McVaney ’ s condition worsened throughout the day, D r. Van Boven ’ s report and affidavit d o not discuss whether the resea r ch on wh ich he relies establis h th e consequences of a delay in treatment. Rather, h is con cl usion s assume with out explanation that the research in the Walgaard study is applicable to the causation issue before us. 13 Although Dr. Van Boven attached the jour n al a rtic les on which he relies to h is report, Dr. Van Boven does not explain or discuss ho w he us ed the research to reach his ultimate conclusion. With out delving into the substance of the underlying medical litera ture on which he relies , the factfind er i s left wi th only Dr. Van
Boven ’ s ult imate conclusions

. 3. Dr. Van Boven ’ s conclusory statement s are n ot evidence o f c ausation To support a claim that a del ayed diagnosis allowed the pa tient ’ s medical condition to wor s en or disease to progress, an expert must e xp lain h ow and why the facts su ppor t this conclusion. For example, in Naderi v. Ratnarajah , a den tist failed to d iagn ose and treat an infected tooth a bscess, causing the patient t o lose part o f his low er jaw. 572 S.W.3d 773 , 776 (Te x. App.

— Houston [14th Dist.] 2019, no pet .)

. The expert exp lained that the abscess was “clearly visible” on a

13 D r. Van B ov en ’ s ex pe r t report ex pressl y st at es t hat his causati o n opinion is “[b] ased o n thes e and pr evious studies

. ”14 radi og raph taken at the ini tial visit, and that the radiog raph showed the infection fro m the tooth spreading into the s u rrounding bone, but the denti st did not ex t ract the to oth or prescribe ant ibiotic s. I d . at 775, 776

– 77. Seven months later, the patient addi ti onall y suff ered from swelling and inflammation insid e his mouth, and still the de ntist took no action. Id . at 775

– 76. The expert in Naderi su pp orted his

cau s ation op ini on by describing how medica l re cords documented the appearance of additional symptoms ov er ti me.
B y contrast, in B aylor Coll ege of Med icine v. Davies , a gynecologist failed to diagn ose and begin treat ment for ovarian cancer , which the plaintiff claimed le d
to significant progression of the cancer resul ting in a worse progn osis and reduced l if e e xp e cta ncy. 599 S.W .3d 323, 3 26

– 27 (Tex. App.

— Houston [14th Dist.] 2020, no pet.)

. However, the initial find ing in the laboratory report stated that the
p lainti ff mi ght have a tumor b ut did not ref lect the sta ge of the tumor. Id . at 330. The plaintiff ’ s exper t con cluded the tumor , at the time of the first patho logy report was a stag e 1 tumor , but offered no explanation of how he reached that conclusion base d on the infor mation in the pa th ology re port

. Id

. F o r these reasons, we held that the plaintiff ’ s e xp ert r eport was conc l usory bec ause it was only support ed by ipse dixit

. Id . at 32 6. McVaney cites the supreme court’s opinion in Bustam a nte v. Po nte as inst r uctive a nd contro lling because it invol v ed the question of whether a n expert ’ s rel iance on a speci fi c me dical study cou l d be used to determine whether a d elay in treatment of a retinal disorder cause d an infant ’ s loss of vision

. Bustamante , 529 S.W.3d at 462

. McVaney primarily r el ies on the Bustam a nte case to rebut the defendants ’ argume n t that the underlying medical studie s do not support Dr. Van
Boven ’ s opinion ( i.e., an “ analytical gap ” )

. However, the cou rt ’ s analysis of the medical study i n Bustama nte is not instructive to the ques tion we must answer in15 this appeal . While the parties i n Bust aman te argued over the applica bility of a

ce rtain study to the situation of the infant injured in that case, the causation experts in Bu sta mante relied o n mu ltip le studies, and “ offered the b ases for their opinions. ” Id . at 459

– 60 , 46 2. We agree with M cVan ey that the law does not requi re Dr. Van Boven to rely on more than one study to establish the reliability of his opinions. We also agree w ith McVaney th at th e l aw does not require that the

s tudy relied on by Dr. Van Boven align perfectly with the f actu al or medical situation at issue in the case. But the law does require Dr. Van Boven to give the bases for h is opinion and explain his opin ion. See B usta mante , 5 29 S.W.3d at 462 (opinion is conc luso ry if stated basis f or opinion provides no supp ort ) ; C oope r Tire & Rubber Co. v. Mende z , 20 4 S.W.3d 797, 806 (Tex. 2006) ( expert opinion is “fundamentally unsupp orted” wh en onl y link b etwee n expert ’ s con clusion and underlying facts is expert ’ s “own sa y
- s o ” )

. Opinion testimo ny that is conclusory or speculati ve is not relevant evidence , because it does not tend to make the existence of a material fact “more or less
pr obable.” See Tex. R. Ev id. 401. It may b e , as Mc Vane y argues in his ap pellate brief, that Dr. Van Bov en “ logically deduced ” his opinion from the fi ndin gs of the Walgaard stud y. But bec ause Dr. Van Boven never explained how he logically de duced his opinion nor did he link his opinio n to specific facts , h is opinions in this case are not competen t ev ide nce

. See Abshire , 563 S.W.3d at 224 ; Coastal Transp. Co. v. Crown Central Petrol. Corp ., 136 S.W.3d 227, 232 ( Tex. 2004) ( c itations omitted).

We therefore co nclude the tria l co urt d id not err in granting the defendants ’

no
- e vid e nc e su mmary judgment mo tion and o verrul e McV aney ’ s sole issue on
ap pe al.16 III. C ONCLUSION
We aff irm the judgment of the trial court as challeng ed on appeal.

/s/ Ch arle s A. S pa i n J usti c e

Pan el con sists of C hie f J u s t ice Christo ph er and Just ices Jewell and Spain

.