## COURT OFAPPEALS SECOND DISTRICTOF TEXAS FORT WORTH NO. 2 - 0 8 - 0 7 9 - CV M ALCO L M BARBER AN D APPE L L AN TS LEAN N BA RBER V . LEO C . M ERC ER, JR. , M . D . A PPELL EE

----- ----- -- FR O M THE 78TH DI STRI CT CO URT O F W I CH I TA CO UN TY

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----- ----- -- A p p e l l a n ts M a lc o lm a n d L e a n n B a rb e r s u e d L e o C . M e rc e r, J r., M .D ., a p p e l l e e , a n d o th e rsfo r n e g l i g e n c e i n th e tre a tm e n t a n d c a re o f M a l c o l m ’sh e a rt con di t i on du r i ng a he art bypa ss pr oce dur e. D r . M er ce r w as t he gen er als ur geo n w h o a s s i s te d th e l e a d s u rg e o n b yh a rv e s ti n g a s a p h e n o u s v e i n fro m M a l c o l m ’s l eg. T hi s ca se c ur r ent l y i nvol vesonl y Dr . M er ce r . The Bar ber s cha l l eng e t he tr i a l co u rt ’s d i sm i ss a l o f t h e i r cl a i m ag a i n st D r. M e rce r f o r f a i l u re to co m p l yw i th2

th e e x p e rt re p o rt re q u i re m e n ts o ft h e c i v i l p ra c ti c e a n d re m e d i e sc o d e . W e r eve r sean d r em and . Fac t ualan d Proce duralBac kground The Bar ber s sued num er ousde f end ant s, i ncl udi ng Dr . M er ce r , f or n e g l i g e n c e in c o n n e c ti o n w i th t h e d i a g n o s i sa n d s u rg i c a l tre a tm e n t o f M a l c o l m ’s hea rtco ndi t i on ( an i nt er l ocu t ory a ppe albe t w ee n t he Bar ber s and s eve r aloft he ot he r de f e nd a nt s i s c ur r e nt l y pe nd i ng i n t hi s c ou rt un de r c a us e nu m ber2- 07- 3 5 3 -C V ). M a l c o l m u n d e rw e n t a m u l ti -ve ss e l co ron a ry a rt e ry b y p a ss g raft ( C A BG ) pr ocedu r e at U n i t ed R egi onal H eal t h C ar e Sy st em i n W i chi t a Fal l s, Tex as, i n ear l y2 0 0 4 . The sur ger y l ast ed oversi x hou r s, and af t er w ar ds, M al col m suf f er ed num bness, pai n, and w eakness i n hi s l ef t upp er ar m t hatl ed t o a di agno si s of l eft ul nar ner ve l esi on and ul narcubi t al syndr om e. H e r equi r ed addi t i onal sur ger y and t her apy and ul t i m at el y sued t he phy si ci ans, nur se pr ac t i t i one r s, an d t he hos pi t al i nvol ved i n hi s ca r e f orda m age s r es ul t i ng f r om t he padd i ng and posi t i oni n g o f hi s ar m . D r . M er cer , a gener al sur geon , had a s s is t e d M ik k o P . T a u r ia in e n , M .D ., a c a r d io v a s c u la ra n d t h o r a c ic s u r g e o n , in perf or m i ng t he C A BG pr oce dure o n M al col m ; D r . M er ce rw asr es pons i bl e f or harves t i ng t he l efts aph eno usve i n f r om M al col m ’ s l eg. I n t he B ar ber s’ or i gi nal pet i t i on t hey al l eged m ul t i pl e basi s ofnegl i gence i ncl udi ng s pec i f i ca l l y t hatt he var i ousde f end ant s neg l i gen t l y f ai l ed t o t i m el y,3

pr ope r l y, s af el y, orad equ at el y s upe rvi seorca r e f orM al com ’ s con di t i on du r i ng t he C A BG p r ocedu r e an d post oper at i vel y, p art i cul ar l y r el at i ng t o hi s “l ef tupper ext r em i t y di f f i cul t i es . ” Furt her m or e, t he Bar ber s al l ege d t hats eve r aloft he d e fe n d a n t d o c to rsfa i l e d to a d e q u a te l ytra i n o r s u p e rv i s e o th e rsw h o w e re assi st i ng i n M al com ’ s pr ocedu r e. A fte r th e yfi l e d s u i t, th e B a r b e r s t i m e l yfi l e d th e i r e x p e rt re p o rts . D r. M er ce robj ec t ed t o t he Bar ber s’ f i r stex pertr epo rtda t ed A ugus t5, 2006 on t he gr oun ds t hatt hei rex pert , J ef f r ey A l an W agner , M . D . , M . B. A . , a boar d cert i f i ed anest hesi ol ogi st, w as notqual i f i ed t o pr ovi de t he r eportand t hatD r . W agner f ai l ed t o pr ovi de a f ai rs um m ary ofhi s opi ni onsi n a cc or dan cew i t h s ec t i on 7 4 .35 1( r ) ( 6) oft he ci vi l pr act i ce and r em edi es code. Tex. C i v. Pr ac. & Rem . C odeA nn. § 74. 351 ( r ) ( 6) ( V er non Supp. 200 9) . A ft er a hea r i ng on t he i ss ue i n J u l y2 0 0 7 , th e tri a l c o u rt s p e c i fi c a l l yo v e rru l e d D r. M e rc e r’so bj e c ti o n sto D r. W agn er ’ s qua l i f i ca t i onst o opi ne, buti ts us t ai ned hi s obj ec t i on s as t o t he r eport ’ s f ai l ur e t o pr ovi de a f ai rsum m ary oft he appl i cabl e s tan d a rd ofcar e, br ea ch oft hats t and ar d a s t o e ac h de f end ant , an d c ausat i on u nde rs ec t i on 74. 351. O n Sept em ber25, 2007 , t he t r i alco urten t er ed an or dergi vi ng t he B a rb e rsth i rtyd a y sto c o rre c tt h e d e fe c ts i n th e i r fi rs t e x p e rt re p o rt a sto D r.1 ... The t r i alco urtdi sm i ss ed so m e o ft he nam ed def end ants d ue t o t he

i ns uf f i ci enc y oft he r epo rt , butt he Bar ber s w er e g i ven an oppo rt uni t y t o a m end t hei rr eportas t o D r . M er cerand som e oft he ot herdef endan t s.

2 ... A l t hou gh i tw as t he sa m eexp erts uppl yi ng t he am end ed r epo rtw hom t he t r i al courthad pr evi ousl y f oun d qual i f i ed, t hi s t i m e t he t r i al co urtr ul ed t hat t he expertw as n o t q u a l i fi e d to re n d e r th e re p o rt a n d lim i te d i ts ru l i n g to D r. W agner ’ s l ack ofqual i f i cat i ons al one. 4 M e rc e r. 1 The orderst at ed, “[ O ] bj ect i ons t o t he Exp ertRep ortof Jef f ery A l an W agn er, M . D . ar e h er ebyO V ERRU LED t o t he ext entt hats uch O bj ec t i ons c h a l l e n g e D r. W a g n e r’ s q u a l i fi c a tio n s to o p i n e as an ex p e rt , p u rsu a n t t o Sect i ons 74. 401 an d 74. 402 . . . . ” H ow eve r , t he t r i alco urtde ni ed t he B a rbe rs’ ora l req u e st to su p p l e m e n t witha n e wexp ert a sto d e fe n d a n ts M e rc e r, R o b e rtL e e M o s s , M .D ., U n it e d R e g io n a l H e a lt h C a r e S y s t e m , In c ., a n d S h e llie B a rn e tt-W ri g h t, P A -C . T h e B a rb e rs i m m e d i a te l y fi l e d a m o re e x te n s iv e re p o rt by Dr . W agn er , pa rt i cul ar l y e xpa nde d a s t o s t andar d ofca r e, br ea ch, an d c a u s a ti o n a sto e a c h n a m e d d e fe n d a n t s i n c e th e t r ia l c o u rt h a d d e n i e d D r. M er cer ’ s obj ect i ons t o D r . W agner ’ s qual i f i cat i ons. A fter t h e B a rbe rs fi l e d the i r am e n d e d rep o rtthro u g h the i r sa m e ex p e rt , D r. W a g n e r, D r. M e rc e r fi l e d a s e c o n d m o ti o n to d i s m i s s , w h i c h th e tri a l c o u rt gr ant ed on t he sol e gr oun d t hatt he expertw a s no tqual i f i ed “t o opi ne as an e x p e rt a g a in s t D r. M e rc e r.” 2I n al l ot herr espect s, t he t r i al courtdet er m i ned t hatt he exp ert ’ s am end ed r epo rt , da t ed Sept em ber28, 2007 , “ sa t i sf i est he5

r equ i r em ent s ofs ec t i on 74 . 351 . . . ast o Dr . M er ce r , an d a l l ot herobj ec t i ons by Dr . M er ce rar e over r ul ed. ” T he t r i alcourtt hen gr ant ed D r . M er ce r ’ s m ot i on to d i s m is s h i m w i th p rej u d i c e . T h e B a rb e rsa p p e a l e d . S ee T e x . C i v . P ra c . & R e m . C o d e A n n . § 5 1 .0 1 4 (a )(1 0 ) (V e rn o n 2 0 0 8 ). I ssue on A ppeal In th e B a rb e rs ’ so l e i s s u e o n a p p e a l , th e yc o n te n d th a t th e t r i a l c o u rt abu se d i t s di sc r et i on i n gr ant i ng D r . M er ce r ’ s se con d m ot i on t o di sm i sson t he bas i s t hatD r . W agn erw asnota qua l i f yi ng “ exp ert ” su f f i ci entt o gi ve an opi ni on o n w h e t h e rD r . M e r c e rd e p a rt e d f r o m a c c e p t e d m e d ic a l c a r e u n d e rt h e c iv il p ra c ti c e a n d re m e d i e s c o d e . D r. W a g n e r’s c o m p l e te a m e n d e d re p o rtis a tta c h e d to th i so p i n i o n a sa p p e n d i x“ A .” S t andar d ofRev i ew A l t hough t he Bar ber s as k u s t o reev al uat e t he st and ar d ofr evi ew f or e x p e rtr e p o rt c h a l l e n g e s , T e x a sc o u rtsa n d o u r s u p re m e c o u rt, i n p a rti c u l a r, agr ee t hatr evi ew o fa t r i al court ’ s deci si on on a m ot i on t o di sm i ss under s e c t io n 7 4 .3 5 1 i ss u bj e c t to a n a b u s e o f d i s c re ti o n s ta n d a rd . S e e, e . g . , A m. Transiti onal Care Ctr

s. o f Tex. , I nc. v. Pal

aci os , 46 S. W . 3d 873, 875 ( Tex. 2 0 0 1 ) (a p p l y i n g a b u s e o f d i s c re ti o n s ta n d a rd to p re d e c e s s o r s ta tu te ); Crai g v. D ea r bonne , 2 5 9 S .W .3 d 3 0 8 , 3 1 0 (T e x . A p p .— B e a u m o n t 2 0 0 8 , n o p e t.); San Ja cin to Me th o d

i st Ho sp . v. Benn e tt, 256 S . W . 3d 806, 811 ( Tex.6

A p p .— H o u s to n [1 4 th D i s t.] 2 0 0 8 , n o p e t.); L a l v. Ha rr i s Me th o d

i st F o rt Wo rth , 230 S. W . 3d 468, 471 ( Tex. A pp. — FortW ort h 2007, no p et. ) . W e h ave p rev i o u s lyd e c li n e d the o p p o rt u n i ty to ap p l ya d e n o v o sta n d a rd o f r e v i e w to th i s i s s u e a n d th e re fo re d e c l i n e t h e B a rb e rs ’ i n v i ta ti o n n o w . C tr. f or Neurol ogi cal Di so rder s, P. A . v. G eor

ge , 2 6 1 S .W .3 d 2 8 5 , 2 9 1 (T e x . A p p .— F o rt W o rth 2 0 0 8 , p e t. d e n i e d ). F u rth e rm o re , a t ri a l c o u rt’sd e c i s i o n o n w h e th e r a p h y s ic ia n isq u a lif ie d t o o f f e ra n e x p e rto p in io n in a h e a lt h c a r e lia b ilit yc la im is re v i e w e d u n d e r a n a b u s e o f d i s c re ti o n s t a n d a rd . See Mem ’ l Her m ann Hea lth c a reS ys . v. Bur rell, 2 3 0 S .W .3 d 7 5 5 , 7 5 7 ( T e x . A p p .— H o u sto n [ 1 4 th D i s t.] 2 0 0 7 , n o p e t.). To det er m i ne w het hera t r i alco urtab us ed i t s di sc r et i on, w e m us tde ci de
w he t he rt he t r i alco urtac 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 or ds, 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 . D owner v. A quam ar

i ne Oper ator s, I nc . , 701 S. W . 2d 238, 241– 4 2 (T e x . 1 9 8 5 ), c ert. denied, 47 6 U . S . 11 59 ( 19 86 ) . M er el y because a t r i al c o u rtm a yd eci de a m at t erw i t hi n i t s di scr et i on i n a di f f er entm annert han an appel l at e courtw oul d i n a si m i l arci r cum st ance does not dem onst r at e t hatan a b u s e o f d i s c re ti o n h a so c c u rre d . Id . a t 2 4 2 . A tr i a l c o u rtd o e s n o t ab u se i ts d i s c re ti o n i f i t c o m m i ts a m e re e rro r in j u d g m e n t. S e eE.I. duPo n t deNem o urs & Co. v. Robi

ns on , 9 2 3 S .W .2 d 5 4 9 , 5 5 8 (T e x . 1 9 9 5 ).7 A ppl i cabl e Law I n a he al t h c ar e l i abi l i t y cl ai m , a cl ai m antm us ts erve on e ac h de f end ant an expertr eportthatad dr essesst andar d ofcar e, l i abi l i t y, and causat i on no l at er t han t he 120 t h da y a f t ert he cl ai m i s f i l ed. Tex. C i v. Pr ac . &Rem . Code Ann. § 7 4 .3 5 1 (a ), (j) . Ifa n e x p e rtre p o rth a sn o tb e e n s e rv e d o n a d e f e n d a n tw it h in t he 120- da y pe r i od , t he n on t he m ot i on of t he a f f e c t e d de f e nd a nt , t he t r i al c o u rtm u s td i s m i s st h e c l a i m w i t h p r ej u d i c e a n d a w a r d t h e d e f e n d ant re a s o n a b l e a tto rn e y ’sfe e sa n d c o s ts . Id . § 7 4. 35 1( b) . A r eport“has notbeen se rved ” unde rt he st at ut e w hen i tha s bee n phy si ca l l y s erved buti ti s f ound d e fi c i e n t b yth e tri a l c o u rt. L e wi s v. Fun derb urk , 253 S. W . 3d 204, 207– 08 ( Tex . 20 08 ) . W hen no r eporthas been se rve d b e cause t he r eportt hatw as se rved w asf ound t o bede f i ci ent, t he t r i alco urtha s di sc r et i on t o gr antone t hi rt y- dayext ens i on t o a l l ow t he cl ai m ant t he opport uni t y t o c ur e t he d e fi c i e n c y . T e x . C i v . P ra c . &R e m . C o d e A n n . § 7 4 .3 5 1 (c ). A re p o rtis d e f i c ie n t(t h e r e f o r e s u bje c t in g a c la im t o d is m is s a l) w h e n it “d oesnotr epr es entan obj ec t i ve good f ai t h e f f ortt o c om pl y w i t h t he def i ni t i on o f a n e x p e rt re p o rt” i n th e s ta tu te . Id . § 7 4 . 351( l). W h ile th e e x p e rt re p o rt “need not m ar shal al l t he pl ai nt i f f ’ s pr oof, ” Pal aci os , 46 S. W . 3d at87 8, i tm ust pr ovi de a f ai rsum m ary oft he exp ert ’ s opi ni onsas t 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 i n w h i c h th e c a re re n d e re d b yt h e p h y s i c i a n o r h e a l th c a re8

pr ovi derf ai l ed t o m eetthe st andar ds, an d 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, ha r m , orda m age s cl ai m ed. ” Tex. Ci v. Pr ac . & Rem . Code A n n . § 7 4 .3 5 1 (r)(6 ). T o q u a lif ya sa 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 ofca r e, br ea ch, an d c aus at i on w i t h s uf f i ci ents peci f i ci t y t o i nf or m t he def end antoft he con 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 or t he t r i al court t o concl ude t hat t 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 i f i t 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. Th e i nf or m at i on i n t he r eport“does nothave t o m eetthe sam e r equi r em ent s as t he evi dence off er ed i n a sum m ary-j udg m entpr oceedi ng oratt r i al . ” Id . W hen re v i e w i n g th e a d e q u a c yo f a re p o rt, th e o n l yi n fo rm a ti o n re l e v a n t to th e i n q u i ry i st h e in fo rm a ti o n c o n ta i n e d w i th i n th e fo u r c o rn e rso f th e d o c u m e n t a l o n e . Id . a t 8 7 8 ; se e Bowi

e Mem ’ l Hosp. v. W

r i ght, 7 9 S .W .3 d 4 8 , 5 2 (T e x . 2 0 0 2 ). Thi s r equ i r em entpr ec l udes a courtf r om f i l l i ng ga psi n a r epo rtby dr aw i ng i nferenc es or gu ess i ng as t o w ha t t he ex pe rt l i ke l y m ea nt or i n te n d e d . S ee A us ti n Heart , P. A . v. Webb , 228 S. W . 3d 276, 279 ( Te x. App . — Aus t i n 2007, no pe t . ) ( ci t i ng Bo wi eMem ’l

Ho sp ., 7 9 S .W .3 d a t 5 3 ). A n e x pertr eportconcer ni ng st andar ds ofcar e f orphysi ci ans “aut hor ed b ya p e rso n w h o i s n o t qu a l i fi e d to te sti fy . . . c a n n o t c o n sti tu te an ad e q u a te9

r eport . ” Moore v. Gati ca , 269 S. W . 3d 134, 140 ( Te x. A pp . — Fo rtW ort h 2008, p e t. d e n i e d ); I

n re W i ndi sch , 138 S. W . 3d 507, 511 ( Te x. App . — Am a r i l l o 2004, o ri g . p ro c e e d i n g ); s e eE hr l i ch v. Mi

les , 1 4 4 S. W . 3d 620, 624– 25 ( Tex. A pp. — FortW ort h 2 004 , pet . deni ed) . To be an “e xpe rt ” on t he depa rt ur e f r om a p h y s i c i a n ’ss ta n d a rd o f c a re (th e re fo re q u a l i fy i n g th e s u b m i s s i o n o f a n e x p e rt r epo rt ) , a per so n m us tbea phys i ci an w ho ( 1) i s pr ac t i ci ng m ed i ci ne att he t i m e s uch t es t i m ony i s gi ven or w as pr act i ci ng m edi ci ne att he t i m e t he cl ai m ar ose; ( 2) h a s k n o w l e d g e o f a c c e p t e d s t a n d a r d s o f m e d i c a l c a r e f o rt he di agn osi s, ca r e, ort r ea t m entoft he i l l nes s, i nj ury, orco ndi t i on i nvol ved i n t he cl ai m ; an d ( 3) i s qual i f i ed on t he basi s oft r ai ni ng or e x p e ri ence t o of f eran expertopi ni on r egar di ng t hose accept ed st andar ds ofm edi cal car e. T ex . C i v. Pr ac . & Rem . Code Ann. § 74. 351 ( r ) ( 5) ( A ) , § 74. 401 ( a) ( V er non 20 05 ) . I n det er m i ni ng t he t hi r d el em ento fthi s st andar d, co urt s m ustconsi der
w h et hert he phy si ci an w ho com pl et ed t he r eport( 1) i s boar d cert i f i ed orhas ot hers ubs t ant i alt r ai ni ng orex per i enc e i n a n a r ea ofm edi ca l pr ac t i cer el eva nt to th e c l a i m , a n d (2 ) is a c ti v e l yp ra c ti c i n g m e d i c i n e i n re n d e ri n g m e d i c a l c a re s e rv i c e s re l e v a n t to th e c l a i m . Id . § 7 4. 40 1( c) . I n ot herw or ds, th e re i sn o v a l i d i ty , i f th e re e v e r w a s , t o t h e n o ti o n th a t e v e ry l i c e n se d m e d i c a l d o c to r sh o u l d b e a u to m a ti c a l l yq u a l i fi e d to tes ti fy asan ex perton e ve r y m ed i ca l que st i on. . . . [ T] he pr opone ntof t he t e sti m o ny has t he bur den t o show t hatt he expertpossesses10

sp e c i a l k n o w l e d g e a s to the v e ry m a tter on w h i c h h e p rop o se s to gi ve an opi ni on. Ehr l i ch , 144 S . W . 3d at625 ( quot i ng Broder s v. Hei

se , 924 S. W . 2d 148, 152 –53 ( Tex. 1996 ) ) . Fo rt hi s r ea so n, t he of f er ed r epo rt( al ong w i t h t he p h y s i c i a n ’s c u rri c u l u m v i ta e (C V )) m u s t g e n e ra l l yd e m o n s tra te th a t th e e x p e rt h a s “ k n o w le d g e , s k ill, e x p e r ie n c e , t r a in in g , o re d u c a t io n re g a r d in g t h e s p e c if ic i ssue bef or e t he court w hi ch w oul d qual i f y t he expertt o gi ve an opi ni on on t hat part i cul ar s u b j ect . ” Id. at625 ( quot i ng Roberts v. W i l l i am son , 111 S. W . 3d 1 1 3 , 1 2 1 (T e x . 2 0 0 3 )). H o w e v e r, “th e re a re c e rt a i n sta n d a rds o f m e d i c a l c a re t h a t ap p l yto m ul t i pl e school s of pr act i ce and any m edi cal doct or . ” S e eBla nv. A li, 7 S. W . 3d 7 4 1 , 7 4 6 ( T ex . A pp . — H ou ston [ 1 4 t h D i st. ] 1 9 9 9 , no pe t . ) . T he r efore, a p h y s ic ia n “ w h o isn o to ft h e s a m e s c h o o l o fm e d ic in e [ a st h e d e f e n d a n t ] . . . is com pet entt o t es t i f y i fheha s pr ac t i ca l kn ow l edg e o fw ha ti s us ual l y a nd cust om ar i l y don e b ya p r act i t i onerunderci r cum st ances si m i l art o t hose confr onti ng t h e def endan t . ” Ehr l i ch , 1 4 4S .W .3 d a t 6 2 5 ; se e al soMar l i ng v. Ma i l l a rd, 826 S . W . 2d 735, 740 ( Tex. A pp. — H ou st on [ 14t h Di st . ] 1992 , no w ri t).11 A n a ly s is W het herLaw oft he C ase A ppl i es A fter t h e n e x t he a ri n g o n th e ad e q u a c yo f D r. W a g n e r’ s a m e n d e d rep o rt , t hi s t i m e t he t r i al courtdet er m i ned t hatD r . W agner , a boar d cert i f i ed anest hesi ol ogi st , w as not qual if i ed t o gi ve an opi ni on on Dr . M er ce r ’ s ca r e b ut th a t al l of D r. Mercer ’

s other objecti

ons to D r. W

agner ’ s reportwere over

ruled and t hati n a l l ot herr es pec t s t he r epo rtha d m ett he r equ i r em ent s ofa se ct i on 74 . 35 1 expertreport . Tex . C i v. Pr ac. & Rem . C ode A nn. § 7 4. 35 1. Because th e o n l yb a s i sfo r th e tri a l c o u rt’sd i s m i s s a lo f th e B a rb e rs ’ c l a i m a g a i n s t D r. M er ce rw asbase d on i t s new det er m i nat i on t hatD r . W agn er“f ai l s t o m ee tt he qua l i f i ca t i onst o opi ne asan ex pertag ai ns tD r . M er ce r , ” w e t oo w i l l f ocu s on t hi s gr ound. I m po rt a nt l y, t het r i a l c ou rt ’ si ni t i a l o r de rr e ga r di ng Dr . W a gn e r ’ sf i r st r e p o rta s to D r. M e rc e r s p e c i fi c a l l yo v e rru l e d th e d e fe n s e o bj e c ti o n sto D r. W agner ’ s qual i f i cat i ons to opi ne r egar di ng D r . M er cer ’ s al l eged neg l i gence. Ther ef or e, w e m us tf i r stde ci de t he i m pac t , i fan y, oft he t r i alco urt ’ s pr i or ru l i n g th a t a c tu a l l ya p p ro v e d D r. W a g n e r ’s q u a l i fi c a ti o n sa n d fo u n d h i sre p o rt l ac ki ng on l y on s t and ar d ofca r e, br ea ch, an d c aus at i on. G ene r al l y, onc e an i ss ue hasbe en l i t i gat ed, t hati ss ue m ay notbe r el i t i gat ed. Seegener al ly Nat ’ l Uni on F i re Ins . Co. of

Pittsb ur

gh, Pa. v. John12

Zi nk Co. , 9 7 2 S .W .2 d 8 3 9 , 8 4 5

– 4 6 ( T e x . A p p .— C o rpu s C h ri sti 1 9 9 8 , p e t. d e n i e d ). A n d , i n th i s p a rt i c u l a r c a se , D r. M e rce r f i l e d an i n terl o c u to ry a p p e a l to th i s c o u rt c h a l l e n g i n g th e tri a l c o u rt’sd e n i a lo f h i so bj e c ti o n sto D r. W a g n e r’s q u a l i fi c a ti o n sa n d i ts a l l e g e d d e n i a l o f h i sm o ti o n to d i s m i s sb a s e d u p o n D r. W agn er ’ s qua l i f i ca t i ons . Thi s cou rt di sm i ss ed t hat app ea l i n a m em or and um opi ni on f o r l a c ko fj ur i sdi ct i on t o consi deran i nt er l ocutory appeal ofa t r i al court ’ s f ai l ur e t o r ul e on a d i sm i ss a l m ot i on based on t he i nadeq uacy of an e x p e rt re p o rt a n d i ts g ra n t o f a n e x te n s i o n o f ti m e to c u re . See Barber v. Barber, N o . 0 2 -0 7 -0 0 3 5 3 -C V , 2 0 0 7 W L4 4 6 1 4 1 1 , a t * 1 (T e x . A p p .— F o rt W ort h D ec. 20 , 20 07 , no pet . ) ( m em . op. ) . I n doi ng so, w e not ed t hatt he t r i al c o u rt h a d n o t ru l e d o n D r. M e rc e r’sfi rs t m o ti o n to d i s m i s s . Id . D r . M er cerhad t r i ed t o appeal “onl y t he deni al ofhi s obj ect i ons and m o ti on t o di sm i ss based on [ D r . W agner ’ s] l ack ofqual i f i cat i ons t o opi ne agai nstD r . M er cer . ” Id. A t th e h e a ri n g o n th e s u fficie n c yo f th e a m e n d e d re p o rt, th e B a rb e rs a rg u e d th a t D r. M e rc e r h a d w a iv e d h i sc u rre n t ri g h t to c h a l l e n g e th e e x p e rt r epo rtbe ca us e t hi s, i n e ss enc e, ga ve hi m t w o a t t em pt s t o appea l . The uni que p o s tu re o f th i sc a s e , h o w e v e r, i sth a t o u r c o u rt d i s m i s s e d th e fi rs t i n te rl o c u to ry app ea l f orw antofj ur i sd i ct i on. Thus , t her e r ea l l y ha s bee n no r ev i ew oft he tri a l c o u rt’si n i ti a l o v e rru lin g o f D r. M e rc e r’so bj e c ti o n to D r. W a g n e r’s qua l i f i ca t i onsw hi l e att he sa m e t i m e s us t ai ni ng Dr . M er ce r ’ s obj ec t i onst o t he3 ... W e not e som e di spar i t y w i t h t hi s det er m i nat i on: i ft he t r i al courthad

or i gi nal l y d e term i n e d t hatD r . W agnerw as bot h unq ual i f i ed t o opi ne and t hat t h e re p o rtw a s in a d e q u a t e , t h e B a r b e r slik e lyw o u ld h a v e m o d if ie d t h e ir exp l ana t i onsoft hei rex pert ’ s qua l i f i ca t i ons . Now , how eve r , t heyha ve a p p a r e n t lyu s e d u p t h e iro n e -t im e e x t e n s io n , a n d t h e t r ia l c o u rth a st o t a lly cha nge d i t s m i nd r ega r di ng t hei rex pert ’ s qua l i f i ca t i ons . Thus , t he Bar ber s hav e b e e n d e n i e d a n o p p o rtu n i tyto a m e n d th i sa s p e c t o f th e i r re p o rt e v e n o n c e . S ee T e x . C i v . P ra c . &R e m . C o d e A n n . § 7 4 .3 5 1 (c ). 13 r epo rtf o rf a i l u r e t o a d e q u a t e l ys e tf o rt h t h e s t a n d a r d so fc a r e , b r e a c h , an d ca us at i on. I n ot herw or ds , t he Bar ber s m odi f i ed t hei rf i r str epo rtt o a ddr es s t he def ec t s sp ec i f i ca l l y e num er at ed by t he t r i alco urt
— t hos e t hatw entt o t he adequ acy oft he r eport r egar di ng st andar d ofcar e, br each, and causat i on— as opp osed t o t he qual i f i cat i ons of t hei r expert . Th ey m ade vi rt ual l y no chan ges to th e i n i ti a l re p o rt re g a rd i n g D r. W a g n e r’sq u a l i fi c a ti o n sb e c a u s e t h e tri a l c o u rt had al r eady overr ul ed D r . M er c e r’ s o b j ect i ons t o D r . W agner ’ s qual i f i cat i ons. H ow ever , t he l aw oft he case doct r i ne i s l i m i t ed t o quest i ons ofl aw det er m i ned b ya c o u rt o f l a s t re s o rt. See g eneral ly Cit y of Hous ton v. Ja ckson , 192 S .W .3 d 7 6 4 , 7 6 9 (T e x . 2 0 0 6 ); Bri s c o ev. G o o d

m a rkCo rp . , 102 S . W . 3d 714, 7 1 6 (T e x . 2 0 0 3 ); TruckI ns . Exch. v. Robertson , 89 S. W . 3d 261, 264 ( Tex. A p p .— F o rt W o rth 2 0 0 2 , n o p e t.). T h u s , w e w i l l c o n s i d e r D r. W a g n e r’s q u a lif ic a t io n st o o p in e in t h is a p p e a l. 314

Q ual i f i ca t i onst o O pi ne “[ A ] phy si ci an ‘ w ho i s notoft he sa m e s cho ol ofm edi ci ne [ ast he d e f e n d a n t ] is c o m p e t e n tt o t e s t i f yifh e h a sp r a c t ic a l k n o w le d g e o fw h a tis u su a l l yan d cu s to m a ri l yd o n e b ya p rac ti ti o n e r un d e r ci rcu m sta n c e s s i m i l a r t o t hose confr onti ng t he def endan t . ’ ” Gati ca , 269 S . W . 3d at141 ( ci t i ng Ehr l i ch, 144 S. W . 3d at625) . I n ot herw or ds , such a phys i ci an m ay notbepr ac t i ci ng i n t he “ e x a c t s a m e f i e l d a s t h e d e f e n d a n t p h y s i c i a n , b u t i n s t e a d m u s t . . . be ac t i vel y pr ac t i ci ng m edi ci ne i n r end er i ng m edi ca l ca r e s ervi ce s r el eva ntt o t he cl ai m . ” Kel

ly v. Rendon , 2 5 5 S .W .3 d 6 6 5 , 6 7 4 ( T e x . A p p .— H o u sto n [ 1 4 th D i st . ] 20 08 , no p e t. ). A c c o r di ng t o t he T exas Ru l es ofEvi dence, w hi ch al so pr ovi de gui dance, w e m ay l ook t o “w het herthe off er i ng part y has est abl i shed t hatt h eex pertha s kno w l edg e, s ki l l , ex per i enc e, t r ai ni ng, ored uca t i on r ega r di ng t he speci f i c i ssue befor e the court . ” G el m an v. Cuel

l ar, 268 S. W . 3d 123, 128 ( Te x. App . — Cor pu sChr i s t i20 08 , pe t . d e ni e d) ( c i t i ng Te x. R. E vi d. 702; Ro b erts , 11 1 S . W . 3 d at121) . Fu rt her m or e, t he cou rtm us ten su r e t hatt he expert s have expert i se concer ni ng t he act ual subj ectabout w hi c h they of f er o p i n i o n s . Reed v. Gran bury Hosp. Cor p. , 117 S . W . 3d 404, 410 ( Tex. A p p .— F o rt W o rth 2 0 0 3 , n o p e t.). D r. M e rce r’ s sp e c i fi c o bj e c ti o n s to D r. W a g n e r’ s q u a l i fi c a ti o n s a s s e t f o rt h in h isa m e n d e d r e p o rta n d C V a r e b a s e d u p o n t h e a lle g a t io n t h a tD r . W a g n e ris15

unqua l i f i ed t o t es t i f y on t he part i cul ars ub j ec tm att erasr equ i r ed by s ec t i ons 7 4 .4 0 1 (a ) a n d 7 4 .4 0 3 (a ) o f th e c i v i l p ra c ti c e a n d re m e d i e sc o d e . S ee Tex. Ci v. P ra c . &R e m . C o d e A n n . § § 7 4 .4 0 1 (a ), 7 4 .4 0 3 (a ) (V e rn o n 2 0 0 5 ). I n t he t r i al court , D r . M er cerobj ect ed t o t he f a c t th a t D r . W agneri s an a n e s t h e s io lo g is ta so p p o s e d t o a g e n e r a l s u r g e o n — a sisD r . M e r c e r — a n d s im p ly st at ed t hat because D r . W agner i s an anest hesi ol ogi st w her eas D r . M er ceri s a boa r d c ert i f i ed gen er als ur geo n a nd t he ca sei nvol ved a su r gi ca l pr oce dur e, t he B a rb e rsfa i l e d to e s ta b l i s h D r. W a g n e r’sq u a l i fi c a ti o n sw i th r e g a rd to th e c a re p ro v i d e d b yD r. M e rc e r. M e re l yre fe re n c i n g p a r a g ra p h si n D r. W a g n e r’s a m e n d e d re p o rt h o w e v e r, w i th o u t p ro v i d i n g s o m e a n a l y s i sa sto w h yth e ya re i n s u fficie n t, isn o t e n o u g h . S eeT e x . R . A p p . P . 3 3 .1 (a)( 1 )( A ) (r e q u i ri n g p a rt y t o obj ectw i t h suf f i ci entspeci fi c i ty to m ake t r i al courtaw ar e ofpart i cul ar c o m p l a i n t); Mar

i s v. Hendr

i cks , 2 6 2 S .W .3 d 3 7 9 , 3 8 4

– 8 5 (T e x . A p p .— F o rt W ort h 2 00 8, pet . d e n i e d ) ( hol di ng t hatobj ect i ons t o adequ acy oft i m el y f i l ed re p o rt a re s u bj e c t to p re s e rv a ti o n ru l e s ); see a l so Gati ca , 269 S. W . 3d a t141 (r e i tera ti n g tha t ph y sici a n o f an o th e r sp e c i a l ty m a yb e co m p e ten t t o tes ti fy abo uts t and ar d ofca r e i fhe o rs he h as k now l edg e o fw hati s us ual l y a nd cus t om ar i l y do ne by a pr ac t i t i one rundersi m i l arci r cum st anc es ) . Dr . M er ce rdi d, h o w e v e r , c o n t in u e w it h h is o bje c t io n s , w h ic h h e a ls o ra is e so n a p p e a l.16

D r . M er ce rch al l eng esD r . W agn er ’ s C V , w hi ch adm i t t edl y doe s nots how t hathei s a gene r alsur geo n buta boa r d c ert i f i ed ane st hes i ol ogi st , a f ac tal r ea dy es t abl i sh ed. Dr . M er ce ri ns t ea d c om pl ai nst hat D r . W agn er ’ s C V f ai l s t o s how h o w D r . W a g n e rh a sg a in e d a n y“ k n o w le d g e , t r a in in g , o re x p e r ie n c e t h a tw o u ld qua l i f y hi m t o opi ne on t he st and ar d of ca r e of a g ene r als ur geo n ha rves t i ng a vei n. ” W hi l e i ti s t r ue t hatD r . W agn er ’ s C V m i ghtnotr eve als uch i nf or m at i on w hen r ea d i n i so l at i on, w e a r e a l l ow ed , i fnoti ns t r uct ed, t o c ons i dert he f our c o rn e rso f th e r e p o rt a l o n g w i th th e C V w h e n e v a l u a ti n g th e e x p e rt’s q u a l i fi c a ti o n sto o p i n e o n a p a rti c u l a r s u bj e c t. Pal aci os , 46 S . W . 3d a t878; Ha n s env. S ta rr, 1 2 3 S . W . 3 d 1 3 , 2 0 ( T ex . A pp . — D al l as 2 0 0 3 , pe t . d e n i e d ). B e c a u s e w e d o n o tv ie w D r . W a g n e r ’s C V in is o la t io n , t h i so bje c t io n a lo n e is a n i n s u fficie n t b a s i sfo r th e t r ia l c o u rt’sd e te rm i n a ti o n o n D r. W a g n e r’s qual i f i cat i ons. W h i l e D r. M e rc e r th e n a c k n o w l e d g e sth a t D r. W a g n e r’sa m e n d e d re p o rt sh ow s t ha theha s “a dm i ni st er ed and m ana ged m edi ca l an es t hes i a c ar e a nd t r ea t m entt o ov er10, 000 pa t i ent s unde r goi ng s ur ger i esi n a s upi ne pos i t i on, a n d . . . b e tw e e n 3 0 0 a n d 4 0 0 p a ti e n ts u n d e rg o i n g c a rd i a c s u rg e ry ,”D r. M er cercont ends t hi s exper i ence i s i nsuf f i ci entbecause i t“does notest abl i sh h o w h e c o u l d leg i ti m a tel yb e q u a l i fi e d b ytr a i n i n g o r ex p e ri e n c e to o p i n e as to t he sc opeofD r . M er ce r ’ s dut i esan d r es pons i bi l i t i esasa gen er als ur geo n17

harves t i ng a ve i n, orw hatD r . M er ce rs houl d ha ve kno w n a s a g ene r als ur geo n h a rv e s ti n g a v e i n .”H o w e v e r, e x c e rp ts fro m D r. W a g n e r’sa m e n d e d re p o rt show ot her w i se. Forexam pl e, i n par agr aph si x, D r . W agnerst at es, “I am f am i l i arand exper i enced i n . . . pr oper pat i ent posi t i oni ng t o pr eventper i pher al n e u r o p a t h i e si n t h e u p p e r. . . e x t r e m i t i e so fp a t i e n t s. . . i ncl udi ng c ardi ac sur gical procedures . ” D r . W agn erad di t i ona l l y s aysi n pa r agr aph s eve n, I ha ve su bs t ant i alper so nalknow l edg e and expe r i enc e i n t he m edical d

i agn o sis, c a re, an d

trea tm en t ofad ul tpa t i ent s unde r goi ng gener al anest hesi a forcar di ac sur gi cal pr ocedu r es, and I am f am i l i ar with the m anagem ent of such proce dures, i ncl udi ng the positi

oni ng and pa ddi ng of the pati

ent an d the pati

ent ’ s extrem ities i

n the preventi

on of p er

i operative per

i pheral neuropathi

esunder ci r cum s t a nc e s l i k e or s i m i l a r t o M a l c ol m Ba r be r [ ‘ s ] . . . . I am f am i l i a r w i t h t he m anagem ent ofs uch pr oce dur es , i ncl udi ng t he pos i t i oni ng a nd paddi ng oft he pat i ent . . . . M y m edical m a n ag em en t ofad ul tpa t i ent s unde r goi ng ge ner alan es t hes i a f or car di ac su r gi calpr ocedu r es, and f am i l i ar i t y w i t h t he m anagem ent ofs uch pr oced ures, i ncl udi ng t he pos i t i oni ng a nd pa ddi ng oft he pat i ent. . . has i ncl uded appr oxi m at el y 30 0 to 40 0 p at i ent s. A nd i n par agr aph ei ght, D r . W agnerf urt herst at es,

I a ls o h a v e s u b s t a n t ia l k n o w le d g e o ft h e c a u s a l re la t io n s h ip bet w ee n a n a nes t hes i ol ogi st ’ s [ and ] general a n d t r a u m a t ic s urg e o n ’s. . . f ai l ur est o m ee tt he r ea so nab l e, pr ude ntan d a c c e p ted sta n d a rds o f m edical [ and ]health . . . care and su pervi si on i n the d i a g n o sis, c a re a n d t rea tm e n t of p a ti e n ts u n d e rg o i n g g e n e ra l a n e s th e s i a fo r c a rd i a c s u rg i c a l p ro c e d u re s , . . . i nc l udi ng t he pos i t i oni ng a nd pa ddi ng oft he pat i entan d t he pat i ent ’ s ext r em i t i es i n t he p rev ent i on of per i oper at i ve per i pher al n e u r o p a t h i e s u n d e rc ir c u m s t a n c e slik e o rs im ila rt o M a lc o lm Barber [ ‘ s] as of 20 04 . . . . Furt her m or e, I have su bst ant i al know l edge ofthe ef f ect i veness o rpot ent i al ef f ect i veness ofsuch18

st and ar dsofm e d

i c a l [a n d ] h e a lth . . . ca ref or. . . ge ner alan d t r aum at i c s ur geo ns. . . i n t he di agn os i s, ca r e, an d t r ea t m entof pat i ent s under goi ng gen er al anest hesi a f orcar di ac sur gi cal pr ocedu r es i n t he posi t i oni ng and paddi ng of su rgi cal pat i ent s’ ext r em i t i es, and I am fa m i l i a rw i t h t he m anagem ent oft he p o s i ti o n i n g a n d p a d d i n g o f th e p a ti e n t . . . . A nd, f i nal l y i n par agr aph ni ne, D r . W agnersays,

I ha ve su bs t ant i alkn ow l edg e o fr ea so nab l e, pr ude nt , an d a c c e p ted sta n d a rds o f m e dic a l , h ea lth , n u rs i n g , a n d p h y s i c i a n ’s a s s i s ta n t c a re a p p l i c a b l e to a n e s th e s i o l o g i s ts , [ a nd ]g eneral

an d t r aum at i c sur

geo ns , . . . f ort he ca r e a nd po si t i oni ng a nd pa ddi ng oft he pat i entand t he pat i ent ’ s ext r em i t i es. . . . M y k now l edg e o f su c h sta n d a rds o f m edical, n u rs i n g a n d p h y s i c i a n ’sa s s i s ta n t c a re i s bas ed upon m y a bove

- des cr i bed ed uca t i on, t r ai ni ng a nd exper i ence, m y f am i l i ar i t y w i t h t he appl i cabl e m edical l i t e r a t u r e , my fam i l i a ri ty w i th th e a p p l i c a b l e s tan d a rds o f m edi cal and health c a re

. . . t h a tw e r e a p p lic a b le t o a ll general and t r aum at i c s urg e o n s . . . . [E m p h a s i sa d d e d .] T h e r e isa re p e a t in g t h e m e t o D r . W a g n e r ’s q u a lif ic a t io n s ; h e c o n t in u a lly ti e s h i s e d u c a ti o n a n d tra i n i n g n o t o n l yto h isk n o w l e d g e o f a n e s th e s i a c a re d u ri n g a c a rd i a c p ro c e d u re , b u t a l s o t o th e m e d i c a l a n d h e a l th s ta n d a rd so f c a re f orgener al surgeons l i ke D r . M er cer , w ho per f or m car di ac pr ocedu r es t hat i nvol ve posi t i oni ng and paddi ng of a pat i ent . H e cl ear l y i denti f i es t hathe has ac qui r ed t r ai ni ng a nd e xpe r i enc e i n s t udyi ng, l ea r ni ng, an d obs ervi ng t he app r opr i at e s t and ar dsf orge ner als ur geo nsw i t h r ega r d t o t hei robl i gat i onsf or th e p o s i ti o n i n g a n d p a d d i n g o f th e i r m e d i c a l p a ti e n ts . S eeT e x . C i v . P ra c . & R e m . C o d e A n n . § 7 4 .4 0 1 (a )(3 ).4 ... A l t hough D r . M er ce rnot esal l ega t i onsag ai ns thi m t hatgo b eyo nd t he

p o sit i o n i n g an d p a d d i n g o f t h e ex tr e m i ti e s i n a s u rgica l p roc e d u re a n d req u e sts t hatw e a f f i r m t he di sm i ss alast o t hos e a l l ega t i ons , i ti s qui t e c l ea rt hatt he B a rb e rs ’ c o m p l a i n ts re g a rd i n g D r. M e rc e r in t h e a p p e a l re l a te o n l yt o h i sfa i l u re t o m ana ge t he pos i t i oni ng a nd pa ddi ng ofa pat i ent ’ s ext r em i t i esass how n by th e i r co n c e ss i o n i n the i r r e p l yb ri e f. 19 I n t hi s case, i ti s al so i m port ant to not e t hatt he al l eged m edi cal negl i gence do es notr el at e t o a part i cul arf ai l ur e r egar di ng t he car di ac orgener al sur geon s’ p e r f or m ance oft he act ual oper at i ng t echni ques. H er e, t he al l eged b r e a c h re la t e ss p e c if ic a llyt o t h e p a d d in g a n d p o s it io n in g o f t h e p a t ie n ta n d h is ext r em i t i esdur i ng t he pr oce dur e. The pad di ng a nd po si t i oni ng ofa pat i ent d u r in g s u r g e ryisc o m m o n t o s u r g e r ie sg e n e r a lly , a n d D r . W a g n e rq u it e c le a r ly and r epeat edl y m akes cl eart hathe has know l edge, t r ai ni ng, and exp e ri e n ce r ega r di ng t he m edi ca l and su r gi ca l m ana gem entdut i esoft he gen er als ur geo n dur i ng sur gi cal pr ocedu r es. 4 Foral l t he f or ego i ng r ea so ns , w e b el i evet hatt he t r i alco urt ’ s i ni t i alr ul i ng d e n y i n g D r. M e rc e r’so bj e c ti o n sto D r. W a g n e r’sq u a l i fi c a ti o n sw a sc o rre c t. W e t her ef or e co ncl ude t hatthe B ar ber s’ ex pert , D r . W agner , i s qual i f i ed t o r ender an opi ni on un ders ec t i on 74. 401 ( a) an d ( c) , asw el l ass ec t i on 74 . 403 , as t o a g e n e ral su rge o n ’s d u ty re g a rding the p rop e r po sit i o n i n g an d p a d d i n g o f a c a rd i a c s u rg i c a l p a ti e n t. T e x . C i v . P ra c . &R e m . C o d e § § 7 4 .4 0 1 (a ), (c), 7 4 .4 0 3 (a). W e the refo re a l so d e term i n e tha t t h e tr i a l c o u rta b u se d i ts20

di sc r e t i o n i n s u s t a i n i n g Dr . M e r c e r ’ so bj e c t i o n st o t h e q u a l i f i c a t i o n so ft he Bar ber s’ ex pertupon t he f i l i ng oft hei ram end ed r epo rt . W e sust ai n t he Bar ber s’ s ol e i ss ue and r eve r se a nd rem an d t hi s ca set o t he t r i alco urtf or f urt herpr oceedi ngs.

T E R R I E L I VI NGS T ON J U S T I C E

PA N EL: CA YC E, C. J. ; LI V I N G STO N an d M EI ER, JJ. C A YC E, C. J. co ncu r s w i t houtopi ni on. DEL I VERE D: Oct ob e r15, 2009