Case Name: Debbie WHITWORTH and Gary Whitworth, Appellants, v. Dr. Scott L. BLUMENTHAL, Appellee
Court: Texas Courts of Appeals
Jurisdiction: Texas
Decision Date: 2001-10-22
Citations: 59 S.W.3d 393
Docket Number: No. 05-97-01691-CV
Parties: Debbie WHITWORTH and Gary Whitworth, Appellants, v. Dr. Scott L. BLUMENTHAL, Appellee.
Judges: LAGARDE, KINKEADE, WHITTINGTON, WRIGHT, BRIDGES, FRANCIS and ROSENBERG, JJ. join.
Reporter: South Western Reporter Third Series
Volume: 59
Pages: 393–410

Head Matter:
Debbie WHITWORTH and Gary Whitworth, Appellants, v. Dr. Scott L. BLUMENTHAL, Appellee.
No. 05-97-01691-CV.
Court of Appeals of Texas, Dallas.
Oct. 22, 2001.
Shain Chapman, Law Offices of Shain V.H. Chapman, Mason, Larry Cain, Cain & Chapman, Sherman, for Appellants.
Michael C. Freden, McCue & Lee, P.C., Dallas, David McCue, McCue & Lee, P.C., Addison, for Appellee.

Opinion:
OPINION
Justice O'NEILL.
Opinion by
This is an appeal from the dismissal of a medical malpractice claim for failure to timely file an expert report pursuant to section 13.01 of the Medical Liability and Insurance Improvement Act. See Tex.Rev. Crv. Stat. Ann. art. 4590i, § 13.01 (Vernon Supp.2001). We must decide whether the trial court abused its discretion in concluding the report appellants Debbie and Gary Whitworth filed was not a good faith effort to meet the Act's definition of an expert report. We also address whether the Whitworths were entitled to additional time to provide an expert report under either subsection 13.01(f) or (g) of the Act. We conclude the report tendered did not constitute a good faith effort to comply with the Act's definition of an expert report. However, we also conclude the Whitworths established they were entitled to a thirty-day grace period to comply with the Act under subsection 13.01(g). Consequently, we reverse the trial court's judgment and remand for further proceedings consistent with this opinion.
BACKGROUND
The Whitworths sued Dr. Scott L. Blu-menthal after he surgically implanted an orthopedic bone screw fixation device or "pedicle screw" into Debbie Whitworth's spine. Among other things, the Whit-worths alleged the pedicle screw should not have been used and caused Debbie Whitworth additional health complications. Within 180 days after the Whitworths filed their lawsuit against Blumenthal, they furnished to Blumenthal a document attempting to satisfy the requirements of an expert report in accordance with 13.01(d) of the Act. Eight months later, Blumenthal moved to dismiss with prejudice the Whit-worths' claims against him, asserting the Whitworths did not furnish him an expert report within the time allowed by the statute because the document provided was not an "expert report" as defined by the Act.
Before the hearing on Blumenthal's motion, the Whitworths filed a motion under subsections 13.01(f) and (g) of the Act requesting additional time in which to furnish Blumenthal with an expert report in the event the trial court concluded that the report furnished was not an expert report as defined by the statute. Attached to the Whitworths' motion was an affidavit by their attorney asserting he believed the report initially tendered met the requirements and purpose of the Act and setting forth his efforts to obtain a more detailed report after receiving Blumenthal's motion to dismiss. After a hearing, the trial court granted Blumenthal's motion to dismiss. This appeal followed.
ExpeRt Report
Section 13.01(d) of the Act requires a plaintiff asserting a health care liability claim to submit an expert report, along with the expert's curriculum vitae, for each defendant physician or health care provider no later than the 180th day after filing suit. See Tex.Rev.Civ. Stat. Ann. art.
4590i, § 13.01(d). The Act defines an expert report as a written report providing "a fair summary of the expert's opinions . regarding applicable standards of care, the manner in which the care rendered by the physician or health care provider failed to meet the standards, and the causal relationship between that failure and the injury, harm, or damages claimed." Tex.Rev. Civ. Stat. Ann. art. 4590i, § 13.01(r)(6).
If a claimant furnishes a report to the defendant within the time permitted, a defendant may file a motion challenging the report. See Tex.Rev.Civ. Stat. Ann. art. 4590i, § 13.01(Z). The trial court shall grant the motion only if it appears to the court, after hearing, that the report does not represent a good faith effort to comply with the statutory definition of an expert report. See Tex.Rev.Civ. Stat. Ann. art. 4590i, § 13.01(Z); Am. Transitional Care Ctrs. of Tex., Inc. v. Palacios, 46 S.W.3d 873, 877-78 (Tex.2001). We review a trial court's ruling on a motion challenging a report under an abuse of discretion standard. See id. at 878. Under this standard, we defer to the trial court's factual determinations but review questions of law de novo. Knie v. Piskun, 23 S.W.3d 455, 461 (Tex.App.—Amarillo 2000, pet. denied).
To constitute a good faith effort under the Act, the expert report must provide, for each defendant, a fair summary of the expert's opinions with respect to each of the requirements set forth in subsection (r)(6), i.e. a standard of care, breach of that standard, and causation. Palacios, 46 S.W.3d at 878-79. If a report omits any of the statutory elements, it cannot be a good faith effort. Id. at 879. The report must fulfill the dual purpose of notifying each defendant of the specific conduct called into question and providing support for a trial court to conclude the claims have merit. Id. In determining whether the report represents a good faith effort, the trial court's inquiry is limited to the four corners of the report. Id. at 878.
In his motion to dismiss, Blumen-thal argued the Whitworths did not meet the deadline set out in subsection 13.01(d) for filing an expert report because the report filed did not address any of the Act's specified elements as they related to his treatment of Debbie Whitworth. Specifically, he argued the report did not provide a standard of care relative to his conduct, identify any breach by him, or the causal relationship between his alleged breach and Debbie's injuries. After reviewing the report, we agree with Blumen-thal.
At the time the Whitworths filed their report, they had pending claims against the hospital, Blumenthal, Blumenthal's practice group, and the pedicle screw manufacturer. The report, however, does not identify any particular defendant to which it applies and instead generally asserts "the health care providers" failed to meet the standard of medical care to which Debbie was entitled. The report also raises the following "serious questions." Noting the increased risk of infection associated with the use of hardware, the report asserts post-operative infection should have been anticipated and appropriate therapy provided. It indicates this was not done and infection occurred, requiring addition al treatment and causing unnecessary pain and suffering. The report, however, does not specify the nature of this appropriate therapy, what party was responsible for providing it, or indicate whether it would have prevented infection. Even assuming infection occurred and caused injury, there is no indication that the development of infection was causally connected to a deviation from an identifiable standard of care.
Additionally, the report generally questioned the need to use a pedicle screw in Debbie's case, noting pedicle screws frequently break and cause pain, impairment, and disability in patients in which they are used. The report, however, failed to state how the use of the pedicle screw violated any particular standard of care. The report concludes by stating "the hardware in question and the manner in which it has been utilized has aggravated a pre-existing condition and the patient is more impaired following implantation than before its use."
From the report's conclusory language, it is impossible to determine what standard of care was applicable to Blumenthal, how Blumenthal deviated from the standard of care applicable to him, and whether the alleged deviation is causally connected to Debbie's asserted injuries. The report does not even attempt to define a standard of care applicable to a surgeon with respect to the utilization of pedicle screws. Because the report failed to inform Blumenthal of the specific conduct appellants called into question and failed to provide a basis from which the trial court could conclude the claims had merit, we conclude the report was not an "expert report" as defined by the statute and did not constitute a good faith effort to comply with the statutory definition. See Palac-ios, 46 S.W.3d at 879.
However, having concluded the report did not constitute a good faith effort to comply with the definition of an expert report does not end our inquiry. The Whitworths assert that even if the report did not constitute a good faith effort, the trial court should have given them additional time to comply with the statute under section 13.01 subsections (f) and (g) before dismissing their case. We will first consider whether the trial court abused its discretion in denying the Whitworths a thirty-day extension under subsection (f).
Section 13.01(f) Extension
Under subsection (f), the trial court is permitted to extend the 180-day period in which to furnish an expert report for an additional thirty days on plaintiffs motion if, after a hearing, the trial court finds good cause to grant the extension. See Tex.Rev.Civ. Stat. Ann. art. 4590i, § 13.01®. Section (f) allows for a single extension of no more than thirty days beyond the original 180-day deadline. See Tex.Rev.Civ. Stat. Ann. art. 4590i, § 13.01®; Estrello v. Elboar, 965 S.W.2d 754, 758 (Tex.App.—Fort Worth 1998, no pet.). An extension under this subsection therefore would allow a party to furnish an expert report no later than 210 days of the filing of -the lawsuit. See Tex.Rev.Civ. Stat. Ann. art. 4590i, § 13.01®; Landry v. Ringer, 44 S.W.3d 271, 274 (Tex.App.—Houston [14th Dist.] 2001, no pet.); Knie, 23 S.W.3d at 462; Roberts v. Med. City Dallas Hosp., 988 S.W.2d 398, 402 (Tex.App.—Texarkana 1999, pet. denied). Because the Whitworths did not file a report complying with the statute within 210 days of filing suit, an extension under subsection ® could not provide them relief. See Knie, 23 S.W.3d at 462.
GRACE PERIOD UNDER § 13.01(g)
The Whitworths also assert the trial court erred in denying their request for a thirty-day grace period under subsection (g) of the Act. Subsection (g) states:
Notwithstanding any other provision of this section, if a claimant has failed to comply with a deadline established by Subsection (d) of this section and after hearing the court finds that the failure of the claimant or the claimant's attorney was not intentional or the result of conscious indifference but was the result of accident or mistake, the court shall grant a grace period of 30 days to permit the claimant to comply with that subsection. A motion by a claimant for relief under this subsection shall be considered timely if it is filed before any hearing on a motion by a defendant under Subsection (e) of this section.
Tex.Rev.Civ. Stat. Ann. art. 4590i, § 13.01(g).
After Blumenthal filed a motion to dismiss under subsection (e), but before it was heard, the Whitworths filed a motion seeking a grace period under subsection (g), asserting their failure to comply with the subsection (d) deadline, if any, was not intentional or the result of conscious indifference, but rather was due to accident or mistake. After a hearing, the trial court found that the Whitworths' failure to comply with the subsection (d) deadline was the result of conscious indifference. The trial court dismissed the Whitworths' claims with prejudice.
At trial, the parties and the trial court agreed subsection (g) applied to the case before us. On appeal, the parties again agree that subsection (g) applies. We nevertheless address whether subsection (g) applies in the first instance because the dissent concludes it does not. Specifically, according to the dissent, the Whitworths timely filed an expert report and therefore did not fail to meet a subsection (d) "deadline." The dissent concludes this interpretation is required if we are to give the term "deadline" its ordinary meaning.
We agree we must use the ordinary meaning of the term "deadline" in deciding whether a party failed to comply with a subsection (d) deadline. We also agree a "deadline" is a "date or time before which something must be done." See WebsteR's ThiRD New Int'l DictionaRY 580 (1993). We, however, disagree with the dissent's interpretation of the term without reference to the "something" that is required to be done. Rather, we believe we must decide whether a party failed to meet a deadline by determining whether the party failed to perform the relevant "something" within the prescribed time period. We now turn to subsection (d) to determine what the relevant "something" is.
Subsection (d) requires, among other things, that a claimant furnish each defendant an "expert report" no later than 180 days after filing suit or the last day of any extended period established under subsection (f) or (h) . Therefore, a party fails to meet a subsection (d) deadline if the party fails to file an "expert report" within the time prescribed. The only potential ambiguity in the statute is the meaning of the term "expert report." The legislature has, however, removed any potential ambiguity by clearly defining the term "expert report." An expert report is not just the report of an expert. Rather, as noted above, the legislature has defined "expert report" as a written report providing "a fair summary of the expert's opinions . regarding applicable standards of care, the manner in which the care rendered by the physician or health care provider failed to meet the standards, and the causal relationship between that failure and the injury, harm, or damages claimed." Tex.Rev.Civ. Stat. Ann. art.
4590i, § 18.01(r)(6). Thus, if a report fails to set forth the elements required by statute, it is not, by definition, an "expert report." Here, we have concluded the Whitworths' report failed to meet the statutory definition. It necessarily follows the Whitworths did not file an expert report within 180 days of filing suit and, by not doing so, failed to comply with a deadline set out in subsection (d). See Gutierrez v. Walker, 50 S.W.3d 61, 65-66 (Tex.App.—Corpus Christi, pet. filed) (concluding plaintiff entitled to subsection (g) grace period after filing report that did not comply if failure to comply within deadline not intentional or the result of conscious indifference, but rather due to a mistake or accident); Horsley-Layman v. Angeles, 968 S.W.2d 533, 536 (Tex.App.—Texarkana 1998, no pet.) (same); see also Hightower v. Saxton, 54 S.W.3d 380, 385 (Tex.App.—Waco 2001, no pet.) (suggesting plaintiff can cure defects in an affidavit that does not qualify as an expert report by seeking subsection (g) grace period); Richburg v. Wolf, 48 S.W.3d 375, 379 (Tex.App.—Eastland 2001, pet. denied) (same).
The dissent acknowledges that the report filed was not an "expert report" for purposes of subsection (d), but nevertheless asserts the Wfiiitworths timely filed an "expert report" for purposes of subsection (g). The dissent thereby gives the term "expert report" different meanings within the same statute, one of which is contrary to the statutory definition.
Texas courts are required to construe terms in accordance with their statutory definitions. Transp. Ins. v. Faircloth, 898 S.W.2d 269, 274 (Tex.1995); Foreman v. Sec. Ins. Co. of Hartford, 15 S.W.3d 214, 217 (Tex.App.—Texarkana 2000, no pet.). We presume the legislature intends the same words to have the same meaning throughout a statute. See S. County Mut. Ins. Co. v. Ochoa, 19 S.W.3d 452, 458 (Tex.App. — Corpus Christi 2000, no pet.). In concluding the Whitworths did not file an expert report within 180 days, we consistently apply the statutory definition of "expert report," and thereby give effect to the literal text of the statute. In reaching this conclusion, we necessarily reject the dissent's conclusion that the legislature did not always intend the term "expert report" to mean "expert report" as defined by the statute. The dissent reaches this conclusion based on a mechanism contained in the statute for challenging the "adequacy" of an "expert report." We cannot agree that this provision allows us to ignore a clear statutory definition and conclude a party has timely filed an expert report when a report has been challenged and found not to be an expert report.
Finally, our construction of subsection (g) is not only mandated by its literal text, but also is in harmony with its purpose. As we noted in Broom v. MacMaster:
Unlike subsections (f) and (h), this subsection does not operate to extend the 180 day period set out in subsection (d), but instead provides for a thirty day window of time within which the plaintiff may take the actions required by subsection (d). The provision is a "safety valve" to prevent the forfeiture of claims through an accident or mistake that causes a party to fail to comply with subsection (d) in the first instance.
Broom v. MacMaster, 992 S.W.2d 659, 663 (Tex.App.—Dallas 1999, no pet.). Nor does our construction defeat the overall purpose of section 13.01, which is to prevent frivolous lawsuits. It merely allows a plaintiff a thirty-day grace period to provide an expert report to show the parties and the trial court the suit is not frivolous. If the plaintiff fails to do so, the trial court must then, on motion and hearing, dismiss the cause with prejudice. See e.g., Palacios, 46 S.W.3d at 877.
In reaching our decision, we reject the dissent's suggestion that the Texas Supreme Court's opinion in Palacios addresses the effect of subsection (g). In Palacios, the issue was the application of subsection (e). In construing subsection (e), the Palacios court concluded a trial court must dismiss a plaintiffs claims if the plaintiff files a report that does not meet the statutory requirements and the time for filing the report has passed. See id. No issue was presented to the supreme court with respect to the applicability of subsection (g). Subsection (g), by its plain terms, applies "notwithstanding any other provision" of section 13.01. If this phrase is not to be written out of the statute completely, it must refer, among other things, to subsection (e). Therefore, notwithstanding subsection (e), subsection (g) allows a plaintiff a grace period if the plaintiff can show his failure to file an expert report within the deadline was not intentional or the result of conscious indifference. See Tex.Rev.Civ. Stat. Ann. art. 4590i, § 13.01. Because the issue before the Palacios court was subsection (e), and subsection (g) applies notwithstanding subsection (e), we conclude Palacios is not instructive on a proper construction of subsection (g).
For the above reasons, we conclude the Whitworths were entitled to the subsection (g) grace period provided they showed their failure to file an expert report within the time prescribed was not intentional or the result of conscious indifference, but rather was due to accident or mistake. See Gutierrez, 50 S.W.3d at 65-66; Horsley-Layman, 968 S.W.2d at 536.
We now turn to whether the trial court abused its discretion in denying the Whit-worths' motion for a subsection (g) grace period. In determining whether a plaintiff has shown failure to comply with subsection (d) was not intentional or the result of conscious indifference, we find instructive those cases applying similar language under Craddock v. Sunshine Bus Lines, Inc., 134 Tex. 388, 133 S.W.2d 124 (1939). See Broom, 992 S.W.2d at 663; McClure v. Landis, 959 S.W.2d 679, 681 (Tex.App.—Austin 1997, pet. denied).
In determining whether a party acted intentionally or with conscious indifference, we look to the parties' knowledge and acts or the knowledge and acts of their attorney. See Broom, 992 S.W.2d at 663. Proof of accident or mistake negates intentional disregard or conscious indifference. See Roberts, 988 S.W.2d at 403; Horsley-Layman, 968 S.W.2d at 536. Some excuse, but not necessarily a good excuse, is enough to show lack of intentional disregard or conscious indifference. See Roberts, 988 S.W.2d at 403. "Conscious indifference requires more than mere negligence." Roberts, 988 S.W.2d at 403 (citing Smith v. Babcock & Wilcox Constr. Co., 913 S.W.2d 467, 468 (Tex.1995) and Horsley-Layman, 968 S.W.2d at 536).
Furthermore, under Craddock, a trial court must grant a motion for new trial if the plaintiffs evidence negating conscious indifference is uncontroverted. See Strackbein v. Prewitt, 671 S.W.2d 37, 38-39 (Tex.1984). Other appellate courts reviewing the denial of a subsection (g) motion have likewise held that if the plaintiffs evidence negating conscious indifference is uncontroverted, the trial court abuses its discretion by denying the motion. See Landry, 44 S.W.3d at 275; Tesch v. Stroud, 28 S.W.3d 782, 787 (Tex.App.—Corpus Christi 2000, pet. denied); Finley v. Steenkamp, 19 S.W.3d 533, 539 (Tex.App.—Fort Worth 2000, no pet.); Horsley-Layman, 968 S.W.2d at 536-37. We agree with our sister courts and conclude a plaintiff is entitled to a thirty-day grace period under subsection (g) when he presents uncontroverted evidence negating conscious indifference.
Here, the Whitworths contend the trial court abused its discretion in denying their motion for a grace period because they presented uncontroverted evidence that their failure to timely comply with the Act was not intentional or the result of conscious indifference, but rather was an accident or mistake. In their motion, the Whitworths explained that this case was the first time their attorney, Shain Chapman, had filed a report under the new law and their attorney believed that the report filed by their expert, Dr. Merrill Reuter, satisfied the requirements and the purpose of the new statute. The Whitworths attached the affidavit of their attorney to the motion. In his affidavit, Chapman stated that Dr. Reuter, a well-qualified expert, reviewed Debbie's medical records and concluded she had a valid malpractice claim. Reuter agreed to provide a preliminary report, but explained he would not testify against Dr. Blumenthal in the event of a trial because Dr. Blumenthal was an acquaintance with whom he had traveled and lectured. Chapman explained:
I filed Dr. Reuter's report as I felt that it met the requirements of the statute. I certainly felt that it satisfied the purpose of the statute as I understood it, namely to prevent the filing of frivolous malpractice actions. No defendant complained about the deficiency of this report or requested an additional or more detailed report. Hence, I felt the report was adequate and no one had a concern about it.
At the hearing on the motion to dismiss, Chapman reiterated that be believed the report complied with the statute. We conclude the Whitworths presented sufficient evidence to show that their failure to comply was not intentional or the result of conscious indifference, but was a mistake. See Gutierrez, 50 S.W.3d at 65-66 (evidence that attorney mistakenly believed report complied with Act sufficient to establish mistake such to negate con- seious indifference); Horsley-Layman, 968 S.W.2d at 536-37 (same); see also Bank One, Tex., N.A. v. Moody, 830 S.W.2d 81, 84 (Tex.1992) (mistake of law can qualify as mistake sufficient to negate conscious indifference under Craddock).
Blumenthal, however, asserts he controverted the Whitworths' evidence of mistake with evidence of (1) Reuter's refusal to testify at trial, and (2) the hospital's earlier successful challenge to the expert report, which showed the Whitworths knew the report did not qualify as an expert report. We disagree. First, the expert making the report is not required to testify at trial; thus, the fact Reuter would not testify against Blumenthal at trial is no evidence that the Whitworths knew the report was inadequate. Second, the hospital's motion challenging Reuter's report and the court's order sustaining that challenge both occurred well after the 180-day filing deadline. Thus, any notice provided by the hospital's challenge to the report is no evidence suggesting the Whit-worths' failure to comply within the deadline was intentional or the result of conscious indifference.
Because the Whitworths' evidence was sufficient to negate intentional disregard or conscious indifference and because Blu-menthal failed to controvert that evidence, we conclude the trial court abused its discretion by denying the Whitworths' motion requesting a thirty-day grace period under subsection (g). See McClure, 959 S.W.2d at 681. We reverse the trial court's order of dismissal and remand this cause for further proceedings consistent with this opinion.
LAGARDE, KINKEADE, WHITTINGTON, WRIGHT, BRIDGES, FRANCIS and ROSENBERG, JJ. join.
FITZGERALD, J., dissenting in which JAMES, J. joins.
MORRIS, J., concurring in which THOMAS, C.J. and KINKEADE, MOSELEY and MARTIN RICHTER, JJ. join.
. Although the trial court's order refers only to Blumenthal's motion to dismiss, the trial court implicitly denied the Whitworths' motion for additional time. In its findings of fact and conclusions of law, the trial court specifically found the Whitworths' failure to comply with section 13.01 was the result of conscious indifference, a finding only relevant to a request for additional time under subsection (g).
. The trial court's findings of fact do not contain a specific finding addressing the issue of "good faith effort." Neither party requested nor complained of the omitted finding to the trial court. Because the trial court may grant a motion to dismiss for failure to file an adequate report only if the trial court finds the report was not a good faith effort to comply with the statutory definition, we presume the trial court made the requisite finding in this case. See Tex.R. Civ. P. 299.
. Subsection (h) allows for an extension by agreement of the parties.
.From the supreme court's recitation of facts, it appears the plaintiffs may have already received a subsection (g) grace period before the hearing on the motion to dismiss. Specifically, the supreme court noted the trial court had granted the plaintiffs an extension of time to file their expert report. While the term extension more properly applies to subsection (f), the supreme court cited both subsection (f) and subsection (g) as authorizing the late filing of the report. If the plaintiffs had already received a grace period under subsection (g), they could not rely on subsection (g) to save their case. This is because subsection (g) only applies to a plaintiff's failure to comply with a subsection (d) deadline. While the subsection (d) deadlines include subsection (f) extensions, they do not include subsection (g) grace periods. Therefore, a plaintiff cannot obtain a subsection (g) grace period by showing his failure to comply with a previous grace period was due to accident or mistake. To the extent the dissent believes such a plaintiff could seek a grace period by again relying on their initial failure to file an expert report, we conclude such a plaintiff would be barred by the plain terms of the statute which allows a grace period of only thirty days.
. The dissent would hold that subsection (g) applies if no report is filed within the time to provide an expert report, but would not apply if any report is filed within the time to provide an expert report. We fail to see how this distinction comports with the dissent's interpretation of Palacios.
. The concurring opinion insightfully points out that because of the supreme court's narrow definition of "good faith" effort, an ab sence of good faith and a finding of accident or mistake are not mutually exclusive. Specifically, as noted by the concurrence, a determination of "good faith" is limited to a review of the four corners of the report, but a party may show accident or mistake with extrinsic evidence.