Court Opinion

ID: 9555508
Source: CourtListenerOpinion
Date Created: 2023-08-13 07:09:35.88976+00
Date Added: 2024-06-11T15:35:59.427160
License: Public Domain

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 EPLRMC, P.A.,
                           Appellees

                   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
Medical Center–Lakeway (the hospital) in Travis County with unexplained
weakness and tingling in his extremities. 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 symptoms. McVaney
was later diagnosed at another area medical facility with Guillain-Barré Syndrome
(GBS), a relatively rare neurological condition.

       In this appeal, we must determine whether the trial court erred in rendering
summary judgment on the ground that McVaney produced no evidence of the
causation required for his medical-malpractice claims against appellees the
hospital, Kirby Dale Reed, N.P., Kristie Lee Miller, M.D. and EPLRMC, P.A.
Concluding the trial court did not err, we affirm the judgment of the trial court. 1

                                    I.      BACKGROUND

       McVaney, now a 64-year-old man with a previously unremarkable medical
history, woke up with tingling in his extremities and weakness in his legs on the
morning of February 20, 2018. After his symptoms worsened through the morning,
McVaney’s wife drove him to the emergency department at the hospital around
11:30 a.m. The hospital’s medical records reflect that McVaney was able to walk
and stand without assistance at the time of his admission.

       Despite the fact no doctor ever spoke with or physically examined
McVaney, the hospital’s medical records recite the following diagnoses: “R53.1
Weakness; R20.2 Paresthesia of both hands; R20.2 Paresthesia of both feet; R42
Dizziness; and Z56.6 Work Stress.” McVaney’s condition continued to worsen
after his admission, and he became frustrated that the hospital’s staff had not
diagnosed or treated his condition. Nurse practitioner Kirby Dale Reed discussed
the possibility of sleep apnea, suggested a sleep study, as well as an MRI for
further diagnostics. McVaney requested a discharge five and a half hours after his

       1
          The Supreme Court of Texas ordered the Court of Appeals for the Third District of
Texas to transfer this appeal (No. 03-22-00132-CV) to this court. Misc. Docket No. 22-9025
(Tex. March 29, 2022); see Tex. Gov’t Code Ann. §§ 73.001, .002. Because of the transfer, we
decide the case in accordance with the precedent of the transferor court under principles of stare
decisis if our decision otherwise would have been inconsistent with the transferor court’s
precedent. See Tex. R. App. 41.3.

                                                2
admission in what McVaney described in his petition as a quadriplegic state, being
unable to walk or stand.

      McVaney’s wife contacted a friend who was married to Dr. Richard Van
Boven, a local neurologist unaffiliated with the hospital. Dr. Van Boven came to
McVaney’s home shortly after his discharge from the hospital, examined him,
suspected he had GBS, and called an ambulance. McVaney was then transported to
Seton Medical Center in Austin where he began receiving intravenous
immunoglobulin treatment after medical staff at Seton suspected that he was
suffering from GBS. Though the parties dispute the length of the delay in
treatment, it is undisputed that McVaney began receiving treatment for his GBS
less than 24 hours after the onset of his symptoms.

      GBS is an acute neurological condition that generally begins with symptoms
of numbness, tingling sensation in extremities, weakness, pain in the limbs or some
combination of these symptoms. See Nobuhiro Yuki, M.D. and Hans-Peter
Hartung, M.D., Guillain-Barré Syndrome, N. Eng. J. Med. 2012, 366:2295. 2 “The
main feature is progressive bilateral and relatively symmetric weakness of the
limbs, and the weakness progresses over a period of 12 hours to 28 days before a
plateau is reached.” Id. Unfortunately, the disease has a poor and often severe
prognosis:

      In the majority of patients, the Guillain–Barré syndrome continues to
      progress for up to 1 to 3 weeks after the onset of symptoms. Two
      thirds of patients are unable to walk independently when maximum
      weakness is reached. Respiratory insufficiency occurs in 25% of
      patients, and major complications, including pneumonia, sepsis,
      pulmonary embolism, and gastrointestinal bleeding, develop in 60%
      of intubated patients. Among severely affected patients, 20% remain

      2
         This article was relied on by McVaney’s expert, Dr. Van Boven and attached to the
expert report.

                                            3
       unable to walk 6 months after the onset of symptoms. The variations
       in the rate and extent of recovery in the Guillain–Barré syndrome
       make prognostication difficult.
Id. at 2296. Despite immunotherapy, “up to 20% of patients remain severely
disabled and approximately 5% die.” Id. at 2294.

       After his admission to Seton, McVaney continued to deteriorate reaching his
plateau some weeks later. Following his hospitalizations, McVaney experienced
some recovery and improvement. In 2021, McVaney gave his deposition and
testified he was then able to walk independently for short distances, walk with the
aid of a cane for longer distances, and drive a vehicle without modifications.
Though he returned to work part time, GBS has left him with physical limitations
and constant pain in his legs.

       In April 2019, McVaney filed a medical-malpractice claim subject to Civil
Practice and Remedies Code chapter 74 against the hospital, Kristie Lee Miller,
M.D., Kirby Dale Reed, N.P., and EPLRMC, P.A. 3 for failure to timely diagnose
his GBS and begin appropriate treatment. 4 McVaney’s petition states that this
failure to diagnose and treat led to an increased severity of his GBS and resulted in
“permanent paralysis resulting in permanent disability, disfigurement and
[e]conomic loss.” Kristie Lee Miller, M.D. was McVaney’s attending physician at
the hospital, who electronically signed his medical records. 5 Reed, a nurse

       3
           EPLRMC, P.A. is the professional association which employed Dr. Kristie Miller.
       4
          Tex. Civ. Prac. & Rem. Code Ann. §§ 74.001–.507 (popularly known as Texas Medical
Liability Act (TMLA)).
       5
         Dr. Miller, the attending physician, electronically signed McVaney’s medical records
agreeing to the following statement: “I have seen and examined the above patient.” Although not
pertinent to the causation issue before us, this attestation was investigated by the Texas
Department of State Health Services (DSHS) after Dr. Van Boven lodged a complaint on behalf
of McVaney because Dr. Miller allegedly never physically examined McVaney or spoke with
him.

                                                4
practitioner at the hospital, also signed McVaney’s medical records and agreed to
McVaney’s treatment plan. McVaney subsequently amended his petition to add
claims against all defendants for violations of the Emergency Medical Treatment &
Labor Act, a federal statute. See 42 U.S.C. § 1395dd(a).6

       In 2021, the defendants collectively filed a traditional and no-evidence
motion for summary judgment on the issue of causation. McVaney, in response,
argued that his neurology expert Dr. Van Boven established that defendants’
violations of the standard of care proximately caused the increased severity of his
GBS. After hearing the summary-judgment motions, the trial court granted the
defendants’ no-evidence motion as to McVaney’s claims against the defendants.
McVaney now appeals from the final judgment of the trial court. 7

                                       II.    ANALYSIS

       On appeal, McVaney argues that the trial court erred in rendering summary
judgment because reasonable minds could differ as to whether immunotherapy
treatment earlier in the day would have slowed the progression of his disease.
Therefore, he asserts a fact issue precluded summary judgment.

       6
          Popularly known as the Emergency Medical Treatment and Labor Act (EMTALA). In
his petition, McVaney incorrectly cites to 42 U.S.C. §19395dd(a).
       7
         The final judgment of the trial court contains the following unequivocal “finality”
language:
               [T]he Defendants’ No-Evidence Motion for Summary Judgment should be
       GRANTED as to all claims and causes of action by Plaintiff against the
       Defendants and that said claims and causes of action pled against the Defendants
       are hereby DISMISSED WITH PREJUDICE. IT IS FURTHER ORDERED,
       ADJUDGED AND DECREED by the Court that Plaintiff take nothing by this suit
       for his claims and causes of action against the Defendants.
See Lehmann v. Har-Con Corp., 39 S.W.3d 191, 192–93, 200 (Tex. 2001) (“[A] judgment issued
without a conventional trial is final for purposes of appeal if and only if either it actually
disposes of all claims and parties then before the court, regardless of its language, or it states
with unmistakable clarity that it is a final judgment as to all claims and all parties[.]”).

                                                5
A.    Applicable law

      To prevail on a claim for medical negligence, a plaintiff is required to prove
“(1) a duty by the healthcare provider to act according to a certain standard, (2) a
breach of the applicable standard of care, (3) an injury, and (4) a sufficient causal
connection between the breach of care and the 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 also Windrum v. Kareh, 581 S.W.3d 761,
768 (Tex. 2019) (“To prevail in a wrongful-death suit alleging medical
malpractice, a plaintiff must establish the elements of negligence.”).

      A claimant bringing a medical-negligence claim must serve each defendant
against whom a liability claim is asserted with one or more expert reports. See Tex.
Civ. Prac. & Rem. Code § 74.351(a). The expert must explain the basis of his
statements to link his conclusions to the facts. See Columbia Valley Healthcare
Sys., L.P. v. Zamarripa, 526 S.W.3d 453, 460 (Tex. 2017); HMIH Cedar Crest,
LLC v. Buentello, No. 03-20-00377-CV, 2022 WL 627226, 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 judgment motion, the trial court granted only the no-evidence motion.
Therefore, we consider only the standards applicable to no-evidence motions.

      A no-evidence summary judgment is essentially a pretrial directed verdict,
and we apply the same legal sufficiency standard in reviewing a no-evidence
summary judgment as we apply in reviewing a directed verdict. King Ranch, Inc. v.
Chapman, 118 S.W.3d 742, 750–51 (Tex. 2003). “After adequate time for
discovery, a party without presenting summary judgment evidence may move for

                                          6
summary judgment on the ground that there is no evidence of one or more essential
elements of a claim or defense on which the [nonmovant] would have the burden
of proof at trial.” Tex. R. Civ. P. 166a(i). Once the motion is filed, the burden
shifts to the nonmovant to produce summary-judgment evidence raising a genuine
issue of material fact on the challenged element. See B.C. v. Steak N Shake
Operations, Inc., 598 S.W.3d 256, 259 (Tex. 2020). A trial court properly grants a
no-evidence summary-judgment motion if the nonmovant produces no more than a
scintilla of probative evidence—that is, if the nonmovant’s evidence does not rise
to a level that would enable reasonable and fair-minded people to differ in their
conclusions. Dallas Morning News, Inc. v. Tatum, 554 S.W.3d 614, 625 (Tex.
2018).

C.    The expert report

      Plaintiff produced an expert report from Dr. Van Boven, dated March 27,
2019, describing how defendants deviated from the appropriate standard of care by
not properly screening and examining McVaney. These failures resulted in the
hospital’s failure to appropriately diagnose McVaney and provide the necessary
and standard treatment for GBS. Dr. Van Boven opined that these violations in the
standard of care had a “significant deleterious effect [on] the patient’s long-term
outcome.”

      Specifically addressing causation, Dr. Van Boven explains that the hospital
greatly increased McVaney’s chances for a poor outcome by delaying the
administration of immunotherapy:

      Weakness at hospital admission has been recently found to be a main
      predictor of long-term outcomes in patients with GBS. In the largest
      study of its kind of prognostic indicators, nearly 400 patients with
      GBS followed prospectively, Walgaard et al. found that weakness at
      hospital admission, as measured and quantified by the Medical

                                        7
       Research Council (“MRC”) sumscore, is a major predictor of poor
       prognosis, i.e. being unable to walk independently, at 4 weeks and 6
       months, the latter being a time-frame wherein a plateau in recovery
       may reasonably be expected.
       These data are of relevance to the case of Mr. McVaney. His risk of
       poor outcome was predicted to have more than doubled by the delay
       in treatment caused by [the hospital’s] violations in the standard of
       care. Comparison of his MRC sumscore at initial hospital presentation
       at Baylor Scott & White-Lakeway versus his sumscore upon
       admission at Seton Main not only boded poorly, but has been brought
       to fruition.
       More than one year after the delayed diagnosis and delayed treatment
       of GBS, Mr. McVaney remains wheel-chair or walker dependent. The
       consequences of failure to timely treat GBS parallels the sequela of
       failure to treat other acute, monophasic attacks, e.g. stroke, traumatic
       brain injury, or heart attacks. []
       Based on these and previous studies, I maintain that the delay in acute
       treatment (IV Immunoglobulin) for GBS resultant from Defendants’
       breaches in the standards of care contributed significantly and
       negatively to Mr. McVaney’s long-term outcome.8

       In his report, Dr. Van Boven cites three medical journal articles, two of
which were included with his expert report. Although Dr. Van Boven
supplemented his expert report, his opinion on causation and the basis for his
opinion remained unchanged.

D.     The trial court’s judgment

       The defendants’ summary-judgment motion discusses the standards for
admissibility of evidence under Rule 702 and asks the trial court to exclude Dr.
Van Boven’s opinion because his opinions are not reliable and inadmissible for
establishing causation.9 The defendants also filed, on the same day, a

       8
           The footnotes in Dr. Van Boven’s report have been omitted.
       9
        The record before this court does not reflect that any Daubert/Robinson motions to
exclude were filed or considered by the trial court. See E.I. du Pont de Nemours & Co., Inc. v.
                                                8
Daubert/Robinson motion to exclude the opinion of Dr. Van Boven. See E.I. du
Pont de Nemours & Co., Inc. v. Robinson, 923 S.W.2d 549, 558 (Tex. 1995) (trial
court determines whether expert’s opinion is based on reliable methods and
research).

       The trial court reviewed Dr. Van Boven’s opinions by performing its own
analysis of the medical literature relied on by Dr. Van Boven.10, 11 Ultimately, the
trial court concluded that McVaney did not provide evidence that the delay in
treatment contributed to his injuries. Although the trial court’s judgment appears to
encompass both a summary-judgment analysis as well as a Rule 702 analysis, the
trial court never made a ruling in the record excluding or striking the opinions of
Dr. Van Boven.

       This court has previously concluded that a similar ruling from a trial court
constituted an implied ruling. See Praytor v. Ford Motor Co., 97 S.W.3d 237, 242
(Tex. App.—Houston [14th Dist.] 2002, no pet.) (“The trial court, in holding that
[plaintiff] had failed to present ‘legally competent evidence,’ effectively concluded
that the expert 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 offered by the nonmovant to prove an essential element of the
claim cannot be given weight by the court. See Jacob v. Int’l Cellulose Corp., Inc.,

Robinson, 923 S.W.2d 549, 558 (Tex. 1995) (trial court determines whether expert’s opinion is
based on reliable methods and research).
       10
           While judges act as gatekeepers in determining the admissibility of evidence, judges
are not scientists or doctors and do not decide whether an opinion is correct. See Gammill v. Jack
Williams Chevrolet, Inc., 972 S.W.2d 713, 728 (Tex. 1998) (“The trial court is not to determine
whether an expert’s conclusions are correct, but only whether the analysis used to reach them is
reliable.”).
       11
          The trial court’s final judgment is six pages long and is in effect a four-page opinion
combined with a two-page judgment. For purposes of our review, we only consider the portion
of the writing that constitutes the judgment.

                                                9
No. 03-06-00210-CV, 2007 WL 1237963, at *4 (Tex. App.—Austin Apr. 27,
2007, no pet.) (citing with approval Praytor, 97 S.W.3d at 240).

      Here, the evidence supporting McVaney’s causation argument was an
affidavit from Dr. Van Boven and Dr. Van Boven’s expert report. Given that the
trial court concluded that it had not been provided with sufficient evidence that any
delay in treatment contributed to McVaney’s injuries, the trial court effectively
addressed the competency of the expert opinions.

E.    Causation
      Proximate cause is an essential element of a medical-negligence claim and
consists of (1) cause in fact and (2) foreseeability. Windrum, 581 S.W.3d at 777
(citing Bustamante v. Ponte, 529 S.W.3d 447, 456 (Tex. 2017)). Foreseeability
requires only that the defendants should have anticipated that their negligent acts
or omissions would create danger or harm for others; it does not require the
defendants to have actually anticipated the precise manner in which the injury
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 preponderance of the
evidence that the defendant’s negligent conduct “was a substantial factor in
bringing about the injuries, and without it, the harm would not have occurred.”
Bustamante, 529 S.W.3d at 456 (citation omitted). Consequently, the plaintiff must
“adduce evidence of a ‘reasonable medical probability’ or ‘reasonable
probability’” that the defendant’s negligence caused the plaintiff’s injury—that is,
it must be “‘more likely than not’ that the ultimate harm or condition resulted from
such negligence.” Id. (quoting Jelinek v. Casas, 328 S.W.3d 526. 532–33 (Tex.
2010)).

      The progression and treatment of GBS is not within the common knowledge
and experience of jurors, and therefore requires expert testimony to establish

                                         10
causation. See JLG Trucking, LLC v. Garza, 466 S.W.3d 157, 162 (Tex. 2015). “A
conclusory statement of causation is inadequate; instead, the expert must explain
the basis of his statements and link conclusions to specific facts.” Abshire v.
Christus Health Se. Tex., 563 S.W.3d 219, 224 (Tex. 2018). In addition, “when the
facts support several possible conclusions, only some of which establish that the
defendant’s negligence caused the plaintiff’s injury, the expert must explain to the
fact finder why those conclusions are superior based on verifiable medical
evidence, not simply the expert’s opinion.” Jelinek, 328 S.W.3d at 536.

      The specific causation question in this case is whether the delay in
immunotherapy treatment due to defendants’ failure to diagnose McVaney’s GBS
while he was at the hospital caused McVaney’s GBS to progress faster and/or with
more severity than it would have with more rapid treatment.

F.    Did the trial court err?
      1. Arguments of the parties

      In their no-evidence motion, the defendants argued that Dr. Van Boven’s
opinions “provide no evidence which establishes proximate cause between any
alleged negligence attributable to Defendants and the injuries sustained by Plaintiff
and or the compensable damages sought by the Plaintiff.” They also highlight that
Dr. Van Boven never discussed or explained the medical literature on which he
relied. Then analyzing the medical literature on which Dr. Van Boven specifically
bases his opinion, defendants conclude that Dr. Van Boven’s opinion is not reliable
because the medical literature does not support or corroborate his opinion.

      In response, McVaney argued that Dr. Van Boven’s opinion was reliable and
was based on peer-reviewed medical literature. McVaney countered defendants’
argument that the medical literature did not support Dr. Van Boven’s opinion and
asserted that it “is naive to assert/assume that because there is not a study showing
                                         11
the results of treatment delay at exact particular points in time there is no evidence
of causation when clearly there is evidence that immediate treatment prior to
deterioration nearly doubled the improved prognosis.”

       2. Dr. Van Boven’s opinions

       Dr. Van Boven’s report extensively addresses the hospital’s breach of the
standard of care, which was not challenged by the hospital on summary judgment.
With respect to causation, Dr. Van Boven ultimately concludes in his report that
“the delay in acute treatment (IV Immunoglobulin) for GBS resultant from
Defendants’ breaches in the standards of care contributed significantly and
negatively to Mr. McVaney’s long-term outcome.” However, an expert 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 causation discussion by stating that weakness at
hospital admission, “as measured and quantified by the Medical Research Council
(“MRC”) sumscore,” is found to be a main predictor of poor prognosis.12 Dr. Van
Boven never provided McVaney’s sumscore at the time of his admission to the
hospital, nor does he discuss McVaney’s sumscore at any later point in time. Dr.
Van Boven’s expert report offers no insight into how a sumscore is calculated or
whether or when it was calculated for McVaney. It is also unknown whether
McVaney’s sumscore was calculated by his medical providers and contained
within his medical records or whether it is a measure calculated after the fact.

       In his affidavit, Dr. Van Boven quantifies the delay in treatment as “nearly
12 hours delay.” But, despite this case turning on a delay in medical treatment, Dr.

       12
         The quote is attributed to a Dutch study heavily relied on by Dr. Van Boven. See C.
Walgaard, H.F. Lingsma, L. Ruts, P.A. van Doorn, E.W. Steyerberg & B.C. Jacobs, Early
Recognition of Poor Prognosis In Guillain-Barré Syndrome, NEUROLOGY, 76:968-975 (2011).

                                            12
Van Boven offered no opinion or discussion regarding the appropriate window of
opportunity for treatment, consistent with the standard of care, in which GBS
should have been diagnosed to avoid more serious illness. Instead, Dr. Van Boven
cited to a study that followed 400 patients with GBS and concluded that weakness
at hospital admission is a major predictor of poor prognosis. It is undisputed that
when McVaney presented to the hospital he was already experiencing weakness,
difficulty walking, and tingling in his extremities. Although the record makes clear
that McVaney’s condition worsened throughout the day, Dr. Van Boven’s report
and affidavit do not discuss whether the research on which he relies establish the
consequences of a delay in treatment. Rather, his conclusions assume without
explanation that the research in the Walgaard study is applicable to the causation
issue before us. 13

       Although Dr. Van Boven attached the journal articles on which he relies to
his report, Dr. Van Boven does not explain or discuss how he used the research to
reach his ultimate conclusion. Without delving into the substance of the underlying
medical literature on which he relies, the factfinder is left with only Dr. Van
Boven’s ultimate conclusions.

       3. Dr. Van Boven’s conclusory statements are not evidence of causation

       To support a claim that a delayed diagnosis allowed the patient’s medical
condition to worsen or disease to progress, an expert must explain how and why
the facts support this conclusion. For example, in Naderi v. Ratnarajah, a dentist
failed to diagnose and treat an infected tooth abscess, causing the patient to lose
part of his lower jaw. 572 S.W.3d 773, 776 (Tex. App.—Houston [14th Dist.]
2019, no pet.). The expert explained that the abscess was “clearly visible” on a

       13
          Dr. Van Boven’s expert report expressly states that his causation opinion is “[b]ased on
these and previous studies.”

                                               13
radiograph taken at the initial visit, and that the radiograph showed the infection
from the tooth spreading into the surrounding bone, but the dentist did not extract
the tooth or prescribe antibiotics. Id. at 775, 776–77. Seven months later, the
patient additionally suffered from swelling and inflammation inside his mouth, and
still the dentist took no action. Id. at 775–76. The expert in Naderi supported his
causation opinion by describing how medical records documented the appearance
of additional symptoms over time.

       By contrast, in Baylor College of Medicine v. Davies, a gynecologist failed
to diagnose and begin treatment for ovarian cancer, which the plaintiff claimed led
to significant progression of the cancer resulting in a worse prognosis and reduced
life expectancy. 599 S.W.3d 323, 326–27 (Tex. App.—Houston [14th Dist.] 2020,
no pet.). However, the initial finding in the laboratory report stated that the
plaintiff might have a tumor but did not reflect the stage of the tumor. Id. at 330.
The plaintiff’s expert concluded the tumor, at the time of the first pathology report
was a stage 1 tumor, but offered no explanation of how he reached that conclusion
based on the information in the pathology report. Id. For these reasons, we held
that the plaintiff’s expert report was conclusory because it was only supported by
ipse dixit. Id. at 326.

       McVaney cites the supreme court’s opinion in Bustamante v. Ponte as
instructive and controlling because it involved the question of whether an expert’s
reliance on a specific medical study could be used to determine whether a delay in
treatment of a retinal disorder caused an infant’s loss of vision. Bustamante, 529
S.W.3d at 462. McVaney primarily relies on the Bustamante case to rebut the
defendants’ argument that the underlying medical studies do not support Dr. Van
Boven’s opinion (i.e., an “analytical gap”). However, the court’s analysis of the
medical study in Bustamante is not instructive to the question we must answer in

                                         14
this appeal. While the parties in Bustamante argued over the applicability of a
certain study to the situation of the infant injured in that case, the causation experts
in Bustamante relied on multiple studies, and “offered the bases for their
opinions.” Id. at 459–60, 462. We agree with McVaney that the law does not
require Dr. Van Boven to rely on more than one study to establish the reliability of
his opinions. We also agree with McVaney that the law does not require that the
study relied on by Dr. Van Boven align perfectly with the factual or medical
situation at issue in the case. But the law does require Dr. Van Boven to give the
bases for his opinion and explain his opinion. See Bustamante, 529 S.W.3d at 462
(opinion is conclusory if stated basis for opinion provides no support); Cooper Tire
& Rubber Co. v. Mendez, 204 S.W.3d 797, 806 (Tex. 2006) (expert opinion is
“fundamentally unsupported” when only link between expert’s conclusion and
underlying facts is expert’s “own say-so”).

      Opinion testimony that is conclusory or speculative is not relevant evidence,
because it does not tend to make the existence of a material fact “more or less
probable.” See Tex. R. Evid. 401. It may be, as McVaney argues in his appellate
brief, that Dr. Van Boven “logically deduced” his opinion from the findings of the
Walgaard study. But because Dr. Van Boven never explained how he logically
deduced his opinion nor did he link his opinion to specific facts, his opinions in
this case are not competent evidence. See Abshire, 563 S.W.3d at 224; Coastal
Transp. Co. v. Crown Central Petrol. Corp., 136 S.W.3d 227, 232 (Tex. 2004)
(citations omitted).

      We therefore conclude the trial court did not err in granting the defendants’
no-evidence summary judgment motion and overrule McVaney’s sole issue on
appeal.

                                          15
                               III.   CONCLUSION

      We affirm the judgment of the trial court as challenged on appeal.

                                      /s/    Charles A. Spain
                                             Justice

Panel consists of Chief Justice Christopher and Justices Jewell and Spain.

                                        16