Court Opinion

ID: 9376961
Source: CourtListenerOpinion
Date Created: 2023-03-06 15:07:09.498416+00
Date Added: 2024-06-11T17:17:10.728626
License: Public Domain

Opinion issued February 28, 2023

                                     In The

                              Court of Appeals
                                     For The

                          First District of Texas
                            ————————————
                              NO. 01-21-00484-CV
                           ———————————
                        MARY LOU LARA, Appellant
                                        V.
                             JIMMY BUI, Appellee

                   On Appeal from the 234th District Court
                            Harris County, Texas
                      Trial Court Case No. 2018-14386

                         MEMORANDUM OPINION

      This is a personal injury case stemming from an automobile accident.

Appellant Mary Lou Lara challenges the trial court’s judgment rendered on the

jury’s verdict in favor of appellee Jimmy Bui on his negligence claim against Lara.

In one issue, Lara contends the evidence is legally and factually insufficient to
support the jury’s awards of $20,973.00 for past medical care expenses and

$150,000.00 for future medical care expenses because Bui did not provide any expert

testimony that the automobile accident caused his complained-of injuries. We affirm

in part, reverse and render in part, and reverse and remand in part.

                                    Background

      Lara and Bui were involved in a motor vehicle accident in Houston. In March

2018, Bui sued Lara alleging that Lara’s negligence caused his medical injuries. The

case proceeded to a jury trial. Three witnesses testified: Bui, Lara, and Dr. Alj

Florence Sparrow. The parties presented the following evidence at trial.

      On the morning of September 2, 2016, at approximately 7:30 a.m., Bui was

driving northbound on Almeda Genoa Road and Lara was driving southbound on

the same road. Lara entered a cut-through to make a U-turn on the northbound side

of Almeda Genoa. As she proceeded into the right lane of the northbound side,

Lara’s vehicle collided with Bui’s vehicle. Bui’s airbag deployed, and both vehicles

were towed from the scene. The police arrived at the scene and completed a crash

report. Neither Bui nor Lara sought emergency care or other medical treatment

immediately following the accident.

                                          2
      At trial, Bui testified that he did not have any broken bones, internal bleeding,

or life-threatening injuries as a result of the accident.1 Bui testified that he did not

feel immediate pain but that “over time it did build up to the point that I was

experiencing pain on my back and my hand.” Four days after the accident, Bui was

seen by Nancy Huynh, a chiropractor, for pain in his back, neck, and wrist. Huynh

sent Bui for X-rays and a MRI of his lumbar spine which revealed two herniated

discs. Bui received twenty sessions of chiropractic treatment over the next two

months. At his last visit on November 1, 2016, Huynh released Bui, recommended

that he continue therapeutic exercises and stretching at home, and advised him to see

a specialist “due to un-resolving pain and to return if medically necessary.” In her

chart notes, Huynh wrote “[d]ue to clinical exams and diagnostic studies, it is my

personal opinioned [sic] that Mr. Bui[’s] injuries was the direct cause of the accident

sustained on 9/2/2016.” Huynh noted Bui’s final diagnosis as cervicalgia, thoracic

pain, lumbalgia, fatigue, muscle spasms, hand or wrist pain, and lumbar disc

disorder.

      After experiencing increasing pain in his back, Bui returned to see Huynh

seven months later, on June 6, 2017. In her notes, Huynh stated: “Patient reported

he returned to therapy due to discomfort and achy pain along both sides of the mid

1
      Bui testified that he was a passenger in a motor vehicle accident in 2011. He testified
      that he experienced neck pain after the accident for which he sought chiropractic
      care.
                                             3
back region. [He] mentioned when sitting down in class, he has achy pain in the low

back with shooting sensation up the mid back region.” Under plan/treatment, Huynh

stated: “Patient was advised to get the MRI Thoracic Spine as recommended by the

Pain Management Specialist [Dr. Alj Sparrow] and continue care with the

specialist.” On June 20, Bui had an MRI of his thoracic spine which revealed “no

evidence of disc protrusions/herniations.”

      On July 12, Bui was seen again by Dr. Sparrow. Dr. Sparrow noted:

      Unfortunately, Mr. Bui continues to complain of low back pain
      radiating to mid back. The patient is status post MRI of the thoracic
      spine which revealed no disc herniation. The patient is status post MRI
      of the lumbar spine performed on 10/04/2016 which revealed at L4-5 a
      protrusion-subligamentous disc herniation extending into the epidural
      fat and indenting the thecal sac. At L5-S1 there is an acute/subacute
      protrusion-subligamentous disc herniation extending into the epidural
      fat and indenting the thecal sac. Based on history, MRI report and
      physical exam and the continued complaints of pain and radiculopathy
      symptoms by Mr. Bui, I believe he can benefit from a Lumbar Epidural
      Steroid Injection at L4-5, at this level for a series of three injections.

      Bui ultimately received two epidural steroid injections (ESI). At Bui’s last

visit on October 17, 2017, Dr. Sparrow noted, “Fortunately, Mr. Bui states that his

low back pain has been reduced status post a lumbar ESI performed on 09/26/2017.

I believe he can benefit from home exercise and stretching program as well as follow

up with Dr. Nancy Huynh and continued physical therapy is also recommended.”

      At trial, Dr. Sparrow testified that she reviewed some of Bui’s medical records

and his MRI reports and that, based on her review, she believed that ESIs were the

                                          4
best option for treating Bui’s back pain and that they were medically necessary. She

testified that the two ESIs Bui had received temporarily alleviated his pain but that

the ESIs were not a permanent solution for herniated disks. Regarding future medical

treatment, Dr. Sparrow testified:

      COUNSEL:            Okay. How many do you anticipate, based upon
                          your review of his records, your review of how he
                          did with the MRI, and how he did with ESI
                          injections he received, what is your professional
                          medical opinion as to how many ESI injections he
                          is going to need and for how long?

      DR. SPARROW: He could possibly need one to three injections per
                   year if his pain comes back and is increased. And it
                   could be -- it could be for -- until he’s 60, 70.

Medical records admitted into evidence showed that the two ESIs Bui received cost

a total of $20,973.00.

      After both sides rested, Lara moved to exclude future medical care expenses

from the jury charge on the grounds that Dr. Sparrow did not testify that the expenses

for future medical care were reasonable to a degree of medical certainty or

probability or that Bui’s alleged need for future medical care was caused by the

accident. The trial court denied the motion.

      The jury returned a verdict in favor of Bui on his negligence claim and

awarded him the following damages: (1) $36,488.00 in past medical care expenses,2

2
      The bills for Bui’s past medical expenses admitted into evidence included the
      following: 1st Choice Accident & Injury in the amount of $5,990.00; Healthplus
                                          5
(2) $150,000.00 in future medical care expenses, and (3) $13,512.00 in future

physical impairment. The trial court entered final judgment based on the jury’s

verdict on June 8, 2021.

      Lara moved for judgment notwithstanding the verdict requesting that the trial

court set aside the jury’s verdict regarding some of Bui’s past medical care expenses

and all his future medical care expenses because Bui produced insufficient evidence

at trial to support those damages. Specifically, she argued there was no evidence to

support the jury’s finding of $150,000.00 in future medical care expenses because

Bui’s expert, Dr. Sparrow, never testified that the future medical care she

recommended was required as a result of the motor vehicle accident. She further

argued that Dr. Sparrow’s testimony regarding past medical care treatment at

Complete Pain Solutions and the future medical care treatment she recommended

was conclusory, and that such conclusory testimony cannot support a judgment. The

trial court denied Lara’s motion. This appeal followed.

                                    Discussion

      Lara contends that the evidence is legally and factually insufficient to support

the jury’s award of $20,973.00 for past medical care expenses for treatment at

Complete Pain Solutions and its award of $150,000.00 for future medical care

      Imaging in the amount of $1,100.00; ProHealth Medicine in the amount of $550.00;
      Memorial MRI & Diagnostic, LLC in the amount of $7,875.00; and Complete Pain
      Solutions in the amount of $20,973.00.
                                          6
expenses because Bui did not provide any expert testimony that the motor vehicle

accident caused his complained-of back injuries.3 In response, Bui asserts that Lara

failed to preserve her challenge to the factual sufficiency of the evidence supporting

the jury’s findings because she failed to move for a new trial. He further argues that

the evidence is sufficient to support the jury’s findings that Lara caused the accident

resulting in his injuries for which he required past medical care and which would

require future medical treatment.

A.    Standard of Review

      In conducting a legal sufficiency review, “we must consider evidence

favorable to the finding if the factfinder could reasonably do so and disregard

evidence contrary to the finding unless a reasonable factfinder could not.” Shields

Ltd. P’ship v. Bradberry, 526 S.W.3d 471, 480 (Tex. 2017). We then consider the

evidence in the light most favorable to the challenged findings and indulge every

reasonable inference that supports the findings. George Joseph Assets, LLC v.

Chenevert, 557 S.W.3d 755, 765 (Tex. App.—Houston [14th Dist.] 2018, pet.

denied). When an appellant attacks a finding on an issue on which she did not have

the burden of proof, the appellant must demonstrate that no evidence supports the

adverse finding. Id. Evidence is legally insufficient to support a jury finding when

3
      On appeal, Lara does not challenge the remainder of the award for past medical care
      expenses totaling $15,515.00 or the award of $13,512.00 for future physical
      impairment.
                                           7
(1) the record bears no evidence of a vital fact; (2) the court is barred by rules of law

or of evidence from giving weight to the only evidence offered to prove a vital fact;

(3) the evidence offered to prove a vital fact is no more than a mere scintilla; or (4)

the evidence conclusively establishes the opposite of a vital fact. Shields Ltd. P’ship,

526 S.W.3d at 480.

      A party attacking the factual sufficiency of an adverse finding on an issue on

which she had the burden of proof must demonstrate on appeal that the adverse

finding is so against the great weight and preponderance of the evidence that the

judgment should be set aside. Dow Chem. Co. v. Francis, 46 S.W.3d 237, 242 (Tex.

2001). A verdict can be set aside “only if the evidence is so weak or if the finding is

so against the great weight and preponderance of the evidence that it is clearly wrong

and unjust.” Id.

B.    Factual Sufficiency Challenge

      As a preliminary matter, we address Bui’s assertion that Lara waived her

challenge to the factual sufficiency of the evidence to support the jury’s findings.

      Texas Rule of Civil Procedure 324 requires a party to move for a new trial

before it may complain on appeal about the factual sufficiency of the evidence

supporting a jury verdict. See TEX. R. CIV. P. 324(b)(2); J.M. Krupar Constr. Co. v.

Rosenberg, 95 S.W.3d 322, 336 (Tex. App.—Houston [1st Dist.] 2002, no pet.).

Here, Lara did not move for a new trial but rather moved only for a judgment

                                           8
notwithstanding the verdict asking that the trial court set aside the verdict and

“render judgment.” Because Lara did not file a motion for new trial, we cannot

consider her complaint on appeal that the evidence was factually insufficient to

support the jury’s findings. See J.M Krupar Constr., 95 S.W.3d at 336; see also TEX.

R. APP. P. 33.1(a).

C.    Legal Sufficiency Challenge

      Lara contends that there is legally insufficient evidence to support the jury’s

verdict. Specifically, she argues that there is no evidence to support the jury’s award

of $20,973.00 in past medical care expenses for treatment at Complete Pain

Solutions or its award of $150,000.00 for future medical care expenses because Bui

did not provide any expert testimony that his back injuries were caused by the

accident. Bui responds that Dr. Sparrow was not required to testify explicitly about

causation because Bui’s testimony and the medical records on which Dr. Sparrow

relied established a strong, logically traceable connection between the accident, the

back pain, and the ESI treatment.

      1. Applicable Law

      To prevail on a negligence cause of action, Bui must establish the existence

of a duty, a breach of that duty, and damages proximately caused by the breach. W.

Invs., Inc. v. Urena, 162 S.W.3d 547, 550 (Tex. 2005). “Establishing causation in a

personal injury case requires a plaintiff to ‘prove that the conduct of the defendant

                                          9
caused an event and that this event caused the plaintiff to suffer compensable

injuries.’” JLG Trucking, LLC v. Garza, 466 S.W.3d 157, 162 (Tex. 2015) (quoting

Burroughs Wellcome Co. v. Crye, 907 S.W.2d 497, 499 (Tex. 1995)). In a typical

negligence case, “the plaintiff must establish two causal nexuses: (1) between the

defendant’s negligent act and the occurrence; and (2) between the occurrence and

the injuries of which the plaintiff complains.” Otis Spunkmeyer, Inc. v. Blakely, 30

S.W.3d 678, 684 (Tex. App.—Dallas 2000, no pet.) (citing Morgan v.

Compugraphic Corp., 675 S.W.2d 729, 731 (Tex. 1984)). Specifically, “when an

accident victim seeks to recover medical expenses, he must show ‘what all the

conditions were’ that generated the expenses and ‘that all the conditions were caused

by the accident.’” JLG Trucking, 446 S.W.3d at 162 (quoting Guevara v. Ferrer,

247 S.W.3d 662, 669 (Tex. 2007)).

      Expert testimony is generally necessary to establish causation of medical

conditions outside the common knowledge and experience of lay persons. See

Guevara, 247 S.W.3d at 665. In limited cases, however, lay testimony may support

a causation finding that links an event with a person’s physical condition. Id. at 666.

“This exception applies only in those cases in which general experience and common

sense enable a layperson to determine the causal relationship with reasonable

probability.” Kelley v. Aldine Indep. Sch. Dist., No. 14-15-00899-CV, 2017 WL

421980, at *2 (Tex. App.—Houston [14th Dist.] Jan. 31, 2017, pet. denied) (mem.

                                          10
op.) (citing Guevara, 247 S.W.3d at 666; Morgan, 675 S.W.2d at 733). In such cases,

“lay testimony establishing a sequence of events which provides a strong, logically

traceable connection between the event and the condition is sufficient proof of

causation.” Id. (quoting Morgan, 675 S.W.2d at 733).

2.    No Expert Testimony Regarding Causation

      Lara argues that Bui’s complained-of injuries required expert witness

testimony to establish causation. She asserts that his diagnoses of cervicalgia,

lumbalgia, lumbar radiculopathy, and two herniated discs are not the type of basic

injuries identified in Guevara for which expert testimony regarding the causal

connection between an occurrence and a physical condition is unnecessary. She

argues that because Bui did not provide expert testimony of causation, he cannot

recover for medical expenses for treatment of these diagnosed injuries.

      The Fourteenth Court of Appeals’ decision in Hills v. Donis, No. 14-18-

00566-CV, 2021 WL 507306 (Tex. App.—Houston [14th Dist.] Feb. 11, 2021, pet.

denied) (mem. op.) and our decision in Sanchez v. Leija, No. 01-19-00165-CV, 2020

WL 7349094 (Tex. App.—Houston [1st Dist.] Dec. 15, 2020, no pet.) (mem. op.)

are instructive. In Hills, the plaintiffs sued the defendant following an automobile

accident alleging that her negligence caused the accident and their soft-tissue

injuries. See Hills, 2021 WL 507306, at *1. Medical bills admitted into evidence for

three of the five plaintiffs included diagnoses of cervical radiculitis, lumbar

                                        11
radiculitis, thoracalgia, cervical intervertebral disc (IVD) displacement without

myelopathy, lumbar IVD displacement without myelopathy, thoracic IVD

displacement without myelopathy, cervical discogenic pain, lumbar discogenic pain,

disc herniation, cervical disc disorder, thoracic disc disorder, and lumbar disc

disorder. See id.

       Noting that “[e]xpert testimony is generally necessary to establish causation

of medical conditions that are ‘outside the common knowledge and experience of

jurors,’” the court stated that the types of injuries for which the three plaintiffs sought

compensation—i.e., cervical IVD displacement, lumbar IVD displacement, thoracic

IVD displacement, cervical discogenic pain, lumbar discogenic pain, disc herniation,

cervical disc disorder, lumbar disc disorder, thoracic disc disorder, cervical

radiculitis, lumbar radiculitis, thoracalgia, and lumbalgia—were neither common

nor basic. See id. at *4. Thus, the court concluded, the plaintiffs’ claims did not fall

within the kinds of “basic” injuries identified in Guevara for which expert testimony

regarding the causal connection between an occurrence and a physical condition is

unnecessary. Id. (citing Guevara, 247 S.W.3d at 667).4

4
       In Guevara, the Texas Supreme Court explained that “if [the injured motorist] had
       been pulled from a damaged automobile with overt injuries such as broken bones or
       lacerations, and undisputed evidence which reasonable jurors could not disbelieve
       showed that he did not have such injuries before the accident, then the physical
       conditions and causal relationship between the accident and the conditions would
       ordinarily be within the general experience and common knowledge of laypersons.”
       Guevara v. Ferrer, 247 S.W.3d 662, 667 (Tex. 2007).
                                            12
      Bui argues that while Hills is instructive it is nevertheless distinguishable for

several reasons. He notes that, in Hills, one car was totaled, one car “sustained

substantial damage,” and the third car suffered “minimal damage” so that the driver

was able to drive the vehicle home with three passengers and himself. Here, in

contrast, both Bui’s car and Lara’s car were towed from the scene of the accident.

Bui also points to the fact that “[n]o airbags deployed in any of the vehicles” in Hills

while, in this case, his airbag deployed. Third, he asserts that the plaintiffs in Hills

relied entirely on their own testimony and medical records whereas in this case Bui

offered his own testimony, his medical records, and the testimony of Dr. Sparrow.

Finally, Bui argues that Hills is distinguishable from this case because of the

temporal proximity between the accident and the injuries.

      To the extent there is any difference between the degree of damage to the

vehicles involved in the accident in Hills and this case, as well as the fact that the

airbags did not deploy in the vehicles in Hills, but the airbag deployed in Bui’s car,

these distinctions do not alter the fact that Bui’s injuries are not the types of basic

injuries for which expert testimony regarding causation was unnecessary. See

Guevara, 247 S.W.3d at 667. Bui’s assertion that the plaintiffs in Hills relied solely

on their own testimony and medical records, whereas, in this case, Dr. Sparrow

testified at trial, is similarly unavailing because, as discussed below, Dr. Sparrow

did not testify that Bui’s injuries were caused by the accident. Finally, as to the

                                          13
temporal proximity between the accident and the plaintiffs’ injuries in Hills, one of

the plaintiffs testified that she sought chiropractic care to address her ankle injury

three days after the accident. Here, Bui sought treatment for his back pain four days

after the accident. However, temporal proximity alone cannot support an inference

of medical causation. Guevara, 247 S.W.3d at 667; W. Invs., 162 S.W.3d at 551

(stating proximate causation cannot be shown through conjecture, guess, or

speculation). Rather, evidence of temporal proximity only raises a suspicion that the

event caused the condition but is not legally sufficient to support a finding of

causation. See Guevara, 247 S.W.3d at 668.

      In Sanchez, Sanchez sued Leija and his business following a motor vehicle

accident alleging that Leija caused his medical injuries and property damage. See

2020 WL 7349094, at *1. The trial court granted Leija’s no-evidence motion for

partial summary judgment regarding medical causation, and Sanchez appealed. See

id. We concluded that the types of injuries for which Sanchez sought

compensation—ligament sprain of the thoracic spine and lumbar spine, back spasms,

lumbar radiculopathy, and increased symptoms of post-traumatic stress disorder—

were neither common nor the type of “basic” injuries identified in Guevara. See id.

at *3. Because Sanchez did not provide expert testimony and neither the medical

records nor billing affidavits admitted into evidence raised a fact question with

respect to causation, we held that Sanchez had failed to produce more than a scintilla

                                         14
of competent evidence on the element of causation of his medical injuries and the

trial court did not err in granting summary judgment in favor of Leija. See id. at *3–

4.

      Similar to the complained-of injuries in Hills and Sanchez, Bui was diagnosed

with cervicalgia, lumbalgia, lumbar radiculopathy, and two herniated discs and

sought compensation for the past and future medical expenses for treatment of the

diagnosed injuries. Bui’s injuries are neither common nor the type of basic injuries

for which expert testimony regarding the causal connection between an occurrence

and a physical condition is unnecessary. See Hills, 2021 WL 507306, at *4; Sanchez,

2020 WL 7349094, at *3; see also McGee v. Tatum, No. 05-21-00303-CV, 2022 WL

17248174, at *5 (Tex. App.—Dallas Nov. 28, 2022, no pet.) (mem. op.) (concluding

plaintiff’s diagnoses of bulging discs, herniated disc, disc height reduction, mild

DDD,5 mild central canal stenosis, mild neuroforaminal stenosis, narrowing to

neuroforamina, traumatic cervical strain, cervical neuritis, traumatic lumbar strain,

lumbar neuritis, cervicogenic cephalgia, intervertebral disc disorders with

radiculopathy, thoracalgia, and cervicalgia were not terms within common

knowledge and experience of jurors and cause of soft-tissue back and neck injuries

5
      The court noted in a footnote that “[a]ppellant’s attorney told the jury, and stated in
      appellant’s brief, that ‘DDD’ stands for ‘degenerative disc disease,’ but there is no
      evidence in the record of the abbreviation’s meaning.” McGee v. Tatum, No. 05-21-
      00303-CV, 2022 WL 17248174, at *5 n.2 (Tex. App.—Dallas Nov. 28, 2022, no
      pet.) (mem. op.).
                                            15
were medical conditions outside common knowledge and experience of jurors);

Kelley, 2017 WL 421980, at *3 (“The types of injuries for which Kelley sought

compensation—multiple disc herniations, cervical radiculitis, and lumbar

radiculopathy—are neither common nor basic,” and expert medical testimony was

required to prove casual connection between work-related fall and claimed injuries);

City of Laredo v. Garza, 293 S.W.3d 625, 632 (Tex. App.—San Antonio 2009, no

pet.) (plaintiff’s complaint of back pain one month after on-the-job-accident required

expert medical testimony to establish causal link to accident).

      Bui acknowledges on appeal that Dr. Sparrow did not testify about causation.

Citing to Guevara, Bui argues instead that Dr. Sparrow did not need to testify

explicitly about causation because Bui’s own testimony and his medical records

established a strong, logically traceable connection between the accident, his back

pain, and the ESI treatment. We disagree.

      There is no evidence that Bui sustained overt injuries such as broken bones or

lacerations, or that he experienced objective physical symptoms shortly after the

accident. Thus, this case is not one to which the exception noted in Guevara

applies—that is, it is not a case in which general experience and common sense

enable a layperson to determine the causal relationship with reasonable probability.

Bui needed expert testimony to establish a causal connection between the accident

and his claimed injuries and his own testimony was insufficient to establish

                                         16
causation. See Guevara, 247 S.W.3d at 663; McGee, 2022 WL 17248174, at *7;

Hills, 2021 WL 507306, at *4; Kelley, 2017 WL 421980, at *3; Garza, 293 S.W.3d

at 632–33.

      Bui also relies on his medical records as evidence of a causal connection

between the accident and his injuries. Bui directs us to the following statement in

Huynh’s chart notes: “Due to clinical exams and diagnostic studies, it is my personal

opinioned [sic] that Mr. Bui[‘s] injuries was the direct cause of the accident sustained

on 9/2/2016.” To constitute competent evidence of causation, a medical expert’s

opinion must rest in reasonable medical probability. Burroughs Wellcome, 907

S.W.2d at 500. “This rule applies whether the opinion is expressed in testimony or

in a medical record, as the need to avoid opinions based on speculation and

conjecture is identical in both situations.” Id. Huynh’s opinion is not competent

evidence of causation because her opinion is conclusory. See id. An expert’s bare

proclamation that this one event caused another is not enough to establish causation;

“the expert must go further and explain, to a reasonable degree, how and why the

breach caused the injury based on the facts presented.” Jelinek v. Casas, 328 S.W.3d

526, 539–40 (Tex. 2010). Huynh’s note does not provide the necessary link between

Bui’s diagnosed injuries and the motor vehicle accident. Absent this link, the note is

unreliable speculation, which does not constitute legally sufficient evidence to

support the jury’s verdict. See id. at 532 (“When the evidence offered to prove a vital

                                          17
fact is so weak as to do no more than create a mere surmise or suspicion of its

existence, the evidence is no more than a scintilla and, in legal effect, is no

evidence.”).

      3.       Medical Expenses

      Lara contends that the evidence was legally insufficient to support the jury’s

award of $20,973.00 for the two ESIs that Bui received in the past and its award of

$150,000.00 for Bui’s alleged need for future ESIs. Bui argues that the evidence was

sufficient to support the jury’s awards for past and future medical care expenses.

      Dr. Sparrow testified that she reviewed some of Bui’s medical records and his

MRI reports and that, based on her review, she believed that ESIs were the best

option for treating Bui’s back pain and that they were medically necessary. She

testified that the two ESIs Bui received temporarily alleviated Bui’s pain but that the

ESIs were not a permanent solution for herniated disks. Regarding future medical

treatment, Dr. Sparrow testified:

      COUNSEL:            Okay. How many do you anticipate, based upon
                          your review of his records, your review of how he
                          did with the MRI, and how he did with ESI
                          injections he received, what is your professional
                          medical opinion as to how many ESI injections he
                          is going to need and for how long?

      DR. SPARROW: He could possibly need one to three injections per
                   year if his pain comes back and is increased. And
                   it could be – it could be for – until he’s 60, 70.

                                          18
      “[W]hen an accident victim seeks to recover medical expenses, []he must

show both ‘what all the conditions were’ that generated the expenses and ‘that all

the conditions were caused by the accident.’” JLG Trucking, 466 S.W.3d at 162

(quoting Guevara, 247 S.W.3d at 669). Moreover, to constitute evidence of medical

causation, an expert opinion must rest on reasonable medical probability. Burroughs

Wellcome, 907 S.W.2d at 500. Reasonable probability is determined by the

substance and context of an expert opinion, rather than the use of any particular

words. Id. Where the substance of an expert’s testimony establishes only a mere

possibility, rather than a reasonable probability, of causation, it is no evidence of

causation. See Schaefer v. Tex. Empl’rs Ins. Ass’n, 612 S.W.2d 199, 204–05 (Tex.

1980). Further, to recover future medical expenses, a plaintiff must provide evidence

showing a reasonable probability that the medical expenses will be incurred in the

future, and the probable cost of such expenses. Gunn v. McCoy, 489 S.W.3d 75, 112

(Tex. App.—Houston [14th Dist.] 2016, pet. denied).

      To avoid being conclusory or speculative, Dr. Sparrow was required, to a

reasonable degree of medical probability, to explain how and why the accident

caused Bui’s injuries. See Jelinek, 328 S.W.3d at 536. Dr. Sparrow’s testimony did

not establish that Bui’s injuries and his need for the two ESIs were proximately

caused by the accident. Moreover, her testimony regarding Bui’s need for future

medical care—“[h]e could possibly need one to three injections per year if his pain

                                         19
comes back and is increased”—merely suggested the possibility of a need for future

treatment, rather than a probability, and was conditioned on Bui’s pain returning and

increasing. See Presswood v. Goehring, No. 01-04-00134-CV, 2005 WL 1365188,

at *5 (Tex. App.—Houston [1st Dist.] June 9, 2005, no pet.) (mem. op.) (concluding

medical expert’s testimony that plaintiff “potentially” might need future medical

treatment following motor vehicle accident and that expert would not recommend

plaintiff throw away medical device because she “could perhaps” continue to use it

did not meet standard of “all reasonable probability”); Rosenboom Mach. & Tool,

Inc. v. Machala, 995 S.W.2d 817, 828 (Tex. App.—Houston [1st Dist.] 1999, pet.

denied) (concluding that, absent testimony establishing that in all reasonable

probability patient would require future medical care and cost of such care, evidence

was legally insufficient to support jury’s award of $10,000 for future medical care

and expenses); see also Pilgrim’s Pride Corp. v. Smoak, 134 S.W.3d 880, 905–06

(Tex. App.—Texarkana 2004, pet. denied) (reversing future medical care award as

too speculative where there was no testimony that plaintiff would require any

additional procedures in future beyond mere possibilities).

      We conclude that the evidence is legally insufficient to support the award to

Bui of $20,973.00 for past medical care expenses and $150,000.00 for future medical

care expenses. We therefore sustain Lara’s issue.

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                                        Conclusion

      We reverse the portion of the trial court’s judgment awarding $20,973.00 in

past medical care expenses for the two ESIs Bui received and render a judgment for

$15,515.00 as damages for Bui’s past medical care expenses. We reverse the portion

of the trial court’s judgment awarding $150,000.00 in future medical care expenses

and render judgment that Bui take nothing for future medical care expenses. We

further reverse the award of prejudgment interest, and we remand the case to the trial

court for the limited purpose of calculating the award of prejudgment interest based

on the modified award of damages. We affirm the trial court’s judgment in all other

respects.

                                              Amparo Guerra
                                              Justice

Panel consists of Justices Goodman, Hightower, and Guerra.

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