Court Opinion

ID: 4052533
Source: CourtListenerOpinion
Date Created: 2016-09-29 02:02:57.701837+00
Date Added: 2024-06-11T14:30:42.982151
License: Public Domain

ACCEPTED
                                                                                                     03-14-00765-CV
                                                                                                             4402607
                                                                                            THIRD COURT OF APPEALS
                                                                                                      AUSTIN, TEXAS
                                                                                                  3/6/2015 2:11:03 PM
                                                                                                    JEFFREY D. KYLE
                                                                                                               CLERK
                                           NO. 03–14–00765–CV
                                       IN THE COURT OF APPEALS
                                                                         FILED IN
                                   FOR THE THIRD DISTRICT OF TEXAS 3rd COURT OF APPEALS
                                               AT AUSTIN               AUSTIN, TEXAS
                                                                             3/6/2015 2:11:03 PM
                                                                               JEFFREY D. KYLE
                                         NANCY JO RODRIGUEZ,                         Clerk

                                                          APPELLANT,
                                                     V.
        THE WALGREEN COMPANY AND SARA ELIZABETH MCGUIRE,
                                                          APPELLEES.

                                   On Appeal from the 419th District Court
                                          Travis County, Texas

                                         BRIEF OF APPELLEES

                                                   JUDITH R. BLAKEWAY
                                                   State Bar No. 02434400
                                                   judith.blakeway@strasburger.com
                                                   CYNTHIA DAY GRIMES
                                                   State Bar No. 11436600
                                                   Cynthia.Grimes@strasburger.com
                                                   STRASBURGER & PRICE, LLP
                                                   2301 Broadway
                                                   San Antonio, Texas 78215
                                                   (210) 250-6003 Telephone
                                                   (210) 258-2706 Facsimile

                                                   ATTORNEYS FOR APPELLEES

1751449.6/SPSA/87282/0138/030615
                                    Identity of Parties and Counsel

          In accordance with Rule 38.1(a) of the Texas Rules of Appellate Procedure,

Appellees provide the following complete list of all parties and counsel to the trial

court’s order that forms the basis of this appeal.

                            Party                               Trial Counsel
NANCY JO RODRIGUEZ                                 Lannie Todd Kelly
          Appellant                                State Bar No. 24035049
                                                   THE CARLSON LAW FIRM, P.C.
                                                   11606 N. IH–35
                                                   Austin, TX 78753
                                                   Telephone: (512) 346–5688
                                                   Facsimile: (512) 719–4362
                                                   tkelly@carlsonattorneys.com
THE WALGREEN COMPANY, INC.                        CYNTHIA DAY GRIMES
and                                               State Bar No. 11436600
SARA ELIZABETH MCGUIRE                            Cynthia.Grimes@strasburger.com
    Appellees                                     STRASBURGER & PRICE, LLP
                                                  2301 Broadway
                                                  San Antonio, Texas 78215
                                                  (210) 250-6003 Telephone
                                                  (210) 258-2706 Facsimile
                                                        Trial Counsel
                                                  JUDITH R. BLAKEWAY
                                                  State Bar No. 02434400
                                                  judith.blakeway@strasburger.com
                                                  CYNTHIA DAY GRIMES
                                                  State Bar No. 11436600
                                                  Cynthia.Grimes@strasburger.com
                                                  STRASBURGER & PRICE, LLP
                                                  2301 Broadway
                                                  San Antonio, Texas 78215
                                                  (210) 250-6003 Telephone
                                                  (210) 258-2706 Facsimile
                                                         Appellate Counsel

                                                  ii
1751449.6/SPSA/87282/0138/030615
VIVEK GOSWAMI, M.D. and               Chris Knudsen
AUSTIN HEART, PLLC                    State Bar No. 24041268
    Defendants (not parties to this   cknudsen@serpejones.com
    appeal)                           nandrews@serpejones.com
                                      Nicole Andrews
                                      State Bar No. 00792335
                                      SERPE JONES ANDREWS
                                      CALLENDER & BELL, PLLC
                                      2929 Allen Parkway, Suite 1600
                                      Houston, Texas 77019
                                      (713) 452–4400 Telephone
                                      (713) 452–4499 Facsimile

ST. DAVID’S HEALTH CARE               Missy Atwood
PARTNERSHIP                           State Bar No. 01428020
     Defendant (not a party to this   GERMER, BEAMAN & BROWN, PLLC
     appeal)                          301 Congress Avenue, Suite 1700
                                      Austin, Texas 78701
                                      (512) 472–0288 Telephone
                                      (512) 472–0721 Facsimile
                                      matwood@germer-austin.com

                                      iii
1751449.6/SPSA/87282/0138/030615
                                                    Table of Contents

Identity of Parties and Counsel ................................................................................. ii

Table of Contents ......................................................................................................iv

Table of Authorities ..................................................................................................vi

Statement of the Case................................................................................................. 1

Issue Presented ........................................................................................................... 1
          Did the trial court abuse its discretion in dismissing Plaintiff’s claims
          against Walgreen and McGuire? ..................................................................... 1

Statement of Facts ...................................................................................................... 1
Summary of Argument .............................................................................................. 4

Standard of Review .................................................................................................... 6

Argument.................................................................................................................... 8
          I.         A Chapter 74 report must be from a qualified expert and
                     address in non–conclusory terms the standard of care, breach
                     and causation. ........................................................................................ 8
          II.        The trial court did not abuse its discretion in dismissing claims
                     against Walgreen and McGuire. ............................................................ 9

                     A.            Mr. Hardy’s report is deficient.................................................... 9
                                   1.      Mr. Hardy’s opinion is speculative and conclusory. ........ 9

                                   2.      Mr. Hardy is statutorily disqualified from
                                           addressing causation. ...................................................... 11

                                   3.      Mr. Hardy’s report fails to distinguish between
                                           multiple defendants......................................................... 13

                                   4.      Mr. Hardy is not qualified as a practicing
                                           pharmacist. ...................................................................... 14

                                                                 iv
1751449.6/SPSA/87282/0138/030615
                     B.            Dr. Breall’s expert report is deficient. ...................................... 15

                                   1.      Dr. Breall’s report does not even mention
                                           Walgreen or McGuire. .................................................... 16

                                   2.      Dr. Breall’s report is speculative and conclusory. .......... 17

                                   3.      Dr. Breall is not qualified to testify to the standard
                                           of care for a pharmacy or pharmacist. ............................ 19

Conclusion ............................................................................................................... 19
Certificate of Service ............................................................................................... 21

Certificate of Compliance ........................................................................................ 21
Appendix .................................................................................................................. 22

          1.         Order dated December 3, 2014 ........................................................... 22
          2.         Mr. Hardy’s CV and report ................................................................. 22

          3.         Dr. Breall’s CV and report .................................................................. 22
          4.         TEX. CIV. PRAC. & REM. CODE §74.351 .............................................. 22

          5.         TEX. CIV. PRAC. & REM. CODE §74.402 .............................................. 22

                                                               v
1751449.6/SPSA/87282/0138/030615
                                         Table of Authorities

                                                                                                    Page(s)
CASES
American Transitional Care Centers of Texas Inc. v. Palacios,
  46 S.W.3d 873 (Tex. 2001).......................................................................6, 7, 8, 9

Apodaca v. Russo,
  228 S.W.3d 252 (Tex. App.–Austin 2007, no pet.) ............................................ 17

Austin Heart, P.A. v. Webb,
  228 S.W.3d 276 (Tex. App.–Austin 2007, no pet.) ................................13, 14, 17
Austin Regional Clinic v. Power,
  2012 Tex. App. LEXIS 5242 (Austin 2012, no pet.).......................................... 17

Bogar v. Esparza,
  257 S.W.3d 354 (Tex. App.–Austin 2008, no pet.) ............................................ 17
Bowie Mem’l Hosp. v. Wright,
  79 S.W.3d 48 (Tex. 2002)...............................................................7, 9, 12, 13, 18
Broders v. Heise,
   924 S.W.2d 148 (Tex. 1996) .............................................................................. 15

Constancio v. Bray,
  266 S.W.3d 149 (Tex. App.–Austin 2008, no pet.) ............................................ 18
Cooper v. Arizpe,
  No. 04–07–00743, 2008 Tex. App. LEXIS 2506 (Tex. App.–San
  Antonio, April. 9, 2008, pet. denied) .................................................................. 10

Doades v. Syed,
  94 S.W.3d 664 (Tex. App.–San Antonio 2002, no pet.) .................................... 13

Estate of Allen v. Polly Ryon Hosp. Auth.,
   No. 01–04–00151–CV, 2005 Tex. App. LEXIS 1691 (Tex. App.–
   Houston [1st Dist.] Mar. 3, 2005, no pet.) (mem. op.) ....................................... 12
Fung v. Fischer,
  365 S.W.3d 507 (Tex. App.–Austin 2012), overruled in part by Certified
  EMS, Inc. v. Potts, 392 S.W.3d 625 (Tex. 2013) .........................................10, 16

                                                      vi
1751449.6/SPSA/87282/0138/030615
Jelinek v. Casas,
   328 S.W.3d 526 (Tex. 2010) ................................................................................ 7

Jernigan v. Langley,
   195 S.W.3d 91 (Tex. 2006)...........................................................................6, 7, 9

Kocerek v. Colby,
  No. 03–13–0057–CV, 2014 Tex. App. LEXIS 9336 (Tex. App.–Austin
  2014, no pet.) ...................................................................................................... 18
Lenger v. Physician’s Gen. Hosp.,
   455 S.W.2d 703 (Tex. 1970) .............................................................................. 12

McMenemy v. Holden,
  No. 14–07–00365–CV, 2007 Tex. App. LEXIS 8830 (Tex. App.–
  Houston [14th Dist.] Nov. 1, 2007, pet. denied) (mem. op.) .............................. 12

Murphy v. Mendoza,
  234 S.W.3d 23 (Tex. App.–El Paso 2007, no pet.) ............................................ 11
Perez v. Daughters of Charity Health Servs. of Austin,
   No. 03–08–00200–CV, 2008 WL 4531558 (Tex. App.–Austin, Oct. 10,
   2008, no pet.) (mem. op.).................................................................................... 18

Reddy v. Hebner,
  435 S.W.3d 323 (Tex. App.–Austin 2014, pet. filed) ........................................ 16
Rittmer v. Garza,
   65 S.W.3d 718 (Tex. App.–Houston [14th Dist.] 2001, no pet.) ....................... 13
Samlowski v. Wooten,
  332 S.W.3d 404 (Tex. 2011) ............................................................................ 7, 9

Scoresby v. Santillan,
   346 S.W.3d 546 (Tex. 2011) ................................................................................ 9

Smith v. Wilson,
  368 S.W.3d 574 (Tex. App.–Austin 2012, no pet.) ........................................ 7, 18
Taylor v. Christus Spohn Health Sys. Corp.,
   169 S.W.3d 241 (Tex. App.–Corpus Christi 2004, no pet.) ............................... 14

                                                           vii
1751449.6/SPSA/87282/0138/030615
Tenet Hospitals Ltd. v. De La Riva,
   351 S.W.3d 398 (Tex. App.–El Paso 2011, no pet.) .......................................... 14

Walgreen Co. v. Hieger,
  243 S.W.3d 183 (Tex. App.–Houston [14th Dist.] 2007, pet. denied) ............... 12
Walker v. Gutierrez,
  111 S.W.3d 56 (Tex. 2003)................................................................................... 7

STATUTES
TEX. CIV. PRAC. & REM. CODE 74.001(a)(10) .......................................................... 15

TEX. CIV. PRAC. & REM. CODE § 74.351 .................................................................... 8

TEX. CIV. PRAC. & REM. CODE ANN. § 74.351(i)..................................................... 16

TEX. CIV. PRAC. & REM. CODE § 74.351(r)(6) ...................................................13, 18
TEX. CIV. PRAC. & REM. CODE § 74.402 ..................................................................... 19

TEX. CIV. PRAC. & REM. CODE § 74.402(b)(1)–(3) .................................................. 14
TEX. CIV. PRAC. & REM. CODE § 74.402(c) ............................................................. 15

TEX. CIV. PRAC. & REM. CODE § 74.403(a).............................................................. 11

                                                      viii
1751449.6/SPSA/87282/0138/030615
                                   Statement of the Case

          This is an interlocutory appeal from an order dismissing a health care

liability claim against Walgreen and its pharmacist McGuire for failure to serve

adequate expert reports. Ms. Rodriguez claims that the district court abused its

discretion in concluding that she failed to serve expert reports that comply with

Chapter 74 of the Texas Civil Practice and Remedies Code.

                                      Issue Presented

          Did the trial court abuse its discretion in dismissing Plaintiff’s claims
          against Walgreen and McGuire?

                                    Statement of Facts

          Ms. Rodriguez sued her cardiologist, Dr. Goswami, Walgreen and its

pharmacist, McGuire, claiming that Defendants were negligent because after

Dr. Kessler (who was in the same group as Dr. Goswami) advised that Pradaxa be

discontinued, Walgreen continued to fill a prescription previously issued by

Dr. Goswami. C.R. 6. Dr. Goswami issued the prescription on February 14, 2012,

C.R. 335, with a prescription refill on March 16, 2012. C.R. 336. Ms. Rodriguez

alleged that continued use of Pradaxa caused her to be admitted to the hospital with

hypertension, acute kidney injury and gastrointestinal bleeding. C.R. 6. In support

of her claim, she served reports from Jeffrey Hardy, Pharm. D., M.S., C.R. 39–42,

and Dr. Jeffrey Breall, a professor of clinical medicine. C.R. 43–44.

1751449.6/SPSA/87282/0138/030615
          Mr. Hardy opined that Walgreen, McGuire and a pharmacist with the initials

MDD breached the applicable standard of care because (1) they failed to verify

whether the prescription previously written by Dr. Goswami for Pradaxa should be

continued and (2) dispensed a prescription for Pradaxa after Dr. Kessler indicated

that it be discontinued.

          His report stated:

                                                Standards of Care
          The standard of care required to fill Ms. Rodriguez’s dabigatran
          etexilate (PRADAXA) prescription are as follows:

                                  Pharmacists have a duty to contact the prescribing
                                   physician if patient harm is possible to validate the
                                   prescription
                                  Pharmacists are responsible for ensuring a prescription is
                                   accurately communicated and dispensed as intended by
                                   the prescriber
                                  Pharmacists are responsible for communicating with the
                                   prescribing physician to validate continuation of therapy
                                   when no refills remain on a prescription
                                        Breach of Standard of Care
          Walgreens, Sara Elizabeth McGuire (pharmacist), and pharmacist
          with initials MDD breached the applicable standards of care.
          Specifically, Walgreens, Sara Elizabeth McGuire (pharmacist), and
          pharmacist with initials MDD conduct fell below the standard of care
          by:

                                  Continuing to dispense a prescription for dabigatran
                                   etexilate (PRADAXA) after the prescribing physician
                                   indicated it should be discontinued; and

1751449.6/SPSA/87282/0138/030615                         2
                                  Failing to verify if the prescription for dabigatran
                                   etexilate (PRADAXA) should be continued with the
                                   prescribing physician

          Walgreens, Sara Elizabeth McGuire (pharmacist), and pharmacist
          with initials MDD should have provided Ms. Rodriguez with the care
          and treatment in the standard of care paragraph above. However, this
          expected care was not provided to Ms. Rodriguez as set forth in the
          preceding paragraph.

C.R. 40–41.

          Plaintiff did not offer Mr. Hardy’s opinion as to causation, but instead relied

on the report of Dr. Breall. C.R. 359; R.R. 32. Dr. Breall’s report did not mention

Walgreen or McGuire; it was instead directed solely to the conduct of Dr.

Goswami. C.R. 44. Dr. Breall stated the following about causation:

          Failure to discontinue the use of Pradaxa was a direct cause of her
          subsequent acute admission to the hospital with hypotension, acute
          kidney injury and apparent gastrointestinal bleeding – known side
          effects of the over–use of Pradaxa. Ms. Rodriguez’s entire
          hospitalization was attributable to the failure to stop Pradaxa therapy
          as ordered by Dr. Kessler. More likely than not, had the Pradaxa
          medication been discontinued as requested, Ms. Rodriguez’s
          hospitalization would never have needed to take place.

C.R. 44.

          Walgreen and McGuire objected to both reports, C.R. 64–74, and moved to

dismiss. C.R. 212–20. The trial court granted their motion. C.R. 375–76.

Ms. Rodriguez appeals. Supp. C.R. 3–4.

1751449.6/SPSA/87282/0138/030615                      3
                                   Summary of Argument

          The trial court did not abuse its discretion in dismissing Ms. Rodriguez’s

claims against Walgreen and McGuire. Her experts were not shown to be qualified

and their reports failed to implicate Walgreen or its pharmacists. Neither expert

provided a factual basis for his opinions. Both reports were based on the unstated

assumption that Walgreen and McGuire knew Dr. Kessler had instructed Ms.

Rodriguez to discontinue Pradaxa. Even when read together, there was no report

that implicated the conduct of Walgreen or its pharmacists because Mr. Hardy was

incompetent to render a report as to causation and Dr. Breall never even mentioned

Walgreen or McGuire in his report. The trial court’s dismissal should be affirmed.

          The trial court did not abuse its discretion in finding Mr. Hardy’s report

deficient. First, his report is conclusory ––he fails to provide any facts to support

his conclusion about why Walgreen and its pharmacists failed to meet the standard

of care. He does not recite any facts about the date of Dr. Kessler’s advice to stop

Pradaxa, to whom the instruction may have been communicated, whether

Walgreen or its pharmacists ever had any notice of the advice, the circumstances

under which Walgreen continued to refill her Pradaxa prescription, or any other

relevant facts. If Walgreen received the prescription written by Dr. Goswami,

C.R. 335, and the five refills of Pradaxa, C.R. 336, and was not aware of

Dr. Kessler’s subsequent indication to stop using Pradaxa, there would be no

1751449.6/SPSA/87282/0138/030615            4
reason for Walgreen to refuse to refill her prescription using the prescription it had

on file. Nevertheless, Mr. Hardy’s report does not even mention the fact that

Walgreen had a prescription refill that predated the hospital admission during

which Dr. Kessler said to stop Pradaxa. Nor does it mention whether Walgreen or

McGuire were ever informed of Dr. Kessler’s instruction.

          Second, Mr. Hardy was statutorily disqualified from testifying to causation.

Ms. Rodriguez concedes that Mr. Hardy was unqualified to render an opinion

regarding causation; only a physician may render opinions regarding causation.

Nevertheless, Ms. Rodriguez asserts that when Mr. Hardy’s report is read in

conjunction with Dr. Breall’s report, the causation requirement is satisfied. While

it is true that the expert report requirement may be satisfied by utilizing more than

one expert report, Dr. Breall’s report does not supply the missing causation.

Dr. Breall’s report does not even mention Walgreen or its pharmacists much less

identify any conduct, act or omission attributable to them.

          Third, when a plaintiff sues more than one defendant, the expert report must

set forth the standard of care applicable to each defendant and explain the causal

relationship between each defendant’s acts and the plaintiff’s injury. A claimant

must provide each defendant with an expert report that sets forth the manner in

which the care rendered by that defendant failed to meet the standard of care and

1751449.6/SPSA/87282/0138/030615            5
the causal relationship between that failure and the injuries claimed. This Mr.

Hardy and Dr. Breall failed to do.

          Fourth, Mr. Hardy was not qualified. There is nothing in the four corners of

his report to indicate that he was a practicing pharmacist filling prescriptions at the

time the claim arose or when he made his report.

          The trial court did not abuse its discretion in finding that Dr. Breall’s report

does not bridge the gaps in Mr. Hardy’s report. First, his report does not even

mention Walgreen or McGuire much less recite any facts that Walgreen’s

pharmacists were on notice of Dr. Kessler’s instruction. Second, his report is

speculative and conclusory on the issue of causation. It fails to identify the

prescription used by Ms. Rodriguez after Dr. Kessler said to stop using Pradaxa,

the circumstances under which Walgreen continued to refill the prescription, or

how doing so contributed to Ms. Rodriguez’s injury. Third, Dr. Breall is not

qualified to testify to the standard of care for a pharmacist.

          The trial court’s dismissal should be affirmed.

                                   Standard of Review

          A trial court’s rulings on motions to dismiss health care liability claims are

reviewed for an abuse of discretion. Jernigan v. Langley, 195 S.W.3d 91, 93

(Tex. 2006); American Transitional Care Centers of Texas Inc. v. Palacios,

46 S.W.3d 873, 877 (Tex. 2001). A trial court abuses its discretion by rendering an

1751449.6/SPSA/87282/0138/030615              6
arbitrary and unreasonable decision lacking support in the facts or circumstances of

the case or by acting in an arbitrary or unreasonable manner without reference to

guiding rules or principles. Samlowski v. Wooten, 332 S.W.3d 404, 410 (Tex.

2011) (plurality op.) When reviewing matters committed to the trial court’s

discretion, an appellate court may not substitute its own judgment for that of the

trial court. Bowie Mem’l Hosp. v. Wright, 79 S.W.3d 48, 52 (Tex. 2002). A trial

court does not abuse its discretion merely because it decides a discretionary matter

differently than an appellate court would in a similar circumstance. Id.; see also

Jelinek v. Casas, 328 S.W.3d 526, 542 (Tex. 2010) (Jefferson, C.J., dissenting)

(“The dividing line between a sufficient and an inadequate report is impossible to

draw precisely. We have said, therefore, that the determination must be made in

the first instance by the trial court, and review of that decision asks not how an

appellate court would have resolved that issue, but instead whether the trial court

abused its discretion.”) (citing Jernigan v. Langley, 195 S.W.3d 91, 93 (Tex.

2006); Walker v. Gutierrez, 111 S.W.3d 56, 63 (Tex. 2003)). But if an expert

report contains only conclusions about the statutory elements, a trial court has “no

discretion but to conclude . . . that the report does not represent a good–faith

effort” to satisfy the statute. Palacios, 46 S.W.3d at 877, 880; Smith v. Wilson,

368 S.W.3d 574 (Tex. App.–Austin 2012, no pet.).

1751449.6/SPSA/87282/0138/030615         7
                                        Argument

I.        A Chapter 74 report must be from a qualified expert and address in
          non–conclusory terms the standard of care, breach and causation.
          Pursuant to Section 74.351, medical–malpractice plaintiffs must provide

each defendant health care provider with an expert report or voluntarily nonsuit the

action. TEX. CIV. PRAC. & REM. CODE §74.351. If a claimant timely furnishes an

expert report, a defendant may file a motion challenging the report’s adequacy. Id.

The trial court shall grant the motion only if it appears, after hearing, that the report

does not represent a good faith effort to comply with the statutory definition of an

expert report. See id. §74.351(l). The statute defines an expert report as a written

report by an expert that provides, as to each defendant, a fair summary of the

expert’s opinions, as of the date of the report, regarding: (1) the applicable

standards of care; (2) the manner in which the care provided failed to meet the

standards; and (3) the causal relationship between that failure and the injury, harm,

or damages claimed. See id. §74.351(r)(6).

          Although the report need not marshal all the plaintiff’s proof, it must include

the expert’s opinions on the three statutory elements––standard of care, breach and

causation. See Palacios, 46 S.W.3d at 878. In detailing these elements, the report

must provide enough information to fulfill two purposes: first, it must inform the

defendant of the specific conduct the plaintiff has called into question, and, second,

it must provide a basis for the trial court to conclude that the claims have merit.

1751449.6/SPSA/87282/0138/030615             8
Scoresby v. Santillan, 346 S.W.3d 546, 556 (Tex. 2011) (citing Palacios,
46 S.W.3d at 879). A report that merely states the expert’s conclusions as to the

standard of care, breach, and causation does not fulfill these two purposes. Id. A

report that omits one or more of these required elements, or states the expert’s

opinions as merely conclusions without supporting facts, is insufficient to

constitute a “good faith effort” at compliance with Chapter 74. See Samlowski v.

Wooten, 332 S.W.3d 404, 409–10 (Tex. 2011); Jernigan v. Langley, 195 S.W.3d
91, 93–94 (Tex. 2006) (affirming trial court’s dismissal of suit because expert

reports omitted any allegation about how doctor breached standard of care and

causation); Bowie Mem’l Hosp., 79 S.W.3d at 52. (“[T]he expert must explain the

basis of his statements and link his conclusions to the facts.”) Furthermore, in

assessing a report’s sufficiency, a trial court may not draw any inferences, and

instead must rely exclusively on the information contained within the report’s four

corners. See Scoresby v. Santillan, 346 S.W.3d 546, 556 (Tex. 2011) (citing

Palacios, 46 S.W.3d at 878).

II.       The trial court did not abuse its discretion in dismissing claims against
          Walgreen and McGuire.

          A.         Mr. Hardy’s report is deficient.
                     1.            Mr. Hardy’s opinion is speculative and conclusory.
          Mr. Hardy’s report is speculative because it relies on the assumption that

Walgreen and McGuire were aware of Dr. Kessler’s advice to discontinue the use

1751449.6/SPSA/87282/0138/030615                       9
of Pradaxa. It fails to make a causal link between an allegedly breached standard of

care and injury by requiring an inference that if Walgreen and McGuire had known

of Dr. Kessler’s advice, then Ms. Rodriguez’s outcome would have been different.

His opinions all hinge on Walgreen and McGuire knowing of Dr. Kessler’s advice.

Yet there is nothing in Mr. Hardy’s report that affirmatively shows that Walgreen

and McGuire were aware of the information that is identified as key to their

liability. Any breach of the standard of care discussed in Mr. Hardy’s report is

entirely dependent on what Defendants knew and when. Yet Mr. Hardy’s report is

silent on these crucial facts. Further, Mr. Hardy’s report says Walgreen should

have contacted the prescribing physician––Dr. Goswami. But there is no indication

that at that time Dr. Goswami even knew of Dr. Kessler’s advice or would have

communicated it to Walgreen or McGuire.

          By relying on assumptions instead of facts, the report provides no basis for a

trial court to conclude that the claims against Defendants have merit. Fung v.

Fischer, 365 S.W.3d 507, 533 (Tex. App.–Austin 2012), overruled in part by

Certified EMS, Inc. v. Potts, 392 S.W.3d 625 (Tex. 2013) (finding that report that

depended on unsupported assumptions about what a defendant knew and when he

knew it was speculative); Cooper v. Arizpe, No. 04–07–00743, 2008 Tex. App.

LEXIS 2506 at *9–10 (Tex. App.–San Antonio, April. 9, 2008, pet. denied)

(holding that report that relied on assumption that notes were in chart was

1751449.6/SPSA/87282/0138/030615            10
conclusory and speculative); Murphy v. Mendoza, 234 S.W.3d 23, 28 (Tex. App.–

El Paso 2007, no pet.) (holding that expert’s opinion as to breach of the standard of

care was speculative and conclusory as it was unsupported by facts in report’s four

corners and relied on assumption).

          Mr. Hardy’s opinions regarding Walgreen’s negligence, breach of the

standard of care, and causation––which depend on unsupported assumptions as to

what Walgreen and McGuire knew and when they knew it––are conclusory and

speculative at best. They do not provide a basis for the court to conclude that

Ms. Rodriguez’s healthcare liability claim against Walgreen and McGuire has

merit.

                     2.            Mr. Hardy is statutorily disqualified from addressing
                                   causation.
          Mr. Hardy, Pharm. D., M.S., is a pharmacist and not a medical doctor. Only

a physician can render an opinion on causation. TEX. CIV. PRAC. & REM. CODE

§74.403(a). Therefore, Mr. Hardy, by statute, cannot render an opinion on

causation.

          Moreover, Mr. Hardy’s statement of causation is entirely conclusory in that

it fails to explain the relationship between the alleged injuries and the failure to act

according to the standard of care. He simply states “…It is clear that the long-term

use of dabigatran etexilate (Pradaxa) as dispensed by Walgreens and Sara

Elizabeth McGuire (pharmacist), and pharmacist with initials MDD caused

1751449.6/SPSA/87282/0138/030615                    11
Ms. Rodriguez’s acute kidney injury, anemia, and gastrointestinal bleeding (which

have led to her long-term clinical demise and medical injuries).” C.R. 42.

          The causal connection in healthcare malpractice suits must be made “beyond

the point of conjecture” and “must show more than a possibility” to warrant

submission of the issue to a jury. Lenger v. Physician’s Gen. Hosp., 455 S.W.2d
703, 706 (Tex. 1970); see Bowie Mem’l Hosp., 79 S.W.3d at 53. Reports providing

a “description of only a possibility of causation do not constitute a good–faith

effort to comply with the statute.” Walgreen Co. v. Hieger, 243 S.W.3d 183, 186–

87 (Tex. App.–Houston [14th Dist.] 2007, pet. denied) (holding that expert report

stating claimant had symptoms “consistent with” known side effects of medication

was insufficient to demonstrate causal link); see McMenemy v. Holden, No. 14–

07–00365–CV, 2007 Tex. App. LEXIS 8830, at *15–16 (Tex. App.–Houston

[14th Dist.] Nov. 1, 2007, pet. denied) (mem. op.) (concluding that expert’s report

expressing uncertainty about possibility of positive outcome for patient failed to

make causal link indicating plaintiffs’ claim had merit); Estate of Allen v. Polly

Ryon Hosp. Auth., No. 01–04–00151–CV, 2005 Tex. App. LEXIS 1691, at *16–17

(Tex. App.–Houston [1st Dist.] Mar. 3, 2005, no pet.) (mem. op.) (holding that

expert’s report failed to meet statutory causation requirement by opining merely

that breach of standard of care “could have contributed” to decline in claimant’s

condition).

1751449.6/SPSA/87282/0138/030615          12
          Further, a court may not fill in gaps in a report by drawing inferences or

guessing what the expert meant or intended. Austin Heart, P.A. v. Webb,

228 S.W.3d 276, 279 (Tex. App.–Austin 2007, no pet.). Instead, the report must

include the required information within its four corners. Bowie Mem’l Hosp.,
79 S.W.3d at 53. This Mr. Hardy’s report fails to do. The trial court thus did not

abuse its discretion in finding it inadequate.

                     3.            Mr. Hardy’s report fails to distinguish between multiple
                                   defendants.
          Also, Mr. Hardy’s report does not separately set out the alleged acts of

negligence and causal connection for each of the multiple defendants. When a

plaintiff sues more than one defendant, the expert report must set forth the standard

of care applicable to each defendant and explain the causal relationship between

each defendant’s individual acts and the injury. See TEX. CIV. PRAC. & REM. CODE

§74.351(r)(6) (a claimant must provide each defendant with an expert report that

sets forth the manner in which the care rendered failed to meet the standard of care

and the causal relationship between that failure and the injuries claimed); Doades

v. Syed, 94 S.W.3d 664, 671-72 (Tex. App.–San Antonio 2002, no pet.); Rittmer v.

Garza, 65 S.W.3d 718, 722-23 (Tex. App.–Houston [14th Dist.] 2001, no pet.).

          An expert report may not assert that multiple defendants are all negligent for

failing to meet the standard of care without providing an explanation of how each

defendant breached the standard of care and how that breach caused or contributed

1751449.6/SPSA/87282/0138/030615                     13
to cause the injury. Austin Heart, 228 S.W.3d at 282-83 (finding deficient expert

report that was “silent as to whether a single physician, multiple physicians, or all

physicians’ mentioned in the report failed to meet the standard of care and caused

injury to [the patient]”); Tenet Hospitals Ltd. v. De La Riva, 351 S.W.3d 398 (Tex.

App.–El Paso 2011, no pet.) (finding deficient expert report that failed to state who

among multiple defendants caused the injuries); Taylor v. Christus Spohn Health

Sys. Corp., 169 S.W.3d 241, 245–46 (Tex. App.–Corpus Christi 2004, no pet.)

(finding deficient expert report that failed “to state what each defendant should

have done in order to meet the standard of care, what each defendant failed to do,

and how such failure led to [the patient’s] death”).

          Because Mr. Hardy’s report does not explain what conduct, act or omissions

are attributable to which of the defendants, it is deficient, and the trial court did not

abuse its discretion in finding it did not satisfy the statutory requirements.

                     4.            Mr. Hardy is not qualified as a practicing pharmacist.
          A person may qualify as an expert witness on whether a health care provider

departed from accepted standards of care only if, at the time the claim arose or at

the time the testimony is given, he is practicing the same type of care or treatment

as the defendant, and is qualified by training or experience. TEX. CIV. PRAC. &

REM. CODE §74.402(b)(1)–(3). In determining whether a witness is qualified, a

court considers whether the witness (1) is certified by the licensing agency, and

1751449.6/SPSA/87282/0138/030615                       14
(2) is actively practicing health care in rendering health care services relevant to

the claim. TEX. CIV. PRAC. & REM. CODE §74.402(c). “Health care” is defined as

“any act or treatment performed or furnished, or that should have been performed

or furnished, by any health care provider for, to or on behalf of a patient during the

patient’s medical care, treatment, or confinement.” TEX. CIV. PRAC. & REM. CODE

74.001(a)(10). A plaintiff offering medical testimony must establish that the expert

has expertise regarding “the specific issue before the court which would qualify the

expert to give an opinion on that particular subject.” Broders v. Heise, 924 S.W.2d
148, 153 (Tex. 1996). The analysis focuses on “the very matter” on which the

expert is to give an opinion. Id.

          Here, there is no showing in the four corners of his report that Mr. Hardy is

practicing and rendering health care in “the very matter” on which he is giving an

opinion. Mr. Hardy’s CV shows only that he is involved in pharmacy “information

technology.” There is no showing that he was, at the pertinent times, filling

prescriptions for patients. Nothing in the four corners of Mr. Hardy’s report

indicates that he is qualified to opine on the standard of care, breach or causation.

          B.         Dr. Breall’s expert report is deficient.
          Conceding that Mr. Hardy is prohibited by statute from stating any opinions

on causation, Ms. Rodriguez still asserts that when Mr. Hardy’s report is read in

conjunction with the report provided by Dr. Breall, causation is found. While it is

1751449.6/SPSA/87282/0138/030615                15
true that the expert report requirement may be satisfied by utilizing more than one

expert report, and thus, a court may read those reports together to supply missing

elements, see TEX. CIV. PRAC. & REM. CODE ANN. §74.351(i), Dr. Breall’s report

does not supply the missing causation.

                     1.            Dr. Breall’s report does not even mention Walgreen or
                                   McGuire.
          Dr. Breall does not mention Walgreen or McGuire, does not discuss any

standard of care pertaining to Walgreen or McGuire, and does not discuss any

causal connection between anything done or failed to be done by Walgreen or

McGuire and the injuries sustained by Ms. Rodriguez. In fact, the report does not

mention Walgreen or McGuire at all; instead, the report discusses only

Dr. Goswami. His report thus does not constitute an expert report as required to

maintain a suit against Walgreen and McGuire. Accordingly, the trial court was

correct to grant the motion to dismiss.

          When a defendant is not identified within the four corners of a report, the

report is, for that reason alone, deficient as to that defendant because it requires the

reader to infer or make an educated guess as to whose actions caused the injuries.

See Reddy v. Hebner, 435 S.W.3d 323, 328 (Tex. App.–Austin 2014, pet. filed)

(finding report that did not mention doctor or discuss how doctor’s treatment did

not meet the standard of care, did not constitute a good-faith effort to comply with

the statutory requirements); Fung v. Fischer, 365 S.W.3d 507, 529 (Tex. App.–

1751449.6/SPSA/87282/0138/030615                    16
Austin 2012, no pet.) overruled on other grounds by Certified EMS, Inc. v. Potts,

392 S.W.3d 625 (Tex. 2013) (concluding that report did not implicate defendant

when it did not allege breach by defendant or any causal link between defendant’s

breach and injury); Austin Regional Clinic v. Power, 2012 Tex. App. LEXIS 5242

(Austin 2012, no pet.) (concluding that trial court abused its discretion by denying

motion to dismiss claims against certain defendant when the expert report did not

mention that defendant); see also Bogar v. Esparza, 257 S.W.3d 354, 363 (Tex.

App.–Austin 2008, no pet.); Austin Heart P.A. v. Webb, 228 S.W.3d 276, 281

(Tex. App.–Austin 2007, no pet.); Apodaca v. Russo, 228 S.W.3d 252, 257-58

(Tex. App.–Austin 2007, no pet.). Dr. Breall’s report falls below the minimal

standard and thus does not constitute an expert report as required to maintain a suit

against Walgreen and McGuire.

                     2.            Dr. Breall’s report is speculative and conclusory.
          Like Mr. Hardy’s, Dr. Breall’s report would have to be based on the

assumption that Walgreen and McGuire––although they are never mentioned––

knew about Dr. Kessler’s advice to stop Pradaxa. But there is nothing in his report

about to whom the advice was communicated, whether the prescription that was

used by Ms. Rodriguez predated the advice, or any other circumstances under

which Ms. Rodriguez continued to refill her prescription. Dr. Breall simply does

not provide facts to establish the causal link between Walgreen’s alleged breach

1751449.6/SPSA/87282/0138/030615                       17
and Ms. Rodriguez’s injuries, one of the required statutory elements of an expert

report. See TEX. CIV. PRAC. & REM. CODE §74.351(r)(6). “To avoid being

conclusory, an expert must explain the basis of the statements to link his

conclusions to the facts.” Bowie Mem’l Hosp. v. Wright, 79 S.W.3d 48, 52 (Tex.

2002).

          This Court has consistently required more than what Dr. Breall has provided

in terms of expert testimony on causation. See Kocerek v. Colby, No. 03–13–

0057–CV, 2014 Tex. App. LEXIS 9336 (Tex. App.–Austin 2014, no pet.)(holding

insufficient expert report that failed to show specific actions defendant did or did

not take would have prevented patient’s injuries); Smith v. Wilson, 368 S.W.3d
574, 578 (Tex. App.–Austin 2012, no pet.)(holding that expert failed to show how

doctor’s alleged breach of standard of care caused patient to commit suicide);

Constancio v. Bray, 266 S.W.3d 149, 157–58 (Tex. App.–Austin 2008, no pet.)

(holding insufficient expert report that alleged that breach of standard of care by

doctor caused patient’s death when report did not explain how increased

monitoring of patient, detection of hypoxemia, and other consequence would have

prevented patient’s death); Perez v. Daughters of Charity Health Servs. of Austin,

No. 03–08–00200–CV, 2008 WL 4531558, at *4 (Tex. App.–Austin, Oct. 10,

2008, no pet.) (mem. op.) (concluding expert report insufficient on causation

because it did not link hospital’s actions to patient’s death or any cause of death

1751449.6/SPSA/87282/0138/030615           18
and did not identify any specific injury that would have been prevented had

hospital complied with standard of care). To find Dr. Breall’s report sufficient on

causation, the trial court would have had to make inferences beyond the four

corners of his report, which it could not do. For this additional reason, the trial

court was correct to grant the motion to dismiss.

                     3.            Dr. Breall is not qualified to testify to the standard of care
                                   for a pharmacy or pharmacist.
          An expert report must demonstrate within the four corners of the report that

the purported expert is qualified to testify about the particular matters for which the

opinion is offered. TEX. CIV. PRAC. & REM. CODE §74.351, 74.402. Dr. Breall is

not a pharmacist qualified on the basis of training or experience to offer an expert

report regarding accepted standards for a pharmacy or pharmacist. Because he is

not qualified to give opinions as to the standard of care, he cannot connect any

breaches of the standard of care with the damages claimed. Therefore, the Court’s

dismissal of Ms. Rodriguez’s claims against Walgreen and McGuire was correct.

                                                CONCLUSION

          The trial court was correct in dismissing the claims against Walgreen and

McGuire. Its order should be affirmed.

1751449.6/SPSA/87282/0138/030615                       19
                                   Respectfully submitted,

                                    /s/ Judith R. Blakeway
                                   JUDITH R. BLAKEWAY
                                   State Bar No. 02434400
                                   judith.blakeway@strasburger.com
                                   CYNTHIA DAY GRIMES
                                   State Bar No. 11436600
                                   Cynthia.Grimes@strasburger.com
                                   STRASBURGER & PRICE, LLP
                                   2301 Broadway
                                   San Antonio, Texas 78215
                                   (210) 250-6003 Telephone
                                   (210) 258-2706 Facsimile

                                   ATTORNEYS FOR APPELLEES
                                   THE WALGREEN COMPANY AND
                                   SARA ELIZABETH MCGUIRE

1751449.6/SPSA/87282/0138/030615     20
                                    CERTIFICATE OF SERVICE

          Pursuant to E-Filing Standing Order, I certify that on March 6, 2015, I

electronically filed the foregoing with the Clerk of Court using the

EFile.TXCourts.gov electronic filing system which will send notification of such

filing to the following:

     Lannie Todd Kelly
     State Bar No. 24035049
     THE CARLSON LAW FIRM, P.C.
     11606 N. IH–35
     Austin, TX 78753
     Telephone: (512) 346–5688
     Facsimile: (512) 719–4362
     tkelly@carlsonattorneys.com
            Attorneys for Appellant Nancy Jo Rodriguez

                                                   /s/ Judith R. Blakeway
                                                   JUDITH R. BLAKEWAY

                                   CERTIFICATE OF COMPLIANCE

          In accordance with Tex. R. App. P. 9.4(i)(1), I hereby certify that this Brief

of Appellees contains no more than 4,460 words.

                                                   /s/ Judith R. Blakeway
                                                   JUDITH R. BLAKEWAY

1751449.6/SPSA/87282/0138/030615              21
                                           NO. 03–14–00765–CV
                                       IN THE COURT OF APPEALS
                                   FOR THE THIRD DISTRICT OF TEXAS
                                               AT AUSTIN

                                         NANCY JO RODRIGUEZ
                                                          APPELLANT,
                                                     V.
         THE WALGREEN COMPANY AND SARA ELIZABETH MCGUIRE
                                                          APPELLEES.

                                   On Appeal from the 419th District Court
                                          Travis County, Texas

                                                APPENDIX

1.        Order dated December 3, 2014

2.        Mr. Hardy’s CV and report
3.        Dr. Breall’s CV and report

4.        TEX. CIV. PRAC. & REM. CODE §74.351
5.        TEX. CIV. PRAC. & REM. CODE §74.402

1751449.6/SPSA/87282/0138/030615                     22
APPENDIX 1
DEC-03-2014     14:56                                                                                                       P.002/006
                                                                                                         FHed In The District Court
                                                                                                          of Travis County, Texas

                                                                                                                  DEC 03 2014      {If1-
                                                   CAUSE NO. D-l-GN-000903
                                                                                                         AL       ' :~l1 fa:' _M.
                                                                                                                         a; Clark
                                                                                                         Amalia RJdriguez.Mendo

       NANCY.TO          RODRIGUEZ                                     §               IN THE DISTRICT            COURT    OF
                                                                       §
                           PLAINTIFF,                                  §
                                                                       §
                vs,                                                    §
                                                                       §                      TRAVIS    COUNTY, TEXAS
       THE WALGREEN     COMPANY, SARA                                  §
       ELIZA6ETH    MCGUIRE, AUSTIN HEART                              §
       PLLC,     sr.
                 DAVID'S HEALTH CARE                                   §
       PARTNERSHIP,   DA YID 11
                                              Tex. Civ. Prac. & Rem. Code § 74.351

physician    or health care provider.

     U) Nothing in this section shall be construed      to require the serving of an expert report regarding   any issue other
than an issue relating to liability or causation.

     (k) Subject to Subsection     (t), an expert report served under this section:

       (I) is not admissible   in evidence by any party;

       (2) shall not be used in a deposition,    trial, or other proceeding;   and

       (3) shall not be referred to by any party during the course of the action for any purpose.

     (l) A court shall grant a motion challenging the adequacy of an expert report only if it appears to the court, after
hearing, that the report does not represent an objective good faith effort to comply with the definition of an expert report
in Subsection (r)(6).

     (m) to (q) [Reserved].

     (r) In this section:

        (I) "Affected parties" means the claimant and the physician or health care provider who are directly affected by
an act or agreement required or permitted by this section and does not include other parties to an action who are not
directly affected by that particular act or agreement.

       (2) "Claim" means a health care liability claim.

       (3) [Reserved].

      (4) "Defendant" means a physician or health care provider against whom a health care liability claim is asserted.
The term includes a third-party defendant, cross-defendant, or counterdefendant.

       (5) "Expert" means:

            (A) with respect to a person giving opinion testimony regarding whether a physician departed from accepted
standards     of medical care, an expert qualified to testify under the requirements of Section 74.40 I;

            (B) with respect to a person giving opinion testimony regarding whether a health care provider departed from
accepted     standards of health care, an expert qualified to testify under the requirements of Section 74.402;

         (C) with respect to a person giving opinion testimony about the causal relationship between the injury, harm, or
damages claimed and the alleged departure from the applicable standard of care in any health care liability claim, a
physician who is otherwise qualified to render opinions on such causal relationship under the Texas Rules of Evidence;

         (D) with respect to a person giving opinion testimony about the causal relationship between the injury, harm, or
damages claimed and the alleged departure from the applicable standard of care for a dentist, a dentist or physician who
is otherwise qualified to render opinions on such causal relationship under the Texas Rules of Evidence; or

        (E) with respect to a person giving opinion testimony about the causal relationship between the injury, harm, or
damages claimed and the alleged departure from the applicable standard of care for a podiatrist, a podiatrist or physician
who is otherwise qualified to render opinions on such causal relationship under the Texas Rules of Evidence.

       (6) "Expert report" means a written report by an expert that provides a fair summary of the expert's opinions as of
the date of the report regarding applicable standards of care, the manner in which the care rendered by the physician or
                                                                                                                            Page 2
                                         Tex. Civ. Prac. & Rem. Code § 74.351

health care provider failed to meet the standards, and the causal relationship between that failure and the injury, harm,
or damages claimed.

    (s) Until a claimant has served the expert report and curriculum vitae as required by Subsection (a), all discovery in
a health care liability claim is stayed except for the acquisition by the claimant of information, including medical or
hospital records or other documents or tangible things, related to the patient's health care through:

      (I) written discovery as defined in Rule 192.7. Texas Rules of Civil Procedure;

      (2) depositions on written questions under Rule 200. Texas Rules of Civil Procedure; and

      (3) discovery from nonparties under Rule 20S. Texas Rules of Civil Procedure.

     (t) If an expert report is used by the claimant in the course of the action for any purpose other than to meet the
service requirement of Subsection (a), the restrictions imposed by Subsection (k) on use of the expert report by any
party are waived.

    (u) Notwithstanding any other provision of this section, after a claim is filed all claimants, collectively, may take
not more than two depositions before the expert report is served as required by Subsection (a).

HISTORY: Enacted by Acts 2003, 78th Leg., ch. 204 (H.B. 4), § 10.01, effective September 1,2003; am. Acts 2005,
79th Leg., ch. 635 (H.B. 2645), § I, effective September I, 2005; am. Acts 2013, 83rd Leg., ch. 870 (H.B. 658), § 2,
effective September I, 2013.

                                                                                                                     Page 3
APPENDIX 5
                                                         LEXSTAT

                                         LexisNexis (R) Texas Annotated Statutes
                                  Copyright © 2014 by Matthew Bender & Company, Inc.
                                            a member of the LexisNexis Group
                                                   All rights reserved.

                          ***   This document is current through the 2013 3rd Called Session     ***
                                       CIVIL PRACTICE AND REMEDIES CODE
                                            TITLE 4. LIABILITY IN TORT
                                         CHAPTER 74. MEDICAL LIABILITY
                                        SUBCHAPTER I. EXPERT WITNESSES

                                    GO TO TEXAS CODE ARCHIVE DIRECTORY

                                       Tex. Civ. Prac. & Rem. Code § 74.402 (2014)

§ 74.402. Qualifications of Expert Witness in Suit Against Health Care Provider

  (a) For purposes of this section, "practicing health care" includes:

      (I) training health care providers in the same field as the defendant health care provider at an accredited
educational institution; or

      (2) serving as a consulting health care provider and being licensed, certified, or registered in the same field as the
defendant health care provider.

    (b) In a suit involving a health care liability claim against a health care provider, a person may qualify as an expert
witness on the issue of whether the health care provider departed from accepted standards of care only if the person:

       (1) is practicing health care in a field of practice that involves the same type of care or treatment as that delivered
by the defendant health care provider, if the defendant health care provider is an individual, at the time the testimony is
given or was practicing that type of health care at the time the claim arose;

        (2) has knowledge of accepted standards of care for health care providers for the diagnosis, care, or treatment of
the illness, injury, or condition involved in the claim; and

       (3) is qualified on the basis of training or experience to offer an expert opinion regarding those accepted standards
of health care.

    (c) In determining whether a witness is qualified on the basis of training or experience, the court shall consider
whether, at the time the claim arose or at the time the testimony is given, the witness:

       (I) is certified by a licensing agency of one or more states of the United States or a national professional
certifying agency, or has other substantial training or experience, in the area of health care relevant to the claim; and

      (2) is actively practicing health care in rendering health care services relevant to the claim.

     (d) The court shall apply the criteria specified in Subsections (a), (b), and (c) in determining whether an expert is
qualified to offer expert testimony on the issue of whether the defendant health care provider departed from accepted

                                                                                                                        Page 1
                                          Tex. Civ. Prac. & Rem. Code § 74.402

standards of health care but may depart from those criteria if, under the circumstances, the court determines that there is
good reason to admit the expert's testimony. The court shall state on the record the reason for admitting the testimony if
the court departs from the criteria.

     (e) This section does not prevent a health care provider who is a defendant, or an employee of the defendant health
care provider, from qualifying as an expert.

      (f) A pretrial objection to the qualifications of a witness under this section must be made not later than the later of
the 21st day after the date the objecting party receives a copy of the witness's curriculum vitae or the 21st day after the
date of the witness's deposition. If circumstances arise after the date on which the objection must be made that could not
have been reasonably anticipated by a party before that date and that the party believes in good faith provide a basis for
an objection to a witness's qualifications, and if an objection was not made previously, this subsection does not prevent
the party from making an objection as soon as practicable under the circumstances. The court shall conduct a hearing to
determine whether the witness is qualified as soon as practicable after the filing of an objection and, if possible, before
trial. If the objecting party is unable to object in time for the hearing to be conducted before the trial, the hearing shall
be conducted outside the presence of the jury. This subsection does not prevent a party from examining or
cross-examining a witness at trial about the witness's qualifications.

HISTORY: Enacted by Acts 2003, 78th Leg., ch. 204 (H.B. 4), § 10.01, effective September 1,2003.

                                                                                                                      Page 2