Court Opinion

ID: 9748926
Source: CourtListenerOpinion
Date Created: 2023-08-27 16:17:49.90852+00
Date Added: 2024-06-11T07:25:40.729488
License: Public Domain

TAFT, Justice,
dissenting.
The Palacios present issues challenging the trial court’s dismissal of a medical malpractice action by utilizing an abuse-of-discretion standard of review of a trial court’s imposition of sanctions.1 Whether the issue is failure to make a good faith effort to comply, or the failure to provide a fair summary, and regardless of which standard of review is used,2 I would hold that the trial court did not err in dismissing the case. Accordingly, I respectfully dissent.
Did Expert Report Provide Fair Summary of Standard of Care and Failure to Meet that Standard?
The Hospital contends Dr. Bontke’s report did not provide a “fair summary” of her opinions concerning the applicable standard of care, nor how the Hospital failed to meet that standard, as required by subsection (r)(6) of article 4590i of the Medical Liability and Insurance Improvement Act. See Tex.Rev.Civ. Stat. Ann. art. 4590i, § 13.01(r)(6) (Vernon Supp.1999). The Palacios respond by referring us to the following portions of a letter from Dr. Bontke to counsel for the Palacios:
Based on the available documentation I was able to conclude that: Mr. Palacios fell from his bed on 5/14/94 while trying to get out of it on his own. The nursing notes document that he was observed by nursing on the hour for two hours prior to the fall. In addition, ten minutes before the fall, the nursing notes documents [sic] that his wrist/vest restraint were [sic] on. Yet, at the time of his fall he was found on the floor with his vest/ wrist restraints on but not tied to the *864bed. It is unclear how he could untie all four of the restraints from the bedframe in under ten minutes. Obviously, Mr. Palacios had a habit of trying to undo his restraints and precautions to prevent his fall were not properly utilized.
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All in all, Mr. Palacios sustained a second brain injury with a left subdural hematoma while he was an inpatient at [the Hospital].... In my opinion, the medical care rendered to Mr. Palacios at the time of his second brain injury was below the accepted and expected standard of care which he could expect to receive. Moreover, this below the accepted standard of care extends to both the cause of the second injury as well as the subsequent treatment ....
(Emphasis added). The Hospital contends these statements are conclusory and do not distinguish the different standards that would apply to each of the health care providers sued. However, subsection (r)(6) requires only that an expert report provide a “fair summary” of the expert’s opinion regarding the applicable standard of care and how that standard was breached. Tex.Rev.Civ. Stat. Ann. art. 4590i, § 18.01(r)(6).
Determining what constitutes a “fair summary” of the applicable standard of care, and how the standard was breached under section 13.01(r)(6) of article 4590i, appears to present a question of first impression. See Wood, 988 S.W.2d at 831-32 (analyzing closely similar issues). I would begin by examining precedents that de-. scribe what constitutes a statement of the applicable standard of care and how the standard is breached.
A standard of care for medical malprac- ' tice is the mode or form of treatment that a reasonable and prudent member of the medical profession would undertake. White v. Wah, 789 S.W.2d 312, 317 (Tex.App.-Houston [1st Dist.] 1990, no writ). One of our prior cases provides an example of a statement of a standard of care:
Based upon the qualifications described above, I am familiar with the standard of care and treatment of the patient with injuries and medical problems faced by the patient in question. That standard of care requires that the physician examine the patient, evaluate her medical condition, and treat the injury, prescribe medication if necessary, and refer the patient for follow-up treatment if necessary.
Armbruster v. Memorial Southwest Hosp., 857 S.W.2d 938, 943 (Tex.App.-Houston [1st Dist.] 1993, no writ).
A breach of a standard of care arises in relation to the standard required. For example, failure to prescribe necessary medication would constitute a breach of the standard stated in Armbruster. When the health-care provider is a hospital, the standard of care would conform to the reasonable and prudent mode of hospital care. Failure to follow the reasonable and prudent mode of hospital care would constitute a breach of the hospital’s standard of care.
Here, Dr. Bontke stated that Mr. Palac-ios had a habit of trying to undo his restraints, and precautions to prevent his fall were not properly utilized. She also stated the medical care rendered to Mr. Palac-ios was below the accepted standard of care. Dr. Bontke did not, however, state what precautions constituted the standard of care, nor how the Hospital could have complied with the accepted standard of care. It follows that she did not specify the manner in which the Hospital did not utilize precautions. The Palacios argue that a logical inference from Dr. Bontke’s report is that Mr. Palacios’s restraints *865were not properly tied to the bed. The Palacios further contend the implicit standard of care was thus to have tied the restraints to the bed properly, and that failure to tie the restraints properly constitutes the breach.
While a “fair summary” is something less than a full statement of the applicable standard of care and how it was breached, even a fair summary must set out what care was expected, but not given. In this case, I would expect a statement something like either of the following: “the applicable standard of care required the Hospital to check on the patient every five minutes, and the Hospital did not do so”; or “the applicable standard of care required the Hospital to secure the restraints with adhesive tape over the ties, but the Hospital did not do so.”
I agree with the Hospital that Dr. Bont-ke’s statement was conclusory. The statement amounted to no more than stating the health care provider did not take sufficient precautions to avoid the injury to the patient. Accordingly, Dr. Bontke’s statement did not provide a basis for the trial court to conclude with confidence that the Palacios’ medical malpractice suit had any substance. See Wood, 988 S.W.2d at 880; Horsley-Layman v. Angeles, 968 S.W.2d 538, 537 (Tex.App.-Texarkana 1998, no pet.) (explaining that purpose of article 4590i is to curtail frivolous claims against physicians and health care providers).
That Dr. Bontke’s report is conclusory is supported by the lack of any basis for her conclusion that “[Mr.] Palacios obviously was in the habit of trying to undo his restraints.” Furthermore, the report does not indicate what procedures should have been taken to restrain a regular patient, much less one who habitually tries to undo his restraints, such as using more secure restraints or checking the patient more frequently. It follows that the report does not state how the hospital failed to utilize such procedures. It is also noteworthy that Dr. Bontke’s report indicates that even though Mr. Palacios was scheduled only for hourly checks, on the hour, a nurse checked on him at 20 minutes after the hour. Finding Mr. Palacios trying to undo his restraints, the nurse tightened the restraints to the bed frame and brought in a Spanish-speaking nurse to admonish Mr. Palacios not to loosen his restraints, but to call for help when needed. This conduct demonstrates extraordinary care taken just 10 minutes before Mr. Palacios was found on the floor, having fallen out of his bed.
I agree with the Palacios that we cannot consider Dr. Bontke’s deposition testimony, given months after her report, in evaluating whether her report constituted a fair summary for purposes of section 13.01(r)(6). While rejecting the testimony for that purpose, it is still noteworthy because it shows that Dr. Bontke could not, even at the time of her deposition, state any precautions the Hospital could have taken to prevent Mr. Palacios’s fall out of bed.
I would conclude the trial court would not have abused its discretion in finding Dr. Bontke’s report did not contain a fair summary of the applicable standard of care and its breach.
Did Expert Report Constitute a Good Faith Effort to Provide Fair Summary of Standard of Care and Failure to Meet that Standard?
What the Palacios rely on as an expert report in this case is, from its face, a letter from Dr. Bontke to counsel for the Palac-ios explaining what went wrong in the Hospital’s care of Mr. Palacios. There is no reference to expert reports or subsection (r)(6) of section 13.01(Z) of article 4590L There is no attempt to comply with the requirements of an expert report by setting out the standard of care and its breach. The Palacios sought to make a silk purse (expert report) out of a sow’s ear (physician’s letter to counsel).
Accordingly, whether the issue was the Palacios’ failure to make a good faith effort to comply with the requirement of provid*866ing an expert report, or whether it was the Palacios’ failure to provide an expert report, I would hold that the Palacios failed to do so as a matter of law, so that it does not matter which standard of review is used. Therefore, I would overrule the Pa-lacios’ first two points of error.
Conclusion
I would affirm the trial court’s order dismissing the case.

. While we are not bound by the Palacios’ choice of the appropriate standard of review, the Palacios adopt the standard employed by the only other case reviewing the issue. See Wood v. Tice, 988 S.W.2d 829, 830 (Tex.App.-San Antonio 1999, pet. denied).

. The Majority Opinion sees the trial court’s dismissal as determining only the merits of the lawsuit. But it is also possible that a plaintiff’s disregard of the procedure might be considered in assessing the sanction of dismissal. See Tex.Rev.Civ. Stat. Ann. art. 4590i(e) (Vernon Supp.1999).