Court Opinion

ID: 9947176
Source: CourtListenerOpinion
Date Created: 2024-03-03 09:17:00.759154+00
Date Added: 2024-06-11T14:26:11.268181
License: Public Domain

Reversed and Remanded and Memorandum Opinion filed February 27, 2024.

                                      In the

                    Fourteenth Court of Appeals

                              NO. 14-23-00306-CV

MEMORIAL HERMAN HEALTH SYSTEM D/B/A MEMORIAL HERMAN
                 PEARLAND, Appellant
                                        V.

                         NAKISHA MASON, Appellee

                   On Appeal from the 164th District Court
                           Harris County, Texas
                     Trial Court Cause No. 2022-35358

                 MEMORANDUM                     OPINION

      In this case involving health care liability claims, the defendant moved for
dismissal on the ground that the plaintiff’s expert report was so inadequate as to
constitute no report. The trial court denied the motion. We conclude, however, that
the report does not constitute a good faith effort to comply with the Texas Medical
Liability Act’s definition of an “expert report.” We accordingly reverse the ruling
and remand the case for the trial court to award the defendant its reasonable
attorney’s fees and to dismiss the plaintiff’s health care liability claims with
prejudice.

                      I. THE TEXAS MEDICAL LIABILITY ACT

      Under the Texas Medical Liability Act, a claimant asserting a health care
liability claim is required to serve on each defendant physician or health care
provider the curriculum vitae of a qualified expert and the expert’s report providing
a fair summary of the expert’s opinion regarding the applicable standard of care, the
manner in which the defendant breached the standard of care, and the causal
relationship between that failure and the injury, harm, or damages claimed. TEX.
CIV. PRAC. & REM. CODE § 74.351(a), (r)(6). The Act requires expert reports so that
the trial court can “expeditiously weed out claims that have no merit.” Loaisiga v.
Cerda, 379 S.W.3d 248, 263 (Tex. 2012). To that end, an expert report must present
“a fair summary of the expert’s opinions about the applicable standard of care, the
manner in which the care failed to meet that standard, and the causal relationship
between that failure and the claimed injury.” Am. Transitional Care Ctrs. of Tex.,
Inc. v. Palacios, 46 S.W.3d 873, 878 (Tex. 2001). The expert reports must
collectively address each of these three elements. Bowie Mem’l Hosp. v. Wright, 79
S.W.3d 48, 52 (Tex. 2002) (per curiam). The experts must explain, based on facts
set out in the report, how and why the breach caused the injury. See Van Ness v.
ETMC First Physicians, 461 S.W.3d 140, 142 (Tex. 2015) (per curiam) (citing
Jelinek v. Casas, 328 S.W.3d 526, 539–40 (Tex. 2010)).

      If the claimant fails to serve the required materials by the 120th day after the
defendant answers the suit, the trial court must, on the defendant’s motion, dismiss
the claim with prejudice and award the defendant reasonable attorney’s fees and
costs of court. Id. § 74.351(a), (b). If the report is timely served but is deficient, the
trial court may grant the motion only if it appears to the court, after hearing, that the

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report does not represent an objective good faith effort to comply with the [Act’s]
definition of an “expert report.” Id. § 74.351(l). If the expert’s lack of relevant
qualifications or the report’s inadequacies are curable deficiencies, then the trial
court may grant the claimant a single thirty-day extension to cure the deficiencies.
Id. § 74.351(c).

                                    II. BACKGROUND

       Nakisha Mason sued Memorial Hermann Health System d/b/a Memorial
Hermann Pearland Hospital, alleging that during her hospitalization in August 2020,
a certified nursing assistant employed by the Hospital sexually assaulted her while
she was sedated. She asserted claims of vicarious liability for sexual assault and
direct liability for negligent supervision. The Hospital asserts that these are health
care liability claims subject to the Texas Medical Liability Act, and Mason does not
dispute that assertion.1 We therefore assume, without deciding, that the Act’s
requirement to serve the defendant with a qualified expert’s report and curriculum
vitae applies to these two claims.

       To meet the expert-report requirement, Mason served the Hospital with a letter
from her primary-care physician. The letter is dated September 9, 2022, which is
also identified as the date of Mason’s visit. The letter states as follows:

       To Whom It May Concern:
       This letter is to highlight the effects of sedation in the hospital.
       Nakisha Shennell Mason is a 48 y.o. who has a medical history of
       hypertension and CKD stage IV. I am writing this letter on her behalf
       as her primary care physician.

       1
         Mason further alleged that the Hospital committed common-law fraud and violated the
Deceptive Trade Practices–Consumer Protection Act by misrepresenting that the Hospital had not
received Mason’s initial request for her medical records and by failing to respond to Mason’s
second request for the records. Because the Hospital does not contend that claims arising from
Mason’s record requests are health care liability claims, we do not address them.

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      Procedural sedation involves the use of short-acting analgesic and
      sedative medications to enable clinicians to perform procedures
      effectively, while monitoring the patient closely for potential adverse
      side effects. Procedural sedation does alter the consciousness with the
      goal of relieving anxiety and pain.
      Once the procedure sedation has stopped, the patient may experience
      grogginess for several hours after the procedure. A patient may require
      assistance after the procedure as mental status and physical function
      may not have returned to baseline.
      It is my medical opinion that if Nakisha Mason suffered harm or injury
      within the first several hours after sedation, then, to a reasonable degree
      of medical certainty, the Hospital breached the standard of care.
      If you have any questions or concerns, please don’t hesitate to call.
      Sincerely
      /s/ Stephanie Ariana Warfield, DO

      The     Hospital    moved     to   dismiss     Mason’s     sexual-assault     and
negligent-supervision claims on the ground that Warfield’s letter is so deficient as
to constitute no expert report at all, inasmuch as it is unaccompanied by a curriculum
vitae and not only fails to describe the standard of care, the Hospital’s acts or
omissions that breached the standard of care, and causation, but does not even aver
that there was a breach, a harm, or injury.

      Mason responded that that the report represented a good-faith effort to comply
with the statutory requirements and that any deficiencies were curable. Mason asked
for a thirty-day extension to cure any deficiencies if the trial court found the report
to be insufficient.

      At the hearing, the trial court insisted that the Hospital’s motion to dismiss
was really a motion to strike Warfield as an expert witness. The trial court announced
from the bench that it was denying the motion as premature. The Hospital brings this
interlocutory appeal of the denial of its motion.

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                                    III. ANALYSIS

      We will reverse a trial court’s ruling on the experts’ qualifications and the
sufficiency of the experts’ reports only if the rulings constituted an abuse of
discretion. Id. A trial court abuses its discretion if it rules without reference to
guiding rules or principles. Id. A trial court has no discretion in determining what
the law is or applying the law to the facts. Walker v. Packer, 827 S.W.2d 833, 840
(Tex. 1992). In determining whether the trial court abused its discretion, the scope
of our review is limited to the four corners of the expert report and the expert’s
curriculum vitae. See Methodist Hosp. v. Addison, 574 S.W.3d 490, 503 (Tex.
App.—Houston [14th Dist.] 2018, no pet.).

      On appeal, the Hospital re-urges the argument that Warfield’s letter not only
fails to meet the requirements of an expert report but is so inadequate that it is no
report.

      The first part of that argument is not seriously disputed. The Act defines an
“expert report” as

      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 health care provider failed to meet the standards, and the
      causal relationship between that failure and the injury, harm, or
      damages claimed.
TEX. CIV. PRAC. REM. & REM. CODE § 74.351(r)(6). Warfield was not shown to be
qualified to offer an expert opinion on the standard of care applicable to the Hospital,
and she does not describe the standard of care, an act or omission by the Hospital
that breached the standard of care, or causation. Thus, the report’s contents meet
none of the Act’s requirements.

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       Mason has not argued that the document fulfilled all of the statutory
requirements of an “expert report.” She has not filed an appellate brief, and in
Mason’s response in the trial court to the motion to dismiss, she offered no argument
concerning the report’s failure (a) to address Warfield’s qualifications as an expert,
(b) to describe the applicable standard of care, (c) to identify an act or omission that
breached the standard of care, or (d) to explain the causal relationship between any
breach of the standard of care and the injury, harm, or damages claimed. Instead,
Mason asserted, without explanation, that she made a good-faith effort to comply
with the Act’s requirements, and she asked for a thirty-day extension in which to
cure any deficiencies should the trial court find the report insufficient.

       At best, the report is severely deficient. Thus, the question on appeal is
whether Warfield’s report represents a good-faith effort to comply with the Act or is
instead so inadequate that it is the legal equivalent of no report. If the former, then
the trial court must be given the opportunity to determine whether to grant Mason’s
request for a thirty-day extension to cure the report’s deficiencies. See id.
§ 74.351(c). But if the report is the legal equivalent of no report, then the trial court
must grant the motion to dismiss, award the Hospital its reasonable attorney’s fees
and costs of court, and dismiss with prejudice the health care liability claims against
it. See id. § 74.351(b), (l).

       A timely-served document qualifies as an expert report if it contains “a
statement of opinion by an individual with expertise indicating that the claim
asserted by the plaintiff against the defendant has merit.” Scoresby v. Santillan, 346
S.W.3d 546, 549 (Tex. 2011). The report also must implicate the defendant’s
conduct. Id. at 557. If the document satisfies these requirements, then it meets the
“minimal standard” necessary to avoid mandatory dismissal. See id. But the report
“must actually allege that someone committed malpractice.” Id. at 559 (Willett, J.,
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concurring). If the report “never asserts that anyone did anything wrong,” it is not
merely deficient; it is not an expert report at all, and the plaintiff “cannot receive an
extension” to file a conforming report. Id. at 558 (emphasis in original).

       Limiting our review to the information contained in Warfield’s report, as we
must,2 we conclude that it fails to meet the minimal standard to constitute an expert
report. Far from indicating that Mason’s claims have merit, Warfield does not
indicate that Mason has a claim at all. Warfield does not make a single factual
allegation about the Hospital, any Hospital employee or class of employees, or any
event occurring in the Hospital. She does not even represent that Mason was ever
hospitalized. Although Warfield speaks generally about procedural sedation and
says that “[a] patient may require assistance after the procedure,” she does not allege
that Mason has ever undergone any procedure, in or out of the Hospital. Warfield
concludes her report with the statement, “It is my medical opinion that if Nakisha
Mason suffered harm or injury within the first several hours after sedation, then, to
a reasonable degree of medical certainty, the Hospital breached the standard of
care.”3 But Warfield does not contend that Mason did suffer any harm or injury, or
that Mason was ever sedated, or that any such harm or injury was sustained “within
the first several hours after sedation,” or that the Hospital or any of its employees
did something that should not have been done, or failed to do something that should
have been done, or in any way caused Mason any harm or injury at any time.

       We sustain the sole issue presented.

       2
         See Abshire v. Christus Health Se. Tex., 563 S.W.3d 219, 223 (Tex. 2018) (per curiam)
(citing Palacios, 46 S.W.3d at 878).
       3
           Emphasis added.

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                                  IV. CONCLUSION

      Warfield’s report is inadequate as a matter of law, and because it neither
“contains the opinion of an individual with expertise that the claim has merit” nor
implicates the Hospital’s conduct, it does not meet even the minimal requirements
necessary to obtain a thirty-day extension. Id. at 557. We reverse the trial court’s
order denying the Hospital’s motion to dismiss, and we remand the case for the trial
court to determine and award to the Hospital its reasonable attorney’s fees and costs
of court and to thereafter dismiss with prejudice Mason’s health care liability claims.

                                        /s/       Tracy Christopher
                                                  Chief Justice

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

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