Court Opinion

ID: 9376933
Source: CourtListenerOpinion
Date Created: 2023-03-06 11:07:01.368528+00
Date Added: 2024-06-11T17:17:10.429359
License: Public Domain

In the
                     Court of Appeals
             Second Appellate District of Texas
                      at Fort Worth
                  ___________________________
                       No. 02-22-00030-CV
                  ___________________________

                 CHYANNE NICHOLS, Appellant

                                 V.

MARC AARON WILSON, M.D.; ALLIANCE HEALTH PARTNERS, PLLC; AND
        ALLIANCE OB/GYN SPECIALISTS, PLLC, Appellees

               On Appeal from the 342nd District Court
                       Tarrant County, Texas
                   Trial Court No. 342-301065-18

                Before Kerr, Bassel, and Womack, JJ.
               Memorandum Opinion by Justice Bassel
                           MEMORANDUM OPINION

                                   I. Introduction

      Appellant Chyanne Nichols1 appeals from a take-nothing judgment in a

medical-malpractice action rendered in favor of Appellees Marc Aaron Wilson, M.D.;

Alliance Health Partners, PLLC; and Alliance Ob/Gyn Specialists, PLLC. 2 A jury

answered “[n]o” to a charge question that asked whether Appellees’ acts were

negligent or a proximate cause of Appellant’s injuries.

      Mrs. Dozier raises two issues on appeal. We will address her second issue—in

which she attacks the adverse jury finding on legal- and factual-sufficiency grounds—

first. We overrule this issue because the jury heard a battle of medical experts and

because the record establishes that there is some evidence supporting the jury’s

answer and that the answer is not against the great weight and preponderance of the

evidence.

      We also overrule Mrs. Dozier’s first issue that challenges the trial court’s refusal

to permit her counsel to question one of Dr. Wilson’s expert witnesses on a particular

topic. Mrs. Dozier contends that it was error to prohibit questioning the expert about

whether he was biased because he had been sued by Mrs. Dozier’s counsel for

      1
       We will refer to Appellant as Appellant, Plaintiff, or Mrs. Dozier, which is her
married name and the name by which she was referred to during the trial.
      2
       With regard to Appellees, we will refer solely to Dr. Wilson as he is the doctor
who performed the procedure that is the subject of Mrs. Dozier’s claims of
negligence; the remaining Appellees are practice groups with which he is affiliated.

                                           2
allegedly previously committing breaches of the standard of care similar to those that

she had alleged against Dr. Wilson. We overrule this issue because Mrs. Dozier never

explains how this one alleged error so tainted the record that it probably caused the

rendition of an improper judgment, i.e., how—in view of the numerous opinions

going both ways—the jury would have changed its answer if it had been privy to the

fact that one of Dr. Wilson’s experts had previously acted negligently or had injured

another patient. Here, the view that this restriction on cross-examination caused the

rendition of an improper judgment is even more unlikely because the expert’s

credibility had already suffered a blow from the cross-examination that resulted when

the expert changed his opinion in front of the jury, switching from his conclusion that

Dr. Wilson had not met the standard of care to one that he had. Further, the trial

court did not abuse its discretion by limiting the scope of cross-examination; to have

permitted cross-examination on the expert’s alleged prior negligence would have

created the real possibility of a lengthy trial within a trial dealing with whether claims

against the expert were similar to those alleged against Dr. Wilson and whether the

proof that would be offered to establish the existence and similarity of the claims was

appropriate. The trial court had the discretion to limit cross-examination of the

expert so as to not spend excessive time dealing with a subsidiary issue.

      Based on our disposition of these issues, we affirm the trial court’s judgment.

                                            3
                      II. Factual and Procedural Background

      For six days, the jury heard testimony, including the testimony of twelve

medical doctors who offered opinions on whether the care that Mrs. Dozier had

received met the required standard of care and when and how her injury had

occurred. In the simplest terms, Plaintiff’s theory of the case was that Mrs. Dozier’s

bowel had been perforated during a procedure performed by Dr. Wilson and that the

standard of care required a “meticulous inspection and examination of the surgical

area” before ending the procedure “to ensure [that the surgeon had not] caused an

unintended injury to the surgical anatomy.” According to Plaintiff’s theory,

Dr. Wilson failed to meet this standard of care because he had not examined

Mrs. Dozier’s bowel before ending the procedure, even though the procedure he

conducted involved the bowel. 3

      A.     The medical procedure that is at issue in this appeal

      Mrs. Dozier suffers from endometriosis, which is a condition that occurs when

“[t]he tissue that normally grows inside the uterus [grows] outside of the uterus.” It is

a persistent and painful condition. The procedure that is the focus of the instant suit

was the third procedure that Mrs. Dozier had undergone to treat her condition.

      During the procedure at issue, Mrs. Dozier underwent a fulguration, which is a

burning of the uterine tissue growing outside of the uterus. The procedure on

      3
        The injury occurred to Mrs. Dozier’s transverse colon. For simplicity and
because the record frequently refers to the injury as having occurred to the bowel, we
will use that term when describing the organ involved.

                                           4
Mrs. Dozier was performed laparoscopically. In essence, a laparoscopic procedure

involves using an instrument called a trocar to make small incisions in the patient’s

belly into which instruments are placed. In the procedure at issue, two incisions were

made—one in the belly button and the other below that point above the pelvis. As

the first step in the process, pneumoperitoneum—the introduction of air or gas into

the belly—occurred when carbon dioxide was introduced “in the abdomen to displace

the abdomen so that it’s away from the intestines.”

      During the procedure at issue, two sets of instruments were inserted through

the incisions.   A camera was inserted in one port, and as the procedure was

performed, the surgeon watched a screen on which the images from the camera were

projected. In this case, the inserted camera took color photographs at various stages

of the procedure, and the record contains sixteen color photographs taken at various

points throughout.    The other port was used for the insertion of two other

instruments at different points during the procedure. The first was an endo shear,

which was described as a long stick with a little pair of scissors on the end and a

cautery device that was used to “burn off” any endometriosis that was found during

the procedure. The second instrument was a blunt probe.

      During the laparoscopy, the patient’s body was positioned according to a

“steep Trendelenburg” procedure by which the patient’s feet were elevated and the

head was lowered. This procedure was intended to displace organs, including the

bowel, out of the abdominal cavity.

                                          5
       A central focus of the litigation was the contact of surgical instruments with

Mrs. Dozier’s bowel during the procedure. As a result of endometriosis and prior

procedures, scar tissue may form in the abdomen of a patient. This scar tissue creates

adhesions, which in this case were “the [bands of] scar tissue that [were] holding the

bowel to the other anatomy.” Because of the presence of these adhesions, even

though Mrs. Dozier was positioned using the Trendelenburg procedure, her bowel

was not completely displaced by the force of gravity. Instead, the adhesions had to be

lysed, i.e., cut through. Dr. Wilson described using both the blunt probe and the endo

shears to separate the bowel from surrounding tissue to “identify the endometriosis.”

The focus of Mrs. Dozier’s questioning of Dr. Wilson involved whether he had

adequately inspected the bowel before ending the surgery when he failed to use a

probe to look within the folded structure of the bowel to determine whether an injury

to it had occurred during the procedure.

      B.      The course of Mrs. Dozier’s illness that occurred after the
              laparoscopic procedure at issue

      Another central focus of the trial was Mrs. Dozier’s condition and the

treatment that she received in the days after the laparoscopic procedure performed by

Dr. Wilson.    This was a central focus on the question of whether the bowel

perforation that was eventually discovered had occurred during the procedure

performed by Dr. Wilson or whether it had occurred in the days after the procedure.

The basic chronology of events is as follows:

                                           6
      8/24/16      Dr. Wilson performed the laparoscopic procedure at issue, and

      Mrs. Dozier was discharged.

      Same day     One hour and 18 minutes after discharge from the surgery center

      where the laparoscopic procedure was performed, Mrs. Dozier went to the

      emergency room of a local hospital and reported pain at a level of nine out of

      ten and nausea and vomiting.      She also reported guarding and rebound

      tenderness of the area where the surgery occurred.4 Dr. Wilson was consulted,

      a sonogram was performed, pain medication was administered, and

      Mrs. Dozier was sent home without being admitted to the hospital.

      8/26/16      Mrs. Dozier returned to the emergency room again complaining

      of severe pain. A CT scan was performed that was read as normal by a

      radiologist (who was another defendant in this matter due to allegedly

      misreading the scan). A gynecologist on call for Dr. Wilson was consulted but

      did not come to the ER. Again, Mrs. Dozier was sent home without being

      admitted to the hospital.

      8/29/16      Mrs. Dozier returned to the emergency room. One of the new

      symptoms that she reported was distension of her abdomen. Mrs. Dozier was

      admitted to the hospital.

      4
       The record explains that “abdominal guarding [is] tensing of the abdominal
muscles to guard inflamed organs within the abdomen” and that “[r]ebound
tenderness is pain [that occurs] after removing pressure from the abdomen when
someone presses hands on the abdomen and then quickly removes them.”

                                         7
      8/30/16      In the early morning, another CT scan was performed. This CT

      scan was read as “suspicious for developing intra-abdominal abscesses.”

      Dr. Wilson testified that at this point, he consulted with Mrs. Dozier and her

      mother and told them that he wanted to give the antibiotics that he had

      administered time to work, but if there were a change, he would operate the

      next morning. Dr. Wilson also testified that he decided to operate when

      Mrs. Dozier’s white cell count increased.

      8/31/16      Dr. Wilson performed surgery and found that there was a

      perforation in Mrs. Dozier’s bowel.         Upon discovery of the perforation,

      Dr. Wilson called in a general surgeon who had been on standby to repair the

      bowel. The surgeon removed the portion of the bowel that was perforated and

      performed a colostomy.5

      Post-8/31/16        Mrs. Dozier testified that, in the days after the colostomy,

      her condition continued to worsen. Mrs. Dozier’s mother demanded that she

      be transferred to another hospital, and she was. After transfer, another general

      surgeon undertook the care of Mrs. Dozier. This surgeon also operated on

      Mrs. Dozier and reported on the state of the infection that he found and how

      portions of the wound had pulled apart. This surgeon also described the

      5
        As noted in the record, “[C]olostomy surgery is cutting the colon and then
reattaching one end to the skin through a hole in the abdomen so it can empty poop
into a bag.”

                                          8
      ongoing treatment of Mrs. Dozier over the ensuing months and the procedures

      that she had to endure.

      C.     The effect that the bowel perforation had on Mrs. Dozier’s life

      At the time of trial, Mrs. Dozier was twenty-five years of age. She testified

poignantly about the pain and anxiety that she had endured after the procedure

performed by Dr. Wilson and the course of treatment that she had also endured to

treat the bowel perforation, including having to wear a colostomy bag. Though she

had married and had given birth to a child after the events at issue, she and her

husband also testified about the lasting pain and effects on her life that the bowel

perforation had caused. For example, Mrs. Dozier’s husband testified that her pain

often reached a level that she had to be taken to the emergency room. Mrs. Dozier

described how the pain she experienced caused her to have panic attacks. She went

on to testify that she was no longer able to pursue activities that she had once

enjoyed, such as riding horses and racing mini sprint cars. She also described her fear

that the physical effects of the bowel perforation would impact her ability to engage in

activities with her daughter.

      D.     The clash that occurred at trial over whether Dr. Wilson had met
             the standard of care when performing the laparoscopic procedure

      At the outset of the testimony, Dr. Wilson agreed with Plaintiff’s counsel that

“the standard of care requires meticulous inspection and examination of the surgical

area following fulguration of endometriosis to ensure you haven’t caused an

                                           9
unintended injury to the surgical anatomy, including the bowel.” Over the ensuing six

days of testimony, the jury was presented with a divergence of opinion on whether

Dr. Wilson had met this standard. Both sides’ experts were presented as highly

qualified in their fields and were strenuously cross-examined about their backgrounds,

qualifications, prior service as experts on one side of the docket or the other, and the

tens of thousands of dollars in fees that they had received for serving as experts in this

case.

        On Plaintiff’s side of the equation, a gynecological surgeon testified in detail

about the surgical procedure that Mrs. Dozier had undergone. This expert opined

that Dr. Wilson had injured Mrs. Dozier’s bowel “[w]ith the combination of lysis of

adhesions and the fulguration of endometriosis.”            He relied heavily on the

intraoperative photographs, which were the “colored pictures that Dr. Wilson actually

took . . . during his surgery.” This expert took the jury through the procedure using

the photos. The expert pointed out the anatomy on which Dr. Wilson had performed

the procedure and criticized his using only endo shears and not some type of grasper

because the endo shears transmitted electricity to cauterize and because using the

shears could cause an injury to the tissue touched by the shears. The expert identified

areas in the photos where he concluded that the endo shears had caused an injury to

the surrounding tissue. The expert also opined that Dr. Wilson had been lysing

adhesions in the area where it was later discovered that Mrs. Dozier’s bowel was

perforated. The expert opined on what Dr. Wilson should have done to meticulously

                                           10
inspect the surgical area and concluded that the matters on which Dr. Wilson had

relied (such as a lack of bleeding—referred to as hemostasis—and watching what he

was doing as he performed the procedure) were not adequate to meet the standard of

care for meticulous inspection.

      A general surgeon who operated on Mrs. Dozier after she was transferred to

another hospital also presented opinions of the standard of care for a general surgeon.

This expert operated under a presumption that “if you have a procedure today and

two days or three days from now you have a bowel perforation, until you prove

otherwise, it’s what happened at the time of the procedure.” He further opined that it

was the duty of the surgeon to inspect an area where he had been lysing adhesions

and to “be certain that there [was] no injury to the bowel.” This expert also opined

that hemostasis alone constitutes inadequate inspection of the surgical area.         In

essence, the expert concluded that “if you don’t look for it, you won’t find it.”

      A defense expert, whose deposition testimony was introduced by Plaintiff,

testified that his “best guess” was that “the injury that caused [Mrs. Dozier’s] bowel to

perforate was in all probability part of [the laparoscopic] procedure.” He also opined

on the “standard of care require[d] . . . for intraoperative repair of serosal [the outer

layer of the colon] injury if it’s identified prior to closure of a procedure” and stated

that the “standard of care requires a gynecologic surgeon to meticulously inspect the

bowel in the operative field to identify full thickness and serosal injuries prior to

closure.” This expert, however, did not provide an opinion on whether Dr. Wilson

                                           11
had violated the standard of care when he performed the laparoscopic procedure on

Mrs. Dozier.

      Marshalled against Plaintiff’s experts’ opinions and that of the expert quoted in

the preceding paragraph were those of Dr. Wilson and the other defense experts.

When questioned by his counsel, Dr. Wilson testified that he had met the applicable

standard of care, that he was not negligent, and that his care did not proximately cause

an injury to Mrs. Dozier. In response to questions from his counsel, Dr. Wilson

described the process that he had followed as outlined in his operation report:

      Q. Okay. Second page of your operation report, what’s my pen
      pointing to?

               A. Trendelenburg position. Steep Trendelenburg.

               Q. We discussed that already, correct?

               A. Correct.

               Q. What’s the word it’s pointing to?

               A. Pneumoperitoneum.

               Q. What is that?

               A. [CO2] gas in the abdomen.

            Q. Okay. You create a pneumoperitoneum when you put in the
      [CO2] gas?

               A. Correct.

             Q. You talk about a second port. Would you be kind enough to
      read that?

                                           12
      A. A second port was then placed in the left upper quadrant.

      Q. Okay.

      A. Was done on direct visualization.

      Q. Where would that be?

      A. Up here (indicating).

      Q. Okay.

      A. Yeah.

      Q. Read that sentence, please.

       A. The Endo Shears were then used to take down the filmy
adhesions and cauterize the endometrial implants noted in the upper
gastric region of the abdomen.

      Q. Read that.

      A. Good hemostasis was noted.

      Q. What is hemostasis?

      A. Bleeding. There’s no -- there’s no bleeding whatsoever.

      Q. Okay. Now, follow me. I’m going to ask you a question.

      A. Okay.

        Q. When you are doing the procedure, is -- I asked this earlier --
but is the camera in?

      A. Correct.

       Q. All right. Every cut with the Endo Shears, is the camera on
the cut?

      A. Yes.

                                   13
      Q. Okay. Every manipulation or takedown with a blunt-forced
instrument, is the camera there?

      A. Yes.

       Q. Okay. So when you -- when you say “good hemostasis,”
[your] meaning was obtained or the good hemostasis was noted. What
does that mean?

       A. That means that when I did the procedure and once I took
down the adhesions, because of the possibility of bleeding, which is a
very common complication associated with this procedure, we wanted to
make sure that that was not the case, that she did not have any bleeding
after we took down those adhesions.

      Q. All right. So if I have a camera pointed on this --

      A. Uh-huh.

      Q. -- in the abdomen and I’m taking down adhesions along
where the lining is at --

      A. Right.

      Q. -- my camera is pointing at it, and then I create good
hemostasis, am I looking at exactly where my cutting or blunt-forced
instruments were at?

      A. Absolutely.

       Q. If you had an injury to the bowel of any sort, would you see it
while you’re verifying your hemostasis?

      A. You would.

      Q. Okay. Now, you don’t go and say in your report specific
words of “I looked for injury to a bowel,” you don’t say those words, do
you?

      A. No.

                                   14
       Q. Okay. Why not?

      A. Because I didn’t have an injury. I wasn’t -- when we looked at
the adhesions and when we were doing the procedure, I was taking
down the adhesions; so the bowel may have been in the vicinity, but it
was not in the area that I was operating in.

       Q. Okay. Every place that you cut, you’ve got a camera?

       A. Correct.

      Q. Every place there’s a blunt-forced instrument, you’ve got a
camera?

       A. Correct.

       Q. Every place you do that, you check for hemostasis?

       A. Correct.

       Q. And if you see nothing, you know there’s no injury there at
all?

       A. Correct.

       Q. To any structure?

       A. Right.

      Q. Okay. Did you do anything different in Mrs. Dozier’s
procedure after, whatever it was, 20 years of doing these? Did you do
something -- and you never had one -- did you do something different in
hers?

       A. Absolutely not.

       Q. Did you get in a hurry in hers?

       A. No.

       Q. But even though you never had before?

                                   15
             A. No.

            Q. Did you exercise less skill and less concern and less
      observation in hers than you did in any of the other ones for 19 years?

             A. Absolutely not.

            Q. In reasonable medical probability, can you tell us whether or
      not you believe there was a bowel perforation at the end of your
      procedure when you finished?

             A. No, there was not.

             ....

             Q. Do the pictures show any evidence of a bowel perforation?

             A. No.

            Q. In the totality of what you saw through the camera during
      your procedure, did you ever see any sign or symptom or evidence of a
      bowel perf at all that was apparent to you?

             A. No, absolutely not.

             Q. And during your procedure, did you look in the areas where
      you removed or blunt-forced adhesions, did you look, while doing it, for
      injury to surrounding structures?

             A. Yes.

             Q. And did you see it anywhere?

             A. No.

      Though he had initially agreed with Plaintiff’s counsel that Dr. Wilson had not

met the standard of care, the defense’s first expert on the standard of care stated his

opinion that Dr. Wilson had appropriately evaluated Mrs. Dozier before ending the

                                          16
procedure.6 Emphasizing facts similar to those emphasized by Dr. Wilson, this expert

noted that the operative record showed good hemostasis. The expert then went on to

express why he had concluded that Dr. Wilson had acted within the standard of care:

      Q. From your review of the medical records and your review of Dr.
      Wilson’s sworn deposition testimony, can you tell us whether or not you
      have an opinion as to whether or not he would have, during the
      procedure, while lysing adhesions, have been able to see whether or not
      injuries to the bowel had occurred?

            A. Yes, I have formed an opinion.

            Q. And that is what?

             A. That Dr. Wilson took pictures before he did the surgery and
      he actually took pictures during the surgery while he was actually cutting,
      lysing the adhesions, and then he took pictures after the surgery where
      you could see the adhesions were now gone. The area that he burned to
      get rid of the endometriosis fulgurated, cauterized[,] and you could see
      the bowel in there. And then he looked for bleeding or no bleeding, and
      since there was no bleeding, he had to evaluate the area.

            So, yes, that’s my opinion.

The expert later testified that it was not necessary to look twice at the area where

procedures were performed.      He reiterated that Dr. Wilson had looked because

Dr. Wilson had reported good hemostasis, which indicated that he had looked at the

areas that he had lysed because he could not “evaluate hemostasis without looking at

all of the areas where he [had] lysed adhesions.” The expert also noted that the

general surgeon—who had operated on Mrs. Dozier at the second hospital, who had

      Whether the trial court erroneously limited the scope of this expert’s cross-
      6

examination is the subject of Mrs. Dozier’s first issue.

                                          17
testified as a Plaintiff’s expert, and whose testimony is outlined above—produced an

operative report that did not “say anywhere in here that at the conclusion of his lysing

of adhesions that he looked all over the bowel and all up and down the bowel for a

double look or a second look before he says my hemostasis was good.” Instead, that

surgeon’s notation—“my hemostasis was good”—was the same as Dr. Wilson’s.

      The defense’s second expert who testified on whether Dr. Wilson had met the

standard of care stated that Dr. Wilson was not negligent. The second defense expert

opined that the operative report prepared by Dr. Wilson with respect to the procedure

at issue was excellent. He noted that the report included sixteen photos and described

the taking of that many photographs as going above and beyond. The number of

photographs indicated that “this is someone [who] cares about what [he is] doing and

is taking care during the conduct of the surgery.” The second defense expert on the

standard of care went on to describe his conclusions as follows:

      [Q.] If a doctor notes in [his] operative report good hemostasis, what
      does that mean to you?

             A. It means that there wasn’t bleeding.

              Q. If you’re looking at where you’re lysing and you’re taking
      down adhesions, and you note good hemostasis, is there any way to do
      that, to note good hemostasis without having looked exactly everywhere
      you lysed and everywhere you cut adhesion?

             A. No. I mean, if you note that, it means you looked.

             Q. So when Dr. Wilson’s operative report notes good hemostasis
      was noted, and he notes that before the procedure was completed, as a
      peer-reviewer at one of the more well thought of institutions in -- I think

                                          18
      in the world, does that tell you whether or not Dr. Wilson evaluated and
      looked at every single place where he lysed or cut an adhesion?

             A. Yeah. I mean, I would say that, you know, he’s -- he
      described -- he’s described the steps of the surgery and what he saw very
      well, and part of doing surgery is looking at what you’re doing and seeing
      it, and knowing if, in fact, you need to go back and look at something
      again.

             So I’m confident that he’s describing that very well, and that good
      hemostasis was noted and that nothing was seen that looked unusual.
      And there’s more confidence in that opinion because based on the fact
      that there’s 16 pictures. So I mean, there’s a lot here that shows me that
      the conduct of the case was good.

      The defense’s second expert on the standard of care stated the same opinion

that had been given by the first expert that a “second look” of the surgical area was

not required:

      Q. If Dr. Wilson is looking with a camera on the big screen while lysing
      adhesions, if he’s further noting in his op report that he has good
      hemostasis, meaning there’s nothing seen in that area and that he’s
      looking, and if he further has documented bits and pieces of this with 16
      pictures, more than what you would have ever seen, do you think
      Dr. Wilson has met the standard of care?

                A. Yes, I do.

            Q. And do you think that there was anything required by the
      standard of care for Dr. Wilson, after he had done all of this, to go back
      and just re-explore the entire abdomen a second time before he closes?

                A. No.

              Q. And, in fact, not only do you say that’s not the standard, do
      you even see reasonable prudent well-trained doctors at your medical
      institution, when they’ve done everything that Dr. Wilson did, and we
      know he did, they don’t go back and re-explore for a second look before
      they close, do they?

                                         19
             A. No.

      The defense’s second expert on the standard of care was subject to a lengthy

and dogged cross-examination. The expert agreed that the standard of care required a

meticulous inspection of the surgical area before ending the laparoscopic procedure

and that “[i]f you lyse adhesions on the bowel, you would inspect it.” The expert

conceded that he was not aware that Dr. Wilson had lysed on Mrs. Dozier’s bowel

“prior to coming in here.”      A continued back-and-forth exchange ensued, with

Plaintiff’s counsel trying to back the expert away from his opinion that Dr. Wilson

had conformed to the standard of care based on Dr. Wilson’s statement that he had

lysed adhesions on the bowel but not inspected it before ending the procedure and

the expert’s sticking by his opinion that Dr. Wilson had acted within the standard of

care. For example,

      Q. And you’ve now learned that contrary to what your thought was,
      that [Dr. Wilson], in fact, did cut adhesions on the transverse colon, but
      you’re still refusing to change your opinion, right?

             A. I mean, he -- you know, it’s -- you’re trying to oversimplify
      this. I mean, an adhesion -- the adhesion that he was describing that was
      attached to the transverse colon may have actually been eight or nine
      inches away from the transverse colon. He may have cut the adhesion at
      the abdominal wall. The adhesion may have been six inches away.

             So, I mean, again, I didn’t talk to him about the case or hear about
      this before, but it’s unlikely that the transverse colon was attached to the
      abdominal wall in this area where he was lysing the adhesions. I mean,
      the transverse colon lies on the posterior part of the abdominal cavity,
      and it would be very unlikely that the whole transverse colon was up
      there and he was cutting right on the transverse colon. That’s the
      anatomy.

                                          20
      At another point, the following exchange occurred,

      Q. And that’s the reason that you can’t just rely on looking in one
      direction while you’re cutting to make sure you didn’t cause an injury,
      because you have to go back and inspect and make sure it’s not in one of
      those folds or where the bowel is turned, right?

            A. I mean, as I said before and I’ll say again, I mean, he was
      looking at the area that he was lysing adhesions on, and he was doing a
      meticulous inspection of that area while he was doing it, and that’s what
      you need to do.

      Another defense theme relied on literature that reported delayed diagnosis in a

large percentage of bowel injuries occurring during laparoscopic surgery. Countering

this literature, Plaintiff’s counsel noted that the literature included a broad range of

procedures and that the types of injuries not found were of a different and more

difficult to find type than the injury that was allegedly caused by Dr. Wilson.

      E.     The clash that occurred at trial over when and how Mrs. Dozier’s
             bowel perforated

      Another hotly contested issue before the jury was when the perforation in

Mrs. Dozier’s bowel had occurred.         Plaintiff’s theory was obviously that the

perforation had occurred during the laparoscopy and that the meticulous inspection

of the surgical area required by the standard of care would have revealed its presence.

The defense’s theory was that other forces not caused by the procedure, or which

were not apparent during the procedure, caused the perforation and that the

perforation did not occur until shortly before its discovery during the follow-up

surgery conducted by Dr. Wilson and the general surgeon who was called in to

                                           21
perform the colostomy. A host of disputes arose during which each side tried to

support its position and undermine that of its opponent.

      The parties clashed as to whether the visits that Mrs. Dozier had to the

emergency room on the day of and two days after the laparoscopic procedure

suggested the existence of a bowel perforation or were more indicative of normal

post-operative complaints. The defense view characterized the symptoms that Mrs.

Dozier manifested as not creating a high index of suspicion—i.e., a doctor would not

consider a certain diagnosis to be a strong possibility—that a perforation was present.

A central feature of this view was that Mrs. Dozier had displayed similar complaints

after a prior laparoscopic procedure when no bowel perforation had been present.

Indeed, the jury heard from another defense expert who testified as follows:

      Q. Between your report and your deposition, do you think we’ve
      covered all of your opinions?

             A. Not quite.

             Q. Okay. What haven’t we covered?

              A. Well, again, it’s my opinion that three different teams
      evaluated [Mrs. Dozier] from the time that she had her initial surgery to
      the time that her bowel injury was -- from the time of re-op, let’s say
      that. So there was a seven-day period between the surgery Dr. Wilson
      performed and the second surgery at which he took part where her
      bowel was initially repaired. And it’s -- it’s my opinion that of those
      three teams -- you know, the first being the two nurses at post-op, the
      next being that first ER encounter[,] and the third team being the ER
      encounter 24 hours later, [Mrs. Dozier] was never admitted. So you
      could say that all three teams missed a bowel perforation. I think that’s
      less likely than the fact that her bowel perforation hadn’t happened yet.

                                          22
      She had some pretty vague symptoms that are pretty common; she’s
      nauseated, she’s hurting.

             And then Team 1 sends her home and Team 2 sends her home
      and Team 3 sends her home, but eventually she gets sick. And in my
      experience, these patients get very sick. They’re febrile, you can just spot
      them across the room. And working in the ER, I make probably one of
      these diagnos[e]s every three or four months. I work one day a week as
      an ER doctor myself GYN ER, so that -- I don’t think we dove real
      deep into that part of things.

       Plaintiff’s counsel challenged this view by arguing that the conclusions drawn

were either simply wrong or had failed to account for subtleties regarding why

Mrs. Dozier did not exhibit worrisome symptoms. Plaintiff’s counsel cross-examined

Dr. Wilson on a number of points, such as whether (1) his action in admitting

Mrs. Dozier to the hospital after a prior laparoscopy was consistent with his failure to

admit her when she returned to the ER after the procedure at issue, (2) the fact that

the differential diagnosis during her second visit to the ER included a suspicion of

bowel perforation, (3) Mrs. Dozier’s white blood cell count during her second ER

visit indicated infection, (4) the fact that Mrs. Dozier did not exhibit all the signs of a

bowel perforation in her ER visits before she was admitted to the hospital did not rule

out the possibility that she had a perforation based on the symptoms that she did

exhibit, and (5) Mrs. Dozier had been constipated during the visits to the ER before

her admission. As another example, the defense noted that Mrs. Dozier was not

running a temperature; that fact was countered by the fact that Mrs. Dozier was being

given medication to reduce her temperature. Other challenges to the contention that

                                            23
her symptoms did not create a high degree of suspicion were whether her abdominal

guarding and rebound tenderness were symptoms that should have been viewed as

signs of developing peritonitis.

       Counterposed to these challenges, a defense expert opined that Mrs. Dozier

could not have demonstrated the symptomology that she had on her second visit to

the ER if a perforation had been releasing feces into her system for two days before

that visit:

       Q. All right. Do you think in reasonable medical probability that
       Mrs. Dozier could have had a perforation in her bowel on, let’s take the
       26th of August, and had been spilling poop into her abdomen for two
       days and gone in and had no fever, no elevated white count, no
       abdominal distention, that all of these things could have been normal if
       she had been spilling poop into her abdomen for two days?

              A. No, I don’t think that that could be possible and/or probable
       and -- to the best of my medical decision.

       The jury also heard testimony about the findings of the CT scan conducted

during Mrs. Dozier’s second visit to the ER, and the conflicting evidence regarding

whether the level of air and fluids or indicators of an abscess in that scan suggested

the presence of a perforation. One of the defendants who settled with Mrs. Dozier

during trial was the radiologist whom she claimed had misread the CT scan, and

Mrs. Dozier presented expert testimony that the findings in the scan were much more

dire than the radiologist had reported. But before his dismissal, the radiologist

defendant strenuously defended his reading of the scan and his conclusion that the

scan did not betray the signs of infection suggesting a perforation.

                                           24
      The jury also heard about what was revealed during the surgery on August 31

when the perforation was discovered.          Dr. Wilson described the fecal matter

discovered during the surgery as “fresh.” The general surgeon who performed the

colostomy during the August 31 surgery was more explicit in his opinion that the

perforation was recent. The surgeon stated this opinion in response to a question

asked of him by Dr. Wilson’s counsel:

      Q. Let me just stop right there for a second.

             You said it was fresh -- it was a fresh perforation of the bowel.
      Upon what did you -- what did you see, what did you observe that tells
      you that this was a fresh perforation of the bowel, and what time are you
      talking about?

              A. Well, when a bowel perforates and you get spillage of bowel
      contents into the abdomen, when it’s initially there, it’s just that, it’s just
      stool that’s within the abdominal cavity. It hasn’t had time to set up a
      significant infectious inflammatory process.

             When people have had a perforation of their bowel that is partly
      contained by the normal healing processes in the abdomen, you get the
      development of a thick, yellowy, infected material, and we didn’t see
      that. We saw just some cloudy fluid, which was the start of an infection.
      Might have been leftover fluid from the original operation Dr. Wilson
      did, but we didn’t see any signs that there was any several-day history of
      ongoing infection.

             So we saw that stool. The immediate step is to stop that stool
      from leaking, which we did, and then we cleared all of the stool from the
      abdominal cavity, cleared it out completely, and then I made the decision
      that a colostomy would be the best option for her.

            In terms of the timing, I’m not sure. That’s how we progressed
      with the operation. Do you mean the timing of -- what I think the
      timing of the perforation was?

                                            25
             Q. Yeah. You said it was a fresh perforation of the bowel and
      you now explained why, and I -- I don’t even know what you’re going to
      say, but what time period do you think this perforation existed?

           A. A few hours. Probably at or about the time she would have
      come back to the emergency room that evening.

The surgeon also supported his position about the age of the perforation and what

caused the perforation by the nature of the necrosis—dead tissue—associated with

perforation. When challenged that it takes time for necrosis to develop, the surgeon

opined that the necrosis indicated that there had been tissue death rather than

penetration by an instrument.

      The surgeon’s conclusions that he gained from seeing the necrosis illustrated

another conflict in the testimony about the cause and timing of the perforation. The

pathologist who examined the section of bowel removed by the surgeon testified that

the necrosis that she saw was possibly inflicted by an instrument:

      Q. Then you say sections of the transmural defect show focal bowel
      necrosis with acute inflammation in keeping with the clinical perforation.

            So let’s break down a little bit of that. We already talked about
      the transmural defect being the through-and-through hole from the
      outside all the way through the inside layer, right?

             A. Correct.

             Q. And then . . . show focal bowel necrosis, tell us what that is.

             A. Focal bowel necrosis means part of the bowel wall is dead.

             Q. And that would be from a lack of blood supply being able to
      get to it?

                                          26
              A. You know, many things cause tissue to be dead, but ultimately,
      that’s -- that’s the underlying cause.

             Q. But you could have that focal bowel necrosis from an
      instrumental injury, you would still have that focal bowel necrosis; is that
      right?

             A. Yes.

            Q. And so, for instance, if there was a surgical instrument that
      caused that focal transmural defect, those are the types of findings you
      could have, would be the focal bowel necrosis?

             A. Correct.

      In the following exchange, Plaintiff’s counsel also highlighted that the

surgeon’s opinion was at odds with that of a pathologist who had reviewed the bowel

section:

      Q. And when [the pathologist] was asked, “There’s nothing in your
      findings that would indicate that it’s not a bowel perforation from an
      instrument seven days before,” what was her answer?

             A. She said, “Correct.”

             Q. And you are in no position to challenge her pathology
      findings in that regard, right?

            A. I believe I am[] because I believe that the tissue necrosis
      occurred and then later the bowel perforation occurred.

In his redirect of the surgeon, Dr. Wilson’s counsel then highlighted other responses

from the pathologist by which she acknowledged that she could not state the cause of

the injury and could only date it within a reasonable medical probability to be at least a

day old.

                                           27
      With respect to the timing of the perforation, the jury also heard from a

gynecological pathologist presented by the defense who stated his opinion as follows:

      Q. Okay. Can you date the bowel injury in this case to be any older
      than 24 hours?

           A. I think, if I want to, based on the . . . pathologist report[ of]
      Dr. Hopkovitz, and the bowel injury probably was within a day or so.

             Q. Okay. Bowel injury probably occurred within a day or so?

             A. Uh-huh.

             Q. Yes or no?

             A. Yes.

             Q. Why?

            A. Because there is only focal necrosis and acute inflammation
      mentioned in that area.

             Q. All right. Bowel injury, if you aged it, from your perspective
      and probability, it’s within a day or so; and you base that upon the report
      of focal necrosis and acute inflammation. Did I say that correctly?

             A. Correct.

      Of course, if Mrs. Dozier’s bowel were not perforated during the laparoscopy,

the question became what caused it to perforate. This presented the jury with another

clash of expert opinions.          The defense presented a theory of a spontaneous

perforation. Dr. Wilson thought perhaps the wall of the bowel was weakened during

the procedure and later perforated. He explained this possibility in response to a

question by Plaintiff’s counsel:

                                            28
      Q. Okay. So you have no evidence there was endometriosis. You have
      no evidence there was weakening. You have no evidence that this
      spontaneous perforation happened, you’re just guessing that, right?

             A. So, no. So, again, when you think about the anatomy and the
      fact that the bowel is extremely thin, and you have the bowel that’s
      extremely thin attached to the adhesion, this stuff there, so it’s not
      inconceivable to think that once you tease that bowel away that you
      could get a potential injury to the bowel in that area once you tease it,
      because the bowel is attached to the adhesion.

             So if I’m moving the adhesion down and the bowel is attached
      there, then that could certainly happen.

      Other defense experts echoed similar opinions. For example, the following

quote from a deposition was read to the jury:

      “Doctor” – [P]laintiff’s counsel -- “so how is it you believe the
      perforation occurred to [Mrs. Dozier’s] transverse colon?” That was his
      question. 22, line 23 by [P]laintiff’s counsel. Answer, “I think that -- I
      think that, you know, something happened. I think that there is some
      validity to the theory that she had a weakened bowel wall from
      endometriosis, that somehow lysed adhesions weakened further. I think
      that’s my -- that’s my -- that’s the theory they would go with, that you
      know the surgery that was done, the lysis of adhesions and fulguration
      somehow weakened and already -- what was possibly an already weak
      bowel wall, and, you know, it caused it to eventually rupture.” That’s the
      totality of his answer.

      Another defense expert responded to the following question on cross-

examination:

      [Q.] Now, you have an opinion that what may have happened[] was
      there was an endometriosis on the transverse colon that spontaneously
      ruptured sometime after surgery, right?

               A. That’s my conclusion, yes.

                                          29
      Plaintiff’s counsel attacked these opinions because of an absence of evidence of

endometriosis on Mrs. Dozier’s bowel and the fact the medical literature recorded no

prior incident of a spontaneous bowel perforation due to endometriosis. Another

Plaintiff’s expert opined that he could “rule out in reasonable medical probability that

there was a spontaneous rupture of endometriosis that caused this [bowel]

perforation.”

      Plaintiff’s counsel also noted that the pathologist who examined the section of

Mrs. Dozier’s bowel that was removed during the August 31 colostomy identified

certain types of cells associated with inflammation but did not identify those as the

type of cells associated with endometriosis. In turn, this opinion was challenged by

the defense pathologist who testified that the first pathologist had not done the

necessary testing of the cells to determine whether they were endometrial or not.

Based on Mrs. Dozier’s clinical history, the defense pathologist testified that the

likelihood of endometriosis involvement in her bowel was high.

      F.        The jury’s verdict that Dr. Wilson’s actions were not negligent or a
                proximate cause of Mrs. Dozier’s injuries

      The charge’s definitions of negligence, ordinary care, and proximate cause were

routine:

      14. “Negligence,” when used with respect to the conduct of
      [Dr. Wilson,] means failure to use ordinary care, that is, failing to do that
      which an obstetrician gynecologist of ordinary prudence would have
      done under the same or similar circumstances or doing that which [an]
      obstetrician gynecologist of ordinary prudence would not have done
      under the same or similar circumstances.

                                           30
            15. “Ordinary care,” when used with respect to the conduct of
      [Dr. Wilson], means that degree of care that an obstetrician gynecologist
      of ordinary prudence would use under the same or similar
      circumstances.

            16. “Proximate cause,” when used with respect to the conduct of
      [Dr. Wilson], means a cause that was a substantial factor in bringing
      about an injury, and without which cause such injury would not have
      occurred. In order to be a proximate cause, the act or omission
      complained of must be such that an obstetrician gynecologist using
      ordinary care would have foreseen that the injury, or some similar injury,
      might reasonably result therefrom. There may be more than one
      proximate cause of an injury.

There were no objections to the charge.

      The jury answered only one question in the charge:

      QUESTION NO. 1:

             Did the negligence, if any, of those named below proximately
      cause the injury in question?

             Answer “Yes” or “No” for each of the following:

             1. [Dr. Wilson]: No

      The trial court signed an amended final judgment that Mrs. Dozier take

nothing from Dr. Wilson. Mrs. Dozier filed a “Combined Motion for New Trial and

Alternative Motion For Judgment Not Withstanding [sic] the Verdict,” which was

overruled by operation of law. Mrs. Dozier then filed a notice of appeal.

                                          31
                                      III. Analysis

       A.     Mrs. Dozier’s legal- and factual-sufficiency challenges to the jury’s
              response to Question No. 1 of the charge fail.

       Though we have tried to be thorough in our factual background, a summary

cannot capture the give and take that occurred in the 1,300 pages of testimony in the

reporter’s record that chronicled the bout in the trial court. Appellant’s brief’s second

issue predicates its sufficiency analysis on the several punches that Plaintiff’s counsel

threw during the bout that landed hard. But it fails to acknowledge that the jury sat

through the bout and scored the punches of the contestants that were hard hits,

glancing blows, or failed to connect at all. In the end, the jury scored the bout in

Dr. Wilson’s favor. The legal- and factual-sufficiency standards of review do not

permit us to rescore the jury’s determination, especially since Plaintiff had the

handicap of bearing the burden of proof.

       B.     Standards of Review

              1.     We set forth the legal-sufficiency standard of review.

       When a party attacks the legal sufficiency of an adverse finding on an issue on

which the party had the burden of proof—as Mrs. Dozier does in this appeal—the

party must demonstrate on appeal that the evidence establishes, as a matter of law, all

vital facts in support of the issue. Cath. Diocese of El Paso v. Porter, 622 S.W.3d 824, 834

(Tex. 2021). In reviewing a “matter of law” challenge, we must first examine the

record for evidence that supports the finding, while ignoring all evidence to the

                                            32
contrary. Dow Chem. Co. v. Francis, 46 S.W.3d 237, 241 (Tex. 2001). If no evidence

supports the finding, then we will examine the entire record to determine if the

contrary position is established as a matter of law. Id. We will sustain the issue only if

the contrary position is conclusively established.         Id.   Evidence conclusively

establishes a fact when the evidence leaves “no room for ordinary minds to differ as

to the conclusion to be drawn from it.” Int’l Bus. Mach. Corp. v. Lufkin Indus., LLC,

573 S.W.3d 224, 235 (Tex. 2019).

             2.     We set forth the factual-sufficiency standard of review.

      When a party attacks the factual sufficiency of an adverse finding on an issue

on which she has the burden of proof, that party must show that the adverse finding

is against the great weight and preponderance of the evidence. Francis, 46 S.W.3d at

242. When reviewing an assertion that the evidence is factually insufficient to support

a finding, we set aside the finding only if, after considering and weighing all the

pertinent record evidence, we determine that the credible evidence supporting the

finding is so weak, or so contrary to the overwhelming weight of all the evidence, that

the finding should be set aside and a new trial ordered. Pool v. Ford Motor Co., 715

S.W.2d 629, 635 (Tex. 1986) (op. on reh’g); Cain v. Bain, 709 S.W.2d 175, 176 (Tex.

1986); Garza v. Alviar, 395 S.W.2d 821, 823 (Tex. 1965).

                                           33
             3.     We set forth the burden of proof in a medical malpractice
                    suit and how conflicting medical expert testimony creates a
                    battle of the experts that is within the purview of the jury to
                    decide.

      The elements of a medical malpractice suit are simply stated as follows:

      A medical malpractice plaintiff bears the burden of proving “the
      existence of a legal duty, a breach of that duty, and damages proximately
      caused by the breach.” Windrum v. Kareh, 581 S.W.3d 761, 768 (Tex.
      2019) (quoting Bustamante v. Ponte, 529 S.W.3d 447, 456 (Tex. 2017)).
      Establishing a breach of a duty requires proof of the applicable standard
      of care, which is defined as “what a doctor of ordinary prudence in that
      particular field would or would not have done under the circumstances.”
      Id.

Collins v. Vivanco, 603 S.W.3d 843, 847 (Tex. App.—El Paso 2020, no pet.).

       It is axiomatic that expert testimony is usually necessary to establish the

standard of care in a medical malpractice suit. Carl J. Battaglia, M.D., P.A. v. Alexander,

177 S.W.3d 893, 899 (Tex. 2005) (stating that “as in most health care liability cases,

[the standard of care] must be established by competent expert testimony”); St. John v.

Pope, 901 S.W.2d 420, 423 (Tex. 1995) (observing that the “standard of care demanded

in medical malpractice cases requires skills not ordinarily possessed by lay persons”

and “typically requires expert testimony to establish the medical standard of care”

(citing Hood v. Phillips, 554 S.W.2d 160, 165–66 (Tex. 1977))). The same is true with

respect to evidence of causation—“[i]n medical malpractice cases, expert testimony

regarding causation is the norm:        ‘The general rule has long been that expert

testimony is necessary to establish causation as to medical conditions outside the

                                            34
common knowledge and experience of jurors.’” Jelinek v. Casas, 328 S.W.3d 526, 533

(Tex. 2010).

       As we have explained, medical malpractice cases often present a “battle of the

experts,” and it is the jury’s role to sort out which expert’s testimony it credits:

       In a battle of competing experts, it is the sole obligation of the jury to
       determine the credibility of the witnesses and to weigh their testimony.
       See Welch v. McLean, [191 S.W.3d 147, 160 (Tex. App.—Fort Worth 2005,
       no pet.) (op. on reh’g), disagreed with on other grounds by Phillips v. Bramlett,
       288 S.W.3d 876 (Tex. 2009);] Warner v. Hurt, 834 S.W.2d 404, 408–09
       (Tex. App.—Houston [14th Dist.] 1992, no writ). It is particularly
       within the jury’s province to weigh opinion evidence and the judgment
       of experts. Cruz[ v. Paso del Norte Health Found.], 44 S.W.3d [622,] 647
       [(Tex. App.—El Paso 2001, pet. denied)] (citing Pilkington v. Kornell, 822
       S.W.2d 223, 230 (Tex. App.—Dallas 1991, writ denied)). The jury
       decides which expert witness to credit. Id.

Morrell v. Finke, 184 S.W.3d 257, 282 (Tex. App.—Fort Worth 2005, pet. denied); see

also Gunn v. McCoy, 554 S.W.3d 645, 665 (Tex. 2018) (“Like many medical-malpractice

cases, this case involved a battle of the experts. In such cases, jurors are the sole

judges of the credibility of the witnesses and the weight to give their testimony.”

(citation omitted)).

       In Morrell, we also noted the constraints that we operate under when reviewing

a record that presents a conflict—such as battling expert opinions—for the jury to

resolve:

       When we review evidence, we are not free to reweigh the evidence and
       set aside a jury verdict merely because we feel a different result is more
       reasonable. Pool . . . , 715 S.W.2d [at] 634 . . . . We may not merely
       substitute our opinion for that of the trier of fact and determine that we
       would reach a different conclusion. Cruz, 44 S.W.3d at 647; Merckling v.

                                              35
      Curtis, 911 S.W.2d 759, 763 (Tex. App.—Houston [1st Dist.] 1995, writ
      denied). We cannot sit as a thirteenth juror, and we cannot under any
      circumstances retry the case. See Warner, 834 S.W.2d at 408–09.

184 S.W.3d at 282.

      Certainly, there are avenues to challenge whether an expert opinion has

probative value. In the context of whether expert testimony supported a plaintiff’s

verdict, the Texas Supreme Court has held that a conclusory expert opinion will not

support the judgment:

      To establish breach of a duty, the plaintiff must establish an applicable
      standard of care. See generally Nabors Drilling, U.S.A., Inc. v. Escoto, 288
      S.W.3d 401, 404–05 (Tex. 2009); Am. Transitional Care Ctrs. of Tex., Inc. v.
      Palacios, 46 S.W.3d 873, 879–80 (Tex. 2001). In a medical malpractice
      negligence case, the standard of care is what a doctor of ordinary
      prudence in that particular field would or would not have done under
      the circumstances. See James v. Brown, 637 S.W.2d 914, 918 (Tex.
      1982) . . . . “Whether a defendant breached his or her duty to a patient
      cannot be determined absent specific information about what the
      defendant should have done differently.” Palacios, 46 S.W.3d at 880.
      Conclusory testimony cannot support a judgment in a medical
      malpractice case. See City of San Antonio v. Pollock, 284 S.W.3d 809, 816
      (Tex. 2009). As such, we must examine the record to determine whether
      [the patient’s surviving spouse] provided non-conclusory expert
      testimony to support the jury’s verdict that [the neurosurgeon] breached
      a duty owed to [the patient]. See id.

Windrum, 581 S.W.3d at 768. Here, Mrs. Dozier highlights certain opinions that

support her sufficiency arguments but leaves unacknowledged those to the contrary.

She does not state that the opinions to the contrary lack probative value. Thus, she

offers no reason why the jury could not credit the expert opinions that undermine her

view of the record.

                                          36
         C.    We set forth why we reject Mrs. Dozier’s sufficiency challenges.

               1.     The concessions by Dr. Wilson that are noted in Appellant’s
                      brief fail because they pay no heed to the portions of the
                      record that support the verdict.

         As we noted in the introduction to our analysis of Mrs. Dozier’s sufficiency

challenge, she emphasizes the punches landed by her counsel, the first of which was

Dr. Wilson’s concession that “the standard of care requires meticulous inspection and

examination of the surgical area following fulguration of endometriosis to ensure you

haven’t caused an unintended injury to the surgical anatomy, including the bowel” and

that he did not go back over Mrs. Dozier’s bowel before ending the procedure.

         Though Appellant’s brief correctly quotes the testimony, the brief simply

ignores the various opinions offered by both Dr. Wilson and his experts that what he

did by checking for hemostasis and watching what he was doing while performing the

procedure via the inserted camera met the standard of care and that under these

circumstances, a second look before closing was not required. We have outlined this

testimony in our recitation of the factual background.

         From a legal-sufficiency standpoint, this is some evidence to support the jury’s

answer to charge question number one. Thus, Mrs. Dozier does not meet the first

step in the legal-sufficiency challenge for an issue upon which she bore the burden of

proof.

         From a factual-sufficiency standpoint, Mrs. Dozier’s argument offers one side’s

perspective of one skirmish in the battle between the experts that the jury heard. As

                                            37
we have noted, when faced with such a battle, it is the jury’s prerogative to decide

whom to believe. The jury’s verdict is not against the great weight and preponderance

of the evidence.7

      Appellant’s brief is equally circumscribed with its attack that the perforation

must have occurred during the laparoscopic procedure.          This attack highlights

Dr. Wilson’s concession that the absence of a high white blood cell count immediately

after the surgery did not exclude the possibility that her bowel had been perforated.

Of course, highlighting this fact in isolation simply ignores the volume of evidence on

the other side of the question, such as whether Mrs. Dozier’s symptoms revealed a

high index of suspicion of a bowel injury, or the results of the CT scan during her

second visit to the ER, or the testimony of the general surgeon who operated with

Dr. Wilson that the perforation was recent. These pieces of evidence are some

evidence that the perforation did not occur during the laparoscopic procedure and

show that there was some evidence to support a finding in that regard. Further, this

mix of evidence shows that the record is not so tilted that the jury’s conclusion—that

the perforation occurred after the procedure—is against the great weight and

preponderance of the evidence.

      7
       The argument also spends much of its time discussing that the perforation of
Mrs. Dozier’s bowel produced an infection and required her to undergo a colostomy.
This was not disputed at trial. But what was highly contested was whether
Dr. Wilson’s treatment was negligent and proximately caused Mrs. Dozier’s injuries.

                                          38
             2.     The isolated portions of other experts’ testimony that
                    Appellant’s brief cites ignore the full record and cannot
                    sustain a legal- or factual-sufficiency challenge.

      Next, Appellant’s brief adopts an approach of citing snippets of testimony

from defense experts that are favorable to her case and ignoring the unfavorable

portions. Again, this approach does not present a viable legal- or factual-sufficiency

challenge.

      Appellant’s brief cites the first defense expert on the standard of care in

performing the laparoscopic procedure who appeared to concede that Dr. Wilson had

not inspected Mrs. Dozier’s bowel in accordance with the standard of care. Again,

the brief accurately quotes the testimony of the expert. But what the brief does not

note is how the expert later recanted this opinion.

      The following exchange during Plaintiff’s counsel’s redirect of the defense

expert highlighted this change of heart:

      Q. Dr. Dulemba, when I talked to you this morning, you told us and in
      no uncertain terms that Dr. Wilson [had] breached the standard of care
      in failing to look at the transverse colon prior to closing, right?

             A. Well, that’s what I stated, but there were some things that I
      did leave out, when I realized I hadn’t discussed the entire aspect.

            Q. And then, Doctor, after we took a break for lunch, and you
      went and had lunch with the attorneys for Dr. Wilson, who paid you
      $32,000 to defend your friend, that you called him, Dr. Wilson, you
      come in here after lunch and now your opinion is he didn’t breach the
      standard of care, right?

             A. No, that’s incorrect.

                                           39
             Q. So your opinion is still that he breached the standard of care?

             A. No.

             Q. Okay. So you changed your opinion after you had lunch?

             A. No, my opinion initially on my -- on the expert opinion and
      also in my deposition that I gave, he did not breach the standard of care,
      because he looked at it several times. What -- you have me confused,
      and I admit, you did, you had me confused this morning when you said
      that he said that he didn’t look and then he said that I -- that you had to
      look twice. He did. He had pictures. He looked while he was doing it[,]
      and he took pictures afterwards. I didn’t realize it when I said it this
      morning. I didn’t come in and say, hey, I want to change my testimony.
      But no, if you ask me the question again, I’m going to tell you he did not
      breach the standard of care.

Appellant’s brief both fails to mention this event or to tell us why it presented the jury

with anything more than a question of the expert’s credibility. To the extent that

Appellant’s brief argues that the snippet it cites was conclusive evidence of a breach

of the standard of care, the quote shows that it was not.8

      8
        Appellant’s brief also makes an additional argument based on the expert’s
testimony: “[Dr.] Dulemba also admitted that there was no evidence of endometriosis
on the transverse colon during [Dr.] Wilson’s surgery and that there was no evidence
of endometriosis there during subsequent surgeries. This testimony entirely
undermines his alternate ‘theory’ that there was endometriosis on the transverse colon
that spontaneously ruptured.” [Record citations omitted.] The testimony cited is not
as certain as it is portrayed in the brief:

      Q. Okay. So we can rule that out as well. All right.

            Now, you have an opinion that what may have happened, was
      there was an endometriosis on the transverse colon that spontaneously
      ruptured sometime after surgery, right?

             A. That’s my conclusion, yes.

                                           40
       Q. Okay. So let’s -- let’s put that here. Endo on transverse colon
that spontaneously ruptured. So let’s talk about some of that. We know
that Dr. Wilson didn’t identify any endometriosis on the transverse
colon during his August 24th surgery, right?

          A. Correct.

       Q. Okay. And we know that there was no evidence of
endometriosis identified on Dr. Wilson’s and Dr. Mosier’s [the general
surgeon called in by Dr. Wilson to perform the colostomy on August 31]
surgeries to wash out the infection from the perforation and to put the
colostomy in, right?

      A. Well, there’s so much inflammation during that process of
what they dealt with, there’s no way you would be able to identify any
endometriosis almost anywhere.

      Q. Okay. But there’s no evidence of endometriosis on the
transverse colon surgery, right?

          A. Correct.

     Q. No endo on transverse colon during [Dr.] Wilson and
Dr. Mosier, 8/31 surgery.

       Okay. And we know that Dr. Aronoff [the surgeon treating Mrs.
Dozier after her transfer to another hospital] did a number of surgeries
in the ensuing weeks where he didn’t identify any endometriosis on the
transverse colon, right?

          A. That’s correct, but I wouldn’t have expected him to be looking
for it.

      Q. Now, let’s get to the important one. Dr. Hopkovitz reviewed
pathology of the bowel where the actual perforation was, right?

          A. I assume that’s the pathologist’s name?

       Q. Yes, sir. Dr. Hopkovitz was the pathologist at Presby Denton
that reviewed the actual bowel and the hole that was there, okay?

          A. Yes.

                                      41
      Appellant’s brief adopts the same narrow-viewed strategy with respect to the

defense’s second expert on the standard of care involved in performing the

laparoscopic procedure. The brief cites one page of the expert’s more than 100-page

testimony. The cited testimony focuses on the fact that the expert did not know until

he testified that Dr. Wilson had lysed adhesions on the bowel. As we have noted, this

expert was subject to intense cross-examination because of this concession. But we

have also noted the expert’s opinion that the procedures that Dr. Wilson followed still

met the standard of care. This opinion is encapsulated in a simple answer that we

have already quoted: “I mean, as I said before and I’ll say again, I mean, he was

looking at the area that he was lysing adhesions on, and he was doing a meticulous

inspection of that area while he was doing it, and that’s what you need to do.” Again,

a complete view of the record demonstrates that the snippet cited in Appellant’s brief

does not represent the full extent of the record.

      Another example of turning a blind eye to testimony that is contrary to an

argument is Appellant’s brief’s description of the testimony of the pathologist who

examined the portion of Mrs. Dozier’s bowel that was removed during the colostomy.

             Q. And she didn’t document any endometriosis on the pathology
      study, right?

             A. Correct.

       Further, Appellant’s brief notes that the expert conceded that a bowel
perforation had caused injury to Mrs. Dozier and that there was a need for subsequent
surgical procedures. As we have noted, that fact is not what was at issue during trial.

                                           42
The short snippets of testimony referenced in Appellant’s brief note that the

pathologist found no endometriosis on the bowel and that there was nothing in her

findings that was inconsistent with the injury to the bowel being caused by an

instrument seven days before the bowel’s removal. Of course, this view of the record

ignores the defense pathologist’s testimony that the pathologist who had examined

the bowel did not perform the necessary tests to determine whether the cells on the

bowel were endometrial or not.      It also ignores that on cross-examination, the

pathologist who had examined the bowel stated that she could not state in reasonable

medical probability “that the perforation [was] any older than a day old.” It further

ignores the testimony of the surgeon who performed the initial colostomy that the

injury to Mrs. Dozier’s bowel was not caused by an instrument.

      Appellant’s brief ends by highlighting the testimony of the general surgeon who

treated Mrs. Dozier after her transfer to another hospital from the one in which the

colostomy was performed. The quoted testimony sets forth the doctor’s opinions

dealing with the standard of care of a general surgeon and states that (1) in a

laparoscopic procedure, meticulous inspection of the surgical area requires finding

and fixing any bowel perforations that may have been caused; (2) failing to identify

the perforation intraoperatively is a breach of the standard of care; and (3) the

proximate cause of Mrs. Dozier’s bowel perforation was the laparoscopic surgery

performed before she was transferred to the doctor’s care. We have catalogued the

host of opinions concluding that Dr. Wilson’s actions during the procedure did

                                         43
conform to the standard of care. Again, highlighting favorable evidence and ignoring

the unfavorable is an attempt to argue that the jury mis-weighed the evidence when it

was within its purview to decide which experts to credit and which to not. This

approach cannot sustain a legal- or factual-sufficiency challenge.

      We overrule Mrs. Dozier’s second issue.

      D.     We set forth why we reject Mrs. Dozier’s claim that the trial court’s
             refusal to permit one area of cross-examination of a defense expert
             constituted harmful error.

      In her first issue, Mrs. Dozier argues that the trial court erred by limiting her

cross-examination of one of Dr. Wilson’s experts. The cross-examination involved

the contention that the expert had been previously sued by the same law firm that

represented Mrs. Dozier for an act of malpractice similar to that alleged against

Dr. Wilson in causing a perforation and in failing to identify it intraoperatively. Being

sued for a similar wrong allegedly gave the witness a bias to protect himself by

testifying that Dr. Wilson’s actions were not negligent.

      We take Mrs. Dozier’s issues out of the order that she presents them. We do

this because by addressing Mrs. Dozier’s sufficiency issue first, we can convey the

blizzard of expert opinions that the jury had to sort through to reach its verdict and

why Mrs. Dozier’s sufficiency challenge offered no grounds for us to second-guess

the verdict. The state of the record prompts our second somewhat unorthodox

approach of assuming error and addressing whether the trial court’s ruling—which

                                           44
limited the scope of cross-examination—was harmful before addressing whether the

trial court’s ruling was an abuse of discretion.

       Mrs. Dozier offers no harmful-error analysis in her opening brief. Though

Dr. Wilson challenges whether any error was harmful in his brief, Mrs. Dozier offers

no analysis regarding why it was harmful in her reply, other than stating a conclusion

that the error was harmful. Even assuming that the trial court erred, we conclude that

error was not harmful. First, Mrs. Dozier never explains how the foreclosed topic of

cross-examination would have caused the jury to reweigh its resolution in this intense

battle of the experts.     Nor does Mrs. Dozier explain how the topic of cross-

examination that the trial court did not let her pursue would have so undermined this

expert’s credibility—after he changed his opinion from one unfavorable to Dr. Wilson

to a favorable one—that a different verdict would have resulted. And beyond the

question of harm, the trial court did not abuse its discretion by denying the proposed

cross-examination topic.

              1.     We set forth the topic upon which Plaintiff’s counsel sought
                     to cross-examine the expert.

       The trial court granted a motion in limine that restricted the discussion of

“inquiry of [Dr. Wilson] or any other physician called as a witness, with respect to any

lawsuits or claims as the result of prior or subsequent unrelated incidents.” At the

end of the testimony of Dr. Dulemba (whom we have described above as

Dr. Wilson’s first defense expert on the standard of care), Plaintiff’s counsel made an

                                            45
offer of proof “regarding Dr. Dulemba’s previous similar -- substantially similar

lawsuits.” The offer began with the question to Dr. Dulemba regarding whether he

“had an incentive in this case in defending Dr. Wilson to give the opinion that it was

okay to miss a bowel perforation and not fix it intraoperatively during a laparoscopic

endometriosis surgery.” The alleged incentive was that at the time that Dr. Dulemba

wrote his expert report in the underlying matter, the counsel representing Mrs. Dozier

“had a lawsuit, representative client, in a lawsuit against [Dr. Dulemba] for failing to

identify a perforation intraoperatively to the bowel on a patient, and the patient

resulted in a similar, very similar situation to [Mrs.] Dozier.”

       In response, Dr. Dulemba vigorously challenged that the evidence in the case

against him showed a bowel perforation; that challenge produced a four-page

discussion in the reporter’s record of what the evidence showed in the suit against

Dr. Dulemba and the sources that Plaintiff’s counsel had relied on to support the

claim. Further, Dr. Wilson challenged the document that Plaintiff’s counsel used as

the basis to impeach Dr. Dulemba.           When the trial court sought to focus the

questioning on Dr. Dulemba’s incentive to testify as he did on behalf of Dr. Wilson,

another three-page discussion ensued regarding whether the facts of the case brought

against Dr. Dulemba and whether the allegations made in that suit were similar to

those alleged against Dr. Wilson, including whether the procedures were similar and

whether the injuries were similar. The trial court denied the request to cross-examine

Dr. Dulemba about the suit against him by Mrs. Dozier’s counsel.

                                            46
             2.     We set forth the standard in civil cases for determining
                    whether an error is harmful.

      Not every error that occurs during trial warrants reversal; thus, Rule 44.1(a)(1)

of the Texas Rules of Appellate Procedure provides that in civil cases, “[n]o judgment

may be reversed on appeal on the ground that the trial court made an error of law

unless the court of appeals concludes that the error complained of . . . probably

caused the rendition of an improper judgment.” Tex. R. App. P. 44.1(a)(1). Whether

an error is harmful or harmless “is based on our understanding that ‘a litigant is not

entitled to a perfect trial for, indeed, few trials are perfect.’” Gunn, 554 S.W.3d at 668

(quoting Lorusso v. Members Mut. Ins. Co., 603 S.W.2d 818, 819 (Tex. 1980)). The

determination regarding “whether the error probably caused the rendition of an

improper judgment ‘necessarily is a judgment call entrusted to the sound discretion

and good senses of the reviewing court.’” Id. (quoting McCraw v. Maris, 828 S.W.2d

756, 759 (Tex. 1992)).

      Appellate courts apply a harmful-error analysis in deciding whether limiting the

scope of the cross-examination of an expert warrants a case’s reversal. See Watson v.

Isern, 782 S.W.2d 546, 549–50 (Tex. App.—Beaumont 1989, writ denied) (showing

that appellate court questioned whether trial court had acted properly in denying

cross-examination on defense counsel’s representation of expert in malpractice cases

filed against expert but concluded that in view of the entirety of the direct

examination and cross-examination of the expert, appellate court did not think “that

                                           47
the bill of exception presented error that amounted to such a denial of the rights of

the [a]ppellants as was reasonably calculated to cause and probably did cause a

rendition of an improper judgment in the case”); see also C.H. v. Tex. Dep’t of Family &

Protective Servs., No. 03-19-00900-CV, 2020 WL 2786864, at *3 (Tex. App.—Austin

May 28, 2020, no pet.) (mem. op.) (“However, even if a trial court erroneously limits

cross-examination, we will not reverse unless the error ‘probably caused the rendition

of an improper judgment’ or ‘probably prevented the appellant from properly

presenting the case’ to this [c]ourt.” (quoting Tex. R. App. P. 44.1(a), and citing

Davidson v. Great Nat’l Life Ins. Co., 737 S.W.2d 312, 314 (Tex. 1987))); Chavez Constr.,

Inc. v. McNeeley, 177 S.W.3d 593, 602–05 (Tex. App.—Houston [1st Dist.] 2005, pet.

granted, judgm’t vacated w.r.m.) (holding harmless under Texas Rule of Appellate

Procedure 44.1(a) refusal to permit cross-examination on changed deposition answers

because jury had heard in general terms that witness had changed his answers); Stam v.

Mack, 984 S.W.2d 747, 751 (Tex. App.—Texarkana 1999, no pet.) (holding harmless

trial court’s refusal to permit cross-examination on the topic that defense counsel had

previously represented expert in malpractice action because party was able to put the

issue of expert’s bias before the jury); Harlow v. Hayes, 991 S.W.2d 24, 29 (Tex. App.—

Amarillo 1998, pet. denied) (“However, even assuming arguendo [that] the trial court

erred in excluding [expert’s] cross-examination with regard to the standards, the

excluded examination would not present an error of sufficient magnitude that it

probably caused the rendition of an improper judgment or prevented appellant from

                                           48
properly presenting her case.”); Am. Cyanamid Co. v. Frankson, 732 S.W.2d 648, 654–55

(Tex. App.—Corpus Christi–Edinburg 1987, writ ref’d n.r.e.) (stating that “[a] trial

court has considerable discretion in permitting cross-examination of a witness to

show bias or prejudice” and holding that “in this instance[,] the trial court should have

allowed the questioning, because of the great latitude that should be allowed on cross-

examination, but its failure to do so was not reversible error in this case”).

       To show harmful error in the admission or exclusion of evidence, we apply the

following standards:

          • “[W]e review the entire record.” Interstate Northborough P’ship v. State, 66

              S.W.3d 213, 220 (Tex. 2001) (op. on reh’g).

          • “Typically, a successful challenge to a trial court’s evidentiary rulings

              requires the complaining party to demonstrate that the judgment turns

              on the particular evidence excluded or admitted.” Id.

          • “And, ordinarily, this [c]ourt will not reverse a judgment because a trial

              court erroneously excluded evidence when the evidence in question is

              cumulative and not controlling on a material issue dispositive to the

              case.” Id.

          • “If erroneously[ ]admitted or []excluded evidence was crucial to a key

              issue, then the error was likely harmful, but not conclusively or per se

              harmful.” In re A.P., No. 02-22-00180-CV, 2022 WL 16646478, at *14

                                            49
             (Tex. App.—Fort Worth Nov. 3, 2022, no pet.) (mem. op.) (citing Gunn,

             554 S.W.3d at 668).

          • But “‘likely’ does not mean ‘definitively,’” and “we apply the same

             standard—whether the erroneous exclusion of evidence probably caused

             the rendition of an improper judgment—even when the excluded

             evidence related to a key issue.” Id. at 668–69, 671; JLG Trucking, LLC v.

             Garza, 466 S.W.3d 157, 165 (Tex. 2015).

             3.     We explain why we conclude that any error in prohibiting
                    Plaintiff’s counsel from cross-examining the expert about
                    the lawsuit brought against him was not harmful error.

      Here, addressing whether harmful error occurred by the trial court’s actions in

restricting the expert’s cross-examination, Dr. Wilson notes the mix of testimony

heard by the jury—a mix that we have highlighted in our discussion of Mrs. Dozier’s

sufficiency issue and in the factual background:

      Moreover, in no way could exclusion of this amount to harmful error.
      [Dr.] Dulemba was hardly the only defense witness. And, as to timing of
      the perforation (the issue about which Appellant sought to impeach
      [Dr.] Dulemba), not only did [three other experts] testify to similar
      timing, even . . . [P]laintiff’s expert pathologist . . . was unable to time the
      perforation as any older than a day prior to [the] August 31 surgery, a
      week after Dr. Wilson’s laparoscopic procedure. [Dr.] Dulemba was also
      not the only standard[-]of[-]care defense expert. Dr. Wilson himself and
      [another defense expert] are described above. [Record reference
      omitted.]

Appellant’s reply brief does not mention the harmful-error standard of Rule 44.1(a)

nor pay much more than lip service to the question in Dr. Wilson’s brief regarding

                                            50
whether the error raised was harmful. The reply brief states, “Because the bias of this

expert was necessarily material, it defies logic to assert as [Dr. ]Wilson does that the exclusion of

this evidence did not affect the jury’s verdict. To vindicate these universal and unquestionable

principles, this [c]ourt should reverse the judgment in this case.” [Emphasis added.]

       The reply brief never explains how Dr. Wilson’s harmful-error analysis defies

logic. In essence, Mrs. Dozier seeks to retry a case that lasted eight days because of a

single error in restricting the scope of one expert’s cross-examination. And in doing

so she does not even try to answer two pivotal questions regarding harm—one

general to the overall record and one specific to the expert in question.

       Generally, in light of the raft of opinions regarding whether Dr. Wilson’s

actions conformed to the standard of care and whether the perforation occurred

during the laparoscopic procedure performed by Dr. Wilson, how can we conclude

that the limitation on cross-examination probably caused the rendition of an improper

judgment? In other words, what logical force is there to the argument that if the jury

had only heard that one of the experts who opined favorably to Dr. Wilson had also

been sued for acts similar to that of Dr. Wilson, the jury would have been swayed by

that fact alone to rebalance its view of all the other opinions it heard and reach a

different verdict?

       And that possibility—that hearing of the suit against Dr. Dulemba, the jury

here would have turned its disposition of the case upside down—is even more remote

in this case. The specific question that is not answered in Appellant’s brief and in her

                                                 51
reply brief is how the jury’s view of the evidence would have been completely

upended by the excluded information when Dr. Dulemba’s credibility had already

been subject to strenuous attack. Dr. Dulemba is the expert who, as we referenced in

our sufficiency analysis, initially testified that Dr. Wilson had failed to examine

Mrs. Dozier’s bowel in accordance with the standard of care before ending the

procedure and then returned after lunch to give the opposite opinion. As we have

noted, this seeming about-face produced a cross-examination regarding whether the

doctor had changed his testimony in essence because of being coached by

Dr. Wilson’s lawyers at lunch, because he was a friend of the doctor, and because of

the tens of thousands of dollars he had been paid in expert-witness fees. Thus, to

find harmful error, we must conclude that in light of the various opinions heard in

this hotly contested battle of the experts and the blows that Dr. Dulemba’s credibility

had already suffered, the inability to cross-examine Dr. Dulemba on the excluded

topic probably caused the rendition of an improper judgment, i.e., the jury would have

answered the first question of the charge differently to find that Dr. Wilson was

negligent and that his actions were a proximate cause of Mrs. Dozier’s injuries. Under

the circumstances we have outlined, we cannot conclude that the trial court’s

challenged action was harmful.

                                          52
             4.     The trial court did not abuse its discretion by restricting the
                    scope of Dr. Dulemba’s cross-examination.

      At the end of Plaintiff’s case, the trial court was faced with a claim that an

expert had been sued for similar acts of negligence as Dr. Wilson and that this fact

showed a bias that caused him to shade his expert report. In response, the expert

strenuously denied that the claims against him were similar to those alleged against

Dr. Wilson. The record in the offer of proof showed that permitting this issue to be

raised in front of the jury could well have prompted a round robin of Plaintiff’s

counsel raising the issue, the expert defending himself by claiming that the claim was

dissimilar and invalid, and Dr. Wilson’s counsel challenging the proof that Plaintiff’s

counsel relied on to establish the allegedly similar occurrence. Further, the trial court

had—as had the jury—witnessed the challenges made to Dr. Dulemba’s credibility

when he was accused of changing his opinion in midstream. The trial court had the

discretion and, in this case, did not abuse its discretion by denying cross-examination

on this topic to avoid a time-consuming trial within a trial of the claim against

Dr. Dulemba.

      A trial court has considerable control over the scope of cross-examination; the

parameters of that control are described as follows:

      “A witness may be cross-examined on any matter relevant to any issue in
      the case, including credibility.” Tex. R. Evid. 611(b). The trial court has
      reasonable control over the mode and order of interrogating witnesses
      and presenting evidence. [Tex. R. Evid.] 611(a). Considerations include
      the effective ascertainment of the truth, avoiding needless consumption
      of time, and protecting witnesses from harassment or undue

                                           53
      embarrassment. Id. A trial court abuses its discretion if it unduly
      restricts cross-examination regarding a key issue in the case. In re
      Commitment of Campbell, No. 09-11-00407-CV, 2012 WL 2451620, at *6
      (Tex. App.—Beaumont June 28, 2012, pet. denied) (mem. op.).

In re Commitment of Smith, 422 S.W.3d 802, 809 (Tex. App.—Beaumont 2014, pet.

denied). Thus, we must decide whether the trial court abused its discretion—whether

it acted “with disregard of guiding rules or principles or [acted] in an arbitrary or

unreasonable manner”—by not permitting the cross-examination of Dr. Dulemba

sought by Appellant’s counsel. In re Acad., Ltd., 625 S.W.3d 19, 25 (Tex. 2021) (orig.

proceeding) (stating standard for abuse of discretion).

      Indisputably, a witness may be cross-examined “on any relevant matter,

including credibility.” Tex. R. Evid. 611(b). It is also indisputable that an appropriate

topic of cross-examination for an expert witness is bias. See, e.g., In re Plains Mktg.,

L.P., 195 S.W.3d 780, 782 (Tex. App.—Beaumont 2006, orig. proceeding)

(per curiam) (“To establish bias or prejudice, ‘an expert medical witness may be cross-

examined regarding the number of times he has testified in lawsuits, payments for

such testifying and related questions.’ . . . Furthermore, ‘[p]roof of bias may be

offered to impeach the credibility of a witness.’” (first quoting In re Weir, 166 S.W.3d

861, 864 (Tex. App.—Beaumont 2005, orig. proceeding) (per curiam); and then citing

Tex. R. Evid. 613(b))).

      Here, the alleged bias-producing event was a prior lawsuit filed by

Mrs. Dozier’s counsel against Dr. Dulemba for perforating a bowel while performing

                                           54
a surgical procedure. Courts generally question the admissibility of impeachment by

allegations that a party may have been negligent on another occasion, and the

Beaumont Court of Appeals applied that rule to an attempt to impeach an expert

witness with the claim that he had been sued for malpractice:

      As the bill of exception [on the other suits against the expert] was
      presented, we decide that there was no error in excluding the testimony
      from the jury. [The doctor] was a witness—not a defendant. Reasoning
      by analogy, we think that on an issue of whether a person—in this case a
      medical doctor—was negligent at a certain time and on a certain
      occasion, is not usually provable or susceptible of proof by other alleged
      acts of negligence at other times under other circumstances. A habit or
      custom of either careful or negligent conduct in respect to a particular
      act in question would apparently have some probative force. But the
      courts have usually excluded even habit or custom on one or two
      theories. The first theory is that such habit or custom is really equivalent
      to character or disposition and is therefore inadmissible in evidence
      under the rule against the use of character in civil cases; or, secondly,
      that such habit or custom or such other acts amount to nothing more
      than an attempt to prove negligence or lack of ordinary care by
      testimony or proof of particular acts of negligence on other occasions
      under other circumstances which is likewise disallowed. . . . If such
      evidence is not admissible against a party, we perceive the same should
      not be admissible against an expert witness. On the theory of bias, [the
      doctor] was not asked about particular facts or acts.

Watson, 782 S.W.2d at 549.

      In a different context, the Amarillo Court of Appeals noted that opening the

door to whether a defendant was negligent on a different occasion may raise a host of

satellite evidentiary issues on whether the other events were similar. In determining

whether it was error to deny rebuttal evidence that challenged a defendant doctor’s

opinions with proof of prior malpractice suits, the Amarillo court explained,

                                          55
      [T]o the extent that evidence of similar wrongs may be admissible,
      despite Rule 404(b), it is clear that, at the very least, the circumstances of
      the incidents and conditions under which they occurred must be
      reasonably similar. Nissan Motor Co. v. Armstrong, 145 S.W.3d [131,] 138
      [(Tex. 2004)] (involving unintended acceleration of a vehicle); Farr v.
      Wright, 833 S.W.2d 597, 601 (Tex. App.—Corpus Christi[–Edinburg]
      1992, writ denied) (involving a malpractice claim). And, the degree of
      similarity required depends upon the fact or issue in dispute. Nissan
      Motor Co. . . . , 145 S.W.3d at 138. Yet, even if similar, the evidence
      remains subject to exclusion if it creates undue prejudice, confusion, or
      delay. Id.

McKee v. McNeir, 151 S.W.3d 268, 270 (Tex. App.—Amarillo 2004, no pet.).

      The Amarillo court also noted that allegations of similar acts of negligence may

spark issues such as whether there is proof that the other event actually occurred:

      Additionally, inherent in both Nissan and Farr is the requirement that the
      proponent of the evidence illustrate that the supposedly similar incident
      actually occurred. Simply put, if the incident did not happen, then it
      could hardly be admissible to prove the occurrence of some other act or
      event. And, therein lies the problem here. The only evidence of record
      purporting to illustrate the existence of the extraneous incidents of
      malpractice were copies of pleadings and final orders issued by various
      courts. Yet, most anything can be said in a pleading, whether true or
      not. Consequently, including an allegation favorable to the pleader in
      such a document is seldom evidence of its occurrence. See In re [Marriage
      of] M.C., 65 S.W.3d 188, 193 (Tex. App.—Amarillo 2001, no pet.)
      (stating that “generally, pleadings are not admissible as proof of their
      contents in favor of the pleader”).

Id.

      And the Rules of Evidence give a witness the right to defend against a charge

of bias.   Specifically, Texas Rule of Evidence 613(b)(1) requires that “[w]hen

examining a witness about the witness’s bias or interest, a party must first tell the

witness the circumstances or statements that tend to show the witness’s bias or

                                           56
interest.” Tex. R. Evid. 613(b)(1). Rule of Evidence 613(b)(3) then provides that a

witness charged with bias may offer a defense to that charge: “A witness must be

given the opportunity to explain or deny the circumstances or statements that tend to

show the witness’s bias or interest.      And the witness’s proponent may present

evidence to rebut the charge of bias or interest.” Tex. R. Evid. 613(b)(3).

      Here, after days of testimony, the trial court was confronted with a situation

regarding whether it would open the door to cross-examination on whether

Dr. Dulemba had committed a similar wrong to that alleged against Dr. Wilson—an

act that Dr. Dulemba vehemently denied that he had committed. Though Plaintiff’s

counsel had filed suit alleging a similar act of negligence against Dr. Dulemba, it was

apparent that Dr. Dulemba would claim that there had been no perforation in that

suit. And in the offer of proof itself, Dr. Wilson’s counsel was already challenging the

basis for the claim by attacking whether Plaintiff’s counsel was relying on the

allegations of an expert report or an actual pathology report showing that there had

been a bowel perforation. If, as the Amarillo court states, pleadings are not sufficient

to establish that a similar act occurred and Dr. Dulemba has the right to defend

himself under Rule 613(b)(3), then the trial court was faced with a situation in which,

if it permitted the cross-examination, it would have to let Dr. Wilson’s jury decide

whether there was a bowel perforation in Dr. Dulemba’s case. Further, the trial court

was already well aware of the intense cross-examination to which Dr. Dulemba had

already been subjected when he appeared to change his opinion on whether

                                           57
Dr. Wilson had met the standard of care. As we have noted, a trial court may restrict

cross-examination for various reasons, including to prevent the excessive

consumption of time. Commitment of Smith, 422 S.W.3d at 809. Faced with the

situation below, the trial court acted within the bounds of its discretion in avoiding

the sideshow that would have resulted if it had permitted an attack on the credibility

of an expert whose credibility had already been strenuously attacked.

      We conclude that the trial court’s actions in limiting the scope of

Dr. Dulemba’s cross-examination was neither harmful error nor an abuse of

discretion. Accordingly, we overrule Mrs. Dozier’s first issue.

                                   IV. Conclusion

      Having overruled Mrs. Dozier’s two issues, we affirm the trial court’s

judgment.

                                                      /s/ Dabney Bassel

                                                      Dabney Bassel
                                                      Justice

Delivered: March 2, 2023

                                          58