Karen Miller, Individually & as Representative of the Estate of Betty Ruth Hathcock, and Betty Crockett, Individually, Petitioners,
JSC Lake Highlands Operations, LP d/b/a Villages of Lake Highlands & Villages of Lake Highlands Assisted Living, Metrostat Diagnostic Services, Inc., Richard M. Williams, M.D., and Richard M. Williams, M.D., P.L.L.C., Respondents
Petition for Review from the Court of Appeals for the Fifth
District of Texas
Texas Medical Liability Act requires plaintiffs asserting a
health care liability claim to serve each defendant with an
"adequate" expert report or face dismissal of their
claim. Tex. Civ. Prac. & Rem. Code § 74.351(1). The
issue in this case is whether the trial court abused its
discretion by denying the defendants' motions to dismiss
when it read several experts' reports together to satisfy
the Act's adequacy requirement. See id. We hold
the trial court did not abuse its discretion and therefore
reverse the judgment of the court of appeals and remand for
Ruth Hathcock was a resident at Village of Lake Highlands, an
assisted-living facility. On March 22, 2013, Hathcock
reported to the Village's staff that she had lost her
dental bridge. The staff looked for the bridge but did not
find it. That evening, Hathcock began coughing and showing
signs of chest congestion. Dr. Derek LeJeune, the
Village's on-call physician, ordered a "stat"
chest x-ray. Metrostat, a mobile-imaging facility,
conducted the x-ray and forwarded the images to Dr. Richard
M. Williams for review. Although the images revealed the
presence of the missing dental bridge in Hathcock's
trachea, neither Metrostat's technician nor Dr. Williams
noticed or identified the problem or noted it in a report.
condition worsened over the course of the evening. Early the
next morning, the Village's staff discovered Hathcock
unresponsive and called for an ambulance. When emergency-room
physicians attempted to insert a ventilation tube into
Hathcock's trachea, they found the missing dental bridge.
The physicians extracted the bridge and transferred Hathcock
to an intensive-care unit, but she died soon thereafter.
Hathcock's official cause of death was pulmonary edema,
pneumothorax, and aspiration.
Miller, Hathcock's daughter,  filed health care liability
claims against the Village, Metrostat, and Dr. Williams,
alleging their respective failures to timely discover the
bridge led to her mother's death. Miller filed four
separate expert reports to satisfy the Act's
requirements. See id. § 74.351(i). Three
reports discussed the respective conduct of one of the three
defendants, while the fourth report, by Dr. Ravi Patel,
discussed the medical cause of Hathcock's death.
defendant moved to dismiss Miller's claims for failure to
serve adequate expert reports. See id. §
74.351(1). The trial court found the reports deficient but
granted Miller an extension to cure the deficiencies. After
Miller amended the reports, the trial court denied the
defendants' renewed motions to dismiss. The court of
appeals reversed, holding the trial court abused its
discretion in denying the motions to dismiss as to all three
defendants. S.W.3d, 2016 WL 4575536, at *10 (Tex. App.-Dallas
2016). Miller petitioned for review in this Court.
review a trial court's ruling on the adequacy of an
expert report for abuse of discretion. Van Ness v. ETMC
First Physicians, 461 S.W.3d 140, 142 (Tex. 2015) (per
curiam); Am. Transitional Care Ctrs. of Tex., Inc. v.
Palacios, 46 S.W.3d 873, 877 (Tex. 2001). "A trial
court abuses its discretion if it rules without reference to
guiding rules or principles." Van Ness, 461
S.W.3d at 142. When reviewing matters committed to the trial
court's discretion, "the reviewing court may not
substitute its judgment for that of the trial court."
Walker v. Packer, 827 S.W.2d 833, 839 (Tex. 1992).
standard for serving an adequate expert report is well
established. The Act requires a plaintiff asserting a health
care liability claim to serve each defendant with an expert
report that includes "a fair summary of the expert's
opinions . . . regarding applicable standards of care, the
manner in which the care rendered by the physician or health
care provider failed to meet the standards, and the causal
relationship between that failure and the injury, harm, or
damage claimed." Tex. Civ. Prac. & Rem. Code §
court must sustain a challenge to a report's adequacy if
the report does not represent an "objective good faith
effort" to provide a fair summary of the applicable
standard of care, the defendant's breach of that
standard, and how that breach caused the patient's harm.
Id. § 74.351(1). A good-faith effort must
"provide enough information to fulfill two purposes: (1)
it must inform the defendant of the specific conduct the
plaintiff has called into question, and (2) it must provide a
basis for the trial court to conclude that the claims have
merit." Bowie Mem'l Hosp. v. Wright, 79
S.W.3d 48, 52 (Tex. 2002) (per curiam); see also
Palacios, 46 S.W.3d at 879. A trial court may read
several reports in concert in determining whether a plaintiff
has made a good-faith effort to comply with the Act's
requirements. Tex. Civ. Prac. & Rem. Code §
74.351(i); TTHR Ltd. P'ship v. Moreno, 401
S.W.3d 41, 43 (Tex. 2013) (noting section 74.351(i)
"authoriz[es] fulfilling the expert report requirements
by serving multiple reports").
defendants contend Miller's four reports-even when read
together- do not constitute a good-faith effort because Dr.
Patel's medical-causation report does not discuss the
conduct of any particular defendant. The court of appeals agreed,
concluding that Dr. Patel's report was independently
insufficient because it "does not state that he reviewed
any of the other expert reports in reaching his conclusions,
" and thus the court could not "determine whose
conduct Dr. Patel's causation opinion implicates."
2016 WL 4575536, at *4.
disagree. Dr. Patel's report on the medical cause of
Hathcock's death is brief, but substantive:
I was a physician at Doctors Hospital of Dallas and treated
Ms. Betty Ruth Hathcock as a patient on March 23 and 24, 2013
at Doctors Hospital arriving by EMS ambulance from the
nursing facility the morning of March 23, 2013. When
Ms. Hathcock presented to the hospital, it appears she
aspirated on her denturesas this was found in the ...