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Miller v. JSC Lake Highlands Operations, LP

Supreme Court of Texas

December 15, 2017

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

         On Petition for Review from the Court of Appeals for the Fifth District of Texas

          PER CURIAM

         The 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 further proceedings.

         Betty 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.[1] 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.

         Hathcock's 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.

         Karen Miller, Hathcock's daughter, [2] filed health care liability claims against the Village, Metrostat, and Dr. Williams, [3] 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.

         Each 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.

         We 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).

         The 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 § 74.351(r)(6).

         A trial 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.[4] 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").

         The 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.[5] 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.

         We 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 dentures[6]as this was found in the ...

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