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Rehabilitative Care System of America v. Davis3/28/2001
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Negligence requires a showing of proximate cause, the components of which are cause in fact and foreseeability. Determining whether an actor's act or omission was a proximate cause of damages is usually a fact issue. Causation in fact requires that the defendant's conduct be a substantial factor in bringing about plaintiff's damages. Liability cannot turn on speculation or conjecture. Establishing causation requires the plaintiff to bring forth sufficient facts so that the evidence, and its logical inferences, support the reasonable probability that the defendant's acts or omissions were a substantial factor in bringing about injury . Purina Mills, Inc. v. Odell, 948 S.W.2d 927, 935-36 (Tex. App.-Texarkana 1997, pet. denied).
In Texas expert medical testimony can enable a plaintiff's action to go to the jury if the testimony is that there is a reasonable probability of a causal connection between the allegedly negligent act and the present injury . Parker v. Employers Mut. Liab. Ins. Co. of Wisconsin, 440 S.W.2d 43, 46 (Tex. 1969). Plaintiff's proof must establish a causal connection based on reasonable medical probability, not mere conjecture, speculation, or possibility. Bradley v. Rogers, 879 S.W.2d 947, 953-54 (Tex. App.-Houston [14th Dist.] 1994, writ denied). An expert may appropriately testify concerning possible causes of a plaintiff's condition in order to assist the jury in evaluating other evidence of causation. However, a possible cause becomes probable only when in the absence of other reasonable causal explanations it becomes more likely than not that the injury was a result of its actions. This is the "outer limit" of inference upon which an issue can be submitted to the jury. Parker, 440 S.W.2d at 47; Blankenship v. Mirick, 984 S.W.2d 771, 775 (Tex. App.-Waco 1999, pet. denied).
A jury may decide the required causal nexus between the event and the plaintiff's injuries where
1. general experience and common sense will enable a layperson to fairly determine the causal connection;
2. expert testimony establishes a traceable chain of causation from the injuries back to the event; or
3. a probable cause nexus is shown by expert testimony. Blankenship, 984 S.W.2d at 775.
The causation question in the present case is one determinable only through the testimony of expert medical professionals. Ins. Co. of N. Am. v. Myers, 411 S.W.2d 710, 713 (Tex. 1966). Causal connection in such cases must rest in reasonable probabilities; otherwise, the inference that such actually did occur is no more than speculation and conjecture. Lenger v. Physician's Gen. Hosp., Inc., 455 S.W.2d 703, 706 (Tex. 1970); Myers, 411 S.W.2d at 713. When expert medical testimony establishes only the possibility that the alleged negligent act caused the injury to the plaintiff, rather than a reasonable medical probability, the evidence is not legally sufficient, i.e., it is "no evidence" to support a plaintiff's jury verdict. Otis Elevator Co. v. Wood, 436 S.W.2d 324, 331 (Tex. 1968). However, "reasonable medical probability" can be based on the evidence as a whole, and it is not absolutely necessary that an expert couch his or her opinion in terms of "reasonable medical probability." Duff v. Yelin, 751 S.W.2d 175, 176 (Tex. 1988); Parker v. Employers Mutual Ins. Co. of Wisconsin, 440 S.W.2d 43, 48 (Tex. 1969).
Since the existence of the requisite causal connection is a matter of proof, we will review the testimony of Dr. Harris to determine whether there was any evidence that, in reasonable medical probability, Davis's injuries were caused by RCSA's negligent supervision of his exercise activities:
Q: Based on reasonable me
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