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Birdwell v. Texarkana Memorial Hospital12/12/2003
eet the standards, and the causal relationship between that failure and the injury, harm, or damages claimed." Tex. Rev. Civ. Stat. Ann. art. 4590i, § 13.01(r)(6).
If a claimant furnishes a report within the time permitted, a defendant may file a motion challenging the report. See Tex. Rev. Civ. Stat. Ann. art. 4590i, § 13.01(l). The trial court shall grant the motion only if it appears to the court, after a hearing, that the report does not represent a good faith effort to comply with the statutory definition of an expert report. See id.; Palacios, 46 S.W.3d at 877-78.
If a report omits any of the statutory elements, it cannot be a good faith effort. Palacios, 46 S.W.3d at 879. A report that merely states the expert's conclusions about the standard of care, breach, and causation is not sufficient. Id. In determining whether the report represents a good faith effort, the trial court's inquiry is limited to the four corners of the report. Id. at 878.
The expert report must set forth an applicable standard of care and a breach of that standard. Tex. Rev. Civ. Stat. Ann. art. 4590i, § 13.01(r)(6). The standard of care for a hospital is what an ordinarily prudent hospital would do under the same or similar circumstances. Palacios, 46 S.W.3d at 880. Identifying the standard of care is critical: whether a defendant breached its duty to a patient cannot be determined absent specific information about what the defendant should have done differently. Id. "While a 'fair summary' is something less than a full statement of the applicable standard of care and how it was breached, even a fair summary must set out what care was expected, but not given." Id.
The expert's report must also contain information on causation. It is not enough for a report to contain conclusory insights about the plaintiff's claims. Bowie Mem'l Hosp. v. Wright, 79 S.W.3d 48, 52 (Tex. 2002). Rather, the expert must explain the bases of the statements and link the expert's conclusions to the facts. Id. (citing Earle v. Ratliff, 998 S.W.2d 882, 890 (Tex. 1999)).
Analysis
The Estate presented an expert report in letter form. Thigpen's letter, in its entirety, states:
After careful review of the clinic notes, hospital records, etc. on the above referenced patient, I offer the following observations. I reviewed Collom & Carney Clinic records and records from Wadley Regional Medical Center from April 15, 1998 through September 21, 1998. Based upon reasonable medical probabilities, it is my opinion that the nurses at Wadley and Dr. Malcolm Smith deviated from the appropriate standard of care while treating Bessie Birdwell and that this deviation from the appropriate standard of care was a cause of Ms. Birdwell's injuries suffered on June 16, 1998 as more fully explained.
The patient was an elderly female with multiple medical problems, including but not limited to multiple Transient Ischemic Attacks, Cerebrovascular Accident with resultant Seizure Disorder. Mrs. Birdwell developed another temporal bleed while on Coumadin in May 1998 and the Coumadin was stopped. Approximately one month later (hospitalization from 6/11/98 -6/16/98), the patient developed a Deep Venous Thrombosis and Pulmonary Embolism. With the history of previous bleeds being contraindication to systemic Heparin, Mrs. Birdwelll received subcutaneous Heparin. A Greenfield filter was then placed to prevent further emboli.
The records indicate that Mrs. Birdwell had a relatively uneventful hospital course until the last few days of her stay. Multiple entries indicate the patient's confusion, disorientation and inability to learn safety procedures. During the last 48 hours of t
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