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Birdwell v. Texarkana Memorial Hospital12/12/2003
y of the expert's opinions. Tex. Rev. Civ. Stat. Ann. art. 4590i, § 13.01(l); Palacios, 46 S.W.3d at 875. To constitute a good faith effort, the report must discuss the standard of care, breach, and causation with sufficient specificity to inform the defendant of the conduct the plaintiff has called into question, and to provide a basis for the trial court to conclude that the claims have merit. Palacios, 46 S.W.3d at 875.
Thigpen's report states her opinions concerning the standard of care, the breach, and causation in these particulars:
Standard of Care:
he Wadley Regional Medical Center's Practice Guideline: Fall Precautions, and policy on use of restraints. The policy clearly states the standard of care is: "The patient will be provided an environment that is safe so that the patient is protected from injury during his/her hospital stay." The use of restraints is clearly outlined in the details of the policy. The patient's documented confusion, and inability to be taught, indicates a need for additional protection.
Breach:
The failure to provide this protection for Mrs. Birdwell was clearly below the medical center's own standard of care.
Causation:
As a result of the fall and multiple intracranial hemorrhages, the patient was left obtunded and with a left hemiplegia. . . . Had additional measures been taken, the fall more likely than not could have been prevented. . . . It is evident from the documentation that the patient's debilitated condition as a result of the fall contributed to some of the adverse events late in the hospital course.
We find the report is a good faith attempt to give a fair summary of the standard of care, the hospital's breach, and the injuries Birdwell suffered as a result of that breach. While the report does not provide a direct statement that the standard of care required the hospital to use restraints, that the hospital breached that standard of care by failing to use restraints, and that Birdwell's injuries were caused by that breach, the substance of Thigpen's report provided the hospital with fair notice of all those required elements. Magic words are not always used, but magical words are not necessary. Wright, 79 S.W.3d at 53. It is the substance of the opinions, not the technical words used, that constitutes compliance with the statute. Moore v. Sutherland, 107 S.W.3d 786, 790 (Tex. App.—Texarkana 2003, pet. denied). The substance of Thigpen's report gave fair notice to the hospital of (1) the standard of care, i.e., the standard of providing restraints to ensure an environment that is safe so that the patient is protected from injury ; (2) what the hospital did wrong, i.e., the failure to provide restraints; and (3) the cause of Birdwell's hemorrhages and paralysis, i.e., her fall as a result of the failure to provide restraints as an additional fall precaution.
The expert report need not present evidence as if it were litigating the merits of the case. It may be informal, and the information presented need not meet the same requirements as evidence offered in a summary judgment proceeding or in a trial. Palacios, 46 S.W.3d at 879.
Wadley contends Palacios and Wright support its position that Thigpen's report is inadequate. In Palacios, however, there was no statement whatsoever in the expert report as to what the standard of care was. There was only a statement that the medical care rendered to Palacios was below the accepted and expected standard of care. Here, Thigpen's report stated a standard of care which provided the hospital and trial court with information as to what the hospital specifically failed to do. That report provides that "
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