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Clark v. HCA8/25/2005
y that Lovenox was contraindicated; he merely asserted that Clark met the exclusion criteria. There was no discussion of risk v. benefit. Instead, Dr. Pacheco focused on the symptoms of compartment syndrome although the medical records were unclear as to whether Clark actually suffered from compartment syndrome. And he concluded, without detailing the factual basis for his conclusion, that Clark indeed had compartment syndrome. Finally, Dr. Pacheco failed to state what each of the defendants should have done differently.
Causation
The report also fails to adequately address causation, primarily because of a large analytical gap. Stated simply, Dr. Pacheco opined that Appellees failed to treat the complications resulting from the improper use of Lovenox. He then jumped to the conclusion that "the acute, compartment syndrome created the 'devasting dysfunction created by ischemic damage' causing the complete loss of use of Lela Clark's right arm." The missing link is not that compartment syndrome caused devastating dysfunction. The missing link is that the improper use of Lovenox caused compartment syndrome. We conclude that Dr. Pacheco's expert report was inadequate. Point of Error Two is overruled.
GOOD FAITH EFFORT
In Point of Error Three, Clark complains that the trial court erred in finding that the report was not a good faith effort to comply with the requirements of Article 4590i. To constitute a good-faith effort, an expert 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. To inform the defendant of the specific conduct the plaintiff has called into question, the report must support the cause of action alleged in the plaintiff's petition. Windsor, 121 S.W.3d at 50. When the expert report's conclusory statements do not put the defendant or the trial court on notice of the conduct complained of, the trial court no discretion but to find that the report does not represent a good faith effort. Palacios, 46 S.W.3d at 880. Since the report did not discuss the standard of care and breach with sufficient specificity, it cannot constitute a good faith effort. See Palacios, 46 S.W.3d at 875. Moreover, the report does not support the cause of action Clark alleged in her pleadings. She alleged that Appellees breached the standard of care by failing "to properly assess Plaintiff's medical history and properly prescribe medications." In other words, the standard of care was breached by the administration of Lovenox. Dr. Pacheco, on the other hand, opined that the standard of care was breached by "failing to properly assess, monitor and timely treat the complications . . . of Lovenox."
Since the report did not represent a good faith effort to comply with the statutory requirements, the trial court had no discretion but to dismiss Clark's claim with prejudice. See Palacios, 46 S.W.3d at 880. We overrule Point of Error Three and affirm the judgment of the trial court.
Before Barajas, C.J., McClure, and Chew, JJ.
(McClure, J., not participating)
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