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Bustillos v. Rowley8/31/2005
ed not include a full statement of the applicable standard of care and how it was breached, but a fair summary must set out what care was expected, but not given. See Palacios, 46 S.W.3d at 880. Here, Dr. Levine's report provided sufficient specific information about what Rowley should have done differently. The report succinctly states that the appropriate standard of care for emergency department personnel in this case was repeat monitoring of vital signs and cardiac function including, blood pressure, respiratory rate, pulse, temperature, oxygen saturation, and blood gases, and to appropriately treat any symptoms indicating instability. Dr. Levine indicated in his report that failure to monitor and treat Ms. Arriola's pulmonary edema led to her cardiac arrest. He also indicated that appropriate treatment for the incrementally worsening symptoms of pulmonary edema may in fact prevent cardiac arrest. According to Dr. Levine's report, the medical records showed an absence of appropriate monitoring by the emergency department personnel after 1:10 a.m. We conclude that Dr. Levine's report fairly summarized the alleged standard of care and how that standard of care was breached.
The report also provides a fair summary of Dr. Levine's opinions as to the causal relationship between Rowley's alleged breach and the harm claimed. The report states that if Ms. Arriola had been properly monitored, her pulmonary edema and cardiac arrhythmia would have been detected and treated. According to Dr. Levine, appropriate treatment for incrementally worsening symptoms of pulmonary edema may in fact prevent cardiac arrest. The report clearly indicates that if Ms. Arriola's vital signs had been regularly monitored between her admission and first cardiac arrest, emergency department personnel could have had information which would have led to appropriate treatment and could have prevented her cardio-vascular collapse. The report states that the cardio-vascular collapse Ms. Arriola experienced could have been prevented if she had been properly monitored by the emergency department personnel. Although not eloquently stated, Dr. Levine's statements adequately address causation by indicating that if Ms. Arriola had been properly monitored, emergency department personnel could have detected and treated the worsening symptoms of Ms. Arriola's pulmonary edema, the life-threatening condition which was aggravated by the preventable conditions of cardio-vascular collapse and cardiac arrest and cause of her death. See In re Tenet Hosps. Ltd., 116 S.W.3d at 826 (the words "cause" or "causation" do not have to be used as long as a substitute word, phrase, or reference is used); see also Bowie Memorial Hosp. v. Wright, 79 S.W.3d 48, 53 (Tex. 2002)(expert need not express the causal relationship in terms of magic words such as "reasonable medical probability"). Therefore, we conclude Dr. Levine's report constitutes a good faith effort to comply with the statutory definition of an expert report. We conclude the trial court abused its discretion in dismissing the case. Appellant's Issue Two is sustained.
We reverse the trial court's order of dismissal and remand this cause to the trial court for further proceedings.
Before Barajas, C.J., McClure, and Chew, JJ
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