Gerald Harrington, M.D. v. Sandra Schroeder and Duane J. Ramos, Individually and as All Heirs to the Estate of Sylvia Ramos, 04-15-00136-CV

Background

Sylvia Ramos, a long-term resident at Trisun Care Center, suffered repeated falls and assaults by other residents and died after a resident pushed her in July 2012; appellees (Schroeder and Ramos heirs) sued Trisun and several medical providers, including Dr. Gerald Harrington, for healthcare liability.
Appellees served an expert report by Dr. Loren G. Lipson under Tex. Civ. Prac. & Rem. Code § 74.351, alleging Harrington breached duties to input into the care plan, perform timely assessments, document care, and coordinate appropriate discharge.
Harrington moved to dismiss under § 74.351, arguing Lipson’s report failed to (1) show Lipson is competent to testify as an expert and (2) adequately explain causation linking Harrington’s breaches to Ramos’s injuries and death.
At the dismissal hearing plaintiffs abandoned a service-timeliness objection, so the trial court considered the substantive sufficiency of Lipson’s report; the trial court denied Harrington’s motion to dismiss.
The court of appeals reviewed for abuse of discretion and affirmed, finding Lipson’s qualifications and his explanations of standard, breach, and causation sufficiently met the statute’s requirements at the report stage.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether Harrington waived service/timeliness objections to his Chapter 74 objections	Plaintiffs argued service was defective and timely service required	Harrington argued objections were timely filed but not served within 21 days	Plaintiffs abandoned the service objection at hearing; issue not preserved on appeal
Whether Lipson is qualified to opine on applicable standard of care	Lipson is a geriatrician with extensive training, academic posts, and ongoing roles teaching/practicing, so qualified	Harrington argued Lipson’s board certifications lapsed and report does not affirmatively show active practice	Court held Lipson’s CV and report show sufficient training/experience and active involvement (including teaching) to be qualified despite lapsed board certification
Whether Lipson is qualified to offer causation opinions when not Texas-licensed	Plaintiffs: a physician licensed in any U.S. state satisfies § 74.401(g) for suits against physicians	Harrington: Lipson is not licensed in Texas so cannot opine on causation	Court held federal/statutory reading permits a physician licensed in one or more U.S. states to qualify; Lipson’s California/other licensing and credentials suffice
Whether Lipson’s report adequately explains causation between alleged breaches and injuries/death	Lipson tied breaches (lack of assessment, care-plan input, discharge) to preventive measures that would likely have prevented falls/assaults and ultimately death	Harrington: report’s causation statements are conclusory and do not link breaches to injuries with reasonable medical probability	Court held report, read as whole, explains how listed interventions could have prevented falls/assaults and provides a sufficient factual basis to show claims have merit at this stage

Key Cases Cited

Van Ness v. ETMC First Physicians, 461 S.W.3d 140 (Tex. 2015) (abuse-of-discretion standard for review of expert-report sufficiency)
Rosemond v. Al–Lahiq, 331 S.W.3d 764 (Tex. 2011) (standards for expert-report review)
Am. Transitional Care Ctrs. of Tex., Inc. v. Palacios, 46 S.W.3d 873 (Tex. 2001) (expert report must inform defendant of challenged conduct and show claim has merit)
Bowie Mem’l Hosp. v. Wright, 79 S.W.3d 48 (Tex. 2002) (four-corners rule; report must explain basis of opinions)
Jelinek v. Casas, 328 S.W.3d 526 (Tex. 2010) (expert must link conclusions to facts; ipse dixit insufficient)
In re McAllen Med. Ctr., Inc., 275 S.W.3d 458 (Tex. 2008) (analysis of qualifications limited to report and CV)
Kramer v. Lewisville Mem’l Hosp., 858 S.W.2d 397 (Tex. 1993) (reasonable-medical-probability standard for causation in malpractice cases)
Olveda v. Sepulveda, 141 S.W.3d 679 (Tex. App.—San Antonio 2004) (expert qualifications must appear in report/CV and cannot be inferred)