Humble Surgical Hospital, LLC, K & S Consulting, LLC D/B/A K+S Consulting v. Shannon Davis, 542 S.W.3d 12

Davis underwent an eight‑hour foot surgery at Humble Surgical Center in December 2013 and was observed for 23 hours; she experienced fever, tingling, and severe pain during observation and after discharge.
Follow‑up revealed toe discoloration and gangrene; despite inpatient care, Davis ultimately underwent a below‑knee amputation in January 2014.
Davis sued Humble Surgical Hospital and K & S Consulting (the Hospital Parties) asserting vicarious liability for negligent nursing care; she served expert reports from physician Dr. Damien Dauphinee and nurse Claudia Estrada under Tex. Civ. Prac. & Rem. Code § 74.351.
The Hospital Parties moved to dismiss the claims as insufficient under the Medical Liability Act; the trial court granted a 30‑day cure period, Davis amended her reports, and the Hospital Parties renewed their dismissal motion, which the trial court denied.
On interlocutory appeal, the court evaluated whether the amended expert reports satisfied the statute’s requirements as to standard of care, breach, and causation.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether expert reports satisfy § 74.351 (standards, breach, causation)	Davis: amended reports cure deficiencies and collectively show standard, breach, and causation	Hospital Parties: reports—particularly Dauphinee’s—are conclusory on causation; nurse Estrada not qualified to opine causation	Reports inadequate as to causation; dismissal required
Whether nurse expert may offer causation opinion	Davis: Estrada’s report supports causal link jointly with physician report	Hospital Parties: only a physician can give causation under the Act	Estrada not qualified to opine on causation; court relies on Dauphinee’s report for causation analysis
Whether defendants waived objections by counsel remarks or late‑raised points	Davis: statements at hearing amounted to stipulation; some objections raised first on appeal are waived	Hospital Parties: preserved objections in initial and renewed motions to dismiss	No waiver; court finds statements ambiguous and objections sufficiently preserved
Whether amended reports overcome analytical gaps re: proximate cause	Davis: Dauphinee explains how delay would have led to diagnosis/treatment and saved limb	Hospital Parties: Dauphinee fails to explain why physicians would have acted differently or why signs would have been diagnostic; relies on assumptions	Held: Dauphinee’s causation opinion contains analytical gaps and ipse dixit; insufficient to show proximate cause

Van Ness v. ETMC First Physicians, 461 S.W.3d 140 (Tex. 2015) (standard of review: abuse of discretion on expert report adequacy)
Palacios v. American Transitional Care Centers of Texas, 46 S.W.3d 873 (Tex. 2001) (expert report must be a good‑faith effort identifying standard, breach, causation)
Bowie Memorial Hosp. v. Wright, 79 S.W.3d 48 (Tex. 2002) (report must link conclusions to facts; no analytical gaps)
Jelinek v. Casas, 328 S.W.3d 526 (Tex. 2010) (expert must explain how and why breach caused injury to reasonable medical probability)
Costello v. Christus Santa Rosa Health Care Corp., 141 S.W.3d 245 (Tex. App.—San Antonio 2004) (expert report insufficient where no explanation how earlier actions would have changed outcome)