Jelinek v. Casas, 328 S.W.3d 526

Casas, with advanced colon cancer, was admitted for abdominal pain and fever suggesting possible infection.
Two broad-spectrum antibiotics (Maxipime and Flagyl) were prescribed July 11, continued after surgery on July 13.
A four-and-a-half-day lapse occurred from July 18–23 where antibiotics were not administered.
Culture later showed Candida and coagulase-negative staph, not susceptible to Maxipime/Flagyl.
The Casases sued the Hospital and two doctors for negligence; jury found majority liability on the Hospital and awarded damages for pain and suffering.
Casas died approximately two months after a September re-admission; estate sought damages and later sanctions against a treating physician.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Legal sufficiency of causation evidence	Casas’s estate argues lapse caused an infection treated by the omitted antibiotics, increasing pain.	Hospital contends no evidence linked lapse to a causative infection or added pain.	No legally sufficient causation evidence; causation not proven beyond conjecture.
Adequacy of the Casases’ expert report	Dr. Daller’s report provides basis linking breach to increased harm.	Report is conclusory; lacks explanation tying breach to specific injury.	Trial court abused discretion; remanded for attorney’s fees and costs; report lacked adequate causal basis.

City of Keller v. Wilson, 168 S.W.3d 802 (Tex. 2005) (no evidence points require strong factual support; circumstantial proof must show reasonable probability)
Guevara v. Ferrer, 247 S.W.3d 662 (Tex. 2007) (expert causation typically required in medical malpractice)
Kramer v. Lewisville Mem’l Hosp., 858 S.W.2d 397 (Tex. 1993) (standard of proof: reasonable medical probability)
Lenger v. Physician’s Gen. Hosp., Inc., 455 S.W.2d 703 (Tex. 1970) (expert testimony needed when evidence is not within lay understanding)
Hart v. Van Zandt, 399 S.W.2d 791 (Tex. 1966) (medical negligence requires expert guidance for causation)
Palacios, 46 S.W.3d 873 (Tex. 2001) (good-faith requirement for expert reports; explain basis for opinions)
Bowie Memorial Hosp. v. Wright, 79 S.W.3d 48 (Tex. 2002) (necessity of linking breach to injuries in expert reports)
Pollock v. City of San Antonio, 284 S.W.3d 809 (Tex. 2009) (rejects ipse dixit; requires basis linking facts to conclusions)
Earle v. Ratliff, 998 S.W.2d 882 (Tex. 1999) (summary-judgment standard; require basis linking facts to conclusions)