Oceans Behavioral Healthcare of Longview, Audubon Behavioral Hospital of Longview, LLC D/B/A Oceans Behavioral Hospital of Longview and Oceans Acquisition, Inc. and Javen v. Cavazos, M.D. v. Nancy M. Butler, Individually and as of the Estate of Huey D. Butler, and on Behalf of the Wrongful Death Beneficiaries of Huey D. Butler
12-17-00297-CV
| Tex. App. | Nov 27, 2017Background
- Plaintiff Nancy M. Butler (individually and as executor) sued over care provided to her husband, Huey D. Butler, who was admitted to Oceans Behavioral Hospital (a psychiatric facility) for major depressive disorder with psychosis and dementia in March 2015 and later died in August 2015 after subsequent hospital and nursing-home stays.
- Plaintiff served a Chapter 74 expert report (April 10, 2017) and CV from Keith E. Miller, M.D., a family physician, alleging failures by Oceans and staff (e.g., over-sedation, dehydration, improper use of restraints, medication management) that proximately caused Mr. Butler’s deterioration and death.
- Defendants (Oceans entities and Oceans Acquisition, Inc.) moved to dismiss under Tex. Civ. Prac. & Rem. Code § 74.351, arguing Dr. Miller’s report is legally insufficient because he is not qualified to opine about psychiatric-hospital standards and because the report fails to adequately address standard of care, breach, and causation.
- The trial court reviewed the four corners of Dr. Miller’s report and CV and entered an order overruling defendants’ objections and denying the motions to dismiss, finding Dr. Miller sufficiently qualified and his report sufficient on standards, breaches, and causation for Chapter 74 purposes.
- Defendants appealed the interlocutory denial, presenting issues whether the trial court abused its discretion in finding qualification and report adequacy.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Dr. Miller is qualified to give standard-of-care opinions about a psychiatric hospital | Miller is sufficiently experienced by training and practice to opine on the applicable standards for the care at issue | Miller is a family practitioner who does not practice or train in psychiatric/behavioral-hospital care and his report/CV do not show required §74.402 qualifications | Trial court held Miller sufficiently qualified; denial of dismissal affirmed at trial-court level (issue preserved for appeal) |
| Whether the report adequately identifies applicable standards of care and specific breaches | The report identifies standards and explains what defendants should have done differently regarding hydration, medication management, restraints, and monitoring | The report uses conclusory language (e.g., "ensure"), fails to specify concrete steps or practices required, and improperly infers breach from bad outcome alone | Trial court found the report set out specific standards and breaches and overruled objections |
| Whether causation is adequately explained in the expert report | The report states, based on medical probability, that the alleged breaches more likely than not caused the injuries, hospitalization, and death | The causal statements are conclusory, fail to link specific breaches to injuries within the four corners of the report, and do not exclude mere possibility of causation | Trial court concluded Miller sufficiently linked breaches to injuries; denial of dismissal resulted |
| Whether the trial court abused its discretion in denying dismissal under Chapter 74 | Plaintiff: the report meets Palacios/Bowie good-faith threshold and need not marshal all proof | Defendant: the court had to dismiss absent a good-faith report that explains qualifications, standard, breach, and causation | Trial court denied dismissal; defendants appealed alleging abuse of discretion (trial court applied Chapter 74 standards to find report adequate) |
Key Cases Cited
- American Transitional Care Ctrs. of Tex. v. Palacios, 46 S.W.3d 873 (Tex. 2001) (defines good‑faith expert report and explains that report must link conclusions to facts)
- Bowie Mem'l Hosp. v. Wright, 79 S.W.3d 48 (Tex. 2002) (trial court must grant dismissal only if report is not a good‑faith effort under §74.351)
- Broders v. Heise, 924 S.W.2d 148 (Tex. 1996) (expert must have expertise on the specific subject of opinion)
- Earle v. Ratliff, 998 S.W.2d 882 (Tex. 1999) (expert must explain basis of opinions to connect conclusions to facts)
- Tenet Hosp. Ltd. v. Love, 347 S.W.3d 743 (Tex. App.—El Paso 2011) (court cannot fill gaps in report by inference regarding expert qualifications)
- Senior Care Centers, LLC v. Shelton, 459 S.W.3d 753 (Tex. App.—Dallas 2015) (expert must state concrete steps that constitute the standard of care; bad result alone insufficient to show breach)
- Jelinek v. Casas, 328 S.W.3d 526 (Tex. 2010) (expert cannot merely assert "medical probability" without factual linkage)
- Van Ness v. ETMC First Physicians, 461 S.W.3d 140 (Tex. 2015) (expert must explain, based on facts, how breach caused injury)