St. Joseph Regional Health Center v. Maria Gonzales, Individually and as Representative of the Estate of Patricia Gonzales, 10-17-00088-CV

Maria Gonzales (individually and as representative of Patricia Gonzales’s estate) sued St. Joseph Regional Health Center for wrongful death/survival based on events in Jan–Feb 2014 relating to a dislodged tracheostomy tube and alleged respiratory failure.
Plaintiff served two expert reports: an initial report from an RN (Kelly Hill) and, after the trial court sustained objections, a physician report from Eugene C. Deal, M.D., served during the cured-report period.
Hospital moved to dismiss under Tex. Civ. Prac. & Rem. Code § 74.351, arguing the reports—especially Dr. Deal’s—failed to provide a good-faith showing of causation.
Dr. Deal’s report described breaches (no continuous pulse oximetry, intermittent restraints, gaps in vitals documentation) and concluded the tube dislodgement caused respiratory failure and death, but gave little explanation tying facts to how the breaches produced the death.
The trial court denied the Hospital’s motion to dismiss; the hospital appealed interlocutorily. The court of appeals reviewed for abuse of discretion.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether expert reports satisfy § 74.351 by showing causation	Dr. Deal’s conclusion that staff actions "directly led" to death and temporal proximity suffice to show causation	Report is conclusory as to causation and fails to explain how breaches produced respiratory failure	Report is deficient on causation; dismissal required
Whether the reports together cure deficiencies	Combined RN and physician reports constitute a fair summary of opinions	Only physician reports can supply causation and Dr. Deal’s report is inadequate	Physician report alone is insufficient; analytical gap remains
Whether plaintiff is entitled to an additional 30‑day extension to cure report	Plaintiff sought additional time to correct report defects	Statute allows only one 30‑day extension to cure deficiencies	No further extension allowed; plaintiff already used the single 30‑day cure period

Jelinek v. Casas, 328 S.W.3d 526 (Tex. 2010) (expert must explain how and why breach caused injury; mere ipse dixit insufficient)
Palacios v. Castillo, 46 S.W.3d 873 (Tex. 2001) (expert report must provide fair summary of standard, breach, and causation)
Bowie Mem'l Hosp. v. Wright, 79 S.W.3d 48 (Tex. 2002) (scope of trial court review of expert reports; report must link conclusions to facts)
Van Ness v. ETMC First Physicians, 461 S.W.3d 140 (Tex. 2015) (expert must explain causation based on facts set out in the report)
Leland v. Brandal, 257 S.W.3d 204 (Tex. 2008) (statutory interpretation: only one 30‑day extension to cure expert report deficiencies)