Texas Home Health Skilled Services, LP and Texas Home Health v. Judy Anderson, Individually and as Representative of the Estate of Elizabeth Timmons, 10-15-00440-CV

Judy Anderson sued Texas Home Health Skilled Services (AccentCare) for wrongful death/survival after Elizabeth Timmons died June 7, 2014, alleging home-health failures in monitoring anticoagulation (Coumadin), documentation, and care that led to a massive subdural hematoma, hospitalization, pressure ulcers, dehydration, renal failure, and death.
Anderson served expert reports and CVs from Dr. Paul Warshawsky (physician) and Nurse Lori Rozas (R.N.); defendant objected that the reports failed to (1) show Dr. Warshawsky’s qualifications to opine about home-health nursing, and (2) adequately address breach and causation.
The trial court found the reports sufficient and denied defendant’s motion to dismiss under Tex. Civ. Prac. & Rem. Code § 74.351; defendant appealed interlocutorily.
On appeal the court reviewed qualification, standard-of-care/breach, and causation under the abuse-of-discretion standard (legal questions de novo, factual determinations deferential).
The court held experts were qualified and the reports adequately alleged standard of care and breach, but they failed to adequately tie the alleged breaches to Timmons’s death (insufficient causation analysis).
Because the reports were not so deficient as to be no report at all, the case was reversed and remanded for the trial court to consider whether to allow a 30-day cure under § 74.351(c).

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether experts were qualified to opine on nursing/home‑health standards	Warshawsky (physician) and Rozas (nurse) are qualified; CVs and reports show relevant experience	Warshawsky lacks specific home‑health nursing qualifications	Court held experts sufficiently qualified (Warshawsky adequate; Rozas unchallenged)
Whether reports adequately describe applicable standard of care and breach	Reports (esp. Rozas) detail failures to monitor INR, medication reconciliation, documentation, communication	Reports are conclusory and lack specifics	Court held reports adequate as to standard of care and breach
Whether reports adequately establish causation between breaches and death	Plaintiff: failure to monitor Coumadin led to coagulopathy, subdural bleed, hospitalization, subsequent complications (dehydration, renal failure) and death	Defendant: reports do not explain how subdural bleed led to the death from dehydration; chain of causation is speculative	Court held causation analysis deficient — experts failed to connect the alleged breaches/subdural hematoma to the ultimate cause of death
Remedy after deficient report	Plaintiff sought opportunity to cure if reports deficient	Defendant sought dismissal for failure to serve compliant expert report	Court reversed trial court’s denial of dismissal and remanded for trial court to consider 30‑day extension to cure

Jelinek v. Casas, 328 S.W.3d 526 (Tex. 2010) (expert must explain how breach caused injury based on facts in report)
Palacios v. Andrews, 46 S.W.3d 873 (Tex. 2001) (expert report must be a good‑faith effort discussing standard, breach, causation)
Van Ness v. ETMC First Physicians, 461 S.W.3d 140 (Tex. 2015) (expert must explain, based on facts, how and why breach caused injury)
Gardner v. U.S. Imaging, Inc., 274 S.W.3d 669 (Tex. 2008) (if report is not so deficient as to be no report, court must allow remand for possible 30‑day cure)