518 S.W.3d 496
Tex. App.2017Background
- Lancer ("Lance") Windrum presented to North Cypress Medical Center in Feb 2010 with intermittent neurologic episodes (slurred speech, confusion, imbalance); imaging showed enlarged ventricles and aqueductal stenosis (hydrocephalus).
- Neurosurgeon Dr. Kareh placed a ventricular monitor; intracranial pressure (ICP) readings showed transient spikes but no sustained elevation; Kareh discharged Lance without placing a permanent shunt. Lance later saw other treating physicians; an April MRI showed worsening findings but Kareh was not informed of those results.
- Lance died in his sleep on May 2, 2010; autopsy reported marked aqueductal stenosis and listed complications of hydrocephalus due to aqueductal stenosis as cause of death.
- Plaintiff (Tracy Windrum, individually and as estate rep and on behalf of minor children) sued for wrongful death/medical malpractice; jury found Kareh 80% negligent and awarded multi-million dollar damages; trial court applied statutory caps and entered judgment for plaintiff.
- On appeal the court addressed legal and factual sufficiency of evidence on (1) breach of standard of care (failure to place shunt) and (2) causation; the panel concluded plaintiff's proof was insufficient and reversed and rendered a take-nothing judgment.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether plaintiff proved breach of the neurosurgical standard of care (duty to place a shunt on Feb 4, 2010) | Parrish (plaintiff expert): MRI + "classic" intermittent symptoms equaled symptomatic obstructive hydrocephalus requiring a shunt; Kareh should have recommended/placed a shunt and informed of risks of non-treatment | Kareh: ICP monitoring showed no sustained elevated pressure; risks of shunt in patient with normal pressure; standard did not require shunt based on monitoring and clinical course | Reversed for plaintiff — court held plaintiff failed to present legally or factually sufficient evidence of breach beyond conclusory expert opinion (Parrish's testimony was insufficiently supported) |
| Whether plaintiff proved proximate causation between failure to place a shunt and Lance's death on May 2, 2010 | Parrish and Dragovic: death resulted from acute obstruction of aqueduct causing fatal rise in ICP; earlier failure to treat left a foreseeable, progressive, ultimately fatal condition | Kareh: decision not to shunt was based on normal monitoring and resolved symptoms; any later worsening (April MRI) was not communicated to Kareh; temporal remoteness; other experts found no autopsy evidence of elevated ICP | Reversed — court held even assuming breach, Kareh's February decision was too remote from May death and causation was not proven by preponderance of legally sufficient evidence |
| Admissibility/weight of plaintiff experts' opinions (conclusory/explained basis) | Plaintiff relies on Parrish's experience and opinions; plaintiff argued expert testimony adequately explained basis (imaging, symptoms, experience) | Kareh challenged causation and methodology; court examined whether expert linked data to opinion or relied on ipse dixit | Court treated Parrish's opinion as conclusory/insufficiently supported (no medical literature or adequate analytical connection presented to establish that shunt was required “every time”), so expert evidence could not sustain verdict |
| Procedural disposition (trial judgment & remaining issues) | Plaintiff seeks to uphold jury verdict and judgment after caps applied | Defendant seeks JNOV/new trial or reversal | Court reversed and rendered judgment that plaintiff take nothing on malpractice claim; remaining appellate issues not reached because essential elements lacked legally sufficient evidence |
Key Cases Cited
- City of Keller v. Wilson, 168 S.W.3d 802 (Tex. 2005) (standard for legal- and factual-sufficiency review of jury findings)
- Jelinek v. Casas, 328 S.W.3d 526 (Tex. 2010) (medical causation requires reasonable medical probability and expert explanation of how negligence caused injury)
- Coastal Transp. Co. v. Crown Cent. Petroleum Corp., 136 S.W.3d 227 (Tex. 2004) (expert testimony must have a reliable basis; conclusory opinions are not probative)
- Gammill v. Jack Williams Chevrolet, Inc., 972 S.W.2d 713 (Tex. 1998) (experience can support expert testimony but must be sufficiently connected to opinion)
- Merrell Dow Pharm., Inc. v. Havner, 953 S.W.2d 706 (Tex. 1997) (expert proof standards for causation and reliable basis)
- Burrow v. Arce, 997 S.W.2d 229 (Tex. 1999) (the basis of an expert's opinion, not mere credentials, determines its probative value)