DEBORAH HENDRYX AND KPH-CONSOLIDATION, INC. D/B/A KINGWOOD MEDICAL CENTER v. CAROLINA DUARTE, INDIVIDUALLY AND AS NEXT FRIEND AND PERSONAL REPRESENTATIVE OF THE ESTATE OF BABY BOY DUARTE, AND ISRAEL DUARTE
No. 09-18-00070-CV
Court of Appeals Ninth District of Texas at Beaumont
March 7, 2019
On Appeal from the 410th District Court, Montgomery County, Texas, Trial Cause No. 17-05-05997-CV
MEMORANDUM OPINION
In this interlocutory appeal, we are asked to decide whether the trial court abused its discretion by denying a hospital’s and a physician’s respective motions to dismiss a lawsuit filed by Carolina and Israel Duarte, which involved health care
Background
Carolina’s baby died on May 16, 2015, approximately six hours after he was born. The expert medical report, filed by the Duartes, states that the baby died due to being deprived of oxygen and blood when he was born in a prolonged “breech presentation.”3 Just under two years after the baby died, Carolina, her husband, and
In their original petition, the Duartes alleged that Kingwood Medical and Dr. Hendryx were negligent for allowing Carolina to deliver the baby via a vaginal delivery instead of delivering the baby by cesarean section.4 In July 2017, the Duartes served the hospital and Dr. Hendryx with an expert medical report, authored by Dr. William E. Roberts. Dr. Roberts attached his resume to his report. In his report, Dr. Roberts explained why he believed he had the qualifications required to render opinions about the care that Carolina received from Dr. Hendryx and Kingwood Medical. The report contains Dr. Roberts’ opinions, which are critical of the care Kingwood Medical and Dr. Hendryx provided Carolina. The report also explains how the doctor and the hospital violated the standards of care that apply to patients who present with signs and symptoms like those Carolina had when she arrived, by ambulance, at Kingwood Medical in May 2015 to deliver her baby. According to Dr. Roberts’ report, Carolina’s baby would have survived delivery had he been delivered via cesarean.
Dr. Roberts’ report and resume contain information that is relevant to his qualifications as an expert. The information in the report and the resume shows that Dr. Roberts is currently licensed to practice medicine in Tennessee, that he has specialties in obstetrics and gynecology, and that he is a subspecialist in maternal fetal medicine. Dr. Roberts holds board certifications from the American Board of Obstetrics and Gynecology. He first received his board certification in 1981 and has been recertified since then in the field of obstetrics and gynecology, and in his subspecialty of maternal fetal medicine.
Dr. Roberts’ resume reflects that he has authored or co-authored two books in the fields of his specialties, authored or co-authored eighteen chapters in other books that were published in the field of obstetrics, and authored or co-authored eighty-three journal articles, published on subjects relevant to his certifications. Dr. Roberts has also authored or co-authored 104 abstracts in fields that involved his specialties.
The report at issue shows what records Dr. Roberts reviewed in forming his opinions in the Duartes’ case. He reviewed records from Carolina’s treating obstetrician, Northeast Ob/Gyn Associates, records from Cypress Creek EMS (the organization that transported Carolina to the hospital), and the preliminary and
Dr. Roberts’ report includes his opinions on the medical care Carolina received from the hospital and Dr. Hendryx on May 16, 2015. Dr. Roberts’ opinions are premised on the fact, as shown in Carolina’s medical records, that Carolina’s baby was in a breech position at birth. The records Dr. Roberts reviewed also show the baby was believed to be in a breech position when Carolina was last seen by her treating obstetrician, more than a week before she delivered her baby. According to Dr. Roberts, Carolina’s medical records show that in early April 2015, Carolina’s treating obstetrician determined that Carolina’s baby was not in a head-down position in her womb. Carolina saw her treating obstetrician again on May 5, 2015, eleven days before she went to Kingwood Medical, where she delivered the baby. The treating obstetrician’s records show that Carolina was thirty-four weeks pregnant when last seen, but that her baby had still not turned in her womb. According to Dr. Roberts’ report, Carolina’s obstetrician told her of “the continued fetal malpresentation and the need for a cesarean delivery if it persists[.]” Carolina’s obstetrician advised Carolina to contact the labor and delivery unit of the hospital should she experience the symptoms of labor.
Dr. Roberts’ report also mentions what he found significant in Kingwood Medical’s records. Upon Carolina’s arrival at the hospital, Carolina was seen by a nurse. The nurse noted that Carolina’s cervix was completely effaced and dilated, at eight centimeters. Around 12:42 a.m., Kingwood Medical notified Dr. Hendryx, the obstetrician who was on-call that night, that Carolina had been admitted to the hospital. At 12:47 a.m., Carolina requested that the nurse perform an ultrasound, but the nurse who performed the test noted in the hospital’s records that she was unable to determine the baby’s position in Carolina’s womb. At 12:53 a.m., the nurse called Dr. Hendryx and asked that the doctor “perform the ultrasound to determine fetal
Alleging that the negligence of Dr. Hendryx and Kingwood Medical caused the baby’s death, the Duartes sued Dr. Hendryx and Kingwood Medical, alleging that they failed to timely and adequately assess Carolina’s condition, failed to timely provide her with the care she needed for her condition, and failed to timely and adequately diagnose her condition. The petition also alleges that the acts and
After the Duartes served the defendants with Dr. Roberts’ report, Dr. Hendryx objected to it on the ground that the report showed that Dr. Roberts, as of October 2012, was no longer actively engaged in the practice of medicine. Kingwood Medical objected to Dr. Roberts’ report for additional reasons, claiming that the information Dr. Roberts included with his report failed to show that Dr. Roberts was qualified to express opinions about the care Carolina received from the hospital. Additionally, Kingwood Medical argued that Dr. Roberts was no longer actively practicing medicine as a health care provider. Finally, Kingwood Medical objected to Dr. Roberts’ report because his opinions about how the hospital’s acts or omissions caused the baby’s death were overly conclusory.
After the Duartes failed to amend or supplement Dr. Roberts’ report, Dr. Hendryx and Kingwood Medical moved to dismiss the Duartes’ claims. In late January 2018, the trial court conducted a hearing on the defendants’ respective motions to dismiss. Following the hearing, the trial court denied both motions. In its order, the trial court found that Dr. Roberts’ report satisfied the expert report requirements in the Act.5 The trial court also found that, to the extent there were any
Issues
In their appeals, both Dr. Hendryx and Kingwood Medical contend that Dr. Roberts failed to establish he is actively practicing medicine to author an expert report that complies with the requirements of the Act.7 Unlike Dr. Hendryx, whose only complaint concerns whether Dr. Roberts was actively practicing medicine as required by the Act, Kingwood Medical also contends that Dr. Roberts failed to show that he is knowledgeable about the standards of care applicable to a hospital’s nursing staff and that his opinions about what caused the baby’s injury and death are overly conclusory.
Standard of Review
In appeals from rulings on expert reports in health care liability cases, a trial court’s ruling on a defendant’s motion to dismiss is reviewed by the appellate court
Recently, the Texas Supreme Court explained that “the purpose of the expert report requirement is to weed out frivolous malpractice claims in the early stages of litigation, not to dispose of potentially meritorious claims.”18 After noting the report’s purpose, the Court then explained that in ruling on motions to dismiss health care liability claims, the trial court “need only find that the report constitutes a ‘good faith effort’ to comply” with statutory requirements, as the expert, in the report, is not required to “‘marshal all the claimant’s proof[.]’”19
In deciding whether an expert’s report in a health care liability case is adequate to comply with the requirements of the Act, courts are to “consider only the information contained within the four corners of the report.”20 Thus, as to a health care provider’s complaint that a report fails to adequately explain how the provider
Analysis
Qualifications
As both Dr. Hendryx and Kingwood Medical argue that Dr. Roberts was not qualified to render opinions about Carolina’s care because he was no longer actively engaged in practicing medicine, we address their arguments about whether the trial court abused its discretion by finding he is actively practicing medicine before addressing Kingwood Medical’s remaining issues. In evaluating an expert’s qualifications, the qualifications the expert possesses must be evident from the four corners of the report and from the resume that accompanies the expert’s report.22 We use an abuse-of-discretion standard when reviewing the trial court’s decision that an expert in a health care liability case has the qualifications that are required to allow
To qualify as an expert in a health care liability claim against a physician, the Act requires the expert to be a physician who
(1) is practicing medicine at the time such testimony is given or was practicing medicine at the time the claim arose;
(2) has knowledge of accepted standards of medical care for the diagnosis, care, or treatment of the illness, injury, or condition involved in the claim; and
(3) is qualified on the basis of training or experience to offer an expert opinion regarding those accepted standards of medical care.24
The Act goes on to define the terms “practicing medicine” as including, but are not limited to, “training residents or students at an accredited school of medicine or osteopathy or serving as a consulting physician to other physicians who provide direct patient care, upon the request of such other physicians.”25 In assessing the expertise of individuals who author reports for health care liability claims against physicians, trial courts are authorized to consider whether the author of the report is
Section 74.402 of the Act addresses the qualifications for experts who author expert reports in health care liability cases that are critical of the care provided to patients by hospitals. To qualify as an expert on the subject of the medical care a patient received at a hospital, the Act states the person may qualify as an expert witness only if the person
(1) is practicing health care in a field of practice that involves the same type of care or treatment as that delivered by the defendant health care provider, if the defendant health care provider is an individual, at the time the testimony is given or was practicing that type of health care at the time the claim arose;
(2) has knowledge of accepted standards of care for health care providers for the diagnosis, care, or treatment of the illness, injury, or condition involved in the claim; and
(3) is qualified on the basis of training or experience to offer an expert opinion regarding those accepted standards of health care.29
The term “‘practicing health care’” is defined in the Act to include “training health care providers in the same field as the defendant health care provider at an accredited educational institution[,]” or “serving as a consulting health care provider and being licensed, certified, or registered in the same field as the defendant health care provider.”30 Nevertheless, as to hospitals, the Act allows courts to find that an individual who is practicing medicine in a field of practice that involves the same type of treatment involved in the claim as the treatment provided by the health care provider to have the qualifications needed to be knowledgeable about the standards of care that apply to hospitals.31 In determining whether the author of a report is qualified to express opinions about a health care provider, and if the author’s qualifications are based on his training and experience, the Act authorizes courts to consider whether the person who authored the expert report is “certified by a
Dr. Roberts’ expert report and resume show that before October 2012, he was actively involved in and had a great deal of experience writing, teaching, and practicing medicine in the field of obstetrics, including the more specialized field of high-risk pregnancies. His report shows that currently, he works as a consultant in the field of perinatal medicine. As a consultant in that field, the trial court could have inferred that Dr. Roberts consults on medical matters that arise in a period immediately before or after a baby’s birth. Nevertheless, the name “Perinatal Consultants” does not reveal whether Dr. Roberts has consulted with patients and doctors (as opposed to consulting only with lawyers) on matters that concern childbirth, either in May 2015, when Carolina was treated at Kingwood Medical, or in January 2017, when he signed the report.
The information that Dr. Roberts provided to the trial court shows that he is currently licensed, that he is board certified in multiple fields relevant to delivering babies, and that he is currently consulting in the field of medicine that is relevant to the Duartes’ claims. Currently, Dr. Roberts consults on matters involving new-born
Nonetheless, even if the information the trial court had about Dr. Roberts’ consulting work was incomplete, the Act gave the trial court the right to excuse the active practice requirement if, “under the circumstances, the court determines that there is a good reason to admit the expert’s testimony.”38 Here, the trial court specifically found that the exception applied, basing its decision on Dr. Roberts’ experience training others and teaching in the field of medicine that is relevant to the issues in dispute.39 The trial court’s decision to relax the active practice requirement is stated on the record, and the trial court did not abuse its discretion by relaxing the active practice requirement under the circumstances in this case.40
We disagree that the exception, found in subsection (d), applies only when the information before the court about a physician who authors an expert report affirmatively shows that the physician is no longer practicing medicine. Subsection (d) allows trial courts to depart from the other criteria the Legislature set out in subsections (a)-(c) if the trial court finds that “there is good reason to admit the expert’s testimony,” and it states that reason on the record.41 Put simply, the Legislature did not restrict the way trial courts apply the exception to prevent the trial court from applying it under the circumstances that were before it here.
Causation
Lastly, Kingwood Medical argues that because Dr. Roberts’ opinions on causation are conclusory and speculative, the trial court should have agreed with its claims that his report did not constitute a good faith effort to comply with the requirements of the Act.43 Kingwood Medical’s argument is premised on its apparent belief that Dr. Roberts’ opinions about the hospital’s care revolve entirely around his assumption that Cypress Creek’s emergency responders passed on the information to the hospital’s nurses that Carolina’s baby was not in a head-down position in her womb. Kingwood Medical concludes that Dr. Roberts’ criticisms about the hospital’s care, as to causation, were based entirely on that one assumption.
To comply with the causation requirements in the Act, the physician who authors the expert report must link his conclusions to the facts involved in the patient’s treatment.44 While Kingwood Medical assumes that Dr. Roberts relied entirely on an assumption that the emergency responders told the nurses that Carolina told them her baby was in a breech position at the last appointment she had with her obstetrician, the trial court could have reasonably concluded that Carolina
When explaining causation “the expert need not prove the entire case or account for every known fact; the report is sufficient if it makes ‘a good-faith effort to explain, factually, how proximate cause is going to be proven.’”46 Here, the trial court could have reasonably found that Dr. Roberts’ report represented a good faith effort to explain how the hospital’s acts and omissions proximately caused the baby
We conclude that Dr. Roberts’ report provides a straightforward link between the treatment that Carolina received from Kingwood Medical and her baby’s death.47 We further conclude that the opinions that Dr. Roberts expressed in his report are not overly conclusory, as the facts that Dr. Roberts relied on in the medical records are tied to his ultimate conclusions.48
For the reasons discussed, we overrule the appellants’ issues and affirm the trial court’s order.
AFFIRMED.
HOLLIS HORTON
Justice
Submitted on June 4, 2018
Opinion Delivered March 7, 2019
Before McKeithen, C.J., Kreger and Horton, JJ.
