MEMORANDUM
This medical malpractice controversy arises out of the death of an eighteen-day old infant, Shahayla Poindexter. Plaintiffs allege that Defendants, the doctors who treated Shahayla, were negligent in failing to properly treat her. Defendant Dr. Bon-sukan moves to strike the report of Plaintiffs’ expert, Dr. Stanley Spinner, because, allegedly, his report does not satisfy the requirements of section 13.01(r)(6) of the Texas Medical Liability and Insurance Improvement Act (Act). Defendant United States of America (USA) moves to strike the report of Dr. Gary Noel because, allegedly, his report was not presented within the timeframe set out in section 13.01(d) of the Act. Plaintiffs contest Defendants’ alie-
I. Introduction
Befоre the birth of Shahayla Poindexter, Goldie Poindexter, her mother, received an intra-partum antibiotic treatment for Group B Streptococcus (Group B Strep) bacterial infection from physicians with East Texas Community Health Services, Inc. She was treated by Dr. Ghazala Khan and Dr. Farahaba Kakhdir. The treatment was completed without complication, but the risk that the child would contract Group B Strep was higher than it would have been had her mother not needed the treatment. Shahayla was born on June 25, 1998. Seventeen days later the Poindex-ters took Shahayla to the emergency room at Nacogdoches Memorial Hospital because she had a temperature of 102 degrees and had been crying for several hours. After examining Shahayla, Defendant Dr. Eulogio Bonsukan sent the Poin-dexters home. Shahayla died thirteen hours later.
The Poindexters allege that Shahayla’s death was caused by Dr. Bonsukan’s failure to perform various medical procedures on the child when he knew she (1) had a high fever, (2) had been crying for a sustained period of time, and (3) was predisposed to contracting Group B Strep. Plaintiffs also allege that Dr. Khan and Dr. Kakhdir were negligent in causing Shahay-la’s death. Because federal law considers Dr. Kahn and Dr. Kakhdir to be federal employees, see 42 U.S.C. § 223(g)-(n), Defendant USA was substituted as the proper defendant. See 28 U.S.C. § 1346(b), 2401(b), 2671-2680 (Federal Tort Claims Act). Under Texas law, Plaintiffs are required to submit an expert report and curriculum vitae from a qualified expert within 180 days of their suit. Plaintiffs seek to meet this requirement with the expert opinion of Dr. Spinner and Dr. Noеl. Defendant challenges the timeliness of Dr. Noel’s report and the adequacy of Dr. Spinner’s report under the Act.
II. Texas Medical Liability and Insurance Improvement Act
The Texas legislature enacted the Act to curtail frivolous claims against physicians and other health care providers.
See Horsley-Layman v. S.M. Angeles, M.D.,
III. Applicability of section 13.01 in Federal Court
As a general rule, discovery is a procedural matter governed in federal court by the Federal Rules of Civil Procedure and not by state discovery practice.
See 8
Wright and Miller, Federal Practice and Procedure § 2005 (Supp.2000) (noting that except for matters of privilege and Rule 69 discovery in aid of execution, it is “wholly settled that discovery in a federal court is governed only by these rules and that state discovery practices are irrelevant”);
Broussard v. Lemons,
Federal courts apply state substantive law “when adjudicating diversity-jurisdiction claims, but in doing so apply federal procedural law to the proceedings.”
Cates v. Sears, Roebuck & Co.,
In determining whether a conflict exists, the Supreme Court has explained that the “direct collision” language in
Hanna
“expresses the requiremеnt that the federal statute be sufficiently broad to cover the point in dispute.”
Stewart Org.,
487 U.S.
Expert disclosure rules and sanctions for failure to comply with those rules are governed in federal court by the Federal Rules of Civil Procedure. Of particular relevance here are Rules 26(a)(2) and 37(c)(1).
Rule 26(a)(2) provides that “a party shall disclose to other parties thе identity of any person who may be used at trial to present evidence under Rules 702, 703, or 705 of the Federal Rules of Evidence.” Fed. R.Civ.P. 26(a)(2)(A). The Rule is geared toward disclosure; it does not require a party to engage an expert. “This disclosure shall, with respect to a witness who is retained or specially employed to provide expert testimony in the case, ... be accompanied by a written report prepared and signed by the witness.” Fed.R.Civ.P. 26(a)(2)(B). Rule 26 then elaborates on the required content of the expert report:
An expert report shall contain a complete statement of all opinions to be expressed and the basis and reasons thereof; the data or other information considered by the witness in forming the opinions; any exhibits to be used as a summary of or support for the opinions; the qualifications of the witness, including a list of all publications authored by the witness within the preceding ten years; the compensation to be paid for the study and testimony; and a listing of any other cases in which the witness has testified as an expert at trial or by deposition within the preceding four years.
Fed.R.Civ.P. 26(a)(2)(B). Finally, the Rule provides that “[t]hese disclosures shall be made at the times and in the sequence directed by the court.” Fed. R.Civ.P. 26(a)(2)(C). The purpose of these procedures is “to provide information on expert testimony sufficiently in advance of trial [so] that opposing parties have a reasonable opportunity to prepare for effective cross examination and perhaps arrange for expert testimony from other witnesses.” Fed.R.Civ.P. 26, 28 U.S.C.A. (advisory committee notes 1993) (West supp.2000).
Rule 37(c) provides the course of action a court is to take when a party fails to comply with Rule 26’s disclosure requirements. In addition to or in lieu of not allowing the non-complying party to use the undisclosed information or witness as evidence at a trial, at a hearing, or on a motion, a court may “impose other appropriate sanctions.” Fed.R.Civ.P. 37(c)(1). These sanctions may include dismissing the case against the non-complying party. Id.
Section 13.01 provides that in a health care liability claim, not later than 180 days after the date the claim is filed, a claimant shall, for each physician against whom a claim is asserted: (1) furnish to counsel for each physician one or more expert reports, with a curriculum vitae for each expert listed in the report or (2) voluntarily non-suit the action against the physician.
See
§ 13.01(a). The statute outlines what plaintiffs need to include in their expert reports.
See
§ 13.01(r)(6). They must set forth (1) the applicable standard of care, (2) the violation of the standard of care, and (3) that the violation caused some
The question then is whether the federal rules are sufficiently broad to control the area addressed by section 13.01 or whether the provisions can operate simultaneously. There is no doubt that the timing provisions, the expert repоrt content requirements, and the sanctions found in Rule 26 conflict with those in section 13.01. An examination of similar cases, however, reveals that there is little agreement among federal courts as to whether this is sufficient to disregard the state provision in a diversity case.
* There is no Fifth Circuit case directly on point. There are Fifth Circuit cases that have addressed conflicts between federal rules and state statutes.
See, e.g., Exxon,
A district court in Minnesota specifically rejected the supposed conflict between Federal Rule of Civil Procedure 26(a) and a state requirement that plaintiffs in medical malpractice cases submit an “expert disclosure affidavit.”
See Ellingson v. Walgreen Co.,
First, it held that although the Minnesota Supreme Court had held that the statute’s timing provisions were procedural, the federal courts that had reviewed the statute had consistently considered the statute as substantive.
See Ellingson,
78
In an earlier case relied upon by
Elling-son
for its procedure/substance conclusion, a district court applied the Minnesota statute in the face of plaintiffs argument that the expert disclosure requirement conflicted with the Federal Rules of Civil Procedure.
See Oslund v. United States,
If the contrary were true, the anomalous result would be that the federal government would be exposed to liability when a cause of action involving similar conduct would be dismissed in a diversity case or in a state court action. The more reasonable view is that compliance with § 145.682 is necessary in any claim of malpractice under Minnesota law, no matter how the court obtains jurisdiction over the claim. Id. at 714.
Apart from the court’s concerns about treating federal question cases the same as diversity and state cases, the implication is that federal rule or no federal rule, it makes more “sense” to apply the state statute — regardless of the fact that the state courts had labeled the statute procedural and regardless of supposed conflicts.
This reasoning, whatever the merits of the conclusion, is insufficient under Supreme Court precedent. Again, characterizing a state statute as substantive as opposed to purely procedural does not answer the question whether the statute conflicts with a Federal Rule of Civil Procedure.
See Hanna,
But other courts have reached different results. The Eleventh Circuit Court of Appeals, for instance, sidestepped plaintiffs argument that Georgia’s expert affidavit requirement conflicted with Rule 8. The court concluded that “because the district court erred in dismissing [the plaintiffs] claims with prejudice
whether or not the Georgia expеrt affidavit requirement applies in diversity cases,
[it] need not decide in which category [procedural or substantive] the requirement belongs.”
Brown v. Nichols,
There were two central reasons the Supreme Court concluded in
Burlington
that Alabama’s statute imposing a mandatory affirmance penalty of 10% of the amount of the judgment conflicted with Rule 38. First, the statute impinged on Rule 38’s “discretionary. mode of operation.”
Bur
In this case, the mandatory timing, report content, and sanction provisions of section 13.01 abrogate the discretion provided by Rules 26(a)(2) and 37. Applying section 13.01 would so impinge on the broad procedural powers of the federal district courts to control discovery that it must yield to the federal scheme. First, the purposes of the federal and state provisions are sufficiently coextensive. Both seek to enable courts to penalize parties that file baseless suits. See also Fed.R.Civ.P. 11 (allowing sanctions for frivolous claims) (indicating Rule 37 governs sanctions for discovery disputes). Whereas the federal rules adopt a case-by-case approach to discovery of experts and “to identifying and deterring frivolous appeals,” section 13.01 precludes any exercise of discretion within its scope of operation. The federal rules thus occupy the state statute’s field of operation so as to preclude its application in federal diversity actions. Sеction 13.01’s mandatory approach, providing a trial court with little discretion, is permissible in state court where the federal rules do not apply. But it cannot apply in federal court.
Second, the timing provisions in section 13.01 directly collide with the discretionary power vested in the federal court. Rule 26 provides that expert report disclosures “shall be made at the times and in the sequence directed by the court.” See Fed. R.Civ.P. 26(a)(2)(c) (emphasis added). Section 13.01(d), by contrast, provides that expert reports shall be made within 180 days from the date of suit. See § 13.01(d)(1). If a plaintiff fails to comply with this provision and the defendant files a motion seeking sanctions, a trial court has no discretion and must enter an order dismissing the case with prejudice. See § 13.01(e)(3). Thus the discretion provided in the federal rule is wiped out by the state rule.
Third, the federal and state rules require different content to be included in the expert reports. Under Rule 26, an expert report
shall
contain a complete statement of all opinions to be expressed and the basis and reasons thereof; the data or other information considered by the witness in forming the opinions; any exhibits to be used as a summary of or support for the opinions; the qualifications of the witness, including a list of all publications authored by the witness within the preceding ten years; the compensation to be paid for the study and testimony; and a listing of any other cases in which the witness has testified as an expert at trial or by deposition within the preceding four years.
See
Fed.R.Civ.P. 26(a)(2)(B). Under section 13.01, by contrast, the expert
Finally, the sanction or penalty provisions in the two rules directly collide. The federal rules, for instance, impose potentially harsh penalties for noncompliance with Rule 26(a)(2)(B). See Fed.R.Civ.P. 26(a)(2)(B) (expert must provide a written report containing “a complete statement of all opinions to be expressed”); Fed. R.Civ.P. 37(c)(1) (party who “without substantial justification fails to disclose information required by Rule 26(a).. .shall not, unless such failure is harmless, be permitted to use as evidence at a trial. . .any.. .information not so disclosed”); id. (“In addition to or in lieu of this sanction, the court, on motion and after affording an opportunity to be heard, may impose other appropriate sanctions[;]” these sanctions may include dismissing the case against the disobedient party). But they set discretion in the federal trial judge to determine the appropriate sanction. This is contrary to the mandatory sanction of dismissal in the Texas rule. See § 13.01(e). Defendant USA’s brief in support of section 13.01 admits that the difference between Rule 26 and section 13.01 is that former is “quite flexible,” but asserts that the two can coexist. The Court disagrees.
The problem is that the rules cannot operate simultaneously without one being subordinated to the other. And although the substantive/procedural distinction is not relevant when the state and federal rules directly collide, at best, section 13.01 falls within the uncertain area between substance and procedure and is “rationally capable of classification as either.”
Hanna,
What matters is that the federal rule is sufficiently broad that it covers the point in dispute. The timing provisions are different; the expert report requirements are different; and the sanctions for noncompliance are different. In each case, the discretion vested in the federal trial judge is abrogated by the state rule. Under Hanna and Burlington, this is precisely the kind of conflict that forces a choice between applying the federal rule of procedure or the state rule. And in that contest, the federal rules must prevail in federal court.
IV. Applying the Act
Although the Act’s expert reporting provisions do not apply in federal court, even if they did apply, the Court would not strike the reports or dismiss the case against Defendants. Plaintiffs have successfully invoked the exceptions provided for in the statute.
A. Dr. Spinner’s Report
Defendant Dr. Bonsukan moves to strike Dr. Spinner’s expert report because the report is allegedly inadequate under section 13.01(r)(6). Bonsukan argues that because the report is insufficient under the statute, Plaintiff has failed to meet the expert report 180-day deadline under section 13.01(d). The penalty for such noncompliance is dismissal with prejudice.
Texas courts “read both sections 13.01(e) and 13.01(i) as applying to a trial court’s dismissal of a medical malpractice suit for failure to comply with the requirements in providing an expert report.”
Palacios v. American Transitional Care Centers of Texas,
A court shall grant a motion challenging the adequacy of an expert report only if it appears to the court, after hearing, that the report does not represent a good faith effort to comply with the definition of an expert report in Subsection (r)(6) of this section.
§ 13.01(i). The central issue, therefore, is whether Plaintiffs expert report demonstrates a good faith effort to comply with the requirements of section 13.01(r)(6).
To determine whether Plaintiffs effort was a good faith effort, the Court must consider what is required in an expert report and compare that to what Plaintiff provided. The Act requires plaintiffs in medical malpractice cases to set forth (1) the applicable standard of care, (2) the violation of the standard of care, and (3) that the violation caused some damage. See § 13.01(r)(6). Plaintiffs expert report provides:
I have reviewed all the records pertaining to the Shahayla Rose Poindexter case. This infant was seen at the Nac-ogdoches Memorial Hospital emergency room on July 12, 1998 due to the presence of fevеr and irritability. At that time Shahayla was seventeen days old, and had a documented rectal temperature of 102 F. in the emergency room. She was examined by a physician, had a CBC and a chest x-ray, and was sent home with a diagnosis of acute viral illness and gastric spasm.
Any infant, twenty-eight days of age or younger, who presents with a rectal temperature of 100.6 F. or higher, should undergo a complete sepsis workup, including blood and urine cultures, as well as a spinal tap for spinal fluid culture. In addition, the infant should be admitted into the hospital and treated with IV antibiotics pending the results of those cultures.
Clearly, the treatment given Shahayla Poindexter on July 12, 1998 was not appropriate, as it fell well below the standard of care.
Dr. Spinner signed the report, which was produced on his letterhead.
In light of the fact that section 13.01(£) “favors the plaintiff,”
see Palacios,
Bonsukan also argues that Dr. Spinner’s report is inadequate because it fails to show a causal link between a failure to follow the standard of care and the injury, harm, or damages alleged. He contends that Dr. Skinner’s report must “stand on its own.” A causal link, in other words, as an element of the required expert report, must be included in each individual report. Defendant cites no authority for this position. Section 13 requires simply that a plaintiff file “one or more expert reports” to support its claim. See § 13.01(d). Moreover, section 13 actually seems to provide just the opposite from what Defendant suggests:
Notwithstanding any other provision of this section, a claimant may satisfy any requirement of this section for filing an expert report by filing reports of separate experts regarding different physicians or health care providers or regarding different issues arising form the conduct of a physician or health care provider, such as issues of liability or causation. Nothing in this section shall be construed to mean that a single expert must address all liability and causation issues with respect to all physicians or health care providers or with respect to both liability and causation issues for a physician or health сare provider.
See § 13.01(f) (emphasis added). The purpose of this provision is to allow plaintiffs to meet the expert report requirement by filing more than one report addressing some or all of the elements required in such a report.
The Act’s expert reporting scheme attempts early disposal of frivolous medical malpractice claims. That goal is not frustrated if a plaintiff obtains more than one expert to report on the same physician.
Importantly, Plaintiffs have offered as much or more than some plaintiffs who have been found to have complied with the Act.
See, e.g., Palacios v. American Transitional Care Ctrs., Inc.,
B. Dr. Noel’s Report
Defendant USA moves to strike the exрert report of Dr. Gary J. Noel under section 13.01(e) of the Act and to dismiss all claims against it. Plaintiffs filed Dr. Noel’s report 302 days after filing their Original Complaint. Thus, Plaintiffs missed the 180-day deadline by over four months. Defendant USA requests, therefore, that the Court dismiss Plaintiffs claims with prejudice in accordance with section 13.01(e)(3).
Plaintiffs concede that they missed the deadline. Therefore, as their only option to bar dismissal, they request a grace period of 30 days to permit them to comply with section 13.01(d).
See
§ 13.01(g);
see also Buruato v. Mercy Hosp. Of Laredo,
Notwithstanding any other provision of this section, if a claimant has failed to cоmply with a deadline established by Subsection (d) of this section and after hearing, the court finds that the failure of the claimant or the claimant’s attorney was not intentional or the result of conscious indifference but was the result of an accident or mistake, the court shall grant a grace period of 30 days to permit the claimant to comply with that subsection.
§ 13.01(g). The central question in this case is whether Plaintiffs failure to file the expert report was the result of accident or
Plaintiffs have attached the affidavit of their attorney, Glenn Douglas. Douglas states that the failure to file the expert report was not the result of conscious indifference but rather was the result of an accident or mistake. He explains that the 180-day deadline was mistakenly never calendared by his law office. (Pis’ Resp. Opp’n USA Mot., Exhibit A.) He also states that he had retained Dr. Noel prior to the 180-day deadline to review the case and provide an opinion, even though he did not meet the reporting requirements. These statements, if true, do not support a finding that Douglas’ failure to file the expert report within the 180-day deadline was intentional or the result of conscious indifference. Texas courts have held that calendaring errors are not intentional or the result of cоnscious indifference.
See Presbyterian Healthcare Sys. v. Afangideh,
Unless the nonmovant specifically controverts the evidence presented by the movant regarding a mistaken belief, the movant prevails on the issue of mistake and the statutory provision allowing an extension of time is satisfied.
See Director, State Employees Workers’ Compensation Division v. Evans,
The Court, therefore, must grant Plaintiffs a grace period of 30 days to permit them to comply with the provisions of section 13.01(d). Because Dr. Noel’s report is on file, however, no grace period is necessary. Defendant USA’s Motions to Strike and Dismiss are DENIED.
V. Conclusion
Because the expert reporting provisions in the Act do not apply in federal court, Defendants’ motions to strike and dismiss are DENIED. Even if those provisions do apply, however, Defendants’ motions are DENIED because Dr. Skinner’s report represents a good faith effort to comply with the reporting requirements and Dr. Noel’s report was untimely filed as a
