Aguilera v. Costilla

1

OCTAVIO AGUILERA; THE SCHUMACHER GROUP OF TEXAS, INC.; VHS HARLINGEN HOSPITAL COMPANY, LLC D/B/A VALLEY BAPTIST MEDICAL CENTER-HARLINGEN; ADRIAN ALANIZ; KRISTEN WHITE; GEORGE HUDDLESTON, IV, M.D.; AND WILLIAM TAW, M.D., Appellants, v. ELIAZAR COSTILLA, INDIVIDUALLY AND AS THE REPRESENTATIVE OF THE ESTATE OF KRISTY RENEE COSTILLA, DECEASED, AND AS NEXT FRIEND OF A.J.C. AND C.K.C., MINORS; MELINDA RODRIGUEZ LEAL; AND CAMILO TREVINO, Appellees.

No. 13-21-00135-CV

Court of Appeals of Texas, Thirteenth District, Corpus Christi-Edinburg

March 30, 2023

On appeal from 197th District Court of Cameron County, Texas.

Before Justices Benavides, Tijerina, and Peña

MEMORANDUM OPINION

JAIME TIJERINA, JUSTICE

Appellants Octavio Aguilera, The Schumacher Group of Texas, Inc. (SGT) VHS Harlingen Hospital Company, LLC d/b/a Valley Baptist Medical Center-Harlingen (VBM), Adrian Alaniz, Kristen White George Huddleston IV, M.D., and William Taw, M.D. appeal the trial court's denial of their Chapter 74 motions to dismiss in a healthcare liability claim brought by appellees Eliazar Costilla, individually and as the representative of the estate of Kristy Renee Costilla, deceased, and as next friend of A.J.C. and C.K.C., minors; Melinda Rodriguez Leal and Camilo Trevino. Appellants assert that appellees' expert reports fail to comply with § 74.351 of Texas Civil Practice and Remedies Code. See TEX. CIV PRAC. &REM. CODE ANN. § 74.351 (PROVIDING FOR EXPERT REPORT REQUIREMENTS IN HEALTH CARE LIABILITY ACTIONS); id. § 51.014(a)(9) (providing for interlocutory appeal of an order denying relief under § 74.351).

Aguilera and SGT further argue that the trial court abused its discretion in overruling their objections to appellees' expert reports and denying their motion to dismiss because the report was so lacking, it constituted "no report" and was incurable.

Dr. Huddleston argues the trial court erred in denying his motion to dismiss because the expert reports failed to implicate him, failed to state a standard of care applicable to him, failed to specify how he breached a standard of care, and failed to explain how an alleged breach caused Kristy's injuries.

White and Alaniz argue the expert reports were deficient because one expert is unqualified as a matter of law, and there is no causal link between their alleged breaches and Kristy's death. White additionally argues the alleged standard of care within the report would require her to violate the Nurse Practice Act. Alaniz further argues that the report shows his alleged breaches occurred after Kristy suffered irreversible brain ischemia that caused brain death.

VBM asserts the trial court should have granted its motion to dismiss because there were no expert reports that established an alleged direct negligence claim against it, and the expert reports identifying the hospital's employees, White and Alaniz, were insufficient.

Dr. Taw asserts the expert reports failed to properly establish the applicable standard of care as applied to him and failed to properly establish that he breached a standard of care, which resulted in Kristy's injuries.^[1]

We reverse and remand.

I. Background

The underlying proceeding arose following Kristy's death on September 25, 2018. On September 24, 2018, forty-one-year-old Kristy arrived at VBM with symptoms of a hemorrhagic stroke. Following a CT scan, Kristy was diagnosed with a subarachnoid hemorrhage (brain bleed) at 9:30 p.m., and she was transferred to the Intensive Care Unit at 11:50 p.m. At approximately 3:10 a.m., Kristy began experiencing seizures again. She was intubated and put on mechanical ventilation. Ultimately, her condition worsened, and she passed away at 5:01 p.m. on September 25, 2018.

On September 22, 2020, appellees filed a healthcare liability claim against several medical professionals and entities, including: a hospital (VBM), two nurses (Alaniz and White), a nurse practitioner (Aguilera) and his employer (SGT), a hospitalist (Dr. Huddleston), a radiologist (Dr. Taw), and three other physicians.^[2] Appellees alleged VBM's staff was negligent as they "failed to accurately assess and document [Kristy's] deteriorating condition." According to appellees' petition, nurses White and Alaniz failed to recommend to a physician the need for an emergency CT scan of Kristy's head after her neurological status deteriorated. They asserted VBM was negligent in training and supervising its staff and in failing to ensure that neurosurgical or neuro-interventional services were always available. Appellees further alleged that Dr. Taw erroneously interpreted Kristy's CT scan, which precluded further treatments. Appellees did not allege any specific action or inaction of Dr. Huddleston other than general negligence.

Appellees filed three expert reports by Van V. Halbach, M.D., Michael Griffith, R.N., and Erwin A. Cruz, M.D. in accordance with § 74.351. See id. § 74.351(a) ("In a health care liability claim . . . a claimant shall . . . serve on [a defendant health care provider] one or more expert reports, with a curriculum vitae [CV] of each expert listed in the report.").

On November 4, 2020, Dr. Huddleston filed a motion to dismiss, asserting he was a hospitalist physician who is board certified in internal medicine; therefore, appellees' experts consisting of a radiologist, a neurologist, and a nurse practitioner, were not qualified to render a medical opinion as to him. Furthermore, he alleged the expert reports failed to set forth a standard of care, an alleged breach, and causation as to his actions or inactions specifically.

On December 11, 2020, Aguilera and SGT filed objections to the expert reports. They asserted: (1) the experts were unqualified as to Aguilera, a nurse practitioner, (2) Griffith was unqualified to render medical causation opinions, (3) the experts failed to provide their CV as required by Chapter 74, and (4) the reports were insufficient as to standard of care, breach, and causation. They subsequently moved to dismiss, contending that the expert reports failed to represent a "good faith" effort to comply with the statute. Id. § 74.351(1) ("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 an objective good faith effort to comply with the definition of an expert report ....").

On April 1, 2021, VBM, Alaniz, and White filed a motion to dismiss, asserting: (1) Dr. Cruz was unqualified to offer a nurse's standard of care opinion, (2) Dr. Cruz's opinions were conclusory, and (3) Dr. Cruz failed to establish causation. They further asserted Griffith was unqualified to render causation opinions because he was not a physician. Lastly, they challenged Dr. Halbach's report asserting it: (1) was conclusory and vague, (2) failed to address Kristy's morbidity and mortality, and (3) failed to show harm but for their alleged negligent acts.

Dr. Taw filed a motion to dismiss and objected to Dr. Halbach's report, asserting it failed to set forth the standard of care for a radiologist, failed to connect any alleged breaches to him, and failed to explain how his alleged negligence caused injury and death.

On April 13, 2021, appellees filed one response to all the motions to dismiss, generally asserting that the reports were sufficient and attaching each expert's CV. According to appellees, the standard of care is "one size fits all," and their reports identified a breach of the "one size fits all" standard because all physicians failed to diagnose an impending brain herniation. Following a hearing, the trial court denied appellants' motions to dismiss. This appeal followed.^[3]

II. Standard of Review &Applicable Law

Texas Civil Practice and Remedies Code provides that a plaintiff in a health care liability suit must serve the medical defendant with an expert report that complies with § 74.351 and is accompanied by the expert's CV. See id. § 74.351. If a plaintiff fails to do so within 120 days after the defendant's original answer is filed, then the trial court must dismiss the claim with prejudice on the defendant's motion. Baty v. Futrell, 543 S.W.3d 689, 692 n.1 (Tex. 2018); see TEX. CIV. PRAC. &REM. CODE ANN. § 74.351(A), (B)(2).

The goal is "to deter frivolous lawsuits by requiring a claimant early in litigation to produce the opinion of a suitable expert that his claim has merit." Columbia Valley Healthcare Sys., L.P. v. Zamarripa, 526 S.W.3d 453, 460 (Tex. 2017) (citing Scoresby v. Santillan, 346 S.W.3d 546, 552 (Tex. 2011)); see also Abshire v. Christus Health Se. Tex., 563 S.W.3d 219, 223 (Tex. 2018) (per curiam). Therefore, the expert report requirement is a low threshold that merely demonstrates that a claim is not frivolous. Loaisiga v. Cerda, 379 S.W.3d 248, 264 (Tex. 2012). It must provide a fair summary of the expert's opinions regarding applicable standards of care, the manner in which the care rendered by the health care provider failed to meet the standards, and the causal relationship between that failure and the injury, harm, or damages claimed. See TEX. CIV. PRAC. &REM. CODE ANN. § 74.351(R)(6).

"A trial court must sustain a challenge to a report's adequacy if the report does not represent an objective good faith effort to provide a fair summary of the applicable standard of care, the defendant's breach of that standard, and how that breach caused the patient's harm." Miller v. JSC Lake Highland Operations LP, 536 S.W.3d 510, 513 (Tex. 2017) (per curiam) (cleaned up); see TEX. CIV. PRAC. &REM. CODE ANN. §§ 74.351(1), (r)(6). "A good-faith effort must 'provide enough information to fulfill two purposes: (1) it must inform the defendant of the specific conduct the plaintiff has called into...