Singley v. Staats

1

Dr. Jamie Singley; DDS Dentures &Implant Solutions; Affordable Dentures &Implants, Fort Worth P.A.; Affordable Dentures &Implants, Texas PLLC; and DDS Dentures and Implants, Appellants v. Greg Staats, Appellee

No. 02-23-00094-CV

Court of Appeals of Texas, Second District, Fort Worth

August 31, 2023

On Appeal from the 153rd District Court Tarrant County, Texas Trial Court No. 153-334018-22

Before Birdwell, Bassel, and Wallach, JJ.

MEMORANDUM OPINION

Wade Birdwell Justice

Appellee Dr. Jamie Singley performed a dental-implant procedure on Appellant Greg Staats, and soon thereafter, Staats developed a fever. He sought treatment from his primary care physician and later, he reported his fever to Dr. Singley. But according to Staats, Dr. Singley "refused" to examine him. Less than forty-eight hours after this alleged "refus[al]," Staats went to the hospital and was diagnosed with a liver abscess.

Staats sued Dr. Singley, along with Dr. Singley's dental practice (DDS Dentures and Implant Solutions) and several related dental-implant companies (collectively, Dr. Singley). To comply with the Medical Liability Act (MLA), Staats served Dr. Singley with two expert reports.^[1] See Tex. Civ. Prac &Rem. Code Ann. § 74.351(a). Both reports allege that Dr. Singley's postoperative failure to examine Staats breached the standard of care. Dr. Singley moved to dismiss based on the reports' inadequacy on causation but the trial court denied the motion.

Because neither of Staats's expert reports identifies how or why Dr. Singley's alleged breach of the standard of care-her alleged postoperative refusal to examine Staats-caused or worsened Staats's liver abscess or resulted in any other damage, we will reverse and remand.

I. Background

On June 16, 2020, Dr. Singley performed a dental-implant procedure on Staats. The next day, Staats developed a high fever. At the time, COVID-19 was a significant public health concern, but according to Staats, he tested negative for COVID-19.

About a week later, on June 23, Staats consulted his primary care physician, who diagnosed him with a "viral syndrome" and treated him with various medications. Staats's fever persisted, so after another week, Staats returned to his primary care physician and was treated with additional medication for what was still believed to be a "viral syndrome."

Around that same time, on June 29, Staats contacted Dr. Singley and reported his fever.^[2] The parties dispute how Dr. Singley responded. According to Staats, Dr. Singley "refused to examine him" out of a fear of contracting COVID-19, and she instead referred him back to his primary care physician. Dr. Singley contends she saw him.^[3]

Within forty-eight hours of this alleged "refus[al]" and referral,^[4] Staats went to the emergency room, where he was diagnosed with and treated for a liver abscess.^[5]

Staats sued Dr. Singley for dental malpractice based on Dr. Singley's alleged failure to diagnose his condition and failure to treat his postoperative complications, among other things. Staats then served Dr. Singley with two expert reports pursuant to the MLA. See id.

In Staats's expert reports, Dr. James Melville and Dr. David Witt^[6] opine that Staats's liver abscess was "[p]ossibl[y]" or "likely related to the dental procedure" and that "Dr. Singley's refusal to see and examine Mr. Staats after [the] procedure . . . fell below the standard of care."

Dr. Singley moved to dismiss under the MLA, arguing that the expert reports were inadequate because, among other things, they failed to explain the causal connection between Dr. Singley's breach-i.e., her alleged refusal to conduct a postoperative examination of Staats-and Staats's injury. See id. § 74.351(b), (r)(6). Staats, though, claimed that the reports described how Dr. Singley "abandoned [her] patient from treating him postoperatively for a condition caused by the dental procedure." After a hearing, the trial court denied Dr. Singley's dismissal motion. Dr. Singley appeals. See id. § 51.014(a)(9).

II. Governing Law and Standard of Review

Under the MLA, a claimant asserting a health care liability claim must serve each health care provider with a timely, adequate expert report early in the proceedings. See id. § 74.351(a); Baty v. Futrell, 543 S.W.3d 689, 692 (Tex. 2018). If the report is untimely or inadequate, then upon the defendant's motion, the trial court must dismiss the claim.^[7] See Tex. Civ. Prac. &Rem. Code Ann. § 74.351(b), (l); Baty, 543 S.W.3d at 692-93.

An expert report is inadequate if "it appears to the [trial] court, after hearing, that the report does not represent an objective good faith effort to comply with the [MLA's] definition of an expert report." Tex. Civ. Prac. &Rem. Code Ann. § 74.351(l). The MLA's definition of an expert report, in turn, requires "a fair summary of the expert's opinions . . . regarding applicable standards of care, the manner in which the care rendered by the physician or health care provider failed to meet the standards, and the causal relationship between that failure and the injury, harm, or damages claimed." Id. § 74.351(r)(6); see Baty, 543 S.W.3d at 693-94 (noting that expert report must "inform[] the defendant of the specific conduct called into question and . . . provid[e] a basis for the trial court to conclude the claims have merit").

In addressing "the causal relationship," Tex. Civ. Prac. &Rem. Code Ann. § 74.351(r)(6), the expert report "must explain, based on facts set out in the report, how and why [the health care provider's] breach [of the standard of care] caused the injury." Columbia Valley Healthcare Sys., L.P. v. Zamarripa, 526 S.W.3d 453, 459-60 (Tex. 2017) (quoting Van Ness v. ETMC First Physicians, 461 S.W.3d 140, 142 (Tex. 2015)). Causation "has two components: (1) foreseeability and (2) cause-in-fact." Id. at 460 (quoting Rodriguez-Escobar v. Goss, 392 S.W.3d 109, 113 (Tex. 2013)). For the latter component (cause-in-fact), the expert must clarify why, "absent the act or omission-i.e., but for the act or omission-the harm would not have occurred." Id. (italics removed) (quoting Rodriguez-Escobar, 392 S.W.3d at 113). "A bare expert opinion that the breach caused the injury will not suffice." Van Ness, 461 S.W.3d at 142.

A trial court's ruling on the adequacy of an expert report is reviewed for an abuse of discretion. Id.; Jelinek v. Casas, 328 S.W.3d 526, 539 (Tex. 2010).

III. Discussion

In a single appellate issue, Dr. Singley contends that Staats's expert reports do not adequately address causation, so the trial court abused its discretion by denying the motion to dismiss. We agree.

The expert reports do not identify any damage-physical, financial, or otherwise-caused by Dr. Singley's alleged postoperative negligence. The only damage Staats's expert reports discuss is his liver abscess. But both Dr. Melville and Dr. Witt state that the liver abscess "was very likely related to [Staats's] dental procedure"^[8]-not Staats's postoperative care. Neither expert claims that Dr. Singley negligently performed the implant procedure that allegedly caused the liver abscess. Rather, they state that Dr. Singley's negligence came later, a couple of weeks after the implant procedure, when she "deviated from the standard of care required for a postoperative patient in [her] refusals to evaluate Mr. Staats."^[9]

Staats attempts to solve this issue by lumping the implant procedure together with Dr. Singley's postoperative care and treating both as a single incident-a single incident that, in his view, caused the liver abscess. But Staats cannot reverse the sands of time. Again, under Staats's own theory of the case, the source of his liver abscess predated Dr. Singley's alleged negligence by approximately two weeks. And but-for causation necessitates that the cause (i.e., the negligence) occurs prior to the injury. If the injury is already in place before the negligent action is taken, then it cannot be said that "absent the [negligent] act or omission . . . the harm would not have occurred." Columbia Valley Healthcare, 526 S.W.3d at 460 (quoting Rodriguez-Escobar, 392 S.W.3d at 113, and summarizing cause-in-fact).

This is not to say that postoperative negligence could not have contributed to the liver abscess, worsened the abscess, or caused related damage. And, though not Staats's primary argument, he alludes to this possibility as well. He emphasizes that Dr. Singley "fail[ed] to treat and diagnose" his liver abscess despite his "deteriorating condition," which we liberally construe as arguing that Dr. Singley's negligence allowed him to deteriorate further. See Tex.R.App.P. 38.9.

Yet, Staats's expert reports do not address how Dr. Singley's examination of him on June 29 would have lessened the damage his liver abscess inflicted. In such cases-when "the allegations are that a patient, who had a pre-existing condition [before the alleged negligence], would have experienced a better outcome had earlier diagnosis or treatment been undertaken"-"[t]he need to explain the causal connection between breaches of the standards of care and the claimed injury or death is particularly acute." Northcutt v. Stephens, No. 02-21-00217-CV, 2022 WL 60720, at *4 (Tex. App.-Fort Worth Jan. 6, 2022, no pet.) (mem. op.) (holding expert report inadequate).

Here Dr. Singley's alleged refusal to examine Staats delayed his diagnosis and treatment by, at most, two days; he spoke to Dr. Singley on June 29, and on July 1, he went to the hospital and received treatment. Neither Dr. Melville nor Dr. Witt explains what damage occurred between June 29 and July 1 that Dr. Singley could have prevented. See Ngo v. Lewis, No. 09-10-00140-CV, 2010 WL 3518225, at *3 (Tex. App.-Beaumont Sept. 9, 2010,...