In a case where a defendant physician has presented an affidavit detailing his or her treatment and attesting that his or her actions were within the applicable standard of care and the plaintiff fails to present summary judgment evidence by an appropriate expert that the physician's actions were not within the applicable standard of care, the trial court does not err in granting summary judgment with respect to the plaintiff's claim for medical malpractice. See Perez v. Cueto, 908 S.W.2d 29, 31-32 (Tex. App.--Houston [14th Dist.] 1995, no writ). a medical malpractice claim of negligence has the following elements: (1) a duty by the physician to act according to a certain standard of care; (2) a breach of the applicable standard of care; (3) an injury; and (4) a causal connection between the breach of care and the injury. See Martin v. Durden, 965 S.W.2d 562, 564 (Tex. App.-Houston [14th Dist.] 1997, pet. denied). In general, because medical malpractice actions involve technical and specialized issues, "both establishing summary judgment and precluding summary judgment are dependent upon expert testimony." See id. However, expert testimony is not necessary to establish the underlying facts of a case. See generally Texarkana Mem. Hosp., Inc. v. Murdock, 946 S.W.2d 836 (Tex. 1997).