Am. Transitional Care Ctrs. of Tex., Inc. v. Palacios

In Am. Transitional Care Ctrs. of Tex., Inc. v. Palacios, 46 S.W.3d 873 (Tex. 2001), Palacios was a patient who suffered injuries after falling from his hospital bed; Palacios and his family then brought suit against the hospital, seeking compensation for the injuries Palacios sustained from his fall. The supreme court stated that the statement the Palacioses relied on in their expert report to establish the standard of care--"that precautions to prevent Palacios' fall were not properly used"--was not a statement of a standard of care, stating: "Neither the trial court nor the hospital would be able to determine from this conclusory statement if the expert believes that the standard of care required the hospital to have monitored Palacios more closely, restrained him more securely, or done something else entirely." (Id. at 880.) The Texas Supreme Court stated that the trial court "should look no further than the report . . ." 46 S.W.3d at 878. In construing former section 13.01(l), the court stated that the "issue for the trial court is whether 'the report' represents a good-faith effort to comply with the statutory definition of an expert report." Id. Thus, as to each defendant, the report must contain "a fair summary of the expert's opinions about the applicable standard of care, the manner in which the care failed to meet that standard, and the causal relationship between that failure and the claimed injury." Id. Moreover, Palacios specifically states that "because the statute focuses on what the report discusses, the only information relevant to the inquiry is within the four corners of the document." Id. In Am. Transitional Care Ctrs., Inc. v. Palacios, the expert report stated that the claimant was injured by falling out of his hospital bed, that the claimant had on bed restraints minutes before his fall, that it is unclear how claimant could have untied the bed restraints, and that "obviously claimant had a habit of trying to undo his restraints and precautions to prevent his fall were not properly utilized." Id. at 879. The court found that the report was insufficient because it did not state what the defendant should have done differently--such as monitor the claimant more closely, place restraints on the claimant more securely, or do something completely different. Id. at 880. The expert's opinion that the hospital did not take precautions to prevent claimant's fall would only be useful if the hospital had an absolute duty to prevent such falls. Id. The Texas Supreme Court held that an expert report concerning a fall from a hospital bed was deficient because it failed to specifically relate the injurious event to a breach of a particular standard of care. See Palacios, 46 S.W.3d at 879-80. There, the expert failed to state what specific conduct the standard of care required and what the defendant should have done differently--whether the patient should have been restrained differently, or monitored more closely, or some other precaution was required. Id. Expert testimony is required to support a medical-malpractice claim. Palacios, 46 S.W.3d at 876. Under former subsection 13.01(r)(6), a claimant in a health care liability claim must file an expert report "that provides a fair summary of the expert's opinions as of the date of the report 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. " The expert report must represent a good-faith effort to comply with this statutory definition. Palacios, 46 S.W.3d at 878. The report can be informal and need not marshal all of the plaintiff's proof, but must include the expert's opinion on each of the elements identified in the statute--standard of care, breach, and causation. Id. To constitute a good-faith effort, (1) the report must inform the defendant of the specific conduct the plaintiff has called into question and (2) must provide a basis for the trial court to conclude that the claims have merit. Id. at 879. A report that merely states the expert's conclusions as to the standard of care, breach, and causation does not fulfill these two purposes. Id.