In Bowie Mem'l Hosp. v. Wright, 79 S.W.3d 48, 52 (Tex. 2002), a hospital employee diagnosed a fractured patella sustained in an automobile accident but missed a fracture to the foot. Wright, 79 S.W.3d at 50.
The employee's supervisor referred the patient to an orthopedic surgeon without noting the fractured foot. Id.
The orthopedic surgeon did not discover the fractured foot until after the knee had been operated on. Id.
The expert's report stated that if the x-rays had been correctly read and the appropriate medical personnel acted on the findings, the patient would have had a possibility of a better outcome, but the expert's report failed to identify the specific injuries caused by the failure to correctly read the x-rays and also failed to explain how the failure to properly read the x-ray caused an injury. Wright, 79 S.W.3d at 52-53.
In that case, the plaintiffs complained that the hospital's personnel had failed to diagnose the patient's foot fracture, protect the patient's foot, review diagnostic tests ordered and administered at the hospital, or properly supervise a physician's assistant who x-rayed and diagnosed the patient. Wright, 79 S.W.3d at 50.
Regarding causation, the plaintiffs' expert stated, "I do believe that it is reasonable to believe that if the x-rays would have been correctly read and the appropriate medical personnel acted upon those findings then Wright would have had the possibility of a better outcome." Id. at 51.
The supreme court concluded:
"After reviewing this report, we conclude that the trial court could have reasonably determined that the report does not represent a good-faith effort to summarize the causal relationship between Bowie's the hospital's failure to meet the applicable standards of care and Barbara's injury. That is because the report simply opines that Barbara might have had "the possibility of a better outcome" without explaining how Bowie's conduct caused injury to Barbara. We cannot infer from this statement, as the Wrights ask us to, that Bowie's alleged breach precluded Barbara from obtaining a quicker diagnosis and treatment for her foot. Rather, the report must include the required information within its four corners. Because the report lacks information linking the expert's conclusion (that Barbara might have had a better outcome) to Bowie's alleged breach (that it did not correctly read and act upon the x-rays), the trial court could have reasonably determined that the report was conclusory. A conclusory report does not meet the Act's requirements, because it does not satisfy the Palacios test. " Id. at 53 .