Texas Judiciary Online - HTML Opinion

However, for this = purpose,=20 statements concerning the standard of care and breach need only = identify=20 what care was expected and not given with such specificity that = inferences=20 need not be indulged to discern them. See Jernigan, = 195=20 S.W.3d at 93-94; Palacios, 46 S.W.3d at 880. In this = case,=20 Grossbard=3Ds report specifies = that the=20 care expected but not given was to follow up on the findings in = the March=20 28, 2002 report, that the nodule had increased in size and that a = neoplasm=20 was more likely, with a biopsy in March of 2002. Because = this was=20 adequate to inform Alford of the conduct the Thomases had called = into=20 question, it was not a proper basis to find the report=20 deficient.

Regarding the causal=20 relationship between Alford=3Ds failure to meet the = standard=20 of care and the injury claimed, Grossbard=3Ds report = states:

After a 47 month = delay, the=20 patient was found to have a metastatic well-differentiated = adenocarcinoma=20 involving the liver in 2/06. Based on my review of the = records, it=20 is apparent that the right lower nobe nodule present in 2002 = served as the=20 primary tumor.

If Dr. Alford had = proceeded=20 with appropriate evaluation in 3/02, this patient more likely than = not=20 would have been diagnosed with an early stage lung cancer (stage = I) that=20 would have been surgically resectable and curable, likely without = the need=20 for chemotherapy or radiation therapy. When the = patient=3Ds disease was = diagnosed in=20 2/06, he had stage IV lung cancer for which only palliative = therapy is=20 available. Mr. Thomas=3D disease is incurable = and will=20 prove fatal. The median survival for patients with stage IV = lung=20 cancer is less than one year. Thus, the delay in diagnosis = in this=20 patient=3Ds lung cancer allowed = his tumor=20 to progress from stage I to stage IV and eliminated his chance for = curative therapy.

In Bowie, the=20 expert=3Ds report stated as to = causation: AI do believe that it = is=20 reasonable to believe that if the x‑rays would have been = correctly read=20 and the appropriate medical personnel acted upon those findings = then=20 Wright would have had the possibility of a better = outcome.@ 79 S.W.3d at = 51. =20 In finding this insufficient to set forth the causation element, = the Court=20 reasoned that:

[T]he report simply = opines that=20 Barbara might have had "the possibility of a better outcome" = without=20 explaining how Bowie's conduct caused injury to Barbara. We = cannot=20 infer from this statement, as the Wrights ask us to, that Bowie's = alleged=20 breach precluded Barbara from obtaining a quicker diagnosis and = treatment=20 for her foot. Rather, the report must include the required=20 information within its four corners. Because the report = lacks=20 information linking the expert's conclusion (that Barbara might = have had a=20 better outcome) to Bowie's alleged breach (that it did not = correctly read=20 and act upon the x‑rays), the trial court could have = reasonably determined=20 that the report was conclusory.