The Beaumont Court of Appeals has upheld a trial court order denying a hospital’s motion to dismiss a health care liability claim for an inadequate expert report.
Chi St. Luke’s Community Health Services-The Woodlands Hospital v. Sharon Smith (No. 09-25-00044-CV; July 31, 2025) arose from the alleged malpractice of two physicians and a hospital. Plaintiff experienced symptoms associated with individuals at risk of a stroke and was admitted into St. Luke’s Hospital on May 20, 2023. Dr. Katherine Luu, MD, was charged with her care. Her symptoms included headache, high blood pressure, and numbness and tingling in the right side of her body. Dr. Luu’s evaluation at 8:13 on that day noted that Smith had a sensory deficit to her right face, right arm, and right leg, and assigned her a score of “one” on the National Institutes of Health Stroke Scale. Smith’s CT scans revealed “no acute intracranial abnormality or large vessel occlusion.” Smith was diagnosed with hypertensive emergency and right-sided numbness and was discharged.
Smith was admitted to the hospital emergency department upon her return the next day at 12:12 pm. She was examined by Dr. Steven Ellis, who noted Smith’s slurred speech, right-sided weakness, and right facial droop and assigned her a score of “five” on the NIHSS. A neurology consultation was planned for the following day, but her family withdrew her in frustration by her family on the night of the May 21. She was then taken to the Houston Methodist Hospital and determined to have symptoms indicative of a stroke. CT scans determined that she suffered a a stroke but was ineligible for thrombolytic therapies because she had exited the 4.5 hour window for which that treatment would be available. She was discharged on May 28 to an inpatient rehab center.
Ms. Smith filed suit, asserting negligence and gross negligence against Dr. Luu, her PLLC, Dr. Ellis (both of whom are not parties to this appeal), and St. Luke’s Community Health Services, St. Luke’s Health System Corporation, and St. Luke’s The Woodlands Hospital. Plaintiff alleged that the hospital breached the standard of care in failing to follow stroke protocols, accurately diagnose Ms. Smith, and offer thrombolytics. Defendant filed an general denial, challenged Plaintiff’s expert report, and asserted several affirmative defenses. the parties signed an Agreed Order allowing Plaintiff to file an amended petition with an amended expert report . The trial court denied the hospital’s motion to dismiss, Which sought interlocutory relief.
In an opinion by Justice Johnson, the court of appeals affirmed. Plaintiff’s expert report opined that thrombolytic treatment would have improved Ms. Smith’s neurological outcome had she been accurately assessed in the first place. He further averred that Dr. Luu’s actions were inconsistent with stroke protocol and the proper standard of care. Defendant argued that the report was speculative and conclusory, insufficiently explained the chain of causation between Dr. Luu’s allegedly negligent actions and Plaintiff’s injuries, failed to to identify the hospital’s alleged negligence, and did not comply with the § 74.351’s good faith requirement. They also argued that the report did not explain thrombolytic therapy’s benefits or what specific neurological deficits Plaintiff had suffered. Plaintiff responded that she was not required to muster all available evidence in the preliminary stage of the litigation, that the report adequately established a chain of causation causality between the failure to meet the standard of care and Plaintiff’s injuries. The report, she asserted, clearly identified the progression of events beginning with the failure to trigger stroke protocol and timely ordering thrombolytic therapy, which the report explained aims to limit a clot before it can lead to a major stroke.
The hospital countered that Plaintiff’s response grossly mischaracterized the expert’s report, maintaining that the expert’s opinion hinged on flimsy “loss of chance” conjecture, a line of reasoning not recognized by Texas common law. The hospital further took issue with the claim that Dr. Luu’s failure to diagnose Plaintiff’s stroke resulted in Plaintiff losing her “best’ chance at prevention (i.e., no causation), asserted that Luu was not an employee of the hospital at the time of Plaintiff’s care, and lacked control of her decisions at the time of Plaintiff’s care. Plaintiff responded to the effect that experts are not required to opine about a provider’s business relationships, that the hospital’s arguments were defenses beyond the scope of the expert report stage, and that Plaintiff had not pled a loss of chance theory, distinguishing this case from Varkey v. Melhem, No. 14-20-00186-CV, 2022 Tex. App. LEXIS 5665 (Tex. App.—Houston [14th Dist.] Aug. 9, 2022, no pet.)(mem. op.).
As the court observed, causation requires “how and why,” and conclusions must be linked to specific facts. See § 74.351(r)(6), CPRC. To satisfy these requirements, a report must make a good-faith effort to explain how Plaintiff will prove proximate cause. Here the expert physician’s report drew a direct line between Dr. Luu’s failure to properly diagnose Plaintiff and her failure to follow stroke protocol to Plaintiff’s diminished condition, supporting his conclusion that these failures caused Plaintiff’s condition to worsen. Not all possible defensive theories must be explored under Chapter 74, the court noted, nor must Plaintiff meet the burden of proof as if she were litigating the merits. The court, consequently, affirmed the trial court’s order denying the hospital’s motion to dismiss.
TCJL Intern Satchel Williams researched and prepared the draft of this article.
