In Nexion Health at Garland, Inc. v. Townsend, a 69-year-old Texas woman was admitted to a rehabilitation center after a back surgery. The center assessed her as a high fall risk with good potential for rehabilitation, and two people were required to assist with transfers. She was found to have deep vein thrombosis in her lower extremities. Bed rest and anticoagulants were ordered. Testing showed some issues with her coagulation, but no further tests were ordered. The woman was not able to balance at one point and sat down on the floor. There were no signs of fracture, but later she was found to have a hematomal bump and suffered from labored breathing.
The woman had to be transferred to a medical center. She was diagnosed with anemia, weakness, tachycardia, and an altered mental status. She was suffering from a hematoma that was secondary to anticoagulation. The ICU admitted her, and she was placed on ventilation and received several blood transfusions, among other things.
She died there. Her estate filed a health care liability suit against the decedent’s treating physician and the rehabilitation center. The estate offered an expert report to support its claims. The rehabilitation center filed objections and moved to dismiss the claim. The objections were overruled and the motion denied.
The appellate court explained that every person who files a health care liability claim in Texas must provide an expert report plus curriculum vitae within 120 days of the defendant’s original answer under Chapter 74 of the civil practice and remedies code. The report should provide a summary of the expert’s opinion about the standard of care, how the standard of care was breached, and the causal connection between the breach and the injury.
The court is not allowed to fill gaps in an expert report by drawing inferences or guessing what was meant or intended. Instead, the expert must explain why and how the breach caused the injury. The goal of the expert report requirement is to deter frivolous claims. The causal relationship must show that the negligent actions or omissions were a substantial factor in creating the harm and that without those actions or omissions, the harm wouldn’t have happened.
The rehabilitation center argued that the expert report didn’t establish breach of conduct or a causal relationship. The report claimed that the rehabilitation center failed to prevent her fall and failed to adequately monitor her after the fall or transfer her to the medical center immediately. The anticoagulants prescribed increased the risk of bleeding because they were used together and the decedent’s levels had to be monitored with increased frequency.
In this case, the hematoma was more likely because of the medication. The woman’s fall resulted in blunt force injuries, but the staff didn’t conduct a neurological exam and didn’t know the risks of the medications together and therefore didn’t relay critical information to her physician. If they had been adequately knowledgeable, they would have monitored her more closely and transferred her in time to save her life. The appellate court affirmed the trial court’s decision.
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