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Click here for the full text of this decision The trial court could have reasonably determined that expert reports submitted by appellant, a medical-malpractice plaintiff, did not represent a good-faith effort to summarize the causal relationship between the defendant doctor’s alleged failure to meet the applicable standards of care and appellant’s alleged injuries. FACTS:The appellant, Barko, was admitted to an emergency room on two consecutive days. On each occasion, she was treated by appellee, Genzel. Barko complained of a back injury and notified Genzel that she was pregnant. Genzel twice treated her with pain medications and instructed her to follow up with a neurosurgeon. On the third day, Barko visited her neurosurgeon, who immediately scheduled surgery to repair a large disc re-herniation. Barko suffered a miscarriage on the day of her surgery. Barko filed suit against Genzel and the hospital, contending that Genzel failed to timely diagnose and treat her back injury and that defendants’ negligence led to her miscarriage and other permanent neurologic damage. She submitted two expert reports in an attempt to comply with the expert report requirements of the former Medical Liability and Insurance Improvement Act repealed during the 78th Texas legislative session. The defendants filed a motion to dismiss, challenging the sufficiency of the expert reports. The trial court granted the motion. Barko now appeals the dismissal with respect to her claim against Genzel. HOLDING:Affirmed. The act requires medical-malpractice plaintiffs to submit expert reports to defendants. If a defendant files a motion to dismiss based on a report’s inadequacy, the motion must be granted if the report”does not represent a good faith effortto comply” with the act’s requirements. The “good-faith effort” standard is met if a report identifies the specific conduct called into question and provides a basis to conclude that the claims have merit. American Transitional Care Centers of Texas Inc. v. Palacios, 46 S.W.3d 873 (Tex. 2001). Three relevant elements, standard of care, breach and causal relationship, must be addressed in the report. Conclusory statements are not sufficient; instead, the expert must link his conclusions to the facts in the case. The court uses an abuse-of-discretion standard to review a trial court’s order dismissing a claim for failure to submit a sufficient expert report. The final expert report submitted by Barko claims that Genzel’s “violations of the standards of emergency medical practice were a proximate cause in this patient’s injury.” The report fails to link the miscarriage to Genzel’s care. While the report details Barko’s deteriorating condition, it does not indicate that Barko would have recovered satisfactorily but for Genzel’s alleged negligent treatment, nor does it state that back surgery could have been avoided but for the negligence. Last, the report makes no attempt to eliminate the back injury itself or the surgery as possible causes for the damage alleged. The trial court could reasonably have determined that the reports did not make a good-faith effort to summarize the causal relationship between Genzel’s alleged failure to meet the applicable standards of care and appellant’s alleged injuries. OPINION:Arnot, C.J.; Arnot, C.J., Wright and McCall, JJ.

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