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Click here for the full text of this decision FACTS:Roberto Gallardo died at the Sunset Haven Nursing Center in 1999. His son, Roberto Gallardo Jr., sued Sunset and his father’s doctor, Adrian O. Ugarte, for medical malpractice. In November 2001, Sunset filed a motion for a stay because its insurer had been placed in liquidation in Pennsylvania. The trial court granted the motion and stated, “all matters pertaining to this suit are stayed for 90 days from October 3, 2001, [the date of liquidation order] including, but not limited to, discovery in this case, the trial of this case and all currently imposed deadlines until further notice. In January 2002, Gallardo served the defendants with an expert report by Dr. Gunda Kirk. The 28-page report goes through the nurses’ notes chronologically and provides commentary regarding deficiencies in the care rendered by Ugarte and others. The primary complaints in the report are the failure to prevent or adequately treat decubitus ulcers and the failure to prevent acute exacerbation of congestive heart failure. Ugarte filed a motion to dismiss on April 29, 2003, arguing that Kirk’s report did not constitute a good faith effort to comply with the definition of an expert report under the Medical Liability and Insurance Improvement Act. The trial court granted the motion to dismiss and severed the claims again Ugarte from the rest of Gallardo’s claims. HOLDING:Reversed and remanded. The court confirms that the Property and Casualty Insurance Guaranty Act allows for a six-month stay when an insurer with an obligation to defend is impaired, and that in some types of cases, actions taken while the stay is in effect are void. Gallardo argues the stay is still in effect and the deadline for filing the expert report remains suspended. The court concedes that the stay ordered in this case is less than clear since it mentions 90 days and also says “until further notice” but there is nothing in the record here to indicate that the Texas Commissioner of Insurance had designated Sunset’s insurer as impaired, which is a requirement of the property and casualty act. There is nothing to show that the stay was mandated by the statute; instead, the trial court apparently granted the stay as an act of comity, and such a stay is at the discretion of the trial court. “[Gallardo] has not cited any authority for the proposition that a trial court’s purported violation of its own stay order may be raised for the first time on appeal. We therefore conclude that this issue is not preserved for review.” Turning, then, to the adequacy of the report: Regarding decubitus ulcers, the report states that more frequent checking by a nurse to insure that Gallardo changed position every two hours, padding his bed, and applying a particular spray are “but a few of the things” that “could have been done to prevent as well as treat the decubitus.” The statement explains the standard of care by listing the steps that could have been taken and explains how the standard of care was breached by noting that none of the steps were taken. Thus, the statement specifically addresses what care was expected but not given, even if it doesn’t use the specific word “causation.” As for the congestive heart failure, the report expresses the standard of care by stating the therapeutic level of digoxin. It explains how Ugarte breached the standard by stating that he placed Gallardo at risk for an acute exacerbation of congestive heart failure by lowering the digoxin below the therapeutic level. The care that was expected but not given was that Ugarte would maintain Gallardo at an adequate dosage of digoxin, the report concludes. “In short, the report adequately informs Ugarte of the specific conduct [Gallardo] has called into question and it provides and adequate basis for the court to conclude that the claim has merit.” OPINION:Larsen, J.; Larsen, McClure and Chew, JJ.

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