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Click here for the full text of this decision FACTS:Clyde Hardy, a diabetic, was admitted to a San Angelo hospital in August 2002 suffering from an acute myocardial infarction. Dr. Denver Marsh performed a catheterization on Hardy, as well as coronary angioplasty. Though Hardy appeared to be doing well immediately after surgery, he later began to experience pain and weakening in his legs. Hardy thought he had a blood clot, but Marsh dismissed him anyway. Hardy returned to the hospital a week later and a surgical procedure was performed on Hardy’s leg, but it did not help with the continued problems. Three days later, Hardy’s leg had to be amputated above the knee. Hardy and his wife sued Marsh for medical malpractice. Hardy submitted the expert report of Dr. Robert Cassella, which repeated the series of events leading up to Hardy’s leg amputation. As to the standard of care, Cassella stated, “An important consideration which would help discern procedures to be followed would be a demonstration of an adequate run-off to the vessels supplying the legs. Judicious use of aortagrams [sic] and more distal arteriorgrams [sic] are considered important adjuncts in the precise and effective management of ischemic disease of the lower extremities.” As to causation, Cassella said, “It is my opinion that this patient should have had a consultation with a vascular surgeon in view of his complaints before his discharge on 8-9-02. I recognize fully the importance of his other medical problems. It is my opinion then that if this patient had had more immediate treatment that a salvage of his right leg would have been more probable.” The trial court granted Hardy’s motion to dismiss the report as inadequate under Texas Civil Practice & Remedies Code 74.351. The trial court refused to grant Hardy a 30-day extension to cure the defect. HOLDING:Affirmed. The court finds that Cassella’s statements do not identify the standard of care. The sentence quoted above identifies “important considerations,” but does not state the procedures or treatments that should have been followed when Hardy complained of leg pain. Furthermore, Cassella’s additional statement that Marsh failed to consult with a vascular surgeon did not put Marsh on notice of the specific conduct at issue because it did not identify the specific symptoms that would have necessitated such consultation. The court further faults the report’s failure to establish causation. There is nothing in Cassella’s statements linking Marsh’s decision to discharge instead of treat to Hardy’s amputation. Cassella does not say what steps Marsh should have taken to avoid amputation, and he does not give a medical basis for his opinion. The court rejects Hardy’s argument that the word may in 74.351 requires a trial court to grant an extension. The court says it will stick to the general rule that may is not synonymous with shall, but, instead, creates discretionary authority. Additionally, the trial court’s decision not to grant the extension was not an abuse of discretion, as Hardy gave presuit notice of their claim almost a year before they actually filed suit, so he had sufficient time to get an expert report that complied with 74.351, the court finds. OPINION:Ross, J.; Morriss, C.J., Ross and Carter, JJ.

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