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Click here for the full text of this decision FACTS:Lela Clark sued HCA Inc., El Paso Healthcare Systems, Del Sol Rehabilitation Hospital, Dr. Robert Moreno and Dr. Mariano Palacios on a medical malpractice claim. Clark was evaluated at Del Sol for chest pain, cardiac problems, nausea and stomach pain and subsequently was admitted and transferred to its acute-care facility. There, a doctor evaluated Clark, and, suspecting an infected hematoma, recommended incision and drainage with decompression to ensure that Clark had not developed compartment syndrome. This procedure was performed the next day and revealed a large hematoma but “no evidence of compartment syndrome . . . with complete function of the hand and muscle on inspection.” Clark was discharged. There was no mention of her range of motion upon discharge. Clark alleged that she subsequently was forced to endure a painful condition that required painful surgery and was left with an 80 percent to 90 percent paralysis of her right hand. She claimed to have lost all independence and to have been forced to remain in a long-term care facility in order to receive appropriate care. Clark timely filed an expert report and curriculum vitae (CV) from Dr. Elmer Pacheco, who reviewed the medical care provided to Clark in rendering his opinion. The trial court granted the motions challenging the report and dismissed the suit with prejudice. Clark appealed. HOLDING:Affirmed. In order to encourage the screening of medical malpractice claims by experts prior to filing, the Medical Liability and Insurance Improvement Act requires a plaintiff to provide each defending physician or health-care provider with one or more expert reports relating to liability and causation. Also, to comply with 13.01(d) and (r)(6) of the act, the expert report must establish, on its face, that the purported expert is qualified. Former Texas Revised Civil Practice and Remedies Code Article 4590i, 14.01 sets out the requirements for an expert witness in a suit against a physician. A person may qualify as an expert witness on the issue of whether the physician departed from accepted standards of medical care only if the person is a physician wh 1. is practicing medicine at the time such testimony is given or was practicing medicine at the time the claim arose; 2. has knowledge of accepted standards of medical care for the diagnosis, care or treatment of the illness, injury or condition involved in the claim; and 3. is qualified on the basis of training or experience to offer an expert opinion regarding those accepted standards of medical care. Clark contends that Pacheco was qualified to render an opinion on the standard of care. His CV reveals that he is board certified in internal medicine, oncology and nuclear medicine. The court finds that Pacheco’s expert report makes no mention of his training, experience or familiarity with Lovenox, anticoagulant medications, deep venous thrombosis, diagnosis and treatment of compartment syndrome or the causes and results of hematoma. The court notes that he merely quotes a few medical reference materials with no supporting information concerning the qualifications or expertise of the authors. The court holds that Pacheco’s specialty in hematology may well qualify him to render an opinion, but finds that the record is silent as to his current role as a hematologist or his experience with anticoagulation therapy. Therefore, the court cannot conclude that the trial court abused its discretion in finding that Pacheco was not qualified to testify as an expert. Clark next complains that the trial court erred in finding that the expert report was inadequate in that it did not properly set out the standard of care, breach or causation. In his report, Pacheco narrated the sequence of events constituting Clark’s treatment, and, rather than stating his personal knowledge of the applicable standard of care, he set out nine text boxes containing excerpts from different publications. Pacheco’s report quoted several sources that all inpatients should be screened and considered for venous thromboembolism prophylaxis based on a risk factor assessment, and, if pharmacologic prophylaxis is indicated, Lovenox should be given unless other exclusion criteria apply. He then referenced five articles in which compartment syndrome was discussed. At no point did he indicate that he was personally familiar with the standard of care or that the authors of the various articles had sufficient expertise. Pacheco alleged that the standard of care was breached by Moreno, Palacios and Del Sol, since they failed to properly assess, monitor and timely treat the complications that developed as a result of the improper use of Lovenox. The court finds that Pacheco opined that appellees failed to treat the complications resulting from the improper use of Lovenox, then jumped to the conclusion that “the acute, compartment syndrome created the”devasting dysfunction created by ischemic damage’ causing the complete loss of use of Lela Clark’s right arm.” The court determines that the missing link is not that compartment syndrome caused devastating dysfunction, but that the improper use of Lovenox caused compartment syndrome. Consequently, the court concludes that Pacheco’s expert report was inadequate. Finally, Clark complains that the trial court erred in finding that the report was not a good faith effort to comply with the requirements of Art. 4590i. The court finds that, because the report did not discuss the standard of care and breach with sufficient specificity, it cannot constitute a good faith effort. Moreover, the court holds that the report does not support the cause of action Clark alleged in her pleadings. Therefore, the court concludes that the trial court had no discretion but to dismiss Clark’s claim with prejudice. OPINION:Chew, J.; Barajas, C.J., McClure, and Chew, JJ.

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