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Click here for the full text of this decision FACTS:Appellants sued three doctors and Southwest Methodist Hospital, alleging, in part, that the hospital nurses’ negligence resulted in a delay in diagnosis that caused 75-year-old patient Guadalupe M. Rodriguez’s condition to deteriorate. Appellants claimed that the delay in diagnosis delayed the discovery of a cerebral hemorrhage. According to appellants, if the hemorrhage had been discovered and treated sooner, Rodriguez’s neurological deterioration and death could have been averted. After filing suit against the hospital and doctors, appellants filed the expert report of Dr. Kenneth C. Fischer. Appellants sought review of the trial court’s dismissal of their medical malpractice case against the hospital on the grounds that appellants’ expert report did not satisfy the requirements of the Medical Liability and Insurance Improvement Act. HOLDING:Reversed and remanded. The act requires appellants to provide “a fair summary of the expert’s opinions as of the date of the report regarding applicable standards of care, the manner in which the care rendered by the physician or health care provider failed to meet the standards, and the causal relationship between that failure and the injury, harm, or damages claimed.” Although the report is not required to marshal all of appellants’ proof, it has to include the expert’s opinion on each of the three elements that the act identifies: standard of care, breach and causal relationship. The report could not merely state the expert’s conclusions about those elements. As to the standard of care, the court concludes that Fischer’s report sufficiently sets forth the standard of care because he specifically states what should have been done for a patient “with acute neurological process.” The court also concludes that Fischer’s report sufficiently sets forth how the standard of care was breached because he specifically states what the nurses should have, but did not, do. The court also determines that the expert report is a “fair summary” of the expert’s opinions on causation. The court points out that Fischer links his conclusion regarding the nurses’ alleged breach of the standard of care with his conclusion that Rodriguez’s neurological condition would not have deteriorated, resulting in the need for surgery. The court also notes that Fischer states that if the nurses had “carefully inform[ed] the treating physicians of changes in the patient’s clinical status . . . [the] type of lesion harbored by Ms. Rodriguez . . . . [should have resulted in] prompt cessation of the Coumadin, an immediate brain CT scan, immediate institution of fresh frozen plasma to reverse the Coumadin, and obtaining neurological and neurosurgical consultation on a stat basis . . . [then] . . . [w]ithin reasonable medical probability, the dramatic neurological deterioration and death of Ms. Rodriguez would have been averted.” The court therefore holds that Fischer’s report satisfies the act’s requirement on causation. The court concludes that Fischer’s report put the hospital on notice of the conduct complained of, and represents a good-faith effort to provide a fair summary of the statutory elements of standard of care, breach and causation. The court therefore reverses the trial court’s order of dismissal and remands the cause for further proceedings. OPINION:Marion, J.; Sarah B. Duncan, Karen Angelini, Sandee Bryan Marion, JJ.

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