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Click here for the full text of this decision FACTS:In January 2005, Lillian and Marcelino Guerra sued Dr. Clement Ugorji, alleging medical negligence in the care and treatment of Lillian and her newborn infant, Marcela, at Polly Ryon Memorial Hospital. Among other things, the Guerras alleged that Ugorji was absent when Marcela was born and absent for the following four minutes to five minutes. Following her birth, Marcela was in need of respiratory assistance. But, when Ugorji attempted to rectify Marcela’s breathing difficulties, they allege he misplaced an endotracheal tube intended to assist Marcela’s respiration, causing further respiratory problems. And they claim that Ugorji also failed to give Marcela glucose. The Guerras claimed that these and other mistakes caused Marcela’s permanent, severe brain damage. The Guerras later amended their petition to allege direct and vicarious liability for Ugorji’s treatment against entities they claimed were in charge of managing and staffing the emergency room, including Emergency Health Services Associates (ESHA), EmCare Inc., EmCare of Texas Inc., EmCare Holdings Inc., EmCare OP LP, EmCare (a registered trademark), Emergency Medical Services LP, Dr. Leonard M. Riggs Jr. and Dr. Dighton Packard. Neither Riggs nor Packard treated Lillian or Marcela Guerra, but the Guerras alleged that Riggs and Packard were liable in both their individual capacities and their corporate capacities based on their positions as officers, directors, members, shareholders or employees of the defendant entities. The Guerras alleged that the entities were engaged in the practice of medicine in Texas; that the entities were responsible for staffing, supervising and providing medical care to patients in the emergency department at Polly Ryon Memorial Hospital; and that their failures in these responsibilities caused Marcela’s brain damage. The Guerras also claimed that Packard and Riggs were directly liable but also included allegations of liability based on alter ego, piercing the corporate veil, single business enterprise, joint venture and vice principal. The Guerras first filed the expert report of Dr. Timothy Cooper pursuant to Texas Civil Practice & Remedies Code �74.351. Cooper’s report focused on alleged breaches by Ugorji and the “Entities,” which included the corporate entities, and Packard and Riggs individually and in their employment capacities. The defendants challenged the adequacy of Cooper’s expert report and moved to dismiss the Guerras’ claims against them. The trial court denied the challenge to the adequacy of the expert report as to Ugorji, and this ruling was not appealed. In response, the Guerras filed an additional expert report by Dr. Andrew P. Garlisi, regarding EmCare Inc., EmCare of Texas Inc., EmCare Holdings Inc., EmCare, EHSA, EmCare OP LP, Packard and Riggs. The defendants again objected to the adequacy of the Guerras’ expert reports and moved to dismiss their claims. The trial court ruled that the expert reports of Cooper and Garlisi were “deficient, but good faith efforts to comply with Section 74.351.” Specifically, the court found the reports to be “conclusory” as to Packard and Riggs, and it further found that Garlisi’s report seemed to assume that the contractual duties with Polly Ryon Hospital defined the standard of care relating to the medical care given to Marcela. The court ordered that the Guerras correct these deficiencies within 30 days. In response to the trial court’s order, the Guerras supplemented their expert reports. The supplement included copies of the earlier expert reports of Cooper and Garlisi, supplemental reports by Garlisi, and new reports from Dr. Albert C. Weihl and from Adrienne Randle Bond, a corporate lawyer. For a third time, the defendants moved to dismiss the Guerras’ claims for failing to timely file a compliant expert report and sought attorneys’ fees. The trial court first denied Riggs’ motion to dismiss. In its order, the trial court noted that it “did not rely upon Ms. Bond’s report for any causation opinions she may have rendered.” Moreover, the court stated the following after citing to ��74.401(d) and 74.402(d): “[T]he Court finds good cause to permit plaintiffs to file, and for their expert report physicians to rely upon, the report of Adrienne R. Bond, a non-physician expert in legal and corporate contracts. Specifically, the Court finds that the contractual and corporate inter-relationships of the various defendants, including specifically Leonard Riggs and several of the corporate defendants, render such an expert report helpful (if not absolutely necessary) to demonstrating the duties owed and to assisting the physician experts in their presentations of the applicable standards of care. Such corporate and legal testimony would not be within the experience of a typical physician otherwise qualified to render a report in this case.” The trial court, in a reformed order, denied the motion to dismiss as to the Guerras’ claims of direct liability against Packard, EmCare Inc., EmCare Holdings Inc. and EHSA. An interlocutory appeal followed. On appeal, Packard and the other appellants contended generally that the trial court erred in denying their motions to dismiss the Guerras’ claims, because the Guerras’ expert reports were insufficient. They claimed that the doctors’ reports could not be read collectively and that, individually, they did not address the three items of proof necessary for an expert report: standard of care, breach and causation. The appellants also claimed that Bond’s report was unreliable, because she failed to meet the qualifications necessary for an expert in a health-care liability claim. HOLDING:Affirmed. To be adequate under �74.351, an expert’s medical liability report must establish his or her qualifications, the applicable standard of care, how the standard was breached by the particular actions of the defendant and how that breach caused the plaintiff’s alleged damages. To constitute a good faith summary of the expert’s opinions, a report must do more than merely state the expert’s conclusions. It must fulfill two purposes: 1. inform the defendant of the specific conduct that is being called into question; and 2. provide a basis for the trial court to conclude that the plaintiff’s claims have merit. The purpose of Cooper’s report, the court stated, was to explain the standard of care, the breach of the standard of care and causation as to Ugorji. Garlisi’s initial report sought to outline the standard of care and causation as to each individual appellant. Weihl’s report, the court stated, explained: 1. that the standard of care required appellants to implement a quality assurance program; 2. that Marcela’s injuries were caused by the appellants’ failures to implement or follow a quality assurance program; and 3. what a quality assurance program consistent with the standard of care should have included. Bond’s expert report, the court stated, addressed the issues of corporate and director responsibility on the part of Packard, Riggs and the EmCare entities. When read as a whole, the reports addressed each of the defendants separately, the court stated. The court found that the expert reports of the doctors could be considered together to supply the expert testimony on standard of care, breach and causation. The court also held that the trial court properly relied on the expert report of a corporate lawyer to define and explain what the appellants promised to do for Polly Ryon Hospital (i.e., allegedly manage and staff its emergency room with doctors), and what level of responsibility each had in fulfilling that promise. Finally, the court held that the expert reports in the aggregate adequately addressed the standard of care, breach of the standard of care and causation on the part of each appellant. OPINION:Fowler, J.; Anderson and Fowler, JJ., and Edelman, S.J.

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