OPINION ON REHEARING[1]This is an interlocutory appeal from the trial courtâs order dismissing health care liability claims for failure to serve adequate expert reports. See Tex. Civ. Prac. & Rem. Code §§ 51.014(a)(9), 74.351(a), (b).According to the expert reports, Nancy Curnel presented to the emergency room of Houston Methodist Hospital-Willowbrook with elevated liver enzymes caused by a recently prescribed antibiotic. Curnel was examined by a hospitalist, Dr. Michael Esantsi, who misdiagnosed her with viral hepatitis; ordered that she continue taking her current medications, including the antibiotic that was causing her elevated liver enzymes; and admitted her to the hospital. Once admitted, Curnel continued to receive the hepatotoxic antibiotic, and she began to receive another well-known hepatotoxic medication, acetaminophen, again by an order of Esantsi. On the third day of her hospitalization, Curnel was examined by a gastroenterologist, who noted that she might be suffering from drug-induced liver injury. He ordered a biopsy of Curnelâs liver to test for other potential causes. Later that same day, another hospitalist discontinued the antibiotic. Curnelâs liver enzymes began to improve. Curnelâs physicians did not cancel or postpone the biopsy. On the morning of the fifth day of Curnelâs hospitalization, a blood clotting test ordered by Esantsi to clear Curnel for the biopsy returned as normal, and a radiologist performed the biopsy as scheduled. During the biopsy, the radiologist nicked Curnelâs artery, causing her severe injuries.Curnel and her husband, Ronald, asserted health care liability claims against Esantsi and Methodist, among others. They served a series of expert reports from a gastroenterologist, Dr. Todd Sheer, and a registered nurse, Julie Fomenko. Esantsi and Methodist both filed motions to dismiss. The trial court found that the expert reports were deficient as to both Esantsi and Methodist, denied the Curnelsâ request for an extension to cure the deficiencies, and dismissed the Curnelsâ claims with prejudice. The Curnels filed a motion for reconsideration, supported by amended expert reports, which the trial court denied as well.In three issues, the Curnels contend that the trial court abused its discretion by (1) granting Esantsiâs and Methodistâs motions to dismiss, (2) denying their request for an extension to cure, and (3) denying their motion for reconsideration. We hold that the expert reports were deficient but may be curable. Therefore, we reverse the trial courtâs order dismissing the Curnelsâ claims against Esantsi and Methodist and remand the case for further proceedings.Factual BackgroundThe expert reports of Sheer and Fomenko provide the background facts in this case. There are five reports from Sheer (one original and four supplemental) and three reports from Fomenko (one original and two supplemental). We accept the expert reportsâ factual statements for the limited purpose of this appeal and do not address the merits of the Curnelsâ claims. See Bowie Mem âl Hosp. v. Wright, 79 S.W.3d 48, 52 (Tex. 2002) (per curiam) (review of Chapter 74 report is limited to four corners of report).Curnel is prescribed an antibiotic that can cause elevated liver enzymesOn October 4, 2015, Nancy Curnel presented to a local walk-in clinic âwith a complaint of two days of subjective fever, rash, chronic cough, generalized pain, nasal congestion, dysuria, and diarrhea.â At the time, Curnel was on âmultiple medications,â including âacyclovir, alprazolam, duloxetine, hydrochlorothiazide, lisdexamfetamine, levothyroxine, zolpidem, and nasonex.â Curnel was examined by a nurse practitioner, who diagnosed Curnel with a urinary tract infection and prescribed her the antibiotic nitrofurantoin, â100mg twice a day for 7 days.â Nitrofurantoin (also known as Macrodantin or Macrobid) is known for potential hepatotoxic effects and can cause drug-induced liver injury (DILI). Curnel presents to the Methodist ER with elevated liver enzymesFour days later, on Thursday, October 8, Curnel presented to the Methodist emergency room. According to Dr. Sheerâs expert reports, Curnel had been sent to the ER âby her primary medical provider to find out why recent blood work identified abnormal liver tests (hepatitis).â Curnelâs âmedical history was negative for drug or alcohol abuse and chronic liver disease.â âShe was taking several medications for longstanding medical conditions, with no history that these medications had caused hepatotoxicity in the past.â The only ânew drugâ she was taking was the nitrofurantoin. After she began taking nitrofurantoin, âliver function studies performed by her primary care provider demonstrated elevated values.âCurnel told the nursing staff that she had been sent to the ER by her primary care physician because recent blood work indicated that she had elevated liver enzymes. An ER nurse took Curnelâs medical history, noting that âCurnel had recently started nitrofurantoin and was then referred to the hospital for evaluation of elevated liver enzymes.â However, there is no documentation that the nurse evaluated Curnelâs âcurrent medications, including nitrofurantoin,â for âpotential hepatotoxicity.âAfter the nurse took Curnelâs medical history, Curnel was examined by an emergency medicine physician, Dr. Scott Wiesenborn. Wiesenborn noted that Curnel had recently begun taking nitrofurantoin and had been referred to the ER for elevated liver enzymes. Wiesenborn ordered that Curnelâs liver enzymes be tested, and the results confirmed that several of her liver enzymes were abnormally high, including her alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP). Wiesenborn diagnosed Curnel with a fever and âelevated liver function tests/probable acute hepatitis,â although he did not specify whether it was âdrug, viral, autoimmune, etc.âCurnel is hospitalizedWiesenborn called the on-duty hospitalist, Dr. Michael Esantsi, to determine whether to admit Curnel for hospitalization. According to Sheerâs expert reports, Esantsiâs âhistory and physicalâ was ânot significantly different from the one performed in the ERâ by Wiesenborn. Esantsi documented that Curnel had started nitrofurantoin, but he did ânot list this in his Medications section.â He diagnosed Curnel with âabnormal liver function tests,â specifying that the probable cause was âviral-induced hepatitis.â According to Sheer, â[d]rug-induced liver injury [was] not considered in the history and physical,â and Esantsiâs âplan include[d] continuing current regular home medications.â Esantsi ordered that Curnel take ânitrofurantoin 100 mg capsule oral two times dailyâ and that she undergo a gastrointestinal consultation.One of the nurses documented Esantsiâs order concerning Curnelâs medications, âwhich included nitrofurantoin SR (Macrobid) 100 mg capsule oral two times daily.â There is no documentation that the nurses ever developed âa plan for an evaluation for the hepatotoxic potential of the medications, and there is no documentation elsewhere in the medical record that such evaluation was completed.âThat afternoon, Curnel was transferred from the ER to the medical-surgical unit, where she was examined by a gastroenterologist, Dr. Steven Ugbarugba. Ugbarugbaâs consultation notes made âno mentionâ of Curnel âstarting nitrofurantoin recentlyâ and âomit[ted] a list of her medications.â Ugbarugba performed a number of tests, which ruled out a number of potential causes of Curnelâs elevated liver enzymes.[2] Ugbarugba did not note nitrofurantoin as a potential cause of Curnelâs elevated liver enzymes. Again quoting from Sheerâs reports, there is âno documentation that drug-induced liver injury [was] consideredâ by Ugbarugba at that time.Later that evening, Curnel received a dose of nitrofurantoin, which was âdispensed from the pharmacyâ and âadminister[ed]â by one of the nurses.On the morning of Friday, October 9, Curnelâs liver enzymes were tested again. The test results showed a âslight increaseâ in both her ALT and AST. Curnel underwent additional testing, which indicated that she did not have viral hepatitis but was suffering from DILI instead. A complete blood count (CBC) revealed that Curnel had eosinophilia, a condition that is âindicativeâ or âsuggestiveâ of DILI.According to Sheer, Esantsiâs notes indicate that, when he saw Curnel again that day, he ârepeat[ed] the running diagnosis of probable viral hepatitis, despite negative test results,â with âno documentation that drug-induced liver injury [was] considered.â At the nursesâ request, Esantsi ordered that Curnel begin to take acetaminophen, âanother well-known hepatotoxic medication.â A nurse administered the medication to Curnel that afternoon.That evening, Curnel received another dose of nitrofurantoin, âdispensed from the pharmacyâ and âadminister[ed]â by another nurse.On the morning of Saturday, October 10, Curnel received yet another dose of nitrofurantoin. Her liver enzymes were tested again, and the results showed increases in her ALT and ALP, and a slight decrease in her AST, which nevertheless remained abnormally high. The results also showed a âslight riseâ in her bilirubin.Later that day, she was examined again by Dr. Ugbarugba, who ordered that Curnel undergo a liver biopsy. Ugbarugba wrote a progress note, which âreaffirm[ed]â the general diagnosis of â acute hepatitisâ but added that the etiology remained âunclearâ and that there was a âpossibilityâ that the hepatitis was âmedication-induced.â Sheerâs expert reports state that this is the âfirst documentationâ of a medical provider considering DILI as a potential cause of Curnelâs elevated liver enzymes. Ugbarugba ârecommend[ed] holding Acyclovir, Vyvance, and Tylenol specifically,â and he made âa general suggestion to âhold hepatotoxic medications.ââLater that afternoon, Curnel was examined by another physician, Dr. Yamini Naygandhi, who was âcovering for Esantsi.â Naygandhi noted that Curnel might be suffering from âmedication related hepatitisâ (i.e., DILI) instead of âviralâ hepatitis and ordered a review of Curnelâs medications âto find out what [was] causing [her] elevated LFT [liver function tests].â She also ordered that Curnel discontinue nitrofurantoin.[3]By Sunday, nitrofurantoin was âno longer on [Curnel]âs patient medication list and was not administered.â Her bilirubin and ALP increased, but her ALT and AST decreased.Curnelâs artery is nicked during her liver biopsyOn the morning of Monday, October 12, the day of Curnelâs scheduled liver biopsy, Curnelâs enzymes showed âfurther improvement.â Her bilirubin began to decrease, her AST continued to decrease, and her ALT and ALP underwent ânonÂsignificant changes.âAt 9:00 a.m., Curnel was examined for a third time by Ugbarugba. His progress note contained the âexactâ same âassessment from the day priorâ except that it noted, âLiver bx today.â âA pre-procedure prothrombin time/INR ordered by Dr. Esantsi return[ed] as normal (this was the first time checked since presentation).â[4]At 10:30 a.m., a radiologist, Dr. Mark Brodie, performed the biopsy. He obtained two âcores,â which showed that âthe liver function abnormalities were due to medication effects.â During the biopsy, Brodie nicked Curnelâs artery, causing severe injuries. Curnel required multiple blood transfusions, medications to maintain circulation, mechanical ventilation, prolonged resuscitation, and extended ICU care. According to Sheer, Curnel âwill have a slow and painful recovery.âProcedural HistoryThe Curnels asserted health care liability claims against Esantsi and Methodist, among others. The Curnels served Esantsi and Methodist with a series of expert reports from Sheer and Fomenko. Sheerâs reports addressed both Esantsi and Methodist, while Fomenkoâs addressed only Methodist.Esantsi and Methodist filed objections and motions to dismiss for failure to serve adequate expert reports. The Curnels responded that the reports were adequate. They requested that the trial court deny the motions to dismiss or, alternatively, grant them a 30-day extension to cure any deficiencies in the reports.The trial court heard the motions to dismiss and found that the combined expert reports of Sheer and Fomenko were deficient as to both Esantsi and Methodist. The trial court sustained Esantsiâs and Methodistâs objections, denied the Curnelsâ request for a 30-day extension to cure, and dismissed the Curnelsâ claims with prejudice.The Curnels filed a motion for reconsideration, supported by amended expert reports. The trial court denied the motion, and the Curnels appealed.Motions to DismissIn their first issue, the Curnels contend that the trial court abused its discretion in granting Esantsiâs and Methodistâs motions to dismiss for failure to serve adequate expert reports.A. Applicable law and standard of reviewUnder the Medical Liability Act, a plaintiff asserting health care liability claims must timely serve each defendant physician and health care provider with one or more expert reports and a curriculum vitae of each expert whose opinion is offered to substantiate the merits of the claims. Tex. Civ. Prac. & Rem. Code § 74.351(a), (i); see Mangin v. Wendt, 480 S.W.3d 701, 705 (Tex. App.â Houston [1st Dist.] 2015, no pet.). The expert report must provide a âfair summaryâ of the expertâs opinions regarding the (1) applicable standards of care, (2) manner in which the care rendered by the physician or health care provider failed to meet the standards, and (3) causal relationship between that failure and the injury, harm, or damages claimed. Tex. Civ. Prac. & Rem. Code § 74.351(r)(6). âNo particular words or formality are required, but bare conclusions will not suffice.â Scoresby v. Santillan, 346 S.W.3d 546, 556 (Tex. 2011). Instead, the report must explain the basis of the expertâs statements and link the expertâs conclusions to the facts of the case. Jelinek v. Casas, 328 S.W.3d 526, 539 (Tex. 2010).For standard of care and breach, the expert report must explain what the physician or health care provider should have done under the circumstances and what the physician or health care provider did instead. Am. Transitional Care Ctrs. of Tex., Inc. v. Palacios, 46 S.W.3d 873, 880 (Tex. 2001). For causation, the expert report must explain how and why the physicianâs or health care providerâs breach proximately caused the plaintiffâs injury. Columbia Valley Healthcare Sys., L.P. v. Zamarripa, 526 S.W.3d 453, 459-60 (Tex. 2017).Proximate cause has two components: (1) cause-in-fact and (2) foreseeability. Id. at 460. A physicianâs or health care providerâs breach was a cause-in-fact of the plaintiffâs injury if the breach was a substantial factor in bringing about the harm, and absent the breach (i.e., but for the breach) the harm would not have occurred. Id. Even if the harm would not have occurred absent the defendantâs breach, âthe connection between the defendant and the plaintiffâs injuries simply may be too attenuatedâ for the breach to qualify as a substantial factor. Allways Auto Grp., Ltd. v. Walters, 530 S.W.3d 147, 149 (Tex. 2017) (per curiam) (quoting Union Pump Co. v. Allbritton, 898 S.W.2d 773, 776 (Tex. 1995)). A breach is not a substantial factor if it âdoes no more than furnish the condition that makes the plaintiffâs injury possible.â Id. A physicianâs or health care providerâs breach is a foreseeable cause of the plaintiffâs injury if a physician or health care provider of ordinary intelligence would have anticipated the danger caused by the negligent act or omission. See Price v. Divita, 224 S.W.3d 331, 336 (Tex. App.âHouston [1st Dist.] 2006, pet. denied).The plaintiff may serve reports of separate experts regarding different physicians or health care providers or regarding different issues arising from the conduct of a single physician or health care provider. Tex. Civ. Prac. & Rem. Code § 74.351(i). However, only a qualified physician may give opinion testimony about the causal relationship between the claimed injury, harm, or damages and the alleged departure from the applicable standard of care. See id. § 74.351 (r)(5)(C).The expert report is not required to prove the plaintiffâs case but only to provide notice of the conduct forming the basis of the plaintiffâs claim. Gracy Woods I Nursing Home v. Mahan, 520 S.W.3d 171, 189 (Tex. App.âAustin 2017, no pet.). The report âneed not anticipate or rebut all possible defensive theories that may ultimately be presentedâ in the case. Owens v. Handyside, 478 S.W.3d 172, 187 (Tex. App.âHouston [1st Dist.] 2015, pet. denied). Nor must the report ârule out every possible cause of the injury, harm, or damages claimed.â Baylor Med. Ctr. at Waxahachie, Baylor Health Care Sys. v. Wallace, 278 S.W.3d 552, 562 (Tex. App.âDallas 2009, no pet.).In reviewing the adequacy of an expert report, a trial court may not consider an expertâs credibility, the data relied upon by the expert, or the documents that the expert failed to consider at this pre-discovery stage of the litigation. See Mettauer v. Noble, 326 S.W.3d 685, 691 (Tex. App.âHouston [1st Dist.] 2010, no pet.); Gonzalez v. Padilla, 485 S.W.3d 236, 245 (Tex. App.âEl Paso 2016, no pet.). Instead, the trial court must limit its review to the âfour cornersâ of the expert report and, when the question of adequacy hinges on the expertâs qualifications, the âfour cornersâ of the expertâs curriculum vitae. Mangin, 480 S.W.3d at 706.The statuteâs purpose is not to determine the merits of the claim but to rule out frivolous lawsuits at the onset of litigation, before the parties have conducted full discovery. Ross v. St. Lukeâs Episcopal Hosp., 462 S.W.3d 496, 502 (Tex. 2015); Mangin, 480 S.W.3d at 706. As we have explained:The requirement to serve an expert report arises at the outset of litigation and before the opportunity for the plaintiff to engage in significant discovery, including taking oral depositions of the defendants. As such, the statute itself contemplates that the amount and quality of evidence available at the time of drafting the expert reports will be less than that available at trial on the merits or even the summary-judgment stage.Mangin, 480 S.W.3d at 713 (citations omitted). Thus, the requirements of the statute have been variously described as a âlenient standard,â[5] âlow threshold,â[6] and ârelatively low bar.â[7]If the plaintiff âfails to timely serve an expert report, then on the affected health care providerâs motion the trial court must dismiss the pertinent health care liability claim with prejudice and award attorneyâs fees.â Baty v. Futrell, 543 S.W.3d 689, 692 (Tex. 2018) (citing Tex. Civ. Prac. & Rem. Code § 74.351(b)). âHowever, if the motion challenges the adequacy of an otherwise timely report, the trial court may grant the motion âonly if it appears to the court, after hearing, that the report does not represent an objective good faith effort to comply with the [Act's] definition of an expert report.ââ Baty, 543 S.W.3d at 692-93 (quoting Tex. Civ. Prac. & Rem. Code § 74.351 (l)).A report qualifies as an objective good faith effort to avoid dismissal if it discusses each element with sufficient specificity that it (1) informs the defendant of the specific conduct the plaintiff questions and (2) provides a basis for the trial court to conclude that the plaintiffâs claims have merit. Miller v. JSC Lake Highlands Operations, LP, 536 S.W.3d 510, 513 (Tex. 2017) (per curiam). In determining whether an expert report constitutes an objective good faith effort to address each element, âa trial court may not draw inferences; instead, it must exclusively rely upon the information contained within the four corners of the report.â Cornejo v. Hilgers, 446 S.W.3d 113, 123 (Tex. App.âHouston [1st Dist.] 2014, pet. denied); see Baty, 543 S.W.3d at 693.We review a trial courtâs ruling on a motion to dismiss a health care liability claim for an abuse of discretion. Van Ness v. ETMC First Physicians, 461 S.W.3d 140, 142 (Tex. 2015) (per curiam). Under this standard, we âdefer to the trial courtâs factual determinations if they are supported by evidence, but review its legal determinations de novo.â Id. âA trial court abuses its discretion if it rules without reference to guiding rules or principles.â Id.B. Adequacy of expert reports on EsantsiThe Curnels supported their claim against Esantsi with expert reports from Sheer. The trial court found that Sheerâs reports were deficient on all three elements.1. Sheerâs opinions on elements of standard of care and breachWe begin by considering whether Sheerâs reports provide adequate opinions on the first two elements: standard of care and breach. In his reports, Sheer explains that the standard of care required Esantsi to take certain actions and to refrain from taking others throughout the course of Curnelâs treatment at Methodist.Sheer writes that, as Curnelâs âprimary physicianâ at the hospital, Esantsi was âresponsibleâ for the âdecision to admit and dischargeâ her. At the âmost basicâ level, a hospitalist like Esantsi must âunderstand the effect of medications on a patient, especially when evaluating liver function.â When a patient presents with elevated liver enzymes, âmedications should be at the top of the list of potential causes, which is especially true when the patient has recently initiated a course of a frequently implicated agent such as nitrofurantoin.â And, Sheer continues, when a patientâs elevated liver enzymes are âdrug-induced,â a liver biopsy is ârarely helpful.âAccording to Sheer, when Curnel presented to the hospital after having recently initiated an antibiotic well-known for its hepatotoxic potential, the standard of care required Esantsi to âevaluate the hepatotoxic potentialâ of Curnelâs medications; ârecognize drug-induced liver injury as the probable cause of [her] elevated liver enzymesâ; âdiscontinue the offending drug,â nitrofurantoin; refrain from ordering other hepatotoxic medications; and âdischarge her to be followed as an outpatient with her primary care physician to confirm normalization of the liver tests on serial lab testing.â Sheer explains that Esantsi breached this standard by failing to take any of these steps. Esantsi failed to evaluate the hepatotoxic potential of her medications, recognize DILI as the probable cause of her elevated liver enzymes, discontinue the antibiotic, refrain from ordering other hepatotoxic medication, and discharge her for outpatient monitoring. Instead, Esantsi misdiagnosed Curnel with probable viral hepatitis, ordered that she continue to take nitrofurantoin and begin to take hepatotoxic acetaminophen, and admitted her for hospitalization and âunnecessary testing.âAfter Curnel was admitted for hospitalization, Sheer explains, Esantsi continued to be responsible for deciding when to discharge her, and the standard of care required him to recognize that a liver biopsy was not âwarrantedâ or âjustifiedâ under the circumstances.[8] Sheer further explains that Esantsi breached this standard by âmaintaining [Curnel's] admission to the hospital for the biopsyâ and ordering a pre-procedure prothrombin time test âin preparation of the liver biopsy.âThus, in his reports, Sheer explains in detail what he believes the standard of care required Esantsi to have done under the circumstances and what Esantsi did instead. See Palacios, 46 S.W.3d at 880. We hold that Sheerâs reports provide adequate opinions on the standard of care applicable to Esantsi and the manner in which the care rendered by Esantsi failed to meet that standard. See TEx. CIv. Prac. & Rem. Code § 74.351(r)(6).2. Sheerâs opinion on element of causationWe next consider whether Sheerâs reports provide an adequate opinion on the third element: causation. To show causation, Sheer explains a chain of events that begins with Esantsiâs initial breachesâEsantsiâs failure to evaluate Curnelâs medications for hepatotoxic potential when she first presented, to diagnose her with DILI, and to discharge her for outpatient monitoring. He instead misdiagnosed her with viral hepatitis, ordered that she continue to take the contraindicated antibiotic and another hepatotoxic medication, and improperly admitted her for hospitalization and unnecessary testing. The chain of the events then continues to Esantsiâs subsequent breachesâEsantsiâs act and omissions in continuing to misdiagnose Curnel with viral hepatitis, maintaining her admission to the hospital, and ordering the prothrombin time test in preparation for the biopsy. And the chain ends with the unwarranted biopsy taking place as scheduled.The chain of events leading up to Curnelâs injuries includes many other acts by many other actors. These actors notably include Ugbarugba, who ordered the liver biopsy even though he considered DILI a potential cause of Curnelâs elevated liver enzymes and Curnel showed improvement after nitrofurantoin was discontinued, and Brodie, who actually performed the biopsy and nicked Curnelâs artery.An event that starts a chain of events can be too attenuated from an injury to cause it. See Providence Health Ctr. v. Dowell, 262 S.W.3d 324, 330 (Tex. 2008) (holding that medical providersâ ânegligence was too attenuated from the [harm] to have been a substantial factor in bringing it aboutâ); Shenoy v. Jean, No. 01-10- 01116-CV, 2011 WL 6938538, at *9 (Tex. App.âHouston [1st Dist.] Dec. 29, 2011, pet. denied) (mem. op.) (âA causal link can be too attenuated to satisfy the causation requirement for an expert report.â). It is not enough that one event occurred before the other; that is only evidence of but-for causation. Shenoy, 2011 WL 6938538, at *9; see Jelinek, 328 S.W.3d at 533 (âCare must be taken to avoid the post hoc ergo propter hoc fallacy, that is, finding an earlier event caused a later event merely because it occurred first.â). Rather, the event must have been a substantial factor in bringing about the harm. Zamarripa, 526 S.W.3d at 460. And an event is not a substantial factor if it is âtoo attenuatedâ from the harm or âdoes no more than furnish the condition that makes the plaintiffâs injury possible.ââ Walters, 530 S.W.3d at 149 (quoting Allbritton, 898 S.W.2d at 776).Esantsiâs initial breachesâthe breaches he committed when Curnel first presented to Methodistâare too attenuated from Curnelâs injuries to be considered a substantial factor in bringing those injuries about. It is true that, if Esantsi had followed the identified standard of care when determining whether to admit Curnelâhad he recognized that Curnel was likely suffering from DILI caused by the recently-prescribed nitrofurantoin, discontinued the nitrofurantoin, and discharged her for outpatient monitoringâthen Curnelâs liver would have never been biopsied, and her injuries would have never occurred. Nevertheless, Esantsiâs initial breaches, which occurred days before the biopsy and before she was even admitted to the hospital, did âno more than furnish the conditionâ that made Curnelâs injury âpossible.â Id. That is, as a result of Esantsiâs initial breaches, Curnel was admitted for hospitalization, which made it possible for Ugbarugba to order the biopsy and for Brodie to perform the biopsy, among other causal links in the chain. Given the numerous different acts by other physicians and nurses during the multiple days between Curnelâs admission and her biopsy, Esantsiâs initial breaches do not constitute a cause-in-fact of Curnelâs injuries. See Zamarripa, 526 S.W.3d at 461 (holding that expert reports were deficient because they failed to explain how hospital proximately caused death of pregnant patient); Dowell, 262 S.W.3d at 330 (holding that âthe defendantsâ negligence was too attenuated from the [harm] to have been a substantial factor in bringing it aboutâ); Shenoy, 2011 WL 6938538, at *9 (holding that expert report was deficient on causation because physicianâs negligence in clearing patient for surgery was âtoo attenuatedâ from patientâs death from post-surgery complications); cf. Allways Auto Grp., Ltd. v. Walters, 530 S.W.3d 147, 147-49 (Tex. 2017) (per curiam) (holding that car dealership did not proximately cause collision between intoxicated motorist and other driver by providing loaner vehicle to motorist 18 days before collision occurred, despite fact that motorist was also intoxicated when dealership provided him vehicle).In his reports, Sheer identifies two subsequent breaches by Esantsi: (1) âmaintaining [Curnel's] admission to the hospital for the biopsyâ and (2) ordering a pre-procedure prothrombin time test âin preparation of the liver biopsy.â To conclude that either of these subsequent breaches was a substantial factor in bringing about Curnelâs injuries, we would have to infer that Esantsi had a duty to prevent the biopsy from taking place or that he participated in the decision to biopsy Curnelâs liver in a manner that was âcollaborative,â much like the âthe screening, diagnosis, and treatmentâ of the two defendant-physicians in Bustamante v. Ponte was âcollaborative.â 529 S.W.3d 447, 457 (Tex. 2017). This is particularly true given that Ugbarugba possessed the information that DILI was a potential cause of Curnelâs elevated liver enzymes and nevertheless ordered a biopsy. The reports do not state how Esantsi âhad either the right or the means to persuadeâ Ugbarugba and Brodie to cancel the biopsy. Zamarripa, 526 S.W.3d at 461. Nor do they otherwise explain whether Esantsi âhad any say in the matter.â Id. We hold that Sheerâs reports on Esantsi do not provide an adequate opinion on cause-in-fact.We further hold that Sheerâs reports do not provide an adequate opinion on foreseeability, either. In his reports, Sheer explains that, because the liver is âvery vascularâ and âit is not possible to visualize all of the blood vessels during the biopsy,â âin the process of removing pieces of liver tissues, there is [a] risk of cutting one or more blood vessels.â Sheer does not state, however, whether this risk was known to Esantsiâwho is not a gastroenterologist and does not perform liver biopsiesâor should have been recognized before the biopsy. Nor can we draw this inference from Sheerâs reports. Cornejo, 446 S.W.3d at 123. Sheer does not address whether the risk was generally known or recognized by hospitalists like Esantsi before the surgery. Nor does Sheer provide information demonstrating that the risk is part of the informed consent disclosures or that a hospitalist of ordinary intelligence would have anticipated the danger of a patientâs blood vessel being cut during this type of procedure. See Price, 224 S.W.3d at 336.We hold that Sheerâs reports on Esantsi fail to adequately address both components of proximate cause. C. Adequacy of expert reports on MethodistThe Curnels supported their claim against Methodist with expert reports from Fomenko and Sheer. Fomenkoâs expert reports address standard of care and breach,[9] while Sheerâs address causation. The trial court found that the combined expert reports were deficient on all three elements.1. Fomenkoâs opinions on elements of standard of care and breachWe begin our analysis by considering whether Fomenkoâs reports provide adequate opinions on the first two elements: standard of care and breach. See Tex. Civ. Prac. & Rem. Code § 74.351(r)(6).With respect to the Curnelsâ claim against Methodist for its allegedly inadequate policies, Fomenko opines that the standard of care required the hospital to have in place and enforce policies and procedures requiring all physicians, nurses, and pharmacists providing care to a patient to evaluate the patientâs medications for hepatotoxicity and other negative effects and contraindications through in-house computer formulary programs and pharmaceutical publications. She further opines that the policies and procedures should require such an evaluation to occur when the patient is admitted to the hospital and, once admitted, when the patient is prescribed a given medication. According to Fomenko, Methodist breached this standard because such policies and procedures were either not in place or not enforced, as evidenced by the fact that Curnelâs medications were not evaluated for hepatotoxicity when she was admitted to the hospital or before the nurses administered nitrofurantoin to her for three consecutive days.With respect to the Curnelsâ vicarious liability claim based on negligence by the Methodist nursing staff, Fomenko opines that the standard of care required the nurses to evaluate Curnelâs medications; recognize that nitrofurantoin was hepatotoxic and thus contraindicated given Curnelâs elevated liver enzymes; refrain from administering nitrofurantoin to Curnel; notify the ordering practitioner, Esantsi, of the reason for their decision; and seek clarification of his order.According to Fomenko, the nurses breached the standard of care by failing to take any of these steps. The nurses failed to evaluate the hepatotoxic potential of Curnelâs medications when Curnel presented to the ER or when she was admitted to the hospital, and they failed to document the need to perform such an evaluation in Curnelâs plan of care. They noted Curnel had been taking nitrofurantoin, but they failed to recognize that nitrofurantoin is hepatotoxic and thus failed to clarify the contraindicated nitrofurantoin order with Esantsi or any other practitioner. And instead of holding the medication, they administered it to Curnel for three consecutive days.In her reports, Fomenko explains in detail what she believes the standard of care required Methodist and its nursing staff to have done under the circumstances and what they did instead. Palacios, 46 S.W.3d at 880; see Gardner v. U.S. Imaging, Inc., 274 S.W.3d 669, 671-72 (Tex. 2008) (per curiam) (when health care liability claim involves vicarious liability theory, expert report that adequately implicates actions of partyâs agents or employees is sufficient to implicate party itself). We hold that Fomenkoâs expert reports provide adequate opinions on the standard of care applicable to Methodist and the manner in which the care Methodist rendered breached that standard. See Tex. Civ. Prac. & Rem. Code § 74.351(r)(6).2. Sheerâs opinion on element of causationWe next consider whether Sheerâs reports provide an adequate opinion on the third element: causation. In his reports, Sheer opines that, by failing to promptly evaluate Curnelâs mediations and instead administering the contraindicated antibiotic for three consecutive days, Methodist and its nursing staff deprived Curnelâs physicians of ânecessary data and information for making the correct diagnosis and considering discharge from the hospital.âAccording to Sheer, had the Methodist nurses complied with the standard of care identified by Fomenko, the physicians would have had the benefit of data showing a declining trend in Curnelâs liver enzymes, which, in turn, would have led them to diagnose her with DILI and discharge her for further monitoring on an outpatient basis, thereby avoiding the liver biopsy and the injuries that Curnel received from it.[A]dministration of the nitrofurantoin to [Curnel] during her hospitalization (due to failure to evaluate the hepatotoxic potential of the medication) perpetuated the elevated liver enzymes. In reasonable medical probability, if the nurses had not administered nitrofurantoin, [Curnel]âs liver enzymes would have immediately improved. Thus, the nursesâ administration of the drug deprived the physicians of data relevant to a diagnosis of probable drug induced liver injury and discharge for outpatient monitoring.Sheerâs reports about the nurses, like his reports on Esantsi, attempt to show proximate cause by explaining a chain of events that begins with the Methodist nursesâ failure to evaluate Curnelâs medications and to refrain from administering the contraindicated nitrofurantoin and ends with Curnelâs artery being nicked and the resulting injuries. And like the alleged negligence of Esantsi, the alleged negligence of Methodist and its nursing staff is too attenuated from Curnelâs injuries to be considered a substantial factor in bringing those injuries about.Curnelâs physicians identified DILI as a potential cause of her elevated liver enzymes two days before the biopsy. Ugbarugba and Naygandhi both considered DILI a potential cause of Curnelâs elevated liver enzymes, both ordered that Curnel stop taking all hepatotoxic medications, and Naygandhi specifically ordered that Curnel stop taking nitrofurantoin. Once Curnel stopped taking nitrofurantoin, her enzymes began to improve. And, as Sheer states in his reports, by October 12, the liver tests showed even âfurther improvement.â None of Curnelâs physicians ordered that the biopsy not take place. The physicians had the information to diagnose Curnel with DILI and discharge her from the hospital before the biopsy. Instead, armed with the very information that Curnel claims they needed, they elected to go forward with the biopsy on its scheduled date. Sheerâs reports do not explain how and why additional information from the nurses would have led the physicians to cancel the biopsy if the information the physicians already had did not or how the nurses âhad either the right or the means to persuadeâ the physicians to cancel the biopsy. Zamarripa, 526 S.W.3d at 461. Nor do Sheerâs reports state that Methodistâs nurses were part of the decision to perform the biopsy or its timing. We hold that Sheerâs reports do not adequately address cause- in-fact for the claims against Methodist.We further hold that Sheerâs reports do not adequately address foreseeability, either. They do not explain how and why Methodistâs nurses should have anticipated Curnelâs artery being nicked because of either Methodistâs failure to implement and enforce policies and procedures requiring the evaluation of hepatotoxic medication or the nursesâ failure to evaluate Curnelâs medications for hepatotoxicity and to refuse to administer the drug. Thus, we hold that Sheerâs reports on Methodist fail to adequately address both components of proximate cause.D. Conclusion on adequacy of expert reportsIn sum, we hold that Sheerâs reports on Esantsi provide adequate opinions on the standard of care and breach but do not provide an adequate opinion on either component of proximate cause. We further hold that Fomenkoâs reports on Methodist provide adequate opinions on the standard of care and breach but that Sheerâs reports on Methodist do not provide an adequate opinion on either component of proximate cause. Therefore, the trial court did not abuse its discretion in finding the reports inadequate as to both Esantsi and Methodist. Accordingly, we overrule the Curnelsâ first issue.Motions for Extension to CureIn their second and third issues, the Curnels contend that the trial court abused its discretion by denying their motion for a 30-day extension to cure the deficient expert reports and by denying their motion for reconsideration.Under the Act, if the plaintiff timely serves an expert report, and the trial court concludes that the report is an objective good faith effort to comply with the statute but nevertheless deficient in some way, the trial court has the discretion to grant the plaintiff one 30-day extension to cure the deficiencies. Tex. Civ. Prac. & Rem. Code § 74.351(c); Mangin, 480 S.W.3d at 705-06. The trial court should err on the side of granting the extension. Samlowski v. Wooten, 332 S.W.3d 404, 416 (Tex. 2011) (Guzman, J., concurring) (âIn order to preserve the highest number of meritorious claims, trial courts should err on the side of granting claimantsâ extensions . . . .â); see Samlowski, 332 S.W.3d at 411 (plurality op.) (agreeing with concurrence that trial court should err on side of granting extension). And the trial court must grant the extension if the deficiencies are curable. Zamarripa, 526 S.W.3d at 461.The Texas Supreme Court established a âminimalâ standard for determining whether a deficient report is curable: âa 30-day extension to cure deficiencies in an expert report may be granted if the report is served by the statutory deadline, if it contains the opinion of an individual with expertise that the claim has merit, and if the defendantâs conduct is implicated.â Scoresby, 346 S.W.3d at 557.We review a trial courtâs ruling on motion for an extension to cure a deficient expert report for an abuse of discretion. Quintero v. Hous. Methodist Hosp., No. 01-14-00448-CV, 2015 WL 831955, at *2 (Tex. App.âHouston [1st Dist.] Feb. 26, 2015, pet. denied) (mem. op.); Henry v. Kelly, 375 S.W.3d 531, 535 (Tex. App.âHouston [14th Dist.] 2012, pet. denied).The Curnels served Methodist and Esantsi with expert reports before the statutory deadline, Methodist and Esantsi filed objections to the reports, and the Curnels served Methodist and Esantsi with additional reports in response to the objections. As discussed above, despite their deficiencies, these reports contain the opinions of qualified experts that the Curnelsâ claims had merit and implicated the conduct of Methodist and Esantsi; they qualify as objective good faith efforts to comply with the statute. See Scoresby, 364 S.W.3d at 557.The trial court dismissed their claims without affording them an opportunity to cure their deficient reports. Part of the purpose of the extension is to afford a plaintiff who made a good faith effort the chance to cure a defective report after the deficiencies have been identified by the trial court. Given the Supreme Courtâs minimal standard and the Curnelsâ objective good faith efforts, we cannot say that the Curnelsâ reports were incurable. See Zamarripa, 526 S.W.3d at 461.Moreover, when the trial court dismissed the Curnelsâ claims, it was unclear whether the statute required expert reports to address foreseeability, and at least two courts of appeals had held that it did not. See Rio Grande Regâl Hosp. v. Ayala, No. 13-11-00686-CV, 2012 WL 3637368, at *19 (Tex. App.âCorpus Christi Aug. 24, 2012, pet. denied) (mem. op.), abrogated by Columbia Valley Healthcare Sys., L.P. v. Zamarripa, 526 S.W.3d 453 (Tex. 2017); Adeyemi v. Guerrero, 329 S.W.3d 241, 246 (Tex. App.âDallas 2010, no pet.). The Texas Supreme Court resolved the issue while this appeal was pending when it issued Zamarripa and held that an expert report must address both cause-in-fact and foreseeability. 526 S.W.3d at 460. Given this development, the Curnelsâ should be afforded the opportunity to amend their reports to address foreseeability and to cure the other deficiencies identified in this opinion.Therefore, we hold that the trial court abused its discretion in denying their motion for an extension to cure and motion for reconsideration. Accordingly, we sustain the Curnelsâ second and third issues.ConclusionWe reverse the trial courtâs order and remand for further proceedings.Harvey Brown JusticePanel consists of Justices Jennings, Bland, and Brown.