mark-d-bogar-md-v-dolores-g-esparza-individually-and-as ( 2007 )


Menu:
  •       TEXAS COURT OF APPEALS, THIRD DISTRICT, AT AUSTIN
    NO. 03-07-00037-CV
    Mark D. Bogar, M.D., Appellant
    v.
    Dolores G. Esparza, Individually and as Administrator of the Estate of
    Katherine G. Guerrero; Deceased; Fernando Guerrero; Sofia G. Butschy;
    Gilberto Guerrero; Antonio Guerrero; Rosie G. Garza; Benito Guerrero;
    Josey G. Selvera; and Frances G. Faz, Appellees
    FROM PROBATE COURT NO. 1 OF TRAVIS COUNTY, NO. 82,917-A,
    HONORABLE GUY S. HERMAN, JUDGE PRESIDING
    OPINION
    We again address issues arising from the expert report requirements of section 74.351
    of the civil practice and remedies code. See Tex. Civ. Prac. & Rem. Code Ann. § 74.351
    (West Supp. 2006). Appellant Mark D. Bogar, M. D. appeals the probate court’s denial of his
    motion to dismiss appellees’ health care liability claim for failure to make an objective, good faith
    effort to timely serve an expert report that complies with subsections 74.351(a) and (r)(6). The three
    issues presented here concern: (1) our subject matter jurisdiction over Dr. Bogar’s interlocutory
    appeal; (2) whether the report appellees served complied with section 74.351’s requirements; and,
    if not, (3) the appropriate appellate remedy. We conclude that we have jurisdiction over Dr. Bogar’s
    interlocutory appeal and that the controlling law and “four corners” of appellees’ report leave us no
    alternative but to reverse and render judgment dismissing appellees’ claim and awarding attorney’s
    fees and costs. See 
    id. § 74.351(b).
    We remand to the probate court to determine the amount of
    attorney’s fees to which Dr. Bogar is entitled. See Garcia v. Marichalar, 
    198 S.W.3d 250
    , 255
    (Tex. App.—San Antonio 2006, no pet.); Pro Path Servs., L.L.P. v. Koch, 
    192 S.W.3d 667
    , 672
    (Tex. App.—Dallas 2006, pet. denied).
    BACKGROUND
    Appellees sued Dr. Bogar and Healthsouth on May 1, 2006, alleging negligence in
    connection with medical care provided to Katherine R. Guerrero by Dr. Bogar and the “agents,
    servants, employees, representatives, and staff” of Healthsouth Rehabilitation Hospital of Austin
    between December 28, 2004, and January 12, 2005, when Ms. Guerrero died. Appellees alleged that
    following surgery, Ms. Guerrero was placed under the care of Dr. Bogar and Healthsouth and, in the
    course of her rehabilitative treatment, was given a fatal overdose of pharmaceutical products.
    Appellees pleaded that an autopsy report from the Travis County Medical Examiner concluded that
    Ms. Guerrero “died as a result of an overdose of oxycodone and propoxyphene.”
    On or around June 6, 2006, Appellees served on Dr. Bogar and Healthsouth an expert
    report prepared by Dr. Jesse Adame that purported to comply with the requirement of subsection
    74.351(a). See Tex. Civ. Prac. & Rem. Code Ann. § 74.351(a) (“In a health care liability claim, a
    claimant shall, not later than the 120th day after the date the claim was filed, serve on each party or
    the party’s attorney one or more expert reports . . . for each physician or health care provider against
    whom a liability claim is asserted.”). Both defendants timely filed objections to the sufficiency of
    Dr. Adame’s report. See 
    id. (“Each defendant
    physician or health care provider whose conduct is
    implicated in a report must file and serve any objection to the sufficiency of the report not later than
    2
    the 21st day after the date it was served, failing which all objections are waived.”). Each defendant
    contended that Dr. Adame’s report failed to satisfy the statutory definition of an “expert report” by
    failing to provide a fair summary of the expert’s opinions regarding applicable standards of care, the
    manner in which the care rendered by each defendant failed to meet the standards, and the causal
    relationship between such failure and Ms. Guerrero’s death. See 
    id. § 74.351(a),
    (l), (r)(6). Further,
    Dr. Bogar urged that Dr. Adame, a pathologist, had failed to demonstrate that he was an “expert”
    qualified to render opinions concerning the standards of care applicable to Dr. Bogar, a physical
    medicine rehabilitation physician. See 
    id. § 74.351(r)(5),
    §74.401 (West 2005).
    Subsequently, after appellees’ 120-day deadline for serving their expert reports
    expired, see 
    id. § 74.351(a),
    Dr. Bogar and Healthsouth filed a joint motion seeking dismissal with
    prejudice, attorney’s fees and costs for failure to file an expert report complying with section 74.351.
    See 
    id. § 74.351(b).
    Dr. Bogar later filed an amended motion to dismiss adding his earlier challenge
    to Dr. Adame’s qualifications. On January 10, 2007, the probate court denied the dismissal motions.
    Both Dr. Bogar and Healthsouth timely filed notices of interlocutory appeal. In the
    interim, Healthsouth settled with appellees. We accordingly address only the appellate issues
    presented by Dr. Bogar.
    ANALYSIS
    In a single issue, Dr. Bogar argues that the probate court abused its discretion in
    denying his motion to dismiss and request for attorney’s fees and costs. In addition to disputing
    the merits of this contention, appellees have filed a motion to dismiss Dr. Bogar’s interlocutory
    3
    appeal for want of jurisdiction, contending that no statute authorizes him to appeal the order he seeks
    to challenge.
    Jurisdiction
    Appellate courts generally have subject matter jurisdiction only over appeals from
    final judgments and have jurisdiction over appeals of interlocutory orders only when that authority
    is explicitly granted by statute. Academy of Oriental Med., L.L.C. v. Andra, 
    173 S.W.3d 184
    , 185
    (Tex. App.—Austin 2005, no pet.) (citing Stary v. DeBord, 
    967 S.W.2d 352
    , 352-53 (Tex. 1998)).
    Section 51.014(a) of the civil practice and remedies code authorizes an interlocutory appeal from
    two types of orders regarding expert reports under chapter 74. First, an interlocutory appeal may be
    taken from an order that “denies all or part of the relief sought by a motion under Section 74.351(b),
    except that an appeal may not be taken from an order granting an extension under Section
    74.351(c).” Tex. Civ. Prac. & Rem. Code Ann. § 51.014(a)(9) (West Supp. 2006). Second, an
    interlocutory appeal may be taken from an order that “grants relief sought by a motion under Section
    74.351(l).” 
    Id. § 51.014(a)(10).
    Appellees assert that the order from which Dr. Bogar seeks to appeal is neither of
    these. They suggest that “the relief sought by a motion under Section 74.351(b)” is available only
    where a claimant has failed to timely file an instrument purporting to be an “expert report” by the
    120-day deadline of subsection (a), not when a purported “expert report” is timely filed but is found
    to be deficient. See 
    id. § 74.351(b)
    (“If . . . an expert report has not been served within the period
    specified by Subsection (a) . . . .”). Here, appellees maintain, there is no dispute that “the expert
    report of Dr. Adame was served within the required period of time.” Appellees further assert that
    4
    challenges to the sufficiency of expert reports, as contrasted with timeliness, are governed
    exclusively by section 74.351(l). Section 74.351(l) states that “[a] court shall grant a motion
    challenging the adequacy of an expert report only if it appears to the court, after hearing, that the
    report does not represent an objective good faith effort to comply with the definition of an expert
    report in Subsection (r)(6).” 
    Id. § 74.351(l).
    Because Dr. Bogar’s motion, in appellees’ view, is “a
    motion under section 74.351(l),” they assert that his right of interlocutory appeal is controlled by
    section 51.014(a)(10) rather than (a)(9), and no appeal is available from the probate court’s order
    denying him relief. See 
    id. § 51.014(a)(10)
    (permitting appeal from an order that “grants relief
    sought by a motion under Section 74.351(l)”) (emphasis added). They equate this case to Academy
    of Oriental Medicine, L.L.C. v. Andra, where we held that an order denying a motion challenging
    the sufficiency of an expert report was governed by section 74.351(l) rather than section 74.351(b)
    and that “[b]ecause this appeal challenges an order that is neither an order denying the relief sought
    by a motion under § 74.351(b) nor one granting relief sought by a motion under § 74.351(l), we lack
    jurisdiction to hear 
    it.” 173 S.W.3d at 186-89
    .
    We disagree with appellees’ readings of section 74.351 and Andra. Under section
    74.351(b), as we have recently reiterated, an “expert report has not been served within the period
    specified by Subsection (a)” not only if it is untimely (or never) served, but also if the purported
    timely filed “expert report” is deficient with respect to its required contents. See Austin Heart P.A.
    v. Webb, ___ S.W.3d ___, ___; No. 03-06-00607-CV, 2007 Tex. App. LEXIS 3600, at *19
    (Tex. App.—Austin May 9, 2007, no pet. h.); Apodaca v. Russo, ___ S.W.3d ___, ___ No. 03-06-
    00258-CV, 2007 Tex. App. LEXIS 3467, at *13-14 (Tex. App.—Austin May 2, 2007, no pet. h.);
    5
    cf. Walker v. Gutierrez, 
    111 S.W.3d 56
    , 61 (Tex. 2003) (dismissal under former article 4590i
    warranted for “failure to comply” with report deadline by either failure to file or failure to file
    adequate report). This conclusion is apparent from the text and structure of section 74.351.
    Subsection (a) requires the claimant to file one or more “expert reports” not later than the 120th day
    after the date the original petition was filed, and subsection (b) mandates sanctions “[i]f, as to a
    defendant physician or health care provider, an expert report has not been served within the period
    specified by Subsection (a).” “Expert report” is defined within section 74.351 as: “a written report
    by an expert that provides 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.” Tex. Civ. Prac. & Rem. Code Ann. § 74.351(r)(6); see 
    id. § 74.351(r)(5)
    (definition of “expert”). Thus, if the instrument does not comply with subsection (r)’s
    “expert report” definition, it does not satisfy the claimant’s requirement under subsection (a) and
    exposes the claimant to potential sanctions under (b).
    Consistent with this construction, subsection (c) of section 74.351 contemplates that
    noncompliance with the subsection (r) “expert report” definition renders a purported “expert report”
    not “served” for purposes of subsection (a) and (b). Subsection (c) provides that “[i]f an expert
    report has not been served within the period specified by Subsection (a) because elements of the
    report are found deficient,” the trial court is afforded discretion to grant a single 30-day extension
    “in order to cure the deficiency.” Tex. Civ. Prac. & Rem. Code Ann. § 74.351(c) (emphases added).
    Subsection (c), as we will later discuss, is an exception to subsection (b)’s sanctions requirement in
    6
    cases where “an expert report has not been served within the period specified by Subsection (a)”
    because the report is deficient, and applies to a subset of such cases. 
    Id. § 74.351(b).
    Contrary to appellees’ suggestions, section 74.351(l) does not create a distinct
    procedure for challenging the sufficiency of expert reports that is mutually exclusive of motions
    seeking sanctions under subsection (b). Subsection (l) establishes a standard of proof for any motion
    challenging the sufficiency of an expert report: whether the report represents “an objective good
    faith effort to comply with the definition of an expert report in Subsection (r)(6).” 
    Id. § 74.351(l).
    A motion challenging the sufficiency of an expert report, section 74.351 contemplates, may be made
    either before or after the expiration of the 120-day deadline in subsection (a). If made after the
    deadline passes, the defendant may assert the insufficiency of the report as grounds for sanctions
    under subsection (b), subject to subsection (c), for the claimant’s failure to “serve” an “expert report”
    within the 120-day period. If the motion is made before the 120-day deadline—as may be
    necessitated by subsection (a)’s 21-day deadline to file and serve any objection to the sufficiency of
    a purported “expert report,” 
    id. § 74.351(a)—the
    defendant cannot yet seek sanctions under
    subsection (b) because the claimant could still serve a proper “expert report” “within the period
    specified by Subsection (a).” 
    Id. § 74.351(b).
    With this type of motion, unlike a motion seeking
    subsection (b) sanctions, the relief available, as we observed in Andra, “is not so clearly
    enumerated,” but would appear to contemplate a declaration of the report’s insufficiency or the
    striking of 
    it. 173 S.W.3d at 187
    .
    In Andra, we also pointed out that for purposes of the interlocutory appeals available
    under section 51.014(a)(9) and (10), in effect “[a] motion challenging the adequacy of an expert
    7
    report that does not request the relief set out in section 74.351(b) is a motion for relief under
    74.351(l).” 
    Id. We held
    that the motion in question was governed exclusively by subsection (l), and
    thus subject to section 51.014(a)(10), because it had been filed before the claimant’s 120-day
    deadline had expired and had not requested the sanctions of dismissal or attorney’s fees characteristic
    of section 74.351(b) motions. See 
    id. at 186-89.
    However, we acknowledged that “where there is
    no timely expert report because the report or reports were found deficient,” an interlocutory appeal
    would be available “when the court had denied a defendant’s motion [under 74.351(b)] but had not
    granted the plaintiff additional time to cure deficiencies.” 
    Id. at 184
    n.7 (emphasis added).
    Here, Dr. Bogar filed objections to the sufficiency of Dr. Adame’s report within 21
    days of service, see Tex. Civ. Prac. & Rem. Code Ann. § 74.351(a), and a motion, after the 120-day
    deadline had expired, explicitly invoking subsection (b) and asserting that the probate court should
    dismiss appellees’ claim against him with prejudice and award attorney’s fees and costs for failure
    to file a proper “expert report” by the deadline. See 
    id. § 74.351(b).
    The probate court denied that
    motion without granting an 30-day extension. 
    Id. § 74.351(b),
    (c). That order “denies all or part of
    the relief sought by a motion under Section 74.351(b),” and we have subject matter jurisdiction to
    adjudicate Dr. Bogar’s appeal from that order. 
    Id. § 51.014(a)(9);
    see 
    Andra, 173 S.W.3d at 186-87
    .
    We accordingly deny appellees’ motion to dismiss Dr. Bogar’s appeal.
    Sufficiency of Dr. Adame’s report
    We turn now to Dr. Bogar’s issue. In his motion for sanctions under section
    74.351(b), Dr. Bogar asserted that (1) Dr. Adame’s report was insufficient under the “expert report”
    definition of section 74.351(r)(6), and (2) Dr. Adame, as a pathologist, was not qualified as an expert
    8
    to evaluate Dr. Bogar’s performance as a rehabilitative medicine specialist. We agree with the
    former contention and need not reach the latter.
    As noted above, the “expert report” or reports that a health care liability claimant
    must serve under section 74.351(a) must provide “a fair summary of the expert’s opinion as of the
    date of the report regarding the 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.” Tex. Civ. Prac. & Rem. Code Ann.
    § 74.351(r)(6). A trial court, again, must grant a motion challenging the adequacy of a report only
    if the report “does not represent an objective good faith effort to comply” with this definition of
    “expert report.” 
    Id. § 74.351(l).
    To constitute a “good faith effort,” the report must provide enough
    information to fulfill two purposes: (1) it must inform the defendant of the specific conduct the
    plaintiff has called into question; and (2) it must provide a basis for the trial court to conclude that
    the claims have merit. Austin Heart, ___ S.W.3d at ___, 2007 Tex. App. LEXIS 3600, at *4 (citing
    Bowie Mem’l Hosp. v. Wright, 
    79 S.W.3d 48
    , 52 (Tex. 2002); American Transitional Care Ctrs. of
    Tex., Inc. v. Palacios, 
    46 S.W.3d 873
    , 879 (Tex. 2001)). Although a report need not marshal all of
    a claimant’s proof, it must include the expert’s opinion on each of the elements identified in section
    74.351. 
    Id. at *4-5
    (citing 
    Palacios, 46 S.W.3d at 878
    ). It is not enough for the report merely to
    state the expert’s conclusions about the statutory elements. 
    Id. (citing Palacios,
    46 S.W.3d at 379).
    “Rather, the expert must explain the basis of his statements to link his conclusions to the facts.” 
    Id. at *5
    (quoting Bowie 
    Mem’l, 79 S.W.3d at 52
    ) (quoting Earle v. Ratliff, 
    998 S.W.2d 882
    , 890
    (Tex. 1999)).
    9
    Importantly, because the statute dictates what is required in the report, the only
    information relevant to determining whether a report complies with the statute is that within “the
    four corners” of the report. Id. (citing 
    Palacios, 46 S.W.3d at 878
    ). This requirement “precludes
    a court from filling gaps in a report by drawing inferences or guessing as to what the expert likely
    meant or intended.” 
    Id. (citing Bowie
    Mem’l, 79 S.W.3d at 53
    ).
    We review a trial court’s ruling on a section 74.351(b) motion under an abuse of
    discretion standard. 
    Palacios, 46 S.W.3d at 877-78
    . A trial court abuses its discretion when it acts
    in an arbitrary or unreasonable manner or acts without reference to any guiding rules or principles.
    Downer v. Aquamarine Operators, Inc., 
    701 S.W.2d 238
    , 241 (Tex. 1985). A clear failure by the
    trial court to analyze or apply the law correctly also constitutes an abuse of discretion. Walker
    v. Packer, 
    827 S.W.2d 833
    , 840 (Tex. 1992).
    The document prepared by Dr. Adame recites his qualifications and concludes that
    “I am qualified based on my education, training and experience to offer an expert opinion regarding
    the cause and mechanism of death of Mrs. Katherine Ramirez Guerrero. As a pathologist, I am
    familiar with the standard of care required of physicians not to prescribe drugs either alone or in
    combination that will cause a fatal overdose.” “Such conduct,” Dr. Adame adds, “falls below the
    standard of care required of physicians.”
    Dr. Adame then lists the medical records and other materials he had reviewed, and
    summarizes Ms. Guerrero’s medical history. Dr. Adame notes that Ms. Guerrero was 76 years of
    age, and had a “past medical history of hyperlipidemia, osteoarthritis, poorly controlled hypertension,
    and chronic dizziness.” He recounts that Ms. Guerrero had complained of left hip pain following
    10
    a December 25, 2004 fall and had been “admitted to Seton/Brackenridge Hospital after is was
    determined that she had a nondisplaced fracture of the left femur,” but “[i]t was also determined at
    that time, that no surgical intervention was needed.” Adame then states:
    Her medical problems and rehabilitation were managed by HealthSouth
    Rehabilitation Hospital of Austin. She was transferred to that facility on December
    28, 2004. She was placed on a Duragesic patch at 25 mcg on December 29, 2004.
    It was increased to 50 mcg on December 30, 2004 because of continued significant
    pain. She was also given her usual home medications including Doxepin, Norvasc,
    Zescril, Tenormin, and Imdur. Because of significant drowsiness with the Duragesic
    patch, her dose was reduced back to 25 mcg. She was also given Protonix for
    gastrointestinal prophylaxis. Despite a fairly stable hospital course, her pain
    increased. On January 7, 2005, after her records were reviewed and she was cleared
    for surgery, she was taken to the operating room at Seton/Brackenridge Hospital for
    open reduction and internal fixation of her left femur. Her surgery went well and she
    was transferred back to HealthSouth Rehabilitation Hospital of Austin on January 8,
    2005. She resumed her medical regimen along with physical and occupational
    therapy. Her pain persisted and she was taken off of Duragesic patch post surgery.
    OxyContin was added to her therapy, initially at 10 mg and later increased to 20 mg.
    She had bouts of constipation and loose stool which was medically managed. On
    January 12, 2005 at 9:34 p.m. she experienced cardiopulmonary arrest. Despite
    cardiopulmonary resuscitation until 10:13 p.m., she was pronounced dead.
    Dr. Adame then summarizes the “significant findings” of the autopsy report from the Travis County
    Medical Examiner’s Office, including “the conclusions . . . that Mrs. Guerrero died as a result of an
    overdose of oxycodone and propoxyphene.”
    Adame then states his “opinions and conclusions.” He begins: “I concur with the
    autopsy conclusions.” He observes that the medical examiners “performed a complete autopsy with
    toxocological analysis of blood, vitreous humor, and urine,” and references certain autopsy findings.
    Dr. Adame describes the composition and effect of oxycodone and propoxyphene as various dosing
    11
    levels, including the levels indicative of toxicity and death. Drawing on these observations, he states
    the following:
    Mrs. Guerrero had postmortem blood oxycodone concentration of 0.25 mg/L. This
    level and the clinical findings of nausea and labored breathing (noted in nursing notes
    shortly before her death) indicates that the oxycodone was inducing respiratory
    depression.
    *         *       *
    Mrs. Guerrero had postmortem blood propoxyphene levels of 1.0 mg/L. This
    concentration of propoxyphene and the clinical findings of nausea, labored breathing,
    and cardiac arrest (noted in nursing notes shortly before her death) indicates that the
    propoxyphene was inducing respiratory depression, cardiac arrhythmia, and
    circulatory collapse and subsequent death. In addition, the respiratory depression was
    exacerbated by the high concentrations of oxycodone (see above).
    Dr. Adame then concludes:
    In summary, Mrs. Guerrero had toxic levels of oxycodone along with lethal levels of
    propoxyphene which caused her demise. The mechanism of death was respiratory
    depression, cardiac arrhythmia, and circulatory collapse. Additionally, autopsy
    examination failed to demonstrate an anatomic cause of death.
    All of my opinions above are predicated upon a reasonable medical probability.
    Dr. Adame’s report fails to comply with the requirements of section 74.351. Most
    notably, it does not identify the person or persons whose conduct is the subject of any of his opinions
    regarding standard of care, causation, and death. We have held that where the identity of a defendant
    is not explicitly mentioned within the “four corners” of the report, the report is, for that reason alone,
    deficient as to that defendant because it would require the reader to infer or make an educated guess
    as to whose actions the expert is complaining. Austin Heart, ___ S.W.3d at ___, 2007 Tex. App.
    
    12 LEXIS 3600
    , at *15; Apodaca, ___ S.W.3d at ___, 2007 Tex. App. LEXIS 3467, at *13; see
    
    Marichalar, 198 S.W.3d at 255
    . The report likewise fails to explain, among other things, how
    Dr. Bogar breached any standard of care or how that alleged breach caused Ms. Guerrero’s death.
    See Jernigan v. Langley, 
    195 S.W.3d 91
    , 93-94 (Tex. 2006) (affirming dismissal under former article
    4590i where report made only “passing mention” of defendant physician and failed to state how he
    breached the standard of care or how his alleged breach caused injury); see also 
    Palacios, 46 S.W.3d at 879-80
    (conclusory statement that “precautions to prevent [patient’s] fall were not properly
    utilized” did not sufficiently apprise physician whether the expert believed that the standard of care
    required him “to have monitored [the patient] more closely, restrained him more securely, or done
    something else entirely”). We hold that the probate court abused its discretion in denying
    Dr. Bogar’s motion for sanctions under section 74.351(b). We sustain Dr. Bogar’s issue.
    Remedy
    In the probate court, appellees requested that, in the event Dr. Adame’s report was
    found deficient, the court grant them a discretionary 30-day extension under section 74.351(c) to
    enable them to cure any deficiencies in the report. See Tex. Civ. Prac. & Rem. Code Ann.
    § 74.351(c). As earlier noted, subsection (c), like (b), applies when “an expert report has not been
    served within the period specified by Subsection (a).” See 
    id. § 74.351(b)
    , (c). Where the “expert
    report has not been served . . . because elements of the report are found deficient,” the trial court is
    afforded discretion to grant a single 30-day extension in which the claimant can “cure the
    deficiency.” 
    Id. § 74.351(c).
    On appeal, appellees requested that if we reversed the probate court’s
    order denying Dr. Bogar’s motion, we remand to the probate court, in lieu of rendering a judgment
    13
    of dismissal, to afford the lower court the opportunity to exercise its discretion under subsection (c).
    We recently granted such relief in another case involving an “expert report” that we held deficient.
    Austin Heart, ___ S.W.3d at ___, 2007 Tex. App. LEXIS 3600, at *20-21. We discerned that
    subsection (c) manifested legislative intent that in “at least some situations where a timely report is
    deficient . . . the trial court should consider whether the deficiency is such that it warrants allowing
    a cure period.” 
    Id. We found
    such a situation to exist in Austin Heart, and held that subsection (c)
    required us to remand in lieu of rendering a judgment of dismissal and sanctions. 
    Id. In Austin
    Heart, we considered an expert report that repeatedly referred in a
    background section to a defendant physician, Dr. Kessler, among other identified and unidentified
    caregivers, but failed to explicitly link Dr. Kessler’s conduct to the expert’s otherwise sufficient
    opinions regarding the applicable standard of care, how it was breached, and how the breach caused
    injury. 
    Id. at *14-15.
    We concluded that the report was deficient because “it requires the reader to
    infer or make an educated guess that Dr. Cororve [the expert] is identifying Dr. Kessler as the
    physician who breached the standard of care and caused injury” and that “[t]here is nothing in the
    report that links Dr. Kessler to Dr. Cororve’s opinions regarding the breach of the standard of care
    and causation any more than Dr. Rodgers or the other ‘various physicians’ references.” 
    Id. at *11.
    However, we concluded that “[t]he tenor of Dr. Cororve’s report, coupled with the fact that there is
    only one physician defendant, makes it quite likely that Dr. Cororve intended to opine that
    Dr. Kessler breached the standard of care and caused injury even though the report did not contain
    that opinion. The report’s failure on this point is the kind of defect that the cure provisions of section
    74.351(c) were designed to address.” 
    Id. at *14.
    We added that the report “was served timely, it
    14
    makes more than a passing reference to Dr. Kessler, and it notes conduct by Dr. Kessler that could
    be linked to the expert’s conclusions regarding the breach of the standard of care and causation. It
    is deficient only because it does not expressly make the link between the expert’s conclusions and
    the referenced conduct of Dr. Kessler.” 
    Id. at *19.
    We distinguished Dr. Cororve’s report with those that other courts have held to be
    so deficient as to constitute an incurable “no report”—as if the claimant had wholly failed to file an
    instrument purporting to be an “expert report” as to the defendant within the 120-day period–—and
    not merely containing “elements . . . found deficient.” 
    Id. at *19;
    see Tex. Civ. Prac. & Rem. Code
    Ann. § 74.351(c). In Jernigan v. Langley, the Texas Supreme Court affirmed a trial court’s dismissal
    of a health care liability claim as to Dr. Jernigan based on a report that made a mere “passing
    reference” to him and wholly failed to link him or his conduct to the expert’s opinions regarding
    breach of standard of 
    care. 195 S.W.3d at 94
    . The supreme court concluded that “the trial court had
    no discretion but to conclude, as it did here, that Langley’s claims against Dr. Jernigan must be
    dismissed.” 
    Id. Similarly, in
    Garcia v. Marichalar, a report referenced several health care providers
    without mentioning the defendant 
    physician. 198 S.W.3d at 254-55
    . As we observed, “[t]here was
    literally nothing in the report that related to the physician in any way” and that “[t]hus, the report was
    no report to him.” Austin Heart, ___ S.W.3d at ___, 2007 Tex. App. LEXIS 3600, at *16. We
    acknowledged that in these types of cases, trial (and appellate) courts logically could have no
    discretion to effectuate a cure period where no report exists as to a defendant; the only possible
    “cure” would be the creation of a new, previously nonexistent report, an alternative that the
    legislature has forbidden under section 74.351. 
    Id. at *18;
    see Apodaca, ___ S.W.3d at ___, 2007
    Tex. App. LEXIS 3467, at *13; 
    Marichalar, 198 S.W.3d at 255
    .
    15
    We contrasted these reports with that in Austin Heart, observing that:
    [i]f the expert is of the opinion that Dr. Kessler’s conduct breached the standard of
    care and caused injury, he will not have to generate a new, previously nonexistent
    report. He will simply have to add the link between his already stated conclusions
    and the already referenced conduct of Dr. Kessler. Therefore, the circumstances here
    are not similar to the situation where a plaintiff simply has missed the deadline for
    serving a report with respect to the conduct of a physician.
    Austin Heart, ___ S.W.3d at ___, 2007 Tex. App. LEXIS 3600, at *21. By contrast, we conclude
    that the present case is.
    As previously noted, Dr. Adame never mentions Dr. Bogar anywhere in his report.
    He never describes the standard of care potentially applicable to Dr. Bogar, other than a broad
    reference to “the standard of care required of physicians not to prescribe drugs either alone or in
    combination that will cause a fatal overdose,” which he never applies or analyzes in light of specific
    facts and circumstances. Dr. Adame never describes how Dr. Bogar might have breached a standard
    of care. In essence, Dr. Adame’s report is a second autopsy report, opining about the cause of
    Ms. Guerrero’s death without explaining who caused it or how.
    Although the line between “no report” and a defective-but-curable report may
    sometimes be elusive, we conclude that Dr. Adame’s report is clearly “no report.” Its defects include
    the types of wholesale omissions identified in Jernigan and Marichalar, and Dr. Adame cannot cure
    them simply by “add[ing] the link between his already stated conclusions and the already referenced
    conduct” of Dr. Bogar. See Austin Heart, ___ S.W.3d at ___, 2007 Tex. App. LEXIS 3600, at *21.
    There is nothing in the report regarding Dr. Bogar that could be linked to anything. Consequently,
    16
    Dr. Adame could “cure” the deficiencies in his report only by “generat[ing] a new, previously
    nonexistent report” as to Dr. Bogar. See 
    id. Such a
    remedy is proscribed by section 74.351.1
    CONCLUSION
    We must render judgment dismissing appellees’ claims against Dr. Bogar with
    prejudice and awarding Dr. Bogar attorney’s fees and costs. See Tex. Civ. Prac. & Rem. Code Ann.
    § 74.351(b). We remand to the probate court for a determination of the amount of the attorney’s fee
    award. See 
    Marichalar, 198 S.W.3d at 256-57
    ; Pro Path Servs., L.L.P. v. Koch, 
    192 S.W.3d 667
    ,
    672 (Tex. App.—Dallas 2006, pet. denied).
    __________________________________________
    Bob Pemberton, Justice
    Before Justices Patterson, Pemberton and Waldrop;
    Dissenting Opinion by Justice Patterson
    Reversed and Remanded
    Filed: June 28, 2007
    1
    The dissent criticizes this holding, suggesting that we could remand to the probate court
    in the same manner as in Austin Heart, ___ S.W.3d at ___ (Patterson, J., dissenting). As the dissent
    has acknowledged in Austin Heart and elsewhere, section 74.351 does not permit such a remedy
    where, as here, the report constitutes no report. See Austin Heart, ___ S.W.3d at ___, 2007
    Tex. App. LEXIS 3600, at *39 (Patterson, J., dissenting) (“[t]he difference between the two is
    strategically significant. If the report is ‘no report,’ then the trial court must dismiss the case with
    prejudice and has no discretion to grant a 30-day extension.”) (emphasis in original); Apodaca, ___
    S.W.3d at ___, 2007 Tex. App. LEXIS 3467, at *13 (“If a report fails to address the defendant
    physician, it constitutes no report as to that defendant, and the trial court may not grant a 30-day
    extension.”) (citing Garcia v. Marichalar, 
    185 S.W.3d 70
    , 74 (Tex. App. San Antonio 2005,
    no pet.).
    17