Rodolfo De La Pena, Individually, on Behalf of All Wrongful Death Beneficiaries and as Personal Representative of the Estate of Beatriz De La Pena v. Kevin R. Gordon, M.D. ( 2019 )


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  •                          In the
    Court of Appeals
    Second Appellate District of Texas
    at Fort Worth
    ___________________________
    No. 02-18-00030-CV
    ___________________________
    RODOLFO DE LA PEÑA, INDIVIDUALLY, ON BEHALF OF ALL WRONGFUL
    DEATH BENEFICIARIES AND AS PERSONAL REPRESENTATIVE OF THE
    ESTATE OF BEATRIZ DE LA PEÑA, Appellant
    V.
    KEVIN R. GORDON, M.D., Appellee
    On Appeal from the 17th District Court
    Tarrant County, Texas
    Trial Court No. 017-263281-12
    Before Gabriel, Pittman, and Bassel, JJ.
    Memorandum Opinion by Justice Pittman
    MEMORANDUM OPINION
    A jury found in favor of Appellee Kevin R. Gordon, M.D., on the health care
    liability claim brought against him by Appellant Rodolfo De La Peña (Rodolfo),
    individually, on behalf of all wrongful death beneficiaries, and as personal
    representative of the estate of his wife Beatriz De La Peña (Beatriz). 1 In three issues,
    Rodolfo contends that the evidence was legally and factually insufficient to support
    the jury’s finding of no negligence, that the trial court erred in denying his motion for
    judgment notwithstanding the verdict, and that the trial court erred in denying his
    motion for new trial. We affirm.
    BACKGROUND
    On December 20, 2010, Beatriz went to Trinity Park Surgery Center for a
    laparoscopic hysterectomy and hernia repair.            Dr. Gordon performed the
    hysterectomy. Dr. Jason Harrison performed the hernia repair. During the surgery,
    upon discovering the severity of Beatriz’s endometriosis, Dr. Gordon decided to
    remove her ovaries and to convert from laparoscopic to open surgery. The surgery
    lasted two hours. Dr. Gordon then transferred Beatriz to Medical Center Arlington
    (MCA) for monitoring. Dr. Gordon was the admitting and attending physician. On
    the evening of December 21, while still at MCA, Beatriz died from a pulmonary
    embolism (PE).
    Because Rodolfo De La Peña and Beatriz De La Peña share the same last
    1
    name, we use their first names to distinguish them in this opinion.
    2
    Rodolfo sued Dr. Gordon for failing to prevent the PE.2 He alleged that Dr.
    Gordon had negligently failed to properly perform the medical treatment necessary to
    Beatriz’s welfare and to provide proper assessment and treatment for the prevention
    of deep vein thrombosis (DVT) and PE. Rodolfo pled for damages for himself and
    the couple’s children under Texas’s Wrongful Death Act. See Tex. Civ. Prac. & Rem.
    Code Ann. § 71.002.
    At trial, Rodolfo called Dr. Paul E. Marik, an internist and critical care
    specialist, to testify as an expert. Dr. Marik testified that a DVT can cause a PE and
    that patients at risk for a DVT must be given appropriate DVT prophylaxis. Dr.
    Marik explained that under the applicable guidelines, Beatriz had a high DVT risk and
    that patients with a high DVT risk must be given certain blood thinners, wear a
    sequential compression device (SCD), or be ambulating, or have some combination of
    the three options. Dr. Gordon agreed with this part of Dr. Marik’s testimony.
    Dr. Marik further testified that Dr. Gordon breached the applicable standard of
    care by failing to provide Beatriz with appropriate DVT prophylaxis. Either Rodolfo
    or one of his and Beatriz’s daughters were in her hospital room at all times, and they
    testified that while Beatriz was at MCA, she walked no more than a few steps from
    2
    He also sued Dr. Harrison, Trinity Park, MCA nurse Beverly Cobb, and Dr.
    John Tiu, a critical care doctor who attempted to treat the PE at MCA. He nonsuited
    without prejudice Tiu, Trinity Park, and Nurse Cobb. Prior to trial, the trial court
    signed an agreed order dismissing with prejudice the claims against MCA and an order
    dismissing with prejudice the claims against Dr. Harrison.
    3
    her bed to a chair and back and did not have on an SCD. Dr. Gordon testified that
    he did not order that Beatriz be administered blood thinners because of a risk of
    postoperative bleeding, but he presented evidence contradicting Dr. Marik’s testimony
    about whether he ordered an SCD and whether Beatriz was ambulating.
    The jury found that there was no negligence by Dr. Gordon that proximately
    caused Beatriz’s death. Rodolfo filed a motion for new trial and a motion for JNOV.
    The trial court denied the motion for JNOV and rendered judgment that Rodolfo
    take nothing. The motion for new trial was denied by operation of law.
    STANDARD OF REVIEW
    We may sustain a legal-sufficiency challenge—that is, a no-evidence
    challenge—only when (1) the record discloses a complete absence of evidence of a
    vital fact, (2) the rules of law or of evidence bar the court from giving weight to the
    only evidence offered to prove a vital fact, (3) the evidence offered to prove a vital
    fact is no more than a mere scintilla, or (4) the evidence establishes conclusively the
    opposite of a vital fact. Ford Motor Co. v. Castillo, 
    444 S.W.3d 616
    , 620 (Tex. 2014) (op.
    on reh’g); Uniroyal Goodrich Tire Co. v. Martinez, 
    977 S.W.2d 328
    , 334 (Tex. 1998) (op.
    on reh’g). In determining whether legally sufficient evidence supports the finding
    under review, we must consider evidence favorable to the finding if a reasonable
    factfinder could and must disregard contrary evidence unless a reasonable factfinder
    could not. Cent. Ready Mix Concrete Co. v. Islas, 
    228 S.W.3d 649
    , 651 (Tex. 2007); City of
    Keller v. Wilson, 
    168 S.W.3d 802
    , 807, 827 (Tex. 2005). If a party is attacking the legal
    4
    sufficiency of an adverse finding on an issue on which the party had the burden of
    proof, and if no evidence supports the finding, we review all the evidence to
    determine whether the contrary proposition is established as a matter of law. Dow
    Chem. Co. v. Francis, 
    46 S.W.3d 237
    , 241 (Tex. 2001); Sterner v. Marathon Oil Co.,
    
    767 S.W.2d 686
    , 690 (Tex. 1989).
    When reviewing a party’s assertion that the evidence is factually insufficient to
    support a finding on which the party had the burden of proof, we set aside the finding
    only if, after considering and weighing all the pertinent record evidence, we determine
    that the failure to find is against the great weight and preponderance of the credible
    evidence. Dow 
    Chem., 46 S.W.3d at 242
    ; Cropper v. Caterpillar Tractor Co., 
    754 S.W.2d 646
    , 651 (Tex. 1988); see Gonzalez v. McAllen Med. Ctr., Inc., 
    195 S.W.3d 680
    , 681–
    82 (Tex. 2006).
    DISCUSSION
    I.    The Jury’s Verdict Is Supported by Sufficient Evidence.
    In his first issue, Rodolfo contends that the jury’s verdict is not supported by
    legally and factually sufficient evidence. However, in his brief he discusses only the
    evidence contrary to the finding and fails to discuss the evidence supporting the
    finding.   See In re A.C., 
    560 S.W.3d 624
    , 631 (Tex. 2018) (stating that factual
    sufficiency review requires weighing disputed evidence contrary to the finding against
    all the evidence favoring the finding). After reviewing the record, we hold that
    sufficient evidence supports the jury’s verdict.
    5
    The evidence established that upon Beatriz’s admission to MCA, she was at
    high risk for a DVT. Dr. Marik testified that DVT prevention guidelines published by
    various health organizations set the standard of care for DVT prevention and specify
    the options for high-risk patients. Dr. Gordon equivocated about what the applicable
    standard of care requires for DVT prevention, but he agreed with Dr. Marik’s
    testimony about what the guidelines on which Dr. Marik relied called for regarding
    DVT prophylaxis options, and defense witness Dr. Russell Dickey stated that “[t]he
    standard of care is that you follow a guideline to prevent DVT.” Both sides presented
    evidence that under applicable guidelines, there are three recognized options for DVT
    prevention: (1) chemical or pharmacological prophylaxis, primarily in the form of
    either low-dose unfractionated heparin or low-molecular-weight heparin (Lovenox);
    (2) mechanical prophylaxis by way of SCDs, which squeeze the legs 3; or
    (3) ambulating. However, as we discuss below, the jury heard conflicting evidence
    about whether Dr. Gordon ordered appropriate DVT prevention measures at MCA,
    whether chemical prophylaxis was contraindicated for Beatriz, whether she wore an
    SCD at MCA, and whether she was walking enough for DVT prevention.
    Dr. Harrison testified that “[b]asically SCDs are supposed to simulate the act
    3
    of walking” and that walking “stimulates proteins to start a fibrinolytic system,
    whatnot, to try to prevent the coagulation cascade from—from coming down and
    making a DVT.”
    6
    A.     Sufficient Evidence Supports a Finding that Dr. Gordon Properly
    Declined to Order Chemical Prophylaxis.
    Dr. Gordon did not dispute that Beatriz had no chemical prophylaxis
    administered. He testified that he decided against using it because Beatriz was at risk
    for bleeding, and thus using an anticoagulant could be deadly.
    Dr. Gordon provided two bases for his opinion that Beatriz was at risk for
    bleeding. First, a lab test measured her pre-surgery hemoglobin concentration level at
    9.5, but a measurement an hour after surgery, run on a different machine at Trinity
    Park, showed her hemoglobin concentration at 6.4. A repeated test at Trinity Park an
    hour later had the same result. The difference between 9.5 and 6.4 represents about
    three units of blood. That much blood loss could indicate she was bleeding internally,
    which would contraindicate chemical prophylaxis.
    The two sides presented conflicting evidence about whether the hemoglobin
    concentration test results from Trinity Park were accurate and consequently whether
    Dr. Gordon reasonably relied on them to conclude that chemical prophylaxis was
    contraindicated. Dr. Marik pointed out that a lab test performed at MCA at 5:00 p.m.
    on the same day measured Beatriz’s hemoglobin concentration level at 8.2. Dr. Marik
    opined that it was medically impossible for Beatriz’s hemoglobin concentration levels
    to increase that much in that little time. “That does not happen in medical science”—
    a human cannot transfuse themselves, and “the only way the blood hemoglobin could
    have gone from a 6.4 to 8.2 is either [Beatriz] received a blood transfusion, which we
    7
    know didn’t happen, or the two previous [6.4] numbers were spurious.” Dr. Marik
    further opined that, considering that Beatriz showed no signs or symptoms of active
    bleeding, Dr. Gordon should have concluded that the earlier Trinity test results were
    inaccurate and that Beatriz was not actively bleeding. He testified that in that case,
    given Beatriz’s high risk for a DVT, Dr. Gordon should have administered an
    anticoagulant. Dr. Gordon disputed that Beatriz’s stable vital signs ruled out an active
    bleed. He explained that she had chronic anemia, and her body had therefore adapted
    to having less blood and had developed “a lot of defense mechanisms to keep blood
    going to your brain, keep that blood pressure up.” However, Dr. Gordon offered no
    probative evidence to contradict Dr. Marik’s testimony that Beatriz’s hemoglobin
    concentration level could not have risen that quickly. 4
    Nevertheless, Dr. Gordon offered a second, independent reason Beatriz was at
    risk for bleeding: the state of Beatriz’s blood vessels. Dr. Gordon explained that after
    her surgery, Beatriz had what he described as extensive “raw surface” internally, giving
    her a “significant high risk” for postoperative bleeding. Dr. Gordon stated that while
    Beatriz had no bleeding arteries at the end of the surgery, during the procedure she
    4
    Dr. Harrison testified that the different results were not surprising given that
    the test with the 6.4 result was done using a machine at Trinity Park and the later
    8.2 reading came from a different machine in a lab at MCA. Dr. Harrison was asked
    if he agreed with Dr. Marik that the 6.4 was “impossible because she’s too close to
    being out of surgery and her metabolism could not equilibrate within this time frame,”
    to which he responded, “Not at all,” but did not explain the basis for that opinion.
    No defense witness explained how Beatriz’s hemoglobin concentration could have
    increased that much in that time period without a transfusion.
    8
    had a large amount of “ooze,” that is, blood oozing from blood vessels. He explained
    that once in surgery, he and Dr. Harrison discovered that Beatriz had severe
    endometriosis, and Dr. Harrison testified that oozing can occur from the
    inflammation that endometriosis causes.         Dr. Harrison stated that “oozing just
    basically doesn’t stop with the normal things that we use to try to stop” bleeding. He
    testified that with that kind of oozing, the surgeon can end the procedure with no
    evidence of bleeding, but then, once the patient is no longer anesthetized and their
    blood pressure goes up, “[t]hat oozing can . . . start up again.” Dr. Gordon agreed
    that once the patient’s blood pressure “get[s] turned up,” “all of a sudden those areas
    that you didn’t appreciate that were oozy, now can be a little bit more . . . of a
    concern.” And, Dr. Peter Heidbrink,5 testifying for Dr. Gordon, confirmed that
    chemical prophylaxis can cause “significant postoperative bleeding” because “[t]hat’s
    their job, is to prevent clotting, so if you’re preventing clotting, then you’re—you’re
    maybe propagating bleeding.”
    Dr. Marik told the jury that even if a patient is undergoing a type of surgery
    that generally carries a bleeding risk, the patient nevertheless can receive a low dose of
    anticoagulant (i.e., a form of chemical prophylaxis) because “if it’s low dose . . . it
    doesn’t increase the risk of bleeding significantly,” and it is therefore used with
    patients who have had major surgery. Thus, if a patient has a high DVT risk, “you
    5
    Like Dr. Marik, Dr. Heidbrink is a specialist in internal medicine and critical
    care medicine.
    9
    would use both” chemical prophylaxis and SCDs. And, if after the surgery the doctor
    determines that the patient “truly” has a high risk for bleeding, it is “a time-limited
    contraindication [for chemical prophylaxis]. It’s not a forever contraindication. It’s
    until the risk of bleeding is less.” And Rodolfo introduced evidence that Dr. Tiu, in
    attempting to treat Beatriz’s PE, administered Lovenox.
    On the other hand, Dr. Gordon told the jury that he did not believe it was safe
    to give Beatriz chemical prophylaxis at any time while she was at MCA. He explained,
    [Beatriz] had such extensive raw surfaces. Even though a patient may
    not be actively bleeding— . . . [e]ven though she may not be actively
    bleeding, I did not feel, nor did any of the other surgeons there feel
    comfortable in placing her on pharmacologic anticoagulation within the
    first 24 hours after surgery[.] [T]hat was . . . not an option. Even if . . . I
    had checked [her hemoglobin concentration] Tuesday morning and it
    was exactly the same, I’m still not going to order anticoagulation, given
    the surfaces. It takes longer than, you know, sometimes just a few hours
    to allow that peritoneal surface, which had been completely removed, to
    heal back and grow to where that risk of bleeding decreases. It does not
    decrease just in the first 24 hours.
    Dr. Gordon told the jury, “in my professional opinion, if I gave [Beatriz]
    anticoagulation after surgery, then I think I would be sitting here under an
    exsanguination trial of how I killed Ms. De La Peña this way.” Dr. Heidbrink agreed,
    stating that had Beatriz been given medication to prevent a DVT, “she would have
    bled everywhere”; “it would have been a different way for her to expire.”
    With the evidence presented by Dr. Gordon, even accepting Dr. Marik’s
    testimony that Dr. Gordon should have known that the postsurgical hemoglobin
    concentration testing at Trinity Park was not accurate and was not an indication of
    10
    active bleeding, the jury could reasonably find that Beatriz had a high postoperative
    risk of bleeding and that Dr. Gordon was not negligent in concluding that chemical
    prophylaxis was contraindicated.
    B.     Sufficient Evidence Supports a Finding that Dr. Gordon Properly
    Ordered SCDs and Reasonably Believed They Were Used.
    Dr. Gordon acknowledged that, given that Beatriz had no chemical
    prophylaxis, DVT prevention protocol required her to be walking or wearing an SCD.
    The parties presented contradictory evidence about whether Beatriz wore an SCD
    while at MCA.
    While Dr. Gordon’s preoperative orders for Beatriz include an order for
    Beatriz to wear an SCD at Trinity Park, Dr. Marik testified that the orders did not
    automatically transfer to and become effective at MCA, even if they were included
    with the part of her medical chart that Trinity Park sent with Beatriz to MCA. He
    stated that Dr. Gordon, as the physician admitting Beatriz to MCA, had to write a
    DVT prevention order specifically for MCA, including ordering an SCD, but that the
    record is devoid of SCD orders at MCA.
    Dr. Gordon, however, testified to the contrary—that he transferred the
    preoperative orders, including the SCD order, to MCA and that they therefore
    became effective there. In fact, he had “[n]o doubt at all” that his SCD order was in
    place at MCA. Dr. Heidbrink agreed with Dr. Gordon that his order from Trinity
    11
    Park transferred to MCA. He explained, “Perhaps it varies from . . . state to state,”
    but “it’s the standard in Texas. That’s the way we transfer patients.”
    As for whether Dr. Gordon negligently relied on the nurses following the SCD
    order, the parties again presented conflicting evidence. Dr. Gordon testified that he
    expects nurses to follow his orders and the applicable DVT prevention protocols, and
    if “the patient is unable to do that,” then he expects a nurse to call him. And in
    Beatriz’s chart, at 7:30 a.m. on the 21st, Nurse Cobb included this note: “DVT
    Guidelines initiated/continued? Y.” Although there was some evidence that the
    nurses did not follow all of Dr. Gordon’s orders (as noted below), he testified that at
    the time he had no doubt that they were following his SCD order. Dr. Heidbrink
    testified that from his review of the nurses’ notes in Beatriz’s medical chart from
    MCA, it appeared that the nurses were following Dr. Gordon’s orders for DVT
    prevention. Dr. Heidbrink further testified that he would expect the MCA nursing
    staff to carry out Dr. Gordon’s orders and, importantly, that it was appropriate for
    Dr. Gordon to write orders for DVT prevention and then delegate to the nurses the
    duty of carrying them out.
    Both sides also presented conflicting evidence about whether Beatriz wore an
    SCD as ordered and to the extent necessary to prevent a DVT. Dr. Marik testified
    that in order for SCDs to work, “they have to be on the patient, on the patient’s legs
    for at least 18 hours a day.” Dr. Gordon and Dr. Harrison both testified that Beatriz
    wore an SCD during the surgery at Trinity Park, and the operating room record for
    12
    the procedure supports this testimony.6 Beatriz’s husband and daughters testified that
    at MCA, however, Beatriz did not wear an SCD. Beatriz’s MCA records indicate that
    an SCD was not in place at her admission to MCA on the 20th, was on at 9 p.m. that
    night, and was off again at 7:30 the next morning. The records contain no other
    references to whether Beatriz had on an SCD.
    However, Dr. Gordon testified that Beatriz was transferred from Trinity Park
    wearing an SCD and that he saw Beatriz wearing an SCD when he visited her around
    6 p.m. on the 20th. Beatriz was admitted to MCA at 3:15 p.m. on the 20th. The jury
    thus had evidence that she was wearing an SCD through her surgery and transfer, was
    not wearing one at 3:15 p.m. but was wearing one again by no later than 6 p.m., and
    was wearing one several hours later. Dr. Gordon further testified that although
    Beatriz was not wearing an SCD when he saw her on the 21st, the nurses told him
    that she had just returned to bed after standing. Dr. Gordon explained that it was
    appropriate for Beatriz not to wear an SCD while standing or walking, as it creates a
    fall risk. Dr. Heidbrink also testified that SCDs are removed once a patient is walking
    because when a patient is walking, SCDs are no longer necessary. As discussed
    below, the jury also heard evidence that Beatriz was up and walking on both the 20th
    and the 21st.
    A “pre-op checklist” completed by a Trinity Park nurse left blank the check
    6
    box next to “SCD’s [sic] applied.” However, the operating room record states that an
    SCD was “on functioning prior to induction.”
    13
    Based on this evidence, the jury could find that Dr. Gordon followed DVT
    prevention guidelines by ordering that Beatriz wear an SCD and that he was
    reasonable to rely on the nurses to carry out his orders and to believe that they were
    doing so. Further, the jury could believe his testimony that he personally saw Beatriz
    wearing an SCD and the nurse’s note that she had one on in the evening of the 20th
    and could consequently disbelieve her family’s testimony that she did not wear them
    at any point.
    C.        Sufficient Evidence Supports a Finding that Dr. Gordon Ordered
    Beatriz to Ambulate and that She Did So.
    As part of his postoperative orders at Trinity Park, Dr. Gordon instructed that
    Beatriz should “ambulate as tolerated.” On the morning of the 21st, he wrote an
    order at MCA for her to “ambulate with assistance.”7            The parties offered
    contradictory testimony about whether she did so.
    Beatriz’s family members testified that while at MCA, Beatriz stayed in her
    hospital bed except to go to the sink to rinse her throat and to move to a chair for a
    sponge bath. Dr. Gordon agreed that this minimal amount of walking would not be
    sufficient ambulation to prevent a DVT. However, Dr. Gordon presented evidence
    that Beatriz did more walking than what her family described.
    7
    Dr. Marik defined “ambulating” as “walk[ing] without support at a rate less
    than running.” Other witnesses, including Dr. Gordon, disputed the “without
    support” part of Dr. Marik’s definition for purposes of DVT prevention, asserting
    instead that as long as a patient is moving her legs, her walking works as DVT
    prevention.
    14
    Records from Trinity Park show that on May 20, a Trinity Park nurse called
    and spoke to Rodolfo, who reported that Beatriz was “up and walking.” Rodolfo
    testified that he did not have that conversation and could not have spoken to the
    nurse at the time she claimed to have called because he was at work and could not
    take calls. One of his daughters testified that she and her sister were the only ones at
    the hospital with Beatriz at that time and were therefore the only ones in the family
    who had knowledge about whether Beatriz was walking, and they did not tell their
    father that she was. Nevertheless, the jury could have believed the nurse’s note.
    As for Beatriz’s activity on the 21st, Dr. Gordon testified without objection
    that Nurse Cobb stated in her deposition that she helped Beatriz walk in the hallway
    that day and also saw Beatriz walking in the hallway with a family member. (Nurse
    Cobb was not called to testify, either live or by deposition.) Dr. Gordon testified that
    he believed Beatriz was walking, that he gave orders for her to walk with assistance,
    that nurses did not tell him that she was not walking, and that he had no doubt that
    the nurses were following his orders to have her walk. 8 And, as noted above, he
    8
    The nurses did not follow all of Dr. Gordon’s orders. On the 21st, his written
    orders included an instruction for Beatriz to shower. However, the nurses’ notes state
    that upon Dr. Gordon’s approval, they gave her a sponge bath instead. Dr. Gordon
    acknowledged at trial that in fact he did not approve the sponge bath instead of a
    shower. He nevertheless believed the deposition testimony of Nurse Cobb (which he
    read prior to trial) on the subject of whether Beatriz was walking. He stated, “[S]he
    didn’t take a shower, . . . but I can’t say that she was not walking, because . . . Nurse
    Cobb stated that she walked with the patient in the hallway once and saw her walking
    in the hallway once with a family member.”
    15
    testified that he expected a nurse to call him if for some reason Beatriz was unable to
    follow his orders. Further, Dr. Harrison testified that he visited Beatriz on the
    morning of the 21st and saw her walking with support from a family member and an
    IV pole. A nurse’s notes on the 21st twice indicate that Beatriz did not feel well
    enough to walk at that time but promised to walk later in the day, but a nurse’s note
    from earlier in the day characterizes her activity as “walks occasionally.”
    The jury had sufficient evidence to believe that, in accordance with DVT
    prevention guidelines, Dr. Gordon appropriately ordered Beatriz to ambulate, that he
    believed her to be walking as ordered, that he was reasonable to believe that the
    nurses would call him if Beatriz was not walking sufficiently, and that she was walking
    on the 20th and the 21st, and not just to the sink or a chair in her room.
    In summary, the jury heard evidence on which it could base a finding that Dr.
    Gordon appropriately declined to order chemical prophylaxis, that he appropriately
    ordered mechanical prophylaxis, that mechanical prophylaxis was employed, that
    Beatriz was ambulating for DVT prevention, and that Dr. Gordon reasonably
    believed she was ambulating sufficiently for DVT prevention. Based on this record,
    applying the appropriate standards of review, the evidence was legally and factually
    sufficient to support the jury’s finding that Dr. Gordon was not negligent. More than
    a scintilla of evidence supported the jury’s finding, and the finding was not against the
    great weight and preponderance of credible evidence. We overrule Rodolfo’s first
    issue. See Coronel v. Providence Imaging Consultants, P.A., 
    484 S.W.3d 635
    , 638 (Tex.
    16
    App.—El Paso 2016, pet. denied) (stating that in a medical malpractice case, a
    plaintiff must prove the defendant breached the applicable standard of care); Parrott v.
    Caskey, 
    873 S.W.2d 142
    , 149 (Tex. App.—Beaumont 1994, no writ) (stating that a
    viable cause of action under the Wrongful Death Act requires a showing that the
    decedent’s death was caused by the negligence of the defendant).
    II.    The Trial Court Did Not Abuse its Discretion in Denying Rodolfo’s
    Motion for New Trial by Operation of Law.
    In his second issue, Rodolfo asserts that the trial court erred in overruling his
    motion for new trial. We review a trial court’s denial of a motion for new trial for
    abuse of discretion. Dolgencorp of Tex., Inc. v. Lerma, 
    288 S.W.3d 922
    , 926 (Tex. 2009).
    A trial court abuses its discretion if it acts without reference to any guiding rules or
    principles—that is, if its act is arbitrary or unreasonable. Low v. Henry, 
    221 S.W.3d 609
    , 614 (Tex. 2007); Cire v. Cummings, 
    134 S.W.3d 835
    , 838–39 (Tex. 2004). Because
    legally and factually sufficient evidence supports the jury’s verdict, the trial court did
    not abuse its discretion in denying the motion for new trial.
    III.   The Trial Court Did Not Err in Denying Rodolfo’s JNOV Motion.
    In his third issue, Rodolfo argues that the trial court erred in overruling his
    JNOV motion. We disagree. “A motion for JNOV should be granted when the
    evidence is conclusive and one party is entitled to recover as a matter of law or when
    a legal principle precludes recovery.” Morrell v. Finke, 
    184 S.W.3d 257
    , 290 (Tex.
    App.—Fort Worth 2005, pet. denied). Because the evidence did not conclusively
    17
    establish Rodolfo’s right to recover, and he has not argued any legal principle
    precludes recovery, we overrule this issue. See id.; Fredonia State Bank v. Gen. Am. Life
    Ins. Co., 
    881 S.W.2d 279
    , 284–85 (Tex. 1994) (recognizing long-standing rule that error
    may be waived due to inadequate briefing); Devine v. Dallas Cty., 
    130 S.W.3d 512
    , 513–
    14 (Tex. App.—Dallas 2004, no pet.) (holding party failing to adequately brief
    complaint waived issue on appeal).
    CONCLUSION
    Having overruled Rodolfo’s three issues, we affirm the trial court’s judgment.
    /s/ Mark T. Pittman
    Mark T. Pittman
    Justice
    Delivered: April 4, 2019
    18