Opinion
No. 09-06-443 CV.
Submitted on January 11, 2007.
Opinion Delivered February 15, 2007.
On Appeal from the 172nd District Court Jefferson County, Texas. Trial Cause No. E-177080.
Before McKEITHEN, C.J., GAULTNEY and KREGER, JJ.
MEMORANDUM OPINION
This appeal involves the adequacy of an expert report in a healthcare liability claim. After complaining of shoulder and chest pains, Wanda Lanham was admitted to Christus Health Southeast Texas, d/b/a Christus St. Elizabeth Hospital. During her hospitalization, a nursing assistant helped Lanham take a shower. While Lanham sat on a shower chair, the chair collapsed underneath her. Lanham filed suit against the hospital for injuries she sustained in the fall. St. Elizabeth appeals the trial court's denial of its motion challenging the sufficiency of the expert report of Cissi Oloomi, RN. See Tex. Civ. Prac. Rem. Code Ann. § 74.351( l) (Vernon Supp. 2006). We affirm the trial court's order.
The parties agree Chapter 74 of the Civil Practice and Remedies Code applies and an expert report is required. See id. § 74.351(a). Lanham served expert reports from Dr. Major Blair and Cissi Oloomi, RN. See id. Oloomi's report supplied the standard of care expected of hospitals and nurses in providing care to patients and stated how St. Elizabeth failed to meet those standards. See id. § 74.351(r)(6). Blair's report addressed the causal connection relationship between the breach of the standard of care and the injury, harm, or damages claimed. See id. St. Elizabeth filed a motion to dismiss challenging the sufficiency of both reports. The hospital argued that Oloomi's report failed to adequately address the applicable standard of care and the specific conduct that breached the standard of care. The hospital complained that Blair's report failed to adequately address the causal relationship between the alleged breach of the standard of care and the alleged harm. The trial court granted the hospital's challenge to Blair's report and denied the challenge to Oloomi's report. Lanham supplemented Blair's report. On appeal, St. Elizabeth contests only the trial court's ruling regarding the sufficiency of Oloomi's report.
We review a trial court's decision regarding the adequacy of an expert report under an abuse of discretion standard. Am. Transitional Care Ctrs. of Tex., Inc. v. Palacios, 46 S.W.3d 873, 878 (Tex. 2001). "A trial court abuses its discretion if it acts in an arbitrary or unreasonable manner without reference to any guiding rules or principles." Bowie Mem'l Hosp. v. Wright, 79 S.W.3d 48, 52 (Tex. 2002). A trial court does not abuse its discretion merely by deciding a discretionary matter differently than an appellate court would under similar circumstances. Downer v. Aquamarine Operators, Inc., 701 S.W.2d 238, 242 (Tex. 1985).
Plaintiffs who assert a healthcare liability claim must provide each defendant physician and healthcare provider an expert report. Tex. Civ. Prac. Rem. Code Ann. § 74.351(a). The issue for the trial court is whether the report represents a good-faith effort to provide a fair summary of the expert's opinions. Palacios, 46 S.W.3d at 878. To constitute a good faith effort, the report "must discuss the standard of care, breach, and causation with sufficient specificity to inform the defendant of the conduct the plaintiff has called into question and to provide a basis for the trial court to conclude that the claims have merit." Id. at 875. A report does not need to marshal all of the plaintiff's proof, but must include the expert's opinion on each of the statutory elements. See id. at 878.
In her report, Oloomi cites the following three sections of The Joint Commission on the Accreditation of Hospital Organizations: (1) Standard EC.1.10 for managing safety risks; (2) Standard EC.1.20 for maintaining a safe environment; and (3) Standard EC.8.10 for establishing and maintaining an appropriate environment. She asserts these standards must be met to ensure patient safety and the appropriate care. The report then states that the standard of care requires the effective management of the environment of care in the following manner: by reducing and controlling environmental hazards and risks, preventing accidents and injuries, and maintaining safe conditions for patients. The hospital must perform periodic inspections of all equipment, identify risks by performing environmental tours, and see that safety policies and procedures are followed to ensure proper maintenance and safety of all equipment. All furnishings and equipment must be maintained and inspected and must be safe and in good repair. In addition, there should be a policy regarding the removal of any equipment that needs repair or is not in good working order and all personnel should be oriented regarding that policy.
Oloomi states that the hospital breached the standard of care by failing to provide Lanham with a shower chair that was safe and in good working order. She says the hospital also failed to have systems of routine inspection and failed to enforce policies and procedures for the removal of unsafe equipment by nursing personnel. Oloomi opines that as a result of the hospital's failure to provide safe and appropriate equipment and to ensure implementation of appropriate inspections and policies, the hospital provided negligent and substandard care, and Lanham suffered injuries. St. Elizabeth argues that Oloomi's report contains "vague generalizations about the maintenance and inspection of `all equipment'" and fails to address the standard of care specifically for the use of a hospital shower chair. The hospital contends the report fails to state how frequently shower chairs should be inspected and how they should be monitored. An adequate report, the hospital argues, would provide "details on what constituted an adequate equipment inspection policy and staff training program within the applicable standards of care."
St. Elizabeth also argues the report fails to provide a factual basis for Oloomi's conclusion that the hospital breached the applicable standard of care. The hospital contends the report should have "stated what was wrong with the equipment inspection policies and procedures . . . in existence at the time of the events that form the basis of this suit." In addition, the report should specifically state "what acts and omissions . . . constituted the failure to provide a safe environment with regard to hospital shower chairs, and what Christus St. Elizabeth Hospital could have done differently to ensure that the events did not occur and would not reoccur."
Lanham's petition essentially alleges that the hospital failed to inspect the shower chair for defects before she used it. Under these circumstances, the expertise and degree of specificity required to explain the standard of care in maintaining a shower chair is minimal. Oloomi states that the hospital must perform periodic inspections of furnishings and equipment and must remove them if they are found to be in unsafe working order. The report does not specify the frequency or manner of the inspection required. Lanham complains of the lack of any inspection of the chair; the report states that the hospital failed to have an inspection system in place and failed to have a procedure for removing unsafe equipment. The court may reasonably have concluded an inspection procedure would have discovered a defective chair. Under the circumstances, the report provides sufficient information to inform the defendant of the conduct called into question, adequately sets out the standard of care and breach of that standard, and gives the trial court sufficient information on which to evaluate the merits of the claim. The trial court's order is affirmed.
AFFIRMED.