Memorandum Opinion by Chief Justice Christopher, 14-24-00742-CV, January 27, 2026.
On appeal from the 127th District Court of Harris County.
Synopsis
The Fourteenth Court of Appeals reversed a trial court’s denial of a motion to dismiss, holding that an expert report is legally inadequate if it fails to provide a non-conclusory explanation of proximate causation. Under the Texas Medical Liability Act (TMLA), an expert must do more than merely attribute injuries to a defendant; the report must articulate the “how and why” the specific breach of the standard of care served as a substantial factor in bringing about the claimant’s injuries.
Relevance to Family Law
While this is a TMLA case, the “conclusory trap” is a jurisdictional and evidentiary minefield for family law litigators, particularly in high-stakes guardianship proceedings and contested custody matters involving psychological evaluations or business valuations. Texas courts are increasingly harmonizing the standards for expert reliability across disciplines. When a custody evaluator recommends a specific possession schedule or a business appraiser determines a community interest without a transparent “how and why” analytical bridge, they are susceptible to the same challenges raised here. Litigators must view this holding as a strategic blueprint for striking inadequate expert testimony in cases involving mental health assessments under Texas Family Code Chapter 107 or capacity evaluations in guardianship disputes.
Case Summary
Fact Summary
The plaintiff, Richard Aurisano, underwent a laparoscopic sigmoid colectomy at CHI St. Luke’s Health-The Vintage Hospital. Following the procedure, Aurisano suffered a drop in blood pressure and fell while attempting to use the bathroom, necessitating a transfer to the ICU. His postoperative course was further complicated by an anastomotic leak, sepsis, a secondary surgery, and the development of a sacral decubitus ulcer (bed sore). Aurisano sued the hospital, alleging negligence in nursing care, failure to follow protocols for bed sores, and failure to identify him as a fall risk. To satisfy the TMLA’s threshold requirements, Aurisano served two reports from Dr. Fred Simon. While Dr. Simon detailed the clinical decline, the Hospital challenged the reports, arguing they were conclusory because they failed to link the Hospital’s alleged failures (the breaches) to the specific injuries sustained (causation) with sufficient factual specificity.
Issues Decided
The primary issue was whether the expert reports constituted an objective “good faith effort” to comply with TMLA Section 74.351. Specifically, the court addressed whether Dr. Simon’s reports provided a sufficient factual basis to explain the causal relationship between the Hospital’s alleged breaches of the standard of care and Aurisano’s fall and subsequent bed sores.
Rules Applied
The court applied the Texas Medical Liability Act, specifically Tex. Civ. Prac. & Rem. Code § 74.351, which requires a “fair summary” of the expert’s opinions on the standard of care, the breach, and the causal link. The court relied on the Scoresby v. Santillan “lenient standard” but balanced it against the Bowie Memorial Hospital v. Wright requirement that a report must contain a factual basis rather than bare conclusions. Crucially, the court utilized the “how and why” framework established in Bush v. Columbia Medical Center of Arlington, requiring experts to explain how a breach was a “substantial factor” in bringing about the harm.
Application
In evaluating the reports in the aggregate, the court found a fatal analytical gap. Although Dr. Simon identified the Hospital’s failure to communicate clinical changes to the surgeon and the failure to manage fall risks, he failed to bridge the gap between those omissions and the resulting injuries. The court noted that in the second report, Dr. Simon did not even enumerate the Hospital’s alleged breaches of the standard of care, yet still attributed the injuries to the Hospital. The court reasoned that a report is not a “good faith effort” if the trial court must fill in the blanks or engage in inferences to understand the expert’s logic. Because Dr. Simon’s opinions on proximate causation—specifically “cause-in-fact”—were not supported by a factual explanation of how the Hospital’s specific conduct led to the fall or the ulcers, the reports remained legally conclusory.
Holding
The Court of Appeals held that the trial court abused its discretion by denying the Hospital’s motion to dismiss because the expert reports failed to meet the statutory requirements for causation. The court emphasized that the TMLA requires more than a mere summary of the patient’s medical history followed by a statement of causation; there must be a transparent, fact-based link between the two.
The court further held that when an expert report fails to address the “how and why” of the causal link, it is not a report at all for purposes of the TMLA’s “good faith” requirement. Consequently, the court reversed the trial court’s order and remanded the case for the trial court to consider whether to grant a 30-day extension to cure the deficiencies or to dismiss the claims with prejudice.
Practical Application
For the family law practitioner, this case reinforces the necessity of the “Analytical Bridge.” Whether you are defending a SAPCR or challenging a guardianship, you must ensure your expert’s report doesn’t just state a conclusion (e.g., “The mother has a personality disorder and therefore access should be supervised”).
Under the standard articulated in Aurisano, you should move to strike or exclude expert testimony that fails to explain the how and why. In a property context, if a forensic accountant opines that assets were wasted or secreted, the report must show the factual path from the transaction to the conclusion of “fraud on the community.” In guardianship, an MD’s certificate of medical examination must provide the factual “how” regarding the proposed ward’s inability to manage their own affairs, rather than just checking boxes.
Checklists
Challenging an Opposing Expert’s Report
- Identify Conclusory Statements: Scrutinize the report for “because I said so” logic where the expert assumes a causal link without a factual explanation.
- The “How and Why” Test: Can the court determine the exact mechanism of the injury/damage based solely on the four corners of the report?
- Check for Aggregation Issues: If the expert filed multiple reports (original and supplemental), ensure they don’t contradict each other or omit previously stated breaches.
- Verify Substantial Factor: Does the report explain how the specific breach—and not some other intervening factor—was a substantial factor in the outcome?
Drafting a Defensible Family Law Expert Report
- Factual Recitation: Ensure the expert lists every document, interview, and observation relied upon.
- Linkage: Explicitly connect the “Standard of Care” (or professional standard) to the “Breach” and then to the “Result.”
- Eliminate Inference: Don’t leave it to the judge to connect the dots. Use phrases like, “X led to Y because of Z facts.”
- Avoid Adjectives, Use Actions: Instead of saying a parent is “unstable,” describe the specific behaviors and explain how those behaviors directly impact the child’s safety.
Citation
CHI St. Luke’s Health-The Vintage Hospital v. Aurisano, No. 14-24-00742-CV, 2026 WL ______ (Tex. App.—Houston [14th Dist.] Jan. 27, 2026, no pet. h.) (mem. op.).
Full Opinion
Full Opinion: CHI St. Luke’s Health-The Vintage Hospital v. Aurisano
Family Law Crossover
In Texas family litigation, this ruling can be effectively weaponized to challenge “bare bones” custody evaluations or capacity assessments in guardianship cases. If a Chapter 107 custody evaluator recommends a restriction on a parent’s rights but fails to provide a factual, non-conclusory link between a parent’s specific conduct and the child’s best interest, that report is vulnerable under the Aurisano “how and why” standard.
Similarly, in high-net-worth divorces, use this case to challenge valuation experts who provide a “black box” valuation of a closely-held business. If the appraiser provides a number without explaining the factual basis for the chosen capitalization rate or the specific adjustments made, their report is “conclusory” as a matter of law. By citing Aurisano’s strict adherence to the “substantial factor” and “cause-in-fact” analysis, family litigators can force experts to provide more transparency or face total exclusion before trial.
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