Memorandum Opinion by Justice Soto, 08-25-00213-CV, January 29, 2026.
On appeal from the 205th Judicial District Court, El Paso County, Texas.
Synopsis
The El Paso Court of Appeals reversed a trial court’s order finding Chapter 74 expert reports adequate, holding that experts must demonstrate they were “practicing health care” in the relevant field specifically at the time the claim arose or when testimony is given. Because the nurse expert had not practiced since 2021 and the physician retired in 2019—while the claim arose in 2023—their qualifications failed the strict temporal requirements of the Texas Civil Practice and Remedies Code.
Relevance to Family Law
In high-stakes custody litigation involving medically fragile children or allegations of medical neglect, family law practitioners often rely on medical experts to establish the “best interest” of the child. This ruling serves as a critical warning: the Texas appellate courts are tightening the temporal requirements for expert qualifications. If your expert—whether a physician, nurse, or potentially a mental health professional by analogy—has transitioned into a “consultant-only” role or has retired from active practice, their testimony may be vulnerable to a strike under the same “active practice” logic applied here, potentially gutting your evidentiary basis for medical necessity or parental fitness.
Case Summary
Fact Summary
O.S., a medically fragile infant born prematurely and dependent on a tracheostomy tube, was discharged to home health care provided by AOC TX, LLC. In January 2023, O.S. went into respiratory and cardiac arrest after a home health nurse was unable to successfully replace his breathing tube; the child tragically died three days later. The parents filed a health care liability claim and served threshold expert reports from Alfredia Williams, R.N., and Dale Bull, M.D. The defendant, AOC, challenged the qualifications of both experts. Williams’s curriculum vitae indicated she had not actively practiced as an RN since 2021, and Dr. Bull’s CV explicitly stated he had retired in 2019. The trial court overruled AOC’s objections, finding the reports met the “good faith” requirements of the statute.
Issues Decided
The central issue was whether the trial court abused its discretion in overruling objections to the expert reports where the experts’ CVs failed to establish they were “practicing health care” in the same field as the defendant at the specific times required by Texas Civil Practice and Remedies Code § 74.402(b)(1).
Rules Applied
The court applied Texas Civil Practice and Remedies Code § 74.351 and § 74.402. Under § 74.402(b), a person is qualified to opine on a breach of the standard of care only if they are “practicing health care” in a field involving the same type of care at the time the testimony is given or were doing so at the time the claim arose. “Practicing health care” is narrowly defined to include active clinical practice, training health care providers at an accredited institution, or serving as a consulting provider while maintaining active licensure/certification in the same field.
Application
The court conducted a de novo review of the legal qualifications of the experts based on the “four corners” of the reports and CVs. Regarding Nurse Williams, the court found her CV deficient because it failed to show any active practice or teaching role after 2021, whereas the claim arose in 2023. The court rejected the notion that general experience could bridge this gap. Regarding Dr. Bull, the deficiency was even more pronounced; his own CV stated he retired in 2019. The court reasoned that because neither expert was practicing in the field of pediatric home health or tracheostomy care at the time of the incident (2023) or at the time of the report, they failed the statutory prerequisite. The court noted that while the experts had significant historical experience, the statute’s temporal requirements are mandatory and not subject to judicial relaxation.
Holding
The court held that the trial court abused its discretion by overruling the objections because the experts did not meet the statutory definition of “practicing” in the relevant field at the required time intervals. The court emphasized that an expert’s credentials must affirmatively demonstrate current or contemporaneous practice to satisfy the Texas Medical Liability Act.
The court further held that despite the deficiency, the appropriate remedy was to reverse and remand the case. Because the reports were timely and implicated the defendant’s conduct, the plaintiffs were entitled to have the trial court consider a 30-day extension to cure the deficiencies, in line with the Supreme Court’s instruction to be lenient in granting such extensions to prevent the loss of claims due to curable technicalities.
Practical Application
This case provides a roadmap for disqualifying experts in any family law matter that touches upon medical standards of care or specialized pediatric needs. Practitioners should scrutinize an opposing expert’s CV not just for what they did, but when they last did it. If a child’s medical regimen or a parent’s ability to manage a “medically fragile” child is at issue, ensuring your expert is currently in the trenches of clinical practice—or at least teaching in an accredited program—is no longer a “best practice,” but a legal necessity to survive a motion to strike.
Checklists
Verify Expert Recency
- Confirm the expert’s CV shows active clinical practice or teaching at an accredited institution during the year the incident occurred.
- Audit “Consulting” experts to ensure they hold active certifications in the exact sub-field (e.g., pediatric respiratory care) required by the case.
- Flag any expert who uses the term “retired” or “semi-retired” on their CV for immediate challenge.
Defensive Expert Preparation
- If your expert has a gap in practice, supplement the report with specific details on “consulting” work that meets the definition of § 74.402(a).
- Ensure the CV explicitly links the expert’s current activities to the “same type of care or treatment” involved in the litigation.
- Request a 30-day extension at the earliest sign of a qualification challenge to preserve the client’s cause of action.
Citation
AOC TX, LLC d/b/a Angels of Care Pediatric Home Health v. Naomi Landeros and Carlos Silva, No. 08-25-00213-CV (Tex. App.—El Paso Jan. 29, 2026, no pet. h.).
Full Opinion
Family Law Crossover
This civil ruling can be weaponized in Texas divorce or custody cases to disqualify “professional” medical or psychological experts who have spent years in the courtroom but years away from the clinic. In modifications where a party seeks to change conservatorship based on a child’s specialized medical needs, you can move to exclude an opponent’s expert by arguing that their failure to meet the “active practice” standards of Chapter 74 (by analogy) renders their opinion on the “standard of care” for that child unreliable under Robinson or Daubert. By holding experts to this “practicing at the time the claim arose” standard, you can effectively silence an out-of-date expert and force the court to rely on currently practicing clinicians who may be more favorable to your client’s position.
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