In the
Court of Appeals
Second Appellate District of Texas
at Fort Worth
No. 02-26-00314-CV
GRANBURY HOSPITAL CORPORATION D/B/A LAKE GRANBURY MEDICAL
CENTER; HEINZ-DIETER SCHWARZKOPF, D.O.; KATHRYN LITTLE, M.D.;
ALI ALIAN, M.D.; AND RADIOLOGY ASSOCIATES OF NORTH TEXAS P.A.,
Appellants
V.
JAMIE AGUILAR, Appellee
On Appeal from County Court at Law No. 1
Tarrant County, Texas
Trial Court No. 2025-006984-1
Before Sudderth, C.J.; Womack and Walker, JJ.
Memorandum Opinion by Chief Justice Sudderth
MEMORANDUM OPINION
The three interlocutory appeals at issue in this single cause number boil down
to one question: Does Appellee Jamie Aguilar’s expert report—a report that criticizes
“the doctors at Granbury” without identifying who the relevant doctors are—satisfy
the Texas Medical Liability Act (TMLA)? See Tex. Civ. Prac. & Rem. Code § 74.351.
Because the answer is no, and because the trial court erroneously answered yes, we
will reverse the trial court’s order, render judgment dismissing her claims with
prejudice, and remand for an award of attorney’s fees and court costs.
I. Background
Aguilar went to the emergency room at Lake Granbury Medical Center due to
what she later described as “dizziness and nausea.” After undergoing CT scans of her
head and abdomen, she was diagnosed with gastritis and was discharged. According
to Aguilar, she “spoke with a physician [just] once as she was being discharged,” and
the unidentified physician told her that the CT scan of her head “did not show
anything.” But in reality, Aguilar’s head CT scan had shown that she had an
arachnoid1 cyst.
Aguilar’s symptoms grew worse after discharge, so less than six weeks later, she
went to a different hospital, underwent a new CT scan, and learned of the cyst. She
1
See Arachnoid, Merriam-Webster, https://www.merriamwebster.com/dictionary/arachnoid#medicalDictionary (last visited Oct. 1, 2026) (defining “arachnoid” as “a thin membrane of the brain and spinal cord”).
2
initially “hope[d] that she could avoid surgery,” but after a third visit to yet another
emergency room, she had the cyst removed.2
Bothered by her experience at Lake Granbury Medical Center, Aguilar filed
negligence claims against three doctors—Appellants Heinz-Dieter Schwarzkopf,
D.O.; Kathryn Little, M.D.; and Ali Alian, M.D. (collectively, the Doctors)—and two
vicariously liable entities—Appellant Granbury Hospital Corporation, doing business
as Lake Granbury Medical Center (the Hospital), and Radiology Associates of North
Texas P.A. (the Radiology Entity). Aguilar’s petition did not specify which Doctor
had played which role in her care,3 nor did it clarify which of the Doctors she sought
to hold the Hospital or Radiology Entity vicariously liable for. Instead, Aguilar
broadly pleaded that “the misconduct of [Appellants collectively]” caused her injuries,
that Appellants collectively “owed [her] a duty of care” as “reasonable medical
providers,” that Appellants’ collective negligence had caused her cyst to go
“unchecked and unmonitored for over 2 months as her symptoms worsened and the
2
The removal was performed at an unrelated medical facility.
3
Later, in Aguilar’s response to Appellants’ TMLA motions, she described Dr. Schwarzkopf and Dr. Little as “the attending treating emergency physicians” and Dr. Alian as “the interpreting radiologist and an employee of [the Radiology Entity].” The Doctors also identified themselves in their filings, with Dr. Schwarzkopf and Dr. Little describing themselves as “emergency medicine physicians” and with Dr. Alian describing himself as a radiologist.
3
cyst grew,” and that Appellants collectively “may be held liable for the negligent acts
of [their unidentified] agents/employees.”4
Pursuant to the TMLA, Aguilar timely served Appellants with an expert report
from a neurosurgeon (the Expert Report).5 See id. § 74.351(a). The Expert Report did
not purport to address any claims for direct liability against the Hospital or the
Radiology Entity; it was confined to negligence committed by “the doctors at
Granbury.” But the Expert Report did not identify who “the doctors at Granbury”
were.
The Expert Report did not mention any of the Doctors by name, nor did it
reference them by their status as defendants, nor by any other identifying
characteristic. Instead, it criticized “the doctors at Granbury” in broad, passive terms,
stating, for example, that Aguilar “was not informed of th[e] intracranial abnormality”;
that “[n]o documented referral, follow-up plan, or neurosurgical consultation was
arranged”; and that Aguilar “was discharged . . . without disclosure . . . and without
instructions related to potential neurological progression.” The expert opined that
these passively listed “acts and omissions fell below the accepted standard of care for
Although one of the Doctors and the Radiology Entity filed special
4
exceptions, the other two Doctors and the Hospital did not. See infra note 8.
The expert had “30 years of experience” in neurosurgery, including experience
5
in treating “disorders similar to what is involved in this case.” He indicated that the standard of care applied throughout the Expert Report was that of “a physician . . . providing ‘ordinary neurosurgical care,’” and he defined ordinary care as that used by “a physician, neurosurgeon, or mid-level provider of ordinary prudence.”
4
emergency physicians and radiologists” and that such failures by “the doctors at
Granbury” delayed Aguilar’s surgery, which prolonged her suffering.
Appellants responded in three subgroups—(1) two of the Doctors joined
forces; (2) the other Doctor and the Radiology Entity teamed up; and (3) the Hospital
filed its own response. The three subgroups each objected to the Expert Report and
moved to dismiss Aguilar’s claims under the TMLA.6 See id. § 74.351(b). Aguilar, in
turn, insisted that her Expert Report was adequate. And although she initially
requested an extension “to cure any found deficiencies,” she withdrew that request at
a later hearing on the Expert Report, doubling down on her position that her
“[Expert R]eport [wa]s good.”7 The trial court agreed, overruling all of Appellants’
objections and denying their motions to dismiss.
Each of the three subgroups of Appellants appealed.
6
The Hospital and two of the Doctors filed unambiguous motions to dismiss. The other Doctor and the Radiology Entity filed objections to the Expert Report, but in their objections, they argued that the Expert Report “d[id] not satisfy the requirements of Chapter 74, [so] dismissal . . . [wa]s warranted.”
7
At the hearing on Aguilar’s Expert Report, the trial court observed that Aguilar had only “one shot” to amend and that “[e]ither [the Expert Report] is good and [Appellants] will appeal and lose, or it isn’t good and [Appellants will] appeal and [they] win[].” The trial court then asked Aguilar “what [she] want[ed]” to do, implicitly offering her the opportunity to amend. Aguilar insisted that her “[Expert R]eport [wa]s good” and asked the trial court to deny her motion to amend.
5
II. Standard of Review
“We review for an abuse of discretion a trial court’s decision to grant or deny a
defendant’s motion to dismiss based on the adequacy of an expert report.” Bush v.
Columbia Med. Ctr. of Arlington Subsidiary, L.P., 714 S.W.3d 536, 544 (Tex. 2025); Abshire
v. Christus Health Se. Tex., 563 S.W.3d 219, 223 (Tex. 2018); Bondugula v. Hamilton, No.
02-26-00266-CV, 2026 WL 2449996, at *5 (Tex. App.—Fort Worth Aug. 20, 2026, no
pet. h.) (mem. op.). In analyzing an expert report’s adequacy, our review is confined
to the four corners of the document. Baty v. Futrell, 543 S.W.3d 689, 693–94 (Tex.
2018); Bondugula, 2026 WL 2449996, at *5; Apodaca v. Russo, 228 S.W.3d 252, 257 (Tex.
App.—Austin 2007, no pet.).
The four corners of an expert report satisfy the TMLA if the report presents a
good-faith effort to fairly summarize the expert’s opinions regarding the applicable
standard of care, how the defendant breached that standard, and how the breach
caused the plaintiff damages. See Tex. Civ. Prac. & Rem. Code § 74.351(l), (r)(6); Bush,
714 S.W.3d at 543; Apodaca, 228 S.W.3d at 255. This is a “lenient standard”; the
expert report “need not marshal all the [plaintiff’s] proof” or contain “magical
words.” Bush, 714 S.W.3d at 543–44; Bondugula, 2026 WL 2449996, at *5; see Scoresby v.
Santillan, 346 S.W.3d 546, 556 (Tex. 2011).
But the report must still satisfy the TMLA’s requirements, and “omissions may
not be supplied by inference.” Scoresby, 346 S.W.3d at 556. “[A] report that does not
address a defendant health care provider at all constitutes no report as to that
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defendant, . . . and one that does not specifically identify the complained-of doctor
and apply the statutory elements to that doctor’s conduct will not qualify as a goodfaith effort.” Bondugula, 2026 WL 2449996, at *5; see Copley v. Guidry, No. 09-24-00046-CV, 2025 WL 1074805, at *5 (Tex. App.—Beaumont Apr. 10, 2025, no pet.)
(mem. op.).
III. Discussion
The three subgroups of Appellants raise separate but related appellate issues,
one of which is dispositive: The Expert Report does not identify “the doctors at
Granbury” it criticizes.8
A. The Expert Report is deficient.
For an expert report to support a claim against a given doctor—or a vicarious
liability claim against the doctor’s employer or principal—it must “inform[] the
defendant of the specific conduct called into question.” Bush, 714 S.W.3d at 543; see
Certified EMS, Inc. v. Potts, 392 S.W.3d 625, 632 (Tex. 2013) (clarifying that, under the
TMLA, “an expert report that meets the statutory standards as to the employee is
sufficient to implicate the employer’s conduct under the vicarious theory”). And, of
The Hospital argues that Aguilar’s petition does not provide sufficient notice
8
that she is asserting a vicarious liability claim. Cf. Seton Fam. of Hosps. v. White, 593 S.W.3d 787, 793–94 (Tex. App.—Austin 2019, pet. denied) (rejecting similar argument when defendant failed to specially except). But the Hospital also argues that, even if Aguilar’s petition states a vicarious liability claim, the Expert Report is deficient as to the individual Doctors. Because the Hospital’s second argument is dispositive, we need not address its first argument. See Tex. R. App. P. 47.1.
7
course, to be able to identify a given defendant’s “specific conduct,” the expert must
clarify who he is talking about. See, e.g., Methodist Hosp. v. Garner, No. 01-24-00674-CV,
2025 WL 1184230, at *6 (Tex. App.—Houston [1st Dist.] Apr. 24, 2025, no pet.)
(mem. op.) (holding that expert report constituted “no report” as to one doctor when
it did not mention him by name and “did not identify [him] as part of a surgical team
or in any other manner”); Haskell v. Seven Acres Jewish Senior Care Servs., Inc., 363 S.W.3d
754, 760–61 (Tex. App.—Houston [1st Dist.] 2012, no pet.) (holding that expert
report was materially deficient as to nurse because, “[o]ther than being named as one
of the intended recipients of the report, her name d[id] not appear anywhere in the
report,” and “[t]here [wa]s no description of any action she [had taken],” nothing that
applied the alleged standard of care to her, and nothing that “link[ed]” her to the
patient’s allegedly wrongful discharge); Laredo Tex. Hosp. Co. v. Gonzalez, 363 S.W.3d
255, 258–59 (Tex. App.—San Antonio 2012, no pet.) (holding that expert report
constituted “no report” when it “completely omit[ted] the names of the individual
defendants and wholly fail[ed] to implicate the[ir] conduct”); Apodaca, 228 S.W.3d at
255–58 (holding expert report deficient when it failed to identify relevant doctor
because, even though doctor was sole defendant, report referenced other providers as
well and did not mention relevant defendant by name or discuss how her actions had
breached the standard of care); Garcia v. Marichalar, 198 S.W.3d 250, 255 (Tex. App.—
San Antonio 2006, no pet.) (holding expert reports deficient as to a specific
surgeon—Dr. Garcia—because “neither report mention[ed] Dr. Garcia at all” so they
8
did not “discuss[] how the care rendered by Dr. Garcia [had] failed to meet the
applicable standard of care or how Dr. Garcia’s failure [had] caused [the plaintiff] to
suffer injury, harm, or damages”); accord Copley, 2025 WL 1074805, at *5–7; Rivenes v.
Holden, 257 S.W.3d 332, 334–39 (Tex. App.—Houston [14th Dist.] 2008, pet. denied)
(op. on reh’g). “[W]here a defendant is not identified at least in some manner 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.” Copley, 2025 WL 1074805, at *5 (internal
quotation marks omitted).
Our sister court recognized as much in Rivenes. 257 S.W.3d at 334–39. There,
the plaintiff’s expert report “d[id] not refer to [Dr. Rivenes] by name or position.” Id.
at 338–39. Although the report stated that “the emergency room staff” should have
provided certain immediate treatment for the plaintiff’s eye condition, it never
“explain[ed] what people [it] mean[t] to include within the term” Id. at 334–35, 338 &
n.5. And because the report did not “discuss how the care rendered by appellant [Dr.
Rivenes had] failed to meet the applicable standard of care, or how appellant’s failure
[had] caused [the plaintiff] to suffer injury, harm, or damages,” the report was “no
report at all as to him.” Id. at 338–39.
Another sister court reiterated this rule in Copley. See 2025 WL 1074805, at *5–
7. There, the expert report stated the standard of care for a medical facility “and [its]
staff,” and the report alleged collective breaches by the medical center’s “employees,
9
agents, servants, nurses, [and] doctors.” Id. at *1–3, *6. But nothing in the report’s
four corners “identif[ied] the [two doctors at issue] as members of the facility’s staff
who were involved in [the plaintiff’s] care.” Id. at *6. The court of appeals held that,
although the report was not required to identify the doctors by name, it was required
to identify each of them “in some manner,” and because it had failed to do so, it
“constitute[d] no report with respect to the [two doctors].” Id. at *5–7.
The Expert Report here is equally threadbare. It lists acts and omissions of
“the doctors at Granbury” collectively and opines that “[t]hese acts and omissions fell
below the accepted standard of care for emergency physicians and radiologists.” See
id. at *6 (holding expert report’s “collective references [we]re insufficient”). But are
any of the three Doctors sued—Dr. Schwarzkopf, Dr. Little, or Dr. Alian—among
“the doctors at Granbury” that the Expert Report criticizes? See id. (reiterating that
“[c]ollective assertions of negligence against various defendants are inadequate”);
Rivenes, 257 S.W.3d at 338–39 (emphasizing that deficient expert report did not
“explain how any of [the expert’s] statements appl[ied] to [the specific defendant]”).
Were any of the three Doctors “emergency physicians [or] radiologists” involved in
Aguilar’s care? And which of the Doctors, if any, committed which of the listed “acts
and omissions [that] fell below the accepted standard of care”?9 See Garcia, 198
9
Aguilar’s appellate arguments inadvertently underscore her Expert Report’s deficiencies. For example, in defending her Expert Report’s lumping together of emergency physicians and radiologists, she acknowledges “that a radiologist [does not] ha[ve] the same discharge counseling duty as [an] emergency physician” and argues
10
S.W.3d at 255 (emphasizing that deficient expert report did not “discuss[] how the
care rendered by Dr. Garcia failed to meet the applicable standard of care”). The
Expert Report does not say.10 It does not mention any of the three Doctors by name,
nor does it identify them by position, by role, or in any other manner. And a report
“that does not specifically identify the complained-of doctor and apply the statutory
elements to that doctor’s conduct [does] not qualify as a good-faith effort.” Bondugula,
2026 WL 2449996, at *5–6; see Copley, 2025 WL 1074805, at *5. Thus, Aguilar’s
Expert Report is deficient as to the Doctors and cannot support her negligence or
vicarious liability claims premised on their conduct.11
We sustain this dispositive issue.
that the Expert Report should be interpreted as criticizing “emergency physicians” for their “failure[s] to inform” Aguilar while “criticiz[ing] the radiolog[ist] for [his] role in the failure to communicate . . . [the] CT finding in a manner that resulted in disclosure.” But the Expert Report does not make this distinction; it lists breaches of the “standard of care for emergency physicians and radiologists” generally. Plus, the Expert Report does not identify who the relevant “emergency physicians [or] radiologists” are anyway.
Aguilar’s petition similarly fails to identify the Doctors’ individual roles in her
10
care—even if we could use her petition to fill gaps in the Expert Report, which we cannot. See Apodaca, 228 S.W.3d at 257–58 (rejecting argument that expert report that did not identify defendant implicitly implicated her conduct and stating that a “report does not satisfy [the TMLA] for a specific defendant merely because he or she is a defendant”).
11
In portions of Aguilar’s brief, she alludes to the Hospital’s potential liability for physicians other than the Doctors as well. But, to the extent that she seeks to hold the Hospital liable for other physicians, the Expert Report is deficient as to those physicians for the same reason it is deficient as to the Doctors: It does not apply its criticisms to a specific physician.
11
B. The Expert Report’s deficiencies render it equivalent to no report.
Aguilar attempts to limit the impact of her Expert Report’s deficiencies by
asserting that, even if the Expert Report is deficient, she should be afforded an
opportunity to cure by amendment. But both law and equity dictate otherwise.
Under the TMLA, if a plaintiff serves a timely but deficient expert report and
the deadline for serving another report has passed, the plaintiff may be granted an
extension to amend her expert report and cure its deficiencies. See Tex. Civ. Prac. &
Rem. Code § 74.351(c); Scoresby, 346 S.W.3d at 556–57; Copley, 2025 WL 1074805, at
*5; Rivenes, 257 S.W.3d at 340. But if the plaintiff’s report is so deficient as to
constitute no report, the extension is unavailable, and the plaintiff’s claims must be
dismissed. Scoresby, 346 S.W.3d at 556–57; Copley, 2025 WL 1074805, at *4–5; Rivenes,
257 S.W.3d at 339.
A report is so deficient as to constitute no report if “the defendant’s conduct is
[not even] implicated.” Scoresby, 346 S.W.3d at 556–57 (recognizing that a plaintiff
may be granted an extension to amend and cure if her noncompliant expert report
“contains the opinion of an individual with expertise that the claim has merit[]
and . . . the defendant’s conduct is implicated”); see also id. at 559 (Willett, J.,
concurring) (describing the “bar [a]s low but not subterranean”). And, here, because
the Expert Report does not identify the individual Doctors in any manner, their
conduct is not implicated. See Copley, 2025 WL 1074805, at *6–7 (holding expert
report constituted “no report” as to two doctors when report failed to identify them);
12
Haskell, 363 S.W.3d at 760–61 (holding expert report constituted “no report” as to
nurse defendant when it failed to name nurse or describe any action she took); Laredo
Tex. Hosp. Co., 363 S.W.3d at 258–59 (holding expert report constituted “no report”
when it “completely omit[ted] the names of the individual defendants and wholly
fail[ed] to implicate the[ir] conduct”); Apodaca, 228 S.W.3d at 257–58 (holding expert
report constituted “no report” when it failed to identify doctor); cf. Bondugula, 2026
WL 2449996, at *2–3, *6 (remanding to allow trial court to consider whether
deficiency could be cured by amendment when expert report condemned actions of
singular “attending physician” and petition identified attending physician). Thus, the
Expert Report constitutes no report as to the Doctors, and the law does not allow
Aguilar to amend. See Tex. Civ. Prac. & Rem. Code § 74.351(b), (c).
And even if the law allowed Aguilar to amend—even if her Expert Report
implicated the Doctors’ conduct—equity would not support it. When the Texas
Supreme Court clarified the line between a deficient report and “no report,” it
emphasized that the TMLA’s “principal purpose is to reduce the expense of health
care liability claims.” Scoresby, 346 S.W.3d at 556–57 (describing principal purpose of
reducing expense as a guiding consideration). And “multiple interlocutory appeals”
add to that expense. Id. (noting that “permitting two [interlocutory] appeals . . . is
simply wasteful”). Yet, when Aguilar was offered the opportunity to amend her
Expert Report in advance of this appeal—and thereby avoid the risk of multiple
interlocutory appeals—she declined to do so.
13
At the Expert Report hearing, the trial court noted that Aguilar had just “one
shot” to amend and—predicting that the defendants would file an interlocutory
appeal—asked Aguilar “what [she] want[ed]” to do, i.e., if she wanted to use her “one
shot” to cure her Expert Report’s deficiencies. As we have now explained, the TMLA
did not authorize even this “one shot.” See id.; Garner, 2025 WL 1184230, at *6
(holding that trial court had no discretion to grant extension to amend the expert
report as to one doctor because report did not name the doctor and amounted to “no
report at all”). But even if it had, Aguilar chose to reject the opportunity, insisting
that her “[Expert R]eport [wa]s good.”
Aguilar’s current request to cure by amendment thus finds no support in law or
equity. Her claims must be dismissed with prejudice. See Tex. Civ. Prac. & Rem.
Code § 74.351(b).
IV. Conclusion
Aguilar’s Expert Report does not implicate the Doctors’ conduct and cannot
support her negligence or vicarious liability claims based on that conduct. We reverse
the trial court’s order, render judgment dismissing Aguilar’s claims with prejudice, and
remand the case for an award of “reasonable attorney’s fees and costs of court
incurred by the physician[s] or health care provider[s].”12 See id.; Rivenes, 257 S.W.3d at
336, 441.
Not all of Appellants expressly requested attorney’s fees and court costs in
12
their TMLA motions. Nonetheless, the motions were all rooted in the TMLA, and
14
/s/ Bonnie Sudderth
Bonnie Sudderth
Chief Justice
Delivered: October 8, 2026
the TMLA “requires the trial court to award costs and attorney’s fees when a plaintiff fails to comply with the expert-report requirement.” Rogers v. Bagley, 623 S.W.3d 343, 356–57 (Tex. 2021) (noting that, although dismissal motion did not expressly request fees, it did not need to plead for fees mandated by statute, so fees remained pending at time of nonsuit).
15