Patricia D. Salvato, M.D. and Diversified Medical Practices, PA v. Faustina Angelo, Individually and as Representative of the Estate of Arthur Leon Angelo, Jr., Deceased, Lucas Angelo, Sofia Angelo, Arthur Angelo, Sr. and Connie Angelo--Appeal from 281st District Court of Harris County

Affirmed and Memorandum Opinion filed April 8, 2008

Affirmed and Memorandum Opinion filed April 8, 2008.

In The

Fourteenth Court of Appeals

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NO. 14-07-00784-CV

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PATRICIA D. SALVATO, M.D. AND DIVERSIFIED MEDICAL PRACTICES, PA, Appellants

V.

FAUSTINA ANGELO, INDIVIDUALLY AND AS REPRESENTATIVE OF THE ESTATE OF ARTHUR LEON ANGELO, JR., DECEASED, LUCAS ANGELO, SOFIA ANGELO, ARTHUR ANGELO, SR. AND CONNIE ANGELO, Appellees

On Appeal from the 281st District Court

Harris County, Texas

Trial Court Cause No. 2007-02024

M E M O R A N D U M O P I N I O N

In this interlocutory appeal, appellants Patricia D. Salvato, M.D. and Diversified Medical Practices, PA (collectively ADr. Salvato@) appeal the trial court=s denial of a motion to dismiss a medical malpractice action. See Tex. Civ. Prac. & Rem. Code Ann. ' 74.351 (Vernon 2005). Dr. Salvato contends the expert report served by appellees Faustina Angelo, individually and as representative of the estate of Arthur Leon Angelo, Jr., deceased, Lucas Angelo, Sofia Angelo, Arthur Angelo, Sr., and Connie Angelo (collectively AAngelo@) was insufficient. Finding no abuse of discretion, we affirm.

I. Background

On December 14, 2000, Arthur Angelo, a body-builder with a history of anabolic steroid use, came to Dr. Salvato for treatment of low testosterone levels and generalized anxiety disorder. Mr. Angelo was informed that he could receive prescriptions for anabolic steroids only if he joined a clinical study being conducted by Dr. Salvato focusing on the efficacy of anabolic steroids in HIV/AIDS patients suffering from wasting syndrome. Mr. Angelo volunteered and was enrolled as a member of the control group in Dr. Salvato=s clinical study. The initial study included the prescription of anabolic steroids and human growth hormone over a nine-month period, beginning on December 14, 2000. Following the initial nine-month study, Dr. Salvato enrolled Mr. Angelo in extensions over the next several years. In addition to anabolic steroids and human growth hormone, Dr. Salvato also prescribed Valium to Mr. Angelo for pain.

Mr. Angelo exhibited side effects of steroid use during the study, including hypertension, testicular atrophy, worsening anxiety, and insomnia. Mr. Angelo also complained of chest discomfort and exhibited signs of left ventricular hypertrophy in ECG readings that showed elevated QRS voltage attributable to left ventricular hypertrophy.[1] Dr. Salvato continued to prescribe anabolic steroids and human growth hormones to Mr. Angelo.

Mr. Angelo last communicated with Dr. Salvato concerning his treatment sometime between March 1, 2004 and September 7, 2004. Mr. Angelo was found dead in his home on October 31, 2004. Mr. Angelo=s death was attributed to hypertensive and atherosclerotic cardiovascular disease.[2]

Suit was filed on January 11, 2007, contending that Dr. Salvato was negligent in prescribing medications which were inappropriate, unlawful, and not in accordance with the standards of medical care in and around Harris County, Texas at the time. It was further alleged that these acts and omissions were the proximate cause of Arthur Angelo=s death.

Pursuant to statute, an expert report from Nancy Campbell, M.D. was timely served on May 3, 2007. See Tex. Civ. Prac. & Rem. Code Ann. '' 74.351, 74.401 (Vernon 2005). In that report, Dr. Campbell opined that Dr. Salvato departed from the normal standard of care by (1) failing to obtain IRB approval[3] and continuing review of the clinical study; (2) failing to maintain an adverse event log; (3) failing to maintain records of proper oversight and monitoring by another party; (4) continuing to prescribe anabolic steroids for more than three years despite the appearance of known side effects of anabolic steroid use in Mr. Angelo=s examinations; (5) failing to conduct necessary lab work related to known side effects of anabolic steroid use; and (6) failing to conduct further tests when medical examinations indicated and Mr. Angelo reported signs of heart disease. Dr. Campbell further opined that Dr. Salvato=s continued prescription of anabolic steroids led to cardiomegaly[4] with left ventricular hypertrophy and stenosis of 70% of the left anterior descending coronary artery, which in turn led to Mr. Angelo=s death from hypertensive and atherosclerotic cardiovascular disease.

Dr. Salvato moved to dismiss Angelo=s suit in trial court under section 74.351(b).[5] The trial court denied the motion to dismiss.

Dr. Salvato contends on appeal that Dr. Campbell=s expert report does not satisfy sections 74.351 and 74.401. Dr. Salvato contends that (1) Dr. Campbell is not qualified to opine on key issues in this case; and (2) Dr. Campbell=s report is deficient because it is conclusory with regard to the standard of care and causation.

II. Appellate Jurisdiction

We first consider this court=s appellate jurisdiction. This is a question of law reviewed de novo. State v. Holland, 221 S.W.3d 639, 642 (Tex. 2007).

When, as here, a trial court has not signed a final and appealable order, we may not proceed unless an interlocutory appeal is allowed. Tex. A&M Univ. Sys. v. Koseoglu, 233 S.W.3d 835, 840 (Tex. 2007). When reviewing a statutory grant of interlocutory appellate jurisdiction, we look to the legislature=s intent as expressed in the statute=s plain words and consider disputed provisions in context. See id.; Tex. Dep=t of Transp. v. Needham, 82 S.W.3d 314, 318 (Tex. 2002). Civil Practice and Remedies Code section 51.014 governs appeals from interlocutory orders; it should be strictly construed as Aa narrow exception to the general rule that only final judgments and orders are appealable.@ Bally Total Fitness Corp. v. Jackson, 53 S.W.3d 352, 355 (Tex. 2001).

Section 51.014(a)(9) allows an immediate appeal from an interlocutory order that Adenies all or part of the relief sought by motion under section 74.351(b), except that an appeal may not be taken from an order granting an extension under Section 74.351.@[6] Tex. Civ. Prac. & Rem. Code Ann. ' 51.014(a)(9) (Vernon Supp. 2007). In turn, section 74.351(b) states:

(b) If, as to a defendant physician or health care provider, an expert report has not been served within the period specified by Subsection (a), the court, on the motion of the affected physician or health care provider, shall, subject to Subsection (c), enter an order that:

(1) awards to the affected physician or health care provider reasonable attorney=s fees and costs of court incurred by the physician or health care provider; and

(2) dismisses the claim with respect to the physician or health care provider, with prejudice to the refiling of the claim.

Tex. Civ. Prac. & Rem. Code Ann. ' 74.351(b) (Vernon Supp. 2007).

Angelo argues that an interlocutory appeal is not available for the denial of Dr. Salvato=s motion to dismiss. Angelo seizes on this statement from Dr. Salvato=s brief: AThis interlocutory appeal seeks relief from the August 6, 2007 denial of Appellants= Motion to Dismiss filed pursuant to Tex. Civ. Prac. & Rem. Code ' 74.351(c) for failure to serve a competent expert report as required by ' 74.351(a) in this healthcare liability claim.@ Based on this statement, Angelo contends that Dr. Salvato challenged the sufficiency of Dr. Campbell=s report only under section 74.351(c). Angelo seeks dismissal of this appeal, arguing that the interlocutory appeal statute authorizes immediate appellate review of an order denying dismissal under section 74.351(b) based on the failure to file a report B but not an order denying dismissal under section 74.351(c) based on the filing of a deficient report.

Angelo=s argument fails for two reasons. First, Dr. Salvato specifically invoked section 74.351(b) in the motion to dismiss filed in the trial court. Second, this court already has held that the denial of a motion to dismiss based upon an assertedly deficient report under section 74.351(c) is appealable under section 51.014(a)(9), reasoning that A[a]n expert report >has not been served, for purposes of section 74.351(b), if elements of the report are found to be deficient.=@ Group v. Vicento, 164 S.W.3d 724, 726 n.2 (Tex. App.CHouston [14th Dist.] 2005, pet. filed). Therefore, this court has jurisdiction to review the denial of Dr. Salvato=s motion to dismiss a timely served but allegedly deficient expert report.[7]

III. Sufficiency of the Expert Report

A. Standard of Review

Dr. Salvato contends the trial court erred in failing to dismiss the case with prejudice because Angelo=s expert report from Dr. Campbell is deficient. Dr. Salvato contends the report is deficient because Dr. Campbell is not qualified to opine in this case, and because portions of her expert report are conclusory.

We review a trial court=s determination under section 74.351 for abuse of discretion. Larson v. Dowing, 197 S.W.3d 303, 304-305 (Tex. 2006); Mem=l Herman Healthcare Sys. v. Burrell, 230 S.W.3d 755, 757 (Tex. App.CHouston [14th Dist.] 2007, no pet.). Similarly, we review a trial court=s ruling regarding the adequacy of an expert report for abuse of discretion. Am. Transitional Care Ctrs. of Tex., Inc. v. Palacios, 46 S.W.3d 873, 877 (Tex. 2001);Group, 164 S.W.3d at 727. A trial court commits an abuse of discretion when it acts in an arbitrary or unreasonable manner without reference to guiding rules or principles. See Dowing, 197 S.W.3d at 304-305; Jernigan v. Langley, 195 S.W.3d 91, 94 (Tex. 2006). Under this standard, an appellate court may not substitute its judgment for that of the trial court. Gray v. CHCA Bayshore L.P., 189 S.W.3d 855, 858 (Tex. App.CHouston [1st Dist.] 2006, no pet.).

Analysis of expert qualifications under section 74.351 is limited to the four corners of the expert=s report and the expert=s curriculum vitae. See Palacios, 46 S.W.3d at 878; Mem=l Herman Healthcare Sys., 230 S.W.3d at 758; Gray, 189 S.W.3d at 859. Qualifications cannot be inferred, but must be present in the expert report. See Olveda v. Supulveda, 141 S.W.3d 679, 683 (Tex. App.CSan Antonio 2004, pet. denied); Hansen v. Starr, 123 S.W.3d 13, 19 (Tex. App.CDallas 2003, pet. denied). To be qualified to provide opinion testimony regarding whether a physician departed from the accepted standard of health care, an expert must satisfy section 74.401. See Tex. Civ. Prac. & Rem. Code Ann. ' 74.351(r)(5)(A) (Vernon 2005). Section 74.401 provides:

(a) In a suit involving a health care liability claim against a physician for injury to or death of a patient, a person may qualify as an expert witness on the issue of whether the physician departed from accepted standards of medical care only if the person is a physician who:

(1) is practicing medicine at the time such testimony is given or was practicing medicine at the time the claim arose;

(2) has knowledge of accepted standards of medical care for the diagnosis, care, or treatment of the illness, injury, or condition involved in the claim; and

(3) is qualified on the basis of training or experience to offer an expert opinion regarding those accepted standards of medical care.

Tex. Civ. Prac. & Rem. Code Ann. ' 74.401(a) (Vernon 2005).

Under section 74.351, health care liability claimants must provide an expert report to the defendant no later than 120 days after filing the original petition. See Tex. Civ. Prac. & Rem. Code Ann. ' 74.351(a) (Vernon Supp. 2007). A defendant may file a motion challenging the adequacy of the report; the trial court should grant the motion only when it appears that the report does not represent a good faith effort to comply with the statutory definition of an expert report. See Tex. Civ. Prac. & Rem. Code Ann. ' 74.351(l) (Vernon Supp. 2007).

When determining if a good faith effort has been made, the trial court is limited to the four corners of the report and cannot consider extrinsic evidence. See Palacios, 46 S.W.3d at 878; Mem=l Herman Healthcare Sys., 230 S.W.3d at 758; Gray, 189 S.W.3d at 859 (Ain assessing the report=s sufficiency, the trial court may not draw any inferences, and must instead rely exclusively on the information contained within the report=s four corners@). An expert report must provide a fair summary of the expert=s opinion regarding (1) the applicable standard of care; (2) the manner in which the care provided failed to meet that standard; and (3) the causal relationship between the failure and the injury, harm or damages claimed. See Tex. Civ. Prac. & Rem. Code Ann. ' 74.351(r)(6) (Vernon Supp. 2007); Patel, 237 S.W.3d at 904.

To satisfy these standards, the expert report must include enough information to satisfy two requirements. The report must (1) inform the defendant of the specific conduct the plaintiff has called into question; and (2) provide a basis for the trial court to conclude the claims are meritorious. Palacios, 46 S.W.3d at 879; Patel, 237 S.W.3d at 904. AA report merely expressing the expert=s conclusions concerning the standard of care, breach, and causation fails to fulfill these purposes.@ Patel, 237 S.W.3d at 904 (citing Palacios, 46 S.W.3d at 879). The expert=s report need not identify all evidence necessary to litigate the merits of the plaintiff=s case, but it must link the expert=s opinions on these elements to the facts in the case. Wright, 79 S.W.3d at 52; Palacios, 46 S.W.3d at 879.

 B. Dr. Campbell=s Qualifications

Angelo contends that Dr. Salvato was negligent in prescribing anabolic steroids to Mr. Angelo as part of her clinical study of the effects of anabolic steroids on HIV/AIDS patients suffering from wasting syndrome. Angelo further contends that these acts and omissions were the proximate cause of Mr. Angelo=s death. Angelo relies on Dr. Campbell to support these contentions.

Angelo retained Dr. Campbell to review the medial records from Dr. Salvato=s office, the autopsy report from the medical examiner, and the death certificate. Based upon these records, and her experience, training, knowledge, and qualifications as a physician, Dr. Campbell opined that Dr. Salvato departed from the normal standard of care by (1) failing to obtain IRB approval and continuing review of the clinical study; (2) failing to maintain an adverse event log; (3) failing to maintain records of proper oversight and monitoring by another party; (4) continuing to prescribe anabolic steroids to Mr. Angelo for more than 40 months despite the appearance of known side effects of anabolic steroid use; (5) failing to conduct necessary lab work related to known side-effects of anabolic steroid use; and (6) failing to conduct further tests when medical examinations indicated and Mr. Angelo reported signs of heart disease. Dr. Campbell further opined that Dr. Salvato=s continued prescription of anabolic steroids led to cardiomegaly with left ventricular hypertrophy and stenosis of 70% of the left anterior descending coronary artery; this in turn caused Mr. Angelo=s death from hypertensive and atherosclerotic cardiovascular disease.

Under section 74.401(a), only a physician can opine as an expert against another physician. It does not follow, however, that every physician is a qualified expert. See Broders v. Heise, 924 S.W.2d 148, 152 (Tex. 1996). While Aexpert qualifications should not be too narrowly drawn . . . given the increasing specialization and technical nature of medicine, there is no validity, if there ever was, to the notion that every licensed medical doctor should be automatically qualified to testify as an expert on every medical question.@ Larson, 197 S.W.3d at 305 (citing Broders, 924 S.W.2d at 152). However, when a subject matter is common to and equally recognized in all fields of practice, any physician familiar with the subject may testify as to the standard of care. See Keo v. Vu, 76 S.W.3d 725, 732 (Tex. App.CHouston [1st Dist.] 2002, pet. denied). Likewise, where two fields of medicine overlap, and a procedure is common to more than one field, a physician in one of these fields may opine as to the standard of care for that procedure in the other field. Id.

Dr. Campbell=s curriculum vitae recites that she spent three years in residency at Memorial Hospital Southwest, and that she has been board certified in family practice for more than 13 years. She states that her opinions in the report are based upon her experience, training, knowledge, and qualifications as a physician. As a board certified family practitioner who has been an active staff member of Memorial Hospital Southwest for more than a decade, has been Medical Director of Brenco Research, and has conducted more than 100 clinical studies, Dr. Campbell has experience in treating patients with a wide range of maladies. Dr. Campbell described her knowledge regarding the standard of care governing clinical studies like the one conducted by Dr. Salvato, and regarding the monitoring of cardiovascular health for each participant as part of the overseeing physician=s responsibility. We cannot say that the trial court abused its discretion in concluding that Dr. Campbell demonstrated sufficient qualifications to opine about standards of care in connection with monitoring the health, including cardiovascular health, of patients participating in clinical studies.

Dr. Salvato concedes that Dr. Campbell may be qualified to opine about the standard of care governing Dr. Salvato=s research methodology and findings. Dr. Salvato nonetheless maintains that Dr. Campbell is not qualified to opine about standards of care governing the prescribing of anabolic steroids or about cardiovascular disease. Dr. Salvato contends that Dr. Campbell is not a cardiologist and lacks other experience that would qualify her to give expert testimony on the treatment of cardiovascular disease; Dr. Salvato also emphasizes that Dr. Campbell is not an endocrinologist, and asserts that she is not otherwise qualified to testify about the side effects of anabolic steroids. While Dr. Salvato concedes that some family practitioners might be qualified to opine about steroid use or cardiovascular disease, Dr. Salvato contends that Dr. Campbell=s curriculum vita and report fail to establish her particular experience or qualifications to opine on these areas of medical expertise. Dr. Salvato=s contentions fall short of establishing an abuse of discretion. ADespite the fact that we live in a world of niche medical practices and multilayer specializations, there are certain standards of medical care that apply to multiple schools of practice and any medical doctor.@ Blan v. Ali, 7 S.W.3d 741, 746 (Tex. App.CHouston [14th Dist.] 1999, no pet.).

The facts in Blan are instructive. The physician at issue properly was able to opine about the standard of care for a stroke patient, and was not purporting to offer expert medical opinions peculiar to the field of cardiology. For that reason, the trial court in Blan abused its discretion by excluding the expert=s testimony about the standard of care when his testimony concerned a matter common to all physicians. Id.; see also McKowen v. Ragston, __ S.W.3d __, 2007 WL79330, at *5 (Tex. App.CHouston [1st Dist.] Jan. 11, 2007, no pet.) (when Athe subject of inquiry is common to and equally recognized and developed in all fields of practice, then any physician familiar with the subject may testify as to standard of care@) (citing Sears v. Cooper, 574 S.W.2d 612, 614 (Tex. App.CHouston [14th Dist.] 1978, writ ref=d n.r.e.)).

Here, the trial court acted within its discretion by applying this teaching and concluding that Dr. Campbell is qualified to opine about specific areas B such as the conduct of a clinical study and cardiac health B that are common to multiple fields of practice.

Dr. Campbell=s curriculum vitae and report also provide a reasonable basis for the trial court to have concluded that Dr. Campbell is qualified to opine about the effects of hormones. Dr. Salvato acknowledged at oral argument that one need not necessarily be an endocrinologist to address issues regarding the effects of hormones. Dr. Campbell=s curriculum vitae demonstrates experience with clinical studies involving hormone-related research. These studies include research regarding the prescription of Eclomiphene to treat low testosterone in men and parathyroid hormone studies in women. Thus, while Dr. Campbell is not an endocrinologist, she provides sufficient evidence of her knowledge in connection with studies prescribing and monitoring hormones in patients. See McKowen , __ S.W.3d __, 2007 WL79330, at *5 (AA medical witness from one practice area may be qualified to testify if he has practical knowledge of what is customarily done by other practitioners under circumstances similar to those at issue in the case@); Blan, 7 S.W.3d at 745 (the emphasis is on the plaintiff=s condition, not the defendant=s expertise, and physician expert need not be a specialist to opine).

The trial court found that Dr. Campbell is qualified to opine as an expert on medical treatment of Mr. Angelo. The trial court=s decision comported with guiding principles and rules governing sufficiency of expert reports. The trial court acted within its discretion. See Larson, 197 S.W.3d at 304-05 (Aexpert qualifications should not be too narrowly drawn;@ in a close call, the decision as to whether expert testimony qualifies must go to the trial court).

We overrule Dr. Salvato=s first issue.

C. Standard of Care and Causation

Dr. Salvato argues next that the expert report is deficient. Dr. Salvato argues that Dr. Campbell=s report does not set forth the standard of care for conducting a clinical study or for prescribing anabolic steroids. Dr. Salvato claims that Dr. Campbell=s report does not Aconvincingly tie the alleged departure from the standard of care to specific facts of the case.@ Dr. Salvato argues that because Dr. Campbell=s report does not set forth a standard of review, it does not inform Dr. Salvato as to how he breached that standard of care. Dr. Salvato also contends that Dr. Campbell=s report does not link the allegations of negligence to the damages Angelo claims. Dr. Salvato therefore concludes that Dr. Campbell=s opinions concerning causation are impermissibly conclusory.

An expert report need not marshal all of the plaintiff=s proof, but it must include the expert=s opinions on the three statutory elements B standard of care, breach, and causation. Gray, 189 S.W.3d at 859. Likewise, a trial court shall grant a motion challenging the adequacy of a report only if it appears to the court that the report does not represent a good faith effort to comply with the definition of an expert report in section 74.351(r)(6). See Tex. Civ. Prac. & Rem. Code ' 74.351(l) (Vernon Supp. 2007); Palacios, 46 S.W.3d at 879 (if any of the three statutory elements are missing, the report is not a good faith effort). An expert report must provide enough information to fulfill two purposes to constitute an objective good faith effort. The report must inform the defendant of the specific conduct the plaintiff has called into question, and it must provide a basis for the trial judge to conclude the claims have merit. See Palacios, 46 S.W.3d at 878-79; Baylor Univ. Med. Ctr. v. Biggs, 237 S.W.3d 909, 916-17 (Tex. App.CDallas 2007, pet. filed); Gray, 189 S.W.3d at 859.

Applying these precepts in light of the standard of review, we conclude that the trial court acted within its discretion in concluding that Dr. Campbell=s report provided sufficient specificity regarding the standard of care and causation.

Dr. Campbell=s report addresses the standard of care required for a clinical study in which the physician is prescribing a medication with known side effects. Dr. Campbell describes the proper conduct of a clinical study, noting the FDA=s requirement of IRB approval of any clinical study; the need for oversight; the need to monitor the patient=s health; the need to record potential adverse effects; the preeminence of patient health throughout; the need to determine the cause of apparent adverse health indicators; and the need to withdraw a patient from a study when that patient demonstrates indicators of adverse health. Dr. Campbell opines as to the standard of care required for any doctor prescribing medicine to a patient, especially with heart disease symptoms like those exhibited by Mr. Angelo, including the need for further tests, proper diagnosis, and cessation of the test medication.

Dr. Campbell opined that Dr. Salvato=s continued prescription of anabolic steroids when Mr. Angelo was experiencing Aknown toxic side-effects of those steroids@ was a breach of the standard of care for a doctor conducting a clinical study and having the obligation to put the health of the participant first. Dr. Campbell=s report gives Dr. Salvato adequate notice of the alleged breaches of the standard of care in her treatment of Mr. Angelo during his participation in Dr. Salvato=s clinical study. See Palacios, 46 S.W.3d at 878-79; Biggs, 237 S.W.3d at 916-17; Gray,189 S.W.3d at 859.

Dr. Campbell=s report does not state conclusions without reference to the underlying facts upon which she has premised her opinion. Patel, 237 S.W.3d at 904 (citing Palacios, 46 S.W.3d at 879). She links each element of the standard of care in the treatment of a participant in a clinical study to the facts of the case, noting where and how Dr. Salvato departed from that standard of care. Dr. Campbell opined that Dr. Salvato failed to correctly monitor Mr. Angelo. As an example, she focused on Dr. Salvato=s failure to monitor Mr. Angelo=s lipid levels in light of the known increase in lipid levels associated with anabolic steroid use that were noted in Dr. Salvato=s notes. Dr. Campbell opined that Dr. Salvato assessed Mr. Angelo=s lipid levels in 2001, but then failed to do so for the following three years. Dr. Campbell noted that Dr. Salvato failed to monitor lipid levels even while aware that it was important for cardiac health to watch them. Dr. Campbell=s report noted that Mr. Angelo suffered chest pains, elevated blood pressure, and increased QRS voltage, all symptoms of heart disease. Dr. Salvato=s notes also revealed that Mr. Angelo complained of worsening anxiety, insomnia, and testicular atrophy, all known side effects of anabolic steroid abuse. Dr. Campbell noted that no adverse event log was maintained; that symptoms of cardiac disease were overlooked or mis-diagnosed; and that Mr. Angelo was prescribed additional steroids. Even when Mr. Angelo was diagnosed with hypertension, Dr. Salvato continued to prescribe anabolic steroids to Mr. Angelo in violation of the standard of care associated with a clinical study and the prescription of a drug. The trial court acted within its discretion in concluding that these opinions suffice to identify specific conduct and to provide a basis for concluding the claims have merit.

As to causation, Dr. Campbell opines that the warning signs of cardiac disease should have led Dr. Salvato to (1) exclude Mr. Angelo from the study; (2) cease prescribing anabolic steroids to Mr. Angelo once adverse health indicators were noted; and (3) conduct further cardiovascular evaluation to properly diagnose left ventricular hypertrophy, an abnormality related to the abuse of anabolic steroids. Dr. Campbell opines that these failures, and the continued prescription of anabolic steroids, caused the left ventricular hypertrophy and related chronic hypertension that proximately caused Mr. Angelo=s death B which the autopsy attributed to cardiac disease. According to Dr. Campbell=s report, Dr. Salvato failed to accurately monitor Mr. Angelo=s health and withdraw him from the study given the harm that the anabolic steroids were causing.

The trial court found that Dr. Campbell=s report was sufficient to apprise Dr. Salvato of the specific conduct Angelo alleges was a departure from the standard of care, and the basis for establishing a causal link between the departures and Mr. Angelo=s death. Gray, 189 S.W.3d at 859. The trial court=s decision was within the scope of its discretion. Larson, 197 S.W.3d at 304-05; see also Mem=l Herman Healthcare Sys., 230 S.W.3d at 757.

We overrule Dr. Salvato=s second issue.

IV. Conclusion

The trial court found that Dr. Campbell=s report, coupled with her curriculum vitae, provided a sufficient basis to conclude she is qualified to offer expert testimony in this case. The trial court concluded that the requisite specificity regarding standard of care and causation are present in Dr. Campbell=s report. The trial court acted within its discretion in so doing.

The trial court=s order is affirmed.

/s/ William J. Boyce

Justice

Judgment rendered and Memorandum Opinion filed April 8, 2008.

Panel consists of Chief Justice Hedges, and Justices Anderson and Boyce.

[1] The QRS complex is a structure on the electrocardiogram (ECG) that corresponds to the Q, R, and S waves representing the depolarization of the ventricles. A proper ECG reading can measure the rate and regularity of heartbeats, as well as determine the size and position of the chambers. This enables a practitioner to assess the presence of any damage to the heart and the effects of drugs or devices to regulate the heart. Elevated QRS readings have been linked to left ventricular hypertrophy B a condition that may occur naturally but also has been linked to certain conditions. Left ventricular hypertrophy is a thickening of the muscle on the left ventricle of the heart, and has been linked to aortic stenosis (a malfunction of the valve between the left ventricle and the aorta which impedes blood flow); aortic insufficiency (a malfunction of the valve between the left ventricle and the aorta which allows blood to flow in the wrong direction); and hypertension (chronic high blood pressure).

[2] Atherosclerotic cardiovascular disease is a disease that affects the arterial blood vessels, often referred to as Ahardening@ or Afurring@ of the arteries.

[3] All clinical studies are required to have Institutional Review Board (IRB) approval before commencing. Universities and medical establishments that conduct clinical trials appoint knowledgeable individuals to sit on these boards and to screen all trials to insure that they are ethical, protective of the health of the individuals, and conducted in accordance with solid methodological standards.

[4] Cardiomegaly is a medical condition wherein the heart is enlarged.

[5] Defendants=motion to dismiss, filed June 7, 2007, sought dismissal pursuant to Texas Civil Practice and Remedies Code section 74.351(b); the motion did not assert that Angelo failed to file a report, but rather that Angelo failed to file a Acompetent expert report by a qualified expert.@

[6] Section 51.014(a)(10) also allows an interlocutory appeal from the granting of a motion to dismiss under section 74.351(l), which provides that a court Ashall grant a motion challenging the adequacy of an expert report only if it appears to the court, after hearing, that the report does not represents an objective good faith effort to comply with the definition of an expert report in Subsection (r)(6).@ See Tex. Civ. Prac. & Rem. Code ' 74.351(l) (Vernon Supp. 2007).

[7] The following decisions adopt Group=s reasoning or employ similar reasoning: CHCA Mainland, L.P. v. Burkhalter, 228 S.W.3d 221, 224B25 (Tex. App.CHouston [1st Dist.] 2007, no pet.); HealthSouth Corp. v. Searcy, 227 S.W.3d 907, 908 (Tex. App.CDallas 2007, no pet.); Sides v. Guevara, ___ S.W.3d ___, 2007 WL 2456882, at *2 (Tex. App.CEl Paso Aug. 30, 2007, no pet.). Other decisions conclude there is no appellate jurisdiction under these circumstances. See, e.g., Jain v. Stafford, 214 S.W.3d 94, 97 (Tex. App.CFort Worth 2006, no pet.); Lewis v. Funderburk, 191 S.W.3d 756, 759 (Tex. App.CWaco , 2006, pet. granted). The Texas Supreme Court has not decided this issue, which is pending before the court in Funderburk.