This is an analysis of the case Bush v. Columbia Medical Center of Arlington, as decided by the Texas Supreme Court in May 2025. You can read the full opinion by clicking here.
The case centers on a medical malpractice claim brought by Jared Bush after the death of his wife, Ireille Williams-Bush, who was misdiagnosed and discharged from Medical City Arlington Hospital without being properly screened for pulmonary embolism, which ultimately caused her death.
The legal issue is whether the plaintiff's expert report against the hospital was adequate under Texas law. Texas requires health care liability claimants to serve a timely expert report that provides a "fair summary" of the expert's opinions on the applicable standard of care, breach, and causation.
Background
Williams-Bush presented with symptoms consistent with pulmonary embolism but was admitted under a heart attack diagnosis. The consulting cardiologist performed a procedure but did not screen her for pulmonary embolism. She was discharged and died three days later from undetected clots.
Bush sued the hospital and physicians for negligence. The focus here is on the hospital's liability, specifically claims the hospital failed to have or enforce adequate policies and protocols to ensure proper patient evaluation.
Expert Report and Legal Dispute
The expert, Dr. Cam Patterson, a highly qualified cardiologist and hospital administrator, issued a report asserting that hospitals treating acute cardiac patients must have system-based policies to ensure proper evaluation, including protocols like the "Triple Rule Out" to screen for life-threatening conditions such as pulmonary embolism. He opined the hospital breached the standard of care by failing to implement such protocols, which caused a lack of communication and led to the patient's death.
The hospital challenged the report as inadequate, arguing it was conclusory and failed to show how hospital policies could override physicians' independent medical judgment. The trial court upheld the report's adequacy, but the court of appeals reversed, dismissing the claims. The appeals court criticized the report for not explaining how hospital protocols could have influenced the physicians' decisions, citing the Texas prohibition on hospitals practicing medicine.
Texas Supreme Court's Analysis
The Supreme Court reversed the court of appeals, holding that the expert report was adequate at this early stage. Key points include:
- The report provided a fair summary linking the hospital's failure to implement policies with the misdiagnosis and death.
- The report explained how the hospital's lack of protocols resulted in missing the pulmonary embolism diagnosis.
- The court rejected the notion that the report had to explain how hospital policies could override physician decisions. Hospitals are responsible for administrative policies that guide non-physician staff, not for practicing medicine directly.
- The court emphasized that the expert report need only make a good-faith effort to explain causation and breach, not prove the entire case or anticipate all defenses.
- The court distinguished this case from prior cases where reports failed to link hospital conduct to harm or failed to explain how the hospital had the authority to intervene.
- It noted that issues regarding the hospital potentially unlawfully practicing medicine or the actual enforceability of protocols are factual questions for later stages, not for the expert report threshold.
Conclusion
The Supreme Court held that the expert report met the low threshold required to survive a motion to dismiss under Texas Medical Liability Act. The trial court did not abuse its discretion by denying dismissal, and the case was remanded for further proceedings.
Girards Law Firm specializes in severe injury and wrongful death cases, especially those that involve brain damage, heart damage, spinal cord injuries or severe burns in Texas, Arkansas and Oklahoma. Contact us at www.girardslaw.com by using the chat feature for more information