What Constitutes Medical Malpractice in Texas?

In a medical negligence case, the plaintiff must prove, by competent expert testimony, that the defendant’s breach of duty proximately caused the plaintiff’s injuries. Duff v. Yelin, 751 S.W.2d 175, 176 (Tex. 1988); Hart v. Van Zandt, 399 S.W.2d 791, 792 (Tex. 1966). On the causation element, the plaintiff is required to show evidence of a reasonable medical probability that the injury was proximately caused by the breach of the defendant. Park Place Hosp. v. Estate of Milo, 909 S.W.2d 508, 511 (Tex. 1995); Duff, 751 S.W.2d at 176.

Through expert testimony, the plaintiff must prove:
(1) A duty by the physician to act according to a certain standard of care;
(2) A breach of that standard of care;
(3) An injury; and
(4) A causal connection between the breach of care and the injury.

Morrell v. Finke, 184 S.W.3d 257, 271 (Tex. App.─Fort Worth 2005, pet. denied).
The threshold question in a medical malpractice case is the standard of care. Jones v. Miller, 966 S.W.2d 851, 854 (Tex. App.─Houston [1st Dist.] 1998, no pet.). The applicable standard must be established so the fact finder can decide if the defendant deviated. Id. In medical malpractice cases, the standard of care must be established by expert testimony unless the mode or form of treatment is a matter of common knowledge or is within the experience of a layman. Jackson v. Axelrad, 221 S.W.3d 650, 655 (Tex. 2007).

To establish proximate cause, a plaintiff must prove both (1) cause-in-fact, and (2) foreseeability. Duff, 751 S.W.2d at 176. Cause-in-fact requires the plaintiff to establish a causal connection between the injuries suffered and the defendant’s breach of duty based upon “reasonable medical probability,” not mere conjecture, speculation, or possibility. See Park Place Hosp., 909 S.W.2d at 511. The ultimate standard of proof on causation is “whether, by a preponderance of the evidence, the negligent act or omission is shown to be a substantial factor in bringing about the harm and without which the harm would not have occurred.” Kramer v. Lewisville Memorial Hosp., 858 S.W.2d 397, 400 (Tex. 1993). Importantly, reasonable probability is determined by the substance and context of an expert’s opinion, and does not turn on semantics or on the use of a particular term or phrase. Arlington Mem’l Hosp. Found., Inc. v. Baird, 991 S.W.2d 918, 922 (Tex. App.─Fort Worth 1999, pet. denied) (citing Burroughs Wellcome Co. v. Crye, 907 S.W.2d 497, 500 (Tex. 1995)).