Full Opinion

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.merriam- webster.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 6 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 good- faith 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