This question has been addressed in 1 Texas court opinion:
COA14 — January 27, 2026
In CHI St. Luke’s Health-The Vintage Hospital v. Aurisano, the Fourteenth Court of Appeals addressed the legal adequacy of expert reports under the Texas Medical Liability Act (TMLA). The hospital challenged a plaintiff's medical expert reports, arguing they were "conclusory" because they failed to explain the causal link between the hospital's alleged negligence and the patient's injuries, including a fall and bed sores. The court analyzed the reports using the "how and why" framework, which requires experts to provide a transparent analytical bridge showing how a specific breach of care was a substantial factor in causing the harm. The court held that because the expert failed to provide a factual explanation linking the hospital's conduct to the injuries—leaving the trial court to fill in the blanks with inferences—the reports were legally insufficient. The court reversed the trial court’s denial of the motion to dismiss and remanded the case.
Litigation Takeaway
“To survive a challenge, an expert report must provide an "analytical bridge" that explains the 'how and why' behind a conclusion. In family law—whether dealing with custody evaluations, capacity assessments, or business valuations—practitioners must ensure that experts do not simply state a result but instead provide a transparent, fact-based path from the breach or behavior to the specific outcome or recommendation.”