Rajesh Nambiar, M.D. v. Chris Pumphrey

In The
Court of Appeals
Seventh District of Texas at Amarillo

No. 07-26-00004-CV

RAJESH NAMBIAR, M.D., APPELLANT

V.

CHRIS PUMPHREY, APPELLEE

On Appeal from the 47th District Court
Potter County, Texas
Trial Court No. 112714-A-CV, Honorable Dee Johnson, Presiding

May 27, 2026
MEMORANDUM OPINION
Before PARKER, C.J., and DOSS and YARBROUGH, JJ.

Appellant, Rajesh Nambiar, M.D., appeals the trial court’s order denying his motion

to dismiss and objections to the Chapter 74 expert report served by appellee Chris

Pumphrey. We reverse and render.

BACKGROUND

Pumphrey filed this medical malpractice case in February of 2025 alleging that Dr.

Nambiar left a catheter wire inside Pumphrey following a laser ablation procedure,
breaching the applicable standard of care. As required by Chapter 74 of the Texas Civil

Practice and Remedies Code, Pumphrey served an expert report, which was prepared

by Daniel E. Miga, M.D. See TEX. CIV. PRAC. & REM. CODE § 74.351(a). Dr. Nambiar

timely filed his objections to the sufficiency of the report on March 18, 2025. He then filed

a motion to dismiss on July 15, 2025. A hearing on Dr. Nambiar’s objections and motion

to dismiss was held on November 21, 2025. Following the hearing, the trial court signed

an order overruling the objections and denying the motion. It is from this order that Dr.

Nambiar brings this interlocutory appeal. 1 See id. § 51.014(a)(9) (authorizing

interlocutory appeal from order denying all or part of motion to dismiss filed under

§ 74.351(b)).

ANALYSIS

Applicable Law

A claimant bringing a healthcare liability claim must timely provide each defendant

healthcare provider with an expert report. Id. § 74.351(a). The goal of section 74.351 is

to “deter frivolous lawsuits by requiring a claimant early in litigation to produce the opinion

of a suitable expert that his claim has merit.” Columbia Valley Healthcare Sys., L.P. v.

Zamarripa, 526 S.W.3d 453, 460 (Tex. 2017) (internal quotation marks omitted); see also

Certified EMS, Inc. v. Potts, 392 S.W.3d 625, 631 (Tex. 2013) (expert report requirement

is “a threshold mechanism to dispose of claims lacking merit . . .”).

1 Pumphrey served Dr. Nambiar with a Supplemental Expert Report on December 19, 2025. We
will not consider the supplemental report in our analysis as it was not before the trial court.

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An expert report is a “written report by an expert that provides a fair summary of

the expert’s opinions as of the date of the report regarding applicable standards of care,

the manner in which the care rendered by the physician or health care provider failed to

meet the standards, and the causal relationship between that failure and the injury, harm,

or damages claimed.” TEX. CIV. PRAC. & REM. CODE § 74.351(r)(6). In setting out the

expert’s opinions, the report must inform the defendant of the specific conduct the plaintiff

has called into question as well as provide a basis for the trial court to conclude that the

claims have merit. Scoresby v. Santillan, 346 S.W.3d 546, 556 (Tex. 2011). A report that

merely states the expert’s conclusions as to the standard of care, breach, and causation

does not fulfill these purposes. Am. Trans. Care Ctrs. of Tex., Inc. v. Palacios, 46 S.W.3d

873, 879 (Tex. 2001). The expert “must explain the basis of his statements to link his

conclusions to the facts.” Columbia Valley, 526 S.W.3d at 460–61 (quoting Earle v. Ratliff,

998 S.W.2d 882, 890 (Tex. 1999)). If a plaintiff does not timely serve an expert report

meeting the required elements, the trial court must dismiss the healthcare claim on motion

of the affected healthcare provider. See TEX. CIV. PRAC. & REM. CODE § 74.351(b), (l);

Miller v. JSC Lake Highlands Operations, LP, 536 S.W.3d 510, 513 (Tex. 2017) (per

curiam). The trial court shall grant a motion challenging the adequacy of an expert report

only if it appears to the court that the report “does not represent an objective good faith

effort to comply with the definition of an expert report in Subsection (6).” TEX. CIV. PRAC.

& REM. CODE § 74.351(l); Strom v. Mem’l Hermann Hosp. Sys., 110 S.W.3d 216, 221

(Tex. App.—Houston [1st Dist.] 2003, pet. denied).

We review a trial court’s decision to grant or deny a motion to dismiss a healthcare

liability claim under an abuse of discretion standard. Palacios, 46 S.W.3d at 875. We

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apply the same standard when reviewing a trial court’s determination as to whether an

expert is qualified. See Broders v. Heise, 924 S.W.2d 148, 151–52 (Tex. 1996). When

reviewing matters within a trial court’s discretion, an appellate court may not substitute its

judgment for that of the trial court. Bowie Mem’l Hosp. v. Wright, 79 S.W.3d 48, 52 (Tex.

2002) (per curiam). A trial court does not abuse its discretion merely because it decides

a discretionary matter differently than an appellate court would have. E.I. du Pont de

Nemours & Co. v. Robinson, 923 S.W.2d 549, 558 (Tex. 1995). Rather, the test for abuse

of discretion is “whether the trial court acted without reference to any guiding rules or

principles.” Id.

Sufficiency of the Expert Report

By his first issue, Dr. Nambiar asserts that Dr. Miga’s report is insufficient and

constitutes “no report” as a matter of law. He contends that Dr. Miga’s report fails to

identify the applicable standard of care, fails to allege how that standard was breached,

and contains no opinions regarding causation.

In his expert report, Dr. Miga summarized the care received by Pumphrey related

to his left thigh endovascular laser ablation performed by Dr. Nambiar in August of 2023.

Dr. Miga noted that Pumphrey experienced “persistent left upper thigh pain and a bruise”

following the procedure. Then, on September 10, 2024, Pumphrey “was massaging the

bruised area when he suddenly felt a sharp metal object poke through the skin.”

Pumphrey contacted Dr. Nambiar’s office, and “[a] retained wire was removed by the vein

clinic staff.” Pumphrey then sought care from another physician, and an additional

retained wire fragment was removed on October 1, 2024.

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Dr. Miga opined, “Transcatheter intravascular procedures such as venous

ablations are commonplace in the medical field. Guidewire retention after intravascular

insertion is a known complication of these procedures. [. . .] Guidewire retention is

considered a ‘never event.’” Dr. Miga opined that there is a “need for increased vigilance

for complications including close inspection of intravascular wires/laser fibers at the

conclusion of the procedure.” He further wrote, “It is my expert opinion that the standard

of care was not met under multiple circumstances. First, the retention of the fiber ablation

catheter and secondly the failure to respond to the patient’s concerns in a timely manner

resulting [in] prolonging pain and suffering.”

The trial court determined that Dr. Miga’s report was adequate to put Dr. Nambiar

on notice of what care was required but not given. We disagree. “To adequately identify

the standard of care, an expert report must set forth ‘specific information about what the

defendant should have done differently.’” Abshire v. Christus Health Se. Tex., 563

S.W.3d 219, 223 (Tex. 2018) (per curiam) (quoting Palacios, 46 S.W.3d at 880). Stating

that “retention of the fiber ablation catheter” did not meet the standard of care does not

inform the defendant of what action or inaction the plaintiff has called into question.

Similarly, stating that there was a “need for increased vigilance” does not reveal what Dr.

Nambiar should have done differently.

A “fair summary” of the applicable standard of care and breach identifies the type

of care expected but not rendered. See Palacios, 46 S.W.3d at 880. For example, an

expert report sufficiently stated the standard of care for staff responsible for assessing,

removing, and changing a patient’s wound VAC device where the report explained that

staff “should have discovered the presence of a foreign body in the left flank wound of the
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patient and alerted physicians for appropriate treatment,” “should have assessed [the

patient] on a daily basis and [made] sure that no wound VAC device remain[ed] in this

patient’s hip for more than two days,” and “should have properly cleaned the wound . . .

and properly removed and/or replaced the wound VAC sponge device . . . .” Health Care

Unlimited, Inc. v. Villarreal, No. 13-09-00456-CV, 2010 Tex. App. LEXIS 980, at *14–15

(Tex. App.—Corpus Christi Feb. 11, 2010, no pet.) (mem. op.). The report further

explained that the “proper technique” for staff “involved thoroughly exploring the full extent

of the wound at each removal and/or replacement,” which would ensure that no foreign

bodies were left in the patient’s wound. Id. at *15. By explaining the specific tasks and

responsibilities required, the report sufficiently set forth the standard of care. Id.; see also

Hood v. Kutcher, No. 01-12-00363-CV, 2012 Tex. App. LEXIS 8120, at *2 (Tex. App.—

Houston [1st Dist.] Sept. 27, 2012, no pet.) (mem. op.) (in case involving fragments of

glass left in patient’s wound, upholding expert report explaining standard of care required

that wound be explored, prepared, and cleaned, including irrigation and debridement, if

necessary, to detect foreign bodies).

In contrast, in Agahi v. Flynt, a case in which the plaintiff ingested orthodontic

brackets that became dislodged following an orthodontic visit, the Third Court of Appeals

found the expert report deficient because it failed to “specify the standard of care to which

an orthodontist is held when positioning, adjusting, and activating orthodontic

appliances—the actions that allegedly caused [the plaintiff’s] injuries . . . .” No. 03-24-

00835-CV, 2025 Tex. App. LEXIS 4546, at *12 (Tex. App.—Austin June 27, 2025, pet.

denied) (mem. op.). Because the report did not provide specific information about what

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the defendant should have done differently, it was found to constitute “no report” at all.

See id. at *15–16.

The “fair summary” required in an expert report is “something less than a full

statement” of the applicable standard of care, how it was breached, and how that breach

caused the plaintiff’s injury. Spitzer v. Berry, 247 S.W.3d 747, 750 (Tex. App.—Tyler

2008, pet. denied) (citing Palacios, 46 S.W.3d at 880). However, “if an expert report

contains only conclusions about the statutory elements, the trial court has ‘no discretion

but to conclude . . . that the report does not represent a good-faith effort’ to satisfy the

statute.” Smith v. Wilson, 368 S.W.3d 574, 577 (Tex. App.—Austin 2012, no pet.)

(quoting Palacios, 46 S.W.3d at 880).

Dr. Miga’s report does not identify what steps Dr. Nambiar should have taken but

failed to take in his treatment of Pumphrey. Because Dr. Miga’s report does not identify

the standard of care applicable to Dr. Nambiar, it does not meet the minimum standards

set forth in section 74.351. Consequently, we conclude that the trial court abused its

discretion in denying Dr. Nambiar’s motion to dismiss. See TEX. CIV. PRAC. & REM. CODE

§ 74.351(l). We sustain Dr. Nambiar’s first issue.

Because issue one is dispositive, we need not address Dr. Nambiar’s other

arguments concerning the expert report or his challenge to Dr. Miga’s qualifications. TEX.

R. APP. P. 47.1.

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CONCLUSION

We reverse the trial court’s order denying Dr. Nambiar’s motion to dismiss and

render judgment dismissing Pumphrey’s claims against Dr. Nambiar.

Judy C. Parker
Chief Justice

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