Background
Tahirih Kennedy was admitted to the hospital on December 22, 2019, at 39 weeks of pregnancy with severe preeclampsia. Dr. Steven Suba, her obstetrician, performed a Cesarean section without noted complications. On December 26, a radiograph revealed significant small bowel and proximal colon distention suggesting possible ileus or obstruction. Tahirih was discharged on December 28.
On January 1, 2020, Tahirih returned to the hospital with severe abdominal and back pain. Dr. Leslie Ann Phillips examined her, diagnosed a reducible umbilical hernia, prescribed pain medication, and discharged her. The next morning, Tahirih suffered a rupture of her C-section incision. Emergency surgery revealed a perforated cecum and wound dehiscence. She developed acute respiratory failure, septic shock, kidney injury, and required a ventilator and ileostomy.
In March 2022, the Kennedys sued Drs. Suba and Phillips for negligence in post-surgical management, alleging the physicians failed to recognize and treat the bowel perforation, and that a CT scan would have prevented the injuries. The trial court granted summary judgment for the defendants in October 2025. The Kennedys appealed.
The Court’s Holding
The court affirmed summary judgment, holding that the Kennedys failed to establish proximate causation with reasonable medical probability. The plaintiffs’ expert, Dr. Izumi Cabrera, testified that she could not state that Tahirih’s outcome would have been different had the doctors performed additional diagnostic testing. Cabrera’s opinion that appropriate management “could have potentially prevented” the outcome did not meet the required standard. The court emphasized that expert opinion stating negligence “caused or contributed to” injury without establishing reasonable medical probability is insufficient as a matter of law.
The court rejected the Kennedys’ argument that causation could be determined by lay jurors’ common sense. The causation question is not whether a bowel perforation causes the injuries Tahirih suffered, but whether the doctors’ specific negligent acts were the proximate cause of the particular injuries. The court found this complex question requires expert testimony establishing a causal connection within reasonable medical probability, particularly where other plausible causes exist.
Key Takeaways
- Expert testimony on causation in medical malpractice cases must establish a “reasonable medical probability,” not mere possibility or what “could have” happened
- Vague or speculative expert opinions are insufficient to defeat summary judgment
- When multiple plausible causes of injury exist, plaintiffs must present evidence excluding alternative causes with reasonable certainty
- Causation in medical negligence cases generally requires expert opinion and is not within lay jurors’ common knowledge
Why It Matters
This decision reinforces the high evidentiary bar for medical malpractice plaintiffs in Texas. Physicians are protected from liability when expert testimony fails to establish that their specific actions or omissions—as opposed to other medical conditions—caused the plaintiff’s injuries. The ruling makes clear that speculation about what might have happened with different treatment is insufficient; causation must be proven to a reasonable medical probability. This standard prevents juries from imposing liability based on hindsight or general principles without specific, credible expert evidence linking the defendant’s conduct to the plaintiff’s harm.
The decision also illustrates the importance of expert witness preparation in medical malpractice cases. Even when post-surgical complications are serious and allegedly preventable, liability cannot attach without expert testimony establishing a causal nexus meeting the “reasonable medical probability” standard. For healthcare providers and their insurers, the ruling provides protection against speculative causation theories.