Shaikh v. Rodriguez, 01-25-00182-CV, July 28, 2026.
On appeal from 268th District Court, Fort Bend County, Texas
Synopsis
The First Court of Appeals held that Chapter 74 does not require a physician expert to share the defendant’s specialty if the expert is qualified on the specific medical issue in dispute. Where the challenged opinions concerned prednisone-related glucose monitoring, risk warnings, and coordinated diabetic care, an ophthalmologist and a critical care physician could qualify to opine even though the defendant was a rheumatologist.
Relevance to Family Law
For Texas family law litigators, this opinion matters because specialty-based qualification fights arise far beyond health care liability cases. In divorce, custody, and property litigation, parties routinely rely on physicians, mental-health professionals, business valuation experts, tracing experts, and digital-forensics witnesses whose credentials may not perfectly match the opposing party’s preferred niche. Shaikh reinforces a useful advocacy principle: Texas courts focus on whether the expert is qualified on the precise issue before the court, not whether the expert shares a title, label, or subspecialty with the person whose conduct or condition is being evaluated. That framing can be critical in disputes over parental medical decision-making, a child’s treatment needs, capacity issues affecting contract or testamentary acts, reimbursement claims involving medical expenses, and characterization or valuation fights that turn on expert methodology rather than job description.
Case Summary
Fact Summary
The plaintiff, Irma Rodriguez, was a type 2 diabetic who began treating with Dr. Anam Aslam Shaikh, a rheumatologist, for polymyalgia rheumatica in 2022. Shaikh prescribed prednisone, a corticosteroid. According to the opinion, record evidence showed that corticosteroids such as prednisone can materially affect blood glucose levels in diabetic patients and, in that setting, may contribute to serious vision complications.
Rodriguez later developed worsening vision problems, including progression of cataracts, diabetic retinopathy, and vision loss in one eye. She sued, alleging that Shaikh negligently prescribed prednisone without appropriate diabetes-management adjustments, without ensuring vigilant glucose monitoring, without adequate coordination with other providers, and without sufficient warning regarding steroid-related risks, including increased blood sugar and resulting vision complications.
Rodriguez first served an expert report from an ophthalmologist, Dr. Matthew McMenemy. The trial court accepted that report only as to causation and limited it accordingly. Rodriguez then served an amended McMenemy report and a second report from Dr. Alex Lechin, a physician board-certified in critical care, internal medicine, pulmonary medicine, and sleep medicine. Both experts emphasized experience with corticosteroids and diabetic patients. Lechin specifically stated that he had decades of experience managing autoimmune conditions and prescribing corticosteroids to diabetic and non-diabetic patients, and that polymyalgia rheumatica is not exclusively managed by rheumatologists.
The defendant again objected and sought dismissal, arguing the experts were unqualified because neither demonstrated expertise in treating polymyalgia rheumatica as a rheumatologist. The trial court denied dismissal, and the defendant pursued interlocutory appeal.
Issues Decided
- Whether, under Texas Civil Practice and Remedies Code sections 74.351 and 74.401, a physician expert must practice in the same specialty as the defendant to opine on the applicable standard of care.
- Whether an ophthalmologist and a critical care/internal medicine physician were qualified to opine on standards governing prednisone use in a diabetic patient when the defendant was a rheumatologist treating a rheumatologic condition.
- Whether the expert reports adequately addressed the alleged duties to monitor blood glucose, warn of corticosteroid-related risks, and coordinate care in light of the patient’s diabetes.
Rules Applied
Chapter 74’s expert-report framework requires a claimant to serve a report from a qualified expert that represents a good-faith effort to summarize the applicable standard of care, breach, and causation. The court cited Texas Civil Practice and Remedies Code section 74.351(r)(5) for the proposition that only a qualified expert can satisfy the report requirement.
On standard-of-care qualifications, the governing inquiry came from section 74.401: whether the expert has knowledge of accepted standards of care for the diagnosis, care, or treatment of the illness, injury, or condition involved, and is qualified by training or experience to offer those opinions. The opinion reflects the familiar Texas rule that the expert need not be in the identical specialty if the expert has knowledge, skill, experience, training, or education regarding the specific issue before the court.
The court also relied on abuse-of-discretion review, citing authorities including Columbia Valley Healthcare Sys., L.P. v. Zamarripa, 526 S.W.3d 453 (Tex. 2017), Pankaj v. Hernandez, 695 S.W.3d 900 (Tex. App.—Houston [1st Dist.] 2024, no pet.), and Puppala v. Perry, 564 S.W.3d 190 (Tex. App.—Houston [1st Dist.] 2018, no pet.). The opinion additionally referenced prior prednisone-related cases recognizing that qualification turns on the medical question at issue rather than rigid specialty matching.
Application
The First Court of Appeals treated the qualification question as issue-specific, not specialty-specific. That was the decisive move. The defendant framed the case as one about a rheumatologist’s treatment of polymyalgia rheumatica, and from that premise argued that only someone with rheumatology expertise could address the standard of care. The court instead focused on what the reports actually criticized: prescribing prednisone to a diabetic patient without ensuring blood-glucose monitoring, without adequate warnings about steroid-related risks, and without coordinated management of the patient’s diabetic care.
Once the issue was defined that way, the qualifications analysis changed. McMenemy’s ophthalmology background was relevant because the claimed injury involved vision complications associated with uncontrolled diabetic effects and corticosteroid use, and his report stated he was very familiar with the effect of medications like prednisone on diabetic patients. Lechin’s qualifications were even more directly tied to the disputed standard of care. He described more than three decades of internal-medicine and critical-care practice, including regular treatment of autoimmune conditions and repeated prescribing of corticosteroids to diabetic patients. He also explained that polymyalgia rheumatica is not an illness managed exclusively by rheumatologists, which supported the proposition that the relevant care questions were not unique to one subspecialty.
The court therefore looked past labels and asked whether these experts had demonstrated expertise in the concrete medical tasks at issue: assessing steroid risk in a diabetic patient, warning about those risks, ensuring daily glucose monitoring, considering non-steroid alternatives, and coordinating care with other providers. Because the reports linked the experts’ experience to those precise duties, the trial court acted within its discretion in concluding the reports were sufficient for Chapter 74 purposes.
Holding
The court held that a physician expert does not have to practice in the same specialty as the defendant to qualify under Chapter 74. The proper inquiry is whether the expert is qualified on the specific medical issue before the court through knowledge, skill, experience, training, or education.
The court further held that, on this record, both the ophthalmologist and the critical care/internal medicine physician were qualified to address the relevant standard-of-care issues because their opinions targeted prednisone’s effects in diabetic patients, including glucose monitoring, risk disclosure, and coordinated care, rather than subspecialty rheumatology judgment in the abstract.
Finally, the court upheld the trial court’s refusal to dismiss the case, concluding the reports were adequate to address the alleged duties surrounding blood-sugar monitoring and corticosteroid-risk warnings in the treatment context presented.
Practical Application
For family lawyers, Shaikh is a useful reminder that expert admissibility and expert sufficiency arguments should be framed around the exact question the court must decide. In a conservatorship dispute over whether a child’s diabetes, psychiatric condition, eating disorder, or seizure disorder is being properly managed, the right expert may not be the most niche specialist on paper. The better expert may be the physician, psychologist, nurse practitioner, or care coordinator who can show real experience with the particular treatment-risk, monitoring obligation, or informed-consent issue in dispute.
The same principle can matter in SAPCR modification proceedings where one parent alleges the other failed to follow a child’s medication protocol, in enforcement proceedings involving medical reimbursement or treatment directives, and in divorce cases involving diminished capacity, fitness to execute documents, or causation of medical spending. When the dispute concerns a specific risk-management duty—monitoring labs, coordinating prescriptions, recognizing adverse effects, communicating warnings, or arranging follow-up care—the advocate should build the qualification showing around that specific duty. Conversely, when attacking the other side’s expert, the more effective challenge may be that the expert has not tied their experience to the precise issue before the court, rather than simply noting a mismatch in titles or board certifications.
Checklists
Building an Issue-Specific Expert Qualification Record
- Define the disputed issue narrowly and accurately before designating the expert.
- Match the expert’s qualifications to the actual task in dispute, such as monitoring, warnings, coordination of care, capacity assessment, valuation methodology, or tracing methodology.
- Include concrete facts in the affidavit or report showing hands-on experience with that precise issue.
- Identify training, board certifications, publications, or clinical practice that bear directly on the issue presented.
- Explain why the issue is not confined to a single specialty, if that point helps.
- Avoid relying on conclusory statements that the expert is “qualified” without factual support.
Attacking the Opposing Expert in Family Litigation
- Separate specialty labels from issue-specific expertise.
- Test whether the expert’s report actually addresses the standard relevant to the pending family-law issue.
- Look for gaps between the expert’s credentials and the precise opinion offered.
- Challenge reports that recite broad qualifications but do not connect them to the disputed task.
- Press whether the expert identifies accepted standards, not merely personal preference.
- Examine whether the report explains how the alleged breach caused the claimed family-law consequence, such as harm to the child, unnecessary expense, or inability to manage affairs.
Using Shaikh in Medical Decision-Making Disputes
- Frame the controversy around the treatment-risk or monitoring obligation actually in dispute.
- Use experts with demonstrated experience managing the condition or medication consequences at issue.
- Develop evidence of coordination-of-care standards when multiple providers are involved.
- Address informed-consent or warning obligations where medication risks are central.
- Show how the provider’s or parent’s actions affected follow-up care, compliance, or patient safety.
- Tie the expert’s opinions to best-interest or material-and-substantial-change elements where applicable.
Avoiding the Nonmovant’s Vulnerability on Expert Sufficiency
- Do not assume the court will infer qualifications from a prominent title alone.
- Do not leave the expert’s report at a high level of generality.
- Do not define the issue so broadly that the opinion appears untethered to the case facts.
- Do not ignore whether another provider or generalist commonly manages the same issue.
- Do not omit the practical care obligations at the center of the dispute, such as daily monitoring or inter-provider communication.
- Do not overlook the need to connect breach allegations to a concrete injury or litigation issue.
Family Law Crossover
The procedural lesson from Shaikh is that qualification turns on the specific subject matter of the proposed opinion, and the proponent should define that subject matter with precision. In family law, that same mechanism arises whenever a party offers expert testimony under the Texas Rules of Evidence or through affidavit-based interim proceedings: disputes over a child’s medical regimen, a parent’s mental-health functioning, the effect of medications on parenting capacity, forensic accounting methodology, business valuation, or tracing separate property. The advocate who frames the issue as a concrete practice question—such as medication monitoring, recognition of adverse effects, decision-making capacity, or accepted valuation methodology—will often be better positioned to defend an expert whose credentials do not mirror a single narrow specialty but do squarely fit the issue the trial court must decide.
Citation
Shaikh v. Rodriguez, No. 01-25-00182-CV, ___ S.W.3d ___ (Tex. App.—Houston [1st Dist.] July 28, 2026, no pet. h.).
Full Opinion
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