§ 74.403.Qualifications of Expert Witness on Causation in Health Care Liability Claim

Title 4. Liability in Tort · Chapter 74. Medical Liability · Subchapter I. Expert Witnesses · Last amended 2023 · Last verified August 29, 2026

In one sentenceSection 74.403 requires a causation expert to be a physician, except that a dentist, podiatrist, or chiropractor may testify on causation in a claim against one of their own.

Full Text of § 74.403

Text sizeJump to: (a) (b) (c) (c-1) (d)

(a)Except as provided by Subsections (b), (c), and (c-1), in a suit involving a health care liability claim against a physician or health care provider, a person may qualify as an expert witness on the issue of the causal relationship between the alleged departure from accepted standards of care and the injury, harm, or damages claimed only if the person is a physician and is otherwise qualified to render opinions on that causal relationship under the Texas Rules of Evidence.

(b)In a suit involving a health care liability claim against a dentist, a person may qualify as an expert witness on the issue of the causal relationship between the alleged departure from accepted standards of care and the injury, harm, or damages claimed if the person is a dentist or physician and is otherwise qualified to render opinions on that causal relationship under the Texas Rules of Evidence.

(c)In a suit involving a health care liability claim against a podiatrist, a person may qualify as an expert witness on the issue of the causal relationship between the alleged departure from accepted standards of care and the injury, harm, or damages claimed if the person is a podiatrist or physician and is otherwise qualified to render opinions on that causal relationship under the Texas Rules of Evidence.

(c-1)In a suit involving a health care liability claim against a chiropractor, a person may qualify as an expert witness on the issue of the causal relationship between the alleged departure from accepted standards of care and the injury, harm, or damages claimed if the person is a chiropractor or physician and is otherwise qualified to render opinions on that causal relationship under the Texas Rules of Evidence.

(d)A pretrial objection to the qualifications of a witness under this section must be made not later than the later of the 21st day after the date the objecting party receives a copy of the witness's curriculum vitae or the 21st day after the date of the witness's deposition. If circumstances arise after the date on which the objection must be made that could not have been reasonably anticipated by a party before that date and that the party believes in good faith provide a basis for an objection to a witness's qualifications, and if an objection was not made previously, this subsection does not prevent the party from making an objection as soon as practicable under the circumstances. The court shall conduct a hearing to determine whether the witness is qualified as soon as practicable after the filing of an objection and, if possible, before trial. If the objecting party is unable to object in time for the hearing to be conducted before the trial, the hearing shall be conducted outside the presence of the jury. This subsection does not prevent a party from examining or cross-examining a witness at trial about the witness's qualifications.

End

Plain-English Summary

The qualification rule for the causation opinion, and its default is narrower than for standard of care.

A person may qualify as an expert on the causal relationship between the alleged departure and the injury only if the person is a physician and is otherwise qualified to render such opinions under the Texas Rules of Evidence.

Causation is reserved to physicians. A nurse may testify that nursing care fell below the standard, but not that the failure caused the injury — that opinion requires a physician.

The reasoning is that causation in a medical case is a question of medical diagnosis: what produced this outcome in this body. That is the physician's domain regardless of who delivered the care.

Three professions get their own rule. In a claim against a dentist, a dentist or physician may give the causation opinion. Against a podiatrist, a podiatrist or physician. Against a chiropractor, a chiropractor or physician.

Each of those is a licensed independent practice with its own diagnostic training in a defined domain, and the exception is reciprocal rather than general — a dentist may opine on causation against a dentist, not against a surgeon.

The same 21-day objection deadline applies, running from the curriculum vitae or the deposition, with a hearing as soon as practicable and, if possible, before trial.

Note that the expert report section incorporates these categories directly in its own definition of "expert," so the qualification question arises at the 120-day stage rather than at trial.

Frequently Asked Questions

Who can testify about causation in a Texas malpractice case?

A physician, unless the claim is against a dentist, podiatrist, or chiropractor — in which case a member of that profession or a physician may give the opinion.

Can a nurse testify on causation?

No. A nurse may address the nursing standard of care, but the causation opinion requires a physician.

Why is causation treated differently?

Causation in a medical case is a question of medical diagnosis — what produced the outcome — which is the physician's domain whoever delivered the care.

When does the qualification question arise?

Usually at the expert report stage, since Section 74.351 incorporates these categories in its definition of "expert."

Amendment History

Added by Acts 2003, 78th Leg., ch. 204, Sec. 10.01, eff. Sept. 1, 2003.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 63 (S.B. 2171), Sec. 2, eff. September 1, 2023.

Source & verification. Section text is reproduced verbatim from Texas Legislature Online (statutes.capitol.texas.gov). Enacted by the Texas Legislature. Current through May 14, 2026. Last verified August 29, 2026. · Official source