With no explanation, chose the best option from "A", "B", "C" or "D". (quoting Haynes & Boone v. Bowser Bouldin, Ltd., 896 S.W.2d 179, 182 (Tex.1995) (quoting Rourke v. Garza, 530 S.W.2d 794, 801 (Tex.1975)))). 47 . Trinity Universal Ins. Co. v. Bleeker, 966 S.W.2d 489, 491 (Tex.1998); see also Doe v. Boys Clubs of Greater Dallas, Inc., 907 S.W.2d 472, 481 (Tex.1995) (“A producing cause is a substantial factor which brings about the inju ry and without which the injury would not have occurred.”); Union Pump, 898 S.W.2d at 775 (noting that causation in fact is common to both proximate and producing cause, and that "[clause in fact means that the defendant’s act or omission was a substantial factor in bringing about the injury which would not otherwise have occurred”); Prudential Ins. Co. of Am. v. Jefferson Assocs., Ltd., 896 S.W.2d 156, 161 (Tex.1995)

A: holding that allegation of procedural injury does not affect the issues of injury in fact or causation
B: holding that the element of actual causation in fact common to both proximate and producing cause requires proof that an act or omission was a substantial factor in bringing about injury which would not otherwise have occurred
C: holding that negligence must be the proximate cause of injury
D: holding that a physicians negligence need only be a proximate cause not the proximate cause of plaintiffs injury
B.