Opinion by: STEVEN C. HILBIG, Justice.
The issue in this accelerated appeal is whether Dora Almazan's cause of action against Texas Laurel Ridge Hospital, L.P. d/b/a Laurel Ridge Treatment Center ("Laurel Ridge") is a health care liability claim subject to the expert report requirement in section 74.351 of the Texas Civil Practice and Remedies Code. We hold the cause is a health care liability claim, and because the trial court found Almazan's expert report was fatally deficient after giving her an opportunity to cure, the court erred in denying Laurel Ridge's motion to dismiss.
Almazan sued Dr. Gundlapalli Surya and Laurel Ridge, alleging that when Almazan went to Laurel Ridge in June 2007 for voluntary outpatient therapeutic counseling services, the staff "closed the door behind her and did not permit her to leave." Almazan alleged she was diagnosed with mood disorder, depression, and having suicidal thoughts and plans, without having been interviewed by her treating physician, Dr. Surya, and without anyone consulting her family. She contended the admission staff prepared documents "with numerous fabrications, alleging she was suicidal and dangerous to herself, purportedly requiring inpatient mental health treatment." According to Almazan, she was confined to a locked ward and refused food until she signed a voluntary admission form. Almazan asserted she was not suicidal, and that the Laurel Ridge staff and Dr. Surya repeatedly refused to reevaluate her. She alleged she was drugged without her consent and that she was "given drugs against her will that rendered her comatose." According to Almazan, she was summarily discharged without a professionally developed continuity of care treatment plan when the insurance company refused to pay for further inpatient care. In addition, Almazan alleged that Laurel Ridge took blood samples from her that revealed "extremely high concentration of lymphocytes, a clear indication of Leukemia," and that she was not told of these results. She contends she was not diagnosed with leukemia until a year later, when she was hospitalized because of excessive bleeding. Almazan alleged that Laurel Ridge and its medical and nursing staff, including Dr. Surya, "failed to satisfy the operative standards of care for such professionals" and violated her "patient rights."
Almazan sued Dr. Surya for medical negligence and "common law negligence." She sued Laurel Ridge for: (1) medical negligence; (2) "common law negligence;" (3) fraud; (4) violations of the Texas Deceptive Trade Practices Act; (5) negligence per se, based on alleged violations of the Texas Mental Health Code, the Texas Health & Safety Code, and the Texas Nurse Practices Act; and (6) violation of the "patient's bill of rights" promulgated under to section 321.002 of the Health and Safety Code.
Almazan attached to her petition the expert report of George S. Glass, M.D. "in compliance with Texas Civil Practice and Remedies Code § 74.351." The defendants objected to Dr. Glass's qualifications and to the sufficiency of his report. The trial court sustained the objections and gave Almazan thirty days to cure the deficiencies. After Almazan served an addendum to Dr. Glass's report, the defendants filed further objections and motions to dismiss pursuant to section 74.351(b) of the Texas Civil Practice and Remedies Code. Following a hearing, the trial court issued an order finding the report "so deficient as to the statutory requirements of § 74.351 that it constitutes no report at all." The court dismissed with prejudice all "causes of action pertaining to and involving medical malpractice claims," and awarded defendants costs and attorney's fees. The court subsequently expressly denied Laurel Ridge's motion to dismiss the claim brought under chapter 321 of the Texas Health and Safety Code, ruling the claim was not a health care liability claim subject to the expert report requirement of section 74.351 of the Civil Practice and Remedies Code. All other claims against Laurel Ridge and all Almazan's claims against Dr. Surya were dismissed.
We generally review a trial court's ruling on a motion to dismiss a claim pursuant to section 74.351 for abuse of discretion. See Am. Transitional Care Ctrs. Of Tex., Inc. v. Palacios, 46 S.W.3d 873, 875 (Tex.2001). However, when resolution of the issue requires the interpretation of a statute, we apply a de novo standard. Buchanan v. O'Donnell, 340 S.W.3d 805, 810 (Tex.App.-San Antonio 2011, no pet.).
Section 74.351(a) of the Civil Practice and Remedies Code requires a claimant in a health care liability claim, not later than the 120th day after the petition was filed, to serve on all parties one or more expert reports for each physician or health care provider against whom a liability claim is asserted. TEX. CIV. PRAC. & REM.CODE ANN. § 74.351(a) (West 2011). The report must "provide[ ] 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." Id. § 74.351(r)(6). On timely objection that the report is insufficient, the trial court may grant one 30-day extension of time to cure the deficiency. Id. § 74.351(a), (c). If the trial court concludes the report does not represent an objective good faith effort to comply with the report requirement, the court must grant a motion to dismiss the claim. Id. § 74.351(b)(1).
Chapter 74 of the Civil Practice and Remedies Code is a recodification of former article 4590i of the Texas Revised Civil Statutes. Article 4590i, enacted in 1977, represented the Texas Legislature's efforts to modify the liability laws relating to health care claims in order to address a "crisis [that] has had a material adverse effect on the delivery of medical and health care in Texas." Act of May 30, 1977, 65th Leg., R.S., ch. 817, § 1.02(6), 1977 Gen. Laws 2039, 2040 (former Tex.Rev.Civ.
In 1995, the Legislature amended article 4590i to add a requirement that an expert report be served on each physician or health care provider sued within 180 days after a health care liability claim was filed. Act of May 5, 1995, 74th Leg., R.S., ch. 140, § 1, 1995 Tex. Gen. Laws 985, 986 (former art. 4590i, § 13.01(d)(repealed 2003)). Failure to comply with the expert requirement could result in dismissal of the suit. Id. 1995 Tex. Gen. Laws at 986 (former art. 4590i, § 13.01(e) (repealed 2003)). The new expert report requirement in article 4590i also included a conflict of laws provision, which stated, "In the event of a conflict between this section and another law, including a rule of procedure or court rule, this section controls to the extent of the conflict." Id. 1995 Tex. Gen. Laws at 987 (former art. 4590i, § 13.01(p)) (repealed 2003).
In 2003, the Legislature amended parts of article 4590i, repealed it, and recodified it as chapter 74 of the Texas Civil Practice and Remedies Code. Act of June 2, 2003, 78th Leg., R.S., ch. 204, §§ 10.01, 10.09, 2003 Tex. Gen. Laws 847 (amended 2005, 2007, 2011) (current version at TEX. CIV. PRAC. & REM.CODE ANN. § 74.001 et seq. (West 2011)). In so doing, the Legislature found that the number of health care liability claims and the amounts being paid in judgments and settlements had "increased inordinately" since 1995 and "created a medical malpractice insurance crisis in Texas" that "has had a material adverse effect on the delivery of medical and health care in Texas." Id. § 10.11(a). Chapter 74 applies to all "health care liability claims," and section 74.002(a) provides that "[i]n the event of a conflict between this chapter and another law, including a rule of procedure or evidence or court rule, this chapter controls to the extent of the conflict." TEX. CIV. PRAC. & REM.CODE ANN. § 74.002(a) (West 2011). The newly codified law maintained the expert report requirement, but reduced the time for serving the report. See id. § 74.351.
Chapter 321 of the Texas Health and Safety Code was enacted in 1993 as part of a comprehensive legislative response to abuses in private psychiatric and substance abuse facilities in Texas. See Act of May 25, 1993, 73rd Leg., R.S., ch. 705, § 1.01, 1993 Tex. Gen. Laws 2743, 2743 (current version at TEX. HEALTH & SAFETY CODE § 321.001 et seq. (West 2010)); Gregg Timmons, Crisis In the Mental Health Care Industry: An Analysis of the Practices of Private, For-Profit Psychiatric Hospitals and the Governmental Response, 31 HOUSTON L.R. 323, 343-350 (1994). In 1991, widespread media coverage of a case involving a teenager taken from his family over their objections and committed to a private psychiatric institution led to the formation of a Senate subcommittee. See House Public Health Coram., Bill Analysis, Tex. SB 205, 101-102, 73rd Leg., R.S. (May 20, 1993); Timmons, 31 HOUSTON L.R. at 343-44. The subcommittee conducted hearings around the state and made proposals that formed the basis for a number of legislative initiatives in 1993, including the enactment of chapter
In the newly enacted Chapter 321, the Legislature directed the Texas Board of Mental Health and Mental Retardation, Texas Board of Health, and Texas Commission on Alcohol and Drug Abuse to each adopt a "patient's bill of rights" addressing the basic rights of patients receiving mental health and chemical dependency services in an inpatient facility. TEX. HEALTH & SAFETY CODE ANN. § 321.002(a) (West 2010); Bill Analysis SB 205, at 102-103; Timmons, 31 HOUSTON L.R. at 344-46. The Legislature gave enforcement authority to agencies and the Attorney General and provided penalties for facilities that engaged in illegal or abusive practices. See Timmons, 31 Houston L.R. at 346. In addition, the Legislature authorized a private cause of action in favor of a person harmed by a mental health facility's violation of the patient's bill of rights. TEX. HEALTH & SAFETY CODE ANN. § 321.003(a), (b) (West 2010). A person so harmed may sue the facility for injunctive relief, damages, or both. Id. Chapter 321 authorizes an award of mental anguish damages, even in the absence of other injury, and awards of exemplary damages and attorney's fees to prevailing plaintiffs. Id. § 321.003(c), (d). The only procedural provisions regarding such suits found in Chapter 321 are venue and statute of limitations provisions. See id. § 321.003(e), (f).
Neither Chapter 321 of the Health and Safety Code nor Chapter 74 of the Civil Practice and Remedies Code refers explicitly to the other statute.
Chapter 74 defines a "health care liability claim" as:
TEX. CIV. PRAC. & REM.CODE ANN. § 74.001(a)(13) (West 2011). A health care liability claim thus "consists of three elements. First, a physician or a health care provider must be the defendant. Second, the suit must be about the patient's treatment, lack of treatment, or some other departure from accepted standards of medical care or health care or safety. And, third, the defendant's act, omission, or other departure must proximately cause the patient's injury or death." Marks v. St. Luke's Episcopal Hosp., 319 S.W.3d 658, 662 (Tex.2010). A private mental hospital such as Laurel Ridge is a "health care provider" within the meaning of Chapter 74. See TEX. CIV. PRAC. & REM. CODE ANN. § 74.001(a)(11), (12)(A), & (14).
To determine whether the second element is met, we examine the nature of the underlying claim and are not bound by the form of the pleading or the plaintiff's characterization of her claims. See Marks, 319 S.W.3d at 664; Diversicare, 185 S.W.3d at 847; Buchanan, 340 S.W.3d at 811. If the alleged acts or omissions are an inseparable or integral part of the rendition of medical services or health care, then the claim is a health care liability claim. Marks, 319 S.W.3d at 664; Diversicare, 185 S.W.3d at 848-49; Buchanan, 340 S.W.3d at 810. Chapter 74 defines "health care" as "any act or treatment performed or furnished or that should have been performed or furnished, by any health care provider for, to or on behalf of
Almazan's petition alleged a laundry list of conduct she contended constituted negligence, medical negligence, and negligence per se
In the section of her petition that alleged a private cause of action under chapter 321 of the Health and Safety Code, Almazan referred to the "various statutory and regulatory violations" already pleaded, and alleged:
The essence of Almazan's Chapter 321 cause of action is that Laurel Ridge departed from the applicable standards of medical and health care, those standards being the patient bill of rights and the rules and regulations promulgated pursuant to section 321.002(a) of the Health and Safety Code. The alleged wrongful acts and omissions were inseparable from Laurel Ridge's rendition of mental health care services to Almazan. Almazan concedes the facts upon which she bases her Chapter 321 cause of action are the same as those underlying her medical malpractice and negligence per se claims, and that in order to prevail on the claims she would be required to provide expert testimony. Almazan also does not dispute the third element — that the injuries she alleges were proximately caused by the claimed departures from the applicable standards of medical and health care.
Almazan contends a "health care liability claim" has an additional element: the cause of action alleged must "sound in tort or contract." See TEX. CIV. PRAC. & REM.CODE ANN. § 74.001(a)(13). She argues her Chapter 321 cause of action does
We conclude the cause of action Almazan alleged under Chapter 321 falls squarely within Chapter 74's definition of health care liability claim. See Broxterman v. Carson, 309 S.W.3d 154, 158 (Tex. App.-Dallas 2010, pet. denied) (plaintiff's claims of fraud, intentional infliction of emotional distress, violations of Texas Health and Safety Code, assault, battery, and civil rights violations, including claims of involuntary medication, all arose from the rendition of mental health care services and were health care liability claims requiring expert report); Tex. Cypress Creek Hosp., L.P. v. Hickman, 329 S.W.3d 209, 217 (Tex.App.-Houston [14th Dist.] 2010, pet. denied) (plaintiff's cause of action under chapter 321 of the Texas Health and Safety Code, alleging medication errors, unsafe conditions, and inadequate staff supervision by mental health facility was health care liability claim); Groomes v. USH of Timberlawn, Inc., 170 S.W.3d 802, 806-07 (Tex.App.-Dallas 2005, no pet.) (various causes of action of parent and her minor son arising out of hospital's failure to discharge child on parent's request and administration of medication without consent, were all health care liability claims because they were integrally related to the provision of mental health care services); Parker v. CCS/Meadow Pines, Inc., 166 S.W.3d 509, 513 (Tex.App.-Texarkana 2005, no pet.) (claims that private mental hospital improperly restrained patient, had insufficient and improperly trained staff, violated patient's rights as set out in Patient's Bill of rights, and failed to properly treat his injuries, all required reference to standards by which mental health institutions restrain and otherwise care for patients and are all health care liability claims requiring expert report).
Having concluded that Almazan's Chapter 321 cause of action against Laurel Ridge is a health care liability claim, we turn to Almazan's arguments that the expert report requirement in Chapter 74 of the Civil Practice and Remedies Code does not apply to the claim.
Almazan contends that a cause of action filed pursuant to Chapter 321 is a "civil rights claim" that "stands separate and
The only direct authority Almazan cites for the proposition that a Chapter 321 claim for violation of the patient bill of rights may proceed independently of Chapter 74 is this court's 2002 opinion in Zuniga v. Healthcare San Antonio, Inc., 94 S.W.3d 778 (Tex.App.-San Antonio 2002, no pet.). Zuniga was an involuntary in-patient at Laurel Ridge who was sexually assaulted by another patient. She sued, alleging causes of action for medical negligence, common law negligence, and breach of the patient bill of rights under Chapter 321. This court held that Zuniga's common law negligence and premises liability claims were not based on the rendition of medical treatment and did not implicate a breach of an accepted standard of safety, and therefore were not health care liability claims. Id. at 783. Having found Zuniga's claims were not health care liability claims, we also concluded that Zuniga's Chapter 321 claims could proceed because Chapter 321 does not contain an expert report requirement and does not expressly require compliance with article 4590i (the predecessor to Chapter 74). Id.
Three years later, the Texas Supreme Court in Diversicare held that when the underlying nature of the claim alleged is one for breach of the standard of care for a health care provider, the claim is a health care liability claim, without regard to the form of the pleading. 185 S.W.3d at 847-49. The court expressly disapproved of several appellate court decisions, including Zuniga, which had held that patient's claims for assault based on allegations of inadequate monitoring, supervision, and health care, were premises liability claims and not health care liability claims. Id. at 853. The court rejected the argument that a plaintiff could allege a claim for premises liability based on inadequate health care independently of a health care liability claim because that "would open the door to splicing health care liability claims into a multitude of other causes of action with standards of care, damages, and procedures contrary to the Legislature's explicit requirements." Id. at 854. The Supreme Court has since held that "[w]hen the underlying facts are encompassed by provisions of [Chapter 74] in regard to a defendant, then all claims against that defendant based on those facts must be brought as health care liability claims. Application of [Chapter 74] cannot be avoided by artfully pleading around it or splitting claims into both health care liability claims and other types of claims." Yamada, 335 S.W.3d at 193-94. In light of these decisions, the Zuniga opinion is no longer authoritative support for appellant's position.
Almazan next asserts that people with mental illness are entitled to some constitutional protections not afforded persons receiving general medical care.
Lastly, Almazan argues that to the extent there is a conflict between Chapter 74 and Chapter 321, Chapter 321 prevails because it was enacted after the Legislature began to regulate health care liability claims and is the more specific statute. Initially, we agree with Almazan that, as relevant to this appeal, there is no conflict between the statutes. The only provisions of Chapter 74 at issue in this appeal are the requirement in section 74.351 that an expert report be filed and the mandate that the trial court dismiss a health care liability claim if a complying report is not timely filed. Although Chapter 321 does not contain its own expert report requirement, imposing the requirement on a Chapter 321 claim does not conflict with a provision of that statute.
If, as Almazan sometimes asserts, applying the expert report requirement is fundamentally inconsistent with Chapter 321, then we agree with Laurel Ridge that general principles of statutory construction compel the conclusion that Chapter 74 prevails. The requirement in former article 4590i, § 13.01(d) that an expert report be filed in all health care liability claims and the enactment of Chapter 74 both occurred after Chapter 321 was enacted. See Act of May 25, 1993, 73rd
The trial court found Almazan's expert report inadequate and gave her an opportunity to cure the deficiencies. The court subsequently found the supplemental expert report so deficient that it constituted no report at all, and dismissed all Almazan's claims except her Chapter 321 cause of action. See TEX. CIV. PRAC. & REM.CODE ANN. § 74.351(b), (c) (West 2011). The factual complaints underlying all of Almazan's causes of action concern the same set of circumstances and are all health care liability claims. We therefore hold Almazan failed to file an expert report as required by section 74.351, and the trial court should have dismissed all her claims. See Yamada, 335 S.W.3d at 197-98; Hickman, 329 S.W.3d at 218.
We reverse the part of the trial court's order that denied Laurel Ridge's motion to dismiss Almazan's Chapter 321 cause of action. We remand the case to the trial court with instructions to dismiss Almazan's claims with prejudice and to consider Laurel Ridge's request for attorney's fees and costs relative to the Chapter 321 cause of action.
