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Premises Liability vs. Safety Claim Against Healthcare Providers

By: Nisha Byers

Given the strict requirements and limitations placed on “health care liability claims” under Chapter 74 of the Texas Civil Practice and Remedies Code, the issue of whether a particular lawsuit falls within that definition may be vigorously contested.  Section 74.001 defines a “health care liability claim” as:

A cause of action against a health care provider or physician for treatment, lack of treatment, or other claimed departure from accepted standards of medical care, or health care, or safety or professional or administrative services directly related to health care, which proximately results in injury to or death of a claimant, whether the claimant’s claim or cause of action sounds in tort or contract.

Tex. Civ. Prac. & Rem. Code § 74.001(a)(13).  Therefore, the statute expressly provides that a health care liability claim is not limited to negligence allegations that involve direct medical care and treatment, but also includes a much broader category of safety related claims against a health care provider.  Although claims against health care providers do not have to be directly related to the provision of health care, there must be a “substantive nexus” between the alleged safety standard violation and the provision of health care. 

Frequently, arguments arise over whether a claim for a “slip and fall” or similar claim against a health care provider is a premises liability claim versus a health care liability claim.  In Ross v. St. Luke’s Episcopal Hosp., 462 S.W.3d 496, 504 (Tex. 2015), the Texas Supreme Court considered whether a hospital visitor’s claim that she slipped and fell near lobby exit doors was a health care liability claim within the meaning of Chapter 74.    Id. at 505.  The Court concluded that the claim before it was not based on safety standards that had a substantive relationship to the hospital’s providing of health care, and set forth seven non-exclusive considerations for such an analysis:

  • Did the alleged negligence of the defendant occur in the course of the defendant’s performing tasks with the purpose of protecting patients from harm;
  • Did the injuries occur in a place where patients might be during the time they were receiving care, so that the obligation of the provider to protect persons who require special, medical care was implicated;
  •  At the time of the injury was the claimant in the process of seeking or receiving health care;
  • At the time of the injury was the claimant providing or assisting in providing health care;
  • Is the alleged negligence based on safety standards arising from professional duties owed by the health care provider;
  • If an instrumentality was involved in the defendant’s alleged negligence, was it a type used in providing health care; or
  • Did the alleged negligence occur in the course of the defendant’s taking action or failing to take action necessary to comply with safety-related requirements set for health care providers by governmental or accrediting agencies?

Thus far, post-Ross, in each case in which the claimant was a patient, the courts of appeals have found a health care liability claim.  For instance, in Little v. Riverside General Hospital, Inc., No. 14-14-00797-CV, 2016 Westlaw 208142 (Tex. App.—Houston [14th Dist.], Jan. 14, 2016, no pet.),  the plaintiff was an inpatient resident obtaining substance abuse treatment, who was injured during an informal cook-out on the outdoor grounds of the hospital. The patient asserted a premises liability theory against the defendant hospital.  The court held that protection of patient safety, including keeping the hospital grounds maintained to prevent injury, was “part and parcel of the provision of health care,” and that Chapter 74 applied.  Id. at *3.  In Phillips v. Jones, No. 05-15-00005-CV, 2016 WL 80561 (Tex. App.—Dallas, Jan. 7, 2016, no pet.), a patient alleged that she slipped and fell off a step next to her physician’s examining table, injuring herself.  The court held that the Ross “substantive nexus” was satisfied because plaintiff was a patient seeking medical care when she slipped and fell off the step in the examination room.  Id. at *3.

In contrast, when a claim involves a fall by a visitor to a healthcare facility, the courts have not been inclined to find a healthcare liability claim.  In Galvan v. Memorial Hermann Hospital System, 476 S.W.3d 429 (Tex. 2015), the Texas Supreme Court held that a hospital visitor’s claim that she slipped and fell on water in a hallway was not governed by Chapter 74.  Similarly, the Texas Supreme Court has found that a visitor’s claim that she fell when she slipped on a floor mat between the hospital’s entrance and the front desk was not a health care liability claim.  See also Cage v. The Methodist Hospital, 470 S.W.3d 596, 603 (Tex. App.—Houston [1st Dist.], no pet.); Chamie v. Memorial Hermann Health System, No. 14-14-00213-CV, No. 14-14-00226-CV, 2015 Westlaw 4141106 (Tex. App.—Houston [14th Dist.], July 9, 2015, no pet.); and Seton Family of Hospitals v. Haywood, No. 03-13-00817-CV, 2015 Westlaw 4603594 (Tex. App.—Austin, July 29, 2015, no pet.).

Although each case is examined on its facts, with regard to alleged premises liability claims, such as “slip and falls,” it appears that the claimant’s status as a patient may be the strongest, if not the determining factor, in the health care liability claim analysis.


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