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Ross v. St. Luke's Episcopal Hospital - What Defines a Health Care Liability Claim?

By: R. Brent Cooper and Diana Faust

Over the last few months, the Supreme Court of Texas has addressed multiple issues arising through Chapter 74 of the Texas Civil Practice and Remedies Code.  Here, we will discuss the Court’s most recent opinion – the long-awaited decision in Ross v. St. Luke’s Episcopal Hospital, No. 13-0439, ___ S.W.3d ___, 2015 WL 2009744 (Tex., May 1, 2015).  Ross addresses the issue of whether a claim asserted as a slip-and-fall premises liability claim is a “health care liability claim,” governed by Chapter 74 and its section 74.351 requirement to serve an expert report. 

A. Background

The issue before the Court was what constitutes a “health care liability claim” (an “HCLC”).  In this case, Lezlea Ross accompanied her friend who was visiting a patient in St. Luke’s Hospital.  As she was leaving the hospital through the lobby, Ross approached the exit doors and slipped and fell in an area where the floor was being cleaned and buffed.  Ross sued St. Luke’s asserting a premises liability theory.  The Hospital moved to dismiss based on the failure to serve an expert report, arguing that the case was an HCLC.  The trial court granted the motion to dismiss, and the court of appeals affirmed.  Ross v. St. Luke’s Episcopal Hospital, 2013 WL 1136613; ____ S.W.3d ____ (Tex. App.—Houston [14th Dist.] Mar. 19, 2013, pet. granted) (mem. op.). 

B. The Statutory Definition

The Texas Medical Liability Act (“TMLA”) defines “health care liability claim” as:
"Health care liability claim" means 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.

This definition is the same as the definition of “health care liability claim” found in the former statute, Article 4590i of the Texas Revised Civil Statutes, with the addition by the Legislature in 2003 of the phrase “or professional or administrative services directly related to health care.”

C. Applying the Definition to a Slip-and-Fall Claim

The Hospital advanced two arguments.  First, it argued that every slip-and-fall event within a hospital is directly related to health care because it is necessarily related to the safety of the patients.  Second, the Hospital argued that Ross’s claim was related to health care because she alleged the hospital breached standards applicable to maintaining a safe environment for patients.

     1. It is Not an HCLC Where the Only Relationship Between the Conduct of the Defendant and  the Rendition of Medical or Health Care is the Setting

Addressing the first argument, the Supreme Court referred back to its prior decision in Loaisiga v. Cerda, 379 S.W.3d 248 (Tex. 2012), where it concluded that a patient’s claim against a medical provider for assault during a medical examination is not an HCLC if the only possible relationship between the alleged improper conduct and the rendition of medical services or health care is the setting in which the conduct occurred.  The Court concluded that Ross’s only relationship between the alleged improper conduct and the rendition of medical services or health care was the setting: Ross was not a patient and was on the premises as a licensee or an invitee.

     2. Seven Factors Announced for Determining Whether Safety-Based Claim is an HCLC

Responding to the Hospital’s second argument, Ross contended that the Hospital failed to exercise reasonable care in making the floors safe.  The Court concluded that the record did not show that the area where Ross fell was an area where patient care was provided nor did the Hospital demonstrate that this area had to meet a particular standard for cleanliness or for maintenance.

The Court explained:

The TMLA does not specifically state that a safety standards-based claim falls within its provisions only if the claim has some relationship to the provision of health care other than the location of the occurrence, the status of the defendant, or both.  But the Legislature must have intended such a relationship to be necessary, given the legislative intent explicitly set out in the TMLA and the context in which “safety” is used in the statute.  We said as much in Loaisiga. 379 S.W.3d at 257.  Even though the statute’s phrase “directly related to health care” does not modify its reference to safety standards, that reference occurs within a specific context, which defines an HCLC to be “a cause of action against a health care provider or physician for [a] treatment, [b] lack of treatment, [c] or other claimed departure from accepted standards of medical care, or health care, or safety.”  TEX. CIV. PRAC.& REM. CODE § 74.001(a)(13).  Where the more specific items, [a] and [b], are followed by a catchall “other,” [c], the doctrine of ejusdem generis teaches that the latter must be limited to things like the former.

The Court concluded that for a safety-based standards claim to be an HCLC, there must be a substantive nexus between the safety standards allegedly violated and the provision of “health care.”

The Court noted that the line between a safety-based standards claim that is not an HCLC and one that is an HCLC may not always be clear.  But it provided seven non-exclusive considerations for analyzing whether such a claim is substantively related to the defendant’s provision of medical or health care and whether the claim is an HCLC.  These considerations include:

  1. 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?
  2. 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?
  3. At the time of the injury was the claimant in the process of seeking or receiving health care?
  4. At the time of the injury was the claimant providing or assisting in providing health care?
  5. Is the alleged negligence based on safety standards arising from professional duties owed by the health care provider?
  6. If an instrumentality was involved in the defendant’s alleged negligence, was it a type used in providing health care?
  7. 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?

The Court examined Ross’s claim in light of these seven factors and concluded there was not a substantive nexus between the safety standards and the providing of health care, such that the claim was not an HCLC.  As a result, Ross was not required to serve an expert report as required by the TMLA.

D. The Concurring Justices

Justice Lehrmann and Justice Devine concurred in the result.  These Justices would adopt a narrower test for determining whether a claim is an HCLC: that claims arising out of alleged violation of safety standards are limited to the claims of patients.  However, the patient limitation was rejected by the Court in Texas West Oaks Hospital, LP v. Williams, 371 S.W.3d 171, 177–78 (Tex. 2012), which addressed the claims of an employee who was assaulted by a patient. 

Read both opinions here.

Majority Opinion:  http://www.txcourts.gov/media/951862/130439.pdf
Concurring Opinion:  http://www.txcourts.gov/media/951863/130439c.pdf