Iasis Healthcare Corp. and SJ Medical Center, LLC D/B/A St. Joseph Medical Center v. Alan Pean

Citation: Not availableDocket: 01-17-00638-CV

Court: Court of Appeals of Texas; June 21, 2018; Texas; State Appellate Court

Original Court Document: View Document

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On June 21, 2018, the Texas Court of Appeals issued an opinion regarding the case of IASIS Healthcare Corporation and SJ Medical Center, LLC (collectively, the 'Hospital Defendants') against Alan Pean. The appeal arose from the 127th District Court of Harris County, Texas, concerning whether Pean's claims constituted health care liability claims under the Medical Liability Act (Chapter 74 of the Texas Civil Practice and Remedies Code) and whether his expert report met statutory requirements.

The court determined that Pean’s negligence claim was indeed a health care liability claim, concluding that his expert report did not satisfy the necessary legal standards, leading to a reversal of the negligence claim. In contrast, the court affirmed Pean’s other two claims—malicious prosecution and conspiracy—since they were not classified as health care liability claims under Chapter 74.

The background reveals that Pean was admitted to SJMC following a mental health crisis, during which he exhibited confusion. An altercation occurred when police officers, employed as hospital security, responded to the situation, resulting in Pean being tased and handcuffed. Pean faced felony and misdemeanor charges, which were ultimately dismissed.

Pean's negligence claim argued that the Hospital Defendants acted irresponsibly by deploying armed officers without proper supervision to manage his condition. He contended that the hospital failed to adequately train security personnel for such situations. Pean's malicious prosecution and conspiracy claims alleged collusion between Iasis and the police to unjustly charge him. Although Pean provided an expert report from Charles M. Brosseau, Jr., who is not a physician, the Hospital Defendants challenged the classification of his claims and the adequacy of the report. The trial court initially sided with Pean, denying the Hospital Defendants' motion to dismiss.

The Texas Medical Liability Act (Chapter 74) mandates that expert reports are required only for health care liability claims. Pean's negligence claim qualifies as a health care liability claim, thus necessitating compliance with Chapter 74, including the service of a statutory expert report, which Pean failed to provide. In contrast, Pean's malicious prosecution and conspiracy claims do not fall under the definition of health care liability claims and are therefore not subject to Chapter 74's requirements.

The determination of whether a claim is a health care liability claim is a legal question assessed de novo. Chapter 74 defines such claims as those against health care providers related to treatment or a deviation from accepted medical standards that result in injury or death. The analysis focuses on the underlying facts, rather than the specific wording used in pleadings. A claim is considered a health care liability claim if there is a substantive connection between the alleged violations of safety standards and the provision of health care.

Key factors in this determination include whether the negligence occurred while the provider was performing patient safety tasks, if the injury happened in a patient care area, and whether the claimant was receiving or assisting in health care at the time of the injury. Additional considerations include the role of health care safety standards, the involvement of health care instruments, and adherence to safety regulations set by authorities. The necessity of expert testimony from a health care professional is also crucial in evaluating whether a claim is intrinsically linked to the delivery of medical services.

Pean’s negligence claim is classified as a health care liability claim against the Hospital Defendants for failing to meet the standard of care. He contends that the hospital sent armed officers, untrained in managing mentally ill patients and unsupervised by healthcare professionals, to his room, which led to a shooting incident. This claim arises from an alleged breach of safety standards tied to the Hospital Defendants' responsibilities as health care providers, particularly their duty to ensure patient safety, as outlined in TEX. CIV. PRAC. REM. CODE. 74.001(a)(13). 

The analysis utilizes the Ross factors, which assess the relationship between the alleged negligence and the hospital's health care duties. The first factor indicates that the negligence occurred while the defendants were attempting to protect patients, as Pean experienced a mental health crisis and was shot after security was called by nursing staff. The second factor, concerning the location of the incident, supports the claim since it occurred in Pean’s hospital room, a private area related to his treatment. The third factor examines whether Pean was receiving health care at the time of the injury; despite disputes regarding his discharge status, it is agreed that Pean was in his room during the incident, seeking care for his mental health issues. The record demonstrates that the officers' actions, which included tasering and shooting Pean, reflect an infringement of the Hospital Defendants' obligation to protect patients in a treatment setting.

Pean contends that he was either discharged or about to be discharged when he was shot, yet no evidence supports this claim; both his expert report and amended petition indicate he was shot "during his admission." The record does not show that his medical care was complete at the time of the incident. Pean alleges the Hospital Defendants acted negligently by sending armed police officers, without healthcare supervision, to manage an unarmed, peaceful individual and failing to adequately train security personnel to handle vulnerable patients, such as those who are mentally ill or disoriented. He asserts that the Hospital Defendants lacked proper policies to ensure patient safety. This negligence claim hinges on safety standards integral to the healthcare provider's duties. Expert testimony is deemed necessary to assess the standard of care for managing mental health patients, as the general public lacks the knowledge to evaluate the adequacy of patient protection measures. While some Ross factors may suggest a lack of connection to healthcare, overall, they indicate that Pean's negligence claim is substantially related to the healthcare services provided by the Hospital Defendants.

Pean's negligence claim is categorized as a health care liability claim under Chapter 74. However, his claims of malicious prosecution and civil conspiracy are not governed by this chapter. Pean asserts that Iasis and two police department defendants, not involved in this appeal, acted with malice and without probable cause in bringing criminal charges against him, which were ultimately resolved in his favor, resulting in damages. The core of these claims is the alleged collusion between Iasis and the police defendants to wrongfully charge Pean. Unlike the negligence claim, these allegations do not relate to health care or professional services and therefore do not require medical expert testimony to establish Iasis's involvement in the alleged conspiracy. Pean’s claims do not accuse Iasis of failing to meet healthcare standards or breach any professional duties required for licensure or accreditation. Thus, they are distinct from his negligence claim and focus solely on the wrongful legal actions taken against him.

Claims were made that the hospital failed to request an inquest following a death, instead obtaining permission for a private autopsy under fraudulent circumstances, and that the body was improperly moved without consent. These allegations were tied to the hospital's obligations as a licensed health care provider, suggesting that violations could lead to license suspension or revocation. However, Pean’s claims of malicious prosecution and conspiracy do not qualify as health care liability claims under Texas law. Chapter 74 does not encompass claims for defamation, deceptive trade practices, negligence, or intentional infliction of emotional distress related to statements about a patient’s mental health, nor does it apply to invasion of privacy claims stemming from the wrongful disclosure of sensitive information in court filings. 

Since Pean's negligence claim is classified as a health care liability claim, he was required to provide an expert report in compliance with Chapter 74, which he failed to do. The statutory duty preventing retaliation against employees reporting legal violations is not directly related to patient treatment. Pean argued that the Hospital Defendants waived their right to require an expert report by engaging in discovery and not asserting Chapter 74 as a defense. However, the evidence did not support this assertion. The defendants entered into a Rule 11 agreement that postponed the report's due date without prejudice to their arguments regarding Chapter 74. Their limited participation in discovery prior to the submission of the expert report did not constitute a waiver of their rights under Chapter 74.

The Hospital Defendants, under the Rule 11 agreement, retained the right to challenge the case under Chapter 74, asserting that their actions did not indicate a waiver of their right to seek dismissal. A plaintiff in a health care liability claim must provide expert reports and CVs for each expert to substantiate claims, with Chapter 74 typically requiring that causation experts be physicians. Exceptions exist only for dentists or podiatrists, which are not applicable in this case, thus necessitating a physician as an expert. The report submitted by Brosseau, who is not a physician, fails to comply with Chapter 74's requirements and cannot establish causation regarding the patient’s death. Pean's argument that common sense suffices for establishing causation is rejected by Texas law, as a formal causation opinion is mandatory.

Pean must adhere to Chapter 74's expert report requirements, even if expert testimony on causation may not ultimately be necessary. Texas courts mandate that a party cannot bypass the need for a statutorily-sufficient expert report, as established in Murphy v. Russell. The Legislature intended that a case should not proceed without at least one expert evaluating the standard of care, its breach, and the causal link to the claimed injuries. Therefore, Pean's deficient expert report fails to meet Chapter 74 requirements, leading to an affirmation of the trial court's decision regarding malicious prosecution and conspiracy claims. However, the decision for Pean's negligence claim is reversed, allowing for a 30-day extension to rectify deficiencies in the expert report as per TEX. CIV. PRAC. REM. CODE §74.351(c). Courts should be lenient in granting such extensions, provided the report is submitted on time and contains a qualified expert's opinion on the merits of the claim. The Texas Supreme Court's guidance indicates that deficiencies related to an expert's qualifications can be cured. The trial court will have the opportunity to consider this extension upon remand for the negligence claim.