In its opinion filed on February 16, 2017, the Court of Appeals Second District of Texas Fort Worth (“Appellate Court”) handed the medical malpractice plaintiffs a rare win in Texas, which is one of the most difficult states in the United States for victims of medical malpractice to obtain fair and adequate compensation for their injuries resulting from medical negligence, when the Appellate Court held that section 74.153, which provides a willful and wanton standard for liability in certain medical malpractice cases, does not apply to emergency medical care provided in an obstetrical unit when the patient was not evaluated or treated in a hospital emergency department immediately prior to receiving the emergency medical care.
The Underlying Facts
The Texas medical malpractice plaintiffs are the mother and father of a child who suffered a brachial plexus injury during labor and delivery as a complication from shoulder dystocia. The mother had been admitted to the defendant hospital the night before, for an elective induction of labor. The next morning, the mother received Pitocin to begin her contractions; her labor was monitored throughout the day.
It was not until later in the evening that the baby stopped descending in the birth canal, after which forceps were used to deliver the baby’s head. The shoulder dystocia was then diagnosed and attempts were made to release the baby’s shoulder in order to perform the delivery. All of the parties to the Texas medical malpractice case agreed that the shoulder dystocia presented an emergent situation that placed both the mother and the baby at risk for injury or death if the baby could not be quickly extricated from that position. The parties also agreed that the baby suffered a brachial plexus injury, but the parties disagree as to whether the defendants’ conduct caused the injury or whether the child’s injury would have occurred despite the medical care provided during delivery.
The defendants moved for summary judgment, arguing that section 74.153 applied and therefore the plaintiffs must prove negligence by a willful and wanton standard. The trial court granted the defendants’ motion for summary judgment on the plaintiffs’ claims of ordinary negligence, ruling that section 74.153 applies to medical care performed in an obstetrical unit and that the plaintiffs must prove their claims against Appellees under a “wilful and wanton negligence” standard. The plaintiffs sought permission to appeal and the Appellate Court granted the appeal to answer the question whether section 74.153 applies to medical care provided in an obstetrical unit without the patient’s first having been evaluated in a hospital emergency department.
Tex. Civ. Prac. & Rem. Code Ann. § 74.153
Section 74.153 provides: “In a suit involving a health care liability claim against a physician or health care provider for injury to or death of a patient arising out of the provision of emergency medical care in a hospital emergency department or obstetrical unit or a surgical suite immediately following an evaluation or treatment of a patient in a hospital emergency department, the claimant bringing the suit may prove that the treatment or lack of treatment by the physician or health care provider departed from the accepted standards of medical care or health care only if the claimant shows by a preponderance of the evidence that the physician or health care provider, with wilful and wanton negligence, deviated from the degree of care and skill that is reasonably expected of an ordinarily prudent physician or health care provider in the same or similar circumstances.”
The Appellate Court analyzed the wording of section 74.153, finding that it was ambiguous (“we are simply unable to ascertain the meaning of section 74.153 vis-à-vis the Evaluation or Treatment Phrase from the “plain words” of the statute as written”) and noting that it is but one part of an entire statutory scheme referred to as the Texas Medical Liability Act (TMLA). Section 74.153 is included, along with three other statutes, in Subchapter D of the TMLA, under the heading “Emergency Care.”
The Appellate Court stated that the four statutes, read together, signal a concern that in circumstances when emergency medical care must occur in the dark—when medical care providers or first responders perform blindfolded as to the recipient’s relevant past and current medical conditions—those medical care providers should not be held to a standard of ordinary negligence. Instead, before the beneficiary of emergency medical care administered under such inauspicious circumstances may seek damages for negligent care received, he or she must prove that the medical care provider deviated from the standard of care by a willful and wanton degree.
The Appellate Court stated that “[a]pplying the “Related Statutes” canon leads us to conclude that the legislative scheme with regard to emergency medical care focuses more on when rather than where the care was administered. The relevant inquiry for jurors in determining liability in these cases is whether the situation presented an emergency requiring medical care by a provider who had no prior knowledge, or realistic opportunity to acquire knowledge, about the patient’s history. In such circumstances, the overall statutory scheme provides a limitation on liability for medical care that under more propitious circumstances—care administered by a patient’s longtime family physician, for example—might constitute negligent care,” and that the legislative history “certainly supports this view.”
The Appellate Court held: “we cannot ignore what plain grammar also tells us is a reasonable reading of this ambiguous statute—that section 74.153 does not apply to patients who were not evaluated or treated in a hospital’s emergency department immediately before receiving emergency care. Such an interpretation achieves our primary objective—ascertaining and effectuating legislative intent … we hold that the Evaluation or Treatment Phrase applies to all three locations and is not limited only to emergency medical care provided in a surgical suite. The protections of section 74.153 are triggered by the evaluation and treatment of the patient in the hospital emergency department. Once triggered, whether the subsequent emergency medical care is administered in the hospital emergency department itself or whether the patient is then transferred to an obstetrical unit or a surgical suite to receive the emergency medical care, a willful and wanton negligence standard applies.”
The Appellate Court concluded: “We hold that section 74.153, which provides a willful and wanton standard for liability, does not apply to emergency medical care provided in an obstetrical unit when the patient was not evaluated or treated in a hospital emergency department immediately prior to receiving the emergency medical care. We reverse the trial court’s summary judgment and remand for further proceedings consistent with this opinion.”
Source D.A. and M.A. v. Texas Health Presbyterian Hospital of Denton, No. 02-16-00148 CV.
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