In its August 31, 2017 Memorandum Opinion, the Court of Appeals Second District of Texas Forth Worth (“Texas Appellate Court”) stated that “[t]he lone issue is a familiar one: the often hazy question of whether a claim, though labeled otherwise, is a healthcare-liability claim subject to the TMLA’s mandatory expert-report and dismissal provisions.”
The Texas Appellate Court held that the plaintiffs’ promissory-estoppel claim was a healthcare-liability claim subject to the Texas Medical Liability Act (“TMLA”) because expert testimony will be necessary to show breach of an applicable standard of care.
The Underlying Facts
The plaintiffs’ filed their Texas healthcare liability lawsuit (Texas medical malpractice lawsuit) on April 6, 2016, alleging that they experienced pain, infection, and other mental and physical maladies after the defendant dentists performed dental services for them. The plaintiffs alleged that one of them visited the defendants in April 2014 to correct a food trap between two molars. The defendants filled a cavity and performed temporary and permanent crown procedures to address the persistent tooth pain that the plaintiff subsequently experienced, but she ultimately visited other dentists who, among other things, corrected the food-trap and crown procedures that the defendant dentists had previously performed. With regard to the other plaintiff, the defendant dentists filled multiple cavities for her in late 2013, after which she also experienced persistent tooth pain and had the cavities re-treated by other dentists.
The plaintiffs also alleged in their lawsuit that when they confronted the defendants with the problems they were experiencing, one of the defendants promised to reimburse them for the costs they had incurred to have the issues corrected by other dentists. The plaintiffs presented the defendants with invoices documenting the dental work performed by other dentists, but the defendants failed to reimburse them. Specifically, the plaintiffs’ promissory estoppel claim alleged that the defendant dentist promised to reimburse them for the costs they incurred to correct the procedures that the defendants had performed; that the defendants should have foreseen, and did foresee, that the plaintiffs would rely on the promise; that the plaintiffs did in fact substantially rely upon the defendant’s promise; and that the plaintiffs were injured because the defendants reneged on the promise to reimburse them.
The plaintiffs subsequently nonsuited their dental malpractice claims but stated their intention to proceed solely on their promissory estoppel claim. The defendants filed a combined traditional and noevidence motion for summary judgment and a motion to dismiss under the TMLA, arguing in part that the plaintiffs’ claims should be dismissed because the plaintiffs failed to comply with the TMLA’s applicable expert-report requirement. The trial court denied the defendants’ motions, and the defendants appealed.
The Texas Appellate Court’s Opinion
The Texas Appellate Court stated that a plaintiff must serve an expert report for each physician or health care provider against whom a healthcare-liability claim is asserted. Tex. Civ. Prac. & Rem. Code Ann. § 74.351(a). A party’s obligation to serve an expert report thus depends on whether its claim falls within the statutory definition of “health care liability claim.” If the expert-report requirement applies, and a report is not served, the trial court is required, upon motion by the affected health care provider, to dismiss the claim with prejudice and to award reasonable attorney’s fees and costs.
A healthcare-liability claim contains three elements: (1) a physician or healthcare provider must be the defendant; (2) the claim at issue must concern treatment, lack of treatment, or a departure from accepted standards of medical care, or health care, or safety; and (3) the defendant’s act, omission, or other departure must proximately cause the patient’s injury or death. A dentist is considered a healthcare provider in Texas.
A cause of action alleges a departure from accepted standards of medical care or health care if the act or omission complained of is an inseparable part of the rendition of medical services. The defendants argued on appeal that the plaintiffs’ promissory estoppel claim alleges a departure from accepted standards of health care.
The Texas Appellate Court stated that in determining whether the plaintiffs’ promissory estoppel claim is a cause of action that alleges a departure from accepted standards of medical care or health care, it considers the alleged wrongful conduct and the duties allegedly breached, whether expert testimony is necessary to show breach of an applicable standard of care, whether the alleged act involves medical judgment related to the patient’s care or treatment, and whether a specialized standard in the healthcare community applies: if expert medical or health care testimony is necessary to prove or refute the merits of the claim against a physician or health care provider, the claim is a health care liability claim (a claim may still be a health care liability claim even if expert testimony may not be necessary to support a verdict).
The Texas Appellate Court stated that if a claim is premised on facts that could support liability for breach of an applicable standard of care, then the claim is properly characterized as a healthcare-liability claim, and the TMLA applies. The Texas Appellate Court further stated that the TMLA essentially creates a presumption that a claim is a healthcare-liability claim when it involves a physician or health care provider and is based on facts evolved during the course of the patient’s care.
In the case it was deciding, the Texas Appellate Court stated the appropriate question is whether the plaintiffs’ claim is premised on facts that could support a healthcare-liability claim: whether the gravamen of the plaintiffs’ promissory-estoppel claim requires expert testimony that will be necessary to show breach of an applicable standard of care.
The Texas Appellate Court held that the true gravamen of the plaintiffs’ promissory-estoppel claim is that they seek reimbursement for the costs they incurred correcting the issues arising from the dental surgeries negligently performed by the defendants: to prove damages under the theory of promissory estoppel, the plaintiffs must rely on testimony that only a medical expert can provide because they must prove the amount of subsequent dental work they incurred to correct
the issues arising from the dental surgeries negligently performed. Furthermore, the defendants’ contention that they are not responsible for reimbursing the plaintiffs because they did not negligently perform one or more of the initial dental procedures will require medical expert testimony.
The Texas Appellate Court held that the plaintiffs’ promissory-estoppel claim thus concerns an alleged departure from accepted standards of health care, and expert testimony will be necessary to support the claim. Because the plaintiffs were required to serve an expert report but failed to do so, the trial court had no option but to dismiss the plaintiffs’ promissory-estoppel claim, and it abused its discretion by not doing so.
Source Calabria-Ellis, P.C. v. Ho, No. 02-16-00424-CV
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