## IN THE SUPREME COURT O F TEX AS

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. 14-0333

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### L O U IS A 

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. R E D D IC 

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### T E X A S 

### M E D IC A L 

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### H E A L T H 

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### , I N D IV ID U A L L Y A N D D 

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### E A S T 

### T E X A S 

### M E D IC A L 

### C E N T E R 

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O N P E T I T I O N F O R R E V I E W F R O M T H E C O U R T O F A P P E A L S F O R T H E T W E L F T H D I S T R I C T O F T E X A S

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This case involves a claim ag ainst a hospital by a visitor who fell in the hospital lobby

. The question is whether it is a health car e liability claim under the Texas Medica l L iability Act. See T E X
. C I V
. P R A C
. & R E M
. C O D E ch. 74. We conclude it is not, beca use t he record does not demonstrate

a substantive rela tionship betwee n the safe ty standards the visitor alleg ed the hospital brea ched and the provision of health car e. We r ever se the judgme nt of the court of appea ls and rema nd the case to the trial court f

or fur ther proc eeding s. L o u i sa Reddic, a visitor at East Texas Medica l Center- Crockett Hospital, fell when she slipped on a floor mat betwee n the hos p i t al ’s m ain entra nce and the front desk. Reddic sued the hospital on a premises liability theory

. The hospital responde d, in part, by filing a motion to dismiss in which it asser

ted t hat R eddic’ s claim was a health car e li ability claim (HCL C) under the TexasMedica l L iability Act (the Act), and she did not serve an expert repor t as is require d by the Act. See 1
T E X
. C I V
. P R A C
. & R E M
. C O D E § 74.351(a) , (b) (re quiring dismiss al of an HCL C if a claimant fails to timely serve an expert re port).
I n moving for dismiss al, the hospital pr imarily relied on Texas W est Oaks Hospital, L.P. v

. W illiams , 371 S.W .3d 171, 186 (Tex. 2012). I n that case , we held that when a safe ty standards- based claim is ma de ag ainst a hea lth care provider, the Act does not r equire the standards underly ing the claim to be direc tly rela ted to the provision of health car e in order for the claim to be an HCL C. The hospital urg ed that beca

use Reddic claimed that the hospital depar ted from standards of safe ty , her claim was an HCL C. The trial court denied the hospital’s motion, but the court of appea ls reve rsed. E. Tex. Me d. Ctr. Reg’l Health Care Sys. v . Reddic , 426 S.W .3d 343 (Tex. App.—Ty ler 2014). I t conclude d that “the car e of the floor around an are a fre quented by numerous patients throug hout the day has an indirect rela tionship to the provision of health car e that is sufficie nt to satisfy the safe ty
prong of the [Act].” Id. at 348. After the court of appea ls issued its opinion, we addre ssed a fac tually simil ar matter in Ross

v. St. Luke’s Episcopal Hospital , 462 S.W .3d 496 (Tex. 2015 ). I n t h at case , L ezlea Ross

acc ompanied a friend who was visiti ng a patient in St. L uke’s Hospital. Ross slipped and fell in the

U n d e r t h e A c t , a h e a l t h c a r e l i a b i l i t y c l a i m i s 1

a c a u s e o f a c t i o n a g a i n s t a h e a l t h c a r e p r o v i d e r o r p h y s i c i a n f o r t r e a t m e n t , l a c k o f t r e a t m e n t , o r o t h e r c l a i m e d d e p a r t u r e f r o m a c c e p t e d s t a n d a r d s o f m e d i c a l c a r e , o r h e a l t h c a r e , o r s a f e t y o r p r o f e s s i o n a l o r a d m i n i s t r a t i v e s e r v i c e s d i r e c t l y r e l a t e d t o h e a l t h c a r e , w h i c h p r o x i m a t e l y r e s u l t s i n i n

j u r y t o o r d e a t h o f a c l a i m a n t , w h e t h e r t h e c l a i m a n t ’ s c l a i m o r c a u s e o f a c t i o n s o u n d s i n t o r t o r c o n t r a c t

. T E X
. C IV
. P R A C
. & R E M
. C O D E § 7 4

. 0 0 1 ( a ) ( 1 3 )

. 2lobby near the hos pital exit doors and sued t he hospi tal on a pre mises liabilit y theory

. Id. at 499. The hospital moved for dismiss al beca use Ross did not serve an expert repor t in acc ordanc e with the Act’s require ments. The trial c ourt g rante d the motion and the cour t of appe als aff

irmed. Id. We

reve rsed, concluding that a safe ty standards- based claim ag ainst a health car e provider is an HCL C only if a “substantive nexus” exis ts betwee n the “saf ety standards alleg edly violated and the provision of health car e.” Id. at 504. We set out sever al non-exclusive considerations for analy zing whether a saf ety standards- based c laim is an HCL C: 1. Did the alleg ed neg lige nce of the defe ndant occur i n t h e co u rse of the defe ndant’s perf

orming tasks with the purpose of protec ting patients from harm; 2. Did the injuries occur in a place wher e patients might be during the time they wer e rec eiving car e, so that the obliga tion of the provider to protec t persons who re quire spec ial, medical c are was implicated; 3. At the time of the injury was the claimant in the proce ss of seekin g o r rec eiving health ca

re; 4. At the time of the injury was the claimant providing or assisting in providing health ca re; 5. I s the alleg ed neg lige nce based on safe ty standards arising from profe ssional duties owed by

the hea lth care provider; 6. I f an instrumentality was involved in the defe ndant’s alleg ed neg lige nce, was it a ty pe used in providing health ca re; or 7. Did the al leg ed neg lige nce occur in the course of the defe ndant’s taking ac t i o n o r failing to take action nece ssary to comply with safe ty -re lated require ments set for health car e providers b y go vernme ntal or acc rediting ag encie s? Id. at 505. We conclude d that under the rec ord befor e us, the answe r as to eac h of the considerations was “no,” t hus Ross’s claim was based on safety standards that had no substantive rela tionship to the provision of hea lth care and it was not an H CL C. Id.

3Reddic arg ues that the fac ts underly ing her claim are simil ar to those in Ross , her claim does
not have a substantive rela tionship with the provision of health car e just as Ross’s claim did not, and
t h e re s u l t s h o u l d be the same. She also asser ts that if her claim is held to be an HCL C, then dismiss ing it violates the Texas Constit ution’s open courts and special laws provisi ons. See T E X
. C O N S T . art. I , § 13; id. art. I I I , § 56(a) (28). The hospital responds that Ross is inapplicable to this case , but that even if it does apply , Reddic’s claim is never

theless an HCL C. Be cause maintenanc e of the hospital’s premises is subject
to reg ulations focuse d on the s afe ty of bot h patients and other s, the hospital rea sons, maintenanc e of the pre mises is subst antively rela ted to the provision of hea lth care

. I n support of its position th at R o s s does not apply here , the hospital points out that the hospital in Ross did not asser t that the are a wher e Ross fell was a patient car e are a, nor did it claim that the ar ea w here Ross fell ha d to me et particula r maintenanc e standards rela ted to the provision of health car e. The hospital posits that three case s other than Ross

— Loaisi ga v. Cerda , 379 S.W .3d 248 (Tex. 2012); Texas W est Oaks Hospital, L.P. v. W illiams , 37 1 S

. W.3d 171 (Tex. 2012); and Harr i s Methodist Fort W orth v. Ollie , 342 S.W .3d 525 (Tex. 2011)—should control here

. We disag ree . None of the case s the hospital ref ere nces involved the question prese nted both in Ross and here : whether a non-patient’s claim for a hospital’s violation of premises-r elated safe ty standards is

an HC L C. See Loaisi

ga , 379 S.W .3d at 257 (consider ing whether a patient’s claim ag ains t h er health car e provider for an alleg ed assault during the course of trea tment was an HCL C); W

illiams , 371 S.W .3d at 186 (conc luding that claims for injuries to a health car e provider’ s employ ee arising from his a lterca tion with a patient wer e HCL Cs be cause they wer e for depar tures fr om health car e
4standards as well as safe ty standards) ; Ollie , 342 S.W .3d at 527 (conc luding that a patient’s claims

ag ainst a hospital based on her slipping and falling afte r taking a bath wer e direc tly rela ted to health

car e). So we will look to Ross for g uidance

. Having anticipated that Ross might apply , the hospital sets out four Ross fac tors that it say s mandate c lassify

ing Re ddic’s cla im a s an HCL C: (1) the hospital’s alleg ed neg lige nce was re lated to protecting patients from ha rm, (2) the injury occur

red in a location wher e patients mig ht be, (3) the alleg ed neg lige nce is based on s af et y standards arising from profe ssional duties owed by the hospital as a health car e provider, and (4) the alleg ed neg lige nce occur red in co n nection with a failure “to take action neces s ar y to comply with safe ty -re lated require ments set for health car e p ro viders by g overnme ntal or acc rediting ag encie s.” We disag ree that the rec ord supports th e hospital’s position.
I n arg uing the applicability of the first two fac to rs i t re fe re nces, the hospital urg es that Reddic’s injury occur

red in a location wher e patients would be, or at least might be, beca use “[o] ne
cannot dispute patients seeking car e at [t he hospital] will not only be in the hospital lobby , [but ] they wi ll also be in the are a of the front desk.” The court of appea ls conclude d that “ca re of the floo r around a n are a fr equente d by

numerous patients throug hout the day has an indirect relationship to the provision of hea lth care .” Reddic , 426 S.W .3d at 348. We ag ree that floor car e in an are a fre quented by persons seeking or rec eiving health car e is rel ated to the provision of health car e. But as we deter mined in Ross , the Act require s that for a claim t o be an HCL C, it must have more of a re lationship to t he provision of he alth car e than that it arises fr om an occ urre nce inside a hospital. 462 S.W .3d at 504. I n that reg ard, this re cord doe s
5not support the court of appea ls’ statement that numerous patients fre quented the are a wher e Reddic

fell. Nor does it support the hospital’s arg ument that patients might be in that are a while rec eiving

car e, thus implicating the obliga tion of the hospital “to protec t persons who require specia l, medical

car e.” See id. at 505. As to the last two Ross fac tors the hospital ref ere nces, the hospital’s asser tions are essentially that the fac ts Reddic relies on could support a cl ai m b as ed on safe ty standards imposed on the hospital by applicable fede ral and state authorities and acc rediting ag encie s, so her neg lige nce claim is substantively

rela ted to the provision of health car e. The hospital points t o multipl e re g ulations in support of i ts arg ument. First, it say s that under fede ral reg ulations, hospitals participa ting in Medica re must m ee t ce rt ain g ener al safe ty require ments including require ments that the hospital
must be “maintained to e nsure the safe ty of the patient,” and “[f]acilites .

. . must be maintained to

ensure an ac cepta

ble level of

safe ty .” 42 C.F.R. §§ 482.1, .41, .41(c) (2). The hospital also points
to require ments in the standards of The J oint Commi ssion—an independent org anization that

acc redits and cer

tifies health car e org anizations. Unde r t h e s tandar ds the hospital ref ere nces, hospitals a

re evalua ted on whether they have a written plan for manag ing both the “envir onmental safe ty of patients and ever y one else who enter s the hospital’s fac iliti es,” and “sec urity of ever y one who enter s the hospital’s fac iliti es.” J O I N T C O M M ’ N S T A N D A R D S EC.01.01.01. Hospitals a re also evalua ted for whether they identify “saf ety and secur ity risks associate d with the environment of car e that could aff

ect patients, staff and other people coming to the hospital’s fac iliti es, ” whether they “take [] ac t i o n to minimi ze or eliminate identified safe ty and secur ity risks in the phy sical environment,” and whether they “maintain[] all g rounds.” Id. at EC.02.01.01. Finally , the hospital
6notes that Texas require s hospitals to be licensed by the Depa rtment of State Hea lth Service s, T E X
. H E A L T H & S A F E T Y C O D E § 2 41.021, and the State require s a licensed hospital to have a multidisciplinary safe ty committee an d a s afe ty office r to car ry out a safe ty prog ram. 25 T E X
. A D M I N
. C O D E §133.142. Whil e the hospital lists require ments of various entities with which it must comply and urg es that the fa ctor re g arding comply ing or failing to comply

with require ments is met, the rec ord does
not show that the hospital’s comply ing or failing to comply with them had a substantive rela tionship
to the safe ty standards underly ing Reddic’s claim. Fo r example, the hospital ref ere nces state administrative require ments t h at i t must have a multi-discipli nary safe ty committee and a safe ty office r, and J oint Commi ssion standards that it must have a written plan fo r manag ing safe ty and

secur ity of both patients and other p er s o ns who enter the hospital. But Reddic’s claim is for the hospital’s failing to proper ly inspect and maintain its floor mats in the lobby , reg ardle ss of whether it had a saf

ety committee, a wr itten plan for mana g ing sa fety , or a sa fety office r. As for g ener al safe ty s t an d ar d s such as fede ral reg ulations requiring hospitals to maintain fac iliti es “to ensure an acc eptable level of safe ty ,” 42 C.F.R. § 482.41(c) (2), we noted in Ross that hospital standards for floor maintenanc e “may also be the same standards many businesses g ener ally have for maintaining their floors.” 462 S.W .3d at 503. We said that “[t] he pivotal issue in a safe ty standards- based claim is whether the standards on which the claim is based implicate the defe ndant’s duties as a health car e provider, including i t s d u t ies to provide for patient safe ty .” Id. at 505. Although hospitals are require d by reg ulation to ensure an acc eptable level of safe ty for those within its confine s , t h e re co rd does not show that the safe ty standards at issue here are rela ted to the

7provision of health car e by more than the location of Reddic’s fall being inside a hospital. That is,

the rec ord does not support a conclusion that safe ty standards reg arding maintenanc e of the floor and mats where Reddic fe ll were substantively rela ted to the safe ty

of patients rec eiving health car e or persons see king he alth car e. Citi ng Denton Regional Medic al Center v. LaCroi x , 947 S.W .2d 941, 951 (Tex. App.—For t Worth 1997, pet. denied), the h o s p i t al arg ues t hat reg ulations provide evidence of t he st andar d of

car e applicable to hospitals. Whil e we d o n o t nece ssarily disag ree with the proposition that applicable reg ulations in some instances might bear on or evidenc e a standard of car e, we note that the court in LaCroi

x was addre ssing whether expert testimony was re q u i red to establish the hospital’s standard of car e. Id. at 950-51. I n doing so, it said that reg ulations or a hospital’s internal policies may

be considered in establishing the standard of car e. Id. at 951. B ut in the case befor e
us, th e h o s p i tal does not identify a commission or ag ency reg ulation that it say s evidenc es a particula r standar d of car e that both is substantively rela ted to the provision of health car e and underlies Red d i c’s claim. See Y amada v. Friend , 335 S.W .3d 192, 196 (Tex. 2010) (noting that whether a claim is an HCL C depends on the underly ing nature of the claim); Baylor All Saints Med. Ctr. v. Martin , 340 S.W .3d 529, 534-35 (Tex. App.—For t Worth 2011, no pet.) (h o lding that an expert repor

t did not establish the s tandar d of care where the ex pert stated th at J o i nt Commi ssion
reg ulations require d policies to safe g uard pa tients but did not identify any such policies). We conclude that the rec ord befor e us does not ref lect a substantive nexus betwee n the safe ty standards Reddic claims the hospital violated and the hospital’s provision of health car e. See Ross , 462 S.W .3d at 504 (stating that the fac t that a visitor to the hospital would not have been injured but
8for her falling inside the hospital is not a sufficie nt r elationship betwee n safe ty standards alleg edly

violated by the hospital and the hospital’s health car e activities for the claim to be an HCL C). Thus, the rec ord does not support the hospital’s contention that Reddic’s claim is an HCL C. We need not and do not addr ess Reddic’s c halleng e to the constitutionality of the Ac t. We g rant the petition for revie w. Wit hout hear ing oral arg ument, see T E X
. R. A P P
. P. 59.1,

we reve rse the court of appea ls’ judgme nt and rema nd the case to the trial court for further
proce eding s consistent with this opi nion.

OP INION DELIVERED: October 30, 2015

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