### NUM BER 13-08- 0020 0-CV 

## COURT OF A PP EA LS T H I R T E E N T H D I S T R I C T O F T E X AS C O R P U S C H R IS T I - 

## EDI NBURG
VA LL EY B A PT IST M EDIC A L CEN TE R, A pp ellan t,
v . NOE M ORA LES, JR., AS A DM INI STRA TOR OF THE EST A TE OF PA UL INA

M ORA LE S, D ECE A SED , A pp ellee.
On ap pe al f rom th e 4 04t h Dist rict C ou rt of C amero n Co un ty , T exas . 

## O P I N I O N B efo re J u st ic es R o d rig u ez , G arza , a n d V el a Opin ion b y

Ju stice R od rigu ez T his is a statut oryconstruct ion case . In a ma nda mu s p rocee ding, the district court
or der ed appe ll ant, Val ley Bapt is t M edi cal C enter ( VBM C) , t o produce the medic al re cords of Pauli na M or ale s t o appel lee , Noe Mo ra les , Jr

. (M or ale s) , as admini strator of the e sta teVB M C f i l ed a m ot i on t o f i x super sedeas. T he t r i al cour t hear d t he m ot i on, at whi ch t i m e t he p ar t i es 1 a g re e d th a t M o ra l e s w o u l d p l a c e $ 1 ,1 4 3 .0 0 , re p re s e n ti n g a re a s o n a b l e fe e fo r p ro d u c ti o n o f t h e re c o rd s , see infr a n .3 , i n tru s t fo r V B M C p e n d i n g th e o u tc o m e o f t h i s a p p e a l a n d th a t V B M C w o u l d p ro d u c e th e re c o rd s to M or al es. 2 of Pauli na M or ale s, decea sed, w it hout charg e. By a s ing le is sue, VBM C cont ends that the tr ia l co u rterr e d in ord e rin g p r o d u c ti o n of th e rec o rd s with o u t c h a rge be ca u se , a lt h o u gh Mo ra les i s e nti tl ed to a c opy of M s. Mo ra les 's medi cal r ecords pur suantto sec ti on 74.051( d) of the Tex as Ci v il Pr actic e s a n d R emedie s C ode, VBM C maych ar g e a
re asona ble fee for prov idi ng the infor mati on unde r sec ti on 241. 1 5 4 of the Tex as Hea lt h and Sa fetyC ode. See T EX
. C IV
. P R AC
. & R EM
. C OD E A NN
. § 74 .05 1(d) (Vernon 200 5); T EX
. H E A L TH & S A F E T Y C OD E A NN
. § 24 1.1 54 (Ve rnon 200 1). W e reverse and rend er. I. Bac kg ro und Mo ra les pr ov ide d VBM C w it h a w ri tten re q uestand pr oper auth or iz ati on for copi es of Ms . M or ale s' s medi cal r ecords. See T EX
. C IV
. P R AC
. & R EM
. C OD E A NN
. §§ 7 4.0 51(d ), 74.052 (V er non 200 5)

. Upo n r ecei pt of the noti ce, VBM C adv is ed M or ale s that the fee for the r e co rd s wou ld be $1, 143.00. See T EX
. H E A L TH & S A F E T Y C OD E A NN
. § 241. 154. Challen ging the f ee request , Morales f iled a pe tition se eking a ma nda mu s order tha t VBMC pr oduce co pie s o f the r ecords w it hout charg e. VBM C answ e re d c o n te n d ing thati t w as
e n ti tl e d to be co m p e n sa te d fo r pr o vidi n g a co p y of th e m e d ica l re co r d s. Fol lo wing a hear ing on M or ale s' s p eti ti on, t he di str ic t c o u rtente re d j udg ment t hat V BM C pr ov ide Mo ra les w it h a fr ee c opy of Ms . M or ale s' s medi cal r ecords. V BM C appeal s fr om that jud g ment. 1 II. Ap pli cabl e Law and Standa rd of Rev iew Sect ion 74.0 51( d) of the c iv il pr act ic es and r emedie s c ode s tates thatT h e fo rm u l a fo r d e te rm i n i n g a re a s o n a b l e fe e i s s e t o u t i n s e c ti o n 2 4 1 .1 5 4 (b )( 1 ). See T EX
. H EALTH 2 & S A F E T Y C OD E A NN
. § 2 41

. 15 4(b )( 1) (V ern on 20 01 ). 3 [a]l l par ti es shal l be entit led to obtai n complet e and unal ter ed c opi es of the pati ent' s medi cal r ecords from any other par ty w it hin 45 day s fr om the date of rec eip t of a w ri tten re q uestfor s uch re cords; prov ide d, how ev er , that t he re cei pt of the medi cal auth or iz ati on i n the form r eq uir ed by Sec ti on 74. 052 ex ecut ed by

the cl aimanther ein sh all be c onsi der ed co m pli ance by the cl aimantw it h thi s s ubsec ti on. T EX
. C IV
. P R AC
. & R EM
. C OD E A NN
. § 74. 051( d)

. Sect ion 241. 154 of the heal th an d s afety code pr ov ide s t he foll ow ing , i n r ele v ant p art: (a ) On r ecei pt of a w ri tten author iz ati on from a pati ent o r leg all y auth or iz ed re pr esent ati v e to ex amine or co py al l or par t of the pati ent' s re corded hea lt h car e i nformati on, .
. . a hospi tal or it s a g ent, as pr omptl y as r eq uir ed unde r the circumsta nces b ut no t later tha n the 15th day aft er the d ate the request and paymen t aut horized und er Sub section (b) are r eceived, sha ll: (1 ) mak e t h e i n fo r ma t i o n a v a i l a b l e fo r e x a mi n a t i o n d u r i n g r e g u l ar busi ness hours a nd prov ide a c opy to the r eq uest or , i f req uest ed; o r (2 ) infor m the author iz ed req uest or if the informat ion does not ex is t or canno t be found. (b ) Ex ceptas pr ov ide d by Subs ect io n ( d ), t h e hos pit al or i ts ag ent may charg e a r eason abl e fee for prov idi ng the heal th car e informati on and is not re q uir ed to per mit the e x amina ti o n , copy ing , or r ele ase of the i nformati on re q uest ed unt il the fee is pai d unl ess there i s a medi cal emer g ency .[ ] 2 * * * * (d) A hospita l may not charge a f ee f or: (1 ) pr ov idi ng heal th c ar e i nformation un der Subs ect ion ( b) to the ex tent the fee i s p ro hib it ed unde r Subc hapter M , C hapter

161; (2 ) a pat ien t t o ex amine the p ati ent' s o w n heal th c ar e i nformati on; (3 ) pr ov idi ng an i temi z ed s tatementof bil led se rv ic es to a pati ent o r thi rd -p arty

pay or , ex ceptas pr ov ide d under Sec ti on 311. 002( f); or4 (4 ) heal th c ar e i nformati on r ela ti ng to tr eatment or hospi tal iz ati on for w hic h w or kers' compensat ion benef it s are bei ng soug ht, ex ceptto the e x tent per mitt ed unde r Cha pter 408, Labor

C ode. T EX
. H E A L TH & S A F E T Y C OD E A NN
. § 241. 154. Stat utor y co nst ru cti on i s a q uest ion of l aw , w hic h appel lat e c our ts re v iew de n ov o, g iv ing no d eferenc e to the t ri al cour t' s i nter pr etati on. See F.F.P. Oper ati ng Par tner s, L.P.
v. Due nez , 237 S.W .3d 680, 683 (Tex . 2007). Our goal is to ascer

tai n and g iv e eff ectto the L eg is lat ur e's i ntentby ex amini ng the sta tute' s p lai n l ang uag e. City of D esoto v . White , No . 0 7 -1 0 3 1 , 2 0 0 9 T e x. LE XIS 39 5 , a t * 1 2 (T e x. Ju n e 19 , 2 0 0 9 ) (ci ti n g D u e n ez , 2 37 S.W .3d a t 683 ); Rodrigu ez v. Tex. W

orkforce Comm 'n , 9 8 6 S

. W

. 2 d 7 8 1 , 7 8 3 (T e x. App.–C or pus Chr is ti 1999, pet. deni ed)

. "Therefor e, ou r pr act ic e w hen c onst ru ing a s tatut e is to re cog niz e tha t ' the w or ds [the Le gis lat ur e] c hoose s s houl d be the s ur estg uid e to leg is lat iv e i ntent .' " Ent ergy Gulf State s, Inc. v. Su m m ers , 282 S.W .3d 433, 43 7 ( Tex . 200 9) (ci ti n g Fitz

gera ld v. Adva nced Spin e Fixation Sys., Inc. , 996 S .W .2d 864 , 866 (Tex. 1999 )). "W here possible , courts are to construe language used in st atu tes so as to harm onize all
re lev ant l aw s, not c re a te c o n f lic t. " Rod ri guez , 986 S.W .2d at 783 . "Only w hen those
w or ds ar e ambig uous do w e 'r esor t to ru les of c onst ru cti on or extr ins icai ds. '" Summ ers , 2 8 2 S. W .3 d at 43 7 (cit in g In re Esta te of Nash , 220 S

. W .3d 914 , 917 (Tex. 2007 )); Rod ri guez , 986 S.W .2d a t 783

. III

. Di sc uss ion By a s ing le is sue, VBM C cont ends that sec ti on 241.154 (b ) of t he Tex as Hea lt h and Safety C ode and se cti on 74. 051( d) of the Tex as Ci v il Pr act ic e and Remedi es Cod e ar e not in confli ct. I t as ser

ts that to ho ld other

w is e w oul d be to di sr eg ar d s ect ion 241. 154( b) w henI t i s und i sput ed t hat t he f ee f or M s. M or al es' s re cor ds, as cal cul at ed under t he f ee schedul e i n eff ect 3 at t hat t i m e, was $1 , 143. 00. 5 itw oul d be poss ibl e t o g iv e eff ectto both the e nti tl ement t o r ecords in sec ti on 74. 051( d) and to the fee sch edu le for those records in section 241 .15 4(b). VBMC urg es tha t the se sta tutes sh oul d be har moniz ed and cons tr ued to all ow M or ale s a co py

of the records, but to al so re q uir e hi m to pay the re asona ble sta tutor y fee. In re spons e, M or ale s a ss erts that, b y i t s t e r ms , s e c t i o n 2 4 1

. 1 5 4 i s n o t s p e c i fi c a l l y a p p l i c a b l e t o r e q u e s t s fo r re cor ds made pur suantto sec ti on 74. 051( d)

. He ar g ues that the unq ual ified enti tl ement to the records
as setout in that sec ti on c onfli cts w it h the l ang uag e of the hos p it al' s req uir ement t o
w it hhol d r ecords pendi ng pay ment of co py ch ar g es cont ain ed i n s ect ion 241. 154. A pla in re adi ng of s ect ion 74.051( d) of t he ci v il pr act ic e and re medies co de prov ide s tha t "[a ]ll parties sha ll be entitled to obtain com plete and una ltered copies of the pa tient 's medic al re cords from any othe r par

ty " w hen a pr oper

medi cal auth or iz a ti o n i s prov ide d. T EX
. C IV
. P R AC
. & R EM
. C OD E A NN
. § 74. 051( d). " En titl e" i s d efined as "[t ]o g ra nt a leg al ri g ht t o or

q ual ify for." B L A CK ' S L AW D I CTI ONA RY 612 (9th ed . 200 9). A pl ain r eadi ng of se ct ion 241. 154( b) of the h eal th an d s afetyco de i ndi cat es that a "h ospita l or i ts agent m ay charg e a reason able fee" for provi ding "he alth ca re infor mati on" upon "r ecei pt of a w ri tten author iz ati on from a

. . . l e gal ly auth or iz ed
re p re se n ta ti ve" an d th a t t h e ho sp it a l " is n o t re qui re d to pe rm it th e exa m in a ti o n , c o p ying,
or r ele ase of the infor mati on r eq uest ed unt il the fee is pai d." T EX
. H E A L TH & S A F E T Y C ODE A NN
. § 241. 154. The sta tute set s out a fee s chedu le that is cons ide re d "r eason abl e" and
a u t h o ri ze s a n n u a l a d ju s t m e n t s t o t h a tfe e sc h e d u le b a s e d o n t h e c o n s u m e r p ri c e in d e x. 36

Id. § 24 1.154( b) (1 ), ( e)

. Sect ion 241. 154 al so id e n ti f ies four sp eci fic i nst ances w hen a hospi tal may

not charg e a fee. See i d. § 241 .15 4(d). In ex amini ng these s tatut es, w e not e tha t s ect ion 74.0 51( d) of the c iv il pr act ic es and
re medies co de prov ide s o nly thatM or ale s i s e nti tl ed to co pie s o f medica l re co rd s. See T EX
. C IV
. P R AC
. & R EM
. C OD E A NN
. § 74. 051( d)

. Mo ra les , a par ty w ho has prov ide d a pr oper medi cal auth or iz ati on as r eq uir ed by 74.052 and w ho is ther efore in compl ian ce w it h section 74.0 51(d ), is ent itled to —tha t is , h e h a s a legal r ight to—receive copies of Ms. Moral e s ' s m e d ical records. How ever, section 74 .05 1(d) doe s not say that Morales is enti tl ed to , or

has a l eg al ri g ht t o, fr

ee medi cal r ecords. I ndeed, sec ti on 74. 051( d) i s s il ent
as to w hether

a fee i s t o be pai d by

M or ale s for

the re q uest ed copi es. It i s a ls o s il ent a s to w het her the fee, if an y , is to be pa id prior to receipt o f the request ed co pies. Sect ion 241 .154(b) of the h eal th an d s afetyco de does , how ev er , prov ide thata
re asona ble fee may

be c har g ed by

a ho spi tal for p ro v idi ng co pie s o f medi cal r ecords to a leg all y auth or iz ed re pr esent ati v e w ho has pr ov ide d the hos pit al w it h w ri tten author iz ati on. See T EX
. H E A L TH & S A F E T Y C OD E A NN
. § 2 4 1

. 1 5 4 (b ). T h e l a n gu a ge i s c le a rl y d is c re t io n a ry, pr ov idi ng thatthe hospi tal may , s houl d i t c hoose to do s o , charg e a r eason abl e fee and
re ceive t h a t f e e before pr ov idi ng the re q uest ed r ecords. See i d. I n addi ti on, t he Leg is lat ur e set out only f our ex cept ion s to this di sc re ti onar y ch ar g e. See i

d. § 24 1.1 54(d ). Non e of the spec ifici nst ances appl y to a c lai mant w ho i s a ss erti ng a he alt h c a re l iab il it y cl aim ag ain st a hos pit al from w hic h the r epr esent ati v e i s r eq uest ing r ecords. See i d. H a d t h e L e g i s l a t u r e i n t e n d e d t o r e q u i r e h e a l t h c a r e d e fe n d a n t s t o p r o v ide a c opy of a pati ent' s medic al re cords free of c har g e, it coul d hav e done s o. See, e.g. , T EX
. B US
.7

& C OM
. C OD E A NN
. § 4.4 06( b) ( Ver non 200 2) ( "A bank sh all prov ide , on re q uestand witho ut char ge to the cu st o m e r, at lea st tw o i tems or a l eg ibl e c opy

of the i tems w it h r espec t t o each sta tement of acco unt s ent t o the c u st o m e r.") ( emphasi s a dded) ; id. § 9. 616( e) (V er non 2002) ("A debtor or co nsumer

obl ig or i s e nti tl ed witho ut c har ge to one respon se to a r equest unde r this sectio n du ring any six -mon th pe riod in w hich th e secu red pa rty did not s end t he debtor

or co nsumer

obl ig or an e x pla nati on pursuantto Subs ect ion ( b) (1 ). ") (e mphasi s a d d e d ); T EX
. E DUC
. C OD E A NN . § 54.641( a) ( Ver non 200 6) ( "Notl ater than J a n u a r y 1 o f e a c h y e a r , t h e b o a r d s h a l l fur nis h w ith o ut c har

ge to each purcha ser a state me nt. . . ." ) ( em pha sis adde d). It chose not to i nclud e the w ords "without charge" in
sec ti on 241. 154( d)

. See T EX
. H E A L TH & S A F E T Y C OD E A NN
. § 241 .15 4(d). T he L egislature also cou ld have add ed a claiman t, such a s M o ra le s , t o the list of e x cept ions set out in
sec ti on 241. 154( d) , butdi d notdo s o. See i d. After ex amini ng the pla in la ng uag e of each statut e and focusi ng on the w or ds the Leg is l a t u r e c h o s e t o u s e , w e c o n c l u d e t h a t t h e s t a t u t e s a r e n o t i n c o n fl i c t a n d c a n be har moniz ed. See White , 2 0 0 9 Te x . L E X I S 3 9 5 , a t*12 ; S u mm ers , 282 S.W .3d a t 437 ; Rod ri guez , 986 S.W .2d at 783 . Th us, ha rmon iz ing the statu tes, Morale s is entitled to Ms. Mo ra les 's medi cal r ecords pursuantto sec ti on 74. 051( d) , and he may also be req uired to pay the fees prov ide d for in sec ti on 241. 154( b) i f req uest ed to do s o by the hospi tal

. See Rod ri guez , 986 S.W .2d a t 783

. Havi ng foun d the statu tes can be harmo nized, w e nee d not add re s s Mo rales's
re m a in in g a rg uments , w hic h ar e pr emis ed upon a find ing thatthe sta tutes co nflic t. See T EX
. R. A PP
. P. 47.1. Ac cordin g ly , w e s ust ain VBM C' s s ole i ss ue.8 IV. C oncl usi on W e r ev er se the t ri al cour t' s w ri t enter ed on Ma rc h 27, 2008, and w e r ender j udg ment that Mo ra les obta in a c omplet e and unal ter ed c opy of Ms . M or ale s' s medic al re cords from VBM C and t hat M or ale s p ay to VBM C the r eq uest ed fee of $1,143. 00 for pr ov idi ng the heal th c ar e i nformati on.

NE LDA V. RO DR IGU EZ J u s t i c e Opinio n de liv ered and f iled this 28th day of Aug ust , 200 9.