Reversed and Remanded and Opinion and Dissenting Opinion filed April 9, 

2015.

In The

Fourteenth Court of Appeals

NO. 14-13-00456-CV

EXXONMOBIL CORPORATION, Appellant

V.

DELIA PAGAYON, MICHELLE FULTON, ALFREDO G. PAGAYON, 

MICHAEL G. PAGAYON, AND THE ESTATE OF ALFREDO M. 

PAGAYON, Appellees

On Appeal from the Probate Court No. 2

Harris County, Texas

Trial Court Cause Nos. 408,329-401 & 408,329

O P I N I O N

Alfredo M. Pagayon (“Alfredo”) died several weeks after an altercation 

between himself, his son Alfredo G. Pagayon (“J.R.”), and an ExxonMobil 

Corporation employee at an ExxonMobil service station/convenience store.

ExxonMobil challenges the judgment rendered on the jury’s verdict in favor of 

Alfredo’s wife, children, and estate (collectively, “the Pagayons”) on their claims 
2

arising from Alfredo’s death. ExxonMobil asserts that the judgment should be 

reversed because (1) it had no duty to control its employee under the facts of this 

case, (2) the evidence is legally and factually insufficient to support a finding that 

its negligent supervision caused Alfredo’s death, (3) issues of causation and 

comparative fault were not fairly tried because the trial court refused to allow 

ExxonMobil to present certain evidence and defenses, (4) the evidence is 

insufficient to support the medical-expenses damages awarded, and (5) a remittitur 

of Alfredo’s widow’s non-pecuniary damages should be suggested because her 

pain and mental anguish were due almost entirely to events that occurred during 

Alfredo’s hospitalization and not to the fight at the convenience store. We 

conclude that ExxonMobil is not entitled to rendition of a take-nothing judgment 

on any of the asserted grounds, that is, we conclude that ExxonMobil had a duty to 

control the employee who injured Alfredo, and there is legally sufficient evidence 

that its breach of that duty caused Alfredo’s death. However, we agree with 

ExxonMobil that the trial court erred in striking its designation of an emergencyroom physician as a responsible third party. We further conclude that the error 

probably caused the rendition of an improper judgment; thus, without reaching 

ExxonMobil’s remaining issues, we reverse the judgment and remand the case for 

a new trial.

I. INTRODUCTION

J.R. Pagayon and Carlos Cabulang were both employed by ExxonMobil as 

sales associates at a convenience store in the Houston area. Cabulang, J.R., and 

J.R.’s father Alfredo had known each other prior to the employment. J.R. had 

conflicts with Cabulang at work and reported those problems not only to his 

ExxonMobil manager, but also to Alfredo. On July 31, 2011, Alfredo telephoned 
3

Cabulang and the two had heated words about the conflict between J.R. and 

Cabulang.

The next day, Cabulang and J.R. worked together. During that time, 

Cabulang repeatedly cursed J.R. and said things to him that J.R. described as 

threats against himself and Alfredo. A co-worker told store manager Roce Asfaw

of Cabulang’s threats against J.R., but Asfaw simply told the co-worker to tell J.R. 

to stay away from Cabulang. J.R. did so, but when Alfredo came into the 

ExxonMobil store to pick up J.R. from work that afternoon, Cabulang left his sales 

register and started a fight with Alfredo. Cabulang struck Alfredo several times in 

the head and back, and Alfredo was transported to a hospital for treatment of his 

injuries. He was treated in the emergency room by Dr. Hung Hoang Dang until 

after midnight, then admitted to the hospital. Shortly thereafter, Alfredo was 

transferred to the intensive-care unit for treatment of his respiratory distress, and 

Dr. Jaime Clavijo intubated him. An attempt to wean Alfredo from the respirator 

failed, and he was transferred to a long-term intensive-care facility. On August 24, 

2011, Alfredo died. The stated cause of death was cardiac arrhythmia, renal 

failure, and respiratory failure. According to Dr. Clavijo, the organ failure was 

caused by sepsis, a blood infection. The source of the infection was not 

definitively identified, and the parties’ respective medical experts had differing 

opinions regarding the most probable source. 

The Pagayons sued ExxonMobil, seeking to hold it directly or vicariously 

liable for Alfredo’s injury and death. The Pagayons attributed Alfredo’s death 

solely to the events at the store. ExxonMobil maintained that it was not liable for 

any harm that Alfredo sustained in the fight, and in any event, his death was caused 

by negligent medical care. ExxonMobil sought to designate Dr. Dang as a 

responsible third party, but the Pagayons successfully moved to strike the 
4

designation. They also successfully moved to exclude the testimony of 

ExxonMobil’s medical expert, Dr. Jose Gregorio Casar.

The jury failed to find that Cabulang’s actions were within the course and 

scope of his employment; thus, ExxonMobil was not held vicariously liable for its 

employee’s actions. The jury did find, however, that ExxonMobil was directly 

liable for its negligent supervision of Cabulang, and that this negligence, together 

with the negligence of both J.R. and Alfredo, proximately caused Alfredo’s death. 

The jury was then asked to apportion liability for the fight among ExxonMobil, 

J.R., and Alfredo. It attributed seventy-five percent of the responsibility for 

causing the fight to ExxonMobil, fifteen percent to J.R., and ten percent to Alfredo.

Finally, the jury assessed damages of over $1.8 million for the Pagayons’ claims.

In accordance with the proportionate-responsibility statute, the trial court signed a 

judgment awarding the Pagayons seventy-five percent of the damages assessed by 

the jury. The trial court denied ExxonMobil’s motion for new trial, and 

ExxonMobil appealed.

II. VICARIOUS V. DIRECT LIABILITY

In ExxonMobil’s first two issues, it argues that it is entitled to rendition of a 

take-nothing judgment on the Pagayons’ two theories of liability: vicarious 

liability as Cabulang’s employer (also called “imputed” liability), and direct 

liability for negligent supervision. The distinction between these two theories is 

crucial to our analysis, because although the jury failed to find ExxonMobil 

vicariously liable, many of ExxonMobil’s appellate arguments pertain only to that

theory of liability rather than to the negligent-supervision theory of liability on 

which the judgment is based. 

To impute liability to an employer for its employee’s tort, the employee’s act

usually must fall within the course and scope of the employee’s general authority 
5

and must have been performed in furtherance of the employer’s business. See 

Wrenn v. G.A.T.X. Logistics, Inc., 73 S.W.3d 489, 493 (Tex. App.—Fort Worth 

2002, no pet.). Intentional torts are not ordinarily within the scope of a worker’s 

employment. Cowboys Concert Hall-Arlington, Inc. v. Jones, No. 02-12-00518-

CV, 2014 WL 1713472, at *9 (Tex. App.—Fort Worth May 1, 2014, pet. denied) 

(per curiam, mem. op.). And as ExxonMobil points out, an employer ordinarily is 

not vicariously liable for the employer’s intentional torts that are motivated by 

personal animosity. See Wrenn, 73 S.W.3d at 494 (citing Tex. & P. Ry. Co. v. 

Hagenloh, 151 Tex. 191, 197, 247 S.W.2d 236, 239 (1952)). 

Unlike a claim of vicarious liability, a claim of negligent supervision does 

not depend on a finding that the employee committed the tort while acting in the 

course and scope of his employment. See Soon Phat, L.P. v. Alvarado, 396 

S.W.3d 78, 100 (Tex. App.—Houston [14th Dist.] 2013, pet. denied). In 

particular, an employer can be held liable under a negligent-supervision theory for 

its employee’s intentional torts. 

To illustrate this, we need only look to the test for determining whether the 

“duty” element of a negligent-supervision claim is satisfied. Where, as here, a 

claimant seeks to hold an employer liable under a negligent-supervision theory for 

an employee’s actions that were outside the scope of his employment, the Texas 

Supreme Court has adopted the following test to determine whether the employer 

had a duty to use reasonable care to control the employee so as to prevent him 

from harming others:

A master is under a duty to exercise reasonable care so to control his 

servant while acting outside the scope of his employment as to 

prevent him from intentionally harming others or from so conducting 

himself as to create an unreasonable risk of bodily harm to them, if

(a) the servant
6

(i) is upon the premises in possession of the master or upon 

which the servant is privileged to enter only as his 

servant, or

(ii) is using a chattel of the master, and

(b) the master

(i) knows or has reason to know that he has the ability to 

control his servant, and

(ii) knows or should know of the necessity and opportunity

for exercising such control.

RESTATEMENT (SECOND) OF TORTS § 317 (1965) (emphasis added), adopted in 

Kelsey-Seybold Clinic v. Maclay, 466 S.W.2d 716, 720 (Tex. 1971), superseded by 

statute on other grounds as stated in Helena Labs. Corp. v. Snyder, 886 S.W.2d 

767, 768 (Tex. 1994) (per curiam); see also Otis Eng’g Corp. v. Clark, 668 S.W.2d 

307, 309 (Tex. 1983) (including this section among other Restatement provisions 

in which, as a matter of law, a relationship imposes certain duties upon the parties); 

accord, Nabors Drilling, U.S.A., Inc. v. Escoto, 288 S.W.3d 401, 404–05 (Tex. 

2009). Thus, under a negligent-supervision theory, an employer that breaches this 

duty can be held directly liable for harm that is proximately caused by its 

employee’s intentional conduct that is outside the scope of his employment. 

Because the jury failed to find ExxonMobil liable on a theory of vicarious 

liability, we do not address ExxonMobil’s arguments and authorities that pertain to 

that theory of liability rather than to the Pagayons’ negligent-supervision claim. 

Specifically, we do not address ExxonMobil’s arguments that liability cannot be 

imputed to it because the altercation was (a) based on intentional conduct or 

personal animosity, (b) unauthorized, (c) not in the course and scope of Cabulang’s 

employment, or (d) not in the furtherance of ExxonMobil’s business. We instead 

analyze only ExxonMobil’s arguments that could require reversal of the judgment 

on the Pagayons’ negligent-supervision claim.
7

III. NEGLIGENT SUPERVISION

To prevail on a claim of negligent supervision, the Pagayons were required 

to prove that (a) ExxonMobil owed Alfredo a duty to supervise its employees, 

(b) ExxonMobil breached that duty, and (c) the breach proximately caused 

Alfredo’s injuries. See Knight v. City Streets, L.L.C., 167 S.W.3d 580, 584 (Tex. 

App.—Houston [14th Dist.] 2005, no pet.). In ExxonMobil’s first issue, it argues 

that, as a matter of law, it had no duty to control Cabulang, and in its second issue, 

it contends that the evidence is legally insufficient to support the finding that its 

actions were a proximate cause of Alfredo’s death. ExxonMobil also makes a 

subsidiary argument that we construe as an assertion that ExxonMobil fulfilled any 

duty that it owed to the Pagayons, or in other words, that it did not breach its duty.

To analyze the legal sufficiency of the evidence, we review the record in the 

light most favorable to the challenged finding, crediting favorable evidence if a 

reasonable factfinder could and disregarding contrary evidence unless a reasonable 

factfinder could not. See City of Keller v. Wilson, 168 S.W.3d 802, 827 (Tex.

2005). Evidence is legally sufficient if it “rises to a level that would enable 

reasonable and fair-minded people to differ in their conclusions.” Ford Motor Co. 

v. Ridgway, 135 S.W.3d 598, 601 (Tex. 2004). We will conclude that the evidence 

is legally insufficient to support the finding only if (a) there is a complete absence 

of evidence of a vital fact, (b) the court is barred by rules of law or evidence from 

giving weight to the only evidence offered to prove a vital fact, (c) the evidence 

offered to prove a vital fact is no more than a mere scintilla, or (d) the evidence 

conclusively establishes the opposite of the vital fact. City of Keller, 168 S.W.3d 

at 810.
8

A. ExxonMobil’s Duty

In its first issue, ExxonMobil contends that there is no evidence to support 

the imposition of a duty. Whether a duty exists is generally a legal question for the 

court. See Nabors Drilling, 288 S.W.3d at 404; Tex. Home Mgmt., Inc. v. Peavy, 

89 S.W.3d 30, 33 (Tex. 2002); Otis Eng’g Corp., 668 S.W.2d at 312. As 

previously discussed, the duty for an employer to use reasonable care to prevent its

employee from harming others can arise if (1) the employee is on the employer’s 

premises, (2) the employer knows it has the ability to control the employee, and

(3) the employer “knows or should know of the necessity and opportunity for 

exercising such control.” RESTATEMENT (SECOND) OF TORTS § 317. According to 

the uncontroverted evidence, Cabulang was on ExxonMobil’s premises when he 

threatened physical violence and when he fought Alfredo, and store manager Roce 

Asfaw knew that she was authorized to exercise control over him, to reprimand 

him, send him home, or terminate his employment. Thus, the question of whether 

ExxonMobil had a duty to use reasonable care to prevent Cabulang from 

intentionally harming others turns on whether there is legally sufficient evidence 

that ExxonMobil knew or should have known “of the necessity and opportunity for 

exercising such control” over Cabulang. See id. 

ExxonMobil asserts there is no evidence that it should have known of 

Cabulang’s violent tendencies, thereby implying that it should not have known of 

the need and opportunity to exercise control over him. But the evidence on this 

issue is uncontroverted; indeed, it consists largely of admissions by Asfaw. 

First, Asfaw’s testimony established that ExxonMobil knew or should have 

known of the need to control Cabulang. Asfaw acknowledged that if she, as the 

store manager, were alerted to a threat of violence, then she should do something 

about it, and that failing to do so could pose a threat to others. It is undisputed that 
9

before the fight occurred, Asfaw was alerted to a threat of violence. Asfaw admits 

that she left the store before Cabulang arrived to work at around 3:30 p.m. to work 

a shift that overlapped with J.R.’s, and while she was away, Cabulang’s co-worker 

Jovita Leslie telephoned her and said that Cabulang was threatening “to beat J.R. 

up” and asking him to go outside to fight. Asfaw agreed that such statements are

threatening. Nevertheless, she did not tell Cabulang to stop, and she did not 

investigate the complaint. 

Second, Asfaw’s testimony established that she had the opportunity to 

exercise control over Cabulang. She acknowledged that J.R. continued working 

until around 4:30 p.m., and she admitted that she received the phone call about 

Cabulang’s threats “long before” that time. Asfaw agreed that although she was 

not physically present at the store when she was told of Cabulang’s threats, she still 

could have sent him home. Indeed, she conceded that, regardless of whether she 

believed the report of Cabulang’s threats, the fight could have been avoided if she 

had just spoken to him.

This evidence distinguishes the facts of this case from those of the cases 

ExxonMobil cites in support of its argument that, as a matter of law, it had no duty 

to exercise reasonable care to prevent Cabulang from intentionally harming others. 

Here, the employee’s manager had advance warning of his current violent 

tendencies, expressed through his verbal threats of physical violence while 

working on the employer’s premises. There was no such evidence in the cases on 

which ExxonMobil relies. See, e.g., Garrett v. Great W. Distrib. Co. of Amarillo,

129 S.W.3d 797, 804 (Tex. App.—Amarillo 2004, pet. denied) (holding that 

employer has no duty to prevent employee from fighting unless it reasonably 

should have known of that particular employee’s propensity for violence; thus, 

beer-distribution company’s executive secretary’s knowledge that “fights could 
10

occur in a bar” or that two other employees had been involved in such a fight did 

not make it foreseeable that different employees would do so on a different 

occasion); Dailey v. Albertson’s, Inc., 83 S.W.3d 222, 229 (Tex. App.—El Paso 

2002, no pet.) (explaining that a grocery store should not have foreseen its 

employee’s physical assault of a customer where the assault was preceded only by 

the employee making loud comments about the customer’s hair and following the 

customer from one check-out line to another); Peek v. Equip. Servs., Inc., 906 

S.W.2d 529, 532 (Tex. App.—San Antonio 1995, no writ) (holding that an 

employee’s shooting of a customer was unforeseeable because although the 

employee was “nervous and sweating” on the day of the shooting, he had made no 

threats and acted “without warning”). In contrast to the holdings of these cases, we 

conclude that the evidence here establishes, as a matter of law, that ExxonMobil 

had a duty to exercise reasonable care to control Cabulang so as to prevent him 

from harming others.

B. Breach

Although not listed as a distinct issue, ExxonMobil also makes an argument 

that appears to be directed to the element of breach of duty. ExxonMobil states

that although it had no duty, Asfaw nevertheless “did take precautions” by relaying 

instructions to J.R. to stay away from Cabulang. ExxonMobil implies that this was 

all that was required. But the duty at issue here was the duty to exercise reasonable 

care “to control the servant while acting outside the scope of his employment as to 

prevent him from intentionally harming others or from so conducting himself as to 

create an unreasonable risk of bodily harm to them.” RESTATEMENT (SECOND) OF 

TORTS § 317 (emphasis added). The only person who expressed an intention to 

harm “others” or who is claimed to have posed an unreasonable risk of bodily 

harm to “others” was Cabulang; thus, ExxonMobil’s duty was to exercise 
11

reasonable care to control Cabulang. Moreover, the duty was owed not just to 

J.R., but to “others” who were similarly situated—including Alfredo. ExxonMobil 

asserts in its reply brief that it could not have foreseen that Cabulang would assault 

Alfredo because Asfaw was told only that Cabulang had threatened J.R. This, 

however, was sufficient, because for a result to be foreseeable, “[a]ll that is 

required is ‘that the injury be of such a general character as might reasonably have 

been anticipated; and that the injured party should be so situated with relation to 

the wrongful act that injury to him or to one similarly situated might reasonably 

have been foreseen.’” Motsenbocker v. Wyatt, 369 S.W.2d 319, 323 (Tex. 1963)

(quoting Carey v. Pure Distrib. Corp., 133 Tex. 31, 35, 124 S.W.2d 847, 849 

(1939)); see also Mindi M. v. Flagship Hotel, Ltd., 439 S.W.3d 551, 557 (Tex. 

App.—Houston [14th Dist.] 2014, pet. pending) (“An employer is negligent if the 

employer hires, retains, or supervises an employee whom the employer knows, or 

by the exercise of reasonable care should have known, is unfit or incompetent, and 

whose unfitness or incompetence creates an unreasonable risk of harm to others

because of the employee’s job-related duties.” (emphasis added)); Watkins v. 

Basurto, No. 14-10-00299-CV, 2011 WL 1414135, at *4 (Tex. App.—Houston 

[14th Dist.] Apr. 14, 2011, no pet.) (mem. op.) (“An employer has a general duty 

to control its employees . . . , and to adequately hire, train, and supervise 

employees to prevent injuries to third parties that are reasonably foreseeable.”

(emphasis added) (citations omitted)). As the facts of this case illustrate, relaying a 

message to one potential victim—J.R.—to “stay away” from Cabulang did not 

prevent Cabulang from harming someone else who was similarly situated.1 

 

1

ExxonMobil does not argue that J.R. and his father were not “similarly situated.”
12

C. Proximate Cause

In its second issue, ExxonMobil asks us to reverse and render a take-nothing 

judgment because the evidence is legally insufficient to support the jury’s finding 

that ExxonMobil’s negligent supervision proximately caused Alfredo’s death.

Proximate cause consists of the elements of cause-in-fact and foreseeability. See 

Doe v. Boys Club of Greater Dall., Inc., 907 S.W.2d 472, 477 (Tex. 1995). Causein-fact is shown by establishing that the negligent act or omission was a substantial 

factor in bringing about the injury; without the act or omission, harm would not 

have occurred. See Transcontinental Ins. Co. v. Crump, 330 S.W.3d 211, 221–23 

(Tex. 2010); Travis v. City of Mesquite, 830 S.W.2d 94, 98 (Tex. 1992). 

Foreseeability means that the actor, as a person of ordinary intelligence, should 

have anticipated the dangers his negligent act or omission created for others. See 

D. Hous., Inc. v. Love, 92 S.W.3d 450, 454 (Tex. 2002). Thus, “before liability 

will be imposed, there must be sufficient evidence indicating that the defendant 

knew or should have known that harm would eventually befall a victim.” Greater 

Hous. Transp. Co. v. Phillips, 801 S.W.2d 523, 526 (Tex. 1990). 

As the jury here was instructed, there can be more than one proximate cause 

of an event. Del Lago Partners, Inc. v. Smith, 307 S.W.3d 762, 774 (Tex. 2010). 

ExxonMobil does not contend otherwise. It instead implies that, as a matter of 

law, other events proximately caused the fight, and that the existence of these other 

causes negates the jury’s finding that ExxonMobil’s negligence was “a proximate 

cause” of the fight or of Alfredo’s death. Specifically, ExxonMobil urges that its 

negligence cannot be a proximate cause of either event because, as a matter of law, 

(1) intentional conduct caused the fight rather than any act or omission by 

ExxonMobil; and (2) the store “merely provided the location for this assault to 

occur,” so that Exxon Mobil was not the legal cause of this “personal-animus 
13

incident.” Stated in terms of the standard of review, ExxonMobil contends that 

“the evidence establishes conclusively the opposite of the vital fact.” See City of 

Keller, 168 S.W.3d at 810.

These arguments are variations of ExxonMobil’s assertion that it cannot be 

liable under a negligent-supervision theory if its employee acted intentionally and 

from personal animus. As previously explained, however, this is incorrect as a 

matter of law. The question of whether Cabulang’s behavior was an intentional 

tort motivated by personal animus is relevant to the determination of whether he 

acted in the course and scope of his employment or in the furtherance of 

ExxonMobil’s business. Those are elements necessary to establish vicarious 

liability, but not to establish ExxonMobil’s direct liability under a negligentsupervision theory. As previously discussed, it is precisely because Asfaw was 

told that Cabulang made threats of violence while he was on the premises working 

that ExxonMobil had a duty to exercise reasonable care “to prevent him from 

intentionally harming others or from so conducting himself as to create an 

unreasonable risk of bodily harm to them.” RESTATEMENT (SECOND) OF TORTS

§ 317 (emphasis added). Thus, even if Cabulang’s conduct were intentional and 

motivated by personal animus, these would not be grounds on which to reverse the 

judgment on the Pagayons’ negligent-supervision claim. Cf. CoTemp, Inc. v. 

Hous. W. Corp., 222 S.W.3d 487, 492 (Tex. App.—Houston [14th Dist.] 2007, no 

pet.) (plurality op.) (“Under the tort of negligent hiring, supervision, or retention, 

an employer who negligently hires an incompetent or unfit individual may be 

directly liable to a third party whose injury was proximately caused by the 

employee’s negligent or intentional act.” (emphasis added)).

2

 

2

This is not the only problem with ExxonMobil’s argument. In addition, it appears to be 

contrary to the position it maintained at trial, where it argued that Cabulang did not cause the 

fight, but instead acted only in self-defense. Whether Cabulang caused the fight was a disputed 
14

ExxonMobil also contends that its conduct was “too attenuated” from the 

fight to have proximately caused it, because the store was “just the location for an 

inevitable wrestling match,” which occurred there “only because events and people 

coincided by chance inside the store.” But the only evidence on these subjects is at 

odds with ExxonMobil’s assertions. First, there is no evidence that the altercation 

was inevitable. Asfaw instead testified that if she had sent Cabulang home or 

simply spoken to him, then the altercation would not have occurred. Cabulang 

additionally testified that if he had just let J.R. and Alfredo walk out of the store, 

then there would have been no fight. Second, it was not a coincidence that the 

participants in the altercation were all inside the store; it instead was foreseeable to 

ExxonMobil, because it scheduled Cabulang and J.R. to work overlapping shifts, 

and it did not send Cabulang home after being informed that Cabulang was 

threatening J.R. It was foreseeable to ExxonMobil that a person “similarly 

situated” to J.R.—his father—would come to the store that afternoon, because 

Asfaw knew that Alfredo provided J.R.’s transportation. And it was foreseeable 

that J.R. and Alfredo would be in the store with Cabulang because Asfaw knew 

both that J.R. customarily waited inside the store for his father—a practice that she 

permitted—and that Alfredo customarily came inside the store when he arrived to 

drive J.R. home. The day of the altercation was no exception to this pattern: J.R. 

called his father when he finished working, and twelve minutes after he changed 

out of his uniform, Alfredo entered the store to pick him up.3 

In sum, the store was the location where ExxonMobil’s duty to supervise its 

employees arose, and the evidence supports the jury’s finding that ExxonMobil’s 

 

question of fact. Moreover, the jury found that ExxonMobil, J.R., and Alfredo acted negligently, 

but it was not asked to find that anyone acted intentionally.

3 Although ExxonMobil points out that its written “policies prohibit loitering inside the 

store,” there is no evidence that J.R. did so. 
15

negligence in supervising Cabulang was a proximate cause of the altercation, as 

described in more detail above. We thus reject ExxonMobil’s argument that the 

store was “merely the location” of the fight and that its conduct was too attenuated 

to have been a proximate cause of Alfredo’s death. We overrule this issue.4 

IV. DESIGNATION OF RESPONSIBLE THIRD PARTIES

In its third issue, ExxonMobil argues that the trial court erred by striking its 

designation of emergency-room physician Dr. Dang as a responsible third party.5

The resolution of this issue turns on the interpretation and application of the 

proportionate-responsibility statute found in Chapter 33 of the Texas Civil Practice 

and Remedies Code and the health-care-liability statute found in Chapter 74 of the 

same code. We review the trial court’s ruling de novo. See Flack v. Hanke, 334 

S.W.3d 251, 261 (Tex. App.—San Antonio 2010, pet. denied) (sub. op.). 

A. Chapter 74’s “Standard of Proof” v. Chapter 33’s “Responsibility” 

The parties principally join issue on the legal question of whether, to survive 

a motion to strike the designation of an emergency-room physician as a responsible 

third party, the designating defendant is required to produce evidence of simple 

negligence, or instead must produce evidence of “wilful and wanton” negligence. 

Under Chapter 74 of the Texas Civil Practice and Remedies Code governing 

health-care-liability claims, “the claimant bringing the suit” for damages arising 

from allegedly deficient emergency medical care cannot establish liability absent 

 

4 Having rejected ExxonMobil’s arguments that it cannot be the proximate cause of 

Alfredo’s death because (a) “intentional conduct” caused the fight, and (b) the store was merely 

the location of the fight, we do not reach its remaining argument under this heading, i.e., that 

“[a]ny reliance on the foreseeability of medical negligence cannot overcome these problems with 

causation.”

5

The parties sometimes refer to the trial court’s ruling as a denial of ExxonMobil’s 

motion to designate Dr. Dang as a responsible third party, and sometimes refer to it as a grant of 

the Pagayons’ motion to strike the designation. Our record contains only an order granting the 

Pagayons’ motion to strike the designation of Dr. Dang as a responsible third party.
16

proof that the physician or health-care provider deviated from the standard of care 

“with wilful and wanton negligence.” See TEX. CIV. PRAC. & REM. CODE § 74.153 

(West 2011). The parties dispute whether this is the correct standard to apply 

when measuring the sufficiency of ExxonMobil’s response to a motion to strike its 

designation of an emergency-room physician as a responsible third party. 

The Pagayons argue that the following provision from Chapter 74 applies:

Standard of Proof in Cases Involving Emergency Medical Care

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 . . . , the claimant bringing the suit may prove that the 

treatment or lack of treatment by the physician or health care provider 

departed from 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.

Id. (emphasis added). Citing this provision, the Pagayons moved to strike 

ExxonMobil’s designation of Dr. Dang as a responsible third party solely on the 

ground that there was no evidence that Dr. Dang deviated from the standard of care 

“with wilful and wanton negligence.”

ExxonMobil responded that the provisions of Chapter 74 should not affect 

the application of responsible-third-party practice because Chapter 74 is designed 

to apply to health-care-liability claims in which damages are sought directly from 

the physician or health-care provider. See id. § 74.001(2), (13) (West Supp. 2014) 

(defining “claimant” as “a person, including a decedent’s estate, seeking or who 

has sought recovery of damages in a health care liability claim,” and defining a 

“health care liability claim” as “a cause of action against a health care provider or 
17

physician for . . . claimed departure from accepted standards of medical care, or 

health care, or safety or professional or administrative services directly related to 

health care, which proximately results in injury or death of a claimant”). In 

contrast, the proportionate-responsibility statute concerns “responsibility,” not 

“liability,” so that a person can be wholly or partially “responsible” for the harm at 

issue without being “liable” for the damages assessed as compensation for that 

harm. Compare id. § 33.011(3) (West 2015) (“‘Liable defendant’ means a 

defendant against whom a judgment can be entered for at least a portion of the 

damages awarded to the claimant.” (emphasis added)) with id. § 33.011(6) 

(“‘Responsible third party’ means any person who is alleged to have caused or 

contributed to causing in any way the harm for which recovery of damages is 

sought . . . .” (emphasis added)). To determine that a person is “responsible,” the 

factfinder need find only that the person “caus[ed] or contribut[ed] to cause in any 

way the harm for which recovery of damages is sought, whether by negligent act or 

omission, by any defective or unreasonably dangerous product, by other conduct or 

activity that violates an applicable legal standard, or by any combination of these.” 

Id. § 33.003 (emphasis added).

B. Chapter 74’s “Standard of Proof” of Liability is Inapplicable

We agree with ExxonMobil that section 74.153 does not apply to the

designation of Dr. Dang as a responsible third party. Since Hood v. Phillips, the 

Texas Supreme Court’s seminal case defining a physician’s standard of care, a 

single standard of care has applied to physicians: the question to be answered is 

whether the physician undertook “a mode or form of treatment which a reasonable 

and prudent member of the medical profession would not have undertaken under 

the same or similar circumstances.” 554 S.W.2d 160, 165 (Tex. 1977). In 

answering that question, “[t]he circumstances to be considered include, but are not 
18

limited to, the expertise of and means available to the physician-defendant, the 

health of the patient, and the state of medical knowledge.” Id. 

Section 74.153 of the Civil Practice & Remedies Code does not purport to 

change this standard of care; it instead provides the standard of proof that is 

required to establish liability for harm to a patient arising from the provision of 

emergency medical care, because with limited exceptions, one “who in good faith 

administers emergency care is not liable in civil damages for an act performed 

during the emergency unless the act is wilfully or wantonly negligent.” See TEX.

CIV. PRAC. & REM. CODE ANN. § 74.151(a) (West Supp. 2014); see also Benish v. 

Grottie, 281 S.W.3d 184, 191 (Tex. App.—Fort Worth 2009, pet. denied) 

(“Section 74.153’s statutorily created standard of proof and the applicable medical 

standards of care are not the same thing.”); Baylor Med. Ctr. at Waxahachie v. 

Wallace, 278 S.W.3d 552, 556 (Tex. App.—Dallas 2009, no pet.) (same); Bosch v. 

Wilbarger Gen. Hosp., 223 S.W.3d 460, 464 (Tex. App.—Amarillo 2006, pet. 

denied) (same). Thus, when a claimant seeks to recover damages for harm caused 

by allegedly deficient emergency medical care, the legislature has heightened the 

standard of proof required to establish the health-care provider’s liability. See 

Bosch, 223 S.W.3d at 464 (citing TEX. CIV. PRAC. & REM. CODE ANN. § 74.153). 

Stated differently, Chapter 74 does not change the “acceptable standard of medical 

care”; it simply allows one providing emergency medical care to deviate from that

standard by a wider margin before becoming liable in damages for its breach. But 

as discussed further below, even if an emergency-room physician has not deviated 

from the standard of care sufficiently to make him “liable” for damages, he 

nevertheless may have deviated from it sufficiently to make him “responsible.” 
19

C. Chapter 33’s Definition of “Responsibility” Applies

In contrast to section 74.153, the proportionate-responsibility statute does 

not address the standard of proof for a claimant to hold a defendant liable for 

damages. It instead provides a means for comparing the extent of fault, providing 

the means for a defendant to reduce both its own liability and the claimant’s 

recovery. See TEX. CIV. PRAC. & REM. CODE ANN. § 33.012 (West 2015) 

(reducing the amount of a claimant’s recovery); id. § 33.013 (reducing the amount 

of a liable defendant’s liability). Because the statute evidences the legislature’s 

intent that the factfinder determine the “percentage of responsibility,” its plain 

language requires the factfinder to compare the conduct of those who allegedly 

violated a legal standard—even if the plaintiff could not hold all of them liable for 

the resulting harm. See In re Transit Mix Concrete & Materials Co., No. 12-13-

00364-CV, 2014 WL 1922724, at *2–3 (Tex. App.—Tyler 2014, orig. proceeding) 

(mem. op.) (agreeing that a motion to strike the designation of a responsible third 

party may be defeated without evidence of an “actionable act or omission” to 

“establish liability”; the designating party need only produce more than a scintilla 

of evidence that the third party is “responsible” for the claimant’s injury or 

damage, as that term is used in the proportionate-responsibility statute (internal 

quotation marks omitted)). We may not ignore such specific statutory language 

even where its application may render a plaintiff less than whole. See, e.g.,

Galbraith Eng’g Consultants, Inc. v. Pochucha, 290 S.W.3d 863, 868–69 (Tex. 

2009) (noting that the proportionate-liability statute is “apparently unconcerned 

with the substantive defenses of responsible third parties” that place them beyond 

the reach of the plaintiff).

Accordingly, we agree with ExxonMobil that for purposes of its response to 

the Pagayons’ motion to strike, it was not required to raise a fact issue regarding 
20

whether Dr. Dang, “with wilful and wanton negligence,” violated the standard of 

care. On the other hand, we disagree with ExxonMobil that it needed only to raise 

a fact issue on whether Dr. Dang “caused or contributed to cause” Alfredo’s death; 

that is, we disagree that causation is the sole question under Chapter 33. As the 

discussion above demonstrates, ExxonMobil needed to respond to the Pagayons’ 

motion to strike by producing evidence sufficient to raise a fact question about 

whether Dr. Dang contributed to causing Alfredo’s death in a manner encompassed 

by the proportionate-responsibility statute, such as by (1) negligent act or omission, 

(2) any defective or unreasonably dangerous product, (3) other conduct or activity 

that violates an applicable legal standard, or (4) any combination of these. See 

TEX. CIV. PRAC. & REM. CODE ANN. § 33.003(a). 

D. Sufficiency of the Evidence

Under the proportionate-responsibility statute, a motion to strike the 

designation of a responsible third party is warranted only if “there is no evidence 

that the designated person is responsible for any portion of the claimant’s alleged 

injury or damage.” See id. § 33.004(l). When measured by the correct standard, 

ExxonMobil produced sufficient evidence to defeat the Pagayons’ motion to strike.

In its response, ExxonMobil asserted that in the opinion of its expert Dr. 

Casar, Dr. Dang breached the standard of care in three interconnected ways. 

First, Dr. Casar contends that Dr. Dang misread a chest x-ray that was taken 

shortly after Alfredo arrived in the emergency room. Alfredo was born without a 

left lung, but according to Dr. Casar, Dr. Dang misinterpreted the chest x-ray 

showing this defect and instead diagnosed Alfredo with a hemothorax on that side, 

meaning that Dr. Dang believed that blood was collecting in the space between 

Alfredo’s chest wall and his left lung. Dr. Casar stated in his report that the x-ray 

revealed three signs that could be “clearly viewed on the chest x-ray” and that were 
21

“inconsistent with the diagnosis of hemothorax.” Dr. Casar additionally stated that 

if Alfredo had been bleeding into his chest cavity, his blood pressure would have 

dropped, but instead, his blood pressure was elevated. 

Second, Dr. Dang failed to order a CT scan of Alfredo’s chest before 

attempting to insert a chest tube to drain the hemothorax that he believed existed. 

Regarding the failure to timely secure a CT scan of Alfredo’s chest, Dr. Casar 

stated in his report only that “any prudent physician would have ordered a CT scan 

in order to acquire more information in regards to the chest x-ray,” and that when 

the scan was actually performed, it revealed that Alfredo was born without a left 

lung and had a large hematoma from the unsuccessful attempt to place a chest tube.

Third, Dr. Casar opined that Dr. Dang breached the standard of care by 

attempting to insert a chest tube to drain the hemothorax. Dr. Casar stated that 

after the failed attempts to insert a chest tube, Alfredo was given ten milligrams of 

morphine for his resulting complaints of pain. Dr. Casar explained that a patient 

who is missing a lung and has pulmonary hypertension is “extremely sensitive to 

the depressing effects of narcotics and it comes as no surprise that the patient 

developed progressive respiratory failure that required intubation and mechanical 

ventilation.” According to Dr. Casar, “This was a direct result of giving the patient 

narcotics to control the chest wall pain caused by the attempted insertion of a chest 

tube that should ha[ve] not been placed to begin with.” He further stated that 

Alfredo developed multiple organ failures, most likely as a result of uncontrolled 

sepsis. He opined that although the source of the sepsis was not clear from the 

cultures obtained, the most likely source was an infected chest-wall hematoma that 

was directly caused by the attempted chest-tube placement. In Dr. Casar’s opinion, 
22

Dr. Dang’s acts and omissions began a chain of medical complications that 

ultimately led to Alfredo’s death.6

This evidence is sufficient to raise a question of fact as to whether Dr. Dang 

is responsible for at least a portion of the Pagayons’ “alleged injury or damage,” 

which is all that the statute requires. See id. 

Although our dissenting colleague would conclude that the trial court did not 

err in granting the motion to strike because Dr. Casar was not familiar with the 

standard of care for an emergency-room physician, that is a conclusion concerning

Dr. Casar’s qualifications. See Roberts v. Williamson, 111 S.W.3d 113, 121–22

(Tex. 2003). But on appeal, no one has challenged Dr. Casar’s qualifications to

offer an expert opinion on the applicable standard of care—nor, so far as we can 

tell, did anyone do so in the trial court. Thus, any objection to his qualifications to 

render an expert opinion on the subject has been neither preserved nor presented. 

See Croft v. State, 148 S.W.3d 533, 544 (Tex. App.—Houston [14th Dist.] 2004, 

no pet.). 

Moreover, the dissent applies the wrong test. Whether Dr. Casar is qualified 

to testify on the causes and effects of a person’s injuries would be measured by 

Texas Rule of Evidence 702. See Roberts, 111 S.W.3d at 121–22. The question to 

be answered is whether the party offering the expert’s testimony has established 

that the witness “has ‘knowledge, skill, experience, training, or education’ 

 

6 We acknowledge that “if evidence presents ‘other plausible causes of the injury or 

condition that could be negated, the [proponent of the testimony] must offer evidence excluding 

those causes with reasonable certainty.’” See Crump, 330 S.W.3d at 218 (quoting Merrell Dow 

Pharm., Inc. v. Havner, 953 S.W.2d 706, 720 (Tex. 1997) (alterations in original)). But, in 

determining whether the trial court erred in striking the designation of Dr. Dang as a responsible 

third party, we must consider the evidence before it at the time of that ruling. See TEX. CIV.

PRAC. & REM. CODE ANN. § 33.004(l). At this point in the proceedings, the trial court was not 

presented with evidence about other possible sources of sepsis; it was simply presented with Dr. 

Dang’s opinion that even though cultures did not clarify the source of the sepsis, the chest-wall 

hematoma from the failed chest-tube insertion was the most likely cause. 
23

regarding the specific issue before the court which would qualify the expert to give 

an opinion on that particular subject.” Broders v. Heise, 924 S.W.2d 148, 153 

(Tex. 1996) (quoting TEX. R. EVID. 702). A physician from one school of practice 

may testify about the negligence of a physician of a different school of practice “so 

long as the ‘subject of inquiry is common to and equally recognized and 

developed’ in both fields.” Id. at 152 (quoting Hart v. Van Zandt, 399 S.W.2d 791, 

797 (Tex. 1965)). Thus, in determining whether a doctor is qualified to testify on 

the specific issue before it, the trial court “should not focus on the specialty of the 

medical expert.” Tenet Hosps. Ltd. v. Love, 347 S.W.3d 743, 750 (Tex. App.—El 

Paso 2011, no pet.) (citing Roberts, 111 S.W.3d at 122). And here, Dr. Casar 

testified repeatedly—and without contradiction—that the standard of care for 

reading a chest x-ray is the same regardless of the physician’s school of practice.

In rejecting Dr. Casar’s opinion on the ground that he was not familiar with 

the standard of care for an emergency-room physician, the dissent follows the 

approach that we rejected in Blan v. Ali. In that health-care-liability case, the 

defendant physicians did not dispute that the opposing expert was “qualified by 

training and experience to offer expert testimony regarding the diagnosis, care and 

treatment of a neurological condition”; they simply argued that the opposing expert 

“does not know the standard of care as applied to emergency room physicians.” 7 

S.W.3d 741, 746 (Tex. App.—Houston [14th Dist.] 1999, no pet.). But as we 

explained in Blan, that argument “ignores the plain language of the statute, which 

focuses not on the defendant doctor’s area of expertise, but on the condition 

involved in the claim.” Id. (emphasis in original) (quoting the predecessor to TEX.

CIV. PRAC. & REM. CODE ANN. § 74.401(a) (West 2011)).

7

 The expert in Blan 

 

7

Tellingly, this statute is entitled, “Qualifications of Expert Witness in Suit Against 

Physician,” and provides as follows:
24

attested “that the standard of care he describes applies to any physician treating a 

patient suffering from a stroke and lupus, regardless of the physician’s area of 

expertise.” Id. (emphasis in original). Although in Blan we discussed the 

application of provisions in the health-care-liability statute concerning expert 

qualifications to testify regarding “the standards applicable to the ‘illness, injury, 

or condition involved in the claim,’”8the inquiry is the same under Texas Rule of 

Evidence 702, that is, whether the expert is qualified to testify “regarding the 

specific issue before the court.” See Broders, 924 S.W.2d at 153 (concluding that 

the trial court properly excluded expert testimony where the proponent failed to 

establish that the physician was qualified to opine “on cause in fact”); see also 

Roberts, 111 S.W.3d at 122 (concluding that the proponent established that a

physician from a different school of practice “had experience and expertise 

regarding the specific causes and effects” of the decedent’s injuries). And here, 

there is no issue before us regarding Dr. Casar’s qualifications to opine that Dr. 

Dang breached the standard of care and proximately caused Alfredo’s death 

 

(a) In a suit involving a health care liability claim against a physician for 

injury to or death of a patient, a person may qualify as an expert witness 

on the issue of whether the physician departed from accepted standards of 

medical care only if the person is a physician who:

(1) is practicing medicine at the time such testimony is given or was 

practicing medicine at the time the claim arose;

(2) has knowledge of accepted standards of medical care for the 

diagnosis, care, or treatment of the illness, injury, or condition 

involved in the claim; and

(3) is qualified on the basis of training or experience to offer an expert 

opinion regarding those accepted standards of medical care.

(emphasis added).

8

Id. at 746 (quoting Act of May 5, 1995, 74th Leg., R.S., ch. 140, § 2, sec. 14.01(a)(2), 

1995 TEX. GEN. LAWS 985, 988, repealed by Act of June 2, 2003, 78th Leg., R.S., ch. 204, 

§ 10.09, 2003 TEX. GEN. LAWS 847, 884).
25

through his misreading of the chest x-ray and his resultant attempts to treat Alfredo 

for a hemothorax he did not have.

In sum, we conclude the evidence is sufficient to raise a question of fact as 

to whether Dr. Dang caused or contributed to causing “in any way the harm for 

which recovery of damages is sought, whether by negligent act or omission . . . , by 

other conduct or activity that violates an applicable legal standard, or by any 

combination of these.” See TEX. CIV. PRAC. & REM. CODE ANN. § 33.003(a). We 

accordingly sustain this issue.

E. Harm Analysis

Although we conclude that the trial court erred in striking ExxonMobil’s 

designation of Dr. Dang as a responsible third party, the error is not reversible 

unless it probably caused the rendition of an improper judgment or probably 

prevented the appellant from properly presenting the case on appeal. See TEX. R.

APP. P. 44.1(a). By striking the designation of Dr. Dang as a responsible third 

party, the trial court removed Dr. Dang from the list of persons whose percentage 

of responsibility could be submitted to the jury. See TEX. CIV. PRAC. & REM. CODE 

ANN. § 33.003(a).

9

 Thus, the result is analogous to charge error, which “is 

generally considered harmful if it relates to a contested, critical issue.” See Thota 

v. Young, 366 S.W.3d 678, 687 (Tex. 2012). To determine if the error was 

harmful, we must examine the entire record. See Timberwalk Apartments, 

Partners, Inc. v. Cain, 972 S.W.2d 749, 756 & n.25 (Tex. 1998) (citing Lorusso v. 

Members Mut. Ins. Co., 603 S.W.2d 818, 821–22 (Tex. 1980) and Patterson 

Dental Co. v. Dunn, 592 S.W.2d 914, 921 (Tex. 1979)); Heritage Gulf Coast 

 

9 Having removed that issue from the jury’s consideration, the trial court also excluded 

evidence relevant to that determination.
26

Props., Ltd. v. Sandalwood Apartments, Inc., 416 S.W.3d 642, 655 (Tex. App.—

Houston [14th Dist.] 2013, no pet.).

Here, the extent to which Dr. Dang was responsible for “causing or 

contributing to cause in any way the harm for which recovery of damages is 

sought”10 was such a “contested, critical issue.” Medical records reflect that the 

Houston Fire Department evaluated Alfredo at the scene at 5:06 p.m. Responders 

were told that Alfredo had been punched in the face and the back. He was alert, 

and complained of swelling in his cheek and pain in his neck. He also had 

difficulty breathing. Alfredo was transported to the hospital’s emergency room, 

arriving at 5:34 p.m. In medical records prepared at that time, the only complaints 

listed were “assault—punched on the left side of head and on the back.” Alfredo 

also continued to be described as alert and oriented. He complained of pain in his 

face and lower back, but when CT scans of his brain and lumbar spine were 

performed later that evening, neither showed any injuries. No one contends that 

Cabulang struck Alfredo in the chest; that Alfredo fell on his chest; or that 

Alfredo’s chest was injured in the fight.

But as Dr. Casar would have testified, something else happened in the 

emergency room. When Alfredo’s vital signs were checked upon his arrival, it was 

discovered that he had no breath sounds from the lower left side of his chest, and 

he had an oxygen saturation of just 75%.11 Dr. Dang ordered a chest x-ray, which 

 

10 See TEX. CIV. PRAC. & REM. CODE ANN. § 33.003(a).

11 There are many inconsistencies in the medical records. To cite a few examples, Dr. 

Dang’s handwritten notes identify Alfredo himself as the person from whom Dr. Dang obtained 

Alfredo’s medical history; other records identify the family as the historian. Dr. DeSantos stated 

on the radiology report that Alfredo was referred for a chest x-ray due to chest pain, but this was 

not listed among Alfredo’s complaints. Although Dr. Clavijo was not present when Alfredo 

arrived at the hospital, he wrote that Alfredo was confused and disoriented at that time; however, 

before Dr. Dang administered sixteen milligrams of morphine as discussed infra, Alfredo was 

consistently described as alert and oriented by those who evaluated him at ExxonMobil and by 
27

was performed at 6:08 p.m. The radiologist, Dr. Luis DeSantos, read the x-ray and 

commented that the “left hemithorax is completely opaque and there is 

displacement of the mediastinum toward the right side suggesting the presence of a 

large amount of fluid in the left hemithorax with displacement of the 

mediastinum.” Dr. Dang reviewed the x-ray and concluded that Alfredo had a 

hemothorax. Although this conclusion was consistent with Dr. DeSantos’s 

observations, it was Dr. Dang who actually diagnosed Alfredo as having a 

hemothorax.

It is undisputed, however, that this diagnosis was wrong. Alfredo did not 

have a hemothorax; he was born without a left lung. Dr. Casar would have 

testified that Dr. Dang breached the standard of care by misreading the x-ray in 

that he failed to note the signs that Alfredo did not have a hemothorax and had 

only one lung. Even Dr. Clavijo, the Pagayons’ testifying medical expert, wrote in 

his own consultation notes, “Chest x-ray showed absence of left lung.” 

According to Dr. Casar, Alfredo’s medical complications and eventual death 

arose from Dr. Dang’s misreading of the chest x-ray and his resultant efforts to 

treat a condition that Alfredo did not have (a hemothorax), while failing to take 

into consideration the condition that Alfredo did have (a missing lung).12 The 

evidence of Dr. Dang’s actions and their consequences is as follows:

 

the emergency-room personnel. Our description of the evidence is intended only to show our 

reasons for concluding that the extent of Dr. Dang’s responsibility, if any, for causing or 

contributing to Alfredo’s death was a contested, critical issue. 

12 Even if a chest CT scan were needed to properly diagnose Alfredo’s true condition and 

rule out a hemothorax, evidence supports Dr. Casar’s opinion that Dr. Dang had time to have the 

scan performed. Dr. DeSantos made his comments on the chest x-ray at approximately 6:10 

p.m., and Dr. Dang did not administer the first dose of morphine in preparation for the chest tube 

until 6:42 p.m.—a time lapse of thirty-two minutes. Medical records also show that Dr. Dang 

finally ordered a chest CT scan at 8:31 p.m., and that it was completed at 8:53 p.m.—a time 

lapse of just twenty-two minutes. Thus, the record supports the conclusion that if Dr. Dang had 

ordered a chest CT scan after seeing the unusual chest x-ray, the extra procedure would not have 
28

Dr. Dang stated in his notes that Alfredo was given morphine for the 

attempted insertion of a chest tube to drain the excess fluid that Dr. Dang believed 

was collecting in Alfredo’s chest. Alfredo was given the first dose of four 

milligrams of morphine at 6:42 p.m., four minutes before Dr. Dang’s first attempt 

to insert a chest tube. He attempted to insert a chest tube at 6:46 p.m. and again at 

around 6:52 p.m. After these attempts, Alfredo’s primary complaint of pain no 

longer concerned his face or back, and he instead complained of pain at the site 

where Dr. Dang had attempted to insert the chest tube. Dr. Dang responded with 

more morphine. Sixteen minutes after Dr. Dang’s second attempt to insert a chest 

tube, Alfredo was given four more milligrams of morphine, and twenty minutes 

after that, Alfredo was given a further six milligrams of morphine. Thus, in 

connection with his attempt to insert a chest tube, Dr. Dang caused Alfredo to be 

given a total of fourteen milligrams of morphine in the space of forty-six minutes.

Dr. Casar would have testified that when a dose of about eight milligrams is given 

to someone with only one lung, it can be expected that the patient will stop 

breathing. He stated that although Alfredo was given a medication to reverse the 

effects of morphine and “for a little bit he became more responsive,”13 his 

condition continued to deteriorate, and he had to be placed on a respirator. At 

12:20 a.m. on August 2, 2011, Dr. Dang wrote in Alfredo’s progress notes, 

 

delayed the insertion of the chest tube if the CT scan had confirmed his diagnosis of a 

hemothorax. We note, however, that it is unclear what role the chest CT scan played in Dr. 

Dang’s treatment of Alfredo. Although other doctors state in their notes that the CT scan 

“confirmed” that Alfredo had only one lung, the CT scan is not mentioned in Dr. Dang’s 

narrative. He instead wrote, “Wife arrive to ER many hours later and I was informed that patient 

was born w/o one lung, but they are not sure which side.”

13 At 11:30 p.m., Dr. Dang wrote that Alfredo was asleep and was given Narcan, a drug 

which, as Dr. Casar explained in his deposition, was intended to reverse the effects of morphine. 

After writing that Narcan was given, Dr. Dang wrote “patient continues to be drowsy → more 

alert now.” The time of this entry was also stated to be 11:30 p.m. (or as written in the records, 

2330 pm).
29

“Discuss [with] Dr. Fisher about events in E.R. Agrees to admit → observation for 

pain controll [sic].” But here, too, the testimony of the Pagayons’ expert Dr. 

Clavijo is consistent with Dr. Casar’s proffered testimony rather than with Dr. 

Dang’s notes. Dr. Clavijo testified that Alfredo was admitted to the hospital from 

the emergency room for observation and for somnolence, because Alfredo “was 

just entirely . . . lethargic.” 

Alfredo was admitted “to the floor” of the hospital, but shortly after his 

arrival, he suffered acute respiratory failure and was transferred to the intensivecare unit where Dr. Clavijo intubated him at 8:20 a.m. Dr. Clavijo testified that 

Alfredo was intubated because he was hypoventilating, meaning that his body 

could not get rid of carbon dioxide. Dr. Clavijo testified that hypoventilating 

“causes somnolence and lethargy and, subsequently, complete respiratory failure,”

but he identified no injuries that Alfredo received in the fight that could have 

caused hypoventilation. He further testified that Alfredo was never able to be 

weaned off of intubation, and that continuing intubation was a problem because 

this leaves tubes in the patient’s body that can cause infection and further 

complications—including, in Alfredo’s case, “a sepsis-type of infection.” 

According to Dr. Clavijo, Alfredo’s respiratory failure also caused his other 

systems to shut down. Dr. Casar, Dr. Clavijo, and Alfredo’s death certificate all 

identify respiratory failure as one of the causes of Alfredo’s death.

Finally, Dr. Clavijo agreed that “the trauma . . . that occurred on August 1, at 

Exxon, it kind of set off a chain of events that caused this respiratory failure that 

then caused [Alfredo’s] renal failure and that eventually resulted in his death.”

(emphasis added). The “trauma” sustained “at Exxon” was not identified, and the 

jury did not hear the evidence that the events in this chain included Dr. Dang’s 

alleged negligence in misreading Alfredo’s chest x-ray, failing to observe that 
30

Alfredo had only one lung, attempting to insert a chest tube, and administering 

morphine in doses high enough to cause respiratory failure. Jurors also did not 

hear Dr. Casar’s testimony that the injuries Alfredo received in the fight did not 

cause his death, and that Alfredo’s death instead was caused by Dr. Dang’s 

negligence. And because the question of Dr. Dang’s responsibility was removed 

from the case by the trial court’s striking of the designation, the jury was unable to 

consider this hotly contested issue.

The Pagayons contend that even if Dr. Dang made errors that increased the 

harm to Alfredo or led to his death, Exxon would still bear the liability for the 

doctor’s negligence under the “original tortfeasor rule.” See, e.g., Cannon v. 

Pearson, 383 S.W.2d 565, 567 (Tex. 1964) (“It has long been an accepted and 

established in this State that one who wrongfully injures another is liable in 

damages for the consequences of negligent treatment by a doctor or surgeon 

selected by the injured person in good faith and with ordinary care.”); Galvan v. 

Fedder, 678 S.W.2d 596, 598 (Tex. App.—Houston [14th Dist.] 1984, no writ) 

(same). But as the Texas Supreme Court recently pointed out, the legislature “has 

overhauled Texas’s system for apportioning fault in negligence cases” over the 

past four decades, enacting a comparative-negligence statute, which was replaced 

by a comparative-responsibility statute, and which has since been modified to 

become our current proportionate-responsibility statute. See Nabors Well Servs., 

Ltd. v. Romero, No. 13-0136, 2015 WL 648858, at *1, *4 (Tex. Feb. 13, 2015). By 

its terms, the proportionate-responsibility statute applies to “any cause of action 

based on tort in which a defendant, settling person, or responsible third party is 

found responsible for a percentage of the harm for which relief is sought.” TEX.

CIV. PRAC. & REM. CODE ANN. § 33.002(a)(1) (West 2015). The Pagayons 

asserted causes of action based on tort, and the jury determined ExxonMobil’s 
31

percentage of responsibility; thus, the proportionate-responsibility statute governs 

the determination of responsibility in this case.

14

 For the reasons we have 

described, we conclude that ExxonMobil was harmed by the trial court’s erroneous 

application of the statute in striking the designation of Dr. Dang as a responsible 

third party.

We sustain this portion of ExxonMobil’s third issue. Because we conclude 

that this error requires us to reverse the judgment and remand the case for a new 

trial, we do not reach ExxonMobil’s remaining issues. 

V. CONCLUSION

Although the evidence is legally sufficient to support the jury’s liability 

finding against ExxonMobil under a negligent-supervision theory, we conclude 

that the trial court erred in striking the designation of Dr. Dang as a responsible 

third party, and that this error harmed ExxonMobil. Thus, without reaching 

ExxonMobil’s remaining issues, we reverse the judgment and remand the case for 

a new trial consistent with this opinion. 

/s/ Tracy Christopher

Justice

Panel consists of Justices Christopher, McCally, and Wise (McCally, J., 

dissenting).

 

14 Although the statute contains a few exceptions to its broad application, the Pagayons 

do not contend that any of the enumerated exceptions applies. See id. § 33.002(c) (providing that 

Chapter 33 does not apply to actions for workers’ compensation benefits, claims for exemplary 

damages, or claims arising from the manufacture of methamphetamine).