### TEXA S COU RT O F AP PEAL S, THIR D DISTRIC T, AT AU STIN
NO. 03-00-00142-CV Margie Rup p, Indi

vidual ly a nd on Beh alf

of J acob R

upp, App el

lan ts
v. Charle s E. L. Brown, M.D.; an d Central Texas Pe rinatal Ass ociates, P.A., Appellees

FROM THE DISTRICT CO URT OF TRAVIS COUNTY, 201S T JUDICIAL DIST RICT NO. 98- 05623-

A, HONORA

BLE F. SCOTT MCCOWN, JUDG E PRESIDING
Appe llantMargi e Rupp ( “Rupp”) br ou ght sui t again st appell

ees, Charl es Brown, M.D. and Cen tral Tex as Pe

ri na tal As soci ates, P .A . (herei

naf ter “Brown and A ssocia

tes”), for all

eged
me dic al mal pra cti ceres ul ti ng i n th e l oss of Ru pp’ s f etu s. The

tri al cou rt gran ted Brow nand Associates’s m

ot ion f or summary

judgm ent, and Rupp app eals. We will rever se t he judg ment a nd
re man d th e c au se to th e tr i al cou rt. BACKGROUND In 19 96 , R upp w as pr eg n an t wi th her s econd chi

l d. Rupp is bl

ood-t y pe O negati

ve/D nega t ivewit h Rh sens itizat ion, and h er husb and i s Rh gen

ot ype Cde/cDe. Due to their bl oo d types, any baby the couple concei

ves wi ll be “ Rh af fected,” m

eani ng that the Rh-sen

si tized mother produces antib odiesth at a

ttack th e R h -a f f ec ted f etu s’ s red b l ood c el

l s, ca us i n g th e fetus to su f

f er se vere2

an emi a. This co ndit ion is ca lled “Rh disea se” and, if l eft unt re at ed, can r esu lt in erythr oblastos is fetalis or d eath of the fetus.

Dur ingRupp’s f

irst pregnan

cy in 1992, her obstetrici an

ref erre d R upp to a perinatologistat Ce nt r al T ex as Pe r ina t al As so cia t es, where h er Rh-compl

ic ated pregnancy

was su cc es sfu lly

managed by gi vi ng th e f etus i ntrau teri ne bl ood trans f

usi ons. Dur ing her sec ond pr eg na nc y, Ru

pp wa s a gai n re f er re d to Central Texas Perinatal Associates, this

tim e to Dr . Charles Bro wn. On Ap r il 4, 19 96 , at t we nt y-s ix- we ek s g es t at io n, amn io ce nt es is r ev ea led a h ig h l ev el of bili ru bin, in dic ating tha

t Rupp’s fetus was in

distress an d t ha t Ru pp ’s an t ibo die s ha d e sc ala t ed t he ir attack on her f

etus’s red bl

ood cel ls. Desp ite t his informat ion, Rup p failed t o r ece ive intr aut er ine t ra nsfusio ns as she h

ad durin g her fi rst pregnancy . At approxim ately thirty-two to thirty-three-weeks ges t at ion, Rupp m

oved t o D allas and t ra nsferr ed he r c ar e t o D r. Kat rina Walsh. At thirty-six -weeks ges t at ion, Rupp stopped f eel in g fet al move me nt and proceeded to t he h ospital where sh

e was in form ed t hat t he fet us w as d ead . R upp wait ed t wo days fo r a n available ho spit al op er at ingroom to have t he fet us d elivered by cesar ean s ect ion.

Rupp fi le d sui t aga i ns t Bro wn and Asso ciat es, Kat rina Walsh, M.D ., and Ka t rina Walsh, M.D., P.A., allegi

ng that Bro wn and As sociates and Wal sh we r e n eg lige nt in t he ir

t re at ment of he r, and that such ne gli

gence proxi

ma tely caused the death of

Rupp’s f etus and ca

used Rup p damages, including men

tal angui sh . Appel

l ees f i l ed a j oin t motion f or sum mary judgm ent arguin g that there is no val id c ause of action for the l oss of a f etus absen

t phys ic al in jury to the mother and, because t her e wa s no evidenc e o f independ ent physical da mages suffer ed by Ru pp, Bro wn and As soci ates w ereen

titl ed to sum mary judgm ent. Af ter t he m ot ion f or summ ary j udgme

nt was f il ed3

butbefo re t he summary judg ment he ar ing, R upp amende d her pet itio n, sp ecifically assert ingcauses of act ion u nder t he wr ong ful deat h and s ur vival sta t ut es, and ra i si n g c on sti tuti on al ch al l en ge s to b oth stat utes. Rupp also fi

led a response to Br own and As so ciat es’s mot ion, t o w hich Bro wn and Associ ates file d a r ep ly. The tria

l court cond

ucted a he ari ng i n D ecem ber 1999 and gran

ted sum mary judg ment in

fav or o f Brown and Associ ates. A n ord er of se v eran ce wa s s i gn ed as to Walsh, a llowing the sum ma ry j udgme nt to becom

e fi nal , and thi s appeal

fol lowed. Ru pp ba se s he rap pe al o n five po int s o f er r o r , ar gu ing t ha t t he t r ial c ourt erred i n gr ant ingsu

m mar y j udgm en t b ec au se (1 ) B row

n an d A ss oci ate s f ai l ed to s tate sp ec i f i ca l l y i n th eir m oti on th e e l em en ts for whi ch t her e is no evidenc e; ( 2) Rup p po sses ses a cau se o f act ion fo r t he i n j ur y to her f etus as par t of he r bo dy; (3 ) Ru pp’ s first amende d pe t itio n ra ised w ro ngful de at h and
su rvi va l ca us esof ac ti on n ot addre ss ed

i n B rown an d A ss oci ate s’ s m oti on f orsu m mar y j udgm en t; (4) case l aw concl udin g t ha t a fet us is no t a “pe rso n” o r a n “individual” wit hin the mea ning o f the Texaswr ong ful deat h and surv i va l statutes i s erron eous; and (5) the f

ail ure t o inc lud e a fet us wit hin t he defi ni tion of a “ person” or an “i

ndi vi dual ” under the Texa s wrongful death and surv

iv al statut es r en de r s bo t h st at ut es un co nst it ut io na l. DISCUSSI ON

B rown and A ssocia

tes moved f

or summ ary j udgme

nt on the grounds that Rup p al le ged no c aus e o f act ion and furt her , t hat if sheal l eg ed a c au se of ac ti on , s h e f

ai l ed to com e f orth wi th an y evi den ce of dam ages to sustai n h er negl i gen ce c l ai m . Be ca us e th e p rop riety

of a sum mary judg ment is a qu est ion o f law, w e r evi ew the t rial co ur t ’s de cision de novo
. Natividad v. Alexsis, Inc. , 875 S. W.2 d 69 5, 699 (T ex. 1994) ; Texas Dep’t of Ins. v. American Home Assurance Co. , 9984

S.W.2d 344, 34 7 (Tex . App.—A usti n 19 99, n

o pet.). The

stan dards f or revi ew of a su m mary judg ment arewel

l -establ i shed: (1 ) the m

ovan t mu st sh ow there is no genui ne i ssue of m

aterial fact and t hat it is en t it led t o jud gme nt as a ma t t er o f l aw ; ( 2) indeci din g whether there i s a di sputed
ma terial fact i ssue precl

ud in g sum mary judg ment, t he co ur t must t ake evidenc e favo ra ble to t he
nonmo vant as t ru e; and (3 ) t he co ur t must indulge e ver y reas ona ble inferenc e in favo r o f the
nonmo vant and r es o lve an y do ub t s inthe n onm ovan t’s f av or. Nixon v. Mr. Prop. Mgmt. Co. , 690 S.W.2d 546 , 5 48- 49 ( Te x. 1 985 ). Bro wn and Asso ciat es ha ve t he bu rd en o f s howin g that Rupp
co uld not suc cee d on a

ny theory pl eade d. See San Ant onio Exp ress New s v. Dracos , 922 S.W.2d 242, 24 7 (Tex . App.—San An toni o 1996, n

o wri t). Rupp’s A llegations

Brownand A ssocia

tes have f ai le d to establ

is h that Rupp coul d n

ot succ ee d on

an y of her plead ed c laims. An amende d plea ding su perc edes an d suppl an ts all previous pleadi

ngs. Tex. R. Civ. P. 65; Johnson v. Coca-Cola Co. , 727 S.W.2 d 756, 758 ( Tex. App .—Da ll as 1987 , wr it ref’d
n.r .e .) . I n her amende d pe t itio n, Rupp alle ged a c au se of ac ti on i n n eg l i ge nc e a

nd ca us esof ac ti on under the Texas wrongf

ul dea t h and s ur vival sta t ut es. We exam i ne Ru pp’ s a l l eg ed ca us esof ac ti on sep aratel y , be gi nn i ng w i th her wron

gf ul death and sur vi va l caus es of action. The Supreme C ourt of Texas h as uni form ly and co n sist ent ly held that t her e is no wrongful de ath or s urv i va l ca us e of action f or the de ath of

a f etus. Edinburg Hosp. Auth. v. Trevino , 941 S. W.2d 76, 78 ( Tex. 199 7); Krishnan v. Sepulveda , 916 S.W.2d478, 479 (T ex. 1 995 ); Pietila
v. Cr i tes , 85 1 S. W.2d 185 , 18 7 (T ex. 1 993 ); Blackman v . Langf ord , 7 95 S .W. 2d 7 42, 743 (T ex. 1990) ; Witty v. American G en. Capital Distribs., Inc. , 727 S. W.2d 503, 50 4 (Tex. 19 87). T hus,5

when Rupp am ended h er petition to add these al

le gations, sh

e fai le d to add a ny ca us e of ac ti on u pon wh ich she co uld r ec o ve r . I f a p laint iff, aft er ame nd ing he rpe t it io n, st ill fails t o ple ad a v alid cla im, t he tri al cou rt m ay gra nt s um mary j udg men t on t he pl eadi ngs . Gross v. Davies , 882 S.W.2d 452, 454 (Tex . App.—Houston [1st Di st.] 1994 , wri

t deni ed). Howev er, in a dd it io n t o he rcla im s unde r the wro ngful

death and survival

stat utes, Rupp’s f i rs t am en de d pe ti ti on a l so a lleg ed c laims arising o ut of Br ow n and As so ciat es’s negligent
me dic al treat me nt of her. In h

er second po i nt of

err o r , Ru pp ar gu es t ha t t he t r ial c o ur t er r ed in grantin g sum ma ry j udgme nt because

she pl eaded a val

id c ause of action aris in

g in negl ige nce. The re is no cause of action in

Texas for the negli

gent t reatment o f or injury to a fetus. Pietila, 851 S.W .2d at 18 6-87. H owev er, Texas does r ec o gn ize t ha t a d o ct o r ’s ne glig en ce in diagno sing an d t r ea t ing a p r eg na nt wo man is “e nt ire ly diffe r en t ” fr o m ne glig en ce in car ing for and treati ng th e f etus. Krishnan , 916 S.W.2 d at 479 -82. In Krishnan , th e p l ai nti f f sough t rec ove ry of dam ages f rom a sti l l b i rth du e to the allegedly

negligen t diagnosis, sup er vision, and t re at ment o f the mothe r’s preec l am psi a con di tion . The courtdis tingui shed Pietila, in

whi ch the pl ai ntif fs alle ged that t he ir injury aro se fro m the d oc t or ’s neg ligent treatm en t of the f etus, n ot the m other. Id . at 479-80. Because t he plaint iff

in Krishnan al

l eg ed n eg l i gen t diagnosi s a nd t re at ment o f her co ndit ion, t he supreme court held that she was entitled to brin g suit and to recover mental angui sh dam ages: We se e n o r at io na l ba sis fo rex clu din g r ec o ve ry o f men t al a ng uis h d ama ge s in personal injury act ions w hich have a s o ne elem en t the l oss of a f etus. Co ns eq ue nt ly, we hold that [the plai

ntif f] m ay recover men

tal an guis h dam ages suf fered as a r es ult of her injury which was proximately caused by [her do cto r’s ] alle ged ly negligent diagnosi s, pr enat al sup er vision and t re at ment o f [t he plaint iff ] a nd which includ es t he loss of her f

etus.1 At t he sa me t ime, t he su pr eme co ur t he ld in both casesthat a parent may not recover under t he wrongful death st atu

te for t he dea th o f a fetus . E dinburg, 941 S. W.2d at 78; Krishnan , 916 S.W.2d at 479. In

Edinburg , the c ourt r ea ffir med t ha t t he r e is no byst an de rca us e o f ac t io n in me dic al ma lpractice cases, precl

udin g a paren t’s s ui t as a b y stan der. Edinburg , 941 S.W.2d at 79-81. 6 Id . at 482 (e

m phasi s ad ded). In Edinbu rg, the suprem

e court followed Krishnan in recognizin

g a ca us e of ac ti on when t he pla int iff alle ge d n eg lige nt t r ea t men t o f t he mo t he r , ne glig en t ad minis tra tion of l ab orin duc ing dr ug s to t he mot her , a nd neg ligent monit or ing o f the mot her , a ll of which re sult ed in a st ill birt h. Edinburg , 941 S.W.2d at 78 -7 9. T oge th er, the cases hol d that “a woman

can recover me ntal anguish dam ages resulting f

rom negli gent t reatment t hat causes the loss of a fetus as part of the w oma n’ s b ody .” 1 Id. at 79; see also Wheeler v. Ye ttie K

ers ting Me

m’l Ho sp., 866 S.W.2d 32, 44-45 (Tex. App.—H oust on [1st Di st.] 199 3, n o wri t) (h ol di ng tha t plai nti f f sta ted a c au se of ac ti on ari si ng f rom a l l eged l y ne gli gen t treatmen

t of the pregn an t woma n, n ot the f etus). Li ke t he plaint iff

s in Krishnan , Edinburg , and Wheeler, Rupp has al le ged that Brown and Asso ciat es w er e neg ligent in tr eat ing her and cause d her physical pa in, suf f eri n g, a n d i m pai rm en t. Rupp alleged t hat app ellees’ mist re at ment o f her caused he

r to suf fer men tal angui sh over the loss of the f etus. She c l ai

med to ha ve su f f ere d a ddi ti ona l i njury at hav i ng to un de rgo a cae sar ian sect ion, and addi tional me ntal a ngui sh wh

en appel le es’ sch edulin g problem s caused h er to carry a de ad fetus inher wo mb for t wo days be for e it w as su rg ically re moved . As e ar ly as 188 8, a T exa s cour t recogniz ed

that even t ho ug h a wo man co uld not recover mental angui sh dam

ages f or a still bi rth when We stern Un i on f ai l ed to del i ver a m ess age to her ph

y sician i n a tim el y man ner, she could nev

ertheless
recover reasonabl

e compensation i

f s he “ suf fered m ore phys ic al

pai n, m ental an xie t y, an

d al arm , on acc ou nt of her

ow n co ndit ion, t han she wo uld have do ne i f [th e doctor] ha

d b een i n a tten da nc e u pon2 The supr em e court dis tingui shed Coop er, wh ere de ath re sul ted f rom a “s econ dary cause” that was too remote, fr o m Krishnan, in which a stil

lbi rt h all egedly resulted direct ly

from the do cto r’s negligent diagno sis, p re nat al sup er vision, and t re at ment o f the pr egna nt wo man. “[ T] o t he extent that Cooper is not distin guis hab le ,” the court said, “we overrul e i t.” Krishnan , 916 S.W.2d at 480. 7 her . . . .” Western UnionTel. Co. v. Cooper , 9 S.W . 598, 59 9 (188 8). 2 Unquestionabl y, Rupp h as alleged suc h “increa sed ” pa in and ment al suffer ing du e t o t he del ay in remo ving t he de ad fet us a nd due to the i

nv asi ve surg ery she requ i red. T his ca se is c o nt r o lled by Krishnan and it s pr og eny, no t by Pietila , i n wh i ch th e p l ai n ti f f s f ai l ed to cl ai m n eg l i gen t t re atm en t of t he pr egna nt wo man. Ac cordi ngl y , we sustai

n R upp’ s se cond

poi nt of error. We ne xt t ur n t o the

no- ev i de nc e p ortion of

Brow n a nd A ss oci ate s’ s m oti on f or sum mary judgm ent to det ermi

ne wh ether Rupp fa

il ed to pr oduce any

evi dence that she

suf fered dam age as a resul

t o f an y n eglige nce. No-Evidence Ground for Summary Judgment In a no-evi dence su m mar y j udgm en t, th e m ov an t m us t sp ec i f i ca l l y sta te th e e l em en ts
as to whi ch there i s no evi

dence. Tex . R. Ci

v. P. 1 66a(i

); Macias v. Fiesta Mart, Inc. , 988 S.W.2d 316, 316 -1 7 ( Te x. Ap p. —Ho ust on [ 1st Dist .] 199 9, no pe t.). In h er f i rs t poi nt of error, Rupp argues that the tri

al court erred

i n gr an tin g sum mary judg ment be cau se Br ow n and A ss oci ate s f ai l ed to s tate sp ec ifica lly

the el em ent of Rupp’s

cause f or which there is no evi dence. Brown an

d Associ at es ’s
m oti on, however, speci

fi cally states: “Ms. Rupp did not suff er pe r so na l i nj ury

as a resu l t of Dr. Bro wn’s care .” Thus, Brown and Associa tes speci fi cally asserted that Rupp fai

le d to show evi

dence that she s uff ered personal

in jury as a resul t o f h er all egations. W

e therefore consi

der whether Rupp8

hasprod uc ed an y ev i de nc e of probative f

orce to rais e a fa

ct issue on the question of her damages. See Qantel Bus. Syss., Inc. v. Custom Controls Co. , 761 S.W .2d 302 , 303-0 4 (Tex . 1988)
.

Brownand A ssoc i ates a sse rt that Rupp has suf

fered no da mag es . T he ir p o sit io n is
co nt ingent up on

th ei r a rgum en t th at a pl ai n ti f f m us t sh ow ph y si ca l i n j ur y to h er se l f se pa ra te and apa rt f rom the l oss of the f etu s. I n s upp ort of their contention, Brown an d A ss oci ate s r ef er to Sosebee v. HillcrestBaptist Medical Center , 8 S.W .3d 42 7 ( Te x . A

pp .—W ac o 19 99 , pe

t. deni ed), whi ch states t ha t “if the m

ot her of a stil

lb orn chi ld a ll eges that she h

ersel f recei

ved n eglige nt pren atal care and shows that thi

s negl i gen t care c aus ed ‘ phy

sical i nj ury and ment al angu ish indepe ndent of t he stil l bi rth,’ then she m ay recover her dam

ages.” Id . at 435 (quot in

g Booth v. Cathey , 893 S.W.2d 715, 718-19 (T ex. App.—Tex

arkan a), rev’d on other grounds , 90 0 S.W.2d 339 (T ex. 199 5) ). Bro wn and Ass o cia tes as se rt that the hol di ng r equi res th at a wom an can recover on ly

if she s hows her own phy si cal i njury i nd ep en de nt of the l oss of the f etu s. B rown

an d A ss oci ate s a rgue that a si

def rom any ot her pr oo f in the r eco rd , R upp ’s de po sitio n t est imony proves as a m

atter of law that she suf

fered
no pers on al

i n j ur y i n de pen den t of th e l oss of th e f etu s. In pa rti cul ar , B row

n an d A ss oci ate s p oi n t to t he fo llowing exc hange fro m Rupp ’s de po sitio n: Q: You didn ’t have a

ny phy si cal in juri es y ourself , did y ou . . . ? Y ou’re

not claiming any physical il ln esses? A: Ju st a

b roken h ea rt. We need n

ot deci de whether a wom an’s loss of a fetus al one co nst itu t es su ffi

cient i nj ury t o en t it le h er t o r ec o ve r . Ra t he r , we mer ely fol low Edinburg and Krishnan in determi ni ng that Rupp has a sser t ed a cau se o f act ion fo r d amage s su ffered as t he r es ult of a personal in jury , which h as9

as one elem ent the loss o f a f etus. See Edinb urg , 941 S.W.2d at 79; Krishnan , 916 S.W.2d at 482. The su mmar y jud gme nt pr o o f co nt ain s s o me ev i den ce th at R upp suf f er ed i n j uri es i n addi ti on to and
se pa ra te from the loss of the f

etus. The sum

ma ry j udgme nt record also contains evi dence that

Rupp suf fered seve re pain and per so nal injury due t o c ar rying t he deceased f etus f or several day s b ef ore bei ng ab le t o ha ve it su r gic ally r emo ve d. Ru pp t es t ified t ha t she r eq uir ed med ica t io n d ur ing t his int er im period. Rupp f

urthe r cla imed ph ysic al p ain an d s uffe r ing fr o m ha ving t he fet us su r gic ally removed by ces arian section ; the rec ordreveals that such surgery was severe enough to confi ne Rupp to the hospi

tal f or t wo days thereaf

ter. When rev

ie win g a no-evi

dence sum

ma ry j ud gme

nt, we consider all

of t he evide nce in t he li

ght most fav

orable to the party agai

nst whom the judgm

ent was rendered; eve ry r ea so nab le infe re nce mus t be ind ulg ed in favor of th e n on mov an t, a n d a n y dou b ts resol ve d i n i ts f av or. See Qantel , 761 S.W.2d at 303-04. The trial court ma y not gr ant a no -e vidence summary judg ment if t he r eco rd co nt ains
m ore tha n a sc i nti l l a of pr ob ati v e ev i den ce

to rai se a g en ui n e iss ue of mate rial f ac t. Tex. R. C i

v. P. 166 a(i); see

Merrell Dow

Pharms., Inc. v. Havner , 953 S.W.2d 706, 711 (Tex. 1997). Mor e than
a scint ill a exist s whe n t he evide nce “r ises t o a level tha t wo uld ena ble rea so nabl e and f ai r-mi nded pe o ple to dif

fer i n thei r conclus ions .” Burroughs Wellcome C o. v. Crye , 9 07 S .W. 2d 4 97, 499 (T ex. 199 5). Under thi s stan

dard of revi ew, we

determ i ne that the record c ontai

ns sum mary judgm en t proof t hat Rup p su ffered damag es, indepe ndent of the l oss of the fet us. Acco rdingly

, t he tr ial cou rt ’s gran t of a n o-evi den ce s um mary j udgm en t on thi s ca

use wasi m proper. CONCLU SION10 Having d et er mined t hat t he trial cour t err ed in

granting sum

mary judgm ent because Rupp asserted a cause of a ction f or her in juri es and b ecause the reco rd co nt ains pr oo f tha t she sustain ed damages, we need not reach Rup p’s other poi nts of error. We rev

erse the s um mary judgm ent and remand the cause to the tr ial cour t for furt her proce edin gs.

Mari ly n A boussie, Chief J

ustice Befo re Chief Just ice Abo uss ie, Ju st ices B. A. S mith and Pat t er so n Reversed a

nd Rem anded File d: Novem

ber 9, 2000 Publish