NUMBER 13-12-00602-CV

COURT OF APPEALS

THIRTEENTH DISTRICT OF TEXAS

CORPUS CHRISTI - EDINBURG

DOCTORS HOSPITAL AT

RENAISSANCE, LTD., Appellant,

v.

CLAUDIA MEJIA, Appellee.

On appeal from the County Court at Law No. 2

of Hidalgo County, Texas.

MEMORANDUM OPINION

Before Chief Justice Valdez and Justices Garza and Longoria

Memorandum Opinion by Chief Justice Valdez

By one issue, appellant, Doctors Hospital at Renaissance, Ltd. (“DHR”), appeals 

the trial court’s interlocutory order denying its motion to dismiss based on the failure of 

appellee, Claudia Mejia, to comply with the expert report requirements of chapter 74 of 

the Texas Civil Practice and Remedies Code. See TEX. CIV. PRAC. & REM. CODE ANN. 

§§ 51.014(a)(9), 74.351 (West 2011). We affirm.
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I. BACKGROUND

Mejia was injured in a slip-and-fall accident that occurred on a premises owned 

by DHR. It is undisputed that DHR is a healthcare provider and that Mejia was not a 

patient at DHR. Instead, Mejia was visiting her father, who was recovering from 

surgery. Mejia alleges that at DHR, she was directed by a DHR employee to walk on a 

freshly waxed walkway and was assured that it was safe. However, she fell and 

sustained injuries.

Mejia sued DHR, alleging among other things that appellant had failed to provide 

“a safe walking area,” “adequate safety measures,” “adequate safety procedures,” 

“adequate safety training,” and “reasonable safeguards for safety and protection of all 

patrons.” Mejia further alleged that DHR had “failed to keep the premises in a 

reasonably safe condition” and that the condition of the premises was “unreasonably 

dangerous” and “unsafe.” 

Mejia did not file an expert report. DHR filed a motion to dismiss and for 

sanctions based on her failure to file an expert report. The trial court denied appellant’s 

motion. This appeal ensued. 

II. ANALYSIS

A. Standard of Review

The denial of the motion to dismiss is reviewed for abuse of discretion. Jelinek 

v. Casas, 328 S.W.3d 526, 539 (Tex. 2010). However, when the issue, as in this case, 

involves the applicability of chapter 74 to the plaintiff’s claims and requires an 

interpretation of the statute, we apply a de novo standard of review. Buck v. Blum, 130 
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S.W.3d 285, 290 (Tex. App.—Houston [14th Dist.] 2004, no pet.); Ponce v. El Paso 

Healthcare Sys., Ltd., 55 S.W.3d 34, 36 (Tex. App.—El Paso 2001, pet. denied).

B. Applicable Law

Chapter 74 of the Texas Civil Practice and Remedies Code entitles a defendant 

to dismissal of a healthcare liability claim if the defendant is not served, within 120 days 

of the date suit was filed, with an expert report showing that the claim has merit. See

TEX. CIV. PRAC. & REM. CODE ANN. § 74.351(b). The report must provide a fair summary 

of the expert’s opinions as of the date of the report regarding: (1) applicable standards 

of care; (2) the manner in which the care rendered by the healthcare provider failed to 

meet the standard of care; and (3) the causal relationship between that failure and the 

injury, harm, or damages claimed. Id. § 74.351(r)(6).

C. Discussion

As a threshold matter, we must decide whether Mejia’s asserted cause of action 

is a healthcare liability claim. Whether a claim is a healthcare liability claim depends on 

the underlying nature of the claim being made, and artful pleading does not alter that 

nature. Yamada v. Friend, 335 S.W.3d 192, 196 (Tex. 2010); see Diversicare Gen. 

Partner, Inc. v. Rubio, 185 S.W.3d 842, 854 (Tex. 2005). The foundations of analyzing 

this issue are “well established.” Tex. W. Oaks Hosp., L.P. v. Williams, 371 S.W.3d 

171, 179 (Tex. 2012).

DHR and the dissent rely heavily on Texas West Oaks Hospital, L.P. v. Williams

to support the conclusion that Mejia’s cause of action is a healthcare liability claim. In a 

6–3 decision, the Texas Supreme Court held that a health care provider employee’s 

(Williams) negligence claims against his former non-subscribing health care provider
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employer (Texas West Oaks Hospital), for injuries he sustained following an altercation 

with a mentally-ill patient, were healthcare liability claims under the Texas Medical 

Liability Act. Id.; see TEX. CIV. PRAC. & REM. CODE ANN. §§ 74.001–.507 (West Supp. 

2011). The court held, in part, that Williams’s claims against West Oaks involved 

departures from the accepted standard of health care, and thus were healthcare liability 

claims. See Tex. W. Oaks Hosp., 371 S.W.3d at 181; see also TEX. CIV. PRAC. & REM.

CODE ANN. § 74.001(a)(13). 

But the West Oaks Court did not end its analysis there. It also held that 

Williams’s claims were healthcare liability claims under the “safety” prong of the 

definition of a healthcare liability claim. See Tex. W. Oaks Hosp., 371 S.W.3d at 181

(citing TEX. CIV. PRAC. & REM. CODE § 74.001(a)(13) (“Health care liability claim” means 

a cause of action against a health care provider or physician for . . . [a] claimed 

departure from accepted standards . . . safety . . . which proximately results in injury to 

or death of a claimant . . . .). The Court recognized that, by including “safety” in the 

statutory definition of a health care liability claim, the Texas Legislature “‘expanded the 

scope of the statute beyond what it would be if it only covered medical and health care,’”

Id. at 183 (citing Diversicare Gen. Partner, Inc. v. Rubio, 185 S.W.3d 842, 855 (Tex. 

2005)), but that it was “not necessary to define the precise boundaries of the safety 

prong.” Id. Although the precise boundaries of the safety prong remain undefined, the 

high court has acknowledged that they are not limitless. See Marks v. St. Luke’s 

Episcopal Hosp., 319 S.W.3d 658, 664 (Tex. 2010) (“[I]t is apparent that the Legislature 

did not intend for standards of safety to extend to every negligent injury that might befall 

a patient. . . .”); Diversicare, 185 S.W.3d at 854 (“There may be circumstances that give 
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rise to premises liability claims in a healthcare setting that may not be properly classified 

as health care liability claims, but those circumstances are not present here.”). The 

West Oaks Court also cited—without further elaboration—Chief Justice Jefferson’s 

concurring and dissenting opinion in Marks1in which he observed that the “common 

meaning” of “safety” could encompass premises liability claims. See Tex. W. Oaks 

Hosp., 371 S.W.3d at 186 (citing Marks, 319 S.W.3d at 674).2

The West Oaks decision stopped short of concluding that all premises liability 

claims involving a healthcare defendant are healthcare liability claims. 371 S.W.3d at 

183. Instead, the court recognized a new type of healthcare liability claim—that is, one

involving safety which is indirectly related to health care. Therefore, we apply West 

Oaks narrowly to govern cases that involve safety claims that are indirectly related to 

health care. 3

The present case, however, does not fall into this category, and at least one of 

our sister courts shares this view. See Good Shepherd Med. Ctr.—Linden, Inc. v. 

Twilley, No. 06-12-00098-CV, 2013 WL 772136 (Tex. App.—Texarkana Mar. 1, 2013, 

 

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Justices Green, Guzman, and Lehrmann joined Chief Justice Jefferson’s concurrence and 

dissent. See Marks v. St. Luke’s Episcopal Hosp., 319 S.W.3d 658, 674 (Tex. 2010) (Jefferson, C.J., 

concurring and dissenting).

2

 We note that Diversicare and Marks are binding precedent and have not been expressly 

overruled. 

3

The dissent’s second footnote suggests that our opinion today somehow abrogates or modifies 

the Texas Supreme Court’s holding in West Oaks. We disagree. In no way does our opinion seek to 

modify or abrogate binding precedent. Instead, we merely conclude that West Oaks is distinguishable. If 

we believed that Mejia’s claims in the present cause of action were indirectly related to health care, we 

agree that we would be bound to follow West Oaks. See Lubbock County, Tex. v. Trammel’s Lubbock 

Bail Bonds, 80 S.W.3d 580, 585 (Tex. 2002). However, because we hold that West Oaks is inapplicable, 

it does not control this case. 
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pet. filed).4 In Twilley, an employee of Good Shepherd Medical Center sued the 

hospital for negligence related to two on-the-job injuries—first, a fall from the top portion 

of a ladder; and second, when he “tripped and fell over a mound of hardened cement on 

the hospital’s premises.” Id. at *1. After a year-long delay, Good Shepherd filed a 

motion to dismiss for failure to file an expert report. See TEX. CIV. PRAC. & REM. CODE 

ANN. § 74.351(a). The trial court denied the motion to dismiss, and the Texarkana Court 

affirmed. Twilley, 2013 WL 772136, at *6–7. In its decision, the Twilley Court held that 

West Oaks does not encompass safety claims that that “are completely untethered from 

health care.” Id. at *5. We agree with that interpretation of Texas West Oaks. 

Furthermore, we ask the same hypothetical question posed by the Twilley Court: does 

a suit against a health care provider for negligence in causing a car accident in a 

hospital parking lot involve a safety claim and thus requires a report from a healthcare 

expert? We believe it would not, because a safety claim must “involve a more logical 

coherent nexus to health care.” Id. (noting that “[t]he simple fact that an injury occurred 

on a health care provider’s premises is not enough” to bring a cause of action under the 

TMLA). 

This view is also consistent with the Texas Supreme Court’s interpretation of the

legislative intent of the Texas Medical Liability Act. Two months after the West Oaks

 

4

 We recognize that the Fourteenth Court of Appeals recently held that a non-patient’s slip and 

fall at a hospital is a health care liability claim under West Oaks. See Ross v. St. Luke’s Episcopal Hosp., 

No. 14-12-00885-CV, 2013 WL 1136613, at *2 (Tex. App.—Houston [14th Dist.], Mar. 19, 2013, no pet. 

h.) (mem. op.). However, we find this case distinguishable. In Ross, the claimant did not contest that her 

allegations were safety-related claims under the Texas Medical Liability Act. See Ross, 2013 WL 

1136613, at *2. Instead, Ross asked the Houston court to “ignore” West Oaks because its application to 

her case would result in an absurd outcome. See id. Here, Mejia asserts that the Texas Medical Liability 

Act does not apply to her cause of action. Furthermore, for the reasons stated in this opinion, we 

disagree with the Houston court that West Oaks is a “decision on point” to cases with factual backgrounds 

similar to Ross’s and Mejia’s. See id. 
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opinion, the Texas Supreme Court noted in Loaisiga v. Cerda, 379 S.W.3d 248, 256 

(Tex. 2012), that it failed 

to see how the Legislature could have intended the requirement of an 

expert report to apply under circumstances where the conduct of which a 

plaintiff complains is wholly and conclusively inconsistent with, and thus 

separable from, the rendition of medical care, or health care, or safety or 

professional or administrative services directly related to health care even

though the conduct occurred in a health care context.[5] 

Furthermore, the Twilley Court made the following observation regarding 

Loaisiga, which we share and find applicable today:

If certain assault claims are excluded from the purview of the TMLA 

because such claims are inconsistent with “medical care, or health care, 

or safety or professional or administrative services directly related to 

health care,” it is likewise logical to recognize that “safety” claims 

completely unrelated to health care are likewise excluded from the ambit 

of the legislated scope of the TMLA.

2013 WL 772136, at *5.

In this case, Mejia was not a DHR patient. Her claim arises from circumstances 

involving her visit to her father, who was a patient at DHR. Mejia alleges that at DHR, 

she was directed by a DHR employee to walk on a freshly waxed walkway and was 

assured that it was safe. As a result, she fell and sustained injuries. Based upon these 

allegations, we hold that the underlying nature of Mejia’s claims is a “garden variety”

slip-and-fall case, see Wal-Mart Stores, Inc. v. Gonzalez, 968 S.W.2d 934, 936 (Tex. 

 

5

Additionally, Justice Hecht made the following observation in his concurrence and dissent in 

Loaisiga:

. . . [D]isagreements over the [Texas Medical Liability Act] expert report requirement, 

which is merely intended to weed out frivolous claims early on, have resulted in 

protracted pretrial proceedings and multiple interlocutory appeals, threatening to 

defeat the Act's purpose by increasing costs and delay that do nothing to advance 

claim resolution. 

Loaisiga, 379 S.W.3d 248, 263–64 (Tex. 2012) (Hecht, J., concurring and dissenting) (internal citations 

omitted). 
8

1998) (discussing the elements of a slip-and-fall cause of action), and are not claims

involving departures from accepted standards of safety that are directly or indirectly 

related to health care. See Tex. W. Oaks Hosp., 371 S.W.3d at 200 n.7. Further, 

Mejia’s pleadings allege a straight-forward premises liability case and do not attempt to 

artfully plead out of the “umbrella” of the Texas Medical Liability Act. See id. at 191 

(“The standards for the conduct at issue, rather than the form of pleadings or identity of 

parties, are paramount in classifying HCLCs.”). 

Moreover, West Oaks held that “if expert medical or health care testimony is 

necessary to prove or refute the merits of the claim against a physician or health care 

provider, the claim is a health care liability claim.” See id. at 182. In this case, Mejia 

does not need expert testimony to prove or refute the merits of her claims against DHR. 

Thus, “safety” claims like those pleaded by Mejia, which are completely unrelated to 

health care, are excluded from the scope of the TMLA. See generally Loaisiga, 379 

S.W.3d at 256 (“In some instances the only possible relationship between the conduct 

underlying a claim and the rendition of medical services or healthcare will be the 

healthcare setting (i.e., the physical location of the conduct in a health care facility), the 

defendant's status as a doctor or health care provider, or both.”); Twilley, 2013 WL 

772136, at *6. 

We recognize that the Texas Supreme Court and our sister appellate courts have 

“repeatedly struggled” with the issue before us today.

6

 With that in mind, and without

clearer guidance from the supreme court, we read the related cases narrowly and 

 

6

“Whether a claim against a health care provider is a health care liability claim is a knotty issue 

this Court has repeatedly struggled with.” Loaisiga, 379 S.W.3d at 265 (Lehrmann, J., concurring and 

dissenting) (internal citations omitted). 
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decline to expand the definition of a healthcare liability claim beyond what the 

legislature intended. Accordingly, DHR’s sole issue is overruled. 

III. CONCLUSION

The trial court’s denial of DHR’s motion to dismiss is affirmed. 

______________________

ROGELIO VALDEZ

Chief Justice

Dissenting Memorandum Opinion

by Justice Nora L. Longoria.

Delivered and filed the 

1st day of August, 2013.