### TEXA S C OU R T OF A PPEAL S, THIR D DIST R ICT , AT AU STIN

NO. 03-0 9 -00 734 -CV

St . D av id’ s He alt hc ar e P ar tn e r ship , L. P ., LLP d/b/a St . D av id’ s Ho spit al; and

St. David’s Com m uni ty Health F ound ation , Appellan ts
v. Ge naro Esparza, Jr., Appellee

F ROM THE DISTRICT CO URT OF TRAVIS COUNTY , 345TH JUDICIAL DISTRICT NO. D-1- GN-09- 0013 36 , HO NORAB LE SUZ ANNE COVINGTO N , JUDGE PRESIDI NG

O P I N I O N
St. David’s Hea lthcare Partnership a nd St. David’s Communi ty Hea lth Foundation (c oll e c tiv e ly , “ St. Da

vid ’s ” ) b ri ngthi s in te rl oc uto ry a pp e a l fr om the tr ia l court ’s or de r de nyingthe ir motion to dismiss under c hapter 74 of the c ivil practice and re medies code
. See Tex. Ci v. Prac. & Re m. Code Ann. §§ 74.001-.507 (West 2005 & Supp. 2009). St. David’ s al l ege s t h at appellee Ge na ro Es pa rza , Jr.’ s c la ims fo r ne g lig e nc e and pr e mis e s lia bil ity are in fa c t he a lth c are l iab il ity claims subject t o chapte r 74, and that St. David’s is entitled to dismiss al base d on Esparza’s f ailure to serve a n expert repor

t. See id. § 74.351 (West Supp. 2009). W e af firm the trial c ourt’s orde r.
BACK GR OUND I n Ap ri l 2 0 09, Esparza filed suit ag ainst St. David’s, bring ing c laims of premises l i ab i l i t y an d n egl i gen c e i nco n n ec t i o nwi t h i n j u ri es h e s u ff

er edas a r es u l to f a fa l l d u ri n g a2

No ve mbe r 2 00 8 h os pit a l st ay . A c c or din g to E sp arza ’s liv e ple a din g , w hil e a patie nt at St. Da

vid ’s , h e s li p p e d o n a tr an s ie n t s u b s ta n c e o n th e f

lo o r o f h is h o s p it a l r o o m an d in ju r e d h im s e lf
. E s p a r za alleg ed that shortly

befor e his fall, a nur se had use d a g elatinous substa n ce t o conduct sonog ram scans on his ab d o m en. Esparza then observe d the nurse sha king he r hands a s she walke d to the restroom fa cilities, causing some of t h e gel ati nous substance to fa ll from her ha nds to the floor. Esparza fur

ther a lleg ed that af

ter the nur se left his room, h e go t up to go to the r estroom and slipped on a subst ance on the floor, whic h he believe d to be the same g elatinous substance used duri nghis so no g ra

m. I n response to Esparza’s pe tition, S t. David’s filed a mo t i on to dismi ss under chapte r 74, ar g uing that Esparza’s ne g lige nce a nd premises li ability claims wer e in fac t health ca re liabi l i t y cl aim s subject to the statutory require ment that an expert re port be ser ved on the pa

rties within 120 day s of the petition being filed. See id. (re quiring d i s m issal on motion of defenda nt health ca re pr ovider if e x pert re port is not served a s require d). I t is undisputed that Esparza did not
serve S t
. David’s with an e x pert re port in connec tion with his claims. The tria l court denie d the motion to di smiss, and this appeal followed.
STA ND AR

D O F RE VI EW Gene rally , we r eview a

trial court’s or der g ranting or deny ing a motion to di smiss for failure to timely

file a se ction 74.351(a) expert repor t under a n abuse- of-d i s cr etion standard. See Austin Heart, P.A. v. W

ebb , 228 S.W .3d 276, 279 (Tex. App.—Austin 2007, no pet .). Howe ver, when the issue pr esente d is purely a question of law, we a pply a de novo sta

ndard of revie w. See Holguin v. Laredo Reg’ l Med. Ctr., L.P. , 256 S.W .3d 3 4 9 , 3 5 2 (Tex . App.—San Antonio 2008,3

no pet.). B e c a

us e the iss ue of

wh e the r E sp arz a ’s c la ims re pr e se nt h e a lthc are lia bil ity c la ims is a question of law, we will review the trial court’ s ruling de novo. See Lee v. Boothe , 235 S.W .3d 448, 451 (Tex. App.—Dallas 2007, pe t. denied).
DI SCU SSIO N I n a single issue on appea l, St. David’s argues that the trial c ourt err ed in deter mining that E sp arza ’s c la ims fo r n e g lig e nc e and premi ses lia

bil ity did no t c on sti tut e he a lthc are lia bil ity claims. When the essenc e of a suit is a h ea l t h ca re liabili ty claim, a plaintiff c annot avoid the require ments of cha

pter 74 by

rec asting his claims as another cause of ac tion. See Garland Cmty. Ho sp . v . R os e , 156 S.W .3d 541, 543 (Tex. 2004) (apply ing pr edec essor statute) . The statute de fines

“ he a lthc are lia

bil ity c la im” a s:

a ca use of a ction ag ainst a hea lth care provider or phy si ci an fo r t re atment, lack of treat m en t , or other c laimed depa rture f rom ac cepte d standards of medical c are , or he a lthc are , o r s a fe ty

or pr of e ssi on a l or

a dmi nis tr a tiv e se rv ic e s d ir e c tl y rel ated t o health ca re, w hich proxim ately

results in injury

to or death of a c laimant, whether the c la ima nt’ s c la im o r c a

us e of a c tio n s ound s in

tor t or c on tr a c t.
Tex. Ci v. Prac. & Rem. Code Ann. § 74.001(a) (13) (West 2005)
. Thus, any alleg ed depa

rture f rom
acc epted standa

rds of medic al ca

re, he alth car e, or sa fety

or prof essional or a dminist rative se rvice s “dire ctly related t o health care ” represe nts a health car e li ability claim. Id. I n deter mining whe ther a cla im i s a hea lth care liability claim, we look to whe ther “ the ac t or omission allege d in the complaint is a

n insepara

ble part of the re ndition of health ca re se rvice s.” Ro se , 156 S.W .3d at 544. Both pa rties cite to Di v e rsi c ar e Ge ne ra l P ar tne r, In c . v . R ub io , 185 S.W .3d 842 (Tex. 2005), in support of their re spective positions. I n Ru bio , the supreme court held that a nur sing4

home r es i d ent’s cla ims based on the nursinghome’s fa ilure to protec t her fr om sex ual assault by another resident wer e health car e liability claims subject to the prede cessor statute to chapte r 74. Id. at 849. I n rea ching this conclusion, the court stated that the nursing ho m e’ s s u pervision of the plaintiff and the resident who assaulted her was “insepa rable from the health car e and n u rsi ng service s provided.” Id. After descr ibing the se rvice s expec t ed of a nursing home, including the supervision and moni toring of i ts residents, the court stated, “This di spute betwee n the parties is, at its c or e , o ve r t

he app ropri a te sta

nd ard of c are ow e d to thi s nur sin g ho me re sid e nt; wh a t se rv ic e s, supervision, and monitori n g we re nece ssary to satisfy the standar d; and whethe r such spe cialized
s t an d ar d s wer e bre ache d.” Id. at 850. The c ourt also found it signif icant that testimony

from an expert in the health car e field would be necessar y to deter mine the appropriate number, training , and
cer tifications of medica l profe ssionals nece ssary to car e for and protect patients from injury by other residents. See id. a t 85 1. We f ind the pr e se nt c a se to b e dis ti nguisha ble fr om Rubio in that no specia liz ed standa

rd of car e is implicate d here and no expert testimony would be nec essar

y to prove Es pa rza ’s c la ims
.

Th e su pr e me c ourt revi si ted the iss ue of ide nti fy inghe a lth c are lia

bil ity c la ims in Marks v. St. Luke’s Episcopal Hospital , ___ S.W .3d ___, No. 07-0783, 2009 Te x . L EXI S 636 (Tex. Aug . 28, 2009). In Marks , the court expressly reje cted the notion that “an y p at i en t injury
ne g lig e ntl y

c a us e d by an uns a fe c on dit ion a t a hea lth c are fa c ili ty ” re pr e se nts a he a lthc are lia

bil ity claim, holding instea d that a health car e liability claim exist s “whe n the unsafe condition . . . is an insepara ble or integ ral pa

rt of the patient’s car e or tre atment.” Id. at *10-11. In deter mining whe ther a cla im is i nsepar able f

rom the patient’s c are or treat m ent, relevant fa ctors include ( 1) whe ther medical e x pert testimony

might be ne cessa

ry to prove the c laim, (2) whe ther a specia liz ed standa

rdThe c ourt noted that under some circ umstances, the assembly or use of a hospital be d might 1 involve profe ssional judgment, suc h as whe n a p at i ent’s condition ca lls for side ra ils or other restra ints. Marks v . St. Luke’s Episcopal Hospital , _ _ _ S
. W
. 3 d _ _ _ , N o . 0 7
- 0 7 8 3 , 2 0 0 9 T e x . LE X IS 636, at *19-20 (T ex. Aug. 28, 2009) . I n that case , a claim of neg lige nce c ould potentially be considere d a hea lth care liability claim. Id. F or that ma tte r, Es pa

rza do e s no t a lle g e that th e nurs e us e d a n e xce ssi ve a mou

nt o f g e l in 2 pe rf or min g t he medic a l pr oc e dure . H is p e tit ion sim ply state s, “ Th e bla dd e r s c an im a g ingte st require d the use of c opious amounts of a g elatinous substance .” 5 of ca re in the he alth car e community would apply to the alleg ed circ umstances, and (3) whether the
n egl i gent act involves medical judg ment related to the patient’s c are or treatment. Id. a t * 1 1

- 12. Ba sed on these f

actor s, the court held that a patient’s claim t hat hospital staff ne g lige ntly assembled h is h o s p it a l b e d , c a

u s in g h im in

ju r y , w a s n o t a h e a lt

h c ar e li a b il it y c la im. Id. at *20 (“ [W ]hen a pie c e of ho sp ita l e qu ipm e nt i s unr e la te d to any pr of e ssi on a l j ud gment and

is m e re ly inc ide nta l to the patie nt’ s c are , it s a lle g e d uns a fe c on dit ion do es no t im pli c a te [the pr e de c e sso r s ta tut e to chapter 74].”). 1 Simi larly , Esparz a’s c laims involve no professional judg ment, require no expert testimony to establish liability , and are merely incidental to his medical ca re. D espite St. David’s arguments to the contrar

y , it is i mmateria l whether the nurse violate d a standa rd of c are by

using excessive amounts of l ubricating ge l in perf orming the s onog ram scan, or whether she violated the sta nd ard of c are fo r i nf

e c tio n c on tr ol b y

fa ili ngto pr op e rl y

dis po se of

the g e l. E ve n if

the a pp lic a ble standards of

car e per mitted the use of unlimit ed amounts of lubricating g el in perf orming sonog ram
sc ans and pla c e d n o r e qu ir e me nts wh a tso e ve r o n the p rop e r d isp os a l of su bs tanc e s th a t c ome in direc t contact with a patient’s body , Esparza could conce ivably prove his c laims for neg lige nce a nd p r e m i s e s l i a

b i l i t y. Fur

thermore , unlike the plaintiff in Ru bio , Esparza was not under the supe rvision 26

or car e of any medical profe ssional at the time he slipped and fe ll, nor does he a lleg e that the hospital failed to prope rly monitor and supervise him as a patient. He sim ply alleg es t hat his injuries were
c a us e d b y a da ng e ro us c on dit ion

—th e sli pp e ry

fl oo r. Th e nurs e ’s a lle g e d ne g lig e nc e in f a ili ngto
reme dy that dang erous c ondition required no pr ofessional judg ment and was mere ly incidental to the
so no g ra m pr oc e dure that sh e ha d p re vio us ly pe rf ormed
. No e xpe rt

te sti mony

is n e c e ssa

ry to
e sta bli shthat sl ipp ing

and fa lli ng on a sli pp e ry fl oo r ca n ca us e pe rs on a l injuri e s. As a re su lt, we ho ld that Esparza’s c laims for neg lige nce and premises liability are not health ca

re liability

claims subject to the expert repor

t require ment of cha

pter 74. See Tex. Ci v. Prac. & Rem. Code Ann. § 74.351. T h i s h o l d i n g i s c o n s i s t e n tw i t h s i m i l ar o p i n i o n s f

r o m o u r s i s t e r c o u rt s o f a p p e a l s . In Ha rri s M e tho dis t F or t W or th v . O lli e , th e c ourt

he ld t hat a ho sp ita l pat ie nt’ s pre mis e s li a bil ity c la im based on he r fa ll on a “slippery wet floor” was not a hea lth care liability claim bec ause the acts of clea ning the floor and failing to war n the patient of its s lippery condition were not insepara ble from t h e r e n d i t i o n o f m e d i c a l s e r v i c e s an d t h e a c c e p t e d

s t an d ar d s o f

s a f e t y w i t h i nt h e h e a l t h c ar e i n d u s t r y. 270 S.W .3d 720, 726-27 (Te x . App.—For t Worth 200 8 , p et
. fi led). Similarly , the cour t in Sh ult s v. Bapti st St. Anthony’s Hospital Corp. , he ld that a patie nt’ s ne g lig e nc e a nd pr e mis e s li a

bil ity c la ims based on injuries he sustained from ste p p i n g o n a shar p paint chip on the hospital bathroom floor
wer e not health car e liability claims, stating, “ We do not believe that the pr esenc e of a sharp pa int chip i n the s hower of S hults’s hospital room could be considere d in any way an ins epar able part of the medica l service s rende red to Shults.” 166 S.W .3d 502, 50 5 (Tex. App.—Amarillo 2005, p e t
. d e n i e d )
. F i n a l l y, in Dual D Healthcare Operations, Inc. v . Kenyon , th e c ourt he ld t hat c la ims based on a

patient’s fa ll in a nursing home afte r worke rs had stripped a nd waxed the floors we re not7

health ca re liability

claims bec ause the plaintiff did not al l ege the brea ch of a ny safe ty standard related to medical c are . 291 S.W .3d 486, 489 (Tex. App.—Dallas 2009, no pet.). Esparza, like the plaintiffs in Ol lie , Sh ult

s , and Kenyon , h a s ma de no a ll e g a tio n th a t St. Da vid ’s br e a c he d a

sa fe ty standard dir ectly

re l ated to medical car e. As a result, we ove rrule the point of err or ra ised by St. David’s on appea l and af firm the trial c ourt’s orde r.

CO NC LU SION We a ff ir m th e tr ia l c ourt ’s or de r d e nyingthe mot ion to d ism iss
.

___________________________________________ Diane M. H enson, Jus tice Be fore J ustices Patterson, Pury ear and He nson Affir med Filed: May

13, 2010