### NUM BER 1 3-08 -005 42-CV



## C O U R T O F AP P E AL S

T H I R T E E N T H D I S T R I C T O F T E X AS

C O R P U S C H R I S T I

- 

## E D I N B U R G

RIO G RA NDE RE GI ONA L HOS PI TA L, INC. A ND COLUM BIA

RI O GRA NDE HE A LTHCA RE, L.P. D/ B/A

RI O GRA NDE RE GI ONA L HOS PI TA L, A ppell ants,

v.

DIA NA LOP EZ V ILLA RREA L, INDI VI DUA LLY A ND A S REPRES ENTA

TIVE O F THE ESTA TE O F HERM ES VI LLA RREA L, DECEA SED, A ND A S NEXT FRIEND OF SA RA H VI LLA RREA L, LA UREN V ILLA RREA L, A ND HERM ES A LEJA NDRO V ILLA RREA L, M INO RS, A ND HERM ELINDA

V ILLA RREA L, A ppell ees.

On a ppeal fr om the 389t h Di str ic t Cour t of Hidal go County , Texas.



## O P I N I O N

Before Chi ef Justi ce Val dez and Just ic es Yañez a nd Benavides

O pini on by

Chi ef Justi ce Val dezT his app eal stem s f rom a w rongf ul dea th and surv iv al action base d on a hea lth care

liability claim brou ght by app ellees, Diana Lop ez Villarreal, individually and as

represe nta tiv e of the esta te of Herme s Villarreal, dece ased
, and as next f riend of S a rah

Villarr e a l, Lau ren Villarreal, and Herme s Alejan dro Villarreal, min ors, and Herma linda

Vi l l ar r ea l
, individually
, against app ellant s, Rio Grand e Regional Hospita l, In c

. an d C ol um bi a

Rio Gran d e He althca re, L.P

. d/b /a Rio Grand e Regional Hospita l. App ellees’ cause of

action perta ins to the suicide of f orme r McAllen atto rney, Herme s Villarreal, w hile he w as

in app ellant s’ care. Af

ter a trial, the jury conclu ded tha t app ellant s w ere 75% respo nsible

f or Herme s’s injuries and dea th and awarded dam ages to app ellees; howev er, the trial

court signed a f inal judgme nt awarding app ellees $68 5,6 00 in actu al dam ages, af ter

app ly ing the app licable d a ma ge caps, $43 ,38 0.9 8 in pre-judgm ent intere st, and court

costs.
By f o u r is sues, app ellant s argue tha t: (1) the record cont ains no evidence

esta blishing tha t app ellant s shou ld have reaso nab ly f orese en tha t Herme s w ould com mit

suicide; (2) the re is no evidenc e t h a t the nurse s’ alleged acts or om issions w ere a

subst ant ial f acto r in bringing a bou t Herme s’s dea th; (3) app ellees f ailed to e stab lish tha t

any of app ellant s’ action s w ere the cause -in-fa ct of Herme s’s dea th; and (4) the jury erred

in rejecting app ellant s’ af f irmative de f ense of

suicide

. See T E X

. C I V

. P R A C

. & R E M

. C O D E

A N N

. § 9 3.0 01(a )(2) (Vernon 2005). On cross-appe al, appe llees a ssert th at: (1) the trial

court erred in allowi ng the jury to consid er Herme s’s prop ortion ate respo nsibility in causin g

his o wn dea th; and (2) the trial court errone ously app lied the $25 0,0 00 dam ages cap

out lined in section 74. 301 of the civ il practice and reme dies code and
, instea d, shou ld have

app lied the dam ages cap provided in section 74. 303 of the civ il pr a c t ic e a nd reme dies

2code
, w hich caps dam ages at $50 0,0 00 adju sted by the consu me r price inde x

. See id. §§

74. 301 , 74 .30 3 (Ve rnon 20 05). W e a f f irm.

I. B A C K G R O U N D

T his dispu te perta ins to a jury v erdict ent ered by a Hidalgo Coun ty jury involv ing the

treat me nt and
, ultim ate ly
, the dea th of Herme s. Herme s w as a law y er w ho ran his own law

f irm in Pha rr, T exas. Herme s w as ma rried and had three children
, Sarah

, Lau ren, and
Alejan dro. In a d dition
, Herme s w as v ery close to his mo the r, Herma linda, and he of ten

of f ered v arious f orms of assistan ce, includin g mo ney, to Herme linda. By all accou nts, 1

Herme s ha d a close and loving relatio nship w ith h is f am ily

. Beginnin g in April 200 5, Herme s began experiencing strange sensa tions in his ears,

insom nia, anxiety, and severe, unre len t in g hea dach es. Herme s believed tha t the se

ma ladies w ere relate d to his ear, and he com plaine d tha t he f elt “air com ing out of one of

his ea rs.” Beca use of

the se sy mp tom s, Hermes was una ble t o slee p, co ncen trate , th ink
clearly
, and f ollow w hat peo p le we re saying
, and
, beca use he had never experience d

sy mp tom s suc h a s t h e s e bef ore, he beca me “ex trem ely anxious.” As a result, Herme s

sched uled an app ointm ent w ith a local neu rologist, Ruy Mie reles, M.D. In an atte mp t to

det ermin e the cau se o f his a bno rmal symp tom s, Dr. Mireles recom me nde d tha t Herme s

und ergo an MRI on his brain. Herme s agreed, and the MRI w as cond u c t e d o n April 14,

200 5.

W hile awaiting the results of the MRI, Herme s cont inue d to suf f er anxiety, insom nia,

and severe hea dach es. Herme s began to consid er traveling to S a n A n t o n io to seek

add itiona l help f or the se sympt om s. Herm es was v ery w orried and conce rned abo ut his

H e r m e l i n d a t e s t i f i e d a t t r i a l t h a t s h e w a s s i n g l e a n d t h a t H e r m e s ’ s b i o l o g i c a l f a t h e r l e f t t h e f a m i l y 1

w h e n H e r m e s w a s s i x y e a r s o l d

. 3hea lth. He w as describe d as a “ty pe A perso nality” at trial and som eon e w ho w as “driv en, ”

“self -mot iv ate d,” and did not take shortcu ts. By April 16, 200 5, Herme s had ex perien ced

the se sy mp tom s f or three or f our d a ys a n d had not slept at all. Herme s’s sister, Edn a

Eckroat
, testif ied tha t shortly bef ore April 16t h, she and Herme linda me t Herme s f or lunch

.
At that meet ing, Herme s app eare d to be sleep -dep riv ed, and he disclosed to them some

of the he alth prob lem s he w as h aving

.
I n t h e e a rly mo rning hou rs of April 16, 200 5, Diana, Herme s’s w if e, awoke to f ind

Herme s sitting at the kit c hen tab le. Diana w as imm edia tely conce rned beca use it

app eare d tha t Herme s, once again, had f ailed to sleep

. Herme s asked Diana to sit at the

tab le
, and he began to explain tha t the sy mp tom s w ere not going away and tha t he

inten ded to travel to a hosp ital in San Ant onio to f ind out w hat w as causin g the sy mp tom s.

At this time
, he han ded Diana a lette r, w hich w as adm itted into evidence at trial. Herme s 2

f elt like he w as losing his min d and suggested tha t he ma y be com mitt e d t o a m e nta l

institut ion in San Ant onio

. Diana pan icked and argued tha t the San Ant onio hosp ital w as

too f ar away f or her to be w ith him

. Diana convinced Herme s to go to Rio Grand e Regional
Hospita l in McAllen, T exas, inste ad.

A

. Hermes ’s A dmiss ion to Rio Grande Regional Hospital

Once Diana had convinced He rm e s t o go to Rio Grand e Regional Hospita l f or

D i a n a t e s t i f i e d t h a t t h e l e t t e r H e r m e s g a v e h e r o n A p r i l 1 6 t h d i d n o t w o r r y h e r b e c a u s e H e r m e s 2

r e g u l a r l y w r o t e h e r n o t e s w i t h l i s t s o f t h i n g s t o d o , c o n t a c t i n f o r m a t i o n , w h e r e t o g e t m o n e y , a n d s i m i l a r
m a t t e r s w h e n e v e r h e w a s t r a v e l i n g o u t o f t o w n

. D i a n a b e l i e v e d t h a t t h i s l e t t e r w a s s i m i l a r t o o t h e r n o t e s H e r m e s h a d w r i t t e n i n t h e p a s t
, s o s h e r e a d a l i n e o r t w o o f t h e l e t t e r a n d p l a c e d t h e l e t t e r i n h e r p u r s e

. T h e l e t t e r a p p a r e n t l y b e g a n w i t h t h e f o l l o w i n g s t a t e m e n t s : “ I f a n y t h i n g h a p p e n s , s w e e t h e a r t
, p l e a s e f o r g i v e m e

. Y o u s h o u l d b e s t r o n g

. ” D i a n a d e n i e d e v e r h e a r i n g H e r m e s t e l l h e r t h a t h e i n t e n d e d t o c l o s e d o w n h i s l a w p r a c t i c e ; s h e o n l y r e c a l l e d H e r m e s s t a t i n g t h a t h e w a s c o n c e r n e d a b o u t h i s h e a l t h b e c a u s e o f t h e s e v e r e h e a d a c h e s

.

A t v a r i o u s t i m e s d u r i n g H e r m e s ’ s h o s p i t a l i z a t i o n , D i a n a c a m e t o t h e h o s p i t a l t o v i s i t H e r m e s

. A p p e l l a n t s a s s e r t t h a t
, d e s p i t e h e r t r i p s t o t h e h o s p i t a l
, a t n o t i m e d i d D i a n a i n f o r m d o c t o r s a b o u t t h e c o n t e n t s
o f t h e A p r i l 1 6

, 2 0 0 5 l e t t e r w r i t t e n b y H e r m e s

. 4treat me nt, it w as between f our and five in the mornin g on April 16. Beca use the children

w ere aslee p, Diana arranged f or Herme s’s sister, Eckroat
, to me et Herme s at the hosp ital.

Diana agreed to join Herme s shortly the reafter, once she ma de arrangem ent s f or the care

of the children

. Upon arriv ing at Rio Grand e Regional Hospita l, Herme s w as adm itted and atte nde d

to by Marv in T avarez , M.D. Herme s relayed his sy mp tom s to Dr. T avarez , and Dr. T avarez

not ed the com plaint s in Herme s’s me dical records. Regarding Herme s’s initial com plaint s,

Dr. Ta v arez testif ied t hat :

T his 41-year-old ma le [Herme s] tha t [sic] w as se nt t o th e hosp ital beca use of recurrent severe hea dach es. His hea d a c h e had gotten so severe espe cially in the past several days, three to f our days, w here he f eels tha t he passe s ou t an d a ll of

a su dde n tu rns bla ck.

. . . .
He ha s to gr ab unt o [sic] som eth ing f or a f ew second s an d th en he f eels b ette r.

Furthe r, Dr. T avarez ’s not es f or trial, e ntitled “Death Su mm ary ,” indica te t hat :
[Herme s] has been ex trem ely anxious, h e is n erv ous, com plainin g tha t this hea dach e has bee n severe and he cann ot sleep f or the past 3 to 4 days. T he pat ient has not slept day and night. He com plains tha t w hen he goes to the of f ice[,] he w as not able to think clearly

. He is exhauste d. He has bee n und er a lot of pressu re. He is v ery busy. Othe r tha n this, the pat ient did not have any sy ncop al[ ] e p is o de, altho ugh he doe s com plain of som e tingling 3

sensa tion som etim es in his f ace and all his extremities com pat ib le w ith hyperv ent ilation. T his pat ient has den ied any prob lem w ith dep ression, etc. He has never expressed any prob lem w ith depre ssion. How ever, in talking to Dr. Mi re le s , h e also never had any suggestion tha t the pat ient w as dep ressed

.
Dr. T ava re z a d mitt ed Herme s w ith a diagnosis of “[s]evere recurrent hea dach es,

“ S y n c o p e ” i s d e f i n e d a s t h e “ [ p ] a r t i a l o r c o m p l e t e l o s s o f c o n s c i o u s n e s s w i t h i n t e r r u p t i o n o f 3

a w a r e n e s s o f o n e s e l f a n d o n e s s u r r o u n d i n g s

. W h e n t h e l o s s o f c o n s c i o u s n e s s i s t e m p o r a r y a n d t h e r e i s
s p o n t a n e o u s r e c o v e r y , i t i s r e f e r r e d t o a s s y n c o p e o r , i n n o n [

- ] m e d i c a l q u a r t e r s , f a i n t i n g

. ” D e f i n i t i o n o f S y n c o p e , M e d ic in e N e t

. c o m , a v a i l a b l e a t h t t p : / / w w w

. m e d t e r m s

. c o m / s c r i p t / m a i n / a r t

. a s p ? a r t i c l e k e y = 5 6 1 2 ( l a s t

v i s i t e d S e p t

. 2 9

, 2 0 1 0 )

. 5f atigue, f aintin g- like spells, and question able hyperv ent ilation. ” Dr. T avarez adm itted tha t

Herme s’s sy mp tom s w arrante d ho s p italiz ation and not ed tha t the hosp ital staf f w ould

evaluate Herme s f urthe r. Dr. T avarez orde red tha t Herme s be assigned to a priv ate room

in the hosp ital. Lab w ork w as als o orde red, and Herme s w as place d on a Holter

mo nitor—a telem etry mo nitor—b ecau se Herme s had com plaine d tha t his hea rt w as racing

and tha t he w a s dizz y

. An EKG, oth erw ise known as an electro cardiogram
, w as also

orde red in add itio n to a daily dose of ten milligr am s of Lexapro, an ant idep ressan t

me dicatio n.

Herme s w as the n d ir e c ted to the telem etry u nit, w here his chest w as shaved and

f iv e E K G transm itters, w hich mo nitor the hea rt, w ere place d on his chest

. T hese

transm itters relayed inf orma tion to the nurse s’ statio n in the hosp ital f or f urthe r evaluation ;

if the transm itters w ere ever remo v ed, the equipm ent w ould imm edia tely not if y the nurse s

of the discon nect ion.

Once Herme s w as out f itted w ith the EKG transm itt e rs , T o m m y Yee, M.D., a

neu rologist, v isited w ith Herme s. Af ter spea king w ith Herme s, Dr. Yee ma de not es similar 4

to tho se of Dr. T avarez regarding Herme s ’s sy mp tom s. Dr. Yee not ed tha t the re w as a

f am ily history of schizophren ia, but adm itted tha t Herme s den ied bein g dep ressed

. Dr. Yee

recom me nde d tha t Dr. T a va re z wa it on the results of the April 15 MRI cond ucte d by Dr.

Mireles to d ete rmine f urthe r treatm ent . Dr. Yee p rescribed Herme s “ a mild anti[-]an x iety

me dicatio n” and suggested tha t Herme s und ergo a psychiatric consu ltation ; howev er, Dr.

5

D r

. T a v a r e z n o t e d t h a t D r

. M i r e l e s w a s n o t a v a i l a b l e o n A p r i l 1 6

, s o D r

. Y e e w a s a s k e d t o t r e a t 4 H e r m e s

.

T h e a n t i

- a n x i e t y m e d i c a t i o n p r e s c r i b e d b y D r

. Y e e w a s l a t e r i d e n t i f i e d a t t r i a l a s 0

. 2 5 m i l l i g r a m s o f

5 X a n e x , t o b e g i v e n b y m o u t h w h e n H e r m e s e x p e r i e n c e d i n s o m n i a a n d e v e r y f o u r h o u r s a f t e r w a r d s a s n e e d e d f o r s l e e p

. A p p e l l a n t s ’ e x p e r t
, J a n A l l e n F a w c e t t
, M

. D

. , t e s t i f i e d t h a t s h e i s a p h y s i c i a n a n d p s y c h i a t r i s t a n d t h a t t h e d o s a g e o f X a n e x g i v e n t o H e r m e s w a s t h e “ l o w e s t p r e s c r i b a b l e [ s i c ] d o s e ” a n d w a s a “ g e r i a t r i c d o s e

. ” 6Yee state d tha t the nece ssity of the psychiatric consu ltation w as lef t to Dr. T a va re z ’s

discretion

.
B. Nurse G ay e La pura Berga do’s Car e of Herme s on the E v ening of A pril 1 7

At 7:0 0 p.m

. on April 17, 200 5, Gaye Lap u ra B e rg ado
, R.N., began serv ing as

Herme s’s atte ndin g nurse

. In her d epo sition, Nurse Bergado reme mb ered f irst seein g

Herme s w alking the halls of the hosp ital a li t t le b e f o re 9:0 0 p.m

. on April 17. Nurse
Bergado assesse d Herme s’s hea lth and not iced tha t doct ors had diagnose d Herme s w ith

“recurrent severe hea dach es, anxiety, and

. . . f aintin g spells or sy ncop e.” Nurse Bergado

state d tha t Dr. Yee had cond ucte d a psychiatri c c on s ul tatio n w ith Herme s the previous day.
Nurse Bergado recalled tha t Herme s w as sleep -dep riv ed giv en tha t he had not slept w ell

f or several days. In cond ucting her assessm ent
, Nurse Bergado utiliz ed t h e “Glasgow

Com a Scale ” and oth er me asure s and conclu ded tha t Herme s w as strong, a lert, and 6

required no risk-behavior preca ution s. Nurse Bergado also cond ucte d an initial psychiatric

check and not ed tha t Herme s w as “alert and orient ate d” and w as not v iolent
, aggr essive,

or dest ructiv e. Nurse Bergado adm itted tha t Herme s’s me dical records include d a not ation

tha t a “psy chiatric consu lt” had bee n cond ucte d and indicat ed tha t Herme s ma y have had

a “psy chiatric prob lem .” In any event, Nurse Bergado det ermin ed tha t she did not nee d to

do any neu rological assessm ent or ma nagem ent or assess Herme s’s “coping and supp ort”

nee ds. Nurse Bergado testif ied tha t Herme s w a s “ve ry a lert” and “oriente d” and tha t he

v erba liz ed or expressed w hat he f elt. At 9:0 0 p.m ., Nurse Bergado
, upo n his request, gav e

D r

. F a w c e t t a l s o r e c o u n t e d H e r m e s ’ s h e a l t h h i s t o r y , w h i c h i n c l u d e d h o s p i t a l i z a t i o n s i n 1 9 9 2

, 1 9 9 6

, a n d 2 0 0 0 f o r a n x i e t y , a n d n o t e d t h a t X a n e x h a d b e e n p r e v i o u s l y p r e s c r i b e d t o t r e a t H e r m e s ’ s a n x i e t y

.

T h e “ G l a s c o w C o m a S c a l e ” i s a “ s c a l e f o r m e a s u r i n g t h e l e v e l o f c o n s c i o u s n e s s , e s p e c i a l l y a f t e r 6

a h e a d i n j u r y , i n w h i c h s c o r i n g i s d e t e r m i n e d b y t h r e e f a c t o r s : a m o u n t o f e y e o p e n i n g , v e r b a l r e s p o n s i v e n e s s , a n d m o t o r r e s p o n s i v e n e s s

. ” G l a s c o w C o m a S c a l e , a v a i l a b l e a t h t t p : / / m e d i c a l

- d i c t i o n a r y

. t h e f r e e d i c t i o n a r y

. c o m / G l a s g o w + C o m a + S c a l e ( l a s t v i s i t e d S e p t

. 2 1

, 2 0 1 0 )

. 7Herme s 0.2 5 milligr am s of Xanex. A coup le hou rs later, Herme s c o m p la in e d t o Nurse

Bergado abo ut a hea dach e, and
, af ter spea king w it h Dr

. T a varez, Nurse Bergado gav e

Herme s on e gram of

T y leno l.

Herme s’s me dical records ref lect tha t at 6:0 0 a.m

. on April 18, Nurse Bergado ’s shif t

w as over and she w as read y to giv e her report to the next shif t nurse, Nora M uno z , R.N.

Nurse Bergado subse quently gav e her repo rt to Nurse Muno z prior to leaving the hosp ital

at 7 :00 a.m

. 7

C. The Res ults of the MRI

At som e poin t during the day on April 18, Dr. Mireles v isited w ith bot h Herme s and

Diana at t he hosp ital. Dr. Mireles in f orme d Herm es a nd Diana of the results of the MRI,

w hich rev eale d tha t Herme s’s brain w as f unct ioning norm ally

. Dr. Mireles em pha siz ed tha t

Herme s nee ded to relax and rest. How ever, the results of the MRI did not com f ort Herme s

beca use he w as sti ll conce rned abo ut his app aren t inab ility to sleep and the recurring

hea dach es. In lig ht of Herme s’s conce rn s , t h e doct ors at the hosp ital suggested tha t

Herme s extend his hosp ital stay and plan to be discha rg ed f rom the hosp ital on April 19.

Herme s and Diana w er e bot h v ery conce rned abo ut Herme s’s sy mp tom s, espe cially in lig ht

of the f act t hat the re w as “no ph y sical explana tion. ”

D. Nurse Be rgado’s Care of Hermes on the Ev ening of A pril 1 8

Nurse Bergado returne d to the hosp ital to w ork ano the r shif t on the evening of April

18. She testif ied th a t a ro u n d 8 : 0 0 p.m ., she resum ed caring f or Herme s. At this time
,
Nurse Bergado checke d Herm e s ’s vit al signs. Nurse Bergado recalled tha t doct ors had

include d in Herme s’s me dical records tha t the checkin g of his v ital signs shou ld be

N u r s e B e r g a d o s t a t e d t h a t s h e w o r k e d a t t h e h o s p i t a l a s a s h i f t n u r s e o n A p r i l 1 7
, 2 0 0 5
, f r o m 7 p

. m

. 7 t o 7 a

. m

. t h e n e x t d a y

. 8discon tinue d w hile Herme s w as sleep ing. In add ition, Herme s w as not allowed any v isitors

at night so tha t he could get som e sleep

. Even tho ugh doct ors orde red tha t Herme s’s v ital
signs w ere not to be checke d w hile he w as sleep ing, app ellees’ expert, Suzann e Frederick,

R.N., not ed tha t the nurse s w ere still required to check on Herme s thr o u gho ut the night

und er th e a pplicab le sta nda rd of care f or nu rses.

In any event, shortly af

ter Nurse Bergado too k his v ital signs, Herme s began w alking

the hallway s of the hosp ital. Nurse Bergado ’s not es indicat e tha t arou nd 8:3 0 p.m

. on April

18, Herme s too k a shower, even tho ugh he had alread y previously showered earlier in the
day at 12: 00 p.m

. Once he f inished showering at 9:0 0 p.m ., Hermes w as giv en one 0.2 5
milligr am tablet of

X ane x by mo uth

. App rox ima tely an hou r later, Herme s w as g iv en one

t e n-milligr am tab let of Am bien
, a hypnotic tha t “is giv en to help peo ple sleep .” T h is wa s

the f irst time Herme s ha d e v er ta ken Am bien

. 8

Nurse Bergado believed tha t af ter taking the se me dicatio ns, Herme s slept unt il she

w as sum mo ned by Herme s f or mo re Xanex at 2:0 0 a.m

. on April 19. Nurse Bergado gav e

Herme s ano the r 0.2 5 milligr am tab let of Xanex e v en tho ugh she w as “conce rned ” abo ut

the add itiona l dosa ge. Nurse Bergado also ackno w ledged tha t w hen Herme s sum mo ned

her at 2:0 0 a.m ., he app eare d to be v ery anxious and did not app ear to have slept mu ch.

In f act, Nurse Bergado later adm itted tha t s h e wa s u n s u re if Herme s had slept at all.

Nurse Be rg ado test if ied t hat she che cked on Herme s som e tim e b etween 2 :00 an d 4:0 0

a.m

. on April 19 and again at 4:0 0 a.m

. She recalled seein g Herme s aslee p at 4:0 0 a.m

.
At 5:0 0 a.m

. on April 19, Herme s once agai n s um mo ned Nurse Bergado

. At this

D i a n a t e s t i f i e d t h a t H e r m e s w a s g e n e r a l l y r e l u c t a n t t o t a k e a n y k i n d o f m e d i c a t i o n a n d t h a t A m b i e n 8 h a d b e e n p r e v i o u s l y p r e s c r i b e d f o r H e r m e s ’ s i n a b i l i t y t o s l e e p ; h o w e v e r , H e r m e s n e v e r c o n s u m e d a n y o f t h e
m e d i c a t i o n , a s e v i d e n c e d b y t h e f a c t t h a t D i a n a c o u n t e d a l l o f t h e A m b i e n p i l l s i n t h e b o t t l e a n d d e t e r m i n e d t h a t n o p i l l s w e r e m i s s i n g

. 9time
, he requeste d toiletries and a raz or so he could shave portio ns of his chest w here the

EKG transm itters w ere place d. Herme s specif ically indicat ed to Nurse Bergado t h a t he

w ant ed to sh ower and shave his ch est h imse lf . Nurse Be rg ado w ent to the supp ly room

of the h o s p ital and retrieved v arious toiletries and a dou ble-ed ged raz or, w hich Nurse
Bergado testif ied w as the sam e type of raz or giv en to all pat ien t s

. Upon returnin g to

Herme s’s room w ith th e su pplies, Nurse B ergado assisted H erme s i n removing the EKG

transm itters, gav e him the dou ble-ed ged raz or and oth er toiletries, and the n lef t the room

.
Even tho ugh bot h Nurses Muno z and Frederick testif ied tha t it w as unu sual f or a nurse to

allow a pat ient to shave his own chest and tha t nurse s typically shave a pat ient’s bod y hair,

Nurse Bergado did not believe tha t Herme s’s request w as odd

. Moreover, Nurse Bergado

did n ot b elieve tha t Herm es was suicidal when she gav e h im t he raz or.

Nurse Bergado testif ied in her dep osition tha t Herme s began taking a shower a little

af ter 5:0 0 a.m

. and tha t she shou ld have checke d to see how he w as doin g abo ut an hou r

later at 6:0 0 a.m

. T he record, howev er, doe s not indicat e tha t Nurse B e rg a do checke d 9

on Herme s again. Herme s’s me dical records showed tha t Nurs e Bergado w as read y to
giv e her repo rt to Nurse Muno z , the next shif t nurse , at 6:0 0 a.m

. on A p ri l 19. Upon

com pletin g her shif

t at 7:0 0 a.m ., Nurse Bergado inf orme d Nurse Muno z tha t Herme s w as

still in the shower and tha t he had indicat ed tha t he w ould call the nu rs es w hen he had

com plete d his shower. It is und ispute d tha t no one saw Herme s f rom arou nd 5:0 0 a.m

. to

app rox ima tely 8:30 a.m ., while he w as p urpo rtedly in the sho w er. 10

T e s t i m o n y a t t r i a l d e s c r i b e d H e r m e s ’ s h o s p i t a l r o o m a s c o n t a i n i n g a s i n k a n d m i r r o r o u t s i d e o f t h e 9

a r e a d e s i g n a t e d a s t h e b a t h r o o m a n d n o t e n c l o s e d ; t h u s , i t w a s p o s s i b l e f o r H e r m e s t o s h a v e h i s c h e s t w h i l e l o o k i n g i n t h e m i r r o r i n h i s h o s p i t a l r o o m s o t h a t t h e n u r s e s c o u l d e a s i l y o b s e r v e h i m

.

A t e l e m e t r y r e a d i n g w a s p r o d u c e d a t 7 : 3 4 a

. m

. o n A p r i l 1 9

, n o t i n g t h a t t h e E K G t r a n s m i t t e r s w e r e 10

n o t b e i n g u s e d b y H e r m e s a n d i n d i c a t i n g t h a t H e r m e s w a s i n t h e s h o w e r

. 10Sho rtly af ter 7:3 0 a.m ., Nurse Muno z looke d in Herme s’s room and discovered tha t

he w as not in his bed

. She later tried to ope n the bat hroo m doo r, but the doo r w as locked

.
She saw a brea kf ast tray prep ared f or Herme s “just sitting the re” und isturbe d and une ate n.

Nurse Muno z asked ano the r nurse to com e over and try to ope n the doo r. T his secon d

atte mp t to ope n the bat hroo m doo r w as unsu ccessf ul, so m a in t ena nce w as called to

remo v e th e d oor with a screwdriv er.

Once the bat hroo m doo r w as remo v ed, the nurse s f oun d him dea d in the bat htu b. 11

An investig ation rev ealed th at H er me s had horribly mu tilated him self w ith the dou ble-ed ged

raz or and the n bled to dea th over the course of a coup le hou rs. Upon discovering Herme s

dea d in the bat htu b, the nurse s f oun d a suicide not e tha t had bee n w ritten by Herme s. In

this not e, Herme s asked fo r f orgiv ene ss and not ed tha t he had desce nde d into ma dne ss

and tha t, by killing himself , he intend ed to spare his fa mily the shame he associa ted w ith

com mitm ent to a m ent al institu tion.

E x pert testim ony prese nte d by app ellees describe d Herme s’s dea th a s a s lo w
exsanguinatio n, or blee ding to d e a t h. App ellees’ experts testif ied tha t Herme s w as
prob ably aliv e as late as 8:0 0 a.m

. and possib ly 8:1 5 a.m ., bef ore he bled to dea th. Dr. 12

T avarez state d tha t he believed tha t Herme s died at app rox ima tely 7:4 5 a.m

. An aut opsy 13

repo rt indicat ed tha t Herme s cut him self on bot h sides of his neck and bot h arms. Robe rt

H e r m e s ’ s b o d y w a s d i s c o v e r e d i n t h e b a t h r o o m a t a p p r o x i m a t e l y 8 : 2 5 a

. m

. o n A p r i l 1 9

. 11

T h i s s t a t e m e n t w a s s u p p o r t e d b y n o t e s c o n t a i n e d i n H e r m e s ’ s m e d i c a l r e c o r d s t h a t D r

. T a v a r e z 12 l i s t e n e d f o r H e r m e s ’ s h e a r t b e a t a n d d i s c u s s e d p o s s i b l y i n t u b a t i n g H e r m e s a s l a t e a s 8 : 3 4 a

. m

. ; t h u s , a p p e l l e e s ’ e x p e r t s c o n c l u d e d t h a t w h e n H e r m e s ’ s b o d y w a s d i s c o v e r e d
, h e w a s “ j u s t f r e s h l y d e c e a s e d

. ” F u r t h e r , H e r m e s ’ s m e d i c a l r e c o r d s r e f l e c t e d t h a t H e r m e s ’ s b o d y w a s f l a c c i d a n d t h a t r i g o r m o r t i s h a d n o t s e t i n w h e n h i s b o d y w a s d i s c o v e r e d

.

H o w e v e r , o n c r o s s

- e x a m i n a t i o n , D r

. T a v a r e z c o n t r a d i c t e d h i m s e l f b y t e s t i f y i n g t h a t “ [ a t ] 7 : 4 5 [ a

. m

. , ] 13 h e w a s a l i v e

. I w a s t h e r e a t 8 : 0 0 o ’ c l o c k [ s i c ] i n t h e m o r n i n g

. ” 11Charles Bux, M.D., a boa rd-certif ied ana tom ical, clinical, and f oren sic pat holo gist and one

of app ellees’ expert w itnesse s, testif ied tha t he believed tha t Herme s cut his neck f irst, his

le f t a rm s e cond
, and his rig ht arm at the elbo w third. Dr. Bux believed tha t the c u t t o

Herme s’s rig ht a rm was the injury that proved to be f ata l. 14

E. The Law suit
App ellees f iled the ir o rig inal pet ition against a ppe llants, am ong ot hers, on August

16, 200 6, assertin g me dical ma lpractice claim s perta ining to Herme s’s dea th. Doctors

Mireles, Marv in T avarez , Hiram T avarez , and Yee w ere also nam ed as partie s to

app ellees’ origi nal pet ition; howev er, the se individuals w ere non -suited and are not partie s

to this app eal. App ellees’ liv e plea ding, the ir f ourth am end ed pet ition, w as f iled on Janu ary
16, 200 8, and asserte d w rongf ul dea th and me dical ma lpractice claims against app ellant s
specif ically and alleged tha t app ellant s w ere negligent in: (1) “[f ]ailing to prop erly
,
ade quately a nd/ or time ly assess HERMES VIL LARREA L”; (2) “[p]roviding HERMES

VIL LARREA L w ith a dou ble[-]e dged raz or”; (3) “[f ]ailing to prop erly and time ly mo nitor

and /or check-o n HERMES VIL LARREA L”; (4) “[f ]ailing to provide a saf e environme nt”; (5)
“[f ]ailing to cont act atte ndin g physician(s)”; (6) “[f ]ail in g to giv e a prop er repo rt to the

I n h i s “ D e a t h S u m m a r y , ” D r

. T a v a r e z n o t e d t h e f o l l o w i n g r e g a r d i n g H e r m e s ’ s d e a t h : 14

I d i d n o t s e e t h i s p a t i e n t [ H e r m e s ] f r o m t h e t i m e h e w a s a d m i t t e d o n S a t u r d a y , a n d t h e n I

c a m e i n o n T u e s d a y m o r n i n g t o m a k e r o u n d s , a n d w a s a d v i s e d t h a t t h e p a t i e n t w a s i n t h e
s h o w e r , b u t h e w a s n o t a n s w e r i n g

. A t t h a t t i m e , t h e h e a d n u r s e h a d a l r e a d y o r d e r e d a c a l l f o r s e c u r i t y t o c o m e a n d o p e n t h e d o o r

. T h i s w a s o p e n e d s h o r t l y t h e r e a f t e r , a n d t h e p a t i e n t

w a s f o u n d i n t h e t u b u n c o n s c i o u s

. H e h a d c u t h i s w r i s t
, h i s e l b o w s a n t e r i o r l y , a n d a l s o h i s t h r o a t b i l a t e r a l l y s l a s h e d

. H e h a d s o m e b l o o d i n t h e a n t e r i o r c h e s t a n d u p p e r s t o m a c h w h i c h h a d a l r e a d y s t a r t e d c o a g u l a t i n g

. T h e r e w a s a l s o s o m e b l o o d i n t h e t u b
, w h i c h w a s m i n o r
c o m p a r e d t o t h e l e s i o n t h a t h e h a d
, b u t i t i s p o s s i b l e t h a t t h i s b l o o d h a d r u n d o w n t h e d r a i n

. T h e p a t i e n t w a s i n a p o s i t i o n , b e c a u s e o f t h e p l a c e o f t h e t u b
, t h e p a t i e n t w a s l y i n g i n t h e
s a m e f a c e u p

. H e w a s h a r d t o e x a m i n e , h e w a s m o v e d b y t h e n u r s e s t o t h e f l o o r o u t s i d e t h e b a t h r o o m , s o t h a t w e c o u l d e x a m i n e h i m

. A t t h a t t i m e , w e t h o u g h t m a y b e i f w e w o u l d h a v e t o i n t u b a t e , t h i s w o u l d b e a b e t t e r p o s i t i o n

. H o w e v e r , u p o n e x a m i n a t i o n , p u p i l s w e r e d i l a t e d

a n d f i x e d

. T h e p a t i e n t w a s n o t b r e a t h i n g , t h e r e w a s n o h e a r t s o u n d
, a n d t h e p a t i e n t w a s p r o n o u n c e d d e a d

. T h e s u p e r v i s o r c a l l e d t h e n e c e s s a r y p e r s o n n e l i n t h e h o s p i t a l [
, ] a n d t h e p o l i c e d e p a r t m e n t w a s a l s o c a l l e d

. A f t e r t h a t
, t h e p o l i c e t o o k o v e r

. 12onco min g nurse , assigned to care f or HERMES VIL LARREA L”; and (7) “[v ]iolatin g hosp ital

policies and proce dure by f ailing to take suicide preca ution s.” App ellees also asserte d tha t

app ellant s w ere respon sible fo r the negli gent actions of i ts nurses and doct ors unde r the

the ory of respo nde at supe rior. Furthe r, app ellant s re qu e s ted dam ages on beh alf of 15

Diana, Sa rah, Lau ren, Alejan dro, and Herme linda und er th e wr ongf ul de ath an d su rv iv al
provisi ons of the civ il practice and reme dies code

. See id. §§ 71. 001 -.022 (Verno n 200 8).
App ellant s f iled three supp lem ent al a n s we rs challen ging the causa tion elem ent of

ap p e ll e e s ’ c a uses of action and assertin g the af f irmative def ense of suicide. See id. §

93. 001 (a)(2).

T he case proce ede d to trial, and af ter several w eeks of trial, the jury conclu ded tha t

app ellant s w ere negligent in the ir treat me n t of Herme s and app ortion ed the m 75%

respo nsibl e f o r He rmes’s dea th. T he jury also conclu ded tha t Diana and Herme s w ere

15% and 10% respo nsible, respe ctiv ely, and awarded app ellees several million dollars in

dam ages. T he trial court, howev er, redu ced the jury ’s dam age award in accord ance w ith

t he statu tory dam age caps out lined in section 74. 301 of the civ il practice and re m e d ie s

code

. See id. § 74. 301 (Verno n 200 5) (capp ing non -econ om ic dam ages f or each claima nt

in a hea lth care liability claim at $25 0,0 00). T he trial court’s dam age award is as fo llow s:

• Diana: $45 ,32 5 in non -econ om i c da ma g es , $1 10,700 in econ om ic dam ages, and $1 1,0 24. 51 in pre -judgmen t inte rest f or a tota l of $1 67, 049 .51 ;

• Sarah : $58 ,47 5 in non -econ om ic dam ages, $78 ,30 0 in econ om ic dam ages, and $7 ,79 7.8 2 in pre-judgm ent inte rest f or a tota l of $1 44, 572 .82 ;

R e s p o n d e a t s u p e r i o r i s a l e g a l t h e o r y b a s e d o n v i c a r i o u s l i a b i l i t y i n w h i c h o n e p a r t y , t h o u g h n o t 1 5

n e g l i g e n t i t s e l f

, i s r e s p o n s i b l e f o r t h e n e g l i g e n c e o f a n o t h e r p a r t y b a s e d o n t h e r e l a t i o n s h i p b e t w e e n t h e p a r t i e s

. S e e V e c e l l i o I n s

. A g e n c y , I n c

. v

. V a n g u a r d U n d e r w r i t e r s , 1 2 7 S

. W

. 3 d 1 3 4
, 1 3 8 ( T e x

. A p p

. – H o u s t o n [ 1 s t D i s t

. ] 2 0 0 3

, n o p e t

. ) ; S t

. A n t h o n y ’s H o s p

. v

. W h i t f i e l d
, 9 4 6 S

. W

. 2 d 1 7 4
, 1 7 8 ( T e x

. A p p

. – A m a r i l l o 1 9 9 7
, w r i t d e n i e d ) ; s e e a l s o P i c k a r d v

. B r o w n , N o

. 1 3

- 0 7

- 0 0 2 4 5

- C V
, 2 0 0 9 T e x

. A p p

. L E X I S 3 6 9

, a t * * 1 7

- 1 8 ( T e x

. A p p

. – C o r p u s C h r i s t i J a n

. 2 2

, 2 0 0 9

, n o p e t

. ) ( m e m

. o p

. )

. 13• Lau ren: $58 ,475 i n no n- ec on om ic dam ages, $78 ,30 0 in econ om ic dam ages, and $7 ,79 7.8 2 in pre-judgm ent inte rest f or a tota l of $1 44, 572 .82 ;

• Alejan dro: $ 5 8
, 4 7 5 in non -econ om ic dam ages, $78 ,30 0 in econ om ic dam ages, and $7, 797 .82 in pre-judgm ent intere st f or a tota l of $14 4,5 72. 82; and

• Herme linda: $29 ,25 0 in non -econ om ic dam ages, $90 ,00 0 in econ om ic dam ages, and $8, 963 .01 in pre-judgm ent intere st f or a tota l of $12 8,2 13. 01.

In su m, app ellees w ere awarded $72 8,9 80. 98 in dam ages, plus court costs and post

judgme nt in terest

.
Sho rtly the reaf ter, app ellees f ile d a m otion to mo dif y and a mo tion f or new trial,

cont end ing tha t the j uryi ncorrectly app ortion ed Diana 15% negli gent fo r Herme s’s dea th

and tha t the trial court shou ld have app lied the statu tory dam age cap describe d in section

74. 303 of the civ il prac t ic e a n d re m e dies code rathe r tha n section 74. 301

. See id. §

74. 303 (a)-(b) (Verno n 200 5) (provi ding tha t in a w rongf ul dea th or surv iv al action on a

hea lth care lia b il it y claim, the limit of civ il liability f or all dam ages, includin g exemp lary

dam ages, is $50 0,0 00 f or each claima nt and this am oun t shall be increase d or decre ased
“by a sum equal to the am oun t of such limit mu ltiplied by the pe rc e n t a ge in crease or

decre ase in the consu me r price inde x

. . . bet w een August 29, 197 7, and the time at w hich

dam ages subje ct to such limits are awarded by f inal judgme nt or settle me nt”). App ellees
argued tha t by app ly ing the section 74. 3 0 3 dam age cap, the trial court shou ld have

awarded the m $1, 788 ,32 5 in dam ages. T he record doe s not ref lect tha t the trial court 16

ruled on ap p e ll ees’ mo tion to mo dif y and mo tion f or new trial; thu s, the se mo tions w ere
overruled by ope ration of law. See T E X

. R. C I V

. P. 329 b(c).

A p p e l l e e s a r r i v e d a t t h i s c a l c u l a t i o n b y d i v i d i n g t h e J u l y 2 0 0 8 c o n s u m e r p r i c e i n d e x ( 2 1 9

. 9 6 4 ) b y 16 t h e A u g u s t 2 9

, 1 9 7 7 c o n s u m e r p r i c e i n d e x ( 6 1

. 5 )

, w h i c h e q u a l s 3

. 5 7 6 6 5 0

, a n d t h e n m u l t i p l y i n g t h a t n u m b e r b y t h e $ 5 0 0

, 0 0 0 d a m a g e s c a p p r o v i d e d i n s e c t i o n 7 4

. 3 0 3

. S e e T E X

. C I V

. P R A C

. & R E M

. C O D E A N N

. § 7 4

. 3 0 3 ( a )

- ( b ) ( V e r n o n 2 0 0 5 )

. 14App ellant s f iled a mo tion to mo dif y and a mo tion f or judgme nt not w ithsta ndin g the

v erdict. B o t h o f t h e se mo tions w ere den ied by th e trial court. App ellant s and app ellees

bot h tim ely filed no tices o f ap pea l in th is ma tter.

II. L E G A L S U F F I C I E N C Y

In the ir f irst three issues, app ellant s challen ge the legal suf f iciency of the evidence

supp orting the jury ’s v erdict. Spe cif ically
, app ellant s assert tha t the record cont a in s no

evidence tha t: (1) Herm es’s suicide w as f orese eab le by hosp ital em ployees; (2) the

nurse s’ alleged acts or om issions w ere a subst ant ial f acto r in bringing a b out Herme s’s

dea th, or, in oth er w ords, tha t Herme s’s suicide w as an intervening a n d supe rseding

cause ; and (3) Herme s’s dea th w as proximate ly cause d by the brea ch of a legal dut y owed
by app ellant s to Herme s. App ellees coun ter by arguing tha t it w as f orese eab le f or hosp ital

em ployees to ant icipate t h a t som e injury w ould occur giv en Herme s’s sy mp tom s, the

me dicatio n he w as taking, the f act tha t Nurse Bergado gav e him a dou ble-ed ged raz or and

allowed him to shave his o wn chest
, and the f act tha t no one checke d on Herme s f or

a lm o s t three hou rs on the mo rning of April 19. App ellees f urthe r argue tha t the re c o rd

ref lects tha t: (1) app ellant s’ action s and om issions w ere a subst ant ia l f acto r in causin g

Herme s’s dea th; (2) app ellant s owed Herme s a d uty to a ct reaso nab ly during his stay a t

the ho spital; and (3) Herme s’s suicide w as n ot a n int erv enin g and supe rceding cau se.

A

. Standard of Review

In a legal suf

f iciency, or “no-evidence ” rev iew
, w e det ermin e w het her the evidence

w ould en able reaso nab le an d fa ir-minde d peop le to r each the v erdict und er r eview

. City

of Keller v. W

ilson
, 168 S.W .3d 802

, 827 (Te x

. 2 0 0 5 ). I n ma king t his det ermin ation
, w e

credit f a vo ra ble evidence if a reaso nab le f act-f inde r could
, and w e disregard cont rary

15evidence unle ss a reaso nab le f act-f inde r could not

. Id. W e consid er the evidence in the

lig ht mo st f avorable to the f inding und er rev ie w a n d indu lge every reaso nab le inf eren ce

tha t w ould supp ort it. Id. at 822

. So long as the evide n ce f alls w ithin the z one of

reaso nab le disagreem ent
, w e ma y not subst itute our judgme nt f or tha t of the f act-f inde r.

Id. T he trier of f act is the sole judge of the credibil it y o f t h e wit n e sses and the w eight to
giv e the ir tes t im ony. Id. at 819

. Altho ugh w e consid er the evidence in the lig ht mo st

f avorable to the challen ged f indings, indu lg in g every reaso nab le inf eren ce tha t supp orts

the m, w e m ay not d isregard evidence tha t allows only one inf eren ce. Id. at 8 22.

Beca use the jury is the sole judge of the w itnesse s’ credibility, it ma y choo se to

believe one w itness over ano the r, and this Court cann ot imp o s e its own opin ion to the

cont rary

. Id. at 819 ; see Arias v. Brookst one , L

. P.
, 265 S.W .3d 459
, 468 (Te x

. App .–Hou ston [1st Dist. ] 200 7, pet

. den ied). Furthe r, w e mu st assum e tha t the jury

resolved all conf licts in accord ance w ith its v erdict if reas o n a b le h u m an bein gs co uld do

so. City of K

eller , 16 8 S .W .3d at 819 ; Arias , 26 5 S .W .3d at 468

.
B. A pplica ble La w

In a m e d ic al ma lpractice case, the plaint if f is required to show evidence of a

reaso nab le me dical prob ability tha t the injury w as proximate ly cause d by the def end ant ’s
negligence. Park Place Hosp. v. Esta te of Milo
, 909 S.W .2d 508

, 511 (Te x

. 199 5); Duff v.

Yelin , 75 1 S.W .2d 175, 176 ( T ex. 198 8). T he plaint if f must prove: ( 1) a dut y on the pa rt

of the def en d a n t t o act accord ing to app licable stan dard s of care; (2) a brea ch of the

app licable stan dard of care; (3) an injury ; and (4) a c a u s a l c o nne ction, or proximate

causa tion, bet w e en the brea ch of the stan dard of care and the injury

. See Ocomen v.

Rubio
, 24 S.W .3d 461

, 466 (Te x

. App .–Hou ston [1st Dist.] 200 0, no pet .); see also Mariner

16Health Care of Nashville, Inc. v. Robins
, No. 01-0 8-00 830 -CV, 20 1 0 T ex. App

. LEXIS

511 4, a t *2 1 (T ex. App .–Hou ston [1st Dist.] Ju ly 1, 201 0, n o p et.).

In the instan t case, the partie s’ argume nts cent er on the caus a t io n elem ent

.
Proximate causa tion is com prised of tw o com pon ent s: (1) the cause -in-fa ct or “substa ntial

f acto r”; and (2) f orese eab ility

. Transcon

. Ins. Co. v. Crum p , No. 09-0 005
, 201 0 T ex. LEXIS

616
, at **28 -2 9 (T e x

. Aug. 27, 201 0) (citing IHS Ceda rs Treatment Ctr. of Desoto
, Tex.,

Inc. v. Mason
, 143 S.W .3d 794
, 798 (Te x

. 200 3)); Leitch v. Hornsby
, 935 S.W .2d 114
, 118

-

19 (Te x

. 199 6); Travis v. City of Mesqu ite
, 830 S.W .2d 94, 98 (Te x

. 199 2). Foresee ability
requires tha t a person of ordina ry i nte llig ence w ould hav e anticipa ted the danger cause d
by the negli gent act or om ission. Doe v. Bo ys Clubs o f Grea ter Dallas , Inc., 907 S.W .2d

472
, 478 (Te x

. 199 5). Foresee ability doe s not require tha t a perso n ant icipate the precise

ma nne r in w hich an injury w ill occur once he has create d a dan gerous situat ion throu gh his
negligence. See Travis , 83 0 S .W .2d at 98. Inste ad, fore seea bility r equires only

that the
general dan ger, not the exact sequen ce of events tha t prod uced the harm
, be f orese eab le.

W alker v. Harris
, 924 S.W .2d 375
, 377 (Te x

. 199 6); see Lee Lew is Constr., Inc. v.

Harrison , 70 S.W .3d 77 8, 7 85 (Te x . 20 01). T hus, the question of f orese eab ility

involv es

a practica l inquiry base d upo n “comm on experience app lied to h u m a n c o n duct .” City of

Glade wa ter v. Pike
, 727 S.W .2d 514

, 518 (T e x. 198 7) (citing Cook Consu ltant s, Inc. v.

Larso n , 700 S.W .2d 231

, 236 (Te x

. App .–Dallas 198 5, w rit ref ’d n.r.e .)); see Hall v. Son ic

Drive-In of Ang leton , In c. , 17 7 S .W .3d 63 6, 6 48-4 9 (T ex. App .–Hou ston [1st Dist.] 2005

, pet

. den ied). Im porta ntly, “[f ]orese eab ility requires mo re tha n som eon e, v iew ing the f acts

in retrospe ct, the oriz ing an e xt ra o rd inary sequen ce of events w here by the def end ant ’s

cond uct brings abo ut the injury .” Boys Club of Great er D allas, Inc. , 907 S.W .2d at 478

. 17On t he oth er ha nd, “[t]h e te st f or cause -in-fa ct is w het her the act or om ission was

a subst ant ial f acto r in causin g the injury ‘w ithou t w hich the harm w ould not have occurred .’”

Harrison
, 70 S.W .3d at 784 (q uot ing Boys Clubs of Grea t er Dallas, Inc.
, 907 S.W .2d at

477 ). Evi den ce tha t shows only tha t the def end ant ’s alleged negligence did no mo re tha n

f urnish a co nditio n th at ma de the alleg ed injuries possible w ill not suff ice to esta blish th e

“cause -in-fa ct” com pon ent of proximate cause

. See Mason
, 1 4 3 S.W .3d at 799

. Moreover, beca use bot h cause -in-fa ct a n d f orese eab ility elem ent s are required in

esta blishing proximate causa tion, a claima nt w ho est a b li s h es only tha t an injury w as

f orese eab le cann ot prevail. See Grider v. Mi k e O’ Brien, P.C.

, 260 S.W .3d 49, 57 (Te x

. App .–Hou ston [1st Dist.] 200 8, pet

. den ied); see also Robins
, 201 0 T ex. App

. LEXIS 511 4,

at * 22.

W het her a particu lar act of negligence is a cause -in-fa ct of an injury is a particu larly

apt q uest ion f or j urydeterm inatio n. Farley v. MM Cattle Co. , 529 S.W .2d 751, 756 ( T ex.

197 5); see Tex. Dep’

t of Trans

p

. v. Pat e , 170 S.W .3d 840
, 848 (Te x

. App .–T exarkana

200 5, pet

. den ied). Furthe r, the jury has broa d latitude to inf er proximate cause f rom the

evidence and the circumst ance s surroun ding the injury- prod ucing act, esp ecially w hen it

is not possib le to prod uce direct proo f of proximate cause or lack of proximate cause

. J.K.

& Su sie W

adle y Resea rch Inst. & Bloo d Ban k v. Bee son , 835 S.W .2d 689

, 698 (Te x

. App .–Dallas 199 2, w rit den ied) (citing Harris v. LaQ uinta -Redbird Joint Ve n t u re , 522

S.W .2d 23 2, 2 36 (Te x . Civ . Ap p.– T exarkana 197 5, wri t ref ’d n. r.e.)).

“In a me dical ma lpractice case, brea ch of the stan dard of care and proximate cause

mu st be esta blished throu gh expert testim ony.” Ocomen

, 24 S.W .3d at 466

. O p in io n

testim ony tha t am oun ts to “mere conje cture, guess, or specu lation ” is not suf f icient.

18Mason
, 143 S.W .3d at 798 -99; Price v. Divita
, 224 S.W .3d 331
, 337 (Te x

. App .–Hou ston

[1st Dist.] 200 6, pet

. den ied). Expert opin ion testim ony tha t is conclu sory or specu lative

doe s not ten d to ma ke the existence of a ma terial f act “‘more prob able or less prob able ,’”

and it is neith er relevant nor com pet ent

. Coasta l Transp. Co. v. Crown Cent. Pet roleum
Corp. , 13 6 S .W .3d 22 7, 2 32 (Te x . 20 04) (quotin g T E X

. R. E V I D

. 401 ).

Proximate causa tion in a me dical ma lpractice case mu st be base d upo n reaso nab le

me dical prob ab il ity
, see Park Place Hosp. v. Esta te of Milo
, 909 S.W .2d 508
, 511 (Te x

.
199 5), and “[t]he quantu m of proo f required is simp ly tha t it is mo re likely tha n not tha t the

u lt im ate harm or cond ition resulte d f rom such negligence.” Kram er v. Lew isville Me m’

l
Hosp.
, 858 S.W .2d 397
, 400 (Te x

. 199 3). A plaint if f is not required to exclude every oth er

reaso nab le hypothe sis, see Marvelli v. Alston
, 100 S.W .3d 460
, 470 (Te x

. App .–Fo rt W orth

200 3, pet

. den ied), and mo re tha n one proximate cause ma y exist. Lee Lew is Constr., Inc.

v. Harrison
, 70 S.W .3d 778
, 784 ( T ex. 200 1) ( det ermin ing w het her the w rongf ul act “ w as
‘a’ proximate cau se, n ot ‘th e’ pro x ima te ca use” o f de cede nt’s d eat h).

C. Discus sion

On app ea l, app ellant s challen ge the tw o com pon ent s—cause -in-fa ct and

f orese eab ility

—of causa tion perta ining to app ellees’ me di c a l ma lpractice claims.
App ellant s do not dispu te the dut y and brea ch elem ent s of app ellees’ cause of action

. In

the trial court, the crux of app ellees’ claims against app ellant s p e rt a in ed to the f ailure of
hosp ital staf

f to prop erly assess Herme s’s psychiatric nee ds and Nurse Bergado ’s action s

of providing Herme s a dou ble-ed ged raz or to shave his chest by him self and not checkin g

on him f or app rox ima tely three hou rs, even tho ugh he w as hea v ily me dicate d and had not
slept mu ch d ue to h is illness.

191. A ppelle es’ Ev idence

At trial, Suzann e Frederick, R.N., a registered n u rs e with am ple experience as

critical care directo r and nurse supe rv isor at several dif f eren t hos p it a ls
, t estif ied tha t the

stan dard of care f or the nurse s at the hosp ital w as to: (1) closely mo nitor the ef f ects of the

v arious me dicatio ns tha t Herme s w as taking, i nclud ing tho se he had never take n bef ore;
(2) assist Hermes in taking a shower so as to prevent him f rom f alling down or fa inting in

the sho w er; and (3) provide a sa f e e nvir onm ent , which did n ot in clude providing Hermes

w ith a dou ble-ed ged raz or to shave his chest by him self

. Nurse Frederick the n explained

the preca ution s associa ted w ith the v arious me dicatio ns tha t Herme s w as prescribed

. In
particu lar, Nurse Frederick not ed tha t Xanex and Lexapro cont ain w arnings regarding the

pot ent ial f or causin g pat ients to co m m it s u icid e. She also not ed tha t Herme s w as
prescribed Xa n e x f or previous hea dach es, but he had never take n Am bien bef ore. She

later describe d the pot ent iating ef f ect tha t Xanex and Am bien have, bot h of w hich cause 17

the dep ression of the cent ral nervous sy stem
, dizz iness, drowsi ness, and unst e ady

w alking. In f act, bot h of the se me dic a t io ns cont ain explicit instructio ns f rom the

ma nuf actu rer caut ioning tho se w ho take the drugs to not ope rate hea v y ma chine ry

. Nurse

Frederick also testif ied that , be cause of the po ten tiating ef

f ect o f the drugs an d b ecau se

Herme s had never take n Am bien bef ore, Nurse Bergado shou ld have assesse d Herme s’s

hea lth m ore regularly and mo nitore d h im f or side ef f ects.
Regarding Herme s’s request f or a raz or and a shower, Nurse Frederick state d tha t

Nurse Bergado shou ld not have allowed Herme s to shower by him self giv en the pot ent ial

P o t e n t i a t i o n i s d e f i n e d a s “ a s y n e r g i s t i c a c t i o n i n w h i c h t h e e f f e c t o f t w o d r u g s g i v e n s i m u l t a n e o u s l y 17 i s g r e a t e r t h a n t h e s u m o f t h e e f f e c t s o f e a c h d r u g g i v e n s e p a r a t e l y

. ” P o t e n t i a t i o n , a v a i l a b l e a t h t t p : / / m e d i c a l

- d i c t i o n a r y

. t h e f r e e d i c t i o n a r y

. c o m / p o t e n t i a t i o n ( l a s t v i s i t e d S e p t

. 2 1

, 2 0 1 0 )

. 20ef

f ects of the drugs on Herme s. She also state d tha t Nurse Bergado shou ld have v iew ed

Herme s’s thi rd s h o we r request in the last seventee n hou rs as suspiciou s and tha t she

shou ld not have allowed Herme s t o s h ave his chest by him self

. Spe cif ically
, Nurse

Frederick sta ted tha t:

T his guy has anxi ety. She [Nurse Berg ado ] testif ied that the reaso n she gav e him the Xanex w as beca use of a n xie t y. O bviously [,] he had n’t slept hard ly at all during the night, ma y be a little but not mu ch. And the n he’s asking f o r a ra zor saying it’s to shave his chest

. W ell, the nurse s do the shaving of the chest

. Plus[, ] the chest gets shaved w hen w e put tho se lead s on initially

. T hose lead s had to com e of f at 8:0 0 p.m

. T hose lead s had to
com e of f at 12: 00. And the n one oth er time he had a shower during his stay, I believe? And so it is suspiciou s and she shou ld have bee n suspiciou s and she shou ld have w orried. She shou ld have talked to him and asked him w hy do y ou w ant to do this? I’m un com f ortab le w ith y ou taking a shower. M ost of all, she shou ldn’t have let him to go to the shower, lock the doo r[,] and be in th ere a ll by himself

.
T he stan dard of care is t o , li k e t he Nurse Practice Act says, is to provide a saf e environme nt. In the le a s t [ ,] she shou ld have asked him to keep that shower doo r ope n, a nd I’m going to sta nd rig ht o utside this ro om beca use I’m af raid you’re going to f all. Or sh e sh ould ha v e sa id, listen
, it’s f iv e in the mo rning. Let ’s w ait unt il y our w if e gets here

. Let som ebo dy be in the re w ith y ou. She shou ld have reaso ned w ith him

. She shou ld have asked him w hat ’s going on? W hat are y ou f eeling?

. . . .
She shou ld have called a nursing supe rv isor. She shou ldn’t have let him go in the shower by him self

. W hen he specif ically asked f or a raz or, the red f lag shou ld ha v e gone up

.

. . . .
No. I certain ly haven’t allowed a pat ient to shave the ir [sic] own chest

.

. . . .
Beca use—a nd particu larly in this case, this guy has all the se drugs on boa rd in his sy stem

. Num ber 1, y ou know, the nurse knows w here the lead s nee d to be pla c e d

. You’re going to let a guy w ith all the se drugs be doin g this num ber, shaving his chest ? She shou ld be conce rned he is going to cut

21him self . I have never allowed a pat ient to shave their [sic] own che st. T he

nurse do es it f or th em [,] Nu rse Muno z said the sam e th ing.

Lat er, Nurs e F re d e rick w as shown the dou ble-ed ged raz or tha t Nurse Bergado
provided to Hermes, and N urse Frederick stated tha t she had not seen that ty pe of r azor

used in a hosp ital settin g in recen t history and tha t she w ould not have giv en Herme s any
type of raz or. Nurse Frederick disagreed w ith Nurse Bergado ’s state me nts tha t the

gov erning stan dard of care only required tha t she check in on Herme s abo ut every hou r.

Nurse Frederick believed tha t, und er the circumsta nces, Herme s nee ded to be mo nitore d

mo re closely. Base d on the se f acto rs, Nurse Frederick conclu ded tha t app ellant s f ailed 18

to provide a saf e environme nt f or Herme s and ultim ate ly create d a situat ion tha t led to

Herme s’s dem ise.
App ellees also re f eren ced dep osition test imo ny by Nurse Mun oz, w ho state d tha t

it w as “w eird” tha t: (1) Herme s requeste d a raz or und er the circumsta nces; and (2) Nurse
Bergado gav e him the raz or and lef t him alon e. W ith regard to Herme s’s request to shave

his chest
, Nurse Muno z not ed tha t she w ould have help ed him shave his chest rathe r tha n

allow him to do it him self . Nurse Muno z also testif ied that H erme s’s inten se head ache s,
anxiety, and insom nia could have bee n sy mp tom s of dep ression f or w hich app ellant s

app aren tly f ailed to consi d e r or devise a neu rological treat me nt plan

. Nurse Muno z

N u r s e F r e d e r i c k a l s o p o i n t e d o u t t h a t N u r s e B e r g a d o d i d n o t e v e n c o m p l y w i t h t h e s t a n d a r d o f c a r e 18

a b o u t w h i c h s h e o p i n e d b e c a u s e t h e r e c o r d c l e a r l y r e f l e c t s t h a t f r o m t h e t i m e H e r m e s w a s g i v e n t h e d o u b l e

e d g e d r a z o r u n t i l h e d i e d
, n e i t h e r N u r s e B e r g a d o n o r a n y o t h e r n u r s e c h e c k e d t o s e e h o w H e r m e s w a s d o i n g i n t h e b a t h r o o m

. T h e r e c o r d o n l y s h o w s t h a t N u r s e M u n o z b r i e f l y p e e r e d i n t o H e r m e s ’ s r o o m a t a r o u n d 7 : 3 0

a

. m

. , e v e n t h o u g h H e r m e s w a s i n t h e b a t h r o o m w i t h t h e d o o r c l o s e d a n d l o c k e d

. I n f a c t
, N u r s e M u n o z n o t e d i n H e r m e s ’ s m e d i c a l r e c o r d s t h a t a t 7 : 3 4 a

. m

. , h e w a s s t i l l i n t h e s h o w e r

.

N u r s e F r e d e r i c k a l s o o p i n e d t h a t t h e e q u i p m e n t u s e d t o m o n i t o r H e r m e s ’ s h e a r t r e g u l a r l y r e l a y e d i n f o r m a t i o n t o t h e n u r s e s ’ s t a t i o n a b o u t t h e c o n d i t i o n o f H e r m e s ’ s h e a r t a n d t h a t H e r m e s ’ s m e d i c a l r e c o r d s
r e f l e c t e d t h a t h e w a s o f f t h e h e a r t m o n i t o r f o r s e v e r a l h o u r s o n t h e m o r n i n g o f A p r i l 1 9

, w h i c h i l l u s t r a t e s t h a t

n o o n e w a s m o n i t o r i n g H e r m e s a n d t h a t n o o n e q u e s t i o n e d w h y h e w a s o f f h i s h e a r t m o n i t o r f o r s o l o n g d u r i n g t h e t i m e h e w a s i n t h e s h o w e r

. 22ackno w ledged tha t if a hosp ital em ployee put a pat ient at risk f or possib le injury
, the n such

an act would violate the ap plicable stan dard of care.
App ell e e s c a lle d a secon d expert w itness, Gary Michael Glass, M.D., a boa rdcertif ied psychiatrist, to testif y abo ut Herme s’s me nta l state

. Dr. Glass state d tha t the only

reaso n th e d rug Lexapro w ould have bee n prescribed to Herme s w ould be f or trea tm ent

of dep ression. Dr. Glass rev iew ed Herme s’s me dical records and co n c lude d tha t the

nurse s at the hosp ital f ailed to do a tho rough psycho-social assessm ent and tha t Herme s’s

sy mp tom s w ere signif icant eno ugh to require a me nta l-status examina tion, w hich

app aren tly w as not cond ucte d w hile Herme s w as hosp italiz ed. W ith respe ct to the dou bleedge d ra zo r, Dr. Glass testif ied tha t Nurse Bergado ’s act in giv ing it to Herme s w as

“abso lutely, one hun dred perce nt inap prop riate and dan gerous, obvio u s ly .” Dr. Glass

f urthe r opin ed tha t:

You have a ma n w ho had obvious psychiatric prob lem s. He w as adm itted to the hosp ital w ith three diagnose s, tw o of w hich w ere psychiatric in nat ure. T he neu rological consu ltant said this isn’t neu rological, w ait f or th e resu lts, but look into psychiatry f or the issues. He’s on psychiatric me dicines. Again, it is the nursing staf

f ’s respo nsibility to know the me dicines. He’s on an ant i[- ]de pressa nt and he’s on an ant i[-]anxiety and he’s on a sleep aid. W e don ’t do tha t f or a han gnail. Ob v iously, w e d o th is f or som ebo dy w ho’s anxious, dep ressed [,] and has troub le sleep ing. T he beh avior itself has not bee n assesse d. T he gentl e m an too k a shower earlier in the evening. He too k extra dose s of me dicatio n. W hy o n earth w ould he decid e at 5 : 00 a.m ., to
w ant to shave his chest and take a s h ower. Now
, conce iv ably t here might be legitimate reaso ns. I dou bt it, but the re could be, but no one asked him

. No one said, hey, w ait a min ute
, this is a little odd
, num ber one ; num ber tw o, this ma n has bee n on the se d o s e s o f me dicines f or a v ery short time and he’s gotten an extra dose

. Nurse Bergado doe sn’t know or certa inly hasn’t

w ritten tha t he’s able to stan d up, get arou nd[ ,] and w alk w ithou t f alling over f rom the se med icines. He’s on a telem etry unit. He’s pay ing a premiu m to be on a telem etry unit, beca use the re is a consid eratio n tha t the re’s a serious prob lem w ith his hea rt.

. . . Nur s e B e rg a d o , w ithou t asking anybod y or checkin g w ith anyone or certain ly not recording tha t, simp ly take s this of f [the telem etry leads] and says, go, go on into the sho w er.

23. . . .

T here ’s no oversig ht, the re’s no tho ught to this. Okay?

. . . Unf ortun ate ly
, w e’re dealing w ith suicide, but this man could have simp ly fallen and hit his hea d. He could have trippe d, any num ber o f thin gs could h ave hap pen ed, sepa rate and apa rt f rom suicide, tha t could have bee n v ery seriously harm f ul to h im, all be hind tha t locke d d oor, w ith o r w ithou t a raz or.

. . . .
She [Nurse Bergado ] took no pains, in fa ct, nob ody on the staf f too k any pain s to investig ate w hat clearly w as a serious psychiatric ailme nt, and
, as a result, [Herm es is] d ead

.
Dr. Glass th en not ed tha t, in his op inion, ha d so me one che cked on Herme s w hile

he w as in the shower, he might still b e a li ve t o d a y. Dr. Glass f urthe r not ed tha t, in

reaso nab le me dical prob ability, if the app licable stan dard of care had bee n me t in this case

and had the raz or not bee n provided by Nurse Bergado
, Herme s w ould have surv iv ed the
hosp italiz ation an d would h ave bee n tre ate d f or his p sy chiatric a ilmen ts. 19

Dr. Bux, ano the r expert wit n e s s c a lle d by app ellees, testif ied as to how Herme s

killed him self and conclu ded tha t, af ter rev iew ing Herme s’s me dical records, he w as likely

still aliv e as late as 8:1 5 a.m

. on April 19. Dr. Bux not ed tha t w hen Nurse Muno z allegedly

pee red into Herme s’s room at 7:3 0 a.m ., it w as likely tha t Herme s w as still aliv e and “most
likely salvag eab le

. ” Dr. Bux adm itted on cross-examina tion tha t the re is not hing in

Herme s’s me dical records indicat ing t hat he had suicidal ten den cies or t h a t doct ors had

orde red t hat Herme s be restraine d f or prot ection f rom him self

.
2. A ppella nts’ Ev idence

On app eal, app ellant s argue tha t Herme s’s injuries and dea th w ere not f orese eab le

D r

. G l a s s c l a r i f i e d t h a t s o m e , b u t n o t a l l
, s u i c i d e s a r e p r e v e n t a b l e , a n d t h a t m o s t p e o p l e s u f f e r i n g 19 f r o m d e p r e s s i o n w h o r e c e i v e t r e a t m e n t
, “ g e t b e t t e r

. ” D e s p i t e t h e f a c t t h a t n o t a l l s u i c i d e s a r e p r e v e n t a b l e , D r

. G l a s s t e s t i f i e d t h a t H e r m e s ’ s s u i c i d e w a s p r e v e n t a b l e h a d a p p e l l a n t s c o m p l i e d w i t h t h e a p p l i c a b l e
s t a n d a r d s o f c a r e

. 24and tha t the hosp ital’s action s w e re not a subst ant ial f acto r in causin g Herm es’s injuries

and dea th. App ellant s f irst direct us to the lette r tha t Herme s gav e to Diana prior to bein g
hosp italiz ed. App ellant s cont end tha t this lette r conveyed Herme s’s desp eratio n abo ut his

me nta l state and tha t beca use Diana never rev eale d the cont ent s of the lette r, the hosp ital

had no idea that Herme s w as af f ecte d by me nta l illness. Essen tially
, app ellant s cont end

tha t Herme s an d h is f am ily purp osef ully conce aled his cond ition to hide any sham e

associa ted w ith Herme s’s possib le com mitm ent in a me nta l institut ion. Furthe r, app ellant s

assert tha t Herme s den ied bein g dep ressed at the hosp ital during an initial assessm ent in

the em ergency room and to Dr. Marv in T avarez

. App ellant s direct us to Herme s’s me dical

records, w hich are largely devoid of any docu me nta tion regarding any pot ent ial f or me nta l

illness. T he only docu me nta tion in Herme s’s me dical records w hich ma y have suggested

tha t Herme s w as suf

f ering f rom me nta l illness w as a not e by Dr. Yee recom me ndin g tha t

Herme s und ergo a psychiatric consu ltation

. App ellant s not e, howev er, tha t Dr. Yee did not

orde r any kind of suicide prevention
, nor did he not e tha t He rm e s exhibited any signs o f

self -d es truction

. App ellant s f urthe r assert tha t Herme s w as interview ed by several doct ors,

includin g tw o neu rologists, during his hosp italiz ation and tha t non e of the doct ors

docu me nte d a ny concern regarding dep ression or suicida l ten den cies. 20

Nurse Bergado testif ied v ia dep osition tha t Herme s w as generally calm and orient ed
during his hosp italiz ation and tha t he w as able to think, intera ct
, and f unct ion. Nurse
Bergado f urthe r test if ied tha t Herme s w as alert, plea sant
, and coop erative w ith the

atte ndin g doct ors and nurse s. Nurse Bergado did not recall seein g Herme s exhibit any

A p p e l l a n t s s t a t e d i n t h e i r b r i e f t h a t H e r m e s w a s e x a m i n e d b y f o u r d o c t o r s a n d t h a t t w o o f t h e m h a d 20

e x p e r i e n c e w i t h t r e a t i n g p s y c h i a t r i c p a t i e n t s ; h o w e v e r , a p p e l l a n t s d o n o t e x p l a i n w h i c h d o c t o r s h a d s u c h

e x p e r i e n c e , a n d N u r s e B e r g a d o t e s t i f i e d t h a t D r

. Y e e i s a “ n e u r o d o c t o r ” a n d n o t a “ p s y c h i a t r i c d o c t o r

. ” 25v iolen t
, a gg ressiv e, or dest ructiv e beh aviors, includin g “pulling out tub es, try ing to climb

over the side rails [of the bed ],” w hen he w as und er her care. Nurse Bergado did adm it

tha t the f act tha t Dr. Yee recom me nde d tha t Herme s und ergo a “psy chiatric consu lt” might

indicat e tha t Herme s had a “psy chi a t ric prob lem .” Nevertheless, Nurse Bergado

ackno w ledged tha t she did not imp lem ent a plan to ma nage a n y p o t e ntial neu rological
prob lem s tha t Herme s might have, w hich include d enco uraging Herme s to express his

f eelings and providing “cop ing a nd supp ort.” Nurse Bergado did n o t b e li e v e tha t such a
plan w as nece ssary beca use Herme s w as alert and o ri ent ed, highly intelligent, and he
regularly expressed w hat h e f e lt

. Nu rse Bergado explained tha t she did not check on

Herme s w hile he w as in the bat hroo m beca use he had told her tha t he w ould call her w hen

he w as f inished

. Regarding the raz or, Nurse Bergado testif ied tha t the dou ble-ed ged raz or

tha t Herme s received w as the sam e type of raz or tha t oth er hosp ital pat ients received and

tha t she had provided oth er pat ients w ith raz ors in the past w ithou t supe rv ising the ir usage.
App ellant s called tw o expert w itnesse s—Dr. Marv in T avarez and Jan A. Faw cett,

M.D.—to testif

y on the ir beh alf

. Dr. T avarez not ed tha t he me t Herme s at the em ergency

room on April 16. Dr. T avarez , read ing f rom Herme s’s me dical records, the n testif ied tha t:

T his 41-year-old w hite ma le w as sent to the hosp ital beca use of
recurrence of seve re h e a d ache s. His hea dach es had gotten so severe, espe cially in the past several days, three —to—f our days, w here he f eels tha t h e passe s out and all of a sudd en turns black. He had to gr a b o n t o s o m eth ing f or a f ew secon ds and the n he f eels bet ter. He had no t h a d
, howev er, any aph eresis, w hich me ans sw eat ing w ith this. He has, howev er, not ed upo n c lo s e question ing tha t occasio nally he w ill have som e tach y cardia, or f ast hea rtbea t. Also[, ] he has not iced his hea rt racing af ter he is in bed

. T his w ill be prese nt f o r [a] f ew min ute s and af ter w hich time beco me s ba sically

asympt om atic.

. . . .

26T he pat ient also com plaine d he has a sensation of air com ing out of

his lef t ear w ith certain mo v em ent s. He has also not ed tha t his hea dach e is

v ery severe, it is all over his hea d but mo stly in the nuch al area , w hich is the back of the hea d. He h a d h as hea dach es f or ma ny y ears[; ] howev er, this has persiste d and is getting w orse to where his me nta l acuity has decre ased

. . . . T he pat ient has had num erou s stud ies don e bef ore in the past
, had an MR I, CT scan of the brain, and every thing has bee n norm al, and this pat ient has be e n e va lu ate d by Dr. Ruy Mireles and app aren tly no pat holo gy

.
Dr. Ta v arez state d th at He rmes w as gene rally relucta nt to take m edica tion, even th ough

he had requeste d Xanex to help him slee p in t h e e a rl y mo rning hou rs of April 19. Dr.

T avarez did the initial examina tion of Herme s and diagnose d him w it h “s e vere recurrent

hea dach es, f atigue, f aintin g- like spells and question able hyperv ent ilation. ” At this time
, Dr.

T avare z prescribed Herme s the ant i-depressa nt Lexapro, w hich Dr. T avarez adm itted is

used f or “anxiety and de p re s s ion.” Dr. T avarez den ied ever seein g Herme s exhibit any

beh aviors that w arrante d su icide p recau tions.

On cross-examina tion, Dr. T avarez ackno w ledged tha t Herme s likely “w as aliv e” at

7:4 5 a.m

. on April 19, w hich w as shortly af ter Nurse Muno z purp orted ly pee red into

Herme s’s room . W hen aske d whethe r doct ors ever cam e u p with a d iagnosis to explain

Herme s’s sy mp tom s, Dr. T avarez state d tha t doc t ors diagnose d Herme s w ith anxiety;

h o we ve r, Dr. T avarez adm itted tha t anxiety only explained a portio n of Herme s ’s

sy mp tom s. Lat er, Dr. T avarez testif ied tha t Herme s app eare d to be respo ndin g w ell to the

treat me nt provided and tha t he w as sched uled to be release d f rom the hosp ital later in the
day on April 19. Dr. T avarez not ed tha t no doct or w ho obse rv ed Herme s ever diagnose d

him as a risk to co mm it suicide an d th at He rmes den ied b eing de presse d.

Dr. Faw cett, a p hysici an and psychiatrist w ho has w orked at the Nation al In stitute

of Menta l Health and has stud ied su icide a nd dep ression f or m any y ears, testif ied tha t it

27is v ery dif f icult to pred ict suicide. Dr. Faw ce t t o p ined tha t Herme s had anxiety atta cks

dat ing back to 199 2, and tha t Xanex had bee n prescribed previously to treat Herme s’s
anxiety. Dr

. F a wce t t state d tha t Herme s w as only giv en 0.2 5 milligr am s of Xanex, a
“g eriatric dose ,” w hen treat ed at the hosp ital and tha t she usua lly prescribed pat ients w ith

severe anxiety one or tw o milligr am s of Xanex. In f act, Dr. Faw cett state d tha t the dosa ge

of Xanex giv en to Herme s w as the “low est prescribab le [sic] dose .” She f urthe r state d tha t,

af ter rev iew ing Herme s’s me dical records, it did not app ear tha t Herme s exhibited a level

of anxiety th at w ould ma ke a reas o n a b le p e rs o n suspe ct tha t he w as a suicide risk. Dr.

Faw cett the n explained tha t hea dach es and dif f iculty in conce ntrat ion are s ymp tom s of

bot h dep ression and obst ructiv e sleep apn ea an d t h a t Herme s had bee n previously
diagnose d in August 200 3
, wit h possib le sleep apn ea. Dr. Faw cett later describe d the

DSM4 te st th at is u sed by psy chiatrists t o m easu re de pression :

W ell, I w ould l ike to just back up fo r a minu te and tell the —I men tione d this
a little bit. But it’s v ery imp ortan t in our society w e say we ’r e d e p re ssed

w hen w e f eel bad
, and tha t’s not a d e p re ssion. Depressio n has to me et certain criteria f rom tha t DSM4 tha t I m e n t ione d. You have to eithe r have severe—y ou have to have dep ressed mo od f or tw o w eeks const ant ly o r
w hat ’s called inab ility to experience plea sure. T hat me ans w hen som eth ing hap pen s, you wi n so me thing but y ou don ’t fee l any sense of plea sure f rom it, y our kids no longer ma ke y ou f eel good. You d o n ’t enjo y the sunse t anymo re. You have no joy at a ll n o ma tter w hat hap pen s, even if good things hap pen

. You have to have on e o r tw o o f tho se sympt om s to qualif y f or dep ression, f or ma jor dep re ssion and the n y ou have to have f iv e oth er sy mp tom s in a dditio n to that, w hich have to do w ith sleep and appet ite a nd
ene rg y an d h ope lessne ss an d su icidal th oughts and thin gs like [tha t].

Dr. Faw cett did not see anything in Herme s’s record indicat ing tha t he w as d e p re ssed.

Moreover, Dr. Faw cett testif ied tha t hosp ital nurse s checke d Herme s f or dep ression every

tw elve hou rs and tha t no one , includin g doct ors, Herme s’s w if e, and Herme s’s mo the r,

suspe cted tha t Herm es was suf f ering f rom dep ression.

28Dr. Faw cett explained tha t Herme s w as prescribed a low dose —10 milligr am s—of

Lexapro and tha t Lexapro is app rov ed f or “g ene raliz ed anxiety disorde r, w hich is a disorde r

tha t doe sn’t—th e pat ient isn’t dep ressed but has pred o m in ant recurring anxiety.” Dr.

Faw cett also recalled tha t neith er of the tw o neu rologists tha t examine d Herme s not ed tha t

he looke d anxious; instea d, the y not ed tha t Herme s w as calm

. W ith regard to the Am bien
,
Dr. Faw c e t t t e stif ied tha t the Am bien tha t Herme s too k w as dissolved by h is bod y w ithin

tw o-an d-a-ha lf

hours and tha t Herme s did not have any level of Xanex in his blood at the

time of his dea th. Finally
, Dr. Faw cett state d tha t, base d on her me dical experience
, she

did not believe tha t Herme s’s suicide w as f orese eab le and tha t “the hosp ital did w hat the y

could do.

. . . [H]e [Herme s] w ould n’t have told the m anyw ay. But the re’s just no—h e w as

det ermin ed to se para te t hat ou t an d ke ep tha t to him self .”

On cross-examina tion, Dr. Faw cett adm itted tha t Herme s likely had not “comp letely

f orme d the idea of suicide” w hen he w rote the origi nal lette r to Diana on April 16; howev er,

Dr. Faw cett believe d tha t Herme s “w as desp erate ” at tha t poin t. On re-direct 21

examina tion, Dr. Faw cett state d tha t it w as not a brea ch of the app licable stan dard of care

f or Nurse Bergado to giv e Herme s the raz or be cause he ha d su ccessf ully shaved w ith it

the day bef ore. She did adm it, howev er, tha t He rmes w as no longer going to be on the

telem etry mo nitor; t h e re f o re, she imp lied tha t Nurse Bergado ’s explanat ion f or giv ing

Herme s the raz or to shave his chest beca use the telem etry s e n s o rs w ere bot hering him

w as n ot e ntirely believable.

3. Forese eabi lity

D r

. F a w c e t t a c k n o w l e d g e d t h a t a t n o p o i n t i n t h e A p r i l 1 6 l e t t e r t o D i a n a d i d H e r m e s e x p l i c i t l y 21

e x p r e s s a n i n t e n t t o c o m m i t s u i c i d e ; h o w e v e r , D r

. F a w c e t t b e l i e v e d t h a t H e r m e s , “ a h i g h f u n c t i o n i n g a n d i n t e l l i g e n t a t t o r n e y , s u c c e s s f u l l y c o n c e a l e d t h e e x t e n t o f h i s i l l n e s s b e c a u s e o f f e a r g e n e r a t e d b y h i s d e p r e s s i v e d e l u s i o n s o f d o o m

. ” 29He re , app ellees’ expert w itnesse s testif ied tha t Herme s’s injuries and dea th w e re

f orese eab le beca use of the action s of app ellant s’ em ployees. S pecif ically
, app ellees’

expert w itnesse s state d tha t hosp ital em ployees f ailed to: (1) p rope rly assess and treat

Herme s’s psychiatric illness; (2) mo nitor Herme s af te r he to ok s ev eral dif

f eren t me dicatio ns

tha t have a pot ent iating ef f ect; (3) obse rv e and assist Herme s in shaving his chest ; and (4)

check on Herme s f requent ly w hile he w as in the shower. Furthe r, a p p e ll e e s ’ expert

w itnesse s testif ied tha t it w as certain ly f orese eab le tha t Herme s w ould be injured in som e

w ay w hile he w as una tten ded in the shower w ith a raz or and und er the inf luen ce of several
drugs at one time

. T he partie s do no t disp ute tha t Herm es com mitt ed suicide; howev er,

app ellees allege tha t the action s of hosp ital em ployees cause d gr eat dan ger to Herme s’s

w ell-being and
, essen tially
, create d a dan gerous situat ion tha t led to Herme s’s injuries and

dea th. Clearly

, in det ermin ing tha t app ellant s’ em ployees brea ched the dut y of care owed

to Herme s and in awarding dam ages, the jury conclu ded tha t Herme s’s injuries and dea th

w ere f orese eab le. W e a gr ee.

As n ote d e arlier, the juryw as only required to f ind t hat ap pellan ts cou ld f orese e a
general dan ger, rathe r tha n the exact sequen ce of events tha t prod uce d t h e harm

. See

Harrison
, 70 S.W .3d at 785 ; see also W alker
, 924 S.W .2d at 377

. Moreover, the jury w as

not required to conclu de tha t app ellant s could f o re s e e t h e precise ma nne r in w hich the
injury to He rm e s occurred once the dan gerous situat ion w as create d by app ellant s’

purp orted negligence. See Travis
, 830 S.W .2d at 98. T hus
, it wa s n ot incum ben t upo n

the jury to conclu de tha t a p p e ll a n t s could f orese e tha t, as a result of the creatio n of a

dan gerous situat ion, Herme s w ould com mit suicide. See Harrison
, 70 S.W .3d at 785 ; see

also W alker
, 924 S.W .2d at 3 7 7

. I n s t e a d, the jury nee ded only t o conclu de tha t by: (1)

30giv ing Herme s a dou bled -edged raz or to shave his chest desp ite the f act tha t the bat hroo m

did not have a m ir ro r; (2) f ailing to prop erly assess and treat Herme s’s psychiatric

cond ition; (3) f ailing to mo nitor the ef f ects of the several dif

f eren t me dicatio ns tha t Herme s

w as taking; (4) f ailing to consid er tha t Herme s w as suf f ering f rom severe hea dach es and
anxiety w hich of

ten cause d him to beco me dizz y and unst ead y ; and (5) neglecting to check

on Herme s w hil e h e was in the bat hroo m f or app rox ima tely three hou rs, a perso n of

ordina ry intelligence could have ant icipate d tha t the purp orted negligent acts of app ellant s’

em ployees w ould hav e caused g reat dan ger to Herme s’s w ell-being. See Boys Clubs of

Great er Dallas, Inc.
, 907 S.W .2d at 478 ; see also Harrison
, 70 S.W .3d at 785 ; W alker
, 924

S.W .2d at 377

.
On a ppe al, a ppe llants a sk us t o re-weig h th e e v iden ce a ddu ced at trial and arriv e

at a dif f eren t con clusion or, in oth er w ords, subst itute ou r judgme nt f or th at o f the jury ’s.
App ellant s direct us to v arious portion s of the test imo ny prov ided by Nurse Be rg ado an d

Doctors T avarez and Faw c e t t tha t ma y cont radict the testim ony of app ellees’ expert

w itness and supp ort app ellant s’ cont ent ion tha t Herme s’s injuries a n d d e ath w ere not

f orese eab le. How ever, as state d abo v e, the jury is the sole judge of the w itnesse s’
credibility and the w eight to be assigned to cont rary evidence, and this cou rt m a y n ot
imp ose its own o p in io n t o t h e c ont rary

. See City of Keller
, 168 S.W .3d at 819 ; see also

A ri a s , 265 S.W .3d at 468

. Giv en its v erdict, the jury clearly believed the testim ony
provided b y

ap pellee s’ experts an d reje cted the test imo ny of ap pellan ts’ w itnesse s.

In v iew ing the evidence in the lig ht mo st f avorable to the jury ’s v erdict and crediting

f avorable e v iden ce if a reaso nab le f act-f inde r could
, and disregarding con trary evidence

unle ss a reaso nab le f act-f inde r could not
, w e conclu de tha t th e negligent action s of

31app ellant s’ em ployees abo ut w hich app ellees com plain create d a dan gerous situat ion tha t

w as det rimen tal to Herme s’s w ell-being. See Boys Club of Great er Dallas, Inc.
, 907

S.W .2d at 478 ; see a ls o Ha rrison
, 70 S.W .3d at 785 ; W alker
, 924 S.W .2d at 377

.
Furthe rmore , beca use of the dan gerous situat ion create d b y it s em ployees, app ellant s

shou ld have ant icipate d tha t Herme s w ould susta in som e type of injury as a result of the

com plaine d-of negligent action s com mitt ed by appe llants’ e mp loyees. See Harrison
, 70

S.W .3d at 785 ; W

alker , 92 4 S .W .2d at 377 ; see also Travis , 83 0 S .W .2d at 98.

4. Cause -In-Fact

Altho ugh the T exas Sup reme Court has state d tha t “‘the cond uct of the def end ant

ma y be too atte ntu ate d f rom the resulting injuries to the plaint if f to be a subst ant ial f acto r

in bringing abo ut the harm ,’” Provide nce Health Ctr. v. Dow ell
, 262 S.W .3d 324
, 329 (Te x

.
200 8) (q uot ing Mason
, 143 S.W .3d at 799 ), w e conclu de, base d on the f acts of this case,

tha t app ellant s’ acts or om issions of : (1) f ailing to prop erly ass e s s a n d t re at Herme s’s
psychiatric cond ition and closely mo nitor the ef f ects tha t the Xanex, Lexapro, and Am bien

me dicatio ns had on Her m e s ; (2 ) givi ng Herme s a dou bled -edged raz or of the type not

com mo nly use d in mo st hosp itals t o s h a ve his chest by h imse lf in the bat hroo m tha t did

not h a ve a mirror in w hich Herme s could v iew his progress; and (3) f ailing to check on

Herme s f or app rox ima tely three hou rs w hile he w as in the shower w ere subst ant ial f acto rs

in c a u sing Herme s’s injuries and dea th. Several w itnesse s testif ied tha t had app ell a n t s

com plied w ith the app licable stan dard s of care in this case, Herme s w ould li k e ly s t il l be

aliv e. See Harrison , 70 S.W .3d at 784 ; see also Boys Clubs of Great er Dallas, Inc. , 90 9

S.W .2d at 477

. App ellees’ expert w itnesse s testif ied tha t Herme s exhibited several

sy mp tom s typically associa ted w ith dep ression, y et app ellant s f ail e d t o e x am ine the

32possib ility of dep ression. Base d on the record bef ore us, w e believe tha t Herme s’s dea th

could have bee n prevente d had app ellant s com plied w ith the app licable stan dard s of care.
App ellant s, in det ermin ing tha t Herme s w as not suf f ering f rom a psychiatric illness,

argue tha t Herme s, a non -med ical prof ess io n al, state d tha t he w as not dep ressed

.
Ho we ve r, He rmes’s me dical records indicat e tha t Dr. Yee recom me nde d tha t Herme s

und ergo a psychiatric consu ltation ; no psychiatric consu ltation to o k p la ce beca use

app ellant s’ em ployees believed tha t such a consu ltation w as not nece ss a ry giv en tha t

Herme s ap pea red t o b e “ale rt an d o rienta ted .”

On app eal, app ellant s rely hea v ily on the supre me court’s hold ing tha t evidence tha t

dem o n s t ra t e s o nly tha t the def end ant ’s alleged negligence did no mo re tha n f urnish a

cond ition tha t ma de the alleged injuries possib le doe s not suf f ice to esta blish the cause -inf act com pon ent of proximate cause

. See Mason
, 143 S.W .3d at 799

. Base d on our rev iew

of the record, app ellant s’ em ployees did f ar mo re tha n simp ly f urnish a cond ition tha t ma de

Herme s’s injuries possib le. In rely ing on the supre me court’s hold ing in Mason
, app ellant s

essen tially argue tha t the sole transgression in this case is Nurse Bergado ’s giv ing Herme s

a d oub le-edged razor and leaving him a lone to shave. See id.
App ellees alleged in the ir liv e plea ding a sy stem -w id e f ailure on the part of

app ellant s in diagnosin g, assessin g, and treat ing Herme s’s psychiatric illness. In oth er

w ords, app ellees asser t e d t hat app ellant s engaged in a cont inuing pat tern of negligent

beh avior tha t ultim ate ly cause d Herme s’s in ju ries. App ellees argued tha t app ellant s
ignored n um erou s “red f lags” that signified tha t Herm es was suf f ering f rom som e kind of
psychiatric il ln e s s , f ailed to provide ade quate treat me nt f or tha t illness, and create d an
ongoing dan gerous situat ion tha t end angered Herme s’s w ell-being and ultim ate ly cause d

33his injuries and de ath

.

Clearly , w ith its v erdict, the jury , af ter hearing the testimo ny of both parties’ ex pert

w itnesse s and rev iew ing the trial exhibits, det ermin ed tha t app ellant s’ action s or om issions

w ere a subst ant ial f acto r in causin g Herme s’s injuries and dea th. See Farley
, 529 S.W .2d

at 756 ; see also P a t e , 170 S.W .3d at 848

. In consid ering the evidence in the lig ht mo st

f avorable to the jury ’s v erdict and cr editin g f avorable ev iden ce if a rea sona ble f act-f inde r

could and di s regarding cont rary evidence unle ss a reaso nab le f act-f inde r could not
, w e

conclu de tha t the jury w as reaso nab le in conclu ding tha t app ellant s’ action s const itute d a

subst ant ial f acto r or, in oth er w ords, w er e a cause -in-fa ct in bringing abo ut Herme s’s
injuries and dea th. See Crum p , 201 0 T ex. LEXIS 616
, at **28 -29; Mason
, 143 S.W .3d at

798 ; see also P ark Place Hosp. , 90 9 S .W .2d at 511 ; Kram er , 85 8 S .W .2d at 400

.
5. Interv ening a nd Superc eding Caus es
Nevertheless, app ellant s argue tha t He rm es’s suicide w as an intervening,

supe rseding cause w hich negate d any causa tion f inding. Spe cif ically
, app ellant s cont end

tha t “‘[w ]he re an action is brou ght und er a w rongf ul dea th statu te[, ] the general rule is tha t

suicide const itute s an intervening f orce w hich brea ks t h e li n e of causa tion f rom the

w rongf ul act to the dea th and the ref ore the w rongf ul act doe s not rend er def end ant civ illy

liable.’” Exxon Corp. v. Breche en , 526 S.W .2d 519

, 523 (Te x

. 197 5) (q uot ing Ann ota tion,

Civil Liab ility for Death by Suicide

, 11 A.L .R. 751 (195 0)); see She ll Oil Co. v. Humphre y ,
880 S.W .2d 17 0, 1 74 (Te x . Ap p.– Housto n [1 4th Dist.] 1 994 , wr it de nied ).

T he supre me court has recen tly state d tha t “[i]f the act or om ission alleged to have

bee n a new and inde pen den t cause is reaso nab ly f orese eab le a t t he time of the

def end ant ’s alleged negligence, the new act or om ission is a concu rring cause as opp osed

34to a supe rseding or new and inde pen den t cause .” Colum bia Rio Grand e Health care, L.P

.

v. Haw ley
, 284 S.W .3d 851
, 857 ( T ex. 200 9) ( citing Dew v. Crown D errick Erecto rs, Inc.
,
208 S.W .3d 448
, 451 (Te x

. 200 6) (plurality opin ion)). “A new and inde pen den t cause

alters the nat ural sequen ce of eve n t s , p ro d uces results tha t w ould not oth erw ise have

occurred
, is an act or om ission not brou ght into ope ration by the origi nal w rongf ul act of the

def end ant
, and ope rates ent irely inde pen den tly of the def end ant ’s allegedly negligent act

or om ission.” Id. (citing Dew
, 208 S. W

. 3 d at 451 ). In ana ly z ing w het her an intervening

cause is new a nd inde pen den t, rathe r tha n supe rceding, t h e s upre me court has app lied

the v arious f acto rs set f orth in section 442 of the Restat em e n t (Secon d) of T orts, w hich
provide:
(a) the f act tha t its intervention brings abo ut harm dif f eren t in kind f rom tha t
w hich would o the rw ise ha v e resu lted f rom the acto r’s neglig ence ;
(b) the f act tha t its o pera tion or th e co nseque nces the reof app ear af ter the event to be extraordinary rathe r tha n norm al in v iew o f t h e circumsta nces existing at the tim e o f

its op eratio n;
(c) the f act tha t the int e rve ning f orce is ope rating inde pen den tly of any situat ion create d by the acto r’s negligence, or, on the oth er han d, is or is not
a n orma l result o f

such a situ ation ;
(d) the f act tha t the ope ration of the intervening f orc e is due to a third perso n’s act or to his f ailure t o a ct;
(e ) t he f act tha t the intervening f orce is due to an act of a third perso n t h a t is w rongf ul toward the oth er and as such subje cts the third perso n to liability to h im; [an d]
(f ) the degree of culpa bility of a w rongf ul act of a third perso n w hich sets the intervening f orce in m otion

.
Id. (citing R E S T A T E M E N T (S E C O N D ) O F T O R T S § 442 (196 5)); see Hum b le O il & Ref. Co. v.

W hitte n , 427 S.W .2d 313

, 315 (Te x

. 196 8) (a d o p t in g the section 442 f acto rs); see also

35Cow

art v. Km art Corp. , 20 S.W .3d 77 9, 7 84 (Te x . Ap p.– Dallas 20 00, pe t. d enie d).

On t he oth er ha nd, T exas courts have he ld th at m ore t han one action m ay be th e
proximate cause of t h e sam e injury

. W ilson v. Brister

, 982 S.W .2d 42, 44 (Te x

. App .–Hou ston [1st Dist.] 199 8, pet

. den ied) (citing B ro o k s h ir e Bros., Inc. v. Lew

is
, 911

S.W .2d 791
, 7 9 3 (T e x. App .–T y ler 199 5, w rit den ied)). T he negligence of one doe s not

excuse th e n eglig ence of an oth er an d w here bot h the acto r’s neglig ent con duct an d th at

of a third perso n bring abo ut the injury
, the rule of concu rrent causa tion app lies. Id. (citing

Atch ison v. Tex. & Pac. Ry.
, 143 T ex. 466
, 186 S.W .2d 228
, 231 (194 5); Lew is
, 911

S.W .2d at 793 ; R E S T A T E M E N T (S E C O N D ) O F T O R T S § 439 (197 7)). T he rule of concu rrent

causa tion provides tha t all perso ns w ho cont ribute to the injury are liable. Id. (citing Berry

P ro p

. Mgm t., Inc. v. Bliskey
, 850 S.W .2d 644
, 655 (Te x

. App .–Corp us Christi 199 3
, wri t

dism ’d by agr.))

. “Th e intervention of an unf orese en cause of injury doe s not nece ssarily

me an the re is a n e w a n d inde pen den t cause of such chara cter as to const itute a

supe rceding cause w hich w ill reliev e a def end ant f rom liability .” Br o w n sville Med. Ctr. v.

Gracia

, 704 S.W .2d 68, 73 (Te x

. App .–Corp us Christi 198 5, w rit ref ’d n.r.e .). T he
intervening cause of the plaint if f ’s injury
, even if unf orese eab le, ma y be a concu rring cause

if the chain of causa tion f low ing f rom the def end ant ’s origi nal negligence is cont inuo us and

unb roken

. W

ilson
, 982 S.W .2d at 44 (citing Bell v. Campbe ll
, 434 S.W .2d 117

, 122 (Te x

.
196 8); Henry v. Housto n Ligh ting & Pow er Co.

, 934 S.W .2d 748

, 753 (Te x

. App .–Hou ston
[1st Dist.] 19 96, w rit den ied)); see Gracia , 70 4 S .W .2d at 73.

On app eal, app ellant s urge us to app ly the section 442 f acto rs of the Restat em ent
(Secon d) of T orts to conclu de tha t Herme s’s suicide w as an intervening and supe rseding

36cause of the injuries alleged in this case. How ever, w e have alread y conclu ded tha t the 22

record esta b li s h ed tha t Herme s’s injuries and dea th w ere f orese eab le. T here f ore, in

app ly ing supre me court prece den t
, Herme s’s suicide, at best
, w ould be consid ered a

concu rrent cause

. See Haw ley
, 284 S.W .3 d at 857 ; see also Dew
, 208 S.W .3d at 451
(stating tha t “[a] new and inde pen den t cause is one tha t intervenes bet w een the origi nal

w rong and the f inal injury such tha t the injury is attribu ted to the new cause rathe r tha n the

f irst and mo re remo te cause ” and tha t a supe rseding cause can be distinguishe d f rom a

concu rrent cause if the injury tha t is the intervening f orce is bot h unf orese eab le and its

conse quence s are une x pect ed, me anin g it prod uces results tha t w ould not oth erw ise have

occurred ); Robe rt R. W alker, Inc. v. Burgd orf

, 150 T ex. 603
, 244 S.W .2d 506
, 509 (195 1).

T hus, w e do not believe tha t Herme s’s suicide “‘operat ed ent irely inde pen den tl y’” o f t h e
ongoing negligent action s of app ellant s’ em ployees so tha t the suicide ma y be const rued

a s s u perse ding. See Dew
, 208 S.W .3d at 451 (q uot ing 1 J.D. L E E & B A R R Y A. L I N D A H L ,

I f w e w e r e t o r i g i d l y a p p l y t h e f a c t o r s s e t f o r t h i n s e c t i o n 4 4 2 o f t h e R e s t a t e m e n t ( S e c o n d ) o f T o r t s , 22

a s a p p e l l a n t s u r g e , w e c o n c l u d e t h a t t h e a p p l i c a t i o n o f t h e f a c t o r s t o t h e e v i d e n c e i n t h e r e c o r d d o n o t y i e l d

a f i n d i n g t h a t H e r m e s ’ s s u i c i d e w a s a n i n t e r v e n i n g a n d s u p e r c e d i n g c a u s e

. S e e C o l u m b i a R i o G r a n d e H e a l t h c a r e , L

. P

. v

. H a w l e y , 2 8 4 S

. W

. 3 d 8 5 1

, 8 5 7

- 5 8 ( T e x

. 2 0 0 9 ) ; s e e a l s o R E S T A T E M E N T ( S E C O N D ) O F T O R T S § 4 4 2 ( 1 9 6 5 )

. F i r s t
, a p p e l l a n t s h a v e n o t a r g u e d h o w s u b p a r t s ( d ) t h r o u g h ( f ) a r e a p p l i c a b l e i n t h i s m a t t e r ; i n f a c t
, a p p e l l a n t s a c k n o w l e d g e i n t h e i r b r i e f t h a t t h e s e s u b p a r t s a p p l y o n l y t o t h e a c t i o n s o f t h i r d p a r t e s , a n d t h i s
m a t t e r d o e s n o t i n v o l v e t h e i n t e r v e n i n g a c t i o n s o f t h i r d p a r t i e s

. S e e R E S T A T E M E N T ( S E C O N D ) O F T O R T S § 4 4 2 ( d )

- ( f )

. T h e r e f o r e , t h e o n l y r e m a i n i n g a p p l i c a b l e s u b p a r t s w o u l d b e ( a ) t h r o u g h ( c )

. S e e i d

. § 4 4 2 ( a )

- ( c )

. W i t h r e g a r d t o s u b p a r t ( a )

, w e c a n n o t s a y t h a t H e r m e s ’ s s u i c i d e b r o u g h t a b o u t a h a r m d i f f e r e n t f r o m t h a t

w h i c h w o u l d h a v e o t h e r w i s e r e s u l t e d f r o m t h e n e g l i g e n c e o f a p p e l l a n t s ’ e m p l o y e e s b e c a u s e H e r m e s p r e s e n t e d h i m s e l f w i t h s e v e r a l p s y c h i a t r i c s y m p t o m s ; H e r m e s w a s p r e s c r i b e d m e d i c a t i o n t y p i c a l l y g i v e n t o t r e a t d e p r e s s i o n ; a p p e l l a n t s ’ e m p l o y e e s f a i l e d t o a s s e s s H e r m e s ’ s p s y c h i a t r i c c o n d i t i o n i n l i g h t o f D r

. Y e e ’ s
r e c o m m e n d a t i o n f o r a p s y c h i a t r i c c o n s u l t a t i o n ; a p p e l l a n t s ’ e m p l o y e e s f a i l e d t o p r o p e r l y m o n i t o r t h e e f f e c t s t h e m e d i c a t i o n s h a d o n H e r m e s ’ s w e l l

- b e i n g ; a n d a p p e l l a n t s ’ e m p l o y e e s g a v e H e r m e s a d o u b l e

- e d g e d r a z o r
a n d l e f t h i m a l o n e i n a b a t h r o o m w i t h o u t a m i r r o r t o s h a v e h i s c h e s t f o r a p p r o x i m a t e l y t h r e e h o u r s

. S e e i d

. § 4 4 2 ( c )

. G i v e n t h e s e c i r c u m s t a n c e s , a p e r s o n o f o r d i n a r y i n t e l l i g e n c e c o u l d h a v e f o r e s e e n t h a t H e r m e s
w o u l d b e i n j u r e d a n d c o u l d p o s s i b l y c o m m i t s u i c i d e

. S e e D o e v

. B o y s C l u b s o f G r e a t e r D a l l a s , I n c

. , 9 0 7 S

. W

. 2 d 4 7 2

, 4 7 8 ( T e x

. 1 9 9 5 )

. A s a r e s u l t
, a p p e l l a n t s c a n n o t s a y t h a t s u b p a r t ( b ) w a s s a t i s f i e d b e c a u s e H e r m e s ’ s s u i c i d e w a s n o t e x t r a o r d i n a r y g i v e n t h e c i r c u m s t a n c e s

. S e e R E S T A T E M E N T ( S E C O N D ) O F T O R T S § 4 4 2 ( b )

. F i n a l l y , t h e n e g l i g e n t a c t i o n s o f a p p e l l a n t s ’ e m p l o y e e s w e r e o n g o i n g a n d u l t i m a t e l y c a u s e d H e r m e s ’ s i n j u r i e s a n d d e a t h ; t h u s , H e r m e s ’ s s u i c i d e f l o w e d f r o m t h e n e g l i g e n c e o f a p p e l l a n t s ’ e m p l o y e e s

. A s s u c h
, s u b p a r t ( c ) i s n o t s a t i s f i e d b e c a u s e H e r m e s ’ s s u i c i d e i s n o t a n i n d e p e n d e n t f o r c e , a n d i t c a n n o t b e s a i d

c o n c l u s i v e l y t h a t t h e s u i c i d e i s n o t a n o r m a l r e s u l t o f t h e o n g o i n g n e g l i g e n t t r e a t m e n t o f w h a t c o u l d b e
c o n s i d e r e d a p s y c h i a t r i c p a t i e n t

— H e r m e s

— b y a p p e l l a n t s ’ e m p l o y e e s

. S e e i d

. § 4 4 2 ( c )

. 37M O D E R N T O R T L A W § 4:7 at 4-14 -4-15 (2d ed. 200 2)); see also Haw ley
, 284 S.W .3d at 859
(“[W ]he re the risk resulting f rom the intervening act is the sam e risk resulting f rom the
origi nal acto r’s negligence, the intervening act cann ot be classif ied as a supe rseding

cause .”). T hus, beca use app ellant s cont ribute d to Herme s’s dem ise, the y cann ot escap e
liability in th is case. See Dew , 20 8 S .W .3d at 450

.
Add itiona lly , appe llants rely on the Humphre y case out of the Housto n Fourtee nth

Court o f App eals to supp ort its cont ent ion tha t Herme s’s suicide w as an intervening an d

supe rceding cause

. W hile the Humphre y court did me ntion the general prop osition of law

tha t suicide const itute s an intervening f orce, brea king the lin e o f c a usat ion, the court

f urthe r explained tha t:

W here the w rongf ul act, howev er, prod uces a rage or f renzy tha t the perso n injured by def end ant ’s w rongf ul act dest roy s him self during such rage or f renzy , or in respo nse to a n u ncon trollable imp ulse, the act is

. . . consid ered as w ithin and a part of the line of causa tion f rom def end ant ’s

w rongf ul act to the suicide and def end ant ’s act is held to be the proximate
cause of the de ath

.
880 S.W .2d at 174 ( intern al citations and q uot ation s omitte d). T he Humphre y cou rt also

ref eren ced section 32 3 o f the Se cond Resta tem ent of T orts, which provides th at:

One who und ertake s, gr atu itously or f or consid eratio n, to rend er servi c es to ano the r w hich he shou ld recogniz e as nece ssary f or the prote ction of the oth er’s perso n or things, is subje ct to liability to the oth er f or physical harm resulting f rom his f ailure to exer c is e reaso nab le care to perf orm his un derta king if[ :]
(a) his f ailure t o e x ercise su ch ca re increa ses th e risk of such ha rm, o r
(b) t h e harm is suf

f ered beca use of the oth er’s reliance upo n the und ertakin g.

Id. at 176 (quoting R E S T A T E M E N T (S E C O N D ) O F T O R T S § 3 23 (196 5)).

W e f ind the se state me nts to be not eworthy beca use app ellant s have argued at trial

38and on app eal tha t Herme s likely w as cont em platin g suicide prior to hosp italiz ation ; thu s,

accord ing to app ellant s, Herme s oste nsibly had la t e n t s u icidal idea tions. Such an

argume nt is not persu asive beca use, assum ing this argume nt is true, app ellant s’ ongoing
negligent action s directe d towards Herme s trig gered the so-called laten t suicidal idea tions

and theref ore cause d Hermes to com mit suicide. In add ition, the r ecord establishe s that

the negligent action s of app ellant s’ em ployees increase d the risk of harm to Herme s, and

Herme s relied upo n app ellant s to treat his ailme nts. See Humphre y , 880 S.W .2d at 176 ;

see also R E S T A T E M E N T (S E C O N D ) O F T O R T S § 323

. T here f ore, base d on the f o re going,

app ellant s shou ld not be allowed to escap e li a b il it y f or causin g Herme s’s injuries and

dea th. See Hu m

phre y , 880 S.W .2d at 174
, 176 ; see also R E S T A T E M E N T (S E C O N D ) O F

T O R T S § 323

. W e the ref ore conclu de tha t Herme s’s act of com mitt ing suicide doe s not rise

to the level of intervening and supe rceding cause ; instea d, this act const itute s a concu rrent

cause tha t doe s not abso lv e app ellant s of liability in this ma tter. See Haw ley
, 284 S.W .3d

at 8 57; Dew , 20 8 S .W .3d at 451 ; see also G racia , 70 4 S .W .2d at 73.

Base d on the f oregoing, w e conclu de tha t the evidence supp orting the jury ’s v erdict

is legally suf

f icient. See City of Keller
, 168 S.W .3d at 822
, 827

. Accordin gly
, w e overrule

app ellant s’ f irst three issues on app eal.

III. T H E A F F I R M A T I V E D E F E N S E O F S U I C I D E A N D A P P E L L E E ’ S C R O S S -I S S U E A S T O

P R O P O R T I O N A T E R E S P O N S I B I L I T Y

In the ir f o u rt h issue, app ellant s argue tha t the jury ’s v erdict is not supp orted by
legally suf

f icient e viden ce beca use app ellant s esta blished the af f irmative def ense of

suicide as a ma tter of law

. Spe cif ically
, app ellant s com plain abo ut the jury ’s imp licit
rejection of its suicide af f irmative def ense

. App ellees cont end tha t the jury shou ld not have

39bee n allowed to consid er Herme s’s cond uct of com mitt ing suicide beca use his suicide w as

cause d by app ellant s’ f ailure to com ply w ith app licable legal stan dard s. By the ir f irst crossissue, app ellees argue th at the trial court erred in allowi ng the jury to consid er Herm es’s

prop ortion ate respo nsibility in causin g his own dea th beca use app ellant s’ section 93. 001

a f f irm ative def ense ma y not be app lied giv en tha t app ellant s f ailed to com ply w ith

app licable lega l stan dard s and “section 93. 001 una mb iguously and expressly trum ps

app lication of

sectio n 3 3.0 01. ” See T E X

. C I V

. P R A C

. & R E M

. C O D E A N N

. § 3 3.0 01 (Verno n

200 8).

A

. A pplica ble La w

Se ction 93. 001 (a)(2) of the civ il practice and rem edie s cod e p rov ides t hat it is an

af f irmative def ense to a civ il action f or dam ages f or perso nal injury or dea th if the plaint if f

,
at t he time the cau se o f actio n a rose, w as:

c o m m it t in g or atte mp ting to com mit suicide, and the plaint if f ’s cond uct in
com mitt ing or a t t e mp ting to com mit suicide w as the sole cause of the dam ages susta ined ; provide d, how ever, if the suicide or atte m pte d suicide

w a s cause d in wh ole or in part by a failure on the part of any d e f e n d a n t t o com ply with an a p p licable lega l stan dard
, the n such suicide or atte m pte d suicide shall n ot b e a de fen se.

T E X

. C I V

. P R A C

. & R E M

. C O D E A N N

. § 93.0 01(a )(2) (emp hasis add ed). T exas Rule of C iv il

Proced ure 94 requires tha t a n a f f irm ative def ense be plea ded

. T E X

. R. C I V

. P. 94. T he

burd en of plea ding and proving the el e m e n t s o f an af f irmative def ense is on the party

seekin g to r ely on tha t def ense

. See id. ; Qua ntu m Chem. Corp. v. Toen nies , 47 S.W .3d

473

, 481 (Te x

. 200 1); Compass Ban k v. MFP Fin. Servs., Inc.
, 152 S.W .3d 844

, 851 (Te x

. App .–Dallas 200 5, pet

. den ied); see also W est v. Ham ilton
, No. 07-0 7-02 35-CV, 200 8 T ex.

40App

. L E XIS 769 4, at **4-5 (Te x

. App .–A ma rill o Oct. 9, 200 8, no pet .). T o conclu siv ely

prove an af

f irmative def ense , a party mu st have “‘so conclu siv ely proved each elem ent of
[tha t] a f f irmative de f ense

. . . th at t here w as n o f act que stion to su bm it to the juryon an y

of its elem ent s.’” Kup chynsky v. Nardiello
, 230 S.W .3d 685
, 697 (Te x

. App .–Dallas 200 7,

pet

. den ied) (q uot ing Brow n v. Zim m erm an , 160 S.W .3d 695
, 702 (Te x

. App .–Dallas 200 5,

no pet .)). “A ma tter is conclu siv ely esta blished if ordina ry min ds could not dif f er as to the

conclu sion to be drawn f rom the evidence. ” Id. A party is not ent itled to a jury issue on its

af f irmative def ense unle ss it plea ds and proves it. Tricon Tool & Sup ply, Inc. v. Thumann
,
2 2 6 S

. W .3d 494
, 501 (Te x

. App .–Hou ston [1st Dist.] 200 6, pet

. den ied) (citing Free ma n

v. Carroll , 49 9 S .W .2d 66 8, 6 70 (Te x . Civ . Ap p.– T y ler 19 73, w rit ref ’d n. r.e.)).

If an app ellant challen ges the legal suf f iciency of an adverse f inding on an issue on

w hich it had the burd en of proo f —he re , the af

f irmative def ense of suicide—it mu st

dem onst rate on app eal tha t the evidence conclu siv ely esta blished all v ital f acts in supp ort

of the issue. Dow Chem. Co. v. Francis
, 46 S.W .3d 237
, 241 (Te x

. 200 1); accord Uniroyal

Goo drich Tire Co. v. Martinez
, 977 S.W .2d 328
, 340 (Te x. 1 9 9 8 ); see Thumann
, 226

S.W .3d at 501 . In revi ewi ng such a m atte r-of -law cha llenge, we em ploy a tw o-pa rt test.

See Pac. Em

ploye rs Inc. Co. v. Dayton
, 958 S.W .2d 452
, 455 (Te x

. App .–Fo rt W orth 199 7,

pet

. den ied) (citing Victoria Ban k & Trust Co. v. Brady
, 811 S.W .2d 931

, 940 (Te x

. 199 1)).

First, w e examine the record f or evidence supp orting the f inding, w hile ignoring all evidence

to the cont rary

. See Dow Chem. Co

. , 4 6 S

. W

. 3d at 241

. If the re is not any evidence to

supp ort the f inding, the rev iew ing court e x am ines t he ent ire record to dete rmine w het her

the cont rary prop osition is esta bl is h e d a s a ma tter of law

. See id. If the cont rary

prop osition is esta blished conclu siv ely, the n the evidence supp orting the jury ’s decision is

41legally

insuf f icient a nd app ellant ’s issue is su staine d. See id.

B. A ppella nts’ Suic ide A ffirmativ e Defe nse
Here, app ellant s assert tha t the jury shou ld have rend ered a t a k e -n o t hing v erdict

beca use Herme s com mitt ed suicide and the ir actio n s we re not the cause of Herme s’s

suicide. W e have alread y conclu ded tha t the jury ’s det ermin ation tha t app ellant s engaged

in an ongoing pat tern of negligent beh avior t h a t end angered Herme s’s w ell-being and

cause d Hermes ’ s i njuries and dea th w as supp orted by legally suf f icient evidence. Beca use

of this conclu sion, w e cann ot sa y t h a t a p p ellant s have susta ined the ir burd en of

conclu siv ely esta blishing all v ital f acts in supp ort of the ir suicide af f irmative def ense

. See

Dow Chem. Co.

, 46 S.W .3d at 241 ; Martinez
, 977 S.W .2d at 340 ; see also Thumann
, 226

S.W .3d at 501

. Moreover, section 93. 001 (a)(1) itself state s tha t suicide “shall not be a

def ense ” if “the suicide or atte mp ted suicide w as cause d in w hole or in part by a f ailure on

the part of any def end ant to com ply w ith an app licable legal stan dard .” T E X

. C I V

. P R A C

. &

R E M

. C O D E A N N

. § 93. 001 (a)(2); see Alvarad o v. City of Brow nsville
, 865 S.W .2d 148
, 153

-

154 (Te x

. App .–Corp us Christi 199 3), rev’ d on oth er grou nds
, 897 S.W .2d 750 (Te x

. 199 5).

T here f ore, base d on the f oregoing, w e reject app ellant s’ cont ent ion tha t the jury ’s v erdict

is n o t s u p porte d by legally suf f icient evidence beca use the y esta blished the ir suicide

af f irmative def ense as a ma tter of law

. See id. ; see also Do w Ch e m

. Co.

, 46 S.W .3d at

241 ; Martinez
, 977 S.W .2d at 340 ; Thumann
, 226 S.W .3d at 501

. Accordin gly
, w e overrule

app ellant s’ f ourth issue.

C. Hermes ’s P roportionate Res ponsibility
Propo rtiona te respo nsibility under chap ter 33 of the civ il practice and reme dies code
provides tha t “a claima nt ma y not recover da m a ge s if his perce nta ge of respo nsibility is

42gr eat er tha n 50 perce nt.” T E X

. C I V

. P R A C

. & R E M

. C O D E A N N

. § 33. 001

. Chap ter 33 app lies

to “any cause of action base d in tort in w hich a def end ant
, settling perso n, or respo nsible

third party is f oun d respo nsible f or a perce nta ge of the harm f or w hich relief is sought. ” Id.
§ 33. 002 (a)(1) (Verno n 200 8). Furthe r, in det ermin ing the perce nta ge of respo nsibility, the

trier of f act mu st also consid er, am ong oth er things, the respo nsibility of the claima nt and

oth er respo nsible third partie s in causin g or cont ributing in any w ay to the harm f or w hich

the recovery

of da ma ges is sought. Id. § 3 3.0 03(a ).

On app eal, app ellees argue tha t the jury imp rope rly consid ered w het her Herme s’s

action s const itute d “neglig ence aside f rom the v ery act of com mitt ing suicide. ” T he 23

record ref lects that Herme s believ ed he had de scend ed into ma dne ss an d th at h e m ade

a “w eird” request to shower and shave at 5:0 0 a.m

. on April 19, even tho u gh h e h ad

showered tw ice bef ore in the previous seventee n hou rs. Several expert w itnesse s testif ied

tha t Herme s had a psychiatric cond ition tha t app ellant s neglecte d to prop erly assess and

treat

. How ever, prior to com mitt ing suicide, Herme s lef t a suicide not e, w hich suggests tha t

Herme s ma y have consid ered and cont em plate d suicide at som e poin t bef ore he actu ally

carried it o ut.

T he supre me cou rt ha s stat ed tha t a jury ma y “conside r the cond uct of [a] pat ient

w hen det ermin ing prop ortion ate respo nsibility as a part of an in c lu siv e com para tiv e
negligence schem e rathe r tha n com partm ent aliz [ing] negligence in rig id cate gories.”

Jackson v. Axelrad
, 221 S.W .3d 650

, 654 (Te x

. 200 7); see Dow ell
, 262 S.W .3d at 333

A p p e l l a n t s a r g u e t h a t a p p e l l e e s w a i v e d t h i s c r o s s

- i s s u e b e c a u s e t h e y i m p r o p e r l y r a i s e d t h i s c r o s s

23 i s s u e i n t h e i r a p p e l l e e ’ s b r i e f r a t h e r t h a n t h e s e p a r a t e b r i e f f i l e d f o r t h e t h e i r c r o s s

- a p p e a l

. H o w e v e r , t h e
s u p r e m e c o u r t h a s h e l d t h a t w e a r e t o c o n s t r u e t h e b r i e f i n g r u l e s “ r e a s o n a b l y , b u t l i b e r a l l y , w h e n p o s s i b l e s o t h a t t h e r i g h t t o a p p e a l i s n o t l o s t

. . . . ” J a m a r v

. P a t t e r s o n , 8 6 8 S

. W

. 2 d 3 1 8
, 3 1 9 ( T e x

. 1 9 9 3 ) ( p e r c u r i a m ) ;
s e e S a n S a b a E n e r

g y , L

. P

. v

. C r

a w f o r d
, 1 7 1 S

. W

. 3 d 3 2 3

, 3 3 8 ( T e x

. A p p

. – H o u s t o n [ 1 4 t h D i s t

. ] 2 0 0 5
, n o p e t

. )

. I n a n y e v e n t
, g i v e n o u r r e s o l u t i o n o f a p p e l l e e s ’ p r o p o r t i o n a t e r e s p o n s i b i l i t y c r o s s

- i s s u e , w e n e e d n o t a d d r e s s
a p p e l l a n t s ’ w a i v e r a r g u m e n t

. S e e T E X

. R

. A P P

. P

. 4 7

. 1

. 43(W ainwr ight, J., concu rring ); see also T E X

. C I V

. P R A C

. & R E M

. C O D E A N N

. §§ 33. 001 -.003

.

In Dow ell , the deced ent , Lance , a nine tee n-y ear-old ma le, was adm itted f or trea tm ent at

a local hosp ital af

ter threa ten ing to kill him self

. 262 S.W .3d at 325

. Lan ce w as distrau ght
over his gir lf riend threa ten ing to lea v e h im. Id. at 325 -26. He h ad ma de similar th reats

in the past and had bee n previously adm itted to the hosp ital f or treat me nt. Id. W hile at the
hosp ital, nurse s and doct ors f ailed to ma ke a com preh ensive assessm ent of Lan ce’s risk

of suicide. Id. at 326

. Lan ce told docto rs tha t he w as n ot su icidal, a nd, be cause he w as

an adu lt and did not desire to be hosp italiz ed, doct ors release d him pursu an t t o a n o

suicide cont ract, w hich provided tha t Lan ce w ould go to the local Menta l Health and Menta l

Retard ation Cente r (“M HMR” ) f or assessm ent and stay w ith his f am ily unt il the assessm ent

w as com plete d. Id. at 326 -27. La n c e agreed, and the hosp ital discha rg ed him shortly

the reafter. Id. at 327

. Af ter bein g discha rg ed, Lan ce we n t t o a f am ily reun ion and

atte nde d a rode o w ith his broth er. Id. How ever, thirty- three hou rs af ter bein g discha rg ed

and no t ha v ing v isited t he local MHMR cente r, La nce hun g himse lf

. Id.

T he jury f oun d tha t the hosp ital w as negligent and assesse d $40 0,0 00 in dam ages

f or Lan ce’s pare nts and $40 0,0 00 in dam ages f or Lan ce’s esta te. Id. at 327 -28. T he court

of ap pea ls af

f irmed the jury ’s v erdict. Id. at 328 . Howev er, th e su prem e co urt reversed,

h o lding tha t Lan ce could not have bee n hosp italiz ed against his w ill giv en the

circumsta nces and tha t the hosp ital’s d is c h a rg e of Lan ce did not proximate ly cause his

dea th. Id. at 328 -30. T he ma jority opin ion did not discuss the i nte rplay bet w een chapte r

33 and sectio n 9 3.0 01 of the civ il practice and rem edie s cod e. 24

T h e j u r y d i d n o t c o n c l u d e t h a t L a n c e w a s p r o p o r t i o n a l l y r e s p o n s i b l e f o r h i s o w n s u i c i d e ; i n s t e a d
, 24 t h e j u r y d e t e r m i n e d t h a t t w o h e a l t h c a r e p r o v i d e r s a n d a n e m e r g e n c y r o o m p h y s i c i a n w e r e r e s p o n s i b l e f o r L a n c e ’ s s u i c i d e

. P r o v i d e n c e H e a l t h C a r e v

. D o w e l l
, 2 6 2 S

. W

. 3 d 3 2 4
, 3 2 7

- 2 8 ( T e x

. 2 0 0 8 )

. 44In a concu rrence, Justice W ainwr ight, howev er, did consid er the interp lay bet w een

tho se statu tory p rov isions and not ed tha t “[i]f [the dece den t’s] act io n s a p a rt f rom the act

of com mitt ing suicide v iolate d an app licable stan dard of care (such as negligence), a jury

shou ld have w eighed such action s in assigning pr o p o rt iona te respo nsibility.” Id. at 332
(W ainwr ight, J., concu rring ). Justice W ainwr ight not ed tha t a jury could have conclu ded

tha t Lan ce f ailed to f ollow the no-su icide cont ract and tha t the f ailure to f ollow tha t cont ract

cont ribute d to his deat h; there f ore, Justice W ainwr ight conclu ded that L ance en gaged in

action s apa rt f rom the actu al com mission of suicide tha t w ere negligent and
, thu s, partia lly

cause d the com plaine d -o f in juries. Id. (W ainwr ight, J., concu rring )

. Unde r the se

circumsta nces, Justice W ainwr ight det ermin ed tha t the ju ry could have bee n instructe d

abo ut the prop ortion ate respo nsibility statu tes. Id. at 332 -33 (W ainwr ight, J., concu rring ).

On the oth er hand , Justice O’Neill ’s dissen t in Dow ell pointed out that to “attribute

causa tion f or brea ch of a me nta l hea lth stan dard of care to the pat ient w hose und iagnosed

me nta l imp airme nt w as the v ery cause of injury ” w ould be “clearly cont rary to the statu te’s
[sectio n 93. 001 (a)(2)] inten t.” Id. at 337 (O’Neill, J., dissen ting). Justice O’Neill also state d

tha t Justice W ainright’s suggestion t h a t the jury consid er negligent action s take n by the

dece den t ap art f rom com mitt ing suicide was un ten able be cause :

Unde r such an app roach
, a f act[-]f in d er w ould have to som eho w sepa rate Lan ce’s suicide f rom the events lead ing to his suicide. How ever, I f ind it unlikely tha t, in draf ting the statu te, the L e gi s la ture inten ded partie s w ho brea ched the standa rd of care to be abso lv ed f rom liability because the act of isolating one ’s self in orde r to com mit suicide is som eho w sepa rable f rom the act of suicide itself

. Notwi thsta ndin g the dif f iculties inhe rent in requiring the f act[-]f inde r to divorce action s lead ing to suicide f rom the actu al event, the re is no f actu al sup port f or such a su bm ission in this ca se.

Id. at 3 36 (O’Neill, J., disse nting).

45W e agree w ith Justice O’Neill’s ana ly sis as app lied in this case beca use the

negligent action s of app ellan ts ’ em pl oy ee s w er e ongoing and Herme s’s suicide f low ed f rom

tho se action s. Moreover, it is not eworthy tha t Herme s com mitt ed suicide w hile still in the

care of app ellant s’ em ployees, not thirty- three hou rs af ter bein g release d by a hea lth care
provider. See id. at 325

. Beca use of the ongoing nat ure of the negligence, it w ould be
extremely dif

f icult f or the jury to divorce Herme s’s suicide f rom the events lea d ing to his

suicide. See id. at 336 (O’Neill, J., dissen ting). Furthe rmore , w e agree tha t the subm ission

of a question to t h e ju ry regarding Herme s’s prop ortion ate respo nsibility circumvents

sectio n 9 3.0 01(a )(2), w hich provides tha t the af f irmative def ense of suicide ma y not be

asserte d if the def end ant brea ches an app licable lega l dut y and cause s the suicide in

w hole or in part. See id. ; see also T E X

. C I V

. P R A C

. & R E M

. C O D E A N N

. § 93. 001 (a)(2). For

examp le, if the jury had conclu ded tha t Herme s w as 51% respo nsible f or the com plaine d-of
injuries and tha t app ellant s w ere 49% respo nsible, app ellant s w ou ld n ot be allowed to

assert the af

f irmative def ense of suicide beca use the y w ere 49% negligent or , in o t h er

w ords, w ere negligent in part in causin g the sui cide. See T E X

. C I V

. P R A C

. & R E M

. C O D E

A N N

. § 93. 00 1 (a )( 2 ). How ever, in such an event, Herme s w ould be preclud ed f rom
recovering, desp ite the jury ’s conclu sion tha t app ellant s w ere 49% negligent in the ma tter,

beca use his negligence exceede d 50%

. See id. § 33. 001

. Essen tially
, app ellant s w ould

be insulat ed f rom liability and oste nsibly giv en a secon d chan ce at assertin g suicide as an

af f irmative def ense if Herme s’s prop ortion ate respo nsibility is subm itted
, bot h of w hich

cont rav ene the Legislature ’s inten t in prom ulgating chap ter 33 and section 93. 001 (a)(2).

See Dow ell , 26 2 S .W .3d at 336 (O’Neill, J., d issentin g)

. Regardless of w hich app roach is app lied in this ma tter, w e arriv e at the sam e

46conclu sion. T here is n o e vid e n c e tha t Herme s too k any “action s apa rt f rom the act of

com mitt ing s u ic id e ” t h at v iolate d an app licable stan dard of care. See id. at 332

. Nurse
Bergado and Doctor T avarez bot h te s t if ie d tha t Herme s w as “alert and orient ed” and

f ollowed the ir instructio ns f or treat me nt. See Jackson
, 221 S.W .3d at 654 (holdin g tha t a
pat ient has a dut y to coop erate w ith treat in g p hysici ans, includin g coop eratin g in bot h
diagnosis and treat me nt); see also Elba or v

. S mith
, 845 S.W .2d 240
, 245 (Te x

. 199 2)
(same ). Moreover, the re is no evidence in the record clearly expressing Herme s’s tho ughts
regarding t he suicide; the ref ore, w e ca nno t be certain w het her Herme s’s suicide w as an

inten tiona l act or solely the result of Herme s’s desce nt int o m a dne ss tha t w as partia lly

cause d by the negligence of app ellant s’ em ployees; or, in oth er w ords, w e cann ot sepa rate

Herme s’s suicide f rom the events lead ing to his suicide. See Dow ell
, 262 S.W .3d at 334
(O’Neill, J., disse nting) (citing Int’ l & Grea t N. R.R. Co . v. W hite , 10 3 T ex. 567 , 13 1 S .W

.
811
, 812 (191 0) (holdin g tha t a witness ma y not testif y as to w hat a dece ased perso n

w ould ha v e d one be cause such test imo ny is mere specu lation )).

T here f ore, base d on the f oregoing, w e w ould c o n c lu d e tha t it w as error to subm it

Herme s’s prop ortion ate respo nsibility once the jury rejecte d app ellant s’ suicide af f irmative

def ense

. See T E X

. R. C I V

. P. 277 (requir ing tha t app ortion me nt question s be subm itted to

the jury in broa d f orm); see also Rom ero v. KPH Constr., Inc.
, 166 S.W .3d 212

, 215 (Te x

.
200 5) (“But broa d-f orm subm ission [of app ortion me nt question s] cann ot be used to put

be f o re t h e ju ry issues tha t have no basis in the law or the evidence. ”). Despite this

conc lu s io n , app ellees have not ade quately explained how the subm ission of Herme s’s

prop ortion ate respo nsibility harm ed the m. See T E X

. R. A P P

. P. 38. 1(i), 44. 1. Spe cif ically
,

app ellees have f ailed to explain how the jury ’s dam a ge award and prop ortion ate

47respo nsibility calculat ions w ould chan ge giv en th e e rr o n eou s subm ission of Herme s’s

prop ortion ate respo nsibility. W ithou t clearly articulat ing the harm cause d by the imp rope r

subm ission, w e cann ot conclu de tha t the jury ’s v erdict wa s im p ro p er. See Dow ell
, 262

S.W .3d at 331 (W ainwr ight, J., co ncurring) (sta ting tha t “[a] rev iew ing co urt ma y rev erse

and rem and f or a new t rial base d on alleged error in a jury charge only if such error w as

reaso nab ly calculat ed and prob ably did cause the rend ition of an imp rope r judgme nt”)
(inter n a l quo tatio ns om itted ) (citing Ste rling Trust Co. v. Add erley
, 168 S.W .3d 835
, 843
(Te x

. 200 5); Reinha rt v. You ng , 906 S.W .2d 471
, 473 (T e x. 199 5); Island Recreat iona l

Dev. Corp. v. Repu blic of Tex. Sav. Ass’ n , 710 S.W .2d 551
, 555 (Te x

. 198 6)). Accordin gly
,

w e o v errule a ppe llees’ f irst cross-issue.

IV. S E C T I O N S 74. 301 A N D 74. 303 —T H E S T A T U T O R Y D A M A G E C A P S
By the ir secon d cross-issue, app ellees argue tha t the trial court errone ously
imp osed the dam age cap of $25 0,0 00, as provided in section 74. 301 (b) of the civ il practice

and reme dies code
, as opp osed to the dam age cap f oun d in section 74. 303

. See T E X

. C I V

.
P R A C

. & R E M

. C O D E A N N

. §§ 74. 301 (b), .30 3. Spe cif ically , appe llees assert that beca use

the ir claims are w rongf ul dea th and surv iv al action s base d on a hea lth care liability claim,

section 74. 303 rathe r tha n section 74. 301 (b), the dam age cap app licable to ordina ry hea lth

care liab ility

claim s, ap plies. See T E X

. C I V

. P R A C

. & R E M

. C O D E A N N

. §§ 74. 301 (b), .30 3.
App ellant s coun ter by arguing tha t the trial court correctly app lied the $25 0,0 00 non

econ om ic dam age cap of section 74. 301 (b). See id. § 74. 301 (b). App ellant s f urthe r argue

tha t the plain language and legislativ e history of section 74. 301 (b) prove tha t the $25 0,0 00

non -econ om ic dam age cap app lies to all hea lth care liability action s, in c lu ding w rongf ul

dea th a ctions. See id.

48A

. Standard of Review

In ana ly z ing app ellees’ secon d cross-issue, w e mu st resort to the rules of statu tory

in t e rpretat ion. Matte rs of statu tory interp retat ion are question s of law
, over w hich w e

exercise de novo rev iew

. Tex. Dep’ t of Transp. v. Need ham
, 8 2 S.W .3d 314
, 318 (Te x

.
200 2). T he prima ry

r ule of statuto ry

construction i s that a court mu st look to the i nte nt of

the Legislature and mu st const rue the statu te so as to giv e ef f ect to tha t inten t. See T E X

.
G O V ’ T C O D E A N N

. § 312 .00 5 (Verno n 200 5); see also Lee -Hickm an’ s Invs. v. Alph a Inve sco
Corp.

, 139 S.W .3d 698
, 700 (Te x

. App .–Corp us Christi 200 4, no pet .) (per curiam ) (citing
City of Aust

in v. L.S

. Ranch
, Ltd

. , 970 S.W .2d 750
, 752 (Te x

. App .–A ustin 199 8, no pet .)).

It is a rule of statu tory const ruction tha t every w ord of a statu te mu st be presu me d to have

bee n used f or a purp ose, and each sent en c e , clause
, and w ord is to be giv en ef f ect if

reaso nab le and possib le

. S e e Tex. W orkers’ Comp. Ins. Fund v. Del Ind us., Inc.
, 35

S.W .3d 591
, 593 (Te x

. 200 0) (citing Perkins v. Sta te
, 367 S.W .2d 140
, 146 (Te x

. 196 3));

see a ls o Cam eron v. Terrell & Grant

, Inc.
, 618 S.W .2d 535
, 540 (Te x

. 198 1). Likewise,

every w ord e x clude d f rom a sta tute must a lso be presu me d to ha v e b een excluded f or a

purp ose. See Cam eron , 618 S.W .2d at 540

. In add ition, w e do not v iew dispu ted portio ns

of a statu te in isolation

. Del Ind us., Inc.
, 35 S.W .3d at 593 ( citing Bridge ston e/Firesto ne,

Inc. v. Glyn-Jon es , 878 S.W .2d 132

, 133 (Te x

. 199 4)). W e are to discern legislativ e inten t

f rom the plain me anin g of the w ords of the statu te. See Alph a Inve sco Corp.

, 139 S.W .3d

at 7 00 (citing L.S . Ran ch, L td. , 97 0 S .W .2d at 752 ).

B. A pplica ble La w

Sect ion 7 4.3 01(b ) provides tha t:

In an action on a hea lth care liability claim w here f inal judgme nt is rend ered
49a ga inst a single hea lth care institut ion, the limit of civ il liability f or n o n [

-

]eco nom ic dam ages inclusive of all perso ns and ent ities f or w hich v icarious li a b il it y the ories ma y app ly
, shall be limited to an am oun t not to excee d $25 0,0 00 f or ea ch claim ant

.
T E X

. C I V

. P R A C

. & R E M

. C O D E A N N

. § 74. 301 (b). On the oth er han d, section 74. 303 state s

tha t:
(a) In a w rongf ul dea th or surv iv al action on a hea lth care liability claim w here f inal judgme nt is rend ered against a physicia n or hea lth care provider, the limit of ci v il liability

for all dam ages, including exemp lary da ma ges, shall be limited to an am oun t not to exceed $50 0,0 00. 00 f o r each claima nt, regardless of the num be r o f d ef end ant physicians or hea lth care providers against w hom the claim is asserte d or the num ber of se p a ra t e c a uses of action on w hich t he claim is base d.
(b) W hen the re is an increase or decre ase in the consu me r price inde x w ith respe ct to the am oun t of tha t inde x on August 29, 197 7, the liab il it y limit describe d in Sub section (a) shall be increase d or decre ased
, as app licable, by a sum equal to the am oun t of such limit mu ltiplied by the p e rcenta ge increase or decre ase in the consu me r price inde x , as pub lished by the Burea u of Lab or Sta tistics of the Un it e d S tate s Depa rtme nt of Lab or, tha t
me asure s the av erage changes in prices o f goods and serv ices purchase d by urba n w age earn ers a nd clerical w orkers’ f am ilies and single w orkers liv ing alon e (CPI-W : Sea sona lly adju sted U.S. City Average-All ite ms), bet w een August 29, 197 7, and the t im e at w hich dam ages subje ct to such limits a re awarded by fin al jud gmen t or se ttlem ent

. (c) Sub section ( a) does not app ly to the am oun t of

da ma ges awarded o n a hea lth care liability claim f or the expense s of nece ssary me dical, hosp ital, and custo dial care received bef ore judgme nt or re qu ir e d in the f utu re f or treat me nt o f

the injury.

Id. § 7 4.3 03(a )-( c).

T he crux of this issue is w het her w hat seem s to be the m o re ge n e ral provisi on,

section 74. 301 (b), or the mo re specif ic provisi on, section 74. 303

, a p p li e s

. See

Horiz on/ CMS Health care Corp. v. Auld
, 34 S.W .3d 887

, 901 (Te x

. 200 0) (dete rmining tha t

the judgme n t cap provisi ons of section 11. 02 of f orme r article 459 0i prevail over the
general pre-judgm ent int e re s t provisi ons of article 506 9-1.0 5); cf. T E X

. G O V ’ T C O D E A N N

. 50§ 311 .02 6 (Verno n 200 5) (provi ding tha t, w hen const ruing code provisi ons tha t are

irreconcilable
, “the specia l or local provision prevails as an exception to the general
provisi on, unle ss the general provisi on is the later ena ctm ent and the ma nif est inten t is tha t

the general provisi on prevail”)

. On app eal, neith er party cites any case law add ressing the
interp lay bet w een sections 74. 301 (b) and 74. 303 ; howev er, in resea rching this issue, w e

w ere able to f ind one case f rom the Am arillo Court of App eals ad d re s s in g t his precise

issue. See THI of Te x. at Lu bbo ck I, L LC v. P erea , No. 07-0 8-03 59-CV, 201 0 T ex. App

.
LEXIS 5 980 , at **90 -103 (Te x . Ap p.– Am arillo July 28, 2 010 , no pe t. h .). 25

In Perea , th e a ppe als cou rt stat ed the f ollowi ng:

W e f ind no cases w hich directly decid e this issue [the in t e rp la y bet w een section s 74. 301 (b) and 74. 303 ]. Ho w ever, beca use the tw o statu tory provisi ons do not conf lict on the ir f ace, in orde r to giv e f ull ef f ect to the inten t
o f t h e L e gi s lature
, w e see no reaso n w hy one cap shou ld app ly to the exclusion of the oth er cap. Neithe r the express w ording o f t he app licable statu tes, nor the ir le gisl ative history in dicate s tha t t h e L e gislatu re inten ded anything oth er tha n to app ly bot h caps. T here f ore, we c o n clude tha t bot h caps can be app lied, a nd shou ld be ap plied.

Id. at * *97 -98.

T he plain language of section 74. 301 (b) limits a health care provider’s civ il liability

f or non -econ om ic damages at $25 0,0 00 per claima nt, w hile section 74. 303 limits the hea lth

care provider’s tota l c ivil liability
, includin g econ om ic and non -econ om ic dam ages but

e xc lu d in g “nece ssary me dical, hosp ital, and custo dial care” costs, at $50 0,0 00 pe r

claima nt. W e a gr e e t h a t bot h section 74. 301 (b) and section 74. 303 can and shou ld be

app lied to gether. See id. at **97 -98.

I n a l l f a i r n e s s , t h e A m a r i l l o C o u r t o f A p p e a l s ’ s d e c i s i o n i n T H I o f T e x a s a t L u b b o c k I
, L L C v

. P e r e a , 25

w a s h a n d e d d o w n o n J u l y 2 8

, 2 0 1 0

, a n d t h e p a r t i e s ’ b r i e f s a r g u i n g t h i s c r o s s

- i s s u e w e r e f i l e d i n M a y a n d A u g u s t 2 0 0 9

. S e e N o

. 0 7

- 0 8

- 0 3 5 9

- C V
, 2 0 1 0 T e x

. A p p

. L E X I S 5 9 8 0

, a t * * 9 0

- 1 0 3 ( T e x

. A p p

. – A m a r i l l o J u l y 2 8

, 2 0 1 0

, n o p e t

. h

. )

. 51In a ny ev ent , ap pellee s ha v e n ot argued tha t the statu tes are in conf lict. Inste ad,

the y argue tha t, by includin g the “w rongf ul dea th and surv iv al action on a hea lth care
liability claim, ” the Legislature inten ded t o app ly the section 74. 303 cap to such claims,

w hile th e se ction 74. 301 (b) cap app lies to “comm on[ -]law ne gli gence h ealth care liability

claims. ” In app ly ing se ction 74. 303
, as explained by a ppe llees, the trial cou rt ’s d a m a ge

award shou ld have been $1,78 8,3 25 rathe r tha n $728 ,98 0.9 8. W e disagree. Beca use 26

section s 74. 301 (b) and 74. 303 can and s hou ld be read togeth er, see id. at **97 -98, w e

cann ot say tha t section 74.30 3 applies solely to the exclusion of section 74. 301 (b) in this

case. Furth ermo re, a ppe llees h ave not cited to any aut hority directly on po int.

In add ition, several com me nta tors, af ter rev iew ing the statu tes and transcripts of the

hea rings on the T ort Ref orm Act of 200 3, com mo nly known a s Ho u s e Bill 4, have
expressed tha t the Legislature inten ded f or “the w rongf ul death cap” to be “an agg regate

cap on all dam ages. T hus, section 74. 303 w ill app ly secon darily to any c a p on non

econ om ic dam ages. T here f ore, any dam age award w ill b e li m it ed by app ly ing the non

I n i t s d a m a g e s a w a r d
, t h e j u r y a w a r d e d t h e f o l l o w i n g : 26

1

. D i a n a : $ 1 2 3

, 0 0 0 i n e c o n o m i c d a m a g e s ; $ 8 0 0

, 0 0 0 f o r p a s t a n d f u t u r e l o s s o f c o m p a n i o n s h i p a n d

s o c i e t y ; a n d $ 7 5 0

, 0 0 0 f o r p a s t a n d f u t u r e m e n t a l a n g u i s h f o r a t o t a l o f $ 1

. 5 5 m i l l i o n i n n o n

e c o n o m i c d a m a g e s ;

2

. S a r a h : $ 8 7
, 0 0 0 i n e c o n o m i c d a m a g e s ; $ 1 m i l l i o n f o r p a s t a n d f u t u r e l o s s o f c o m p a n i o n s h i p a n d

s o c i e t y ; a n d $ 1 m i l l i o n f o r p a s t a n d f u t u r e m e n t a l a n g u i s h f o r a t o t a l o f $ 2 m i l l i o n i n n o n

e c o n o m i c d a m a g e s

.

3

. L a u r e n : $ 8 7
, 0 0 0 i n e c o n o m i c d a m a g e s ; $ 1 m i l l i o n f o r p a s t a n d f u t u r e l o s s o f c o m p a n i o n s h i p a n d

s o c i e t y ; a n d $ 1 m i l l i o n f o r p a s t a n d f u t u r e m e n t a l a n g u i s h f o r a t o t a l o f $ 2 m i l l i o n i n n o n

e c o n o m i c d a m a g e s

.

4

. A l e j a n d r o : $ 8 7
, 0 0 0 i n e c o n o m i c d a m a g e s ; $ 1 m i l l i o n f o r p a s t a n d f u t u r e l o s s o f c o m p a n i o n s h i p a n d

s o c i e t y ; a n d $ 1 m i l l i o n f o r p a s t a n d f u t u r e m e n t a l a n g u i s h f o r a t o t a l o f $ 2 m i l l i o n i n n o n

e c o n o m i c d a m a g e s

.

5

. H e r m e l i n d a : $ 1 0 0

, 0 0 0 i n p a s t a n d f u t u r e e c o n o m i c d a m a g e s ; $ 5 0 0

, 0 0 0 f o r p a s t a n d f u t u r e l o s s o f

c o m p a n i o n s h i p a n d s o c i e t y ; a n d $ 5 0 0

, 0 0 0 f o r p a s t a n d f u t u r e m e n t a l a n g u i s h f o r a t o t a l o f $ 1 m i l l i o n i n n o n

- e c o n o m i c d a m a g e s

. 52econ om ic dam age cap in se ction 74. 301
, and the n w ill f urthe r be limited by a pplying th e

tota l cap of

section 74.3 03. ” Jeff

W atte rs, Bet ter to Kill tha n to Maim : The Current State

o f Me dical Malpractice W rong ful Death Cases in Texas
, 60 B A Y L O R L. R E V

. 749
, 7 6 0
(200 8); se e Michael S. Hull et al., House Bill 4 and Propo sition 12: An Ana lysis with
Leg islative History, Part Three
, 36 T E X

. T E C H L. R E V

. 169
, 175
, 243 n.4 64 (200 5) (stating,

af ter consu lting w ith Forme r Chairma n of the T exas Sen ate Robe rt L. Dunca n and Forme r

Chairma n of the T exas House of Re p re s e n t atives, Josep h M. Nix on, tha t “[a]s an

aggr ega t e c a p on all dam ages, the w rongf ul dea th and surv iv al action cap w ill app ly

secon darily to any cap on non [-]eco nom ic dam ages. T here f ore, any dam age award w ill

be limited by app ly ing the non [-]eco nom ic dam age cap, and the n w ill be f urthe r limited by

a p plyi ng the tota l cap in cases w here it app lies.

. . . Nothin g in the Act f o rc e s t h e

def end ant to choo se one cap to the exclusion of any oth er caps tha t might also app ly .”).

Base d on the f o re going, we believe tha t the Legislature inten ded f or the w rongf ul

d e a t h and surv iv al action cap, section 74. 303
, to app ly secon darily to the cap o n n o n

econ om ic dam ages, section 74. 301 (b), espe cially consid ering tha t app ellees’ w rongf ul

dea th and surv iv al claims arose out of a hea lth care liability claim. See T E X

. C I V

. P R A C

. &

R E M

. C O D E A N N

. §§ 74. 301 (b), 74 .30 3; see also T E X

. G O V ’ T C O D E A N N

. § 3 12. 005 ; Alph a

Inve sco Corp.

, 139 S.W .3d at 700 ; L

. S

. Ra nch, Ltd

. , 970 S.W .2d at 752

. W e do not

believe tha t section 74. 303 shou ld be read to the exclusion of section 74. 301 (b). See T E X

.
C I V

. P R A C

. & R E M

. C O D E A N N

. §§ 74. 301 (b), 74 .30 3.

In this case, the trial court did not award any of the f iv e clai m a n t s m o re t h an
$25 0,0 00 in no n-eco nom ic dam ages ind iv idua lly . In f act, the sum total of non-eco nom ic

dam ages awarded to the claima nts w as $25 0,0 00. T his f igure com ports w ith section

5374. 0 0 1 (a )( 2)’s requireme nt tha t “all perso ns claimin g to have susta ined dam ages as the

result of the bod ily injury or dea th of a single perso n are consid ered a single claima nt” and

the $25 0,0 00 dam age cap provided in section 74. 301 (b). See id. §§ 74. 001 (a)(2) (Verno n

200 5), 74. 301 (b); see also Perea
, 201 0 T ex. App

. LEXIS 598 0, at **93 -95 (conclud ing tha t

f or purp oses of app ly ing the hea lth care liability dam age caps, the esta te of the dece ased

and the de cease d’s f our sons all const itute d one claima nt). W e ca nno t say tha t th e trial

court erred in app ly ing the dam age cap provisi ons provided in section s 74. 3 0 1 (b ) and

74. 303

. See T E X

. C I V

. P R A C

. & R E M

. C O D E A N N

. §§ 74. 3 0 1 (b ), 74. 303

. Accordin gly
, w e
overrule app ellees’ se cond cross-issue.

V. C O N C L U S I O N

Beca use w e have ove rr u le d all issues and cross-issues on app eal, w e af f irm the
judgme nt o f

the trial cou rt.

ROGEL IO V ALDEZ Chief Justice

Deliv ered an d f iled th e 30t h d ay of

Se pte mb er, 2 010

.

54