Opinion ID: 894688
Heading Depth: 2
Heading Rank: 1

Heading: Statute of Limitations for Health Care Liability Claims

Text: Rubio filed suit in July 1999 for injuries from two alleged falls at Goliad Manor. In September 2000, nearly five and one-half years after the alleged assaults took place, she amended her complaint to plead claims for sexual assaults by another nursing home resident during 1995. Rubio argues that because her claims are not health care liability claims under the MLIIA, they are governed by the general statute of limitations for personal injury claims, which tolls the statute of limitations due to mental incapacity. Tex. Civ. Prac. & Rem.Code §§ 16.001(b), 16.003. Diversicare argues that these claims are barred by the two-year statute of limitations under the MLIIA, which does not provide for tolling based on mental incapacity. [2] The parties agree that Rubio was mentally incapacitated during her entire stay at Goliad Manor. Section 10.01 of the MLIIA states: Notwithstanding any other law, no health care liability claim may be commenced unless the action is filed within two years from the occurrence of the breach or tort or from the date the medical or health care treatment that is the subject of the claim or the hospitalization for which the claim is made is completed.... Except as herein provided, this subchapter applies to all persons regardless of minority or other legal disability. Former TEX.REV.CIV. STAT. art. 4590i, § 10.01. The MLIIA's two-year statute of limitations applies to health care liability claims as defined by the statute. [3] To determine whether a cause of action is a health care liability claim that falls under the rubric of the MLIIA, we examine the underlying nature of the claim and are not bound by the form of the pleading. See Sorokolit v. Rhodes, 889 S.W.2d 239, 242 (Tex.1994). The MLIIA defines a health care liability claim as: a cause of action against a health care provider or physician for treatment, lack of treatment, or other claimed departure from accepted standards of medical care or health care or safety which proximately results in injury to or death of the patient, whether the patient's claim or cause of action sounds in tort or contract. Former TEX.REV.CIV. STAT. art. 4590i, § 1.03(a)(4). Health care is broadly defined as any act or treatment performed or furnished, or which should have been performed or furnished, by any health care provider for, to, or on behalf of a patient during the patient's medical care, treatment, or confinement. Id. § 1.03(a)(2). A nursing home is a health care provider. Id. § 1.03(a)(3). In this case, we must determine if Rubio's claims for inadequate supervision and nursing services to protect her from assault and meet her health care needs during confinement in the nursing home are governed by the MLIIA. A cause of action against a health care provider is a health care liability claim under the MLIIA if it is based on a claimed departure from an accepted standard of medical care, health care, or safety of the patient, whether the action sounds in tort or contract. Id. § 1.03(a)(4); MacGregor Med. Assoc. v. Campbell, 985 S.W.2d 38, 41 (Tex.1998); Gormley v. Stover, 907 S.W.2d 448, 449 (Tex.1995); Sorokolit, 889 S.W.2d at 242; Mulligan v. Beverly Enters.-Tex., Inc., 954 S.W.2d 881, 884 (Tex.App.-Houston [14th Dist.] 1997, no pet.); Waters ex rel. Walton v. Del-Ky, Inc., 844 S.W.2d 250, 258-59 (Tex.App.-Dallas 1992, no writ). A cause of action alleges a departure from accepted standards of medical care or health care if the act or omission complained of is an inseparable part of the rendition of medical services. See former TEX.REV.CIV. STAT. art. 4590i, § 1.03(a)(2), (4); Walden v. Jeffery, 907 S.W.2d 446, 448 (Tex.1995); Shaw v. BMW Healthcare, Inc., 100 S.W.3d 8, 15 (Tex.App.-Tyler 2002, pet. denied). The necessity of expert testimony from a medical or health care professional to prove a claim may also be an important factor in determining whether a cause of action is an inseparable part of the rendition of medical or health care services. Garland Cmty. Hosp. v. Rose, 156 S.W.3d 541, 544 (Tex.2004); see, e.g., Bush v. Green Oaks Operator, Inc., 39 S.W.3d 669, 674 (Tex.App.-Dallas 2001, no pet.) (Dodson, J. dissenting) (Further, the claims in this case are of the type that would require expert testimony as to the appropriate standard of care in segregating patients in a psychiatric hospital. . . .); Rogers v. Crossroads Nursing Serv., Inc., 13 S.W.3d 417, 419 (Tex.App.-Corpus Christi 1999, no pet.). But see Haddock v. Arnspiger, 793 S.W.2d 948, 951 (Tex.1990) (noting that expert testimony is not needed to establish breach of a medical duty where the departure is plainly within the common knowledge of laymen, such as leaving a sponge in a patient after surgery). In Walden, this Court held that a claim for ill-fitting dentures is a health care liability claim governed by the MLIIA. 907 S.W.2d at 448. Lena Jeffery sued her dentist Dr. Terry Walden for breach of implied warranty, breach of contract, and DTPA violations for failure to provide dentures that fit. Id. at 447. We held that providing dentures was inseparable from health care provided to the patient as part of the provision of professional dental services. Id. at 448. In Shaw, the court of appeals, following our decision in Walden, held that a plaintiff could not bring a claim for intentional elder abuse separate from his MLIIA claim for negligence because the alleged negligent administration of an overdose of sedatives to a nursing home resident constituted a breach of the standard of care for a health care provider. Shaw, 100 S.W.3d at 15. Shaw, a patient, was administered sedatives to restrain him from possible injury by wandering around the facility. Id. at 10. He was hospitalized and a month later developed very high blood sugar levels and died. Id. at 10-11. Shaw argued that the nursing home was negligent in allowing its nursing staff to administer chemical restraints to Shaw and that this conduct gave rise to two independent causes of action: one for negligence governed by the MLIIA and one for intentional elder abuse outside the scope of the Act. Id. at 14. The court of appeals held that the claim for intentional elder abuse was in substance a claim for breach of the applicable standard of care for a health care provider governed by the MLIIA. Id. at 15. Therefore, dismissal of the claim was proper because the plaintiff did not file an expert report as mandated by the statute. Id. The court noted that the facts which gave rise to Shaw's MLIIA claims were the same as those relied upon for his claim for intentional elder abuse, and both were based on breaches of the accepted standard of care for a health care provider. Id. The court of appeals correctly recognized that if the act or omission that gave rise to the claim is so integral to the rendition of medical services by the provider to be an inseparable part of those services, it constitutes a breach of the standard of care applicable to health care providers and is governed by the MLIIA. See id. In Waters, Will Walton, a nursing home patient who required constant attention, fell from a second-story window. 844 S.W.2d at 252. He died four days later as a result of the injuries he sustained in the fall. Id. His sister, Ruby Mae Waters, brought suit against the nursing home under the Texas Survivorship statute and the Texas Deceptive Trade Practices Act for her brother's injuries on the ground that the nursing home failed to provide him with appropriate physical and medical care. Id. at 252-53. Waters's DTPA action was based on the nursing home's alleged express warranty that it would provide, inter alia, adequate medical care evaluation and sufficient qualified personnel to properly supervise her brother. Id. at 254. The court of appeals held that the MLIIA applied because the negligent supervision of a helpless resident was a claim for deviations from the applicable standard of care for the nursing home even if the claim is framed as a misrepresentation or failure to comply with an express warranty. Id. at 258-59. In Waters, the court of appeals rejected the contention that the legal disability of unsound mind contained in the general tolling statute tolls the two-year statute of limitations in MLIIA's section 10.01. Id. at 256. We apply these legal tenets to Rubio's claims.