Court Opinion

ID: 9678743
Source: CourtListenerOpinion
Date Created: 2023-08-24 06:30:57.090139+00
Date Added: 2024-06-11T12:32:40.522842
License: Public Domain

O’CONNOR, Justice,
dissenting.
I dissent. The panel’s opinion permits the health care providers to use the Medical Liability and Insurance Improvement Act (the Medical Act) as a shield to protect them from liability for their medical malpractice.1 The lesson we taught the medical community in Casey v. Methodist Hospital, 907 S.W.2d 898 (Tex.App.—Houston [1st Dist.] 1995, no writ), was that a health care provider can hide a patient’s medical records while the statute of limitations runs. In this case, we see that St. Luke’s and its medical staff have learned and applied the lesson. We should reverse this case and overrule Casey.
Because this is a summary judgment case, we must assume the plaintiff’s summary judgment evidence is true, even though contradicted by the defendants. Thus, the underlying premise in this appeal is the doctors and St. Luke’s were negligent and their negligence caused the plaintiffs injury.2
Background
This suit involved a plaintiff who sustained an on-the-job injury and underwent a back operation, which was to be paid by Cigna, the employer’s workers’ compensation carrier. What began as an operation for a worker’s compensation injury became a situation in which the carrier, as well as the plaintiff, accused the defendants of conspiring to hide and alter medical records. Cigna wanted the medical records to determine if it should pay *380all the expenses for the three month hospital stay, or if it was liable for only the costs associated with the back operation.3 The plaintiff wanted the records to determine if he was injured as a result of medical malpractice. When suit was filed, both the plaintiff and Cigna claimed fraud on the part of the defendants.
In June of 1991, the plaintiff was admitted to the hospital for what was to be a simple back operation. Almost four months later, after six hospitalizations and eleven surgeries, and after having suffered progressive pulmonary edema, congestive heart failure, and acute kidney failure, the plaintiff was discharged with scars across his chest and from his chest to his ankle, and the loss of 70 percent of the muscles in his leg. Why had things gone so terribly wrong? The plaintiff understandably thought somebody did something wrong — most back operations do not leave the front of the patient’s body crisscrossed with scars.
When the plaintiff asked what went wrong, one of the doctors assured him the treatment was necessary to save his life. He did not tell the plaintiff that the doctors had made mistakes in their treatment, including performing a dangerous and possibly unnecessary surgery, not cheeking the plaintiffs EKG or x-rays that indicated a calcified aorta and a history of eardia infarction, choosing to perform the surgery from the front, thus requiring them to shift the plaintiffs calcified aorta, clearing the plaintiff to leave intensive care even though he showed signs of restricted blood flow and other complications, and using an x-ray technician instead of a operating room nurse during the surgery. To compound the deception, the defendants then hid the plaintiffs medical records until after the statute of limitations had run.
Not only did the defendants hide, alter, and refuse to produce the medical records, they delayed completing the records until after the statute of limitations ran. Even the majority’s opinion admits there was “extensive evidence of concealment.” The discharge summary for the June 1991 operation — the most important of the records for determining the possibility of malpractice— was not even dictated until October 15, 1993, two years and five months after the initial surgery, well after the statute of limitations had run. St. Luke’s did not give the records to the plaintiff and Cigna until after the discharge summary was dictated, in October 1993, more than two years and five months after the initial surgery. Two months after receiving the records, in December of 1993, the plaintiff filed suit. However, even those records were not complete. When the plaintiff and Cigna finally secured the records, they found the records full of questionable deletions, mark-outs, and corrections. It was not until 1995 that the plaintiff and Cigna secured all of his medical records.
The majority holds that even if the records were hidden, the plaintiff must have known from the beginning that he had a cause of action against the defendants, and, for that reason, was not entitled to raise the affirmative defense of fraudulent concealment. Thus, the majority concludes, the two year statute of limitations barred the plaintiffs suit. I disagree.
Defendants’ Duty to Admit Their Negligence
When a doctor is negligent, the doctor has the duty to admit it. Borderlon v. Peck, 661 S.W.2d 907, 908 (Tex.1983). Because the doctor-patient relationship is one of trust and confidence, Texas recognizes a duty on the part of the doctor to disclose to a patient that an injury has occurred due to the doctor’s negligence. Id. Failure to disclose negligence constitutes fraudulent concealment which prevents the wrongdoer from perpetrating further fraud by using limitations as a shield. Id.
The summary judgment evidence established that the defendants hid the fact of their negligence from the plaintiff and Cig-*381na.4 Thus, the defendants should not be able to rely on the statute of limitations to hide their breach of their duty to disclose their own negligence.
Section 13.01 of the Medical Act requires a plaintiff to provide expert reports outlining each defendant’s liability within 180 days of filing a medical malpractice suit, or to non-suit any defendant about which the plaintiff does not file an expert report. Tex.Rev.Civ. Stat. art. 4590i, § 13.01(d) (1998). Under section 13.01, a defendant is entitled to a dismissal with prejudice and sanctions if, within 180 days of filing suit, a plaintiff does not produce an expert report. Tex.Rev.Civ. Stat. art. 4590i, § 13.01(e) (1998).
A plaintiff may suspect he has a cause of action for malpractice but, under the unique provisions of the Medical Act, he is precluded from filing suit until he knows he will be able to secure an expert report within six months. No other cause of action punishes a plaintiff as does the Medical Act — if a plaintiff is unable to file an expert report that proves liability and causation within six months of filing suit, his suit will be dismissed with prejudice and monetary sanctions can be imposed. Thus, fraudulent concealment in a medical malpractice case is completely different from fraudulent concealment in any other case.
The majority opinion states, “A party cannot wait to file suit until his attorney tells him he has a cause of action and thereby avoid limitations.” That may generally be true, but I believe the Medical Act changed that rule as it applies to a medical malpractice case.
The provisions of section 13.01 are calculated to cause a plaintiff to delay the filing of a medical malpractice suit until he knows an expert is willing to state under oath that the plaintiff was injured as a result of specific medical malpractice. To do that, the plaintiff must provide the expert with his medical records. The Medical Act requires an expert’s report to both identify (1) the manner in which the care rendered by the defendant did not meet the applicable standards of care and (2) the causal relationship between that failure and the injury. Tex.Rev.Civ.Stat. art. 4590i, § 13.01(r)(6) (1998). The Medical Act does not permit an expert report to simply rely on a bad result as proof of negligence. See Tex .Rev.Civ.Stat. art. 4590i, § 7.02(a) (1998) (jury must be informed that negligence cannot be based solely on evidence of bad result).
The panel opinion holds that the plaintiff should have filed suit against the doctors in this case based on nothing more than the bad result of the operation, without any proof of negligence or causation. Yet, if the plaintiff had filed suit before he had any information about negligence, as the panel suggests, he and his lawyer would have risked sanctions.5 In another type of case, the plaintiff could have filed suit and used discovery to search for evidence of liability and causation. The Medical Act precluded him from using this tactic in his medical malpractice suit.
The summary judgment evidence in this case showed the plaintiff did not even receive the discharge summary from his stay at St. Luke’s until two years, five months, and five days after his first surgery. Realistically, he could not have produced an expert report within two years and six months from the date of injury because the defendants engaged in a scheme to hide and alter the plaintiff’s medical records.
Defendants’ Duty to Provide Medical Records
This is not, as the majority opinion implies, just another discovery dispute that the plain*382tiff failed to pursue to resolution. The plaintiff and Cigna had a right under two different statutes to copies of the medical records; the defendants had a corresponding duty to provide those records, regardless of whether a suit was even filed.
First, the Medical Act entitled both the plaintiff and Cigna to copies of the medical records within ten days of making a request. Section 4.01(d) provides:
All parties shall be entitled to obtain complete and unaltered copies of the claimant’s medical records from any other party ■within 10 days from the date of receipt of a written request for such records; provided, however, that the receipt of a medical authorization executed by the claimant herein shall be considered compliance by the claimant with this section.
Tex.Rev.Civ.Stat. art. § 4590i, § 4.01(d) (1998) (emphasis added).
Second, under the Worker’s Compensation Act, both the plaintiff and Cigna were entitled to copies of the medical records. The provision of the Worker’s Compensation Act effective in 1991 was section 4.66(b), which provided:
A health care facility shall, on request of either the injured employee, the employee’s attorney, or the insurance carrier, furnish records pertain to treatment or hospitalization for which compensation is being sought.
See Tex.Rev.Civ.Stat. art. § 8308-4.66 (repealed),6 formerly Tex.Rev.Civ.Stat. art. 8306, § 7 (repealed).
Under Texas Workers’ Compensation Commission’s Board Rule 42.30, the health care provider should send a patient’s medical records with the invoices it sends to the carrier. Under Board Rule 42.25, the health care provider must submit complete, adequate, and detailed reports when required or requested by the insurance carrier or the claimant. St. Luke’s failure to provide the plaintiff and Cigna with complete records violated the Medical Act, the Worker’s Compensation Act, and the Workers’ Compensation Commission Board Rules.
The plaintiff provided an affidavit of an expert in the area of hospital administration which stated St. Luke’s had a legal duty to timely and accurately compile and maintain medical records. If a hospital does not complete a patient’s medical records within the time required by the hospital’s own by-laws and according to national standards, it is impossible for a patient to determine what treatment he received. See St. Luke’s Episcopal Hospital Medical Staff Rules & Regulations, approved 5-10-90, p. 9, B-17; Medicare, Part 482 — Conditions of Participation for Hospitals, 482.24, Medical Record Services. The medical record of a patient’s stay in a hospital is the only record of the care and treatment provided a patient while in the hospital. St. Luke’s violated its own internal rules and fell below the national minimum standards.
Conclusion
This is not a case that the plaintiff and Cigna did not, but should have, realized something went wrong. Both the plaintiff and Cigna immediately realized something went wrong and for more than two years actively sought the records to confirm their suspicions. The defendants refused to provide the records time and time again and fraudulently tampered with the records. Their acts should toll the statute of limitations. To hold otherwise essentially tells health care providers to, as a matter of course, withhold medical records containing indications of negligence until two years and seven months after the botched treatment. Then, any medical malpractice claims arising out of the negligence are effectively barred.

. The panel opinion, authored by Justice Andell, resolves the two issues in this case holding: (1) the plaintiff carried his burden to show fraudulent concealment, and (2) even without the records the plaintiff should have known that he had a suit for medical malpractice. Justice Cohen concurs with the result of Justice Andell’s opinion but disagrees that the plaintiff showed fraudulent concealment. I agree with Justice Andell that the defendants’ fraudulently concealed the records, but I dissent from his conclusion that the plaintiff could have filed suit without the records.

. The concurring opinion states that to defeat the motion for summary judgment, the plaintiff was required to show that the medical records that were concealed "kept him from suing within the period of limitations.” The plaintiff made a sufficient showing of that through the affidavit of an expert witness, Dr. James Stum, who is both a medical doctor and a lawyer. In his affidavit, Dr. Stum said:
Based upon reasonable medical certainty, Plaintiff's injuries occurred as a result of a deviation from the acceptable standard of care.
Based upon reasonable medical certainty, the injuries to Plaintiff were of a type that the Defendant physicians immediately knew had occurred and how they occurred....
Based upon a reasonable medical certainty, it would be impossible to determine whether or not medical malpractice occurred in the care of Mr. Rubalcaba without having Mr. Ru-balcaba’s complete St. Luke’s Hospital records available for review. This is because the records from the defendant doctors’ offices do not contain the complete records of Mr. Rubalca-ba's hospitalizations at St. Luke’s.

. Cigna intervened as a plaintiff and sued the defendants for (1) subrogation (in the event the plaintiff was successful in his suit against the defendants), (2) the recovery of money paid to the defendants for treatment which was not reasonable or necessary or related to the plaintiff’s workers' compensation injury, and (3) attorney fees. Cigna was not willing to cover the costs associated with the doctors' negligence.

. Even today, the defendants contend they were not required to produce records because they were not negligent. The defendants miss the point entirely. As noted below, they were not required to produce records only if they were negligent; they were required to produce records upon request, separate and apart from any negligence.

. In footnote two, the panel opinion mistakenly says the plaintiff could have obtained an extension of time to file the expert reports. Section § 13.01(f) specifically prohibits the trial court from granting more than one 30-day extension for filing the expert report outside the time limits provided in section 13.01. See Tex.Rev.Civ.Stat. art. 4590i, § 13.01(f) (1998). The plaintiff could not have secured additional time by asking for an injunction.

. Act of Dec. 12, 1989, 71st Leg., 2d C.S., ch. 1, § 4.66, 1989 Tex.Gen.Laws 47-8, repealed by Act of May 29, 1993, 73d Leg.R.S., ch. 269, § 1, 1993, Tex.Gen.Laws 987, 990. Now, see TexLab. Code § 408.025(d).