Court Opinion

ID: 9758645
Source: CourtListenerOpinion
Date Created: 2023-08-28 23:39:06.74151+00
Date Added: 2024-06-11T10:00:07.509231
License: Public Domain

VANCE, Justice,
concurring.
I join Chief Justice Davis’ opinion and agree that this case should be remanded for trial. I write separately to discuss the issues presented in light of the Medical Liability and Insurance Improvement Act (the “Act”). Tex.Rev.Civ. Stat. Ann. art. 4590Í (Vernon Supp.2001).
Rebecca and Ray Cobb sued the Hospital and two doctors under the Act in cause 17-154790-94. Id. The order granting the *828Hospital’s motion for summary judgment dismisses the Cobbs’ claims against the Hospital. Apparently to make that order final, those claims were severed into a new cause, No. 17-177355-99, and were again dismissed. Appeal was taken from the second order.1
MEDICAL LIABILITY AND INSURANCE IMPROVEMENT ACT
We should be addressing such claims in light of the Act, by which the Legislature has given us several definitions to consider:
“Health care” means 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.
“Health care provider” means any person, partnership, professional association, corporation, facility, or institution duly licensed or chartered by the State of Texas to provide health care as a registered nurse, hospital, dentist, podiatrist, pharmacist, or nursing home, or an officer, employee, or agent thereof acting in the course and scope of his employment.
“Health care liability claim” means 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.
“Medical care” means any act defined as practicing medicine in Article 4510, Revised Civil Statutes of Texas, 1925, as amended, performed or furnished, or which should have been performed, by one licensed to practice medicine in Texas for, to, or on behalf of a patient during the patient’s care, treatment, or confinement.
Tex.Rev.Civ. Stat. Ann. art. 4590i, § 1.03(a)(2), (3), (4), (6) (Vernon Supp. 2001).
NATURE OF THE CLAIMS
Note should be taken of the difference between the Act’s definitions of “health care,” which can be delivered by any “health care provider,” and “medical care,” which can be delivered only by one licensed to practice medicine. Id. § 1.03(a)(2), (3), (6). Using those definitions Rebecca Cobb is not asserting a claim for “medical care” against the Hospital.
One may question whether Rebecca Cobb is asserting a “health care liability claim” against the Hospital. Id. § 1.03(a)(4). The answer depends on the meaning ascribed to the word “act” in the definition of “health care.” Id. § 1.03(a)(2). Given its broadest definition, “act” would include everything a hospital does with respect to a patient because every act claimed to have been done or omitted could be said to have been “performed or furnished, or which should have been performed or furnished, by [a] health care provider for, to, or on behalf of a patient during the patient’s medical care, treatment, or confinement.” Id.
The Hospital is a “health care provider” under the statutory definition. Id. *829§ 1.03(a)(3). But hospitals furnish many services. They employ other “health care providers,” such as nurses and pharmacists, to provide “health care” to patients. They also employ many persons normally thought to be “non-providers,” who work at such things as administration, building maintenance, food-service, laundry, and other tasks that make the institution operate efficiently. The Act’s definition of “health care provider” might be read, however, to include such “non-providers” because it includes all officers, employees, and agents of providers who are acting in the course and scope of their employment. Id.
The question that naturally arises is whether every “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” would lead to a “health care liability claim” under the Act, even if performed by a staff-member who is a “non-provider” in his or her own right.2 Tex.Rev.Civ. Stat. Ann. art. 4590i § 1.03(a)(2). Giving these definitions their most expansive scope, the cook in a hospital would be classified as a “health care provider” delivering “health care.” The maintenance electrician repairing a light fixture in the lobby would be classified as a “health care provider” delivering “health care.” The legislature could not have so intended.
REVIEW OF THE SUMMARY JUDGMENT
How should we analyze the trial court’s rejection of the Cobbs’ claims? As Chief Justice Davis points out, the review standard tells us to accept all evidence favorable to the non-movants, the Cobbs, as true and indulge every reasonable inference and resolve all doubts in their favor. Although a doctor selected the hardware installed in her back from the items available in the operating room, the summary-judgment evidence shows that the hardware implanted in Rebecca’s back was among items delivered to “central supply” at the Hospital, processed and sterilized, then taken to the operating room. There, the hardware was laid out for use during the operation. More items of hardware were delivered to the hospital, however, than were available in the operating room at the time of the surgery.
What the summary judgment evidence does not show is the name or status of the hospital’s employee or employees who accepted delivery of the hardware, sterilized it, and delivered it to the operating room. Indulging reasonable inferences and resolving doubts in the Cobbs’ favor, we may assume that those were “non-medical” personnel, i.e., persons who are not “providers” under the Act in their own right. Using that assumption, the claim should be viewed as an ordinary, non-medical negligence case, even though it occurred in a medical setting.
ELEMENTS OF THE CLAIM
The elements of a medical negligence claim are: (1) a duty to act according to an applicable standard of care; (2) a breach of that standard of care; (3) an injury; and (4) a causal connection between the breach and the injury. Reynosa v. Huff, 21 S.W.3d 510, 513 (Tex.App. — San Antonio 2000, no pet.); Wyatt v. Longoria, 33 S.W.3d 26, 31 (Tex.App. — El Paso 2000, no pet.). Little has been said in the decisions *830to date about how these elements relate to the Act.
However, the elements of a claim based on general negligence concepts are: (1) a legal duty; (2) a breach of that duty; and (3) damages proximately resulting from the breach. See El Chico Corp. v. Poole, 732 S.W.2d 306, 311 (Tex.1987).
DUTY
Duty is always the threshold inquiry, which is a question of law for the court to decide. See Greater Houston Transp. Co. v. Phillips, 801 S.W.2d 523, 525 (Tex.1990). The operative question in this appeal is: did the hospital have a duty to Rebecca Cobb with respect to the pedicular hardware kit that was used in her operation. I have no difficulty in finding a duty under general negligence principles, considering the risk, foreseeability, and the likelihood of injury weighed against the social utility of the hospital’s conduct, the magnitude of the burden of guarding against the injury, and the consequences of placing that burden on the hospital. See Van Horn v. Chambers, 970 S.W.2d 542 (Tex.1998) (citing the balancing test of Greater Houston Transp., 801 S.W.2d at 525 (Of all these factors, foreseeability of the risk is “the foremost and dominant consideration.”)).
NEGLIGENCE
Under this record, a fact issue exists about whether the Hospital breached its duty and thereby contributed to Rebecca Cobb’s injuries.
SUMMARY
Because the summary judgment evidence raises genuine issues of material fact about a breach of duty by the Hospital and damages proximately resulting from the breach, I join in the decision to reverse the summary judgment and remand the cause for trial. El Chico, 732 S.W.2d at 311.

. I question whether a dismissal was proper. Although dismissal might be the proper disposition on a summary-judgment motion that established that the plaintiff had no right to maintain the suit, the granting of a defendant’s summary-judgment motion based on evidentiary considerations should result in a take-nothing judgment.

. Because "health care liability claim” is defined in terms of a departure from accepted standards with respect to a "patient,” a claim of breach of duty by a "non-provider” employee of a hospital to a non-patient, e.g., a visitor, is not covered by the Act. Id. § 1.03(a)(3).