In a Texas medical malpractice case decided by the Texas Court of Appeals, Third District, at Austin (“Texas Appellate Court”) on February 10, 2021, the plaintiff argued that the trial court erred in determining that the medical care the defendants provided to treat her post-C-section hemorrhaging constituted “emergency medical care” as defined in the TMLA, triggering the “willful and wanton standard of proof” for the plaintiff to prevail.
The Underlying Facts
The plaintiff was admitted to the hospital on January 29, 2015 for induction of labor for her first child. She alleged that after a trial of labor, the decision was made to proceed with a cesarean section due to arrest of descent. The C-section was completed in the early morning hours of January 31, 2015, but thereafter the plaintiff experienced significant post-partum hemorrhaging beginning at 3:34 a.m. She alleges that hypotension and tachycardia accompanied her hemorrhaging but that defendants spent three hours ineffectively attempting to stop the bleeding rather than proceeding to definitive treatment (i.e., hysterectomy). The plaintiff alleges that due to the defendants’ alleged failures to follow the hospital’s “Perinatal Hemorrhage Protocol,” to adequately monitor her, and to administer sufficient plasma, platelets, and blood-clotting medicine, the plaintiff’s “pulse was lost” and she “coded” twice. Although she was “ultimately resuscitated,” the plaintiff alleges that she suffered “an anoxic brain injury and other sequelae as a result of the [heart] arrests.”
After discovery, the defendants moved for traditional and no-evidence summary judgment, contending that the care they provided the plaintiff beginning at 3:34 a.m. constituted “emergency medical care” under Section 74.001(a)(7) of the TMLA, requiring the plaintiff to prove willful and wanton negligence as provided by Section 74.153, of which she could produce no evidence. After a hearing, the trial court granted the defendants partial summary judgment for the care they provided the plaintiff between 3:34 a.m. and 6:20 a.m. but determined that “a fact issue exists as to whether the care at issue in this case provided to Plaintiff from [6:20 a.m.] until [7:18 a.m.] constituted ‘emergency medical care’ as defined by” section 74.001(a)(7) and that the plaintiff’s claims as to the latter period “may proceed to trial.” However, finding that “an immediate interlocutory appeal from the portion of” the order granting summary judgment “may materially advance the ultimate termination of the litigation,” the trial court granted the plaintiff’s motion to pursue an interlocutory appeal and stayed all further proceedings pending resolution of the interlocutory appeal.
Tex. Civ. Prac. & Rem. Code § 74.153 provides: “In a suit involving a health care liability claim against a physician or health care provider for injury to or death of a patient arising out of the provision of emergency medical care in a hospital emergency department or obstetrical unit or in a surgical suite immediately following the evaluation or treatment of a patient in a hospital emergency department, the claimant bringing the suit may prove that the treatment or lack of treatment by the physician or health care provider departed from accepted standards of medical care or health care only if the claimant shows by a preponderance of the evidence that the physician or health care provider, with wil[l]ful and wanton negligence, deviated from the degree of care and skill that is reasonably expected of an ordinarily prudent physician or health care provider in the same or similar circumstances.”
Tex. Civ. Prac. & Rem. Code § 74.001(a)(7) defines “emergency medical care” as “[B]ona fide emergency services provided after the sudden onset of a medical or traumatic condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected to result in placing the patient’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part. The term does not include medical care or treatment that occurs after the patient is stabilized and is capable of receiving medical treatment as a nonemergency patient or that is unrelated to the original medical emergency.”
Texas Appellate Court Opinion
The Texas Appellate Court stated “the phrase “original medical emergency” simply refers to the initial “sudden onset of a medical or traumatic condition” requiring “bona fide emergency services” so as to distinguish such services from later-rendered services “unrelated” to that initial condition. It dictates nothing about when or where the medical emergency must occur.”
With regard to the plaintiff’s argument that she was stable and capable of receiving medical treatment as a nonemergency patient when she presented to the hospital’s obstetrical unit on January 29, 2015 and, therefore, hospital care that occurred thirty-two hours later on January 31, 2015 is care that occurred after she was stable and capable of receiving medical treatment as a nonemergency patient, the Texas Appellate Court stated: “[The plaintiff’s] proposed construction of the statute would render the exclusion meaningless, because the essence of an emergency is that a person suddenly progresses from a “stable” condition to a severely threatened one; if the patient presented to the hospital or obstetrical unit in a stable condition, there would be no need for an exclusion for that person’s care provided after admission to the facility because there would be no medical emergency in the first place. We therefore overrule [the plaintiff’s] second issue.”
The Texas Appellate Court held that “the trial court properly construed and applied Sections 74.001(a)(7) and 74.153 of the TMLA, we affirm its partial summary judgment.”
Source Morris v. Piparia, M.D., No. 03-19-00473-CV.
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