The Supreme Court of Texas (“Texas Supreme Court”) stated in its opinion filed on February 25, 2022: “The plaintiff in this case alleges that the defendants negligently administered various treatments that caused scarring and discoloration to her skin. The primary issue is whether her claims constitute “health care liability claims” under the Texas Medical Liability Act. A preliminary issue is whether the Act prohibited the plaintiff from filing an amended petition after the Act’s deadline for serving expert reports. We hold that the Act did not prohibit the plaintiff from filing an amended petition and that her claims constitute health care liability claims. Because the plaintiff failed to timely serve an expert report, the Act requires that her claims be dismissed. We reverse the court of appeals’ judgment and remand the case to the trial court for an award of attorney’s fees, as the Act requires.”
The Underlying Facts
Erika Gaytan sued Lake Jackson Medical Spa, Ltd., its employee, aesthetician Jamie Gutzman, and its owner, Dr. Robert Yarish, complaining that Gutzman negligently performed various skin treatments that caused scarring and discoloration. Gaytan originally sued only the Medical Spa and Gutzman, expressly asserting claims for “medical negligence” involving an “improper and negligent course of medical treatment.” She later added Dr. Yarish as a defendant in her first amended petition, alleging he negligently allowed Gutzman to administer the “medical treatments” even though he knew or should have known they were “improper and would cause physical harm.”
Gaytan filed a response to the defendants’ dismissal motion, arguing that the Texas Medical Liability Act does not apply (and thus did not require her to serve an expert report) because she is not asserting a “health care liability claim” against any of the defendants. Instead, she argued, she complains only about “cosmetic skin treatments” she received “purely for aesthetic reasons.” Consistent with her response, Gaytan filed a second-amended petition the day before the hearing on the defendants’ dismissal motion, in which she omitted all references to the Act and to “medical” treatments or negligence.
The trial court denied the defendants’ dismissal motion, and the defendants took an interlocutory appeal. The court of appeals affirmed, and the Texas Supreme Court thereafter granted the defendants’ petition for review.
Texas Supreme Court Opinion
The Texas Supreme Court stated, “Because the defendants have not asserted that Gaytan’s second amended petition “operated as a surprise” to them, neither the Act nor our rules prohibited Gaytan from amending her petition in response to the defendants’ dismissal motion … the trial court’s consideration of an amended pleading properly filed in response to a dismissal motion is consistent with the basis on which the court must determine whether the claimant has asserted a health care liability claim … we hold that the Act does not prohibit trial courts from considering an amended petition filed in response to a dismissal motion under section 74.351.”
The Texas Supreme Court stated: “Reading the definitions of “health care” and “medical care” together clarifies that physicians provide “medical care” and health care providers provide “health care” … But health care providers provide health care only when they furnish treatment to a patient “during”—or as part of—a physician’s provision of “medical care.” TEX. CIV. PRAC. & REM. CODE § 74.001(a)(10). So for Gaytan’s claims to assert departures from accepted standards of “health care,” the record must establish that Gutzman treated Gaytan pursuant to a physician-patient relationship between Gaytan and Dr. Yarish, and that Gutzman provided those treatments during Gaytan’s medical care, treatment, or confinement. We conclude based on this record that both requirements are met.”
“Generally, a physician-patient relationship arises when a physician agrees to provide professional medical services to a patient and the patient agrees to accept the physician’s services … But a patient need not interact directly with or have physical contact with the physician for the relationship to exist … What matters is the physician’s express or implied agreement to provide, and the patient’s express or implied agreement to accept, the physician’s “professional services.””
The Texas Supreme Court held: “We conclude that this record establishes that Dr. Yarish offered, and Gaytan agreed to receive, his professional services, and Gaytan thus became his patient … By seeking treatments from an employee at a medical spa Dr. Yarish owned and operated, she necessarily sought and agreed to receive his professional services. Such services, including “nonsurgical medical cosmetic procedures,” need not be performed by the physician personally, but a physician who provides them indirectly through another is ultimately responsible for the patient’s safety and for ensuring that the person who provides them on the physician’s behalf is appropriately trained and supervised … Gaytan alleges that Dr. Yarish negligently failed in this regard and seeks to hold him responsible, but in the absence of a physician-patient relationship, Dr. Yarish would have no duty to do any of the things she alleges he negligently failed to do … By alleging that Dr. Yarish negligently caused her injuries and seeking to hold him legally liable for that conduct, Gaytan necessarily concedes that she was Dr. Yarish’s patient.”
The Texas Supreme Court further stated: “Gaytan alleges that Gutzman negligently administered a course of skin treatments that included “L.J. acne treatment, L.J. skin pen, L.J. phototherapy acne treatment, skin pen spot treatment, microdermabrasion, and L.J. VI peel treatment.” Nothing in the record establishes or suggests that the nature of and standards for the proper administration of these treatments fall “within the common knowledge of laypersons” … The proper and applicable standards of “dermatological care,” reliance on medical histories, risks involving the use of tretinoin cream, and proper adjustments of a laser-treatment device, as well as whether defendants’ conduct fell below those standards, are all matters that require expert testimony; indeed, it “would blink reality” to conclude otherwise.”
Furthermore, “we conclude that Gaytan asserts health care liability claims even if expert testimony were not required. The necessity of expert testimony prevents the claimant from rebutting the Act’s presumption, but depending on the “totality of the circumstances,” a claimant might not rebut the presumption even when expert testimony is not required … we have held that a claim constitutes a health care liability claim when the conduct complained of is an “inseparable or integral part of the rendition of health care” … We conclude that all of the defendants’ conduct about which Gaytan complains is inseparable from the medical and health care the defendants provided … Because that course of treatment constituted the provision of medical care and health care, Gaytan has failed to rebut the presumption that her claims constitute health care liability claims under the Act.”
The Texas Supreme Court held: “We hold that the Texas Medical Liability Act’s expert-report deadline did not prohibit Gaytan from amending her petition in response to the defendants’ dismissal motion. But even considering her amended petition, Gaytan’s claims against the defendants constitute health care liability claims subject to the Act’s expert-report requirements. Because Gaytan failed to serve an expert report before the Act’s 120-day deadline, her claims must be dismissed. Because the Act requires the trial court to award defendants their reasonable
attorney’s fees and costs, see TEX. CIV. PRAC. & REM. CODE § 74.351(b), we remand the case to the trial court for further proceedings.”
Source Lake Jackson Medical Spa v. Gaytan, No. 20-0802.
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