The Supreme Court of the State of Texas (“Texas Supreme Court”) stated in its opinion delivered on April 16, 2021: “The questions before us are (1) whether claims asserted against a state mental health facility and its employees arising from the death of a patient, pleaded as claims under 42 U.S.C. § 1983, are health care liability claims under the Texas Medical Liability Act (TMLA); and (2) if so, whether section 1983 preempts the TMLA’s requirement to timely serve an expert report. We hold that the claims are health care liability claims subject to the TMLA and that section 1983 does not preempt the TMLA’s expert-report requirement. We therefore reverse the court of appeals’ judgment and remand the case to the trial court for proceedings consistent with this opinion.”
The Underlying Facts
David Bagley (“Bagley”) sued Rio Grande State Center (RGSC) and several of its employees after the death of his thirty-seven-year-old son, Jeremiah Bagley. Jeremiah, who had a history of mental illness, was committed to RGSC, a state mental health facility. While there, Jeremiah was involved in multiple altercations with other patients. After one such altercation, Jeremiah was assigned one-to-one supervision. The incident that led to Jeremiah’s death began when Jeremiah physically struck his one-to-one monitor. Five psychiatric nurse assistants (PNAs) intervened to restrain him and administer injectable anti-psychotic and sedative drugs, Olanzapine and Diphenhydramine.
After Jeremiah calmed, he walked to his room, but he soon became agitated, disoriented, pale, and incoherent. Minutes later, Jeremiah went into cardiac arrest. RGSC staff performed CPR and called EMS. When EMS arrived, they administered CPR using an automated chest compression device. EMS transported Jeremiah to a hospital, where he was pronounced dead.
An autopsy revealed Jeremiah had several fractured vertebrae, cracked ribs, a lacerated spleen, and contusions on his head, shoulders, back, and chest. The stated cause of death was “excited delirium due to psychosis with restraint-associated blunt force trauma.”
Bagley sued individually and as the representative of Jeremiah’s estate, asserting claims under 42 U.S.C. § 1983, alleging (1) excessive force in violation of the Fourth Amendment against the PNAs, (2) deliberate indifference by the supervisors in their training and supervision of the PNAs, and (3) deliberate indifference as to Bagley’s medical care against Dr. Ramona Rogers.
The Texas Medical Liability Act, which governs health care liability claims (HCLCs), requires that the plaintiff, to avoid dismissal, serve an expert report addressing liability and causation as to each defendant within 120 days after the defendant files an original answer. TEX. CIV. PRAC. & REM. CODE § 74.351(a). Bagley served no such expert report.
HCLCs have three elements: (1) the defendant is a health care provider or physician; (2) the claimant’s cause of action is for treatment, lack of treatment, or other claimed departure from accepted standards of medical care, health care, or safety or professional or administrative services directly related to health care; and (3) the defendant’s alleged departure from accepted standards proximately caused the claimant’s injury or death. The Texas Supreme Court stated: “Whether Bagley’s claims are HCLCs therefore turns on the second element—whether Bagley’s section 1983 claims allege a cause of action “for treatment, lack of treatment, or other claimed departure from accepted standards of medical care, or health care, or safety or professional or administrative services directly related to health care.””
The TMLA defines “health care” as “any act or treatment performed or furnished, or that 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.” The TMLA does not define “safety,” but the Texas Supreme Court has defined it as “the condition of being ‘untouched by danger; not exposed to danger; secure from danger, harm or loss.’”
The Texas Supreme Court stated: “Here, Bagley’s section 1983 claims are based on the following allegations: (1) the PNAs improperly restrained Jeremiah for ten minutes with force that was objectively unreasonable and excessive to the need and forcibly injected him with medications to calm him; (2) the RGSC administrators were deliberately indifferent for failing to train and supervise the PNAs to use proper restraint techniques; and (3) Dr. Rogers, Jeremiah’s treating physician, was deliberately indifferent for ignoring Jeremiah’s “serious medical needs.” We agree with the court of appeals that these allegations constitute claims based on the departure from accepted standards of health care and therefore fall within the TMLA’s scope … Regardless of how Bagley characterizes them, at their core, his claims turn on whether the defendants adhered to the appropriate standards of care for restraining a psychiatric patient, supervising and training those who would restrain a psychiatric patient, and properly treating and administering medication to a psychiatric patient. As we have previously recognized, physical restraint, training and staffing policies, and supervision behind the use of restraint are integral components of the rendition of health care services to potentially violent psychiatric patients … Bagley’s allegations regarding Jeremiah’s restraint also constitute complaints that the defendants departed from safety standards and should be classified as HCLCs for that independent reason … Bagley’s claims are HCLCs for a third reason: their proof requires expert testimony … All of Bagley’s claims allege a departure from accepted standards of health care or safety. Therefore, we hold they are all “health care liability claims” under the TMLA.”
The Texas Supreme Court held: “Because the TMLA’s expert-report requirement is procedural in nature and would not cause reliably different outcomes in section 1983 cases brought in state and federal court, we hold that section 74.351 is not preempted by section 1983.”
Fortunately for Bagley, the Texas Supreme Court also held: “In this case, Bagley’s failure to serve the requisite expert reports was not a mere error in interpreting section 74.351. Rather, our conclusion that an expert report was required in this case turns on a previously unaddressed preemption question. Because our decision today substantially clarifies that novel issue, we will remand Bagley’s claims against the individual defendants to the trial court and direct the trial court to provide Bagley an additional sixty days to comply with section 74.351.”
Source Rogers v. Bagley, No. 19-0634.
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