After struggling with her gender identity throughout her teenage years, Soren Aldaco contacted the Crane Clinic to schedule a double mastectomy. Clinic staff advised that, to move forward, she’d need a letter from a practitioner recommending her for the surgery. They provided a template for the letter, plus a list of practitioners who would sign it upon request.
Aldaco requested the necessary letter from Barbara Rose Wood, a therapist with whom she’d been having telehealth sessions to talk about relationship issues. On February 22, 2021, Wood signed the letter “endors[ing] . . . top surgery” for Aldaco. After Aldaco missed a subsequent therapy session, failed to pay the no-show fee, and discontinued contact, Wood terminated Aldaco’s psychotherapy on May 14, 2021.
On June 11, 2021, Aldaco underwent a double mastectomy at the Crane Clinic on the strength of Wood’s letter. But the surgery Aldaco had hoped would solve her problems only made them worse. She experienced post-surgical complications that required emergency medical care. Research and self-reflection ultimately led her to regret the life-changing and body-altering procedure she’d once embraced.
In 2023, Aldaco sued the providers who made her double mastectomy possible, including Wood and her employer, Thriveworks. She claimed that Wood committed negligence and fraud during her therapy, and that Thriveworks was directly and vicariously liable. According to Aldaco, Wood’s decision to sign the letter was “a severe departure from any recognized standard of care.” She alleged that, among other falsehoods, the letter misrepresented the extent to which Wood had treated Aldaco for gender dysphoria.
Wood and Thriveworks sought summary judgment under the TMLA’s two-year statute of limitations. Tex. Civ. Prac. & Rem. Code § 74.251(a). The district court granted their motion and severed Aldaco’s claims against them, thereby “making final the judgment against [Wood and Thriveworks].” Aldaco appealed that final judgment, but the court of appeals affirmed. 727 S.W.3d 213, 218–20, 222 (Tex. App.—Fort Worth
2024).
The Supreme Court of Texas stated in its June 26, 2026 Opinion: “Aldaco couldn’t ascertain any bodily injury until after completion of her treatment. Wood terminated psychotherapy on May 14, 2021, but the double mastectomy wasn’t performed until June 11, 2021. At any time during the course of treatment, Wood could’ve (and perhaps should’ve) withdrawn her allegedly negligent and fraudulent letter of February 22, 2021 … Wood’s alleged negligence posed the same risk on the last day of treatment as it did on the day she wrote the letter—namely, that Aldaco would act on the surgery recommendation that was never withdrawn. Under that theory of the case, even if we ignore Section 74.251(a)’s disjunctive “or” and give priority to the ascertainable date of the alleged negligence under the precedents quoted above, we’re left with a range of dates extending at least to May 14, 2021. Within that timeframe, there’s no ascertainable date of injury on which Aldaco’s limitations period began to run under Shah and its ilk. By giving presuit notice within two years of Wood’s completion of treatment, therefore, Aldaco satisfied the statute of limitations.”
“According to Aldaco, Wood’s act of providing the letter gave rise to claims of negligence and fraud. Each of these torts entails some injury to the plaintiff … Aldaco suffered no injury until June 11, 2021, when the Crane Clinic performed the double mastectomy in reliance upon Wood’s letter. Had Aldaco sued after receiving Wood’s letter but before undergoing the surgery, her claims of negligence and fraud would’ve failed as a matter of law because a tort had not yet occurred.”
The Texas Supreme Court held: “For purposes of Section 74.251(a), therefore, the injurious surgery on June 11, 2021 marked “the occurrence of the . . . tort” and triggered the two-year statute of limitations. Aldaco gave pre-suit notice on May 9, 2023, over a month before the deadline of June 11, 2023, so her claims were timely for this independent reason … Aldaco’s claims against Wood are not time-barred under Section 74.251(a). Accordingly, we reverse the judgment of the court of appeals and remand to the district court for further proceedings.”
Source Aldaco v. Wood, No. 24-1069.
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