Art Tontiplaphol, M.D.; Bongsun "Sunny" Rich; And Methodist Healthcare System of San Antonio, Ltd., L.L.P. D/B/A Methodist Hospital v. Melba Ortiz Urdiales, as Personal Representative of the Estate of Graciela Urdiales, Deceased; Ricardo Urdiales; Ricardo Miguel Urdiales; Melba Ortiz Urdiales; And Gerardo Daniel Urdiales

CourtCourt of Appeals of Texas
DecidedApril 30, 2025
Docket04-24-00423-CV
StatusPublished

This text of Art Tontiplaphol, M.D.; Bongsun "Sunny" Rich; And Methodist Healthcare System of San Antonio, Ltd., L.L.P. D/B/A Methodist Hospital v. Melba Ortiz Urdiales, as Personal Representative of the Estate of Graciela Urdiales, Deceased; Ricardo Urdiales; Ricardo Miguel Urdiales; Melba Ortiz Urdiales; And Gerardo Daniel Urdiales (Art Tontiplaphol, M.D.; Bongsun "Sunny" Rich; And Methodist Healthcare System of San Antonio, Ltd., L.L.P. D/B/A Methodist Hospital v. Melba Ortiz Urdiales, as Personal Representative of the Estate of Graciela Urdiales, Deceased; Ricardo Urdiales; Ricardo Miguel Urdiales; Melba Ortiz Urdiales; And Gerardo Daniel Urdiales) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Art Tontiplaphol, M.D.; Bongsun "Sunny" Rich; And Methodist Healthcare System of San Antonio, Ltd., L.L.P. D/B/A Methodist Hospital v. Melba Ortiz Urdiales, as Personal Representative of the Estate of Graciela Urdiales, Deceased; Ricardo Urdiales; Ricardo Miguel Urdiales; Melba Ortiz Urdiales; And Gerardo Daniel Urdiales, (Tex. Ct. App. 2025).

Opinion

Fourth Court of Appeals San Antonio, Texas MEMORANDUM OPINION

No. 04-24-00423-CV

Art TONTIPLAPHOL, M.D.; Bongsun “Sunny” Rich; and Methodist Healthcare System of San Antonio, Ltd., L.L.P. d/b/a Methodist Hospital, Appellants

v.

Melba Ortiz URDIALES, as Personal Representative of the Estate of Graciela Urdiales, Deceased; Ricardo Urdiales; Ricardo Miguel Urdiales; Melba Ortiz Urdiales; and Gerardo Daniel Urdiales, Appellees

From the 37th Judicial District Court, Bexar County, Texas Trial Court No. 2022CI21571 Honorable Monique Diaz, Judge Presiding

Opinion by: Rebeca C. Martinez, Chief Justice

Sitting: Rebeca C. Martinez, Chief Justice Irene Rios, Justice Adrian A. Spears II, Justice

Delivered and Filed: April 30, 2025

REVERSED AND RENDERED IN PART; REMANDED

Art Tontiplaphol, M.D., Bongsun “Sunny” Rich, N.P., Methodist Healthcare System of

San Antonio, Ltd., L.L.P. d/b/a Methodist Hospital (collectively appellants) bring this

interlocutory appeal from the trial court’s order denying their Chapter 74 motions to dismiss

healthcare liability claims regarding the death of Graciela Urdiales brought by Graciela’s husband, 04-24-00423-CV

children, and the personal representative of her estate (collectively appellees). 1 See TEX. CIV.

PRAC. & REM. CODE ANN. § 51.014(a)(9) (“A person may appeal from an interlocutory order of a

district court . . . that denies all or part of the relief sought by a motion under Section 74.351(b) . .

. .”). In three issues, appellants contend that appellees failed to timely serve an expert report, and

the trial court abused its discretion in denying dismissal of: (1) appellees’ newly pleaded derivative

and vicarious liability claims; (2) claims asserted by Melba as personal representative of Graciela’s

estate; and (3) appellees’ claims of patient abandonment, euthanasia, and violations of section

1983 of Title 42 of the United States Code (“section 1983 claims”). We reverse and render, in

part, and remand.

I. BACKGROUND

On November 3, 2020, Graciela, who was seventy-two years old, was admitted to

Methodist Hospital. At the time of Graciela’s admission, she suffered from oral ulcers and had a

history of pulmonary fibrosis that required oxygen supplementation. After admission, Graciela

was diagnosed with significant weight loss due to dehydration and malnutrition, acute renal failure,

anemia, hypoxic respiratory failure, and cardiac instability.

According to appellees’ live petition, on November 8, 2020, Graciela started choking and

was resuscitated. Dr. Tontiplaphol and nurse practitioner Rich told Gerardo Daniel to “let her go”

and “there’s nothing more we can do.” Both healthcare providers, according to appellees, refused

Gerardo Daniel’s request that Graciela be kept alive long enough to say goodbye to her husband,

and they “refused and withdrew life support.” Graciela died on November 8, 2020.

1 Respectively, these parties are Ricardo Urdiales, Ricardo Miguel Urdiales, Gerardo Daniel Urdiales, Melba Ortiz Urdiales, Individually, and Melba Ortiz Urdiales, as personal representative of the Estate of Graciela Urdiales, deceased.

-2- 04-24-00423-CV

On November 1, 2022, appellees filed their original petition, which named appellants and

Methodist Healthcare Ministries of South Texas, Inc. and HCA Health Services of Texas, Inc. as

defendants. Appellants were served with citation, and they timely answered. Appellees did not

serve an expert report within the 120-day period applicable to each appellant. See id. at §

74.351(a).

After the expert-report deadlines, appellees e-mailed an expert report signed by Sumit

Gupta, M.D. Appellants nevertheless filed motions to dismiss, asserting that appellees had failed

to timely serve an expert report in accordance with section 74.351 of the Texas Civil Practice and

Remedies Code. See id.

On April 27, 2023, appellees filed their second amended petition, responded to appellants’

motions to dismiss, and arranged, for the first time, for service of citation on Methodist Healthcare

Ministries of South Texas, Inc. and HCA Health Services of Texas, Inc. Also on April 27, 2023,

Melba filed an original petition in intervention as personal representative of Graciela’s estate. In

these filings, appellees generally argued that a combination of newly pleaded vicarious or

derivative liability claims, Melba’s assertion of a healthcare liability claim as the personal

representative of Graciela’s estate, and Dr. Gupta’s report substantiated denial of appellants’

motions to dismiss. Appellants filed replies in support of their motions to dismiss, and the trial

court held a hearing on appellants’ motions to dismiss.

On June 6, 2024, the trial court signed an order, tendered by appellees, providing:

It is Ordered, Adjudged, and Decreed that the motions to dismiss are granted as to the direct liability of these defendants for plaintiffs’ health care liability claims asserted in their individual capacities. These defendants’ possible derivative or vicarious liability for plaintiffs’ claims being asserted against the defendants who have not yet appeared has not been adjudicated.

Plaintiffs’ patient abandonment/euthanasia/§ 1983 claim is not dismissed because it is either outside the § 74.351 expert report requirement, or the claim is novel and

-3- 04-24-00423-CV

Texas law is unsettled as to this statute’s applicability to this claim, justifying an extension of the deadline for plaintiffs’ expert report that was served on April 18, 2023.

The granting of defendants’ motions to dismiss does not apply to parties not presently before the Court: defendants Methodist Healthcare Ministries of South Texas, Inc. and HCA Health Services of Texas, Inc. and intervenor Melba Ortiz Urdiales, in her capacity as personal representative of the estate of Graciela Urdiales.

(hereinafter “dismissal order” or “dismissal order tendered by appellees”). Appellants timely

appeal from the dismissal order. 2

II. DISCUSSION

A. Standard of Review

We generally review a trial court’s order on a motion to dismiss a health care liability claim

under an abuse-of-discretion standard. Am. Transitional Care Ctrs. of Tex., Inc. v. Palacios, 46

S.W.3d 873, 877 (Tex. 2001). A trial court abuses its discretion if it acts without reference to any

guiding rules or principles. Van Ness v. ETMC First Physicians, 461 S.W.3d 140, 142 (Tex. 2015)

(per curiam).

2 We note that, also on June 6, 2024, the trial court signed an order, tendered by Methodist Hospital, that provides:

It is therefore ordered, adjudged, and decreed by this Court that any and all claims and causes of action by and between Plaintiffs the Estate of Graciela Urdiales, Deceased, Ricardo Urdiales, Ricardo Miguel Urdiales, Melba Ortiz Urdiales, and Gerardo Daniel Urdiales and Defendant Methodist Healthcare System of San Antonio, Ltd., L.L.P. d/b/a Methodist Hospital be and are hereby dismissed with prejudice.

(hereinafter “dismissal order tendered by Methodist”). Appellants filed motions to reconsider regarding the dismissal order tendered by appellees, contending that it impermissibly divides appellees’ healthcare liability claims into direct liability claims, vicarious liability claims, and claims of patient abandonment, euthanasia, and violations of section 1983. The trial court did not rule on appellants’ motions to reconsider.

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Art Tontiplaphol, M.D.; Bongsun "Sunny" Rich; And Methodist Healthcare System of San Antonio, Ltd., L.L.P. D/B/A Methodist Hospital v. Melba Ortiz Urdiales, as Personal Representative of the Estate of Graciela Urdiales, Deceased; Ricardo Urdiales; Ricardo Miguel Urdiales; Melba Ortiz Urdiales; And Gerardo Daniel Urdiales, Counsel Stack Legal Research, https://law.counselstack.com/opinion/art-tontiplaphol-md-bongsun-sunny-rich-and-methodist-healthcare-texapp-2025.