Doctors Hospital at Renaissance, LTD. D/B/A DHR Health v. Alma Rosa Corona

• Court: Court of Appeals of Texas
• Decided: October 30, 2025
• Docket: 13-25-00360-CV
• Status: Published

Opinion

NUMBER 13-25-00360-CV

COURT OF APPEALS

THIRTEENTH DISTRICT OF TEXAS

CORPUS CHRISTI – EDINBURG

DOCTORS HOSPITAL AT RENAISSANCE, LTD. D/B/A DHR HEALTH, Appellant,

v.

ALMA ROSA CORONA, Appellee.

ON APPEAL FROM THE 93RD DISTRICT COURT OF HIDALGO COUNTY, TEXAS

MEMORANDUM OPINION

Before Chief Justice Tijerina and Justices Cron and Fonseca Memorandum Opinion by Justice Cron

Doctors Hospital at Renaissance, Ltd. d/b/a DHR Health appeals from an

interlocutory order denying its motion to dismiss Alma Rosa Corona’s claim under the

Texas Medical Liability Act (TMLA or Act). See TEX. CIV. PRAC. & REM. CODE ANN. ch. 74. DHR maintains that Corona’s slip-and-fall claim is a health care liability claim (HCLC)

under the Act, and therefore, the trial court should have dismissed her suit for failure to

timely serve an expert report. See id. §§ 74.001(a)(13) (defining HCLC), 74.351(a), (b)

(requiring dismissal of an HCLC if a claimant fails to timely serve an expert report).

Because we agree, we reverse and remand.

I. BACKGROUND

Corona’s physician referred her to DHR for aquatic therapy, a form of physical

therapy performed in a pool. Corona alleged in her petition that DHR “brought [her] back

into the premises for care but left her unattended for a prolonged period of time.” After

completing the therapy session, she allegedly “slipped [and fell] on a puddle of water that

was in the locker room,” causing her to suffer bodily injuries.

Corona sued DHR for premises liability, alleging that the health care provider

breached its duty of care to her in several ways, including “[f]ailure to keep the floor safe

and dry,” failure to inspect the premises for the dangerous condition, and “[f]ailure to warn”

of the dangerous condition. In its original answer, DHR invoked several provisions of the

Act as limitations on Corona’s recoverable damages.

DHR subsequently filed a motion to dismiss arguing: (1) Corona’s premises liability

claim was an HCLC because it involved an alleged departure from health-care-related

safety standards, see id. § 74.001(a)(13); and (2) Corona failed to serve DHR with an

expert report within 120 days of DHR filing its answer, see id. § 74.351(a), (b). In support

of its motion, DHR attached a daily progress note from the day of Corona’s fall. Under a

section titled “Precautions,” Corona was described as a “High Fall Risk,” and the use of

2 a gait belt was recommended. It is not clear from the record whether this assessment was

made before or after Corona’s fall.

During the hearing, Corona’s counsel described her claim as “a vanilla slip-and-

fall case” and elaborated on the allegedly defective condition: “She was simply changing

[in the locker room], and she slipped on water because there was no rubber mat outside

the shower.” The trial court denied the motion to dismiss, and this interlocutory appeal

followed. See id. § 51.014(a)(9).

II. STANDARD OF REVIEW & APPLICABLE LAW

Whether a particular claim is an HCLC is a question of law we review de novo.

Collin Creek Assisted Living Ctr., Inc. v. Faber, 671 S.W.3d 879, 885 (Tex. 2023). In

conducting our review, we are not bound by the labels plaintiffs use in their pleadings;

instead, we examine the entire record to determine whether the operative facts could

support an HCLC. Id. at 885–86; see Lake Jackson Med. Spa, Ltd. v. Gaytan, 640 S.W.3d

830, 838 (Tex. 2022) (explaining that a “claimant cannot avoid the Act’s application by

artfully pleading claims for ordinary negligence or premises liability”).

As relevant here, the TMLA defines an HCLC as a cause of action against a health

care provider for a claimed departure from accepted safety standards that proximately

caused the claimant’s injury. 1 TEX. CIV. PRAC. & REM. CODE ANN. § 74.001(a)(13). The

term “safety” in the context of the statute has been construed to mean “the condition of

being ‘untouched by danger; not exposed to danger; secure from danger, harm or loss.’”

1 It is undisputed that DHR is a health care provider under the Act and that Corona sufficiently

alleged causation. See TEX. CIV. PRAC. & REM. CODE ANN. § 74.001(a)(11)(G), (12)(A)(vii). 3 Diversicare Gen. Partner, Inc. v. Rubio, 185 S.W.3d 842, 855 (Tex. 2005) (quoting Black’s

Law Dictionary 1336 (6th ed. 1990)).

For a safety-related claim to qualify as an HCLC, the Act does not require a direct

relationship between the safety standards allegedly violated and the provision of health

care, but “there must be a substantive nexus” linking the two. Ross v. St. Luke’s Episcopal

Hosp., 462 S.W.3d 496, 502, 504 (Tex. 2015); Tex. W. Oaks Hosp., LP v. Williams, 371

S.W.3d 171, 185 (Tex. 2012) (holding that “safety is not constricted by the subsequent

addition to the statute of the phrase ‘professional or administrative services directly

related to health care’”). The Supreme Court of Texas has provided a nonexclusive, multi-

factor test for determining whether this substantive relationship exists:

1. Did the alleged negligence of the defendant occur in the course of the defendant’s performing tasks with the purpose of protecting patients from harm;

2. Did the injuries occur in a place where patients might be during the time they were receiving care, so that the obligation of the provider to protect persons who require special, medical care was implicated;

3. At the time of the injury was the claimant in the process of seeking or receiving health care;

4. At the time of the injury was the claimant providing or assisting in providing health care;

5. Is the alleged negligence based on safety standards arising from professional duties owed by the health care provider;

6. If an instrumentality was involved in the defendant’s alleged negligence, was it a type used in providing health care; or

7. Did the alleged negligence occur in the course of the defendant’s taking action or failing to take action necessary to comply with safety-related requirements set for health care providers by governmental or accrediting agencies?

4 Ross, 462 S.W.3d at 505. “A safety standards-based claim does not come within the

TMLA’s provisions just because the underlying occurrence took place in a health care

facility, the claim is against a health care provider, or both.” Id. at 503. On the other hand,

“the fact that the incident could have occurred outside . . . a [health care] facility or setting

does not preclude the claim from being an HCLC.” Id. at 505. Rather, the “pivotal” inquiry

in such a case “is whether the standards on which the claim is based implicated the

defendant’s duties as a health care provider, including its duties to provide for patient

safety.” Id.

When asserting an HCLC, the plaintiff must serve an expert report on the

defendant providing a summary of the expert’s opinion on the applicable standard of care,

breach, and causation. TEX. CIV. PRAC. & REM. CODE ANN. § 74.351(a), (r)(6). If the plaintiff

does not timely serve the report, then the trial court must grant the defendant’s motion to

dismiss and award reasonable attorney’s fees and court costs. Id. § 74.351(b).

III. ANALYSIS

Both parties argue that the Ross factors weigh in their favor. Corona notes that her

fall did not occur “during treatment” or while she was “under the supervision of medical

personnel.” She also contends that a wet floor in a locker room “is not unique” to a health

care facility or setting. According to her, the locker room in this case “is a shared,

transitional space, accessible to anyone who uses the therapy center, and its function is

identical to that of locker rooms in gyms, spas, or community pools.” For that reason,

Corona argues that her “claim involves a basic premises safety duty” that is “wholly

independent of any professional health care services.”

5 DHR counters that Corona “had just completed a prescribed course of aquatic

therapy and was using the hospital’s locker room and shower facilities—areas provided

as an integral component of the therapeutic process to promote patient hygiene, safety,

and recovery.” DHR also argues that its duty to protect patients from harm is not limited

to potential hazards in the pool area because many of its patients suffer from “mobility

limitations or post-treatment fatigue.”

After surveying the caselaw, we note that a pattern has emerged in slip and fall

cases that largely depends on the status of the claimant. Claims brought by visitors,

especially those who slip and fall in lobbies or other common areas of a health care

facility, generally fall outside the Act because the relationship between the safety

standards allegedly violated and the provision of health care is too attenuated. See, e.g.,

Ross, 462 S.W.3d at 505 (visitor who slipped and fell “near the exit”); Galvan v. Mem’l

Hermann Hosp. Sys., 476 S.W.3d 429, 429, 433 (Tex. 2015) (per curiam) (visitor who

slipped and fell “walking from the pharmacy to her relative’s room”); Reddic v. E. Tex.

Med. Ctr. Reg’l Health Care Sys., 474 S.W.3d 672, 672–73, 676 (Tex. 2015) (per curiam)

(visitor who “fell when she slipped on a floor mat between the hospital’s main entrance

and the front desk”); Cage v. Methodist Hosp., 470 S.W.3d 596, 603 (Tex. App.—Houston

[1st Dist.] 2015, no pet.); Drs. Hosp. at Renaissance, Ltd. v. Mejia, No. 13–12–00602–

CV, 2013 WL 4859592, at *3 (Tex. App.—Corpus Christi–Edinburg Aug. 1, 2013, pet.

denied) (mem. op.) (visitor who fell “on a freshly waxed walkway”). Conversely, claims

brought by patients who slip and fall in health care facilities are typically HCLCs. See,

e.g., Harris Methodist Fort Worth v. Ollie, 342 S.W.3d 525, 527 (Tex. 2011) (patient who

6 fell on “a wet bathroom floor”); Phillips v. Jones, No. 05-15-00005-CV, 2016 WL 80561,

at *1, 3 (Tex. App.—Dallas Jan. 7, 2016, no pet.) (mem. op.) (patient who “slipped and

fell off of the step next to the examining table”). Although not a bright line rule, this patient-

visitor distinction is consistent with the Supreme Court of Texas’s recent observation that

“a claim usually will meet the statutory definition of an HCLC when the injured party is the

defendant’s patient.” Leibman v. Waldroup, 715 S.W.3d 367, 376 (Tex. 2025).

Here, it is undisputed that Corona was DHR’s patient and was at the facility for the

purpose of receiving health care. See Ross, 462 S.W.3d at 505. Corona emphasizes that

her therapy session had already ended at the time of her fall, but the Act does not require

a direct relationship between the violation of the safety standard and the provision of

health care, only “a substantive nexus.” Id. at 504. In that regard, we agree with DHR that

the locker room, where patients shower and change after aquatic therapy, is indirectly

related to the provision of health care. See Ollie, 342 S.W.3d at 527 (“[S]ervices a hospital

provides its patients necessarily include those services required to meet patients’

fundamental needs such as cleanliness—whether that cleanliness is obtained by means

of hospital employees cleaning or bathing the patient, or by providing means for the

patient to do so herself—and safety.”).

Further, unlike a hospital lobby or some other common area where visitors

frequent, the record indicates that the locker room at this outpatient, physical therapy

facility was used primarily, if not exclusively, by patients like Corona. See Ross, 462

S.W.3d at 505. Finally, contrary to Corona’s suggestion, the fact that the allegedly

dangerous condition was not unique to a locker room in a health care facility “does not

7 preclude [her] claim from being an HCLC.” Id.

Having considered the relevant Ross factors, we conclude that Corona’s safety

standards-based claim is an HCLC. Consequently, because Corona failed to timely serve

DHR with an export report, the trial court erred by denying DHR’s motion to dismiss. See

TEX. CIV. PRAC. & REM. CODE ANN. § 74.351(b). We sustain DHR’s issue.

IV. CONCLUSION

We reverse the trial court’s interlocutory order and remand the case to the trial

court with instructions to dismiss Corona’s claims against DHR with prejudice and to

award DHR its reasonable attorney’s fees and costs. 2 See id.

JENNY CRON Justice

Delivered and filed on the 30th day of October, 2025.

2 We note that, upon request, a trial court is required to provide a claimant with “a preliminary

determination regarding whether a claim made by the claimant is a health care liability claim for the purposes of Section 74.351.” TEX. CIV. PRAC. & REM. CODE ANN. § 74.353(a). If the trial court answers in the negative and that decision is reversed on interlocutory appeal, the claimant’s expert report is deemed timely if served within “120 days after the date that the appellate court issues [its] opinion.” Id. § 74.353(e). This 2021 amendment to the Act “mitigate[s] some of the risk that previously befell plaintiffs who, at the end of lengthy litigation about HCLC status, learned that their characterization of their claim was wrong.” Collin Creek Assisted Living Ctr., Inc. v. Faber, 671 S.W.3d 879, 896 (Tex. 2023) (Young, J., concurring). 8