Jesus Virlar, M.D., and Gonzaba Medical Group A/K/A GMG Health Systems Associates, P.A. A/K/A GMG Health Systems P.A. v. Maria Esther Carr, as Independent Administrator and Personal Representative of the Estate of Jo Ann Puente

CourtTexas Court of Appeals, 4th District (San Antonio)
DecidedApril 30, 2026
Docket04-24-00551-CV
StatusPublished

This text of Jesus Virlar, M.D., and Gonzaba Medical Group A/K/A GMG Health Systems Associates, P.A. A/K/A GMG Health Systems P.A. v. Maria Esther Carr, as Independent Administrator and Personal Representative of the Estate of Jo Ann Puente (Jesus Virlar, M.D., and Gonzaba Medical Group A/K/A GMG Health Systems Associates, P.A. A/K/A GMG Health Systems P.A. v. Maria Esther Carr, as Independent Administrator and Personal Representative of the Estate of Jo Ann Puente) is published on Counsel Stack Legal Research, covering Texas Court of Appeals, 4th District (San Antonio) primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Jesus Virlar, M.D., and Gonzaba Medical Group A/K/A GMG Health Systems Associates, P.A. A/K/A GMG Health Systems P.A. v. Maria Esther Carr, as Independent Administrator and Personal Representative of the Estate of Jo Ann Puente, (Tex. Ct. App. 2026).

Opinion

Fourth Court of Appeals San Antonio, Texas OPINION

No. 04-24-00551-CV

Jesus VIRLAR, M.D., and Gonzaba Medical Group a/k/a GMG Health Systems Associates, P.A. a/k/a GMG Health Systems P.A., Appellants

v.

Maria Esther CARR, as Independent Administrator and Personal Representative of the Estate of Jo Ann Puente, Deceased, Appellees

From the 131st Judicial District Court, Bexar County, Texas Trial Court No. 2014-CI-04936 Honorable Norma Gonzales, Judge Presiding

Opinion by: Lori Massey Brissette, Justice

Sitting: Lori I. Valenzuela, Justice Lori Massey Brissette, Justice H. Todd McCray, Justice

Delivered and Filed: April 30, 2026

REMITTITUR SUGGESTED

This appeal arises from a judgment entered on remand from the Texas Supreme Court in a

medical malpractice action. After reviewing the record and the parties’ briefing, we conclude the

trial court erred by allocating an excessive amount from the jury’s award as a lump sum in its

judgment on remand. Nevertheless, because we conclude that this error can be cured by remittitur

and that the trial court did not reversibly err in any other respect, we suggest a remittitur of 04-24-00551-CV

$533,038.51. If within twenty days of the date of this opinion, appellee files in this court a

remittitur of $533,038.51, we will modify the trial court’s judgment in accordance with this

opinion and affirm the judgment as modified. If appellee does not timely file the suggested

remittitur, the trial court’s judgment will be reversed and the cause remanded for entry of a proper

judgment consistent with this opinion. See TEX. R. APP. P. 46.3.

BACKGROUND

In 2011, Jo Ann Puente underwent “Roux-en-Y” gastric-bypass surgery performed by Dr.

Nilesh Patel. Puente developed complications and was admitted to the intensive care unit at

Metropolitan Methodist Hospital and ordered to take nothing by mouth. Dr. Jesus Virlar, who was

employed by GMG Health Systems Associates, P.A. a.k.a. and d.b.a. Gonzaba Medical Group

(“Gonzaba”), assumed care for Puente. Evidence at trial showed that, although nurses noted

Puente’s difficulty walking, dizziness, continued vomiting, and “fixed gaze,” Dr. Virlar did not

read their notes and was unaware of the symptoms. Dr. Virlar failed to order thiamine supplements,

which Puente’s expert witness testified led her to develop Wernicke’s disease, a brain dysfunction

associated with thiamine deficiency. The disease progressed to a more debilitating brain disorder,

Korsakoff’s syndrome.

Puente, her minor daughter, C.P., and her mother, Maria Esther Carr, sued Dr. Patel, Dr.

Virlar, Gonzaba, Metropolitan Methodist Hospital, and other healthcare providers, including Dr.

Manuel Martinez, another physician employed by Gonzaba. Puente sought damages for physical

pain, mental anguish, loss of earning capacity, and medical expenses, while C.P. and Carr sought

damages for loss of services and loss of consortium. Before trial, Carr and C.P. either settled 1 or

1 C.P. and Carr settled with all defendants except Dr. Virlar, Dr. Martinez, and Gonzaba.

-2- 04-24-00551-CV

nonsuited all of their claims. Puente also entered into a settlement with several of the defendants,

leaving only her claims against Dr. Virlar, Dr. Martinez and Gonzaba for trial.

The jury found Dr. Virlar and Dr. Patel negligent, attributing 60% of the responsibility to

Dr. Virlar and 40% to Dr. Patel. It did not find Dr. Martinez negligent. The jury awarded Puente

$133,202 for loss of past earnings, $888,420 for loss of future earning capacity, and

$13,262,874.86 for future medical expenses.

The trial court rendered judgment for Puente and against Dr. Virlar and Gonzaba, as Dr.

Virlar’s employer, and denied their motion for new trial. Dr. Virlar and Gonzaba also moved for a

settlement credit, arguing that C.P.’s $3.3 million settlement with Metropolitan Methodist Hospital

should reduce Puente’s recovery under Chapter 33 of the Texas Civil Practice and Remedies Code.

While the trial court rejected that argument, it granted a credit of $200,000 for Puente’s settlement

with Dr. Patel. The trial court also denied Dr. Virlar and Gonzaba’s motion for periodic payment

of the award for future medical expenses. The trial court’s judgment awarded Puente the entire

$14,109,349.02 in a lump sum. Dr. Virlar and Gonzaba appealed, and Puente passed away on

March 30, 2020, while the appeal was pending.

First Appeal

On rehearing, this court largely affirmed the trial court’s judgment, reversing only to

suggest an $8,000 remittitur of the award for lost future earning capacity for lack of evidence,

which Puente accepted. Virlar v. Puente, 613 S.W.3d 652, 662, 682–85 (Tex. App.—San Antonio

2020). This court affirmed the denial of a credit for C.P.’s settlement, holding such a credit under

Chapter 33 would be unconstitutional as applied. Id. at 685–697. Finally, this court affirmed the

denial of periodic payments, holding that Dr. Virlar and Gonzaba did not present sufficient

-3- 04-24-00551-CV

evidence for the trial court to grant payments. Id. at 697–704. Dr. Virlar and Gonzaba then filed a

petition for review, which the Texas Supreme Court granted.

The Texas Supreme Court affirmed the judgment in part and reversed in part, holding the

judgment erred in two respects. First, the Court held Chapter 33 required a dollar-for-dollar credit

for C.P.’s settlement and this application of Chapter 33 is not unconstitutional. Virlar v. Puente,

664 S.W.3d 53, 60–61 (Tex. 2023). Thus, the approximately $14.1 million total damages awarded

to Puente by the trial court must be reduced by the dollar amount of C.P.’s settlement with

Metropolitan Methodist Hospital for $3.3 million, resulting in Puente’s recovery being reduced to

approximately $10.8 million total. Id. at 61. Second, the Texas Supreme Court held there was

sufficient evidence to establish that the Texas Medical Liability Act (TMLA) required the trial

court to order at least partial periodic payments for future medical expenses. Id. at 65. The Texas

Supreme Court remanded the case to the trial court “to form a proper judgment on these issues of

damages.” Id. at 66.

Judgment on Remand

On remand, the parties filed competing proposals for calculating the new judgment, and

the trial court held a hearing. The trial court expressed its understanding that on remand, it must

“go back to the date of the jury verdict and the judgment, and take it as it is then,” i.e. when Puente

was still living. After the hearing and after additional briefing by the parties, the trial court issued

its judgment on remand, in which it applied the credit for C.P.’s settlement, ordered a portion of

the damages to be paid in a lump sum upon entry of judgment and ordered that further damages,

specifically future medical expenses, be paid via scheduled periodic payments. Dr. Virlar and

Gonzaba requested findings of fact and conclusions of law, and the parties filed competing motions

-4- 04-24-00551-CV

to modify the judgment. The trial court issued amended findings of fact, and the motions to modify

the judgment were overruled by operation of law. Dr. Virlar and Gonzaba timely appealed.

Supplemental Findings

Because the judgment and the amended findings failed to precisely quantify the dollar

amount of two components of the lump sum, this court abated this appeal and remanded the case

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Jesus Virlar, M.D., and Gonzaba Medical Group A/K/A GMG Health Systems Associates, P.A. A/K/A GMG Health Systems P.A. v. Maria Esther Carr, as Independent Administrator and Personal Representative of the Estate of Jo Ann Puente, Counsel Stack Legal Research, https://law.counselstack.com/opinion/jesus-virlar-md-and-gonzaba-medical-group-aka-gmg-health-systems-txctapp4-2026.