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

Texas Court of Appeals, 4th District (San Antonio)·Decided April 30, 2026·No. 04-24-00551-CV·Published

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

$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.

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

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

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 to the trial court, ordering the trial court to set out the exact dollar amounts in the lump sum for (1) litigation expenses and costs and (2) the total interim medical costs for the period between the time of the trial and the date the first periodic payment would have been due. See TEX. R. APP. P. 44.4(a). A supplemental clerk’s record was filed, containing the trial court’s “Supplemental Findings Pursuant to Court of Appeals’ Order,” which quantified these dollar amounts. The supplemental record also included further briefing by the parties in the trial court before the supplemental findings were issued.

DISCUSSION

Dr. Virlar and Gonzaba bring seven issues on appeal, which we have reordered as follows:

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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).

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) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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