COURT OF APPEALS EIGHTH DISTRICT OF TEXAS EL PASO, TEXAS
PATHLINK OF TEXAS, LLC, § No. 08-24-00090-CV
Appellant, § Appeal from the
v. § County Court at Law No. 3
ASHLEE M. BALDERRAMA and § of El Paso County, Texas ALEJANDRO J. MARTINEZ, § (TC# 2023DCV2379) Appellees.
OPINION
This is a companion to a case we recently decided: Tenet Hosps. Ltd. v. Balderrama,
No. 08-23-00263-CV, 2024 WL 3845451, (Tex. App.—El Paso Aug. 16, 2024, pet. filed). The
issue there was whether a hospital’s alleged missteps in discharging its professional or
administrative services attendant to an autopsy are “directly related to health care” when the
autopsy is performed on a person who expired while a patient in the hospital. That question is
relevant to whether the aggrieved patient (or the patient’s representatives) must file an expert
report. Tex. Civ. Prac. & Rem. Code Ann. § 74.351. We held that it was, and they did need to file
a report. In this appeal, the physician group that employs the pathologist who performed the
autopsy asks the same question, and for reasons expressed in the Tenet Hospital case, we give the
same answer. I. BACKGROUND1
Ashlee Balderrama and Alejandro Martinez are married and share three children. When
Ashlee was pregnant with their fourth child—a son, who they named Aiden—the family received
his devastating diagnosis of trisomy 18.2 The family understood Aiden’s condition to be terminal.
Ashlee gave birth to Aiden on April 12, 2023, at Providence Memorial Hospital by a caesarian
section. Aiden died a few hours later. At oral argument in Tenet Hosps. Ltd., the the Parents agreed
that during his brief life, Aiden was a patient at Providence Memorial Hospital.
When Ashlee’s doctor discussed performing an autopsy on Aiden, she “made it clear . . .
that she did not want an invasive autopsy or for Aiden to be cut in any way since all parties already
knew that Aiden died due to trisomy 18.” But Ashlee orally agreed to a non-invasive autopsy after
her doctor described it as limited to a visual examination and medical imaging. She later signed an
autopsy consent form in which she limited her consent to only a “non[-]invasive autopsy.” She
again confirmed with the nurse who co-signed the consent form that “the autopsy would not
involve any cutting.”
While at Aiden’s viewing about a week later, the Parents discovered an invasive autopsy
had been performed and some of Aiden’s organs were missing. They immediately called
Providence, where a patient safety officer told them that the invasive autopsy had been necessary
1 Because the question before us is whether the Parents have asserted a health care claim, the facts we recite are as alleged in the Parents’ petition. Lake Jackson Med. Spa, Ltd. v. Gaytan, 640 S.W.3d 830, 836 (Tex. 2022). Pathlink has not conceded these facts. 2 Trisomy 18, or Edwards syndrome, is a chromosomal disorder that causes severe growth and developmental delays. When a trisomy 18 diagnosis is present, most pregnancies end in miscarriage or stillbirth, and the survival rate for babies born with trisomy 18 is low. Cleveland Clinic, Edwards Syndrome (Trisomy 18), https://my.clevelandclinic.org/health/diseases/22172-edwards-syndrome (last visited June 25, 2024).
2 to “determine cause of death,” and Ashlee’s consent form has been “misinterpreted.” Providence
later returned Aiden’s remaining organs to the funeral home, where he was finally cremated.
The Parents sued Providence, asserting a negligence claim that sought mental anguish
damages. Later, the Parents amended their petition to add Pathhlink as a defendant. The Parents
alleged that the autopsy was performed by “Dr. Harry L. Wilson, a pathologist, who was an
employee, agent, or servant of Pathlink, a third party which contracted with Providence to provide
pathology services, including autopsies.” The amended petition alleges that Pathlink was
vicariously liable for the acts of its agents and employees who had the following duty:
[T]o exercise the degree of care that a reasonably prudent medical provider would use to avoid harm to others under the circumstances . . . including preventing Aiden’s autopsy, determining Aiden’s cause of death and verifying the existence and extent of Ms. Balderrama’s limited Consent Form, allowing for the return of Aiden’s bloody body in a manner presentable and suitable for return to his parents, and allowing for the return of Aiden’s body with his organs intact to allow for proper burial.
They claimed that Pathlink breached that duty by “a) Negligent mishandling of a human body;
b) Failing to prevent Aiden’s unauthorized autopsy and organ removal; and c) Keeping Aiden’s
organs until demand was made for them after their absence was noted.”
After Pathlink answered, the Parents moved for a preliminary determination of whether
their claims are health care liability claims under Chapter 74 (TMLA), arguing that they are not.
See Tex. Civ. Prac. & Rem. Code Ann. § 74.353(a) (“On motion of a claimant filed not later than
30 days after the date each defendant’s original answer is filed, a court may issue a preliminary
determination regarding whether a claim made by the claimant is a health care liability claim for
the purposes of [the expert-report requirement].”).3 Pathlink responded, arguing that the claims
3 Section 74.353 was added in part to remedy the harsh result when a plaintiff sues a health care provider and erroneously concludes that the claim is not a “health care liability claim” for the purposes of the Act's expert report requirement. See Judiciary & Civil Jurisprudence Committee, Bill Analysis, Tex. S.B. 232, 87th Leg., R.S. (2021)
3 are health care liability claims. After a hearing on the motion, the trial court granted the Parents’
motion, finding that their claims are not health care liability claims under the TMLA. Providence
brought this accelerated interlocutory appeal under § 74.353(d). See id. § 51.014(a)(15)
(permitting interlocutory appeal from order making a preliminary determination on a claim under
§ 74.353).
II. DISCUSSION
A. The TMLA and health care liability claims
In response to the “medical malpractice insurance crisis” of the 1970s, the Texas
Legislature enacted the Medical Liability and Insurance Improvement Act (MLIIA) to reduce the
“excessive frequency and severity of health care liability claims in a manner that would not unduly
restrict a claimant’s rights any more than necessary to deal with the crisis.” Rogers v. Bagley, 623
S.W.3d 343, 348–49 (Tex. 2021) (cleaned up). The Legislature replaced the MLIIA with the
TMLA in 2003. Id. at 349. “The TMLA effectuates the Legislature’s goal of deterring frivolous
lawsuits by requiring a claimant early in litigation to produce the opinion of a suitable expert that
his claim has merit.” Id. (cleaned up). Health care liability claims under the TMLA are subject to
various statutory rules, including the requirement that a plaintiff serve the defendant with an expert
report at the beginning of her suit. Tex. Civ. Prac. & Rem. Code Ann. § 74.351.
(“Sometimes, potentially meritorious claims are even dismissed because claimants fail to serve an expert report not realizing that their claim is a health care liability claim.”); see e.g., Bioderm Skin Care, LLC v. Sok, 426 S.W.3d 753, 756 (Tex. 2014) (ordering dismissal of claims arising out of allegedly improper laser hair removal because they were health care liability claims and no expert report had been filed); Simmons v. Outreach Health Cmty. Care Services, L.P., 511 S.W.3d 163, 166 (Tex. App.—El Paso 2014, pet. denied) (dismissing with prejudice claim of nursing assistant injured while moving patient for failure to file required expert report under the TMLA). Under Tex. Civ. Prac. & Rem. Code Ann. § 74.353, a plaintiff may seek a preliminary answer to question of whether the claim is a health care liability claim for the purpose of knowing whether a report is required or not. Id. § 74.353(f) (“A preliminary determination under this section applies only to the issue of whether a claimant is required to serve an expert report under Section 74.351.”). We express no opinion on whether this preliminary determination interplays with other provisions of the TMLA, other than the expert report requirement.
4 Whether a claim is a health care liability claim under the TMLA is a legal question that we
review de novo. Ross v. St. Luke’s Episcopal Hosp., 462 S.W.3d 496, 501 (Tex. 2015). In
answering that question, “we examine the underlying nature and gravamen of the claim, rather
than the way it is pleaded.” CHRISTUS Health Gulf Coast v. Carswell, 505 S.W.3d 528, 534
(Tex. 2016). That is, we “focus on the set of operative facts ‘underlying the claim’ that are relevant
to the alleged injury, not on how ‘the plaintiff’s pleadings describ[e] the facts or legal theories
asserted.’” Collin Creek Assisted Living Ctr., Inc. v. Faber, 671 S.W.3d 879, 885 (Tex. 2023)
(quoting Loaisiga v. Cerda, 379 S.W.3d 248, 255 (Tex. 2012)). The TMLA’s “broad language”
indicates the “legislative intent for the statute to have expansive application.” Loaisiga, 379
S.W.3d at 256.
A health care liability claim has three essential elements: (1) the defendant is a physician
or health care provider; (2) the claim is for treatment, lack of treatment, or another alleged
departure from accepted standards of medical care, health care, or safety or professional or
administrative services directly related to health care; and (3) the defendant’s act or omission
proximately caused the claimant’s injury or death. Faber, 671 S.W.3d at 886 (citing Tex. Civ.
Prac. & Rem. Code Ann. § 74.001(a)(13)). Only the second element is contested here. Pathlink
argues that the claim is a health care liability for two reasons: it is an alleged departure from
accepted standards of (1) medical care, and (2) professional or administrative services directly
related to health care.
The Parents dispute that an autopsy is medical care but concede that an autopsy can involve
professional or administrative services as defined by the TMLA. The TMLA defines “professional
or administrative services” as “those duties or services that a physician or health care provider is
required to provide as a condition of maintaining the physician’s or health care provider’s license,
5 accreditation status, or certification to participate in state or federal health care programs.”
Tex. Civ. Prac. & Rem. Code Ann. § 74.001(a)(24). Both criminal and administrative code
provisions prohibit a physician from performing a post-mortem examination or autopsy without
written informed consent. See Tex. Code Crim. Proc. Ann. art. 49.32; 22 Tex. Admin. Code
§ 190.8(a)(l)(I)(Tex. Med. Boards, Disciplinary Guidelines); see also Carswell, 505 S.W.3d at 535
(noting hospital could lose its license if it violated various state regulations governing autopsies
and concluding post-mortem claims based on an autopsy thus alleged a departure from accepted
standards of “professional or administrative services”). So the question here as it relates to
professional or administrative services boils down to whether Pathlink’s professional or
administrative services pertaining to Aiden’s autopsy were “directly related to health care.”
(1) “Directly related to”
The term “directly related to” is not defined in the TMLA, but the Texas Supreme Court
has recently told courts how to construe the term:
The Act does not define “directly related to,” so we look to the words’ common meanings. “Direct” or “directly,” as most applicable here means “without the intervention of a medium or agent” or “immediately.” “Related” is commonly defined as “[c]onnected in some way; having relationship to or with something else.” When those definitions are combined, they yield the conclusion that the plain and common meaning of the phrase “directly related to” is “an uninterrupted, close relationship or link between the things being considered.”
Carswell, 505 S.W.3d at 535–36 (dictionary and case citations omitted).
(2) Health care
The TMLA defines “health care” as “any act or treatment performed or furnished, or that
should have been performed or furnished, by any health care provider for, to, or on behalf of a
patient during the patient’s medical care, treatment, or confinement.” Tex. Civ. Prac. & Rem. Code
Ann. § 74.001(a)(10). “Medical care” is defined as “any act defined as practicing medicine under
6 Section 151.002, Occupations Code, performed or furnished, or which should have been
performed, by one licensed to practice medicine in this state for, to, or on behalf of a patient during
the patient’s care, treatment, or confinement.” Id. § 74.001(a)(19). Section 151.002(a)(13) of the
Occupations Code defines “practicing medicine” as “the diagnosis, treatment, or offer to treat a
mental or physical disease or disorder or a physical deformity or injury by any system or method,
or the attempt to effect cures of those conditions, by a person who [] publicly professes to be a
physician or surgeon; or [] directly or indirectly charges money or other compensation for those
services.” Tex. Occ. Code Ann. § 151.002 (a)(13). Though the TMLA does not define either
“treatment” or “patient,” the Texas Supreme Court has noted that “both have ordinary meanings
that do not require the active provision of medical care by a physician—much less a physician
furnished by the health care provider.” Faber, 671 S.W.3d at 890–91.
B. Do the Parents allege a departure from accepted standards of professional or administrative services directly related to healthcare?
(1) Pathlink’s arguments
Pathlink argues that because physicians are required to obtain written informed consent
before performing an autopsy, the allegation that they failed to do so is an allegation that they
violated standards of professional and administrative services. Further, it argues that because the
purpose of the diagnosis was to confirm Aiden’s trisomy 18 diagnosis, there is a nexus between
the provision of health care and the professional or administrative service (i.e., the autopsy). In
support of its position, Pathlink primarily relies on CHRISTUS Health Gulf Coast v. Carswell.4
In Carswell, the plaintiff alleged the hospital (1) committed acts of medical malpractice
that lead to the death of Jerry Carswell; and (2) improperly obtained his wife’s approval to perform
4 And as we explain below, the Parents likewise believe Carswell supports their position.
7 an autopsy. Carswell, 505 S.W.3d at 530. For the autopsy claim, the wife contended the hospital
fraudulently obtained her consent for a private autopsy in a related medical facility and moved the
body there without the medical examiner’s permission. Id. at 534–35. She claimed the hospital
orchestrated the autopsy to cover-up its alleged malpractice. Id. The jury did not find that medical
negligence caused Jerry’s death, but it did find the hospital liable on the autopsy related claims.
The issue before the Texas Supreme Court was whether the autopsy related claims were health
care liability claims under the TMLA, because if they were, the autopsy claims were barred by
limitations.
To answer that question, the Court had to decide whether the autopsy claims were directly
related to health care based on the TMLA’s definitions of “health care” and “medical care.” Id. at
535. And the Court articulated a definition important here: “directly related to” means “an
uninterrupted, close relationship or link between the things being considered.” Id. at 535–36. The
Court noted that the autopsy claim hinged on the allegation that the hospital obtained the plaintiff’s
consent for the autopsy to conceal its own malpractice that led to her husband’s death. Id. at 536.
Given those circumstances, the Court concluded “the claim [is] directly related to acts or
treatments the [plaintiff] alleged were improperly performed or furnished, or that should have been
performed or furnished, to [her husband] during his treatment and confinement,” and determined
the fraud claim was a health care liability claim under the TMLA. Id.
Pathlink argues that the autopsy “had a close and uninterrupted relationship to Aiden’s
trisomy 18 diagnosis during Balderrama’s pre-natal care, the c-section delivery, and the post-natal
care both Aiden and Balderrama received at the hospital.” This relationship, it argues was
sufficient for the alleged negligent acts to be directly related to medical care.
8 We note that the Carswell court explicitly left open two key questions: whether an
individual can be a patient after death, see id. at 535, and whether performing an autopsy or failing
to obtain informed consent to perform an autopsy, without more, is health care under the TMLA,
see id. at 536–37.
(2) The Parents’ arguments
The Parents argue that the “directly related to health care” element is not satisfied because
Aiden’s autopsy was unrelated to the health care provided to either Ashlee or Aiden in the hospital.
That is, they contend their claim is not a health care liability claim because Pathlink’s “pertinent
services . . . did not engage with the medical treatment of Ms. Balderrama or Aiden, nor were they
intended to directly affect patient health outcomes.”
And the Parents contend Carswell confirms that their claims are not health care liability
claims under the TMLA. They state that “[u]nlike Carswell, where the underlying facts supported
a nexus to health care due to alleged concealment of treatment errors, the autopsy of plaintiff’s
child here was not conducted with the intent to hide or misrepresent the quality of health care
services previously provided.” Here, because the allegations involve no underlying negligent acts
while Aiden or Ashlee were Providence patients, the Parents maintain their claims are not health
care liability claims.
Along with discussing Carswell, the Parents focus on two other cases that support their
position: Hare v. Graham, No. 2-07-118-CV, 2007 WL 3037708 (Tex. App.—Fort Worth Oct. 18,
2007, pet. denied) (mem. op.) and Salazar v. Dickey, No. 04-08-00022-CV, 2010 WL 307852
(Tex. App.—San Antonio Jan. 27, 2010, pet. denied) (mem. op.).
In Hare, the plaintiff sued the pathologist who performed her husband’s autopsy. 2007 WL
3037708, at *1. She alleged the hospital employees misled and intentionally deceived her about
9 consent for the autopsy, and she sued the pathologist for intentional infliction of emotional distress,
negligent mishandling of a corpse, and interference with the right of possession of a dead body.
Id. In arguing that her claims were not health care liability claims subject to the TMLA, the plaintiff
contended that her case concerned “not whether the autopsy was performed according to
acceptable standard, but that it was not authorized and was performed without proper consent.” Id.
at *2.
The Fort Worth Court of Appeals agreed, reasoning that the allegations did not raise a
health care liability claim because the plaintiff’s husband could not be a “patient” based on the
Texas Health and Safety Code’s definition of that term: “a person who is admitted to a hospital or
residing in a nursing home.” Id. at *3 (quoting Tex. Health & Safety Code Ann. § 313.002(8)).
The court inferred that this definition “clearly implies that a person must be alive in order to be a
‘patient,’” agreeing with a prior case that determined “a body was not a patient, nor was an autopsy
a form of medical treatment.” Id. (citing Putthoff v. Ancrum, 934 S.W.2d 164, 171 (Tex. App.—
Fort Worth 1996, writ denied)). Thus, the court concluded “a dead body is not a patient” nor can
a body “receive ‘medical care, treatment, or confinement’ after death,” and determined the
plaintiff’s claims were not health care liability claims. Id.
The San Antonio Court of Appeals in Salazar similarly adopts Hare’s reasoning. The
plaintiff sued, among others, the physician who signed his father’s death certificate, alleging that
the doctor had a duty to, but did not, order an autopsy. 2010 WL 307852, at *1. The court relied
on the definition of “patient” found in the Health and Safety Code and concluded that these
allegations were not health care liability claims because the plaintiff’s father was already dead
when the doctor allegedly departed from acceptable standards and practices, such that his father
could not be a patient or receive medical care, treatment, or confinement. Id. at *4.
10 The Parents contend that their suit is not predicated on allegations of medical malpractice
regarding either Ashlee or Aiden’s care but is instead narrowly focused on the specific terms of
consent for Aiden’s autopsy. They point to the Carswell court’s discussion of Hare and Salazar,
in which it distinguished those two cases as turning on post-mortem actions that were not linked
to pre-mortem healthcare. Carswell, 505 S.W.3d at 537. Finally, the suit here seeks only mental
anguish damages, which the Parents contend arise from Providence and Pathlink’s “handling of
their child’s autopsy—a matter distinct from the health care services typically addressed in liability
claims.”
(3) These allegations are health care liability claims
Prior cases are instructive, but not controlling for the issue before us. The Houston First’s
decision in CHCA Bayshore, L.P. v. Ramos is closely analogous as it dealt with the mishandling
by a hospital of the remains of a dilation and curettage procedure performed at the hospital. CHCA
Bayshore, L.P. v. Ramos, 388 S.W.3d 741, 743 (Tex. App.—Houston [1st Dist.] 2012, no pet.). In
Ramos, a woman suffered a miscarriage at about 12 weeks, and underwent a dilation and curettage
procedure. 388 S.W.3d at 743. Because she and her husband wanted to hold a funeral, the doctor
who performed the procedure instructed the hospital’s pathology department to test the fetal
remains, then hold the specimen for the funeral home. Id. After the funeral, the couple learned that
the hospital gave the funeral home the wrong specimen; thinking the fetal remains were of their
child, they had in fact buried the amputated toe of another patient. Id. The hospital later returned
the fetal remains to the couple. Id.
The couple sued, urging that the hospital was negligent in establishing and following
procedures related to handling, identifying, monitoring, and disposing of a specimen from a
medical procedure, and that this was not a health care liability claim governed by the TMLA. Id.
11 at 743–44. The hospital argued that the couple’s claims alleged a departure from accepted
standards of “health care” and “professional or administrative services directly related to health
care.” Id. at 744.
Focusing on the alleged departure from accepted standards of care for “professional or
administrative services directly related to health care,” as are we, the Court found the alleged
conduct directly related to health care. Id. at 746. That is, the hospital’s alleged negligent
mishandling of the fetal remains was “an immediate consequence of having performed the
procedure that resulted in the Hospital’s handling of the remains, and as such, it was directly related
to the health care rendered to [the woman] by the Hospital.” Id. at 746. The court thus found
unpersuasive the couple’s argument that the mishandling of the remains occurred after the
woman’s medical treatment ended. Id.
Hare and Salazar focus on the definition for “health care”—which incorporates the
definition of “medical care”—which in turn uses the term “patient.” Those courts reason that
performing (or not performing) an autopsy could not be health care because a non-living person
can no longer be a “patient.” Hare, 2007 WL 3037708, at *3; Salazar, 2010 WL 307852, at *4.
But neither case directly addresses the “professional or administrative services” portion of
§ 74.001(a)(13) and its nexus with health care. More particularly, Hare and Salazar do not address
how “professional or administrative services” attendant to autopsies might directly relate to pre-
mortem health care services.
The most helpful case here is Carswell and its articulation of the definition for “directly
related to.” As the Carswell court instructed, the phrase “directly related to” simply means “an
uninterrupted, close relationship or link between the things being considered.” Id. at 536. The
allegation here fits that definition. It describes an infant delivered by caesarian section, accepted
12 briefly as a patient, and who then expired all while in the hospital. Balderrama, while also a patient
in the hospital, verbally communicated and documented in a written consent form her desire for
only a limited autopsy to hospital personnel.5 For reasons yet to be discovered, the hospital and
Pathlink are alleged to have exceeded the scope of her consent through some conduct part and
parcel of its professional and administrative services. The pleading before us describes a sufficient
direct nexus between the provision of health care and the alleged improper autopsy. See Carswell,
505 S.W.3d at 537 (distinguishing Hare and Salazar where the claims are not “based entirely on
postmortem actions of [the hospital] that were directed to a dead body” absent any link to pre-
mortem health care).
We acknowledge that the Parents here do not complain about the health care Balderrama
received as patient in her own right, or that Aiden received until his death. But we do not read
Carswell (including its treatment of Hare and Salazar) to mean that for a post-mortem claim to be
“directly related to health care,” there must be allegations of deficient or improper health care
before the patient’s death. See Carswell, 505 S.W.3d at 535–36. The plain language of the TMLA
does not support that interpretation. See Tex. Civ. Prac. & Rem. Code Ann. § 74.001(a)(13).6 Nor
does the TMLA support the Parents’ position that a patient must be alive when the alleged
negligent conduct occurs. Instead, the TMLA applies to professional or administrative services
5 The petition alleges that Aiden was delivered at Providence on April 12, 2023. Ashlee was discharged from the hospital on April 14, 2023. On the 12th (while still a patient and as the parent of Aiden) she discussed with her OBGYN an autopsy and she “made it clear to . . . Providence nursing staff that she did not want an invasive autopsy[.]” The consent form was executed by Ashlee on April 14, the same day she was discharged. 6 Were it otherwise, we would create the anomalous situation that the same improper professional or administrative service in one case would be a health care liability claim, while in another case not, based only on whether the claimants complain about the pre-mortem care. And if this were the rule, must the complaint of pre-mortem care be raised in a filed malpractice claim? Or would a verbal complaint to the hospital administration be enough? Would the complaint have to make a wrongful death allegation, or might it only relate to some other aspect of the pre-mortem care? Nothing in the text of § 74.001(a)(13) answers those questions because nothing in the text establishes a “pre- mortem complaint” requirement as a component of a professional and administrative services-based claim.
13 “when the claimed injury is directly related to health care of some patient.” Carswell, 505 S.W.3d
at 537 (citing Tex. Civ. Prac. & Rem. Code Ann. § 74.001(a)(10), (13)).
Because this appeal arises from the trial court’s preliminary determination for the expert
report requirement, we have a limited record consisting primarily of the pleadings. See Tex. Civ.
Prac. & Rem. Code Ann. § 74.353. The Parents’ petition alleges that Pathlink “violated [its] duty”
“to exercise the degree of care that a reasonably prudent medical provider would use to avoid harm
to others” in the circumstances surrounding Aiden’s autopsy. The allegation describes a deviation
from accepted standards of a health care practice: an autopsy performed in a hospital following the
death of one of its patients. The TMLA uses “broad language” which “evidences legislative intent
for the statute to have expansive application.” Loaisiga, 379 S.W.3d at 256. Because the
professional or administrative services underlying the Parents’ complaint were directly related to
health care Aiden and Ashlee received while they were patients, the claims are health care liability
claims under the TMLA. See Carswell, 505 S.W.3d at 537; Ramos, 388 S.W.3d at 746. The trial
court erred in concluding otherwise. We sustain Pathlink’s first issue.
Because we conclude that the Parents’ claims are health care liability claims because they
allege “departure[s] from accepted standards of . . . professional or administrative services directly
related to health care,” we do not reach Pathlink’s issue arguing that the claims also involve
departures from accepted standards of “medical care.”
III. CONCLUSION
For the above reasons, we conclude that the Parents’ claims are health care liability claims
under the TMLA for the purpose of deciding whether the Parents must file an expert report as
14 required by the TMLA; we reverse the trial court’s order holding they are not. We remand the case
to the trial court for further proceedings consistent with this opinion.7
JEFF ALLEY, Chief Justice
December 30, 2024
Before Alley, C.J., Palafox and Soto, JJ. Soto, J., dissenting without written opinion8
7 See Tex. Civ. Prac. & Rem. Code Ann. § 74.353(e) (“If on interlocutory appeal an appellate court reverses a trial court's preliminary determination that a claim is not a health care liability claim, the claimant shall serve an expert report as required by Section 74.351 not later than 120 days after the date that the appellate court issues an opinion reversing the preliminary determination.”). 8 I respectfully dissent for the same reasons articulated in my dissent in Tenet Hosps. Ltd. v. Balderrama, No. 08- 23-00263-CV, 2024 WL 3845451, Tex. App.—El Paso Aug. 16, 2p024, Pet. filed).