Hospital doctors

At times, the Supreme Court of Texas will review a case and provide an interpretation of the underlying law in a manner such that those who rely on the law, or whose livelihoods are impacted by it, can better understand its meaning. And then there are cases where the Supreme Court goes beyond the legislative intent and expands the law into an area in a manner that was neither planned nor desired.

Such was the case on Dec. 21, 2018, when the Texas Supreme Court delivered an opinion in Texas Health Presbyterian Hosp. of Denton v. D.A. providing physicians in a hospital obstetrical suite with protection from liability, indicating patients can only bring suit against such doctors in cases of “willful and wanton” negligence.

The case arose from a partial summary judgment in favor of an obstetrician, which was later reversed by the Fort Worth Court of Appeals. The Fort Worth court held that the “willful and wanton” standard should not extend beyond the hospital emergency room.

Before the court was the issue of whether the “willful and wanton” negligence standard should be applied to emergency medical care provided in a hospital's obstetrical unit. Describing it as the Texas Medical Liability Act's emergency-medical-care provision, the Supreme Court held that “the provision applies to claims arising from emergency medical care provided in a hospital's obstetrical unit regardless of whether the patient was first evaluated or treated in a hospital's emergency department.”

The underlying case raises the question of whether Texas common law affords greater protection than Chapter 74 of the Civil Practice and Remedies Code.

The facts of the case involved a woman who elected to have labor induced at 39 weeks and checked into the hospital's obstetrical unit the evening before the scheduled procedure. The delivery process the next day was, according to the Supreme Court, “initially uneventful. But at the time of the actual delivery, the baby had difficulty moving through the birth canal.” The obstetrician, who was the mother's doctor throughout the pregnancy, made the decision to use forceps to deliver the baby's head. The baby's shoulder became stuck on his mother's pelvis due to a complication called shoulder dystocia. The doctor forcefully pulled the baby out causing permanent injury to the network of nerves in his shoulder, called a brachial plexus injury.

The Texas Medical Liability Act defines “emergency medical care” to mean:

Bona fide emergency services provided after the sudden onset of a medical or traumatic condition manifesting itself by acute symptoms of sufficient severity, including pain, such that the absence of immediate medical attention could reasonably be expected to result in placing the patient's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part. The term does not include medical care or treatment that occurs after the patient is stabilized and is capable of receiving medical treatment as a non-emergency patient or that is unrelated to the original medical emergency.

In handing down its opinion, the Supreme Court focused on statutory construction of the language used by the Texas Legislature. After an excruciatingly thorough analysis of punctuation and prepositional phrases, the high court proclaimed that the statute is not ambiguous. But it did note, on several occasions, that it or the Legislature must do something to address further the confusion caused by the existing statutory language.

The Supreme Court described Section 74.153 as statutory language that “is certainly not a model of clarity, particularly in light of its lack of any helpful punctuation.” The opinion's author, Justice Boyd, noted that, “We recognize, of course, that the legislature may sometimes mistakenly enact language that—though unambiguous—does not accurately reflect its collective intent,” noting, “Courts are not responsible for omissions in legislation [and] are not empowered to 'fix' the mistake by disregarding direct and clear statutory language that does not create an absurdity.”

The ignored legislative intent, which the Texas Senate voted unanimously to publish, was noted in the opinion:

Senator Ratliff stated that the section “does not apply to emergencies that arise during the surgery or labor and delivery,” and instead applies only “to emergencies that exist when the patient is brought to the ER and still exists when the patient goes immediately to an OB unit or surgical suite from the ER.” S.J. of Texas, 78th Leg., R.S. 5004 (2003) (Statement of Sen. Bill Ratliff).

Similarly, Rep. Joe Nixon stated, “It is the intent of this legislation that emergency situations where you do not have a prior relationship with the patient is the one given the protection. If you have a prior relationship with a patient, and you know about their medical history and their background you should not be given the protection to the same extent as someone who just shows up in the emergency room.” H.J. of Texas, 78th Leg., R.S. 6040 (2003) (Statement of Rep. Joe Nixon).

In order to protect our citizens and future children, our hope is that this decision and its far-reaching implications will be the subject of further litigation. Or, perhaps the Texas Legislature will fix the statute as the Supreme Court subtly invites it to do.

For in one regard, the Texas Supreme Court is quite correct. “Not all that is lawful is beneficial.”

Reid Martin and Jack Walker are the founding partners of Martin Walker and specialize in representing plaintiffs in medical malpractice cases. Their emails are [email protected] and [email protected].