a cause of action against a health care provider or physician for treatment, lack of treatment, or other claimed departure from accepted standards of medical care, or health care, or safety or professional or administrative services directly related to health care, which proximately results in injury to or death of a claimant, whether the claimant’s claim or cause of action sounds in tort or contract.
Tex. Civ. Prac. & Rem. Code Ann. § 74.001(a)(13). A “health care provider” is further defined as “any person, partnership, professional association, corporation, facility, or institution duly licensed, certified, registered, or chartered by the State of Texas to provide health care, including: (i) a registered nurse, (ii) a dentist, a podiatrist, (iii) a pharmacist, (iv) a chiropractor, an optometrist, [or] (v) a health care institution.” Tex. Civ. Prac. & Rem. Code Ann. § 74.001(a)(12); but see San Antonio Extended Med. Care, Inc. v. Vasquez, 327 S.W.3d 193, 197– 98 (Tex. App.—San Antonio 2010, no pet.) (reiterating the list is not exclusive).
Whether a claim falls within this definition requires an examination of “the gravamen of the claim, not the form of the pleadings.” Marks v. St. Luke’s Episcopal Hosp., 319 S.W.3d 658, 664 (Tex. 2010) (citing Diversicare Gen. Partner, Inc. v. Rubio, 185 S.W.3d 842, 847 (Tex. 2005)). The Texas Supreme Court set forth a three prong test to satisfy this definition: “(1) a physician or health care provider must be a defendant; (2) the claim . . . must concern treatment, lack of treatment, or a departure from accepted standards of medical care, or health care, or safety or professional or administrative services directly related to health care;” and (3) the defendant’s act or omission complained of must proximately cause the injury to the claimant.” Williams, 371 S.W.3d at 179–80; accord Marks, 319 S.W.3d at 664.
For Trejo’s claims to fall under the umbrella of a medical malpractice claim and require the timely filing of an expert report, Hill Country must be both a health care provider and Rene’s injuries must have resulted from either treatment, lack of treatment, or a departure from acceptable standards of care as defined by section 74.001(a)(13). See Tex. Civ. Prac. & Rem. Code Ann. § 74.001(a)(12), (13).
We first address whether Hill Country is a health care provider as defined by section 74.001(a)(12). Id.
A. Health Care Provider
1. Arguments of the Parties
a. Trejo Asserts Hill Country is Not a Health Care Provider
Trejo contends that Hill Country is an adult day-care facility and not within the protections of Chapter 74. We agree.
Section 74.001(a)(18) specifically provides for an “[i]ntermediate care facility” as “a licensed public or private institution to which Chapter 252, Health and Safety Code, applies.” Id. § 74.001(a)(18). With respect to licensing, Trejo contends that although Hill Country points to the Department of Aging and Disability Services (DADS) as a licensing agency, the memorandum to which Hill Country refers was for a different facility than the facility in which her son was injured. In distinguishing Hill Country from an intermediate care facility, Trejo argues that Hill Country is an adult day-care facility governed by Chapter 103 of the Human Resources Code, “Adult Day-care Act.” Tex. Hum. Res. Code § 103.003. Unlike the Health and Safety Code, the Human Resource Code does not contain any medical or health care personnel training or qualifications requirements. Id. § 103.003(2).
As further evidence of Hill Country’s lack of health care provider status, Trejo points to the deposition of Mabel Arteaga-Zielinksi, the individual in charge of day-to-day operations at Hill Country. In her deposition, Arteaga-Zielinksi testified (1) Hill Country employed no medical personnel, provided no medical services, had no state licensed staff of any kind; (2) Hill Country provided services including assistance in acquiring life skills, day trips, board games, lunch, and recreational activities; and (3) Hill Country referred to each of the individuals at the center as “consumers, ” not patients.
b. Hill Country Asserts the Agency is a Health Care Provider
Hill Country argues this court should look at the facts surrounding the underlying claim to determine its true character and whether it is actually a health care provider. Gomez v. Matey, 55 S.W.3d 732, 735 (Tex. App.—Corpus Christi 2001, no pet.). Hill Country argues the facts show that it falls under the TMLA’s definitions of “health care providers” and “health care institutions.”
Hill Country first points to the TMLA definition which provides that “health care provider[s]” include “ any person, partnership, professional association, corporation, facility, or institution duly licensed, certified, registered, or chartered by the State of Texas to provide health care, including . . . a health care institution.” Tex. Civ. Prac. & Rem. Code Ann. § 74.001(a)(12)(A) (emphasis added). Hill Country then directs us to the TMLA’s definition of health care institution as “a home and community-based services waiver program for persons with mental retardation adopted in accordance with Section 1915(c) of the federal Social Security Act.” Tex. Civ. Prac. & Rem. Code Ann § 74.001(a)(11)(I) (emphasis added). Hill Country argues that its annual certification by DADS, a Texas State Agency, is proof that their agency is “duly licensed.” Hill Country then concludes that because it provides services for persons with mental retardation and is a duly licensed institution, the claims asserted by Trejo must fall within the framework of the TMLA. We disagree.
2. Analysis
In determining whether a facility is “provid[ing] health care” as prescribed by section 74.001(a)(12), we look at the essence of the underlying claim, not merely the words contained within the pleadings. Tex. Civ. Prac. & Rem. Code. Ann. § 74.001(a)(12); Marks, 319 S.W.3d at 664; accord Harris Methodist Fort Worth v. Ollie, 342 S.W.3d 525, 527 (Tex. 2011); Yamada v. Friend, 335 S.W.3d 192, 197 (Tex. 2010). Here, the question is whether Hill Country is a provider with regard to medical care, treatment, or confinement. Tex. Civ. Prac. & Rem. Code. Ann. § 74.001(a)(10).
We are also mindful that completely outside of the confines of the Civil Practice and Remedies Code, the Human Resources Code defines an “adult day-care center” as a “facility that provides services under an adult day-care program on a daily or regular basis but not overnight to four or more elderly or handicapped persons who are not related by blood, marriage, or adoption to the owner of the facility.” Tex. Hum. Res. Code. § 103.003(1); see id. § 103.007 (requiring an adult day-care licensee applicant to show “(1) the ability to comply with the requirements of the department; (2) responsible management; and (3) qualified professional staff and personnel”). The code further defines an “adult day-care program” as “a structured, comprehensive program that is designed to meet the needs of adults with functional impairments through an individual plan of care by providing health, social, and related support services in a protective setting.” Id. at § 103.003(2).
The gravamen of each of Trejo’s petitions allege her son was injured due to the lack of supervision, monitoring, and assistance appropriate for an individual of his physical and mental capabilities. Unlike the psychiatric hospital in Texas West Oaks Hospital, L.P. v. Williams, Hill Country is not providing medical care, treatment, or confinement. 371 S.W.3d at 177. Rene was brought to the center for a couple of hours at a time; he was neither confined nor given any medical care or treatment. Hill Country employees, specifically the employee to which Rene was assigned that day, are not registered nurses and do not hold any type of medical training. Hill Country is not overseen by any medical professionals and does not provide any health care services. Accordingly, Hill Country does not fall under the “health care provider” as defined in Chapter 74. Tex. Civ. Prac. & Rem. Code Ann. § 74.001(a)(12).
Even assuming Hill Country is a health care provider, “[t]he simple fact that an injury occurred on a health care provider’s premises is not enough.” Good Shepherd Med. Ctr.—Linden, Inc. v. Twilley, No. 06-12-00098-CV, 2013 WL 772136, at *5 (Tex. App.—Texarkana Mar. 1, 2013, pet. denied). The injuries sustained by Trejo’s son must still qualify as a health care liability claim under the Act. We therefore turn to Chapter 74 for further guidance.
B. Health Care Claim
Trejo contends her son’s injuries did not result from a breach of medical, health care, or safety codes. Tex. Civ. Prac. & Rem. Code Ann. § 74.001(a)(13). We agree.
1. Injuries Occurring Outside of a Health Care Facility
With regard to Rene’s injuries occurring outside the facility, Hill Country contends his injuries were sustained during the course of transportation and are, therefore, health care liability claims. See Sherman v. HealthSouth Specialty Hosp., 397 S.W.3d 869, 873 (Tex. App.—Dallas 2013, pet. denied) (failing to properly secure invalid passenger being transported in a van before transporting her from a clinic to her home implicates acceptable standards). In Sherman, the court held it was HealthSouth’s duty to insure that Sherman was “untouched by danger” or “secure from danger, harm, or loss” during transport from the clinic to her home. Id.; see also Omaha Healthcare Ctr., LLC v. Johnson 344 S.W.3d 392, 395 (Tex. 2011) (concluding that failure to protect patient from spider bite was failure to protect from danger or harm). The distinct difference between Trejo’s and Sherman’s claims rests on the types of services being provided by the agency. HealthSouth was taking Sherman to her residence as part of her treatment plan. Sherman, 397 S.W.3d at 874. To the contrary, Rene was being taken on “an outing” that was separate and distinct from any medical treatment or doctor-prescribed plan. Accordingly, we cannot say that Hill Country’s services outside of its facility, including transportation to and from daily activities, implicated standards associated with the medical care of Trejo’s son.
2. Injury a Result of Treatment of Departure from Acceptable Standards
Hill Country contends Trejo’s allegations flow from alleged breaches in Hill Country’s treatment, lack of treatment, or even a departure to accepted standards of medical care. Marks, 319 S.W.3d at 662; see also Doctors Hosp. at Renaissance, Ltd. v. Mejia, No. 13-12-00602-CV, 2013 WL 4859592, at *3 (Tex. App.—Corpus Christi Aug. 1, 2013, no pet.) (mem. op.) (holding visitor’s injuries were a “garden variety” slip-and-fall after being directed by hospital employee to walk over freshly waxed walkway on the hospital premises). Yet, Trejo asserts her son suffered injuries as a result of ordinary negligence: (1) Hill Country’s employee left him in a hot car without making sure he made it into the facility, and (2) Hill Country’s employee allowed her son to depart the vehicle unattended and left him laying with a broken leg on the hot pavement for an unknown period of time.
In Texas West Oaks Hospital, LP v. Williams, the Texas Supreme Court provided a better understanding of what actions fall under health care liability claims. 371 S.W.3d at 179–80. Williams, an employee at an inpatient psychiatric hospital, was assigned to supervise a patient that could be removed from the psychiatric unit only by direct order of a physician. Id. at 175. When Williams took the patient to an outdoor, enclosed space, the patient attacked Williams resulting in injuries to Williams and, ultimately, the death of the patient. Id. Williams sued the facility alleging the facility failed to properly train him and provide a safe working environment. Id. In holding that Williams’s claims were health care liability claims, the court relied on the necessary training regarding working with potentially violent psychiatric patients, providing a safe workplace at a medical health hospital, and safety standards required for working with potentially violent schizophrenic patients. Id. at 176–77. As such, Williams’ claims were Chapter 74 health care claims based on alleged departures from accepted standards of health care and safety. Id.
Unlike the injuries sustained in Williams, Rene’s injuries did not result from an employee’s failure to follow doctor’s orders on how to “handle” Rene or where to take Rene. Instead, Trejo argued Hill Country’s employee was negligent by (1) leaving her son in the van when it was unsafe to do so, (2) failing to make sure her son departed the vehicle safely, and (3) leaving him laying with a broken leg on the hot pavement for an unknown period of time.
Rene’s injuries were sustained outside the Hill Country facility and were not a result of a breach of medical, health care, or safety standards. We, therefore, conclude Trejo’s claims sound in general negligence and are not health care liability claims under Chapter 74.
C. Conclusion
The services Hill Country provided to Rene did not include medical care, treatment, or confinement as required by the Civil Practice and Remedies Code. Instead, we conclude that Hill Country is more properly defined as an adult day-care facility under the Human Resources Code. Accordingly, Hill Country is not a “health care provider” as defined in Chapter 74. Tex. Civ. Prac. & Rem. Code Ann. § 74.001(a)(12).
Moreover, based on the injuries suffered by Rene, and alleged by Trejo, we cannot conclude the claims resulted from Hill Country’s treatment, lack of treatment, or even a departure from accepted standards of medical care. As such, the claims are not health care liability claims under the TMLA. Tex. Civ. Prac. & Rem. Code Ann. § 74.001(a)(13).
Accordingly, because Hill Country is not a health care provider under Chapter 74, and the alleged injuries were not a health care liability claim, the trial court did not err in failing to dismiss Trejo’s suit for failure to file a timely expert report.
Trejo’s Cross-Appeal: Trial Court’s Denial of Sanctions
An appellate court reviews a trial court’s sanctions determination for abuse of discretion. Low v. Henry, 221 S.W.3d 609, 614 (Tex. 2007). The test is whether the “court acted without reference to any guiding rules and principles” or whether the act was “arbitrary or unreasonable.” Id. Section 10.004 provides that the trial court may order a party to pay a sanction for violation of section 10.001 for “the amount of the reasonable expenses incurred by the other party because of the filing of the pleading or motion, including reasonable attorney’s fees.” See Tex. Civ. Prac. & Rem. Code Ann. § 10.001, .004 (West 2002); id. § 9.011(“the signing of a pleading . . . constitutes a certificate by the signatory to the signatory’s best knowledge, information, and belief . . . .”).
Trejo asks this court to conclude the trial court abused its discretion in failing to award sanctions. Although the record suggests Hill Country’s motives were less than admirable, and their pleadings did not abide by the spirit of section 9.011, there is no evidence in the record to show that the trial court’s denial was arbitrary or unreasonable. See Tex. Civ. Prac. & Rem. Code Ann. § 9.011; Henry, 221 S.W.3d at 614. Accordingly, we overrule Trejo’s cross-appeal.
Having overruled all issues on appeal, we affirm the trial court’s order.
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