OPINION Before PIRTLE and PARKER and DOSS, JJ. Relator, Casie Muller, filed this original petition for writ of mandamus in which she requests that we instruct the trial court to vacate its order denying her motion to compel discovery and grant said motion. We deny Muller’s petition. Background Muller sought medical care for herself and her newborn son from the Lubbock County Hospital District d/b/a University Medical Center (“UMC”) on fourteen dates in 2017 and 2019. On some of her visits to UMC, Muller signed an agreement acknowledging that she was responsible for the charges made in connection with UMC’s treatment; however, UMC and Muller did not have a contract establishing a price for the goods and services Muller received. Although Muller and her son were covered by an insurance plan, UMC was not an in-network provider under the plan. UMC therefore based Muller’s bill, which totaled $54,532.25, on its chargemaster rates.[1] After receiving payments totaling $14,087.41, UMC filed suit against Muller alleging that it is still owed $40,444.84 for the goods and services it provided to her and her son. UMC brought claims, pled in the alternative, for suit on account, breach of contract, and quantum meruit. Muller asserts that, since no contract set the prices for the goods and services she received, UMC must prove the reasonable value of those goods and services. She claims UMC has already been paid the reasonable value of those goods and services and that the additional amounts UMC is attempting to collect are excessive and unreasonable. In an effort to gather evidence in support of her defenses, Muller served UMC with discovery requests. Ten of her requests are at issue in the instant dispute. Four requests relate to UMC’s costs associated with the goods and services it provided: For each line item on the subject medical bills reflecting a tangible item, state: (1) the date each item was purchased by the Hospital; (2) the vendor from whom the item was purchased; (3) the price paid for the item; and (4) any way in which the Hospital increased the value of the item above the amount that the Hospital paid to purchase the item. Please state the Hospital’s cost to provide the goods and/or services listed on the subject medical bills. [Produce] [a]ll invoices reflecting the purchase by the Hospital of each and every tangible item listed on the subject medical bills for which the Hospital contends Defendant is responsible to pay. [Produce] [a]ll documents reflecting the Hospital’s actual cost to provide the goods and services listed on the subject medical bills. Four more concern UMC’s overall cost structure: Please describe all ways in which the Hospital determines, tracks, records or ascertains its costs to provide goods and services to patients. [Produce] [a] complete copy of all tax documents filed by the Hospital for time periods encompassed within the relevant time period. [Produce] [a] complete copy of all audited financial statements for the Hospital for time periods encompassed within the relevant time period. [Produce] [a]ll budget sheets, financial statements, and other indicia of the Hospital’s financial performance during the relevant time period. The final two involve payment information: Please state the average amount paid to the Hospital for the goods and services listed on the subject medical bills for the relevant time period. Please state the percentage of accounts for which the Hospital collected 100% of its chargemaster rates during the relevant time period. UMC did not produce the requested information. It objected on the bases of relevance, burden, overbreadth, and confidentiality. Muller then filed a motion to compel UMC to provide complete disclosures. After a hearing, the trial court denied Muller’s motion. This petition for writ of mandamus followed. Prerequisites to Mandamus Mandamus is both an extraordinary remedy and a discretionary one. In re Garza, 544 S.W.3d 836, 840 (Tex. 2018) (orig. proceeding) (per curiam). Mandamus relief is warranted only when the trial court clearly abused its discretion and there is no adequate remedy by appeal. In re N. Cypress Med. Ctr. Operating Co., 559 S.W.3d 128, 130 (Tex. 2018) (orig. proceeding). The relator bears the burden of proving both of these requirements. In re H.E.B. Grocery Co., 492 S.W.3d 300, 302 (Tex. 2016) (orig. proceeding) (per curiam). A trial court abuses its discretion when its ruling is arbitrary or unreasonable, or is made without regard for guiding legal principles or supporting evidence. In re Nationwide Ins. Co. of Am., 494 S.W.3d 708, 712 (Tex. 2016) (orig. proceeding). An abuse of discretion also occurs when a trial court fails to analyze or apply the law correctly. Id. Although appellate courts generally do not review orders refusing to compel discovery, mandamus relief may be justified when the denial of discovery goes to the heart of a party’s case or vitiates or severely compromises a party’s ability to present a viable claim or defense. In re Allied Chem. Corp., 227 S.W.3d 652, 658 (Tex. 2007) (orig. proceeding); Able Supply Co. v. Moye, 898 S.W.2d 766, 772 (Tex. 1995) (orig. proceeding). Analysis Muller argues in her first issue that the trial court abused its discretion when it denied her motion to compel. In her second issue, she asserts that the trial court’s ruling left her without an adequate remedy on appeal. Did the Trial Court Clearly Abuse its Discretion? In this mandamus action, Muller has the burden of establishing that the trial court could reasonably have reached only one decision. Walker v. Packer, 827 S.W.2d 833, 839-40 (Tex. 1992) (orig. proceeding). The scope of discovery is largely within the trial court’s discretion. Dillard Dep’t Stores, Inc. v. Hall, 909 S.W.2d 491, 492 (Tex. 1995) (orig. proceeding) (per curiam). “In determining whether the trial court clearly abused its discretion, an appellate court may not substitute its judgment for the trial court’s determination of factual or other matters committed to the trial court’s discretion, even if the mandamus court would have decided the issue differently.” In re State Farm Lloyds, 520 S.W.3d 595, 604 (Tex. 2017). Muller argues that the trial court abused its discretion because she sought relevant, discoverable evidence; UMC failed to establish the requests were unduly burdensome; and UMC’s confidentiality concerns were assuaged by a protective order. “Our procedural rules allow broad discovery of unprivileged information that is ‘relevant to the subject matter of the pending action.’” In re N. Cypress, 559 S.W.3d at 129 (quoting TEX. R. CIV. P. 192.3(a)). In In re North Cypress Medical Center Operating Company, a case involving the enforceability of a hospital lien, the Texas Supreme Court determined that the “subject matter” of the action encompassed the reasonableness of the hospital’s charges. Id. Muller submits that this case is similar, and relies extensively on North Cypress as support for her position that the trial court should compel production of the requested information. See id. In North Cypress, an uninsured patient was treated in North Cypress Medical Center’s emergency room for injuries sustained in an automobile accident. Id. The hospital billed the patient for its services at its full chargemaster prices, totaling $11,037.35, and filed a hospital lien. Id. After she was unable to obtain a reduction of her bill, the patient filed a declaratory judgment action against the hospital, requesting a judgment that its “charges were unreasonable and its lien invalid to the extent it exceeded a reasonable and regular rate for services rendered.” Id. at 130. Via discovery, the patient sought information about North Cypress’s reimbursement rates from insurers and government payors. The hospital objected to the requests on the basis that the information sought was irrelevant, proprietary and confidential, and the requests were overly broad. Id. The Texas Supreme Court rejected North Cypress’s argument that reimbursements from insurers and government payors, which account for most of the hospital’s income, were not relevant to the patient’s claims. The high court explained, “[W]e fail to see how the amounts a hospital accepts as payment from most of its patients are wholly irrelevant to the reasonableness of its charges to other patients for the same services.” Id. at 133. In reaching its decision, the court identified holdings in other states that “demonstrate at least the potential connection between reimbursement rates and the reasonableness of billed charges.” Id. at 135. However, the court made clear that it was not concluding that “reimbursement rates standing alone are dispositive of the question of what constitutes a reasonable and regular rate for a hospital’s services.” Id. The Supreme Court concluded that the trial court did not abuse its discretion in compelling production of reimbursement information. In the case before us, UMC has already produced the information that was at issue in North Cypress, i.e., information on the amounts the hospital accepts as payment for the same services from other patients, including those covered by private insurance and government benefits. Specifically, UMC has produced its annual Medicare cost reports, Medicare reimbursement rates for the goods and services Muller received, Medicaid reimbursement rates for the goods and services Muller received, the amounts UMC would have accepted as payment in full had Muller been covered by an insurer that contracted with UMC, and the discounts to which uninsured patients are entitled under the Affordable Care Act. The discovery sought by Muller in this proceeding goes beyond the payment and reimbursement information discussed in North Cypress. Muller seeks far more granular data here, such as the costs, vendors, and markups for individual products, and the hospital’s budgets, financial statements, and tax returns. These extensive requests include, for instance, requests for UMC to disclose “[a]ll documents reflecting the Hospital’s actual cost to provide the goods and services listed on the subject medical bills” and to provide “[a]ll invoices reflecting the purchase by the Hospital of each and every tangible item listed on the subject medical bills for which the Hospital contends Defendant is responsible to pay.” In our view, North Cypress should not be read as expansively as Muller asserts. The court in North Cypress held that the trial court did not abuse its discretion in determining that the amounts the hospital was willing to accept as payment from other patients was relevant to the reasonableness of its charges for the same services rendered to an uninsured patient. Id. at 136. The court did not conclude that the hospital’s cost information, cost structure, or other categories of payment information were relevant and discoverable. Thus, the trial court could have reasonably concluded that the information requested by Muller was not discoverable. Moreover, even if we were to assume that the requested discovery might have some relevance in determining the reasonable value of the services UMC provided to Muller, the trial court had to consider both this potential relevance and the burden on UMC. In its response to Muller’s motion to compel, UMC presented evidence that the process for identifying and compiling the requested information would be labor-intensive and time-consuming. For example, UMC provided an affidavit from its Director of Patient Financial Services in which she testified regarding how UMC would go about determining the average amount patients paid for each of the goods and services it provided to Muller. She explained that UMC would have to run a query to identify all the patients that received each good and service, determine what payment had been received from those patients, and calculate the average. Responsive documents would have to be redacted before they were produced to Muller. The affiant stated that a Basic Metabolic Panel, one service that Muller received during one visit in November of 2017, was provided to 1,682 UMC patients during November of 2017. UMC estimated that it would take 35 days to locate the information needed to answer Muller’s interrogatory for this single service. A trial court may limit discovery when “the discovery sought is unreasonably cumulative or duplicative, or is obtainable from some other source that is more convenient, less burdensome, or less expensive” or when “the burden or expense of the proposed discovery outweighs its likely benefit, taking into account the needs of the case, the amount in controversy, the parties’ resources, the importance of the issues at stake in the litigation, and the importance of the proposed discovery in resolving the issues.” TEX. R. CIV. P. 192.4. Additionally, discovery may not be used as a fishing expedition or to impose unreasonable discovery expenses on the opposing party. In re Alford Chevrolet-Geo, 997 S.W.2d 173, 180-81 (Tex. 1999) (orig. proceeding). Here, the trial court could have reasonably determined that the requested discovery was not proportional to the needs of the case or that the burden or expense of production outweighs its likely benefit.[2] See In re State Farm Lloyds, 520 S.W.3d at 599 (“Reasonableness and its bedfellow, proportionality, require a case-by-case balancing of jurisprudential considerations, which is informed by factors the discovery rules identify as limiting the scope of discovery and geared toward the ultimate objective of ‘obtain[ing] a just, fair, equitable and impartial adjudication’ for the litigants ‘with as great expedition and dispatch at the least expense . . . as may be practicable.’”) (citations omitted). Therefore, we conclude that Muller has not met her burden to establish that the trial court clearly abused its discretion in denying her motion to compel. Does Muller have an Adequate Appellate Remedy? Because we conclude that Muller has failed to show that the trial court abused its discretion, we must deny the petition for writ of mandamus. Accordingly, it is unnecessary to determine whether an adequate remedy on appeal exists. Conclusion For the foregoing reasons, we deny the petition for writ of mandamus. Judy C. Parker Justice
