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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. 03-17-00352-CV
Regular Panel Decision
Aug 22, 2018

Vista Medical Center Hospital Vista Healthcare, Inc. And Surgery Specialty Hospital, Inc.// State Office of Risk Management v. State Office of Risk Management// Vista Medical Center Hospital Vista Healthcare, Inc. And Surgery Specialty Hospital, Inc.

This case involves cross-appeals stemming from a dispute over the appropriate reimbursement for medical services provided by Vista Medical Center Hospital and its affiliates to injured employees covered by the State Office of Risk Management (SORM) under Texas workers’ compensation statutes. The district court had affirmed 23 administrative orders that required SORM to make additional payments to Vista, a decision which SORM challenged on appeal citing insufficient evidence. Vista, in turn, cross-appealed the district court's denial of prejudgment interest. The appellate court found substantial evidence supported the administrative law judges' conclusion that SORM's original reimbursement model was unfair and unreasonable, and that Vista's proposed methodology was valid. Consequently, the court affirmed the district court's judgment but modified it to include the prejudgment interest that Vista was statutorily entitled to.

Workers' CompensationMedical ReimbursementAdministrative LawAppellate ReviewSubstantial EvidencePrejudgment InterestTexas LawHealthcare ProvidersInsurance DisputesFee Guidelines
References
23
Case No. 03-21-00242-CV
Regular Panel Decision
Dec 28, 2022

Vista Medical Center Hospital, Surgery Specialty Hospital of America, Southeast Houston and Vista Hospital of Dallas v. Texas Mutual Insurance Company

This appeal stems from a dispute over workers' compensation medical benefits reimbursement between multiple hospitals (Vista Parties) and numerous insurance carriers (Carriers) in Texas. The core issue revolves around the application of a "stop-loss exception" under Former Rule 134.401, designed for unusually costly or lengthy hospital stays, which the Vista Parties sought for 542 injured workers. After the State Office of Administrative Hearings (SOAH) largely denied additional reimbursement, the district court affirmed SOAH's order. The Court of Appeals, Third District, affirmed the district court's judgment, rejecting the Vista Parties' arguments that the SOAH order was arbitrary and capricious or lacked substantial evidence. The court found that SOAH properly conducted a case-by-case inquiry into whether services were "unusually costly and unusually extensive" and did not err in its application of the rule or in its findings.

Workers' CompensationMedical ReimbursementStop-Loss ExceptionAdministrative LawAppellate CourtTexas Court of AppealsSubstantial Evidence ReviewArbitrary and CapriciousFee GuidelinesHospital Reimbursement
References
51
Case No. No. 02-10-00291-CV
Regular Panel Decision
Aug 31, 2011

Chesser v. LIFECARE MANAGEMENT SERVICES

Curtis Chesser, through his spouse and power of attorney Ava Chesser, sued LifeCare Management Services (LMS) and LifeCare Hospitals of North Texas (Hospital) for health care liability. After Chesser suffered a mild stroke, he was transferred to Hospital where a PEG tube was surgically inserted. The tube's bolster was too tight, leading to severe pain, tissue necrosis, hemorrhage, cardiac arrest, cerebral injury, and permanent cognitive deficits. A jury found for Chesser. The Court of Appeals sustained Chesser's issue that no evidence supported the negligence of three settling doctors, modifying the judgment to apply a dollar-for-dollar settlement credit of $183,000. It also sustained Appellees' challenge to the jury's joint enterprise finding, removing joint and several liability for LMS and making it severally liable for 30% of the judgment. Furthermore, the court modified the judgment to impose several liability on Hospital and LMS for their respective $250,000 noneconomic damage awards, affirming the trial court's judgment as modified.

Health Care LiabilityMedical NegligencePEG Tube ProcedureJoint EnterpriseVicarious LiabilityComparative ResponsibilitySettlement CreditNoneconomic DamagesPrejudgment InterestStatutory Caps
References
70
Case No. 03-02-00803-CV
Regular Panel Decision
Jul 24, 2003

All Saints Health System All Saints Episcopal Hospital/Fort Worth All Saints Episcopal Hospital/Cityview Baptist Health System Baptist Medical Center North Central Baptist Hospital Northeast Baptist St. Luke's Baptist v. Texas Workers' Compensation Commission State Office of Risk Management Continental Casualty Company Texas Association of School Boards Risk Management Fund Mid-Century Insurance Company Truck Insurance Exchange Farmers Insurance Exchange

This case addresses a dispute between hospitals and the Texas Workers' Compensation Commission and various insurers regarding reimbursement for medical services provided under a 1992 hospital fee guideline that was later invalidated. The hospitals sought reevaluation of claims under an expired 1991 emergency guideline or direct application of statutory standards. The insurers, conversely, argued that managed care contracts should cap the reimbursement amounts. The court affirmed the trial court's declaratory judgment, ruling that reimbursements must be determined on a fee-for-service basis, guided by the 'fair and reasonable' statutory requirements of Texas Labor Code section 413.011(d) and Rule 134.1. While managed care contracts are considered relevant evidence, they do not serve as a definitive cap on reimbursement.

Workers' Compensation LawHospital ReimbursementFee GuidelinesAdministrative LawDeclaratory JudgmentTexas Labor CodeMedical Cost ControlManaged Care ContractsRule InvalidationFee-for-Service Model
References
20
Case No. 01-04-00797-CV
Regular Panel Decision
Jul 20, 2006

Marine Transport Corporation v. the Methodist Hospital, the Institute for Preventive Medicine/Methodist Healthcare Systems, the Methodist Hospital/Institute for Preventive Medicine Management, Inc. and Rashid Khan, M.D.

Marine Transport Corporation (Marine) appealed the dismissal of its claims against The Methodist Hospital and Dr. Rashid Khan. Marine's employee, Richard Guillory, a seaman, was certified fit for duty by the appellees despite medical issues and later died from an infection. Marine sought damages under the maritime doctrine of maintenance and cure, alleging negligence in the fitness-for-duty certification. The appellate court affirmed that while federal maritime law applied to Marine's claim, the underlying health care liability claims were governed by state law's former article 4590i, requiring expert reports. However, the trial court abused its discretion by denying Marine's motion for a 30-day extension to file these reports, as the attorney's failure was due to accident or mistake, not conscious indifference. Therefore, the judgment of dismissal was reversed, and the case was remanded for further proceedings.

Maritime LawMaintenance and CureHealth Care LiabilityMedical NegligenceExpert Report RequirementTexas Civil Practice and Remedies CodeAbuse of DiscretionAccident or MistakeSeaman InjuryFitness for Duty Certification
References
41
Case No. DC-13-04564-L
Regular Panel Decision
Apr 16, 2015

in Re: Island Hospitality Management, Inc., Post Properties, Inc. and Post Addison Circle Limited Partnership

Plaintiff Jane Doe filed a lawsuit alleging sexual assault and related damages, including mental anguish. Her designated psychologist, Dr. William Flynn, conducted a mental examination. Defendants Island Hospitality Management, Inc., Post Properties, Inc., and Post Addison Circle Limited Partnership sought an independent psychological examination of the plaintiff by their expert, Dr. Lisa Clayton. The district court initially denied this motion, and subsequently denied the defendants' joint motion for reconsideration. This mandamus record documents the appellate review of this discovery dispute.

Sexual AssaultMental AnguishPsychological ExaminationDiscovery DisputeForensic PsychologyPremises LiabilityMandamus PetitionCivil ProcedureExpert WitnessTexas Law
References
59
Case No. 02-10-00291-CV
Regular Panel Decision
Aug 31, 2011

Curtis Chesser, Individually, and Through His Spouse and Power of Attorney, Ava Chesser v. LifeCare Management Services, L.L.C. and LifeCare Hospitals of North Texas, L.P. D/B/A LifeCare Hospital of Fort Worth

Curtis Chesser filed a health care liability suit against LifeCare Management Services, L.L.C. and LifeCare Hospitals of North Texas, L.P. d/b/a LifeCare Hospital of Fort Worth following injuries from a PEG tube insertion. A jury found for Chesser, but the trial court applied statutory damage caps and a percentage-of-responsibility settlement credit. The appellate court sustained Chesser's appeal, reversing the percentage settlement credit and applying a dollar-for-dollar credit due to insufficient evidence of negligence by settling doctors. The court also sustained the Appellees' challenge to the jury's joint enterprise finding, removing joint and several liability for LifeCare Management Services. The judgment was affirmed as modified, with LifeCare Management Services and LifeCare Hospitals of North Texas each severally liable for $250,000 in noneconomic damages.

Health Care LiabilityMedical MalpracticePEG Tube ComplicationsProximate CauseJoint EnterpriseSettlement CreditNoneconomic Damages CapStatutory InterpretationAppellate ProcedureSufficiency of Evidence
References
67
Case No. MISSING
Regular Panel Decision

Huntington Hospital v. Huntington Hospital Nurses' Ass'n

Huntington Hospital initiated an action under the Federal Arbitration Act to partially vacate an arbitration award, while the Huntington Hospital Nurses’ Association cross-petitioned to confirm it. The dispute originated from the Hospital unilaterally granting two nurses, Betty Evans and Lynn Meyer, longevity pay credits exceeding the ten-year cap stipulated in their collective bargaining agreement (CBA). The arbitrator found the Hospital violated the CBA's sections on pay and exclusive bargaining rights. The arbitrator mandated the Hospital roll back excess credits and recover overpayments. The District Court denied the Hospital's petition, dismissing arguments regarding public policy, manifest disregard for law, and lack of award finality, ultimately confirming the arbitration award.

Arbitration AwardCollective Bargaining AgreementLabor LawFederal Arbitration ActWage DisputesLongevity PayUnion RightsPublic Policy ExceptionManifest Disregard of LawContract Interpretation
References
22
Case No. 03-02-00429-CV
Regular Panel Decision
May 30, 2003

Hospitals and Hospital Systems v. Continental Casualty Company

Hospitals and Hospital Systems appealed a declaratory judgment favoring Continental Casualty Company and other insurers, concerning the application of a one-year statute of limitations (rule 133.305(a)) for workers' compensation medical claims. The claims arose after the 1992 Acute Care Hospital Fee Guideline was invalidated. Hospitals argued the limitations period should be tolled due to prior litigation challenging the guideline and that the Commission waived the rule through a settlement agreement. The Texas Court of Appeals, Third District, Austin, found no basis for tolling, noting hospitals were not prevented from filing claims earlier. It also ruled that the Commission's executive director lacked authority to waive the rule, and that any waiver could not revive time-barred claims. The court affirmed the trial court's judgment, upholding the applicability of rule 133.305(a) and barring the Hospitals' claims.

Workers' CompensationAdministrative LawDeclaratory JudgmentStatute of LimitationsTollingWaiverTexas Court of AppealsFee GuidelinesMedical Dispute ResolutionAgency Rules
References
10
Case No. NO. 09-04-368 CV
Regular Panel Decision
Apr 28, 2005

Silsbee Hospital, Inc. D/B/A Columbia Silsbee Doctors Hospital v. Lonny George

Lonny George, an employee of Silsbee Hospital, Inc., a nonsubscriber to workers' compensation, sustained injuries and sued the hospital. He had signed a waiver agreement related to an employee benefit plan, which the hospital contended released them from liability for personal injuries. The Court of Appeals examined the waiver agreement's language, applying contract construction rules and the express negligence doctrine, and found it only applied to the parent company, Columbia/HCA Healthcare Corporation, not the subsidiary Hospital, as George's injuries arose from employment with the Hospital. The court also rejected the Hospital's affirmative defenses of ratification, release, waiver, and estoppel. However, the appellate court determined there was harmful error in jury selection due to the trial court's failure to strike two unequivocally biased veniremembers. Consequently, the judgment was reversed and the case remanded for a new trial.

NonsubscriberWorkers' Compensation WaiverEmployee InjuryExpress Negligence RuleJury BiasAppellate ReversalRemand for New TrialContract InterpretationAffirmative DefensesTexas Law
References
38
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