Civil Practice & Remedies Code § 74.153 – Standard of Proof in Emergency Medical Care Cases

Table of Contents

• Code Details
• Exact Statute Text
• Civil Practice & Remedies Code § 74.153 Summary
• Purpose of Civil Practice & Remedies Code § 74.153
• Real-World Example of Civil Practice & Remedies Code § 74.153
• Related Statutes
• Case Law Interpreting Civil Practice & Remedies Code § 74.153
• Why Civil Practice & Remedies Code § 74.153 Matters in Personal Injury Litigation

Code Details

CIVIL PRACTICE AND REMEDIES CODE

TITLE 4. LIABILITY IN TORT

CHAPTER 74. MEDICAL LIABILITY

Exact Statute Text

Click to view the complete statute text

STANDARD OF PROOF IN CASES INVOLVING EMERGENCY MEDICAL CARE. (a) Except as provided by Subsection (b), in a suit involving a health care liability claim against a physician or health care provider for injury to or death of a patient arising out of the provision of emergency medical care in a hospital emergency department, in an obstetrical unit, or in a surgical suite immediately following the evaluation or treatment of a patient in a hospital emergency department, the claimant bringing the suit may prove that the treatment or lack of treatment by the physician or health care provider departed from accepted standards of medical care or health care only if the claimant shows by a preponderance of the evidence that the physician or health care provider, with willful and wanton negligence, deviated from the degree of care and skill that is reasonably expected of an ordinarily prudent physician or health care provider in the same or similar circumstances.

(b) Subsection (a) does not apply to:

(1) medical care or treatment:

(A) provided after the patient is:

(i) stabilized; and

(ii) receiving medical care or treatment as a nonemergency patient; or

(B) that is unrelated to a medical emergency; or

(2) a physician or health care provider whose negligent act or omission proximately causes a stable patient to require emergency medical care.

Added by Acts 2003, 78th Leg., ch. 204, Sec. 10.01, eff. Sept. 1, 2003.

Amended by:

Acts 2019, 86th Leg., R.S., Ch. 1364 (H.B. 2362), Sec. 1, eff. September 1, 2019.

Civil Practice & Remedies Code § 74.153 Summary

This Texas statute establishes a unique and elevated standard of proof for certain medical malpractice lawsuits that arise from emergency medical care. Generally, in most medical liability claims, a plaintiff must prove that a healthcare provider’s actions or inactions fell below the ordinary standard of care for a reasonably prudent professional. However, for cases involving injuries or death resulting from emergency medical treatment in a hospital emergency department, obstetrical unit, or surgical suite immediately following emergency department evaluation, the claimant must meet a higher bar. They must demonstrate, by a preponderance of the evidence, that the physician or healthcare provider acted with “willful and wanton negligence.” This means showing the provider deviated from the expected degree of care and skill in a manner that was extreme or reckless.

There are specific situations where this heightened standard does not apply. If the medical care is provided after the patient has been stabilized and is no longer an emergency patient, or if the care provided is completely unrelated to a medical emergency, the traditional standard of care applies. Additionally, if a healthcare provider’s negligence causes a patient who was initially stable to then require emergency medical attention, the elevated “willful and wanton negligence” standard would not be invoked.

Purpose of Civil Practice & Remedies Code § 74.153

The legislative intent behind this section of the Civil Practice and Remedies Code is to provide a certain level of protection to healthcare professionals who provide critical emergency medical care. Lawmakers recognized that emergency situations are inherently high-stress, fast-paced environments where immediate decisions must often be made with limited information. Requiring proof of “willful and wanton negligence” rather than ordinary negligence aims to prevent physicians and other healthcare providers from being held liable for every less-than-perfect outcome in these challenging circumstances.

This statute seeks to encourage medical professionals to provide emergency services without undue fear of litigation for honest errors or less than optimal results that might occur in a crisis. The purpose is to balance the need to protect patients from truly egregious medical mistakes with the need to ensure that healthcare providers are willing and able to deliver urgent, life-saving care without the constant threat of a lawsuit for ordinary negligence. By raising the standard of proof, the law aims to filter out claims based on mere mistakes or less-than-ideal outcomes, focusing instead on conduct that demonstrates a clear, conscious indifference or extreme departure from accepted medical practice.

Real-World Example of Civil Practice & Remedies Code § 74.153

Imagine a scenario where a patient, Sarah, is brought to a hospital emergency room with severe abdominal pain and a rapidly declining condition. Dr. Miller, an emergency room physician, quickly evaluates Sarah, orders tests, and attempts a specific emergency procedure to address what he believes is a critical internal bleed. Despite Dr. Miller’s efforts, Sarah’s condition worsens, and she tragically dies.

Sarah’s family believes that Dr. Miller made an error in judgment regarding the diagnosis or the procedure, leading to her death, and decides to file a medical malpractice lawsuit. Because Sarah received care in a hospital emergency department and her claim arises out of the provision of emergency medical care, Civil Practice & Remedies Code § 74.153 would apply.

To succeed in their lawsuit, Sarah’s family would not just need to show that Dr. Miller’s actions fell below the typical standard of care. Instead, they would have to prove by a preponderance of the evidence that Dr. Miller acted with “willful and wanton negligence.” This would require demonstrating that Dr. Miller’s deviation from accepted medical standards was not just a mistake or ordinary carelessness, but an extreme departure from what an ordinarily prudent physician would do, indicating a conscious indifference to Sarah’s welfare or a reckless disregard for her safety in the emergency setting.

Now, consider an exception: if Sarah had been stabilized after the initial emergency, admitted to a regular hospital room, and then Dr. Miller provided subsequent non-emergency care during which a separate, unrelated act of negligence occurred that caused injury. In that situation, the “willful and wanton negligence” standard would likely not apply, and the family could pursue the claim under the traditional standard of ordinary negligence. Similarly, if Dr. Miller’s negligence *before* the emergency caused Sarah to become unstable and require emergency care, then the heightened standard would also not apply.

Related Statutes

Several other sections within the Texas Civil Practice & Remedies Code, particularly within Chapter 74 (Medical Liability), are closely related and often referenced alongside § 74.153. These statutes provide context, definitions, and procedural requirements for medical liability claims:

• Civil Practice & Remedies Code § 74.001 (Definitions): This section defines key terms used throughout Chapter 74, such as “health care provider,” “physician,” “medical care,” “health care liability claim,” and “emergency medical care,” which are crucial for interpreting the scope and application of § 74.153.
• Civil Practice & Remedies Code § 74.003 (Limitation of Liability for Emergency Care): This statute provides a general limitation on liability for certain emergency care providers and volunteers, often requiring a showing of willful or wanton negligence for them to be held liable, reinforcing the legislative policy seen in § 74.153.
• Civil Practice & Remedies Code § 74.051 (Expert Report): This section outlines the requirement for a claimant in a health care liability claim to file an expert report detailing the standard of care, how it was breached, and the causal link to the injury. When § 74.153 applies, the expert report must specifically address how the provider’s conduct met the “willful and wanton negligence” standard.
• Civil Practice & Remedies Code § 74.002 (Applicability of Chapter): This foundational statute establishes that Chapter 74 applies to all health care liability claims, setting the stage for specific provisions like § 74.153 to govern particular types of claims.

Case Law Interpreting Civil Practice & Remedies Code § 74.153

Texas courts have frequently interpreted and applied Civil Practice & Remedies Code § 74.153, particularly in determining what constitutes “willful and wanton negligence” in the context of emergency medical care.

One notable case is Houston Healthcare Sys., L.P. v. Richard, 533 S.W.3d 380 (Tex. App.—Houston [1st Dist.] 2016, pet. denied). In this case, the court discussed the high burden imposed by § 74.153, emphasizing that “willful and wanton negligence” requires more than mere thoughtlessness or carelessness; it necessitates showing an extreme degree of risk created by a conscious indifference to the rights, safety, or welfare of others. The court clarified that the standard involves an actor’s “mental attitude.”

More recently, Garcia v. Strake, No. 04-20-00465-CV, 2021 WL 3144883 (Tex. App.—San Antonio July 26, 2021, pet. denied) (mem. op.), involved an interpretation of the statute in the context of an emergency room visit. Although an unpublished opinion, it provides an example of how courts assess the sufficiency of an expert report in light of the “willful and wanton negligence” standard, particularly after the 2019 amendments. These cases, among others, help clarify the stringent requirements claimants face when pursuing medical liability claims for emergency care in Texas.

Why Civil Practice & Remedies Code § 74.153 Matters in Personal Injury Litigation

Civil Practice & Remedies Code § 74.153 profoundly impacts personal injury litigation in Texas, particularly for claims involving medical malpractice in emergency settings. For plaintiffs, this statute creates a significantly higher hurdle. Instead of proving that a healthcare provider simply made a mistake or was ordinarily negligent, they must demonstrate “willful and wanton negligence.” This requires evidence of a reckless disregard for patient safety or a conscious indifference to their well-being, which is much more challenging to establish. This higher standard means that many cases that might otherwise proceed under ordinary negligence would be dismissed if they involve emergency care.

For personal injury attorneys representing plaintiffs, this statute necessitates a rigorous initial investigation to determine if the facts can support a claim of willful and wanton negligence. It requires expert witnesses not only to identify a deviation from the standard of care but also to articulate how that deviation rose to the level of extreme, reckless, or intentional wrongdoing. The specific location of care (ER, obstetrical unit, surgical suite immediately following ER evaluation) and the patient’s status (emergency vs. stabilized) are critical factors that directly influence the applicable standard of proof.

Conversely, for defense attorneys representing physicians and healthcare providers, § 74.153 serves as a robust shield. It provides a strong basis for seeking early dismissal of claims that allege only ordinary negligence in an emergency care context. Defense strategies often focus on demonstrating that the care provided, while perhaps imperfect, did not meet the definition of “willful and wanton negligence” and that the provider acted reasonably given the high-pressure circumstances of an emergency. This statute underscores the importance of precisely categorizing the nature of the medical care and the patient’s condition when evaluating a potential medical liability claim in Texas.