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Is a hospital bed an integral part of medical care? As a federal judge considers the constitutionality of Texas’ 2003 medical malpractice reform — and Gov. Rick Perry campaigns for more lawsuit restrictions — the state Supreme Court has ruled that hospital injuries seemingly unrelated to doctor error can fall under Texas’ stringent medical malpractice caps. Some legal observers say the decision is a perversion of legislative intent, but tort reform advocates contend the high court simply closed a huge loophole in liability reforms.

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Does a broken hospital bed constitute a medical mistake?

As a federal judge considers the constitutionality of Texas’ 2003 medical malpractice reform — and Gov. Rick Perry campaigns for more lawsuit restrictions — the Texas Supreme Court has narrowly ruled that hospital injuries seemingly unrelated to doctor error can still fall under the state’s stringent medical malpractice caps.

The case centers on Irving Marks, who fell while recuperating from back surgery at Houston’s St. Luke’s Episcopal Hospital in 2000. Marks alleged that a broken footboard on his hospital bed led to his fall and that he should be entitled to sue St. Luke’s for unlimited damages with a so-called “premises liability” claim. The hospital argued the Marks incident involved medical care and should fall under Texas’ medical malpractice law — which requires a timely expert report and caps damages for pain and suffering at $250,000.

The 5-4 high court ruling late last month reversed a 2009 high court decision that Marks’ claims did not fall under medical malpractice law because the bed was not integral to his medical care. Under the new ruling, the court disqualified Marks for damages because he did not get a timely expert report, required in a medical malpractice case, on the broken bed. 

Texas’ medical lawsuit rules define a health care liability claim as a “cause of action against a health care provider or physician for treatment, lack of treatment” or other medical shortfalls that lead to injury or death. When lawmakers capped damages in 2003, they did it to fix a medical malpractice insurance "crisis," one they said negatively affected health care delivery in Texas.

The Marks ruling comes at a welcome time for advocates of Texas’ tort reform, including Perry, who is campaigning on a pledge to pass more extensive legislation against what tort reformers call frivolous litigation. Last week, a federal magistrate recommended upholding the constitutionality of the 2003 legislation’s cap on medical liability damages, which is being challenged by several alleged victims of medical malpractice in federal court in the Eastern District of Texas. A judge is expected to rule on the case within the next few weeks.

"The Supreme Court’s prior opinion [in the Marks case] could have opened a huge loophole in Texas’ health care liability reforms, allowing plaintiffs to dodge the expert report requirement and sidestep the noneconomic damage cap," said Jon Opelt, executive director of the Texas Alliance For Patient Access, which advocates for medical malpractice reform. "Had the court not reversed its earlier decision, plaintiffs might have tried to artfully plead medical malpractice lawsuits as simple negligence cases."

But trial lawyers say the case could have dangerous repercussions for patients. “The implication for all patients is, regardless of what happens to them in the hospital — whether it’s due to a wet floor or the way a bed is put together or an electricity failure — this court has found a way to cap the damages,” said Jay Harvey, a medical malpractice attorney based in Austin.

Some legal observers say the Marks decision is a perversion of the intent of the Legislature’s health care liability reform. “If the Legislature had wanted to immunize doctors and hospitals from all tort liability, it could have done so," said David Anderson, a professor at the University of Texas School of Law. “But it didn’t.”

The Marks case hinged on the shifting views of Justice David Medina, a Republican who wrote the majority opinion in 2009 noting that the hospital bed was “unrelated to any professional judgment and is merely incidental to the patient’s case.” One year later, after the court granted St. Luke's motion for a rehearing, Medina was the swing vote that led to the ruling’s reversal; he wrote that medical equipment such as Marks’ hospital bed “is an integral and inseparable part of the health care services provided.” In both cases, the vote was 5-4. 

Medina did not return phone calls to explain his change of heart; a court spokesman said he couldn’t comment on it in the event it comes back for another rehearing. In the dissenting opinion, Chief Justice Wallace Jefferson expressed concern about the court’s inconsistency. “The Court must explain how a piece of wood at the end of a bed is integral to medical care,” he wrote.

Marks’ attorneys argued the hospital bed claim related to improper maintenance and unsafe conditions and should fall under a premises liability claim — which has no caps — not medical malpractice. The Supreme Court opinion acknowledges that “not every accidental injury to a patient in a health care setting would constitute a health care liability claim.” But a majority of justices said Marks’ case — and thus, a hospital bed — does qualify. 

Harvey, the former president of the Texas Trial Lawyers Association, said this means that whenever patients slip and fall in a hospital or trip over some broken equipment, they’ll have to “run and find a maintenance man to write an expert report” if they want to be entitled to any damages. 

But Charles Bailey, general counsel for the Texas Hospital Association, said that not every fall or injury will be a health care liability claim. He said the Supreme Court ruling offers good insight on one type of equipment in particular: beds. The Marks ruling “does not allow plaintiffs to be clever in how they plead a case to take it outside of healthcare liability,” he said. “This case helps draw some of those important lines.”

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