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D.A. v. Texas Health Presbyterian Hospital of Denton

Court of Appeals of Texas, Second District, Fort Worth

February 16, 2017

D.A. AND M.A., INDIVIDUALLY AND AS NEXT FRIENDS OF A.A., A MINOR APPELLANTS
v.
TEXAS HEALTH PRESBYTERIAN HOSPITAL OF DENTON, MARC WILSON, M.D., AND ALLIANCE OB/GYN SPECIALISTS, PLLC D/B/A/ OB/GYN SPECIALISTS, PLLC APPELLEES

         FROM THE 442ND DISTRICT COURT OF DENTON COUNTY TRIAL COURT NO. 2013-70299-431

          PANEL: MEIER, GABRIEL, and SUDDERTH, JJ.

          OPINION

          BONNIE SUDDERTH JUSTICE.

         I. Introduction

         Appellants D.A. and M.A. bring this interlocutory appeal challenging the trial court's grant of summary judgment in favor of Appellees Texas Health Presbyterian Hospital of Denton (THP), Marc Wilson, M.D., and Alliance OB/GYN Specialists, PLLC d/b/a OB/GYN Specialists, PLLC. We granted permission to appeal on a single issue-whether civil practice and remedies code section 74.153 applies to medical care provided in an obstetrical unit without the patient having first been evaluated in a hospital emergency department. See Tex. Civ. Prac. & Rem. Code Ann. § 74.153 (West 2011). In reversing the judgment below, we hold that it does not.

         II. Background

         Appellants' child, A.A., suffered a brachial plexus injury during labor and delivery when the infant's shoulder became lodged against M.A.'s pubic symphysis bone, resulting in a condition known as "shoulder dystocia." The night before A.A. was born, M.A. checked into THP for an elective induction of labor. The next morning, Wilson prescribed the administration of Pitocin to begin M.A.'s contractions, and he monitored her labor progression throughout the remainder of the day. Nothing occurred that caused Wilson to believe that either M.A. or A.A. was facing an emergency situation until later that evening when A.A.'s progress in descending from M.A.'s pelvis ceased. Although Wilson applied forceps to deliver A.A.'s head, the rest of the infant's body did not follow.

         At that point Wilson recognized the shoulder dystocia and began maneuvers to release the shoulder and deliver the infant. Both sides agree that A.A.'s shoulder dystocia presented an emergent situation that placed both M.A. and A.A. at risk for injury or death if the infant could not be quickly extricated from that position. And while neither side disputes that A.A. suffered a brachial plexus injury, the parties disagree as to whether Appellees' conduct caused the injury or whether A.A.'s injury would have occurred despite the medical care provided during delivery.

         Challenging the ordinary negligence claims filed against them in the medical malpractice lawsuit that ensued, Appellees sought summary judgment, arguing that since the allegations levied against them are governed by civil practice and remedies code section 74.153, Appellants must prove negligence by a willful and wanton standard. See id. That statute provides,

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 or 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 the 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 wilful 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.

Id. (emphases added).

         The trial court agreed with Appellees and granted summary judgment on Appellants' claims of ordinary negligence, ruling that section 74.153 applies to medical care performed in an obstetrical unit and that Appellants must prove their claims against Appellees under a "wilful and wanton negligence" standard. Appellants filed a petition for permission to appeal this interlocutory judgment, [1] and we granted permission to appeal on the question of whether section 74.153 applies to medical care provided in an obstetrical unit without the patient's first having been evaluated in a hospital emergency department. See Tex. R. App. P. 28.3.

         III. Standard of Review

         We review matters of statutory interpretation de novo. Tex. W. Oaks Hosp., LP v. Williams, 371 S.W.3d 171, 177 (Tex. 2012). And while the primary objective of statutory interpretation is to "ascertain and effectuate the Legislature's intent, " the supreme court instructs us that the source for legislative intent is found, whenever possible, in the plain language of the statute itself. Janvey v. Golf Channel, Inc., 487 S.W.3d 560, 572 (Tex. 2016). As the supreme court has further instructed us, when a statute's words "yield a single inescapable interpretation, " our inquiry ends. Alex Sheshunoff Mgmt. Servs., L.P. v. Johnson, 209 S.W.3d 644, 651-52 (Tex. 2006). That is, we do not resort to extrinsic aids to interpret a statute that is clear and unambiguous. Sullivan v. Abraham, 488 S.W.3d 294, 299 (Tex. 2016). But when a statute is ambiguous, we must resort to rules of construction or extrinsic aids. Greater Houston P'ship v. Paxton, 468 S.W.3d 51, 58 (Tex. 2015).

         IV. Is the Statute Ambiguous?

         A. Identifying the Relationship Between the Statute's Phrases

         In this appeal we are asked to consider the relationship between the phrase "immediately following the evaluation or treatment of a patient in a hospital emergency department" (hereinafter "Evaluation or Treatment Phrase") and two other phrases, "in a hospital emergency department or obstetrical unit" and "in a surgical suite" that appear in section 74.153. See Tex. Civ. Prac. & Rem. Code Ann. § 74.153. As presented and briefed by the parties, the question before us is: To which location (or locations) does the Evaluation or Treatment Phrase apply? Surgical suites? Obstetrical units? Hospital emergency departments? Or all three?

         If the Evaluation or Treatment Phrase applies only to surgical suites, as Appellees argue, then the emergency medical care provided to A.A. is subject to section 74.153 because emergency care provided in an obstetrical unit-where A.A. received emergency care-need not immediately follow evaluation or treatment in the hospital emergency department to trigger the statute. If, however, the phrase applies to obstetrical units, as Appellants argue, then the emergency medical care provided to A.A. does not invoke section 74.153 because it was not provided immediately following evaluation or treatment in the hospital emergency department.

         B. Grammar and Usage

         When examining statutory text, the Code Construction Act mandates that we read words and phrases in context and construe them according to the rules of grammar and usage. Tex. Gov't Code Ann. § 311.011(a) (West 2013) (providing that "[w]ords and phrases shall be read in context and construed according to the rules of grammar . . . ."); see Entergy Gulf States, Inc. v. Summers, 282 S.W.3d 433, 437 (Tex. 2009) (op. on reh'g) ("Only when those words are ambiguous do we 'resort to rules of construction or extrinsic aids.'" (quoting In re Estate of Nash, 220 S.W.3d 914, 917 (Tex. 2007))).

         Grammar is an intrinsic aid, not an extrinsic aid. See Larry M. Eig, Congressional Research Service, 97-589, Statutory Interpretation: General Principles and Recent Trends 4-5, 12 (2011) (defining "language" canons of construction as "neutral, analytical guides for discerning the meaning of particular text, " including the rules of grammar among the "language" canons, and stating that "the language canons are intrinsic aids only"), https://fas.org/sgp/crs/misc/97-589.pdf. And while the supreme court directs us not to resort to the use of extrinsic aids when construing an unambiguous statute, we have been instructed that grammar should be used, because an interpretation that "turns grammar on its head" will not support a claim of ambiguity since it is not a reasonable interpretation. Wellington Underwriting Agencies Ltd. v. Houston Expl. Co., 267 S.W.3d 277, 288 (Tex. App.-Houston [14th Dist.] 2008), aff'd, 352 S.W.3d 462 (Tex. 2011). Therefore, when considering whether this statute is subject to more than one reasonable interpretation, we first apply the rules of grammar to see if more than one reasonable interpretation would comport with the rules of language that govern us.[2] If the statute is ambiguous under the rules of grammar, then we turn to the extrinsic tools created to assist in construing ambiguous language. See Entergy Gulf States, Inc., 282 S.W.3d at 437.

         1. Grammatical Rules Applicable to Words and Phrases

         To analyze the statute before us, we must consider the roles of the various phrases in use; specifically, participial phrases and prepositional phrases.[3] A brief primer on the pertinent parts of speech is helpful in this pursuit.

         Nouns are words that name persons, places, and things. Webster's New World, supra note 3, at 7. Verbs are words that express an act, an occurrence, or a state of being-that is, one cannot do or be anything without them. Id. at 45.

         Grammar becomes more complex when modifiers are added. A modifier is "a word that describes or limits another word, " and, depending upon what kind of word it modifies, it can be either an adjective or an adverb. Id. at 85. An adjective "describes or limits a noun or pronoun, " placing restrictions on any noun with which it associates. Id. Adjectives usually answer which, what kind, or how many. Id. An adverb, on the other hand, generally modifies a verb, an adjective, or another adverb, but may also modify other words, including prepositions. Id. at 95. Adverbs most often describe when, where, why, and how. Id.

         Phrases-groups of words-may also act as modifiers. For purposes of our analysis here, we must examine two types of phrases.

         A participial phrase is a phrase that is introduced with a participle. Id. at 86, 213. A participle is a word that "combines characteristics of a verb with those of an adjective" by taking the base form of a verb, such as "arise, " and adding -ing to the end.[4] Id. at 32, 213, 368. Participial phrases function exactly as adjectives function-they describe or limit a noun or pronoun, often answering which, what kind, or how many. Id. at 86, 213.

         A prepositional phrase combines a preposition and its object and may include other words that pattern with the object. Id. at 109, 369. Prepositions may appear as a single word-in, to, from, with, for example-or a collection of words- such as by way of, with regard to, in comparison with, and in case of. To complicate matters, certain participles-assuming, including, regarding, and following, for example-also function as prepositions. Id. at 112. When participles function as prepositions, they are referred to as participial prepositions. Id.

         The prepositional phrase as a whole may function as an adjective or an adverb, depending upon how the phrase modifies a particular word. If the prepositional phrase describes or limits a noun, it serves as an adjective and is categorized as an adjectival prepositional phrase. Id. at 200. If, on the other hand, the prepositional phrase modifies a verb, adjective, adverb, or another prepositional phrase, it functions as an adverb and is referred to as an adverbial prepositional phrase. Id.

         2. Application

         The statutory language in dispute begins with the phrase "arising out of the provision of emergency medical care":

In a suit . . . arising out of the provision of emergency medical care in a hospital emergency department or obstetrical unit or in a surgical suite immediately following the evaluation or treatment of a patient in a hospital emergency department . . . .

         Tex. Civ. Prac. & Rem. Code Ann. § 74.153 (emphasis added). The bold-face phrase is a participial phrase whose function is to act as an ...


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