Pathlink of Texas, LLC v. Ashlee M. Balderrama and Alejandro J. Martinez

COURT OF APPEALS
EIGHTH DISTRICT OF TEXAS
EL PASO, TEXAS

PATHLINK OF TEXAS, LLC, § No. 08-24-00090-CV

Appellant, § Appeal from the

v. § County Court at Law No. 3

ASHLEE M. BALDERRAMA and § of El Paso County, Texas
ALEJANDRO J. MARTINEZ,
§ (TC# 2023DCV2379)
Appellees.

OPINION

This is a companion to a case we recently decided: Tenet Hosps. Ltd. v. Balderrama,

No. 08-23-00263-CV, 2024 WL 3845451, (Tex. App.—El Paso Aug. 16, 2024, pet. filed). The

issue there was whether a hospital’s alleged missteps in discharging its professional or

administrative services attendant to an autopsy are “directly related to health care” when the

autopsy is performed on a person who expired while a patient in the hospital. That question is

relevant to whether the aggrieved patient (or the patient’s representatives) must file an expert

report. Tex. Civ. Prac. & Rem. Code Ann. § 74.351. We held that it was, and they did need to file

a report. In this appeal, the physician group that employs the pathologist who performed the

autopsy asks the same question, and for reasons expressed in the Tenet Hospital case, we give the

same answer.
I. BACKGROUND1

Ashlee Balderrama and Alejandro Martinez are married and share three children. When

Ashlee was pregnant with their fourth child—a son, who they named Aiden—the family received

his devastating diagnosis of trisomy 18.2 The family understood Aiden’s condition to be terminal.

Ashlee gave birth to Aiden on April 12, 2023, at Providence Memorial Hospital by a caesarian

section. Aiden died a few hours later. At oral argument in Tenet Hosps. Ltd., the the Parents agreed

that during his brief life, Aiden was a patient at Providence Memorial Hospital.

When Ashlee’s doctor discussed performing an autopsy on Aiden, she “made it clear . . .

that she did not want an invasive autopsy or for Aiden to be cut in any way since all parties already

knew that Aiden died due to trisomy 18.” But Ashlee orally agreed to a non-invasive autopsy after

her doctor described it as limited to a visual examination and medical imaging. She later signed an

autopsy consent form in which she limited her consent to only a “non[-]invasive autopsy.” She

again confirmed with the nurse who co-signed the consent form that “the autopsy would not

involve any cutting.”

While at Aiden’s viewing about a week later, the Parents discovered an invasive autopsy

had been performed and some of Aiden’s organs were missing. They immediately called

Providence, where a patient safety officer told them that the invasive autopsy had been necessary

1
Because the question before us is whether the Parents have asserted a health care claim, the facts we recite are as
alleged in the Parents’ petition. Lake Jackson Med. Spa, Ltd. v. Gaytan, 640 S.W.3d 830, 836 (Tex. 2022). Pathlink
has not conceded these facts.
2
Trisomy 18, or Edwards syndrome, is a chromosomal disorder that causes severe growth and developmental delays.
When a trisomy 18 diagnosis is present, most pregnancies end in miscarriage or stillbirth, and the survival rate for
babies born with trisomy 18 is low. Cleveland Clinic, Edwards Syndrome (Trisomy 18),
https://my.clevelandclinic.org/health/diseases/22172-edwards-syndrome (last visited June 25, 2024).

2
to “determine cause of death,” and Ashlee’s consent form has been “misinterpreted.” Providence

later returned Aiden’s remaining organs to the funeral home, where he was finally cremated.

The Parents sued Providence, asserting a negligence claim that sought mental anguish

damages. Later, the Parents amended their petition to add Pathhlink as a defendant. The Parents

alleged that the autopsy was performed by “Dr. Harry L. Wilson, a pathologist, who was an

employee, agent, or servant of Pathlink, a third party which contracted with Providence to provide

pathology services, including autopsies.” The amended petition alleges that Pathlink was

vicariously liable for the acts of its agents and employees who had the following duty:

[T]o exercise the degree of care that a reasonably prudent medical provider would
use to avoid harm to others under the circumstances . . . including preventing
Aiden’s autopsy, determining Aiden’s cause of death and verifying the existence
and extent of Ms. Balderrama’s limited Consent Form, allowing for the return of
Aiden’s bloody body in a manner presentable and suitable for return to his parents,
and allowing for the return of Aiden’s body with his organs intact to allow for
proper burial.

They claimed that Pathlink breached that duty by “a) Negligent mishandling of a human body;

b) Failing to prevent Aiden’s unauthorized autopsy and organ removal; and c) Keeping Aiden’s

organs until demand was made for them after their absence was noted.”

After Pathlink answered, the Parents moved for a preliminary determination of whether

their claims are health care liability claims under Chapter 74 (TMLA), arguing that they are not.

See Tex. Civ. Prac. & Rem. Code Ann. § 74.353(a) (“On motion of a claimant filed not later than

30 days after the date each defendant’s original answer is filed, a court may issue a preliminary

determination regarding whether a claim made by the claimant is a health care liability claim for

the purposes of [the expert-report requirement].”).3 Pathlink responded, arguing that the claims

3
Section 74.353 was added in part to remedy the harsh result when a plaintiff sues a health care provider and
erroneously concludes that the claim is not a “health care liability claim” for the purposes of the Act's expert report
requirement. See Judiciary & Civil Jurisprudence Committee, Bill Analysis, Tex. S.B. 232, 87th Leg., R.S. (2021)

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are health care liability claims. After a hearing on the motion, the trial court granted the Parents’

motion, finding that their claims are not health care liability claims under the TMLA. Providence

brought this accelerated interlocutory appeal under § 74.353(d). See id. § 51.014(a)(15)

(permitting interlocutory appeal from order making a preliminary determination on a claim under

§ 74.353).

II. DISCUSSION

A. The TMLA and health care liability claims

In response to the “medical malpractice insurance crisis” of the 1970s, the Texas

Legislature enacted the Medical Liability and Insurance Improvement Act (MLIIA) to reduce the

“excessive frequency and severity of health care liability claims in a manner that would not unduly

restrict a claimant’s rights any more than necessary to deal with the crisis.” Rogers v. Bagley, 623

S.W.3d 343, 348–49 (Tex. 2021) (cleaned up). The Legislature replaced the MLIIA with the

TMLA in 2003. Id. at 349. “The TMLA effectuates the Legislature’s goal of deterring frivolous

lawsuits by requiring a claimant early in litigation to produce the opinion of a suitable expert that

his claim has merit.” Id. (cleaned up). Health care liability claims under the TMLA are subject to

various statutory rules, including the requirement that a plaintiff serve the defendant with an expert

report at the beginning of her suit. Tex. Civ. Prac. & Rem. Code Ann. § 74.351.

(“Sometimes, potentially meritorious claims are even dismissed because claimants fail to serve an expert report not
realizing that their claim is a health care liability claim.”); see e.g., Bioderm Skin Care, LLC v. Sok, 426 S.W.3d 753,
756 (Tex. 2014) (ordering dismissal of claims arising out of allegedly improper laser hair removal because they were
health care liability claims and no expert report had been filed); Simmons v. Outreach Health Cmty. Care Services,
L.P., 511 S.W.3d 163, 166 (Tex. App.—El Paso 2014, pet. denied) (dismissing with prejudice claim of nursing
assistant injured while moving patient for failure to file required expert report under the TMLA). Under Tex. Civ.
Prac. & Rem. Code Ann. § 74.353, a plaintiff may seek a preliminary answer to question of whether the claim is a
health care liability claim for the purpose of knowing whether a report is required or not. Id. § 74.353(f) (“A
preliminary determination under this section applies only to the issue of whether a claimant is required to serve an
expert report under Section 74.351.”). We express no opinion on whether this preliminary determination interplays
with other provisions of the TMLA, other than the expert report requirement.

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Whether a claim is a health care liability claim under the TMLA is a legal question that we

review de novo. Ross v. St. Luke’s Episcopal Hosp., 462 S.W.3d 496, 501 (Tex. 2015). In

answering that question, “we examine the underlying nature and gravamen of the claim, rather

than the way it is pleaded.” CHRISTUS Health Gulf Coast v. Carswell, 505 S.W.3d 528, 534

(Tex. 2016). That is, we “focus on the set of operative facts ‘underlying the claim’ that are relevant

to the alleged injury, not on how ‘the plaintiff’s pleadings describ[e] the facts or legal theories

asserted.’” Collin Creek Assisted Living Ctr., Inc. v. Faber, 671 S.W.3d 879, 885 (Tex. 2023)

(quoting Loaisiga v. Cerda, 379 S.W.3d 248, 255 (Tex. 2012)). The TMLA’s “broad language”

indicates the “legislative intent for the statute to have expansive application.” Loaisiga, 379

S.W.3d at 256.

A health care liability claim has three essential elements: (1) the defendant is a physician

or health care provider; (2) the claim is for treatment, lack of treatment, or another alleged

departure from accepted standards of medical care, health care, or safety or professional or

administrative services directly related to health care; and (3) the defendant’s act or omission

proximately caused the claimant’s injury or death. Faber, 671 S.W.3d at 886 (citing Tex. Civ.

Prac. & Rem. Code Ann. § 74.001(a)(13)). Only the second element is contested here. Pathlink

argues that the claim is a health care liability for two reasons: it is an alleged departure from

accepted standards of (1) medical care, and (2) professional or administrative services directly

related to health care.

The Parents dispute that an autopsy is medical care but concede that an autopsy can involve

professional or administrative services as defined by the TMLA. The TMLA defines “professional

or administrative services” as “those duties or services that a physician or health care provider is

required to provide as a condition of maintaining the physician’s or health care provider’s license,

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accreditation status, or certification to participate in state or federal health care programs.”

Tex. Civ. Prac. & Rem. Code Ann. § 74.001(a)(24). Both criminal and administrative code

provisions prohibit a physician from performing a post-mortem examination or autopsy without

written informed consent. See Tex. Code Crim. Proc. Ann. art. 49.32; 22 Tex. Admin. Code

§ 190.8(a)(l)(I)(Tex. Med. Boards, Disciplinary Guidelines); see also Carswell, 505 S.W.3d at 535

(noting hospital could lose its license if it violated various state regulations governing autopsies

and concluding post-mortem claims based on an autopsy thus alleged a departure from accepted

standards of “professional or administrative services”). So the question here as it relates to

professional or administrative services boils down to whether Pathlink’s professional or

administrative services pertaining to Aiden’s autopsy were “directly related to health care.”

(1) “Directly related to”

The term “directly related to” is not defined in the TMLA, but the Texas Supreme Court

has recently told courts how to construe the term:

The Act does not define “directly related to,” so we look to the words’ common
meanings. “Direct” or “directly,” as most applicable here means “without the
intervention of a medium or agent” or “immediately.” “Related” is commonly
defined as “[c]onnected in some way; having relationship to or with something
else.” When those definitions are combined, they yield the conclusion that the plain
and common meaning of the phrase “directly related to” is “an uninterrupted, close
relationship or link between the things being considered.”

Carswell, 505 S.W.3d at 535–36 (dictionary and case citations omitted).

(2) Health care

The TMLA defines “health care” as “any act or treatment performed or furnished, or that

should have been performed or furnished, by any health care provider for, to, or on behalf of a

patient during the patient’s medical care, treatment, or confinement.” Tex. Civ. Prac. & Rem. Code

Ann. § 74.001(a)(10). “Medical care” is defined as “any act defined as practicing medicine under

6
Section 151.002, Occupations Code, performed or furnished, or which should have been

performed, by one licensed to practice medicine in this state for, to, or on behalf of a patient during

the patient’s care, treatment, or confinement.” Id. § 74.001(a)(19). Section 151.002(a)(13) of the

Occupations Code defines “practicing medicine” as “the diagnosis, treatment, or offer to treat a

mental or physical disease or disorder or a physical deformity or injury by any system or method,

or the attempt to effect cures of those conditions, by a person who [] publicly professes to be a

physician or surgeon; or [] directly or indirectly charges money or other compensation for those

services.” Tex. Occ. Code Ann. § 151.002 (a)(13). Though the TMLA does not define either

“treatment” or “patient,” the Texas Supreme Court has noted that “both have ordinary meanings

that do not require the active provision of medical care by a physician—much less a physician

furnished by the health care provider.” Faber, 671 S.W.3d at 890–91.

B. Do the Parents allege a departure from accepted standards of professional or
administrative services directly related to healthcare?

(1) Pathlink’s arguments

Pathlink argues that because physicians are required to obtain written informed consent

before performing an autopsy, the allegation that they failed to do so is an allegation that they

violated standards of professional and administrative services. Further, it argues that because the

purpose of the diagnosis was to confirm Aiden’s trisomy 18 diagnosis, there is a nexus between

the provision of health care and the professional or administrative service (i.e., the autopsy). In

support of its position, Pathlink primarily relies on CHRISTUS Health Gulf Coast v. Carswell.4

In Carswell, the plaintiff alleged the hospital (1) committed acts of medical malpractice

that lead to the death of Jerry Carswell; and (2) improperly obtained his wife’s approval to perform

4
And as we explain below, the Parents likewise believe Carswell supports their position.

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an autopsy. Carswell, 505 S.W.3d at 530. For the autopsy claim, the wife contended the hospital

fraudulently obtained her consent for a private autopsy in a related medical facility and moved the

body there without the medical examiner’s permission. Id. at 534–35. She claimed the hospital

orchestrated the autopsy to cover-up its alleged malpractice. Id. The jury did not find that medical

negligence caused Jerry’s death, but it did find the hospital liable on the autopsy related claims.

The issue before the Texas Supreme Court was whether the autopsy related claims were health

care liability claims under the TMLA, because if they were, the autopsy claims were barred by

limitations.

To answer that question, the Court had to decide whether the autopsy claims were directly

related to health care based on the TMLA’s definitions of “health care” and “medical care.” Id. at

535. And the Court articulated a definition important here: “directly related to” means “an

uninterrupted, close relationship or link between the things being considered.” Id. at 535–36. The

Court noted that the autopsy claim hinged on the allegation that the hospital obtained the plaintiff’s

consent for the autopsy to conceal its own malpractice that led to her husband’s death. Id. at 536.

Given those circumstances, the Court concluded “the claim [is] directly related to acts or

treatments the [plaintiff] alleged were improperly performed or furnished, or that should have been

performed or furnished, to [her husband] during his treatment and confinement,” and determined

the fraud claim was a health care liability claim under the TMLA. Id.

Pathlink argues that the autopsy “had a close and uninterrupted relationship to Aiden’s

trisomy 18 diagnosis during Balderrama’s pre-natal care, the c-section delivery, and the post-natal

care both Aiden and Balderrama received at the hospital.” This relationship, it argues was

sufficient for the alleged negligent acts to be directly related to medical care.

8
We note that the Carswell court explicitly left open two key questions: whether an

individual can be a patient after death, see id. at 535, and whether performing an autopsy or failing

to obtain informed consent to perform an autopsy, without more, is health care under the TMLA,

see id. at 536–37.

(2) The Parents’ arguments

The Parents argue that the “directly related to health care” element is not satisfied because

Aiden’s autopsy was unrelated to the health care provided to either Ashlee or Aiden in the hospital.

That is, they contend their claim is not a health care liability claim because Pathlink’s “pertinent

services . . . did not engage with the medical treatment of Ms. Balderrama or Aiden, nor were they

intended to directly affect patient health outcomes.”

And the Parents contend Carswell confirms that their claims are not health care liability

claims under the TMLA. They state that “[u]nlike Carswell, where the underlying facts supported

a nexus to health care due to alleged concealment of treatment errors, the autopsy of plaintiff’s

child here was not conducted with the intent to hide or misrepresent the quality of health care

services previously provided.” Here, because the allegations involve no underlying negligent acts

while Aiden or Ashlee were Providence patients, the Parents maintain their claims are not health

care liability claims.

Along with discussing Carswell, the Parents focus on two other cases that support their

position: Hare v. Graham, No. 2-07-118-CV, 2007 WL 3037708 (Tex. App.—Fort Worth Oct. 18,

2007, pet. denied) (mem. op.) and Salazar v. Dickey, No. 04-08-00022-CV, 2010 WL 307852

(Tex. App.—San Antonio Jan. 27, 2010, pet. denied) (mem. op.).

In Hare, the plaintiff sued the pathologist who performed her husband’s autopsy. 2007 WL

3037708, at *1. She alleged the hospital employees misled and intentionally deceived her about

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consent for the autopsy, and she sued the pathologist for intentional infliction of emotional distress,

negligent mishandling of a corpse, and interference with the right of possession of a dead body.

Id. In arguing that her claims were not health care liability claims subject to the TMLA, the plaintiff

contended that her case concerned “not whether the autopsy was performed according to

acceptable standard, but that it was not authorized and was performed without proper consent.” Id.

at *2.

The Fort Worth Court of Appeals agreed, reasoning that the allegations did not raise a

health care liability claim because the plaintiff’s husband could not be a “patient” based on the

Texas Health and Safety Code’s definition of that term: “a person who is admitted to a hospital or

residing in a nursing home.” Id. at *3 (quoting Tex. Health & Safety Code Ann. § 313.002(8)).

The court inferred that this definition “clearly implies that a person must be alive in order to be a

‘patient,’” agreeing with a prior case that determined “a body was not a patient, nor was an autopsy

a form of medical treatment.” Id. (citing Putthoff v. Ancrum, 934 S.W.2d 164, 171 (Tex. App.—

Fort Worth 1996, writ denied)). Thus, the court concluded “a dead body is not a patient” nor can

a body “receive ‘medical care, treatment, or confinement’ after death,” and determined the

plaintiff’s claims were not health care liability claims. Id.

The San Antonio Court of Appeals in Salazar similarly adopts Hare’s reasoning. The

plaintiff sued, among others, the physician who signed his father’s death certificate, alleging that

the doctor had a duty to, but did not, order an autopsy. 2010 WL 307852, at *1. The court relied

on the definition of “patient” found in the Health and Safety Code and concluded that these

allegations were not health care liability claims because the plaintiff’s father was already dead

when the doctor allegedly departed from acceptable standards and practices, such that his father

could not be a patient or receive medical care, treatment, or confinement. Id. at *4.

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The Parents contend that their suit is not predicated on allegations of medical malpractice

regarding either Ashlee or Aiden’s care but is instead narrowly focused on the specific terms of

consent for Aiden’s autopsy. They point to the Carswell court’s discussion of Hare and Salazar,

in which it distinguished those two cases as turning on post-mortem actions that were not linked

to pre-mortem healthcare. Carswell, 505 S.W.3d at 537. Finally, the suit here seeks only mental

anguish damages, which the Parents contend arise from Providence and Pathlink’s “handling of

their child’s autopsy—a matter distinct from the health care services typically addressed in liability

claims.”

(3) These allegations are health care liability claims

Prior cases are instructive, but not controlling for the issue before us. The Houston First’s

decision in CHCA Bayshore, L.P. v. Ramos is closely analogous as it dealt with the mishandling

by a hospital of the remains of a dilation and curettage procedure performed at the hospital. CHCA

Bayshore, L.P. v. Ramos, 388 S.W.3d 741, 743 (Tex. App.—Houston [1st Dist.] 2012, no pet.). In

Ramos, a woman suffered a miscarriage at about 12 weeks, and underwent a dilation and curettage

procedure. 388 S.W.3d at 743. Because she and her husband wanted to hold a funeral, the doctor

who performed the procedure instructed the hospital’s pathology department to test the fetal

remains, then hold the specimen for the funeral home. Id. After the funeral, the couple learned that

the hospital gave the funeral home the wrong specimen; thinking the fetal remains were of their

child, they had in fact buried the amputated toe of another patient. Id. The hospital later returned

the fetal remains to the couple. Id.

The couple sued, urging that the hospital was negligent in establishing and following

procedures related to handling, identifying, monitoring, and disposing of a specimen from a

medical procedure, and that this was not a health care liability claim governed by the TMLA. Id.

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at 743–44. The hospital argued that the couple’s claims alleged a departure from accepted

standards of “health care” and “professional or administrative services directly related to health

care.” Id. at 744.

Focusing on the alleged departure from accepted standards of care for “professional or

administrative services directly related to health care,” as are we, the Court found the alleged

conduct directly related to health care. Id. at 746. That is, the hospital’s alleged negligent

mishandling of the fetal remains was “an immediate consequence of having performed the

procedure that resulted in the Hospital’s handling of the remains, and as such, it was directly related

to the health care rendered to [the woman] by the Hospital.” Id. at 746. The court thus found

unpersuasive the couple’s argument that the mishandling of the remains occurred after the

woman’s medical treatment ended. Id.

Hare and Salazar focus on the definition for “health care”—which incorporates the

definition of “medical care”—which in turn uses the term “patient.” Those courts reason that

performing (or not performing) an autopsy could not be health care because a non-living person

can no longer be a “patient.” Hare, 2007 WL 3037708, at *3; Salazar, 2010 WL 307852, at *4.

But neither case directly addresses the “professional or administrative services” portion of

§ 74.001(a)(13) and its nexus with health care. More particularly, Hare and Salazar do not address

how “professional or administrative services” attendant to autopsies might directly relate to pre-

mortem health care services.

The most helpful case here is Carswell and its articulation of the definition for “directly

related to.” As the Carswell court instructed, the phrase “directly related to” simply means “an

uninterrupted, close relationship or link between the things being considered.” Id. at 536. The

allegation here fits that definition. It describes an infant delivered by caesarian section, accepted

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briefly as a patient, and who then expired all while in the hospital. Balderrama, while also a patient

in the hospital, verbally communicated and documented in a written consent form her desire for

only a limited autopsy to hospital personnel.5 For reasons yet to be discovered, the hospital and

Pathlink are alleged to have exceeded the scope of her consent through some conduct part and

parcel of its professional and administrative services. The pleading before us describes a sufficient

direct nexus between the provision of health care and the alleged improper autopsy. See Carswell,

505 S.W.3d at 537 (distinguishing Hare and Salazar where the claims are not “based entirely on

postmortem actions of [the hospital] that were directed to a dead body” absent any link to pre-

mortem health care).

We acknowledge that the Parents here do not complain about the health care Balderrama

received as patient in her own right, or that Aiden received until his death. But we do not read

Carswell (including its treatment of Hare and Salazar) to mean that for a post-mortem claim to be

“directly related to health care,” there must be allegations of deficient or improper health care

before the patient’s death. See Carswell, 505 S.W.3d at 535–36. The plain language of the TMLA

does not support that interpretation. See Tex. Civ. Prac. & Rem. Code Ann. § 74.001(a)(13).6 Nor

does the TMLA support the Parents’ position that a patient must be alive when the alleged

negligent conduct occurs. Instead, the TMLA applies to professional or administrative services

5
The petition alleges that Aiden was delivered at Providence on April 12, 2023. Ashlee was discharged from the
hospital on April 14, 2023. On the 12th (while still a patient and as the parent of Aiden) she discussed with her OBGYN
an autopsy and she “made it clear to . . . Providence nursing staff that she did not want an invasive autopsy[.]” The
consent form was executed by Ashlee on April 14, the same day she was discharged.
6
Were it otherwise, we would create the anomalous situation that the same improper professional or administrative
service in one case would be a health care liability claim, while in another case not, based only on whether the
claimants complain about the pre-mortem care. And if this were the rule, must the complaint of pre-mortem care be
raised in a filed malpractice claim? Or would a verbal complaint to the hospital administration be enough? Would the
complaint have to make a wrongful death allegation, or might it only relate to some other aspect of the pre-mortem
care? Nothing in the text of § 74.001(a)(13) answers those questions because nothing in the text establishes a “pre-
mortem complaint” requirement as a component of a professional and administrative services-based claim.

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“when the claimed injury is directly related to health care of some patient.” Carswell, 505 S.W.3d

at 537 (citing Tex. Civ. Prac. & Rem. Code Ann. § 74.001(a)(10), (13)).

Because this appeal arises from the trial court’s preliminary determination for the expert

report requirement, we have a limited record consisting primarily of the pleadings. See Tex. Civ.

Prac. & Rem. Code Ann. § 74.353. The Parents’ petition alleges that Pathlink “violated [its] duty”

“to exercise the degree of care that a reasonably prudent medical provider would use to avoid harm

to others” in the circumstances surrounding Aiden’s autopsy. The allegation describes a deviation

from accepted standards of a health care practice: an autopsy performed in a hospital following the

death of one of its patients. The TMLA uses “broad language” which “evidences legislative intent

for the statute to have expansive application.” Loaisiga, 379 S.W.3d at 256. Because the

professional or administrative services underlying the Parents’ complaint were directly related to

health care Aiden and Ashlee received while they were patients, the claims are health care liability

claims under the TMLA. See Carswell, 505 S.W.3d at 537; Ramos, 388 S.W.3d at 746. The trial

court erred in concluding otherwise. We sustain Pathlink’s first issue.

Because we conclude that the Parents’ claims are health care liability claims because they

allege “departure[s] from accepted standards of . . . professional or administrative services directly

related to health care,” we do not reach Pathlink’s issue arguing that the claims also involve

departures from accepted standards of “medical care.”

III. CONCLUSION

For the above reasons, we conclude that the Parents’ claims are health care liability claims

under the TMLA for the purpose of deciding whether the Parents must file an expert report as

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required by the TMLA; we reverse the trial court’s order holding they are not. We remand the case

to the trial court for further proceedings consistent with this opinion.7

JEFF ALLEY, Chief Justice

December 30, 2024

Before Alley, C.J., Palafox and Soto, JJ.
Soto, J., dissenting without written opinion8

7
See Tex. Civ. Prac. & Rem. Code Ann. § 74.353(e) (“If on interlocutory appeal an appellate court reverses a trial
court's preliminary determination that a claim is not a health care liability claim, the claimant shall serve an expert
report as required by Section 74.351 not later than 120 days after the date that the appellate court issues an opinion
reversing the preliminary determination.”).
8
I respectfully dissent for the same reasons articulated in my dissent in Tenet Hosps. Ltd. v. Balderrama, No. 08-
23-00263-CV, 2024 WL 3845451, Tex. App.—El Paso Aug. 16, 2p024, Pet. filed).

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