Glenn v. Leal, 546 S.W.3d 807

Background

Dawn Leal underwent an elective induction and labor management by her longtime obstetrician, Dr. Christopher Glenn, in a hospital obstetrical unit; delivery developed shoulder dystocia and the infant sustained a permanent brachial plexus injury.
Dr. Glenn performed accepted maneuvers (McRoberts, suprapubic pressure) and delivered the baby within seconds; plaintiffs alleged negligence (pulling/twisting) causing the injury.
The Leals sued Dr. Glenn and his practice for medical malpractice; jury awarded substantial past and future damages, including $1.2 million for future medical expenses.
Dr. Glenn moved for directed verdict and JNOV arguing (1) Texas Civil Practice & Remedies Code § 74.153 (willful-and-wanton standard for emergency care) applied to the obstetrical emergency and thus plaintiffs failed to prove the heightened standard, and (2) legally insufficient evidence supported the award of future medical expenses.
Trial court denied the motions; on appeal the Texas appellate court considered (1) the proper scope of § 74.153 when an emergency arises in an obstetrical unit absent prior ER evaluation, and (2) sufficiency of evidence for future medical expenses (including arguments about contractual discounts and the ACA).

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether Tex. Civ. Prac. & Rem. Code § 74.153 (willful-and-wanton standard) applies where an emergency develops during delivery in an obstetrical unit but the patient was not first evaluated in a hospital ER	§ 74.153 should not apply; when care begins as elective obstetrical care and becomes emergent in the unit, ordinary negligence standard governs	§ 74.153 applies whenever emergency medical care is provided in an obstetrical unit, regardless of prior ER evaluation, so willful-and-wanton standard applies	Court held § 74.153 applies only if the patient was evaluated or treated in the hospital ER immediately prior to the emergency care; ordinary negligence standard applies here
Whether there was legally sufficient evidence of future medical expenses under Tx. Civ. Prac. & Rem. Code § 41.0105 (amounts actually paid or incurred)	Life-care-plan projections and provider charge rates are admissible absent evidence of contractual limits or law reducing the providers' right to be paid; future discounts/insurance are speculative	Expert relied on provider billed charges and did not adjust for discounts, insurance, or statutory limitations; therefore evidence is insufficient to prove amounts actually payable	Court held evidence was sufficient: without proof of contractual or statutory limits or future discounts, jury may reasonably award full projected future medical expenses
Whether the Affordable Care Act requires adjusting future medical-expense awards to reflect expected insurance coverage (premiums/out-of-pocket)	Plaintiffs: possibility of future coverage is speculative; plaintiffs need not assume they will obtain coverage or that coverage will pay all projected services	Defendant: ACA makes it unrealistic to assume full out-of-pocket payment; future awards should be limited to premiums and out-of-pocket costs	Court held ACA does not require adjustment; future insurance coverage is speculative and plaintiffs need not reduce awards based on potential future coverage
Jury-charge instruction under § 74.154 (consideration of medical history, pre-existing physician-patient relationship)	Plaintiffs relied on ordinary negligence instructions because § 74.153 did not apply	Defendant sought willful-and-wanton instruction and related jury questions	Court found no reversible error in charge as § 74.153 did not apply and trial court properly refused requested § 74.153/§ 74.154 instructions

Key Cases Cited

D.A. v. Texas Health Presbyterian Hosp. of Denton, 514 S.W.3d 431 (Tex. App.—Fort Worth 2017) (interpreting § 74.153 and holding protections trigger only after ER evaluation immediately prior to subsequent emergency care)
Haygood v. De Escabedo, 356 S.W.3d 390 (Tex. 2011) (limits recovery of medical expenses to amounts actually paid or incurred under § 41.0105)
Metro. Transit Auth. v. McChristian, 449 S.W.3d 846 (Tex. App.—Houston [14th Dist.] 2014) (admitting full billed medical charges absent evidence providers lack right to be paid those amounts)
Big Bird Tree Servs. v. Gallegos, 365 S.W.3d 173 (Tex. App.—Dallas 2012) (no reduction of billed medical charges where no contractual prohibition on recovery shown)
Guzman v. Jones, 804 F.3d 707 (5th Cir. 2015) (refusing to apply Haygood to reduce uninsured plaintiff's recoverable medical expenses based on hypothetical discounted rates)
In re Canales, 52 S.W.3d 698 (Tex. 2001) (statutory interpretation principles and legislative intent)