in Re: Union Pacific Railroad Company and Wanda Heckel, 459 S.W.3d 127

A Union Pacific train operated by Wanda Heckel struck and killed 14-year-old Justin Alcantar; plaintiffs sued Union Pacific, Heckel and crew for negligence and gross negligence.
Heckel disclosed she had been diagnosed with sleep apnea (treated with CPAP) and took several prescription medications; Alcantar sought Heckel’s comprehensive medical records from multiple providers.
Heckel and Union Pacific asserted physician-patient privilege and HIPAA protections and moved for protective orders; Alcantar argued Rule 509(e)(4) exception applied because Heckel’s awareness, reaction time, vision, and related capacities were at issue.
The trial court conducted an in camera review and ordered production of portions of records from Dr. Pinaroc and Sonno Sleep Care Center; relators sought mandamus and obtained a stay.
The court of appeals considered whether Alcantar’s pleadings placed Heckel’s medical condition “a part” of the claim so as to trigger the Rule 509(e)(4) exception to the physician–patient privilege.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether Heckel must produce medical records protected by physician–patient privilege under Tex. R. Evid. 509	Alcantar: records are relevant because Heckel’s medications and sleep apnea could have affected her alertness and are relevant to awareness/reaction time	Heckel/UP: records are privileged; Alcantar’s pleadings do not place Heckel’s medical condition "a part" of her claim or defense under Rule 509(e)(4)	Court: privilege applies; Alcantar failed to plead that Heckel’s condition was an ultimate/central issue, so the Rule 509(e)(4) exception does not apply — writ conditionally granted to vacate production order

R.K. v. Ramirez, 887 S.W.2d 836 (Tex. 1994) (explains Rule 509(e)(4) requires the patient’s condition to be a fact to which substantive law assigns significance)
In re The University of Texas Health Center at Tyler, 33 S.W.3d 822 (Tex. 2000) (mandamus appropriate to review orders compelling disclosure of privileged medical information)
Peeples v. Honorable Fourth Supreme Judicial Dist., 701 S.W.2d 635 (Tex. 1985) (party asserting privilege must plead and produce evidence establishing it)
M.A.W. v. Hall, 921 S.W.2d 911 (Tex. App.—Hous. [14th Dist.] 1996) (medical condition placed at issue where pleadings alleged possible impairment from substances)
In re Whiteley, 79 S.W.3d 729 (Tex. App.—Corpus Christi 2002) (physician relied on other patients’ outcomes as central to defense, bringing those records within exception)
In re USA Waste Management Resources, L.L.C., 387 S.W.3d 92 (Tex. App.—Houston [14th Dist.] 2012) (party seeking discovery bears burden to prove Rule 509 exception applies)