Rodriguez-Escobar v. Goss, 392 S.W.3d 109

Goss, with a history of suicidal behavior, was evaluated by Dr. Rodriguez-Escobar after a 2003 shooting incident and was not involuntarily hospitalized.
Goss had been voluntarily admitted to MMBHC, then discharged to Tropical with a plan for transfer to Rio Grande State Center for further treatment.
Michael Goss obtained a Detention Warrant for emergency detention after fearing continued risk of self-harm, while Dr. Matos discharged Goss with a plan for transfer and outpatient care.
Dr. Rodriguez-Escobar conducted a preliminary examination at Rio Grande, interviewed Goss for about 45 minutes, and concluded she did not meet involuntary hospitalization criteria, releasing her.
Goss died by suicide on March 30, 2003, three days after release; her sons sued Rodriguez-Escobar for negligence in failing to involuntarily hospitalize her.
The trial court and court of appeals ruled against Rodriguez-Escobar; the Texas Supreme Court granted review and reversed, rendering judgment in his favor on causation issues.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether immunity applies to Rodriguez-Escobar.	Gosses argue issues were preserved; immunity does not apply.	Rodriguez-Escobar asserts statutory official immunity.	Immunity issues not dispositive; focus is proximate cause (causation defense) and available defenses.
Whether there was legally sufficient causation between failure to hospitalize and Goss’s death.	Hospitalization would have prevented the suicide; death was a probable result of non-hospitalization.	No substantial evidence that hospitalization would have prevented death; release was too attenuated.	Legal insufficiency: absence of evidence that hospitalization would probably have prevented death; remand not required; judgment for Rodriguez-Escobar.
Whether the evidence supports that hospitalization would have been a substantial factor in preventing suicide.	Testimony supports foreseeability and potential prevention.	Testimony fails cause-in-fact; too speculative about post-release outcome.	Evidence not enough to establish cause-in-fact; held for Rodriguez-Escobar.

IHS Cedars Treatment Ctr. v. Mason, 143 S.W.3d 794 (Tex. 2004) (elements of negligence; proximate cause includes foreseeability and cause-in-fact)
Park Place Hosp. v. Estate of Milo, 909 S.W.2d 508 (Tex. 1995) (cause-in-fact and substantial factor formulation of proximate cause)
Providence Health Ctr. v. Dowell, 262 S.W.3d 324 (Tex. 2008) (hospitalization as proximate cause; attenuated connection exception)
Dowell, 262 S.W.3d 324 (Tex. 2008) (discharge from ER not a proximate cause; no evidence hospitalization would have prevented suicide)
City of Lancaster v. Chambers, 883 S.W.2d 650 (Tex. 1994) (official immunity is an affirmative defense)