*679 OPINION
In this medical malpractice case, appellant, Safwat Kamel, appeals from the trial court’s grant of appellee University of Texas Health Science Center at Houston’s (“UTHSCH’s”) plea to the jurisdiction. In four issues, Kamel argues that (1) the trial court abused its discretion in granting UTHSCH’s plea to the jurisdiction because no fact issue remained regarding whether Kamel’s claim was based upon an employee of UTHSCH’s use or misuse of tangible personal property, as required by the Texas Tort Claims Act (TTCA) 1 for waiver of a governmental entity’s immunity; (2) he properly pleaded that UTHSCH waived its immunity under the TTCA and no fact issue exists regarding the trial court’s jurisdiction over UTHSCH; (3) the trial court was bound by its previous ruling dismissing with prejudice Kamel’s claims against UTHSCH’s employee; and (4) the trial court’s rulings violated “the Open Courts Provisions” of the Texas Constitution.
We affirm.
Background
On June 26, 2005, Kamel visited Lyndon B. Johnson General Hospital complaining of an enlarged testicle. Dr. Run Wang and Dr. Tiffany Sotelo diagnosed him with a hydrocele, or accumulation of fluid around the testicle, and epididymitis, or inflammation of the epididymis, of the right testicle and recommended surgery. On July 8, 2005, Dr. Wang and Dr. Tiffany performed the hydrocelectomy, or removal of the hydrocele, with Kamel’s consent. During the surgery, Dr. Wang determined that the testicle “looked very abnormal” and he became concerned that, given Ka-mel’s previous history of colon cancer, the cancer had metastasized to the testicle. Dr. Wang removed the testicle. He used various surgical instruments to remove Kamel’s testicle, including scissors, hemostats, and sutures. Subsequent testing revealed that Kamel did not have cancer in his testicle.
On June 9, 2006, Kamel sued Dr. Sotelo, Dr. Wang, and Lyndon B. Johnson General Hospital for medical malpractice. Dr. Wang moved for dismissal from the suit pursuant to section 101.106(f) of the TTCA. Dr. Wang argued that Kamel’s claims against him should be dismissed because Kamel “has filed this cause of action against [Dr. Wang] alleging conduct that is within the general scope of his employment with [UTHSCH] ” and that “this case could have been brought against [UTHSCH].”
Kamel responded to Dr. Wang’s motion to dismiss, arguing that Dr. Wang did not adequately establish that he was an employee of a governmental entity as defined by the TTCA and that Dr. Wang did not meet “the second prong of his burden for dismissal in that he has not shown how this Cause could have been brought against his alleged government employer as required for a Motion to Dismiss pursuant to [TTCA, section] 101.106(f).” Ka-mel’s response also included a request for leave to file an amended petition “[i]n the event that the Court will Grant [Dr. Wang’s] Amended Motion to Dismiss.”
Dr. Wang replied, arguing, “Of note, Plaintiffs Original Petition alleges sufficient facts to find a waiver of immunity based on the use and misuse of tangible personal property. The underlying basis of Plaintiffs claims against Dr. Wang relate to the use or misuse of tangible real property, namely surgical instruments that were used to remove his right testicle.” Dr. Wang argued that Kamel’s claims all *680 related to the removal of his testicle, that the “testicle was removed by using a scalpel and other surgical instruments,” that “Dr. Wang’s direct use of these surgical instruments ... caused the removal” of Kamel’s testicle, and that Kamel’s injury “was immediately] and directly caused by the use (or misuse) of the surgical instruments,” and, thus, UTHSCH’s sovereign immunity was waived under section 101.021(2).
Kamel moved to dismiss Dr. Wang and to amend his pleadings to replace Dr. Wang with UTHSCH “pursuant to [TTCA section] 101.106(f).” The trial court granted Kamel’s motion to dismiss and Kamel subsequently filed his second amended petition dismissing Dr. Wang from the suit and adding UTHSCH as a defendant. Accordingly, no hearing was held on Dr. Wang’s motion to dismiss and the trial court did not sign an order addressing that motion. Kamel also dismissed Lyndon B. Johnson General Hospital from the suit.
On January 31, 2007, Dr. Sotelo filed a motion to dismiss pursuant to sections 101.106(a) and (f) of the TTCA.
2
The trial court granted her motion to dismiss without stating which ground it relied upon. The trial court severed the claims against Dr. Wang and Dr. Sotelo and issued final judgments. Kamel appealed the dismissal of Dr. Sotelo to this Court, arguing that dismissal of Dr. Sotelo was inappropriate because Dr. Sotelo was not an employee of a governmental entity for purposes of section 101.106.
Kamel v. Sotelo,
No. 01-07-00366-CV,
UTHSCH filed its second amended plea to the jurisdiction, arguing that it was a state entity that is immune from suit and that Kamel’s claims did not fall within the waiver of immunity under the TTCA.
Kamel’s third amended petition, the live pleading, alleged that UTHSCH was liable because Dr. Wang and Dr. Sotelo “negligently used tangible personal property, namely a scalpel, scissors, and/or other surgical instruments to negligently injure plaintiff by injuring and removing plaintiffs right testicle. Such removal was negligent in that the removal was a breach of the standard of care owed to plaintiff.” It also alleged that “Wang failed to obtain the appropriate consent”; that Dr. Wang failed to disclose “that [Kamel] may [lose] his testicle as a risk of the procedure”; and that “a reasonable and prudent physi *681 cian would not have removed Mr. Kamel’s testicle unless there was a medical necessity and/or would not have removed Mr. Kamel’s testicle without obtaining the proper informed consents and/or would not have further injured Mr. Kamel’s testicle as a result of the intended hydrocele procedure.”
On December 3, 2008, the trial court granted UTHSCH’s plea and dismissed Kamel’s claims for lack of jurisdiction. This appeal followed. 4
Analysis
In his first issue, Kamel argues that the trial court erred in granting UTHSCH’s plea to the jurisdiction.
A. Standard of Review
A plea to the jurisdiction challenges the trial court’s subject-matter jurisdiction to hear the case.
Bland Indep. Sch. Dist. v. Blue,
The plaintiff has the burden to allege facts affirmatively demonstrating that the trial court has subject-matter jurisdiction.
Tex. Ass’n of Bus.,
B. Waiver of UTHSCH’s Immunity Under Texas Tort Claims Act
Sovereign immunity deprives a trial court of subject-matter jurisdiction in lawsuits against the state or certain governmental units unless the state consents to suit. 5 Id. at 224. It is undisputed that UTHSCH is a governmental entity. The *682 TTCA provides a limited waiver of governmental liability from suit. Tex. Civ. Prac. & Rem.Code Ann. § 101.021 (Vernon 2005).
1. Waiver provision of Section 101.021 Section 101.021 provides:
A governmental unit in the state is liable for:
(1) property damage, personal injury, and death proximately caused by the wrongful act or omission or the negligence of an employee acting within his scope of employment if:
(A) the property damage, personal injury, or death arises from the operation or use of a motor-driven vehicle or motor-driven equipment; and
(B) the employee would be personally liable to the claimant according to Texas law; and
(2) personal injury and death so caused by a condition or use of tangible personal or real property if the governmental unit would, were it a private person, be liable to the claimant according to Texas law.
Tex. Civ. Prac. & Rem.Code Ann. § 101.021. Thus, to come within this limited exception, Kamel must allege that his personal injury was proximately caused by the use of tangible personal property.
See Dallas
County
Mental Health & Mental Retardation v. Bossley,
Kamel relies on
Salcedo v. El Paso Hospital District,
Other courts have used the reasoning in
Salcedo
to find waiver of immunity under section 101.021(2).
See Robinson v. Cent. Tex. MHMR Ctr.,
However, the supreme court later specifically limited its holding in
Salcedo
to the particular facts of that case.
Bossley,
When Salcedo was decided [in] 1983, the [TTCA] provided for waiver of sovereign immunity for “death of personal injuries so caused from some condition or some use of tangible property.... (Emphasis added). At the time, the [TTCA] also provided, “[t]he provisions of this Act shall be liberally construed to achieve the purposes thereof.” However, when the Legislature codified the [TTCA] and adopted the Texas Civil Practice and Remedies Code in 1985, two years after Salcedo, the word “some” was deleted preceding “condition” and “use.” Additionally, the mandate for liberal construction of provisions of the [TTCA] was repealed and not carried forward in the codification.
Texas Tech Univ. Health Sci. Ctr. v. Ward,
More recent opinions of the supreme court have limited the waiver of immunity under 101.021(2). In
University of Texas Medical Branch at Galveston v. York,
In
Dallas County Mental Health & Mental Retardation v. Bossley,
Section 101.021(2) states that for immunity to be waived, personal injury or death must be proximately caused by a condition or use of tangible personal or real property. The requirement of causation is more than mere involvement, although exactly how much more has been difficult for courts to define. If only involvement were required, the waiver of immunity would be virtually unlimited, since few injuries do not *684 somehow involve tangible personal or real property. Requiring only that a condition or use of the property be involved would conflict with the [TTCA’s] basic purpose of waiving immunity only to a limited degree.
Id. at 342-43. The court also held that “[p]roperty does not cause injury if it does no more than furnish the condition that makes the injury possible.” Id. at 343. The court concluded that while the unlocked doors permitted the patient’s escape, they did not cause his death, and thus the nexus between the use or condition of the doors and the patient’s death was too attenuated to constitute a waiver of immunity. Id.
In
Texas Department of Criminal Justice v. Miller,
There cannot be waiver of sovereign immunity in every ease in which medical treatment is provided by a public facility. Doctors in state medical facilities use some form of tangible personal property nearly every time they treat a patient. If there is waiver in all of those cases, the waiver of immunity is virtually unrestricted, which is not what the Legislature intended.
Id. at 588 (internal quotations and citations omitted). The court stated that while TDCJ did “use” various drugs and medical equipment in treating the inmate, it is not sufficient for waiver purposes “that some property is merely involved.... Using that property must have actually caused the injury.” Id. The court concluded that the property used on the inmate here might have furnished the condition that made his injury possible, but they did not hurt the inmate or make him worse in and of themselves. Id.
Several intermediate courts of appeals have followed these more recent cases in limiting
Salcedo
and its progeny.
See Anderson v. City of San Antonio,
Specifically, the Dallas Court of Appeals has recently addressed waiver of immunity
*685
under section 101.021(2) in the context of a breast implant replacement surgery.
Arnold,
Finally, the court in
Arnold
examined the plaintiffs specific allegations that the breast implants themselves caused her injuries.
Id.
at 470. The court recognized that we must focus “on the true nature of disputes rather than allowing artful pleading to gain favorable redress under the law.”
Id.
(citing
Baylor Univ. v. Sonnichsen,
2. Application of Section 101.021(2) to Kamel’s Claims
In his third amended petition, Ka-mel alleged that, through Dr. Wang and Dr. Sotelo, UTHSCH was negligent as follows:
• Doctors “negligently used tangible personal property, namely a scalpel, scissors, and/or other surgical instruments” to injure and remove his testicle, and a “reasonable and prudent physician would not have removed [Kamel’s] testicle unless there was a medical necessity,” would have obtained consent, and would not have “further injured [Kamel’s] testicle as a result of the intended hydrocele procedure”;
• Dr. Wang failed to obtain the appropriate consent before removing the testicle and failed to infoi’m Kamel of his “true physical state before and after treatment”;
• Dr. Wang and Dr. Sotelo negligently failed to completely disclose the risks *686 and hazards posed by the hydrocelec-tomy;
• Dr. Wang negligently supervised and advised Dr. Sotelo as she performed the hydrocelectomy;
• Dr. Sotelo failed to perform the medical treatment necessary;
• Dr. Sotelo failed to “recognize and/or acknowledge her recognition of [Ka-mel’s] symptoms that resulted from her negligent use of personal tangible property during treatment; and
• Dr. Sotelo failed to use acceptable practices to limit the likelihood and probability of infection following treatment.
As in
Arnold,
Kamel’s claims regarding failure to disclose risks and to receive informed consent do not fall within the waiver provision of the TTCA.
See id.
at 469 (“Failure to receive informed consent [does] not waive immunity under the TTCA.” (citing
Miller,
Finally, Kamel contends that the doctors’ use of surgical instruments was the actual cause of his injury. Like the court in
Arnold,
we must focus on the true nature of the dispute between Kamel and UTHSCH to determine whether his claims are an attempt to artfully plead around the requirements of the TTCA.
See Arnold,
We overrule Kamel’s first issue.
C. Trial Court’s Previous Ruling on Dr. Sotelo’s Motion to Dismiss under Section 101.106
In his second issue, Kamel argues that he properly pleaded that UTHSCH waived its immunity under the Texas Tort Claims Act and no fact issue exists regarding the trial court’s jurisdiction over UTHSCH. In his third issue, Kamel argues that the trial court was bound by its previous ruling dismissing with prejudice Kamel’s claims against Dr. Sotelo, UTHSCH’s employee. Specifically, he argues that the trial court’s grant of UTHSCH’s plea to the jurisdiction is erroneous because the trial court and this Court “previously ruled ... that Dr. Tiffany Sotelo was an employee of defendant UTHSCH during the rele *687 vant times herein, and that [Kamel’s] claims against her can only be brought against defendant UTHSCH by virtue of that employment and the [TTCA section] 101.106.” Thus, Kamel is arguing that the trial court had to have determined that it had jurisdiction over UTHSCH in order to dismiss Dr. Sotelo, and he asserts that he “was forced to substitute” UTHSCH as a defendant for Dr. Wang and Dr. Sotelo. However, these assertions are not supported by the record.
Dr. Wang moved for dismissal under section 101.106(f), which is part of the TTCA Election of Remedies provision. Section 101.106(f) provides:
If a suit is filed against an employee of a governmental unit based on conduct within the general scope of that employee’s employment and if it could have been brought under this chapter against the governmental unit, the suit is considered to be against the employee in the employee’s official capacity only. On the employee’s motion, the suit against the employee shall be dismissed unless the plaintiff files amended pleadings dismissing the employee and naming the governmental unit as defendant on or before the 30th day after the date the motion is filed.
Tex. Civ. Prao. & Rem.Code Ann. § 101.106(f). “Therefore, to be entitled to dismissal under section 101.106(f), a defendant must show the plaintiffs suit (1) was based on conduct within the general scope of the defendant’s employment with a governmental unit and (2) could have been brought under the [TTCA] against the governmental unit.”
Hall,
However, Dr. Wang was never required to make any such showing and the trial court never ruled that he had done so because Kamel voluntarily amended his pleadings removing Dr. Wang as a defendant and adding UTHSCH. Thus, Ka-mel’s case is distinguishable from one in which the employee must satisfy the burden of proving both prongs under 101.106(f).
6
See Hintz v. Lally,
After Kamel amended his pleadings adding UTHSCH, Dr. Sotelo moved for dismissal, arguing that she was entitled to dismissal under 101.106(a) or, alternatively, under 101.106(f). Section 101.106(a) provides:
The filing of a suit under this chapter against a governmental unit constitutes an irrevocable election by the plaintiff and immediately and forever bars any suit or recovery by the plaintiff against any individual employee of the governmental unit regarding the same subject matter.
Tex. Civ. Prao. & Rem.Code Ann. § 101.106(a). The trial court dismissed Dr. Sotelo from the suit without stating
*688
which provision it relied on. Dr. Sotelo could have been properly dismissed under section 101.106(a) because Kamel’s addition of UTHSCH as a defendant constituted an “irrevocable election” that barred “any suit or recovery ... against any individual employee of the governmental unit.”
See id.; see also Hintz,
Nor does the opinion of this Court on Kamel’s appeal of Dr. Sotelo’s dismissal constitute a ruling that his claims could have been brought against UTHSCH under the TTCA. The only question that our opinion in Kamel v. Sotelo addressed was whether Dr. Sotelo was considered an “employee” of a governmental entity, in this case, UTHSCH, for purposes of section 101.106. We determined that she was an employee, a determination that was necessary to support either ground for dismissal under section 101.106. See Tex. Civ. PRAC. & Rem.Code Ann. § 101.106(a), (f).
We overrule Kamel’s second and third issues.
D. Open Courts
In his fourth issue, Kamel contends that the dismissal of his claims against Dr. Sotelo combined with the subsequent dismissal of his claims against UTHSCH violates the open courts provision of the Texas Constitution.
“The open courts provision states that ‘[a]ll courts shall be open, and every person for an injury done him, in his lands, goods, person or reputation, shall have remedy by due course of law.’ ”
Hintz,
Because the open courts provision affects common law claims and not statutory claims, the provision does not apply to claims under the TTCA.
Villasan,
We overrule Kamel’s fourth issue.
Conclusion
We affirm the judgment of the trial court.
Notes
. See Tex. Civ. Prac. & Re.vi.Code Ann. §§ 101.001-.109 (Vernon 2005).
.
Section 101.106(a) provides that "[t]he filing of a suit under this chapter against a governmental unit constitutes an irrevocable election by the plaintiff and immediately and forever bars any suit or recovery by the plaintiff against any individual employee of the governmental unit regarding the same subject matter.” Tex. Civ. Prac. & Rem.Code Ann. § 101.106(a).
Section 101.106(f) provides that "[i]f a suit is filed against an employee of a governmental unit based on conduct within the general scope of that employee’s employment and if it could have been brought under this chapter against the governmental unit, the suit is considered to be against the employee in the employee's official capacity only. On the employee’s motion, the suit against the employee shall be dismissed unless the plaintiff files amended pleadings dismissing the employee and naming the governmental unit as defendant on or before the 30th day after the date the motion is filed.” Id. § 101.106(f).
. The opinion of this Court referred specifically to section 101.106(f) and did not discuss 101.106(a). We stated, "Sotelo moved for a dismissal under subsections (a) and (f) of section 101.106 of the Texas Tort Claims Act. Because we find the application of section 101.106(f) to be dispositive, we address it solely.”
Kamel v. Sotelo,
No. 01-07-00366-CV,
. See Tex. Civ. Prac. & Rem.Code Ann. § 51.014(a)(8) (Vernon 2005) (allowing interlocutory appeal of grant or denial of plea to jurisdiction of governmental unit).
. The terms "sovereign immunity” and "governmental immunity” are often used interchangeably even though they involve two distinct concepts. Sovereign immunity refers to the State’s immunity from suit and liability. Governmental immunity refers to the immunity of political subdivisions of the State.
See Wichita Falls State Hosp.
v.
Taylor,
. Although Kamel alleges he was "forced” to substitute, nothing in the record supports this statement. There is no ruling by the trial court or record of any hearing indicating that Dr. Wang's motion was or would soon be granted.
