Lead Opinion
delivered the opinion of the Court in
This is a wrongful death action brought by James and Genevie Clark to recover damages for the death of their daughter, Rebecca Clark Ligón, who was murdered by her husband, Gary Ligón. The Clarks sued Kerr-ville State Hospital (KSH) for negligently releasing Gary, a mental patient, from its care. They also sued the Texas Department of Mental Health and Mental Retardation (MHMR) for failure to adequately ensure KSH’s compliance with MHMR standards. A jury awarded the Clarks damages in excess of two million dollars. The trial court, however, entered judgment n.o.v. for MHMR and rendered judgment against KSH for $250,000, the maximum amount allowable under the Texas Tort Claims Act. See Tex.Civ. PRAC. & Rem.Code § 101.023(a). The court of appeals affirmed.
I.
The Clarks’ daughter, Rebecca, was married to Gary Ligón, who had a history of mental problems. In April 1989, after threatening his wife and resisting arrest, Li-gón was taken to KSH for treatment. The Institutional Review Board determined that Ligón was “manifestly dangerous” and therefore recommended that he be transferred to a maximum security unit at Vernon State Hospital. However, because Vernon State Hospital had no vacancy, Ligón remained at KSH for about one month. The Institutional Review Board then met again and determined that Ligón was no longer manifestly dangerous. Ligón began an outpatient commitment with KSH, pursuant to a court order, so that KSH could monitor his medication. Ligon’s medication regimen included Antabuse to control his alcohol intake, lithium carbonate, Tegretol, and Thorazine, an antipsychotic medicine that was given to Li-gón in an oral form.
On May 22, 1990, Ligón voluntarily checked into KSH for treatment. It appeared that Ligón had been drinking and had not been taking his medication at proper levels. On May 24, KSH released Ligón at his request, reinstating the outpatient commitment. On June 1, Ligón brutally murdered his estranged wife, decapitating, dismembering, and burning her body. He then attempted to hide her remains in a field.
As stated earlier, the trial court rendered judgment for the Clarks against KSH, and the court of appeals affirmed. KSH now petitions this Court to reverse the judgment
II.
KSH is a governmental entity entitled to sovereign immunity. However, under the Texas Tort Claims Act, a state entity can waive its sovereign immunity under limited circumstances. The Act did not abolish sovereign immunity, and we must look to the terms of the Act to determine the scope of its waiver. University of Texas Medical Branch v. York,
This Court has never held that mere non-use of property can support a claim under the Texas Tort Claims Act. Kassen v. Hatley,
In Lowe v. Texas Tech Univ.,
This rationale was also applied to invoke the Act’s waiver provisions in Robinson v.
These cases represent perhaps the outer bounds of what we have defined as use of tangible personal property. We did not intend, in deciding these eases, to allow both use and non-use of property to result in waiver of immunity under the Act. Such a result would be tantamount to abolishing governmental immunity, contrary to the limited waiver the Legislature clearly intended. The precedential value of these cases is therefore limited to claims in which a plaintiff alleges that a state actor has provided property that lacks an integral safety component and that the lack of this integral component led to the plaintiffs injuries. For example, if a hospital provided a patient with a bed lacking bed rails and the lack of this protective equipment led to the patient’s injury, the Act’s waiver provisions would be implicated. Lowe,
The facts of the present case, however, are distinguishable from Lowe and Robinson. The Clarks have not alleged that KSH failed to provide Ligón with property lacking an integral safety component. In fact, they acknowledge that KSH prescribed to and gave Ligón Thorazine, an anti-psychotic medication. To the contrary, the Clarks argue that the treatment prescribed to Ligón was not as effective as an alternative method of treatment would have been. For Lowe to apply to the Clarks’ claims, we must assume that the university would have waived its immunity even if it had provided Lowe with a knee brace as long as Lowe could show that another type of knee brace would have better protected him. Likewise, for Robinson to apply, we must assume that MHMR would have waived its sovereign immunity even if it had provided Robinson a life preserver if Robinson could show that MHMR should have provided him with a better one. Thus, the facts of this case are different than those in Lowe and Robinson.
III.
The factual scenario of this cáse parallels Kassen v. Hatley,
There cannot be waiver of sovereign immunity in every case in which medical treatment is provided by a public facility. Doctors in state medical facilities use some
Because the failure to prescribe a certain form of drug simply does not fall within .the definition of use under the Act, KSH did not waive its sovereign immunity. For the foregoing reasons, we reverse the judgment of the court of appeals and render judgment for KSH.
Notes
. Ligón was charged with murder, but was declared incompetent to stand trial and was transferred to the maximum security unit at Vernon State Hospital.
. Because we hold that the Clarks’ claims are barred by sovereign immunity, we need not consider KSH’s other alleged grounds for reversal.
. The Clarks presented expert testimony that in-jectionable Prolixin and Haldol can be effective for up to one month after the initial injection.
Dissenting Opinion
joined by PHILLIPS, Chief Justice, CORNYN and SPECTOR, Justices, dissenting.
I dissent because the Court incorrectly interprets the facts and abandons precedent. The Court erroneously classifies this as a “non-use” case under the Texas Tort Claims Act and concludes that sovereign immunity is not waived. In reality, this case involves a “misuse” of drugs. Evidence showed that Kerrville State Hospital (KSH) prescribed drugs which were inappropriate for the purpose intended. Under this Court’s precedent, use of an inappropriate drug constitutes misuse of tangible personal property and waives sovereign immunity.
The treatment plan KSH created for Gary Ligón required him to meet with a KSH staff member at least once a month “for delivery of medications.” KSH was aware that Ligón was not taking his medications and that he became violent when not medication-compliant. Nonetheless, KSH prescribed the oral medication, Thorazine, and released Ligón. Dr. Schultheis, a physician who treated Li-gón at KSH, and Dr. Coons, an expert for KSH, testified that Haldol and Prolixin are injectable antipsychotic medications which could be used instead of Thorazine and could be effective for up to one month. Dr. Rosen-thal, an expert for the Clarks, testified that the long lasting injections of Prolixin or Hal-dol should have been used instead of the oral form of Thorazine. Dr. Rosenthal further testified that the use of a long lasting, inject-able antipsychotic medication, rather than the inappropriate oral medication, would have kept Ligón medication-compliant and safe for release, preventing the tragic murder of Rebecca Ligón. This evidence, indicating misuse of Thorazine, waived sovereign immunity. Similarly, the condition of the medication — oral rather than injectable— causes a waiver of sovereign immunity.
I.
The Texas Tort Claims Act (Act) waives sovereign immunity for “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 § 101.021(2). The “use” of tangible personal property occurs when the property is brought into action or is employed for a given purpose. Mount Pleasant Indep. Sch. Dist. v. Lindburg,
Clearly, prescription drugs are tangible personal property. See Kassen v. Hatley,
“Liability has been imposed when the injuries are alleged to have proximately resulted from the negligent use of property in some respect deficient or inappropriate for the purpose for which it was used.” Hopkins v. Spring Indep. Sch. Dist.,
Admittedly, non-use or failure to use an available drug is not, standing alone, a use of tangible personal property sufficient to waive immunity under the Act. Kassen,
In Lowe, this Court held that the failure to include a knee brace when providing a football uniform was a condition or use of tangible personal property. Lowe,
The Court struggles to distinguish Lowe and Robinson and says that the “difficulty of interpreting the Act’s waiver provisions has led this Court on several occasions to request guidance from the Legislature in interpreting these provisions.” Ante at 584. The Court ignores, however, its previous and consistent proclamation that legislative inaction following judicial interpretation evidences legislative adoption of such interpretation. See Robinson,
II.
KSH also claims that it had no duty to Rebecca. Relying on Bird v. W.C.W.,
The Clarks concede that health care professionals owe no blanket duty to the public. But, they disagree with the assertion that a specific threat against a specific person is required to establish a duty to a non-patient. Instead, the Clarks argue that KSH had a duty because KSH had control over Ligón and knew or reasonably should have known that he posed a serious danger to a readily identifiable person or class of persons. I agree.
At the outset, I conclude that Bird does not control this case. In Bird, we held that a mental health professional who negligently misdiagnoses sexual abuse of a child owes no duty of care to the child’s parent who may suffer false accusations and adverse legal consequences from the misdiagnosis. In reaching that decision, we relied on factors unique to that factual setting, such as the inherent difficulty in diagnosing sexual abuse of a child and the social utility in encouraging a full investigation of sexual abuse claims. Bird,
More analogous to this case is Otis Engineering Corp. v. Clark,
In recognizing this duty, we have relied in part on section 319 of the Restatement (Second) of Torts which provides:
§ 319. Duty of Those in Charge of Person Having Dangerous Propensities
One who takes charge of a third person whom he knows or should know to be likely to cause bodily harm to others if not controlled is under a duty to exercise reasonable care to control the third person to prevent him from doing such harm.
Restatement (Second) of ToRts § 319 (1965); see Otis Eng’g,
Section 319 establishes a duty of care in this case. Following Ligon’s release from KSH in August 1989, he remained under a court-ordered out-patient commitment. In the out-patient commitment order, the court rendered findings that Ligón is “mentally ill,” that as a result of that mental illness he is “likely ... [t]o cause serious harm to self and/or others,” and that, if not treated, he will “continue to suffer severe and abnormal mental, emotional or physical distress....” The court designated Lois Hutson, a clinical social worker with KSH, as the individual responsible for Ligon’s out-patient care, directing her to submit a treatment program to be incorporated into the commitment order. See TexHealth & Safety Code § 574.037. This treatment program recognized that Li-gón had a long history of “assaultive and aggressive behaviors” and was “potentially very dangerous.” It called for treatment through a drug regimen to control Ligon’s physical aggression and to alleviate his psychotic symptomatology, and it required Li-gón to return to the hospital for periodic examinations to monitor his compliance. Hutson was required by statute to inform the court if Ligón failed to comply with the treatment program. See TexHealth & Safety Code § 574.037(c)(1). Under these circumstances, KSH was in “charge” of Ligón for purposes of section 319 of the Restatement.
Further, there is evidence that KSH knew or should have known that Ligón posed a likely threat to Rebecca if he was not properly medicated. In addition to the findings in the commitment order and treatment program, Ligon’s medical records indicated that he was the “most dangerous [type of] patient
III.
KSH next argues that there is no evidence that any action on its part caused Rebecca’s death. When deciding a no evidence point we must consider only the evidence and all reasonable inferences which support the jury finding. See Orozco v. Sander,
Proximate cause has two elements, foreseeability and cause-in-fact. Travis v. City of Mesquite,
As discussed earlier, there are notes in Ligon’s medical file discussing his homicidal tendencies, his assaultive behavior towards his family, his failure to remain medication-compliant, and his violent behavior when not medication-compliant. Further, Ligón was originally committed to KSH for assaulting his wife. This is some evidence that KSH knew or should have known that Ligón would assault Rebecca if released without being properly medicated. As such, the foreseeability prong is satisfied.
Cause-in-fact may be proven by circumstantial evidence. Havner v. E-Z Mart Stores, Inc.,
Experts for both the Clarks and KSH testified that Ligon’s medical records indicated that he had been violent towards Rebecca when not medication-compliant and that if released without being properly medicated he would likely be violent towards Rebecca again, especially considering his ongoing separation and divorce. Ligón admitted to the KSH doctors that he was not taking his medication. Dr. Rosenthal, an expert for the Clarks, testified that KSH could have assured Ligon’s compliance with his treatment plan by administering long-acting forms of antipsychotic medication by injection, and that the absence of such injections was a “real deficiency” in his treatment plan. This, coupled with the evidence of Ligon’s history of violent behavior when off antipsychotic medication, and Ligon’s violent murder of Rebecca only seven days after being discharged, is some evidence from which the jury could infer that the hospital’s misuse of medication caused Rebecca’s death.
IV.
While I conclude that there is some evidence that KSH misused tangible personal property within the meaning of the Tort Claims Act, KSH correctly contends that the trial court erred in submitting the liability issue to the jury. Question 1, which the jury answered affirmatively, provided as follows:
Was Kerrville State Hospital negligent in discharging Gary Ligón on May 24, 1990?
You are instructed that in determining the negligence, if any, of the officers and employees of Kerrville State Hospital, consider only their use or misuse of medical records, admission and discharge documents, and/or medications of Gary Ligón,
(emphasis added). KSH objected to this question, arguing to the trial court that “the
KSH argues that the jury should not have been permitted to consider the use or misuse of medical records or other documents, over its timely objection. I agree. While the paper on which medical records and other documents are printed constitutes tangible personal property, the information contained in the records and documents is intangible. See University of Texas Med. Branch v. York,
For the foregoing reasons, I would reverse the judgment of the court of appeals and remand this cause to the trial court for a new trial.
