OPINION
Opinion by
Stephen M. Schexnayder, M.D., a resident of Arkansas, has filed an interlocutory appeal from an order denying his special appearance in a medical malpractice lawsuit in which he contested the jurisdiction of the Texas court over him. The suit was filed against him by Shan-trece Daniels, in her individual capacity, and as representative of the estate of her deceased daughter, Journee Daniels. Schexnayder attempts to avoid jurisdiction *242 based on an alleged lack of minimum contacts -with Texas.
Background
The lawsuit is based on events leading to Journee’s death June 11, 2003. Journee, age two, was hospitalized at Wadley Regional Medical Center in Texarkana, Texas, June 10, 2003, in serious condition. On June 11, Wadley contacted Arkansas Children’s Hospital (ACH) in Little Rock, and Schexnayder, who was the intensive care unit’s attending physician at that time, approved the transfer on behalf of ACH. ACH was to provide transportation of the child to Little Rock. A transport team was dispatched to Texarkana which included two ACH employees and one resident physician, Barrett Lewis, M.D. Schexnay-der did not personally go to Texarkana.
The ACH team arrived at Wadley and took over Journee’s care in an attempt to stabilize her adequately for transport. In this process, the team apprised Schexnay-der by telephone of Journee’s condition and Schexnayder directed the care to be given. There evidently was a problem with the child’s oxygen tube, her oxygen levels were low, and the ACH team attempted to insert different tubes (in sequence) in an attempt to avoid air leakage. It appears the team ultimately intubated the child successfully, but Journee (who had already coded and been resuscitated at least once) again coded, and resuscitation efforts were unsuccessful. It was Schexnayder who ultimately made the decision that further resuscitation efforts would be futile. Journee died at Wadley. Standard of Review
A nonresident defendant challenging personal jurisdiction through a special appearance carries the burden of negating all bases of personal jurisdiction.
BMC Software Belg., N.V. v. Marchand,
In this case, Schexnayder contends the evidence clearly demonstrates he is not subject to jurisdiction. There is no specific argument directed at either legal or factual sufficiency as such — the argument is that the evidence concerning his connection to the medical care and treatment of the patient, (with which Schexnayder does not disagree or controvert), does not meet the legal standard for imposing the jurisdiction of Texas courts.
Scope of Personal Jurisdiction
The Texas long-arm statute permits courts to exercise personal jurisdiction over a nonresident defendant, limited by the federal constitutional requirements of due process.
Marchand,
The purpose of the minimum contacts analysis is to protect the defendant from being haled into court when its relationship with Texas is too attenuated to support jurisdiction.
Coleman,
where the defendant “deliberately” has engaged in significant activities within a State, or has created “continuing obligations” between himself and residents of the forum, he manifestly has availed himself of the privilege of conducting business there, and because his activities are shielded by “the benefits and protections” of the forum’s laws it is presumptively not unreasonable to require him to submit to the burdens of litigation in that forum as well.
As the cases have developed, there are two variations within the bounds of personal jurisdiction. Personal jurisdiction exists if the nonresident defendant’s minimum contacts give rise to either specific or general jurisdiction.
Marchand,
Specific jurisdiction exists when the defendant’s liability arises from or is related to an activity conducted within the forum.
Marchand,
General jurisdiction exists when the defendant’s contacts with Texas “are continuous and systematic so that the forum may exercise personal jurisdiction over the defendant even if the cause of action did not arise from or relate to activities conducted within the forum state.”
Marchand,
Under either formulation, minimum contacts are required to justify the application of the concept. One description of the purpose of the minimum-contacts analysis in the context of purposeful acts is to prevent a foreign corporation from being haled into Texas courts when its relationship to Texas is so remote that it could not reasonably anticipate having to defend itself in a Texas court.
World-Wide Volkswagen Corp. v. Woodson,
Evidence of Minimum Contacts
Schexnayder provided evidence that he is a salaried employee of the University of Arkansas Center for Medical Sciences and is on staff at ACH. He provided evidence that he is not a Texas resident,- owns no property in Texas, was not and has never been licensed to practice medicine in Texas, does not operate an office in Texas, has no staff privileges in any Texas hospital, and has never personally advertised his services or recruited patients in Texas. Schexnayder acknowledges he was contacted in three telephone conversations, all originating in Texas and totaling about an hour in length, from individuals caring for Journee. He points out that he did not initiate the calls, but acknowledges that the conversations were all directly connected with Journee’s care. Daniels presented evidence that the telephone conversations involved a discussion about the condition of the patient, and deposition testimony that Schexnayder,- as an active participant with the team, took over as her attending physician and' became directly engaged in her care. We have reviewed the audio recordings of the conversations. It is apparent that, in this emergency situation, Lewis was not merely asking Schex-nayder for advice and then determining whether to follow it, but that Schexnayder was directing the team in its care of Jour-nee.
Lewis called Schexnayder after he arrived at the hospital and explained the child’s apparent problems, then followed Schexnayder’s orders about procedures to be followed. After Journee coded, Lewis called again, and (except for one break when the connection failed) Schexnayder stayed on the telephone with Lewis from then until Journee was eventually pronounced dead. During this process, Schexnayder gave Lewis detailed instructions on treating and medicating Journee, including multiple dosages of epinephrine and the administration of needle decompression on her chest, all of which directions were promptly followed by Lewis. Schexnayder ultimately made the decision that further efforts to save the child would be futile.
This evidence is largely uncontroverted. The parties agree about the sequence of events and about, the actions that occurred. What they disagree on, and the problem we face, is the legal impact of that evidence. Thus, our review of the order is de novo, based on all the evidence before the Court.
Analysis
Specific Jurisdiction
Schexnayder contends the evidence is insufficient to support a finding of specific jurisdiction and cites
Brocail v. Anderson, M.D.,
As noted below, the facts in the instant case are distinguishable from
Brocail.
Further, they do not match those set out in any Texas decision. The closest case appears to be
Mason v. Shelby Co. Health Care Corp.,
There is one substantive difference between that case and the present one: the extent of the physically absent physician’s involvement with the team on site in providing medical care for the patient. Based on the record in the instant case, we necessarily conclude that Schex-nayder was not merely providing advice to the team, but that he fully participated in the care given by the team to this child and did, in fact, make the most important decisions concerning her care. He was not a mere bystander, but was effectively there with the team in all but body. That team was sent from Little Rock to Texas to take over the full medical care for this child, and Schexnayder was a part of that team. Had he been physically present in Texas, jurisdiction would not be an issue. He acknowledges that the other team members who were physically present do not contest jurisdiction of the Texas court over them. There is no logical reason why the team leader, although not physically present in Texas, but who headed up the medical treatment by telephone from Arkansas, should not likewise be subject to jurisdiction in Texas. The evidence indicates that, from the time the team instituted stabilizing procedures on the child until her ultimate demise, all at Wadley hospital in Texas, the team was in complete control of her care and treatment. The child was the patient of the team during that time, and as a fully participating member of that team, Schexnayder was, except for not being physically present, as involved as any of its other members.
Schexnayder contends that, because he was present only by telephone calls initiated from Texas, he was not adequately present at this event. We disagree. Un
*246
der some circumstances, as in the situation discussed in
Michiana,
a telephone call may be nothing more than, a mere contact with another person.
Michiana Easy Livin’ Country, Inc. v. Holten,
As described by the United States Supreme Court, a nonresident defendant that has “purposefully availed” itself of the privileges and benefits of conducting business in the foreign jurisdiction has sufficient contacts with the forum to confer personal jurisdiction.
Rudzewicz,
Although not determinative, foreseeability is a consideration in deciding whether the nonresident defendant has purposefully established “minimum ' contacts” with the forum state.
Id.; Guardian Royal Exch. .Assurance, Ltd.,
Once it has been determined that the nonresident defendant purposefully established minimum contacts with the forum state, we then evaluate the contacts in light of other factors. to determine whether the assertion of personal jurisdiction comports with fair play and substantial justice.
Guardian Royal Exch. Assurance, Ltd.,,
Applying the named factors, we recognize there would be some burden on Schexnayder for having to defend himself in a lawsuit 150 miles away from his home, in another state. However, we also recognize that distance is not so important a factor now as it has been historically. Also, because Schexnayder is licensed in Arkansas, not in Texas, it would appear that, in connection with a medical malpractice claim, his state of residence would have more interest in the dispute than would Texas. However, because Journee was a Texas resident, this State has an inherent interest in protecting its citizens and providing them with a remedy for alleged tortious injuries inflicted on them within this State. Daniels also has an inherent interest in pursuing the lawsuit locally rather than being required to travel the 150 miles to pursue her interests— perhaps under a different set of laws than those of her resident state. The factor of efficiency does not appear to be an issue in any respect.
The final factor involves the shared interest of the states in furthering fundamental substantive social policies. That concept is implicated in this case. There is a fundamental notion that the citizens of each state should be able to access knowledge and specialized expertise and seek assistance across state lines without unnecessary hindrance. Competing against that is the notion that an injured party should be able to seek recompense — in the state of the party’s residence where the event occurred — for damages allegedly caused by the negligent behavior of another.
In this case, except for geographic considerations, there is no suggested reason why the case should be brought in Arkansas rather than Texas. Based on evidence that Schexnayder was the one who approved Joumee’s transfer to ACH and was actively involved with the transport team in treating her as a patient in this State, we conclude the contacts involving Schex-nayder were not so attenuated as to violate concepts of due process.
Although we recognize the bright-line attraction of looking solely to the place where the calls originated as determining whether jurisdiction lies in Texas, that simplistic formula is not persuasive.
Compare Mason,
We conclude that, under this evidence and under the application of the law to that evidence as set out above, Schexnay-der’s contacts with Texas were sufficient in this particular instance to meet the requirements of due process and allow the litigation to proceed in this State. We emphasize, however, that this ruling is limited to these facts, and should not automatically be expanded to dissimilar situations. It is critical to our analysis that the team in this case was from Schexnayder’s own hospital and that it was working to *248 gether on a person who had been accepted as a patient of that hospital.
General Jurisdiction
As previously set out, determining whether general jurisdiction exists requires a more stringent level of analysis than specific jurisdiction. General jurisdiction exists when the contacts are continuous and systematic so that the forum may exercise personal jurisdiction over the defendant even if the cause of action did not arise from or relate to activities conducted within the forum state.
Marchand,
In this case, there is no evidence that Schexnayder did business on a regular basis in Texas. Schexnayder has never advertised his services in Texas, but his services are advertised in the websites of ACH and the University of Arkansas for Medical Sciences, along with his job description as critical care section chief, certifications, background, and contact information. Daniels also points out that the hospitals advertise that they provide helicopter transport throughout Arkansas and the region for critically ill and injured infants and children to their specialized facility. There was also evidence that Schexnayder had received patients from Texas hospitals about seven times in the months around Journee’s death and that he had assisted with the care of patients by telephone conference numerous times.
Daniels did not allege that jurisdiction exists because Schexnayder maintained an office, warehouse space, a mailing address, a telephone listing, subscribed to an answering service, or had or has any other direct business location in Texas.
Cf. Michel v. Rocket Eng’r Corp.,
We do not find the testimony that Schexnayder talked on the telephone with doctors in Texas, even assisting those doctors in treatment of their patients, establishes either a continuous or systematic presence in the State of such a nature as to justify treating him as a person who might be haled into court in Texas. Thus, general jurisdiction does not lie on these facts. The remaining question is whether that evidence, together with evidence about the ACH and University of Arkansas for Medical Sciences websites, might combine to show such a presence.
We review the evidence related to the websites to determine whether it is sufficient to support the implied findings of specific and general jurisdiction by the trial court. “Internet use is characterized as falling within three categories on a sliding scale for purposes of establishing personal jurisdiction.”
Michel,
In this case, the evidence shows that Schexnayder’s biography, credentials, and job description were all set out on the ACH website. The main thrust of the website is informational in nature — which would necessarily lead to the potential for use of ACH for its specialized purpose. The evidence shows that it was possible to interact via e-mail with the site, that physicians could register for continuing medical education on the site, and that individuals could apply online for jobs. The evidence does not indicate that doctors interacted on patient care online. Even if we ascribed all of the actions on the website to Sehexnayder, this level of connectivity simply does not rise to the level or purpose of interaction that would justify finding that Sehexnayder had submitted himself to the jurisdiction of Texas courts. The evidence does not reach the higher level necessary to justify a finding that the minimum contacts necessary to support a finding that the website, either alone or in combination with the other evidence subjected him to the general jurisdiction of the court.
Conclusion
Because we find the evidence of minimum contacts is sufficient to support a finding of specific jurisdiction, we affirm the judgment.
Notes
.
See Townsend v. Univ. Hosp.-Univ. of Colo.,
