The opinion
Supreme Court of Texas
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No. 25-0917
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Patricia Oramas,
Petitioner
v.
UTMB Health (Hospital) at Galveston,
Respondent
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On Petition for Review from the
Court of Appeals for the First District of Texas
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JUSTICE YOUNG, with whom Justice Devine and Justice Busby join,
concurring in the denial of the petition for review.
Important public-policy reasons animate the legislature’s decision
to impose daunting substantive and procedural requirements on plaintiffs
who pursue medical-liability claims. Those requirements deter frivolous or
weak claims and expedite preliminary screening of claims that are filed.
Deterring weak claims, of course, entails imposing burdens on strong claims,
too. The legislature must strike that balance. In doing so, cases like this one
illustrate one consideration that should be added to the scale: access to justice.
This sad case comes to us from a pro se petitioner, Patricia Oramas.
In her petition, Mrs. Oramas alleges that her husband, Henry, died while
in the care of the University of Texas Medical Branch at Galveston. Mrs.
Oramas tells us that, despite his serious condition, he was left unattended
and found disconnected from his oxygen, lying in a pool of blood. According
to Mrs. Oramas, Henry was administered several rounds of a drug that is
dangerous for patients with kidney problems even though he was known
to have serious kidney problems.
All courts must assume at this preliminary stage that Mrs. Oramas’s
allegations are true. At trial, she would have to prove them, and if she
could, she would have a powerful medical-negligence claim. The hospital
may have compelling defenses. But I agree with the thoughtful court of
appeals’ opinion, which “reject[ed] any suggestion that Oramas’s case is in
fact frivolous,” even as it agreed “that the trial court had no choice but to
grant the motion to dismiss.” No. 01-24-00399-CV, 2025 WL 2446013, at
*4 (Tex. App.—Houston [1st Dist.] Aug. 26, 2025).
In other words, we will never know the relative merits of Mrs.
Oramas’s case because it will not proceed at all, much less to trial. That is
because the Texas Medical Liability Act imposes a 120-day deadline for a
plaintiff to serve the defendant with a compliant expert report (and the
expert’s professional curriculum vitae, so that the expert’s qualifications to
opine on the defendant’s alleged negligence can be tested). See Tex. Civ.
Prac. & Rem. Code § 74.351(a), (b)(2). Mrs. Oramas missed that deadline.
The hospital invoked the statute and moved to dismiss Mrs. Oramas’s case.
The trial court eventually granted the motion, and the court of appeals
affirmed. 2025 WL 2446013, at *2.
Neither court had any other choice. They acknowledged Mrs.
Oramas’s difficulties, but their hands were tied—they could not, as the court
of appeals put it, “rewrite a valid law passed by the people’s representatives.”
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Id. at *4. “The law at issue here leaves no room for judges to create
exceptions to make the law more flexible or less harsh.” Id. So Mrs.
Oramas’s case was dismissed with prejudice before it could really begin.
In one sense, this outcome is not all that surprising. Dismissals of
healthcare-liability claims for untimely or inadequate expert reports are
routine. Nor is there anything untoward about the requirement itself. No
orderly system of justice can survive without rules that must be
followed, and rules are not really rules unless noncompliance entails
some consequences. All procedural requirements have the potential to
derail claims before they are considered on their merits. The more
burdensome the requirement, the more cases it will affect.
What the rules are, and how severe the consequence for their
violation, generally flow from the objectives that make the rules necessary
in the first place. It has long been established that the legislature
consciously demanded expeditious expert reports to redress what it
regarded as a harm to all Texans when, under a prior freewheeling
approach to medical-negligence claims, too many frivolous cases led to
skyrocketing costs and a shortage of access to medical services. Just as the
courts have inherent authority to manage their dockets efficiently to provide
fair, impartial, and swift justice and to prevent parties from abusing the
judicial system, the legislature has the authority to impose various
requirements on litigants predicated on its policy judgments about the
State’s interests.
Absent a constitutional impediment, the courts will enforce
whatever requirements the legislature enacts into positive law. Inherent
in lawmaking is that legislatively drawn lines will leave difficult cases on
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either side. Applying laws even when they generate tough outcomes is
likewise essential to the rule of law. Certainty and predictability flow
from the public’s (and the government’s) recognition that the courts can
articulate with clarity what the law is and that the courts will then
follow the law.
All of this, again, is ordinary, not revelatory. What makes this case
notable enough for the court of appeals to write a detailed opinion and for
me to write this concurrence is why Mrs. Oramas failed to comply with the
statutory requirement. Mrs. Oramas explains that she did her very best
to find a lawyer to help her but that none would take the case. She
identified three considerations that help explain why lawyers might
rationally decline cases even when, as here, the claims are not frivolous:
(1) the hospital at issue is a state entity entitled to sovereign or
governmental immunity, see Harris County Hosp. Dist. v. Tomball Reg’l
Hosp., 283 S.W.3d 838, 842 (Tex. 2009), which injects complex issues into
litigation even when a waiver of immunity is alleged; (2) Henry was
hospitalized for COVID-19, so the hospital’s potential liability is limited
to claims for gross or willful negligence, Tex. Civ. Prac. & Rem. Code
§ 74.155(b), which is of course harder to prove; and (3) even if she were able
to clear the immunity hurdle and establish gross or willful negligence, her
potential damages would be capped at $250,000, id. § 74.301(b), which
makes an already-difficult case even less economical to pursue. Indeed, an
overarching fourth consideration is that all medical-liability claims are
subject to the statute’s many substantive and procedural hurdles, which
make such cases more expensive and challenging.
Despite these daunting circumstances, Mrs. Oramas proceeded alone.
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She says she first learned of § 74.351’s expert-report and CV requirement
when the hospital filed a motion to dismiss on the ground that she had
missed the deadline. She scrambled to find an expert willing to work with
her—one who was adequately qualified and who could examine all the
records that she had obtained to be able to prepare a report that would
satisfy the statute. She found such an expert more quickly than one might
have imagined, and she served the resulting report nineteen days after the
hospital’s motion and about two months after it was due under § 74.351.
At the hearing on the motion to dismiss, Mrs. Oramas expressed
understandable frustration that the hospital’s lawyer met with her after
the TMLA deadline had passed to agree on a scheduling order—an order
that provided a deadline for expert designation months in the future—only
to file a motion to dismiss based on the TMLA deadline a few weeks later.
To someone unfamiliar with the TLMA’s particular expert-report deadline,
a scheduling order’s standard deadline for expert designation and reports
would seem misleading at best. About a month after the hearing, the trial
court granted the hospital’s motion to dismiss. I agree with the court of
appeals that the statute required this result due to “the undeniable
reality . . . that the deadline was not met.” 2025 WL 2446013, at *1.
As the lower courts recognized, we judges have no authority to do
anything but follow clear statutory mandates as long as those mandates
are constitutional. As the court of appeals put it, “[i]f the trial court had
had a choice, it may have allowed Oramas to have her day in court before
a jury of her peers.” Id. at *3. But it did not get to choose.
The legislature, however, always has the power to reconsider the
lines it has drawn or to draw new lines to address new circumstances. One
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such circumstance that might be relevant is why a plaintiff forfeits a
determination on the merits. As the court of appeals described at some
length in rejecting the hospital’s request to strike Mrs. Oramas’s briefs,
this Court has a marked preference for deciding cases on the merits rather
than on procedural technicalities. Id. at *2. That preference, of course,
must yield to a clear statutory mandate. But I hope the legislature agrees
that, as a general matter, it is better for a citizen of Texas—at least one
operating in good faith—to lose a case after a court hears her on the merits
than to lose because of an inability to comply with a technical requirement.
I do not suggest that early dismissal would not still be entirely sound
in many cases. For example, if a procedural default is based on a plaintiff’s
lack of diligence in even trying to find a lawyer or expert, it likely reflects
the plaintiff’s own assessment that the case is not worth pursuing too hard.
That circumstance is not a bad proxy for the merits, so dismissal after a
lackluster effort screens out the very sort of case that the legislature seeks
to discourage. But what about when the plaintiff is scrambling to do her
very best? It seems quite different to tell her that a court will not even
listen to her strenuous efforts to seek justice for her husband’s death—that
she must lose without being heard even if everything she alleges is true
and even if the law would strongly support her claim if she had satisfied
its procedural requirements.
Of course, one reason a plaintiff may not obtain representation is
that every lawyer who sees the case considers it frivolous. But the court of
appeals recognized (and I agree) that Mrs. Oramas’s case was not frivolous.
Id. at *4. Her ability to get an expert report once she realized she needed
one is further indication that the claim, however it would ultimately be
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resolved if it went to trial, had some merit. It seems instead likely that the
potential payout simply did not entice any of the attorneys from which Mrs.
Oramas sought help for the reasons I described above. This case does not
reflect sloth or a lack of diligence; it reflects a lack of access to capable
professional assistance in navigating an incredibly complex legal regime.
If Mrs. Oramas’s failure to follow all the procedural demands flows from a
demonstrable inability to obtain legal assistance despite her exertion—and
if her inability to obtain legal assistance flows from lawyers’ collective
assessment that the statutory regime makes it economically unsound to
take her case even if it may have merit—then the legislature may conclude
that some limited exception to the expert-report deadline is warranted.
Whether such relief is possible or desirable is a question not for the
courts but for the legislature. I write today not to advocate any particular
change, or indeed to advocate that there be any change at all. Rather, I
write to confirm my own perception that serious access-to-justice problems
may be preventing citizens from pursuing their substantial rights because
of their inability to find counsel. When a law is as unusually complex and
demanding as the TMLA, a pro se plaintiff is almost destined to failure, no
matter the merits.
In this case, though, Mrs. Oramas performed far better than
expected. She failed to discover the expert-report requirement until it was
too late. But once made aware of it, she managed—amazingly, it seems to
me—to obtain one in short order. Without significantly prejudicing the
rights of defendants or unraveling the rigors of the current law, it might be
possible for a pro se plaintiff facing a motion to dismiss for noncompliance
with the expert-report requirement to receive an additional period of time
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to secure counsel or at least an expert. What if this escape hatch
incentivizes plaintiffs to proceed pro se? Perhaps the extra time might be
conditioned on a judge’s acceptance of the plaintiff’s assertion that she has
diligently sought in good faith to find counsel but has been unsuccessful.
If that is not enough, perhaps the extra time would require that any
eventual recovery be reduced by some percentage, which would further
diminish any improper dilatory incentives and encourage alacrity.
Perhaps there are other ways to address the problem. Perhaps the
legislature will conclude that it is a problem but that any solution would
cause more harm than good. Perhaps it will conclude that someone else
should solve the problem—that the bar of Texas should do more to serve
the needs of our fellow citizens even if doing so is not as lucrative as taking
other cases. Perhaps the legislature will conclude that there is in fact no
real problem and that the status quo is working fine.
As it stands today, however, the statute leaves no doubt about the
legal result here. Claims must be dismissed with prejudice when a plaintiff
fails to serve the defendant with an expert report and curriculum vitae
within 120 days of the defendant’s answer. While I find it entirely
understandable how Mrs. Oramas missed this deadline, and while I have
great sympathy for her loss of her husband and for her desire for vindication
within the legal system, the lower courts correctly applied the law as
written. I therefore concur in the Court’s denial of her petition for review.
Evan A. Young
Justice
OPINION FILED: June 19, 2026
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