In Lake Jackson Med. Spa, Ltd. v. Gaytan, No. 20-0802, 65 Tex. Sup. Ct. J. 512, 2022 Tex. LEXIS 197 (Feb. 25, 2022), the Texas Supreme Court clarified a plaintiff’s expert report obligations, under Chapter 74 of the Texas Civil Practice and Remedies Code, in relation to an amended petition.

Under the Texas Medical Liability Act, a claimant who asserts a healthcare liability claim against a physician or a healthcare provider must serve on each defendant one or more expert reports describing the expert’s opinions addressing: (1) the applicable standards of care; (2) how the defendant’s conduct failed to meet those standards; and (3) how those failures caused claimant’s injury, harm, or damages. See Tex. Civ. Prac. & Rem. Code § 74.351(a),(r)(6). If a claimant fails to serve the report within 120 days after the defendant files an original answer, the trial court must dismiss the claim with prejudice and award the defendant attorneys’ fees and costs. Id. § 74.351(b). The Texas Supreme Court reviewed the merits of this case for several reasons, but most critically had to decide whether the claims asserted were governed by Chapter 74 and whether the filing of an amended petition obviated the expert report requirement.

Lake Jackson Med. Spa, Ltd. v. Gaytan

The plaintiff in this case sued both the aesthetician and the medical spa, claiming the aesthetician negligently performed various skin treatments resulting in scarring and discoloration. In her first amended petition, the plaintiff added the physician-owner of the medical spa, alleging he negligently allowed the aesthetician to administer “medical treatments.” The defendants moved to limit discovery, as the plaintiff had not yet served expert reports pursuant to the Texas Medical Liability Act’s requirements. Five months later, the defendants moved to dismiss the plaintiff’s claims because she failed to serve an expert report within the time period prescribed. In response, the plaintiff argued that the Act did not apply because she was not specifically asserting a healthcare liability, but rather the treatments were purely aesthetic in nature. Days before the hearing, the plaintiff amended her petition a second time, to remove any references to the Act or “medical treatments.”

The Court’s Analysis

First, the Texas Supreme Court reviewed whether an amended, recast petition obviated the plaintiff’s expert report obligations. The plaintiff argued that her second amended petition set forth the nature of her claims as general negligence rather than a healthcare liability claim; thus, she had no obligation to serve an expert report. Critically, the court noted that one cannot artfully avoid the Act’s application by pleading claims for ordinary negligence. The Act’s application depends not on the labels within the pleading, but instead whether the facts that demonstrate the claims fall within the Act’s definition of a healthcare liability claim. The Texas Supreme Court held that the Act does not prohibit trial courts from considering an amended petition but also cannot prevent dismissal by merely recasting claims through the artful use of different labels.

Second, the court reviewed whether the aesthetic procedures benefitted from the protections of the Act. In doing so, the court looked at the three basic elements: (1) the defendant must be a physician or healthcare provider; (2) the claim must concern “treatment, lack of treatment, or a departure from accepted standards of medical care, or healthcare, or safety or professional or administrative services directly related to healthcare;” and (3) the defendant’s conduct must proximately cause the claimant’s injury or death.

In this case, the court found that the aesthetician was acting within the scope of her employment by the physician and the medical spa when she treated the plaintiff; thus, the first element was met. Further, Texas precedent creates a presumption that a patient’s claim against her physician or healthcare provider is indeed a complaint regarding “medical care or treatment.” Here, the plaintiff alleged the defendants failed to properly evaluate her skin condition prior to administering an “abrasive dermatological treatment.” To apply standards of dermatological care to determine whether defendants fell below these standards would require expert testimony and to find otherwise would “blink reality;” thus, the second element was met. The court did not address the third element as the plaintiff clearly asserted damage as a result of the treatment.

Ultimately, the Texas Supreme Court held that the Texas Medical Liability Act expert report deadline did not prohibit a plaintiff from amending her petition, but, even considering the amended petition, the claims at hand clearly constituted a healthcare liability claim. Because the plaintiff failed to serve an expert report before the Act’s 120-day deadline, the claims must be dismissed. The court remanded the case to the trial court to award defendants reasonable attorneys’ fees and costs.


This decision shows that Texas’ highest court will not abide a litigant’s attempt to circumvent the expert requirements of the Texas Medical Liability Act through artful (or inartful) pleading. Defense counsel in the Lone Star State should be wary of this tactic and prepared to cite this decision if facing a similar situation.