Texas Supreme Court Narrows Scope of Health Care Liability Claims in Leibman v. Waldroup

On June 6, 2025, the Texas Supreme Court issued a 5-4 opinion in Leibman v. Waldroup, No. 23-0317, a closely watched case testing the boundaries of the Texas Medical Liability Act (TMLA). At issue was whether a physician’s conduct—authoring letters for a former patient supporting the need for a service animal—constituted a “health care liability claim” (HCLC) subject to the procedural requirements of Chapter 74 of the Texas Civil Practice and Remedies Code. The Court said no.

This ruling is significant. It clarifies the extent to which a physician’s actions, particularly those outside the traditional physician-patient setting, may be shielded under the TMLA. The case drew sharp lines between the majority and dissenting justices over the purpose and reach of the statute.

Background: When Medicine Meets Misrepresentation

Dr. Maurice Leibman, a gynecologist, provided two letters for his former patient, Jennifer Romano, attesting that she required a service animal to assist with generalized anxiety disorder. These letters were used by Romano to fraudulently obtain service animal credentials for her dog, Kingston. More than a year after her treatment with Dr. Leibman ended, Kingston attacked a child, R.W., in a Houston-area restaurant.

The child’s parents sued Dr. Leibman, alleging negligence and fraud. Dr. Leibman responded with a motion to dismiss under the TMLA, arguing that the claims were HCLCs and should be dismissed due to the plaintiffs’ failure to serve an expert report within 120 days, as required by Section 74.351.

The trial court denied the motion. The appellate court affirmed. Dr. Leibman petitioned the Texas Supreme Court, arguing that his conduct—assessing Romano’s mental health condition and documenting the need for a service animal—was inextricably intertwined with the provision of medical care.

The Supreme Court Majority Opinion: Attenuation and the Limits of the TMLA

Writing for the majority, Chief Justice Hecht concluded that the Waldroups' claims did not fall under the TMLA.

The Court emphasized that:

• Dr. Leibman’s conduct did not involve diagnosis, treatment, or professional medical judgment regarding Romano’s condition at the time the letters were issued;

  
  

• The letters were written well after the physician-patient relationship ended;

• The harm (a dog bite to a third party) was too remote and attenuated from any act of medical care;

• No expert medical testimony was necessary to assess whether Dr. Leibman acted reasonably in providing the letters.

The Court cautioned that applying the TMLA to these facts would unreasonably extend its protections to non-clinical conduct with only tangential ties to health care.

“To say that this is an HCLC is to stretch the Act beyond what its plain language supports,” Chief Justice Hecht wrote.

The Dissent: A Warning Against Artful Pleading

Justice Huddle, joined by Justices Devine, Young, and Bland, dissented sharply. She argued that the majority’s focus on the post-treatment timing and third-party injury ignored the TMLA’s broader scope. She emphasized that under Texas West Oaks Hospital v. Williams, the statute encompasses claims involving “safety” standards if they bear a substantive relationship to the provision of medical care.

The dissent viewed Dr. Leibman’s conduct as a continuation of medical services:

• The letters were based on Dr. Leibman’s treatment of Romano for anxiety;

  
  

• The decision to endorse the need for a service animal required professional judgment;

• Evaluating whether he acted within the standard of care would require expert testimony.

Justice Huddle warned that the majority’s opinion invites plaintiffs to evade Chapter 74’s protections through creative pleading.

“The Court allows an artfully pleaded claim to bypass the Legislature’s express requirements for HCLCs,” the dissent concluded.

Key Takeaways: What This Decision Means Going Forward

1.     The Physician’s Role Alone Is Not Determinative

Just because a physician authored the document at issue doesn’t make the resulting claim an HCLC. The context, timing, and nature of the act matter.

2.     Attenuation Matters

Conduct occurring well after the treatment relationship has ended—and resulting in harm to third parties—may not qualify as related to health care.

3.     Expert Testimony as a Touchstone

A central question remains whether expert testimony is necessary to evaluate the claim. If not, the claim likely falls outside the TMLA.

4.     Artful Pleading or Legitimate Classification?

The dissent’s concern signals that future disputes will likely turn on how well plaintiffs craft their pleadings to avoid Chapter 74’s procedural hurdles.

Conclusion

Leibman v. Waldroup marks a notable boundary-setting decision in Texas health care liability jurisprudence. While it provides clarity on the limits of Chapter 74, it also leaves room for future litigation over when a professional opinion—even outside the exam room—crosses the line into protected medical conduct.

This case is a must-read for Texas litigators, health care providers, and insurers navigating the evolving contours of health care liability law.