1. APPELLATE COURT CASE NO. 105-5793
STATE OF TEXAS
IN COURT OF APPEALS
Paul Boren,
Plaintiff-Respondent,
vs.
Texoma Medical Center,
Defendant-Appellant
APPELLANT’S BRIEF
Faith Harvey (No. 39584)
Attorney for Appellant
Webster & Associates
5000 Ross Ave, Suite 400
Dallas, TX 75202
Telephone: (214) 985-6543
Paul Boren (No. 214853)
Attorney for Respondent
Boren & Associates
678 Main Street, Suite 210
Dallas TX 75202
Telephone: (214) 042-4235

2. TABLE OF CONTENTS
TABLE OF AUTHORITIES ...............................................................................................i
STATEMENT OF THE ISSUE...........................................................................................1
STATEMENT OF THE CASE AND FACTS.....................................................................1
The Case...................................................................................................................1
The Facts..................................................................................................................1
SUMMARY OF ARGUMENT ...........................................................................................3
ARGUMENT.......................................................................................................................3
This Court should uphold the judgment in favor of Appellant and should not
grant Respondent’s motion for a new trial, thereby upholding well-tested case law that
states an entity does not have responsibility over a person or their future actions simply
due to the fact that there was an interaction between the parties.
A. Although the doctors were in the process of processing paperwork to
admit Andre T., he left before the staff were able to legally establish a
relationship, and therefore a duty could not have been imposed ...........4
B. No special relationship existed between Texoma Medical Center and
Andre T. to warrant a duty and responsibility of care between the two
parties.....................................................................................................5
C. An entity cannot be held liable for actions that are not reasonably
foreseeable with no evidence to establish a possible pattern that might
cause future harm...................................................................................5
CONCLUSION....................................................................................................................6

3. TABLE OF AUTHORITIES
CASES:
City of Keller v. Wilson, 168 S.W.3d 802, 824-25 (Tex.2005)............................................3
Dallas Cent. Appraisal Dist. v. Cunningham, 161 S.W.3d 293, 295 (Tex.App.—Dallas
2005, no pet.). ..........................................................................................................3
Kerrville State Hospital v. Clark, 923 S.W. 2d, 582, 588-89 (Tex. 1996) ..........................4
Mellon Mortgage Co. v. Holder, 5 S.W. 3d 654 , (Tex. 1999)............................................6
Thapar v. Zezulka. 994 S.W. 2d 635, 637-40 (Tex. 1999) ..................................................4
Timberwalk Apartments Partners, Inc. V. Cain, 972 S.W. 2d 749, 756 (Tex.1998)...........6
LEGAL ENCYCLOPEDIA:
Texas Jurispruidence 3d. Third ed. Eagan, MN. Thomson Reuters, 2005..................4, 5, 6
TOPICAL REPORTER:
American Law Reports, 6th Ed. Thomson Reuters. Eagan, MN. 2010. ALR Assignment:
Memorandum of Law.......................................................................................4, 5, 6
COMMENTARY:
Texas Practice Series: Texas Elements of an Action, 2013-2014. Thomson Reuters, 2013.4

4. STATEMENT OF THE ISSUE
Did Texoma Medical Center, the Appellant have a duty of responsibility towards
Andre T., the Respondent based on the interaction that took place between the two,
although Andre T. was never under the care of Texoma as a patient at any point?
Summary judgment for Texoma Medical Center was granted after it was found
that the hospital was not liable for non-patient’s actions and had no duty of responsibility.
STATEMENT OF CASE AND FACTS
The Case
Civil charges of health care liability were brought by Boren (acting as the
representative of the estate) in the Collin County District Court, based on the hospital’s
treatment of an emergency room patient (Andre T.).
Summary judgment was then granted for Texoma Medical Center by the District
Court after it was found that the hospital was not liable for non-patient’s actions and the
danger of harm to other by patient was not foreseeable. Boren now appeals the summary
judgment granted to Texoma Medical Center.
The Facts
At 7am, Andre T entered the Texoma emergency room with a self-inflicted knife
wound. The medical team performed an x-ray, which showed the knife would as
superficial. A nurse noted depression as Andre’s T. primary complaint, and a mental
assessment was performed, in which it was decided that Andre T was physically stable
but had major psychological issues. Dr. Bowen referred Andre T. to the hospital’s mental
health department for evaluation, however Andre T. refused hospitalization on a
voluntary basis. However, Dr. Bowen completed an application for an emergency
detention and attempted to detain Andre T; however, he left before the process could be
completed.
At around 7pm that evening, Andre T. went to the apartment of his ex-wife Laura,
who lived with her boyfriend Bryant and her two children, Andre B. and Leyha where he

5. stayed there until almost midnight. The next morning at between 6 and 7 am, Bryant, the
boyfriend of the deceased Laura, saw Andre T. walking towards Laura’s apartment. He
then phoned the father of the deceased, Paul, where Paul discovered the murdered bodies
of Laura and her two children, Andre B and Leyha.

6. SUMMARY OF ARGUMENT
Texoma Medical Center is a hospital facility that provides necessary treatment to
those that walk through its doors. The doctors and the medical team provided those
services to Andre T., a psychotic patient who had come to Texoma because of his self-
inflicted stab wound. The doctors treated the wound, but found that Andre T. had many
mental issues that required hospitalization. Doctors initiated hospitalization proceedings,
however, Andre T. left the hospital before these proceedings could be completed;
therefore, since he was not a patient, the hospital had no duty towards him.
However, even if the paperwork completed by the doctor could be seen as Andre
T. being admitted as a patient and perhaps the beginning of a duty of care and
responsibility towards Andre T., the entire process was never completed, as Andre T.
refused treatment and left before he could be admitted, therefore, a duty of care could
never be established in the first place. Moreover, case law supports the rationale that you
cannot have a duty of care over a person that was never a patient, nor one that a long-
standing relationship can be proven.
In the trial court, bot parties, having stipulated the facts, moved for summary
judgment. The trial court rightfully granted summary judgment to Texoma Medical
Center. That judgment should be upheld, and Boren’s appeal should be denied.
ARGUMENT
This Court should uphold the judgment in favor of Appellant and should not grant
Respondent’s motion for a new trial, thereby upholding well-tested case law that
states an entity does not have responsibility over a person or their future actions
simply due to the fact that there was an interaction between the parties.
A summary judgment is reviewed de novo “to determine whether a party has
established its right to summary judgment as a matter of law.” Dallas Cent. Appraisal
Dist. v. Cunningham, 161 S.W.3d 293, 295 (Tex.App.—Dallas 2005, no pet.). When
reviewing a summary judgment, the entire record must be examined most favorable to the
nonmovant, indulging every reasonable inference and resolving any doubts against the
movement. City of Keller v. Wilson, 168 S.W.3d 802, 824-25 (Tex.2005).

7. A. Although the doctors were in the process of processing paperwork to
admit Andre T., he left before the staff were able to legally establish a relationship,
and therefore a duty could not have been imposed.
When Dr. Bowen completed an application for an emergency detention order for
a temporary hospitalization, it can be said that he commenced the steps to hold Andre T.
in the care of Texoma Medical Center. However, since Andre T. left before these
proceedings could be completed, he was never a patient of Texoma Medical Center, and
case law has been consistent in declining to “create or recognize a duty from a healthcare
provider to a third party non-patient arising out of the healthcare provider’s treatment of a
patient.” Thapar v. Zezulka, 994 S.W.2d 635, 637-40 (Tex.1999).
According to the Texas Practice Series there exist factors that prove to establish a
legal duty: “(1) the relationship between the parties, (2) the reasonable foreseeability of
harm to the person injured, and (3) public policy considerations.” (16 Tex. Prac. Ser.
2013-2014 ed. Texas Elements of an Action § 22:1 (2013)). To address these factors on a
point-by-point basis: (1) There was no relationship between Andre T. and Texoma, as
Andre T. was never under the care of Texoma in the capacity of a patient at any time in
his short stay at the hospital: (2) Andre T.’s actions were not foreseeable, and the trial
court “rejected the claim by the victims’ families that the patient’s murderous acts were
foreseeable and that the hospital should have known that he was a threat to others, thus
creating a duty to protect the victims from an allegedly known dangerous patient” (80
A.L.R 6TH § 48 View that harm must be foreseeable before liability attaches (2010)): and
(3): public policy and case law have established a precedent that states a legal duty
cannot exist when there is no relationship between the parties, and even when the
relationship has terminated, as stated in Kerrville State Hospital v. Clark (923 S.W. 2d,
582, 588-89 (Tex. 1996)).
When a party is not even able to establish any kind of relationship, it begs the
question as to whether a duty can legally be imposed. According to Texas Jurispruidence,
“if a third person does not act under the defendant’s supervision or control, the defendant
generally has no legal duty to prevent the third person’s criminal acts.” (53 Tex. Jur. 3d
Negligence § 58 (2005)). Andre T.’s criminal acts did not occur while a patient of

8. Texoma, but before he could be admitted, thus, Texoma had no legal duty in which to be
held liable.
B. No special relationship existedbetween Texoma Medical Center and
Andre T. to warrant a duty and responsibility of care between the two parties.
Although Texoma attempted to obtain an emergency detention order, Ander T.
left before this order could be signed by the justice of the peace. Since Andre T. was not
admitted to the hospital as a patient, Texoma had no lawful right to restrain, detain or
control Andre T. Texoma had no special relationship with Andre T. to justify extending a
duty to Texoma to control Andre T.
A duty can exist however, “when there is a special relationship between the
defendant and the person whose behavior needs to be controlled or the person who is a
foreseeable victim of that condition.” (80 A.L.R 6th 469 § 36 View that common-law duty
to control contingent upon ability to control patient (2010)). Such a special relationship
“may exist between a parent and child, master and servant, employer and employee, and
independent contractor and contractee under special circumstances.” (53 Tex. Jur. 3d
Negligence § 220 (2005)). However, since no relationship of this sort was even able to
commence as Andre T. left the hospital before anything could happen, this “special
relationship exception” cannot be applied.
Furthermore, this special relationship cannot exist “where the patient had not yet
been admitted or been committed to a state mental health care facility, the hospital had no
contract with the state requiring supervisory control over him, and the hospital had no
lawful right to restrain, detain, or control him.” (42A Tex. Jur. 3d Healing Arts &
Institutions § 225) (2005)).
C. An entity cannot be held liable for actions that are not reasonably
foreseeable with no evidence to establish a possible pattern that might cause future
harm.
Another facet of this case is the assertion by Boren that Texoma was responsible
for the actions committed by Andre T. after he left the hospital, claiming his actions were
or should have been foreseeable to Texoma, therefore creating a duty of care on behalf of
Texoma. As stated by the American Law Reports: “Before imposing a duty of care, the

9. risk of harm must be foreseeable, stated the court, and for the risk of harm to be
foreseeable, the injury must be of such a general character, as might reasonably have
been anticipated.” (80 A.L.R 6TH § 48 View that harm must be foreseeable before liability
attaches (2010)).
However there was no evidence that when at Texoma, Andre T. showed any
behavior that might indicate that he would be a threat to himself or others in the future as
“there was no evidence patient exhibited behavior dangerous to others or expressed any
threat to injure others at the hospital, or any specific threat to injure the victims.” (42 Tex.
Jur. 3d Health § 758 (2005)).
Based on his conduct at Texoma, however erratic, nothing indicated that he would
harm or kill anybody in the future, and from Timberwalk Apts, “foreseeability is not
measured by hindsight, but instead by what the actor knew or should have known at the
time of the alleged negligence (972 S.W.2d 749, 757 (Tex.1998), and since the risk of
harm “must be of such a character as might reasonably have been anticipated” (Mellon
Mortgage Co. v. Holder, 5S.W.3d 654, 655 (Tex.1999)), no liability is attached to
Texoma due to foreseeability.
CONCLUSION
The attorneys on behalf of Texoma Medical Center respectfully requests this
Court to uphold the trial court’s summary declaratory judgment in favor of Texoma
Medical Center, and not grant summary judgment to Paul Boren.
Dated: Dec. 10 2013 Respectfully submitted,
By: /s/Faith Harvey (No. 39584)
Webster & Associates
5000 Ross Ave, Suite 400
Dallas, TX 75202
Telephone: (214) 985-6543
ATTORNEY FOR APPELLANT
Texoma Medical Center, Inc.