Three-year-old R.W. entered the Loose Caboose restaurant in Spring, Texas, with her parents, Cleveratta and James Waldroup, where Kingston, a dog belonging to Jennifer Romano and wearing a "Service Animal" vest, bit her cheek and injured her severely, in an attack the Waldroups allege was unprovoked.¹ Dr. Maurice Leibman, a board-certified gynecologist, wrote multiple letters for Romano, his patient, saying that her "service animals" help manage her generalized anxiety disorder, that she "needs" Kingston to control her anxiety, and that her animals are "certified to be with her"; the letters were written at her request to avoid eviction from her apartment.²

The Waldroups sued Romano, the restaurant's owner, and Dr. Leibman, alleging negligence and aiding and abetting against him because he negligently or fraudulently issued the letters without taking steps to determine whether Kingston was actually a service animal.¹ Dr. Leibman moved to dismiss for lack of an expert report under the Texas Medical Liability Act; the trial court denied the motion and the First Court of Appeals affirmed, holding the claims are not inseparable from the rendition of health care and thus not health care liability claims.² Dr. Leibman petitioned for review on June 6, 2023, and the Waldroups responded on September 7, 2023; the Court requested merits briefing on November 10, 2023, granted review on September 27, 2024, and heard argument on December 5, 2024, after which it requested supplemental briefs on standing; it decided the case on June 6, 2025.³

Petition for review from the First Court of Appeals in an interlocutory appeal from the denial of a motion to dismiss for lack of an expert report; argued December 5, 2024, and decided June 6, 2025, with a dissent.⁴

Dr. Leibman presents whether the Waldroups' claims are health care liability claims under section 74.001(a)(13) that required an expert report, including as claimed departures from accepted standards of health care or safety.¹ The Waldroups present whether their claims are general negligence claims and not health care liability claims, and whether the failure to disclose that theory violated Rule 194.2 and due process.² The Court first decided whether the Waldroups have standing and then whether their claims are health care liability claims.³

Standing is a jurisdictional question, and when a court reviews standing on its own motion it construes the petition in the party's favor and reviews the record for evidence supporting standing; whether claims are health care liability claims is reviewed de novo, looking to the operative facts underlying the claim and not its labels.¹

Whether the claims are health care liability claims requiring an expert report.

Petitioner (Dr. Leibman): The claims center on his statements that his patient's service dogs benefited her condition and are inextricably intertwined with, and an inseparable part of, his health care services, and lay persons cannot determine whether a physician was qualified or fulfilled his duty in writing such letters.¹

Respondents (the Waldroups): Despite the Act's broad definition, the claims fall outside it because Dr. Leibman acted outside his professional capacity as a medical provider in writing letters about his patient's dogs, no applicable standard of medical care exists, and no expert testimony is needed to show a departure from one.²

Dr. Leibman argued that the claims arise from a physician's letters for his patient and are health care liability claims under controlling precedent, raising issues of departures from health care and safety standards.¹ The Waldroups responded that the court of appeals' judgment should be affirmed.²

• Standing. Asked whether the Waldroups have standing, a jurisdictional issue, Dr. Leibman's counsel agreed it was jurisdictional but said Dr. Leibman did not represent the dog as certified. (Oral Argument, 0:17:02; 0:18:10)
• What the dispute is. Asked whether it is disputed that a service dog would have helped the patient, Dr. Leibman's counsel said no; the dispute is whether Kingston was qualified for the task. (Oral Argument, 0:02:13; 0:03:36)
• Expert needed. Asked what a physician must do to vouch for a dog, counsel said an expert is needed to say what steps a physician takes to judge the dog's training. (Oral Argument, 0:04:39)
• Breadth of the statute. Asked whether anything a physician writes is then a health care liability claim, Dr. Leibman's counsel said the statute is very broad, with a rebuttable presumption. (Oral Argument, 0:15:21)
• Certifying fitness. Asked whether every suit against a doctor needs an expert report, the Waldroups' counsel said doctors certify medical fitness to drive, but not that a particular truck is road-ready. (Oral Argument, 0:40:55)
• Bad prescription analogy. Asked why the letter is beyond what a doctor should say, the Waldroups' counsel said a bad prescription is closely analogous, since prescribing follows a medical standard. (Oral Argument, 0:39:24)

• Wolfgang P. Hirczy de Mino of Bellaire, Texas filed an amicus curiae letter on June 6, 2025.

Holding

The Waldroups have standing, narrowly, because their pleading permits a reasonable inference that the doctor's letters contributed to the dog's presence in the restaurant; and their claims are not health care liability claims, because no claimed departure from an applicable standard of medical care is alleged, no medical expert is needed to prove standard of care, breach, or causation, and any presumption that the claims are health care liability claims is inapplicable or rebutted.¹

Reasoning

Standing. Standing requires a concrete injury fairly traceable to the defendant's conduct that a favorable decision would redress, and the injury and redressability elements were readily satisfied; traceability was less clear because the letters were written a year or more earlier and the Waldroups do not allege that Romano showed them to the restaurant staff.² The Court narrowly concluded that the pleadings allege letters that enabled Romano to present Kingston as a service animal, which supports a reasonable inference that the letters emboldened her to bring the dog into public spaces, which sufficed at the pleading stage, a reading consistent with Dr. Leibman's own description of their theory in the trial court.³

Health care liability claim. A claim against a physician is a health care liability claim if expert medical testimony is necessary to prove or refute the claim's merits, so the Court first asked whether a medical expert is needed to establish the standard of care, breach, and causation.⁴ No party suggested a medical expert is relevant to causation, the Waldroups do not challenge the diagnosis or the opinion that a service animal could help treat Romano's anxiety, and the record shows no negligent medical care.⁵ The operative breach alleged is that calling Kingston a "service animal" implied he was trained to behave in public, which Dr. Leibman did not verify; the letters say nothing about the dog's temperament toward third parties, and opinion testimony about a dog's temperament is the province of veterinarians and trainers, so there is no applicable standard of medical care to address in an expert report.⁶

Presumption and totality. The Court explained that Loaisiga's observation about a presumption concerns claims by patients about conduct during the course of care, and that the Waldroups are strangers to the physician-patient relationship and nothing shows the letters were written as part of treatment.⁷ Even if a presumption applied, the record rebuts it: the Waldroups consistently deny that their claims arise from the diagnosis or treatment opinion, the letters were written to help Romano avoid eviction, and the connection between the letters and the injury is so thin that it barely clears the standing threshold.⁸ The Court rejected the argument that the claims are inseparable from medical treatment, because those cases involve patients alleging substandard care, and the claim-splitting cases are not implicated here.⁹

Dissent (Justice Huddle, joined by Chief Justice Blacklock and Justices Bland and Sullivan). She would hold that the claims are health care liability claims because they rest on letters written in the course of treating a patient, the Court cherry-picked isolated statements from the letters and embraced artful pleading contrary to Yamada, Loaisiga, and Gaytan, and the Waldroups failed to rebut the presumption, since expert testimony would be needed to establish what opinions a physician may properly give in such letters.¹⁰ She was unpersuaded by the Waldroups' alternative notice and due-process arguments.¹¹

Disposition

The Court affirmed the court of appeals' judgment and remanded the case to the trial court.¹²

Vote Breakdown

Majority Opinion by Justice Busby

Joined by Boyd, Devine, Lehrmann, and Young, JJ.

Dissent by Justice Huddle

Joined by Blacklock, C.J., and Bland and Sullivan, JJ.