After struggling with her gender identity, Soren Aldaco contacted the Crane Clinic about a double mastectomy, was told she needed a letter from a practitioner recommending her, and asked her therapist, Barbara Rose Wood, for one.¹ Wood signed a letter "endors[ing] . . . top surgery" on February 22, 2021, terminated Aldaco's psychotherapy on May 14, 2021 after she missed a session and failed to pay a no-show fee, and on June 11, 2021 Aldaco had the surgery, after which she suffered complications and came to regret it.² Aldaco sued Wood and her employer, Thriveworks, in 2023 for negligence and fraud, alleging the letter was a severe departure from the standard of care and misrepresented the extent of Wood's treatment for gender dysphoria.³ She gave pre-suit notice on May 9, 2023.⁴

Wood and Thriveworks moved for summary judgment under the Texas Medical Liability Act's two-year limitations provision, section 74.251(a), and the district court granted it and severed Aldaco's claims into a final judgment.¹ The Second Court of Appeals (Fort Worth) affirmed, holding the clock began on February 22, 2021 when Wood provided the letter.² The Supreme Court granted review and heard argument on February 11, 2026,³ and on June 26, 2026 reversed and remanded in an opinion by Justice Sullivan, unanimous in Parts I, II.A and III, with Part II.B a plurality.⁴

Petition for review from the Second Court of Appeals (Fort Worth); argued February 11, 2026; opinion by Justice Sullivan issued June 26, 2026, with a concurrence by Justice Young.⁵

• Aldaco:¹ whether the court of appeals erred in measuring limitations from the date of Wood's letter and not from the date she relied on it and suffered a legal injury, and whether that reading of the Act is unconstitutional because she had no standing before June 11, 2021.
• Wood and Thriveworks:² whether, as a matter of law, the statute began to run on the date of the alleged tort, February 22, 2021, and whether Aldaco's pleadings establish the limitations defense.

Summary judgments are reviewed de novo, and the Court began with the text of the statute.¹

Whether the limitations period began with the letter.

Wood and Thriveworks (Respondents): As a matter of law the statute began to run on the date of the alleged tort, February 22, 2021, which is the plain meaning of section 74.251(a) and accords with this Court's reading for about four decades, and the Legislature intentionally omitted "accrual" from the statute.¹ The statute of repose does not alter that reading, and the roughly four months between the letter and the surgery did not make suit exceedingly difficult.²

Aldaco (Petitioner): All fraud and Medical Liability Act causes of action require a legal injury, which she did not suffer until the June 11, 2021 surgery, so the court of appeals unraveled decades of precedent in measuring from the letter.³ In reply, she argues that Chapter 74 did not eliminate the injury requirement, that the course-of-care exception applies and that the ten-year repose provision's "act or omission" language shows the two-year provision requires a legal injury.⁴

Whether limitations could run from completion of treatment.

Aldaco (Petitioner): The "course of care" exception also applies here and differs from failure-to-diagnose cases, because her therapy with Wood was not completed until May 14, 2021.⁵

The Court granted review of a recurring question about when the two-year limitations period under the Texas Medical Liability Act begins to run, and heard argument.¹

• "Or tort." Asked if the words "or tort" are superfluous, respondents' counsel agreed they do no work and the statute would mean the same without them. (Oral Argument, 0:44:07)
• Backup date. Asked where section 74.251(a) supports Aldaco's May 14 backup date, her counsel said she did not see it in the text and relied on the Court's reading to date. (Oral Argument, 0:13:55; 0:14:50)
• Open courts. Asked whether a patient is time-barred before ever having a claim, respondents' counsel said "Yes and no": barred but rescued by open courts, which does not apply here. (Oral Argument, 0:26:12)
• Standing before limitations. Asked whether any court has held limitations runs before a plaintiff could sue, respondents' counsel knew of none and said the question has not been put to the Court. (Oral Argument, 0:36:10; 0:43:16)
• The letter. Asked if Aldaco would have a claim had the letter never been written, her counsel said no, the letter is the negligent conduct. (Oral Argument, 0:11:16)
• Unique facts. Aldaco's counsel said they knew of no health care liability case on these facts, and the closest involve a pharmacist who misprescribed drugs. (Oral Argument, 0:05:42; 0:06:54)
• Statute of repose. Asked if the statute of repose changes the analysis, respondents' counsel said no; the Court has long read "breach or tort" as one thing. (Oral Argument, 0:22:51; 0:25:09)

None noted

Holding

Aldaco's claims were timely because a claim is timely if filed within two years of either alternative triggering event in section 74.251(a), and her psychotherapy with Wood was completed on May 14, 2021, within two years of her May 9, 2023 pre-suit notice, and the precedents in Shah v. Moss and its line are distinguishable because those plaintiffs suffered an ascertainable bodily injury during treatment.¹ A four-justice plurality would also hold that "the occurrence of the . . . tort" means when the tort's injury element is met, here the June 11, 2021 surgery, which is an independent reason her claims were timely.²

Reasoning

Section 74.251(a) uses a disjunctive "or," so a claim filed within two years of either alternative triggering event is timely, and the psychotherapy that produced the letter was the relevant health care treatment, completed on May 14, 2021.³ Shah, Husain and Kimball held that where the date of the tort is ascertainable limitations runs from it, but in each the plaintiff suffered a bodily injury on an ascertainable date before treatment ended, whereas Aldaco could not ascertain any bodily injury until after treatment ended, and her theory of continuing negligence in not withdrawing the letter yields a range of dates extending to May 14, 2021.⁴ In Part II.B the plurality reasoned that the statute of repose runs from "the act or omission that gives rise to the claim," so the different words in the limitations provision denote the tort's occurrence, which requires injury, and that this does not revive the abolished discovery rule because it concerns whether a tort has occurred at all and not when a plaintiff learned of it.⁵ Justice Young, joined by Justice Bland, concurred in Part II.A, which he said is limited and narrow, doubted the reasoning in Part II.B and said any change to limitations for such claims belongs to the Legislature.⁶

Disposition

Court of appeals' judgment reversed and the case remanded to the district court for further proceedings.⁷

Statutory interpretation and the application of a limitations statute to essentially undisputed facts, beginning with the statutory text.¹

Justice Sullivan delivered the opinion, unanimous as to Parts I, II.A and III, with Part II.B a plurality joined by Justices Lehrmann, Devine and Busby, and Justice Young filed a concurring opinion joined by Justice Bland.¹