No one expects to become a victim of medical negligence, much less the subject of a Texas Supreme Court opinion. But that’s exactly what happened to Jared Bush, whose wife Ireille — just 35 years old and a mother of two — was prematurely discharged from Medical City Arlington despite showing classic signs of a pulmonary embolism. She died shortly after returning home.
Our firm had the privilege of representing Jared and his children. We filed suit against the physicians and the hospital, arguing that her death could have been prevented had the hospital adopted and enforced standard screening protocols — specifically, a “Triple Rule Out” approach used to detect life-threatening conditions like pulmonary embolism, aortic dissection and heart attack.
The case quickly turned into a procedural battle at the Chapter 74 expert report stage. Our brilliant colleague Matt Kita joined our team as appellate counsel as the case made its way to the Texas Supreme Court.
The Legal Backdrop: Chapter 74 and the Corporate Practice of Medicine
In Texas, hospitals often defend malpractice lawsuits by invoking the prohibition against the corporate practice of medicine — the idea that corporations (including hospitals) cannot control or influence how physicians diagnose or treat patients.
But in the modern healthcare environment, that doctrine and the actual practice of medicine don’t always align.
Hospitals may not be directly prescribing medications or dictating specific diagnoses, but they do set the framework in which care is delivered. They control protocols, standing orders, staffing levels, communication systems, diagnostic tools, escalation pathways, and even access to imaging or specialist consultation.
This distinction was central to our case. We didn’t claim the hospital told doctors what to diagnose. We argued that it failed to implement basic systems and protocols that could have helped prevent a missed — and ultimately fatal — diagnosis.
What the Texas Supreme Court Said
The hospital argued that our expert report — filed as required by Chapter 74 — was insufficient because it didn’t explain how the hospital had overridden physician judgment or “practiced medicine.” The Second Court of Appeals agreed and dismissed the claims against the hospital.
The Texas Supreme Court saw it differently.
In a unanimous opinion, the Court reversed and held that our report met the statutory standard. More importantly, the Court clarified several critical principles:
Hospitals can be held directly liable for failing to implement systems, protocols or policies that prevent medical errors — even when the actual care is delivered by independent-contractor physicians.
Administrative policies and clinical protocols that guide care (without dictating it) are within the hospital’s domain and don’t violate the corporate practice prohibition.
Chapter 74 expert reports do not need to explain the full mechanics of causation at trial-level detail. A fair summary is enough at the preliminary stage.
The case citation is: Jared Bush, Jr. v. Colombia Medical Center of Arlington Subsidiary, L.P. d/b/a Medical City Arlington and HCA Inc .(No. 23-0460; May 23, 2025)
Why Every Lawyer Should Pay Attention
You don’t have to practice medical malpractice law to care about this case. Here’s why:
This ruling impacts all Texans — because we’re all patients. When a hospital’s internal policies (or lack thereof) shape how and when care is delivered, those decisions have real-life consequences. This decision affirms that such decisions come with corresponding responsibility.
It also clarifies the legal boundary between administrative responsibility and medical judgment. Hospitals remain prohibited from practicing medicine — but that doesn’t shield them from liability when systemic breakdowns in policy, staffing or procedure cause harm.
A Measured Shift Toward Accountability
To be clear, this decision doesn’t open the floodgates to unlimited hospital liability. It doesn’t require hospitals to micromanage physicians or override clinical judgment.
Instead, it acknowledges a modern reality: hospitals are not just passive landlords. They are complex, highly regulated healthcare entities that influence nearly every aspect of patient care through their administrative choices. When those systems fail — when there’s no policy in place to catch a potentially fatal blood clot — pointing the finger at the physician is not always a sufficient defense.
This ruling is a win for every patient in Texas. It reinforces the principle that safety is a shared responsibility. And when hospitals fail to uphold their end, they can and should be held accountable.
No matter your practice area or which side of the “v” you’re on, this decision matters — to you, your family and your clients. Because before we’re lawyers, we’re patients. And when it comes to patient safety, accountability isn’t optional. Our lives depend on it — literally.
