Memorial Hermann Hospital System D/B/A Memorial Hermann Southwest Hospital v. Jewell Hayden ( 2014 )


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  • Opinion issued June 17, 2014.
    In The
    Court of Appeals
    For The
    First District of Texas
    ————————————
    NO. 01-13-00154-CV
    ———————————
    MEMORIAL HERMANN HOSPITAL SYSTEM D/B/A MEMORIAL
    HERMANN SOUTHWEST HOSPITAL, Appellant
    V.
    JEWELL HAYDEN, Appellee
    On Appeal from the 333rd District Court
    Harris County, Texas
    Trial Court Case No. 2010-24879
    MEMORANDUM OPINION
    In this interlocutory appeal, 1 Memorial Hermann Hospital System d/b/a
    Memorial Hermann Southwest Hospital appeals a trial court’s order denying its
    1
    See TEX. CIV. PRAC. & REM. CODE ANN. § 51.014(a)(9) (West Supp. 2013).
    motion to dismiss Jewell Hayden’s slip-and-fall claim arising out of an injury she
    suffered while she was assisting a patient at the hospital. The trial court held that
    Memorial Hermann waived its right to seek dismissal based on Hayden’s failure to
    file an expert report as required for a health care liability claim. 2 Memorial
    Hermann contends that the trial court abused its discretion by finding waiver and
    by denying its motion to dismiss. We affirm.
    Background
    In April 2010, Jewell Hayden filed this lawsuit against Memorial Hermann,
    alleging she was seriously injured at the hospital as a result of its failure to
    properly treat her “very weak and sick” friend whom she had brought there.
    Hayden maintained that her friend “became violently ill while . . . in the
    Emergency Room” and the hospital failed to provide her friend with necessary
    “physical help and medical attention,” because it “did not have anyone to assist”
    her friend. Despite having seen a doctor and several nurses coming in and out of
    2
    In 2013, the legislature amended section 74.351(a) of the Texas Civil Practice and
    Remedies Code to require each health care liability claimant to serve an expert
    report “not later than the 120th day after each defendant’s original answer is
    filed.” See Act of May 26, 2013, 83rd Leg. R.S., ch. 870, § 2 (emphasis added).
    The new provision applies to all suits filed after September 1, 2013. Hayden filed
    her claims in 2010 and, therefore, the former section 74.351 still applies. See Act
    of May 18, 2005, 79th Leg., R.S., ch. 635, §1, 2005 TEX. GEN. LAWS 1590
    (amended 2013) (current version at TEX. CIV. PRAC. & REM. CODE ANN. § 74.351
    (West Supp. 2013)). Under the earlier version, health care liability claimants must
    serve an expert report on each health care provider defendant no later than 120
    days after filing their initial petition. 
    Id. 2 the
    friend’s waiting room, Hayden was forced to help her friend to the public
    restroom, where the friend fell on her. Memorial Hermann moved to dismiss,
    arguing that Hayden had asserted a health care liability claim but had failed to
    provide an expert report as required by section 74.351 of the Texas Medical
    Liability Act (TMLA).
    In October 2010, while Memorial Hermann’s motion to dismiss was
    pending, Hayden amended her petition. She continued to allege the same
    background facts; however, she abandoned her original complaint that her friend
    fell on her and that the hospital breached its duty by failing to provide medical and
    physical assistance to her friend. Instead, she alleged that “[w]hile attempting to
    assist” her friend in the restroom in the hospital emergency room, they both slipped
    and fell. Hayden asserted that the hospital failed to provide “adequate maintenance
    to ensure the premises was free from slip hazards as a reasonable premises owner
    would provide,” to clean the floor of the premises, or to provide anti-slip mats or
    rugs “in an area that was known to be wet.” She further alleged that the hospital
    failed to “provide adequate staffing resources” to ensure a safe environment.
    Hayden simultaneously filed a response to Memorial Hermann’s pending motion
    to dismiss, arguing that her amended claim did not constitute a health care liability
    claim. Relying on Marks v. St. Luke’s Episcopal Hospital, 
    319 S.W.3d 658
    , 664
    (Tex. 2010) and Diversicare General Partner, Inc. v. Rubio, 
    185 S.W.3d 842
    , 854
    3
    (Tex. 2005), Hayden insisted that Memorial Hermann’s acts and omissions did not
    constitute a health care liability claim because they were not inseparably related to
    the rendition of health care services. Memorial Hermann’s pending motion had
    already been set for the trial court to rule on it, but Memorial Hermann passed on
    the hearing.
    For the next 22 months, Memorial Hermann did not reset its motion to
    dismiss. Instead, both parties conducted discovery and prepared for trial. As part of
    that discovery, Memorial Hermann “propounded multiple sets of written
    discovery” and “participated in ten fact and expert witness depositions.” During a
    July 2011 deposition, Hayden testified that she accompanied her friend to the
    emergency room where the friend was seen by the doctor and a nurse and that the
    nurse was told that the friend was unable to use a bed pan. According to Hayden,
    the friend was “extremely weak” and had to get up from the room in which he was
    waiting and “walk past the nurses’ station” to get to the public bathroom. Hayden’s
    friend walked by himself to the bathroom at least three times and lost control of his
    bowels in the hallway before he reached the bathroom. During his third trip to the
    bathroom, Hayden noticed that her friend was in the bathroom “too long,” and she
    knocked on the door to ask whether he needed help. When he did not answer,
    Hayden entered the bathroom and recalled seeing feces on the floor around the
    toilet stall occupied by her friend. Hayden was reaching to get some paper towels
    4
    when she slipped and fell. Hayden, who was seventy years old, fell and broke both
    of her legs. One month after Hayden’s deposition, Memorial Hermann moved for
    summary judgment on Hayden’s premises liability claim. As part of its motion,
    Memorial Hermann noted that Hayden had simply “recast” her health care liability
    claim “as a premises liability lawsuit.” The trial court denied summary judgment.
    Memorial Hermann did not reset its motion to dismiss for hearing.
    Approximately one year later, on June 29, 2012, the Texas Supreme Court
    issued Texas West Oaks Hospital, L.P. v. Williams, holding that a hospital
    employee who sued the hospital for the hospital’s failure to provide a safe work
    environment after the employee was assaulted by a patient was required to comply
    with the expert-report requirement of TMLA section 74.351. See TEX. CIV. PRAC.
    & REM. CODE § 74.351; Tex. W. Oaks Hosp., L.P. v. Williams, 
    371 S.W.3d 171
    ,
    175 (Tex. 2012). Six weeks later, which was four days before the trial court
    actually called the case to trial, Memorial Hermann filed a second motion to
    dismiss Hayden’s suit, contending that under Williams Hayden was required—but
    failed—to serve a section 74.351 expert report.
    In response, Hayden argued that there was “no commonality of fact”
    between Williams and her claims. Hayden further contended that Memorial
    Hermann’s delay in pursuing its second motion to dismiss and its extensive trial
    preparation waived any right to dismissal.
    5
    Memorial Hermann excused its failure to pursue its motion based on its pre-
    Williams good faith belief that Hayden’s amended petition did not state a health
    care liability claim subject to the expert report requirement. Hayden does not
    dispute that statement. Indeed, the parties later stipulated that Memorial Hermann
    “believed based on the case law at that time, that [the amended p]etition did not
    assert a health care liability claim and, therefore a motion to dismiss for failure to
    file an expert report was groundless.”
    The trial court found, however, that Memorial Hermann had waived its right
    to seek dismissal for failure to file an expert report and denied Memorial
    Hermann’s motion to dismiss. The trial court also found that Hayden’s claim
    constitutes a health care liability claim, a determination that Hayden does not
    contest.3
    Memorial Hermann filed a timely notice of appeal from the trial court’s
    interlocutory order denying the motion to dismiss. See TEX. CIV. PRAC. & REM.
    CODE ANN. § 51.014(a)(10) (West Supp. 2013).
    3
    In Ross v. St. Luke’s Episcopal Hospital, the court of appeals held that a premises
    liability slip-and-fall claim against a hospital is a “health care liability claim” to
    which the expert-report requirement applies. No. 14–12–00885–CV, 
    2013 WL 1136613
    (Tex. App.—Houston [14th Dist.] Mar. 19, 2013, pet. filed) (mem. op.).
    6
    Standard of Review
    We review a trial court’s ruling on a motion to dismiss a health care liability
    lawsuit pursuant to chapter 74 of the Texas Civil Practice and Remedies Code for
    an abuse of discretion. See TEX. CIV. PRAC.    AND   REM. CODE ANN. § 74.351; see
    also Am. Transitional Care Ctrs. of Tex., Inc. v. Palacios, 
    46 S.W.3d 873
    , 875
    (Tex. 2001) (reviewing dismissal under section 74 predecessor statute for abuse of
    discretion); Runcie v. Foley, 
    274 S.W.3d 232
    , 233 (Tex. App.—Houston [1st Dist.]
    2008, no pet.) (reviewing chapter 74 dismissal for abuse of discretion). We defer
    to a trial court’s factual findings if they are supported by evidence, but where there
    is no factual dispute, only the legal question of whether the conduct constitutes
    waiver remains. See Am. Transitional Care 
    Ctrs., 46 S.W.3d at 875
    ; Crosstex
    Energy Servs., L.P. v. Pro Plus, Inc., No. 12–0251, 
    2014 WL 1258307
    , at *8 (Tex.
    Mar. 28, 2014) (“Generally, waiver presents a question of fact, but ‘when the facts
    and circumstances are admitted or clearly established, the question [of waiver]
    becomes one of law.’”) (citation omitted); Jernigan v. Langley, 
    111 S.W.3d 153
    ,
    156–57 (Tex. 2003) (“[W]hen the surrounding facts and circumstances are
    undisputed, the question [of waiver] becomes one of law.”). When a reviewing
    court conducts an abuse-of-discretion review, the issue of whether a party waived
    certain procedural rights—which requires a balancing of “a multitude of potential
    factors”—constitutes “a question of law for the court, and we do not defer to the
    7
    trial court on questions of law.” Perry Homes v. Cull, 
    258 S.W.3d 580
    , 598 (Tex.
    2008). Neither party disputes Memorial Hermann’s conduct or the surrounding
    factual circumstances. Therefore, whether Memorial Hermann waived its right to
    seek dismissal is a question of law, which we review de novo. See Crosstex
    Energy, 
    2014 WL 1258307
    , at *8; Perry 
    Homes, 258 S.W.3d at 598
    n.102;
    
    Jernigan, 111 S.W.3d at 156
    –57.
    Waiver
    Memorial Hermann contends that it did not relinquish a known right by
    waiting until August 16, 2012—over 670 days after Hayden amended her petition
    to raise a slip-and-fall claim—to move for dismissal for failure to serve a
    section 74.351(b) expert report.
    A.    Waiver defined
    Section 74.351 of the Texas Civil Practice and Remedies Code requires a
    party who alleges a health care liability claim to serve an expert report on every
    physician or health care provider against whom liability is asserted. TEX. CIV.
    PRAC. & REM. CODE ANN. § 74.351; see Heriberto Sedeno, P.A. v. Mijares, 
    333 S.W.3d 815
    , 822–23 (Tex. App.—Houston [1st Dist.] 2010, no pet.). The plaintiff
    must file the expert report within 120 days of filing the initial petition. TEX. CIV.
    PRAC. & REM. CODE ANN. § 74.351(a). If a timely expert report is not filed, the
    affected health care provider may file a motion to dismiss, and the court must
    8
    dismiss the claim with prejudice. 
    Id. § 74.351(b).
    A defendant can waive his right
    to seek dismissal for failure to file an expert report. 
    Jernigan, 111 S.W.3d at 156
    .
    Waiver is the intentional relinquishment of a known right or intentional
    conduct inconsistent with claiming that right. 
    Id. at 156–57;
    see also Crosstex
    Energy, 
    2014 WL 1258307
    , at *6. “The elements of waiver include (1) an existing
    right, benefit, or advantage held by a party; (2) the party’s actual knowledge of its
    existence; and (3) the party’s actual intent to relinquish the right or intentional
    conduct inconsistent with the right.” Ulico Cas. Co. v. Allied Pilots Ass’n, 
    262 S.W.3d 773
    , 778 (Tex. 2008); see also Alli v. Wachovia Bank, N.A., No. 01–11–
    00800–CV, 
    2013 WL 772946
    , at *4 (Tex. App.—Houston [1st Dist.] Feb. 28,
    2013, no pet.) (mem. op.); TeleResource Corp. v. Accor N. Am., Inc., No. 02–12–
    00475–CV, 
    2014 WL 975736
    , at *5 (Tex. App.—Fort Worth Mar. 13, 2014, pet.
    filed); In re Estate of Lynch, 
    395 S.W.3d 215
    , 222 (Tex. App.—San Antonio 2012,
    pet. denied).4
    4
    This court and others have stated that the second element may be satisfied by
    constructive knowledge. See, e.g., Forged Components, Inc. v. Guzman, 
    409 S.W.3d 91
    , 103 (Tex. App.—Houston [1st Dist.] 2013, no pet.); In re C.H.C., 
    396 S.W.3d 33
    , 43 (Tex. App.—Dallas 2013, no pet.); Nash v. Beckett, 
    365 S.W.3d 131
    , 144 (Tex. App.—Texarkana 2012, pet. denied); Furmanite Worldwide, Inc. v.
    NextCorp, Ltd., 
    339 S.W.3d 326
    , 334 (Tex. App.—Dallas 2011, no pet.); Fed.
    Deposit Ins. Corp. v. Attayi, 
    745 S.W.2d 939
    , 946 (Tex. App.—Houston [1st Dist.]
    1988, no writ); see also Perry 
    Homes, 258 S.W.3d at 602
    –3 (Johnson, J.,
    concurring in part, dissenting in part) (stating elements of waiver include “an
    existing right, benefit, or advantage held by a party . . . and the party’s actual or
    constructive knowledge of its existence . . . .”). “Constructive knowledge is a
    substitute in the law for actual knowledge.” CMH Homes, Inc. v. Daenen, 15
    9
    In Jernigan, a medical malpractice case involving a late-filed challenge to
    the adequacy of an expert report, the Court considered whether the defendant had
    waived his right to seek dismissal. Whether a party has waived his rights largely
    depends on the party’s intent; an implied intent to waive through a party’s actions
    “must be clearly demonstrated by the surrounding facts and circumstances.”
    
    Jernigan, 111 S.W.3d at 156
    . When the party charged with waiver says or does
    nothing inconsistent with the intent to rely on a right, there is no waiver. 
    Id. However, inaction
    may establish waiver if it is for so long a period that it shows an
    intent to yield a known right. 
    Id. at 157.
    There is no deadline to file a motion to dismiss for failure to timely serve
    section 74.351 expert reports. 
    Jernigan, 111 S.W.3d at 156
    ; see also Heriberto
    Sedeno, 
    P.A., 333 S.W.3d at 823
    –24; Obstetrical & Gynecological Assocs., P.A. v.
    McCoy, 
    283 S.W.3d 96
    , 103 (Tex. App.—Houston [14th Dist.] 2009, pet. denied).
    Thus, Memorial Hermann’s more than 670-day delay in pursuing it motion to
    dismiss did not, based upon timing alone, waive its right to dismissal. See
    
    Jernigan, 111 S.W.3d at 157
    ; Heriberto Sedeno, 
    P.A., 333 S.W.3d at 823
    , 825
    (delaying 912 days held not waiver). Waiver cannot be “based solely on the length
    of delay”; rather, waiver occurs when a party acts in such a way that it
    S.W.3d 97, 102 (Tex. 2000). Constructive knowledge is “knowledge that one
    using reasonable care or diligence should have, and therefore that is attributed by
    law to a given person.” BLACK’S LAW DICTIONARY 950 (9th ed. 2004).
    10
    intentionally relinquishes a right or intentionally is not claiming it. In re Universal
    Underwriters, 
    345 S.W.3d 404
    , 408 (Tex. 2011) (considering waiver for failure to
    invoke arbitration clause); see Crosstex, 
    2014 WL 1258307
    , at *8 (“We will not
    find waiver where a person ‘says or does nothing inconsistent with an intent to rely
    upon such right.’” (quoting 
    Jernigan, 111 S.W.3d at 156
    )). “In other words, while
    the time period may be instructive in interpreting the parties’ intentions, it alone is
    not the standard by which courts determine” whether waiver has occurred. In re
    Universal 
    Underwriters, 345 S.W.3d at 408
    . Before we address whether Memorial
    Hermann’s conduct, in addition to its 670-day delay, was inconsistent with
    claiming a known right, we consider Memorial Hermann’s contention that it did
    not have a known right to obtain dismissal and that such a pleading would have
    been groundless before Williams was decided.
    B.    Memorial Hermann had a known right to seek dismissal
    Memorial Hermann contends that before Williams “the law did not subject
    slip and falls by a hospital visitor to the [expert report] requirements of Chapter
    74.” Therefore, before Williams, Memorial Hermann believed it had, at most, only
    “a potential, theoretical, or arguable right,” but not a known right to obtain a
    dismissal for Hayden’s failure to file an expert report in a slip-and-fall case.
    Hayden responds that the Court’s holding in Williams “did not change” the law; it
    11
    merely “clarified its interpretation” of a statute that had existed since 2003, “long
    before . . . Hayden filed her claim.”
    A party cannot waive a hypothetical right—it must be a “right actually
    known.” 
    Ulico, 262 S.W.3d at 778
    . Stated differently, a party cannot waive a right
    that does not exist at the time. Discovery Operating, Inc. v. Baskin, 
    855 S.W.2d 884
    , 887 (Tex. App.—El Paso 1993, no writ).
    But Memorial Hermann had more than a hypothetical right before Williams;
    regardless of whether it anticipated that it would prevail on its motion to dismiss, it
    had a right to seek dismissal. Memorial Hermann not only had that right, it
    exercised that right before passing on a hearing on its motion. To limit the rights
    that may be waived only to those where the law clearly establishes an ability to
    prevail is to demand too much.
    A party has a right to pursue various legal strategies and in choosing one
    over another, the party must still bear the consequences of his decision. For
    example, the enforceability of an arbitration clause, forum-selection clause, or
    appraisal clause may not be clearly established, but the party may nonetheless
    waive its right to invoke those clauses. See, e.g., Perry 
    Homes, 258 S.W.3d at 593
    –
    94 (concluding waiver of right to arbitration); In re Universal 
    Underwriters, 345 S.W.3d at 411
    (considering waiver of appraisal clause); In re ADM Investor Servs.,
    Inc., 
    304 S.W.3d 371
    , 374 (Tex. 2010) (“A party waives a forum-selection clause
    12
    by substantially invoking the judicial process to the other party’s detriment or
    prejudice.”).
    Memorial Hermann contends that it should not be penalized for not asserting
    a defense it subjectively believed had no basis under the law at the time. But
    Memorial Hermann’s subjective beliefs about the status of the law before the
    Williams holding is not the issue. Rather, the issue is whether it would have had a
    reasonable basis—that is, one that would not have been groundless—for seeking
    dismissal of Hayden’s claims at the time.
    Memorial Hermann argues, based on Ross v. St. Luke’s Episcopal Hospital,
    that the Williams result could not have been reasonably anticipated. No. 14–12–
    00885–CV, 
    2013 WL 1136613
    , at *2 (Tex. App.—Houston [14th Dist.] Mar. 19,
    2013, pet. filed) (mem. op.) (“Ross likely never imagined that, under the Texas
    Supreme Court’s construction . . . the Texas Medical Liability Act would swallow
    her garden-variety slip and fall case. But it has.”). This objective-sounding
    argument is closer to the mark. But, to be more precise, the issue is whether a
    motion asserting that the law required dismissal of Hayden’s slip-and-fall claim
    would have been groundless before Williams, not whether it reasonably could have
    been expected to prevail. TEX. R. CIV. P. 13. Groundlessness is an objective inquiry
    that examines whether such a motion would have had “no basis in law or fact” and
    was “not warranted by good faith argument for the extension, modification, or
    13
    reversal of existing law.” 
    Id. (defining groundless
    and permitting counsel to file
    pleading when she believes “after reasonable inquiry the [pleading] is not
    groundless and brought in bad faith or groundless and brought for purpose of
    harassment.”); Harrison v. Harrison, 
    363 S.W.3d 859
    , 863 (Tex. App.—Houston
    [14th Dist.] 2012, no. pet.) (“To determine if a pleading was groundless, the trial
    court uses an objective standard: did the party and counsel make a reasonable
    inquiry into the legal and factual basis of the claim?” (citation omitted)).5 Cf. Tex.
    Disciplinary Rules Prof’l Conduct R. 3.01, cmt. 1, reprinted in TEX. GOV’T CODE
    ANN., tit. 2, subtit. G, app. A (West 2013) (Tex. State Bar R. art. X, § 9) (noting
    law is never static and that advocates must account for “the law’s ambiguities and
    potential for change”).
    The law before Williams—which Memorial Hermann was presumed to
    know 6—did not dictate that an amended motion to dismiss would be groundless.
    Two months before Hayden amended her original petition, the hospital defendant
    5
    In contrast, whether a pleading is brought in bad faith or for purposes of
    harassment involves a subjective inquiry. Parker v. Walton, 
    233 S.W.3d 535
    , 540
    (Tex. App.—Houston [14th Dist.] 2007, no pet.); see also Thielemann v. Kethan,
    
    371 S.W.3d 286
    , 294 (Tex. App.—Houston [1st Dist.] 2012, pet. denied).
    6
    See Greater Houston Transp. Co. v. Phillips, 
    801 S.W.2d 523
    , 525 n.3 (Tex.
    1990); Stewart v. Tex. Lottery Com’n, 
    975 S.W.2d 732
    , 735–36 (Tex. App.—
    Corpus Christi 1998, no pet.); Gabaldon v. Gen. Motors Corp., 
    876 S.W.2d 367
    ,
    369 (Tex. App.—El Paso 1993, no writ).
    14
    in Williams made this argument, 7 which Memorial Hermann later adopted, and no
    one suggested that the Williams health care provider’s argument was groundless.8
    7
    See Petition for Review at *3, Tex. W. Oaks Hosp., L.P. v. Williams, 
    371 S.W.3d 171
    (Tex. 2012) (No. 10–0603); see also Reply to Response to Petition for Review
    at *1–7, Tex. W. Oaks Hosp., L.P. v. Williams, 
    371 S.W.3d 171
    (Tex. 2012) (No.
    10–0603).
    8
    We note that it is still unsettled whether Williams mandates that all slip-and-fall
    claims be treated as health care liability claims. While Memorial Hermann argues
    that pre-Williams, “the law did not subject slip and falls by a hospital visitor to the
    requirements of Chapter 74,” case law following Williams reflects courts’ abiding
    disagreement about whether slip-and-fall claims at a medical facility constitute
    health care liability claims. Compare Methodist Healthcare Sys. v. Dewey, 
    423 S.W.3d 516
    , 520 (Tex. App.—San Antonio 2014, pet filed.) (concluding patient
    visitor’s claim that hospital’s electronic doors malfunctioned and caused him to
    fall and break his hip was straightforward premises-liability claim and not health
    care claim because it was “completely untethered from health care”), and
    Weatherford Tex. Hosp. Co. v. Smart, 
    423 S.W.3d 462
    , 467–68 (Tex. App.—Fort
    Worth 2014, pet. filed) (holding hospital patient visitor claim that he slipped and
    fell on puddle in lobby not health care claim because “gravamen of Smart’s claim
    [was] a slip-and-fall, implicating the question of whether there should be a
    difference between a safety claim occurring in the lobby of a department store,
    bakery, or lawyer’s office and a safety claim occurring in the lobby of a health
    care provider when health care services are not involved” and “totally unrelated to
    the provision of health care services.”), with Mem’l Hermann Hosp. Sys. v.
    Galvan, No. 14–13–00120–CV, 
    2014 WL 295166
    , at *10 (Tex. App.—Houston
    [14th Dist.] Jan. 28, 2014, no pet. h.) (holding that premises liability claim by
    hospital visitor arising from slip and fall on water coming from men’s restroom
    constituted health care liability claim because, under Williams, claims based on
    alleged departure from accepted safety standards for protection from danger, harm,
    or loss are sufficient to constitute health care liability claim and departure need not
    be directly or indirectly related to health care), and Ross, 
    2013 WL 1136613
    , at *1
    (holding slip-and-fall premises claim by patient visitor constituted health care
    liability claim because under Williams, “a connection between the act or omission
    and health care is unnecessary” and “[a]n allegation pertaining to safety, standing
    alone and broadly defined, is sufficient.”). These cases demonstrate that claims
    arising from a slip-and-fall at a hospital may or may not be treated as a health care
    liability claim. Yet the right to pursue that result is clear, as it was pre-Williams.
    The test for being a “known legal right” cannot be whether a motion will succeed,
    but whether a motion would be groundless. Cf. Tex. Disciplinary Rules Prof’l
    15
    Memorial Hermann could have argued—as the health care provider did in
    Williams—that health care liability claims include any claims of departure from
    safety standards, including claims brought by a non-patient. See 
    Williams, 371 S.W.3d at 186
    .9
    Memorial Hermann’s initial motion to dismiss would not have been legally
    groundless even after Hayden amended her petition. A court is not bound by the
    legal theories in a plaintiff’s pleadings in determining whether a claim is a health
    care liability claim. Harris Methodist Fort Worth v. Ollie, 
    342 S.W.3d 525
    , 527
    (Tex. 2011). The “focus in determining whether claims come under the TMLA is
    not the status of the claimant, but the gravamen of the claim or claims against the
    health care provider.” 
    Williams, 371 S.W.3d at 178
    . The focus is “on the facts
    underlying the claim, not the form of, or artfully-phrased language in, the
    plaintiff’s pleadings describing the facts or legal theories asserted.” Loaisiga v.
    Conduct R. 3.01, cmt. 1, reprinted in TEX. GOV’T CODE ANN., tit. 2, subtit. G, app.
    A (West 2013) (Tex. State Bar R. art. X, § 9) (noting that “the law is not always
    clear and never is static. Accordingly, in determining the scope of advocacy,
    account must be taken of the law’s ambiguities and potential for change.”).
    Otherwise, Memorial Hermann could continue to not pursue a motion to dismiss
    even after Williams given the current split in case law.
    9
    The health care provider in Williams was not alone in believing that the TMLA
    might reach premises liability claims that did not directly involve patient care. See
    Paula Sweeney, Medical Malpractice in Texas, 2010, State Bar of Tex. Prof. Dev.
    Program, Advanced Medical Malpractice Course, 130–31 (2010) (asserting “that
    virtually all conduct occurring on the premises of a health care provider, or
    involving health care defendants, equates to health care” and observing that “[a]
    host of attempts to evade 4590i have failed.”).
    16
    Cerda, 
    379 S.W.3d 248
    , 255 (Tex. 2012) (citing Yamada v. Friend, 
    335 S.W.3d 192
    , 196–97 (Tex. 2010)) (emphasis added); see 
    Diversicare, 185 S.W.3d at 847
    ,
    854.
    Hayden did not allege that she fell while walking through a waiting room or
    a common area. The “gravamen” of her claim is different than a slip-and-fall
    “occurring in the lobby of a department store, bakery, or lawyer’s office,” and is
    different than a “safety claim occurring in the lobby of a health care provider when
    health care services are not involved.” Weatherford Tex. Hosp. Co. v. Smart, 
    423 S.W.3d 462
    , 467 (Tex. App.—Fort Worth 2014, pet. filed) (construing Williams).
    Hayden fell while attempting to physically assist a “violently ill” and “very weak”
    patient to a bathroom while he was undergoing health care treatment in the
    emergency room of a hospital. She even alleged that the hospital failed to “provide
    adequate staffing resources” to ensure a safe environment—a not uncommon
    medical malpractice claim. Hayden’s allegations asserted a causal link between
    Hayden’s injury and the level of competence of the hospital staff, implying that
    understaffing compromised her safety while visiting the hospital. See, e.g.,
    
    Diversicare, 185 S.W.3d at 845
    (concluding that complaint, among others, that
    health care provider failed “to budget for, hire, and train a sufficient number of
    qualified direct health care staff” was health care claim). These assertions are not
    17
    “totally unrelated to the provision of health care services.” 
    Weatherford, 423 S.W.3d at 468
    .
    The legislative history of chapter 74 and related caselaw further support the
    conclusion that a motion to dismiss Hayden’s claims would not have been
    groundless before Williams. Article 4590i, the predecessor statute of Texas Civil
    Practice and Remedies Code Chapter 74, defined a health care liability claim as a
    “cause of action against a health care provider or physician for treatment, lack of
    treatment, or other claimed departure from accepted standards of medical care or
    health care or safety which proximately results in injury or death of the
    patient . . . .” Act of May 5, 1995, 74th Leg., R.S., ch. 140, § 1, sec. 13.01(d), (e),
    1995 TEX. GEN. LAWS 985, 986, repealed by Act of June 2, 2003, 78th Leg., R. S.,
    ch. 204, § 10.09, 2003 TEX. GEN. LAWS 847, 884. Under article 4590i, the term
    “safety” was not defined, but the claim had to stem from injury or death to a
    patient. See 
    id. § 1.03;
    see also 
    Diversicare, 185 S.W.3d at 855
    (noting statute did
    not define “safety”).
    In 2003, when article 4590i section 1.03 was recodified as Civil Practice and
    Remedies Code section 74.001, the Legislature defined a health care liability claim
    as a claim against a health care provider for “treatment, lack of treatment, or other
    claimed departure from accepted standards of medical care, or health care, or
    safety or professional or administrative services directly related to health care,
    18
    which proximately results in injury to or death of a claimant, whether the
    claimant’s claim or cause of action sounds in tort or contract.” TEX. CIV. PRAC. &
    REM. CODE ANN. § 74.001(a)(13) (West Supp. 2013) (emphasis added). The term
    “safety” remained undefined, but the statute was broadened to include injury to a
    “claimant.” See 
    id. The term
    “claimant” is defined as “a person” who seeks
    recovery or damages in a health care liability claim. See 
    id. § 74.001
    (a)(2) (West
    Supp. 2013).
    Two years later, the Texas Supreme Court explained in Diversicare that
    former article 4590i “did not define” the term “safety,” as it related to the
    definition of a health care liability claim, and the Court applied the “commonly
    understood meaning of safety” as “the condition of being ‘untouched by danger . . .
    harm or loss.’” 
    Diversicare, 185 S.W.3d at 855
    (citing BLACK’S LAW DICTIONARY
    1336 (6th ed. 1990)). The Court recognized that the “Legislature’s inclusion within
    the scope of [4590i] claims based on breaches of accepted standards of safety
    expand[ed] the scope of the statute beyond what it would be if it only covered
    medical and health care.” 
    Id. Diversicare was
    decided seven years before Williams.
    In Williams, the Court noted that the term “safety” remained undefined in
    section 74.001, and, accordingly, applied the definition used in Diversicare.
    
    Williams, 371 S.W.3d at 183
    –84 (citing 
    Diversicare, 185 S.W.3d at 855
    (applying
    the “commonly understood meaning of safety” as “the condition of being
    19
    ‘untouched by danger . . . harm or loss.’”)). The Williams Court again recognized
    that the Legislature’s “inclusion of safety ‘expanded the scope of the statute
    beyond what it would be if it only covered medical and health care.’” 
    Id. at 184.
    It
    also held that “the safety component of [health care liability claims] need not be
    directly related to the provision of health care . . . .” 
    Id. at 186.
    Additionally, the
    plaintiff’s status as an injured employee, instead of a patient, did not determine the
    nature of the claim. 
    Id. at 188–89.
    Under Williams, the focus shifted to whether the
    hospital’s alleged misconduct involved a departure from accepted standards of
    safety. 
    Id. at 179,
    185.
    Based on Diversicare, the text of chapter 74, and Hayden’s claim of
    inadequate staffing resources to ensure a safe environment, a motion to dismiss
    that contended that Hayden’s claim was a health care liability claim because it was
    “for . . . [a] claimed departure from accepted standards of . . . safety . . . which
    proximately results in injury to . . . a claimant” would not have been groundless
    before Williams. TEX. CIV. PRAC. & REM. CODE ANN. § 74.001(a)(13) (stating
    elements of health care liability claim).
    Notably, in its briefing to the trial court in support of its second motion to
    dismiss, Memorial Hermann likened Hayden’s claims to Omaha Healthcare
    Center v. Johnson, 
    344 S.W.3d 392
    , 394 (Tex. 2011), which was issued the year
    before Williams. In Omaha, a nursing home patient was bitten by a spider while at
    20
    the nursing home and died. The patient’s family brought a premises liability claim,
    alleging that the nursing home had failed to maintain its premises in a safe
    condition. Memorial Hermann explained that the Omaha court found the plaintiff’s
    claim was “directly related to health care” and “fell within the statutory definition
    of a health care liability claim.” 
    Id. at 395
    (emphasis added). In its briefing,
    Memorial Hermann likewise asserted, “[L]ike Ms. Hayden in this case, the claim
    [in Omaha] was brought as a premises liability claim against the facility for failing
    to keep the facility safe.” Memorial Hermann’s reliance on the Omaha case one
    year before it set its own motion to dismiss for hearing further supports the
    conclusion that Memorial Hermann had a known right to seek dismissal.
    Further, a plaintiff cannot recast a health care liability claim as another cause
    of action to avoid the statute. Yamada v. Friend, 
    335 S.W.3d 192
    , 196 (Tex. 2010).
    Nevertheless, Memorial Hermann passed on the hearing on its motion to dismiss
    and instead sought final judgment by filing a summary judgment motion, in which
    it contended that Hayden had “recast the case as a premises liability lawsuit.” The
    same argument would have supported its pending motion to dismiss.
    We conclude that, even after Hayden amended her petition, Memorial
    Hermann could have pursued its motion to dismiss and that the pleading would not
    have been groundless before Williams. Accordingly, we hold that, before Williams,
    Memorial Hermann had a known right to seek dismissal.
    21
    C.    Conduct inconsistent with the right to seek dismissal
    Because Memorial Hermann had a known right to seek dismissal, we turn to
    consider whether its conduct demonstrated that it waived that right. Memorial
    Hermann argues that it did not engage in conduct inconsistent with a known right.
    And we recognize that engaging in pretrial preparation, including conducting
    discovery, by itself does not constitute waiver. See Crosstex Energy, 
    2014 WL 1258307
    , at *9 (citing 
    Jernigan, 111 S.W.3d at 157
    ) (holding that propounding
    11,000 pages of discovery and filing answer “inconsequential” in determining
    whether engagement of judicial process constitutes intent to waive rights). Hayden,
    however, contends that Memorial Hermann did not just participate in the litigation
    process, but it conducted itself in a manner inconsistent with pursuing dismissal
    under section 74.351(b).
    Before Memorial Hermann filed its second motion to dismissal for a failure
    to file an expert report, the parties actively engaged in extensive trial preparations.
    According to the parties’ stipulation, Memorial Hermann moved for summary
    judgment (which was denied); “propounded multiple sets of written discovery to
    [Hayden]”; participated “in ten fact and expert witness depositions” (the majority
    of which Memorial Hermann initiated); moved for a trial setting in February 2012;
    submitted trial preparation documents, including briefs, a jury charge, motion in
    limine, facts witness lists, and exhibit lists; and announced ready for trial on two
    22
    occasions. Hayden argues these facts, along with Memorial Hermann’s decision to
    “abandon” its original motion to dismiss, demonstrate conduct inconsistent with
    the right to seek dismissal and, therefore, resulted in waiver.
    In Jernigan, the court of appeals found waiver of the right to dismissal based
    on the health care provider’s (1) waiting 646 days after the lawsuit was filed, (2)
    undertaking discovery, (3) filing a motion for summary judgment based on
    charitable immunity, and (4) filing an amended answer that deleted language in the
    original answer specifically referencing a failure to satisfy statutory prerequisites.
    Langley v. Jernigan, 
    76 S.W.3d 752
    , 756–57 (Tex. App.—Waco 2002), rev’d, 
    111 S.W.3d 153
    (Tex. 2003). The Supreme Court found this conduct insufficient to
    constitute waiver. 
    Jernigan, 111 S.W.3d at 156
    –57. The Court reasoned that
    “attempting to learn more about the case” by requesting documents and submitting
    interrogatories is not inconsistent with moving for dismissal for failure to meet the
    expert-report requirement and observed that most of the discovery was conducted
    by the plaintiff. 
    Id. at 157;
    see Crosstex Energy, 
    2014 WL 1258307
    , at *8–9
    (applying same standard of waiver). Moving for summary judgment on other
    grounds also did not waive the right to dismissal under section 74.351. 
    Jernigan, 111 S.W.3d at 157
    ; see also Seifert v. Price, No. 05–08–00655–CV, 
    2008 WL 5341045
    , at *2 (Tex. App.—Dallas, Dec. 23, 2008, pet. denied) (mem. op.).
    “Waiver is largely a matter of intent.” 
    Jernigan, 111 S.W.3d at 156
    ; see also
    23
    Crosstex Energy, 
    2014 WL 1258307
    , at *8 (same). And the totality of the
    circumstances in Jernigan did not “clearly demonstrate” an intent to not claim a
    known right. 
    Jernigan, 111 S.W.3d at 156
    –57; see also Motor Vehicle Bd. of Tex.
    Dept. of Transp. v. El Paso Indep. Auto. Dealers Ass’n, Inc., 
    1 S.W.3d 108
    , 111
    (Tex. 1999).
    Hayden argues that the facts here are stronger than Jernigan and likens
    Memorial Hermann’s conduct to that of the defendant health care provider in In re
    Sheppard, 
    197 S.W.3d 798
    (Tex. App.—El Paso 2006, orig. proceeding). In
    Sheppard, the court of appeals held that “extensive participation in discovery”
    along with a delay of 1,183 days were sufficient, without more, to demonstrate that
    the defendant had waived the right to seek dismissal for failure to meet the expert-
    report 
    requirement. 197 S.W.3d at 801
    –02. The defendant sent discovery requests
    after receiving the plaintiff’s expert report, designated its own experts, deposed the
    plaintiff and her experts, allowed the plaintiff to depose its experts, and announced
    ready for trial.10 
    Id. at 801–02.
    The court distinguished Jernigan on the ground that
    this discovery involved “far more” than learning about the case and was not
    initiated solely by the plaintiff. 
    Id. at 802.
    Under the totality of the circumstances
    10
    The opinion does not indicate whether a hearing was held on the motion to
    dismiss. It only states that the defendant health care provider permitted its experts
    to be deposed after it had filed its motion to dismiss and before the trial court
    granted the motion. See In re Sheppard, 
    197 S.W.3d 798
    , 801–2 (Tex. App.—El
    Paso 2006, orig. proceeding).
    24
    of that case—where discovery had been completed and the defendant had
    announced ready for trial—the health care provider had engaged in conduct
    “inconsistent with an intent to rely upon the right to seek dismissal.” Id.; see also
    Apodaca v. Miller, 
    281 S.W.3d 123
    , 127 (Tex. App.—El Paso 2008, no pet.)
    (noting that implicit waiver is only inferred by Texas courts in extreme
    circumstances, and identifying announcement of ready for trial as one of those
    circumstances); cf. Martinez v. Lakshmikanth, 
    1 S.W.3d 144
    , 148–49 (Tex. App.—
    Corpus Christi 1999, pet. denied) (analyzing waiver under section 74 predecessor
    statute, holding waiver of right to dismissal may be implied when health care
    provider defendant delays moving for dismissal until after case is disposed of on
    other grounds).
    The totality of the circumstances in this case is stronger than those in
    Sheppard. First, Memorial Hermann not only conducted most of the discovery—it
    completed its discovery. But more importantly, Memorial Hermann announced that
    it was ready for trial twice before pursuing its motion to dismiss, and it did not
    move to dismiss the case again until “four days prior to the trial court actually
    calling the case to trial.” Memorial Hermann had filed a motion to dismiss 22
    months earlier and intentionally did not pursue it. Effectively, Memorial Hermann
    strategically decided not to pursue its initial motion; instead, it attempted to obtain
    a final judgment through other means. Cf. Spinks v. Brown, 
    211 S.W.3d 374
    , 379
    25
    (Tex. App.—San Antonio 2006, no pet.) (holding health care provider waived
    rights by “strategic[ally]” choosing not to pursue motion to dismiss).
    Viewing the totality of the circumstances, we conclude that the trial court
    did not err in denying “on the ground of waiver” Memorial’s motion to dismiss
    Hayden’s health care liability claim for failure to file an expert report. See
    
    Jernigan, 111 S.W.3d at 156
    (holding intent must be discerned by reviewing “the
    surrounding facts and circumstances”); see also Perry 
    Homes, 258 S.W.3d at 591
    (stating that “courts should look at the totality of the circumstances” in determining
    whether there is waiver); cf. Murphy v. Gutierrez, 
    374 S.W.3d 627
    , 633, 635 (Tex.
    App.—Fort Worth 2012, no. pet.) (stating that, in analyzing whether defendant
    waives right to dismissal for failure to file expert reports for claims against
    architects and similar professional engineers, court should examine totality of
    circumstances).
    Accordingly, we overrule Memorial Hermann’s sole issue.
    Conclusion
    We affirm the trial court’s interlocutory order.
    Harvey Brown
    Justice
    Panel consists of Justices Jennings, Sharp, and Brown.
    26