Leibman v. Waldroup (Tex. 2025): When Physician Conduct Falls Outside “Health Care Liability Claims” Under the Texas Medical Liability Act

I. Introduction

In Maurice N. Leibman, M.D. v. Cleveratta & James Waldroup, the Supreme Court of Texas addressed whether a lawsuit against a physician, arising from letters he wrote about his patient’s “service animals,” qualifies as a “health care liability claim” (HCLC) under the Texas Medical Liability Act (TMLA), Chapter 74 of the Civil Practice and Remedies Code.

The case arises from a tragic incident in which a three-year-old child, R.W., was severely injured when a dog—wearing a “Service Animal” vest—attacked her in a restaurant. The child’s parents sued multiple defendants, including the restaurant, the dog’s owner, and the dog owner’s former gynecologist, Dr. Maurice Leibman. They alleged that Dr. Leibman negligently or fraudulently issued letters that allowed his patient to present the dog, Kingston, as a “service animal,” without taking steps to determine whether the dog was actually trained and safe in public.

The core legal question before the Court was not whether the parents could ultimately prove negligence against the doctor, but whether their lawsuit was procedurally barred because they did not timely serve an expert report under the TMLA. That depends on whether their claims are HCLCs, which triggers the expert-report requirement. The Court held that the claims against Dr. Leibman are not HCLCs and therefore do not require a Chapter 74 expert report.

The opinion, authored by Justice Busby and joined by four Justices (with four dissenting), significantly clarifies the scope of the TMLA in two respects:

• It narrows the reach of Chapter 74 by emphasizing that the statute covers only departures from applicable standards of medical care—not every action a physician happens to take while someone is their patient.
• It refines the so-called “presumption” that claims against physicians arising during the course of patient care are HCLCs, especially in cases brought by non-patients.

The decision also contains an important discussion of standing—particularly the “traceability” element—highlighting how little plaintiffs must allege at the pleading stage for their injuries to be fairly traceable to a defendant’s conduct.

II. Summary of the Opinion

A. Facts and Procedural Posture

Three-year-old R.W. and her parents entered the Loose Caboose restaurant in Spring, Texas. There, they encountered Kingston, a dog owned by Jennifer Romano and wearing a “Service Animal” vest. The pleadings allege that Kingston attacked R.W. without provocation, biting her cheek and causing severe injuries.

The Waldroups sued:

• Jennifer Romano (the dog’s owner) and her companion,
• The restaurant owner, and
• Dr. Maurice Leibman, Romano’s former gynecologist.

As to Dr. Leibman, the petition alleges that he wrote multiple letters stating that Romano’s “service animals” helped manage her generalized anxiety disorder and that she needs Kingston to perform daily tasks and control her anxiety. The letters also described Kingston as “certified to be with her.” The parents did not challenge:

• Romano’s diagnosis of generalized anxiety disorder, or
• The therapeutic benefit she derived from having service animals.

Instead, they alleged that:

• Leibman took no steps to determine whether Kingston was actually a trained service animal with appropriate public behavior;
• His letters enabled Romano to present Kingston as a “service animal” to the public; and
• These misrepresentations proximately caused, aided and abetted, or contributed to R.W.’s injuries.

After some discovery, Dr. Leibman moved to dismiss under TMLA section 74.351, arguing that the claims were HCLCs and must be dismissed because no medical expert report was served within the statutory deadline. The trial court denied the motion; the court of appeals affirmed, holding that the claims did not challenge diagnosis or treatment and thus were not HCLCs. The Supreme Court of Texas granted review.

B. Issues Presented

1. Whether the Waldroups had standing to sue Dr. Leibman—specifically, whether their child’s injuries were sufficiently “fairly traceable” to his conduct in writing the letters.
2. Whether the claims against Dr. Leibman constitute health care liability claims under the TMLA, thereby requiring the service of a medical expert report under section 74.351.

C. Holdings

1. Standing: The Court (narrowly) held that the parents have standing. At the pleading stage, their allegations allow a reasonable inference that Leibman’s letters emboldened Romano to present Kingston as a service animal in public places, including the restaurant, thereby contributing to the risk that led to R.W.’s injuries.
2. Health Care Liability Claim: The Court held that the claims are not HCLCs because:
   • The alleged wrongdoing—a failure to ascertain a dog’s training and temperament toward third parties—is not a departure from an applicable standard of medical care.
   • No medical expert testimony is needed to prove the alleged breach or causation; opinions about a dog’s public behavior and training belong to veterinarians or dog trainers, not physicians.
   • The Loaisiga “presumption” that claims against a physician during the course of patient care are HCLCs does not apply—or is rebutted—on these facts, particularly given that the plaintiffs are not the doctor’s patient.

The Court therefore affirmed the court of appeals’ judgment and remanded the case to the trial court for further proceedings on the merits, unencumbered by Chapter 74’s expert-report requirement.

III. Detailed Analysis

A. Standing: Traceability at the Pleading Stage

1. General standing framework

Texas standing doctrine, paralleling federal law, requires:

• a concrete injury in fact;
• that is fairly traceable to the defendant’s conduct; and
• that is likely to be redressed by a favorable court decision.

The Court cites Heckman v. Williamson County, 369 S.W.3d 137 (Tex. 2012), which in turn draws on Lujan v. Defenders of Wildlife, 504 U.S. 555 (1992). Standing is jurisdictional and must exist in every civil case, including private tort suits (USAA v. Letot; Linegar; DaimlerChrysler v. Inman; Douglas v. Delp).

Here:

• Injury-in-fact is straightforward: a child’s severe bodily injury from a dog attack is classic compensable harm.
• Redressability is likewise clear: money damages can redress that harm.
• Traceability is the contested and “close” question.

2. The “traceability” problem

The alleged causal chain between Leibman’s letters and the dog attack is attenuated:

• The letters were written a year or more before the incident.
• They were initially requested to help avoid eviction from an apartment, not to access restaurants.
• The pleadings do not allege that Romano presented the letters to the restaurant staff or that staff asked for or relied on them.
• The parents affirmatively allege that the restaurant made no attempt to verify Kingston’s service-animal status.

Moreover, the parents disclaim any challenge to the accuracy of the medical diagnosis or to Leibman’s professional opinion that a service animal could help treat Romano’s anxiety. They instead target his failure to ensure that Kingston was in fact a trained service animal safe in public.

3. Why the Court still finds traceability

The Court emphasizes a procedural point: at the pleading stage, plaintiffs are not required to prove causation—only to allege facts from which causation can be reasonably inferred. Standing’s “traceability” requirement is less demanding than proof of proximate cause at trial.

The Court relies on several pleaded facts:

• Texas law generally forbids animals in restaurants except “service animals.”
• Leibman prepared “multiple letters” that “enabled” Romano to present Kingston as a service animal.
• Kingston wore a “Service Dog” vest at the time of the incident.
• Leibman took no steps to ascertain whether Kingston was actually a trained service animal.

The core inference the Court draws is that the letters:

“emboldened Romano to take greater risks with Kingston, and that without the letters she would have been less likely to bring Kingston into public spaces like the restaurant.”

Whether that is ultimately correct is a merits question; for standing, it is enough that the allegation is plausible and non-speculative. The Court also notes that Leibman himself, in the trial court, understood the theory this way—saying that, under the plaintiffs’ theory, Romano “could not and/or would not have gotten a service dog vest [and taken Kingston to the restaurant] but for” his letters. That understanding is not a jurisdictional concession but confirms that the plaintiffs’ allegations are not implausible or fanciful.

4. Distinguishing standing from merits causation

The majority is careful to separate:

• Traceability: a jurisdictional, threshold inquiry satisfied by reasonable allegations of a causal connection; and
• Proximate cause: a merits question to be proven (or disproven) with evidence at later stages.

The Court expressly disclaims any view on whether the plaintiffs can ultimately prove the causal link between the letters and the attack. It holds only that they have alleged enough to get into court.

B. The Texas Medical Liability Act and the Definition of an HCLC

1. Statutory framework

The TMLA (Chapter 74) was enacted to reduce the “frequency and severity” of medical malpractice claims while preserving meritorious ones, by:

• Defining “health care liability claims” (HCLCs), and
• Imposing procedural hurdles on such claims, especially a pre-suit or early-suit expert-report requirement (section 74.351).

A claim qualifying as an HCLC is subject to dismissal with prejudice if the claimant fails to timely serve an adequate expert report addressing:

• the applicable standard of care,
• how the defendant failed to meet that standard, and
• how that failure caused injury.

The relevant statutory provision here is the definition of an HCLC against a physician:

A “health care liability claim” means a cause of action against a physician or health care provider for treatment, lack of treatment, or other claimed departure from accepted standards of medical care … which proximately results in injury to or death of a claimant. (Tex. Civ. Prac. & Rem. Code § 74.001(a)(13), emphasis added.)

“Medical care” is further defined as:

any act of diagnosis, care, or treatment of a physical or mental condition … performed or furnished by a physician for, to, or on behalf of a patient during the patient’s care or treatment. (§ 74.001(a)(19); cf. Tex. Occ. Code § 151.002(a)(13))

The key statutory phrase, repeatedly emphasized in the opinion, is that the claim must involve a “claimed departure from accepted standards of medical care” that are “applicable” to the context of the alleged wrong.

2. The “expert testimony” test

Texas cases have developed a functional test: if expert medical or health-care testimony is needed to prove or refute:

• the applicable standard of care,
• a breach of that standard, or
• causation,

then the claim is an HCLC. See:

• Texas West Oaks Hospital, LP v. Williams, 371 S.W.3d 171, 182 (Tex. 2012).
• Bioderm Skin Care, LLC v. Sok, 426 S.W.3d 753, 760 (Tex. 2014).
• Lake Jackson Med. Spa, Ltd. v. Gaytan, 640 S.W.3d 830, 844 (Tex. 2022).
• Collin Creek Assisted Living Ctr., Inc. v. Faber, 671 S.W.3d 879, 885–86 (Tex. 2023).

Conversely, if no medical expert testimony is necessary, courts then look to the “totality of the circumstances” to decide whether the claim is nonetheless functionally bound up with health care.

C. Applying the TMLA: Why the Claims Are Not HCLCs

1. Identifying the “operative facts” and the “operative breach”

Texas courts are directed to look past labels (“negligence” vs. “medical malpractice”) and focus on the “operative facts underlying the claim that are relevant to the alleged injury.” (Collin Creek, 671 S.W.3d at 885–86.)

The Court carefully parses what the parents are not alleging:

• No claim that diagnosing Romano with generalized anxiety disorder was negligent.
• No claim that recommending or recognizing the therapeutic benefits of a “service animal” for her anxiety was negligent.
• No claim that Kingston did not help manage Romano’s anxiety.
• No claim that Kingston was “uncertified” as a service animal; the record indicates Romano obtained a credential from “USA Service Dog,” and nothing suggests otherwise.

Instead, the “operative breach” alleged is:

• By calling Kingston a “service animal” and describing him as “certified to be with” Romano, Leibman implied that Kingston had been appropriately trained to behave safely in public and around third parties; and
• He made that implied representation without taking any steps to confirm the dog’s temperament or training.

Put differently, the parents’ grievance is about a non-medical representation about an animal’s public behavior and training, and a failure to investigate that animal’s fitness for public access.

2. Are there “applicable standards of medical care”?

The threshold question is whether there exists any medical standard of care that governs:

• a physician’s assessment of a dog’s behavioral training for public spaces, or
• representations about a dog’s temperament toward third parties.

The Court’s answer is “no.” Several key points support this:

• The statutory definition of “medical care” covers acts of diagnosis or treatment of diseases or disorders of a patient. Evaluating a dog’s temperament toward strangers is not diagnosing or treating a human disorder.
• While a physician may, as part of care, opine that an animal helps a patient’s anxiety (and that would be medical), the alleged failure here concerns the dog’s training and public behavior, not its therapeutic effect on the patient.
• The Court observes that expertise about a dog’s general temperament belongs to veterinarians and dog trainers, not to physicians—underscoring that this is not a subject governed by “accepted standards of medical care.”

Because there is no applicable medical standard of care regarding the topic in dispute, an HCLC—by definition—cannot arise. And no medical expert report could legitimately address a “medical” standard where none exists.

3. No need for medical expert testimony

Consistent with Bioderm and Williams, the Court asks whether a medical expert is needed to establish:

• how a reasonable physician should investigate or opine about a dog’s training and public behavior; and
• whether Leibman fell below such a standard.

It concludes that no medical expert is required. Any testimony about:

• what constitutes a properly trained “service animal,”
• how dogs with certain temperaments tend to behave in public, or
• what a reasonable person must do before vouching for a dog’s behavior,

would come from lay witnesses, dog trainers, or veterinarians—not from gynecologists. Therefore, the expert-report requirement, which is designed to screen out meritless medical claims, has no role here.

4. The Loaisiga “presumption” and why it does not control here

In Loaisiga v. Cerda, 379 S.W.3d 248 (Tex. 2012), the Court said that the TMLA:

“essentially creates a presumption that a claim is an HCLC if it is against a physician or health care provider and is based on facts implicating the defendant’s conduct during the course of a patient’s care.”

This language has often been treated as a strong tilt toward finding HCLC status whenever a physician is sued for conduct occurring while someone is their patient. The dissent in Leibman relies heavily on this, arguing the claims here are HCLCs.

The majority significantly narrows the force of this “presumption”:

• It notes that the statutory text itself contains no formal presumption; Loaisiga’s language was descriptive, not a binding rule of evidence.
• Loaisiga dealt with claims by the patient against the physician; this case involves third-party plaintiffs (the Waldroups) who have no physician–patient relationship with Leibman.
• The presumption logically rests on the idea that most interactions between a doctor and patient “during the course” of care are indeed medical care. But when a doctor’s action relates primarily to third-party harms (here, a dog attack on a restaurant patron), that reasoning weakens.

Crucially, the Court reads “during the course of a patient’s care” as referring to acts that are actually part of diagnosis or treatment—not any act that happens to coincide in time with a physician–patient relationship. The letters in this case:

• were requested primarily to avoid eviction, not to secure medications or clinical interventions;
• were not written in a treatment facility or as part of a treatment protocol; and
• concerned Romano’s status for housing or public-access purposes, not a medical intervention.

On that view, the letters were not actions “during the course” of care in the statutory sense, even if they were written while Romano was a patient.

The Court therefore holds that:

• The Loaisiga presumption does not apply here; or
• If it did, it is rebutted by the record, because:
  • the parents explicitly disclaim any challenge to diagnosis or treatment; and
  • nothing shows the letters were part of medical diagnosis or treatment.

5. Inseparability and “claim splicing”

The Court has previously held that plaintiffs cannot “slice” or “relabel” claims that are functionally about medical negligence to avoid Chapter 74. If a claim is inseparable from a physician’s medical care, it is an HCLC regardless of label. See, for example, Lake Jackson Med. Spa v. Gaytan and other decisions discussed there.

The dissent argues the Waldroups’ claims are inseparable from Romano’s medical treatment because the letters were part and parcel of how her anxiety was managed. The majority rejects this:

• Inseparability analysis has almost always involved suits by patients alleging substandard care rendered to them—not claims by non-patients about third-party harms.
• Here, the parents are not challenging the medical judgment that animals helped Romano’s anxiety. They only challenge the non-medical aspect: representing Kingston as a fully trained “service animal” without investigating his public behavior.
• Because there is no alleged defect in diagnosis or treatment, there is nothing to splice off as “ordinary negligence”; the entire claim is already about non-medical conduct.

The Court stresses that its holding does not open a loophole for relabeling genuine medical-malpractice claims. Rather, on these facts, there simply is no medical-malpractice claim at all.

6. Contrast with Weems

The Court contrasts this case with Baylor Scott & White Hillcrest Med. Ctr. v. Weems, 575 S.W.3d 357 (Tex. 2019). In Weems, a nurse’s opinions about the cause of her patient’s injuries were at issue, and the Court held that was a departure from accepted standards of professional services directly related to health care—hence, an HCLC.

In Leibman:

• No opinion about the cause of Romano’s injury or her medical condition is at issue.
• No aspect of her medical treatment is alleged to be substandard.
• The wrong alleged concerns only the doctor’s statements and omissions about a third party’s behavior (the dog) toward other third parties (restaurant patrons).

Thus, Weems provides a useful “foil” showing what is, and what is not, sufficiently tied to health care to trigger Chapter 74.

D. Precedents and Their Influence

1. Loaisiga v. Cerda and the “presumption” of HCLC status

Loaisiga involved patients alleging that a physician sexually assaulted them during medical examinations. The Court there formulated a “rebuttable presumption” that when:

• a patient sues a physician, and
• the facts implicate the physician’s conduct during the patient’s care, treatment, or confinement,

the claim is presumed to be an HCLC. The Court in Leibman repositions that language:

• As a practical observation, not a textual mandate;
• As targeted at physician–patient disputes, not necessarily third-party plaintiffs; and
• As limited to conduct that is truly part of the course of care or treatment.

This recalibration curbs the over-extension of Chapter 74 into areas only tangentially related to health care.

2. Texas West Oaks Hospital v. Williams and the expert-testimony criterion

In Williams, the Court emphasized that when medical or health-care expert testimony is necessary to establish the standard of care and breach, the claim is an HCLC. Leibman applies this principle in a negative form: because the alleged wrong here is not governed by a medical standard and does not require a medical expert, the claim falls outside the TMLA.

3. Bioderm, Lake Jackson Med. Spa, and Collin Creek: “operative facts” and totality of circumstances

These cases collectively instruct courts to:

• Look to the operative facts, not labels;
• Ask whether expert medical testimony is necessary; and
• If not, examine the totality of the circumstances, including:
  • whether the claim is inseparable from health care;
  • whether it arises out of a physician–patient relationship; and
  • whether it appears to be an attempt to avoid Chapter 74 by artful pleading.

Leibman follows this methodology and concludes that the totality of the circumstances supports treating the claims as ordinary negligence, not HCLCs.

4. Standing precedents: Heckman, Lujan, and Mosaic Baybrook

The Court applies federal-style standing analysis (traceability, redressability) drawn from Heckman and Lujan, and relies on Mosaic Baybrook One, L.P. v. Simien, 674 S.W.3d 234 (Tex. 2023), which allowed standing where the allegations permitted a reasonable inference that the injury was fairly traceable “in part” to defendants’ actions. That case is used to justify reading the pleadings generously for traceability in Leibman.

E. Impact and Significance

1. Narrowing the scope of the TMLA

The decision has clear practical effects on Texas medical-liability litigation:

• It limits the TMLA’s reach to claims involving a genuine departure from “accepted standards of medical care” that are actually applicable to the alleged wrong.
• Physicians are not automatically cloaked in Chapter 74 protection whenever they are sued; the conduct must be truly “medical.”
• Third-party plaintiffs injured by conduct tangentially related to a doctor–patient relationship (e.g., letters about service animals, certifications for non-medical purposes) may pursue ordinary negligence claims without facing the expert-report hurdle.

2. Guidance for “borderline” physician conduct: letters, certifications, and non-clinical opinions

Many physicians write letters and complete forms for patients that intersect with legal, housing, employment, or public-accommodation contexts—for example:

• letters supporting emotional-support or service animals,
• disability or work-accommodation forms,
• school or military fitness certifications, or
• clearance letters for participation in activities.

Leibman strongly suggests:

• If the alleged negligence concerns the medical substance of such a letter (misdiagnosis, incorrect medical restrictions, unsound therapeutic judgment), the claim will almost certainly be an HCLC, requiring an expert report.
• If the alleged negligence concerns a non-medical aspect—such as certifying something outside the scope of medical expertise (e.g., dog training, building safety, or non-medical legal status)—the claim may fall outside Chapter 74.

This distinction will likely be litigated in future cases, but Leibman provides a clear analytical starting point.

3. Clarifying the role of non-patient plaintiffs

The opinion reinforces that Texas’s HCLC jurisprudence is most robust when applied to claims by patients against their own providers. When non-patients sue a physician based on conduct that incidentally arises from the doctor–patient relationship, courts must:

• Examine whether the alleged wrong is actually part of diagnosis or treatment; and
• Avoid reflexively applying the Loaisiga presumption.

This is particularly important in tort actions where third parties allege injuries “downstream” of medical interactions, like:

• misrepresentation to the public about a patient’s fitness to operate a vehicle or carry a weapon;
• certifications that enable access to certain environments; or
• failure to warn third parties of specific, known dangers.

Leibman indicates that such suits should not automatically be funneled into the TMLA framework.

4. Standing: lowering the pleading bar for traceability

On standing, the decision confirms:

• At the pleading stage, plaintiffs need not spell out a detailed causal chain or allege but-for causation.
• General factual allegations, if plausible, can satisfy traceability even when intervening actors (here, the dog owner and restaurant) play a large role.
• Courts must interpret pleadings in favor of standing when it is not “readily apparent,” and may infer reasonable causal links (Tex. Ass’n of Bus. v. Texas Air Control Board).

This approach makes it less likely that defendants can defeat suits at the threshold by characterizing causation issues as standing defects rather than merits issues.

IV. Simplifying the Key Legal Concepts

A. What is a “health care liability claim”?

A “health care liability claim” (HCLC) is a special type of lawsuit defined by the TMLA. To be an HCLC, a claim must:

1. Be brought against a physician or health care provider;
2. Be based on conduct in providing (or failing to provide) medical care—that is, diagnosis, treatment, or other accepted medical procedures; and
3. Allege that the defendant’s conduct departed from accepted standards of medical care and proximately caused injury or death.

If a lawsuit is an HCLC, Texas law imposes extra procedural requirements—especially the early expert report.

B. What is the Chapter 74 expert-report requirement?

In any HCLC, the plaintiff must, within a short statutory period after filing suit, serve a report from a qualified medical expert that:

• identifies the applicable standard of medical care,
• explains how the defendant’s conduct failed to meet that standard, and
• explains how that failure caused the plaintiff’s injury.

If the plaintiff does not serve such a report on time, the court must dismiss the case with prejudice and award attorney’s fees to the defendant. This is meant to weed out frivolous medical-malpractice claims early.

The central fight in Leibman is whether the parents’ claim against the doctor is an HCLC at all—because, if it is, the absence of an expert report would be fatal.

C. “Medical care” vs. ordinary negligence

Not every mistake by a doctor is “medical care.” For example, if a doctor:

• rear-ends someone while driving,
• makes a purely business misrepresentation unrelated to treatment, or
• misjudges the behavior of a dog toward strangers,

those acts are ordinarily just that—ordinary negligence (or another tort), not medical malpractice. The law looks at:

• Is the alleged wrong part of diagnosing or treating a patient’s medical condition?
• Does resolving the case require a medical expert to explain what a reasonable doctor should have done?

If the answer to both is “no,” the claim is typically not an HCLC.

D. Standing and “traceability” in plain terms

“Standing” is about whether the plaintiff is the right person to bring a lawsuit in court. Among other things, the plaintiff must show that:

• They were actually harmed;
• The harm is not too speculative; and
• The harm is reasonably connected to what the defendant did or failed to do.

“Traceability” does not require the plaintiff to prove, at the beginning of the case, that the defendant definitely caused the harm. Instead, at the pleading stage, the plaintiff must allege facts that make it reasonable to say: “What you did was part of why this happened.”

In Leibman, the Court says: while it is not clear that the doctor’s letters truly caused the dog attack, the parents have alleged enough that it is at least reasonable to trace some part of the harm back to those letters. Whether they can ultimately prove that link is a question for later stages of litigation.

E. “Inseparability” and “claim splicing”

Plaintiffs sometimes try to avoid Chapter 74’s strict requirements by describing their claims in non-medical terms (e.g., “negligent hiring,” “ordinary negligence”) even though the core complaint is about medical treatment. Texas courts respond with the “inseparability” doctrine:

• If the alleged wrong is inseparable from the medical care—meaning, you can’t realistically talk about it without addressing how the defendant diagnosed or treated the patient—then it is an HCLC, no matter how it is labeled.
• Courts will not allow “claim splicing” where a medical-malpractice theory is chopped into ordinary negligence pieces to dodge Chapter 74.

In Leibman, by contrast, the Court concludes there is no medical-malpractice core at all—only a non-medical allegation about a dog’s training and public behavior—so inseparability and claim-splicing concepts do not apply.

V. Conclusion

Maurice N. Leibman, M.D. v. Waldroup is a significant decision in Texas medical-liability jurisprudence. It holds that:

• The TMLA’s expert-report requirement does not apply to claims against a physician that do not involve a departure from applicable standards of medical care.
• Representations concerning a patient’s dog’s training and public temperament, without more, are not “medical care” under the statute.
• The Loaisiga “presumption” that claims against physicians arising from conduct during patient care are HCLCs is limited, particularly in suits brought by non-patients, and may be rebutted by showing that the alleged wrong is non-medical.
• Standing’s “traceability” requirement is modest at the pleading stage; plaintiffs need only allege facts that permit a reasonable inference that the defendant’s conduct contributed in a non-speculative way to their injury.

The case marks an important check on the expansion of the TMLA. It ensures that Chapter 74’s powerful procedural protections for health care providers remain tethered to genuine medical-malpractice allegations. Physicians remain protected when they are sued over their medical diagnoses and treatments, but they do not gain automatic immunity from ordinary tort principles for non-medical statements or actions—especially where no medical standard of care governs the conduct at issue.

Going forward, courts and litigants will likely rely on Leibman when evaluating whether physician conduct at the margins—letters, certifications, or other non-clinical assistance—falls inside or outside the TMLA. The decision thereby preserves the statute’s core purpose of screening out weak medical-malpractice suits, while preventing it from becoming a blanket shield for every aspect of a physician’s interactions that happen to arise in the context of a doctor–patient relationship.