Texas Medical-Liability Limitations: For Relationship-Based Counseling, § 74.251(a) Runs from the End of the Counselor–Patient Relationship

Introduction

In Soren Aldaco v. Barbara Rose Wood and Three Oaks Counseling Group, LLC d/b/a Thriveworks, No. 24-1069 (Tex. June 26, 2026), the Supreme Court of Texas addressed a recurrent but difficult limitations problem under the Texas Medical Liability Act (TMLA): when the alleged negligence is not a single, readily timestamped medical act, but rather unfolds through a counseling relationship and a course of treatment.

The petitioner, Soren Aldaco, sued her counselor, Barbara Rose Wood, and Wood’s practice entity (Thriveworks). A central issue was timeliness under Texas Civil Practice and Remedies Code § 74.251(a). The court of appeals had treated a later surgery as “the core of Aldaco’s allegations” and measured limitations accordingly (727 S.W.3d 213, 220 (Tex. App.—Fort Worth 2024)). Justice Young, joined by Justice Bland, concurred to emphasize that the Court’s actual holding (Part II.A) is narrow and grounded in existing precedent, while cautioning against the alternative rationale discussed in Part II.B (which he notes is not part of the Court’s opinion).

Summary of the Opinion (as addressed in the Concurrence)

Justice Young agrees with the Court’s Part II.A conclusion: Aldaco’s claim was timely because, on these allegations, limitations is measured from the end of the counselor–patient relationship (i.e., the completion of the course of treatment), not from the date of the eventual surgery.

He characterizes the judgment’s basis as “narrow,” unlikely to have significant consequences outside comparable relationship-based treatment settings, and suggests that broader policy adjustments—if warranted—should come from the legislature rather than judicial reinterpretation.

Analysis

1) Precedents Cited

Course-of-treatment limitations and the statutory dichotomy

Justice Young situates Part II.A within long-standing limitations doctrine under § 74.251(a) and predecessor statutes, which provide alternative measuring points tied to (i) a discrete “tort”/occurrence and (ii) the completion of a course of treatment or hospitalization. He quotes the Court’s settled explanation that the dichotomy aims “to aid a plaintiff who was injured during a period of hospitalization or a course of medical treatment but has difficulty ascertaining the precise date of the injury.” (Husain v. Khatib, 964 S.W.2d 918, 919 (Tex. 1998) (citing Kimball v. Brothers, 741 S.W.2d 370, 372 (Tex. 1987))).

The concurrence underscores doctrinal continuity: Kimball v. Brothers relied on Morrison v. Chan, 699 S.W.2d 205 (Tex. 1985), which affirmed the court of appeals’ clearer articulation (668 S.W.2d 483, 485 (Tex. App.—Fort Worth 1984)). For Justice Young, these cases are not obstacles to the Court’s result; they are the reason the result is correct.

Discrete-act cases contrasted (but, in Young’s view, ultimately consistent)

Justice Young contrasts Aldaco’s allegations with classic medical-malpractice limitations cases involving a single, objectively identifiable act or omission: a failure to diagnose (Husain v. Khatib, 964 S.W.2d 918, 919 (Tex. 1998)) or a single operation (Shah v. Moss, 67 S.W.3d 836, 839 (Tex. 2001)). He reads these cases as involving a “transaction with an obvious beginning and end” where the negligence date can be “determine[d] objectively and precisely.”

But he resists the suggestion that the Court must “distinguish” this case from those precedents; rather, he views Part II.A as a straightforward application of the completion-of-treatment prong to a different kind of “treatment”—one constituted by a relationship itself. He also notes the Court’s expressed ambivalence about “Shah and its ilk,” but argues those cases “support the completion-of-treatment rationale.”

Stare decisis, statutory interpretation, and legislative acquiescence

Justice Young defends the stability of the Court’s longstanding reading of § 74.251(a), emphasizing stare decisis in statutory construction. He cites Mitschke v. Borromeo, 645 S.W.3d 251, 260 (Tex. 2022) for the proposition that stare decisis “exists to protect wrongly decided cases,” and id. at 265 for the idea that statutory stare decisis has its “greatest force.”

Even if earlier cases were “botched as a textual matter,” he argues, decades of consistency—together with legislative inaction across multiple revisions— counsels against judicial alteration now; any change should come from the legislature.

Part II.B (not the Court’s opinion): injury-based “tort” and the statute of repose

Justice Young sharply questions the Part II.B rationale (which he describes as not part of the Court’s opinion), noting it echoes a concern expressed in the Shah v. Moss dissent: limitations should not begin before an injury occurs (67 S.W.3d at 848 (O’Neill, J., dissenting)).

He warns that if Part II.B’s premise were adopted—i.e., that an act (here, a “letter”) cannot be a “tort” until injury occurs—limitations could be effectively delayed for years depending on when surgery occurs, injecting broad uncertainty into medical-liability exposure.

He also disputes an interpretive move that would treat the 2003 enactment of a statute of repose as changing the meaning of the earlier-enacted word “tort.” He cites authorities rejecting reliance on later enactments to “interpret” older text, including: United States v. Est. of Romani, 523 U.S. 517, 536 (1998) (Scalia, J., concurring in part and in the judgment) (quoting Almendarez-Torres v. United States, 523 U.S. 224, 237 (1998)); Hyundai Motor Co. v. Alvarado, 974 S.W.2d 1, 13 (Tex. 1998) (quoting Russello v. United States, 464 U.S. 16, 26 (1983)); and Rowan Oil Co. v. Tex. Emp. Comm’n, 263 S.W.2d 140, 144 (Tex. 1953).

2) Legal Reasoning

The operative characterization: relationship-as-treatment

The concurrence’s core analytic move is definitional: for “gender-dysphoria counseling,” “no single moment is dispositive,” and “the relationship itself, and not some particular service like an operation or an exam, is what constitutes the treatment.” On that framing, the relevant § 74.251(a) anchor is “completion of treatment”—here, when the counselor–patient relationship ended.

Why the surgery is not the limitations trigger (on these allegations)

Justice Young offers two key conclusions:

  1. The surgery is not the “critical moment” for limitations because Aldaco could have sued based on the alleged harmful counseling even if the surgery never occurred (the surgery might affect damages, not accrual under the completion-of-treatment theory).
  2. The relationship’s termination is the critical moment because until then the counselor had a continuing duty “to competently steer” Aldaco, including “refusing to recommend harmful surgery and rescinding any such recommendation that had been made.” That continuing duty makes the termination date the proper point for limitations to begin running under § 74.251(a).

Built-in limits of the completion-of-treatment approach

Justice Young emphasizes that ongoing treatment does not “expand the two-year window”; it determines when that window starts to run. He adds an important containment principle: measuring from the relationship’s end does not open the door to damages for “far earlier conduct” outside the relevant period—nothing in § 74.251(a) contemplates limitless reach-back simply because a relationship is long-running.

The court of appeals’ analytical error

The concurrence identifies the court of appeals’ mistake as focusing on what it deemed “the core” allegation—one manifestation of injury (the surgery)— rather than the full alleged scope of harm (affirmatively damaging counseling across the relationship). On that view, the case “falls squarely within” the completion-of-treatment prong.

Institutional competence: courts interpret; legislature draws lines

Justice Young closes with separation-of-powers concerns: if the current two-year rule yields uncomfortable results in this context, the legislature can recalibrate limitations and repose rules as a policy judgment, while courts must apply the enacted framework. He links this to broader TMLA policy choices and procedural screens for medical-liability suits, citing Collin Creek Assisted Living Ctr. v. Faber, 671 S.W.3d 879, 895 (Tex. 2023) (Young, J., concurring), and cautions against judicial policymaking where the legislature has occupied the field, citing Elephant Ins. Co. v. Kenyon, 644 S.W.3d 137, 158-59 (Tex. 2022) (Young, J., concurring).

3) Impact

The concurrence frames the decision’s real-world implications as intentionally limited:

  • Narrow doctrinal footprint: The holding should have “few applications” beyond circumstances where the “treatment” is essentially the therapeutic relationship itself rather than a discrete medical event.
  • Greater fit for certain mental-health contexts: The rationale may matter most where harm is alleged to accrue through ongoing counseling guidance rather than a one-time procedure.
  • Stability preserved by rejecting (or at least not adopting) Part II.B: Justice Young’s critique signals that an injury-triggered redefinition of “tort” could significantly destabilize limitations expectations across medical-liability cases.
  • Legislative invitation: The concurrence explicitly encourages legislative clarification if disagreements about “tort,” injury timing, and repose/limitations interaction persist.

Complex Concepts Simplified

  • Statute of limitations vs. statute of repose: Limitations generally sets a deadline measured from a triggering event (here, § 74.251(a) offers alternative triggers). A repose provision is a harder outer cutoff that can bar claims after a fixed time regardless of discovery or later consequences.
  • “Completion of treatment”: When care occurs over time and the injury date is hard to pinpoint, the law may measure the filing deadline from the end of the treatment course rather than from a single act.
  • Relationship-as-treatment: In some care models (as described here), the “treatment” is the ongoing therapeutic relationship—guidance and decision-steering—so the legally relevant endpoint is when that relationship terminates.
  • Stare decisis (especially statutory): Courts are generally more reluctant to overrule prior interpretations of statutes because the legislature can amend the statute if it disagrees.
  • Legislative acquiescence: When a legislature repeatedly revises a statutory scheme but does not alter a judicially interpreted phrase, courts sometimes treat that as evidence the legislature accepted the interpretation—though Justice Young notes this is not absolute.
  • Using later laws to interpret earlier text: Justice Young rejects the idea that a later legislature’s different language can retroactively change what an earlier legislature meant by the same word, absent an actual amendment to the earlier text.

Conclusion

Justice Young’s concurrence defends a limited but meaningful principle under § 74.251(a): when the alleged malpractice is inseparable from an ongoing counseling course of treatment, limitations can properly run from the end of the counselor–patient relationship, not from a later discrete event used to illustrate or quantify harm. He emphasizes continuity with Husain, Kimball, and Morrison; cautions against a broader, injury-triggered redefinition of “tort” hinted at in Part II.B; and frames any substantial policy recalibration as a legislative task.