Texas TMLA Limitations: In Relationship-Based “Course of Treatment” Claims, the Two-Year Period Runs from the End of the Provider–Patient Relationship

I. 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 how to measure timeliness under the Texas Medical Liability Act (TMLA), specifically Texas Civil Practice and Remedies Code § 74.251(a), when the alleged negligence is not a discrete medical act but an ongoing, relationship-driven course of counseling.

The petitioner, Soren Aldaco, sued counselor Barbara Rose Wood and her affiliated counseling entity (Thriveworks). The timeliness dispute turned on which date triggers the TMLA’s two-year limitations period: (1) the date of a later surgical procedure allegedly connected to the counseling, or (2) the date the counselor–patient relationship ended, marking completion of the relevant “course of treatment.”

Justice Young, joined by Justice Bland, concurred. He agreed with the Court’s holding in Part II.A that Aldaco’s claim was timely and emphasized that the decision is narrow. He also expressed serious reservations about reasoning discussed in Part II.B (which he noted “is not part of the opinion of the Court”), warning it could destabilize medical-liability limitations doctrine and should be left, if at all, to legislative revision.

II. Summary of the Opinion (as described in the concurrence)

Justice Young explains that Part II.A of the Court’s opinion holds Aldaco’s claim was timely because timeliness is measured “not by the date of the eventual surgery but based on when her counselor-patient relationship with Wood ended.” In his view, gender-dysphoria counseling “inherently requires a course of treatment,” in which the relationship itself constitutes the treatment, making it inappropriate to anchor limitations to a single later event (such as surgery) when the alleged harm is relational and cumulative.

He also clarifies what the completion-of-treatment approach does—and does not—do: it does not extend limitations indefinitely; rather, it identifies when the two-year window begins to run. Under his description, where the relationship’s termination and the later surgery both fall within two years of suit, the claim is timely without expanding the statute beyond its established framework.

III. Analysis

A. Precedents Cited

1. Discrete-act limitations cases distinguished by the nature of the alleged negligence

  • Husain v. Khatib, 964 S.W.2d 918 (Tex. 1998): Justice Young treats Husain as a paradigm of a case in which negligence can be fixed to an objectively ascertainable time, such as an alleged failure to diagnose cancer. Such claims more naturally attach limitations to a specific act or omission. He also relies on Husain for its explanation that the statute’s dual triggers (tort vs. completion of treatment/hospitalization) exist to assist plaintiffs injured during a course of treatment who cannot readily identify the precise injury date.
  • Shah v. Moss, 67 S.W.3d 836 (Tex. 2001): Justice Young characterizes Shah similarly—an allegedly improperly conducted eye surgery is a “transaction with an obvious beginning and end,” enabling a precise negligence date. He rejects any suggestion that Shah is in tension with applying the completion-of-treatment prong here, stating that, properly read, such cases “support the completion-of-treatment rationale.”

2. The “course of treatment” line and its statutory purpose explanation

  • Kimball v. Brothers, 741 S.W.2d 370 (Tex. 1987): Cited (through Husain) for the understanding that the statute’s structure is designed to aid plaintiffs injured during a course of treatment who have difficulty pinpointing an injury date. Justice Young uses Kimball to show the Court is not creating a new doctrine but applying a longstanding one.
  • Morrison v. Chan, 699 S.W.2d 205 (Tex. 1985) and the affirmed court of appeals decision, 668 S.W.2d 483, 485 (Tex. App.—Fort Worth 1984): Invoked as earlier anchors for the same course-of-treatment understanding later recognized in Kimball. Justice Young’s point is cumulative: the completion-of-treatment option is not a modern invention but embedded in decades of Texas law.

3. Stare decisis and legislative acquiescence in statutory interpretation

  • Mitschke v. Borromeo, 645 S.W.3d 251 (Tex. 2022): Quoted for two propositions: (1) stare decisis can protect even wrongly decided cases, and (2) it has “greatest force” in statutory construction. Justice Young uses Mitschke to argue that even if earlier readings emphasized “purpose,” decades of consistent interpretation of § 74.251(a) counsel against judicial alteration now—particularly when the Legislature has repeatedly amended the statutory scheme without repudiating that interpretation.

4. Later-enacted statutes do not retroactively redefine earlier text

  • United States v. Est. of Romani, 523 U.S. 517 (1998) (Scalia, J., concurring in part and in the judgment), citing Almendarez-Torres v. United States, 523 U.S. 224 (1998): Cited for the principle that later-enacted laws do not “declare the meaning of earlier law.”
  • Hyundai Motor Co. v. Alvarado, 974 S.W.2d 1 (Tex. 1998), quoting Russello v. United States, 464 U.S. 16 (1983): Used to reinforce the danger of inferring earlier legislative intent from later legislative views.
  • Rowan Oil Co. v. Tex. Emp. Comm'n, 263 S.W.2d 140 (Tex. 1953): Cited for the Texas-specific statement that one legislative session cannot construe the acts or intent of a past session.

5. Separation of powers and deference to legislative policy judgments in medical-liability design

  • Collin Creek Assisted Living Ctr. v. Faber, 671 S.W.3d 879 (Tex. 2023) (Young, J., concurring): Quoted for the proposition that the Legislature may impose heightened standards and consequences in health care liability claims.
  • Elephant Ins. Co. v. Kenyon, 644 S.W.3d 137 (Tex. 2022) (Young, J., concurring): Cited to support the idea that courts should not do policy-making “especially after the legislature has occupied a field by legislation.”

6. The court of appeals decision corrected

  • 727 S.W.3d 213, 220 (Tex. App.—Fort Worth 2024): Justice Young criticizes the court of appeals for focusing on what it called “the core of Aldaco’s allegations,” thereby “confus[ing] one manifestation of the injury with its full scope.”

B. Legal Reasoning

1. Why completion-of-treatment, not the later surgery date, controls

Justice Young’s central analytical move is to classify the alleged negligence as inherently relational and continuous rather than discrete. In discrete-act cases like Husain v. Khatib and Shah v. Moss, one can pinpoint the act (missed diagnosis, surgical error). But in “gender-dysphoria counseling,” he says “no single moment is dispositive” because the “relationship itself” constitutes the treatment.

On that view, the alleged harm is not limited to a later surgery or a single recommendation; it is the alleged ongoing “affirmatively damaging treatment” throughout the counseling relationship—conduct that, if proven, would be actionable even if surgery never occurred (albeit with potentially different damages). Thus, the proper statutory trigger is when the counselor–patient relationship ends: the endpoint of the course of treatment under § 74.251(a).

2. The duty-centered endpoint: why relationship termination matters

Justice Young ties the endpoint to duty. Until the relationship ends, the provider has an ongoing obligation “to competently steer” the patient, including an obligation to refuse harmful recommendations and to rescind them if made. So long as that duty persists, the course of treatment is not complete; when it ends, limitations begins.

He also includes an important limiting principle: ongoing treatment does not expand the two-year window; it simply identifies when it starts. He emphasizes that this approach does not create a vehicle to “demand damages for far earlier conduct” outside the limitations framework; it is not a general tolling doctrine, but a statutory trigger selection.

3. The concurrence’s warning about Part II.B (not the Court’s opinion)

Justice Young’s sharpest caution is directed to the alternative rationale in Part II.B. He describes it as adopting a premise similar to the dissent in Shah v. Moss, namely that limitations should not begin until injury occurs—because a letter (or analogous act) is not a “tort” until injury. He warns that if that premise were accepted broadly, it could allow a lawsuit to be revived by a later surgery “any time up to 10 years after the letter,” creating major uncertainty in medical-liability limitations beyond the counseling context.

He also disputes the suggestion (raised in the opinion’s discussion) that a 2003 enactment of a statute of repose can alter the meaning of the unchanged word “tort” in § 74.251(a). Relying on United States v. Est. of Romani, Hyundai Motor Co. v. Alvarado, and Rowan Oil Co. v. Tex. Emp. Comm'n, he insists later legislatures cannot retroactively redefine earlier statutory text. If the Legislature wants a different accrual rule, it can enact one directly and prospectively.

C. Impact

  • Narrow doctrinal shift (or none at all) for relationship-based treatment: As framed by Justice Young, Part II.A largely applies established “completion-of-treatment” jurisprudence to an unusual fact pattern where the relationship itself is the treatment. The practical takeaway is that in similar mental-health or counseling contexts, courts may be more willing to treat the end of the therapeutic relationship as the completion of treatment for § 74.251(a) purposes.
  • Stability for discrete-act medical liability: The concurrence stresses that today’s resolution should not disrupt cases involving discrete negligent acts (e.g., surgery errors, diagnostic omissions), where pinpointing the negligence date is feasible.
  • Legislative spotlight: Justice Young’s separation-of-powers discussion underscores that if the current limitations framework produces undesirable outcomes in this domain, the Legislature—not courts—should recalibrate timelines and screening mechanisms within Chapter 74. His analysis frames the case as exposing a policy problem more than a doctrinal gap.
  • Future fight over “tort” and injury-based accrual remains open: Because Part II.B is “not part of the opinion of the Court,” the broader theory that a “tort” requires injury (and therefore accrual may be delayed until injury) remains unsettled. Justice Young’s concurrence signals that any later adoption of that theory would be a major departure from precedent and could have systemic effects.

IV. Complex Concepts Simplified

  • Statute of limitations (two years under § 74.251(a)): A deadline for filing suit. Miss it, and the claim is barred even if it has merit.
  • Completion-of-treatment prong: § 74.251(a) allows limitations to be measured from the end of a course of treatment/hospitalization when the injury occurs during ongoing care and it is hard to identify a single precise injury date.
  • “Discrete act” vs. “course of treatment”: A discrete act (like a surgery mistake) occurs at a known time. A course of treatment (like ongoing counseling) unfolds over time, and the alleged harm may be cumulative.
  • Statute of repose: A hard outer cutoff that can bar claims after a set period, regardless of when injury is discovered. Justice Young notes the existence of a 2003 repose enactment but argues it cannot be used to retroactively redefine older statutory text.
  • Stare decisis: The principle of adhering to prior decisions for stability and predictability. Justice Young emphasizes its “greatest force” in statutory interpretation because the Legislature can amend statutes if it disagrees with judicial constructions.
  • Legislative acquiescence: The idea that if the Legislature repeatedly revises a statute but leaves an interpreted provision intact, it may be taken as acceptance of the judicial interpretation (not absolute, but a caution against judicial change).

V. Conclusion

Justice Young’s concurrence frames the case as a careful application of § 74.251(a)’s completion-of-treatment concept to a counseling relationship in which the treatment is the relationship. The key doctrinal point is that, in this context, limitations may be measured from the end of the counselor–patient relationship rather than from a later discrete event such as surgery. At the same time, the concurrence warns that any broader move toward injury-based accrual under the statutory term “tort”—as discussed in Part II.B—could unsettle medical-liability law and should be made, if at all, through legislative action rather than judicial innovation.