TMLA Limitations: “Occurrence of the Tort” Requires Injury; Completion-of-Treatment Triggers When Injury Follows Treatment

Case: Soren Aldaco v. Barbara Rose Wood and Three Oaks Counseling Group, LLC d/b/a Thriveworks
Court: Supreme Court of Texas
Date: June 26, 2026
Disposition: Reversed and remanded

1. Introduction

The case arises from a therapist’s letter endorsing elective “top surgery” (double mastectomy) for Soren Aldaco. The Crane Clinic required a practitioner letter to proceed; Barbara Rose Wood—who had been providing telehealth therapy for relationship issues—signed such a letter on February 22, 2021. Wood later terminated psychotherapy on May 14, 2021 after Aldaco missed a session and did not pay a fee. Aldaco underwent surgery on June 11, 2021, later experienced complications and regret, and sued in 2023 for negligence and fraud against Wood and for direct/vicarious liability against Wood’s employer, Thriveworks.

The key issue was limitations under the Texas Medical Liability Act (TMLA): whether the two-year period in § 74.251(a) began on (i) February 22, 2021 (letter signed), (ii) May 14, 2021 (psychotherapy completed), or (iii) June 11, 2021 (surgery/injury). The court of appeals held the claims time-barred, using the letter date. The Supreme Court of Texas reversed.

2. Summary of the Opinion

The Court holds Aldaco’s claims are not time-barred. It provides two independent routes to timeliness:

• Completion-of-treatment route: Because the relevant “health care treatment” (psychotherapy) was completed on May 14, 2021 and Aldaco gave pre-suit notice on May 9, 2023 (tolling limitations under § 74.051(c)), the action is timely under the statutory alternative measuring from treatment completion.
• Occurrence-of-the-tort route: Even focusing only on “occurrence of the … tort,” the tort did not “occur” until Aldaco suffered injury—here, at the June 11, 2021 surgery performed in reliance on the letter. A pre-injury suit would have failed for lack of injury (an element of negligence and common-law fraud), so the letter date cannot be the “occurrence of the … tort” for limitations.

The Court distinguishes prior cases (e.g., Shah v. Moss) that instruct courts to use an ascertainable tort date rather than later treatment completion, explaining those cases involved injuries that occurred on known dates during treatment/hospitalization—unlike Aldaco’s post-treatment injury.

3. Analysis

3.1 Precedents Cited

A. Statutory interpretation framing

• S.V. v. R.V., 933 S.W.2d 1 (Tex. 1996): Cited for the principle that statutes of limitations are the Legislature’s prerogative. The Court uses it to justify a text-first approach rather than policy-driven accrual concepts.
• City of San Antonio v. Realme, 731 S.W.3d 342 (Tex. 2026): Reinforces “begin with the text” methodology.
• In re Oncor Elec. Delivery Co., 630 S.W.3d 40 (Tex. 2021) and Brown v. City of Houston, 660 S.W.3d 749 (Tex. 2023): Drive the Court’s contextual reading of § 74.251(a) alongside § 74.251(b). The Court treats adjacent provisions as key interpretive context and rejects reading a single word (“tort”) in isolation.
• Malouf v. State ex rel. Ellis, 694 S.W.3d 712 (Tex. 2024), DeWitt v. Harris County, 904 S.W.2d 650 (Tex. 1995), and Love v. City of Dallas, 40 S.W.2d 20 (Tex. 1931): Support the presumption that different words signal different meanings—central to distinguishing “tort” (limitations) from “act or omission” (repose).
• Davis v. Morath, 624 S.W.3d 215 (Tex. 2021) and Spradlin v. Jim Walter Homes, Inc., 34 S.W.3d 578 (Tex. 2000): Used for the conjunctive/disjunctive canon—“or” creates alternatives—supporting the Court’s recognition that treatment completion is a separate trigger within § 74.251(a).

B. Medical-malpractice limitations: ascertainable date vs end-of-treatment proxy

• Shah v. Moss, 67 S.W.3d 836 (Tex. 2001): The court of appeals relied on Shah for the proposition that a plaintiff cannot pick the most favorable of the three statutory dates; if the tort date is ascertainable, it controls. The Supreme Court distinguishes Shah: there, injury occurred on a known date during treatment and follow-up care continued. In Aldaco’s case, no bodily injury was ascertainable until after psychotherapy ended.
• Husain v. Khatib, 964 S.W.2d 918 (Tex. 1998) (per curiam) and Bala v. Maxwell, 909 S.W.2d 889 (Tex. 1995) (per curiam): Cited via the court of appeals to support “ascertainable tort date” primacy. The Supreme Court again distinguishes them as misdiagnosis cases where the negligent examination happened on specific dates before later events.
• Kimball v. Brothers, 741 S.W.2d 370 (Tex. 1987): Quoted for why the three-date scheme exists—helping plaintiffs who can’t pinpoint injury during extended treatment/hospitalization. The Court uses Kimball to justify using completion-of-treatment where the injury date is not ascertainable within the treatment period and where the alleged wrong persists as a continuing risk.

C. Tort elements (injury) as the meaning of “tort” in § 74.251(a)

• City of Gladewater v. Pike, 727 S.W.2d 514 (Tex. 1987): Cited for negligence elements, including injury as a required component—supporting the Court’s conclusion that no “tort” occurred until Aldaco was injured.
• DeSantis v. Wackenhut Corp., 793 S.W.2d 670 (Tex. 1990): Cited for fraud elements, including injury—supporting the same point for the fraud claim.
• Columbia Valley Healthcare Sys., L.P. v. Zamarripa, 526 S.W.3d 453 (Tex. 2017) and M.D. Anderson Cancer Ctr. v. Novak, 52 S.W.3d 704 (Tex. 2001): Reinforce that without causation and actual injury, negligence and fraud claims fail; thus the “occurrence” of such torts cannot precede injury.

D. Discovery rule history and statutory evolution

• Regency Field Servs., LLC v. Swift Energy Operating, LLC, 622 S.W.3d 807 (Tex. 2021): Cited for the “general rule” about accrual and for describing how the discovery rule differs (it delays accrual beyond legal injury). The Court uses it to clarify Aldaco is not seeking a discovery-rule extension; she argues no legal injury existed earlier.
• Gaddis v. Smith, 417 S.W.2d 577 (Tex. 1967), Hays v. Hall, 488 S.W.2d 412 (Tex. 1972), and Weaver v. Witt, 561 S.W.2d 792 (Tex. 1977) (per curiam): Examples of applying the discovery rule when injuries were hidden (foreign object, failed vasectomy, severed nerves).
• Morrison v. Chan, 699 S.W.2d 205 (Tex. 1985) and related authorities (Diaz v. Westphal, 941 S.W.2d 96 (Tex. 1997); State v. Thirteenth Ct. of Appeals, 933 S.W.2d 43 (Tex. 1996) (per curiam); Jennings v. Burgess, 917 S.W.2d 790 (Tex. 1996); Nelson v. Krusen, 678 S.W.2d 918 (Tex. 1984)): These cases hold that the Legislature’s removal of “accrued” from medical-liability limitations abolished the discovery rule in that context. The Supreme Court acknowledges this line remains “good law” on discovery, but explains it does not answer the distinct question presented here: whether a “tort” can “occur” before injury.
• Walters v. Cleveland Reg'l Med. Ctr., 307 S.W.3d 292 (Tex. 2010): Used to highlight the 2003 addition of the TMLA statute of repose, which employs different trigger language (“act or omission”). This supports the Court’s contextual argument that “tort” in § 74.251(a) should not be collapsed into “act” in § 74.251(b).

E. Procedure and finality

• Guar. Cnty. Mut. Ins. v. Reyna, 709 S.W.2d 647 (Tex. 1986) (per curiam), and Tex. R. Civ. P. 41: Cited to explain how the severance made the summary judgment final and appealable.

3.2 Legal Reasoning

A. The “or” in § 74.251(a) supplies alternative triggers, including treatment completion

The Court starts from the statutory text: § 74.251(a) permits measurement “within two years from” (1) “the occurrence of the breach or tort” or (2) “the date the medical or health care treatment … is completed” or (3) hospitalization completion. Applying the disjunctive canon, “or” creates alternatives. The Court then identifies the relevant “health care treatment” as Wood’s psychotherapy (the care that produced the disputed letter).

Crucially, the Court refuses to treat the letter as a one-off event disconnected from the treatment relationship. Accepting Aldaco’s pleaded theory that Wood had an ongoing obligation to withdraw the recommendation and that the counseling was “flawed overall,” the risk remained live through the end of treatment. Under that framing, Aldaco’s theory involves at least 82 days of continuing negligence (February 22 through May 14, 2021). Because Aldaco gave pre-suit notice on May 9, 2023 (within two years of May 14, 2021), the completion-of-treatment trigger makes her claims timely.

B. Distinguishing Shah and similar cases: no ascertainable injury date during treatment

The opinion below relied on Shah v. Moss to insist that when an “ascertainable” tort date exists, a plaintiff may not pick the later treatment-completion date. The Supreme Court distinguishes Shah, Husain, Bala, and Kimball on a practical and doctrinal point: in those cases, the plaintiffs suffered bodily injury on known dates during treatment or hospitalization. Here, Aldaco could not have ascertained bodily injury during psychotherapy because the surgery occurred only after therapy ended. Thus, even under the “ascertainable date” framework, there was no single ascertainable injury date within treatment that could displace the treatment-completion trigger.

C. “Occurrence of the … tort” is not “the act that gives rise to the claim”

The Court’s second, independent holding is interpretive and structural: § 74.251(a) uses “occurrence of the breach or tort,” while § 74.251(b) uses “date of the act or omission that gives rise to the claim.” The therapist’s letter is an “act … that gives rise to the claim,” but the “tort” itself—negligence or fraud—requires injury. The Court emphasizes a textual presumption: different words across adjacent subsections signal different meanings.

Applying basic tort elements (from City of Gladewater v. Pike and DeSantis v. Wackenhut Corp.), the Court concludes Aldaco suffered no injury until June 11, 2021 when the surgery was performed “in reliance upon Wood’s letter.” The Court underscores the practical consequence: a suit filed after the letter but before surgery would fail “as a matter of law” for want of injury/causation, citing Columbia Valley Healthcare Sys., L.P. v. Zamarripa and M.D. Anderson Cancer Ctr. v. Novak. Therefore, the court of appeals erred by treating the letter date as “the occurrence of the … tort.”

D. Statutory history does not justify starting limitations before injury

The court of appeals leaned on the historic removal of the word “accrued” from medical-liability limitations statutes (and cases like Morrison v. Chan) to reject “accrual-based” reasoning. The Supreme Court responds that Aldaco is not seeking the discovery rule’s delayed accrual for hidden injuries; rather, she argues the tort had not yet occurred because there was no injury. The Court also notes an important legislative development: the 2003 addition of the statute of repose in § 74.251(b) with a distinct trigger. That neighboring provision (recognized in Walters v. Cleveland Reg'l Med. Ctr.) alters the contextual landscape for interpreting “tort” in § 74.251(a).

3.3 Impact

• Pre-injury “tort” theories are curtailed for TMLA limitations. Defendants may no longer rely on an antecedent “act” date (e.g., a recommendation, certification, referral, authorization, or documentation) as the limitations trigger under § 74.251(a) when the pleaded tort (negligence/fraud) requires injury that occurs later.
• Course-of-treatment framing gains practical significance in nontraditional care settings. The Court treats psychotherapy (including telehealth) as “health care treatment” whose completion can trigger limitations when injury occurs only after the relationship ends, particularly where the provider could have corrected/withdrawn the earlier act.
• Sharper separation between limitations and repose. Litigants should expect courts to enforce the conceptual split:
  • § 74.251(a) (limitations): focuses on when the tort occurs (including injury).
  • § 74.251(b) (repose): focuses on the underlying act/omission regardless of later injury timing.
  This will matter in cases involving delayed harm, latent consequences, or downstream interventions by third-party providers.
• Downstream-procedure cases become more viable against upstream professionals. Where an upstream provider’s conduct enables a later medical procedure by others, plaintiffs may argue the injury—and thus “occurrence of the tort”—happens at the downstream procedure date (subject to proof of causation), while still facing the outer boundary of the 10-year repose.

4. Complex Concepts Simplified

• Statute of limitations vs. statute of repose:
  • Limitations sets a deadline keyed to events tied to the claim’s maturation (here, “occurrence of the … tort” or treatment completion).
  • Repose is a hard stop keyed to the defendant’s act/omission, even if injury happens later; it limits long-tail exposure.
• “Occurrence of the … tort”: A “tort” like negligence or fraud is not merely wrongful conduct; it includes injury. If there is no injury yet, the tort has not “occurred” in the sense required to sue successfully.
• Disjunctive “or”: When a statute lists triggers separated by “or,” each is an alternative path—unless binding precedent or context limits how they apply. Here, treatment completion remains a real trigger where injury timing and continuing-care allegations prevent pinpointing an earlier injury date.
• Discovery rule (and why it is different): The discovery rule delays accrual when an injury exists but is not reasonably discoverable. The Court stresses Aldaco’s argument is not “I was injured but didn’t discover it”; it is “I was not injured yet.”
• Ascertainable date doctrine (from Shah v. Moss): If the injury-causing event occurs on a known date during treatment, the clock runs from that date and not from later follow-up care. This case limits that doctrine’s reach where injury does not occur until after treatment ends.

5. Conclusion

The Supreme Court of Texas reverses a limitations dismissal by clarifying that, under the TMLA, “the occurrence of the … tort” in § 74.251(a) is not synonymous with the defendant’s earlier “act … that gives rise to the claim” in § 74.251(b). For negligence and fraud claims, injury is indispensable; thus the two-year limitations period cannot begin before injury occurs. Separately, where the alleged wrong is tied to a course of treatment and injury is not ascertainable until after that course ends, the statute’s treatment-completion trigger preserves timeliness. The decision reshapes how Texas courts will time-bar (or not time-bar) TMLA claims involving upstream authorizations, recommendations, or documentation that enable later medical interventions.