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Click here for the full text of this decision FACTS:Jodi Marie Mason voluntarily entered a mental health care facility seeking treatment for depression. Three weeks later, Mason’s physician discharged her at her request. A little over a day after Mason’s discharge, she was severely injured while a passenger in a single-car accident. Mason’s roommate at the facility, the driver of the car, was discharged by a different physician at the same time as Mason. Mason sued her physician, her roommate’s physician, the charge nurse and the mental health care facility. After the trial court granted summary judgment in favor of Dr. Teofilo Moses Ramos, a staff psychiatrist at Cedars Hospital, Mason amended her petition to include a claim for breach of contract against the hospital and the Minirth-Meier Clinic for failing to provide her with adequate care and treatment, where Mason claimed to be a third-party beneficiary of the contract between Cedars Hospital and the Minirth-Meier Clinic, and for violations of various Texas statutes not at issue in this appeal. The trial court granted summary judgment in favor of the remaining parties and issued a final order disposing of all causes of action on the ground that defendants’ negligence, if any, was not the proximate cause of Mason’s injuries. Mason appealed, and a divided court of appeals reversed the summary judgment in favor of Ramos, Nurse Sandra Duryea Marx, Cedars Hospital and the Minirth-Meier Clinic and remanded the claims back to the trial court for further proceedings. The dissenting justice opined that the defendants’ conduct fell short of satisfying the substantial factor test for proximate cause. The court of appeals affirmed the summary judgment in favor of Meier for Mason’s negligent treatment and discharge claims and reversed summary judgment and remanded Mason’s claims based on respondeat superior and Meier’s failure to develop adequate policies and procedures for the clinic. Mason did not appeal the summary judgment granted on her claims against Cedars Hospital and the Minirth-Meier Clinic for negligently granting privileges to Ramos and for breach of contract. Ramos, Marx, Cedars Hospital, and the Minirth-Meier Clinic petitioned this court for review. Neither Mason nor Meier appealed the decision of the court of appeals. At the parties’ joint request, this court severed the Minirth-Meier Clinic from this case and remanded the claims against it to the trial court for further proceedings consistent with the parties’ settlement. HOLDING:Reversed and rendered. Precedents establish that merely creating the condition that makes harm possible falls short as a matter of law of satisfying the substantial factor test, the court determines. Mason argues that Ramos’s negligent care, treatment and discharge proximately caused her injuries in the car accident with Cynthia Thomas some 28 hours after Mason’s discharge. Mason argues that had she been discharged on August 20, as scheduled, instead of August 16, she would not have been in the car on August 18, and thus, would have missed the accident by two days. Mason also claims that had Ramos insisted on 96 hours written notice before discharging her, as she had agreed in her admission form, or advised her to remain in treatment, she would not have been in Thomas’s car when it crashed. These facts may raise issues of Ramos’s duty to protect Mason after her discharge and the possible breach of that duty, however, Mason makes no argument that Ramos caused Thomas to experience a psychotic episode, drive wildly, or crash the Corvette. Hence, her argument turns on the assertion that discharging Mason on Wednesday evening allowed her to be in Thomas’s car on Friday morning, thereby creating a circumstance that led to Mason’s injuries. Merely creating the condition in which an accident occurs does not satisfy proximate cause as a matter of law. Thus, even if Ramos had a duty to act to protect Mason after her discharge, her claims fall short of proximate cause as a matter of law. Mason argues that Marx’s negligent care, treatment and assessment of her mental condition for discharge proximately caused her injuries. In addition, Mason asserts that her injuries arose from Marx’s failure to tell Ramos about Mason’s request to be simultaneously discharged with Thomas. Marx was the charge nurse with supervisory authority on duty on the evening of Aug. 16 when Mason and Thomas requested unscheduled discharges. She contacted Meier, Thomas’ attending physician, and processed his order to discharge Thomas from the facility without telling him that she was being discharged with another patient. After Mason made her discharge request, but before Marx contacted Ramos, Marx inquired why Mason wanted to leave the hospital, asked what Mason and Thomas planned to do together after leaving the hospital, and made an assessment of Mason’s physical and mental condition based on her own observations during the course of their brief conversation. She did not review Mason’s chart. Marx then called Ramos to tell him that Mason wanted to be discharged. Marx knew that Mason and Thomas had bonded, and that their relationship hindered their respective treatments. In her deposition, Marx says that it was her “personal preference” that Mason not be discharged. She did not make this known to Ramos or tell him that the two patients were being discharged together. Following Ramos’ instructions, Marx discharged Mason, and she left the hospital with Thomas. Just as Ramos’ negligence, if any, merely allowed Mason to be in Thomas’ car at the time of the accident, Marx’s conduct also did not proximately cause Mason’s injuries for the same reasons discussed above. We therefore hold that neither Marx’s failure to fully inform Ramos of the facts of Mason’s simultaneous discharge with Thomas nor an improper discharge assessment were the cause in fact of Mason’s injuries. Marx’s actions were necessary but not sufficient to cause Mason’s injuries. Mason argues that the failure of Cedars Hospital to provide adequate policies and procedures governing the processing by hospital staff of an unscheduled discharge by a voluntary patient prevented Mason from receiving a proper nursing assessment of her mental condition and her physician from being informed of her plans to leave with another patient. Cedars Hospital’s failure, if any, to provide adequate policies and procedures for discharging Mason was not the cause in fact of her injuries as a matter of law. Just as Ramos’ and Marx’s conduct was too attenuated from the accident to be the cause in fact of Mason’s injuries, the conduct of Cedars Hospital is also too attenuated to have caused the accident. Mason also argues that where competent expert testimony is presented establishing proximate cause in a medical malpractice action, a court cannot negate any of the elements as a matter of law. As part of Mason’s attempt to create a fact issue, she presents expert opinions that she argues rebut the claim that there is no evidence of causation. The court reiterates that the conduct of the defendants is so attenuated from the harm to Mason that it cannot be the cause in fact of her injuries. The conduct only created the condition which made the injury possible. OPINION:Wainwright, J., delivered the court’s opinion.

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