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Click here for the full text of this decision FACTS:This action derives from Debi Rose’s claim that Garland Community Hospital negligently credentialed a doctor who performed cosmetic surgery on her. The trial court ruled that Rose’s claims were health care liability claims under the Medical Liability and Insurance Improvement Act, and it consequently severed and dismissed those claims against the hospital after finding that Rose’s expert report did not satisfy the act’s requirements. The court of appeals reversed and remanded, holding that Rose’s claims were not governed by the MLIIA. HOLDING:Reversed and remanded. Rose’s claims fall under the MLIIA if the claims are “for treatment, lack of treatment, or other claimed departure from accepted standards of medical care or health care or safety.” Texas Revised Civil Statutes Article 4590i, 1.03(a)(4). The court of appeals held that Rose’s negligent credentialing claims did not fall into any of these categories and thus were not governed by the MLIIA. The MLIIA defines “health care” as “any act or treatment performed or furnished, or which should have been performed or furnished, by any health care provider for, to, or on behalf of a patient during the patient’s medical care, treatment, or confinement.” 1.03(a)(2). The court of appeals held that, because the hospital’s act of credentialing the doctor occurred before Rose was a patient, the credentialing act was not “during the patient’s medical care, treatment, or confinement” and thus not covered under the MLIIA’s definition of “health care.” The court of appeals’ strict temporal distinction does not comport with the realities of the credentialing process. Physician credentialing is an ongoing and continuous process, not a series of discrete events. It includes not only a hospital’s initial decision to grant staff privileges, but also formal reevaluations, and continual monitoring and assessment of physician competence. A patient’s complaint about a credentialing decision is not directed solely to the hospital’s initial decision to credential a physician, but also to the hospital’s maintaining those privileges during the time of the patient’s treatment, for it is only during that time that the patient could have been harmed by the negligent credentialing decision. Thus, a hospital’s credentialing activities occur both before and during the treatment of a patient. Rose complains of acts and omissions that occurred, in significant part, during her treatment. Specifically, Rose alleges that the hospital acted negligently and maliciously in allowing the doctor to perform Rose’s surgeries, in entrusting the operating room and other equipment to him, and in failing to suspend or affirmatively review his privileges. These decisions necessarily occurred during Rose’s treatment. It is not necessary, however, to dissect Rose’s claims into pre-treatment and post-treatment components. Regardless of when the acts occurred, the allegations all revolve around the same basic premise: that the hospital put Rose at risk by allowing the doctor to treat her. It makes no sense to conclude that some credentialing claims are subject to the MLIIA and others are not, depending upon what point in time the credentialing decision occurred. When a plaintiff’s credentialing complaint centers on the quality of the doctor’s treatment, as it does here, the hospital’s alleged acts or omissions in credentialing are inextricably intertwined with the patient’s medical treatment and the hospital’s provision of health care. Although neither the hospital as an entity nor the credentialing board actually performed the surgeries on Rose, a doctor lacking credentials could not have performed surgery in that hospital. Likewise, Rose’s negligent credentialing claim derives from the doctor’s alleged negligent treatment. Without negligent treatment, a negligent credentialing claim could not exist. Thus, the hospital’s acts or omissions in credentialing the doctor are an inseparable part of the treatment provided to Rose. A negligent credentialing claim involves a specialized standard of care. a negligent credentialing claim involves “accepted standards of . . . health care.” The court holds hold that negligent credentialing claims involve a claimed departure from an accepted standard of health care and are therefore “health care liability claims” governed by the MLIIA. Because the court of appeals decided that Rose’s claims were not health care liability claims, it did not consider whether the expert reports constituted a good faith effort to comply with the statute. Accordingly, the court remands to that court to determine whether Rose’s expert reports constituted a good faith effort to comply with the statute. OPINION:Jefferson, J., delivered the court’s opinion.

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