On August 29, 2008, the Texas Supreme Court upheld a jury finding of gross negligence in a decision that serves as warning to providers who may elect to outsource emergency medical services without guaranteeing response time. Additionally, the case addresses the application of damage caps to both actual and punitive damages awarded by the trial court. In Columbia Medical Center of Las Colinas Inc. v. Hogue, the lower court awarded punitive damages in the amount of $21 million and actual damages in the amount of $9.2 million. These were adjusted in accordance with tort reform caps to $1.47 and $3.36 million. The Supreme Court upheld the actual and punitive damages, as adjusted by the Texas Court of Appeals, of $3.36 million for punitive and $1.47 million for actual damages.

The hospital elected to outsource echocardiograms, declined a more expensive option to obtain immediate echocardiogram response, and failed to communicate this restriction to its medical staff, which ultimately was determined to have caused the death of a patient.

The court determined that while outsourcing in itself is not necessarily problematic, "the lack of an effective procedure for getting these critical services on a stat basis…supports the jury's gross negligence finding." The court warns that it does "not hold that Texas law requires all hospitals to provide all services to all patients." However, the determinative facts in this case include the fact that the hospital knew of the necessity of rapid echocardiogram capabilities in emergency care but failed to (1) ensure an appropriate response time, (2) inform the medical staff of that restriction, and (3) provide an effective procedure to respond to the situation.