After her husband died suddenly in Christus's care right after a drug was administered it asked whether Carswell would consent to the hospital ordering an autopsy to determine the cause of death. The doctor who performed the autopsy did not do toxicology tests related to the drug administered and, ultimately, stopped his work when Carswell sent a letter asking that evidence be preserved. Some of the tissue samples, including the heart, were lost so that they could not be evaluated as evidence or, eventually, interred.

Carswell brought both conventional medical malpractice claims alleging that the hospital was the cause of her husband's death and, due to the circumstances of the case, sued for fraud, negligence, and fiduciary-duty claims relating to the autopsy, which (it is alleged) prevented her from proving up a normal medical-malpractice case and also prevented her from interring her husband's remains.

As the case developed, the trial court imposed a monetary sanction against Christus for spoliation, based on the tissue samples that were lost.

The jury found that the remaining evidence was not enough to prove medical negligence but was sufficient to show fraud, negligence, and breach-of-fidiciary duty related to the autopsy. The trial court entered judgment. The court of appeals, deeply divided, reversed in part. It rejected the hospital's argument that an autopsy was covered by the health-care liability statute, even though it came after the patient's death. But the court of appeals struck down the sanctions award, reasoning in part that a sanctions award based on attorney's fees needed more precise evidence of fees.

The hospital has filed a petition urging the Supreme Court to rule that the health-care liability act shields it from claims involving fraud in autopsies. Carswell has filed a cross-petition asking the Supreme Court to reinstate the monetary sanction.