South Coast Spine & Rehabilitation Pa v. Brownsville Independent School District, Hector G. Ayala Jr., and Gwendolyn S. Haught

Court of Appeals of Texas·Decided April 30, 2014·No. 13-11-00270-CV·Published

Opinion

NUMBER 13-11-00270-CV

COURT OF APPEALS

THIRTEENTH DISTRICT OF TEXAS CORPUS CHRISTI - EDINBURG

SOUTH COAST SPINE & REHABILITATION PA, Appellant,

v.

BROWNSVILLE INDEPENDENT SCHOOL DISTRICT, HECTOR G. AYALA JR., AND GWENDOLYN S. HAUGHT, Appellees.

On Appeal from the County Court at Law No. 1 of Cameron County, Texas.

MEMORANDUM OPINION

Before Chief Justice Valdez and Justices Garza and Longoria Memorandum Opinion by Chief Justice Valdez By three issues, appellant, South Coast Spine & Rehabilitation PA (South Coast)

challenges the trial court’s granting of a plea to the jurisdiction in favor of appellee, Brownsville Independent School District (BISD), and the dismissal of South Coast’s

causes of action against appellee, Gwendolyn S. Haught (Haught).1 South Coast argues that (1) because BISD was acting in a proprietary capacity by providing its employees with insurance, the trial court erred by finding that BISD had governmental immunity; (2) the trial court erred by finding that BISD did not waive its governmental immunity from South Coast’s breach of contract cause of action by entering into a contract to provide its employees with insurance; and (3) the trial court erred by dismissing its claims against Haught. We affirm in part and reverse and remand in part.

I. BACKGROUND

On November 4, 2008, South Coast filed its original petition in this lawsuit. In its amended petition, South Coast alleged that it was entitled to payment for medical services rendered to employees of BISD. It claimed that BISD was liable for the services performed because it was “a third party beneficiary and first party beneficiary by virtue of assignments [South Coast] received from the plaintiffs.”

The petition asserted that BISD “offers a ‘Brownsville ISD Employee Benefit Plan’

for its employees and enrollees. . . . It is believed that the [BISD] employee insurance plan is a written document to determine the rights and responsibilities between BISD and the employees.” South Coast then detailed the medical services it provided to twenty-six BISD employees. It listed causes of action for (1) breach of contract, as well as (2) civil conspiracy; (3) concert of action; (4) breach of fiduciary duty; (5) fraud; (6) misrepresentation; (7) promissory estoppel; (8) breach of good faith and fair dealing; and

1 South Coast also named Hector Ayala as an appellee. The trial court dismissed South Coast’s claims against Ayala in the same order it dismissed the claims against Haught. The certificate of service on the notice of appeal, filed with this court on April 25, 2011, shows that South Coast served Ayala’s trial attorney J.A. Magallanes with its notice of appeal. However, according to the record, the trial court granted Magallanes’s motion to withdraw as the attorney of record for Ayala on February 24, 2011. Neither Magallanes nor Ayala has filed a brief or any motions with this Court. Because Ayala was not properly served with the notice of appeal, we conclude that he is not a party to this appeal. See TEX. R. APP. P. 9.5.

(9) unjust enrichment. In the petition, South Coast explained that there was no contract between it and BISD, but that it

obtained assignments from the patients to directly receive proper reimbursement from BISD or [its third-party administrator]. Pursuant to the policy and admissions by BISD and [its third-party administrator], medical providers are paid by — through [BISD] by the [third-party administrator] for those benefits that qualify and that the employee has assigned to the medical provider.

In the “Notices” section of its petition, South Coast stated, “An ‘Assignment of Proceeds, Lien, and Authorization’ has been duly executed by all patients and have been forwarded to BISD and [its third-party administrator] under separate cover on May 7, 2009 . . . .” In its First Amended Answer, BISD explained:

Defendant BISD provides medical benefits to its employees pursuant to a self-funded employee medical benefits plan. Such plan is adopted by the Board of Trustees of [BISD] and represents those benefits provided by [BISD] to its employees. The plan is a detailed explanation of benefits and limitations of those benefits. . . . Employees are free to select medical providers of their choosing. When employees select a medical provider, they assign the benefits provided them by [BISD] to that medical provider.

The medical provider thereafter treats and bills the patient at its discretion.

BISD’s commitment is only that it pay the provider the employee’s assigned benefits that the employee is entitled to as per the terms and conditions of its benefit plan. . . . [South Coast] judicially admits that it is not in privity of contract with Defendant BISD and that it only receives assigned benefits . .

..

BISD then filed a plea to the jurisdiction arguing that (1) all of South Coast’s claims are barred by the doctrine of sovereign immunity, and (2) BISD has not waived immunity to South Coast’s claims sounding in contract because “there has been no negotiation between the District and [South Coast] to develop contract terms and there was no intent on the basis of the District to enter in to an agreement with [South Coast].” BISD attached the affidavit of Brett Springston, Interim Superintendent of BISD, in which he stated that, “I verify that at no time has [BISD] ever entered into or negotiated a contract or any other

form of agreement for goods and/or services with [South Coast].” On January 19, 2011, the trial court granted BISD’s plea to the jurisdiction.

BISD also filed a motion to dismiss South Coast’s claims against the individual defendants under the election of remedies provision of the Texas Torts Claims Act (TTCA). BISD moved to have the claims against the individual defendants dismissed because, “[i]f a suit is filed under this chapter against both a governmental unit and any of its employees, the employees shall immediately be dismissed on the filing of a motion by the governmental unit.” See TEX. CIV. PRAC. & REM. CODE ANN. § 101.106(e) (West, Westlaw through 2013 3d C.S). The trial court granted the plea to the jurisdiction and motion to dismiss. This appeal followed.

II. PLEA TO THE JURISDICTION APPLICABLE LAW & STANDARD OF REVIEW A plea to the jurisdiction challenges the trial court’s authority to determine the subject matter of a cause of action. Tex. Dep’t of Transp. v. Jones, 8 S.W.3d 636, 638 (Tex. 1999). Whether a trial court has subject-matter jurisdiction and whether a pleader has alleged facts that affirmatively demonstrate the trial court’s subject-matter jurisdiction are questions of law that we review de novo. Tex. Dep’t of Parks & Wildlife v. Miranda, 133 S.W.3d 217, 226 (Tex. 2004); Tex. Natural Res. Conservation Comm’n v. IT–Davy, 74 S.W.3d 849, 855 (Tex. 2002). The plaintiff has the burden to plead facts affirmatively showing that the trial court has jurisdiction. Tex. Ass’n of Bus. v. Tex. Air Control Bd., 852 S.W.2d 440, 446 (Tex. 1993).

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South Coast Spine & Rehabilitation Pa v. Brownsville Independent School District, Hector G. Ayala Jr., and Gwendolyn S. Haught, (Tex. Ct. App. 2014).

South Coast Spine & Rehabilitation Pa v. Brownsville Independent School District, Hector G. Ayala Jr., and Gwendolyn S. Haught (South Coast Spine & Rehabilitation Pa v. Brownsville Independent School District, Hector G. Ayala Jr., and Gwendolyn S. Haught) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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