Court Opinion

ID: 9892299
Source: CourtListenerOpinion
Date Created: 2023-10-23 07:09:30.350761+00
Date Added: 2024-06-11T08:03:09.290554
License: Public Domain

In the
             Court of Appeals
     Second Appellate District of Texas
              at Fort Worth
           ___________________________
                No. 02-22-00389-CV
           ___________________________

    ACCLAIM PHYSICIAN GROUP, INC., Appellant

                          V.

KIERRA WRIGHT AND DOMONIQE JACKSON, Appellees

        On Appeal from the 236th District Court
                Tarrant County, Texas
            Trial Court No. 236-326748-21

         Before Kerr, Birdwell, and Walker, JJ.
        Memorandum Opinion by Justice Walker
                              MEMORANDUM OPINION

       This is an accelerated interlocutory appeal in a medical negligence case.

Appellant Acclaim Physician Group, Inc. (Acclaim) appeals the trial court’s denial of

its motion to dismiss Dr. Jacqueline Garda from the suit filed pursuant to

Section 101.106(e) of the Texas Tort Claims Act (TTCA). We will reverse the trial

court’s order and render judgment dismissing Garda from the suit. Tex. R. App. P.

43.2(c).

                                    I. BACKGROUND

                                     A. APPELLEES SUE

       Garda is a licensed obstetrician who delivered Appellees Kierra Wright and

Domoniqe Jackson’s baby at Texas Health Harris Methodist Hospital Fort Worth

(Harris Hospital) in July 2019. After the baby suffered injuries to its shoulder during

delivery, Appellees sued Acclaim, Garda, Harris Hospital, and nurse Stephanie

Herbert for negligence.1 Appellees’ petition alleged that at all material times:

    • “[Harris Hospital and Acclaim were] vicariously liable for the negligent conduct
       of their physicians . . . and/or employees under the doctrine of respondeat
       superior”;

    • “[Garda] was an agent, representative, or employee or apparent or ostensible
       agency [sic] of [Acclaim];

    • “[Garda] was acting within the course and scope of her employment, or
       ostensible agency with [Acclaim]; and

       1
           Acclaim is the only Appellant to this appeal.

                                              2
    • [Harris Hospital] and/or [Acclaim] are responsible and vicariously liable for the
       injuries and damages caused by the negligence of [Garda];

                      B. ACCLAIM MOVES TO DISMISS GARDA

      Acclaim filed a motion to dismiss under Section 101.106(e) of the TTCA,

arguing that Garda should be dismissed from the suit because Acclaim was a

governmental unit and Garda had been acting as its employee when she delivered

Appellees’ baby at Harris Hospital.       See Tex. Civ. Prac. & Rem. Code Ann.

§ 101.106(e) (providing that, in a suit filed under the TTCA against a governmental

unit and any of its employees, the “employees shall immediately be dismissed on the

filing of a motion by the governmental unit”).

      First, Acclaim argued that it was a governmental unit on two independent

bases: (1) as a charitable organization formed by Tarrant County Hospital District

d/b/a John Peter Smith Hospital (JPS) and (2) as a hospital district management

contractor. See Tex. Health & Safety Code Ann. §§ 281.0565(b), 281.072.

      Acclaim asserted that it was a nonprofit organization formed in 2015 by two

members: JPS and the University of North Texas Health Science Center at Fort

Worth (UNTHSC).2 As evidence of this, Acclaim attached to its motion a copy of its

Certificate of Formation (Certificate) and a letter from the Texas Medical Board

certifying that Acclaim was “a non-profit health organization.”        The Certificate

      2
        According to Acclaim, UNTHSC is no longer a member of Acclaim, leaving
JPS as its sole member.

                                          3
provided that Acclaim’s purposes were “exclusively charitable, educational, and

scientific within the meaning of section 501(c)(3) of the Internal Revenue Code.” It

further provided that Acclaim would operate “exclusively to benefit” its members by

       engaging in scientific research and research projects in the public interest
       in the fields of medical sciences, medical economics, public health,
       sociology, and related areas; providing, improving, and developing
       capabilities of and support for individuals and institutions studying,
       teaching, and practicing medicine; delivering health care to the public;
       improving population health and care management and engaging in the
       instruction of the general public in the area of medical science, public
       health, and hygiene and related instruction useful to the individual and
       beneficial to the community; and engaging in other activities useful or
       appropriate to the accomplishment of the foregoing purposes.

       According to Acclaim, after its formation it entered into a professional services

agreement (PSA) with JPS that was in effect when Garda delivered Appellees’ baby.

Concerning the PSA3 and Acclaim’s alleged status as a hospital district management

contractor, Daphne Walker, JPS’s senior vice president and chief legal counsel,

attested as follows:

   • “Acclaim provides services under [the PSA] with JPS and is thus a
     ‘hospital district management contractor’ pursuant to Texas Health and
     Safety Code § 285.071”;

   • “The [PSA] requires Acclaim to provide medical services to JPS’s
     patients and provide medical staff services for the sole benefit of JPS,
     oversee administration and management of JPS department operations,
     designate a physician from its staff a ‘Department Chair’ for each JPS
     department who oversees and assumes responsibility for operating and
     managing the department, provide administrative and management

       3
       A copy of the PSA does not appear in the record.

                                            4
      services to JPS in its various departments, assist JPS in developing,
      implementing, monitoring, and reviewing JPS’s quality assurance and
      improvement, utilization review, and peer review programs, procedures,
      guidelines, and policies, and manage various JPS departments and/or
      service lines in a manner that meets JPS’s expectations with respect to
      quality, compliance, performance, and patient/physician satisfaction”;

   • “The [PSA] was in effect at the time of the care . . . at issue in this case.
     The care, though having taken place at [Harris Hospital], was provided
     in accordance with the PSA and for the benefit of JPS”; and

   • “Any employee of Acclaim performing services for the benefit of JPS is
     considered an employee of JPS for purposes of Chapters 101, 102, and
     108 of the Texas Civil Practice and Remedies Code.”

      To support its contention that Garda was acting as an Acclaim employee when

she delivered Appellees’ baby at Harris Hospital, Acclaim proffered (1) Garda’s

affidavit, (2) a billing record for the baby’s delivery, (3) a Harris Hospital patient

consent form purportedly signed by Wright, and (4) a Medical Coverage Services

Agreement between Harris Hospital and Acclaim (Harris–Acclaim Agreement).

      In her affidavit, Garda attested that, at the time of the care in question, she

“was an employee of [Acclaim], was solely employed by Acclaim, and was not

employed by any other [entity] other than Acclaim.” The billing record is a one-page,

itemized statement showing certain charges billed by Acclaim for services rendered by

Garda in the baby’s delivery. The Harris Hospital patient consent form is a document

apparently signed by Wright4 by which she acknowledged that her treating physicians

      4
      In the record copy of this form, the signature block is mostly obstructed and
shows only a partial signature, though there is other identifying information on the

                                           5
“[did] not work for [Harris] Hospital[,] . . . that [Harris] Hospital [was] not responsible

for their judgment or conduct,” and that they “practice[d] independently and [were]

not employees or agents of [Harris] Hospital.”

       The Harris–Acclaim Agreement outlined that Harris Hospital needed

physicians to provide obstetrics services to its patients and that Acclaim “employ[ed]

or contract[ed] with physicians on [Harris] Hospital’s medical staff.” Harris Hospital

agreed to pay Acclaim to provide it with obstetrics services using these Acclaim

physicians. Under the Agreement, Acclaim was obligated to

   • ensure that its physicians held the appropriate professional qualifications, which
     included maintaining membership on Harris Hospital’s medical staff;

   • “make available” the physicians Acclaim employed or contracted with to
     provide round-the-clock obstetrics services to Harris Hospital;

   • furnish Harris Hospital with a monthly schedule of the physicians that Acclaim
     intended to provide these services;

   • remove from the schedule physicians that Harris Hospital refused for cause;
     and

   • ensure that Acclaim and its physicians complied with Harris Hospital’s policies
     and procedures.

       And Harris Hospital was obligated to

   • provide the facilities and equipment necessary for the provision of the
     obstetrics services, except that it was not responsible for paying “the personal
     and professional expenses” of Acclaim’s physicians; and

form indicating that the form was related to Wright’s care at Harris Hospital.
Appellees did not object to the exhibit.

                                            6
   • provide nursing and other administrative staff necessary for providing
     obstetrics services, “the selection, retention, direction[,] and control” of which
     at all times remained with Harris Hospital.

       Under the Harris–Acclaim Agreement, Harris Hospital would pay Acclaim a set

amount per each twenty-four-hour period of obstetrics services provided by Acclaim

physicians.   Acclaim was “solely responsible” for directly billing any patients for

treatment they received from Acclaim physicians at Harris Hospital. And it was

agreed that Harris Hospital would make no withholdings for Acclaim physicians for

“any sum for federal income tax, unemployment insurance, social security, or any

other withholding applicable to employees.” Further, Harris Hospital would not

provide Acclaim or any of its physicians “any of the benefits provided to [Harris]

Hospital’s employees.” All such payments, withholdings, and benefits were “the sole

responsibility” of Acclaim, which would “indemnify and hold harmless” Harris

Hospital from any liability related thereto.

       Regarding the relationship between Acclaim physicians and Harris Hospital, the

Harris–Acclaim Agreement provided as follows:

       Each [Acclaim] [p]hysician, as a medical staff member, shall have the
       rights, privileges[,] and responsibilities set forth in [Harris] Hospital’s
       Medical Staff Bylaws. Provided, however, each [Acclaim] [p]hysician’s
       exercise of medical staff privileges applicable to the [obstetrics services]
       will be contingent upon such [p]hysician’s continued employment or
       contractual relationship with [Acclaim] and the continuation of this
       Agreement. The ability of any [Acclaim] [p]hysician to exercise his
       clinical privileges at [Harris] Hospital shall automatically lapse upon . . .
       the cessation of his/her employment or contractual relationship with
       [Acclaim]; or . . . termination of this Agreement.

                                               7
      ....

      The parties understand and agree that this Agreement . . . is not to be
      construed as an exclusive Agreement between [Harris] Hospital and
      [Acclaim] [p]hysician[s] for the provision of professional medical
      services within . . . [Harris] Hospital.

      ....

      In the performance of the professional medical services and
      responsibilities assumed by [Acclaim] under this Agreement, it is
      mutually understood and agreed that [Acclaim] and all [p]hysicians made
      available by [Acclaim] are, and at all times are, independent practitioners.
      [Acclaim] and [its p]hysicians shall perform the [obstetrics services] free
      of any direction or control by [Harris] Hospital, but in a manner
      consistent with currently approved methods and practices in the medical
      profession and in compliance with the standards of [Harris Hospital]
      Medical Staff and/or as otherwise provided by this Agreement. Nothing
      in this Agreement shall be construed as giving [Harris] Hospital the
      degree of control necessary to create an employer-employee relationship
      between [Harris] Hospital and [Acclaim], and neither [Acclaim] nor any
      [of its p]hysician[s] is a partner or agent of [Harris] Hospital.

      Finally, under a section entitled “Insurance,” it was agreed that Acclaim was “a

non-profit health organization organized by [JPS]” and a “unit of local government

for purposes of Chapter 101 of [the TTCA].” Additionally, “[a]s employees of a local

unit of government, [Acclaim’s] employed [p]hysicians f[ell] under sovereign

immunity and certain limits of liability under [the TTCA] with respect to acts

performed in the course and scope of employment.” As such, Acclaim agreed to

insure its physicians at its discretion “to address liability exposure associated with the

acts and omissions of its physician employees pursuant to [Harris] Hospital’s

requirement for medical staff membership.”          And Acclaim agreed that it was

                                            8
responsible for “any and all liability attributable to [its] employees during the

performance of [obstetrics services at Harris Hospital].”

       Based on this evidence, Acclaim argued that it was a governmental unit—either

as a Section 281 charitable organization or as a hospital district management

contractor—and that Garda had been acting within the scope of her employment for

Acclaim when she delivered the baby at Harris Hospital. For these reasons, Acclaim

concluded that Garda should be dismissed “immediately” upon its Section 101.106(e)

motion to dismiss. See Tex. Civ. Prac. & Rem. Code Ann. § 101.106(e).

                              C. APPELLEES RESPOND

       In response, Appellees did not dispute that Acclaim was a governmental unit or

that Acclaim had paid Garda for delivering their baby. Instead, they argued that the

“entire basis of Acclaim’s motion to [d]ismiss” hinged on whether Garda acted as

Acclaim’s employee while working at Harris Hospital. To support their contention

that Garda had not been acting as Acclaim’s employee when she delivered their baby,

Appellees provided a number of documents, including: (1) an employment agreement

between Acclaim and Garda (Employment Agreement); (2) testimony from Garda’s

deposition; (3) bylaws, rules, and regulations of the Harris Hospital medical staff

(Bylaws and Rules); and (4) Harris Hospital’s shoulder dystocia policy (Dystocia

Policy).

       Garda’s Employment Agreement outlines that Acclaim hired her to provide

obstetrics and gynecological services exclusively at JPS and “other sites as may be

                                           9
approved by” JPS and Acclaim. Garda was prohibited from engaging in the practice

of medicine “except as an employee of Acclaim” unless she secured Acclaim’s written

authorization.   It was agreed that Garda would exercise her “own independent

judgment regarding the treatment of any particular patient” and that Acclaim would

not “control, attempt to control, influence, attempt to influence[,] or otherwise

interfere with” Garda’s independent professional judgment in diagnosing and treating

patients. Garda agreed to “observe, comply with[,] and be bound by all regulations,

policies[,] and procedures of general application to individuals employed by Acclaim.”

      The Employment Agreement contains a liability provision similar to the one in

the Harris–Acclaim Agreement—stating that Acclaim was a unit of local government

for purposes of the TTCA, that Garda was therefore a government employee “for

purposes of determining liability for acts/omissions within the course and scope of

[her] employment,” and that Acclaim would “pay for all costs of suit and legal

representation related to claims against [her]” related to such acts or omissions.5 As

Acclaim’s employee, Acclaim would pay Garda, withhold taxes, and provide her with

all “benefits available to Acclaim employees.” Garda was prohibited from billing or

collecting from patients directly and agreed that if she received payment from any

      5
        The issue of liability appears twice in the Employment Agreement—once in
the main body of the text and again as part of an exhibit attached to the Agreement—
using substantially similar language each time. The language in the exhibit adds that,
in the event that Garda is determined to have been working as Acclaim’s employee
when she committed the acts or omissions underlying a suit in which she is named as
a party, Acclaim would assert that she should be personally dismissed.

                                          10
source for services provided under the Employment Agreement, she would submit

such payment to Acclaim. Garda also agreed to a one-year nonsolicitation agreement

upon termination of her employment with Acclaim.

      The Employment Agreement also discusses the issue of Garda’s potential

assignment to other entities:

      At Acclaim’s discretion, [Garda] may be assigned, leased[,] or
      subcontracted to perform services at or on behalf of other entities. In
      such instance, [Garda] understands and acknowledges that [she] will be
      required to follow, abide by[,] and comply with such entity’s policies,
      procedures, bylaws, compliance programs[,] and other directives, as if
      such entity were [her] employer . . . . In the event [Garda] is assigned,
      leased[,] or subcontracted to perform services at or on behalf of other
      entities . . . the entity to which [she] is assigned, leased[,] or
      subcontracted . . . shall stand in the shoes of Acclaim with respect to the
      duties and obligations hereunder, except as and to the extent otherwise
      agreed between Acclaim[] and the entity receiving [Garda’s] services
      through the assignment, lease[,] or subcontract. Acclaim, however, shall
      remain ultimately responsible to ensure that [Garda] receives
      compensation and benefits in accordance with the terms of this
      Agreement.

      The Bylaws and Rules set out certain requirements for obtaining and

maintaining Harris Hospital admitting privileges and medical staff membership.6 All

staff members must abide by Harris Hospital’s Bylaws, Rules, and policies. This

includes guidelines about administering medications, keeping accurate medical records

that meet specific practice-area criteria,7 participating in continuing education

      6
       The record contains only a portion of the Bylaws and Rules.
      7
       For example, obstetrical records must include “a complete prenatal record”
and be updated within 24 hours of each visit.

                                          11
programs, and providing medical care to Harris Hospital patients “as requested by

[the staff member’s] division chief.” The portion of the Bylaws contained in the

record discusses four classes of staff membership—courtesy staff, consulting staff,

emeritus staff, and affiliate staff—each with varying qualification requirements.

Courtesy staff, for example, are required to “take emergency room call” in certain

situations and are entitled to exercise clinical privileges at Harris Hospital “subject to

any contractual arrangements” that may exist. All four classes are required to “fulfill

the conditions and responsibilities” of medical staff membership.

      The Dystocia Policy is a step-by-step guide for Harris Hospital’s

labor-and-delivery unit to use as “guidance regarding the care of the intrapartum

patient experiencing shoulder dystocia during delivery.” By its terms, the Dystocia

Policy “is not intended as a substitute for the clinician’s judgment and/or experience.”

And the Policy specifically provides that

      [t]he physicians on the medical staff of the hospital are practitioners
      independent of [Harris Hospital] unless they are practitioners
      participating in the care of patients as part of a post-graduate medical
      education program. They are not agents, servants[,] or employees of
      [Harris Hospital] unless they are part of a graduate medical education
      program of [Harris Hospital].”

      In her deposition, Garda confirmed that, though she may have delivered

“slightly more” babies at Harris Hospital in 2019 than at JPS, she only ever acted as “a

salaried physician with Acclaim.” She agreed that she was required to follow the

Dystocia Policy when delivering Appellees’ baby at Harris Hospital, with the

                                            12
understanding that the Policy was only a guideline and not a substitute for her

“clinical judgment.”

                                 II. DISCUSSION

                                  A. JURISDICTION

      We begin with a discussion about our jurisdiction. See Rosenberg Dev. Corp. v.

Imperial Performing Arts, Inc., 526 S.W.3d 693, 698 (Tex. App.—Houston [14th Dist.]

2017) (explaining that appellate courts must examine jurisdiction “independently and

sua sponte” if necessary), aff’d, 571 S.W.3d 738 (Tex. 2019); In re M.G.T., No. 02-10-

00340-CV, 2011 WL 255542, at *1 (Tex. App.—Fort Worth Jan. 27, 2011, no pet.)

(mem. op.) (same).

      Acclaim argues that our jurisdiction lies under Section 51.014(a)(5) of the Texas

Civil Practice and Remedies Code, which provides that a party may appeal an

interlocutory order that “denies a motion for summary judgment that is based on an

assertion of immunity by an individual who is an officer or employee of the state or a

political subdivision of the state.” Tex. Civ. Prac. & Rem. Code Ann. § 51.014(a)(5).

Appellees contend that we lack jurisdiction under this provision because Garda had

not been acting as an employee of the state or a political subdivision of the state when

she delivered the baby.

      We conclude that we have jurisdiction over this appeal—though under

Section 51.014(a)(8)—based on Acclaim’s status as a charitable organization formed

by JPS. Id. § 51.014(a)(8). Section 51.014(a)(8) creates appellate jurisdiction from an

                                          13
interlocutory order that “grants or denies a plea to the jurisdiction by a governmental

unit as that term is defined in Section 101.001.” Id. The supreme court has held that

Section 51.014(a)(8) appeals are not limited to any single procedural vehicle (i.e. a plea

to the jurisdiction) and may lie upon the denial of any motion that challenges the trial

court’s subject matter jurisdiction. Thomas v Long, 207 S.W.3d 334, 339–40 (Tex.

2006); see Austin State Hosp. v. Graham, 347 S.W.3d 298, 300–01 (Tex. 2011). This

includes the denial of motions brought by governmental units to dismiss their

employees pursuant to Section 101.106(e) of the TTCA, as Acclaim brought here. See

Tex. Civ. Prac. & Rem. Code Ann. § 101.106(e); Graham, 347 S.W.3d at 301.

      Thus, our jurisdiction hinges on whether Acclaim was a governmental unit

when it brought its motion to dismiss.

      Section 101.001 defines a governmental unit as, among other things, “any other

institution, agency, or organ of government the status and authority of which are

derived from the Constitution of Texas or from laws passed by the Legislature under

the constitution.”    Tex. Civ. Prac. & Rem. Code Ann. § 101.001(3)(D).              This

definition is broadly applicable, with the phrase “organ of government” encompassing

“an entity that operates as part of a larger governmental system.” Univ. of the Incarnate

Word v. Redus, 518 S.W.3d 905, 910 (Tex. 2017); see Eckerd Youth Alts., Inc. v. Pytel,

No. 02-21-00332-CV, 2022 WL 2176523, at *3 (Tex. App.—Fort Worth June 16,

2022, no pet.) (mem. op.).

                                           14
       As a charitable organization formed by JPS under Section 281.0565 of the

Health and Safety Code, Acclaim falls within this broad definition of governmental

unit. See Tex. Health & Safety Code Ann. § 281.0565(b). Section 281.0565 allows a

hospital district such as JPS to “create a charitable organization to facilitate the

management of a district health care program by providing or arranging health care

services, developing resources for health care services, or providing ancillary support

services for the district.”     Id.   Importantly, for our purposes, “[a] charitable

organization created by a district under this section is a unit of local government only for

purposes of Chapter 101, Civil Practice and Remedies Code.” Id. § 281.0565(c)

(emphasis added).

       The record further establishes that Acclaim operates “as a part of” JPS, a larger

governmental system.8 See Redus, 518 S.W.3d at 910.            Acclaim was created and

organized by JPS to operate “exclusively to benefit” JPS. Further, Walker attested—

and Appellees do not dispute—that Acclaim provides specific operating,

management, and administrative services to JPS and medical care to JPS patients “for

the sole benefit of JPS.” And Acclaim derived its existence and status as “a unit of

local government” from laws passed by the legislature that enable hospital districts to

       8
     JPS is a political subdivision of the State of Texas. Tarrant Cnty. Hosp. Dist. v.
GE Auto. Servs., Inc., 156 S.W.3d 885, 891 (Tex. App.—Fort Worth 2005, no pet.).

                                            15
create charitable organizations to help “facilitate the management” of those districts. 9

See Tex. Health & Safety Code Ann. §§ 281.0565(b), (c).

      For these reasons, we hold that Acclaim is a governmental unit and that we

have jurisdiction to review—as a Section 51.014(a)(8) interlocutory appeal—the trial

court’s denial of Acclaim’s Section 101.106(e) motion to dismiss. See Tex. Civ. Prac.

& Rem. Code Ann. § 51.014(a)(8).

           B. TRIAL COURT ERRED BY DENYING ACCLAIM’S MOTION

      In its sole issue, Acclaim argues that its Section 101.106(e) motion to dismiss

Garda should have been granted because the record established that it is a

governmental unit and that Garda was its employee when she delivered Appellees’

baby at Harris Hospital. Appellees argue that the trial court did not err because

Acclaim was not a governmental unit and because Garda had not been acting as

Acclaim’s employee, both of which would preclude her dismissal. We agree with

Acclaim.

      9
        We are not alone in holding that a Section 281 charitable organization such as
Acclaim (or a similar corporation) is a governmental unit. See Cmty. Health Choice, Inc.
v. ACS Primary Care Physicians Sw., P.A., No. 14-21-00519-CV, 2023 WL 5208809, at
*2 (Tex. App.—Houston [14th Dist.] Aug. 15, 2023, no pet. h.) (“Therefore,
Community Health [a Section 281 charitable organization] is a governmental unit for
purposes of the interlocutory appeal permitted by section 51.014(a)(8).”); see Rosenberg
Dev. Corp. v. Imperial Performing Arts, Inc., 571 S.W.3d 738, 748 (Tex. 2019) (holding
same for economic development corporations created under similar statute). Nor are
we the first court to conclude that Acclaim itself is a governmental unit owing to its
status as a Section 281 charitable organization. See DePaz Gonzalez v. Duane, No. 4:20-
CV-072-A, 2022 WL 743521, at *5 (N.D. Tex. Mar. 11, 2022) (mem. op.) (“Acclaim is
a governmental unit under Texas law.”).

                                           16
                     1. Standard of Review and Relevant Law

      We review de novo a trial court’s ruling on a motion to dismiss brought under

Section 101.106(e) of the TTCA. Crockett Cnty. v. Damian, 622 S.W.3d 58, 60 (Tex.

App.—El Paso 2020, no pet.); City of Webster v. Myers, 360 S.W.3d 51, 56 (Tex. App.—

Houston [1st Dist.] 2011, pet. denied). Such a motion must be granted if no fact issue

exists as to the governmental unit’s entitlement to have its employee dismissed. See

Marino v. Lenoir, 526 S.W.3d 403, 405 (Tex. 2017); Baylor Scott & White v. Peyton,

549 S.W.3d 242, 245–46 (Tex. App.—Fort Worth 2018, no pet.); Powell v. Knipp,

479 S.W.3d 394, 398 (Tex. App.—Dallas 2015, pet. denied).

      The TTCA’s election-of-remedies provision was adopted as a means of

“reducing the resources that the government and its employees must use in defending

redundant litigation and alternative theories of recovery.” Mission Consol. ISD v. Garcia,

253 S.W.3d 653, 657 (Tex. 2008). It provides in pertinent part:

      (a) The filing of a suit under this chapter against a governmental unit
      constitutes an irrevocable election by the plaintiff and immediately and
      forever bars any suit or recovery by the plaintiff against any individual
      employee of the governmental unit regarding the same subject matter.

      (b) The filing of a suit against any employee of a governmental unit
      constitutes an irrevocable election by the plaintiff and immediately and
      forever bars any suit or recovery by the plaintiff against the
      governmental unit regarding the same subject matter unless the
      governmental unit consents.

      ....

                                           17
      (e) If 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.

Tex. Civ. Prac. & Rem. Code Ann. §§ 101.106(a), (b), (e).

      Accordingly, a plaintiff must decide “at the outset whether an employee acted

independently and is thus solely liable, or acted within the general scope of his or her

employment such that the governmental unit is vicariously liable.” Garcia, 253 S.W.3d

at 657. This decision is “an irrevocable election” made “at the time suit is filed.” Id.

Further, “the expedient dismissal” of governmental unit employees is preferred and

courts must, therefore, “favor a construction that most clearly leads to the early

dismissal of a suit against an employee when the suit arises from an employee’s

conduct that was within the scope of employment and could be brought against the

government under the TTCA.” Tex. Adjutant Gen.’s Off. v. Ngakoue, 408 S.W.3d 350,

355 (Tex. 2013).

      When, as here, a plaintiff sues both the governmental unit and the employee,

the governmental unit may file a motion to dismiss the claims against its employee.

Tex. Civ. Prac. & Rem. Code Ann. § 101.106(e). The election-of-remedies provision

is triggered as soon as the governmental unit files a Section 101.106(e) motion to

dismiss. Univ. of Tex. Health Sci. Ctr. at Hous. v. Rios, 542 S.W.3d 530, 538 (Tex. 2017);

Damian, 622 S.W.3d at 61. “By filing such a motion, the governmental unit effectively

confirms the employee was acting within the scope of employment and that the

government, not the employee, is the proper party.” Ngakoue, 408 S.W.3d at 358;

                                           18
Ledesma v. City of Hous., 623 S.W.3d 840, 848 (Tex. App.—Houston [1st Dist.] 2020,

pet. denied) (explaining that the governmental unit is in the best position to know

who its employees are when it files a Section 101.106(e) motion to dismiss). Upon the

employee’s dismissal, the suit “proceeds solely against the government.” Ngakoue,

408 S.W.3d at 358.

      In light of this, Garda should have been immediately dismissed from the suit

upon Acclaim’s motion to dismiss if no fact issues existed as to whether (1) Acclaim

was a governmental unit and (2) Garda was acting as its employee, as defined by the

TTCA. See Tex. Civ. Prac. & Rem. Code Ann. § 101.106(e); Marino, 526 S.W.3d

at 405; Powell, 479 S.W.3d at 398.

             2. Acclaim is Governmental Unit Under Section 101.106

      We have already held for jurisdictional purposes that Acclaim is a governmental

unit because it is a Section 281.0565 charitable organization that operates as a part of

JPS. See Redus, 518 S.W.3d at 910. We hold now, for these same reasons, that no fact

issue existed as to whether Acclaim was a governmental unit for purposes of its

Section 101.106(e) motion to dismiss Garda.10

      Appellees argue that Rosenberg supports their contention that Acclaim is not a

governmental unit for purposes of Garda’s dismissal. See 571 S.W.3d 738 at 747.

      10
        Having held that the record establishes Acclaim’s governmental unit status on
Acclaim’s theory that it was a Section 281.0565 charitable organization, we need not
consider its alternate theory that its governmental unit status derived from its being a
hospital district management contractor. See Tex. R. App. P. 47.1.

                                          19
There, the Texas Supreme Court sought to determine whether an economic

development corporation (EDC)11 was itself entitled to immunity from suit as an arm

of the state.    Id. at 741, 748.    The court recognized that EDCs were in fact

governmental units but ultimately held that “the Legislature did not authorize

municipalities to create economic development corporations as distinct governmental

entities entitled to assert immunity in their own right.” Id. at 751.

       Rosenberg is distinguishable from our case. We are not presented here with the

issue of whether Acclaim was itself entitled to immunity from suit—a determination

that would proceed under a separate analysis. See id. at 748–51. Instead, we are tasked

with determining only whether “a suit [was] filed under [the TTCA] against both a

governmental unit and any of its employees.” See Tex. Civ. Prac. & Rem. Code Ann.

§ 101.106(e). If these clearly delineated elements exist, the TTCA requires that Garda

be immediately dismissed upon Acclaim’s motion.12 See id.

       11
        Through the Development Corporation Act, the Legislature enabled
municipalities to create EDCs for the purpose of promoting and developing
enterprises that promote and encourage employment and the public welfare. Tex.
Loc. Gov’t Code Ann. §§ 501.004(a)(6), .051(c); see Rosenberg, 571 S.W.3d at 744.
       12
        It is also notable that Appellees, in responding in the trial court to Acclaim’s
motion to dismiss, did not dispute Acclaim’s status as a governmental unit. Instead,
they argued that the determination of Acclaim’s motion to dismiss hinged only on
whether Garda was acting as Acclaim’s employee at the time of delivery.

                                            20
                         3. Garda Was Acclaim’s Employee

                                  A. TTCA Employee

       The record established that Garda was Acclaim’s employee under the TTCA.

The TTCA defines “employee” as

       a person, including an officer or agent, who is in the paid service of a
       governmental unit by competent authority, but does not include an
       independent contractor, an agent or employee of an independent
       contractor, or a person who performs tasks the details of which the
       governmental unit does not have the legal right to control.

Tex. Civ. Prac. & Rem. Code Ann. § 101.001(2).

       Appellees do not dispute that Garda was “in the paid service” of Acclaim.

Instead, they contend only that Acclaim did not have the “legal right to control” the

tasks that Garda performed at Harris Hospital because Harris Hospital was the entity

that actually controlled her.

       The Texas Supreme Court has explained that the TTCA’s definition of

employee “does not require that a governmental unit control every detail of a person’s

work.” Murk v. Scheele, 120 S.W.3d 865, 867 (Tex. 2003) (rejecting argument that

physician was not TTCA employee even though exercise of physician’s independent

judgment was outside governmental unit’s right of control). Where there are two

alleged employers, courts look to the contracts between the employers to determine

which retains the legal right of control over the employee. Powell, 479 S.W.3d at 401.

       A contract that explicitly allocates which entity controls the employee is

typically dispositive if no contrary evidence exists. Id.; see Producers Chem. Co. v. McKay,

                                            21
366 S.W.2d 220, 226 (Tex. 1963) (“When a contract, written or oral, between two

employers expressly provides that one or the other shall have right of control,

solution of the question is relatively simple.”); Skapek v. Perkins, No. 05-16-00796-CV,

2017 WL 655950, at *3 (Tex. App.—Dallas Feb. 17, 2017, pet. denied) (mem. op.)

(“A party may establish legal right to control in two ways: 1) evidence of a contract

that expressly assigns the right of control or, absent a contract, 2) evidence of actual

control over the manner in which the work is to be performed.”); see also Marino,

526 S.W.3d at 408 (looking to contracts and other relevant documents to determine

physician’s employee status); St. Joseph Hosp. v. Wolff, 94 S.W.3d 513, 543 (Tex. 2002)

(same). When faced with such express contractual provisions, the nonmovant must

raise a fact issue that the second employer actually controlled the employee “to the

exclusion of” the governmental unit’s legal right of control. Powell, 479 S.W.3d at 401

(citing White v. Liberty Eylau Sch. Dist., 880 S.W.2d 156, 159 (Tex. App.—Texarkana

1994, writ denied) (“A person may be the servant of two employers at one time as to

one act if the service to one does not involve an abandonment of the service to the

other.”)); see Wolff, 94 S.W.3d at 408.

       Garda’s Employment Agreement and the Harris–Acclaim Agreement

established that Garda was Acclaim’s employee for TTCA purposes because Acclaim

retained the legal right to control the details of her work—even work completed at

Harris Hospital.

                                          22
       The Employment Agreement outlines that Garda would provide obstetrics

services for Acclaim at JPS and other approved sites and that she was prohibited from

practicing medicine in any capacity other than as Acclaim’s employee. Acclaim would

pay Garda, withhold requisite taxes, and provide her with all benefits available to her

as Acclaim’s employee. It was agreed that Garda was a government employee due to

her employment with Acclaim, a unit of government, and that Acclaim would

therefore cover all costs related to any legal claims filed against her related to her

work. In the event that Garda was sued, Acclaim agreed that it would move to have

her dismissed under the TTCA.

       On the issue of Garda’s assignment to another entity, such assignments were

exclusively at Acclaim’s discretion. It was agreed that Garda would follow the policies

and directives of the receiving entity and that the receiving entity would “stand in the

shoes of Acclaim with respect to the duties and obligations” in the Employment

Agreement—unless Acclaim and the receiving entity agreed otherwise.

       Acclaim and Harris Hospital did agree otherwise via the Harris–Acclaim

Agreement. They agreed that Harris Hospital was not granted “the degree of control

necessary to create an employer-employee relationship between” it and Acclaim’s

physicians that were assigned to Harris Hospital.           Rather, all Acclaim physicians

would provide their services at Harris Hospital “free of any direction or control by

Harris Hospital” and would lose all clinical privileges at Harris Hospital if the

physician ceased working at Acclaim.

                                             23
      Acclaim took responsibility for ensuring that its physicians complied with

Harris Hospital’s policies and procedures and that they held the appropriate

professional qualifications. All salaries and benefits owed to Acclaim physicians were

Acclaim’s sole responsibility, and Acclaim agreed to indemnify Harris Hospital from

any attendant liability. Acclaim was to set all of its physician schedules at Harris

Hospital and to remove them from working at Harris Hospital if cause existed. And

it was required to directly bill patients for any care they received from Acclaim

physicians at Harris Hospital.

      Finally, Acclaim and Harris Hospital agreed that Acclaim was a unit of local

government under the TTCA and that its physicians fell under Chapter 101 of the

TTCA.     And they agreed that Acclaim was solely responsible for insuring its

physicians and for “any and all liability attributable to [its] employees” arising out of

the care they provided at Harris Hospital.

      Other record evidence supports that Garda acted only as Acclaim’s employee.

Garda testified and attested that she had only ever been a salaried employee of

Acclaim when she provided services at Harris Hospital.             Additionally, Harris

Hospital’s own patient consent form notified patients—including Wright—that their

treating physicians were not Harris Hospital employees and that Harris Hospital was

“not responsible for their judgment or conduct.”

      Taken together, the evidence establishes that Acclaim had the legal right to

control Garda as its employee while she worked at Harris Hospital, and that all

                                             24
contractual parties proceeded under this understanding. Nothing in the record shows

that Harris Hospital made any particular attempt to control Garda in the care that she

provided at Harris Hospital. See Powell, 479 S.W.3d at 403 (“There is no evidence in

the record [that the physician] obtained any directive from anyone at [the borrowing

hospital] as to how [the physician] was to perform his radiological tasks pertaining to

[the injured patient].”).

       Appellees argue that the Bylaws and Rules of the Harris Hospital Medical Staff

and the Dystocia Policy raise at least a fact issue as to whether Harris Hospital—

rather than Acclaim—actually controlled Garda’s care related to the delivery of their

baby. These arguments are unavailing.

       It is not disputed that, to have staff privileges at Harris Hospital, a physician

such as Garda was required to be a member of the Harris Hospital Medical Staff. It is

likewise not disputed that such membership was contingent upon the physician’s

meeting certain qualifications and following the Bylaws and Rules. However, the law

is clear that, generally, “a physician is considered to be an independent contractor with

regard to hospitals at which he has staff privileges.” Dumas v. Muenster Hosp. Dist.,

859 S.W.2d 648, 651 (Tex. App.—Fort Worth 1993, no writ) (internal quotations

omitted).    And independent contractors, by definition, are not employees of or

controlled by the entities to which they provide services. See Farlow v. Harris Methodist

Fort Worth Hosp., 284 S.W.3d 903, 911 (Tex. App.—Fort Worth 2009, pet denied)

(“An independent contractor is one who, in pursuit of an independent business,

                                           25
undertakes specific work for another using his or her own means and methods

without submitting to the control of the other person as to the details of the

work.”).13 In other words, the mere fact that Garda was a member of the medical

staff at Harris Hospital (requiring her to follow its Bylaws and Rules) for the purpose

of obtaining staff privileges there does not mean that Harris Hospital controlled her

as its employee—particularly not to the exclusion of Acclaim’s legal right to control

her as its employee.

       And the Dystocia Policy, rather than supporting Appellees’ contention that

Harris Hospital controlled Garda’s actions, establishes exactly the opposite. After

outlining certain steps that labor-and-delivery practitioners should follow in the event

of a shoulder dystocia event, the Dystocia Policy states that it is merely a “guideline”

that should not “substitute for the clinician’s clinical judgment and/or experience.” It

continues by explaining that the physicians on Harris Hospital’s medical staff “are

practitioners independent of the hospital” unless they are part of its post-graduate

education program and that they “are not agents, servants[,] or employees of [Harris

Hospital] . . . .”

       13
         Notably, in Farlow, we affirmed the trial court’s summary judgment that ruled
that a physician providing services at Harris Hospital was not its employee for
respondeat superior purposes, despite the fact that the physician was required to
maintain staff privileges at Harris Hospital and to abide by the Medical Staff Bylaws.
Farlow, 284 S.W.3d at 911–17.

                                          26
           B. Parties Judicially Admitted Garda Was Acclaim’s Employee

       Beyond the record evidence supporting Garda’s status as Acclaim’s employee,

the parties also judicially admitted as such. The Texas Supreme Court has held that

the parties’ pleaded judicial admissions are dispositive in determining whether a

physician is the employee of a governmental unit for dismissal under

Section 101.106(e). See Rios, 542 S.W.3d at 534–35; Ngakoue, 408 S.W.3d at 358.

       In Rios, the plaintiff alleged in his petition that a governmental-unit hospital had

tortiously interfered with his residency contract “separately[] and through” certain

defendant-physicians. Rios, 542 S.W.3d at 532. The hospital moved to dismiss the

defendant-physicians under Section 101.106(e), claiming that they were hospital

employees.     Id. at 532–33.   The supreme court held that the plaintiff’s pleaded

allegation amounted to a judicial admission as to the defendant-physicians’ status as

hospital employees: “Assuming Rios intended to plead a viable claim, his allegation

was    a     judicial   admission   that   the    [hospital]’s   actions   through     the

[defendant-physicians] were through employees, relieving the defendants of having to

prove that fact.” Id. at 534.

       The court then explained that the act of the governmental-unit hospital moving

to dismiss its employee under Section 101.106(e) served as a judicial admission in its

own right:

       In language we have recently used, “by filing such a motion, the
       [hospital] effectively confirmed the [defendant-physicians] were
       employees acting within the scope of employment and that the

                                            27
      [hospital], not the [defendant-physicians], is the proper party.” Thus, at
      the time the defendants filed their original motion to dismiss, all parties’
      pleadings established that the [defendant-physicians] were [hospital]
      employees.

Id. (cleaned up) (quoting Ngakoue, 408 S.W.3d at 358); see also Ramos v. City of Laredo,

547 S.W.3d 651, 655–56 (Tex. App.—San Antonio 2018, no pet.) (“The City’s

assertion via its plea to the jurisdiction under Section 101.106(e) that [the employee]

was entitled to official immunity amounted to a judicial admission that [the employee]

was acting in the scope of employment.”).

      Here, the parties made similar judicial admissions. Appellees alleged in their

petition that at all relevant times (1) Acclaim was vicariously liable for the negligent

conduct of its employees; (2) Garda was the “agent, representative, or employee or

apparent or ostensible” agent of Acclaim; (3) Garda “was acting within the course and

scope of her employment, or ostensible agency with” Acclaim; and (4) Acclaim was

“responsible and vicariously liable for the injuries and damages caused by the

negligence of Garda.” And, of course, Acclaim filed its Section 106.101(e) motion to

dismiss, wherein it confirmed that Garda was acting as its employee at the delivery of

Appellees’ baby. Thus, as in Rios, the parties’ pleadings here established that Garda

was Acclaim’s employee.

      For these reasons, we hold that no fact issue existed as to whether Garda was

Acclaim’s employee when she delivered Appellees’ baby at Harris Hospital.

                                          28
                                III. CONCLUSION

      Having held that no fact issues existed as to whether Acclaim was a

governmental unit or that Garda was its employee at all times relevant to this dispute,

we sustain Acclaim’s sole issue.     Accordingly, we reverse the trial court’s order

denying Acclaim’s Section 101.106(e) motion to dismiss Garda, and we render

judgment dismissing Garda from the suit. See Tex. R. App. P. 43.2(c); Univ. of Tex.

M.D. Anderson Cancer Ctr., v. Stewart, No. 01-16-00865-CV, 2017 WL 2590230, at *4

(Tex. App.—Houston [1st Dist.] June 15, 2017, no pet.) (mem. op.) (reversing and

rendering after trial court denied Section 101.106(e) motion to dismiss).

                                                      /s/ Brian Walker

                                                      Brian Walker
                                                      Justice

Delivered: October 19, 2023

                                          29