Venodhar Julapalli v. Medical Staff of Houston Methodist the Woodlands Hospital

In The

Court of Appeals

Ninth District of Texas at Beaumont

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NO. 09-22-00179-CV
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VENODHAR JULAPALLI
v.

MEDICAL STAFF OF HOUSTON METHODIST
THE WOODLANDS HOSPITAL

________________________________________________________________________

On Appeal from the 284th District Court
Montgomery County, Texas
Trial Cause No. 21-07-09639-CV
________________________________________________________________________

MEMORANDUM OPINION

Venodhar Julapalli appeals from the trial court’s order dismissing his claim

against the Medical Staff of Houston Methodist The Woodlands Hospital for want

of subject matter jurisdiction. Because the controversy has become moot pending

appeal, we dismiss the appeal.

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Background

Factual History

Julapalli is a medical doctor and board-certified gastroenterologist. Prior to

2021, he had clinical privileges at Houston Methodist The Woodlands Hospital and

a was a member of the Medical Staff of Houston Methodist The Woodlands Hospital

(Medical Staff). The Medical Staff is an organization described by Appellee as

follows:

The Medical Staff is an independent, unincorporated association of the
physicians who see patients at the Hospital. The purpose of The
Medical Staff is [t]o provide a mechanism so that all patients admitted
to or treated in any of the facilities, Departments, or services of the
Hospital shall receive appropriate medical care. A physician must be a
member of the Medical Staff to have clinical privileges at that hospital.
Hospitals are commonly organized this way to protect the professional
autonomy of physicians.

In March 2021, the Medical Staff voted to amend its bylaws to match

Methodist Hospital’s Covid-19 vaccination policy and require all physician

members to have the Covid-19 vaccine. This included Julapalli as a member of the

Medical Staff. According to Julapalli, the amendments required all Medical Staff

members who did not comply with the vaccination requirement to have “automatic

corrective action, leading to an automatic suspension and relinquishment of clinical

privileges.” Julapalli applied for a religious exemption to the Covid-19 vaccine

requirement and was denied the exemption. Julapalli did not get the Covid-19

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vaccine and had his clinical privileges to the Methodist Hospital revoked in

accordance with the new amendment.

Procedural History

In July 2021, Julapalli filed suit against the Medical Staff seeking a

declaratory judgment under the Uniform Declaratory Judgment Act (UDJA) to

reinstate his clinical privileges. In response, the Medical Staff filed a second

amended answer and plea in abatement.1 In its motion, the Medical Staff asserted

that Julapalli failed to comply with the UDJA by not naming important parties with

a substantial interest that would be affected by the outcome, and that the claim should

be abated unless Julapalli complies with the UDJA. The Medical Staff also asserted

a general denial, defenses, and affirmative defenses.

In February 2022, the Medical Staff moved to Dismiss for Want of Subject

Matter Jurisdiction, arguing the controversy at issue was moot. The Medical Staff

contended because the federal government required all healthcare facilities that

receive Medicare and Medicaid funding, such as Houston Methodist, require their

healthcare providers be vaccinated against Covid-19 unless they receive a medical

or religious exemption, the pending legal action by Julapalli was moot. According

to the Medical Staff, this was underscored by the United States Supreme Court’s

decision in Biden v. Missouri allowing the federal mandate to stay in place. See 595

1The Medical Staff also filed a counterclaim that was later nonsuited.

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U.S. 87 (2022). The Medical Staff contended that the cause of action must be

dismissed because the federal mandate and subsequent Supreme Court decision in

Biden v. Missouri meant that “no potential declaration by this Court regarding Bylaw

amendment voting process can or will restore Plaintiff’s clinical privileges at

Houston Methodist[.]” Additionally, the Medical Staff argued even without the

federal government’s mandate, the trial court lacked jurisdiction because Julapalli

failed to plead any facts that established the existence of subject matter jurisdiction

under the UDJA. Specifically, the Medical Staff argued that the trial court lacked

jurisdiction under the UDJA to intervene in the “business of a voluntary,

professional non-profit organization and make declarations on purely factual matter

– the manner in which the Medical Staff amends its Bylaws.” Moreover, the Medical

Staff argued the bylaws are not a contract on which a declaratory action can be based.

Finally, the Medical Staff argued the trial court lacked jurisdiction because Texas

courts have adopted a judicial non-intervention doctrine, in which courts decline to

intervene in the internal management of private, voluntary, non-profit organizations.

Julapalli filed his Motion in Response, arguing he had established subject

matter jurisdiction under the UDJA, that the Act is “broad and remedial in nature[,]”

and the trial court has discretion to enter a declaratory judgment as “it will serve a

useful purpose and terminate a controversy between the parties.” Julapalli also

argued the controversy is not moot because the controversy is whether the Medical

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Staff correctly followed its bylaws and voting procedures when it enacted the Covid-

19 vaccine requirement, not the vaccine mandate itself. According to Julapalli, this

distinction creates a “real and concrete issue” that is a “justifiable controversy.”

Finally, Julapalli argues that Biden v. Missouri is inapplicable because here the

Medical Staff’s mandate was established by improperly passed bylaws, and it was

not Biden that conferred power on the Defendant to terminate and/or suspend clinical

privileges of physicians. Julapalli argued that granting his relief does not prohibit

the Medical Staff from resubmitting the amendment to its bylaws “in a proper

manner to allow for the vaccine mandate.”

After the March 2022 hearing, the trial court took the matter under advisement

and signed an Order on Motion to Dismiss for Want of Subject Matter Jurisdiction,

granting the Medical Staff’s Motion to Dismiss Julapalli’s claims for lack of subject

matter jurisdiction. Julapalli filed a Motion for New Trial that the trial court denied.

Julapalli then timely filed his Notice of Appeal.

Mootness During the Pendency of the Appeal

On appeal, Julapalli argues that the trial court erred when it dismissed his

appeal for lack of subject matter jurisdiction. Specifically, Julapalli argues that the

controversy is not moot, that he need not assert another independent cause of action

under the UDJA, and that although the judicial non-intervention clause may apply,

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the case weighs heavily in favor of judicial intervention by, among other reasons,

protecting a fiduciary duty among patient and physician.

As mootness affects our jurisdiction on appeal, we will address that issue first.

“For a plaintiff to have standing, a controversy must exist between the parties at

every stage of the proceedings, including the appeal.” Williams v. Lara, 52 S.W.3d

171, 184 (Tex. 2001) (citing United States v. Munsingwear, Inc., 340 U.S. 36, 39

(1950)). If the parties lack a legally cognizable interest in the outcome of the case,

or a court’s actions cannot affect the parties’ rights, the case becomes moot. See id.;

see also Pinnacle Gas Treating, Inc. v. Read, 104 S.W.3d 544, 545 (Tex. 2003). If a

judgment, when rendered, will not have practical legal affect upon the parties, the

case is moot. See Houston Indep. Sch. Dist. v. Houston Tchrs. Ass’n, 617 S.W.2d

765, 766-67 (Tex. Civ. App.—Houston [14th Dist.] 1981, no writ). The Fourteenth

Court of Appeals explained,

This court will not proceed to a determination when its judgment would
be wholly ineffectual for want of a subject-matter on which it could
operate. An affirmance would ostensibly require something to be done
which had already taken place. A reversal would ostensibly avoid an
event which had already passed beyond recall. One would be as vain as
the other. To adjudicate a cause which no longer exists is a proceeding
which this court uniformly has declined to entertain.

Id. (quoting Brownlow v. Schwartz, 261 U.S. 216, 217-18 (1923)). “If a case

becomes moot, the parties lose standing to maintain their claims.” Williams, 52

S.W.3d at 184.

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Julapalli’s petition seeks a declaration under the UDJA by the trial court to

have his clinical privileges reinstated. The allegations made in support of Julapalli’s

claims relate to the Medical Staff’s alleged violation of its bylaws and voting

procedures and subsequent bylaw amendments that required its members to have a

Covid-19 vaccine or lose clinical privileges to Houston Methodist. Specifically,

Julapalli alleges the Medical Staff “did not comply with the requirements set out in

Article XVI of its bylaws including but not limited to notice provisions, quorum

requirements, and an inappropriate voting mechanism.” Julapalli argues that because

of the underlying enactment of the bylaw amendment was void, the amendment that

resulted in the loss of his clinical privileges was also void. Julapalli’s declaratory

judgment action seeks to have his clinical privileges restored, but the federal

mandate cited by the Medical Staff is no longer in effect. In May 2023, the federal

government ended the Covid-19 public health emergency and in June 2023, the

Centers for Medicare and Medicaid Services rescinded its mandate requiring

healthcare facilities receiving Medicare or Medicaid funds to require its staff to

receive the Covid-19 vaccine. 88 Fed. Reg. 36485, 36502; see also Phillips v. Rector

& Visitors of the Univ. of Virginia, No. 3:22-CV-00075, 2024 U.S. Dist. LEXIS

49328, at *6-9 (W.D. Va. Mar. 20, 2024). Additionally, in 2024, the State of Texas

passed section 81D.002 under the Health and Safety Code prohibiting private

employers from enacting a Covid-19 vaccine mandate. Tex. Health & Safety Code

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Ann. § 81D.002 (“An employer may not adopt or enforce a mandate requiring an

employee, contractor, applicant for employment, or applicant for a contract position

to be vaccinated against COVID-19 as a condition of employment or a contract

position.”).

Once the federal mandate was recalled and the State’s 81D.002 statute went

into effect, Julapalli’s clinical privileges to Methodist Hospital can no longer be

contingent on his receiving the Covid-19 vaccine. See Heckman v. Williamson Cnty.,

369 S.W.3d 137, 167 (Tex. 2012) (“[W]e agree that the courts have an obligation to

take into account intervening events that may render a lawsuit moot. [D]efendants

are right that where a plaintiff challenges a statute or written policy, that challenge

may well become moot if the statute or policy is repealed or fundamentally

altered.”). While the parties have not informed this Court whether the bylaw

amendment is still in effect, Methodist Hospital and the Medical Staff are now

prohibited from requiring its members to receive a Covid-19 vaccine under Texas

law. Because of intervening events and fundamental alterations in the law, a

declaratory judgment would have no practical legal effect on the parties. It would do

no more than attempt to “require something to be done which [has] already taken

place” or to “avoid an event which [has] already passed beyond recall.” Houston

Indep. Sch. Dist., 617 S.W.2d at 767. Julapalli made no other claims and sought no

other relief against the defendants. Thus, the controversy between the parties has

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ceased to exist. “A case also becomes moot when it is impossible for a court to grant

effective relief for any reason.” Hallbauer v. Oviedo, No. 09-13-00103-CV, 2014

Tex. App. LEXIS 6434, at *14 (Tex. App.—Beaumont June 12, 2014, no pet.)

(citing State v. Gibson Products Co., 699 S.W.2d 640, 641 (Tex. App.—Waco 1985,

no writ)). We need not determine whether the trial court erred in dismissing this case

for lack of jurisdiction. We dismiss this appeal as moot. Tex. R. App. P. 43.2(f).

DISMISSED AS MOOT.

PER CURIAM

Submitted on November 21, 2023
Opinion Delivered August 29, 2024

Before Golemon, C.J., Wright and Chambers, JJ.

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