Texas Acorn v. Texas Area 5 Health Systems Agency, Inc.

Decision Date23 September 1977
Docket NumberNo. 77-1717,77-1717
Citation559 F.2d 1019
PartiesTEXAS ACORN, Dini Turley, et al., Plaintiffs-Appellees, v. TEXAS AREA 5 HEALTH SYSTEMS AGENCY, INC., Defendant-Appellant, Joseph Califano, as Secretary, United States Department of Health, Education and Welfare, Defendant-Appellant, Floyd A. Norman, M. D., as Regional Health Administrator, Public Health Service, etc., Defendant.
CourtU.S. Court of Appeals — Fifth Circuit

Jerry Lee Hughes, Dennis R. Swift, Fort Worth, Tex., Roby Hadden, U.S. Atty., Otis W. Carroll, Jr., Asst. U.S. Atty., Tyler, Tex., Henry L. Gilliam, U.S. Dept. of Health, Education & Welfare, Dallas, Tex., William Kanter, Atty., Paul Blankenstein, Atty., Harry R. Silver, Atty., Civil Div., Appellate Sect., Dept. of Justice, Washington, D.C., for defendants-appellants.

Carl M. Weisbrod, Dallas Legal Services Foundation, Inc., Dallas, Tex., Herbert Semmel Center for Law and Social Policy, Marilyn G. Rose, Washington, D.C., for plaintiffs-appellees.

William D. Wells, NAACP, New York City, J. Francis Pohlhaus, NAACP, Washington, D.C., for amicus curiae.

Appeal from the United States District Court for the Eastern District of Texas.

Before THORNBERRY, AINSWORTH and RONEY, Circuit Judges.

THORNBERRY, Circuit Judge:

Questions striking at the heart of this nation's health planning policy and health resources development permeate this litigation. Plaintiffs, nine individuals and one unincorporated association (Texas Acorn), gainsay the legality of a Health Systems Agency charged by the National Health Planning and Resources Development Act of 1974, 42 U.S.C. § 300k, et seq., with improving the health of area residents, increasing the accessibility to health services, restraining increases in cost, and preventing unnecessary duplication of health resources. 42 U.S.C. § 300l -2. The District Court agreed that the Board of Directors and Executive Committee of the Texas Area 5 Health Systems Agency do not adequately represent the social and economic population of Texas Area 5 because the consumer representation includes an insufficient number of persons with annual family incomes below $10,000. He granted a partial summary judgment for plaintiffs, and enjoined the Health Systems Agency (HSA) from operating. We reverse and remand for a full evidentiary hearing.

Congress enacted the National Health Planning and Resources Development Act of 1974 (Planning Act) 1 after recognizing several problems with regard to health services in this country, including inflationary increases in their cost and unequal access. Further, the lack of a comprehensive approach to the problem was exacerbating the maldistribution and unnecessary duplication of services already approaching the crisis stage. See 42 U.S.C. § 300k(a). The Act requires the Secretary of the Department of Health, Education and Welfare (HEW) to create health service areas, essentially geographic regions, throughout the United States. 42 U.S.C. 300l. The Secretary has designated twelve of these areas in Texas, over 200 throughout the nation. Texas Area 5 consists of nineteen counties in the north central part of that state, centering on the Dallas-Fort Worth Region and covering more than 15,000 square miles containing over 3,000,000 people. On September 21, 1976, the Secretary designated defendant, Texas Area 5 Health Systems Agency, Inc., the health systems agency for Texas Area 5, following a struggle between competing entities. 2

As the statute mandates, health services consumers and providers comprise the Board of Directors and Executive Committee of the HSA. 42 U.S.C. § 300l -1(b) (3)(C). The parties agree, and the District Court found, that approximately 41 of the Board members were consumers, while approximately 38 were providers. The median family income for Texas Area 5 is approximately $10,000 and three of the 41 consumer members had family incomes below that figure. The Executive Committee also maintains the required consumer majority, 51%-60%, with 13 consumers and 12 providers. Two of the 13 consumers on the Committee had family incomes under $10,000.

Confronted by these statistics, plaintiffs, all health services consumers, sought declaratory, mandatory, and injunctive relief in the U.S. District Court for the Eastern District of Texas against the Texas Area 5 HSA and HEW. The gravamen of their complaint was the alleged failure of the HSA's Board to include a sufficiently large number of consumers with incomes below $10,000, and thus its neglect of the statutory mandate to be "broadly representative of the social, economic, linguistic and racial populations, geographic areas of the health service area, and major purchasers of health care." 3 42 U.S.C. § 300l -1(b)(3)(C)(i); 42 CFR 122.109(f)(1). Plaintiffs' Counts I and II concern the alleged under-representation of low income consumers. Plaintiffs also insisted, in Counts III and IV, that the Board's method of selection violated the purposes and provisions of the Planning Act and, in the alternative, that the Planning Act was unconstitutional.

The parties entered into a Stipulation and Agreed Order which enjoined HSA from entering into any contracts or making any grants for health planning. The Order did grant HSA the permission to continue carrying on its day-to-day activities. Plaintiffs then filed a Motion for Partial Summary Judgment on Counts I and II, which the court granted. HSA and HEW have both perfected their appeals from this Order completely enjoining HSA from all operations.

Four issues are paramount. First, there are jurisdictional problems with regard to the federal (HEW) and private (HSA) defendants. Second, both appellants argue that the District Court erroneously construed the Planning Act to require that a representative of a particular economic stratum have an income which is the same as that of his constituency. Third, the appellants argue that the District Court ignored genuine issues of material fact. Finally, HEW in particular argues that the District Court utilized the wrong standard to review the Secretary's decision.

I.

A. Jurisdiction over HEW. The recent amendment to 28 U.S.C. § 1331(a) removes the amount-in-controversy requirement in suits to review federal agency action. 4 Not surprisingly, HEW declines to argue the jurisdictional point, conceding that the District Court could obtain jurisdiction over it. The Northern District of New York recently reached the same conclusion in a case with similar facts. Aldamuy v. Pirro, 436 F.Supp. 1005 (N.D.N.Y.1977) (Civ. # 76-CV-204). 5

B. Jurisdiction over HSA. The amendment to 28 U.S.C. § 1331(a) removes the amount-in-controversy requirement as to the federal defendant but it has no effect on the HSA. The appellees argue that we can obtain jurisdiction over the HSA by using § 1331(a) and exercising pendent jurisdiction. Since the action is against the United States, the pendent jurisdiction doctrines allegedly permit joinder of non-federal defendants. Appellees argue to no avail. The HSA may not be brought into the suit as pendent parties unless an independent basis of jurisdiction over it exists. See Aldinger v. Howard, 427 U.S. 1, 96 S.Ct. 2413, 49 L.Ed.2d 276 (1976).

Appellees cannot satisfy the amount-in-controversy requirement. They have not offered any evidence of potential or direct injury to themselves, beyond merely pointing out that the HSA has received funds totalling $771,535 from HEW and will probably receive millions of dollars within the next several years. Surely a plaintiff cannot satisfy the jurisdictional amount any time a private defendant's annual budget exceeds $10,000. See Aldamuy, supra; Carman v. Richardson, 357 F.Supp. 1148 (D.Vt.1973). In actions for injunctive and declaratory relief, the jurisdictional amount is the value of the right to be protected or the extent of the injury to be prevented. Mississippi & M.R. Co. v. Ward, 67 U.S. (2 Black) 485, 17 L.Ed. 311 (1867); Flato Realty Invs. v. City of Big Spring, 388 F.Supp. 131 (N.D.Tex.1975), aff'd without opinion, 519 F.2d 1087 (5 Cir. 1975); 14 Wright, Miller & Cooper, Federal Practice and Procedure: Jurisdiction § 3708. 6

Plaintiffs do not seek the permanent cessation of all funds to the Texas Area 5 HSA, nor do they claim that $771,535 is excessive. Quite the contrary, plaintiffs deem themselves major beneficiaries of the funding, and demand an end to an alleged deprivation of their right of adequate representation on the Board. They seek reconstitution, not abolition. Their object is not direct participation in the budget, but the right to adequate representation on the Board and Committee, specifically that the Board have more members with incomes less than $10,000. The injury to each individual plaintiff, 7 even if we could reduce it to a monetary standard, would be small indeed. Since each plaintiff's claim is separate and distinct, each must rest on its own independent jurisdictional amount. Plaintiffs cannot aggregate them. Zahn v. International Paper Co., 414 U.S. 291, 94 S.Ct. 505, 38 L.Ed.2d 511 (1973); Clark v. Gray, 306 U.S. 583, 59 S.Ct. 744, 83 L.Ed. 1001 (1939).

In fact, plaintiffs cannot reduce such a speculative benefit to a monetary standard, so there is no pecuniary amount in controversy. See, e. g., Hague v. CIO, 307 U.S. 496, 59 S.Ct. 954, 83 L.Ed. 1423 (1939); Amen v. City of Dearborn, 532 F.2d 554 (6 Cir. 1976); Senate Select Committee on Presidential Campaign Activities v. Nixon, 366 F.Supp. 51 (D.C.D.C.1973). Plaintiffs admit that the injury they complain of is not that any specific decisions of the HSA will be altered, but that they have suffered a denial of "representational rights" granted by 42 U.S.C. § 300l -1(b)(3). (R. 219). A monetary standard requires an injury far less conjectural and speculative than this alleged dilution of representation on an HSA Board. Plaintiffs failed to demonstrate even an approximate dollar value of the relief sought or alleged injury. That failure is...

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