Justia Medical Malpractice Opinion Summaries

Group Health Cooperative (GHO) provided health insurance benefits to Nathaniel (Joel) Coon, who suffered a serious fungal infection and amputation following knee surgery at the Everett Clinic (TEC). The Coon family later settled potential negligence claims against TEC, and GHO initiated this lawsuit seeking reimbursement of its payments from the settlement proceeds. At issue before the Washington Supreme Court was whether genuine issues of material fact remained to preclude summary judgment in favor of GHO regarding whether the settlement constituted full compensation to Coon, and whether GHO suffered prejudice from the Coons’ failure to provide notice prior to finalizing the settlement. The Supreme Court concurred with the Court of Appeals’ conclusion that genuine issues of fact still remained, making summary judgment inappropriate. The matter was remanded for further proceedings. View "Grp. Health Coop. v. Coon" on Justia Law

Douglas Ghee, as the personal representative of the estate of Billy Fleming, appealed a circuit court order dismissing a wrongful-death claim brought against USAble Mutual Insurance Company d/b/a Blue Advantage Administrators of Arkansas ("Blue Advantage"). Fleming presented to the emergency department complaining of constipation and abdominal pain. He would ultimately need a colectomy, but the hospital informed him Blue Advantage had decided that a lower quality of care (continued non-surgical management) was more appropriate than the higher quality of care (surgery) that Fleming's surgeon felt was appropriate. Fleming and his family had multiple conversations with agents of Blue Advantage in an unsuccessful attempt to convince the company that the higher surgery was the more appropriate course of care. Ultimately, an agent of Blue Advantage suggested to Fleming that he return to the hospital in an attempt to convince hospital personnel and physicians to perform the surgery on an emergency basis. For five days, Fleming would present to the emergency room, each time he was treated by non-surgical means, then returned home. On the evening of July 15, 2013, Fleming's condition had deteriorated such that he had to be intubated. He died after midnight of septic shock due to a perforated sigmoid colon with abundant fecal material in the peritoneal cavity. A lawsuit was filed against Blue Advantage, asserting that the combined negligence of the hospitals and clinics involved and Blue Advantage, proximately caused Fleming's death. Because the trial court determined that Ghee's allegations against Blue Advantage as stated in the original complaint were defensively preempted by ERISA, the Alabama Supreme Court found Ghee should have had the right to amend his complaint to clarify his state-law claims. Because the Court concluded that Ghee should have been afforded the right to amend his complaint, it reversed the judgment of the trial court and remanded for further proceedings. View "Ghee v. USAble Mutual Insurance Company d/b/a Blue Advantage Administrators of Arkansas" on Justia Law

SC, an outpatient surgical center, permits outside physicians to perform day surgery at its facility. Its insurance limited APA’s liability to $1 million per claim. In 2002, Dr. Hasson, an outside physician, performed outpatient laparoscopic surgery on Tate at SC. Hasson did not see Tate or sign her discharge instructions before SC released her; SC’s anesthesiologist discharged Tate, giving Tate's boyfriend discharge instructions. Days later, Tate checked into the hospital with a perforated bowel that rendered the previously-healthy 34‐year‐old a quadriplegic. Tate sued Hasson and SC. APA hired attorneys to defend SC. APA set the “Reserve” (money the Michigan Department of Insurance required APA to put aside to cover an adverse verdict) at $560,000. APA believed the damages could exceed the policy limit but that SC was not likely to be found liable. In 2007, APA rejected Tate's offer to settle for policy limits. Hasson’s insurer settled for his policy limit ($1 million). After the Illinois Appellate Court remanded the issue of whether SC’s nursing staff breached the standard of care, APA raised the Reserve to $1 million, stating that it still believed the case was defensible. Before the second trial, APA rejected Tate's second settlement demand for the policy limit. The jury returned a $5.17 million verdict. SC then sued APA for bad faith. The Seventh Circuit affirmed judgment as a matter of law in favor of APA. SC did not establish that anyone involved in litigating the case believed there was more than a mere possibility SC would be found liable; the mere possibility of liability is insufficient under the Illinois Supreme Court’s reasonable probability standard. View "Surgery Center at 900 North Michigan Avenue, LLC v. American Physicians Assurance Corp., Inc." on Justia Law

In 2002, in Texas, Dr. Phillips performed a laparoscopic hysterectomy on Bramlett, a 36-year-old mother. While hospitalized, Bramlett suffered internal bleeding and died. Her family filed a wrongful death lawsuit against the hospital and Dr. Phillips, who held a $200,000 professional liability insurance policy with MedPro. He notified MedPro of the lawsuit. In 2003, the hospital settled with the Bramletts for approximately $2.3 million. The Bramletts wrote to Dr. Phillips’s attorney, Davidson, with a $200,000 Stowers demand; under Texas law, if an insurer rejects a plaintiff's demand that is within the insured’s policy limit and that a reasonably prudent insurer would accept, the insurer will later be liable for any amount awarded over the policy limit. MedPro twice refused to settle. The family won a $14 million verdict. The Supreme Court of Texas capped Dr. Phillips’s liability. The family sued MedPro, which settled. MedPro was insured by AISLIC, which declined to cover MedPro’s settlement. The district court granted AISLIC summary judgment, concluding that coverage was excluded because MedPro should have foreseen the family’s claim. An exclusion precluded coverage for “any claim arising out of any Wrongful Act” which occurred prior to June 30, 2005, if before that date MedPro “knew or could have reasonably foreseen that such Wrongful Act could lead to a claim.” The Seventh Circuit reversed in part, finding genuine issues of material fact regarding whether MedPro’s failure to settle was a Wrongful Act and whether MedPro could have foreseen a "claim" before the malpractice trial. View "Medical Protective Co. of Fort Wayne, Indiana v. American International Specialty Lines Insurance Co." on Justia Law

Pharmacist Joseph McNamara, Jr. appealed the grant of summary judgment in favor of Benchmark Insurance Company ("Benchmark") in Benchmark's indemnity action against McNamara. Benchmark commenced the indemnity action in an effort to recover funds expended to settle a medical-malpractice action brought against Southern Medical, Inc., Benchmark's insured and McNamara's employer. The medical-malpractice action was brought against Southern Medical by Ricky Avant and Kim Avant and was based, at least in part, on the alleged tortious acts and omissions of McNamara. Because the act complained of occurred in January 2010 and Benchmark sued McNamara in February 2014, the Alabama Supreme Court concluded Benchmark's indemnity action was time-barred under section 6-5-482, Ala. Code 1975. Thus, the trial court erred in entering a summary judgment in favor of Benchmark and in denying McNamara's motion for a summary judgment. View "McNamara v. Benchmark Insurance Co." on Justia Law

Essex issued a professional liability insurance policy to Galilee Medical Center, covering claims against Galilee physicians, including Angarita. Galilee’s application asked, “Do[] the Applicant’s employees or independent contractors use drugs for weight reduction for patients?” Galilee answered no. The question continued: “If yes, attach a list of drugs used and percentage of practice devoted to weight reduction.” Galilee did not identify any drugs. Galilee also answered “no” to whether its employees performed any experimental procedures and to “With the exception of surgery for obesity, does your practice include weight reduction or control by other [sic] than diet or exercise? 5.(b) Do you dispense any drugs? 5.(c) Do you use injections for weight control? 9.(a) Do you use experimental procedures, devices, drugs, or therapy in treatment or surgery?” In 2011, Ravelo, Angarita’s former patient, sued Angarita and Galilee for medical negligence based on mesotherapy treatments administered by Angarita. Mesotherapy is a non-surgical treatment involving injections into subcutaneous layers of fat, to dissolve deposits of fat and provide a more desirable body shape. Mesotherapy is not FDA-approved. Angarita admitted to providing mesotherapy treatment to more than 5,000 patients, including Ravelo. Essex denied coverage and sought a declaratory judgment rescinding the Policy. The Seventh Circuit affirmed summary judgment in favor of Essex, based on the misrepresentations in the applications. View "Essex Ins. Co. v. Angarita" on Justia Law

In 1997, Dr. Michael Hayes and Dr. Michael Taillon were working as emergency room physicians at Providence Hospital, presumably as independent contractors. Arthur Sharpe came to the Providence Hospital emergency room complaining of chest pain. Dr. Hayes and Dr. Taillon evaluated Sharpe and diagnosed him as suffering from reflux. Sharpe was discharged. Sharpe had actually suffered a heart attack, which was determined a few days later when he sought further medical care elsewhere. Because of the misdiagnosis, in 1999, Sharpe and his wife filed a medical malpractice and loss of consortium action against Providence Hospital and Dr. Hayes. The Sharpes did not name Dr. Taillon as a defendant. Providence Hospital settled with the Sharpes in 2004. In 2007, Providence Hospital filed this equitable indemnification action against Dr. Taillon and his medical malpractice insurer, The South Carolina Medical Malpractice Liability Joint Underwriting Association (collectively Respondents). Respondents moved for summary judgment on the ground that the medical malpractice statute of repose barred Providence Hospital's claim and the circuit court granted the motion on that basis. Providence Hospital appealed, and the court of appeals affirmed. The issue this case presented for the Supreme Court's review was whether the medical malpractice statute of repose applied to Providence Hospital's indemnity claim. The Court concluded that Providence Hospital's indemnity action was indeed barred by the statute of repose, and as such affirmed the trial court. View "Columbia/CSA-HS Greater Columbia Healthcare System v. So. Carolina Medical Malpractice Liability Joint Underwriting Association" on Justia Law

Petitioner, West Virginia Mutual Insurance Company, Inc. (WVMIC), was a professional medical liability insurer that insured physicians, medical practices and others in West Virginia. The medical malpractice claims underlying the current dispute were asserted by Respondents against their surgeon’s former employer, United Health Professional, Inc. (UHP), a medical corporation insured under a medical malpractice policy issued by WVMIC for the year 2010. Under the terms of a global settlement agreement, WVMIC tendered $3 million to Respondents under an extended reporting endorsement insuring the surgeon. The settlement further provided that Respondents and WVMIC would abide by a judicial determination as to whether additional insurance limits were available for Respondents’ vicarious liability claims against UHP. The circuit court concluded that there was an additional $6 million in policy limits available for Respondents’ claims against UHP. The Supreme Court reversed, holding that UHP has a total of $3 million in separate policy limits under the 2010 policy for Respondents’ claims asserted against it, which amount was in addition to the $3 million that WVMIC previously tendered under the global settlement agreement for the claims asserted against the surgeon. Remanded. View "W. Va. Mut. Ins. Co. v. Adkins" on Justia Law

Susan and Rodney Drown filed a medical malpractice action against Associated Women’s Health Specialists, P.C. (Health Specialists) asserting vicarious liability claims arising from the acts or omissions of its physicians. During the relevant period, Health Specialists was insured through a professional liability policy issued by Medical Inter-Insurance Exchange (Exchange). Health Specialists settled for the full amount of the policy and assigned to the Drowns its rights to recover against Exchange. Health Specialists was subsequently declared insolvent, and the Connecticut Insurance Guaranty Association (Association) assumed liability for the Exchange’s obligations. The Association then commenced this declaratory judgment action seeking a declaration that it had no obligations for the Drowns’ claims. Defendants, the Drowns and Health Specialists, counterclaimed. The trial court granted summary judgment in favor of Defendants. The Appellate Court reversed. The Supreme Court affirmed, holding (1) the Exchange’s preinsolvency breach of its duty to defend Health Specialists did not estop the Association from challenging its liability under the policy; and (2) the policy unambiguously did not cover Health Specialists for its vicarious liability in this case. View "Conn. Ins. Guar. Ass’n v. Drown" on Justia Law

White Oak Manor, Inc. owns and operates a nursing home in York. After sustaining injuries from the improper replacement of a feeding tube, a White Oak resident filed a lawsuit against the nursing home. White Oak ultimately settled the lawsuit without the involvement of its insurer, Lexington Insurance Company. White Oak subsequently filed a declaratory judgment action against Lexington to determine coverage for the malpractice claim. The issue this case presented to the Supreme Court concerned the validity of a service-of-suit clause in an insurance policy in light of Section 15-9-270 of the South Carolina Code (2005) which provides for service of process on an insurer through the Director of the Department of Insurance. The circuit court upheld the service-of-suit clause and refused to relieve the insurer from default judgment. The court of appeals reversed, holding section 15-9-270 provided the exclusive method for serving an insurance company. In its review, the Supreme Court disagreed that section 15-9-270 provided the exclusive means of service on an insurer and held that insurance policy provisions creating alternative methods of service are valid and binding on insurers. Accordingly, the court of appeals' decision was reversed. View "White Oak Manor v. Lexington Insurance Company" on Justia Law