The Missouri Court of Appeals Eastern District Division One (“Missouri Appellate Court”), in its opinion filed on April 23, 2019, held that “the undisputed facts in this case demonstrate Appellants’ claims are subject to two Liability Limits under the terms of the Policy.”
The Underlying Facts
The Missouri medical malpractice plaintiffs filed claims of medical malpractice against an obstetrician (“doctor”), alleging that the doctor provided prenatal care to the plaintiff mother. During the third trimester, the mother began to have preterm contractions and abdominal pain. The doctor admitted the mother to the hospital, where he treated the mother and monitored the baby’s health for four days. At the time the mother was discharged from the hospital, she still had ongoing symptoms and problems.
The mother was seen by the doctor in his office for a follow-up appointment the next day. The following day, the mother returned to the doctor’s office again because her symptoms were not improving. Three days later, the mother returned to the doctor’s office with worsening symptoms. The doctor was unable to detect the mother’s blood pressure at that time and the baby was not moving and had a low and falling heart rate. The doctor performed an emergency cesarean section to deliver the baby in his office, where he did not have access to the medication, anesthesia, equipment, or personnel typically used when performing a cesarean section delivery.
The baby was minimally responsive and had depressed respiratory and heart function at the time of delivery. The doctor did not have the proper equipment to resuscitate the baby but attempted to do so until a pediatrician arrived. Following the delivery, the mother and baby were transferred to the local hospital in critical condition.
As a result of complications from the Cesarean section delivery, the mother is permanently disabled, physically incapacitated, and will never be able to live independently and will require professional and supportive care and treatment for the remainder of her life. The baby suffered significant, permanent, and irreversible brain and organ damage as a result of being deprived of oxygen and blood for a prolonged period of time, and is permanently disabled, physically incapacitated, and will require professional care and treatment for the remainder of his life.
The doctor filed a declaratory judgment action against his medical malpractice insurance carrier, asking the court to determine how the terms of his policy applied to the plaintiffs’ Missouri medical malpractice claims. The doctor’s medical malpractice insurance policy provided coverage for all claims of medical malpractice asserted against him during the term of the policy, subject to a Liability Limit of $1,000,000 per “Medical Occurrence.” The doctor argued that the plaintiffs’ medical malpractice claims against him constituted separate “Medical Occurrences” and were, therefore, subject to two Liability Limits under the terms of the policy. The medical malpractice insurance carrier contended that the plaintiffs’ claims were subject to a single Liability Limit because their claims arose from the same “Medical Occurrence.”
While the doctor’s declaratory judgment action was pending, the plaintiffs, the doctor, and his medical malpractice insurance carrier settled the plaintiffs’ claims against the doctor. The Settlement Agreement did not resolve the question of whether the “maximum limit of professional liability” applicable to the plaintiffs’ claims was one Liability Limit or two. Instead, the Settlement Agreement made the actual amount of the medical malpractice insurance carrier’s liability contingent upon the outcome of the doctor’s declaratory judgment action.
The policy language stated that “medical occurrence” means “any act or omission: A. Under Coverage A – Individual Professional Liability: (1) in the furnishing of professional medical services by the Insured, or which should have been provided by anyone for whom the Insured is legally responsible . . . Any such act or omission, together with all related acts or omissions in the furnishing of such services to any one person shall be considered one medical incident or occurrence.”
The Missouri Appellate Court stated that the policy language expanding the definition of “Medical Occurrence” to include other “related acts or omissions” expressly requires the “related acts or omissions” to arise from the furnishing of medical services “to any one person.” An ordinary person of average understanding purchasing medical malpractice insurance would understand this language in the definition of “Medical Occurrence” to mean that medical treatment provided to different people constitutes separate “Medical Occurrences,” which are subject to separate Liability Limits. Therefore, the definition of “Medical Occurrence” cannot reasonably be interpreted to include all acts or omissions in providing medical services to multiple individuals.
The Missouri Appellate Court held: “We agree with Appellants that these allegations assert Doctor was negligent in providing medical treatment to Child after the delivery, at a time when Child was indisputably a separate person from Mother. Accordingly, they constitute a “Medical Occurrence,” as defined in Section X of the Policy, separate from Doctor’s conduct in treating Mother prior to the delivery and are, therefore, subject to a separate Liability Limit under Section VII of the Policy … we find the plain language of the Policy provides for two Liability Limits under the undisputed facts of this case. Accordingly, the trial court erred in granting summary judgment in favor of MPM-PPIA.”
Source Patty v. Missouri Professionals Mutual-Physicians Professional Indemnity Association, ED106747.
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