- Eastern District of Oklahoma Enforces Medical Professional Services Exclusion
- October 25, 2010 | Authors: Brian P. Cummings; Scott E. Turner
- Law Firm: Troutman Sanders LLP - Chicago Office
In Platte River Insurance Company and Darwin National Assurance Company v. SeminoleHealthCenter d/b/a SeminoleMedicalCenter, et al., No. CIV-09-213-KEW, 2010 U.S. Dist. LEXIS 105179 (E.D. Okla. Sep. 30, 2010), the United States District Court for the Eastern District of Oklahoma recently granted summary judgment in favor of the insurers based upon the application of the general liability coverage parts’ exclusion for injury to a patient admitted or registered to receive medical professional services. In an effort to secure general liability coverage for any judgment he obtained in his suit against a hospital, the underlying claimant attempted to segregate the hospital’s alleged failure to communicate the need for follow-up treatment after the claimant had been discharged from the course of professional treatment he was registered to receive. The Court viewed the alleged lapse in communication as part of the continuum of medical professional services and correctly determined that the medical professional services exclusion barred coverage.
In the underlying suit filed in Oklahoma state court, the claimant alleged that the hospital, doctors and physician’s assistant failed to communicate the results of the claimant’s chest x-ray and the recommendation that he undergo a chest CT because a potential lung mass was detected. The claimant alleged that, due to this failure, the chest CT was not performed and the diagnosis of his cancer was delayed until after it metastasized to his brain.
The hospital was in bankruptcy and had ceased to carry claims-made professional liability coverage when the claim was made. Because there was no professional liability coverage available, the claimant amended his underlying complaint to characterize his claim against the hospital as based on general negligence. The insurers that issued general liability coverage to the hospital during and shortly after the claimant’s treatment obtained relief from the automatic stay and filed a declaratory judgment action in the Eastern District of Oklahoma to establish that there was no coverage. The insurers argued that the policies did not provide general liability coverage for the claim because it fell within an exclusion for claims involving injury to a patient, defined as a person registered to receive medical professional services from an insured on an inpatient, outpatient, or emergency basis.
The Court agreed with the insurers’ contention that the claimant’s allegations fundamentally involved medical professional services. Although the claimant had been discharged at the time of the alleged failure to communicate his x-ray result and recommended follow-up treatment, he remained a “patient” registered to receive medical professional services from the hospital and his doctors. The Court rejected the claimant’s attempt to dissect the alleged negligent act from the professional context in determining the application of the medical professional services exclusion. As the Court recognized, the act of informing the claimant about his test results was simply a continuation of his course of treatment as a patient, such that the claim involved “the very definition” of medical professional services under the policies. Accordingly, the Court found that the medical professional services exclusion applied to preclude general liability coverage for the claim.
With this decision, the Eastern District of Oklahoma clarified that the medical professional services exclusion in general liability policies extends to bar coverage for claims involving the provision of follow-up care.