Stover v. Garfield
Stover v. Garfield
Opinion of the Court
Garnishee-defendant Insurance Company of the West appeals from an order of the circuit
The decedent was admitted to Fenton Extended Care Center in March 1994, in an advanced state of illness and age that rendered him incompetent. Defendant Dr. Garfield attended to the decedent at the facility until the decedent’s death on April 22, 1994. According to the evidence, Dr. Garfield ordered discontinuation of oral and tube feeding and hydration of the decedent and of treatment for the decedent’s pneumonia, several days before the latter’s death, relying on instructions from the decedent’s wife and her personal representative, neither of whom was legal guardian for the decedent. The nursing home had initiated procedures for acquiring the decedent’s living will from the decedent’s family physician but was lackluster in following up on its request. Dr. Garfield testified during his deposition that he knew of no living will associated with the decedent and had not asked about the existence of either a living will or a legal guardian.
The decedent’s living will included a section for indicating treatments that the declarant wished not to be provided once death was unquestionably near. The form specifically listed the following examples: cardiac resuscitation, mechanical respiration, and artificial feeding and fluids by tubes. The decedent specified that only mechanical respiration was to be withheld. The document thus strongly implied that the decedent did not consent to the withholding of artifi
Plaintiff William Stover commenced action on behalf of the decedent’s survivors and estate, alleging that defendants improperly withheld food and water from the decedent, in violation of the latter’s written directives. Plaintiff openly took pains to avoid characterizing the action as one sounding in medical malpractice, expressly wishing to avoid the requirement of filing an affidavit of merit from a medical practitioner, as required in such actions by MCL 600.2912d. The trial court accepted plaintiff’s characterizations and excused that requirement.
Dr. Garfield had an insurance policy with garnishee-defendant. The policy promised to indemnify and defend Dr. Garfield in matters arising from claims against him in connection with his provision of medical services. The policy additionally capped garnishee-defendant’s responsibility for Dr. Garfield’s damages at $200,000, and excluded from coverage intentional misconduct and exemplary damages.
Garnishee-defendant initially took responsibility for the defense of this action, while reserving its right to withdraw in the event that a court determined that the claims at issue fell outside the policy’s definition of professional services. Then, in response to the trial
Plaintiff and defendants then stipulated the entry of judgment in favor of plaintiff, against Dr. Garfield only, in the amount of $200,000, with interest and costs, to be satisfied solely through the proceeds of the insurance policy with garnishee-defendant. The trial court entered the consent judgment on August 24, 1998.
Plaintiff followed with a motion for garnishment. Garnishee-defendant resisted on the ground that garnishee-defendant had no obligations under the insurance policy, arguing that “professional negligence” was synonymous with “malpractice,” and that plaintiff’s emphatic characterization of the underlying action as something other than one alleging malpractice thus absolved garnishee-defendant of obligations pursuant to professional negligence. Alternatively, garnishee-defendant argued that, to the extent that coverage existed, damages — and thus garnishee-defendant’s responsibility for them — should be apportioned according to whether they stemmed from covered or noncovered claims.
The trial court ruled that the insurance contract provided broader coverage than merely for medical malpractice and, therefore, garnishee-defendant erred in deciding to withdraw from its defense of Dr. Garfield. The court additionally held that the amount of the settlement was supportable by any of plaintiff’s three theories of recovery, thus obligating garnishee-defendant for the full amount of the judgment with
Garnishee-defendant argues that the trial court erred in finding the insurance policy applicable to the claims against Dr. Garfield by its general terms and, alternatively, that if the policy did cover the matter generally, the court nonetheless failed to give effect to specific exclusions within it. This Court reviews contract language for ambiguity, and construes clear contract language, de novo. Farm Bureau Mut Ins Co of Michigan v Nikkel, 460 Mich 558, 563; 596 NW2d 915 (1999) (ambiguity); Pakideh v Franklin Commercial Mortgage Group, Inc, 213 Mich App 636, 640; 540 NW2d 777 (1995) (clear contract language).
Ambiguities in insurance contracts must be strictly construed against the drafter. State Farm Mut Automobile Ins Co v Enterprise Leasing Co, 452 Mich 25, 38; 549 NW2d 345 (1996). “[U]nder the rule of reasonable expectation, the court grants coverage under the policy if ‘the policyholder, upon reading the contract language is led to a reasonable expectation of coverage.’ ” Fire Ins Exchange v Diehl, 450 Mich 678, 687; 545 NW2d 602 (1996), quoting Powers v DAIIE, 427 Mich 602, 632; 398 NW2d 411 (1986).
In this case, the insurance policy at issue announces that garnishee-defendant’s obligations under the contract extend to covering “damages because of a professional incident to which this policy applies, which results from your rendering of, or your failure to render, professional services in the practice of your profession . . . .” (Emphasis in original.) “Professional services” is defined within the contract:
*462 Professional services means the delivery of medical services by the individual Named Insured to a patient as permitted by license as a Medical Doctor or Doctor of Osteopathy. Professional services also includes the activities of the individual Named Insured: (i) as a supervisor of the activities of another person who renders medical services to a patient while acting under the direction and control of the individual Named Insured, if the individual Named Insured is legally responsible for the acts and omissions of the other person .... [Emphasis in original.]
“Professional incident” is defined as “an act or omission ... in the furnishing of professional services by the individual Named Insured ... to a patient, that may result in your liability for damages.” (Emphasis in original.)
The question thus becomes whether there can be “professional negligence” arising out of “professional services” or involving a “professional incident” that does not involve “malpractice.” For the reasons expressed below, we hold that such concepts are synonymous and, therefore, because it was previously determined that plaintiffs claims did not sound in malpractice, the professional liability policy at issue does not provide coverage for those claims.
We begin by looking at the definition of “malpractice”:
Professional misconduct or unreasonable lack of skill. This term is usually applied to such conduct by doctors, lawyers, and accountants. Failure of one rendering professional services to exercise that degree of skill and learning commonly applied under all the circumstances in the community by the average prudent reputable member of the profession with the result of injury, loss or damage to the recipient of those services or to those entitled to rely upon them. It is any professional misconduct, unreasonable lack of skill or fidelity in professional or fiduciary duties, evil*463 practice, or illegal or immoral conduct. [Black’s Law Dictionary (5th ed), p 864.]
Also of interest to the determination of this case is the Supreme Court’s observation in Dorris v Detroit Osteopathic Hosp Corp, 460 Mich 26, 45-46; 594 NW2d 455 (1999):
In Bronson v Sisters of Mercy Health Corp, 175 Mich App 647; 438 NW2d 276 (1989), the plaintiff’s complaint included allegations that the defendant hospital had failed to supervise and adequately maintain its staff. The plaintiff argued that the trial court erred in granting summary disposition for failure to fide the claim within the two-year period of limitation applicable to medical malpractice claims, because the complaint stated a claim for ordinary negligence only, which is governed by a three-year period of limitation. The Court of Appeals affirmed the trial court’s order of summary disposition, agreeing with the trial court that the allegations within the plaintiff’s complaint involve issues of medical judgment.
“The key to a medical malpractice claim is whether it is alleged that the negligence occurred within the course of a professional relationship. The providing of professional medical care and treatment by a hospital includes supervision of staff physicians and decisions regarding selection and retention of medical staff. [175 Mich App 652-653 (citations omitted).]”
The determination whether a claim will be held to the standards of proof and procedural requirements of a medical malpractice claim as opposed to an ordinary negligence claim depends on whether the facts allegedly raise issues that are within the common knowledge and experience of the jury or, alternatively, raise questions involving medical judgment. Wilson v Stilwill, 411 Mich 587, 611; 309 NW2d 898 (1981); McLeod v Plymouth Court Nursing Home [957 F Supp 113, 115 (ED Mich, 1997)].
In other words, if a claim arises out of “professional judgment” or a “professional relationship,” then it
Therefore, once it was determined that plaintiffs claims in the case at bar did not involve “malpractice,” and thus did not have to comply with the statutory requirements imposed on medical malpractice claims, coverage under the policy at issue here no longer applied.
Reversed and remanded to the trial court with instructions to enter judgment in favor of garnishee-defendant. We do not retain jurisdiction. Garnishee-defendant may tax costs.
The propriety of allowing this case to go forward as something other than a medical malpractice action in the first instance is not an issue on appeal, and so we do not reach it, and express no opinion in the matter.
It is beyond dispute that plaintiffs claims do not sound in malpractice. First, in ruling on the motion for summary disposition, the trial court acknowledged that there was no malpractice claim:
Since there is no medical malpractice claim alleged, the plaintiff has no obligation under [MCL 600.2912d] to file an affidavit of merit. Section one of that statute provides that the plaintiffs — or, correction, the first sentence of that section says that the: “plaintiff in an action alleging medical malpractice” that does not fit the case at bar, because plaintiff does not allege medical malpractice. And it is in a medical malpractice claim that an affidavit of merit, by a health professional, is required.
Second, in his brief on appeal, plaintiff continues to disavow that this is a malpractice claim:
Because the Michigan Medical Malpractice Statutes, and all of its Tort-reform appendages, scrupulously reserves to the medical profession the protection that its members may not be held liable under it without the opinion testimony of a peer that a departure from acceptable practice had occurred, Plaintiffs Complaint avoided reliance on the Medical Malpractice Statute.
As for the arguments raised by the dissent, our dissenting colleague argues that the complaint, despite plaintiffs adamant denials, sounds in medical malpractice. The dissent suggests that we should not rely on plaintiff’s representations to determine if the claim sounds in malpractice.
With regard to whether garnishee-defendant breached its duty to defend, the dissent correctly observes that there is a duty to defend a suit if the claims arguably fall within the policy coverage. Radenbaugh v Farm Bureau General Ins Co of Michigan, 240 Mich App 134, 137; 610 NW2d 272 (2000). However, garnishee-defendant did just that: it defended up to the point where the trial court determined that the case did not sound in malpractice. Because, as discussed above, the policy only covered malpractice, garnishee-defendant had no duty to defend a claim not sounding in malpractice. Therefore, it did not breach its duty to defend.
Dissenting Opinion
(dissenting). I respectfully dissent. I strongly disagree with the majority’s conclusion that garnishee-defendant Insurance Company of the West is not obligated to indemnify defendant James Garfield, D.O., (hereafter defendant) pursuant to the professional liability insurance policy. The present case provides a clear example of an insurer that wrongfully breached the duty to defend its insured and is seeking to avoid its concomitant duty to indemnify. Because the clear and unambiguous language of the insurance policy provides coverage for damages arising from plaintiff’s claims, I would affirm the trial court’s entry of judgment in favor of plaintiff.
The majority’s conclusion that the professional liability policy does not provide coverage in the instant case turns on its determination that the first amended complaint did not sound in medical malpractice. Ante at 462. According to the majority, because the language in the insurance policy limiting coverage to damages arising out of “professional services” and “professional incident[s]” is synonymous with “malpractice,” defendant is not entitled to coverage. I respectfully disagree. Although the parties do not challenge the trial court’s determination that plaintiff’s claims do not sound in medical malpractice, “ ‘this Court may go beyond the issues raised on appeal and address issues that, in this Court’s opinion, justice requires be considered and resolved.’ ” Adams v Cleveland-Cliffs Iron Co, 237 Mich App 51, 57; 602 NW2d 215 (1999), quoting Frericks v Highland Twp, 228 Mich App 575, 586; 579 NW2d 441 (1998).
In the context of ruling on defendant’s
The defendants have argued that, in reality, plaintiff is asserting a medical malpractice claim. Plaintiff’s counsel says that that’s not true. And I have — I don’t believe that we should require the plaintiff to allege and prove a claim that the plaintiff asserts is not being pled.
Another way to say this is that I’m taking [plaintiff’s attorney] at his word. And [plaintiff’s attorney] says he doesn’t have a medical malpractice claim, I accept that. And I have addressed the specific Counts in the context of what [plaintiff’s attorney] asserts they allege.[4 ]
In my view, rather than relying exclusively on plaintiffs attorney’s representations to discern whether plaintiff’s claims sounded in medical malpractice, a better approach is a thorough review of the first amended complaint.
A review of the first amended complaint leads me to conclude that the thrust of plaintiff’s claims was that defendant was negligent in the course of his professional treatment of plaintiff’s decedent, Charles Dolan, by withholding food, liquid, and oral medication from the decedent without consulting the decedent’s living will. These allegations clearly involve questions of professional judgment not within the ordinary knowledge and experience of the jury. Id. Accordingly, the trial court erred in concluding that plaintiff’s claims did not allege medical malpractice. In my view, the first amended complaint is a clear example of an attempt to evade the medical malpractice action procedural requirements by couching the cause of action in terms of ordinary negligence and intentional misconduct. Id. at 43.
n. garnishee-defendant breached its duty to defend
That garnishee-defendant wrongfully breached its duty to defend in the present case is also apparent from a review of the first amended complaint. It is axiomatic that an insurer’s duty to defend is broader than the duty to indemnify. American Bumper & Mfg Co v Hartford Fire Ins Co, 452 Mich 440, 450; 550 NW2d 475 (1996) (American Bumper II). In Radenbaugh v Farm Bureau General Ins Co of Michigan, 240 Mich App 134, 137; 610 NW2d 272 (2000), this Court recently articulated the well-settled principles governing an insurer’s duty to defend in Michigan. As the Radenbaugh Court observed, “ ‘if the allegations of the underlying suit arguably fall within the coverage of the policy, the insurer has a duty to
“An insurer has a duty to defend, despite theories of liability asserted against any insured which are not covered under the policy, if there are any theories of recovery that fall within the policy. Dochod v Central Mutual Ins Co, 81 Mich App 63; 264 NW2d 122 (1978). The duty to defend cannot be limited by the precise language of the pleadings. The insurer has the duty to look behind the third-party’s allegations to analyze whether coverage is possible. Shepard Marine Construction Co v Maryland Casualty Co, 73 Mich App 62; 250 NW2d 541 (1976). In a case of doubt as to whether or not the complaint against the insured alleges a liability of the insurer under the policy, the doubt must be resolved in the insured’s favor. 14 Couch on Insurance 2d, § 51:45, p 538.” [Radenbaugh, supra at 137-138, quoting Western Casualty & Surety Group v Coloma Twp, 140 Mich App 516, 520-521; 364 NW2d 367 (1985), in turn quoting Detroit Edison Co v Michigan Mut Ins Co, 102 Mich App 136, 141-142; 301 NW2d 832 (1980).]
Thus, in simple terms, an insurer’s duty to defend “ ‘arises . . . from the language of the insurance contract.’ ” Michigan Educational Employees Mut Ins Co v Turow, 242 Mich App 112, 117; 617 NW2d 725 (2000), quoting Stockdale v Jamison, 416 Mich 217, 224; 330 NW2d 389 (1982). Moreover, an insurer’s duty to defend hinges on the threshold determination regarding the scope of available coverage. Marlo Beauty Supply, Inc v Farmers Ins Group of Cos, 227 Mich App 309, 315; 575 NW2d 324 (1998). If coverage is not provided under the policy, it follows that the
In my opinion, garnishee-defendant breached its duty to defend Garfield in the instant action, because the theories set forth in the first amended complaint clearly fell within the coverage of the policy. Count I of the first amended complaint alleged that “defendants intentionally, knowingly, and with premeditation, killed Plaintiff’s decedent . ...” A plain reading of the first amended complaint reveals that this artful drafting on the part of plaintiff’s attorney is nothing more than an attempt to disguise what would otherwise be classified as a medical malpractice claim as a claim alleging murder. Even assuming that this was a theory not covered under the policy, counts n and in of the first amended complaint, alleging negligence in the course of medical treatment, were theories “arguably” within the confines of the policy that invoked garnishee-defendant’s duty to defend. Radenbaugh, supra at 137.
m. THE CLEAR AND UNAMBIGUOUS LANGUAGE OF THE INSURANCE POLICY PROVIDES COVERAGE
In my opinion, the majority errs in concluding that the professional liability insurance policy does not provide coverage in the instant case. In contrast, I agree with the trial court’s determination that the clear and unambiguous language of the insurance policy provides coverage for damages arising from plaintiff’s claims.
“Unlike most contractual relationships, where the parties negotiate contract terms, the terms of liability insurance contracts are standardized and are drafted by the insurance industry. Policyholders have little or no bargaining power to change terms. Consequently, in construing insurance contracts, any ambiguities are strictly construed against the insurer to maximize coverage.
“An insurance contract is ambiguous when its provisions are capable of conflicting interpretations.” Farm Bureau Mut Ins Co of Michigan v Nikkel, 460 Mich 558, 566; 596 NW2d 915 (1999). However, the mere fact that contractual language may be difficult to apply in a certain factual situation does not itself render contractual language ambiguous. See Henderson, supra at 357, n 10.
A review of the clear and unambiguous language of the insurance policy in the instant case convinces me that it provided coverage for damages resulting from plaintiff’s allegations of negligence on the part of
lew agrees with you to pay on your behalf sums that you shall become legally obligated to pay as damages because of a professional incident to which this policy applies, which results from your rendering of, or your failure to render, professional services in the practice of your profession .... [Emphasis in original.]
As this Court recognized in Cavalier Mfg Co v Employers Ins of Wausau (On Remand), 222 Mich App 89, 94; 564 NW2d 68 (1997), “the terms of an insurance contract are interpreted according to the definitions set forth therein ... .”
an act or omission (or series of related acts or omissions), that . . . occurs ... in the furnishing of professional services by the individual Named Insured ... to a patient, that may result in your liability for damages. [Emphasis in original.]
In my view, the clear language of the policy demonstrates that it provides coverage in the instant case, where it is undisputed that (1) defendant was delivering medical services to the decedent and (2) plaintiff alleged that defendant wrongfully withheld food, liquid, and oral medications from the decedent during the course of treatment. In his deposition testimony,
IV. response to the majority opinion
Contrary to the majority’s misguided accusation, I am not attempting “to find a basis to allow [plaintiff] to win.” Ante at 465, n 3. Indeed, I am reluctant to allow such a result in a case where plaintiff’s attorney’s drafting of the first amended complaint was nothing short of subterfuge. The present case places this Court in the unenviable position of having to choose between what Justice Sutherland aptly
Moreover, unlike the majority, I cannot escape the conclusions that, regardless of the language employed in the first amended complaint, (1) the insurance policy provided coverage for plaintiff’s claims and (2) garnishee-defendant breached its duty to defend. Had garnishee-defendant adhered to its duty to defend rather than abandoning defendant at the first opportunity, the fallacious nature of plaintiff’s first amended complaint would undoubtedly have been revealed. As this Court observed in Radenbaugh, supra: “ ‘The duty to defend cannot be limited by the precise language of the pleadings. The insurer has the duty to look behind the third-party’s allegations to analyze whether coverage is possible.’ ” Radenbaugh, supra at 137-138, quoting Western Casualty, supra (emphasis supplied). In my opinion, a logical corollary of this rule is that garnishee-defendant is required to look not only beyond the language of the pleadings to discern whether coverage is provided under the policy
Presented with the issue whether the insurance policy provides coverage, the majority bases its conclusion solely on the specific language employed by plaintiff’s attorney in the first amended complaint and plaintiff’s attorney’s representations that this is not a medical malpractice claim. Thus, according to the majority view, plaintiffs’ attorneys may now successfully avoid an aggressive defense by a physician’s insurer by manipulating the language in the complaint to avoid the medical malpractice procedural requirements. Interestingly, it was this manner of disingenuous behavior on the part of a plaintiff’s attorney that the Supreme Court counseled against in Dorris, supra.
The majority’s refusal to look beyond the language employed in the first amended complaint is inconsistent with the practical purpose of an insurance contract. Ordinary citizens routinely purchase insurance to address occasions where their actions cause injury to others. Accordingly, the determination whether an insurance policy provides coverage should be governed by the individual’s alleged actions in a case, not by the language used in a complaint. In the instant case, it is not disputed that defendant Garfield was
V. CONCLUSION
Finally, I agree with the trial court that where defendant entered into a fair and reasonable settlement after garnishee-defendant wrongfully breached its duty to defend, garnishee-defendant cannot now be heard to complain that it should not be bound by the settlement.
When an insurer breaches its own policy of insurance by refusing to fulfill its duty to defend the insured, the insurer is bound by any reasonable settlement entered into in good faith between the insured and the third parly. [Alyas v Gillard, 180 Mich App 154, 160; 446 NW2d 610 (1989), citing with approval Detroit Edison Co, supra at 144.]
See also Elliott v Casualty Ass’n of America, 254 Mich 282, 287-288; 236 NW 782 (1931).
For these reasons, I would affirm the trial court’s entry of judgment in favor of plaintiff.
The majority opinion has the effect of allowing insurance companies to circumvent the clear terms of an insurance policy and disclaim respon
The determination that plaintiff’s claims do not sound in medical malpractice is central to the majority’s analysis. Ante at 462, n 2.1 am not surprised that, in this comedy of errors, neither party has directly raised the issue in their briefs on appeal. I would note that the complex nature of insurance defense litigation precludes garnishee-defendant from directly raising the issue on appeal, given that it was not a party to the action in which the trial court determined that this case did not sound in medical malpractice. Garnishee-defendant became directly involved as a party only when plaintiff instituted garnishment proceedings in the lower court. In addition, garnishee-defendant would not be wise to raise the issue given that it would amount to a concession that coverage is provided by the professional liability insurance policy. Moreover, plaintiff would be loath
The motion was in fact initially brought by defendants THS Partners I (THS I), THS Partners II (THS IT), and Transitional Health Services, Inc., doing business as Fenton Extended Care Center, with defendant Garfield concurring. THS I, THS n, and Transitional Health Services, Inc., were dismissed as parties in the lower court in a consent judgment entered August 24, 1998, and are not parties to this appeal.
The trial court went on to observe that “plaintiff represents to the Court that there is no claim of medical malpractice asserted here . . . Consequently, in its August 15, 1997, order denying the motion to dismiss, the trial court labeled count i of the first amended complaint as alleging “Intentional Tort: Battery/Murder,” count n as alleging “Gross Negligence,” and count m as alleging “Ordinary Negligence.”
I find it troubling that the majority allows plaintiff’s attorney’s representations regarding the nature of the suit to dictate its decision that the insurance policy does not provide coverage in the instant case. By doing so, the majority fails to recognize that the insured’s actions, together with the policy language, should determine insurance coverage.
I find the present case analogous to Cavalier, supra. Cavalier involved a declaratory action between the plaintiff employer and its insurer to determine whether allegations by the plaintiff’s employee fell within the coverage provided by the insurance policy. In a separate prior action, the plaintiff’s employee had drafted the complaint to allege an intentional tort in an attempt to avoid the exclusive remedy provision of the Worker’s Disability Compensation Act, MCL 418.101 et seq. Cavalier, supra at 91-92. The plaintiff employer moved for summary disposition, arguing that the employee’s allegations did not rise to the level of an intentional tort. The trial court denied the plaintiff employer’s motion. Rather than continuing to defend the plaintiff employer and seek appellate review of the ruling, the defendant insurer “abandoned” its defense of the plaintiff. Id. at 92, n 2. Consequently, in Cavalier, supra, this Court was placed in “the awkward position” of having to resolve the action adversely to the defendant insurer in spite of its determination that summary disposition was originally improperly denied. Id.
The instant case presents this Court with a similar dilemma. Although I am loath to reward plaintiff for his deception in the lower court, I believe preservation of the overriding principle in this case, the insurer’s duty to defend, mandates this result. Additionally, “had [garnishee-defendant] continued its defense of [defendant], it would not now find itself in this situation.” Id.
The trial court entered judgment in favor of plaintiff in the context of entertaining garnishee-defendant’s motion for summary disposition under MCR 2.116(C)(10). Thus, consideration of defendant’s deposition is proper. See Maiden v Rozwood, 461 Mich 109, 120; 597 NW2d 817 (1999).
Our Supreme Court recently cautioned against “pervert[ing]” the plain meaning of a word or creating ambiguity in an insurance contract “where the terms of the contract are clear and precise.” Henderson, supra at 354.
The majority opinion rewards an insurance company for failing to defend its insured. In my view, a more prudent course of action for garnishee-defendant would have been to continue its defense of Garfield in spite of the trial court’s ruling that this claim did not sound in medical malpractice. Specifically, garnishee-defendant should have sought appellate review of the trial court’s erroneous determination, rather than abandoning its defense of Garfield.
Had the trial court properly restrained plaintiffs attorney from engaging in such shenanigans, rather than allowing him to make a mockery of the lower court proceedings, this Court may not have been compelled to wade into these murky waters.
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