Garcia v. Truck Insurance Exchange

682 P.2d 1100, 36 Cal. 3d 426, 204 Cal. Rptr. 435, 1984 Cal. LEXIS 196
CourtCalifornia Supreme Court
DecidedJuly 16, 1984
DocketL.A. 31768
StatusPublished
Cited by149 cases

This text of 682 P.2d 1100 (Garcia v. Truck Insurance Exchange) is published on Counsel Stack Legal Research, covering California Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Garcia v. Truck Insurance Exchange, 682 P.2d 1100, 36 Cal. 3d 426, 204 Cal. Rptr. 435, 1984 Cal. LEXIS 196 (Cal. 1984).

Opinions

Opinion

GRODIN, J.

This case concerns the proper interpretation of an insurance policy issued by defendant Truck Insurance Exchange (Truck) to a hospital, [432]*432after negotiations between the carrier and the California Hospital Association (CHA), representing hospitals throughout the state. The question is whether that policy provides coverage to a physician who is sued by his own patient for malpractice which he allegedly committed while the patient was in the hospital. The trial court, after considering evidence as to the intent of the parties in negotiations, concluded that the policy provided no such coverage. We affirm.

Plaintiffs in the underlying action were Dora Garcia and her minor children. Plaintiffs’ decedent, Gilbert Garcia, was admitted to Queen of Angels Hospital (hospital) on November 29, 1971, as the private patient of Dr. Siegfried Halpern for tests and examination concerning a gastric problem. On November 30, 1971, Dr. Halpern brought Dr. Martin Lewis into the case as a surgical consultant. Dr. Lewis was a surgeon in private practice and a member of the medical staff at the hospital. Staff membership signifies that a physician holds the privilege of practicing at the hospital. Dr. Lewis was not a hospital employee.

From December 1, 1971, until his death on December 10, 1971, Mr. Garcia was Dr. Lewis’s private patient. On December 7, 1971, Dr. Lewis performed gastric surgery upon Mr. Garcia. Following that surgery, Mr. Garcia developed symptoms of peritonitis, a condition which can lead to death if not promptly and properly treated. On December 10, 1971, at 1:25 a.m., Dr. Clark (a hospital employee) reported Mr. Garcia’s worsening condition to Dr. Lewis by telephone. There is no evidence that Dr. Lewis gave any instructions or orders with respect to his patient’s treatment. Mr. Garcia died at approximately 5 p.m. on December 10, 1971.

Plaintiffs commenced a medical malpractice action for wrongful death in December 1972. Defendants included the hospital and Dr. Lewis, as well as two hospital resident-employees, Drs. Clark and Rosenfeld. Truck was the insurer of the hospital and its employees under a comprehensive hospital liability insurance policy. Truck had not issued any insurance policy to Dr. Lewis. Dr. Lewis was not a party to the policy which covered the hospital and its employees. During discovery in the underlying wrongful death litigation, Dr. Lewis testified that he was uninsured against medical malpractice liability.

Early in 1976, prior to any request for defense by Dr. Lewis, Truck substantially completed a settlement on behalf of the hospital and the two resident-employees. All other defendants, except Dr. Lewis, also settled.

[433]*433On April 1, 1976, for the first time, Dr. Lewis, through his counsel, demanded that Truck defend him and pay attorneys’ fees already incurred.1 A second demand letter threatened that if Truck refused to assume Dr. Lewis’s defense, Lewis would stipulate with plaintiffs that he was negligently responsible for the death of plaintiffs’ decedent and that his negligence was of a type that would provide him with coverage as an additional insured under the Truck policy covering the hospital and its employees. The letter also stated that Lewis would permit judgment to be entered against him for $602,114.83 and would then assign his rights against Truck to plaintiffs and assist them in any action they brought against Truck.

Truck refused to undertake Dr., Lewis’s defense, stating that he was clearly not insured by the hospital’s policy. On June 3, 1976, Dr. Lewis’s attorneys executed the threatened stipulation and the judgment was entered on September 2, 1976. On March 9, 1977, plaintiffs filed the complaint in this action against Truck under Insurance Code section 11580, subdivision (b)(2)2 to satisfy the judgment against Dr. Lewis.

At trial, Truck contended that the policy expressly excluded physicians employed by private patients and that hospital staff physicians were insured only with respect to supervisory or instructional services rendered to hospital employees. The trial court then admitted extrinsic evidence to clarify the meaning of the term “supervisory or instructional services.” On the basis of this evidence, the trial court ruled that, as to Mr. Garcia’s death, Dr. Lewis was not insured under the Truck policy and Truck was not bound by the stipulated judgment.

On appeal, plaintiffs argue principally that the extrinsic evidence was inadmissible and that the trial court erroneously interpreted the policy. In addition, plaintiffs contend they were denied the right to a jury trial and that Truck was bound by the stipulated judgment between plaintiffs and Dr. Lewis due to its refusal to defend. None of these arguments carries the day.

[434]*434Two provisions of the policy are relevant to this dispute. Under the heading of “Exclusions” (par. V), the policy states, in pertinent part: “This policy does not apply: . . . 6. To the liability of any individual hired or employed by or on behalf of a patient at any hospital organization holding a certificate under this policy. . . .” Dr. Lewis was such an individual, and on the basis of this provision was excluded.

Dr. Lewis relies, however, upon the “Definition of Insured” in paragraph III of the policy, which states, in pertinent part: “The unqualified word ‘insured’ includes each of the following to the extent set forth in this definition: ...(d) any medical staff member of the named insured or hospital organization . . . but only with respect to his legal liability for providing, or failing to provide, any supervisory or instructional services with respect to employees of the named insured or such hospital organization; ...”

Dr. Lewis did not generally provide “supervisory or instructional services” at the hospital. Nevertheless, he contends that because the malpractice to which he has admitted consisted of his failure to respond when notified by a hospital employee of his patient’s worsening condition, he is for purposes of this case an “insured” within the meaning of the policy.

Truck was permitted to rebut Dr. Lewis’s interpretation of the policy through the testimony of James E. Ludlam, general counsel to CHA since 1953. Mr. Ludlam’s uncontroverted testimony was to the following effect.

CHA represents 90 percent of the hospitals in California including Queen of Angels Hospital. In 1953, acting on behalf of its member hospitals, CHA negotiated the subject insurance policy with Truck. The policy has been in effect since 1954 and has been amended from time to time since then. Mr. Ludlam represented CHA in both the original negotiations in 1953 and in the 1969 negotiations which resulted in the addition of section 111(d) to the policy. In 1953 Truck was a newcomer in the hospital liability field and was anxious to secure an agreement with CHA. CHA had three final proposals for liability insurance to choose from at the time it entered negotiations with Truck. CHA’s bargaining position was at least equal to Truck’s. The provisions of the policy were negotiated paragraph by paragraph. The exclusionary provision which is now section V(6) has been in the policy from the beginning, and specifically excludes liability for direct patient care by a private doctor of his private patient.

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Cite This Page — Counsel Stack

Bluebook (online)
682 P.2d 1100, 36 Cal. 3d 426, 204 Cal. Rptr. 435, 1984 Cal. LEXIS 196, Counsel Stack Legal Research, https://law.counselstack.com/opinion/garcia-v-truck-insurance-exchange-cal-1984.