St. John's Hospital Sisters of the Third Order of St. Francis v. National Guardian Risk Retention Group, Inc.

CourtDistrict Court, C.D. Illinois
DecidedMarch 6, 2020
Docket3:15-cv-03292
StatusUnknown

This text of St. John's Hospital Sisters of the Third Order of St. Francis v. National Guardian Risk Retention Group, Inc. (St. John's Hospital Sisters of the Third Order of St. Francis v. National Guardian Risk Retention Group, Inc.) is published on Counsel Stack Legal Research, covering District Court, C.D. Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
St. John's Hospital Sisters of the Third Order of St. Francis v. National Guardian Risk Retention Group, Inc., (C.D. Ill. 2020).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE CENTRAL DISTRICT OF ILLINOIS SPRINGFIELD DIVISION

ST. JOHN’S HOSPTIAL OF THE ) HOSPITAL SISTERS OF THE THIRD ) ORDER OF ST. FRANCIS, PATRICIA ) FUGATE and ROBERT FUGATE, ) ) Plaintiffs, ) ) v. ) Case No. 15-3292 ) NATIONAL GUARDIAN RISK ) RETENTION GROUP, INC., ) ) Defendant. )

OPINION

RICHARD MILLS, United States District Judge:

Pending is the Defendant’s motion for summary judgment as to Count IV of Plaintiffs’ Third Amended Complaint. I. INTRODUCTION The only remaining count in this case is Count IV of the Plaintiffs’ Third Amended Complaint. Count IV is a breach of contract claim by Plaintiffs St. John’s Hospital, Patricia Fugate and Robert Fugate, as assignees, against Defendant National Guardian Risk Retention Group, Inc. (“National Guardian”). The Plaintiffs allege National Guardian breached the contract by failing to provide coverage, resulting in damage. II. FACTUAL BACKGROUND Central Illinois Emergency Physicians, LLP (“CIEP”) entered into an

Agreement for Emergency Department Management Services (“Agreement”) with St. John’s Hospital to provide physician services. John Byrnes, M.D., Elizabeth McDaniel, D.O. and Aamir Banday, M.D. were employed by CIEP and provided

physician services at St. John’s Hospital pursuant to the Agreement. On March 22, 2011, Patricia and Wallace Fugate filed a multi-count medical malpractice action against eighteen named defendants, including St. John’s Hospital, CIEP and three emergency medical physicians—Drs. Byrnes, McDaniel and

Banday—alleging they failed to timely diagnose and treat Ms. Fugate’s mastoiditis, such that Ms. Fugate developed a brain abscess which required surgery and that she sustained permanent injuries. See Fugate v. McDaniel, et al., No. 11-L-27

(Macoupin County). The Fugates alleged the delay led to Mrs. Fugates’ permanent injuries. At the time that care was rendered to Patricia Fugate, paragraph 9 on page 8 of the Agreement was in effect and stated as follows:

Liability Insurance. [CIEP], at no cost to Hospital, shall ensure that personnel provided by it shall maintain professional liability insurance coverage (primary and excess) in an amount not less than $2,000,000 per occurrence and $4,000,000 annual aggregate (only $1,000,000 per occurrence and $3,000,000 annual aggregate will be provided until 11/1/01, at which time the full coverage will commence), subject to the terms and conditions of the individual policies. Paragraph 9 was subsequently amended to require professional liability insurance coverage (primary and excess) in an amount not less than $1,000,000 per occurrence

and $3,000,000 annual aggregate. Additionally, at all relevant times, the St. John’s Medical Staff Bylaws mandated that all members of the medical staff were required to have professional liability insurance in the amount $1,000,000 per occurrence and

$3,000,000 annual aggregate. National Guardian issued a policy identifying CIEP as a named insured, Policy No. PL1021, which was in effect from January 1, 2009, to January 1, 2010. This is an occurrence-based policy. The facts which gave right to the tort claim

relate to events which transpired on May 3, 4 and 11, 2009, which is within the policy period. St. John’s Hospital alleges it was required to pay incremental increases in the cost of the professional liability premiums on the National Guardian

Policy. In May 2009, the month the alleged underlying torts occurred, St. John’s Hospital’s monthly contribution to CIEP’s premium was $9,888. Dr. Byrnes, McDaniel and Banday were additional named insureds under National Guardian’s medical malpractice insurance Policy No. PL1021 with CIEP,

which provides $1 million per occurrence to its insured and additional named insureds. An “occurrence” under PL 1021 is expressly defined as follows: a series of interrelated Medical Professional Services rendered by an insured, causing injury to third party persons which is neither intended nor expected from the standpoint of the Insured. A series of related medical treatments to the same person shall be considered one Occurrence regardless of (1) the number of claims made or Suits brought and (2) the number of insureds names in such claims or Suits.

Additionally, Policy No. PL1021 expressly prohibits any action against National Guardian (the Company) unless the insured’s obligation to pay is “finally determined, either by judgment against the insured after actual trial, or by written agreement by the insured, the claimant and the Company.” Once National Guardian’s additional named insureds were sued in the

underlying Fugate litigation, National Guardian provided counsel to them. The Fugates alleged that Drs. McDaniel, Banday and Byrnes were each separately negligent in their care and treatment of Ms. Fugate in the Emergency Department at St. John’s on three separate occasions. Because of the alleged negligence, the

Fugates asserted the defendants in Fugate failed to diagnose and treat mastoiditis such that Ms. Fugate developed a brain abscess which required surgery and resulted in permanent injuries. Consultants were retained and experts were disclosed who

supported the additional named insureds’ actions. During the course of the Fugate litigation, various defendants settled out of the case. On June 22, 2015, St. John’s Hospital settled with the Fugates. A copy of the “Confidential Agreement” was subsequently produced by the Plaintiffs in this action

pursuant to United States Magistrate Judge Tom Schanzle-Haskins’ August 6, 2018 Order. Under the express terms of the settlement agreement between St. John’s Hospital and the Fugates, a/k/a the “Confidential Agreement,” St. John’s settled individually with the Fugates for $5 million and denied any wrongdoing or negligence. More importantly, none of National Guardian’s additional named

insureds were parties to the “Confidentiality Agreement.” Illinois Seventh Circuit Judge Kenneth Deihl found that St. John’s Hospital’s settlement with the Fugates was in good faith. None of the National Guardian insureds were part of that good

faith finding. On January 26, 2016, a series of three Assignment Agreements were executed between St. John’s, the Fugates and National Guardian’s additional Named insureds—Drs. Byrnes, McDaniel and Banday. The Assignments assigned Drs.

Byrnes, McDaniel and Banday’s rights under a series of agreements to Plaintiffs. The Fugate litigation proceeded against National Guardian’s additional named insureds until August 22, 2016, when Judge Deihl dismissed Drs. Byrnes, McDaniel

and Banday from the case with prejudice pursuant to 735 ILCS 5/2-619. At no time was a judgment or settlement entered against Drs. Byrnes, McDaniel or Banday in the Fugate litigation, and none of them paid any amount of money to the Fugates. The Plaintiffs allege that, because of National Guardian’s denial of coverage,

St. John’s Hospital and the individual physician Defendants were facing exposure at trial for which they had specifically procured insurance to protect them. St. John’s Hospital settled the underlying Fugate litigation. The Defendants state that, on information and belief, over $7 million in settlement proceeds have been collected by the Fugates in the underlying Fugate litigation.

The Plaintiffs claim that National Guardian has always contended that the coverage, which is applicable to the litigation filed on behalf of Patricia Fugate and Robert Fugate, is the “shared” amount of $1,000,000 rather than $1,000,000 per

physician Defendant (for an aggregate of $3,000,000). St. John’s Hospital and the individual Physician Defendants contend each physician Defendant is entitled to $1,000,000 per occurrence in coverage, for an aggregate of $3,000,000.

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St. John's Hospital Sisters of the Third Order of St. Francis v. National Guardian Risk Retention Group, Inc., Counsel Stack Legal Research, https://law.counselstack.com/opinion/st-johns-hospital-sisters-of-the-third-order-of-st-francis-v-national-ilcd-2020.