The Medical Protective Company v. Kyrsten Sutton

607 F. App'x 276
CourtCourt of Appeals for the Fourth Circuit
DecidedJune 8, 2015
Docket13-1721, 13-1722
StatusUnpublished
Cited by5 cases

This text of 607 F. App'x 276 (The Medical Protective Company v. Kyrsten Sutton) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fourth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
The Medical Protective Company v. Kyrsten Sutton, 607 F. App'x 276 (4th Cir. 2015).

Opinions

Affirmed in part and vacated and remanded in part by unpublished opinion.

Senior Judge Davis wrote the opinion, in which Judge King joined. Judge Floyd wrote an opinion concurring in part and dissenting in part.

Unpublished opinions are not binding precedent in this circuit.

DAVIS, Senior Circuit Judge:

These cross-appeals arise out of an insurance coverage dispute related to claims for alleged birth injuries resulting from professional negligence. Dr. Kyrsten Sutton attended the birth of Richard and Amy Moore’s son, Nathan. The Moores filed suit in state court for medical malpractice against Dr. Sutton. Dr. Sutton’s former insurers, First Professional Insurance Company (“FirstPro”) and the Medical Protective Company (“MedPro”) disagree as to which, if either, insurer owes Dr. Sutton a duty to defend the lawsuit; accordingly, FirstPro filed this declaratory judgment action in federal court. After a bench trial, the district court ruled that MedPro, but not FirstPro, has a duty to defend Dr. Sutton and pay damages as may be required under the MedPro policy. For the reasons that follow, we affirm in part and vacate and remand in part.

I.

A.

Dr. Sutton is a board certified obstetrician-gynecologist who has practiced medicine in South Carolina since 2000. She admitted Amy Moore to St. Francis Hospital in South Carolina for labor and delivery of her child, Nathan Moore, on June 22, 2004. When Nathan was born, he “was documented to be abnormally depressed with poor color, muscle tone, and respiratory effort,” and “required resuscitation in the delivery room.” J.A. 715. Eventually, he was transferred to the Medical Univer[279]*279sity of South Carolina Hospital after experiencing seizures in the nursery.

After Nathan’s birth, Amy Moore continued to be treated by Dr. Sutton. With respect to her son’s prognosis, she told Dr. Sutton at first that Nathan’s treating physicians were uncertain about it, but then “informed [her] that [they] expected him to have some deficits but they may be mild.” Id. During a later visit with Dr. Sutton in August 2004, Amy Moore told her that Nathan’s tests were expected to be normal and that Nathan’s treating physician “was hopeful there would be little to no residual [health] problems.” Id. at 716. During this time, Amy Moore never complained to Dr. Sutton about her care, treatment, or the delivery, and never expressed an intention to bring a lawsuit.

When Nathan was nearly four years old, Dr. Sutton received a letter from the Risk Management Department at St. Francis Hospital disclosing that it had received a request for Amy Moore’s medical records from June 22, 2004 (the day Nathan was born). The letter noted that it was informing Dr. Sutton of the request because of “ongoing Risk Management activities to identify potential claims within our health care system.” J.A. 596. The letter further stated that Dr. Sutton could review the medical record, but gave no further details about any treatment or hospitalization provided. At the time she received the letter, Dr. Sutton did not remember Amy Mpore as her patient or the treatment she provided her; thus, the only information she knew about Amy Moore was contained in the St. Francis letter.

Critical to the district court’s findings and conclusions in this case, Dr. Sutton testified that upon her receipt of the letter, she called her then-insurance company, MedPro, whose policy provided coverage from May 1, 2003 to May 1, 2009. She further testified that during this call, she advised the MedPro representative with whom she spoke of the contents of the letter from St. Francis. There is no documentation of this call in the files of Med-Pro, and Dr. Sutton has none.

In 2011, Dr. Sutton received a notice of intent to sue from counsel for the Moores, acting as parents and guardians ad litem of Nathan, for the injuries he suffered in connection with his birth (“the Moore Lawsuit”). She referred this claim to her then-current insurer, FirstPro, whose policy insured' her from April 1, 2009 to April 1, 2012.

In January 2012, FirstPro filed a complaint based on diversity jurisdiction against Dr. Sutton in the District of South Carolina, seeking a declaratory judgment that FirstPro “has no duty to defend or indemnify [Dr.] Sutton for the claims made in the [Moore] Lawsuit.” J.A. 26. First-Pro argues that the claim is excluded from coverage based on three exclusions in the relevant policy. Only one of these provisions, Exclusion 11(b), was considered by the district court. That provision states that FirstPro refuses to “defend or pay” for injury or damages “arising out of a medical incident or committee incident which prior to the effective date of this policy was” “reported to an insurer.” J.A. 644. FirstPro argues that this exclusion was triggered because Dr. Sutton’s 2008 call to MedPro disclosing her receipt of the medical records request qualifies as a “medical incident” that was reported to another insurer.

In response to the declaratory judgment action, Dr. Sutton counterclaimed against FirstPro and filed a third-party complaint against MedPro, arguing that if FirstPro did not owe her coverage, then MedPro did. MedPro argues that it does not owe coverage to Dr. Sutton because it has no record of receiving the call from Dr. Sutton in 2008, and thus, Dr. Sutton failed to [280]*280notify MedPro about the potential claim as required under the MedPro policy. Med-Pro’s policy explicitly states that “the Company shall have no duty to defend or pay damages” “on a potential claim unless it was reported to the Company during the term of this policy and the report includes all reasonably obtainable information, including the time, place and circumstances of the incident; the nature and extent of the patient’s injuries; and the names and addresses of the patient and any available witnesses.” J.A. 592. Dr. Sutton denies that the medical records request put her on notice of a potential claim arising from her delivery of Nathan. In any event, she contends that her call was enough to relieve her of (or satisfy) her duty to report to MedPro a potential claim.

In due course, the Moores intervened as defendants and argued that FirstPro owed Dr. Sutton coverage for the Moore Lawsuit.1

B.

After the close of discovery, the insurers moved for summary judgment, each arguing, inter alia, that as a matter of law, it had no duty to provide coverage for the Moore Lawsuit. The district court denied both motions. With respect to MedPro’s motion, the district court stated that there was a genuine issue of fact as to “whether Dr. Sutton reported the 2008 Letter to MedPro” and “whether the information allegedly provided by Dr. Sutton to MedPro was sufficient to report a potential claim regarding Nathan Moore.” J.A. 135, 136. As to FirstPro’s motion, the court stated that there was a genuine issue of fact with respect to whether Dr. Sutton’s phone call to MedPro regarding the St. Francis letter triggered Exclusion 11(b) of the FirstPro policy.

To resolve these issues of fact, the district court held a bench trial on March 2, 2013. It heard testimony from only two witnesses, Dr. Sutton and Joseph Costy, MedPro’s claims specialist. Dr. Sutton testified to the following: (1) she called MedPro and notified the representative that she had received a medical records request letter from St.

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Cite This Page — Counsel Stack

Bluebook (online)
607 F. App'x 276, Counsel Stack Legal Research, https://law.counselstack.com/opinion/the-medical-protective-company-v-kyrsten-sutton-ca4-2015.