Travelers Casualty Insurance Company of America v. New Mexico Bone and Joint Institute P.C.

CourtDistrict Court, D. New Mexico
DecidedNovember 7, 2024
Docket2:24-cv-00027
StatusUnknown

This text of Travelers Casualty Insurance Company of America v. New Mexico Bone and Joint Institute P.C. (Travelers Casualty Insurance Company of America v. New Mexico Bone and Joint Institute P.C.) is published on Counsel Stack Legal Research, covering District Court, D. New Mexico primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Travelers Casualty Insurance Company of America v. New Mexico Bone and Joint Institute P.C., (D.N.M. 2024).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW MEXICO

TRAVELERS CASUALTY INSURANCE COMPANY OF AMERICA,

Plaintiff,

v. No. 2:24-cv-0027 MV/DLM

NEW MEXICO BONE AND JOINT INSTITUTE, P.C.; AMERICAN FOUNDATION OF LOWER EXTREMITY SURGERY AND RESEARCH, INC., a New Mexico Corporation; RILEY RAMPTON, DPM; LOREN K. SPENCER, DPM; TERVON DORSEY, Individually; KIMBERLY DORSEY, individually; and KATE FERLIC as GUARDIAN AD LITEM for K.D. and J.D., Minors,

Defendants.

PROPOSED FINDINGS AND RECOMMENDED DISPOSITION

Travelers Casualty Insurance Company of America (Travelers) issued a Commercial General Liability Policy (CGL Policy) to New Mexico Bone and Joint Institute, P.C. (NMBJI). The CGL Policy covers NMBJI and two of its physicians, Riley Rampton and Loren Spencer (the CGL Policy Insureds). Tervon Dorsey, Kimberly Dorsey, and Kate Ferlic, as guardian ad litem for K.D. and J.D., minors (the State Plaintiffs) filed a medical malpractice suit against NMBJI and others in state court, and Travelers is providing a defense under a reservation of rights. Travelers has since filed a declaratory judgment action in this Court seeking a declaration on whether the CGL Policy requires it to defend or indemnify the CGL Policy Insureds in the underlying state action. Travelers contends that the CGL Policy’s “Professional Services” and “Expected and Intended Injury” exclusions preclude coverage. The State Plaintiffs move to dismiss and ask the Court to decline to exercise jurisdiction over the federal declaratory judgment action or, alternatively, to stay this lawsuit pending

resolution of the state suit. The Court held a hearing on the motion on October 30, 2024, during which counsel for both Travelers and the CGL Policy Insureds stated that they are ready to proceed with the federal declaratory judgment action. Having considered the parties’ arguments and the five Mhoon factors, the undersigned recommends that the Court DENY the State Plaintiffs’ motion to dismiss.1 I. Factual Background2 Travelers is a Connecticut insurance company that does business in New Mexico. (Doc. 1 ¶ 1.) NMBJI “is a New Mexico professional corporation” that employs podiatric physicians Drs. Rampton and Spencer. (See id. ¶¶ 2, 4–5, 13.) American Foundation of Lower Extremity Surgery and Research, Inc. (AFLESR) is a non-profit organization that “provides fellowships, scholarships,

and research opportunities for those interested in advancing their medical education.” (Id. ¶¶ 3, 26.) To this end, AFLESR sponsors medically trained fellows who work at NMBJI. (See id. ¶ 26.) The State Plaintiffs allege that these two organizations are “closely associated”: Spencer is both the Treasurer of NMBJI and the Director and President of AFLESR. (Id. ¶¶ 5, 7.) Travelers issued the CGL Policy at issue to NMBJI for the period from January 3, 2020, through January 3, 2021. (Id. ¶ 14; see also Doc. 1-1 at 2.) The parties seemingly agree that the CGL Policy covers NMBJI, Rampton, and Spencer as insureds, but not AFLESR. (See Docs. 3 at 8–9; 25 at 13.) The CGL Policy coverage includes “those sums that the insured becomes legally

1 Senior United States District Judge Martha Vázquez entered an Order of Reference on October 8, 2024, referring the Motion to Dismiss to the undersigned magistrate judge “to conduct hearings, if warranted, including evidentiary hearings, and to perform any legal analysis required to recommend to the Court an ultimate disposition of the case.” (Doc. 41.)

2 The Court recites the facts relevant to this motion as they are derived from the Complaint for Declaratory Relief (Doc. 1 (Compl.)) and the exhibits attached thereto. obligated to pay as damages because of ‘bodily injury’ or ‘property damage’” that “is caused by

an ‘occurrence’ that takes place in the ‘coverage territory’” and “during the policy period . . . .” (Doc. 1 ¶¶ 16–17; see also Doc. 1-1 at 91.) The CGL Policy contains two relevant exclusions. The “Professional Health Care Services” exclusion3 excludes coverage for “‘[p]ersonal injury’ or ‘advertising injury’ arising out of providing or failing to provide ‘professional health care services.’” (See Doc. 1 ¶ 22; see also Doc. 1-1 at 122).) The “Expected or Intended Injury” exclusion excludes coverage for “‘[b]odily injury’ or ‘property damage’ expected or intended from the standpoint of the insured.” (See Doc. 1 ¶ 21; see also Doc. 1-1 at 92.) According to the complaint filed in the state lawsuit, Tervon Dorsey saw Dr. Spencer at NMBJI for podiatry consultations on October 4, 2019, and April 7, 2020. (Doc. 1-2 ¶¶ 39, 47.) Dr. Spencer and two AFLESR fellows performed surgery on Dorsey’s left ankle on February 5, 2020,

and on his right ankle on May 27, 2020. (Id. ¶¶ 45, 48.) Dorsey asserts he was not informed that the AFLESR fellows would be present at or participate in the surgeries. (See id. ¶ 49.) Dorsey further asserts that Dr. Rampton, an AFLESR fellow, performed a faulty nerve block cortisone injection on Dorsey’s right ankle without supervision on April 11, 2020, further injuring Dorsey. (See id. ¶¶ 10, 40, 52–53, 56.) The State Plaintiffs filed suit in state court on July 31, 2023. (See id. at 1.) See also Dorsey v. N.M. Bone & Joint Inst., D-101-CV-2023-01753 (N.M. 1st Jud. Dist. Ct., July 31, 2013). They allege that NMBJI, AFLESR, Spencer, and Rampton (the State Defendants4) “were engaged in a joint venture/enterprise” with the “shared interest and objectives in having their health care

3 Travelers generally refers to this exclusion as the “Professional Services” exclusion (see Docs. 1 ¶¶ 39, 45–46; 31 at 2, 10–11), and the undersigned will do the same.

4 To be clear, the CGL Policy Insureds include NMBJI, Rampton, and Spencer, while the State Defendants include those three defendants and AFLESR. providers . . . perform hasty medical work that fulfilled fellowship criteria and led to company

profits, but that were not properly supervised.” (Doc. 1-2 ¶¶ 16–17.) The state complaint includes claims for: (1) medical negligence and recklessness, i.e., by basing their medical recommendations on profit and surgical opportunities for AFLESR fellows rather than on the best interest of their patients and by failing to inform patients that fellows were performing procedures (id. ¶¶ 65–68); (2) negligent and reckless hiring, training, supervision, retention, policies, and disclosures (id. ¶¶ 69–75); (3) civil conspiracy and joint venture by intentionally deceiving patients about the nature of their relationship (id. ¶¶ 76–87); (4) fraudulent concealment and lack of informed consent “by making inaccurate and misleading notes in the patient record” (id. ¶¶ 88–92); (5) unfair trade practices (id. ¶¶ 93–103); (6) prima facie tort (id. ¶¶ 104–07); (7) intentional infliction of emotional distress (id. ¶¶ 108–10); (8) loss of consortium (id. ¶¶ 111–21); and (9) proximate cause and

damages, including loss of chance and punitive damages (id. ¶¶ 122–26). Although Travelers contends that all claims are excluded from coverage by the Professional Services exclusion or the Expected or Intended Injury exclusion, it commenced defense of the state lawsuit under a reservation of rights. (See Doc. 1 ¶ 41.) On January 9, 2024, Travelers filed this Complaint for Declaratory Relief and asks the Court to declare that Travelers has no duty to defend or indemnify the CGL Policy Insureds in the underlying state lawsuit. (See id. at 1, 11.) The State Defendants have filed an Answer and Counterclaim. (Doc. 24.) Travelers has moved for judgment on the pleadings. (Doc. 3.) In their response, the CGL Policy Insureds also moved for judgment on the pleadings. (Doc. 25.) The State Plaintiffs seek dismissal and ask the Court to decline to exercise jurisdiction or, alternatively, to stay this action

pending resolution of certain factual issues by the state court. (See Doc.

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Travelers Casualty Insurance Company of America v. New Mexico Bone and Joint Institute P.C., Counsel Stack Legal Research, https://law.counselstack.com/opinion/travelers-casualty-insurance-company-of-america-v-new-mexico-bone-and-nmd-2024.