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

CourtDistrict Court, D. New Mexico
DecidedFebruary 10, 2025
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. 2025).

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

Before the Court is an insurance coverage dispute. Travelers Casualty Insurance Company of America (Travelers) issued a Commercial General Liability Policy (CGL Policy) to the New Mexico Bone and Joint Institute, P.C. (NMBJI). The CGL Policy covers NMBJI and two of its physicians (the CGL Policy Insureds) but contains a Professional Health Care Services exclusion that bars coverage for claims arising from medical treatment, advice, or instruction. Tervon Dorsey was allegedly injured after being treated at NMBJI. Together with his family (the State Plaintiffs), Dorsey filed suit against NMBJI and others in New Mexico state court,1 and Travelers is providing a defense under a reservation of rights. Travelers asks this Court to find that it owes no duty to

1 The State Plaintiffs include Tervon Dorsey, Kimberly Dorsey, and Kate Ferlic, as guardian ad litem for K.D. and J.D., minors. The State Plaintiffs named the CGL Policy Insureds and the American Foundation of Lower Extremity Surgery and Research, Inc. (AFLESR) as defendants. (See Doc. 1-2 at 1.) The Court refers to the CGL Policy Insureds and AFLESR collectively as the State Defendants. defend the CGL Policy Insureds in the state lawsuit.

The state lawsuit involves medical negligence and related claims, including claims brought under the New Mexico Unfair Practices Act (UPA). Travelers contends that all claims arise out of medical treatment, advice, or instruction and are thus barred by the CGL Policy’s Professional Health Care Services exclusion. The CGL Policy Insureds and the State Plaintiffs disagree and argue that the UPA claims are grounded in business decisions unrelated to the physicians’ specialized knowledge or training. Travelers and the CGL Policy Insureds have filed cross-motions for judgment on the pleadings. (Docs. 3; 25.) At the heart of this dispute is a discrete issue: whether the State Plaintiffs adequately asserted claims under the UPA that do not implicate the physicians’ medical competence. If they did, then the policy exclusion does not apply, and Travelers must continue to defend the CGL Policy Insureds. If they did not, and their UPA claims only involve

medical negligence, then the policy exclusion applies, and Travelers is not obligated to defend the state lawsuit. Having considered the parties’ arguments and the relevant law, I find the State Plaintiffs have adequately pleaded claims under the UPA that do not involve the physicians’ medical competence, thereby requiring Travelers to continue defending the CGL Policy Insureds. I recommend DENYING Travelers’ motion (Doc. 3) and GRANTING the CGL Policy Insureds’ motion (Doc. 25).2 I further recommend DENYING the State Plaintiffs’ motion to strike. (Doc. 21.)

2 Senior United States District Judge Martha Vázquez entered an Order of Reference on January 27, 2025, referring the pending cross-motions 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. 50 at 1.) I. Factual Background

Travelers is a Connecticut insurance company doing business in New Mexico. (Docs. 1 ¶ 1; 24 ¶ 1.) NMBJI “is a New Mexico professional corporation” that employs podiatric physicians Drs. Rampton and Spencer. (See Docs. 1 ¶¶ 2, 4–5, 13; 24 ¶¶ 2, 4–5, 13.3) American Foundation of Lower Extremity Surgery and Research, Inc. (AFLESR) is a non-profit that “provides fellowships, scholarships, and research opportunities for those interested in advancing their medical education.” (See Docs. 1 ¶¶ 3, 26; 24 ¶¶ 3, 26.) To support its mission, AFLESR sponsors medically trained fellows who work at NMBJI. (See Docs. 1 ¶ 26; 24 ¶ 26.) Spencer is the Treasurer of NMBJI and the Director and the President of AFLESR. (See Doc. 1-2 ¶ 7.) Travelers issued the CGL Policy to NMBJI for the coverage period from January 3, 2020, through January 3, 2021. (Docs. 1 ¶ 14; 2 ¶ 14; see also Doc. 1-1 at 2.) The parties agree that the CGL Policy covers NMBJI, Rampton, and Spencer as insureds, but not AFLESR.4 (See Docs. 3 at

8–9; 25 at 13.) The CGL Policy covers “those sums that the insured becomes legally 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 . . . .” (Docs. 1 ¶ 16; 24 ¶ 16; see also Doc. 1-1 at 91.) It also contains a “Professional Health Care Services” exclusion, which excludes coverage for “‘[p]ersonal injury’ or ‘advertising injury’ arising out of providing or failing to provide ‘professional health care services.’” (See Docs. 1 ¶ 22; 24 ¶ 22; see also Doc. 1-1 at 122.) The CGL Policy defines professional health care services, in relevant part, as “medical, surgical, . . . or nursing services, treatment, advice or instruction . . . .” (See Docs. 1 ¶ 23; 24 ¶ 23;

3 Although the State Defendants do not explicitly admit that Rampton and Spencer are “employees” of NMBJI (see Doc. 24 ¶ 13), the distinction is not relevant to the parties’ motions.

4 To the extent Travelers asks the Court to find that AFLESR is not an insured under the policy, that request is moot. (See Doc. 3 at 8–9.) see also Doc. 1-1 at 122.)

In relevant part, the state complaint asserts that Tervon Dorsey saw Dr. Spencer for podiatry consultations on October 4, 2019, and April 7, 2020. (Doc. 1-2 ¶¶ 39, 47.) Thereafter, 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 alleges he was not informed that the AFLESR fellows would be present at or participate in the surgeries, nor was he told that “Dr. Spencer had a relationship through AFLESR with fellow, Dr. Riley.” (See id. ¶¶ 40, 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 the State Defendants “were engaged in a joint venture/enterprise” with the “shared interest and objectives in having their health care 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 Plaintiffs maintain that “AFLESR fellows effectively provide low cost labor to NMBJI in exchange for fellowship credentialing.” (See id. ¶ 41.) The State Plaintiffs further contend that the State Defendants made “coordinated medical recommendations to Tervon Dorsey that were motivated by profit and [to create] surgical procedure opportunities for fellows of AFLESR, instead of ensuring the recommendations for intervention were in the best interest of [Dorsey] . . . .” (See id. ¶ 66(a).) According to the State Plaintiffs, the State Defendants hid their

“financial biases from [Dorsey] by not informing him that the surgery[ies] and procedures would be used to create opportunities for fellows through AFLESR over which Dr.

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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-2025.