SECOND DI VI SI ON DOYLE, C. J.

, M I LLER, P. J, and REESE, J.

N O T IC E : M otions for r e c ons i de r a tion m us t be ph y sic a l ly r e ce iv ed i n our c le r k ’s offic e w ithin te n da y s of the da te of de c is ion to be de e m ed tim e ly file d.

http://w w w .ga a ppe a l s .us /r ule s

June 2, 2017



# I n th e Co u r t o f

A p p eals o f

G eo r g ia

A1 7 A0 48 5 . FAYETTE COUNTY NURSING HOM E, L LC v . PRI X-RAY, LLC et al

. DO-0 1 9

D O Y LE , Ch ief J ud g e.

Th i s ap p eal ari s es fro m a b reach o f co n t ract cas e fi l ed b y F a y e t t e C o u n t y

Nu rs i n g Ho m e, L L C

, d / b /a So u t h l an d Heal t h & Reh ab i l i t at io n & Cl i n i cal Heal th

Serv i ces ( c o l l ect i v el y “ So u t h l an d”) ag ai n s t PRI X-Ray

, LLC, an d Geo rg i a

Ul t ras o u n d

, LLC, (co l lect i v el y “ PRI”) al l eg i n g PRI fai l ed t o d efen d an d i n d em n i fy

So u t hl an d as req u ired u nd er t h e p art ies ’ s erv ice co n t ract ag a i n s t cl ai m s fi l ed in

co n nect io n wi t h th e d eat h o f Lo i s J o rg en s o n

. T h e t ri al co u rt g ran t ed s u m m ary

ju d g m en t t o PRI aft er fi n d in g tha t the c lai m s al l eg ed ag ai ns t So u th l an d i n J o rg en s o n ’ s

d eat h d i d n o t fal l un d er t h e i nd em n i t y p ro v is io n o f t he s erv i ce co n t ract b et ween t h ep art i es

. Fo r t h e reas o n s th at fo l l o w, w e rev ers e t h e t ri al co u rt ’ s o rd e r g r a n t i n g

s u m m ary ju d g m en t t o PRI.

S u m m a r y ju d g m en t i s p ro p er w h en t h ere is n o g en u i n e i s s u e o f

m at eri al fact an d t h e m o van t i s en t i t l ed to ju dg m en t as a m at t er o f l aw.

A d e n o v o s t an d ard o f r e v i ew ap p li es t o an ap p eal fro m a g ran t o f

s u m m ary ju d g m en t

, a n d we v i ew t h e ev i d en ce, an d al l reas o n ab l e

co n cl u s i o n s an d i nferen ces drawn fro m i t

, i n t h e l i g h t m o s t fav o rab l e t o

t h e n o n m ov an t

. 1

So v i ewed

, t h e reco rd s h o ws t h at So u t h lan d i s a l o n g -t erm n u rs i n g faci l i t y ,

wh i ch pro v i d es res i d en ce, s k i l l ed care, t reat m en t

, an d co n v al es cen t an d reh ab i l i t at i v e

s erv i ces

. In 2 0 11

, So u th l an d co n t ract ed PRI t o p erfo rm v ari o u s x-ray s erv i ces at t h e

faci li t y

. Th e ag reem en t bet ween t h e p art i es co n t ai n s t h e fo l l o wi ng rel ev an t cl au s es

.

Al l em p l oy ees o f PRI wo u l d b e ap p ro p ri at el y t rai ned

, fo ll o w pert i n en t re g u l a t i o n s ,

a n d “ u p h o l d th e et hi cs of t h e p ro fes s i o n.” Al l ex am s , i n cl u d i n g m o b il e x -ray ,

u l t ras o u n d

, an d EKG serv i ces , p erfo rm ed b y PRI wo u ld b e “ o n t h e o rd er o f a d u l y

l i cen sed an d au t ho ri zed p h y s i ci an ” an d wo u l d b e “ i n t erp ret ed b y a d u l y l i cen s ed an d

1 (Ci t at io ns o m i t t ed .) BBL-McCa r t h y, LLC v. Ba l d

wi n Pa vi n g Co

. , 2 8 5 Ga. Ap p

. 4 94 -4 9 5 (6 4 6 SE2 d 6 8 2) (2 0 0 7 ), ci ti n g OCGA § 9 -1 1 -5 6 (c); Br i t t v. Kel l y &

Pi cer n e, In c. , 2 5 8 Ga. A p p

. 84 3 (5 7 5 SE2 d 7 3 2 ) (2 0 02 ); Ph i l l i p s v. Fi rs t Ba nk o

f Ga

. , 2 5 7 Ga. Ap p . 3 4 2 (5 71 SE2 d 4 1 0 ) (2 0 0 2 ).

2q u al i fi ed [r] ad i o l og i s t

. ” Un d er s erv i ces , PRI wo u l d “ p r o v id e [So u t h l an d ] wi t h t ru e

an d accu rat e reco rd s o f s erv i ces p ro vi d ed fo r an d i n s p ect i o n o f ch art s , i f n eces s ary ,

t o as s u re co m

p l i an ce wi t h p h y s ici an o rd ers an d an y an d al l st at e, fed eral

, an d / o r fi s cal

i n t erm ed i ary ru l es an d reg u l at i on s as t h ey ap p l y t o m o b i le u l tras o u n d s erv i ces .” PRI

was al s o req u i red t o u t i l i ze l i cen s ed rad i o l o g i s t s an d card i ol o g i s t s t o i n t e r p ret t h e

ex am s , an d th e co n t ract n ot ed t h at “ [t ] he [r] ad i o lo g i s t w i l l di ct at e a rep o rt fo r each

ex am i n at i o n an d wi l l pro m p t ly fax t h e fu l l wri t t en rep o rt t o [So u t h lan d ] .” Cl au se 5,

t i tl ed “ In s u ran ce,” s t at ed t h e am o u n t o f in s u ran ce each p art y wa s req u i red to

m ai n t ai n

.

Sect io n 1 2 o f t h e ag reem en t co v ers “ In d em n i fi cat i o n an d Co o perat i o n In

Defen s e o f Cl ai m s .” Cl au se 1 2 .1 s t at es t h at

PRI

. . . co v en an t s an d ag rees t o fu l l y d efen d

, p ro t ect

, i n d em n i fy [,] an d

h o l d h arm l es s [So u t h lan d ]

, i t s o ffi cers , d i rect o rs , ag en t s , t ru st ees , h ei rs ,

em p l o y ees , s erv an t s , aff

i l i at ed o rg an izat i o n s , s u b s i d i ari es , s u cces so rs ,

as s i g n s [

, ] a n d rep res en t at i v es ag ai n st each an d ev ery cl ai m , wo rk er’ s

co m p en s at i o n cl ai m , l i en , d em an d [,] o r cau s e o f act i o n an d an y l i ab i l i t y ,

co s t s, p ay m en t o f b en efi ts

, ex p en s es (i n cl u d i n g reas o n ab l e at t o rn ey fees

an d ex p en s es ) d am ag e[,] o r l o s s o r co nn ect i o n t h erewi t h t h at m ay be

m ad e o r as s ert ed b y an y t h i rd p art i es , ad d it i o n al su b co n t ract o rs h i red b y

PRI [,]

. . . o r em

p lo y ees o f PRI

. . . , in cl u d i n g ad d i t io n al s u b co n t rat ors

an d th ei r em

p l oy ees as co n t em

p l at ed b y OCGA § 3 4 -9 -8 o n acco u n t o f

3p ers on al i n ju ry , d eat h

, p ro p ert y d a m a g e[,] o r wo rk er’ s co m p en s at i o n

cl ai m ca us ed b

y, a r i s ing o ut o

f o r i n any w a

y i n c i d e n ta l t o , o r i n

co nnect io n wi t h t he i nd ep end ent co nt r a ct o r rel a t i o ns hi p b et ween P

RI

. . . a nd [So ut

hl a nd ] o r i n t he per fo r m a nce o

f l ab o r a t o r y s er vi ces

her eund er ; an d PRI

. . . ag rees t h at i t m ai n t ai n s , at PRI[‘ s ]

. . . s ol e co s t

an d co n t r o l

, v al i d

, o ng o i n g wo rk ers ’ co m pen s at i o n co v erag e fo r PRI

.

. . fo r PRI

. . . an d a l l P R I [ ‘s ]

. . . em p l o y ees , s u b co n tract o rs [,] an d

s u b co n t ract o r’ s em

p l o y ees t h ro u g ho u t t h e l en g t h of t im e i t t ak es PRI .

. . t o p erfo rm t h e w o rk o r rad i o l o g y s erv i ces an d t o pro v i d e a v al i d

o n g o i n g cert i fi cat e o f wo rk er ’ s c o m p en sat i o n i n s uran ce t o [So u th l an d ]

. 2

Cl au se 1 2 .2 m o re fu l l y art icu l at ed th e rei m b u rs em en t m ech an i s m fro m PRI to

So u t h l a n d fo r wo rk ers ’ co m p en s at i o n cl ai m s, an d Cl au s e 1 2.3 d efi n ed t h e

co o perat i o n p ract i ces b et ween th e p art i es t o d efen s e o f m ed i cal m al p ract i ce o r o t h er

cl ai m s

.

In 2 0 1 3

, J o rg en so n b ro k e h er h i p an d un d erwen t rep arat i v e s u rg ery

. J o rg en so n

d i d n o t ex p eri en ce co m

p l i cat i o n s fro m su rg ery w h i l e at t h e ho s pi t al

, an d o n M ay 2 2,

2 0 1 3

, s h e w as d is ch arg ed an d s en t t o So u t h l an d fo r a 3 0-d ay reh ab i l i t at i o n s t ay

.

W h en J o rg en so n was ad m it ted t o So u t h l an d

, i t was n o t ed t h at s he h ad a b o wel

m o vem en t o n M ay 21

, 2 0 13

, an d s h e h ad a s o ft

, fl at , n o n -t en d er, ab d o m en t h at was

2 (Em p h as i s s u p pl i ed .)

4p o s i t i ve fo r b o wel so u nd s

. So ut h l an d ’ s reco rd s in d icat ed t h at b et ween M ay 2 5 -2 9,

J o rg en s o n d i d n ot h av e a b o wel m ov em en t, was gi v en a l ax at i ve wi th o ut res u l t s , an d

b eg an ex p eri en ci n g d eg rad i n g fu n ct i o n du ri n g reh ab i l i t at i o n ex erci s es

. O n M ay 3 0,

aft er J o rg en s o n recei v ed ad d i t i o n a l t r eat m en t b u t co n t in u ed t o d et eri o rat e,

J o rg en s o n ’ s t reat i n g p h y s i ci an o rd ered a ch es t x -ray an d a k i d n ey , u ret er, an d b l ad d er

(“ KUB”) x -ray t o ru l e o u t an o b s t ru ct i o n

.

Th e K UB an d ch es t x -ray s were p erfo rm ed at 8 : 3 0 p

. m

. b y PRI, an d th e fi l m s

were ev al u at ed an d i n t erp ret ed b y Dr. Farah W i l l i am s

. D r

. W il l iam s d i ct at ed h er

fi nd i ng s , an d t hey were fax ed t o So ut h l an d b y 1 2 : 0 3 a.m

. D r. W i ll i am s ’ s p ract i ce al s o

co n tact ed PRI d irect l y an d i n fo rm ed i t o f a “ cri t i cal fi n di n g ” i n J o rg en s o n’ s x -ray an d

ex p res s ed th at J o rg en s o n ’ s t reat i ng p hy si ci an need ed t o kn o w a b o u t t h e fi n d i n g

i m m ed i at el y

. N ei th er P RI, no r Dr. W i ll i am s , o r h er pract i ce d i rect ly co n t act ed

So u t hl an d o r J o rg en s o n ’ s t reat i n g p h y s i ci an ab o u t t h e fi n d i n g i n t h e x -ray s i n o rd er

t o n o t i fy t h em

o f t h e cri t i cal fi n d i n g

.

At 1 2 : 03 a.m ., a So ut h l an d nu rs e n o t ed t h at sh e co n t a c t e d v i a an s weri n g

s erv i ce J o rg en s o n ’ s t reat i n g p h y s i ci an , bu t t he co m p lai n t fai l ed t o s t at e wh et h er t h e

t reat i n g ph y s i ci an recei v ed t h e x -ray i n fo rm at i o n u n ti l m ak i ng ro u n d s l at e r t h at

m o rn i n g at 1 1 : 3 0 a.m ., wh en s he req u es t ed J o rg en s o n b e t ran s ferred t o t h e h o s p i t al

5t o ru l e o u t a bo wel p erfo rat i o n

. J o rg en s o n u n d erwen t s u rg ery fo r t h e p erfo rat i o n an d

l at er d ied fro m

s ep si s

.

J o rg en s o n ’ s es t at e fi l ed a c o m pl ai n t ag ai ns t v ari o us p art i es , i n cl u d i n g

So u t hl an d

, W i ll i am s , an d W i l l i am s ’ s p ract i ce, bu t n o t n am i n g PRI as a d efen d an t

.

Th e co m p l ai n t al l eg ed

, i n t er al i a, t h at W illia m s’ s pr a c ti ce co n t act ed PRI an d i n fo rm ed

i t t h at t h e KUB h ad a cri t i cal fi n d i n g ab o u t wh i ch th e t reat in g p h y s i ci an sh o u l d b e

i m m ed i at el y i n fo rm ed . Th e rep o rt al l eg ed l y was s en t t o So u t hl an d fro m W i l l i am s ’ s

p ract i ce, b u t n ei t her W i l l i am n o r h er pract i ce co n t act ed So u t h lan d o r t h e t reat i n g

p h y s i ci an to i n fo rm t h em o f t h e cri t i cal fi n di n g ; al t h o u gh PRI k new o f t he cri t i cal

fi nd i ng a n d c o n t a c t e d So ut h l an d to en su re t h e rep o rt arri v ed

, i t d i d n o t ex p l ai n to

So u t hl an d t h at t h ere was a cri t i cal fi n d in g i n t he r ep o rt o r ex p l ai n t h at th e t reat i n g

p h y s i ci an s h ou l d be i m

m ed iat el y i n fo rm ed

. Th e t reat in g p h y s i ci an m o ved J o rg en so n

t o t h e h os p i t al fo r t reat m en t s o m e 1 2 ho u rs l at er. Bas ed o n t h es e fact s , J o rg en so n

al l eg ed cl ai m s o f n eg l i g en ce, p ro fes si o n al n eg l i g en ce, b reach o f co n t ract

, an d

wro ng fu l d eat h

.

So u t h l an d n o t ifi ed PRI o f J o rg en s o n ’ s l aws u i t , b u t PRI refu s ed t o i n d em n i fy

So u t hl an d ag ai n s t J org en s on ’ s cl ai m s

. T h ereaft er, So u t h l an d s et t l ed wi t h J o rg en s o n,

6an d So u t hl an d fi l ed t h e i n s tan t cas e ag ai n s t PRI fo r b reach o f co nt ract b as ed o n t h e

fai l u re t o d efen d an d i n d em n i fy So u t hl an d u n der t h e ag reem en t

.

Th e p art i es fi l ed cro s s -m o t i o n s fo r s u m m ary ju d g m en t

. Th e t ri al co u rt g ran t ed

s u m m ary ju d gm en t i n fav o r o f PRI, fi n d i n g t h at PRI co n t ract ed w i t h So u th l an d to

p ro v id e m o b i l e i m ag in g s erv i ces , no t rad i o l o g y s erv i ces , an d t herefo re, J o rg en s o n ’ s

i n ju ry d i d n o t ari s e o u t o f a b reach o f PRI’ s d u t i es u n der t h e co n tract

, wh i ch res u l t ed

i n a fai l ure t o t ri g g e r t h e du t i es t o d efen d o r i n d em ni fy So u th l an d u n d er t h e

ag reem en t

.

So u t h l an d arg ues t h at t h e t ri al co u rt erred b y gran t i n g s u m m ary ju d g m en t to

PRI. W e ag ree.

As a m at t er o f l aw, t h e s co p e o f t h e wri tt en in d em n i fi cat i o n

p ro v i s i o n s m

u s t b e s t ri ct l y co n s t ru ed ag ai ns t [So u t h l a n d]

, th e

i n d em n i t ee. In ad d i t i on , i t i s wel l es tab l is h ed i n Geo rg ia t h at co n t ract ual

i n d em n i t i es d o n o t ex t en d t o l o s ses cau s ed b y an i n d em n i t ee’ s o wn

n eg l ig en ce u nl es s t he co n t ract ex pres s l y st at es t hat t h e n eg li g en ce o f th e

i n d em n i t ee i s co v ered

. 3

3 (Ci tat i o n s , fo o t no t es , an d p u n ct u at i on om itte d. ) B B L

- M c C arthy

, 285 Ga. Ap p.
at 5 0 0 (2 ).

7Sp eci fi cal l y , So u t h l an d ch al l en g es t h e t ri al co u rt ’ s co n cl u s i o n t h at So u t h l an d

fai l ed t o s h o w th at PRI’ s act i o n s p ro xi m at el y cau s ed th e p at i en t ’ s i nju ri es i n o rd er to

t ri g g er th e i n d em

n i t y cl au s e. In s u p p o rt o f i ts arg u m en t

, S o u t h l an d rel i es pri m ari l y

o n JNJ Fo u n d

a t i on S p eci a l i s t s , In c. v. D. R. Ho r t o n
, In c

. 4 Al t ho u g h t h at cas e i s n ot

b i n d i n g p reced en t, t h e p ro p o si t i o n s wi t h i n t h at cas e u p on wh i ch So u t h lan d rel i es are

b as ed u po n pri or c a s e l a w i n t h i s Co urt

, in cl u d i n g BBL-McCa r t h y , i n wh i ch t h i s

Co u rt ex p l ai n ed t h at “ [s ] i m i l ar t o o u r i n terp ret at i o n o f t h e p h ras e ‘ ari s i ng o u t o f’ i n

i n s u ran ce p o l i ci es , we co n s t ru e t h i s p h ras e i n an in dem n it y cl au s e t o m ean ‘ h ad i t s

o ri g i ns in ’ o r ‘ g rew o u t o f’ an d t o en co m p as s ‘ al m o s t an y c a u s a l c o n n ect i o n o r

rel at i o n s h i p .’ ” 5 Th u s , d es p i t e t h e t ri al co u rt ’ s d et erm i nat i o n o th erwi se, i n t h i s cas e,

t h e o ri g i n at i on o f at l eas t so m e o f t h e cl ai m s ag ai n s t So u t h l an d arg u ab l y aro s e fro m

PRI’ s co m

m u ni cat i o n b et ween So u th l an d an d t h e rad i o l o g i s t PRI co n tract ed to

i n t erp ret t h e fi l m s as req u i r e d i n Cl au s e 1.7

. Ad d i t i o n al ly

, PRI co n t ract ed t o “ u s e”

cert ifi ed rad i o lo g i s ts u nd er b ot h Cl a u s e 1 .2 an d Cl au se 1 .7

. Bas ed o n t h e b ro ad

l an g u ag e o f t h e i n d em

n it y cl au s e o f 1 2

. 1

, PRI w a s r e s p o n s i b le fo r p ro v i d i n g

i n d em ni t y fo r al l cl ai m s “ cau s ed b y , ari s i n g o u t o f o r i n an y way i n ci den t al t o , o r in

4 3 1 1 Ga. Ap p . 2 6 9 (7 1 7 SE2 d 2 1 9 ) (2 0 1 1 ) (p h y s i cal p reced en t o n l y ).

5 2 8 5 Ga. Ap p . at 5 0 0 -5 0 1 (2 ).

8co n nect io n wi t h t he i n dep en den t co n t ract o r rel at i on s h i p b et ween PRI

. . . a n d

[So u th l an d ] o r i n t h e p erfo rm an ce o f l ab orat o r y s e r v i ces h ereu n d er.” 6 Th i s b ro ad

l an g u ag e en co m

p as s es t h e co m

m u n i c a t i o n bet ween t h e rad i ol o g i s t an d So u t h l an d

b e c a u s e PRI was res p on s ib l e fo r act i n g as an in t erm ed i ary b et ween t h e rad i o l o g i s t

an d So u t h l an d u n der t h e co n t ract

. Th e rad i o l o g is t ’ s co m m u n i cat i o n to So u t h l an d,

es p eci al ly wh en t h e rad i o l og i s t ’ s co n cern was k n o wn t o PRI, i s “ i n ci d en t al t o ” PRI’ s

d u t i es u n d er t h e co n t ract

. 7

M o reo v er, PRI s p eci fi cal l y co n t ract ed to p ro vi d e co n s u lt at io n t o So u t h l an d

reg ard i n g “ an ci l l ary h eal t h m at t ers an d i n s p ect i o n o f ch art s , i f n eces sary , t o as s u re

co m p l ian ce wi t h p h y s i ci an o rd ers ,” 8 an d i t s em p l o y ees were req u i red t o b e t rai n ed to

u p h o l d et h i cal o b l i g a t i o n s o f t he p ro fes s i o n

. 9 T h e co nt ract u al o b l i g at i o n o f

“ co n s u l t at i on w i t h So u t hl an d

. . . t o en s u re co m p l ian ce w i t h o rd ers ” i s n o t l i m i t ed to

t h e t i m e p eri o d p ri o r t o th e x -ray o r u l t ras o u n d

. W h en read i n co n ju n ct i o n wi t h t h e

6 See i d . at 5 0 1 (2 ).

7 See i d .; JNJ F

o u n d at i o n S p eci a l i s t s
, I nc. , 3 1 1 Ga. Ap p. at 2 79 -2 8 0 (4 ) (p h y s i cal p reced en t o n l y ).

8 Cl au s e 1 .6

.

9 Cl au s e 1 .4

.

9b ro ad d u t y t o i nd em n i fy 1 0 So u t h l an d i n co n n ect io n w i t h th e s erv i ces u n d er t h e

co n tract

, J o rg en so n ’ s cl ai m s are i n cl u d ed

, an d PRI b reach e d t he i nd em n i ty ag reem en t

b y fai l i n g t o p ro v i d e a d e f e n s e. 1 1 A cco rd i n g ly

, we rev ers e t h e g ran t of s u m m ary

ju d g m en t t o PRI.

Ju d g men t r ever sed . Mi l l er

, P. J., a nd

Rees e, J., co n cu r

.

1 0 PRI ag reed t o “ fu l ly

. . . i n d em n ify an d h o l d harm les s . . . ag ai n s t each an d

e v e r y cl ai m

. . . o r cau se of act i on an d an y l i ab i l i t y , co s t s , p ay m en t o f b en efi t s ,
ex p en s es (i n cl u d i n g reas o n ab l e at to rn ey fees an d ex p en s es ), d am ag e [ ,] o r l o s s o r

co n nect io n t h erewi t h t h at m ay b e m ad e o r as s e r t e d b y an y t h i rd p art i es , . . . o n

acco u n t o f p ers ona l inj ur

y , de a th, p ro pert y dam ag e[,] o r wo rk er’ s co m p en s at i o n cl ai m

c a u s e d b y , ari s i n g o u t o f o r in an y way i n ci d en t al t o , o r i n co n n ect io n wi t h t h e i n d ep en den t co n t ract o r rel at i on s h i p b et ween PRI . . . an d [So u t h l an d ] . . . .”

1 1 See La wyer

s Ti t l e In s. Co r

p

. v. New Fr eed

o m Mt g

. Co rp ., 28 5 Ga. Ap p

. 2 2,
3 0 (2 ) (6 4 5 SE2 d 5 3 6 ) (2 0 0 7 ) (ex p l ai n in g t h at i f “ as h ere, an i n d em ni fi cat i o n cl au s e
req u i res in d em

n ifi cat i o n o f l o s s es t h at ari s e o ut o f cert ai n s p eci fi ed ev en t s b u t d o es

n o t ex p l ici t l y m en ti o n t h e i nd em n i t ee’ s n eg l i g en ce, t h e cl au s e st i ll req ui re s f u l l
i n d em ni fi cat i o n al t h o u g h th e i n d em n i tee’ s n eg l i g en ce m ay h av e p art i al l y cau s ed t h e l o s s ”) (p u n ct u at i o n o m i t t ed ).

10