Opinion ID: 2010567
Heading Depth: 1
Heading Rank: 3

Heading: The Professional Policy

Text: ¶ Engelmann's professional liability policy covers damages resulting from the providing or withholding of professional services. A duty to indemnify arises only on a showing that the insured contingency occurred. Headlee v. New York Life Ins. Co., 69 S.D. 499, 504, 12 N.W.2d 313, 315 (1943). The policy does not specifically define professional services. For guidance on this term, we look to other jurisdictions. In Marx v. Hartford Accident and Indemnity Company, the Nebraska Supreme Court ruled that to find whether an act constitutes a professional service, courts look not to the title or character of the party performing the act, but to the act itself. 183 Neb. 12, 157 N.W.2d 870, 872 (1968). Thus, coverage encompasses professional acts or services, those entailing the performance of a vocation, calling, or occupation requiring learning and intellectual skill. The professional nature of an act qualifies it as professional service. A physician who sexually assaults a patient on the pretense of rendering medical care performs no professional service. Many courts follow the Marx blueprint. Simply put, sexual assaults of medical patients by physicians are not covered functions contemplated within the rendering of professional services. [2] ¶ In contrast, a minority view persists in a few courts. The lead decision in this area is St. Paul Fire & Marine Ins. Co. v. Asbury, 149 Ariz. 565, 720 P.2d 540 (Ariz.Ct.App.1986). There, the court ruled that all tortious acts professionals commit that are intertwined and inseparable from the services provided are covered occurrences. Unlike the Marx formulation, Asbury declares that malpractice insurance covers the physician, not the conduct of the physician. In Asbury, a gynecologist improperly manipulated his patients' clitorises during routine pelvic exams. The court found this misconduct inseparable from professional services. ¶ Although we reject the Asbury rationale because St. Paul's policy language speaks plainly of coverage for professional services, we believe that even Asbury's rule would not permit coverage here. Perhaps a doctor's hand inappropriately touching part of a patient's genitals may in some way be inseparable from the function of performing a pelvic examination. But a doctor's penis in no way belongs in, much less intertwines with, a gynecological exam. All but one of the plaintiffs testified that they were raped when Engelmann inserted his penis into them. [3] Under the professional liability policy, injury from sexual misconduct cannot be considered as having been incurred from the providing or withholding of professional services. See David S. Florig, Insurance Coverage for Sexual Abuse or Molestation, 30 Tort & Ins. L.J. 699, 724 (1995). St. Paul is under no obligation to indemnify Engelmann for such acts. But our analysis does not end here. ¶ If the question were only whether Engelmann's professional liability policy covers rapes and sexual assaults, then, as we have seen, the answer is clearly no. Rape and sexual exploitation in the course of a pelvic exam are intentional acts situated well outside the ambit of failure to use due care and skill in providing professional services. Here, however, there were two theories of recovery given to the jury in the medical malpractice trial: (1) negligence by engaging in improper sexual contact with each plaintiff during her gynecological examination, and (2) negligence by performing gynecological examinations [using] improper positions, procedures and methods in conducting those examinations. The first theory affords no legitimate basis for coverage, but what of the second theory? ¶ A liability policy that provides protection for professional services contemplates coverage for improper or incorrect medical treatment of a physical ailment by the insured doctor. Smith v. St. Paul Fire & Marine Ins. Co., 353 N.W.2d 130, 132 (Minn.1984). The act in question must be a medical or dental act, not an act or service that requires no professional skill. Lindheimer v. St. Paul Fire & Marine Ins. Co., 643 So.2d 636, 638 (Fla.Dist.Ct.App.1994). ¶ We think the second theory allows for coverage in that the medical experts for Martinmaas, Bertsch, and Froning testified that Engelmann's unorthodox methods, such as his gauze procedure, fell below the standard of care for physicians. His acts under the second theory, although medically unsuitable, lie within the scope of professional services and thus are covered under his professional liability policy. Yet St. Paul contends that the plaintiffs' own renditions of fact belie the second theory, since the plaintiffs described Engelmann's acts as intentional sexual assaults. The question is not that simple. Much of the plaintiffs' observations were circumstantial because they could not see what Engelmann was doing. The jury may have doubted part of their testimony, but still accepted enough of it to undergird the experts' opinions that Engelmann's acts fell below the standard of care. We see this as a factual issue. Supporting this conclusion is the fact that the knee-chest position Froning had to assume for a pelvic exam, though not medically indicated in her circumstance, involved no offensive contact. Martinmaas, 2000 SD 85, ¶ 15, 612 N.W.2d at 605. Froning never claimed that she was sexually assaulted. Martinmaas, 2000 SD 85, ¶ 31 n. 6, 612 N.W.2d at 608 n. 6. ¶ The second theory allows for coverage, but we do not know which theory in the malpractice action the jury adopted or whether it adopted both. Although the circuit court ruled that the tort judgment did not collaterally estop St. Paul to assert noncoverage, the court nonetheless used the jury's general verdict against the insurer as the basis for finding coverage. The court granted summary judgment against St. Paul, reckoning that the tort verdict was subject to two different constructions, and one was sustainable for coverage purposes. In our view, neither side was entitled to summary judgment on this issue. What part of the victims' damages can be allocated to the covered second negligence theory must be litigated as a question of fact in this declaratory action. ¶ A court faces a conceptually impossible task in ruling on a summary judgment motion based on facts decided in another case in which multiple theories were presented and only a general verdict was rendered. Here, the verdict in the liability case is susceptible of at least two reasonable interpretations. Summary judgment can be granted only when there is no genuine issue as to any material fact. SDCL 15-6-56(c). Not only must the facts be not in issue, but also there must be no genuine issue on the inferences to be drawn from those facts. Wilson v. Great N. Ry. Co., 83 S.D. 207, 212, 157 N.W.2d 19, 21 (1968). That both sides move for summary judgment does not mean that there are no genuine issues, obliging a court to grant judgment for one side or the other. American Fidelity & Casualty Co. v. London & Edinburgh Ins. Co., 354 F.2d 214 (4th Cir.1965). Both motions must be denied if the court detects genuine issues of fact or genuine issues regarding the inferences to be drawn from the facts. Hindes v. United States, 326 F.2d 150, 152 (5thCir.1964), cert. denied, 377 U.S. 908, 84 S.Ct. 1168, 12 L.Ed.2d 178; 3 Barron and Holtzoff § 1239 (Wright ed. 1958).