A fifty-six-year-old woman, suffering from Huntington's disease and residing at and in the care of a nursing home, claimed that she was the victim of a sexual assault perpetrated by an employee and certified nursing assistant (CNA) at the nursing home (“first CNA”). At the time of the assault, a defendant, another CAN (“second CNA”), was at the nurse's station where she heard the resident's cries for help, but she did not respond. Instead, the second CNA reported the resident's screams to a registered nurse (RN), but the RN also failed to respond. At some point that day, the resident informed a medical technician that she had been raped by the first CNA, and the medical technician reported the incident to the RN on that day and the next. On the day after the alleged assault, the woman reported the assault to the second CNA. The nursing home continued to employ the first CNA even after the woman had informed several nursing home employees of the first CNAs alleged misconduct. Two days after the alleged assault, the nursing home notified the woman’s family. The woman’s son went to the nursing home and insisted that the nursing home immediately report the incident to the police department. The same day a rape kit was administered to the woman at a hospital. The estate alleged that, after the assault but prior to the administration of the rape kit, the resident was given at least three bed baths and one shower at the nursing home. The rape kit revealed bruising, a laceration, excoriation, and trauma or penetration to the vaginal area.
The woman passed away. The woman’s estate sued the nursing home, two of the nursing home’s general partners, and three nursing home employees, including the alleged perpetrator, the first CNA. The complaint contained six counts, including: negligence against the nursing home, two of the nursing home’s general partners, the RN, and the second CNA; and assault and battery against the first CNA. With regard to the negligence counts, the complaint set forth specific allegations including the failure: to properly supervise, train, or screen its employees; to provide proper security measures; to report that a resident had been abused or mistreated within twenty-four hours in accordance with the state reporting statute; and to discipline its employees following the alleged sexual assault. As a direct and proximate result of this alleged negligence, the estate claimed that the resident suffered severe personal injuries, shock and injury to her nervous system, extreme pain and suffering, mental anguish, loss of capacity for the enjoyment of life, humiliation, embarrassment, severe emotional distress, and was otherwise injured and damaged.
At the time of the sexual assault, the nursing home was insured. The policy covered hospital professional liability (HPL) and commercial general liability (CGL). The policy covered the nursing home only for the risks of “bodily injury” or “property damage” that were caused by an “occurrence.” The policy defined “bodily injury” as “bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time.” The policy defined “occurrence” as “an accident, including continuous or repeated exposure to substantially the same general harmful conditions.”
After receiving notice of the estate's complaint, the insurer issued a reservation of rights letter and initiated an investigation to determine whether it had a duty to defend the CNA, the nursing home, two of the nursing home’s general partners, the RN, and the second CNA under the policy. After conducting its review, the insurer concluded that it did not have a duty to defend. In reaching this conclusion, the insurer reasoned that (1) the alleged sexual assault did not constitute a “medical incident” within the ambit of HPL coverage, and (2) the alleged sexual assault could not be construed as an accident under any definition and therefore was not an “occurrence” within the meaning of the CGL insurance coverage.
The insurer commenced an action to determine its legal rights. Specifically, the insurer sought to establish that it owed no duty to defend the first CNA, the nursing home, two of the nursing home’s general partners, the RN, and the second CNA against the allegations set forth in the estate's complaint. The first CNA, the nursing home, two of the nursing home’s general partners, the RN, and the second CNA filed a counter-claim requesting the court to establish that the insurer owed a duty to defend them against the estate’s complaint and damages for the insurer's alleged breach of contract based on its refusal to defend them in the suit. The parties filed motions and cross-motions for summary judgment.
The Providence County Superior Court denied the insurer’s motion for summary judgment and granted the cross-motion for summary judgment. The trial court specified that the insurer owed a duty to defend the nursing home, two of the nursing home’s general partners, the RN, and the second CNA against the negligence claims.
The Supreme Court of Rhode Island affirmed. The court held, on an issue of first impression, that the allegations contained in the estate's complaint brought the injury complained of within the coverage of the insurance policy.
The allegations contained in the estate's complaint brought the injury complained of within the coverage of the insurance policy. To determine whether an insurer has a duty to defend an insured, Rhode Island courts apply the pleadings test that requires the trial court to look at the allegations contained in the complaint and if the pleadings recite facts bringing the injury complained of within the coverage of the insurance policy, the insurer must defend irrespective of the insured's ultimate liability to the plaintiff. By defining an “occurrence” as an “accident,” the policy's definition offered little guidance because the word “accident” is not defined in the policy. The plain and ordinary meaning of the term “accident” as “an unintended and unforeseen injurious occurrence” invited the threshold question of from whose perspective was the unforeseen occurrence to be assessed. The court concluded that the term “accident” should not be assessed based on the subjective intent of the parties, but rather the intent expressed by the language of the contract. The court considered the term “accident” in the context of the policy as a whole. The intended-injury and sexual act exclusions would serve no purpose if all intended injuries and injuries arising out of sexual acts were excluded in the first instance by the terms of the policy itself. The court concluded that the insurer had a duty to defend the nursing home, two of the nursing home’s general partners, the RN, and the second CNA against the allegations of negligence set forth in the complaint.
The Supreme Court of Rhode Island affirmed the trial court’s denial of the insurer’s motion for summary judgment and grant of summary judgment holding that the insurer owed a duty to defend the nursing home, two of the nursing home’s general partners, and two nursing home employees.
See: Medical Malpractice Joint Underwriting Ass'n of Rhode Island v. Charlesgate Nursing Center, L.P., 2015 WL 3534125 (R.I., June 5, 2015) (not designated for publication).
See the Medical Law Perspectives April 2, 2015, Blog: Use of Jury Instruction on Foreseeability in Medical Negligence Case.