Lead Opinion
St. Paul Fire and Marine Insurance Company (St. Paul), Dr. Ronald Kleber’s malpractice insurance carrier, filed the instant declaratory judgment action after Mary Sue Mitchell and her husband filed suits against Dr. Kleber, for medical malpractice. After
1. Appellant St. Paul contends that the trial court erred in granting summary judgment to appellees because the insurance company had no duty to defend Dr. Kleber under the insurance policy. The trial court’s ruling was based on a clause in the insurance policy which provided, in pertinent part: “COVERAGE A-PROFESSIONAL LIABILITY ... the Company shall have the right and duty to defend in his name and behalf any suit against the Insured alleging damages, even if such suit is groundless, false or fraudulent . . .”
The trial court followed the rule enunciated in Loftin v. U. S. Fire Ins. Co.,
The Mitchells’ complaints alleged, inter alia: “. . . Defendant so aroused Mrs. Mitchell’s emotions by manipulation of the transference phenomemon that she fell in love with him. Defendant brought about this result by wrongfully manipulating the doctor-patient relationship to the point where Plaintiff’s feelings were no longer transferred feelings of love for Defendant as a psychiatrist but direct feelings of love for him as a person, beyond the phenomenon of transference . . . Defendant was negligent in his treatment and counseling of Plaintiff in that he failed to exercise the degree of care and skill, or to possess the degree of knowledge
We recognize that if a claim is asserted which does not fall within the contract coverage then the insurer is relieved of his contractual duty to defend. Great American Ins. Co., supra. However, in our opinion, the allegations set forth above assert a claim which falls within the policy coverage.
The policy in question provides that the insurer will “pay on behalf of the Insured all sums which the Insured shall become legally obligated to pay as damages arising out of the performance of professional services rendered or which should have been rendered, during the policy period, by the Insured or by any person for whose acts or omissions the Insured is legally responsible . . .” St. Paul argues that Dr. Kleber’s alleged acts are outside the category of professional services for purposes of coverage.
Courts in other states have held that conduct such as that alleged to have been committed by Dr. Kleber may be considered malpractice by a psychiatrist. In Cotton v. Kambly,
“The gravamen of the petition is that defendant did not treat Mrs. Zipkin properly and as a result she was injured. He [allegedly] mishandled the transference phenomenon, which is a reaction the psychiatrists anticipate and which must be handled properly. He [allegedly] mishandled it over a long period of time. As [experts] explained, to take the relationship outside the office into social relationships, ‘would allow the patient to develop all sorts of unusual ideas just around the feelings that she has about the doctor’...” Thus, we find ample authority for holding that acts such as those alleged in the Mitchells’ complaints come within St. Paul’s contractual obligation to defend for matters arising out of Dr. Kleber’s performance of his professional duties.
St. Paul cites to the contrary Hartogs v. Employers Mut. Ins. Co. of Wis., 391 N.Y. S2d 962 (1977). That case is distinguishable from the facts in the instant case and will not be followed. In Hartogs, after the patient had secured a judgment against the doctor, the doctor brought suit against his insurer seeking recovery of the cost of defending the suit, the insurer having denied liability and having refused to defend. Since a judgment had been rendered against the doctor, he had been adjudicated a wrongdoer. In Hartogs the court stated: “the doctor administering the ‘treatment’ at all times knew, and has so stated in the previous trial and on this motion, that what he was doing was in no way pursuant to the doctor-patient relationship. The obvious purpose was to permit him to accomplish his personal satisfaction.” Id. at 964. “Therefore as between the plaintiff and his insurer those actions could not constitute malpractice and were never intended to be included within the protective coverage of the malpractice policy.” (Emphasis supplied.) Id. at 965.
However, the New York Court also said: “The distinction to be drawn between the injured party and the insured is clear. No longer is it the law in this state ‘that the liability policy existed solely for the protection of the insured’ [Cit.] The courts recognize that the injured person also is to be protected.” Id. at 964. Thus, the court, as between the insurer and the insured doctor, ruled against the doctor so that he would not be indemnified for his immorality. But the court made a distinction between the doctor’s rights as a wrongdoer and the rights of the victim or the injured person to be protected. Of note in the Hartogs case is this statement: “While the appeal was pending, the defendant insurer, despite its disclaimer to Hartogs, settled with the patient and satisfied a reduced judgment.” Id. at 963.
In deciding the issue of whether St. Paul should defend, we are not required to find that the doctor’s alleged activities were immoral,
2. The trial court correctly denied summary judgment to all parties on coverage, reserving this issue for trial, as the issue depends on the resolution of questions of fact. Whether the acts alleged, i.e., the mishandling of the transference phenomenon, amount to medical malpractice or intentional sexual assault requires the testimony of experts, as is required on any other medical subject. Such medical testimony was presented in Zipkin v. Freeman, and in Anclote Manor Foundation, supra. See Seymour v. Lofgreen, Kan.,
Based on the above, it is clear at this stage of the proceeding that neither the trial court nor this court can determine, as a matter of law, that the acts of the doctor and the alleged mishandling of the transference phenomenon constitute medical malpractice. That issue raises questions of fact requiring the aid of an expert to analyze the occurrences in this case vis a vis the duty owed by a psychiatrist to his patient.
Judgment affirmed.
Notes
Appellant does not contest defending that part of the Mitchells’ action against Kleber which alleges his failure to discover a brain tumor.
Dissenting Opinion
dissenting in part.
Mary Sue Mitchell was for several years, off and on, a patient of defendant Dr. Kleber, a psychiatrist. In 1979 she and her husband
St. Paul Fire & Marine then filed the instant complaint for declaratory judgment, joining the Mitchells and Dr. Kleber, and moving for summary judgment on the basis that the suit, if the facts were as stated in the complaint, was a tort action not covered under its liability policy. It filed defensive pleadings on behalf of Dr. Kleber under a reservation of rights agreement, and in the declaratory action moved for partial summary judgment against its insured based on the proposition that it had no obligation to the extent that the Mitchells’ actions sought recovery for sexual misconduct on his part. The Mitchells and Kleber also sought summary judgment, and these were granted to the extent of holding that appellant had a duty to defend the Mitchell actions, and that as to liability jury issues were involved. St. Paul and the Mitchells appeal these portions of the orders adverse to their respective interests.
I.
As to Duty to Defend
The policy in question specifies that the insurer will pay “all sums which the insured shall become legally obligated to pay as damages arising out of the performance of professional services rendered or which should have been rendered during the policy period by the insured . .. and the company shall have the right and duty to defend in his name and on his behalf any suit against the insured alleging damages, even if such suit is groundless, false or fraudulent.” (Emphasis supplied.) Professional services is defined as meaning “injury, sickness, disease, death or destruction due to the rendering of or failure to render any professional service and shall be deemed to include the dispensing of drugs or medicine and the service by the insured as a member of a formal accreditation or similar board or committee of a hospital or professional society.”
The seven count complaint, which is supported on motion by affidavits of the Mitchells, is based on the proposition that the defendant psychiatrist represented that Mrs. Mitchell’s physical symptoms resulted from sexual maladjustments for which he
The complaint further alleges that the first act of intercourse rendered her pregnant, that she suffered a miscarriage two months later, that when she told the defendant these facts he passionately upbraided her for destroying his child, that sessions ceased for a period of time until he “forgave” her, that he wished a child and they entered a period of physical relations of at least once a week, that she eventually became pregnant again and bore him a child. At some period after this she was diagnosed as suffering from an inoperable brain tumor. The complaints seek damages general and punitive for breach of contractual duty, shame and humiliation, recovery of sums paid for psychiatric treatment, loss of income, and failure to properly diagnose and timely refer to a specialist the presence of the brain tumor.
It is obvious that the claim must assert a liability for an act against which the insurer has a contractual duty to defend. Great American Ins. Co. v. McKemie,
“To establish professional medical negligence the evidence presented by the patient must show a violation of the degree of care and skill required of a physician. Code § 84-924. Such standard of
We recognize that under Georgia law, construction of the policy is necessary, and exclusions from coverage are construed against the
Had Kleber admitted the truth of the allegations as to sexual acts and intimacy as charged (adultery, fornication and possible prostitution), it would be my.opinion that no duty to defend would obtain. Great American insured against “bodily” injury or “property” damage but not “nuisance” or breach of other contractual duties. There everyone agreed as to the stipulated facts, hence a question of law existed as to whether there was coverage. Here the doctor denies the acts, therefore, the company is under a duty to defend to determine the truth of the facts.
II.
As to Contract Coverage
It is likewise contended that a jury issue remains as to the ultimate liability of the defendant doctor, both as to its existence and as to the facts from which it arises. In psychiatric relationships transference is an unconscious process on the part of the patient by
Other jurisdictions hold to the contrary and it is my view that Georgia should adopt what the writer believes to be the better rule as set out in Hartogs v. Employers Mutual Liability Ins. Co. of Wis.,
The court in Industrial Sugars v. Standard Accident Ins. Co., 338 F2d 673 (7th Cir. 1964) stated the rule in this manner: “A contract of insurance to indemnify a person for damages resulting from his own intentional misconduct is void as against public policy and the Courts will not construe a contract to provide such coverage.” (Emphasis supplied.) The public policy of Georgia favors stability of marriage and condemns illegal and immoral acts. The criminal laws of Georgia define adultery as follows: “A married person commits adultery when he voluntarily has sexual intercourse with persons other than his spouse and upon conviction shall be punished as for a misdemeanor.” Ga. Code Ann. § 26-2009. “A contract will not be construed so as to authorize one of the parties to take advantage of his own wrong.” National Enterprises, Inc. v. Davis,
Compare Porubiansky v. Emory University,
“Where a deed is executed and delivered in consideration of future illicit intercourse, and the grantee acquires possession under it, neither the grantor nor his heirs can recover the land... As was said by the able counsel for the defendant in error in his brief, ‘it is a conveyance upon the set consideration of a vested remainder in consideration of concubinage for life, — so much land for so much lust.’ ” Watkins v. Nugen,
Whether in any such psychological treatment the standard of care measures up to that ordinarily employed by the branch of the medical profession engaged in psychiatric treatment of problems such as that afflicting the plaintiff here, the court should not reach, as the acts and actions alleged herein are outside performance of legitimate “professional services.” It may be further pointed out that exceptions do exist from the general rule requiring expert medical testimony respecting a physician’s or surgeon’s service to his patient.
The facts in the case of Seymour v. Lofgreen, supra, discusses that the patient had suffered from, among other problems, a swelling of the stomach and had leg cramps and had sued her doctor for failure to diagnose the cause of her problem in that she was mentally ill. The latter question could be addressed by medical expert testimony, but the failure there to properly diagnose a case with legitimate treatment cannot be equated with, as here, the adulterous actions and acts arising out of the conduct but not within the scope of legal acts within professional psychiatric treatment in Georgia. Generally if there is coverage there exists a duty to defend. Likewise if it is clear from a given factual situation there is no coverage there is no duty to defend however groundless the charges may be.
I concur with Division 1 of the majority requiring the insurer to defend inasmuch as the doctor has denied all wrongdoing. If the latter prevails the insurer will also prevail as to any ultimate liability. If the doctor is adjudicated a wrongdoer in a jury trial, then it is my opinion there is no coverage. The personal acts do not represent legitimate professional treatment, but are personal misfeasance separate from coverage, as “nuisance” was separate from “bodily” and “property” coverage in Great American. This question of coverage is a question of law for the court and not for the jury. The majority is in effect saying that if medical experts were to testify that cutting off a patient’s head would cure the patient’s headache the question of medical malpractice or a personal assault on the patient remains a jury question. I must respectfully disagree.
The trial court did not err in holding that appellant had a duty to
The motion to stay the main actions until a final adjudication of this declaratory judgment should have been granted under the facts of this case.
There is a considerable authority that sexual acts by a psychiatrist to and with his patient may be part of “professional services” rendered: “A larger number of psychiatrists — but probably still a small minority of all psychiatrists — favor a wide range of sexual experiences for adults, including selective adultery... The intimacy of psychiatrist and patient — usually a male psychiatrist with a female patient, rarely a female psychiatrist with a male patient or a therapist with a patient of the same sex — can be justified or rationalized on the ground that patients suffer from a lack of love and need warmth, caresses, and closeness ... Various kinds of touching and feeling therapies came into prominence in the 1960s, and there were such aberrant treatment methods as nude group marathons in swimming pools... ‘Laying on of hands’ has been reintegrated into the medical school and nursing currículums; touching and personal contact has been readopted as part of church worship — the ‘tactile liturgy’ . . . The fact that a small minority of therapists who had sexual relationships with their patients advocated this as a method of treatment surfaced in 1969 when the American Psychiatric Association expelled one of its members, James McCartney, an aging Jungian who called himself a psychoanalyst although he had had no formal psychoanalytic training, after he published a paper in The Journal of Sex Research advocating intercourse as therapy... A nationwide survey showed that more than 5 percent of male Ph.D. psychologists had had intercourse with patients and more than 10 percent had had other ‘erotic contact.’ More than 7 percent of male psychologists and more than 0.5 percent of female psychologists had had intercourse with patients within three months after the termination of therapy, and 80 percent of these had had intercourse with more than one patient.” Jonas Robitscher, J.D., M.D., The Powers of Psychiatry, pp. 388, 421, 422, 423, 425 (1980).
