Jacqueline García-Navarro sued an assisted living facility and its insurer, Universal Insurance Company, after her mother died while residing at the facility. The underlying negligence claims stemmed from the facility's failure to provide a blood transfusion to the patient, who had chronic anemia, due to a nurse's erroneous report that the patient was a Jehovah's Witness. Universal denied coverage, arguing that the facility's actions constituted the rendering of 'professional services,' which were excluded from the general liability policy. The District Court initially ruled that some of the facility's alleged failures, such as miscommunicating medical information, were not professional services. However, after the Puerto Rico Supreme Court issued a new decision, Rivera-Matos, adopting an 'intricate part doctrine' that broadened the definition of professional services, the District Court granted summary judgment for Universal. The case proceeded on a stipulated record, where the court found that the facility's failure to keep accurate records and the nurse's miscommunication were an intricate part of the medical services rendered, thus excluding them from coverage.
The First Circuit addressed the appellant's primary contention that the District Court erred by applying the Puerto Rico Supreme Court's intervening decision in Rivera-Matos retroactively. The court first determined that García-Navarro forfeited this argument because she failed to raise the specific claim regarding the temporal efficacy of the decision in the District Court, instead arguing only that the contract should be interpreted under general principles of intent. Even assuming the argument was preserved, the court found no plain error. The court reasoned that Rivera-Matos did not overrule or ignore the prior precedent, Viruet, but rather clarified it. While Viruet excluded purely physical or clerical tasks, Rivera-Matos clarified that acts not requiring specialized knowledge could still be professional services if they were an 'intricate part' of the rendering process. The court cited Puerto Rico authority indicating that decisions merely clarifying existing law are presumed to have retroactive effect. Consequently, the application of Rivera-Matos to the stipulated facts was correct, as the facility's administrative failures were integral to the professional medical services provided.
The decision confirms that insurance carriers in Puerto Rico can rely on clarifying precedents from the Puerto Rico Supreme Court to deny coverage for acts that are an intricate part of professional services, even if those acts were previously considered ministerial. It establishes that parties must raise specific arguments regarding the retroactive application of intervening state law decisions in the trial court to preserve them for appeal. The ruling extinguishes Universal's duty to indemnify the insured for the underlying negligence claims, leaving the facility and its employees personally liable for the damages awarded.
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