ALEXIS VOLLMAR ET AL v. CATHERINE HANAWAY ET AL (2026)

Kenneth Zellers, the Commissioner of the Office of Administration, and Catherine Hanaway, the Attorney General (collectively, “the State”) appeal from the summary judgment entered in favor of Alexis Vollmar, M.D., and Bilal Muzaffar, M.D. (collectively, “the Doctors”) on the Doctors’ petition for a judgment declaring the State Legal Expense Fund (“SLEF”) must pay for their defense in a lawsuit filed against them. The State contends the circuit court erred in denying its summary judgment motion and granting the Doctors’ summary judgment motion because the court improperly considered facts not presented in the Doctors’ statement of uncontroverted facts and misinterpreted the SLEF statute. For reasons explained herein, we affirm.

Factual and Procedural History

In 1983, the legislature created SLEF “to pay claims or judgments against the state, its agencies and employees, as well as other individuals and entities.” City of St. Louis v. State, 699 S.W.3d 503, 504 (Mo. App. 2024). Among the claims or judgments eligible to be paid by SLEF are damages from injured parties arising out of the actions of any physician licensed to practice medicine in Missouri who is employed by or under contract with a county health department to provide medical services to patients for pregnancy, delivery, and child care. § 105.711.2(3)(b).¹ The medical services must have been provided pursuant to the contract. Id. The physician must have provided the services either without compensation or paid for by no source other than a governmental agency or federally funded community health center, except for patient co-payments as required by federal or state law or local ordinance. Id.

The Attorney General is charged with the responsibility to investigate, defend, negotiate, or compromise any claim covered by SLEF, with certain exceptions not relevant here. § 105.716. The Office of Administration is responsible for making all approved payments from SLEF. § 105.711.5. When a physician who meets the coverage requirements for SLEF is sued, the physician or their employer provides notice and tenders the defense of the claims to the Attorney General. § 105.716.

The Doctors are Missouri-licensed physicians who, in March 2022, were under contract with Jackson County Public Health (“JCPH”), a county health department, to provide pregnancy, delivery, and childcare services to indigent patients. In their contracts with JCPH, the Doctors agreed to provide such services without compensation or to be paid from no source other than a governmental agency, except for patient co-payments required by federal or state law or local ordinance.

Pursuant to their contracts with JCPH, the Doctors provided pregnancy and delivery care at University Health Truman Medical Center (“University Health”) to X.C.H., an indigent patient enrolled in Medicaid. Medicaid is a joint federal and state program that provides healthcare coverage for qualified individuals with limited income and resources. X.C.H.’s medical bills related to the labor and delivery were paid by Medicaid. In April 2023, X.C.H. filed a medical malpractice lawsuit (“X.C.H. lawsuit”) against the Doctors and others in Jackson County. The Doctors denied all of the allegations in the lawsuit and wished to vigorously defend against it. The Doctors’ contracts with JCPH were in effect at the time of the acts alleged in the X.C.H. lawsuit.

When the Doctors provided medical services to X.C.H. pursuant to their JCPH contracts, they were also under contracts with other entities. Specifically, in March 2022, Muzaffar was a full-time, salaried, benefit-eligible, OBGYN resident with the University of Missouri-Kansas City (“UMKC”). Vollmar was concurrently an employee of the University of Missouri and was employed by University Health Physicians in its Department of OB/GYN. University Health Physicians agreed in Vollmar's employment contract to provide her “professional liability coverage for patient care services performed within the scope of Employee's employment ․ ; provided, however, if Employee has other professional liability coverage which would cover the patient care services performed hereunder, including but not limited to coverage under [SLEF], such other coverage shall be primary.” Additionally, Vollmar's contract with University Health Physicians required her to maintain privileges on the Medical Staff of the Truman Medical Center. The Truman Medical Center Professional and General Liability Self-Insurance Trust Program excluded from coverage any claim covered by SLEF. The parties disagreed as to whether the liability and malpractice insurance of these other entities covered X.C.H.’s claims.

In May 2023, University Health, on behalf of the Doctors, provided notice of the X.C.H. lawsuit and tendered the defense of the Doctors’ claims to the Attorney General. The notice included a link to access copies of X.C.H.’s medical bills related to her delivery and showed she was a Medicaid patient. University Health's actions were consistent with its past practice of tendering defense to the Attorney General when doctors contracted with JCPH were sued for services related to pregnancy, delivery, and childcare of a Medicaid patient. The Attorney General's Office previously authorized payments from SLEF concerning legal claims against physicians who performed work at University Health.

The Attorney General issued a letter acknowledging receipt of the tender notice and requesting additional documents and information from University Health. After the additional documents and information were provided, the Attorney General notified University Health in October 2023 that no SLEF coverage was available to the Doctors for X.C.H.’s lawsuit because the Doctors “may either be covered by University Health and/or the University of Missouri System.”

The Doctors sued the State, seeking a declaration that SLEF was obligated to pay for their defense of the X.C.H. lawsuit and for any judgment or settlement. The parties filed cross-motions for summary judgment. In their summary judgment motion, the Doctors argued they indisputably met all the requirements of Section 105.711.2(3)(b) to be entitled to SLEF coverage and the existence of any other malpractice insurance did not negate SLEF coverage. In its summary judgment motion, the State acknowledged the Doctors met all of the requirements of Section 105.711.2(3)(b) but argued SLEF coverage did not apply because other malpractice coverage existed.

In August 2025, the circuit court granted the Doctors’ summary judgment motion and denied the State's motion. Specifically, the court found the material facts were uncontroverted, and those facts “clearly and unequivocally establish the Doctors meet all of the statutory requirements to be covered by [SLEF] in this situation.” The court rejected the State's argument that the Doctors did not qualify for SLEF coverage because other malpractice insurance existed. The State appeals.²

Standard of Review

Appellate review of summary judgment is essentially de novo. Green v. Fotoohighiam, 606 S.W.3d 113, 115 (Mo. banc 2020). Summary judgment is appropriate when there are no genuine issues of material fact and the movant is entitled to judgment as a matter of law. Rule 74.04(c)(6). We review the summary judgment record in the light most favorable to the party against whom judgment was entered and accord that party the benefit of all reasonable inferences. Green, 606 S.W.3d at 116. We “do not weigh conflicting evidence or make credibility determinations.” Brentwood Glass Co. v. Pal's Glass Serv., Inc., 499 S.W.3d 296, 302 (Mo. banc 2016). “Instead, summary judgment tests ‘simply for the existence, not the extent’ of genuine issues of material fact.” Id. (citation omitted). “A factual question exists if evidentiary issues are actually contested, are subject to conflicting interpretations, or if reasonable persons might differ as to their significance.” Id. (citation omitted).

The parameters of the record we review on summary judgment are:

[1] Facts come into a summary judgment record only via Rule 74.04(c)’s numbered-paragraphs-and-responses framework. [2] Courts determine and review summary judgment based on that Rule 74.04(c) record, not the whole trial court record. [3] Affidavits, exhibits, discovery, etc. generally play only a secondary role, and then only as cited to support Rule 74.04(c) numbered paragraphs or responses, since parties cannot cite or rely on facts outside the Rule 74.04(c) record. [4] Summary judgment rarely if ever lies, or can withstand appeal, unless it flows as a matter of law from appropriate Rule 74.04(c) numbered paragraphs and responses alone.

Green, 606 S.W.3d at 117-18 (quoting Jones v. Union Pac. R.R. Co., 508 S.W.3d 159, 161 (Mo. App. 2016)).

Analysis

In Point I, the State contends the circuit court erred in denying its motion for summary judgment and granting the Doctors’ summary judgment motion because the court improperly relied on facts contained in an affidavit that were not alleged in the Doctors’ statement of uncontroverted material facts.³ The State argues the court relied on these improper facts to satisfy a missing element from the Doctors’ claim for SLEF coverage.

To be entitled to SLEF coverage for X.C.H.’s claim, the Doctors had to establish they: (1) had a license to practice medicine in Missouri; (2) were employed by or had a contract with JCPH; (3) provided services to X.C.H. for medical care caused by pregnancy, delivery, or child care pursuant to their contract with the county health department; (4) provided services without compensation or with compensation only from a governmental agency. § 105.711.2(3)(b). The State concedes the Doctors established the first three elements. The State argues the Doctors failed to conclusively prove the fourth element, that they provided services to X.C.H. without compensation or with compensation only from a governmental agency. The State asserts the court relied on additional facts in an affidavit attached to the Doctors’ motion, instead of the facts alleged in the Doctors’ statement of uncontroverted facts, to find the Doctors satisfied this element.

The court did not rely on facts in an affidavit that were outside the summary judgment record; rather, it relied on the State's own admissions and concessions. In the State's response to the Doctors’ statement of uncontroverted facts, the State admitted: (1) the Doctors agreed, in their contracts with JCPH, to provide services “without compensation or to be paid from no other source other than a governmental agency, except for patient co-payments required by federal or state law or local ordinances”; (2) the Doctors provided pregnancy and delivery care to X.C.H. “pursuant to their [JCPH] contracts”; and (3) X.C.H.’s “medical bills related to the labor and delivery were paid by the Medicaid program.” The State adopted these same facts in its own statement of uncontroverted facts to support its summary judgment motion. In both the State's suggestions in opposition to the Doctors’ summary judgment motion and its suggestions in support of its summary judgment motion, the State expressly conceded the Doctors “fall within [Section 105.711.2(3)(b)],” but argued the Doctors also “fall within an exception to [the statute's] applicability” because other malpractice coverage may exist. (Emphasis added.)

Almost three months after briefing was concluded on the parties’ summary judgment motions, the State filed a supplemental response in which it attempted to withdraw its concession that the Doctors fall within Section 105.711.2(3)(b). The State argued the Doctors failed to establish what compensation they actually received for X.C.H.’s services. The circuit court rejected the State's “last minute effort to assert a new claim of an alleged controverted fact,” finding the State's admissions and concessions in the summary judgment briefings conclusively established the Doctors were compensated by Medicaid for the services they provided X.C.H. We agree. The State offered no evidence to deny this fact or to support its belated assertion that the Doctors were actually compensated by a source other than Medicaid. Consequently, the fact that the Doctors were compensated by Medicaid for the services they provided X.C.H. was deemed admitted. Green, 606 S.W.3d at 117. The court properly relied on this fact to determine the Doctors met all of the requirements for SLEF coverage under Section 105.711.2(3)(b). The court did not err in denying the State's summary judgment motion. Point I is denied.

In Point II, the State contends the circuit court erred in granting the Doctors’ motion for summary judgment because the court misinterpreted and misapplied the plain language of Section 105.711. Specifically, the State argues that, even if we determine, as we have, that the Doctors met the requirements for SLEF coverage under Section 105.711.2(3)(b), Section 105.711.7 prohibits such coverage if the Doctors were covered by other malpractice insurance. The State argues whether the Doctors were covered by other malpractice insurance is a disputed issue of material fact that precludes summary judgment.

Resolution of this point requires us to interpret subsections of Section 105.711. The goal of statutory interpretation is to ascertain the legislature's intent from the language used and to give effect to that intent if possible. Freeman v. Hawthorn Bank, 516 S.W.3d 417, 423 (Mo. App. 2017). We accord the language its plain and ordinary meaning, and when the language is clear, we must give effect to that language as written and not engage in statutory construction. Rinehart v. Bateman, 363 S.W.3d 357, 368 (Mo. App. 2012).

Section 105.711.7 states:

Except as provided in subsection 3 of this section, in the case of any claim or judgment that arises under sections 537.600 and 537.610 against the State of Missouri, or an agency of the state, the aggregate of payments from the state legal expense fund and from any policy of insurance procured pursuant to the provisions of section 105.721 4 shall not exceed the limits of liability as provided in sections 537.600 to 537.610. No payment shall be made from the state legal expense fund or any policy of insurance procured with state funds pursuant to section 105.721 unless and until the benefits provided to pay the claim by any other policy of liability insurance have been exhausted.

The parties disagree on the extent to which the limiting clause, “Except as provided in subsection 3 of this section, ․” applies to Section 105.711.7. Putting aside that clause for a moment, the remainder of Section 105.711.7 sets out two provisions. The first provision caps SLEF payments for claims or judgments arising out of the State's waiver of sovereign immunity under Sections 537.600 and 537.610 at the limits of liability set forth in those statutes. The second provision of Section 105.711.7 states that no payment shall be made from SLEF unless and until the benefits provided by any other policy of liability insurance have been exhausted.

The State argues the limiting clause, “Except as provided in subsection 3 of this section, ․” applies only to the first provision of Section 105.711.7. The State contends that, because the limiting clause does not apply to the second provision of Section 105.711.7, the Doctors were precluded from receiving any SLEF payments unless and until they had exhausted the benefits of any other liability insurance. In response, the Doctors assert the limiting clause applies to both provisions of Section 105.711.7, and they argue the language of Section 105.711.3 supports their interpretation.

Section 105.711.3 pertains to SLEF payments for claims or judgments specifically against health care providers, arising under Section 105.711.2(3)(a)-(f), including those claims or judgments arising under Section 105.711.2(3)(b), the provision applicable to the Doctors. Section 105.711.3 states, in pertinent part:

The limitation on payments from the state legal expense fund or any policy of insurance procured pursuant to the provisions of section 105.721, provided in subsection 7 of this section, shall not apply to any claim or judgment arising under paragraph (a), (b), (c), (d), (e), or (f) of subdivision (3) of subsection 2 of this section. Any claim or judgment arising under paragraph (a), (b), (c), (d), (e), or (f) of subdivision (3) of subsection 2 of this section shall be paid by the state legal expense fund or any policy of insurance procured pursuant to section 105.721, to the extent damages are allowed under sections 538.205 to 538.235. Liability or malpractice insurance obtained and maintained in force by any health care professional licensed or registered under chapter 330, 331, 332, 334, 335, 336, 337, or 338 for coverage concerning his or her private practice and assets shall not be considered available under subsection 7 of this section to pay that portion of a judgment or claim for which the state legal expense fund is liable under paragraph (a), (b), (c), (d), (e), or (f) of subdivision (3) of subsection 2 of this section.

(Emphasis added.) The first sentence of Section 105.711.3 states that Section 105.711.7's limitation on SLEF payments does not apply to claims or judgments against health care providers. The second sentence of Section 105.711.3 states that SLEF will pay for the claims or judgments against health care providers to the extent damages are allowed under Sections 538.205 to 538.235, which are statutes pertaining to tort actions based on improper health care. The third sentence of Section 105.711.3 states that health care providers’ liability or malpractice insurance for coverage concerning their private practice and assets shall not be considered available under Section 105.711.7 to pay that portion of a judgment or claim for which SLEF is liable.

The plain and unambiguous language of these three sentences in Section 105.711.3 indicates the legislature did not intend for either provision of Section 105.711.7 to apply to claims or judgments against health care providers. Instead of subjecting claims or judgments against health care providers to the limits of liability set forth in Sections 537.600 and 537.610, the legislature has determined such claims or judgments are to be paid to the extent damages are allowed under Sections 538.205 to 538.235. Likewise, rather than requiring the exhaustion of benefits of other liability insurance before SLEF payments can be made on claims or judgments, the legislature has decided health care providers’ other liability or malpractice insurance cannot be considered available to pay the portion of claims or judgments that are covered by SLEF.

The only interpretation of Section 105.711.7's limiting clause, “Except as provided in subsection 3 of this section, ․” that is consistent with the clear legislative intent expressed in Section 105.711.3 is that the limiting clause applies to all of Section 105.711.7. Therefore, the Doctors were not subject to Section 105.711.7's provision that they were precluded from receiving SLEF payments unless and until they had exhausted the benefits of any other liability or malpractice insurance. The court correctly interpreted Section 105.711 and determined the Doctors were entitled to judgment as a matter of law. Point II is denied.

Conclusion

The judgment is affirmed.

FOOTNOTES

1.   All statutory references are to the Revised Statutes of Missouri 2016, as updated by the 2025 Cumulative Supplement.

2.   In their brief, the Doctors assert the State's brief is deficient in several respects. In particular, the Doctors note the State's statement of facts includes facts that were disputed without identifying them as such and injects argument into the facts, both of which violate Rule 84.04(c) and would justify dismissal or denial of the State's points. Switzer Living Tr., U/A Dated Feb. 5, 2019 By & Through Switzer v. Lake Lotawana Ass'n, Inc., 687 S.W.3d 476, 484 (Mo. App. 2024). Additionally, the Doctors argue the State's points are noncompliant with Rule 84.04 because they are multifarious. Because we prefer to decide cases on the merits and can readily understand the claims of error, we exercise our discretion to address the State's points on the merits. Ramirez v. Div. of Emp. Sec., 697 S.W.3d 132, 139 (Mo. App. 2024).

3.   While the denial of a summary judgment motion is generally not appealable, it may be reviewable when, as here, the merits of the motion are “intertwined with the propriety of an appealable order granting summary judgment to another party.” Rank v. Pettis Cnty. Ambulance Dist., 727 S.W.3d 471, 483 n.7 (Mo. App. 2025) (citation omitted).

4.   Section 105.721.1 gives the Commissioner of Administration the discretion to “direct that any or all of the moneys appropriated to [SLEF] be expended to procure one or more policies of insurance to insure against all or any portion of the potential liabilities of the state of Missouri or its agencies, officers, and employees.”

Lisa White Hardwick, Judge

All Concur.