Sandra Rinker and James Rinker Jr. v. Carnival Corporation, Ramanbhai Patel (Ship’s doctor), Yolanda Dormehl (Ship’s nurse), and Susan Law (Ship’s nurse) – Part 3

Lipcon, Margulies, Alsina & Winkleman, P.A

April 13, 2011

Sandra Rinker and James Rinker Jr. v. Carnival Corporation, Ramanbhai Patel (Ship’s doctor), Yolanda Dormehl (Ship’s nurse), and Susan Law (Ship’s nurse) – Part 3

Plaintiff’s Response to Defendant’s Motion to Dismiss for Lack of Personal Jurisdiction

In this action the Plaintiff has sued Defendant Carnival Corporation and the individual doctor and nurses responsible for her negligent medical care onboard a Carnival cruise ship. This is a challenging area of law and our attorneys are at the forefront advocating for the safety of cruise ship passengers. In this particular motion one of the Defendant nurses is arguing that the Court lacks jurisdiction over her and our attorneys are advocating that the Defendant has the requisite contacts with Florida to justify her being haled into court here.

UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF FLORIDA
MIAMI DIVISION
Case No. 09-23154-CIV-SEITZ-O’SULLIVAN
SANDRA RINKER AND
JAMES RINKER Jr.
Plaintiffs,

v.

CARNIVAL CORPORATION,
RAMANBHAI PATEL (Ship’s Doctor),
YOLANDA DORMEHL (Ship’s Nurse),
SUSAN LAW (ship’s nurse).
Defendant.
___________________________/

PLAINTIFF’S RESPONSE IN OPPOSITION TO DEFENDANT SUSAN LAW’S MOTION TO DISMISS FOR LACK OF PERSONAL JURISDICTION

COMES NOW, Plaintiff, Sandra Rinker, by and through undersigned counsel, and hereby files her response in opposition to Defendant Susan Law (“Defendant Law”) Motion to Dismiss. In support thereof, Plaintiff alleges as follows:

I. BACKGROUND.

A. The Claims.

The claims in this matter arise from severe injuries due to the failure of Defendant Law and the other Medical Defendants to promptly, adequately and properly diagnose Plaintiff’s meningitis, and timely evacuate her from the ship, resulting in the loss of her hearing and other serious neurological conditions.

On November 4, 2008, Plaintiff was paying passenger on Defendant Carnival’s vessel “Spirit.” Throughout the night, Plaintiff was suffering from extreme headaches and massive projectile vomiting – common indicators of meningitis. Although, her husband called the ship’s medical facility and asked for a doctor to immediately come to their cabin, his request was denied multiple times. As a result, Plaintiff’s husband took Plaintiff to the ship’s medical facility.
Despite the severity of her symptoms, rather than promptly and adequately diagnosing the Plaintiff’s condition, the ship’s nurses, including Defendant Law, llimited their treatment to administrating a combination of pain killers, including Ketorolac, a drug banned in several countries. Further, even though at all times material, the Plaintiffs’ condition kept worsening (including the consistent swelling of her brain) and despite the fact that the vessel was in the Port of San Diego and Plaintiff’s husband repeatedly asked for an ambulance to be called; the ship’s physician did not recommend Plaintiff’s immediate evacuation and held her in the ship’s medical facility. Plaintiff was forced to stay on the ship and an ambulance was not called until most other passengers were first permitted to disembark the ship. During the several hours that Plaintiff was delayed in the ship’s medical facility by Defendant Law and the rest of the medical staff, Plaintiff’s meningitis progressed and Plaintiff was rendered completely deaf.

Once in port, Plaintiff was taken to the University of California San Diego Hospital (“UCSD”). There, physicians immediately diagnosed her meningitis and supplied her with antibiotics. Although the treatment saved her life, by the time she received it, the neurological damage was already too extensive; including the complete loss of her hearing. Had Plaintiff been timely evacuated by the medical staff (and/or by Carnival) when her husband had first requested, the process of her bacterial meningitis would have been reversed prior to her loss of hearing.

On October 20, 2009, Plaintiff filed her Complaint against Carnival and the ship’s medical personnel, including Defendant Law. The claims against Defendant Law arise from his alleged medical malpractice, both at sea and while in a United States Port.

B. Defendant Law’s Motion to Dismiss for Lack of Personal Jurisdiction [D.E. 70].

On September 22, 2010, Defendant Law filed her Motion to Dismiss for Lack of Personal Jurisdiction. [D.E. 70]. In the Motion, Defendant Law asserts, through an affidavit dated September 21, 2010, that she “do[es] not operate, conduct, engage in, carry on, or transact business in the State of Florida.” In support thereof, Defendant Law asserted in part: 1) “I am not engaged in any activities within the State of Florida”; and 2) “I have not conducted any business activities whatsoever in Florida.”

C. Summary of Defendant Law’s contacts with Florida.

Contrary to Defendant Law’s assertions, however, jurisdictional discovery has reveled that, at all times material, Defendant Law was engaged in substantial and not isolated activities in Florida. Such activities and contacts, assessed over a period of years and considered collectively, establish jurisdiction under Florida’s general jurisdiction statute, §48.193(2).

First: Defendant Law agreed to insure an entity located in Miami, Florida (Carnival), for foreseeable risks in Florida. Defendant Law entered into two separate agreements with Florida based Carnival Corporation to indemnify it and insure it.[1] Florida Statute §48.193(1)(d) provides that “any person who contracts to insure any person, property, or risk located in Florida” is subject to the jurisdiction of Courts in Florida. As shown below, because Defendant Law contractually agreed to indemnify Carnival (an entity located in Miami, Florida) for any harm resulting from his services – including medical malpractice; pursuant to 48.193(1)(d), Defendant Law agreed to insure[2] a person[3] in Florida. As further shown below, Defendant Law also purposefully availed herself of the subject forum by agreeing to indemnify Carnival for foreseeablerisks while in Florida.

Here, on 2009 and 2010, Defendant Law worked as a ship’s nurse aboard a Carnival vessel, while the vessel was in a Florida port on eighteen (18) separate occasions.[4] During each of these times, while the vessel was docked at a Florida port, Defendant Law was expected to provide medical care. As such, at all times material, harm resulting from Nurse Law’s services performed in Florida – was a foreseeable risk in Florida, for which Nurse Law insured Carnival in Florida. Therefore, on this ground alone, this Court has personal jurisdiction over Defendant Law by virtue of the long arm statute’s insurance provision, §48.193(1)(d). See Athanassiadis v. National Car Rental System, Inc., 699 So. 2d 330 (1997) (holding Court had personal jurisdiction where Italian citizen agreed to indemnify Florida rental car company for injury or property damage resulting from use of car, because by entering into the indemnification it was foreseeable that he would be haled into a Florida Court).

Alternatively, at the very least, Defendant Law’s continuing agreements immediately preceding the date of the subject lawsuit, to insure Florida based Carnival should be considered collectively with all of Defendant Nurse Law’s other contacts (described below), to establish jurisdiction under Florida’s general jurisdiction statute, §48.193(2).

Second: Defendant Law appointed Carnival as her exclusive agent in Florida, giving Carnival “absolute and complete control” of all claims brought against him in Florida. In consideration of working as a ship’s nurse for Florida based Carnival Cruise Lines (“Carnival”), Defendant Law signed an indemnity agreement with Carnival. In the indemnity agreement, Defendant Law appointed Florida based Carnival and its insurers her exclusive agents, giving them “absolute and complete control of the defenses of all proceedings against [her]” in Florida.[5] By virtue of such appointment – and giving Carnival a quasi power of attorney – Defendant Law purposefully directed her activities to this forum. See Commercial Union v. Wynn, 656 So. 2d 615 (Fla. 3d DCA 1995) (holding that appointment of agent in Florida through a power of attorney was a sufficient basis to exercise personal jurisdiction). See also Kilma v. Carnival Corporation, 2008 WL 4559231 (S.D. Fla. 2008) (holding that if Carnival had agreements to insure or indemnify non-resident Defendant for services provided by non-resident Defendant to cruise passengers, these activities may be sufficient to establish general jurisdiction under the general jurisdiction long arm statute).

Here, Law and Carnival have both acknowledged that Carnival is providing for Law’s defense, by virtue of this separate indemnity agreement. (mal;”>See March 21, 2011, Deposition of Carnival’s Corporate Representative, and Defendant Law’s deposition). Accordingly, Law has appointed an agent in Florida, other than her attorney, to assume complete control of her defenses in this case.

Third: Defendant Law worked as ship’s nurse in Florida ports. Between November 7, 2009 and January 13, 2010, while working and being compensated as a Carnival ship’s nurse, Defendant Law worked as a nurse in Florida (Florida ports) on eighteen (18) separate occasions.[6].

Fourth: Defendant Law voluntarily obtained continuing medical education provided by the Florida Training Center of the American Heart Association. While working as a Carnival ship’s nurse, in the year 2010, Defendant Law voluntarily took courses in Advanced Cardiovascular Support, provided by the Florida based training center of the American Heart Association. See Dean v. Dale K. Johnson M.D. , 789 So. 2d 1072 (Fla. 1st DCA 2001) (holding that Courts had personal jurisdiction over non-resident physician who had engaged in substantial and not isolated activities in Florida by “treating Florida patients” and “subjecting himself to continuing medical education requirements in Florida”).

Fifth: Defendant purposefully reached out to Carnival in Florida and entered into a long term business arrangement with Carnival to provide medical services to Carnival passengers. In doing so, between 2008 and 2010, Defendant Dormehl entered into three separate contractual agreements with Florida based Carnival. These agreements included two employment agreements and one indemnity agreement.

Sixth: All payments of Defendant Law’s salary were processed by Carnival in Miami, Florida. While working as a ship’s nurse for Carnival, all payments of Defendant Law’s salary, originated from the budget of Carnival’s department of medical services located in Miami, Florida. Further, all of Defendant Law’s salary payments were processed and accounted for at Carnival’s headquarters, in Miami, Florida.

All in all, as discussed below, such activities and contacts, assessed over a period of years and considered collectively, establish jurisdiction under Florida’s general jurisdiction statute, §48.193(2). See Woods v. Nova Companies Belize Ltd., a foreign corporation, 739 So. 2d 617 (Fla. 4th DCA 1999) (Contacts are commonly assessed over a period of years prior to the Plaintiff’s filing of the complaint). See also Helicópteros Nacionales de Colombia S.A. v. Hall, 466 U.S. at 409-411 (1984) (examining contacts over a seven-year period, up to the time the lawsuit was filed). See also Nichols v. Paulucci, 652 So. 2d 389, 391 (Fla. 5th DCA 1995):

We recognize that, standing alone, any one of Nichols’ contacts with the state of Florida might not constitute substantial activity within the meaning of section 48.193(2) When viewed in its entirety, however, the evidence presented in this case supports the trial court’s ruling that it possessed personal jurisdiction over Nichols.

Id. (Emphasis Added).

II. ANALYSIS

A. Contrary to Defendant Law’s assertions in her Motion to Dismiss [D.E. 70], the alleged medical malpractice need not have occurred in Florida or Florida territorial waters – for this Honorable Court to have personal jurisdiction. In fact, while Florida’s specific jurisdiction statute, §48.193(1), requires that a non-resident party’s activities in Florida be related to the cause of action in the complaint (i.e. medical malpractice); under Florida’s general jurisdiction statute, §48.193(2), this Court can exercise personal jurisdiction over a non-resident Defendant’s contacts with Florida – even if those Florida contacts are unrelated to the cause of action being litigated. Here, because Defendant Law’s contacts with Florida, analyzed collectively over a period of years, show that she was engaged in substantial and not isolated activities in Florida; this Honorable Court has personal jurisdiction pursuant to Florida’s general jurisdiction statute, §48.193(2)

In her Motion to Dismiss [D.E. 70], Defendant Law’s argument essentially boils down to the following: For this Honorable Court to have personal jurisdiction, Defendant Law’s contacts with Florida must be related to the cause of action in the Complaint. In other words, under Defendant Law’s interpretation of the law, this Court can have personal jurisdiction, only if the medical malpractice alleged in the complaint took place in Florida. Since the alleged medical malpractice in this case took place outside of Florida (in California) – Defendant Law argues that Florida does not have personal jurisdiction over her. This is simply not correct.

Defendant Law’s interpretation of the law is disingenuous. In fact, pursuant to §48.193(2), Florida’s general jurisdiction long-arm statute, Florida can exercise personal jurisdiction over Defendant Law even if the alleged medical malpractice occurred outside of Florida (in California). In other words, even if Defendant Law’s contacts with Florida are unrelated to the cause of action alleged in the Complaint (i.e. medical malpractice), as long as those contacts were “continuous and systematic,” this Court can exercise personal jurisdiction pursuant to Florida’s general jurisdiction long-arm statute, §48.193(2).

i. The Personal Jurisdiction analysis under Florida law.

Plaintiff’s burden in alleging personal jurisdiction is to plead sufficient material facts to establish the basis for exercise of such jurisdiction. Future Technology Today, Inc. v. OSF Healthcare Systems, 218 F. 3d 1247 (11th Cir. 2000). First, the plaintiff must allege sufficient jurisdictional facts in his complaint to initially support long arm jurisdiction before the burden shifts to the defendant to make a prima facia showing of the inapplicability of the statute. If the defendant sustains this burden, the plaintiff is required to substantiate the jurisdictional allegations in the complaint by affidavits or other competent proof. Id., at 1249.

Generally, when performing a jurisdictional analysis pursuant to a long-arm statute, Florida courts must engage in a two-part analysis. See Venetian Salami Co. v. Parthenais, 554 So. 2d 499, 502 (Fla. 1989). The Court must first determine whether the party has alleged facts sufficient to fall within the scope of Florida’s long arm statute, section 48.193. If the requirements of the long arm statute are satisfied, then the court must inquire as to, (1) whether defendant has satisfied sufficient “minimum contacts” with the state of Florida; and (2) whether the exercise of this jurisdiction over defendant would offend “traditional notions of fair play and [cause] substantial injustice.” Id., at 630-31 quoting, International Shoe v. Washington, 326 U.S. 310 (1945). Where the evidence conflicts, all reasonable inferences must be construed in favor of the Plaintiff. Stubbs v. Wyndham Nassau Resort and Crystal Palace Casino, 447 F. 3d 1357, 1360 (11th Cir. 2006).

Florida’s long arm-statute contains two provisions that confer personal jurisdiction over a non-resident defendant. The first, Florida Statute section 48.193(1), [7] also known as the specific jurisdiction statute, confers jurisdiction if a party’s activities in the forum are related to the cause of action alleged in the complaint. Consolidated Development Corporation v. Sherrit, Inc., 216 F. 3d 1286 (11th Cir. 2000). Although the term ‘arising from’ is somewhat broader than the concept of proximate cause, under Florida law there must nevertheless be some direct affiliation, nexus or substantial connection between the cause of action and the activities within the state.” Sun Trust Bank v. Sun Intl’ Hotels, Ltd., 184 F. Supp. 2d 1246, 1269 (S.D. Fla. 2001). This kind of jurisdiction is often referred to as “connexity jurisdiction,” since it requires a causal connection between defendant’s activities in the forum statute and the plaintiff’s cause of action. American Overseas Marine Corp. v. Braintree Maritime Corp., 632 So. 2d 1124, 1127 (Fla. 3d DCA 1994).

The second, Florida Statute section 48.193 (2), is the general jurisdiction statute. Where specific jurisdiction cannot be exercised, a court in Florida may exercise over a non-resident defendant only where general jurisdiction can be established. American Overseas, 632 So. 2d, at 1127. “General jurisdiction, as distinguished from specific jurisdiction, does not require that the plaintiff’s cause of action arise out of the non-resident defendants business contacts with [Florida].” Id., at 1127. See also Woods v. Nova Companies Belize, Ltd., 739 So. 2d 617 (Fla. 4th DCA) (the general jurisdiction statute does not require connexity between a Defendant’s activities and the cause of action). General personal jurisdiction, on the other hand, arises from a defendant’s contacts with the forum that are unrelated to the cause of action being litigated. Consolidated Development Corporation v. Sherrit, Inc., 216 F. 3d 1286 (11th Cir. 2000).

Section 48.193(2), provides in part:

A defendant who is engaged in substantial and not isolated activity within this state, whether such activity is wholly intrastate, or otherwise, is subject to the jurisdiction of the Courts of this state, whether or not the claim arises from that activity.

In order to obtain jurisdiction under the general jurisdiction statute, therefore, the defendant must be found to have maintained “continuous and systematic general business contacts” with the forum, so it can properly be considered to be present in the forum. American Overseas Marine Corp., 632 So. 2d 1124, 1127 (Fla. 3d DCA 1994). In construing the requirement of “substantial and not isolated activity,” courts in Florida have harmonized this language with the constitutional due process requirements annunciated by the United States Supreme Court. Nichols v. Paulucci, 652 So. 2d 389 (Fla. 5th DCA 1995), citing Helicopteros Nacionales de Colombia, S.A. v. Hall, 466 U.S. 408 (1984):

In Helicópteros, the Supreme Court held that “continuous and systematic general business contacts” were required before a forum could exercise general jurisdiction over a nonresident defendant. Helicopteros, 466 U.S. at 416. The Court explained that a state exercises “general,” as opposed to “specific,” jurisdiction over a defendant when the cause of action does not arise out of, and is not related to, the defendant’s contacts with the state. Helicopteros, 466 U.S. at 414 n. 9. The due process standard of Helicopteros applies in this case because section 48.193 (2) requires no causal connection between a plaintiff’s claim and the defendant’s contacts with the state.

Id. , at 391. These contacts are commonly assessed over a period of years prior to the plaintiff’s filing of the plaintiff’s filing of the complaint. Woods v. Nova Companies Belize, Ltd., 739 So. 2d 617 (Fla. 4th DCA):

The record demonstrates that defendant engaged in continuous and systematic business activities with Florida and derived great pecuniary benefit from its transactions here .Although defendant maintains that some of these business contacts took place after the accident in this case, that fact is not dispositive. “Contacts are commonly assessed over a period of years prior to the filing of plaintiff’s complaint.” [] While any of these activities alone, may not be deemed sufficient, considered collectively, they establish personal jurisdiction.

Id. , at 621 (emphasis added). See also Helicopteros, 466 U.S. at 409 – 411 (examining contacts over a seven-year-period, up to the time the lawsuit was filed). See also Nichols v. Paulucci, 652 So. 2d 389, 391 (Fla. 5th DCA 1995):

We recognize that, standing alone, any one of Nichols’ contacts with the state of Florida might not constitute substantial activity within the meaning of When viewed in its entirety, however, the evidence presented in this case supports the trial court’s ruling that it possessed personal jurisdiction over Nichols.

Finally, this “continuous and systematic” contacts requirement [of the general jurisdiction statute] is [also] sufficient to fulfill the constitutional requirements of “minimum contacts.” Autonation, Inc. v. Whitlock, 276 F. Supp. 2d 1258, 1262 (S.D. Fla. 2003). See also Woods v. Nova Companies Belize, Ltd., 739 So. 2d 617 (Fla. 4th DCA) (“if the Defendant’s activities meet the requirements of section 48.193(2), minimum contacts is also satisfied”).

In sum, this Court can exercise personal jurisdiction over Defendant Law under the Florida general jurisdiction statute, §48.193(2), by a showing that she maintained “continuous and systematic general business contacts” with Florida. These contacts can be assessed over a period of years. Further, while any of these activities alone, may not be deemed sufficient, considered collectively they can establish personal jurisdiction.

For purposes of this analysis, it is irrelevant that Defendant’s contacts with Florida are unrelated to the cause of action (i.e. the medical malpractice) alleged in the complaint. Therefore, contrary to Defendant Law’s assertions, this Court can have jurisdiction over him – even if the alleged medical malpractice took place in California.

ii. Defendant Law’s reliance on Barnett, Laux and Hesteryis misplaced. In these cases, the district Court rendered its ruling primarily on the basis of specific – rather than general jurisdiction. Further, none of these cases involved a ship’s medical Defendant with the overwhelming amount of business contacts that Defendant Law has here with Florida.

Defendant Law cites three Southern District of Florida cases in support of the misplaced argument that his contacts with Florida must be related to the cause of action in the Complaint (i.e. that the medical malpractice occurred in Florida) for this Court to have personal jurisdiction over her. In each and every one of the cases Defendant Law cites, however, the court rendered its ruling primarily on the basis of specific jurisdictionnot general jurisdiction. On this ground alone, Laux v. Carnival, Barnett v. Carnival, and Hesterly v. Royal Caribbean are inapposite, as here, Plaintiff is seeking jurisdiction over Defendant Law under the “general jurisdiction statute,” §48.193(2).[8]

For instance, in Laux v. Carnival Corp., 470 F. Supp. 2d 1379 (S.D. Fla. 2007), the court made the following statement: “ Florida Courts only have personal jurisdiction over a ship’s doctor if the alleged medical malpractice occurred inside Florida’s territorial boundaries.” This statement was made on the basis of “specific jurisdiction” which requires connexity between Defendant’s activities in Florida and a plaintiff’s cause of action. Had the Laux Court made this statement on the basis of “general jurisdiction” – which it did not – it would have been a clear misstatement of the law. In fact, in Laux the Court did not conduct a “general jurisdiction” analysis and therefore did not look at the ship doctor’s contacts (unrelated to the cause of action) with Florida.[9]

Similarly, in Barnett v. Carnival Corp., 2007 U.S. Dist. LEXIS 37481 (S.D. Fla. 2007), the court, citing Laux, the Court made the same statement that “ Florida Courts have personal jurisdiction over a ship’s doctor if the alleged medical malpractice occurred inside Florida territorial boundaries.” Like in Laux, however, this statement was also made on the basis of “specific jurisdiction” which requires connexity between Defendant’s activities in Florida and a plaintiff’s cause of action. Had the Barnett Court made this statement on the basis of “general jurisdiction” – which it did not – it would have been a clear misstatement of the law. Like Laux, the Barnett Court did not conduct a “general jurisdiction” analysis and therefore did not look at the ship doctor’s contacts (unrelated to the cause of action) with Florida.

Finally, in Hesterly v. Royal Caribbean, 2008 U.S. Dist. LEXIS 13892 (S.D. Fla. 2008), the Court citing Laux and Barnett, also relied on the statement that “ Florida Courts have personal jurisdiction over a ship’s doctor if the alleged medical malpractice occurred inside Florida territorial boundaries.” Like in Laux and Barnett, however, this statement was also made exclusively under the Court’s analysis of “specific jurisdiction” – not general jurisdiction.

It’s true that unlike in Laux and Barnett,the Court in Hesterly did conduct a general jurisdiction analysis. In striking contrast to Defendant Law here, however, the ship’s physicals in Hesterly did not maintain continuous and systematic general business contacts with Florida. [10]

Certainly, as shown below, nothing in the opinions in Laux, Barnett or Hesterly, show that the ship’s physicians in those cases had the overwhelming amount of business contacts with Florida that Defendant Dormehl has here. In fact, the Laux and Barnett opinions do not even addresses any contacts that these physicians may have had for purposes of establishing general jurisdiction. Here – in striking contrast to the physicians in Laux, Barnett or Hesterly – the record shows that: Defendant Dormehl 1) appointed an agent in Florida – Carnival – to handle her legal affairs; 2) provided medical care to patients in Florida on 16 separate occasions; 3) obtained 97 hours worth of medical training and continuing medical education in Florida; 4) agreed to indemnify an entity located in Florida, for foreseeable risks in Florida; 5) purposefully reached out to Carnival in Miami, Florida for the purpose of entering into eleven consecutive contractual agreements; and 6) received compensation for services from a Florida based entity – which processed her payments in Florida.

iii. Contrary to Defendant’s assertions courts in Florida have obtained personal jurisdiction over non-resident physicians (where the alleged malpractice occurred outside of Florida), based on the general jurisdiction statute, §48.193(2). Like Defendant Dormehl, in these cases, the Court looked at the non-resident physician’s “general business contacts” with Florida.

In Dean v. Johns, M.D., 789 So. 2d 1072 (Fla. 3d DCA 2001), the Court denied a non-resident foreign doctor’s Motion to Dismiss for Lack of Personal Jurisdiction. In Dean, like in this case, the Plaintiff had sued the medical professional for alleged medical malpractice which occurred outside of Florida (in Alabama). Notwithstanding the fact that the malpractice took place in Alabama, the Court held it had personal jurisdiction over the foreign doctor by virtue of the Florida long arm general jurisdiction statute, §48.193(2). In doing so, the court looked at the foreign physician’s “general business contacts” with Florida (unrelated to the cause of action), holding:

We agree with the appellants that Dr. Oh has engaged in substantial and not isolated activities in Florida. He has treated over 3,200 Florida patients, is licensed to practice medicine in Florida, subjects himself to Florida regulation for the practice of medicine in Florida (including continuing medical education requirements), regularly consults with Florida physicians by telephone, renders reports to Florida physicians for use in treating Florida patients in Florida, and owns real property in Florida.

Id., at 1078. See also Rossa v. Sills, 493 So. 2d 1137 (Fla. 4th DCA 1986):

The complaint alleges that Rose Sills was a cruise line passenger, who after a slip and fall on board, was initially treated by the appellant-ship’s doctor The appellant, a foreign national who is not licensed to practice medicine in the United States, argues that no physician-patient relationship existed in Florida. There is a factual dispute whether his care or the care of the defendant terminated immediately following his treatment of her, or whether it continued into this State. But, regardless of which factual account prevails, the defendant’s conduct was such that he should have and could have reasonably foreseen being subjected to potential liability in Florida.

Id., at 1138 (emphasis added).

B. This Honorable Court has personal jurisdiction over Defendant Law under the general jurisdiction statute, §48.193(2). From 2008 through 2010, Defendant Law maintained “continuous and systematic general business contacts” with Florida. Assessed over a period of years and considered collectively, these contacts establish general jurisdiction pursuant to §48.193(2).

i. Defendant Law agreed to insure an entity located in Miami, Florida (Carnival), for foreseeable risks in Florida. On this ground alone, this Court has personal jurisdiction overDefendant Law by virtue of the long arm statute’s insurance provision, §48.193(1)(d). Alternatively,Defendant Law’s agreements to insure Florida based Carnival should be considered collectively with all of Defendant Law’s other contacts (described below), to establish jurisdiction under Florida’s general jurisdiction statute, §48.193(2).

Florida Statute §48.193(1)(d) provides:

Any person, whether or not a citizen or resident of this state, who personally or through an agent does any of the acts enumerated in this subsection thereby submits himself or herself and, if he or she is a natural person, his or her personal representative to the urisdiction of the courts of this state for any cause of action arising from the doing of any of the following acts: . . . (d) Contracting to insure any person, property, or risk located within this state at the time of contracting.

The concept of insurance is defined consistently within the Florida Statutes pursuant to Florida Statute §624.02, which is entitled “‘Insurance’ defined” and provides: “‘Insurance’ is a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies.” Accordingly, one who contractually indemnifies another, is “insuring” another for purposes of the application of Florida Statute §48.193(1)(d).

Between 2008 and 2010, Defendant entered into two contracts for the provision of medical services aboard Carnival’s ships – including the subject cruise. See Defendant Law’s “Nursing Services Agreement” attached hereto as Exhibit “A.” Within these contracts, Defendant Law was referred to as the “NURSE”. Pursuant to the express terms of each of these contracts, paragraph 10 provides:

Subject to the conditions of the indemnity agreement given by CARNIVAL to NURSE, attached hereto and made part hereof, NURSE agrees to indemnify and hold CARNIVAL harmless from and against any liability, loss, damage or claim, including attorney’s fees caused by or arising out of the performance of NURSE’S services hereunder.

Carnival’s Corporate Representative testified that pursuant to these contracts Defendant Dormehl is required to indemnify Carnival.[11] In doing so, if in the performance of Defendant Law’s services aboard the ship Carnival gets sued, then Defendant Law would have to indemnify Carnival. This agreement whereby Defendant Law undertakes to indemnify Carnival upon determinable contingencies, therefore, constitutes a contract to insure Carnival.

Further, it is undisputed that Carnival has, at all material times, been located in Miami, Florida.[12] Accordingly, this agreement entered into by subjects Defendant Law to personal jurisdiction in the State of Florida pursuant to Florida Statute §48.193(1)(d).

Because Defendant Law contractually agreed to indemnify Carnival (an entity located in Miami, Florida) for any harm resulting from her services – including medical malpractice; pursuant to 48.193(1)(d), Defendant Dormehl agreed to insure a person[13] in Florida.

Further, Defendant Law also purposefully availed herself of the subject forum by agreeing to indemnify Carnival for foreseeable risks in Florida.