The United States Court of Appeals for the Eighth Circuit, applying Missouri and Illinois law, ruled that a nursing home administrator's failure to turn on the nursing home's air conditioning system during a heat wave, resulting in the deaths of multiple patients, was a professional service within the meaning of a professional services exclusion. American Economy Ins. Co. v. Jackson, 476 F.3d 620 (8th Cir. Feb. 14, 2007). The insurance policy contained a professional services exclusion that precluded coverage "due to rendering or failure to render any professional service" including services such as "[m]edical, surgical, dental, x-ray or nursing services, treatment, advice,  instruction . . . [and] [a]ny health or therapeutic service treatment, advice or instruction." The court concluded that the administrator's decision not to turn on the air conditioning constituted "professional services" because she "drew upon her training, expertise, and knowledge" of the medical conditions of residents "before she exercised professional judgment and determined that the HVAC system would not be adjusted." The court also reasoned that the insured's "hiring, management and training of [the administration], the allocation of funds for the purpose of maintaining a working air conditioner and the lack of implementation of an emergency plan, are all decisions that were made using specialized training, skill, experience and knowledge."