Department File Number : | M201887186 |
Claim Number : | F14-0170-A-14 |
Date Submitted : | 12/4/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FD INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3704679 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Diane | M | McNab | ||
Street Address | |||||
9372 Lake Serena Drive | |||||
City | State | Zip | |||
Boca Raton | FL | 33496 | |||
Phone | Ext | Fax | E-Mail Address | ||
(954) 439 - 0580 | dmcnab@norcal-group.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Keith | D | Goldstein | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 7431 N. University Drive, No. 101 | ||||
City | State | Zip Code | County | ||
Tamarac | FL | 33221 | Broward | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MG000364 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME94967 | Hematology - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Broward | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
CORAL SPRINGS MEDICAL CENTER | 110019 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
2/27/2014 | 8/20/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
The patient was admitted to the hospital with Sickle Cell Syndrome, acute chest crisis. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
It was alleged that there was a failure to recognize the patient's impending hemolytic crisis and failed to timely begin red blood cell exchange and transfusions. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
There was no misdiagnosis. | |||||
Principal Injury Giving Rise To The Claim | |||||
Death | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
9/17/2015 | 17th Judicial | ||||
County Suit Filed in | Date of Final Disposition | ||||
Broward | 10/5/2018 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference. | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
9/7/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $63,583 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $63,583 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Insured conferenced with defense counsel and claims specialist |
Updates | |
No updates found. |
Department File Number : | M201781526 |
Claim Number : | F14-0170-A-14 |
Date Submitted : | 3/23/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FD INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3704679 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Sasha | Yamamoto | |||
Street Address | |||||
560 Davis Street | |||||
City | State | Zip | |||
San Francisco | CA | 94111 | |||
Phone | Ext | Fax | E-Mail Address | ||
(415) 735 - 2135 | syamamoto@norcal-group.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Keith | Goldstein | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 7431 N. University Drive, Suite 110 | ||||
City | State | Zip Code | County | ||
Tamarac | FL | 33321 | Broward | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MG000364 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME94967 | Hematology - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Broward | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Critical Care Unit | |||||
Date of Occurrence | Date Reported to Insurer | ||||
2/27/2014 | 8/20/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Hemolytic crisis, sickle cell crisis | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Blood transfusion of packed red blood cells | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Failure to recognize symptoms of impending hemolytic crisis and sickle cell crisis, failure to timely start antibiotics, failure to timely manage red blood cell exchange transfusion | |||||
Principal Injury Giving Rise To The Claim | |||||
Hemolytic crisis, sickle cell crisis resulting in death | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 1/25/2017 | ||||
Other Defendants Involved in this Claim | |||||
Kashif, Anwer Barrett, Terrance North Broward Hospitalists Florida Hospital Medicine Services, Inc. North Broward Radiologists, PA North Broward Hospital District | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Claim or suit abandoned. | |||||
Final Method of Claim Disposition | |||||
No Payment Made | |||||
Court Decision | Other | ||||
Other | Information not provided | ||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | No | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $13,477 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Discussed with insured and Risk Management |
Updates | |
No updates found. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. KEITH D GOLDSTEIN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. KEITH D GOLDSTEIN, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).