| Department File Number : | M201885706 |
| Claim Number : | 162746-1 |
| Date Submitted : | 6/21/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| HEALTH CARE INDEMNITY, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 61-0904881 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Christina | J | Stoker | ||
| Street Address | |||||
| 1100 Charlotte Ave, Ste 500 | |||||
| City | State | Zip | |||
| Nashville | TN | 37203 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (615) 344 - 1779 | (615) 344 - 5889 | christina.stoker@hcahealthcare.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | PATRICIA | M | FERNANDEZ | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 11750 SW 40TH ST STE 427 | ||||
| City | State | Zip Code | County | ||
| MIAMI | FL | 33175 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| HCI-10117 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME114714 | Surgery - Neurology - Including Child | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Dade | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| COLUMBIA KENDALL MEDICAL CENTER | 100209 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 1/25/2017 | 9/26/2017 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| PATIENT PRESENTED WITH BACK PAIN AND WAS FOUND HAVE A CONUS AV FISTULA WITH RETROGRADE VENOUS DRAINAGE UP TO THE CERVICAL LEVEL. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| UNDERWENT CATHETER EMBOLIZATION; PROCEDURE COMPLICATED BY BLEEDING OF ANTERIOR SPINAL ARTERY. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| ALLEGED IMPROPER PERFORMANCE OF SURGICAL PROCEDURE, RESULTING IN PERFORATION OF ANTERIOR SPINAL ARTERY AND PATIENT 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 | 6/7/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed). | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 5/14/2018 | |||||
| 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 | $6,180 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $1,705 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $250,000 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| REVIEW OF POLICIES AND PROCEDURES. | |||||||||||||||||||||
| 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. PATRICIA M FERNANDEZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. PATRICIA M FERNANDEZ, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).