Department File Number : | M201988073 |
Claim Number : | 369097 |
Date Submitted : | 3/6/2019 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
95-3014772 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kelly | Andrews | |||
Street Address | |||||
12724 Gran Bay Parkway, W., Suite 400 | |||||
City | State | Zip | |||
Jacksonville | FL | 32258 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 360 - 3038 | kandrews@thedoctors.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Roberto | F | Beraja | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 2550 South Douglas Road, Suite 300 | ||||
City | State | Zip Code | County | ||
Coral Gables | FL | 33134 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
0954515 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME39484 | Surgery - Opthalmology |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Dade | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Physician's Office | ||||
Date of Occurrence | Date Reported to Insurer | ||||
10/20/2017 | 4/27/2018 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Decreased vision, blurriness right eye, Glaucoma. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Insertion of Ahmed Valve with scleral patching, right eye. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
No misdiagnosis. | |||||
Principal Injury Giving Rise To The Claim | |||||
The patient, a 66-year-old male, presented at insureds office in 2017 with advanced, end-stage glaucoma damage in both eyes, resulting in blindness in his left eye and loss of vision and blurriness in his right eye. He had two Ahmed Valves inserted, which, even with medication, was ineffective in salvaging the vision in his right eye, and the pressure level in his eye was persistently elevated. Insured discussed all of the options with the patient, including non-surgical options and the potential progression of blindness to his right eye. The patient consented to surgical intervention to attempt to salvage what little vision he had left. Before the surgery, insured explained the risks and benefits associated with the procedure, including the possibility that the surgery may not be effective. On 12/20/17, insured inserted a third Ahmed Valve with a sclera patch in the patients right eye, after which the patient developed a known, but rare, complication called aqueous misdirection. The next day, insured referred him to a retina specialist for further treatment.The patient sued, arguing that insured should not have operated, even though his disease progression would have resulted in the same prognosis of permanent blindness and the procedure had at least the potential to slow that progression. A world-renowned ophthalmologist and expert in this field reviewed the medical records in this case and agreed with the care insured provided. This expert, who established the treatment guidelines for glaucoma patients published by the American Academy of Ophthalmology, opined that based on this patient¿s pressure readings, surgical intervention was the appropriate treatment option, the care was appropriate and defensible against a suit, and the post-operative complication of aqueous misdirection, which is seen in about one percent (1%) of similar glaucoma operations, was unavoidable, yet handled appropriately by a prompt referral to a retina specialist. | |||||
Severity Of Injury | |||||
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
7/27/2018 | 18-025455 CA 23 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Dade | 2/6/2019 | ||||
Other Defendants Involved in this Claim | |||||
Beraja Medical Institute, Inc. | |||||
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 | |||||
2/6/2019 |
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 | $12,334 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $6,973 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate. |
Updates | |
No updates found. |
Does Dr. ROBERTO F BERAJA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ROBERTO F BERAJA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).