| Department File Number : | M201885295 |
| Claim Number : | PMG-13-AO-247138-3 |
| Date Submitted : | 5/14/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| Pediatrix Medical Group, Inc. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 26-359560 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kathy | A | Stockton | ||
| Street Address | |||||
| 1900 W. LOOP S., STE. 1500 | |||||
| City | State | Zip | |||
| Houston | TX | 77027 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (713) 935 - 2404 | (713) 461 - 8130 | kathy_stockton@westernlitigation.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | SHAHID | SULTAN | |||
| Insurer Type | Street Address of Practice | ||||
| Self-Insurer | C/O RISSMAN, BARRETT, HURT, ET AL. 1 NORTH DALE MABRY HWY 11TH FL | ||||
| City | State | Zip Code | County | ||
| TAMPA | FL | 33609 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| PHY-0071-12 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME33962 | Neonatal/Perinatal Medicine | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Lee | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| LEE MEMORIAL HOSPITAL-HEALTHPARK | 120005 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Nursery | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 11/13/2013 | 11/18/2013 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| NEWBORN | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| NEWBORN | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| NO MISDIAGNOSIS | |||||
| Principal Injury Giving Rise To The Claim | |||||
| OCCLUDED PICC LINE R/I LEFT ARM AMPUTATION | |||||
| Severity Of Injury | |||||
| Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 6/22/2015 | 15-001454-CA | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Lee | 5/14/2018 | ||||
| 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 subject to arbitration, but settlement reached in lieu of award. | |||||
| Date of Payment | |||||
| 4/27/2018 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $1,000,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $25,000 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| UNKNOWN | |||||||||||||||||||||
| Updates | |
| No updates found. |
This page is not displaying certain sensitive information.
| Department File Number : | M201886049 |
| Claim Number : | PMG-15-AO-330488 |
| Date Submitted : | 8/1/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| Pediatrix Medical Group, Inc. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 26-359560 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kathy | A | Stockton | ||
| Street Address | |||||
| 1900 W. LOOP S., STE. 1500 | |||||
| City | State | Zip | |||
| Houston | TX | 77027 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (713) 935 - 2404 | (713) 461 - 8130 | kathy_stockton@westernlitigation.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | SHAHID | SULTAN | |||
| Insurer Type | Street Address of Practice | ||||
| Self-Insurer | C/O 2501 N ORANGE AVE | ||||
| City | State | Zip Code | County | ||
| ORLANDO | FL | 32804 | Lee | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| PHY-0628-14 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME33962 | Pediatrics - Minor Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Lee | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Hospital/Institution | LEE MEMORIAL HOSPITAL - FLORIDA | ||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Patients' Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 2/23/2013 | 4/14/2016 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| PICC LINE COMPLICATION | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| TREATED BY SEVERAL PHYSICIANS WHILE IN HOSPITAL | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| ALLEGED FAILURE TO RECOGNIZE A COMPLICATION | |||||
| Principal Injury Giving Rise To The Claim | |||||
| HYPOXIC BRAIN INJURY | |||||
| Severity Of Injury | |||||
| Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 1/24/2017 | CACE-16-023038 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Broward | 6/21/2018 | ||||
| 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 subject to arbitration, but settlement reached in lieu of award. | |||||
| Date of Payment | |||||
| 4/19/2018 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $833,333 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $111,111 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| UNKNOWN | |||||||||||||||||||||
| Updates | |
| No updates found. |
This page is not displaying certain sensitive information.
| Department File Number : | M201575547 |
| Claim Number : | 35868 |
| Date Submitted : | 9/8/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| MAG MUTUAL INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 58-1449198 | |||||
| Insurer Contact Information | |||||
| Type | Entity Name | ||||
| Entity | MAG MUTUAL INSURANCE COMPANY | ||||
| Street Address | |||||
| 8427 South Park Circle Suite 130 | |||||
| City | State | Zip | |||
| Orlando | FL | 32819 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (407) 370 - 3813 | (407) 370 - 2247 | ctschanz@magmutual.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Shahid | Sultan | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 9981 S. Healthpark Dr. Ste. 281 | ||||
| City | State | Zip Code | County | ||
| Fort Myers | FL | 33908 | Lee | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| PRF 1408622 00 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME33962 | Neonatal/Perinatal Medicine | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Lee | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| LEE MEMORIAL HOSPITAL-HEALTHPARK | 120005 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Nursery | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 11/28/2009 | 10/19/2010 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Neutropenia and thrombocytopenia | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Placement of a radial arterial line | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Alleged failure to properly place and monitor radial arterial line | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Severe gangrene requiring amputation of fingers 2-5 of right hand | |||||
| Severity Of Injury | |||||
| Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 7/16/2012 | 12-CA-002155 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Lee | 9/1/2015 | ||||
| Other Defendants Involved in this Claim | |||||
| Abril, MD, Ivan F Faisal, MD, Mohamed M Lee Memorial Associates in Neonatology, PA | |||||
| 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 | |||||
| 8/7/2015 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $34,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $79,189 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $31,120 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Risk management has counseled insured | |||||||||||||||||||||
| Updates | |||||||
| Date of Change: | 9/8/2015 2:40:37 PM | ||||||
| Reason for Change: | Report updated to reflect Court Document final disposition date of 09/01/15 | ||||||
| |||||||
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Does Dr. SHAHID SULTAN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. SHAHID SULTAN, MD has at least 3 medical malpractice case(s), lawsuit(s), or complaint(s).