Medical Malpractice Cases

Medical Malpractice Cases In Clay County Florida

Dr. Kelly A Segina Medical Malpractice Lawsuits - Court Case # 04-CA-706E

Indemnity Paid: $1,000,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200536701
Claim Number :502257
Date Submitted :9/20/2005
 
Insurer Information
 
Insurer NameCoverage Type
AMERICAN HEALTHCARE INDEMNITY COMPANYPrimary
Insurer FEINProfessional License Number
59-2048400 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualTerryMBinns
Street Address
1888 Century Park East, Suite 800
CityStateZip
Los AngelesCA90067
PhoneExtFaxE-Mail Address
(310) 556 - 7488 (310) 556 - 7400Tbinns@scpie-ahi.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualKellyASegina
Insurer TypeStreet Address of Practice
Licensed421 Kingsley Avenue, Suite 401
CityStateZip CodeCounty
Orange ParkFL32073Clay
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
60411$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME78973Surgery - Obstetrics - Gynecology 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FClay
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
ORANGE PARK MEDICAL CENTER100226
Location of Institutional InjuryOther Location of Institutional Injury
Labor and Delivery Room 
Date of OccurrenceDate Reported to Insurer
11/15/20021/2/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Full term pregnancy with labor.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
C-section.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
Principal Injury Giving Rise To The Claim
29 y/o, female sustained injury to the uterine artery during a C-section resulting in hypotension and hypovolemic conditions. Uterine artery was successfully repaired; however, patient has evidence of a permanent injury.
Severity Of Injury
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
8/19/200404-CA-706E
County Suit Filed inDate of Final Disposition
Clay8/23/2005
Other Defendants Involved in this Claim
Kelly A. San Gregory, M.D., PA., dba Comprehensive Women's C
Orange Park Medical Center
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
8/23/2005
 
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$33,609
All Other Loss Adjustment Expense Paid$9,093
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Interviews with investigator and defense counsel, review interrogatories & expert opinions, deposition.
 
Updates
 
No updates found.

 

 

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Dr. Marc H Blasser Medical Malpractice Lawsuits - Court Case # 03-CA-412

Indemnity Paid: $500,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200535743
Claim Number :A01-25094-01
Date Submitted :7/6/2005
 
Insurer Information
 
Insurer NameCoverage Type
FIRST PROFESSIONALS INSURANCE COMPANY, INCPrimary
Insurer FEINProfessional License Number
59-6614702 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualCheriMMontague
Street Address
1000 Riverside Drive, Suite 800
CityStateZip
JacksonvilleFL32204
PhoneExtFaxE-Mail Address
(800) 741 - 37423043(904) 358 - 6728montague@fpic.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualMarcHBlasser
Insurer TypeStreet Address of Practice
Licensed1715 Village Way
CityStateZip CodeCounty
Orange ParkFL32073Clay
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
33367$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME59868Surgery - Urological80145

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FClay
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
ORANGE PARK MEDICAL CENTER100226
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
3/29/200111/14/2001
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Patient received a nephrectomy after being diagnosed with huge cyst/mass that totally engulfed kidney.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
There was no injury. Kidney was removed due to this large cyst.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
No misdiagnosis made on behalf of this insured.
Principal Injury Giving Rise To The Claim
This patient suffered from bi-polar disorder. By finding attorneys to mis-represent her case, she was claiming that her kidney should not have been removed since the mass/cyst was benign.
Severity Of Injury
Emotional Only - Fright, no physical damage

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
5/15/200303-CA-412
County Suit Filed inDate of Final Disposition
Clay6/8/2005
Other Defendants Involved in this Claim
Tullot, Dr.
Orange Park Medical Center
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
6/8/2005
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$500,000
Loss Adjust Expense Paid to Defense Counsel$34,089
All Other Loss Adjustment Expense Paid$25,000
Injured Person's Total Non-Economic Loss$500,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Insurance company staff consulted with insured to discuss preventative measures. Risk management referral is made if appropriate.
 
Updates
 
No updates found.

 

 

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Dr. Eugene Bebeau Medical Malpractice Lawsuits - Court Case # 10-GA-25

Indemnity Paid: $500,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201368498
Claim Number :40314-01
Date Submitted :10/2/2013
 
Insurer Information
 
Insurer NameCoverage Type
FIRST PROFESSIONALS INSURANCE COMPANY, INCPrimary
Insurer FEINProfessional License Number
59-6614702 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualOdessa Choice
Street Address
1000 Riverside Avenue, Suite 800
CityStateZip
JacksonvilleFL32204
PhoneExtFaxE-Mail Address
(800) 741 - 37423045(904) 358 - 6728odessa.choice@fpic.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualEugene Bebeau
Insurer TypeStreet Address of Practice
Licensed820 Prudential Dr., Suite 606
CityStateZip CodeCounty
JacksonvilleFL32207Duval
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
99038$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME59387Anesthesiology80151

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FDuval
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
BAPTIST MEDICAL CENTER AND WOLFSON 100088
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
2/17/20106/15/2010
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
The patient was diagnosed with iron deficiency anemia and had to undergo a surgical procedure to rule out the cause.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
The patient suffered hypoxia while under general anesthesia for a hysteroscopy and D&C, which led to a brain injury.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
Principal Injury Giving Rise To The Claim
The patient's permanent brain damage after the episode of hypoxia.
Severity Of Injury
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
3/29/201210-GA-25
County Suit Filed inDate of Final Disposition
Clay9/9/2013
Other Defendants Involved in this Claim
Pennington, M.D., John
Fernandez, D.O., Kristin
Baptist Medical Center-South
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
9/9/2013
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$500,000
Loss Adjust Expense Paid to Defense Counsel$32,023
All Other Loss Adjustment Expense Paid$25,862
Injured Person's Total Non-Economic Loss$500,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Insurance company staff consulted with insured to discuss preventative measures. Risk management referral is made if appropriate.
 
Updates
 
No updates found.

 

 

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Dr. Mary Youngblood Medical Malpractice Lawsuits - Court Case # 10-CA-1385

Indemnity Paid: $495,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201161067
Claim Number :37796-01
Date Submitted :7/18/2011
 
Insurer Information
 
Insurer NameCoverage Type
FIRST PROFESSIONALS INSURANCE COMPANY, INCPrimary
Insurer FEINProfessional License Number
59-6614702 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualOdessa Choice
Street Address
1000 Riverside Avenue, Suite 800
CityStateZip
JacksonvilleFL32204
PhoneExtFaxE-Mail Address
(800) 741 - 37423045(904) 358 - 6728odessa.choice@fpic.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualMary Youngblood
Insurer TypeStreet Address of Practice
Licensed2100 Kingsley Avenue
CityStateZip CodeCounty
Orange ParkFL32073Clay
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
87713$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME63721Rheumatology - No Surgery80252

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MDuval
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Physician's Office 
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
  
Date of OccurrenceDate Reported to Insurer
8/15/200810/15/2008
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Rheumatoid arthritis.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Patient was treated with methotrexate, steroids and anti-inflammatories as well as general medical care and evaluation.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
Disputed allegations of failing to appreciate S & S of patient's underlying cardiac disease and make appropriate referral to a specialist or provide hospital admission to work up possible cardiac etiology.
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
7/26/201010-CA-1385
County Suit Filed inDate of Final Disposition
Clay6/28/2011
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
6/28/2011
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$495,000
Loss Adjust Expense Paid to Defense Counsel$13,873
All Other Loss Adjustment Expense Paid$8,260
Injured Person's Total Non-Economic Loss$495,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Insurance company staff consulted with insured to discuss preventative measures. Risk management referral is made if appropriate.
 
Updates
 
No updates found.

 

 

*NR:Prior to 04/28/1999 this field was not required in submitted claims.

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Dr. Michael S Gilligan Medical Malpractice Lawsuits - Court Case # 03-CA-171

Indemnity Paid: $450,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200747275
Claim Number :B02070535
Date Submitted :10/9/2007
 
Insurer Information
 
Insurer NameCoverage Type
TIG INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
94-1517098 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualKathleenLMentel
Street Address
125 S. Wacker Drive, Suite 700
CityStateZip
ChicagoIL60606
PhoneExtFaxE-Mail Address
(312) 267 - 6045 (312) 606 - 0167lori_mentel@tigspecialty.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualMichaelSGilligan
Insurer TypeStreet Address of Practice
Licensed1409 Kingsley Way, Bldg #8
CityStateZip CodeCounty
Orange ParkFL32073Clay
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
HCF39258849$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME53014Surgery - General 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MClay
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
ORANGE PARK MEDICAL CENTER100226
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
7/11/20009/20/2002
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Abdominal pains, nausea, vomiting, which were diagnosed as pancreatitis.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
laparoscopic cholecystectomy
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Plaintiff does not dispute the diagnosis of pancreatitis.
Principal Injury Giving Rise To The Claim
Plaintiff questions the appropriateness of the treatment for pancreatitis.
Severity Of Injury
Permanent: Minor - Loss of fingers, loss or damage to organs.Includes non-disabling injuries.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
3/24/200303-CA-171
County Suit Filed inDate of Final Disposition
Clay10/1/2007
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 DecisionOther
Othervoluntary dismissal post settlement
Arbitration
Claim not subject to Arbitration.
Date of Payment
10/1/2007
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$450,000
Loss Adjust Expense Paid to Defense Counsel$70,201
All Other Loss Adjustment Expense Paid$0
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$250,000$0
Wage Loss$200,000$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
None taken of which I am aware.
 
Updates
 
No updates found.

 

 

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Dr. Paul A Moir Medical Malpractice Lawsuits - Court Case # 2004-CA-137

Indemnity Paid: $350,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200433537
Claim Number :18444
Date Submitted :11/9/2005
 
Insurer Information
 
Insurer NameCoverage Type
MAG MUTUAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
58-1449198 
Insurer Contact Information
TypeEntity Name
EntityMAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
CityStateZip
OrlandoFL32819
PhoneExtFaxE-Mail Address
(407) 370 - 3813 (407) 370 - 2247cwehner@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualPaulAMoir
Insurer TypeStreet Address of Practice
Licensed8282 Woodgrove Road
CityStateZip CodeCounty
JacksonvilleFL32256Duval
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600584 01$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME76950Emergency Medicine - No Major Surgery03843

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MDuval
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
ORANGE PARK MEDICAL CENTER100226
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
8/5/20029/12/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Massive pseudomonas infection of right eye due to retained foreign body embedded in retina
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Removal of metal fragment
Diagnostic Code :369.9
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to obtain emergent ophthalmology consult
Principal Injury Giving Rise To The Claim
Permanent loss of vision in right eye due to infection
Severity Of Injury
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
2/12/20042004-CA-137
County Suit Filed inDate of Final Disposition
Clay1/7/2005
Other Defendants Involved in this Claim
Orange Park Medical Center
Jacksonville Emergency Consultants, P.A.
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
11/23/2004
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$350,000
Loss Adjust Expense Paid to Defense Counsel$16,803
All Other Loss Adjustment Expense Paid$4,672
Injured Person's Total Non-Economic Loss$350,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$15,000$0
Wage Loss$3,600$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk Management has counseled insured
 
Updates
 
 
Date of Change:11/9/2005 9:54:29 AM
Reason for Change:Corrected various fields pursuant to State audit
 
Field ChangedFormer ValueNew Value
All Other Loss Adjustment Expense Paid21004672
Amount of Loss Adjustment Expense Paid to Defense Counsel1937416803
Defendant Entity NameOrange Park Medical Center
Defendant Entity NameOrange Park Medical CenterJacksonville Emergency Consultants, P.A.
Date of Final Disposition23-NOV-0407-JAN-05

 

 

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Dr. Michael Smith Medical Malpractice Lawsuits - Court Case # 2009-CA-2147

Indemnity Paid: $325,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201264461
Claim Number :38682-01
Date Submitted :8/1/2012
 
Insurer Information
 
Insurer NameCoverage Type
FIRST PROFESSIONALS INSURANCE COMPANY, INCPrimary
Insurer FEINProfessional License Number
59-6614702 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualOdessa Choice
Street Address
1000 Riverside Avenue, Suite 800
CityStateZip
JacksonvilleFL32204
PhoneExtFaxE-Mail Address
(800) 741 - 37423045(904) 358 - 6728odessa.choice@fpic.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualMichael Smith
Insurer TypeStreet Address of Practice
Licensed5218 Jammes Road, Suite C
CityStateZip CodeCounty
JacksonvilleFL32210Duval
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
31042$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Dentistry 
License NumberSpecialty Code & ClassificationCertification Number
DN13788Endodondics80211

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FDuval
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Physician's Office 
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
  
Date of OccurrenceDate Reported to Insurer
5/15/20085/11/2009
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Root canals on teeth #18 & #19.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Root canal on teeth #18 & #19.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Patient claims insured kept her mouth open for excessive periods of time causing TMJ-Temporomandibular Joint Pain.
Principal Injury Giving Rise To The Claim
TMJ-Temporomandibular Joint Pain.
Severity Of Injury
Permanent: Minor - Loss of fingers, loss or damage to organs.Includes non-disabling injuries.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
8/20/20092009-CA-2147
County Suit Filed inDate of Final Disposition
Clay7/11/2012
Other Defendants Involved in this Claim
Michael R. Smith, D.M.D., P.A.
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
7/11/2012
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$325,000
Loss Adjust Expense Paid to Defense Counsel$50,090
All Other Loss Adjustment Expense Paid$50,301
Injured Person's Total Non-Economic Loss$325,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Insurance company staff consulted with insured to discuss preventative measures. Risk management referral is made if appropriate.
 
Updates
 
No updates found.

 

 

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Dr. Amir H Fatemi Medical Malpractice Lawsuits - Court Case # 2010-1371-CA

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201159746
Claim Number :31831
Date Submitted :3/11/2011
 
Insurer Information
 
Insurer NameCoverage Type
MAG MUTUAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
58-1449198 
Insurer Contact Information
TypeEntity Name
EntityMAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
CityStateZip
OrlandoFL32819
PhoneExtFaxE-Mail Address
(407) 370 - 3813 (407) 370 - 2247ctschanz@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualAmirHFatemi
Insurer TypeStreet Address of Practice
Licensed6934 St. Augustine Road
CityStateZip CodeCounty
JacksonvilleFL32217Duval
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600959 08$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME34353Surgery - General 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MDuval
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Outpatient Facility 
Name of InstitutionCode
ORANGE PARK MEDICAL CENTER100226
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
2/29/20089/23/2009
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Adenocarcinoma
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Port-a-cath placement
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to properly perform procedure
Principal Injury Giving Rise To The Claim
Strokes
Severity Of Injury
Permanent: Minor - Loss of fingers, loss or damage to organs.Includes non-disabling injuries.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
6/23/20102010-1371-CA
County Suit Filed inDate of Final Disposition
Clay2/23/2011
Other Defendants Involved in this Claim
Kobrin, MD, Craig A
Latour, MD, Emile A
Howze, MD, Bryan C
Orange Park Medical Center
Drs. Mori Bean & Brooks
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
1/25/2011
 
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$33,138
All Other Loss Adjustment Expense Paid$7,989
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
 
Date of Change:3/11/2011 12:50:46 PM
Reason for Change:Report updated to reflect Court Document final disposition date of 02/23/11
 
Field ChangedFormer ValueNew Value
Date of Final Disposition25-JAN-1123-FEB-11

 

 

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Dr. Philip M Stern Medical Malpractice Lawsuits - Court Case # 2011-CA-219

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201161051
Claim Number :168384
Date Submitted :6/11/2012
 
Insurer Information
 
Insurer NameCoverage Type
PROASSURANCE CASUALTY COMPANYPrimary
Insurer FEINProfessional License Number
38-2317569 
Insurer Contact Information
TypeEntity Name
EntityProAssurance Casualty Company
Street Address
14497 North Dale Mabry Hwy., Suite 115-N
CityStateZip
TampaFL33618-2047
PhoneExtFaxE-Mail Address
(813) 969 - 2010 (813) 969 - 2120SNorris@ProAssurance.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualPhilipMStern
Insurer TypeStreet Address of Practice
Licensed5511 S. Congress Avenue, Suite 135
CityStateZip CodeCounty
AtlantisFL33462Clay
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
MP72684$250,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME64794Intensive Care Medicine00000

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FClay
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
ORANGE PARK MEDICAL CENTER100226
Location of Institutional InjuryOther Location of Institutional Injury
Critical Care Unit 
Date of OccurrenceDate Reported to Insurer
10/31/200810/22/2010
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Term pregnancy.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Cesarean section, tubal ligation.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
No misdiagnosis.
Principal Injury Giving Rise To The Claim
Delay in diagnosis and treatment of postoperative bleeding.
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
4/14/20112011-CA-219
County Suit Filed inDate of Final Disposition
Clay6/21/2011
Other Defendants Involved in this Claim
Orange Park Medical Center, Inc.
HYLER, DAVID
Intensive Cre Consortium, 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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
7/1/2011
 
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$16,673
All Other Loss Adjustment Expense Paid$2,887
Injured Person's Total Non-Economic Loss$250,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Insured has discussed case with insurance company personnel, medical experts, and defense counsel.
 
Updates
 
 
Date of Change:6/11/2012 3:58:49 PM
Reason for Change:State Report has been updated to reflect additional legal fees and expenses paid.
 
Field ChangedFormer ValueNew Value
Amount of Loss Adjustment Expense Paid to Defense Counsel744016673
All Other Loss Adjustment Expense Paid28792887

 

 

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Dr. MD Kim Medical Malpractice Lawsuits - Court Case # 03-441-CA

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200432610
Claim Number :0572MA2187-09T001
Date Submitted :8/25/2004
 
Insurer Information
 
Insurer NameCoverage Type
ST. PAUL FIRE & MARINE INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
41-0406690 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualPatriceAKane
Street Address
3230 West Commercial Blvd., #390
CityStateZip
Ft. LauderdaleFL33309
PhoneExtFaxE-Mail Address
(954) 677 - 33243324(954) 735 - 9028Pat.Kane@stpaul.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualZoo  Kim, MD
Insurer TypeStreet Address of Practice
Licensed2524 Squaw Creek
CityStateZip CodeCounty
ClermontFL34711Lake
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
0572MA2187$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME17136Pathology - No Surgery01

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FClay
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
ORANGE PARK MEDICAL CENTER100226
Location of Institutional InjuryOther Location of Institutional Injury
OtherPathology
Date of OccurrenceDate Reported to Insurer
4/11/20008/5/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Lump in breast
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Diagnosed cancer from pathology when in fact there was no cancer
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Diagnosed breast cancer from pathology when in fact there was no cancer
Principal Injury Giving Rise To The Claim
Chemo and radiation therapy following incorrect diagnosis as well as lumpectomy
Severity Of Injury
Permanent: Minor - Loss of fingers, loss or damage to organs.Includes non-disabling injuries.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
8/23/200303-441-CA
County Suit Filed inDate of Final Disposition
Clay6/30/2004
Other Defendants Involved in this Claim
McKinney, MD, Barbara
Orange Park Medical Center
Stage of Legal System at which Settlement was Reached or Award Made
After arbitration is initiated or prior to suit being filed.
Final Method of Claim Disposition
Settled by parties
Court DecisionOther
No Court Proceedings. 
Arbitration
Claim subject to arbitration, but settlement reached in lieu of award.
Date of Payment
6/30/2004
 
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$16,000
All Other Loss Adjustment Expense Paid$0
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
None known
 
Updates
 
No updates found.

 

 

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Dr. Kristin Fernandez Medical Malpractice Lawsuits - Court Case # 10-GA-25

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201368499
Claim Number :40314-02
Date Submitted :10/2/2013
 
Insurer Information
 
Insurer NameCoverage Type
FIRST PROFESSIONALS INSURANCE COMPANY, INCPrimary
Insurer FEINProfessional License Number
59-6614702 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualOdessa Choice
Street Address
1000 Riverside Avenue, Suite 800
CityStateZip
JacksonvilleFL32204
PhoneExtFaxE-Mail Address
(800) 741 - 37423045(904) 358 - 6728odessa.choice@fpic.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualKristin Fernandez
Insurer TypeStreet Address of Practice
Licensed11437 Central Parkway, Suite 105
CityStateZip CodeCounty
JacksonvilleFL32224Duval
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
98026$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
OS7697Surgery - Gynecology80167

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FDuval
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
BAPTIST MEDICAL CENTER AND WOLFSON 100088
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
2/15/201010/19/2011
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
The patient was diagnosed with iron deficiency anemia and had to undergo a vaginal surgery to rule out the cause of anemia.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
The patient suffered hypoxia while under general anesthesia for a hysteroscopy and D&C, which led to a brain injury.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
Principal Injury Giving Rise To The Claim
The patient's permanent brain injury after suffering the episode of hypoxia.
Severity Of Injury
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
3/29/201210-GA-25
County Suit Filed inDate of Final Disposition
Clay9/9/2013
Other Defendants Involved in this Claim
Bebeau, M.D., Eugene R
Baptist Medical Center-South
Pennington, M.D., John
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
9/9/2013
 
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$15,616
All Other Loss Adjustment Expense Paid$6,510
Injured Person's Total Non-Economic Loss$250,000
Deductible$50,000
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Insurance company staff consulted with insured to discuss preventative measures. Risk management referral is made if appropriate.
 
Updates
 
No updates found.

 

 

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Dr. Abdulhadi Quadri Medical Malpractice Lawsuits - Court Case # 11-1637-CA

Indemnity Paid: $249,999.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201367423
Claim Number :279108
Date Submitted :6/19/2013
 
Insurer Information
 
Insurer NameCoverage Type
DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE)Primary
Insurer FEINProfessional License Number
95-3014772 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualTiffanyDTaylor
Street Address
13450 West Sunrise Blvd
CityStateZip
SunriseFL33323
PhoneExtFaxE-Mail Address
(877) 320 - 0748  TTaylor@thedoctors.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualAbdulhadi Quadri
Insurer TypeStreet Address of Practice
Licensed2045 Professional Center Drive
CityStateZip CodeCounty
Orange ParkFL32073Clay
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
0494389$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME85847Gastroenterology - Minor Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FClay
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
ORANGE PARK MEDICAL CENTER100226
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
7/2/20097/9/2010
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
The patient presented to the ER with symptoms of a colon stricture.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
A flexible sigmoidoscopy with possible stent placement was done.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
Alleged failure to diagnose a perforated colon resulting in arterial thrombosis ultimately requiring a right leg amputation.
Severity Of Injury
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
11/22/201111-1637-CA
County Suit Filed inDate of Final Disposition
Clay5/30/2013
Other Defendants Involved in this Claim
Orange Park Medical Center, Inc. dba Orange PArk Medical Ctr
North Florida Gastroenterology, LLC
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
5/30/2013
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$249,999
Loss Adjust Expense Paid to Defense Counsel$80,000
All Other Loss Adjustment Expense Paid$0
Injured Person's Total Non-Economic Loss$158,999
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$91,000$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Unknown
 
Updates
 
No updates found.

 

 

*NR:Prior to 04/28/1999 this field was not required in submitted claims.

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Dr. Michael S Willens Medical Malpractice Lawsuits - Court Case # 09-975-CA

Indemnity Paid: $224,500.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201058434
Claim Number :1005322-01
Date Submitted :8/18/2011
 
Insurer Information
 
Insurer NameCoverage Type
FLORIDA MEDICAL MALPRACTICE JUAPrimary
Insurer FEINProfessional License Number
59-1625412 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualSUSAN SPIELMAN
Street Address
5814 Reed Street
CityStateZip
Fort WayneIN46835
PhoneExtFaxE-Mail Address
(260) 486 - 0340 (260) 486 - 0782SUSAN.SPIELMAN@MEDPRO.COM
 
Insured Information
 
TypeFirst NameMILast Name
IndividualMichaelSWillens
Insurer TypeStreet Address of Practice
Licensed5757 Booth Rd, Bldg 100
CityStateZip CodeCounty
JacksonvilleFL32207Duval
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
FL005201$250,000$750,000
Profession or BusinessOther Profession or Business
Osteopathic Physician 
License NumberSpecialty Code & ClassificationCertification Number
OS8432Anesthesiology - Pain Management 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MClay
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Physician's Office 
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
  
Date of OccurrenceDate Reported to Insurer
8/22/200611/15/2008
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Lower back and hip pain
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Office exams, series of steroid injections
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Failure to give informed consent regarding risks of injections
Principal Injury Giving Rise To The Claim
Development of avascular necrosis, need for hip replacement
Severity Of Injury
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
7/1/200909-975-CA
County Suit Filed inDate of Final Disposition
Clay9/1/2010
Other Defendants Involved in this Claim
Pain and Rehabilitation Network LLC d/b/a The Pain Center
Paincare Holdings Inc d/b/a The Pain Center
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
8/31/2010
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$224,500
Loss Adjust Expense Paid to Defense Counsel$28,309
All Other Loss Adjustment Expense Paid$10,409
Injured Person's Total Non-Economic Loss$149,500
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
N/A
 
Updates
 
 
Date of Change:2/15/2011 11:10:39 AM
Reason for Change:Update Loss and ALE information
 
Field ChangedFormer ValueNew Value
All Other Loss Adjustment Expense Paid38869356
Indemnity Paid225000224500
Injured Person Total Non-Economic Loss150000149500
Amount of Loss Adjustment Expense Paid to Defense Counsel1797927212
 
Date of Change:8/18/2011 10:32:23 AM
Reason for Change:Update ALE
 
Field ChangedFormer ValueNew Value
All Other Loss Adjustment Expense Paid935610409
Amount of Loss Adjustment Expense Paid to Defense Counsel2721228309

 

 

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Dr. Sook Marino Medical Malpractice Lawsuits - Court Case # 03-CA-1156

Indemnity Paid: $220,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200538871
Claim Number :A03-28800-02
Date Submitted :12/14/2005
 
Insurer Information
 
Insurer NameCoverage Type
FIRST PROFESSIONALS INSURANCE COMPANY, INCPrimary
Insurer FEINProfessional License Number
59-6614702 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualCheriMMontague
Street Address
1000 Riverside Drive, Suite 800
CityStateZip
JacksonvilleFL32204
PhoneExtFaxE-Mail Address
(800) 741 - 37423043(904) 358 - 6728montague@fpic.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualSook Marino
Insurer TypeStreet Address of Practice
Licensed3818 Eldridge Avenue
CityStateZip CodeCounty
Orange ParkFL32073Clay
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
59287$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME55327Gynecology - No Surgery80244

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FClay
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
ORANGE PARK MEDICAL CENTER100226
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
4/23/20027/2/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Cystocele/rectocele with stress incontinence.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Repair of cystocele/rectocele.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
Principal Injury Giving Rise To The Claim
Breakdown of repair of cystocele/rectocele.Need for subsequent surgery.
Severity Of Injury
Temporary: Major - Burns, surgical material left, drug side effect, brain damage.Recovery delayed.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
12/29/200303-CA-1156
County Suit Filed inDate of Final Disposition
Clay11/14/2005
Other Defendants Involved in this Claim
 
Stage of Legal System at which Settlement was Reached or Award Made
After notice of appeal is filed or post judgment relief of action is required for recovery.
Final Method of Claim Disposition
Settled by parties
Court DecisionOther
Judgment for the plaintiff. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
11/14/2005
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$220,000
Loss Adjust Expense Paid to Defense Counsel$33,506
All Other Loss Adjustment Expense Paid$24,083
Injured Person's Total Non-Economic Loss$220,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Insurance company staff consulted with insured to discuss preventative measures. Risk management referral is made if appropriate.
 
Updates
 
No updates found.

 

 

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Dr. Arjav A Shah Medical Malpractice Lawsuits - Court Case # 03-1234-CA

Indemnity Paid: $200,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200538169
Claim Number :A03-29324-03
Date Submitted :11/9/2005
 
Insurer Information
 
Insurer NameCoverage Type
FIRST PROFESSIONALS INSURANCE COMPANY, INCPrimary
Insurer FEINProfessional License Number
59-6614702 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualCheriMMontague
Street Address
1000 Riverside Drive, Suite 800
CityStateZip
JacksonvilleFL32204
PhoneExtFaxE-Mail Address
(800) 741 - 37423043(904) 358 - 6728montague@fpic.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualArjavAShah
Insurer TypeStreet Address of Practice
Licensed11437 Central Parkway, #105
CityStateZip CodeCounty
JacksonvilleFL32224Clay
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
26696$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME75984Surgery - Obstetrics - Gynecology80153

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MClay
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
ORANGE PARK MEDICAL CENTER100226
Location of Institutional InjuryOther Location of Institutional Injury
Labor and Delivery Room 
Date of OccurrenceDate Reported to Insurer
6/25/20039/15/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Full term pregnancy.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Vaginal delivery of fetus.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
Principal Injury Giving Rise To The Claim
Brachial plexus/Erbs Palsy.
Severity Of Injury
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
1/7/200403-1234-CA
County Suit Filed inDate of Final Disposition
Clay10/17/2005
Other Defendants Involved in this Claim
Orange Park Medical Center
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
10/17/2005
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$200,000
Loss Adjust Expense Paid to Defense Counsel$46,053
All Other Loss Adjustment Expense Paid$20,180
Injured Person's Total Non-Economic Loss$200,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Insurance company staff consulted with insured to discuss preventative measures. Risk management referral is made if appropriate.
 
Updates
 
No updates found.

 

 

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Dr. Maria M Ramirez Medical Malpractice Lawsuits - Court Case # 2010-CA-001590

Indemnity Paid: $200,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201162546
Claim Number :1005578-01
Date Submitted :10/4/2012
 
Insurer Information
 
Insurer NameCoverage Type
NATIONAL FIRE AND MARINE INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
47-6021331 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualPamelaAPrudlow
Street Address
5814 Reed Road
CityStateZip
Ft. WayneIN46835
PhoneExtFaxE-Mail Address
(260) 486 - 0370 (260) 486 - 0785pamela.prudlow@medpro.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualMariaMRamirez
Insurer TypeStreet Address of Practice
Licensed5511 S. Congress Ave., Ste. 135
CityStateZip CodeCounty
AtlantisFL33462Palm Beach
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
92RKB101315$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME87064Internal Medicine - No Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FClay
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
ORANGE PARK MEDICAL CENTER100226
Location of Institutional InjuryOther Location of Institutional Injury
Critical Care Unit 
Date of OccurrenceDate Reported to Insurer
10/29/20086/22/2009
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Obese patient underwent scheduled C-section delivery. Post delivery, developed hypotension & tachycardia.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Ultrasound of abdomen & legs. Blood pressure support. Cardiac consult. Diagnosed deep vein thrombosis and/or pulmonary embolus. Prescribed Heparin.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged improperly prescribed Heparin for post surgical patient.
Principal Injury Giving Rise To The Claim
Developed DIC, massive hemorrhage and died.
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
9/29/20102010-CA-001590
County Suit Filed inDate of Final Disposition
Clay12/8/2011
Other Defendants Involved in this Claim
Orange Park Medical Center
Grech, David
Univ. of FL Generation to Generation OB/GYN
Stern, Philip M
Shah, Purvin
Intensive Care Consortium, 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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
11/8/2011
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$200,000
Loss Adjust Expense Paid to Defense Counsel$37,958
All Other Loss Adjustment Expense Paid$0
Injured Person's Total Non-Economic Loss$200,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
n/a
 
Updates
 
 
Date of Change:10/4/2012 10:17:32 AM
Reason for Change:Update to ALE paid.
 
Field ChangedFormer ValueNew Value
Amount of Loss Adjustment Expense Paid to Defense Counsel3660337958

 

 

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Dr. Norma B Milanes Roberts Medical Malpractice Lawsuits - Court Case # 2005-79-CA

Indemnity Paid: $175,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200850686
Claim Number :GS212159
Date Submitted :9/19/2008
 
Insurer Information
 
Insurer NameCoverage Type
GENERAL STAR INDEMNITY COMPANYPrimary
Insurer FEINProfessional License Number
06-0876629 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualCecileMKucinsky
Street Address
1 North Wacker Drive, Suite 1760
CityStateZip
ChicagoIL60606
PhoneExtFaxE-Mail Address
(312) 267 - 86008606(312) 267 - 8520cecile.kucinsky@generalstar.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualNormaBMilanes Roberts
Insurer TypeStreet Address of Practice
Licensed421 Kingsley Avenue #401
CityStateZip CodeCounty
Orange ParkFL32073Clay
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
IJG391370$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME86322Surgery - Obstetrics - Gynecology 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FClay
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Physician's Office 
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
Special Procedure Room 
Date of OccurrenceDate Reported to Insurer
11/7/20029/15/2004
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Anal squamous cell carcinoma and vulvar cancer
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Biopsy of vaginal warts and surgical excision of anal lesion
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Diagnosed vulvar condylomas and perianal lesions, and not cancer
Principal Injury Giving Rise To The Claim
Alleged failure to examine, evaluate and biopsy anal lesion for signs of malignancy allegedly resulted in a significant delay in properly diagnosing and treating caner
Severity Of Injury
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
7/28/20062005-79-CA
County Suit Filed inDate of Final Disposition
Clay6/10/2008
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim subject to arbitration, but settlement reached in lieu of award.
Date of Payment
5/16/2008
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$175,000
Loss Adjust Expense Paid to Defense Counsel$78,225
All Other Loss Adjustment Expense Paid$21,309
Injured Person's Total Non-Economic Loss$0
Deductible$10,000
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
None known
 
Updates
 
 
Date of Change:9/19/2008 11:05:18 AM
Reason for Change:Paid additional expenses after claim was closed
 
Field ChangedFormer ValueNew Value
All Other Loss Adjustment Expense Paid021309

 

 

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Dr. Luis E Rios Medical Malpractice Lawsuits - Court Case # 06-CA-160

Indemnity Paid: $150,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200746313
Claim Number :22234
Date Submitted :8/10/2007
 
Insurer Information
 
Insurer NameCoverage Type
MAG MUTUAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
58-1449198 
Insurer Contact Information
TypeEntity Name
EntityMAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
CityStateZip
OrlandoFL32819
PhoneExtFaxE-Mail Address
(407) 370 - 3813 (407) 370 - 2247cwehner@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualLuisERios
Insurer TypeStreet Address of Practice
Licensed8282 Woodgrove Road
CityStateZip CodeCounty
JacksonvilleFL32256Duval
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600584 02$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME55184Emergency Medicine - No Major Surgery3305

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MDuval
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
ORANGE PARK MEDICAL CENTER100226
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
4/4/20046/6/2004
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Cauda equina syndrome
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Spinal films
Diagnostic Code :344.6
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to timely diagnose and manage cauda equina syndrome
Principal Injury Giving Rise To The Claim
Spinal cord injury and paralysis
Severity Of Injury
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
2/13/200606-CA-160
County Suit Filed inDate of Final Disposition
Clay7/30/2007
Other Defendants Involved in this Claim
Orange Park Medical Center
Jacksonville Emergency Consultants
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
7/17/2007
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$150,000
Loss Adjust Expense Paid to Defense Counsel$39,685
All Other Loss Adjustment Expense Paid$26,860
Injured Person's Total Non-Economic Loss$150,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
 
Date of Change:8/10/2007 11:44:48 AM
Reason for Change:Report updated to reflect Court Document final disposition date of 07/30/07
 
Field ChangedFormer ValueNew Value
Date of Final Disposition26-JUN-0730-JUL-07

 

 

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Dr. Luminita Neacsu Medical Malpractice Lawsuits - Court Case # 08-CA-2786

Indemnity Paid: $125,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201162042
Claim Number :37543-01
Date Submitted :10/27/2011
 
Insurer Information
 
Insurer NameCoverage Type
FIRST PROFESSIONALS INSURANCE COMPANY, INCPrimary
Insurer FEINProfessional License Number
59-6614702 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualOdessa Choice
Street Address
1000 Riverside Avenue, Suite 800
CityStateZip
JacksonvilleFL32204
PhoneExtFaxE-Mail Address
(800) 741 - 37423045(904) 358 - 6728odessa.choice@fpic.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualLuminita Neacsu
Insurer TypeStreet Address of Practice
Licensed1893 Kingsley Avenue, Suite D
CityStateZip CodeCounty
Orange ParkFL32073Clay
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
99495$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME92826Hospitalists80814

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MClay
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
ORANGE PARK MEDICAL CENTER100226
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
5/3/20068/14/2008
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Patient awoke from sleep with righ-sided numbness, weakness and slurred speech and was transported to Orange Park Hospital.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Patient was diagnosed with an acute ischemic stroke and was admitted.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
Principal Injury Giving Rise To The Claim
Plaintiff's contend that care providers did not timely treat patient's stroke with the reversal tPA in time to make a difference.
Severity Of Injury
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
1/14/200908-CA-2786
County Suit Filed inDate of Final Disposition
Clay10/5/2011
Other Defendants Involved in this Claim
Orange Park Hospital
Brodeur, M.D., Mark
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
10/5/2011
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$125,000
Loss Adjust Expense Paid to Defense Counsel$110,407
All Other Loss Adjustment Expense Paid$73,192
Injured Person's Total Non-Economic Loss$125,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Insurance company staff consulted with insured to discuss preventative measures. Risk management referral is made if appropriate.
 
Updates
 
No updates found.

 

 

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Dr. Murshid Al-Awady Medical Malpractice Lawsuits - Court Case # 02-CA-97

Indemnity Paid: $115,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200746321
Claim Number :83007473
Date Submitted :7/20/2007
 
Insurer Information
 
Insurer NameCoverage Type
TRUCK INSURANCE EXCHANGEPrimary
Insurer FEINProfessional License Number
95-2575892 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualLaurieRSchwartz
Street Address
12424 Wilshire Blvd., 9th Flr.
CityStateZip
Los AngelesCA90025
PhoneExtFaxE-Mail Address
(310) 696 - 0286 (310) 979 - 4930lschwartz@litneutral.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualMurshid Al-Awady
Insurer TypeStreet Address of Practice
Licensed3360 Coastal Route 220
CityStateZip CodeCounty
MiddleburgFL32068Clay
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
0118062830000$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME74540Psychiatry - All Other 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FClay
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Other Hospital/InstitutionPsychiatric unit
Name of InstitutionCode
ORANGE PARK MEDICAL CENTER100226
Location of Institutional InjuryOther Location of Institutional Injury
Critical Care Unit 
Date of OccurrenceDate Reported to Insurer
12/25/20009/27/2001
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Psychiatric Condition
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Allegd continued administration of Haldol after repeated dystonic reactions
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
No misdiagnosis made of patient's condition
Principal Injury Giving Rise To The Claim
Dealth following adverse reaction to Haldol administration and sequalle events
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
1/31/200202-CA-97
County Suit Filed inDate of Final Disposition
Clay2/13/2007
Other Defendants Involved in this Claim
Groble, MD, Robert
Orange Park Medical Center
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
7/20/2007
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$115,000
Loss Adjust Expense Paid to Defense Counsel$21,546
All Other Loss Adjustment Expense Paid$6,480
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Unknown
 
Updates
 
No updates found.

 

 

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Dr. Luis E Rios Medical Malpractice Lawsuits - Court Case # 01-673-CA-B

Indemnity Paid: $102,400.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201056273
Claim Number :99J14673PL
Date Submitted :2/1/2010
 
Insurer Information
 
Insurer NameCoverage Type
Univ of FL JHMHC/Jacksonville Self Insurance ProgPrimary
Insurer FEINProfessional License Number
59730209 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualDanelleHTowater
Street Address
3450 Hull Road, Ste 4358
CityStateZip
GainesvilleFL32611-2735
PhoneExtFaxE-Mail Address
(352) 273 - 7006 (352) 273 - 7287towatdt@shands.ufl.edu
 
Insured Information
 
TypeFirst NameMILast Name
IndividualLuisERios
Insurer TypeStreet Address of Practice
Self-Insurer655 W. 8th Street
CityStateZip CodeCounty
JacksonvilleFL32209Duval
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
UFBOT00J$200,000$8,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME55184Emergency Medicine - No Major Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MClay
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
ORANGE PARK MEDICAL CENTER100226
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
7/27/19995/21/2001
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Urosepsis
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Evaluation of patient with complaints of a five hour history of severe right flank pain, nausea, vomiting, and inability to urinate.
Diagnostic Code :995.91
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
Alleged failure to properly evaluate and admit patient and provide antibiotic therapy, resulting in adrenal gland hemorrage and death
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
9/21/200101-673-CA-B
County Suit Filed inDate of Final Disposition
Clay10/1/2004
Other Defendants Involved in this Claim
Orange Park Medical Center
Stage of Legal System at which Settlement was Reached or Award Made
After court verdict and prior to filing of notice of appeal.
Final Method of Claim Disposition
Disposed of by Court
Court DecisionOther
Judgment for the plaintiff. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
10/1/2004
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$102,400
Loss Adjust Expense Paid to Defense Counsel$86,265
All Other Loss Adjustment Expense Paid$67,417
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Assessment of treatment with involved physician
 
Updates
 
No updates found.

 

 

*NR:Prior to 04/28/1999 this field was not required in submitted claims.

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Dr. David A Caro Medical Malpractice Lawsuits - Court Case # 2000-635-CA

Indemnity Paid: $100,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201056263
Claim Number :98J12301PL
Date Submitted :2/1/2010
 
Insurer Information
 
Insurer NameCoverage Type
Univ of FL JHMHC/Jacksonville Self Insurance ProgPrimary
Insurer FEINProfessional License Number
59730209 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualDanelleHTowater
Street Address
3450 Hull Road, Ste 4358
CityStateZip
GainesvilleFL32611-2735
PhoneExtFaxE-Mail Address
(352) 273 - 7006 (352) 273 - 7287towatdt@shands.ufl.edu
 
Insured Information
 
TypeFirst NameMILast Name
IndividualDavidACaro
Insurer TypeStreet Address of Practice
Self-Insurer655 W 8th Street
CityStateZip CodeCounty
JacksonvilleFL32209Duval
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
UFBOT99J$200,000$7,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME73369Emergency Medicine - No Major Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MClay
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
ORANGE PARK MEDICAL CENTER100226
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
4/11/19991/5/2000
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Degenerative joint disease
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Evaluation of patient who had fallen, striking head and neck
Diagnostic Code :721.9
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to diagnose cervical spine fracture
Principal Injury Giving Rise To The Claim
Alleged failure to admit and obtain consult resulting in delay in diagnosis of cervical spine fracture and loss of upper extremity function
Severity Of Injury
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
8/23/20002000-635-CA
County Suit Filed inDate of Final Disposition
Clay8/5/2004
Other Defendants Involved in this Claim
Northeast Florida Neurosurgery, PA
Doctors Hurt, Isaac, Johnson & Cranford, PA
Lohse, Dean C
McInnis, Alexander N
Latour, Emile A
Orange Park Medical Center
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
8/5/2004
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$100,000
Loss Adjust Expense Paid to Defense Counsel$65,963
All Other Loss Adjustment Expense Paid$17,495
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Assessment of treatment with involved physician
 
Updates
 
No updates found.

 

 

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Dr. Annabelle Matias Medical Malpractice Lawsuits - Court Case # 09-CA-3398

Indemnity Paid: $87,500.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201059036
Claim Number :38663-02
Date Submitted :11/8/2010
 
Insurer Information
 
Insurer NameCoverage Type
FIRST PROFESSIONALS INSURANCE COMPANY, INCPrimary
Insurer FEINProfessional License Number
59-6614702 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualOdessa Choice
Street Address
1000 Riverside Avenue, Suite 800
CityStateZip
JacksonvilleFL32204
PhoneExtFaxE-Mail Address
(800) 741 - 37423045(904) 358 - 6728odessa.choice@fpic.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualAnnabelle Matias
Insurer TypeStreet Address of Practice
Licensed1689 Eagle Harbor Parkway, Ste A
CityStateZip CodeCounty
Orange ParkFL32003Clay
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
98758$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME87828Internal Medicine - No Surgery80257

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FClay
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
ORANGE PARK MEDICAL CENTER100226
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
9/10/20058/26/2009
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
The patient was being treated for a urinary tract infection with IV antibiotics and it was later determined that the patient had a malignant ovarian cyst.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
The patient was discharged to her primary care physician after having a positive CT scan of abdomen demonstrative of possible ovarian malignancy.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Failure to timely appreciate a positive CT scan of abdomen.
Principal Injury Giving Rise To The Claim
The patient experienced an approximate 22 month delay of ovarian cancer.
Severity Of Injury
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
1/19/201009-CA-3398
County Suit Filed inDate of Final Disposition
Clay10/15/2010
Other Defendants Involved in this Claim
Go, D.O., Benjamin
Middleburg Family Medical Center
Lionel Gatien, D.O., P.A.
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
10/15/2010
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$87,500
Loss Adjust Expense Paid to Defense Counsel$21,045
All Other Loss Adjustment Expense Paid$11,527
Injured Person's Total Non-Economic Loss$87,500
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Insurance company staff consulted with insured to discuss preventative measures. Risk management referral is made if appropriate.
 
Updates
 
No updates found.

 

 

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Dr. Teddy Garcia Medical Malpractice Lawsuits - Court Case # 10-2008-CA-0414

Indemnity Paid: $65,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200952616
Claim Number :1005057
Date Submitted :9/17/2010
 
Insurer Information
 
Insurer NameCoverage Type
FLORIDA MEDICAL MALPRACTICE JUAPrimary
Insurer FEINProfessional License Number
59-1625412 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualSUSAN SPIELMAN
Street Address
5814 Reed Street
CityStateZip
Fort WayneIN46835
PhoneExtFaxE-Mail Address
(260) 486 - 0340 (260) 486 - 0782SUSAN.SPIELMAN@MEDPRO.COM
 
Insured Information
 
TypeFirst NameMILast Name
IndividualTeddy Garcia
Insurer TypeStreet Address of Practice
Licensed784 Blanding Blvd, Ste 108
CityStateZip CodeCounty
Orange ParkFL32065Clay
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
FL003152$100,000$300,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME42972Family Physicians or General Practitioners - No Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FDuval
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Physician's Office 
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
  
Date of OccurrenceDate Reported to Insurer
11/6/200611/6/2007
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Removal of two tattoos; one over the sacrum and one on the left buttock area
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Surgical removal of tattoos
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Negligence in performance of surgery
Principal Injury Giving Rise To The Claim
Pain and suffering, scarring, need for additional treatment
Severity Of Injury
Permanent: Minor - Loss of fingers, loss or damage to organs.Includes non-disabling injuries.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
2/22/200810-2008-CA-0414
County Suit Filed inDate of Final Disposition
Clay2/13/2009
Other Defendants Involved in this Claim
Teddy Garcia MD 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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
2/13/2009
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$65,000
Loss Adjust Expense Paid to Defense Counsel$31,920
All Other Loss Adjustment Expense Paid$13,925
Injured Person's Total Non-Economic Loss$53,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
N/A
 
Updates
 
 
Date of Change:9/3/2009 11:01:04 AM
Reason for Change:Update ALE
 
Field ChangedFormer ValueNew Value
All Other Loss Adjustment Expense Paid568113923
Amount of Loss Adjustment Expense Paid to Defense Counsel1927331707
 
Date of Change:2/24/2010 4:04:36 PM
Reason for Change:Update ALE financial info
 
Field ChangedFormer ValueNew Value
Amount of Loss Adjustment Expense Paid to Defense Counsel3170731862
All Other Loss Adjustment Expense Paid1392313925
 
Date of Change:9/17/2010 4:17:06 PM
Reason for Change:ALE Update
 
Field ChangedFormer ValueNew Value
Amount of Loss Adjustment Expense Paid to Defense Counsel3186231920

 

 

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Dr. George Tellam Medical Malpractice Lawsuits - Court Case # 96-1795-CA

Indemnity Paid: $50,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200952279
Claim Number :GA-LPT-1941
Date Submitted :1/29/2009
 
Insurer Information
 
Insurer NameCoverage Type
CLARENDON NATIONAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
52-0266645 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualNancyJThomas
Street Address
9821 Katy Freeway
CityStateZip
HoustonTX77024
PhoneExtFaxE-Mail Address
(713) 935 - 8868 (713) 461 - 8130nancy_thomas@ajg.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualGeorge Tellam
Insurer TypeStreet Address of Practice
Licensed981 Kingsley Avenue
CityStateZip CodeCounty
Orange ParkFL32073Clay
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
GA-LPT-97$500,000$1,500,000
Profession or BusinessOther Profession or Business
Podiatric Physician 
License NumberSpecialty Code & ClassificationCertification Number
PO1636  

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MClay
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Other Outpatient FacilityOrange Park Surgery Center
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
3/3/19943/25/1996
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Patient underwent bunionectomies, first on left foot, and six weeks later on right foot.First surgey done utilized scarf bunionectomy.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
On second surgery, surgeon performed a base wedge osteotomy and double osteotomy at base of metatarsal.Consent form was signed allowing surgical judgment to be exercised by subject of this report.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Surgery technique related
Principal Injury Giving Rise To The Claim
Pain, infection, non-union, displacement developed post op to right great toe, which plaintiff alleges prevented him from returning to work.
Severity Of Injury
Permanent: Minor - Loss of fingers, loss or damage to organs.Includes non-disabling injuries.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
9/17/199696-1795-CA
County Suit Filed inDate of Final Disposition
Clay1/28/2009
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim subject to arbitration, but settlement reached in lieu of award.
Date of Payment
12/5/2008
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$50,000
Loss Adjust Expense Paid to Defense Counsel$65,064
All Other Loss Adjustment Expense Paid$23,762
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
UNKNOWN
 
Updates
 
No updates found.

 

 

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