Medical Malpractice Cases

Medical Malpractice Cases In Columbia County Florida

Dr. Robert B Pendrak Medical Malpractice Lawsuits - Court Case # 04-57-CA

Indemnity Paid: $1,000,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200433167
Claim Number :17533
Date Submitted :10/14/2004
 
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
IndividualRobertBPendrak
Insurer TypeStreet Address of Practice
Licensed3140 NW MEDICAL CENTER LN STE 110
CityStateZip CodeCounty
LAKE CITYFL32055-4735Columbia
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600677 00$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME85025Surgery - Abdominal211567768

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
LAKE CITY MEDICAL CENTER100156
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
7/24/20024/17/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Morbid obesity
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Roux-en-Y gastric bypass
Diagnostic Code :998.0
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to diagnose anastomotic leak
Principal Injury Giving Rise To The Claim
Liver disease
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
2/10/200404-57-CA
County Suit Filed inDate of Final Disposition
Columbia9/29/2004
Other Defendants Involved in this Claim
Lake City 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
9/29/2004
 
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$30,727
All Other Loss Adjustment Expense Paid$0
Injured Person's Total Non-Economic Loss$359,600
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$217,300$0
Wage Loss$16,000$372,000
Other Expenses$4,360$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk Management has counseled insured.
 
Updates
 
No updates found.

 

 

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Dr. Robert B Pendrak Medical Malpractice Lawsuits - Court Case # 03-207-CA

Indemnity Paid: $1,000,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200535439
Claim Number :16798
Date Submitted :11/8/2005
 
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
IndividualRobertBPendrak
Insurer TypeStreet Address of Practice
Licensed3140 NW MEDICAL CENTER LN
CityStateZip CodeCounty
LAKE CITYFL32055-4717Columbia
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600677 00$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME85025Surgery - Abdominal4102

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
LAKE CITY MEDICAL CENTER100156
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
7/5/200212/16/2002
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Abdominal pain due to adhesions
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Laparotomy with lysis of adhesion
Diagnostic Code :879.2
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to treat complication
Principal Injury Giving Rise To The Claim
Dehiscense of incision, infection, sepsis
Severity Of Injury
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
4/30/200303-207-CA
County Suit Filed inDate of Final Disposition
Columbia6/8/2005
Other Defendants Involved in this Claim
Lake City 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
5/6/2005
 
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$32,400
All Other Loss Adjustment Expense Paid$0
Injured Person's Total Non-Economic Loss$400,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$300,000$300,000
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:11/8/2005 2:02:29 PM
Reason for Change:Corrected final disposition date
 
Field ChangedFormer ValueNew Value
Date of Final Disposition06-MAY-0508-JUN-05

 

 

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Dr. Agustin Toruno Medical Malpractice Lawsuits - Court Case # 05-162-CA

Indemnity Paid: $900,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200537754
Claim Number :21234
Date Submitted :10/26/2005
 
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
IndividualAgustin Toruno
Insurer TypeStreet Address of Practice
LicensedPO Box 2913
CityStateZip CodeCounty
Lake CityFL32056Columbia
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600068 04$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME21988Anesthesiology68201

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
SHANDS AT LAKE SHORE100102
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
12/3/200312/10/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Abdominal pain
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Esophagogastroduodenoscopy (EGD)
Diagnostic Code :789.07
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to properly monitor and recognize change in status and timely institute corrective measures
Principal Injury Giving Rise To The Claim
Death from anoxic encephalopathy
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
4/21/200505-162-CA
County Suit Filed inDate of Final Disposition
Columbia9/12/2005
Other Defendants Involved in this Claim
Shands at Lake Shore
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
9/12/2005
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$900,000
Loss Adjust Expense Paid to Defense Counsel$6,038
All Other Loss Adjustment Expense Paid$1,510
Injured Person's Total Non-Economic Loss$900,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$48,827$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
 
No updates found.

 

 

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Dr. Donald L McCoy Medical Malpractice Lawsuits - Court Case # 07-329 CA

Indemnity Paid: $882,828.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201058415
Claim Number :SH-PHY-07-69264
Date Submitted :8/30/2010
 
Insurer Information
 
Insurer NameCoverage Type
LEXINGTON INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
25-1149494 
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
IndividualDonaldLMcCoy
Insurer TypeStreet Address of Practice
Licensed130 SW 7th Street
CityStateZip CodeCounty
Vero BeachFL32969Indian River
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
6794385$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Osteopathic Physician 
License NumberSpecialty Code & ClassificationCertification Number
OS5395Emergency Medicine - No Major Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
LAKE CITY MEDICAL CENTER100156
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
2/14/20065/30/2007
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Patient presented to ED 4 days postpartum with second pregnancy and with sudden onset of shortness of breath
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Patient was intubated and later given Labetalol.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
No misdiagnosis.Tests were in progress to determine the etiology of SOB.
Principal Injury Giving Rise To The Claim
Alleged delay in intubation in light of patient's decreasing oxygen sats.
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
8/13/200707-329 CA
County Suit Filed inDate of Final Disposition
Columbia8/27/2010
Other Defendants Involved in this Claim
Lake City 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 subject to arbitration, but settlement reached in lieu of award.
Date of Payment
4/6/2010
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$882,828
Loss Adjust Expense Paid to Defense Counsel$105,356
All Other Loss Adjustment Expense Paid$11,816
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. Robert B Pendrak Medical Malpractice Lawsuits - Court Case # 04-543-CA

Indemnity Paid: $650,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200639213
Claim Number :20066
Date Submitted :1/17/2006
 
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
IndividualRobertBPendrak
Insurer TypeStreet Address of Practice
Licensed3140 NW MEDICAL CENTER LN
CityStateZip CodeCounty
LAKE CITYFL32055-4717Columbia
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600677 01$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME85025Surgery - Abdominal4102

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
LAKE CITY MEDICAL CENTER100156
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
10/24/20035/25/2004
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Bowel obstruction
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Colon resection, temporary colostomy, and ilesotomy
Diagnostic Code :789.03
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged performance of inappropriate ileostomy procedure
Principal Injury Giving Rise To The Claim
Abdominal infection
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
12/15/200404-543-CA
County Suit Filed inDate of Final Disposition
Columbia12/6/2005
Other Defendants Involved in this Claim
Lake City Medical Center
Pendrak Surgical Group
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
12/14/2005
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$650,000
Loss Adjust Expense Paid to Defense Counsel$7,543
All Other Loss Adjustment Expense Paid$4,749
Injured Person's Total Non-Economic Loss$650,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$300,000$100,000
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
 
No updates found.

 

 

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Dr. PANKAJKUMAR Y PARIKH Medical Malpractice Lawsuits - Court Case # 05-292-CA

Indemnity Paid: $562,045.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200642437
Claim Number :21903/21904
Date Submitted :10/2/2006
 
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
IndividualPANKAJKUMARYPARIKH
Insurer TypeStreet Address of Practice
Licensed820 Prudential Drive Suite 713
CityStateZip CodeCounty
JacksonvilleFL32207Duval
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600109 05$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME61626Emergency Medicine - No Major Surgery49548

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
SHANDS AT LAKE SHORE100102
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
9/10/20044/14/2005
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Lower back pain
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
evaluation
Diagnostic Code :344.6
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to diagnose disc herniation and cauda equina syndrome
Principal Injury Giving Rise To The Claim
Disc herniation, cauda equina syndrome
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
7/21/200505-292-CA
County Suit Filed inDate of Final Disposition
Columbia8/31/2006
Other Defendants Involved in this Claim
Emergency Resources Group
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
9/25/2006
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$562,045
Loss Adjust Expense Paid to Defense Counsel$9,758
All Other Loss Adjustment Expense Paid$577
Injured Person's Total Non-Economic Loss$925,000
Deductible$362,955
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
 
No updates found.

 

 

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Dr. Keith G Chisholm Medical Malpractice Lawsuits - Court Case # 11-389 CA

Indemnity Paid: $500,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201265208
Claim Number :09G36750PL
Date Submitted :10/24/2012
 
Insurer Information
 
Insurer NameCoverage Type
Univ of FL JHMHC Self-Insurance ProgramPrimary
Insurer FEINProfessional License Number
59-600205 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualMerryCReid
Street Address
2124 NE Waldo Road, Suite 3100
CityStateZip
GainesvilleFL32609
PhoneExtFaxE-Mail Address
(352) 273 - 7006 (352) 273 - 5424REIDM@ufl.edu
 
Insured Information
 
TypeFirst NameMILast Name
IndividualKeithGChisholm
Insurer TypeStreet Address of Practice
Self-Insurer1600 S. W. Archer Road
CityStateZip CodeCounty
GainesvilleFL32610Alachua
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
UFBOT09G$2,000,000*NR
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME83998Surgery - General 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FAlachua
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
SHANDS AT LAKE SHORE100102
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
5/27/20101/24/2011
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Abdominal pain, nausea
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Gastrectomy
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
Afferent loop obstruction, sepsis, and temporary renal failure
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
8/29/201111-389 CA
County Suit Filed inDate of Final Disposition
Columbia3/26/2012
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
3/26/2012
 
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$13,934
All Other Loss Adjustment Expense Paid$7,439
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 physician
 
Updates
 
No updates found.

 

 

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

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Dr. Ernest P De Leon Medical Malpractice Lawsuits - Court Case # 07-373-CA

Indemnity Paid: $500,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200955522
Claim Number :25491
Date Submitted :1/12/2010
 
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
IndividualErnestPDe Leon
Insurer TypeStreet Address of Practice
Licensed4225 NW American Lane
CityStateZip CodeCounty
Lake CityFL32055Columbia
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600028 08$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME61518Family Physicians or General Practitioners - No Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Physician's Office 
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
4/22/20054/25/2007
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Kidney disease
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
No iatrogenic injury
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged delay in diagnosing kidney disease
Principal Injury Giving Rise To The Claim
Kidney disease
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
8/29/200707-373-CA
County Suit Filed inDate of Final Disposition
Columbia10/28/2009
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 not subject to Arbitration.
Date of Payment
9/24/2009
 
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$48,897
All Other Loss Adjustment Expense Paid$41,670
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$418,137$27,000,000
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:1/12/2010 11:53:43 AM
Reason for Change:Report updated to reflect Court Document final disposition date of 10/2/09
 
Field ChangedFormer ValueNew Value
Date of Final Disposition30-OCT-0928-OCT-09

 

 

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Dr. Robert B Pendrak Medical Malpractice Lawsuits - Court Case # 04-66-CA

Indemnity Paid: $495,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200535469
Claim Number :18439
Date Submitted :6/10/2005
 
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
IndividualRobertBPendrak
Insurer TypeStreet Address of Practice
Licensed3140 NW MEDICAL CENTER LN STE 110
CityStateZip CodeCounty
LAKE CITYFL32055-4735Columbia
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600677 01$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME85025Surgery - Abdominal4102

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
LAKE CITY MEDICAL CENTER100156
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
8/23/20029/12/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Acute cholecystitis and cholelithiasis
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Cholecystectomy
Diagnostic Code :577.1
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged negligence in performance of cholecystectomy
Principal Injury Giving Rise To The Claim
Death
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
2/17/200404-66-CA
County Suit Filed inDate of Final Disposition
Columbia6/7/2005
Other Defendants Involved in this Claim
Lake CIty 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
6/7/2005
 
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$16,719
All Other Loss Adjustment Expense Paid$0
Injured Person's Total Non-Economic Loss$495,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$150,000$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
 
No updates found.

 

 

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Dr. Dwight A Jacobus Medical Malpractice Lawsuits - Court Case # 07-369-CA

Indemnity Paid: $480,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201056218
Claim Number :04G26013PL
Date Submitted :2/1/2010
 
Insurer Information
 
Insurer NameCoverage Type
University of Florida JHMHC Self-Insurance ProgramPrimary
Insurer FEINProfessional License Number
59-600205 
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
IndividualDwightAJacobus
Insurer TypeStreet Address of Practice
Self-Insurer368 Franklin Street
CityStateZip CodeCounty
Lake CityFL32205Columbia
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
UFBOT04G$2,000,000*NR
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
OS8308Surgery - Orthopedic 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
SHANDS AT LAKE SHORE100102
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
12/1/20055/4/2007
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Rotator cuff tears
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Bilateral rotator cuff repair surgeries
Diagnostic Code :726.19
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to properly perform rotator cuff repair surgery
Principal Injury Giving Rise To The Claim
Permanent bilateral shoulder injuries
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
9/6/200707-369-CA
County Suit Filed inDate of Final Disposition
Columbia11/25/2008
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 not subject to Arbitration.
Date of Payment
11/25/2008
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$480,000
Loss Adjust Expense Paid to Defense Counsel$75,385
All Other Loss Adjustment Expense Paid$13,617
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 physician
 
Updates
 
No updates found.

 

 

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

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Dr. Dwight A Jacobus Medical Malpractice Lawsuits - Court Case # 04-187-CA

Indemnity Paid: $300,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200640261
Claim Number :19322
Date Submitted :4/13/2006
 
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
IndividualDwightAJacobus
Insurer TypeStreet Address of Practice
Licensed348 NE Methodist Terrace Suite 101
CityStateZip CodeCounty
Lake CityFL32055Columbia
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600271 02$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
OS8308Surgery - Orthopedic2878

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
LAKE CITY MEDICAL CENTER100156
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
10/11/20011/26/2004
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Posterior fracture dislocation of left humerus
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Reduction
Diagnostic Code :812.0
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to confirm dislocation was properly reduced
Principal Injury Giving Rise To The Claim
Limitation in range of motion
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
4/28/200404-187-CA
County Suit Filed inDate of Final Disposition
Columbia3/24/2006
Other Defendants Involved in this Claim
Jacobus Orthopaedic & Sports Medicine 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
3/30/2006
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$300,000
Loss Adjust Expense Paid to Defense Counsel$67,344
All Other Loss Adjustment Expense Paid$21,604
Injured Person's Total Non-Economic Loss$300,000
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
 
No updates found.

 

 

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Dr. Doroteo C Audije Medical Malpractice Lawsuits - Court Case # 06-266-CA

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200848720
Claim Number :142586
Date Submitted :11/19/2008
 
Insurer Information
 
Insurer NameCoverage Type
PROASSURANCE CASUALTY COMPANYPrimary
Insurer FEINProfessional License Number
38-2317569 
Insurer Contact Information
TypeEntity Name
EntityProNational Insurance Company
Street Address
13919 Carrollwood Village Run
CityStateZip
TampaFL33618-2746
PhoneExtFaxE-Mail Address
(813) 969 - 2010 (813) 969 - 2120SNorris@ProAssurance.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualDoroteoCAudije
Insurer TypeStreet Address of Practice
Licensed2086 SW Main Blvd., Suite 101
CityStateZip CodeCounty
Lake CityFL32025Columbia
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
MP35488$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME46066Cardiovascular Disease - No Surgery00000

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
LAKE CITY MEDICAL CENTER100156
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
1/12/20042/23/2006
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
CVA with left sided hemiparises.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
CT scan showed no acute abnormality, negative for bleed, EKG normal, blood work performed and patient was admitted for observation.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
No misdiagnosis.
Principal Injury Giving Rise To The Claim
Patient subsequently diagnosed with a stroke which resulted in left sided hemiparesis and memory loss.
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
9/5/200606-266-CA
County Suit Filed inDate of Final Disposition
Columbia2/5/2008
Other Defendants Involved in this Claim
Notami Hospital of Florida, Inc. d/b/a Lake City Medical Ctr
D.C. Audije, 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
4/18/2008
 
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$53,235
All Other Loss Adjustment Expense Paid$46,736
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:4/28/2008 10:03:27 AM
Reason for Change:Updated to report indemnity payment, as well as additional legal fees and costs paid.
 
Field ChangedFormer ValueNew Value
Injured Person Total Non-Economic Loss0250000
Amount of Loss Adjustment Expense Paid to Defense Counsel4713552260
Settlement Reached01
Indemnity Paid0250000
All Other Loss Adjustment Expense Paid3808942262
 
Date of Change:6/11/2008 11:14:44 AM
Reason for Change:Report updated to reflect additional legal fees and expenses paid.
 
Field ChangedFormer ValueNew Value
Amount of Loss Adjustment Expense Paid to Defense Counsel5226053040
All Other Loss Adjustment Expense Paid4226246723
 
Date of Change:11/19/2008 10:43:09 AM
Reason for Change:Report updated to reflect additional legal fees and expenses paid.
 
Field ChangedFormer ValueNew Value
All Other Loss Adjustment Expense Paid4672346736
Amount of Loss Adjustment Expense Paid to Defense Counsel5304053235

 

 

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Dr. Ghulam Dastgir Medical Malpractice Lawsuits - Court Case # 04-352-CA

Indemnity Paid: $200,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201471380
Claim Number :00730
Date Submitted :7/22/2014
 
Insurer Information
 
Insurer NameCoverage Type
Univ of FL JHMHC Self-Insurance ProgramPrimary
Insurer FEINProfessional License Number
59-600205 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualMerryCReid
Street Address
201 S. E. Second Avenue, Suite 208
CityStateZip
GainesvilleFL32601
PhoneExtFaxE-Mail Address
(352) 273 - 7006 (352) 273 - 5424REIDM@ufl.edu
 
Insured Information
 
TypeFirst NameMILast Name
IndividualGhulam Dastgir
Insurer TypeStreet Address of Practice
Self-Insurer1600 S. W. Archer Road
CityStateZip CodeCounty
GainesvilleFL32610Alachua
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
UFBOT02G$200,000*NR
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME25680Radiology - Diagnostic - No Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Outpatient Facility 
Name of InstitutionCode
SHANDS AT LAKE SHORE100102
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
8/21/20029/17/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Hematuria
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
CT interpretation
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Failure to identify abdominal mass
Principal Injury Giving Rise To The Claim
Death
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
9/17/200304-352-CA
County Suit Filed inDate of Final Disposition
Columbia7/1/2014
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
7/1/2014
 
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$399,958
All Other Loss Adjustment Expense Paid$145,886
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 physician
 
Updates
 
No updates found.

 

 

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

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Dr. SRINATH R KOSANAM Medical Malpractice Lawsuits - Court Case # 03-59-CA

Indemnity Paid: $200,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200639975
Claim Number :266250
Date Submitted :3/21/2006
 
Insurer Information
 
Insurer NameCoverage Type
MEDICAL PROTECTIVE COMPANY (THE)Primary
Insurer FEINProfessional License Number
35-0506406 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualKarinaLDobberstein
Street Address
5814 Reed Rd
CityStateZip
Fort WayneIN46835
PhoneExtFaxE-Mail Address
(260) 486 - 0490 (260) 486 - 0808karina.dobberstein@medpro.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualSRINATHRKOSANAM
Insurer TypeStreet Address of Practice
Licensed1037 W US HIGHWAY 90 STE 120
CityStateZip CodeCounty
LAKE CITYFL32055Columbia
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
652612$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME78339Internal Medicine - Minor Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MColumbia
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
2/28/20015/15/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
CRACKS ON BOTTOM OF FOOT
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
DIAGNOSIS
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
INADEQUATELY DIAGNOSE AND TREAT AN INFECTION
Principal Injury Giving Rise To The Claim
OSTEOMYLITIS BELOW KNEE 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
5/6/200303-59-CA
County Suit Filed inDate of Final Disposition
Columbia1/4/2006
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
1/4/2006
 
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$46,814
All Other Loss Adjustment Expense Paid$62,514
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
NA
 
Updates
 
No updates found.

 

 

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Dr. ERNEST P DE LEON Medical Malpractice Lawsuits - Court Case # 04-05-CA

Indemnity Paid: $200,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200643234
Claim Number :18311
Date Submitted :2/7/2007
 
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
IndividualERNESTPDE LEON
Insurer TypeStreet Address of Practice
Licensed6719 NW American Lane
CityStateZip CodeCounty
Lake CityFL32055Columbia
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600028 04$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME61518Family Physicians or General Practitioners - No Surgery74801

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Physician's Office 
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
6/15/20008/25/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Prostate cancer
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
No iatrogenic injury
Diagnostic Code :233.4
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to perform appropriate tests
Principal Injury Giving Rise To The Claim
Prostate 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
1/5/200404-05-CA
County Suit Filed inDate of Final Disposition
Columbia1/5/2007
Other Defendants Involved in this Claim
Larsen, PA-C, Marianne
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
11/15/2006
 
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$33,133
All Other Loss Adjustment Expense Paid$9,632
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
Risk Management has counseled insured
 
Updates
 
 
Date of Change:2/7/2007 1:01:42 PM
Reason for Change:Report updated to reflect Court Document final disposition date of 01/05/07
 
Field ChangedFormer ValueNew Value
Date of Final Disposition03-NOV-0605-JAN-07

 

 

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Dr. Jose Quintana Medical Malpractice Lawsuits - Court Case # 06-487-CA

Indemnity Paid: $175,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201160344
Claim Number :31319-01
Date Submitted :4/1/2011
 
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
IndividualJose Quintana
Insurer TypeStreet Address of Practice
Licensed1717 SW Newland Way
CityStateZip CodeCounty
Lake CityFL32025Columbia
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
46929$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME64594Surgery - Gynecology80167

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
LAKE CITY MEDICAL CENTER100156
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
2/20/20048/24/2004
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Right adnexal mass, pelvic pain.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Diagnostic laparoscopy converted to exploratory laparotomy with lysis of adhesions and right salpingo-oophorectomy.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Post operatively, the patient developed a bowel perforation.
Principal Injury Giving Rise To The Claim
Bowel injury requiring surgical repair and temporary colostomy.
Severity Of Injury
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
12/28/200606-487-CA
County Suit Filed inDate of Final Disposition
Columbia3/14/2011
Other Defendants Involved in this Claim
Lake City Hospital
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
3/14/2011
 
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$19,519
All Other Loss Adjustment Expense Paid$14,986
Injured Person's Total Non-Economic Loss$175,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$105,000$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. FREEMAN KAMURU Medical Malpractice Lawsuits - Court Case # xxxxxx1

Indemnity Paid: $150,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201369215
Claim Number :EMC-FL-11-154599
Date Submitted :12/17/2013
 
Insurer Information
 
Insurer NameCoverage Type
CONTINENTAL CASUALTY COMPANYPrimary
Insurer FEINProfessional License Number
36-2114545 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualKathyAStockton
Street Address
9821 Katy Freeway
CityStateZip
HoustonTX77024
PhoneExtFaxE-Mail Address
(713) 935 - 2404 (713) 461 - 8130kathy_stockton@westernlitigation.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualFREEMAN KAMURU
Insurer TypeStreet Address of Practice
Licensed1228 N.E. 13TH STREET
CityStateZip CodeCounty
GAINESVILLEFL32601Alachua
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
HAZ1040025381-9$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME106776Internal Medicine - No Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
LAKE CITY MEDICAL CENTER100156
Location of Institutional InjuryOther Location of Institutional Injury
Critical Care Unit 
Date of OccurrenceDate Reported to Insurer
11/16/20107/13/2011
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Flr to tx pulmonary condition r/i aspirating pneumonia
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Flr to tx pulmonary condition r/i aspirating pneumonia
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Flr to tx pulmonary condition r/i aspirating pneumonia
Principal Injury Giving Rise To The Claim
Flr to tx pulmonary condition r/i aspirating pneumonia
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
7/18/2012xxxxxx1
County Suit Filed inDate of Final Disposition
Columbia11/13/2013
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
5/7/2013
 
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$20,118
All Other Loss Adjustment Expense Paid$7,026
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. DONALD MCCOY Medical Malpractice Lawsuits - Court Case # 12-381CA

Indemnity Paid: $150,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201469602
Claim Number :EMC-FL-11-114631
Date Submitted :1/31/2014
 
Insurer Information
 
Insurer NameCoverage Type
COLUMBIA CASUALTY COMPANYPrimary
Insurer FEINProfessional License Number
47-0490411 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualKathyAStockton
Street Address
9821 Katy Freeway
CityStateZip
HoustonTX77024
PhoneExtFaxE-Mail Address
(713) 935 - 2404 (713) 461 - 8130kathy_stockton@westernlitigation.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualDONALD MCCOY
Insurer TypeStreet Address of Practice
Licensed1130 SW 7TH STREET
CityStateZip CodeCounty
VERO BEACHFL32969Indian River
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
HAZ1040025381-9$250,000$750,000
Profession or BusinessOther Profession or Business
Osteopathic Physician 
License NumberSpecialty Code & ClassificationCertification Number
OS5395Internal Medicine - Minor Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
LAKE CITY MEDICAL CENTER100156
Location of Institutional InjuryOther Location of Institutional Injury
Critical Care Unit 
Date of OccurrenceDate Reported to Insurer
11/16/20107/13/2011
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
FAILURE TO TREAT PULMONARY CONDITION R/I ASPIRATING PNEUMONIA
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
FAILURE TO TREAT PULMONARY CONDITION R/I ASPIRATING PNEUMONIA
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
FAILURE TO TREAT PULMONARY CONDITION R/I ASPIRATING PNEUMONIA
Principal Injury Giving Rise To The Claim
FAILURE TO TREAT PULMONARY CONDITION R/I ASPIRATING PNEUMONIA
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
7/18/201212-381CA
County Suit Filed inDate of Final Disposition
Columbia12/23/2013
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
5/7/2013
 
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$39,847
All Other Loss Adjustment Expense Paid$16,115
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. Steven P Holliman Medical Malpractice Lawsuits - Court Case # 07-196-CA

Indemnity Paid: $125,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201057369
Claim Number :04G21085PL
Date Submitted :5/20/2010
 
Insurer Information
 
Insurer NameCoverage Type
University of Florida JHMHC Self-Insurance ProgramPrimary
Insurer FEINProfessional License Number
59-600205 
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
IndividualStevenPHolliman
Insurer TypeStreet Address of Practice
Self-Insurer1100 SW 11th Street
CityStateZip CodeCounty
Live OakFL32064Suwannee
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
UFBOT04G$2,000,000*NR
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME51227Emergency Medicine - No Major Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MSuwannee
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
SHANDS AT LIVE OAK (SUWANNEE)100146
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
8/8/20048/12/2004
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Epigastric pain
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Evaluation for complaints of epigastric pain
Diagnostic Code :789.0
Misdiagnosis Made, If Any, Of Patient's Actual Condition
pATIENT WITH CARDIAC ARRHYTHMIA WAS DIAGNOSED WITH GERD
Principal Injury Giving Rise To The Claim
Failure to diagnose and treat CARDIAC ARRHYTHMIA RESULTING IN DEATH
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
5/23/200707-196-CA
County Suit Filed inDate of Final Disposition
Columbia4/22/2010
Other Defendants Involved in this Claim
Waseem, Zahoor A
Shands at Live Oak
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
4/22/2010
 
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$61,382
All Other Loss Adjustment Expense Paid$54,245
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 physician
 
Updates
 
No updates found.

 

 

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

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Dr. Joseph M Charles Medical Malpractice Lawsuits - Court Case # 04-122-CA

Indemnity Paid: $125,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200538457
Claim Number :18582
Date Submitted :11/29/2005
 
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
IndividualJosephMCharles
Insurer TypeStreet Address of Practice
Licensed560 E FRANKLIN ST
CityStateZip CodeCounty
LAKE CITYFL32055-3000Columbia
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600457 01$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME82558Surgery - Obstetrics - Gynecology2512

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
SHANDS AT LAKE SHORE100102
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
6/17/20029/15/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Abnormal uterine bleeding
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Diagnostic laparoscopy with hyteroscopy
Diagnostic Code :626.9
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to perform procedure appropriately
Principal Injury Giving Rise To The Claim
Perforation of small bowel
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
3/11/200404-122-CA
County Suit Filed inDate of Final Disposition
Columbia11/15/2005
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
11/15/2005
 
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$13,000
All Other Loss Adjustment Expense Paid$5,730
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
Risk Management has counseled insured
 
Updates
 
No updates found.

 

 

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Dr. Daina P Greene Medical Malpractice Lawsuits - Court Case # 10-734-CA

Indemnity Paid: $113,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201263919
Claim Number :072562
Date Submitted :5/20/2012
 
Insurer Information
 
Insurer NameCoverage Type
TDC SPECIALTY INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
95-4241120 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualSallyLCleaver
Street Address
1888 Century Park East, Suite 850
CityStateZip
Los AngelesCA90067
PhoneExtFaxE-Mail Address
(310) 492 - 4923 (866) 344 - 6029scleaver@thedoctors.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualDainaPGreene
Insurer TypeStreet Address of Practice
Licensed694 N.W. Savannah Circle
CityStateZip CodeCounty
Lake CityFL32055Columbia
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
P94934-11$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME95384Surgery - Obstetrics - Gynecology 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
SHANDS HOSPITAL100113
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
8/31/20097/21/2010
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Plaintiff is an obese (250+lbs) female with history of extensive scar tissue on bowels who presented to ER on 8/31/09 for right, lower quadrant pain. Ultrasound taken revealed hemoperitoneum with right ruptured ectopic pregnancy (6 wks gestation). Insured was called for consult.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Following exam, plaintiff was admitted to hospital and underwent exploratory laparotomy & right salpingectomy with insured that day. Once entered, the peritoneum was obvious for hemoperitoneum. An ectopic was also obvious, & the right tube was excised. Adhesions of small bowel to anterior peritoneum & umbilical hernia noted. Due to adhesions, peritoneum was not closed and plaintiff went to recovery in excellent condition.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
Contamination in her abdomen and developed a necrotizing soft tissue infection which lead to a prolonged hospital stay and subsequent surgery at Shands Hospital, during which the necrotic tissue was removed by another physician and plaintiff¿s abdominal wall was reconstructed with mesh.
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
11/16/201010-734-CA
County Suit Filed inDate of Final Disposition
Columbia4/20/2012
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
4/20/2012
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$113,000
Loss Adjust Expense Paid to Defense Counsel$76,653
All Other Loss Adjustment Expense Paid$23,956
Injured Person's Total Non-Economic Loss$0
Deductible$10,000
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$37,906$0
Wage Loss$6,500$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Insured received positive expert support and only settled as a business decision.
 
Updates
 
No updates found.

 

 

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

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Dr. Bienvenido M Samera Medical Malpractice Lawsuits - Court Case # 10-573CA

Indemnity Paid: $100,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201367189
Claim Number :33702
Date Submitted :5/16/2013
 
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
OrlandoFL38219
PhoneExtFaxE-Mail Address
(407) 370 - 3813 (407) 370 - 2247ctschanz@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualBienvenidoMSamera
Insurer TypeStreet Address of Practice
LicensedPO Box 846
CityStateZip CodeCounty
BranfordFL32008Suwannee
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600556 08$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME28682Family Physicians or General Practitioners - No Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
LAKE CITY MEDICAL CENTER100156
Location of Institutional InjuryOther Location of Institutional Injury
Critical Care Unit 
Date of OccurrenceDate Reported to Insurer
10/4/20084/20/2010
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
C-diff colitis
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
No iatrogenic injury
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to appropriately manage fluids
Principal Injury Giving Rise To The Claim
Death
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
8/30/201010-573CA
County Suit Filed inDate of Final Disposition
Columbia5/1/2013
Other Defendants Involved in this Claim
Lake City Medical Center
Duarte, MD, Diogenes F
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
5/1/2013
 
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$113,207
All Other Loss Adjustment Expense Paid$29,452
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$100,000$0
Wage Loss$0$0
Other Expenses$5,000$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk Management has counseled insured
 
Updates
 
No updates found.

 

 

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Dr. Dwight A Jacobus Medical Malpractice Lawsuits - Court Case # 01-04-36-CA

Indemnity Paid: $100,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200537755
Claim Number :18885
Date Submitted :10/26/2005
 
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
IndividualDwightAJacobus
Insurer TypeStreet Address of Practice
Licensed348 NE Methodist Terrace Suite 101
CityStateZip CodeCounty
Lake CityFL32055Columbia
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600271 02$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
OS8308Surgery - Orthopedic2878

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Physician's Office 
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
9/10/200110/23/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Fracture of distal right radius
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Long arm fiberglass cast
Diagnostic Code :814.0
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to properly treat right arm injury
Principal Injury Giving Rise To The Claim
Dorsal angulation
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
1/24/200401-04-36-CA
County Suit Filed inDate of Final Disposition
Columbia10/14/2005
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
10/14/2005
 
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$16,280
All Other Loss Adjustment Expense Paid$4,070
Injured Person's Total Non-Economic Loss$100,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$20,361$0
Wage Loss$18,926$8,652
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk Management has counseled insured
 
Updates
 
No updates found.

 

 

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Dr. Robert G Busch Medical Malpractice Lawsuits - Court Case # 03-354-CA

Indemnity Paid: $100,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200642863
Claim Number :17520
Date Submitted :12/8/2006
 
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
IndividualRobertGBusch
Insurer TypeStreet Address of Practice
Licensed6721 US Highway 90W
CityStateZip CodeCounty
Lake CityFL32055Columbia
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600475 01$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
OS7006Surgery - Urological3375

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
LAKE CITY MEDICAL CENTER100156
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
1/9/20028/7/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Testicular cancer
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Retroperitoneal lymph node dissection
Diagnostic Code :353.0
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to appropriately perform surgery
Principal Injury Giving Rise To The Claim
Brachial plexus injury
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
7/23/200303-354-CA
County Suit Filed inDate of Final Disposition
Columbia11/21/2006
Other Defendants Involved in this Claim
Cusamano MD, Charles R
Schilling MD, PaulJ
Lake City 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
10/16/2006
 
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$36,068
All Other Loss Adjustment Expense Paid$38,161
Injured Person's Total Non-Economic Loss$100,000
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:12/8/2006 8:33:40 AM
Reason for Change:Report updated to reflect Court document final disposition date of 11/21/06.
 
Field ChangedFormer ValueNew Value
Date of Final Disposition02-OCT-0621-NOV-06

 

 

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Dr. Paul J Schilling Medical Malpractice Lawsuits - Court Case # 03-354-CA

Indemnity Paid: $100,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200642864
Claim Number :18203
Date Submitted :10/24/2006
 
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
IndividualPaulJSchilling
Insurer TypeStreet Address of Practice
Licensed2828 NW 142 Avenue
CityStateZip CodeCounty
GainesvilleFL32609Alachua
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600638 01$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME64027Radiology - therapeutic - minor surgery4804

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MColumbia
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
LAKE CITY MEDICAL CENTER100156
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
1/9/20028/7/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Testicular cancer
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Retroperitoneal lymph node dissection
Diagnostic Code :353.0
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to appropriately perform surgery
Principal Injury Giving Rise To The Claim
Brachial plexus injury
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
7/23/200303-354-CA
County Suit Filed inDate of Final Disposition
Columbia10/2/2006
Other Defendants Involved in this Claim
Cusamano MD, Charles L
Busch DO, Robert G
Lake City 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
10/16/2006
 
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$83,644
All Other Loss Adjustment Expense Paid$20,088
Injured Person's Total Non-Economic Loss$100,000
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
 
No updates found.

 

 

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