Medical Malpractice Cases

Medical Malpractice Cases In St. Johns County Florida

Dr. BARBARA CHASE MCKINNEY Medical Malpractice Lawsuits - Court Case # 16-2000 CA 002671

Indemnity Paid: $750,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200955092
Claim Number :34925-01
Date Submitted :10/8/2009
 
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
IndividualBARBARA CHASE MCKINNEY
Insurer TypeStreet Address of Practice
Licensed1350 13th Avenue South
CityStateZip CodeCounty
Jacksonville BeachFL32250St. Johns
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
67619$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME67010Family Physicians or General Practitioners - Minor Surgery80143

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MSt. Johns
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
1/1/200311/15/2006
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Nasal pharyngeal invasive carcinoma.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Insured read pathological specimens submitted by surgeon.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Insured misread pathology submitted by surgeon.
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
4/11/200716-2000 CA 002671
County Suit Filed inDate of Final Disposition
St. Johns9/18/2009
Other Defendants Involved in this Claim
Ioannides, M.D., Kryakos
O'Laughlin, M.D., Sabine
Sandler, M.D., E D
Baptist Medical Center-Beaches & Downtown
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
9/18/2009
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$750,000
Loss Adjust Expense Paid to Defense Counsel$30,966
All Other Loss Adjustment Expense Paid$20,797
Injured Person's Total Non-Economic Loss$750,000
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. Pachavit Kasemsap Medical Malpractice Lawsuits - Court Case # CA-08-1352

Indemnity Paid: $637,963.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201264454
Claim Number :258698
Date Submitted :7/31/2012
 
Insurer Information
 
Insurer NameCoverage Type
DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE)Primary
Insurer FEINProfessional License Number
95-3014772 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualAngela LaFrance
Street Address
13450 W. Sunrise Blvd., Suite 160
CityStateZip
SunriseFL33323
PhoneExtFaxE-Mail Address
(954) 838 - 9988 (866) 636 - 5421alafrance@thedoctors.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualPachavit Kasemsap
Insurer TypeStreet Address of Practice
Licensed2825 North State Road 7, Suite 300
CityStateZip CodeCounty
MargateFL33063Broward
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
345372$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME87867Surgery - General 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FSt. Johns
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FLAGLER HOSPITAL100090
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
12/28/20062/14/2008
 
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
Laparoscopic cholecystectomy with intra-operative cholangiogram.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
Alleged transection of the patient's common duct and hepatic artery.
Severity Of Injury
Temporary: Slight - Lacerations, contusions, minor scars, rash.No delay.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
7/8/2008CA-08-1352
County Suit Filed inDate of Final Disposition
St. Johns7/27/2012
Other Defendants Involved in this Claim
Surgical Associates of North Florida, LLC
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
Settled by parties
Court DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
 
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$637,963
Loss Adjust Expense Paid to Defense Counsel$180,000
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$100,000$0
Wage Loss$0$0
Other Expenses$137,963$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. Brett W Cutler Medical Malpractice Lawsuits - Court Case # CA02-2666

Indemnity Paid: $500,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200850702
Claim Number :6301-01
Date Submitted :9/2/2008
 
Insurer Information
 
Insurer NameCoverage Type
PODIATRY INSURANCE COMPANY OF AMERICAPrimary
Insurer FEINProfessional License Number
58-1403235 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualKaren Kessler
Street Address
110 Westwood Place
CityStateZip
BrentwoodTN37027
PhoneExtFaxE-Mail Address
(615) 371 - 87762249 kkessler@picagroup.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualBrettWCutler
Insurer TypeStreet Address of Practice
Licensed105 Southpark Blvd.
CityStateZip CodeCounty
St. AugustineFL32086St. Johns
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
1-6596$500,000$1,500,000
Profession or BusinessOther Profession or Business
Podiatric Physician 
License NumberSpecialty Code & ClassificationCertification Number
PO2940  

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FSt. Johns
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
3/27/20029/7/2002
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Left heel pain
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
X-ray of left heel
Diagnostic Code :726.71
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
This is not a claim for malpractice.While getting an x-ray of the heel and repositioning her foot, the patient apparently lost her balance and fell.It appears that insured acted properly, notifying EMS, evaluating patient?s vitals, checking for obvious injury and keeping the patient mostly still until the arrival of EMS, at which time patient had no complaints other than some mild back tenderness and refused treatment.She was sent for an MRI, which shows she had a mild fracture that may have been a pathologic fracture from osteoporosis.Our expert questioned the nature of the injury and is of the opinion that patient and her husband were looking for gain.
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
12/16/2002CA02-2666
County Suit Filed inDate of Final Disposition
St. Johns8/20/2008
Other Defendants Involved in this Claim
PEARCE, BETH S
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
8/21/2008
 
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$50,615
All Other Loss Adjustment Expense Paid$5,751
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 - specialty code #80993
 
Updates
 
No updates found.

 

 

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

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Dr. Derek d Muehrcke Medical Malpractice Lawsuits - Court Case # 08-CA-858

Indemnity Paid: $400,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200850375
Claim Number :25795/26616
Date Submitted :8/4/2008
 
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
IndividualDerekdMuehrcke
Insurer TypeStreet Address of Practice
Licensed1820 Barrs Street, Suite 701
CityStateZip CodeCounty
JacksonvilleFL32204Duval
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600689 06$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME70163Surgery - Cardiac1601

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MFlagler
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FLAGLER HOSPITAL100090
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
6/26/20076/28/2007
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Coronary artery disease
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Left carotid endarterectomy
Diagnostic Code :429.2
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to perform surgery on correct side
Principal Injury Giving Rise To The Claim
Wrong side surgery
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
4/18/200808-CA-858
County Suit Filed inDate of Final Disposition
St. Johns7/23/2008
Other Defendants Involved in this Claim
Cardiothoracic and Vascular Surgical Assoc.
Stage of Legal System at which Settlement was Reached or Award Made
Within 90 days of suit being filed.
Final Method of Claim Disposition
Settled by parties
Court DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
7/11/2008
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$400,000
Loss Adjust Expense Paid to Defense Counsel$4,194
All Other Loss Adjustment Expense Paid$7,030
Injured Person's Total Non-Economic Loss$400,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$1,000$0
Wage Loss$20,800$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. Marc A Warmuth Medical Malpractice Lawsuits - Court Case # CA06-40

Indemnity Paid: $400,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200747776
Claim Number :21597
Date Submitted :1/30/2008
 
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
IndividualMarcAWarmuth
Insurer TypeStreet Address of Practice
Licensed67 South Dixie Highway
CityStateZip CodeCounty
St. AugustineFL32174Volusia
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600149 03$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME73421Neoplastic Diseases - No Surgery4814

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FVolusia
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
7/28/200310/10/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Breast Cancer
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Administration of chemotherapy
Diagnostic Code :233.0
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to recognize unresolved medical contraindications
Principal Injury Giving Rise To The Claim
ARDS
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
2/2/2006CA06-40
County Suit Filed inDate of Final Disposition
St. Johns12/14/2007
Other Defendants Involved in this Claim
North Florida Cancer 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
11/28/2007
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$400,000
Loss Adjust Expense Paid to Defense Counsel$31,195
All Other Loss Adjustment Expense Paid$25,078
Injured Person's Total Non-Economic Loss$400,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$10,000$0
Wage Loss$0$0
Other Expenses$16,525$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
 
Date of Change:1/30/2008 12:21:52 PM
Reason for Change:Report updated to reflect Court Document final disposition date of 12/14/07
 
Field ChangedFormer ValueNew Value
Date of Final Disposition14-NOV-0714-DEC-07

 

 

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Dr. Richard Caputo Medical Malpractice Lawsuits - Court Case # CA-2013-0851

Indemnity Paid: $350,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201469582
Claim Number :FP4374301
Date Submitted :1/30/2014
 
Insurer Information
 
Insurer NameCoverage Type
FIRST PROFESSIONALS INSURANCE COMPANY, INCPrimary
Insurer FEINProfessional License Number
59-6614702 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualKelly Andrews
Street Address
1000 Riverside Avenue, Suite 800
CityStateZip
JacksonvilleFL32204
PhoneExtFaxE-Mail Address
(904) 360 - 3038  kandrews@thedoctors.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualRichard Caputo
Insurer TypeStreet Address of Practice
Licensed301 Health Park Blvd., Suite 214
CityStateZip CodeCounty
St. AugustineFL32086St. Johns
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
IN009562$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME26849Nephrology - Minor Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MSt. Johns
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FLAGLER HOSPITAL100090
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
7/9/201111/6/2012
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
ESRD patient presented to ED with chest pain.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Nephrology Consultation.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Disputed allegations of failing to timely diagnose and treat the patients underlying sepsis and pericardial effusion.
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
5/31/2013CA-2013-0851
County Suit Filed inDate of Final Disposition
St. Johns1/23/2014
Other Defendants Involved in this Claim
Flagler Hospital
Kiekover, Brian
Mesri, Janet
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
 
 
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$18,697
All Other Loss Adjustment Expense Paid$7,889
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
Insurance company staff consulted with insured to discuss preventative measures.Patient Safety referral is made if appropriate.
 
Updates
 
No updates found.

 

 

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Dr. Krishna M Sikaria Medical Malpractice Lawsuits - Court Case # CA12-2388

Indemnity Paid: $300,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201573692
Claim Number : 42174
Date Submitted : 3/6/2015
 
Insurer Information
 
Insurer Name Coverage Type
MAG MUTUAL INSURANCE COMPANY Primary
Insurer FEIN Professional License Number
58-1449198  
Insurer Contact Information
Type Entity Name
Entity MAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
City State Zip
Orlando FL 32819
Phone Ext Fax E-Mail Address
(407) 370 - 3813   (407) 370 - 2247 ctschanz@magmutual.com
 
Insured Information
 
Type First Name MI Last Name
Individual Krishna M Sikaria
Insurer Type Street Address of Practice
Licensed 301 Health Park Blvd., Ste. 329
City State Zip Code County
Saint Augustine FL 32086 St. Johns
Policy Number Per Claim Policy Limits Aggregate Policy Limits
PSL 1600759 10 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME64435 Cardiovascular Disease - Minor Surgery  

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First Name MI Last Name Date of Birth
       
Street Address Gender County where Injury Occurred
  F Flagler
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Inpatient Facility  
Name of Institution Code
FLAGLER HOSPITAL 100219
Location of Institutional Injury Other Location of Institutional Injury
Patients' Room  
Date of Occurrence Date Reported to Insurer
4/14/2011 6/14/2012
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Nausea, vomiting, and severe abdominal pain; UTI'; history of cardiomyopathy
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 refer patient to tertiary care center for heart transplantation
Principal Injury Giving Rise To The Claim
Respiratory arrest and hypotension
Severity Of Injury
Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
12/6/2012 CA12-2388
County Suit Filed in Date of Final Disposition
St. Johns 2/27/2015
Other Defendants Involved in this Claim
Amin, MD, Mohammad B
Smith, MD, Mark A
Flagler Hospital
JH Gatewood Emergency Services
Emcare
Heart Center of St. Augustine
Stage of Legal System at which Settlement was Reached or Award Made
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference.
Final Method of Claim Disposition
Settled by parties
Court Decision Other
No Court Proceedings.  
Arbitration
Claim not subject to Arbitration.
Date of Payment
2/27/2015
 
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 $78,978
All Other Loss Adjustment Expense Paid $19,741
Injured Person's Total Non-Economic Loss $0
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $0 $0
Wage Loss $0 $0
Other Expenses $0 $922,927
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. James Grimes Medical Malpractice Lawsuits - Court Case # CA14-256

Indemnity Paid: $250,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201472714
Claim Number : 13-12-70271-A
Date Submitted : 11/19/2014
 
Insurer Information
 
Insurer Name Coverage Type
MEDMAL DIRECT INSURANCE COMPANY Primary
Insurer FEIN Professional License Number
27-2813188  
Insurer Contact Information
Type First Name MI Last Name
Individual William S Bliss
Street Address
245 Riverside Avenue
City State Zip
Jacksonville FL 32202
Phone Ext Fax E-Mail Address
(904) 482 - 4068   (904) 354 - 4813 saunders@mymedmal.com
 
Insured Information
 
Type First Name MI Last Name
Individual James   Grimes
Insurer Type Street Address of Practice
Licensed One Orthopedic Place
City State Zip Code County
St. Augustine FL 32086 St. Johns
Policy Number Per Claim Policy Limits Aggregate Policy Limits
FL707111 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME68197 Surgery - Orthopedic  

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First Name MI Last Name Date of Birth
       
Street Address Gender County where Injury Occurred
  M St. Johns
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Inpatient Facility  
Name of Institution Code
FLAGLER HOSPITAL 100090
Location of Institutional Injury Other Location of Institutional Injury
Operating Suite  
Date of Occurrence Date Reported to Insurer
3/13/2012 12/2/2013
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Knee replacement.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Knee replacement.
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to treat MRSA infection.
Principal Injury Giving Rise To The Claim
MRSA infection.
Severity Of Injury
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
4/21/2014 CA14-256
County Suit Filed in Date of Final Disposition
St. Johns 10/21/2014
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 Decision Other
No Court Proceedings.  
Arbitration
Claim not subject to Arbitration.
Date of Payment
10/21/2014
 
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 $35,575
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 Date Anticipated
Medical Expense $0 $0
Wage Loss $0 $0
Other Expenses $0 $0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Company personnel consulted with insured.
 
Updates
 
No updates found.

 

 

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Dr. THOMAS OSBORNE Medical Malpractice Lawsuits - Court Case # CA-12-1002-55

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201367600
Claim Number :VRP-11-169505
Date Submitted :7/2/2013
 
Insurer Information
 
Insurer NameCoverage Type
VIRTUAL RADIOLOGIC SERVICES AKA NIGHTHAWKPrimary
Insurer FEINProfessional License Number
27-007453 
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
IndividualTHOMAS OSBORNE
Insurer TypeStreet Address of Practice
Self-Insurer11995 SINGLETREE LANE, SUITE 500
CityStateZip CodeCounty
EDEN PRAIRIEMN55344Out of state
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
C111325$1,000,000$4,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME105251Radiology - Diagnostic - Minor Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MFlagler
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
FLAGLER HOSPITAL100090
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
3/20/20111/9/2012
 
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
CT OF THE ABDOMEN AND PELVIS
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
ENTERITIS
Principal Injury Giving Rise To The Claim
BOWEL PERFORATION AND DEATH
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
5/11/2012CA-12-1002-55
County Suit Filed inDate of Final Disposition
St. Johns6/4/2013
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
9/18/2012
 
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$14,804
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
UNKNOWN
 
Updates
 
No updates found.

 

 

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Dr. MAJDI ASHCHI Medical Malpractice Lawsuits - Court Case # CA16-0962

Indemnity Paid: $250,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201884185
Claim Number : 57656
Date Submitted : 1/26/2018
 
Insurer Information
 
Insurer Name Coverage Type
MAG MUTUAL INSURANCE COMPANY Primary
Insurer FEIN Professional License Number
58-1449198  
Insurer Contact Information
Type Entity Name
Entity MAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
City State Zip
Orlando FL 32819
Phone Ext Fax E-Mail Address
(407) 370 - 3813   (404) 842 - 3319 ctschanz@magmutual.com
 
Insured Information
 
Type First Name MI Last Name
Individual MAJDI   ASHCHI
Insurer Type Street Address of Practice
Licensed 3900 University Blvd. S. Ste. A
City State Zip Code County
Jacksonville FL 32216 Duval
Policy Number Per Claim Policy Limits Aggregate Policy Limits
PSL 1603304 00 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Osteopathic Physician  
License Number Specialty Code & Classification Certification Number
OS5911 Cardiovascular Disease - Minor Surgery  

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First Name MI Last Name Date of Birth
       
Street Address Gender County where Injury Occurred
  F St. Johns
City State Zip Code
     
Location where injury occured Other location where injury occured
Physician's Office  
Name of Institution Code
   
Location of Institutional Injury Other Location of Institutional Injury
Special Procedure Room  
Date of Occurrence Date Reported to Insurer
2/7/2015 5/12/2016
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Varicose veins
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Ablation procedure
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to properly perform procedure
Principal Injury Giving Rise To The Claim
Burns to right leg
Severity Of Injury
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
9/14/2016 CA16-0962
County Suit Filed in Date of Final Disposition
St. Johns 1/2/2018
Other Defendants Involved in this Claim
First Coast Heart & Vascular 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 Decision Other
No Court Proceedings.  
Arbitration
Claim not subject to Arbitration.
Date of Payment
1/2/2018
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $250,000
Loss Adjust Expense Paid to Defense Counsel $102,810
All Other Loss Adjustment Expense Paid $11,697
Injured Person's Total Non-Economic Loss $0
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $58,456 $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. Don D Weiffenbach Medical Malpractice Lawsuits - Court Case # CA-00-1889

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200432394
Claim Number :11494
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
IndividualDonDWeiffenbach
Insurer TypeStreet Address of Practice
Licensed430 Oak Cove Road
CityStateZip CodeCounty
TitusvilleFL32780St. Johns
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 0105131 00$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME10846Emergency Medicine - No Major Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MFlagler
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
FLAGLER HOSPITAL100090
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
7/3/19981/25/1999
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Pulmonary embolus
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Emergency medicine evaluation
Diagnostic Code :415.1
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to timely diagnose PE
Principal Injury Giving Rise To The Claim
Pulmonary embolus
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
12/7/2000CA-00-1889
County Suit Filed inDate of Final Disposition
St. Johns7/16/2004
Other Defendants Involved in this Claim
Grobelny, MD, Mark
Emergency Physicians, Inc.
Flagler 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
8/4/2004
 
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$4,187
All Other Loss Adjustment Expense Paid$3,607
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$10,534$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:11/9/2005 9:16:34 AM
Reason for Change:Corrected various fields pursuant to State audit
 
Field ChangedFormer ValueNew Value
All Other Loss Adjustment Expense Paid03607
Amount of Loss Adjustment Expense Paid to Defense Counsel623104187
Insured License NumberFL 010846ME10846
Date of Final Disposition05-AUG-0416-JUL-04
Defendant Entity NameFlagler Hospital
Payment Date05-AUG-0404-AUG-04
Defendant Last NameGrobelny, MD, Mark
Defendant Entity NameEmergency Physicians, Inc.
No Other Defendants10

 

 

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Dr. Mason Long Medical Malpractice Lawsuits - Court Case # CA06-447 55

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200955378
Claim Number :33402-01
Date Submitted :11/10/2009
 
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
IndividualMason Long
Insurer TypeStreet Address of Practice
Licensed301 Health Park Blvd., Ste 325
CityStateZip CodeCounty
Saint AugustineFL32086St. Johns
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
19954$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME55529Internal Medicine - No Surgery80257

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MSt. Johns
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
5/12/200511/21/2005
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Urinary frequency and dysuria.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Urinalysis-positive for white blood cells and trace blood.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
Principal Injury Giving Rise To The Claim
Patient developed bladder cancer.Loss of bladder.
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
6/19/2006CA06-447 55
County Suit Filed inDate of Final Disposition
St. Johns10/20/2009
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
10/20/2009
 
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$21,826
All Other Loss Adjustment Expense Paid$21,253
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
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. Brian E Haycook Medical Malpractice Lawsuits - Court Case # CA-07-1800

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200953022
Claim Number :250765
Date Submitted :3/23/2009
 
Insurer Information
 
Insurer NameCoverage Type
DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE)Primary
Insurer FEINProfessional License Number
95-3014772 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualAngela LaFrance
Street Address
13450 W. Sunrise Blvd., Suite 160
CityStateZip
SunriseFL33323
PhoneExtFaxE-Mail Address
(954) 838 - 9988 (866) 636 - 5421alafrance@thedoctors.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualBrianEHaycook
Insurer TypeStreet Address of Practice
LicensedOne Orthopedic Place
CityStateZip CodeCounty
Saint AugustineFL32086St. Johns
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
68706$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME87264Surgery - Orthopedic 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MSt. Johns
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FLAGLER HOSPITAL100090
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
2/20/200610/6/2006
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Three level disc disease
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Lumbar discectomy
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
Alleged iliac artery transection, the result of alleged negligent performance of a lumbar discectomy resulting in left foot drop and pain and weakness in left leg.
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
11/2/2007CA-07-1800
County Suit Filed inDate of Final Disposition
St. Johns3/13/2009
Other Defendants Involved in this Claim
Orthopaedic Assoicates of St. Augustine, PA
Cardiothoracic & Vascular Surgical Associates PA
Muehrcke, M.D., Derek D
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
3/6/2009
 
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$103,000
All Other Loss Adjustment Expense Paid$0
Injured Person's Total Non-Economic Loss$100,000
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
Unknown
 
Updates
 
No updates found.

 

 

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

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Dr. Howard B Epstein Medical Malpractice Lawsuits - Court Case # CA03-706

Indemnity Paid: $240,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200534885
Claim Number :A01-24835-01
Date Submitted :4/11/2005
 
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
IndividualHowardBEpstein
Insurer TypeStreet Address of Practice
Licensed545 Health Blvd.
CityStateZip CodeCounty
Daytona BeachFL32114St. Johns
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
33098$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME44446Surgery - Urological80145

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MSt. Johns
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FLAGLER HOSPITAL100219
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
9/27/200110/9/2001
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Right uretral obstruction, secondary to aortic abdominal aneurysm.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Right ureterolysis and ureterostomy.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
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
10/2/2003CA03-706
County Suit Filed inDate of Final Disposition
St. Johns3/11/2005
Other Defendants Involved in this Claim
Atlantic Urological Associates
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
3/11/2005
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$240,000
Loss Adjust Expense Paid to Defense Counsel$35,912
All Other Loss Adjustment Expense Paid$19,718
Injured Person's Total Non-Economic Loss$240,000
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. Anil K Mandal Medical Malpractice Lawsuits - Court Case # 16-2008-MI-002540

Indemnity Paid: $187,500.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201470537
Claim Number :FP3769401
Date Submitted :4/22/2014
 
Insurer Information
 
Insurer NameCoverage Type
FIRST PROFESSIONALS INSURANCE COMPANY, INCPrimary
Insurer FEINProfessional License Number
59-6614702 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualKelly Andrews
Street Address
1000 Riverside Avenue, Suite 800
CityStateZip
JacksonvilleFL32204
PhoneExtFaxE-Mail Address
(904) 360 - 3038  kandrews@thedoctors.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualAnilKMandal
Insurer TypeStreet Address of Practice
Licensed665 State Road, Suite 1
CityStateZip CodeCounty
St. AugustineFL32084St. Johns
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
IN024646$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME74439Nephrology - Minor Surgery 

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 Inpatient Facility 
Name of InstitutionCode
SAINT LUKES' HOSPITAL100151
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
4/5/20069/26/2008
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
The patient presented to hospital with uncontrolled abdominal pain, hypertension and end stage renal disease. A small bowel perforation was discovered during his hospital course.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
The patient suffered an anoxic neuro event in addition to the bowel perforation after he coded and was Resuscitated, but his condition did not improve and patient subsequently expired.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
Plaintiffs allege that a failure to timely assess and monitor patient's condition of bowel perforation and sepsis led to patient¿s demise.
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
9/9/200816-2008-MI-002540
County Suit Filed inDate of Final Disposition
St. Johns4/16/2014
Other Defendants Involved in this Claim
St. Lukes Hospital
Harmon, M.D., Ira
Hoffman, M.D. , Jeffrey
Borland-Grover Clinic
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
4/16/2014
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$187,500
Loss Adjust Expense Paid to Defense Counsel$140,261
All Other Loss Adjustment Expense Paid$52,080
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
Insurance company staff consulted with insured to discuss preventative measures. Patient Safety 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. Pachavit Kasemsap Medical Malpractice Lawsuits - Court Case # CA-10-766

Indemnity Paid: $175,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201161418
Claim Number :32355
Date Submitted :8/23/2011
 
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
IndividualPachavit Kasemsap
Insurer TypeStreet Address of Practice
Licensed12682 NW 32nd Place
CityStateZip CodeCounty
SunriseFL33323Broward
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600940 07$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME87867Surgery - General 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MBroward
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FLAGLER HOSPITAL100090
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
9/10/200711/23/2009
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Hemorrhoids
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Hemorrhoidectomy
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to properly diagnose the patient with Grade IV hemorrhoids and negligently performing surgery
Principal Injury Giving Rise To The Claim
Chronic rectal 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
3/19/2010CA-10-766
County Suit Filed inDate of Final Disposition
St. Johns8/22/2011
Other Defendants Involved in this Claim
Surgical Associates of North Florida, 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
8/22/2011
 
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$28,031
All Other Loss Adjustment Expense Paid$5,610
Injured Person's Total Non-Economic Loss$0
Deductible$100,000
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
Risk management has counseled insured
 
Updates
 
No updates found.

 

 

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Dr. Douglas Dew Medical Malpractice Lawsuits - Court Case # CA03-930

Indemnity Paid: $170,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200952929
Claim Number :28974-01
Date Submitted :3/12/2009
 
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
IndividualDouglas Dew
Insurer TypeStreet Address of Practice
LicensedP. O. Box 1459
CityStateZip CodeCounty
PalatkaFL32178Putnam
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
10404$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME51037Surgery - Orthopedic80154

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MSt. Johns
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FLAGLER HOSPITAL100219
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
5/5/20017/29/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Fracture/dislocation of left hip.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
ORIF left acetabulum.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
Principal Injury Giving Rise To The Claim
Allegations of performing an inadequate fixation, resulting in dislocation; however, the patient's non-compliance was arguable the cause of his dislocation and additional surgeries.
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
1/23/2004CA03-930
County Suit Filed inDate of Final Disposition
St. Johns2/18/2009
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
2/18/2009
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$170,000
Loss Adjust Expense Paid to Defense Counsel$108,500
All Other Loss Adjustment Expense Paid$86,033
Injured Person's Total Non-Economic Loss$170,000
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. Wen I Lin Medical Malpractice Lawsuits - Court Case # CA 14-1417

Indemnity Paid: $160,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201575406
Claim Number : CA 14-1417
Date Submitted : 8/4/2015
 
Insurer Information
 
Insurer Name Coverage Type
Lin, Wen I Primary
Insurer FEIN Professional License Number
none ME32460
Insurer Contact Information
Type First Name MI Last Name
Individual Matthew P McLauchlin
Street Address
50 N. Laura St., Suite 4100
City State Zip
Jacksonville FL 32202
Phone Ext Fax E-Mail Address
(904) 665 - 3655     matt.mclauchlin@nelsonmullins.com
 
Insured Information
 
Type First Name MI Last Name
Individual Wen I Lin
Insurer Type Street Address of Practice
Self-Insurer 3100 US 1 SOUTH, SUITE 2
City State Zip Code County
St. Augustine FL 32086 St. Johns
Policy Number Per Claim Policy Limits Aggregate Policy Limits
01 $1 *NR
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME32460 Surgery - Urological  

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First Name MI Last Name Date of Birth
       
Street Address Gender County where Injury Occurred
  M St. Johns
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Outpatient Facility  
Name of Institution Code
FLAGLER HOSPITAL 100219
Location of Institutional Injury Other Location of Institutional Injury
Operating Suite  
Date of Occurrence Date Reported to Insurer
7/26/2012 9/12/2014
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Gross Hematuria; Bladder Mass
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Allegation of misdiagnosis and/or improper treatment of bladder cancer
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged misdiagnosis of muscle invasive bladder cancer
Principal Injury Giving Rise To The Claim
Alleged Metastatic Bladder Cancer
Severity Of Injury
Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
11/20/2014 CA 14-1417
County Suit Filed in Date of Final Disposition
St. Johns 7/16/2015
Other Defendants Involved in this Claim
Wen I Lin, 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 Decision Other
No Court Proceedings.  
Arbitration
Claim not subject to Arbitration.
Date of Payment
7/30/2015
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $160,000
Loss Adjust Expense Paid to Defense Counsel $0
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 Date Anticipated
Medical Expense $0 $0
Wage Loss $0 $0
Other Expenses $0 $0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
When indicated and/or necessary, additional follow up biopsies may be performed.
 
Updates
 
No updates found.

 

 

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

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Dr. TOD NORTHRUP Medical Malpractice Lawsuits - Court Case # 16-CA-581

Indemnity Paid: $150,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201782537
Claim Number : F16-0026-A-14
Date Submitted : 7/11/2017
 
Insurer Information
 
Insurer Name Coverage Type
FD INSURANCE COMPANY Primary
Insurer FEIN Professional License Number
20-3704679  
Insurer Contact Information
Type First Name MI Last Name
Individual Dionysia   Lawson
Street Address
560 Davis Street
City State Zip
San Francisco CA 94111
Phone Ext Fax E-Mail Address
(415) 735 - 2013   (415) 735 - 2097 dlawson@norcalmutual.com
 
Insured Information
 
Type First Name MI Last Name
Individual TOD   NORTHRUP
Insurer Type Street Address of Practice
Licensed 150 Southpark Blvd, Ste 102
City State Zip Code County
St. Augustine FL 32086 St. Johns
Policy Number Per Claim Policy Limits Aggregate Policy Limits
11677 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
OS7217 Surgery - Orthopedic  

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First Name MI Last Name Date of Birth
       
Street Address Gender County where Injury Occurred
  F St. Johns
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Outpatient Facility  
Name of Institution Code
N/A 000000
Location of Institutional Injury Other Location of Institutional Injury
Operating Suite  
Date of Occurrence Date Reported to Insurer
9/11/2014 1/28/2016
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Elbow fracture with dislocation
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Inserting radial head prosthesis
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Used too large of a redial head prothesis
Principal Injury Giving Rise To The Claim
Large radial head prosthesis resulted in subluxation and subsequent surgeries
Severity Of Injury
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
6/6/2016 16-CA-581
County Suit Filed in Date of Final Disposition
St. Johns 6/26/2017
Other Defendants Involved in this Claim
 
Stage of Legal System at which Settlement was Reached or Award Made
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference.
Final Method of Claim Disposition
Settled by parties
Court Decision Other
No Court Proceedings.  
Arbitration
Claim not subject to Arbitration.
Date of Payment
6/5/2017
 
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 $58,870
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 Date Anticipated
Medical Expense $0 $0
Wage Loss $0 $0
Other Expenses $0 $0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Discussed with Risk Management and Insured
 
Updates
 
No updates found.

 

 

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Dr. LUIZ KUNTZ Medical Malpractice Lawsuits - Court Case # CA992262

Indemnity Paid: $150,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200115641
Claim Number :15548-01
Date Submitted :2/19/2007
 
Insurer Information
 
Insurer NameCoverage Type
AMERICAN PHYSICIANS ASSURANCE CORPORATIONPrimary
Insurer FEINProfessional License Number
38-2102867 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualChristine Sampson
Street Address
200 East Gaines Street
CityStateZip
TallahasseeFL32399
PhoneExtFaxE-Mail Address
(850) 413 - 5358 (850) 921 - 8243Christine.Sampson@fldfs.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualLUIZ KUNTZ
Insurer TypeStreet Address of Practice
Licensed301 HEALTH PARK BLVD. #326
CityStateZip CodeCounty
ST. AUGUSTINEFL32086St. Johns
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
126104$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME21798Cardiovascular Disease - Minor Surgery80281

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FSt. Johns
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FLAGLER HOSPITAL100090
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
5/15/19978/23/1999
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
SUBSEQUENT SURGERY TO REMOVE A PORTION OF THE GUIDE WIRE THAT EMBEDDED IN HER HEART.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
THE PLAINTIFF ALLEGED THAT INSURED FAILED TO INSPECT A GUIDEWIRE AFTER INSERTION OF PICC LINE RESULTING IN SUBSEQUENT SURGERY TO REMOVE A PORTION OF THE GUIDE WIRE THAT EMBEDDED IN HER HEART.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
N/A
Principal Injury Giving Rise To The Claim
PORTION OF GUIDEWIRE EMBEDDED IN PATIENTS HEART.
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
1/19/2000CA992262
County Suit Filed inDate of Final Disposition
St. Johns2/26/2001
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
 
 
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$0
All Other Loss Adjustment Expense Paid$0
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
INSURED CONSULTED WITH DEFENSE COUNSEL AND CLAIMS PERSONNEL REGARDING THIS MATTER.
 
Updates
 
 
Date of Change:2/19/2007 3:58:47 PM
Reason for Change:OIR updating Historical Closed Claim data.
 
Field ChangedFormer ValueNew Value
Injured Person Address CountySt. Johns
County Injury Occurred InSt. Johns
Insured Last NameKUNTZ, MDKUNTZ
Insured License NumberME0021798ME21798
Portal User Nameplcr_migration_dccs plcr_migration_dccsChristine Sampson

 

 

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Dr. Tod Northrup Medical Malpractice Lawsuits - Court Case # CA 08-2316 55

Indemnity Paid: $147,500.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200954458
Claim Number :37035-01
Date Submitted :7/28/2009
 
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
IndividualTod Northrup
Insurer TypeStreet Address of Practice
Licensed150 Southpark Blvd, Ste 102
CityStateZip CodeCounty
Saint AugustineFL32086St. Johns
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
74333$250,000$750,000
Profession or BusinessOther Profession or Business
Osteopathic Physician 
License NumberSpecialty Code & ClassificationCertification Number
OS7217Surgery - Orthopedic80154

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MSt. Johns
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Outpatient Facility 
Name of InstitutionCode
FLAGLER HOSPITAL100090
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
6/5/20074/23/2008
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Patient presented to have a salvage right knee surgery after many attempts at revision by other surgeons.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
The patient had a rare neurovascular event following a right tibial tubercle plasty with right osteotomy and internal fixation removal; an expected complication from this salvage procedure.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
Principal Injury Giving Rise To The Claim
Post operative tingling and numbness in right extremity following the revision/salvage surgery.
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
2/26/2009CA 08-2316 55
County Suit Filed inDate of Final Disposition
St. Johns7/2/2009
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
7/2/2009
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$147,500
Loss Adjust Expense Paid to Defense Counsel$8,919
All Other Loss Adjustment Expense Paid$1,543
Injured Person's Total Non-Economic Loss$147,500
Deductible$5,000
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
No steps required.Incident was an expected complication from the insured's courtesy salvage procedure as a last option for patient.
 
Updates
 
No updates found.

 

 

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Dr. Janice L Vucinich Medical Malpractice Lawsuits - Court Case # CA 99-309

Indemnity Paid: $130,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200848166
Claim Number :E28328
Date Submitted :8/11/2009
 
Insurer Information
 
Insurer NameCoverage Type
PROASSURANCE CASUALTY COMPANYPrimary
Insurer FEINProfessional License Number
38-2317569 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualMaria Gonzalez
Street Address
2801 SW 149th Avenue, Suite 200
CityStateZip
MiramarFL33027
PhoneExtFaxE-Mail Address
(954) 602 - 5834  mgonzalez@pronational.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualJaniceLVucinich
Insurer TypeStreet Address of Practice
Licensed6 E. Street
CityStateZip CodeCounty
Saint AugustineFL32080St. Johns
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PNFL-1007278-00$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME51366Radiology - Diagnostic - No Surgery0

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MSt. Johns
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
8/1/19987/7/1999
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Coronary artery disease
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Alleged failure to timely diagnose congestive heart failure (CHF) on x-ray
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
There was no misdiagnosis made
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
10/8/1999CA 99-309
County Suit Filed inDate of Final Disposition
St. Johns1/8/2008
Other Defendants Involved in this Claim
Baringer, Dudley A
Healing Arts Urgent Care 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
 
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$130,000
Loss Adjust Expense Paid to Defense Counsel$158,084
All Other Loss Adjustment Expense Paid$103,402
Injured Person's Total Non-Economic Loss$130,000
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 discussed claim with insurance personnel and medical experts.
 
Updates
 
 
Date of Change:8/11/2009 3:58:25 PM
Reason for Change:Additional invoices paid after file closed.
 
Field ChangedFormer ValueNew Value
Amount of Loss Adjustment Expense Paid to Defense Counsel156033158084
All Other Loss Adjustment Expense Paid101712103402

 

 

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Dr. Robert E Dupree Medical Malpractice Lawsuits - Court Case # CA02 1623 55

Indemnity Paid: $125,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200642025
Claim Number :A02-25755-00
Date Submitted :8/22/2006
 
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 Avenue, Suite 800
CityStateZip
JacksonvilleFL32204
PhoneExtFaxE-Mail Address
(800) 741 - 37423043(904) 358 - 6728montague@fpic.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualRobertEDupree
Insurer TypeStreet Address of Practice
Licensed201 Healthpark Blvd, Ste 215
CityStateZip CodeCounty
Saint AugustineFL32086St. Johns
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
42031$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME55260Surgery - Obstetrics - Gynecology80153

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FSt. Johns
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FLAGLER HOSPITAL100219
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
4/10/20003/14/2002
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Heavy menstrual flow with increased pain.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Laparoscopic transvaginal hysterectomy and left salpingo-oophorectomy with lysis of adhesions.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
Principal Injury Giving Rise To The Claim
Bowel perforation resulting in colostomy.
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
8/5/2002CA02 1623 55
County Suit Filed inDate of Final Disposition
St. Johns8/2/2006
Other Defendants Involved in this Claim
 
Stage of Legal System at which Settlement was Reached or Award Made
During trial, but before court verdict.
Final Method of Claim Disposition
Settled by parties
Court DecisionOther
Judgment for the plaintiff. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
8/2/2006
 
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$98,969
All Other Loss Adjustment Expense Paid$37,954
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. Mandana Davani Medical Malpractice Lawsuits - Court Case # CA17-135

Indemnity Paid: $116,132.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201887250
Claim Number : 1034674-02
Date Submitted : 12/11/2018
 
Insurer Information
 
Insurer Name Coverage Type
MEDICAL PROTECTIVE COMPANY (THE) Primary
Insurer FEIN Professional License Number
35-0506406  
Insurer Contact Information
Type First Name MI Last Name
Individual Lynn Louthan
Street Address
5814 Reed Road
City State Zip
Ft Wayne IN 46835
Phone Ext Fax E-Mail Address
(260) 486 - 0778     reportaclaim@medpro.com
 
Insured Information
 
Type First Name MI Last Name
Individual Mandana   Davani
Insurer Type Street Address of Practice
Licensed 400 Health Park Blvd
City State Zip Code County
St Augustine FL 32086 St. Johns
Policy Number Per Claim Policy Limits Aggregate Policy Limits
757145 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME77783 Radiology - Diagnostic - Minor Surgery  

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First Name MI Last Name Date of Birth
       
Street Address Gender County where Injury Occurred
  F St. Johns
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Inpatient Facility  
Name of Institution Code
FLAGLER HOSPITAL 100090
Location of Institutional Injury Other Location of Institutional Injury
Radiology, Emergency Room  
Date of Occurrence Date Reported to Insurer
10/8/2015 6/30/2016
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
PICC inserted for antibiotics
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
interpreted chest x-ray & reported PICC line tip in the mid SVC region
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
improperly interpreted chest x-ray
Principal Injury Giving Rise To The Claim
Ischemic brain infarcts
Severity Of Injury
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
2/8/2017 CA17-135
County Suit Filed in Date of Final Disposition
St. Johns 12/7/2018
Other Defendants Involved in this Claim
St Johns Radiology Associates PA
Stage of Legal System at which Settlement was Reached or Award Made
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference.
Final Method of Claim Disposition
Settled by parties
Court Decision Other
No Court Proceedings.  
Arbitration
Claim not subject to Arbitration.
Date of Payment
12/7/2018
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $116,132
Loss Adjust Expense Paid to Defense Counsel $38,921
All Other Loss Adjustment Expense Paid $17,913
Injured Person's Total Non-Economic Loss $0
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
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
 
No updates found.

 

Dr. Stephen Strout Medical Malpractice Lawsuits - Court Case # CA09-3707

Indemnity Paid: $100,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201057639
Claim Number :38967-01
Date Submitted :6/16/2010
 
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
IndividualStephen Strout
Insurer TypeStreet Address of Practice
Licensed10 A St. Johns Park
CityStateZip CodeCounty
Saint AugustineFL32086St. Johns
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
69050$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Dentistry 
License NumberSpecialty Code & ClassificationCertification Number
DN15749Periodontics80211

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FSt. Johns
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
4/4/20087/17/2009
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
The patient suffered permanent damage to her lingual nerve during the extraction of all 4 wisdom teeth.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Instrumental and soft tissue damage to lingual nerve.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.(This injury is a known complication)
Principal Injury Giving Rise To The Claim
Wound excision being made too close to the operative site.
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
11/25/2009CA09-3707
County Suit Filed inDate of Final Disposition
St. Johns5/27/2010
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
5/27/2010
 
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$2,416
All Other Loss Adjustment Expense Paid$960
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
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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