Department File Number : | M202092751 |
Claim Number : | 818963-1 |
Date Submitted : | 6/16/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
LONE STAR ALLIANCE, INC., A RISK RETENTION GROUP | Primary | ||||
Insurer FEIN | Professional License Number | ||||
46-3209483 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | John | D | King | ||
Street Address | |||||
901 south mopac Blvd V ste 400 | |||||
City | State | Zip | |||
Austin | TX | 78746 | |||
Phone | Ext | Fax | E-Mail Address | ||
(512) 425 - 5940 | (512) 328 - 8067 | john-king@tmlt.org |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Amber | L | Jandik | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 13350 Metro Parkway, Suite 301 | ||||
City | State | Zip Code | County | ||
Fort Myers | FL | 33901 | Lee | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
4-100049 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME85353 | Anesthesiology |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Lee | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Outpatient Facility | |||||
Name of Institution | Code | ||||
SANCTUARY SURGICAL CENTRE | 14960388 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Special Procedure Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
12/5/2017 | 7/18/2018 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
patient was scheduled for right carpal tunnel procedure on 12-5-2017 after patient exhibited a history of intrinsic weakness to both of her wrists/arms. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Prior to the surgery, reporting physician was requested by the surgeon to administer a peripheral block for post-operative pain management. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Reporting physician administered the block in the pre-op area. Reporting physician had performed numerous of these types of blocks before and performed in the same manner she had done before. | |||||
Principal Injury Giving Rise To The Claim | |||||
After confirming the needle was in the correct location by use of ultrasound and peripheral nerve stimulator, she injected the area. 30 cc of local anesthetic was used, which was broken down into 5 cc separate injections with each time confirming location. On the last 5 cc, physician aspirated blood and the patient went into cardiac arrest. She was quickly resuscitated and transferred to a full unit hospital where she recovered. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/8/2019 | 19-CA-000096 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Lee | 6/16/2020 | ||||
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 | |||||
5/20/2020 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $275,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $275,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
none- known and recognized complication of a peripheral nerve block addressed in consent form |
Updates | |
No updates found. |
Does Dr. AMBER L JANDIK, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. AMBER L JANDIK, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).