Department File Number : | M201781923 |
Claim Number : | 100466 |
Date Submitted : | 4/25/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
ASCENSION HEALTH ALLIANCE PL/GL SELF-INSURED TRUST | Primary | ||||
Insurer FEIN | Professional License Number | ||||
36-7046706 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Linda | S | Zinselmeier | ||
Street Address | |||||
11775 Borman Drive | |||||
City | State | Zip | |||
Saint Louis | MO | 63146 | |||
Phone | Ext | Fax | E-Mail Address | ||
(314) 733 - 8727 | (314) 733 - 8727 | lzinselmeier@ascension.org |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | ARNE | SIPPENS GROENEWEGEN | |||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 1824 King Street, Suite 300 | ||||
City | State | Zip Code | County | ||
Jacksonville | FL | 32204 | Duval | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
1111 | $10,000,000 | $10,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME95265 | Cardiovascular Disease - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Duval | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
ST VINCENT'S MEDICAL CENTER SOUTHSIDE | 23960088 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
7/11/2014 | 6/12/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Chronic a-fib | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Cardiac ablation | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Performance of contra-indicated cardiac ablation and post-ablation care | |||||
Principal Injury Giving Rise To The Claim | |||||
Death following stroke after cardiac ablation. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 4/10/2017 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed). | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
4/10/2017 |
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 | $50,000 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $430,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
n/a |
Updates | |
No updates found. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Department File Number : | M201886895 |
Claim Number : | 110674 |
Date Submitted : | 10/31/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
ASCENSION HEALTH ALLIANCE PL/GL SELF-INSURED TRUST | Primary | ||||
Insurer FEIN | Professional License Number | ||||
36-7046706 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Linda | S | Zinselmeier | ||
Street Address | |||||
11775 Borman Drive | |||||
City | State | Zip | |||
Saint Louis | MO | 63146 | |||
Phone | Ext | Fax | E-Mail Address | ||
(314) 733 - 8727 | lzinselmeier@ascension.org |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | ARNE | SIPPENS GROENEWEGEN | |||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 1824 King Street, Suite 300 | ||||
City | State | Zip Code | County | ||
Jacksonville | FL | 32204 | Duval | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
1111 | $10,000,000 | $10,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME95265 | Cardiovascular Disease - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Duval | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
ST VINCENT'S MEDICAL CENTER SOUTHSIDE | 23960088 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
3/31/2016 | 6/9/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient was admitted for treatment of atrial fibrillation. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Patient underwent cardioversion and Sotalol loading during the admission. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Plaintiff alleged Sotalol loading was managed contrary to the manufacturer's package insert. Specifically, it was alleged that the initial dose of Sotalol was too high and the patient should have been on telemetry for 72 hrs instead of 48 hrs. It was also alleged the patient developed signs/symptoms of an arrhythmia that should have kept the patient in the hospital. | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient allegedly died from an arrhythmia shortly after discharge. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 10/29/2018 | ||||
Other Defendants Involved in this Claim | |||||
Alban, Erin | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed). | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
10/29/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $571,875 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $40,000 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $350,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
N/A |
Updates | |
No updates found. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. ARNE SIPPENS GROENEWEGEN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ARNE SIPPENS GROENEWEGEN, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).