| Department File Number : | M201782910 |
| Claim Number : | POC-H-007210 |
| Date Submitted : | 8/28/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| Baptist Health South Florida | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 65-0267668 | 0000 | ||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | NANCY | CARR | |||
| Street Address | |||||
| 11440 SW 88th STREET | |||||
| City | State | Zip | |||
| MIAMI | FL | 33176 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (305) 274 - 4070 | (305) 274 - 2701 | carol.lobacz@nccrms.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Carlos | G | Pena | ||
| Insurer Type | Street Address of Practice | ||||
| Self-Insurer | 8940 North Kendall Drive, Suite 701E | ||||
| City | State | Zip Code | County | ||
| Miami | FL | 33176 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| POC1 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME96839 | Surgery - Obstetrics - Gynecology | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Dade | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| BAPTIST HOSPITAL OF MIAMI | 100008 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 5/17/2014 | 9/1/2016 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Large fibroid uterus, bilateral ovarian mass, dysfunctional uterine bleeding, abdominal pain, elevated CA-125 antigen. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Total abdominal hysterectomy and bilateral salpingo-oophorectomy, lysis of extensive adhesions between large and small bowel to uterus. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| There was no misdiagnosis of this patient. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Alleged delay in diagnosis of bladder perforation with subsequent repair and subsequent development of vesico-vaginal and colo-vaginal fistulas with delayed repair. | |||||
| Severity Of Injury | |||||
| Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 6/29/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| Baptist Hospital | |||||
| 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 | |||||
| 7/6/2017 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $144,500 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $5,318 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $19,313 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Not applicable. | |||||||||||||||||||||
| 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 : | M201575207 |
| Claim Number : | POC-H-006473 |
| Date Submitted : | 7/15/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| Baptist Health South Florida | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 65-0267668 | 0000 | ||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | NANCY | CARR | |||
| Street Address | |||||
| 11440 SW 88th STREET | |||||
| City | State | Zip | |||
| MIAMI | FL | 33176 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (305) 274 - 4070 | (305) 274 - 2701 | carol.lobacz@nccrms.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | CARLOS | PENA | |||
| Insurer Type | Street Address of Practice | ||||
| Self-Insurer | 8940 North Kendall Drive, Suite 701E | ||||
| City | State | Zip Code | County | ||
| Miami | FL | 33176 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| PIC 2013/14 PIC 12 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME96839 | Gynecology - No Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Dade | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| BAPTIST HOSPITAL OF MIAMI | 100008 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Labor and Delivery Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 9/14/2013 | 12/9/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Spontaneous rupture of membranes 3 1/2 hours prior to arrival, at 40 weeks gestation without prenatal care. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Biophysical profile reported as 4/8 regarding lack of fetal movement and fetal tone. There was an alleged delay in delivery, allegedly resulting in meconium aspiration syndrome and hypoxic ischemic encephalopathy. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| There was no misdiagnosis made of this patient. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Infant was delivered via C-section for lack of progression of labor and non-reassuring tracings. The infant was born with meconium below the cords, tight nuchal cord with poor tone, respiratory and reactivity. He was ultimately diagnosed with hypoxic ischemic encephalopathy, dysphagia, hypotonia, hypertonia, and neurological deficits. The infant subsequently died on 03/15/14. | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 3/25/2015 | ||||
| Other Defendants Involved in this Claim | |||||
| Baptist Hospital of Miami, Inc. | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Claim or suit abandoned. | |||||
| Final Method of Claim Disposition | |||||
| No Payment Made | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | No | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $12,446 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $12,657 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Not applicable. | |||||||||||||||||||||
| 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. CARLOS G PENA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. CARLOS G PENA, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).