Department File Number : | M201885625 |
Claim Number : | 2010-09-200-023 |
Date Submitted : | 6/14/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
Lexington Insurace Company | Primary | ||||
Insurer FEIN | Professional License Number | ||||
25-114949 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Jessica | Hayden | |||
Street Address | |||||
2985 Drew Street | |||||
City | State | Zip | |||
Clearwater | FL | 33764 | |||
Phone | Ext | Fax | E-Mail Address | ||
(727) 519 - 1268 | jessica.hayden@baycare.org |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | David | Tulsiak | |||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 3001 West Dr Martin Luther King Jr Boulevard | ||||
City | State | Zip Code | County | ||
Tampa | FL | 33607 | Hillsborough | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
839-6469 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME44589 | Emergency Medicine - Including Major Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Hillsborough | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
SAINT JOSEPH'S HOSPITAL | 100075 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
11/19/2010 | 12/3/2010 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented with 6 day history of back pain and presenting to outside physicians and clinics for her complaints. She complained of body aches and musculoskeletal pain fluctuating in intensity. Differential diagnoses of arthritis, viral syndrome, fibromyalgia, back pain and fibrosytis were noted. The patient was discharged to home. Within hours the patient was found to be in PEA at home and was intubated at the scene. Upon return to the ER STEMI alert was called. She was taken for cardiac cath and R coronary artery was 100% occluded. Balloon angioplasty was successful and multiple stents were deployed. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
She remained unresponsive and was admitted. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
The patient suffered anoxic encephalopathy status post cardiac arrest. She was not able to be weaned from the ventilator. She was transferred to long term care where she remained until her death. It was alleged that the ER staff failed to take a thorough history from the patient that would have identified her as being at high risk of coronary artery disease. | |||||
Severity Of Injury | |||||
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
6/28/2013 | 13-CA007001 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Hillsborough | 9/1/2015 | ||||
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 | |||||
9/1/2015 |
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 | $243,120 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Any risk issues have been/will be addressed. |
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 : | M201987551 |
Claim Number : | 2013-09-200-018 |
Date Submitted : | 1/10/2019 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
LEXINGTON INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
25-114949 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kaye | Monello | |||
Street Address | |||||
2985 Drew Street | |||||
City | State | Zip | |||
Clearwater | FL | 33759 | |||
Phone | Ext | Fax | E-Mail Address | ||
(727) 754 - 9268 | (727) 519 - 1276 | kaye.monello@baycare.org |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | David | Tulsiak | |||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 3001 W. Dr. Martin Luther King, Jr. Blvd. | ||||
City | State | Zip Code | County | ||
Tampa | FL | 33607 | Hillsborough | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
112-31-715 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME44589 | Emergency Medicine - No Major Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Hillsborough | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
SAINT JOSEPH'S HOSPITAL | 100075 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
5/29/2011 | 9/17/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
32 yo male presents with complaint of dizziness, headache and right sided hemiparesis. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
It was alleged that the providers failed to diagnose Toxoplasmosis which led to permanent neurologic impairment. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
It was alleged that the providers failed to diagnose Toxoplasmosis which led to permanent neurologic impairment. | |||||
Principal Injury Giving Rise To The Claim | |||||
Permanent neurologic impairment due to delayed diagnosis of Toxoplasmosis. | |||||
Severity Of Injury | |||||
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/17/2014 | 14-CA-000337 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Hillsborough | 1/9/2019 | ||||
Other Defendants Involved in this Claim | |||||
St. Joseph's Hospital Samerson, Dion Kaczynski, Rafal | |||||
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 | |||||
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 | $222,067 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Any risk issues have been addressed. |
Updates | |
No updates found. |
Department File Number : | M201987553 |
Claim Number : | 2013-09-200-018 |
Date Submitted : | 1/10/2019 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
LEXINGTON INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
25-114949 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kaye | Monello | |||
Street Address | |||||
2985 Drew Street | |||||
City | State | Zip | |||
Clearwater | FL | 33759 | |||
Phone | Ext | Fax | E-Mail Address | ||
(727) 754 - 9268 | (727) 519 - 1276 | kaye.monello@baycare.org |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | David | Tulsiak | |||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 3001 W. Dr. Martin Luther King, Jr. Blvd. | ||||
City | State | Zip Code | County | ||
Tampa | FL | 33607 | Hillsborough | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
112-31-715 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME44589 | Emergency Medicine - No Major Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Hillsborough | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
SAINT JOSEPH'S HOSPITAL | 100075 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
5/29/2011 | 9/17/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
32 yo male presents with complaint of dizziness, headache and right sided hemiparesis. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
It was alleged that the providers failed to diagnose Toxoplasmosis which led to permanent neurologic impairment. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
It was alleged that the providers failed to diagnose Toxoplasmosis which led to permanent neurologic impairment. | |||||
Principal Injury Giving Rise To The Claim | |||||
Permanent neurologic impairment due to delayed diagnosis of Toxoplasmosis. | |||||
Severity Of Injury | |||||
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/17/2014 | 14-CA-000337 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Hillsborough | 1/9/2019 | ||||
Other Defendants Involved in this Claim | |||||
St. Joseph's Hospital Samerson, Dion Kaczynski, Rafal | |||||
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 | |||||
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 | $222,067 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Any risk issues have been addressed. |
Updates | |
No updates found. |
Does Dr. DAVID TULSIAK, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DAVID TULSIAK, MD has at least 3 medical malpractice case(s), lawsuit(s), or complaint(s).