| Department File Number : | M201574442 |
| Claim Number : | 136224 |
| Date Submitted : | 4/30/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| MEDICUS INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 20-5623491 | |||||
| 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 | Erenio | Santana | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 3661 South Miami Avenue, Suite 107 | ||||
| City | State | Zip Code | County | ||
| Miami | FL | 33133 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| FL-16013149 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME85879 | Anesthesiology - All Other | ||||
| 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 | ||||
| Emergency Room | |||||
| Name of Institution | Code | ||||
| BAYSIDE AMBULATORY CENTER | 14960495 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 9/20/2013 | 11/18/2013 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| routine colonoscopy | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| routine colonoscopy | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Estate of 71-year-old female alleges failure to timely diagnose a perforated colon, post colonoscopy, resulting in sepsis. | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 8/25/2014 | 14-21553 CA10 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Dade | 3/30/2015 | ||||
| Other Defendants Involved in this Claim | |||||
| Alarez-Gil, Francisco Vargos, Carlos Biscayne Anesthesia Group Ambulatory Surgery 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 | |||||
| 3/12/2014 | |||||
| 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 | $101,405 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $11,974 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Insured met and conferenced with Claims Specialist and Defense Attorney. | |||||||||||||||||||||
| 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. ERENIO SANTANA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ERENIO SANTANA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).