Department File Number : | M201886942 |
Claim Number : | POC-H-008021 |
Date Submitted : | 11/7/2018 |
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 | Isabel | Gomez | |||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 5975 Sunset Drive, Suite 103 | ||||
City | State | Zip Code | County | ||
Miami | FL | 33143 | 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 | |||
ME116711 | Infectious Diseases - 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 | ||||
SOUTH MIAMI HOSPITAL | 100154 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
4/8/2017 | 5/1/2018 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Intra-abdominal pelvic abscess resulting from bowel perforation stemming from prior history of surgical procedure. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Robotic Burch procedure by another physician. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
None. | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleged failure to recommend and order surgical exploration of ab intra-abdominal pelvic abscess resulting in septicemia, cardiac arrest, emergent bowel resection, multisystem failure, multiple abdominal fistulas, and prolonged hospitalization and recovery. The Notice of Intent was withdrawn against this physician. | |||||
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 | 10/8/2018 | ||||
Other Defendants Involved in this Claim | |||||
Estape, Ricardo Estape, Roberto South Miami Hospital | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Claim or suit abandoned. | |||||
Final Method of Claim Disposition | |||||
Dropped before Action Filed | |||||
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 | $5,821 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $14,751 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Physician discussed case with defense counsel and claim consultant. |
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. ISABEL GOMEZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ISABEL GOMEZ, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).