| Department File Number : | M201575735 |
| Claim Number : | SM260333 |
| Date Submitted : | 9/8/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| EVANSTON INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 36-2950161 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Dion | L | Bradford | ||
| Street Address | |||||
| 4600 Cox Road | |||||
| City | State | Zip | |||
| Glen Allen | VA | 23060 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (804) 217 - 8816 | (855) 662 - 7535 | dbradford@markelcorp.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Johan | Mennig San Roman | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 975 Baptist Way | ||||
| City | State | Zip Code | County | ||
| Homestead | FL | 33033 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| SM878844 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Physician Assistant | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| PA3409 | Physicians or Surgeons Assistants | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Dade | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Hospital/Institution | Hospital | ||||
| Name of Institution | Code | ||||
| HEALTHSOUTH REHABILITATION HOSP. (DADE) | 103038 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Physical Therapy Department | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 3/31/2009 | 6/29/2011 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Venous thromboembolism which lead to pulmonary embolism. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| The claimant had a number of significant medical issues. He was being treated for significant bilateral lower extremity weakness. The claimant was on a deep venous thrombosis (DVT) prophylaxis. Also, the claimant complained of acute chest pain. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| There was no misdiagnosis made. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| On April 2, 2009, the claimant complained of acute chest pain. However, this pain resolved and the claimant never complained of leg pain, calf swelling, and shortness of breath. On April 7, 2009, the claimant complained of check pain and shortness of breath. At that time, he was transf3erred by fire rescue to local hospital. An echocardiogram showed right atrium. The claimant was evaluated by a pulmonologist, who referred him to an interventional radiologist for consideration of an inferior vena cava (IVC) filter. However, a Doppler ultrasound of the lower extremities was negative for any DVT. As such, the IVC was not implemented. The claimant was scheduled for a CT of the spine. While in CT, the claimant began to experience chest pain and shortness of breath. Subsequently, he was diagnosed with extensive bilateral pulmonary emboli. At 8:03 p.m. on April 9, the claimant coded. | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 9/15/2011 | 11-27714 CA 32 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Dade | 11/12/2014 | ||||
| Other Defendants Involved in this Claim | |||||
| Orthopaedic Associates USA PA University of Miami Miller School of Medicine Corona MD, Abelardo Salamon MD, Joel Kushner MD, David South Dade Medical Group LLP HealthSouth Corporation dba HealthSouth Rehabilitation Hosp HealthSouth Rehabilitation of Miami LLC Diaz DO, Elaine Sheridan Emergency Medicine Physician Services of South Dade Baptist Hospital of Miami Inc | |||||
| 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 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $125,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $108,112 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $7,250 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
| Deductible | $2,500 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| None | |||||||||||||||||||||
| Updates | |
| No updates found. |
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Does Dr. JOHAN MENNIG SAN ROMAN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JOHAN MENNIG SAN ROMAN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).