Department File Number : | M201885858 |
Claim Number : | 157374 |
Date Submitted : | 7/11/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
HEALTH CARE INDEMNITY, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
61-0904881 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Christina | J | Stoker | ||
Street Address | |||||
1100 Charlotte Ave, Ste 500 | |||||
City | State | Zip | |||
Nashville | TN | 37203 | |||
Phone | Ext | Fax | E-Mail Address | ||
(615) 344 - 1779 | (615) 344 - 5889 | christina.stoker@hcahealthcare.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | JOHN | D | DEPERI | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 3627 UNIVERSITY BLVD S STE 700 | ||||
City | State | Zip Code | County | ||
JACKSONVILLE | FL | 32216 | Duval | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
HCI-10115 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME79425 | Physicians or Surgeons - Major Surgery. NOC classification. |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Duval | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
MEMORIAL HOSPITAL JACKSONVILLE | 100179 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
10/12/2015 | 2/12/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
PATIENT PRESENTED WITH COMPLAINTS OF SHARP RIGHT UPPER QUADRANT PAIN. DIAGNOSED WITH NON INCARCERATED BOWEL WITHIN THE RIGHT LOWER QUADRANT. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
PATIENT UNDERWENT PARASTOMAL HERNIA REPAIR, LYSIS OF ADHESIONS AND A RESECTION OF SMALL SEGMENT OF SMALL BOWEL WITHOUT REPORTED COMPLICATIONS. PATIENT LEFT AMA APPROX 5 DAYS AFTER SURGERY. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
ALLEGED THAT PHYSICIAN DID STOMA REVISION WITHOUT CONSENT DURING HERNIA REPAIR CAUSING KIDNEY INFECTIONS. | |||||
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 | ||||
11/2/2016 | 16-2016-CA-004613 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Duval | 6/29/2018 | ||||
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 subject to arbitration, but settlement reached in lieu of award. | |||||
Date of Payment | |||||
6/26/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $950,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $55,785 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $19,678 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $450,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
staff reeducation and reinforcement of policy and procedure |
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.
Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
This page is not displaying certain sensitive information. |
Department File Number : | M201573556 |
Claim Number : | 152795 |
Date Submitted : | 4/20/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
HEALTH CARE INDEMNITY, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
61-0904881 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Teresa | Ross | |||
Street Address | |||||
One Park Plaza P.O. Box 555 | |||||
City | State | Zip | |||
Nashville | TN | 37202 | |||
Phone | Ext | Fax | E-Mail Address | ||
(615) 344 - 5804 | Teresa.Ross@HCAHealthcare.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | John | Deperi | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 3627 University Blvd. S Suite 700 | ||||
City | State | Zip Code | County | ||
Jacksonville | FL | 32216 | Duval | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
HCI-10113 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME79425 | Surgery - General | 01 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Duval | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Outpatient Facility | Advanced Surgery Center | ||||
Name of Institution | Code | ||||
ADVANCED SURGERY CENTER | 14960622 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
2/7/2013 | 7/29/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Right groin lipoma. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Patient underwent right groin lymph node biopsy with excision of right groin lipoma. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Incorrectly removed cyst instead of infected lymph node. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/3/2014 | 3:13-CV-1182-J-99 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Duval | 2/4/2015 | ||||
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 | |||||
No Payment Made | |||||
Court Decision | Other | ||||
Other | Dismissal | ||||
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 | $5,327 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $35 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Review of policies and procedures. |
Updates | ||||||||||||||||
Date of Change: | 4/20/2015 11:23:40 AM | |||||||||||||||
Reason for Change: | Additional LAE payments made. | |||||||||||||||
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*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. JOHN D DEPERI, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JOHN D DEPERI, MD has at least 3 medical malpractice case(s), lawsuit(s), or complaint(s).