Department File Number : | M201677013 |
Claim Number : | 155908 |
Date Submitted : | 12/27/2016 |
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 | Jolita | Burns | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 2770 Capital Medical Blvd. Suite 110 | ||||
City | State | Zip Code | County | ||
Tallahassee | FL | 32308 | Leon | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
HCI-10114 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME88050 | Surgery - Obstetrics - Gynecology | 01 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Leon | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
TALLAHASSEE COMMUNITY HOSPITAL | 100254 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Labor and Delivery Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
8/20/2014 | 8/10/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Labor & delivery at 40 weeks, elective induction of labor. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Patient had an unsuccessful 2 day induction on 8/12-8/13 with Cervidil & Pitocin. During 2nd induction on 8/19 oral Cytotec was administered over 3 doses resulting in active labor. Periods of tachysystole during night. By 5:30am next morning contractions more painful. Epidural given around 6am. Patient completely dilated at 8:45am followed by SROM with small amount of bloody fluid noted. Fetal bradycardia noted at 8:48am & no response to intrauterine resuscitation measures. STAT C-section done in 10 minutes & large uterine rupture noted. Patient returned to OR a few hours later for excessive bleeding & emergency hysterectomy done. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Ruptured uterus. | |||||
Severity Of Injury | |||||
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 1/21/2016 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed). | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
1/14/2016 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $32,500 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $50,733 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $15,642 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $22,500 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Review of policies and procedures. |
Updates | ||||||||||
Date of Change: | 12/27/2016 2:35:57 PM | |||||||||
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. JOLITA BURNS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JOLITA BURNS, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).