| Department File Number : | M201887186 |
| Claim Number : | F14-0170-A-14 |
| Date Submitted : | 12/4/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| FD INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 20-3704679 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Diane | M | McNab | ||
| Street Address | |||||
| 9372 Lake Serena Drive | |||||
| City | State | Zip | |||
| Boca Raton | FL | 33496 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (954) 439 - 0580 | dmcnab@norcal-group.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Keith | D | Goldstein | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 7431 N. University Drive, No. 101 | ||||
| City | State | Zip Code | County | ||
| Tamarac | FL | 33221 | Broward | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MG000364 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME94967 | Hematology - No Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Broward | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| CORAL SPRINGS MEDICAL CENTER | 110019 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Patients' Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 2/27/2014 | 8/20/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| The patient was admitted to the hospital with Sickle Cell Syndrome, acute chest crisis. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| It was alleged that there was a failure to recognize the patient's impending hemolytic crisis and failed to timely begin red blood cell exchange and transfusions. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| There was no misdiagnosis. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Death | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 9/17/2015 | 17th Judicial | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Broward | 10/5/2018 | ||||
| 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 not subject to Arbitration. | |||||
| Date of Payment | |||||
| 9/7/2018 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $63,583 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $63,583 | ||||||||||||||||||||
| 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 conferenced with defense counsel and claims specialist | |||||||||||||||||||||
| Updates | |
| No updates found. |
| Department File Number : | M201781526 |
| Claim Number : | F14-0170-A-14 |
| Date Submitted : | 3/23/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| FD INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 20-3704679 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Sasha | Yamamoto | |||
| Street Address | |||||
| 560 Davis Street | |||||
| City | State | Zip | |||
| San Francisco | CA | 94111 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (415) 735 - 2135 | syamamoto@norcal-group.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Keith | Goldstein | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 7431 N. University Drive, Suite 110 | ||||
| City | State | Zip Code | County | ||
| Tamarac | FL | 33321 | Broward | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MG000364 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME94967 | Hematology - No Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Broward | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Emergency Room | |||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Critical Care Unit | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 2/27/2014 | 8/20/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Hemolytic crisis, sickle cell crisis | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Blood transfusion of packed red blood cells | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Failure to recognize symptoms of impending hemolytic crisis and sickle cell crisis, failure to timely start antibiotics, failure to timely manage red blood cell exchange transfusion | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Hemolytic crisis, sickle cell crisis resulting in death | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 1/25/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| Kashif, Anwer Barrett, Terrance North Broward Hospitalists Florida Hospital Medicine Services, Inc. North Broward Radiologists, PA North Broward Hospital District | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Claim or suit abandoned. | |||||
| Final Method of Claim Disposition | |||||
| No Payment Made | |||||
| Court Decision | Other | ||||
| Other | Information not provided | ||||
| 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 | $13,477 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Discussed with insured and Risk Management | |||||||||||||||||||||
| 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. KEITH D GOLDSTEIN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. KEITH D GOLDSTEIN, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).