| Department File Number : | M201676818 |
| Claim Number : | 072861 |
| Date Submitted : | 1/11/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| TDC SPECIALTY INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 95-4241120 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Sally | L | Cleaver | ||
| Street Address | |||||
| 1888 Century Park East, Suite 850 | |||||
| City | State | Zip | |||
| Los Angeles | CA | 90067 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (310) 492 - 4923 | (866) 344 - 6029 | scleaver@thedoctors.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Rafael | A | Santiago-Gonzalez | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2407 CYPRESS RIDGE BLVD | ||||
| City | State | Zip Code | County | ||
| Wesley Chapel | FL | 33544 | Pasco | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| P95628-13 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME96525 | Physical Medicine and Rehabilitation | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Pasco | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Physician's Office | |||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 10/15/2013 | 10/18/2013 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| DECEDENT WAS A 5'3", 200-LBS (BMI-35), 1PPD CIGARETTEUSE, DISABLED MARRIED CAUCASIAN FEMALE. SHE ALSO HAD AHISTORY OF BIPOLAR DISORDER, DISKECTOMIES &LAMINECTOMIES AT L4-5, L5-S1 IN 2002; PERMANENT NUMBNESSIN RIGHT FOOT SINCE SURGERY. DUE TO HER CHRONIC PAIN,DECEDENT HAD AN IMPLANTED DEPUY CODMAN INTRATHECAL PAINPUMP BY OTHER PROVIDERS, ALONG WITH ORAL PERCOCET PRN. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| ON 7/16/2013, DECEDENT INITIALLY PRESENTED TO INSUREDWITH CHIEF COMPLAINT OF PAIN IN LOWER BACK, RIGHT ANKLEPAIN, LEFT ANKLE PAIN, WITH RADIATING BILATERAL LEGPAIN. DECEDENT HAD ANTALGIC GAIT TO RIGHT SIDE & USED ACANE. PUMP WAS FILLED WITHOUT INCIDENT ON 7/24/2013 AND9/4/2013. ON 10/15/2013, OUR INSURED ATTEMPTED TO REFILLDECEDENT'S INTRATHECAL PAIN PUMP WITH DILAUDID. SHORTLYAFTER THE INJECTION, SHE SEEMED MEDICATED WHEREBYINSURED EMPTIED RESERVOIR, INJECTED NARCAN, CALLED 911 &DECEDENT WAS TRANSFERRED TO HOSPITAL WITH STABLE VITALSIGNS. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| PLAINTIFF ALLEGES INSURED ATTEMPTED TO REFILL DECEDENT'SPAIN PUMP WITH DILAUDID AND FAILED TO PROPERLY INSERTTHE NEEDLE INTO THE PUMP RESERVOIR AND, INSTEAD,INJECTED SUCH DIRECTLY INTO THE PATIENT CAUSING HER TOOVERDOSE AND SUBSEQUENTLY DIE ON 10/16/2013. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| CAUSE OFDEATH WAS NOTED TO BE HYDROMORPHONE TOXICITY. | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 11/16/2015 | ||||
| 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 | |||||
| 11/16/2015 | |||||
| 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 | $3,285 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $2,903 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| ENSURE CLICK BEFORE FILL INTRATHECAL PAIN PUMP. | |||||||||||||||||||||
| 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.
| Department File Number : | M201678469 |
| Claim Number : | 072687 |
| Date Submitted : | 5/18/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| TDC SPECIALTY INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 95-4241120 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Mark | A | Franzen | ||
| Street Address | |||||
| 1888 Century Park East, Suite 850 | |||||
| City | State | Zip | |||
| Los Angeles | CA | 90067 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (310) 492 - 4928 | (866) 344 - 6029 | mfranzen@thedoctors.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Rafael | A | Santiago-Gonzalez | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2407 Cypress Ridge Blvd Suite A | ||||
| City | State | Zip Code | County | ||
| Wesley Chapel | FL | 33544 | Pasco | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| P95628-12 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME96525 | Physical Medicine and Rehabilitation - Pain Management | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Hillsborough | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Physician's Office | |||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 6/21/2011 | 12/22/2011 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| PLAINTIFF INITIALLY PRESENTED TO OUR INSURED ON 6/14/2011 FOR COMPLAINT OF SEVERE LUMBAR PAIN WHICH RADIATED TO LOWER EXTREMITIES. MRI PERFORMED ON 6/17/2011 SHOWED MILD/MODERATE BULGES AT L5-S1 AND L4-5. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| ON 6/21/2011 AND ON 6/29/2011, OUR INSURED PERFORMED EPIDURAL INTRA-LUMBAR INJECTIONS AT L5-S1. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| PLAINTIFF ALLEGES DEFENDANTS FAILED TO TIMELY DIAGNOSE THE INFECTION. PATIENT WAS SUBSEQUENTLY DIAGNOSED WITH SEPSIS, INTRACRANIAL ABSCESS, AND OSTEOMYELITIS. INSURED RECEIVED POSITIVE EXPERT SUPPORT THAT THE INJECTION WAS PERFORMED WAS WITHIN STANDARD OF CARE. THIS CASE WAS SETTLED FOR ECONOMIC REASONS WITH NO ADMISSION OF PROFESSIONAL LIABILITY OR WRONGDOING. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| PLAINTIFF ALLEGES DEFENDANTS FAILED TO TIMELY DIAGNOSE THE INFECTION. | |||||
| 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 | ||||
| 3/3/2014 | 2014-CA-002230 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Hillsborough | 5/3/2016 | ||||
| Other Defendants Involved in this Claim | |||||
| Brandon Medical Wellness Ctr Springer, DC, Deborah E | |||||
| 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 | |||||
| 5/3/2016 | |||||
| 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 | $91,668 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $30,568 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Patient was referred to neurosurgeon. | |||||||||||||||||||||
| Updates | |
| No updates found. |
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Does Dr. RAFAEL A SANTIAGO-GONZALEZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. RAFAEL A SANTIAGO-GONZALEZ, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).