| Department File Number : | M202092131 |
| Claim Number : | 73847 |
| Date Submitted : | 4/6/2020 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| MAG MUTUAL INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 58-1449198 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Tonya | Ponder | |||
| Street Address | |||||
| 3535 Piedmont Rd., NE, Bldg. 14 - Ste. 1000 | |||||
| City | State | Zip | |||
| Atlanta | GA | 30305 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (404) 842 - 5556 | tponder@magmutual.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Ralph | A | Dematteis | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1900 72nd Ave., NE | ||||
| City | State | Zip Code | County | ||
| St. Petersburg | FL | 33702 | Pinellas | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 1602720 08 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME21255 | Surgery - General | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Pinellas | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| BAYFRONT MEDICAL CENTER | 100032 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Patients' Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 2/9/2018 | 6/22/2019 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Patient presented due to lost distal pulses in his right lower extremity | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Diagnostic consultation and evaluation and balloon angioplasty | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Alleged failure to order/review arterial duplex ultrasound and recognize the extent/location of acute thrombus. A balloon angioplasty on acute thrombus was performed resulting in foot embolization that led to ischemia and need for amputation below the knee. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Below the knee amputation. | |||||
| Severity Of Injury | |||||
| Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 10/29/2019 | 19-007190-CI | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Pinellas | 3/31/2020 | ||||
| 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 | |||||
| 3/31/2020 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $220,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $20,296 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $8,910 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Risk Management has counseled insured. | |||||||||||||||||||||
| Updates | |
| No updates found. |
Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
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Does Dr. RALPH A DEMATTEIS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. RALPH A DEMATTEIS, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).