Dr. RICHARD H HYNES, MD Medical Malpractice Cases, Lawsuits, and Complaints

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Phycicians Practice Address

Dr. RICHARD H HYNES, MD

205 E Nasa Blvd, St 200

Melbourne, FL

32901

Brevard

Court Case #

Indemnity Paid: $425,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Department File Number :	M202091283
Claim Number :	cla0481770
Date Submitted :	1/29/2020

Insurer Information

Insurer Name				Coverage Type
NORCAL MUTUAL INSURANCE COMPANY				Primary
Insurer FEIN		Professional License Number
94-2301054
Insurer Contact Information
Type	First Name		MI	Last Name
Individual	Diane		M	McNab
Street Address
5555 Gate Parkway, Suite 150
City				State	Zip
Jacksonville				FL	32256
Phone	Ext	Fax	E-Mail Address
(954) 439 - 0580			dmcnab@norcal-group.com

Insured Information

Type	First Name		MI	Last Name
Individual	Richard		H	Hynes
Insurer Type		Street Address of Practice
Licensed		222 South Harbor City Blvd.
City		State	Zip Code	County
Melbourne		FL	32901	Brevard
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
720586N		$250,000		$750,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME62236		Surgery - Orthopedic

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Injured Person Information

First Name	MI	Last Name		Date of Birth

Street Address			Gender	County where Injury Occurred
			M	Brevard
City			State	Zip Code

Location where injury occured		Other location where injury occured
Other Outpatient Facility		Surgery Center of Palm Beach Gardens
Name of Institution		Code
SURGCENTER OF PALM BEACH GARDENS		14960821
Location of Institutional Injury		Other Location of Institutional Injury
Operating Suite
Date of Occurrence		Date Reported to Insurer
12/23/2016		3/8/2019

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
The patient had disabling abdominal and back pain issues for years long before presenting to this health care provider. Due to the patient's severe back pain which radiated down the right leg with no relief from back injections, this health care provider performed three back surgeries for this patient.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
On 12/23/16, a L4-S1 fusion was performed. Post-operatively, the records reflect the patient's post op back pain resolved and the radicular pain improved but the patient had radicular pain within the S1 nerve distribution. A CT Myelogram reflected there was something near the nerve root L4-5. On 1/27/17, this health care provider performed a revised laminectomy and facetectomy L4-5 and revision of the pedicle screw and rod fixation L3-4 to S1 on the right side. A second CT Myelogram was performed and reflected a destructive process at the disc space L4-5. Due to continued complaints of back pain, a third surgery was performed on 3/6/17 in which this provider removed the right sided instrumentation but found no impingement.
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Disputed allegation of improper placement of the pedicle screw in the SI joint.
Principal Injury Giving Rise To The Claim
permanent foot drop
Severity Of Injury
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Legal Information

Date of Suit			Circuit Court Case Number
			*NR
County Suit Filed in			Date of Final Disposition
*NR			1/11/2020
Other Defendants Involved in this Claim

Stage of Legal System at which Settlement was Reached or Award Made
Settlement Reached Prior to Pre-Suit Period
Final Method of Claim Disposition
Settled by parties
Court Decision			Other
Other			SETTLED
Arbitration
Claim not subject to Arbitration.
Date of Payment
1/27/2020

Financial Information

Was there a settlement Resulting in payment to the Plaintiff?

Yes

Indemnity Paid by Insurer on behalf of Insured

$425,000

Loss Adjust Expense Paid to Defense Counsel

All Other Loss Adjustment Expense Paid

Injured Person's Total Non-Economic Loss

Deductible

Injured Person's Total Economic Loss

	Incurred to Date	Anticipated
Medical Expense	$0	$0
Wage Loss	$0	$0
Other Expenses	$0	$0

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

Insured met and conferenced with defense attorney and claims specialist.

Updates

No updates found.

Court Case # 05-2006-CA-053135

Indemnity Paid: $99,999.00

Medical Malpractice Closed Claims Report

Department File Number :	M201160193
Claim Number :	1000904R
Date Submitted :	8/18/2011

Insurer Information

Insurer Name				Coverage Type
FLORIDA MEDICAL MALPRACTICE JUA				Primary
Insurer FEIN		Professional License Number
59-1625412
Insurer Contact Information
Type	First Name		MI	Last Name
Individual	SUSAN			SPIELMAN
Street Address
5814 Reed Street
City				State	Zip
Fort Wayne				IN	46835
Phone	Ext	Fax	E-Mail Address
(260) 486 - 0340		(260) 486 - 0782	SUSAN.SPIELMAN@MEDPRO.COM

Insured Information

Type	First Name		MI	Last Name
Individual	RICHARD		A	HYNES
Insurer Type		Street Address of Practice
Licensed		205 E Nasa Blvd, St 200
City		State	Zip Code	County
Melbourne		FL	32901	Brevard
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
FL003137		$250,000		$750,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME62236		Surgery - Orthopedic

Medical Malpractice Closed Claims Report

Injured Person Information

First Name	MI	Last Name		Date of Birth

Street Address			Gender	County where Injury Occurred
			F	Brevard
City			State	Zip Code

Location where injury occured		Other location where injury occured
Hospital Inpatient Facility
Name of Institution		Code
HOLMES REGIONAL MEDICAL CENTER		100019
Location of Institutional Injury		Other Location of Institutional Injury
Operating Suite
Date of Occurrence		Date Reported to Insurer
5/21/2004		1/18/2007

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Back and spine pain
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Laparoscopic spine surgery
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Unnecessary surgery
Principal Injury Giving Rise To The Claim
Pain and suffering, decreased ability to ambulate
Severity Of Injury
Permanent: Minor - Loss of fingers, loss or damage to organs.Includes non-disabling injuries.

Medical Malpractice Closed Claims Report

Legal Information

Date of Suit			Circuit Court Case Number
5/25/2007			05-2006-CA-053135
County Suit Filed in			Date of Final Disposition
Brevard			3/22/2011
Other Defendants Involved in this Claim
Brevard Orthopaedic Spine & Pain Clinic Inc dba The Back Ctr
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
3/22/2011

Financial Information

Was there a settlement Resulting in payment to the Plaintiff?

Yes

Indemnity Paid by Insurer on behalf of Insured

$99,999

Loss Adjust Expense Paid to Defense Counsel

$45,932

All Other Loss Adjustment Expense Paid

$36,038

Injured Person's Total Non-Economic Loss

Deductible

Injured Person's Total Economic Loss

	Incurred to Date	Anticipated
Medical Expense	$0	$0
Wage Loss	$0	$0
Other Expenses	$0	$0

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

N/A

Updates

Date of Change:

8/18/2011 10:24:51 AM

Reason for Change:

Update ALE

Field Changed	Former Value	New Value
Amount of Loss Adjustment Expense Paid to Defense Counsel	33691	45932
All Other Loss Adjustment Expense Paid	27529	36038

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Court Case # 05-2014-CA-14207

Indemnity Paid: $85,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Department File Number :	M201781695
Claim Number :	F13-0207-a-11
Date Submitted :	4/4/2017

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	Dionysia			Lawson
Street Address
560 Davis Street
City				State	Zip
San Francisco				CA	94111
Phone	Ext	Fax	E-Mail Address
(415) 735 - 2013		(415) 735 - 2097	dlawson@norcalmutual.com

Insured Information

Type	First Name		MI	Last Name
Individual	Richard			Hynes
Insurer Type		Street Address of Practice
Licensed		2222 S. Harbor City Blvd. Fl. 6
City		State	Zip Code	County
Melbourne		FL	32901	Brevard
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
MG000189		$250,000		$750,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME62236		Surgery - Orthopedic

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Injured Person Information

First Name	MI	Last Name		Date of Birth

Street Address			Gender	County where Injury Occurred
			M	Brevard
City			State	Zip Code

Location where injury occured		Other location where injury occured
Hospital Inpatient Facility
Name of Institution		Code
N/A		000000
Location of Institutional Injury		Other Location of Institutional Injury
Operating Suite
Date of Occurrence		Date Reported to Insurer
7/1/2011		10/2/2013

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Back pain and discomfort.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Insured performed an anterior lumbar diskecotomy,L2-3 & L3-4 anterior lumbar interbody fusion. Implantation of Medtronic PEEK interbody cage fixation L2-3, L3-4, and psoterior revision of laminectomy, partial laminectomy L3-4.
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
Alleging incorrectly inserting screw into spinal canal and unacceptable instrumentation contruct to maintain appropriate alignment
Severity Of Injury
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Legal Information

Date of Suit			Circuit Court Case Number
4/15/2014			05-2014-CA-14207
County Suit Filed in			Date of Final Disposition
Brevard			9/21/2016
Other Defendants Involved in this Claim
Brevard Orthopaedic Spine and Pain Clinic, Inc
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
9/29/2016

Financial Information

Was there a settlement Resulting in payment to the Plaintiff?

Yes

Indemnity Paid by Insurer on behalf of Insured

$85,000

Loss Adjust Expense Paid to Defense Counsel

$47,393

All Other Loss Adjustment Expense Paid

Injured Person's Total Non-Economic Loss

Deductible

Injured Person's Total Economic Loss

	Incurred to Date	Anticipated
Medical Expense	$0	$0
Wage Loss	$0	$0
Other Expenses	$0	$0

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

Circumstances of the claim have been discussed with the insured and Risk Management.

Updates

No updates found.

*NR: Prior to 04/28/1999 this field was not required in submitted claims.

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Court Case # 2008-CA-34027

Indemnity Paid: $25,000.00

Medical Malpractice Closed Claims Report

Department File Number :	M201264535
Claim Number :	1005051
Date Submitted :	11/16/2012

Insurer Information

Insurer Name				Coverage Type
FLORIDA MEDICAL MALPRACTICE JUA				Primary
Insurer FEIN		Professional License Number
59-1625412
Insurer Contact Information
Type	First Name		MI	Last Name
Individual	SUSAN			SPIELMAN
Street Address
5814 Reed Street
City				State	Zip
Fort Wayne				IN	46835
Phone	Ext	Fax	E-Mail Address
(260) 486 - 0340		(260) 486 - 0782	SUSAN.SPIELMAN@MEDPRO.COM

Insured Information

Type	First Name		MI	Last Name
Individual	RICHARD		A	HYNES
Insurer Type		Street Address of Practice
Licensed		205 E Nasa Blvd, Ste 200
City		State	Zip Code	County
Melbourne		FL	32901	Brevard
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
FL003137		$250,000		$750,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME62236		Surgery - Orthopedic

Medical Malpractice Closed Claims Report

Injured Person Information

First Name	MI	Last Name		Date of Birth

Street Address			Gender	County where Injury Occurred
			F	Brevard
City			State	Zip Code

Location where injury occured		Other location where injury occured
Hospital Inpatient Facility
Name of Institution		Code
HOLMES REGIONAL MEDICAL CENTER		100019
Location of Institutional Injury		Other Location of Institutional Injury
Operating Suite
Date of Occurrence		Date Reported to Insurer
12/13/2004		2/25/2008

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Back pain
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Spinal surgery
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Unnecessary surgery
Principal Injury Giving Rise To The Claim
Pain & suffering; partial disability
Severity Of Injury
Permanent: Minor - Loss of fingers, loss or damage to organs.Includes non-disabling injuries.

Medical Malpractice Closed Claims Report

Legal Information

Date of Suit			Circuit Court Case Number
6/20/2008			2008-CA-34027
County Suit Filed in			Date of Final Disposition
Brevard			8/7/2012
Other Defendants Involved in this Claim
Brevard Orthopaedic Spine & Pain Clinic Inc
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
8/7/2012

Financial Information

Was there a settlement Resulting in payment to the Plaintiff?

Yes

Indemnity Paid by Insurer on behalf of Insured

$25,000

Loss Adjust Expense Paid to Defense Counsel

$39,507

All Other Loss Adjustment Expense Paid

$22,557

Injured Person's Total Non-Economic Loss

$10,000

Deductible

Injured Person's Total Economic Loss

	Incurred to Date	Anticipated
Medical Expense	$0	$0
Wage Loss	$0	$0
Other Expenses	$0	$0

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

N/A

Updates

Date of Change:

8/14/2012 10:43:46 AM

Reason for Change:

Enter corrected CLAIM Number (numbers were transposed)

Field Changed	Former Value	New Value
Claim Number	1001051	1005051

Date of Change:

11/16/2012 1:46:07 PM

Reason for Change:

Correct and update financial information

Field Changed	Former Value	New Value
Amount of Loss Adjustment Expense Paid to Defense Counsel	35053	39507
All Other Loss Adjustment Expense Paid	22541	22557
Injured Person Total Non-Economic Loss	0	10000

This page is not displaying certain sensitive information.

Court Case # 05-2011-CA-039489

Indemnity Paid: $2,500.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Department File Number :	M201574648
Claim Number :	11-0080-A-09
Date Submitted :	1/19/2016

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	Tamla			Lloyd
Street Address
4651 Salisbury Road, Suite 410
City				State	Zip
Jacksonville				FL	32256
Phone	Ext	Fax	E-Mail Address
(904) 296 - 2887	212	(904) 296 - 1245	tlloyd@fdinsurancecompany.com

Insured Information

Type	First Name		MI	Last Name
Individual	Richard			Hynes
Insurer Type		Street Address of Practice
Licensed		2222 South Harbor City Blvd., Suite 610
City		State	Zip Code	County
Melbourne		FL	32901	Brevard
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
MG000189		$250,000		$750,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME62236		Surgery - Orthopedic

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Injured Person Information

First Name	MI	Last Name		Date of Birth

Street Address			Gender	County where Injury Occurred
			F	Brevard
City			State	Zip Code

Location where injury occured		Other location where injury occured
Hospital Inpatient Facility
Name of Institution		Code
HOLMES REGIONAL MEDICAL CENTER		100019
Location of Institutional Injury		Other Location of Institutional Injury
Operating Suite
Date of Occurrence		Date Reported to Insurer
1/20/2009		4/5/2011

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Pt was presented to insured in December 2008 as a referral for pain management for persistent right posterior buttock pain, thigh pain, and tingling pain into the right calf and right foot.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
On 2/20/09, Laparoscopic anterior diskectomy, lumbar interbody fusion with posterior pedicle screw fixation and decompressive laminectomy. On 2/20/09, exploratory surgery.
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None shown
Principal Injury Giving Rise To The Claim
Alleged failure to take appropriate precautions to avoid a misplaced pedicle screw and to properly read & interpret the CT scan of the lumbar spine post-op after the initial procedure.
Severity Of Injury
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Legal Information

Date of Suit			Circuit Court Case Number
12/1/2011			05-2011-CA-039489
County Suit Filed in			Date of Final Disposition
Brevard			4/16/2015
Other Defendants Involved in this Claim
Brevard Orthopaedic Spine & Pain Clinic, Inc. d/b/a The B.A.
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
4/16/2015

Financial Information

Was there a settlement Resulting in payment to the Plaintiff?

Yes

Indemnity Paid by Insurer on behalf of Insured

$2,500

Loss Adjust Expense Paid to Defense Counsel

$74,630

All Other Loss Adjustment Expense Paid

Injured Person's Total Non-Economic Loss

Deductible

Injured Person's Total Economic Loss

	Incurred to Date	Anticipated
Medical Expense	$0	$0
Wage Loss	$0	$0
Other Expenses	$0	$0

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

Circumstances of this case have been discussed with insured and risk management was notified. Risk management has discussed case with insured.

Updates

Date of Change:

1/19/2016 11:29:35 AM

Reason for Change:

Updated LAE amount.

Field Changed	Former Value	New Value
Amount of Loss Adjustment Expense Paid to Defense Counsel	73169	74630

This page is not displaying certain sensitive information.

Court Case # 18 Judicial Circuit

Indemnity Paid: $0.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Department File Number :	M201887119
Claim Number :	158442
Date Submitted :	11/25/2018

Insurer Information

Insurer Name				Coverage Type
NORCAL MUTUAL INSURANCE COMPANY				Primary
Insurer FEIN		Professional License Number
94-2301054
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	Richard		A	Hynes
Insurer Type		Street Address of Practice
Licensed		222 South Harbor City Blvd.
City		State	Zip Code	County
Melbourne		FL	32901	Brevard
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
720586N		$250,000		$750,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME62236		Surgery - Orthopedic

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Injured Person Information

First Name	MI	Last Name		Date of Birth

Street Address			Gender	County where Injury Occurred
			F	Brevard
City			State	Zip Code

Location where injury occured		Other location where injury occured
Hospital Inpatient Facility
Name of Institution		Code
HOLMES REGIONAL MEDICAL CENTER		100019
Location of Institutional Injury		Other Location of Institutional Injury
Operating Suite
Date of Occurrence		Date Reported to Insurer
6/25/2013		9/22/2016

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
The patient presented with severe back pain and lower left extremity pain.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
The health care practitioner performed a anterior/posterior fusion at L4-L5. Due to the Plaintiff's continued complaints of pain, a second fusion was performed. Plaintiff alleged that the first surgery was improperly performed and the second surgery was unnecessary. These allegations were highly disputed by supporting experts.
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
There was no misdiagnosis. Plaintiff alleged improper performance of back surgery.
Principal Injury Giving Rise To The Claim
Back pain and lower left extremity pain.
Severity Of Injury
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Legal Information

Date of Suit			Circuit Court Case Number
8/31/2017			18 Judicial Circuit
County Suit Filed in			Date of Final Disposition
Brevard			10/22/2018
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
No Payment Made
Court Decision			Other
No Court Proceedings.
Arbitration
Claim not subject to Arbitration.
Date of Payment

Financial Information

Was there a settlement Resulting in payment to the Plaintiff?

Indemnity Paid by Insurer on behalf of Insured

Loss Adjust Expense Paid to Defense Counsel

$6,210

All Other Loss Adjustment Expense Paid

$6,210

Injured Person's Total Non-Economic Loss

Deductible

Injured Person's Total Economic Loss

	Incurred to Date	Anticipated
Medical Expense	$0	$0
Wage Loss	$0	$0
Other Expenses	$0	$0

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

Insured conferenced with defense attorneys and claims specialist on this claim.

Updates

No updates found.

Frequently Asked Questions

Does Dr. RICHARD H HYNES, MD have any medical malpractice cases, lawsuits, or complaints?

Dr. RICHARD H HYNES, MD has at least 6 medical malpractice case(s), lawsuit(s), or complaint(s).

Medical Malpractice Cases