Department File Number : | M201885439 |
Claim Number : | 2017-01323 |
Date Submitted : | 6/5/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
CRUDEN BAY RISK RETENTION GROUP, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
27-0057453 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Tracy | Coleman | |||
Street Address | |||||
10140 Centurion Parkway N | |||||
City | State | Zip | |||
Jacksonville | FL | 32256 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 697 - 4205 | (904) 697 - 4202 | tcoleman@nemours.org |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Roberto | Gomez Suarez | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 13535 Nemours Parkway | ||||
City | State | Zip Code | County | ||
Orlando | FL | 32827 | Orange | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
1111 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME116287 | Surgery - Gastroenterology |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Orange | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
NEMOURS CHILDRENS HOSPITAL | 23960096 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
2/22/2017 | 2/23/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
myositis ossificans with dysphagia and malnutrition | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
esophagogastroduodenoscopy with biopsies | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Desaturations during procedure requiring removal of the scope. Patient was unable to be intubated. CPR started but patient could not be resuscitated. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 4/18/2018 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
After arbitration is initiated or prior to suit being filed. | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim subject to arbitration, but settlement reached in lieu of award. | |||||
Date of Payment | |||||
6/1/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $361,889 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $23,552 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Peer reviewed |
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. ROBERTO GOMEZ SUAREZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ROBERTO GOMEZ SUAREZ, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).