| Department File Number : | M201678566 |
| Claim Number : | 14-0134-A-14 |
| Date Submitted : | 5/26/2016 |
| 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 | 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 | Thomas | Bass | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 4519 Tifton Ct. | ||||
| City | State | Zip Code | County | ||
| Fort Myers | FL | 33907 | Lee | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MS001444 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME66691 | Surgery - General | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Lee | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD | 23960057 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 6/23/2014 | 6/30/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Morbidly obese patient presented for gastric bypass surgery. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Gastric bypass surgery | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| None Shown | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Stomach Staple line leak post bariatric bypass surgery which led to death | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 5/1/2015 | 11-2015-CA-000734 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Lee | 3/4/2016 | ||||
| Other Defendants Involved in this Claim | |||||
| Gulf Coast Bariatrics dba Surgical Consultants of Southwest | |||||
| 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 | |||||
| 3/4/2016 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $235,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $44,446 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Circumstances of this case were discussed with the insured and risk management was notified. Risk management discussed the case with the insured | |||||||||||||||||||||
| Updates | |||||||
| Date of Change: | 5/26/2016 1:44:47 PM | ||||||
| Reason for Change: | The last name of the injured party was incorrect. | ||||||
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Does Dr. THOMAS BASS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. THOMAS BASS, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).