M200534859

Insurer Information

Insurer Name				Coverage Type
HEALTH CARE INDEMNITY, INC.				Primary
Insurer FEIN		Professional License Number
61-0904881
Insurer Contact Information
Type	First Name		MI	Last Name
Individual	Teresa			Ross
Street Address
One Park Plaza P.O. Box 555
City				State	Zip
Nashville				TN	37202
Phone	Ext	Fax	E-Mail Address
(615) 344 - 5804(615) 344 - 5804			Teresa.Ross@HCAHealthcare.com

Insured Information

Type	Entity Name
Entity	Columbia Hospital
Insurer Type	Street Address of Practice
Licensed	2201 45th Street
City	State	Zip Code	County
West Palm Beach	FL	33407	Palm Beach
Policy Number	Per Claim Policy Limits		Aggregate Policy Limits
HCI-10103	$10,000,000		$1
Profession or Business		Other Profession or Business
Hospitals
License Number	Specialty Code & Classification		Certification Number

Injured Person Information

First Name	MI	Last Name		Date of Birth

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

Location where injury occured		Other location where injury occured
Hospital Inpatient Facility
Name of Institution		Code
COLUMBIA HOSPITAL		100234
Location of Institutional Injury		Other Location of Institutional Injury
Patients' Room
Date of Occurrence		Date Reported to Insurer
8/4/2003		8/4/2003

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Bipolar disorder, depression.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Patient committed suicide by strangulation in the bathroom of her room. Patient was on Q15 minute checks and was checked at 0345. At 0355, the patient's roommate informed the Mental Health Technician that she needed to use the bathroom and could not get in. The technician unlocked the bathroom door and found patient with a sheet knotted around her neck. Code Blue called at 0400. Patient was pronounced at 0416.
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
Wrongful death.
Severity Of Injury
Permanent: Death.

Legal Information

Date of Suit	Circuit Court Case Number
	*NR
County Suit Filed in	Date of Final Disposition
*NR	3/14/2005
Other Defendants Involved in this Claim

Stage of Legal System at which Settlement was Reached or Award Made
Claim or suit abandoned.
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

$60

All Other Loss Adjustment Expense Paid

$1,350

Injured Person's Total Non-Economic Loss

Deductible

Injured Person's Total Economic Loss

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

Staff education.

Updates

No updates found.