THE LAW FIRM OF G. JUDSON SCOTT, JR.

MEDICAL MALPRACTICE FACTUAL SUMMARY
(Confidential - Subject to Attorney-Client Privilege)

          Please complete the answers to the following questions to provide us with preliminary information to evaluate your potential case so that we will have the necessary information to understand the potential inssues involved. These questions are also designed to assist you in assembling the initial facts and documents which will be needed to evaluate your case.

          If we believe that we may be able to handle your case, we will let you know we will also likely request some further information to more fully understand and evaluate your case in order to make our decision about accepting it and becoming your attorneys in this matter.

          Additional space provided for your use in item 28 if you do not have enough room in the block for each question for your complete response. If you use that space for your supplemental answers, please include the questioin number to which your further information applies.

A. GENERAL BACKGROUND:

1.Your Full Name:

4. E-mail Address:

2. Home address:

3. Home Phone:

Business Phone:

Cell Phone:

Best hours and phone number to reach you:

5. Date of Birth:

6. Does this concern an injury to you, or to someone else?

Self

Someone Else

If the injury is to another person, please tell us his/her name, age, and relationship to you:

7. How were you referred to our law firm for this matter?

8. Current occupation and employer:

If the employer has changed since the time when the malpractice occured, what was it then?

9. Did you lose income from the effect of this malpractice upon you?

Yes

If so, please tell us the total of your gross income loss (before taxes and deduction) to date:

10. In the five years to the malpractice, did you miss employment by reason of any injury, illness or other medical cause?

Yes

If the answer is yes, please tell us the reason for each absence and the inclusive dates you were off work:

11. Have you been advised by any doctor or other medical person that you will miss more work in the future for any reason caused by the malpractice?

Yes

If yes, who said this to you and when?

What were you told will be the reason for missing future work?

Please tell us how much more income you expect to lose and over what time interval, and why you expect to incur that further loss:

C. THE MALPRACTICE OR MEDICAL NEGLICENCE:

12. Date and approximate time of malpractice:

Where did the malpractice occur?

What is the name of each physician, nurse or other person who you believe was responsible for, involved in, or who caused the malpractice and this injury?

13. When did you first know of, or suspect malpractice had occured?

14. How did you discover it, or begin to suspect it?

15. Please tell us what happened, including why you were receiving medical care when the malpractice occured, and what the treatment was which included the medical malpractice:

16. Was the malpractice reported to anyone?

Yes

If yes, please tell us to whom it was reported, why, and when it was reported:

17. Has any doctor, nurse or other medical person told you that this illness or injury was caused by medical malpractice, negligence, error or mistake?

Yes

If so, please tell us who that person(s) was and what they told you about the cause of your illness or iinjury from malpractice:

18. Has any doctor, nurse or other medical person told you that any injury or illness which you understand was caused by this malpractice is permanent or will require further treatment or surgery?

Yes

If so, please tell us who that person(s) was and what they told you about your injury or inllness:

19. Do you believe, or has any doctor, nurse or other medical person told you that any of the illnesses or injuries you described above also existed before the malpractice occurred?

Yes

Please also tell us what illness or injury existed before the malpractice occurred, and whether it changed or increased after the malpractice occurred:

20. What is the date you first consulted an attorney regarding this malpractice?

Who is that attorney?

D. DOCTORS AND MEDICAL EXPENSES

Name:

Address:

Specialty:

Address:

Name:

Specialty:

Address:

Name:

Specialty:

Address:

Name:

22. Approximately what is the total of all medical bills which were incurred to treat you for the effects of the malpractice upon you?

If you can, please tell us how much of that total has actually been paid by your medical insurance or coverage:

E. HOSPITALS:

23. Have you been hospitalized, or seen on an outpatient basis at a hospital since the malpractice?

Yes

If so, please tell us where this occurred, the inclusive dates when you were there, the reason you were seen or hospitalized, and what connection that treatment had to the malpractice if any:

24. Please tell us all of the symptoms or conditions which you believe were caused or made worse by the malpractice and for each, also tell us whether you still have them, or approximately when each resolved:

F. OTHER INFORMATION:

25. Please describe your general physical health and medical condition before the malpractice occurred:

26. List any expenses or damages/injuries not already mentioned which you feel were directly caused by the malpractice:

27. Have you ever brought a claim for medical malpractice before, or have you ever been a party in any lawsuit or legal proceeding?

Yes

If so, please tell us generally what happened, when it occurred, in what county the matter was filed or heard, and the ultimate result of each court matter:

28. Please provide any other information which you feel would be helpful to us in evaluating your potential case:

Date Completed:

Name:

B. PLEASE ANSWER THE FOLLOWING QUESTIONS FOR THE PERSON INJURED BY THE MEDICAL MALPRACTICE.

21. Please provide the name, address and specialty of all doctors and all other health care providers you have seen since the malpractice occurred, whether or not they treated you for injuries connected with the malpractice:

I certify that the above information is true and complete to the best of my knowledge and belief

Please telephone us at 460-0800 if you have any difficulties with these questions or if we can assist you in any way.

We will promptly review the information you have provided here and will contact you if we need additional information. If we have sufficient information to properly evaluate your case, we will also do our best to promptly contact you if we believe we can be of assistance to you. If we will then schedule an office conference to meet you and answer any questions you may have.

PLEASE NOTE: Although the submission of this information does not create an attorney-client relationship with our firm, we will treat it as confidential information which is protected by the attorney-client privilege. An attorney-client relationship with our law firm will only be created if we accept your representation in this matter. This decision will be reached later, after we are able to obtain and evaluate sufficient information about your case.

Please answer every question. Your completion of each question will help us to fully and promptly evaluate your potential claim.

Medical Malpractice

The statutes of limitations for injury or death from medical malpractice cases are more complicated than for personal injury cases because they cover multiple circumstances. They are stated in Code of Civil Procedure section 340.5, and generally provide:

A lawsuit must be filed within one year after the plaintiff discovers the injury, or through the use of reasonable diligence should have discovered the injury OR three years after the date of the injury, whichever occurs first. Please note that this one year limitation can provide less time than the general two year limitation for personal injuries if the malpractice is discovered promptly, or soon after it occurs.
Under either of these circumstances, the time to commence a lawsuit cannot exceed three years from the date of injury unless it can be proven that the filing of the lawsuit was prevented by fraud, by intentional concealment of the injury or its negligent cause, or because the injury was caused by the presence of a foreign body inside the injured person, where the foreign body has no therapeutic or diagnostic purpose or effect.
A lawsuit for a child under the age of 18 must be commenced within three years from when the wrongful act occurred, except that a lawsuit for a minor child who has not yet reached their 7th birthday must be filed within three years, or prior to the 8th birthday, whichever provides a longer period of time. The age limits here refer to the plaintiff’s age when the injury occurred, not their age when suit is filed. The time here is limited to three years and is not extended by delayed discovery.
The time to file a lawsuit for a minor child is extended for any period during which the parent or guardian of that child has committed fraud or collusion with that child’s health care provider or their insurer to fail to bring an action on behalf of that injured child for the professional negligence of that health care provider.

Medical malpractice cases are generally more expensive and complicated to pursue than most personal injury cases because the negligence of the health care provider must be proven through the testimony of medical experts in that field. Medical experts charge several hundred dollars per hour for their time, so such expert testimony can easily increase the costs of such litigation by thousands of dollars.

The recoveries in medical malpractice cases are limited by law in California. Currently, an injured person is generally limited to no more that $250,000 for their “non-economic” damages (such as pain and suffering, disfigurement, physical impairment, inconvenience, loss of enjoyment of life, and emotional distress), in addition to the “present value” of their provable “economic” damages (such as past and future medical expenses, loss of past and future income, and other expenses and damages where exact expenses can be established and proven). These damages limits apply to limit your recovery even if you can prove that your actual damages and losses are far worse. Loss of consortium damages by a spouse has a separate $250,000 damages cap because it is a separate action. Wrongful death claims from medical malpractice are also limited to a single $250,000 cap for non-economic damages for all claimants from that death, although any survival action claim from that same death has its own $250,000 damages cap.

The attorneys’ fees in medical malpractice cases in California are also set by law. They are contingent fees and are computed on the net recovery after the costs of the case/litigation are first deducted and reimbursed to the lawyer who advanced them. The contingent percentage attorneys’ fees of the net recovery after costs in such cases depend upon the amount recovered. They are:

  40% of the recovery up to $50,000, then
  1/3 of any recovery between $50,000 and $100,000, then
  25% of any recovery between $100,000 and $250,000, then
  15% of any recovery above $250,000

Medical malpractice cases against Kaiser for the negligence of its physicians, other health care providers, or in their hospitals or other medical facilities are controlled by the Kaiser enrollment contract and the Kaiser rule which specify that they must be resolved through binding arbitration. Depending upon the circumstances, there can be either one or three arbitrators used to decide the case. The same damages recovery limitations discussed above also apply to arbitration recoveries against Kaiser in California, and the “sliding scale” contingent attorneys’ fees percentages are also the same in such Kaiser medical malpractice cases.

It is the policy if our firm not to accept potential medical malpractice cases until we have been able to obtain all of the relevant medical records, x-ray/CT/MRI films, and other medical information and to have those items reviewed by a qualified medical expert to determine whether the potential case has merit and should be pursued. Because we do not yet represent the potential client, we require the potential client to advance the expenses of obtaining and reviewing those records. We do not charge for our time spent assisting in that effort and in obtaining that expert medical review. If that expert’s opinion is that the case has merit and should be pursued, and if we decide to accept the case, then we advance the further costs and expenses required to pursue the case into and through litigation, if necessary.

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