DEMAND FOR SETTLEMENT - MEDICAL MALPRACTICE

STATE OF ALABAMA

[FIRM NAME]
Attorneys at Law
[Street Address]
[City, Alabama ZIP]
Telephone: [Phone]
Facsimile: [Fax]
Email: [Email]
Licensed in the State of Alabama

DATE: [Date]

VIA CERTIFIED MAIL, RETURN RECEIPT REQUESTED
AND FIRST-CLASS MAIL

[Risk Management / Claims Administrator / Insurance Carrier]
[Hospital / Medical Group / Insurance Company Name]
[Street Address]
[City, State ZIP]

RE: MEDICAL MALPRACTICE CLAIM - SETTLEMENT DEMAND
Patient/Claimant: [Client Full Name]
Date(s) of Negligent Care: [Date or Date Range]
Healthcare Provider(s): [Provider Name(s)]
Facility: [Hospital/Clinic Name]
Claim Number: [If assigned]

Dear [Recipient Name]:

This firm represents [Client Name] in connection with the medical malpractice that occurred during [his/her] care and treatment at [Facility Name] by [Healthcare Provider Name(s)]. This letter constitutes formal notice of our client's claim and our demand for settlement pursuant to the Alabama Medical Liability Act, Ala. Code Section 6-5-480 et seq.

I. ALABAMA-SPECIFIC LEGAL FRAMEWORK

A. Governing Law - Alabama Medical Liability Act

This claim is governed by the Alabama Medical Liability Act (AMLA), Ala. Code Section 6-5-480 et seq., which establishes the standards and procedures for medical malpractice actions in Alabama.

B. Statute of Limitations and Repose

Statute of Limitations: Under Ala. Code Section 6-5-482(a), all actions against healthcare providers must be commenced within two (2) years from the date of the act or omission giving rise to the claim.

Discovery Rule: Alabama applies a limited discovery rule. The limitations period may be extended where the injury was not discovered and could not reasonably have been discovered within the two-year period. Nance v. Matthews, 622 So. 2d 297 (Ala. 1993).

Statute of Repose: Notwithstanding the discovery rule, Ala. Code Section 6-5-482(a) imposes an absolute four (4) year statute of repose from the date of the act or omission. No action may be brought more than four years after the alleged breach regardless of when discovered.

Foreign Object Exception: The statute of repose does not apply to actions involving a foreign object unintentionally left in the patient's body. Ala. Code Section 6-5-482(a).

Minors: For minors under four years of age, the action must be commenced within two years after the child's fourth birthday, but in no event more than four years after the act giving rise to the claim. Ala. Code Section 6-5-482(b).

Relevant Dates in This Matter:
- Date(s) of negligent care: [Date(s)]
- Date of discovery: [Date]
- Two-year limitations period expires: [Date]
- Four-year repose period expires: [Date]

C. Contributory Negligence - CRITICAL

Alabama is one of only four U.S. jurisdictions that still follows the doctrine of pure contributory negligence. Under this doctrine, if the plaintiff is found to have contributed to their injury in any degree whatsoever, they are completely barred from recovery. Williams v. Delta Int'l Mach. Corp., 619 So. 2d 1330 (Ala. 1993).

Our investigation has determined that our client was in no way negligent or contributorily at fault for the injuries sustained. Our client fully complied with all medical instructions and had no role in causing or contributing to the malpractice.

D. Standard of Care Under Alabama Law

Under Alabama law, a healthcare provider must exercise such reasonable care, skill, and diligence as other similarly situated healthcare providers in the same general line of practice ordinarily have and exercise in a like case. Ala. Code Section 6-5-484(a).

Locality Rule: Alabama follows a modified locality rule. The standard of care is based on what similarly situated healthcare providers in the "same general neighborhood" or similar communities would do. Tuscaloosa Orthopedic Appliance Co. v. Wyatt, 460 So. 2d 156 (Ala. 1984). However, for specialists, a national standard may apply.

E. Expert Witness Requirements

Under Ala. Code Section 6-5-548, a plaintiff in a medical malpractice action must present expert testimony to establish:
1. The appropriate standard of care;
2. That the defendant breached that standard; and
3. That the breach proximately caused the plaintiff's injury.

The expert must be a licensed physician who is familiar with the standard of care in the defendant's specialty.

Certification: We certify that we have retained a qualified medical expert who has reviewed the relevant medical records and has concluded that the applicable standard of care was breached and that such breach proximately caused our client's injuries.

F. Damage Caps - Wrongful Death

Wrongful Death Cap: Under Ala. Code Section 6-5-547, in medical malpractice wrongful death actions, noneconomic damages (which constitute all wrongful death damages in Alabama) are capped at $400,000 when the defendant is a physician providing services in a hospital emergency department under certain circumstances.

General Wrongful Death: Alabama's wrongful death statute, Ala. Code Section 6-5-410, provides only for punitive damages, not compensatory damages, and is designed to punish the defendant rather than compensate the estate.

[If applicable:] This claim [involves/does not involve] wrongful death, and the damage cap [applies/does not apply] because [state reasons].

G. Informed Consent

Alabama recognizes the doctrine of informed consent as a basis for medical malpractice liability. A physician has a duty to disclose to a patient sufficient information to enable the patient to make an informed decision about whether to undergo proposed treatment. Fain v. Smith, 479 So. 2d 1150 (Ala. 1985).

The test is whether a reasonable patient would have undergone the treatment had adequate disclosure been made. Bradford v. McGee, 534 So. 2d 1076 (Ala. 1988).

H. Vicarious Liability

Hospital Liability: Alabama hospitals may be held vicariously liable for the negligence of their employees under respondeat superior. Baptist Mem'l Hosp. v. Gosa, 686 So. 2d 1147 (Ala. 1996).

Apparent Agency: Alabama also recognizes apparent agency liability for hospitals with respect to independent contractor physicians when the patient reasonably believes the physician is an employee. Beasley v. Brookwood Med. Ctr., 789 So. 2d 227 (Ala. Civ. App. 2000).

I. Loss of Chance Doctrine

Alabama recognizes the loss of chance doctrine in medical malpractice cases. A plaintiff may recover for the loss of a chance of survival or better recovery caused by medical negligence, even where the plaintiff cannot prove that proper care would have resulted in a more favorable outcome with certainty. McAfee v. Baptist Med. Ctr., 641 So. 2d 265 (Ala. 1994).

J. Res Ipsa Loquitur

Alabama recognizes res ipsa loquitur in medical malpractice cases where:
1. The injury is of a kind that ordinarily does not occur in the absence of negligence;
2. The injury was caused by an instrumentality within the exclusive control of the defendant; and
3. The injury was not due to any voluntary action by the plaintiff.

Lloyd Noland Found., Inc. v. HealthSouth Corp., 979 So. 2d 784 (Ala. 2007).

K. Government/Sovereign Immunity

State Immunity: The State of Alabama and its agencies are protected by sovereign immunity under Art. I, Section 14 of the Alabama Constitution. Claims against state-operated hospitals and facilities are generally barred.

Municipal Immunity: Municipal hospitals have limited immunity under Ala. Code Section 11-47-190, with a cap of $100,000 for tort claims.

II. PRESERVATION OF EVIDENCE - LITIGATION HOLD

YOU ARE HEREBY DIRECTED TO PRESERVE ALL EVIDENCE relating to the care and treatment of [Client Name], including but not limited to:

• Complete medical records (paper and electronic)
• All versions of electronic medical records (including audit trails)
• Nursing notes, medication administration records, and flow sheets
• All diagnostic imaging studies and reports
• Laboratory results and pathology reports
• Operative reports and anesthesia records
• Consultation notes
• Informed consent documents
• Incident/occurrence reports
• Peer review materials (to the extent discoverable)
• Policies, procedures, and protocols in effect at the time of treatment
• Credentialing files for involved healthcare providers
• Staffing records and schedules
• Equipment maintenance records
• Any recorded statements

Modification, destruction, or concealment of any records will result in claims for spoliation, sanctions, and adverse inference instructions under Alabama law. Smith v. Atkinson, 771 So. 2d 429 (Ala. 2000).

III. FACTUAL BACKGROUND

A. Patient History and Presentation

[Client Name], a [age]-year-old [male/female], presented to [Facility/Provider] on [Date] with [chief complaint/reason for visit]:

Relevant Medical History:
- [Relevant past medical history]
- [Relevant surgical history]
- [Current medications]
- [Allergies]

Presenting Symptoms:
- [Symptom 1]
- [Symptom 2]
- [Symptom 3]

B. Chronology of Negligent Care

[Date/Time]: [Describe what occurred]

[Date/Time]: [Describe what occurred]

[Date/Time]: [Describe what occurred]

C. The Medical Error(s)

[Describe specifically what the healthcare provider(s) did wrong]

D. Discovery of Malpractice

Our client [did not discover / could not have reasonably discovered] the malpractice until [Date], when [describe discovery circumstances].

IV. STANDARD OF CARE VIOLATIONS

A. Applicable Standard of Care

Under Ala. Code Section 6-5-484(a), [Defendant Healthcare Provider] was required to exercise such reasonable care, skill, and diligence as other similarly situated healthcare providers in the same general line of practice ordinarily exercise in a like case.

Based on our expert's analysis, the applicable standard of care required [Defendant] to:

1. [Standard 1]
2. [Standard 2]
3. [Standard 3]

B. Breaches of the Standard of Care

Breach 1: [Detailed description of breach]

Breach 2: [Detailed description of breach]

Breach 3: [Detailed description of breach]

C. Expert Opinion

We have retained [Expert Name, M.D.], a board-certified [Specialty] physician licensed in [State] with [number] years of experience. [Dr./Expert Name] has concluded, to a reasonable degree of medical certainty, that:

1. [Defendant Provider] breached the applicable standard of care;
2. These breaches were a direct and proximate cause of [Client Name]'s injuries; and
3. Had appropriate care been rendered, [describe avoided outcome].

V. CAUSATION

A. Factual and Proximate Causation

But for the defendant's breach of the standard of care, our client would not have suffered the injuries described herein. Under Alabama law, the plaintiff must prove both actual cause ("but for" causation) and proximate cause. Vines v. Plantation Motor Lodge, 336 So. 2d 1338 (Ala. 1976).

B. Loss of Chance (If Applicable)

[If applicable:] The defendant's negligence substantially reduced our client's chance of [survival/recovery/better outcome] from [percentage]% to [percentage]%, constituting compensable injury under McAfee v. Baptist Med. Ctr., 641 So. 2d 265 (Ala. 1994).

VI. DAMAGES

A. Physical Injuries

As a direct and proximate result of the defendant's medical negligence, our client has suffered:

Primary Injuries:
- [Injury 1]
- [Injury 2]
- [Injury 3]

Current Medical Status:
[Describe current condition and prognosis]

B. Medical Expenses

Past Medical Expenses:

Future Medical Expenses: $[Amount]

C. Lost Earnings

D. Non-Economic Damages

• Physical pain and suffering
• Mental anguish
• Loss of enjoyment of life
• Permanent disability/disfigurement
• Loss of consortium (spouse's claim)

E. Summary of Damages

VII. SETTLEMENT DEMAND

Based upon the clear breach of the standard of care, the severity of our client's injuries, and the substantial damages incurred, we hereby demand:

$[DEMAND AMOUNT]

This demand will remain open for thirty (30) days from the date of this letter, expiring at 5:00 p.m. Central Time on [Expiration Date].

VIII. RESPONSE AND ADDITIONAL INFORMATION REQUESTED

Please provide:

1. All professional liability insurance policies applicable to this claim
2. Policy limits for each applicable policy
3. Any self-insured retention amounts
4. Excess/umbrella coverage information
5. Hospital liability coverage (if applicable)

IX. DOCUMENTATION ENCLOSED

• Medical records supporting the claim
• Medical bills and itemized statements
• Employment and wage documentation
• Expert curriculum vitae
• Photographs (if applicable)
• HIPAA authorizations

X. CONCLUSION

This case presents clear medical negligence that caused significant harm to our client. Alabama's contributory negligence doctrine does not apply because our client had no role in causing or contributing to the malpractice.

We are prepared to litigate this matter through trial in the Circuit Court of [County] County, Alabama if necessary. However, we believe early resolution serves all parties' interests.

Please respond by the deadline stated above.

Respectfully submitted,

[FIRM NAME]

By: _________________________________
[Attorney Name]
Alabama State Bar No. [Number]
Attorney for [Client Name]

ENCLOSURES: As noted above

cc: [Client Name]
File

ALABAMA MEDICAL MALPRACTICE PRACTICE NOTES

• Contributory Negligence: Alabama is one of only four jurisdictions following pure contributory negligence - ANY plaintiff fault bars recovery entirely.

• AMLA Exclusive: The Alabama Medical Liability Act provides the exclusive remedy for medical malpractice claims.

• No Pre-Suit Requirements: Alabama does not require pre-suit notice, certificate of merit, or expert affidavit before filing.

• Expert Essential: Expert testimony is required except in res ipsa loquitur cases.

• Wrongful Death Cap: $400,000 cap applies only to emergency department physicians under specific circumstances.

• Sovereign Immunity: State-operated hospitals are generally immune from suit.

• Peer Review Privilege: Ala. Code Section 6-5-333 protects peer review materials from discovery.

• Venue: Proper venue is the county where the act or omission occurred or where the defendant resides. Ala. Code Section 6-3-2.

• Punitive Damages: Available for willful misconduct, but capped at three times compensatory damages or $1.5 million (whichever is greater) under Ala. Code Section 6-11-21.

This template is specific to Alabama law. Medical malpractice claims in Alabama have strict requirements and short deadlines. Always verify current law and consult with qualified Alabama medical malpractice counsel.