DEMAND FOR SETTLEMENT - MEDICAL MALPRACTICE

STATE OF ARIZONA

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

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 under Arizona law.

I. ARIZONA-SPECIFIC LEGAL FRAMEWORK

A. Governing Law

This claim is governed by Arizona Revised Statutes Title 12, Chapter 5, Article 5 (Health Care Liability), A.R.S. Section 12-561 et seq., and related provisions governing medical malpractice actions in Arizona.

B. Statute of Limitations

General Rule: Under A.R.S. Section 12-542, a medical malpractice action must be commenced within two (2) years after the cause of action accrues.

Accrual - Discovery Rule: Under Arizona law, a cause of action for medical malpractice accrues when the plaintiff knows or, through reasonable diligence, should have known of the injury and its cause. Walk v. Ring, 202 Ariz. 310, 44 P.3d 990 (2002).

Minors: For minors under the age of 18, the statute of limitations is tolled until the minor reaches 18 years of age, but in no event may an action be brought more than three years after the minor reaches 18. A.R.S. Section 12-502.

Mental Incapacity: The limitations period is tolled during periods of mental incapacity. A.R.S. Section 12-502.

Continuous Treatment Rule: Arizona does not recognize the continuous treatment doctrine as tolling the statute of limitations.

No Statute of Repose: Arizona does not have a statute of repose for medical malpractice claims.

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

C. Pure Comparative Fault

Arizona follows the doctrine of pure comparative fault under A.R.S. Section 12-2505. The plaintiff's recovery is reduced by their percentage of fault, but recovery is not barred regardless of the degree of fault attributed to the plaintiff.

Our investigation confirms that our client bears no responsibility for the injuries sustained.

D. Standard of Care Under Arizona Law

Under Arizona law, a healthcare provider must exercise that degree of care, skill, and learning expected of a reasonable, prudent healthcare provider in the profession or class to which they belong within the state of Arizona, acting in the same or similar circumstances. Seisinger v. Siebel, 220 Ariz. 85, 203 P.3d 483 (2009).

Statewide Standard: Arizona applies a statewide (not locality-based) standard of care. The relevant inquiry is what a reasonable practitioner in Arizona would do, not what practitioners in a particular locality would do.

National Standard for Specialists: For board-certified specialists, Arizona courts may apply a national standard of care.

E. Preliminary Expert Opinion Requirement - A.R.S. Section 12-2603

CRITICAL PRE-SUIT REQUIREMENT: Arizona law requires that before filing a medical malpractice action, the plaintiff or plaintiff's attorney must certify in a signed written statement that:

1. The plaintiff's attorney has consulted with and obtained a preliminary expert opinion from a medical expert who is qualified under A.R.S. Section 12-2604;
2. The preliminary opinion provided by the expert indicates that the defendant's conduct fell outside the accepted standard of care; and
3. The preliminary opinion indicates that the conduct was a proximate cause of the claimant's injury.

This certification must be attached to the complaint when filed.

Certification: Pursuant to A.R.S. Section 12-2603, we certify that we have consulted with a qualified medical expert who has reviewed the relevant medical records and has provided a preliminary opinion that:
1. The defendant's conduct fell outside the accepted standard of care;
2. Such conduct was a proximate cause of our client's injury.

F. Expert Witness Qualifications - A.R.S. Section 12-2604

Arizona has specific expert witness requirements. A testifying expert must:

1. Be licensed as a healthcare provider in any jurisdiction;
2. Have been actively practicing or teaching in the same specialty as the defendant during the year preceding the incident;
3. Have knowledge of the accepted standard of care applicable to the defendant;
4. Base their testimony on objective criteria rather than personal beliefs.

Same Specialty Rule: Generally, the expert must be in the same specialty as the defendant, unless the treatment at issue is within the knowledge of experts in a different specialty.

G. Damage Caps

No Cap on Compensatory Damages: Arizona does not impose a cap on compensatory damages (economic or non-economic) in medical malpractice cases. Article 2, Section 31 of the Arizona Constitution prohibits limitations on damages in tort cases.

Punitive Damages: While compensatory damages are not capped, punitive damages in Arizona may be awarded only upon clear and convincing evidence of a defendant's evil mind (intent to injure or conscious disregard of substantial risk). Rawlings v. Apodaca, 151 Ariz. 149, 726 P.2d 565 (1986).

H. Informed Consent - A.R.S. Section 12-562

Arizona has codified informed consent requirements at A.R.S. Section 12-562. A healthcare provider must disclose to the patient the nature of the treatment, the risks of treatment, and the alternatives to treatment.

The standard is what a reasonable patient would want to know to make an informed decision about treatment. Duncan v. Scottsdale Medical Imaging, Ltd., 205 Ariz. 306, 70 P.3d 435 (2003).

Elements of Informed Consent Claim:
1. Duty to disclose material information;
2. Breach of that duty;
3. Patient would not have consented had disclosure been made;
4. The undisclosed risk materialized and caused injury.

I. Vicarious Liability

Hospital Liability - Respondeat Superior: Arizona hospitals may be held vicariously liable for the negligence of their employees under respondeat superior. Fellin v. Mesa, 207 Ariz. 470, 88 P.3d 161 (Ct. App. 2004).

Apparent Agency: Arizona recognizes apparent agency liability for hospitals with respect to independent contractor physicians when:
1. The hospital holds itself out to the public as the provider of care;
2. The patient looks to the hospital for care and does not select a particular physician; and
3. The patient reasonably believes the treating physician is a hospital employee.

Diggs v. Arizona Cardiologists, Ltd., 198 Ariz. 198, 8 P.3d 386 (Ct. App. 2000).

Corporate/Direct Hospital Negligence: Arizona hospitals may be held directly liable for negligence in credentialing, supervising, and maintaining competent medical staff.

J. Loss of Chance Doctrine

Arizona has adopted a form of the loss of chance doctrine. A plaintiff may recover for a lost chance of a better outcome if the defendant's negligence was a substantial factor in causing the loss. Thompson v. Sun City Cmty. Hosp., Inc., 141 Ariz. 597, 688 P.2d 605 (1984).

Damages may be calculated based on the percentage chance lost multiplied by the total damages that would have been recoverable had the patient died or suffered the ultimate harm.

K. Res Ipsa Loquitur

Arizona recognizes res ipsa loquitur in medical malpractice cases where:
1. The injury would not ordinarily occur in the absence of negligence;
2. The agency or instrumentality causing the injury was within the exclusive control of the defendant;
3. The plaintiff did not contribute to the injury.

Sanchez v. Old Pueblo Anesthesia, P.C., 218 Ariz. 317, 183 P.3d 1285 (Ct. App. 2008).

The doctrine creates a permissive inference of negligence and may be used to get to the jury without expert testimony in obvious cases.

L. Government/Sovereign Immunity

State Claims: Claims against the State of Arizona and its agencies (including state-operated healthcare facilities) are governed by A.R.S. Section 12-820 et seq. (Claims Against Public Entities and Employees). The state has waived sovereign immunity for most tort claims.

Notice Requirements: A claim against a public entity must be filed within 180 days of the accrual of the cause of action. A.R.S. Section 12-821.01.

Damages Limitations: A.R.S. Section 12-820.01 limits the damages recoverable against a public entity.

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 may result in spoliation sanctions and adverse inference instructions under Arizona law. Souza v. Fred Carries Contracts, Inc., 191 Ariz. 247, 955 P.2d 3 (Ct. App. 1997).

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 Arizona law, [Defendant Healthcare Provider] was required to exercise the degree of care, skill, and learning expected of a reasonable, prudent healthcare provider in the same profession or class within the State of Arizona, acting in the same or similar circumstances.

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

Pursuant to A.R.S. Section 12-2603, we have consulted with [Expert Name, M.D.], a board-certified [Specialty] physician who meets the qualifications under A.R.S. Section 12-2604. [Dr./Expert Name] has concluded, to a reasonable degree of medical probability, that:

1. [Defendant Provider]'s conduct fell outside the accepted standard of care;
2. This conduct was a 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. The breaches were the proximate cause of our client's injuries - they were foreseeable consequences of the defendant's negligence.

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 Thompson v. Sun City Cmty. Hosp., Inc., 141 Ariz. 597 (1984).

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

Arizona does not cap non-economic damages:
- Physical pain and suffering
- Emotional distress
- 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. Arizona 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. Pursuant to A.R.S. Section 12-2603, we have obtained a preliminary expert opinion confirming that the defendant's conduct fell below the standard of care and was a proximate cause of our client's injuries.

We are prepared to litigate this matter through trial in the Superior Court of Arizona, [County] County, 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]
State Bar of Arizona No. [Number]
Attorney for [Client Name]

ENCLOSURES: As noted above

cc: [Client Name]
File

ARIZONA MEDICAL MALPRACTICE PRACTICE NOTES

• Preliminary Expert Opinion REQUIRED: A.R.S. Section 12-2603 requires consultation with a qualified expert and certification before filing suit. This is a critical pre-suit requirement.

• No Damage Caps: Arizona Constitution Article 2, Section 31 prohibits caps on damages in personal injury actions.

• Pure Comparative Fault: Plaintiff's recovery is reduced by their percentage of fault but not barred.

• Expert Qualifications: A.R.S. Section 12-2604 sets specific qualifications - same specialty, actively practicing/teaching in prior year.

• Statewide Standard: Arizona applies a statewide (not locality) standard of care.

• Loss of Chance: Recognized - damages calculated as percentage chance lost times total harm.

• No Statute of Repose: Arizona has no absolute cutoff for medical malpractice claims.

• Informed Consent: A.R.S. Section 12-562 - reasonable patient standard.

• Government Claims: 180-day notice requirement for claims against public entities (A.R.S. Section 12-821.01).

• Venue: Superior Court in county where injury occurred, where defendant resides, or where defendant does business.

This template is specific to Arizona law. Medical malpractice claims in Arizona require pre-suit expert certification. Always verify current law and consult with qualified Arizona medical malpractice counsel.