DEMAND FOR SETTLEMENT - MEDICAL MALPRACTICE

STATE OF RHODE ISLAND

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

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 - PRE-SUIT NOTICE AND 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 the mandatory 90-day pre-suit notice required by R.I. Gen. Laws Section 9-19-32.1 and our demand for settlement.

I. RHODE ISLAND-SPECIFIC LEGAL FRAMEWORK

A. Governing Law

This claim is governed by Rhode Island General Laws, including R.I. Gen. Laws Section 9-1-14.1 (limitations), Section 9-19-32 (certificate of merit), and Section 9-19-32.1 (pre-suit notice), which establish the standards and procedures for medical malpractice actions in Rhode Island.

B. Pre-Suit Notice Requirement - CRITICAL

Under R.I. Gen. Laws Section 9-19-32.1, a claimant MUST provide written notice of intent to file suit at least 90 days before filing. This notice:

1. Must identify the claimant and the defendant;
2. Must describe the factual basis for the claim; and
3. Tolls the statute of limitations during the 90-day period.

THIS LETTER CONSTITUTES SUCH NOTICE. The 90-day notice period will expire on [Date 90 days from this letter].

C. Statute of Limitations

Statute of Limitations: Under R.I. Gen. Laws Section 9-1-14.1, actions for medical malpractice must be commenced within three (3) years from the time of the incident giving rise to the action or within three years from the time the patient discovered, or reasonably should have discovered, the injury and its cause.

Discovery Rule: Rhode Island applies a discovery rule. The limitations period begins when the plaintiff knew or should have known of the injury and its causal connection to the medical treatment. Wilkinson v. Harrington, 104 R.I. 224 (1968).

Statute of Repose: Rhode Island does not have a statute of repose for medical malpractice claims.

Minors: For minors, the statute of limitations is tolled during minority. The limitations period begins to run when the minor reaches the age of majority (18).

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

D. Pure Comparative Fault

Rhode Island follows pure comparative fault. Under R.I. Gen. Laws Section 9-20-4, a plaintiff may recover damages even if their negligence exceeds that of the defendant, though damages are reduced by the plaintiff's percentage of fault.

Our investigation has determined that our client was in no way negligent or at fault for the injuries sustained.

E. Standard of Care Under Rhode Island Law

Under Rhode Island law, a healthcare provider must exercise that degree of care and skill expected of a reasonably competent practitioner in the same field of practice, acting in the same or similar circumstances. Sheeley v. Memorial Hosp., 710 A.2d 161 (R.I. 1998).

National Standard: Rhode Island applies a national standard of care, not a locality rule. Sheeley v. Memorial Hosp., 710 A.2d 161 (R.I. 1998).

F. Certificate of Merit Requirement - CRITICAL

Under R.I. Gen. Laws Section 9-19-32, a certificate of merit must accompany the complaint. The certificate must:

1. Be signed by the plaintiff's attorney;
2. State that the attorney has consulted with a qualified expert;
3. State that the expert has concluded that there is a reasonable basis for filing the action; and
4. Be based on the expert's review of the relevant records.

Failure to file the certificate of merit may result in dismissal. Boss v. Am. Express Fin. Advisors, Inc., 844 A.2d 1272 (R.I. 2004).

Certification: We have consulted with a qualified medical expert who has reviewed the relevant medical records and has concluded that there is a reasonable basis for this action.

G. Expert Witness Requirements

Under Rhode Island law, expert testimony is required to establish the standard of care, its breach, and causation in most medical malpractice cases. The expert must:

1. Be qualified by knowledge, skill, experience, training, or education;
2. Have familiarity with the applicable standard of care; and
3. Be competent to render an opinion on the relevant medical issues.

DiPetrillo v. Dow Chem. Co., 729 A.2d 677 (R.I. 1999).

H. Damage Caps

Rhode Island does not impose caps on compensatory damages in medical malpractice cases.

Punitive Damages: Punitive damages may be available upon proof of malice, willful misconduct, or gross negligence.

Collateral Source Rule: Rhode Island follows the traditional collateral source rule. Evidence of payments from collateral sources is generally inadmissible.

I. Informed Consent

Rhode Island recognizes informed consent as a basis for medical malpractice liability. A physician must disclose material risks, alternatives, and the consequences of refusing treatment. Wilkinson v. Vesey, 110 R.I. 606 (1972).

The standard is objective: what a reasonable patient would consider material to the decision.

J. Vicarious Liability

Hospital Liability: Rhode Island hospitals may be held vicariously liable for the negligence of their employees under respondeat superior. Nolan v. Kerry, 461 A.2d 677 (R.I. 1983).

Apparent Agency: Rhode Island recognizes apparent agency liability when patients reasonably believe physicians are hospital employees.

K. Loss of Chance Doctrine

Rhode Island has adopted the loss of chance doctrine. A plaintiff may recover for the loss of a chance of survival or better outcome, with damages proportional to the lost chance. Contois v. Town of W. Warwick, 865 A.2d 1019 (R.I. 2004).

L. Res Ipsa Loquitur

Rhode Island recognizes res ipsa loquitur in medical malpractice cases where the injury is of a kind that does not ordinarily occur without negligence, the instrumentality was under the defendant's exclusive control, and the plaintiff did not contribute to the injury. Hill v. Rhode Island Hosp., 113 R.I. 629 (1974).

M. Government Immunity

Rhode Island Tort Claims Act: Claims against state and municipal healthcare providers are subject to the Rhode Island Tort Claims Act, R.I. Gen. Laws Section 9-31-1 et seq. The state has waived immunity for medical malpractice, but procedural requirements apply.

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 Rhode Island law. Tancrelle v. Friendly Ice Cream Corp., 756 A.2d 744 (R.I. 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 Rhode Island law, [Defendant Healthcare Provider] was required to exercise that degree of care and skill expected of a reasonably competent practitioner in the same field of practice, under 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

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 Rhode Island law, the plaintiff must prove that the defendant's negligence was a proximate cause of the injury. DeMarco v. Travelers Ins. Co., 26 A.3d 585 (R.I. 2011).

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 Rhode Island's loss of chance doctrine. Contois v. Town of W. Warwick, 865 A.2d 1019 (R.I. 2004).

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)
• Emotional distress

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. Eastern Time on [Expiration Date].

Please note: The 90-day pre-suit notice period required by R.I. Gen. Laws Section 9-19-32.1 expires on [Date]. We reserve the right to file suit after that date if settlement is not reached.

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. We have complied with the 90-day pre-suit notice requirement of R.I. Gen. Laws Section 9-19-32.1 and are prepared to file the required certificate of merit under R.I. Gen. Laws Section 9-19-32.

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

ENCLOSURES: As noted above

cc: [Client Name]
File

RHODE ISLAND MEDICAL MALPRACTICE PRACTICE NOTES

• 90-Day Pre-Suit Notice Required: Must be sent before filing suit; tolls statute of limitations.

• Certificate of Merit Required: Must accompany complaint.

• No Damage Caps: Rhode Island does not cap compensatory damages.

• Pure Comparative Fault: Plaintiff can recover even if more than 50% at fault.

• National Standard of Care: Locality rule rejected in Sheeley v. Memorial Hospital.

• Loss of Chance Recognized: Rhode Island allows recovery for loss of chance of survival or recovery.

• No Statute of Repose: Rhode Island has no absolute cutoff period.

• Collateral Source Rule: Traditional rule applies - collateral source payments inadmissible.

• 3-Year Statute of Limitations: From discovery - longer than most states.

• Venue: Proper venue is the county where the cause of action arose or where defendant resides.

This template is specific to Rhode Island law. Medical malpractice claims in Rhode Island have pre-suit notice and certificate of merit requirements. Always verify current law and consult with qualified Rhode Island medical malpractice counsel.