Utah Notice of Intent to Commence Action — Medical Malpractice (Pre-Litigation Panel)

NOTICE OF INTENT TO COMMENCE ACTION

(Utah Code § 78B-3-412 — Health Care Malpractice Act)

VIA CERTIFIED MAIL — RETURN RECEIPT REQUESTED
Article No.: [____________________]

[__/__/____]

TO:
[NAME OF PROSPECTIVE DEFENDANT]
[Title — e.g., M.D., D.O., R.N., P.A.]
[Practice / Hospital Address]
[City, State ZIP]

AND TO:
[NAME OF MEDICAL GROUP / HOSPITAL / FACILITY]
c/o Registered Agent: [____________________]
[Registered Agent Address]
[City, State ZIP]

Re: NOTICE OF INTENT TO COMMENCE ACTION under Utah Code § 78B-3-412
Patient: [PATIENT NAME]
Date(s) of Treatment at Issue: [__/__/____] through [__/__/____]
Patient Date of Birth: [__/__/____]
Medical Record Number (if known): [____________________]

I. STATUTORY NOTICE

Pursuant to Utah Code § 78B-3-412, this letter constitutes formal NOTICE OF INTENT TO COMMENCE ACTION against you for medical malpractice arising out of the medical care identified below. This Notice is served at least ninety (90) days prior to the commencement of any malpractice action, as required by § 78B-3-412(1).

You are hereby notified that, unless this matter is resolved through the prelitigation panel process under Utah Code § 78B-3-416 or by negotiated settlement within the statutory period, the undersigned intends to file a medical malpractice complaint in Utah state court on behalf of [PATIENT NAME / PATIENT'S PERSONAL REPRESENTATIVE / GUARDIAN].

II. STATEMENT OF THE NATURE OF THE CLAIM

(§ 78B-3-412(1)(b))

The general nature of the claim is medical negligence / medical malpractice arising out of the diagnosis, treatment, surgical intervention, medication management, follow-up care, and/or supervision of [PATIENT NAME] during the course of treatment by you and/or your agents, employees, and ostensible agents.

The claim includes, without limitation, theories of:

☐ Medical negligence (failure to meet the applicable Utah standard of care)
☐ Failure to diagnose / delayed diagnosis
☐ Misdiagnosis
☐ Surgical / procedural error
☐ Medication error
☐ Lack of informed consent (Utah Code § 78B-3-406)
☐ Failure to monitor / failure to follow up on test results
☐ Negligent supervision / negligent credentialing (institutional defendants)
☐ Hospital corporate negligence
☐ Vicarious liability for ostensible / apparent agents
☐ Wrongful death (Utah Code § 78B-3-106)
☐ Survival action (Utah Code § 78B-3-105)

III. PERSONS INVOLVED

(§ 78B-3-412(1)(b))

Patient:

• Name: [PATIENT NAME]
• Date of Birth: [__/__/____]
• Address: [____________________]

Patient's Representative (if applicable):

• Name: [____________________]
• Capacity: [Personal Representative / Guardian ad Litem / Spouse / Heir]
• Address: [____________________]

Health Care Providers Whose Conduct Is at Issue:

Other Persons with Knowledge:

• [____________________] — [Role / Relationship]
• [____________________] — [Role / Relationship]

IV. DATE, TIME, AND PLACE OF OCCURRENCE

(§ 78B-3-412(1)(b))

The acts and omissions giving rise to this claim occurred on the following dates and at the following locations:

• [__/__/____] at approximately [__:__ a.m./p.m.] at [Facility Name, Address] — [Brief description: e.g., admission to ED; surgical procedure; clinic visit].
• [__/__/____] at approximately [__:__ a.m./p.m.] at [Facility Name, Address] — [Brief description].
• [__/__/____] at approximately [__:__ a.m./p.m.] at [Facility Name, Address] — [Brief description].

The injury was discovered, or in the exercise of reasonable diligence should have been discovered, on or about [__/__/____].

V. CIRCUMSTANCES SURROUNDING THE CLAIM

(§ 78B-3-412(1)(b))

The circumstances giving rise to this claim are summarized as follows:

1. On [__/__/____], [PATIENT NAME] presented to [Facility / Provider] with the following chief complaint and history: [____________________].

2. [PATIENT NAME]'s condition required, under the applicable standard of care, [____________________ — e.g., immediate differential diagnosis including ruling out [condition]; ordering [diagnostic study]; specialist consultation; informed-consent discussion].

3. Defendants undertook the following course of action: [____________________].

4. Defendants failed to: [____________________].

5. The patient subsequently experienced [progression / complication / event], on [__/__/____], requiring [intervention / additional treatment / hospitalization].

6. As a direct and proximate result of the conduct described above, [PATIENT NAME] sustained the injuries described in Section VII below.

VI. SPECIFIC ALLEGATIONS OF MISCONDUCT

(§ 78B-3-412(1)(b))

The specific allegations of misconduct include, without limitation:

A. As to [Provider Name 1]:

1. [____________________];
2. [____________________];
3. [____________________].

B. As to [Provider Name 2]:

1. [____________________];
2. [____________________];
3. [____________________].

C. As to [Hospital / Facility]:

1. Negligent credentialing and/or supervision of [____________________];
2. Failure to enforce institutional policies regarding [____________________];
3. Inadequate staffing of [____________________];
4. Failure to provide competent nursing / pharmacy / ancillary services;
5. Vicarious liability for the acts and omissions of its employees, agents, and ostensible agents.

VII. NATURE OF ALLEGED INJURIES AND DAMAGES

(§ 78B-3-412(1)(b))

As a direct and proximate result of the misconduct alleged above, [PATIENT NAME] has suffered the following injuries and damages, which are continuing and, in significant part, permanent:

☐ Physical injury: [____________________]
☐ Permanent disability / impairment: [____________________]
☐ Need for additional surgery / corrective procedures
☐ Required ongoing medical treatment and rehabilitation
☐ Loss of organ / limb / function
☐ Disfigurement / scarring
☐ Pain and suffering — past and future
☐ Mental anguish and emotional distress
☐ Loss of enjoyment of life
☐ Lost wages and lost earning capacity
☐ Past medical expenses (approx. $[__________])
☐ Reasonably anticipated future medical expenses
☐ Loss of consortium (spouse / parent-child)
☐ Death of [DECEDENT NAME] on [__/__/____] (wrongful death — Smith v. United States, 2015 UT 68 — uncapped)

VIII. PRELITIGATION PANEL REVIEW UNDER § 78B-3-416

Pursuant to Utah Code § 78B-3-416, the undersigned will file a Request for Prelitigation Panel Review with the Utah Division of Occupational and Professional Licensing ("DOPL") within 60 days after service of this Notice. The DOPL panel proceeding will toll the applicable statute of limitations under § 78B-3-416(2) until the later of: (i) 60 days after the panel issues its written opinion or DOPL issues a Certificate of Compliance under § 78B-3-418; or (ii) the expiration of the time for holding a hearing under § 78B-3-416(3)(b)(ii).

You will receive separate notice from DOPL regarding panel scheduling, evidentiary submissions, and hearing procedures. The panel proceedings are confidential and privileged under § 78B-3-416(5) and statements made therein are inadmissible at any subsequent civil trial.

IX. PRESERVATION OF RECORDS

You are formally directed and requested to preserve all records relating to [PATIENT NAME], including but not limited to:

• Medical records (hospital, clinic, office, emergency department);
• Imaging studies (films, digital DICOM data, reports);
• Pathology specimens, slides, and reports;
• Laboratory results;
• Operative reports, anesthesia records, post-anesthesia recovery records;
• Nursing notes, flow sheets, and medication administration records;
• Electronic health record (EHR) audit trails and metadata;
• Telephone and electronic communications;
• Billing and coding records;
• Incident reports and root-cause analyses (subject to applicable peer-review privileges);
• Credentialing files for involved providers;
• Policies and procedures in effect on the dates of treatment;
• Equipment maintenance and calibration records;
• Email and text-message communications regarding [PATIENT NAME].

SPOLIATION WARNING: Destruction, alteration, or loss of any of the foregoing records may result in claims for spoliation of evidence and adverse inferences at trial.

X. DEMAND TO PRESERVE STATUTORY RIGHTS

Counsel for [PATIENT NAME] reserves all rights and remedies under Utah law, including but not limited to:

• The right to recover full economic damages (uncapped);
• The right to recover noneconomic damages, subject to the cap of § 78B-3-410, the constitutionality of which Plaintiff reserves the right to challenge;
• The right to recover uncapped damages on any wrongful death claim under Smith v. United States, 2015 UT 68;
• The right to seek punitive damages on a sufficient showing under § 78B-8-201;
• The right to assert any tolling, equitable estoppel, or fraudulent concealment doctrine.

XI. APOLOGY STATUTE NOTICE — § 78B-3-422

Be advised that Utah Code § 78B-3-422 renders certain statements of apology, sympathy, condolence, or compassion inadmissible as evidence of an admission of liability. Statements of fault, however, are NOT shielded by the statute and may be used as evidence in any subsequent litigation.

XII. SETTLEMENT INVITATION

The undersigned remains willing to engage in pre-panel settlement discussions. Please direct any settlement inquiries to the undersigned at the address and telephone number below. Absent settlement, this matter will proceed through the DOPL prelitigation panel process and, if not resolved, into formal litigation.

DATED this [____] day of [____________________], 20[____].

[____________________________________________]
[ATTORNEY NAME], Utah Bar No. [__________]
[LAW FIRM NAME]
[FIRM ADDRESS]
[CITY, UT ZIP]
Telephone: [(___) ___-____]
Facsimile: [(___) ___-____]
Email: [____________________]
Attorney for [PATIENT NAME / PERSONAL REPRESENTATIVE]

CERTIFICATE OF SERVICE

I, [ATTORNEY NAME], hereby certify that on the [____] day of [____________________], 20[____], a true and correct copy of the foregoing NOTICE OF INTENT TO COMMENCE ACTION was served on each of the following prospective defendants by certified mail, return receipt requested, in compliance with Utah Code § 78B-3-412(2)(b) and the Utah Rules of Civil Procedure:

I further certify that pursuant to § 78B-3-412(2)(b), service by certified mail is complete on the date of mailing.

____________________________________________
[ATTORNEY NAME]
Utah Bar No. [__________]

ATTORNEY PRE-SERVICE CHECKLIST

☐ Two-year statute of limitations under § 78B-3-404 calculated and confirmed
☐ Discovery date (or reasonably-should-have-discovered date) documented
☐ Four-year statute of repose verified or exception preserved (foreign object / fraudulent concealment / minority)
☐ All prospective defendants identified — physician(s), group, hospital, ostensible agents, NPs/PAs/RNs as appropriate
☐ Each defendant's correct legal name and registered agent confirmed (Utah Division of Corporations search)
☐ Notice served at least 90 days before intended filing date
☐ Notice served by certified mail, return receipt requested, OR via URCP 4 method
☐ Calendar entry for 60-day deadline to file Request for Prelitigation Panel Review with DOPL (§ 78B-3-416)
☐ Calendar entry for 180-day DOPL panel completion deadline
☐ Tolling diary maintained
☐ Records-preservation letter language included
☐ Authorization for release of medical records executed (HIPAA-compliant)
☐ Expert consultation initiated (standard of care + causation)
☐ Wrongful death analysis complete — note Smith v. United States, 2015 UT 68 (uncapped)
☐ Client engagement letter executed and conflicts cleared
☐ All certified-mail green cards retained for proof of service

CRITICAL DEADLINES SUMMARY

SOURCES AND REFERENCES

• Utah Code § 78B-3-412 — Notice of Intent: https://le.utah.gov/xcode/Title78B/Chapter3/78B-3-S412.html
• Utah Code § 78B-3-416 — Prelitigation Panel Review: https://le.utah.gov/xcode/Title78B/Chapter3/78B-3-S416.html
• Utah Code § 78B-3-404 — Statute of Limitations
• Utah Code § 78B-3-422 — Apology Statute
• Utah DOPL Prelitigation Forms (sample Notice of Intent): https://dopl.utah.gov/prelitigation/forms/
• Utah DOPL Prelitigation Overview: https://dopl.utah.gov/prelitigation/overview/
• Utah Rules of Civil Procedure: https://www.utcourts.gov/en/about/rules.html
• Smith v. United States, 2015 UT 68 — Wrongful death cap unconstitutional
• Vega v. Jordan Valley Medical Center, 2019 UT 35 — Affidavit-of-merit / DOPL gatekeeping unconstitutional

This template is a procedural framework. Counsel must adapt allegations to specific facts, retain qualified experts before service, and confirm current statutes and case law. Service of the Notice is a condition precedent — defects can result in dismissal.