**Recommendation: Accept the case.**

### 1. Breach and causation

The facts support both elements at the intake stage.

- **Breach:** The MRI at 11:18 p.m. showed a probable spinal epidural abscess and recommended immediate surgical consultation. The emergency physician acknowledged the report but did not call surgery until 7:30 a.m. A board-certified emergency physician has preliminarily opined that this delay breached the standard of care.
- **Causation:** The neurosurgeon preliminarily opines that decompression before 2:00 a.m. would have given Lena a **60% probability** of avoiding permanent neurological deficit. That is greater than 50%, so it satisfies the governing more-likely-than-not causation rule. It is not a mere possibility.

The defense’s expected argument about sepsis and abscess location is a trial causation dispute. It does not make the case unsupportable, and the panel’s 55% plaintiff-success probability already accounts for that risk.

### 2. Expert certificates and filing timetable

- Limitations expires in **110 days**.
- Both experts can sign certificates within **20 days** if retained immediately.
- The firm must file with both supporting expert certificates at least **30 days before expiration**, i.e., by day **80**.
- Retaining experts now and filing once certificates are signed, around day **20**, leaves a **90-day cushion**.

The case can satisfy the filing/certificate requirement if the firm acts immediately.

### 3. Conditional expected verdict

Using the supplied verdict distribution:

\[
0.6(1,200,000)+0.3(2,400,000)+0.1(4,000,000)
= 1,840,000
\]

**Conditional expected verdict = $1,840,000.**

### 4. Lena’s net recovery by verdict branch

For each verdict, costs are reimbursed first, then fee, then lien:

\[
\text{Lena net} = \frac{2}{3}(V - 240,000) - 160,000
\]

| Verdict | Probability | Attorney fee | Lena net after costs, fee, and lien |
|---|---:|---:|---:|
| $1,200,000 | 60% | $320,000 | $480,000 |
| $2,400,000 | 30% | $720,000 | $1,280,000 |
| $4,000,000 | 10% | $1,253,333 | $2,346,667 |

### 5. Lena’s expected net recovery

Conditional on plaintiff success:

\[
0.6(480,000)+0.3(1,280,000)+0.1(2,346,667)
= 906,667
\]

Overall expected net recovery:

\[
0.55(906,667) = 498,667
\]

**Lena’s overall expected net recovery = approximately $498,667.**

### 6. Firm’s expected return

Conditional expected fee:

\[
0.6(320,000)+0.3(720,000)+0.1(1,253,333)
= 533,333
\]

Expected fee across all outcomes:

\[
0.55(533,333) = 293,333
\]

Expected unreimbursed cost loss if the case loses:

\[
0.45(240,000) = 108,000
\]

Expected net fee after expected unreimbursed costs:

\[
293,333 - 108,000 = 185,333
\]

That exceeds the firm’s **$175,000** intake threshold.

### 7. Decision

**Accept the case.**

First concrete steps:

1. Execute the contingency engagement letter with Lena.
2. Immediately retain both the emergency physician and neurosurgeon.
3. Obtain signed expert certificates within 20 days.
4. Prepare the complaint and certificate of merit for filing.
5. File as soon as certificates are ready, and in any event well before day 80, to preserve the limitations deadline.