## Recommendation: **Accept the case** The matter satisfies the firm’s intake policy: 1. **Expected net fee after expected unreimbursed costs is $185,333**, which is above the **$175,000** threshold. 2. The case **can be filed with support from both required experts at least 30 days before limitations expires**. The experts can convert their preliminary opinions to signed certificates within **20 days**, and the policy filing target is **Day 80**, while limitations expires on **Day 110**. --- # 1. Breach and causation under the supplied greater-than-50-percent rule ## A. Breach The breach issue is supported by the supplied expert record. - Lena presented with fever, severe back pain, and progressive leg numbness. - An MRI report timestamped **11:18 p.m.** identified a **probable spinal epidural abscess**. - The MRI report recommended **immediate surgical consultation**. - The emergency physician electronically acknowledged the report but did not call surgery until **7:30 a.m.** - Decompression occurred at **10:10 a.m.** - A **board-certified emergency physician** has signed a preliminary opinion that the failure to obtain an immediate consultation breached the standard of care. Under the governing law, medical malpractice requires qualified expert testimony unless the issue is within ordinary knowledge. The timing of surgical consultation for a probable spinal epidural abscess is not within ordinary knowledge. The emergency physician’s preliminary opinion therefore supplies the required qualified expert support for breach. **Conclusion on breach:** The preliminary expert record supports breach. --- ## B. Causation The neurosurgeon’s preliminary opinion states that decompression before **2:00 a.m.** would have given Lena a **60 percent probability** of avoiding permanent neurological deficit. The supplied causation rule provides: > Causation is satisfied when negligent delay more likely than not caused the permanent injury. A greater-than-50-percent probability that timely treatment would have avoided the injury is sufficient; a mere possibility is not. Here, the expert’s probability is **60 percent**, which is greater than **50 percent**. Therefore, under the supplied rule, the causation element is satisfied. The defense is expected to argue that sepsis and the abscess location would have produced the deficit despite earlier surgery. That argument is not fatal under the supplied standard. The rule does not require elimination of all alternative causes. It requires only that timely treatment would more likely than not have avoided the injury. A 60 percent probability of avoiding the injury is sufficient. **Conclusion on causation:** The preliminary expert record supports causation under the greater-than-50-percent rule. --- # 2. Whether the preliminary expert record supports filing The two required expert supports are present: 1. **Breach expert:** Board-certified emergency physician has signed a preliminary opinion that immediate surgical consultation was required and that its absence breached the standard of care. 2. **Causation expert:** Neurosurgeon has signed a preliminary opinion that decompression before 2:00 a.m. would have given Lena a 60 percent probability of avoiding permanent neurological deficit. The court requires that a **supporting expert certificate accompany the complaint**. The facts state that the two preliminary experts will convert their opinions to **signed certificates within 20 days if retained**. Therefore, if the firm retains both experts immediately, the required expert certificates should be available by **Day 20**. Because limitations expires in **110 days**, the firm can file with both certificates well before the 30-day-before-expiration deadline. **Conclusion on filing support:** Yes, the preliminary expert record supports filing, provided the experts are retained promptly and their opinions are converted into compliant signed certificates. --- # 3. Conditional expected verdict The panel’s probability of plaintiff success at trial is **55 percent**. Conditional on a plaintiff verdict, the supplied distribution is: | Verdict | Conditional Probability | |---:|---:| | $1,200,000 | 60% | | $2,400,000 | 30% | | $4,000,000 | 10% | Conditional expected verdict: \[ (0.60 \times \$1,200,000) + (0.30 \times \$2,400,000) + (0.10 \times \$4,000,000) \] \[ = \$720,000 + \$720,000 + \$400,000 \] \[ = \boxed{\$1,840,000} \] **Conditional expected verdict:** **$1,840,000**. For reference, the unconditional expected verdict, using the 55 percent success probability, is: \[ 0.55 \times \$1,840,000 = \boxed{\$1,012,000} \] But the intake policy requires use of the supplied success probability and conditional verdict distribution. --- # 4. Lena’s net recovery in each verdict branch after costs, fee, and lien Given: - Litigation costs: **$240,000**, reimbursed first from any recovery. - Contingency fee: **one-third** of the amount remaining after cost reimbursement. - Hospital lien: **$160,000**, paid from Lena’s remainder after the fee. - All verdicts are collectible. - No settlement odds are used. Let: \[ R = \text{verdict} \] \[ C = \$240,000 \] \[ L = \$160,000 \] Amount remaining after cost reimbursement: \[ R - C \] Attorney fee: \[ \frac{R - C}{3} \] Lena’s share before lien: \[ \frac{2}{3}(R - C) \] Lena’s net recovery after lien: \[ \frac{2}{3}(R - C) - L \] ## Branch-by-branch results | Verdict | Prob. | After Costs | Firm Fee | Lena Before Lien | Lien | Lena Net Recovery | |---:|---:|---:|---:|---:|---:|---:| | $1,200,000 | 60% | $960,000 | $320,000 | $640,000 | $160,000 | **$480,000** | | $2,400,000 | 30% | $2,160,000 | $720,000 | $1,440,000 | $160,000 | **$1,280,000** | | $4,000,000 | 10% | $3,760,000 | $1,253,333 | $2,506,667 | $160,000 | **$2,346,667** | All verdict branches are large enough to reimburse the $240,000 cost advance and still leave enough in Lena’s share to pay the $160,000 lien. --- # 5. Lena’s overall expected net recovery Lena’s expected net recovery is zero if she loses, and the conditional expected net recovery if she wins is: \[ (0.60 \times \$480,000) + (0.30 \times \$1,280,000) + (0.10 \times \$2,346,667) \] \[ = \$288,000 + \$384,000 + \$234,667 \] \[ = \$906,667 \] Now weight by the 55 percent probability of plaintiff success: \[ 0.55 \times \$906,667 = \boxed{\$498,667} \] **Lena’s overall expected net recovery:** **$498,667**. This is before any possible later lien negotiation or settlement discount. The analysis uses only the supplied trial probabilities and verdict distribution. --- # 6. Firm’s expected fee and expected unreimbursed-cost loss ## A. Firm’s expected fee Conditional on a plaintiff verdict, the firm’s expected fee is one-third of the expected amount remaining after costs: \[ \frac{\$1,840,000 - \$240,000}{3} \] \[ = \frac{\$1,600,000}{3} \] \[ = \$533,333 \] Now weight by the 55 percent probability of plaintiff success: \[ 0.55 \times \$533,333 = \boxed{\$293,333} \] **Firm’s expected fee:** **$293,333**. Equivalently, using the branch fees: \[ 0.55 \times [(0.60 \times \$320,000) + (0.30 \times \$720,000) + (0.10 \times \$1,253,333)] \] \[ = 0.55 \times \$533,333 \] \[ = \$293,333 \] --- ## B. Firm’s expected unreimbursed-cost loss The projected litigation costs are **$240,000**, incurred whether the firm wins or loses. - If the firm wins, the costs are reimbursed from the recovery. - If the firm loses, there is no recovery, so the firm bears the full **$240,000** cost. Probability of no recovery: \[ 1 - 0.55 = 0.45 \] Expected unreimbursed-cost loss: \[ 0.45 \times \$240,000 = \boxed{\$108,000} \] **Firm’s expected unreimbursed-cost loss:** **$108,000**. --- # 7. Firm’s expected net return under its intake policy The intake policy requires expected net fee after expected unreimbursed costs of at least **$175,000**. \[ \text{Expected net fee} = \text{Expected fee} - \text{Expected unreimbursed cost} \] \[ = \$293,333 - \$108,000 \] \[ = \boxed{\$185,333} \] **Firm’s expected net return:** **$185,333**. Because: \[ \$185,333 > \$175,000 \] the financial prong of the intake policy is satisfied. The case clears the threshold by: \[ \$185,333 - \$175,000 = \boxed{\$10,333} \] --- # 8. Filing and certificate timetable Assume today is **Day 0**. | Day | Event | |---:|---| | Day 0 | Retain both experts; request signed expert certificates; request medical records. | | Day 20 | Both experts should have converted preliminary opinions to signed certificates, if retained on Day 0. | | Day 80 | Latest date under the intake policy to file with both required expert supports, because limitations expires in 110 days and the firm requires filing at least 30 days before expiration. | | Day 110 | Statute of limitations expires. | The policy requires that the case **can be filed** with support from both required experts at least 30 days before limitations expires. Because the experts can provide signed certificates within **20 days**, and the policy filing deadline is **Day 80**, the firm has a comfortable window: - Certificates available: **Day 20** - Latest policy-compliant filing date: **Day 80** - Buffer: **60 days** **Conclusion on timetable:** The case satisfies the filing and certificate timetable if experts are retained promptly. To be conservative, the firm should target filing by **Day 75**, rather than waiting until Day 80. --- # 9. Acceptance decision ## Accept. The matter should be accepted because: 1. **Breach is supported** by the emergency physician’s preliminary opinion. 2. **Causation is supported** by the neurosurgeon’s 60 percent probability opinion, which exceeds the greater-than-50-percent standard. 3. The preliminary expert record can be converted into compliant signed certificates within **20 days**. 4. The case can be filed with both required expert supports by **Day 80**, at least 30 days before the **Day 110** limitations expiration. 5. The firm’s expected net fee after expected unreimbursed costs is **$185,333**, which exceeds the **$175,000** intake threshold. --- # 10. First concrete steps if accepted If the firm accepts the case, it should immediately take the following steps: ## 1. Execute the representation agreement - Confirm the contingency terms: - Costs are advanced and reimbursed first from any recovery. - Attorney fee is one-third of the amount remaining after cost reimbursement. - The hospital lien is paid from Lena’s remainder after the fee. - If there is no recovery, Lena owes no fee or cost reimbursement. ## 2. Retain both experts immediately - Retain the board-certified emergency physician. - Retain the neurosurgeon. - Request that each convert the signed preliminary opinion into a **signed expert certificate** suitable for filing with the complaint. - Calendar the 20-day certificate deadline from the date of retention. - Confirm that the breach opinion addresses the standard of care and that the causation opinion expressly states the greater-than-50-percent probability. ## 3. Obtain the core records immediately Request and review: - Emergency department records. - Nursing notes. - Triage notes. - Vitals and progression of neurologic symptoms. - MRI report and images. - Electronic acknowledgment timestamp. - Physician notes. - Surgery consultation timestamps. - Anesthesia and operative records. - Postoperative neurologic examinations. - Discharge records. - Current treatment records documenting permanent weakness, brace use, and reduced work hours. ## 4. Preserve the limitation and filing deadlines - Calendar the statute of limitations expiration: **Day 110**. - Calendar the policy filing target: **Day 80**. - Calendar a target filing date of **Day 75** as a conservative internal deadline. - Do not rely on court extension for ordinary law-office delay; the governing law says the court cannot extend the requirement for ordinary delay. ## 5. Prepare and file the complaint with certificates - Draft the complaint once both signed certificates are received. - File the complaint and required expert certificates together. - Ensure service is proper. - Preserve copies of the filed complaint and certificates for the file. ## 6. Manage the hospital lien - Do not reduce the verdict amounts or fee calculations by the lien. - Use the supplied **$160,000** lien for intake purposes. - The lien is valid and currently nonnegotiable, but any later negotiation would only affect Lena’s net recovery, not the firm’s fee calculation under the supplied terms. - Ensure the lien is paid from Lena’s remainder after cost reimbursement and fee. --- ## Final intake conclusion **Accept the case.** The liability record is sufficient under the supplied rules, the expert certificates can be obtained in time, and the expected financial return satisfies the firm’s intake policy. The firm should proceed immediately with expert retention, records collection, and complaint preparation, with a target filing date no later than **Day 80** and preferably by **Day 75**.