The Spinal-Infection Intake

Question 67: The Spinal-Infection Intake

Your role

You are evaluating a medical-malpractice case for Lena Orr, who suffered permanent leg weakness after an emergency-department delay. Decide whether the firm should accept or decline the matter using the supplied liability assessment, verdict distribution, cost schedule, lien, contingency terms, and filing deadline.

Governing law

Assume the following rules apply:

1. Medical malpractice requires duty, breach of the professional standard of care, factual and proximate causation, and damages, proved through qualified expert testimony unless the matter is within ordinary knowledge.

2. 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.

3. A complaint must be filed within two years after the injury. A supporting expert certificate must accompany the complaint. The court cannot extend either requirement for ordinary law-office delay.

4. Recoverable damages include past and future medical expense, lost earnings, and noneconomic loss. The supplied verdict amounts already account for applicable damages limits and collectability.

5. The hospital's lien is paid only from a recovery. It does not increase the defendant's liability and is deducted from the client's share.

6. Under the proposed contingency agreement, case costs are reimbursed first from any recovery. The attorney fee is one-third of the amount remaining after cost reimbursement. The lien is then paid from the client's remainder.

7. If there is no recovery, the firm bears the litigation costs and charges Lena no fee or cost reimbursement.

8. For intake purposes, use the supplied probability of plaintiff success and the supplied conditional verdict distribution. Do not invent settlement odds or adjust the medical panel's numbers.

9. The firm's written intake policy accepts a contingent case only if expected net fee after expected unreimbursed costs is at least $175,000 and the case can be filed with support from both required experts at least 30 days before limitations expires.

Facts

Lena, age 46, went to North Vale Hospital with fever, severe back pain, and progressive leg numbness. An MRI report timestamped 11:18 p.m. identified a probable spinal epidural abscess and recommended immediate surgical consultation. The emergency physician electronically acknowledged the report but did not call surgery until 7:30 a.m. Lena underwent decompression at 10:10 a.m. and now has permanent weakness requiring a brace and reduced work hours.

A board-certified emergency physician has signed a preliminary opinion that the failure to obtain an immediate consultation breached the standard of care. A 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 defense is expected to argue that sepsis and the abscess location would have produced the deficit despite earlier surgery.

The firm's medical screening panel assigns a 55 percent probability of plaintiff success at trial. Conditional on a plaintiff verdict, it supplies this distribution:

• 60 percent probability of a $1,200,000 verdict.
• 30 percent probability of a $2,400,000 verdict.
• 10 percent probability of a $4,000,000 verdict.

Projected litigation costs are $240,000 and are incurred whether the firm wins or loses. Lena has a $160,000 hospital lien that is valid and currently nonnegotiable. All verdicts are collectible.

Limitations expires in 110 days. The two preliminary experts will convert their opinions to signed certificates within 20 days if retained. No other firm has a claim to fees.

Assignment

Analyze:

• Breach and causation under the supplied greater-than-50-percent rule.
• Whether the preliminary expert record supports filing.
• The conditional expected verdict.
• Lena's net recovery in each verdict branch after costs, fee, and lien.
• Lena's overall expected net recovery.
• The firm's expected fee and expected unreimbursed-cost loss.
• The firm's expected net return under its intake policy.
• The filing and certificate timetable.
• Whether to accept or decline, with the first concrete steps if accepted.

Q67 key (Spinal-Infection Intake)

1. The signed preliminary opinions support breach and the supplied causation threshold: the neurosurgeon states a 60 percent probability that timely decompression would have avoided permanent deficit, exceeding 50 percent. The sepsis defense creates trial risk already reflected in the 55 percent success probability. Missed: a sufficient causation opinion is mislabeled a mere lost possibility or treated as certainty.
2. Conditional expected verdict is 60 percent of $1,200,000 plus 30 percent of $2,400,000 plus 10 percent of $4,000,000, equaling $1,840,000. Missed: the 55 percent liability probability is applied twice or omitted.
3. At $1.2 million: reimburse $240,000 costs, leaving $960,000; fee is $320,000; Lena receives $640,000 before lien and $480,000 after the $160,000 lien. At $2.4 million: Lena nets $1,280,000. At $4 million: Lena nets approximately $2,346,667. Missed: fee is calculated before cost reimbursement or the lien is charged to gross recovery.
4. Conditional expected client net is 60 percent of $480,000 plus 30 percent of $1,280,000 plus 10 percent of $2,346,667, approximately $906,667. Multiply by 55 percent success probability for overall expected client net of approximately $498,667. Missed: loss branches or the conditional distribution are omitted.
5. Conditional expected fee is one-third of the $1,600,000 remaining after subtracting $240,000 in costs from the $1,840,000 conditional expected verdict, or approximately $533,333. Expected fee is 55 percent of that, approximately $293,333. Expected unreimbursed cost loss is 45 percent of $240,000, or $108,000. Expected net return is approximately $185,333. Missed: reimbursed costs are counted as profit or losing-case costs disappear.
6. The expected net return exceeds the firm's $175,000 threshold by approximately $10,333. The client economics are also materially positive on the supplied inputs. Missed: the case is accepted or declined without applying the firm's own criterion.
7. Accept the case, retain both experts immediately, obtain final certificates within 20 days, complete investigation and pleadings, and file no later than day 80 so the complaint is supported at least 30 days before the day-110 deadline. Missed: a financially qualifying case is lost to an avoidable certificate or limitations failure.