__[Attorney name]__
__[Address]__
__[Telephone number]__
Attorney for __[e.g., Plaintiff]__, name]__
_ _ _ _ _ _ Court, County of _ _ _ _ _ _
__[_ _ _ _ _ _ District]__
_ _ _ _ _ _ _ _ _ _ _ _ _ ) No. _ _ _ _ _ _
Plaintiff(s))
vs. )RESPONSE OF __[E.G., PLAINTIFF]__
)TO SEPARATE STATEMENT OF
_ _ _ _ _ _ _ _ _ _ _ _ _ ) DISPUTED AND UNDISPUTED
Defendant(s))MATERIAL FACTS
_________________________ )
Hearing: __[date; time]__
Department: _ _ _ _ _ _
__[Estimated length:_ _]__
Trial Date: __[if set]__
Plaintiff, __[name]__, submits this separate statement of
disputed and undisputed facts in opposition to the motion of
defendant, __[name]__, for summary judgment or summary
adjudication of issues and in response to defendant's separate
statement of undisputed material facts:
1. Plaintiff AGREES that this fact is undisputed: "The
alleged acts of `medical malpractice' on which plaintiff's first
cause of action is based occurred on or before March 3, 1994."
2. Plaintiff DISAGREES that this fact is undisputed:
"Plaintiff became aware of defendant's alleged medical
malpractice, and of all injuries allegedly sustained as a result,
on or before March 12, 1994."
SUPPORTING EVIDENCE:
a.Plaintiff's declaration at p 3, lines 12-14.
3. Plaintiff AGREES that this fact is undisputed: "This
action was commenced on the filing of plaintiff's original
complaint on April 1, 1995."
4. Plaintiff AGREES that this fact is undisputed:
"Plaintiff was fully informed regarding the consequences and
complications that could result from the surgical procedure."
5. Plaintiff AGREES that this fact is undisputed:
"Plaintiff verbally expressed his understanding of the
consequences and complications that could result from the
surgical procedure."
6. Plaintiff AGREES that this fact is undisputed:
"Plaintiff read, dated, and executed a form titled `Consent to
Surgery--Binding Waiver of Liability,' which included the
following language: `I have discussed with my doctor in
considerable detail the nature, extent, and dangers of the
surgery to be performed, as well as the possible consequences,
complications, and side effects of that surgery, all of which I
fully understand. I still want the surgery. I do NOT want a
second opinion."
7. Plaintiff AGREES that this fact is undisputed:
"Plaintiff read, dated, and executed a form titled `Consent to
Surgery--Binding Waiver of Liability' after having been fully
informed regarding the consequences and complications that could
result from the surgical procedure."
8. Plaintiff DISAGREES that this fact is undisputed:
"Plaintiff did not sustain any loss of wages."
SUPPORTING EVIDENCE:
a.Plaintiff's declaration at p 1, lines 12-14.
b.Copy of payroll stub from Miami Import Co.,
attached as Exhibit A to plaintiff's declaration.
PLAINTIFF SUBMITS THAT THE FOLLOWING ADDITIONAL FACTS ARE
BOTH MATERIAL AND DISPUTED IN THIS CASE:
1. The date on which plaintiff became aware of defendant's
medical malpractice was May 10, 1994.
SUPPORTING EVIDENCE:
a.Transcript of plaintiff's deposition at p 27,
lines 3-5 (signed original attached).
2. Plaintiff was not informed of the possible consequences
and complications of the surgery until March 5, 1994, after it
had been completed.
SUPPORTING EVIDENCE:
a.Plaintiff's declaration at p 2, line 23.
3. Plaintiff signed the form titled "Consent to
Surgery--Binding Waiver of Liability" on March 5, 1994, after the
surgery had been completed.
SUPPORTING EVIDENCE:
a.Plaintiff's declaration at p 2 line 25.
b.Copy of form, attached as Exhibit B to defendant's
declaration supporting this motion.
Date: _ _ _ _ _ _ [Signature]
________________________
__[Typed name]__
Attorney for _ _ _ _ _ _ _ _ _ _
Return to Table of Contents for
Legal Forms : Set Two