IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF [COUNTY]

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1 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF [COUNTY] [PLAINTIFF], CASE NO. Plaintiff, (Negligence Medical Malpractice v. Claim Not Subject to Mandatory Arbitration [NAMES] (Prayer Amount $ Fee Statute: ORS (1(D Defendants. Plaintiff alleges as follows: 1. At all material times herein, Defendant [NAME], was and is an Oregon Corporation doing business as [NAME] with its principal office located in [NAME]. 2. At all material times herein, Defendant [NAME] was and is an Oregon corporation with its principal office located in [NAME]. 3. Page 1.

2 At all material times herein, Defendant [NAME]. was and is a physician licensed to practice medicine in the State of Oregon. 4. At all material times herein, Defendant [NAME], was an employee or agent of Defendant [NAME] acting within the course and scope of her employment or agency when she operated on [NAME] on [DATE]. 5. At all material times herein, Defendant [NAME] was an employee or agent of Defendant [NAME] acting within the course and scope of her employment or agency when she operated on [NAME] on [DATE]. 6. At all material times herein, Defendants were in a physician/patient relationship with [NAME] and owed a duty to [NAME], which included the duty to use the same care, skill, and diligence used and exercised by ordinarily prudent physicians practicing medicine in the same or similar circumstances in their community, or similar community. 7. On or about [DATE], Defendant [NAME] performed a laparoscopic cholecystectomy on [NAME] at the [NAME], in [NAME]. 8. Defendant [NAME] performed the laparoscopic cholecystectomy in a manner causing physical injury to [NAME] by severing [NAME] common hepatic bile duct. 9. During the laparoscopic cholecystectomy, Defendant [NAME] did not seek advice from nor consult with any other physicians before clipping and cutting [NAME] common hepatic bile duct. Page 2.

3 10. During the laparoscopic cholecystectomy, Defendant [NAME] did not seek advice from, nor consult with, any other physicians before converting to an open cholecystectomy. 11. During the laparoscopic cholecystectomy, Defendant [NAME] did not use an intra-operative cholangiogram before clipping and cutting [NAME] common hepatic bile duct. 12. Had Defendant [NAME] utilized an intra-operative cholangiogram during the laparoscopic cholecystectomy she would not have clipped and cut [NAME] common hepatic bile duct. 13. Defendant [NAME] had an opportunity to convert from a laparoscopic cholecystectomy to an open cholecystectomy before clipping and cutting [NAME] common hepatic bile duct. 14. It was Defendant [NAME] decision to use a T-tube to repair [NAME] injured common hepatic bile duct. 15. As a direct result of the severed common hepatic bile duct, [NAME] required additional medical care and treatment. 16. Page 3.

4 As direct result of the severed common hepatic bile duct, [NAME] was required to undergo a roux-en-y hepaticojejunostomy. 17. [NAME] was not contributory/comparatively negligent. CLAIM FOR RELIEF (Count 1 Medical Malpractice v. [NAME] 18. As applicable, [NAME] incorporates the above. 19. At the time and place of the cholecystectomy, [NAME], by and through its employee/agent Defendant [NAME], failed to follow the applicable standard of medical care due and owed to [NAME] and was negligent in one or more of the following particulars: A. Failing to properly identify [NAME] anatomy during the laparoscopic cholecystectomy; B. Clipping and cutting [NAME] common hepatic duct during the laparoscopic cholecystectomy; C. Failing to use an intra-operative cholangiogram before clipping and cutting [NAME] common hepatic bile duct; D. Failing to seek advice from or consult with another physician before clipping and cutting [NAME] common hepatic bile duct; E. Failing to convert from a laparoscopic cholecystectomy to an open cholecystectomy before clipping and cutting [NAME] common hepatic bile duct; and F. Attempting to repair [NAME] cut common hepatic bile duct using the T- tube method. Page 4.

5 20. incurred reasonable and necessary medical expenses in the amount of $. 21. suffered physical injury, emotional distress, pain, inconvenience, and interference with her normal and usual activities. For these harms and losses, [NAME] seeks compensation in the amount of $. (Count 2 Medical Malpractice v. [NAME] 22. As applicable, [NAME] incorporates the above. 23. At the time and place of the cholecystectomy, [NAME], by and through its employee/agent Defendant [NAME], failed to follow the applicable standard of medical care due and owed to [NAME] and was negligent in one or more of the following particulars: A. Failing to properly identify [NAME] anatomy during the laparoscopic cholecystectomy; B. Clipping and cutting [NAME] common hepatic duct during the laparoscopic cholecystectomy; C. Failing to use an intra-operative cholangiogram before clipping and cutting [NAME] common hepatic bile duct; D. Failing to seek advice from or consult with another physician before clipping and cutting [NAME] common hepatic bile duct; Page 5.

6 E. Failing to convert from a laparoscopic cholecystectomy to an open cholecystectomy before clipping and cutting [NAME] common hepatic bile duct; and F. Attempting to repair [NAME] cut common hepatic bile duct using the T- tube method. 24. incurred reasonable and necessary medical expenses in the amount of $. 25. suffered physical injury, emotional distress, pain, inconvenience, and interference with her normal and usual activities. For these harms and losses, [NAME] seeks compensation in the amount of $. (Count 3 Medical Malpractice v. [NAME] 26. As applicable, [NAME] incorporates the above. 27. At the time and place of the cholecystectomy, Defendant [NAME] failed to follow the applicable standard of medical care due and owed to [NAME] and was negligent in one or more of the following particulars: A. Failing to properly identify [NAME] anatomy during the laparoscopic cholecystectomy; B. Clipping and cutting [NAME] common hepatic duct during the laparoscopic cholecystectomy; C. Failing to use an intra-operative cholangiogram before clipping and cutting [NAME] common hepatic bile duct; Page 6.

7 D. Failing to seek advice from or consult with another physician before clipping and cutting [NAME] common hepatic bile duct; E. Failing to convert from a laparoscopic cholecystectomy to an open cholecystectomy before clipping and cutting [NAME] common hepatic bile duct; and F. Attempting to repair [NAME] cut common hepatic bile duct using the T- tube method. 28. incurred reasonable and necessary medical expenses in the amount of $. 29. suffered physical injury, emotional distress, pain, inconvenience, and interference with her normal and usual activities. For these harms and losses, [NAME] seeks compensation in the amount of $. WHEREFORE, [NAME] prays for judgment against defendants as follows: 1. For $ as compensation for reasonable and necessary medical expenses; 2. For $ as compensation for physical injuries, emotional distress, conscious pain and suffering, inconvenience and interference with her normal and usual activities; 3. For [NAME] costs and disbursements incurred herein; and 4. For such other relief as this Court deems just and proper. Daniel A. Rayfield OSB # Attorneys for Plaintiff Trial Attorneys: Page 7.

8 Daniel A. Rayfield OSB#06479 SUBMITTED BY: Daniel A. Rayfield OSB # Nelson & MacNeil, P.C. 213 Water Ave NW #100 Albany, OR ( Page 8.

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