Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_13-cv-01106/USCOURTS-cand-3_13-cv-01106-23/pdf.json

Nature of Suit Code: 555
Nature of Suit: Prisoner - Prison Condition
Cause of Action: 42:1983 Prisoner Civil Rights

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United States District Court

For the Northern District of California

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IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

CESAR URIBE,

Plaintiff,

 v.

PHILIP BABIENCO,

Defendant. /

No. C 13-01106 WHA

SPECIAL VERDICT FORM

Case 3:13-cv-01106-WHA Document 113 Filed 07/26/16 Page 1 of 5
United States District Court

For the Northern District of California

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Your answers to the following questions must be unanimous.

Dental Malpractice Claim.

1. With respect to the first claim for dental malpractice, has plaintiff Cesar Uribe proven by

a preponderance of the evidence that defendant Philip Babienco was professionally

negligent and that this professional negligence was a substantial factor in causing harm

to plaintiff?

Yes ______ No _____

If you answered No, go to question 6. Otherwise go to the next two questions.

2. What is the total amount of damages for pain and suffering proven by plaintiff from

November 9 to 28, 2011?

Damages for pain and suffering: $_____________________

3. Has defendant proven by a preponderance of the evidence that plaintiff was

comparatively at fault for any harm caused by defendant’s professional negligence and

that plaintiff’s comparative fault was a substantial factor in causing the harm?

Yes ______ No _____

If you answered No, go to Question 6. Otherwise go to Questions 4 and 5.

Case 3:13-cv-01106-WHA Document 113 Filed 07/26/16 Page 2 of 5
United States District Court

For the Northern District of California

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4. What percentage of fault do you assign to plaintiff and defendant respectively (the total

must add up to 100)?

Plaintiff ____________%

Defendant ____________%

5. If you assigned a percentage of fault to defendant in Question 4, what are the damages

for which defendant is responsible?

Damages for which defendant is responsible: $_____________________

Go to Question 6.

Section 1983 Claim.

6. With respect to the Section 1983 claim, has plaintiff proven by a preponderance of the

evidence that defendant was deliberately indifferent to plaintiff’s serious medical needs

and that this deliberate indifference caused harm to plaintiff?

Yes ______ No _____

If you answered No, you are done, go to the end. Otherwise, go to the next two

questions.

Case 3:13-cv-01106-WHA Document 113 Filed 07/26/16 Page 3 of 5
United States District Court

For the Northern District of California

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7. What is the total amount of damages for pain and suffering proven by plaintiff from

November 9 to 28, 2011? (This should be the same number as for Question 2 above.)

Damages for pain and suffering: $_____________________

If you answered No, go to Question 10. Otherwise go to the next question.

8. Has defendant proven by a preponderance of the evidence that plaintiff failed to use

reasonable efforts to mitigate damages?

Yes ______ No _____

9. If you answered yes to Question 8, what is the total amount of damages for pain and

suffering after subtracting the amount by which plaintiff should have mitigated

damages? 

$_____________________

10. Has plaintiff proven by a preponderance of the evidence that punitive damages should

be awarded against defendant?

Yes ______ No _____

If you answered Yes, there will be a short supplemental proceeding immediately after your

verdict. The purpose of the short supplemental proceeding would be to allow you to fix the

amount of any punitive damages.

Note: If you award damages for both claims, the Court will take care of the potential for

double-counting by awarding the larger of the two amounts (they will not be added together).

Case 3:13-cv-01106-WHA Document 113 Filed 07/26/16 Page 4 of 5
United States District Court

For the Northern District of California

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ONCE YOU HAVE FINISHED ANSWERING THE NECESSARY QUESTIONS UNANIMOUSLY,

PLEASE HAVE THE FOREPERSON SIGN AND DATE THIS FORM. THEN CONTACT THE DEPUTY

MARSHAL TO INFORM HIM OR HER THAT YOU HAVE COMPLETED YOUR DELIBERATIONS.

Date: July __, 2016. __________________________

 FOREPERSON

Case 3:13-cv-01106-WHA Document 113 Filed 07/26/16 Page 5 of 5