UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF NEW JERSEY 

CHARLES S. HOTIENSTEIN, 

Administrator for the Estate of Tracy 

Hottenstein, CHARLES S. HOTIENSTEIN, 

and ELIZABETH K. HOTIENSTEIN, 

Plaintiffs, 

v. 

CITY OF SEA ISLE CITY, et al., 

Defendants. 

HONORABLEROBERTB.KUGLER 

CIV. NO. 11-cv-740 (RBK/JS) 

VERDICT SHEET 

1. Has the Plaintiff proven by a preponderance of the evidence that Dr. Zaki Khebzou 

deviated from accepted standards of medical practice? 

Yes No _X__ 

IF YOUR ANSWER IS "YES", PROCEED TO QUESTION NO. 2. 

IF YOUR ANSWER IS "NO", PROCEED TO QUESTION NO. 6. 

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2. Has the Plaintiff proven that Dr. Zaki Khebzou's deviation from accepted standards of 

medical practice increased the risk of harm posed by Tracy Hottenstein' s pre-existing 

condition? 

Yes No 

IF YOUR ANSWER IS "YES", PROCEED TO QUESTION NO. 3. 

IF YOUR ANSWER IS "NO", PROCEED TO QUESTION NO. 6. 

3. Was Dr. Zaki Kehbzou' s deviation a substantial factor in causing the increased risk of 

death of Tracy Hottenstein? 

Yes No 

IF YOUR ANSWER IS "YES", PROCEED TO QUESTION NO. 4. 

IF YOUR ANSWER IS "NO", PROCEED TO QUESTION NO. 6. 

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4. Has the Plaintiff proven by a preponderance of the evidence that Atlanticare Regional 

Medical Center held out Dr. Zaki Khebzou as an agent and/or employee? 

Yes No 

IF YOUR ANSWER IS "YES", PROCEED TO QUESTION NO. 5. 

IF YOUR ANSWER IS "NO", PROCEED TO QUESTION NO. 6. 

5. Has the Plaintiff proven by a preponderance of the evidence that Dr. Zaki Khebzou was 

acting within the scope of his apparent authority as an agent and/or employee of 

Atlanticare Regional Medical Center? 

Yes No 

PROCEED TO QUESTION NO. 6. 

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6. Has the Plaintiff proven by a preponderance of the evidence that the Atlanticare 

defendants through the actions of Michael Senisch deviated from accepted standards of 

paremdic practice? 

Yes No L 

IF YOUR ANSWER IS "YES", PROCEED TO QUESTION NO. 7. 

IF YOUR ANSWER IS "NO", AND YOU ANSWERED "YES" TO EACH OF 

QUESTIONS NO. 1, NO. 2, AND NO. 3, PROCEED TO QUESTION NO. 9. 

IF YOUR ANSWER IS "NO", AND YOU ANSWERED "NO" TO ANY OF 

QUESTIONS NO. 1, NO. 2, OR NO. 3, HA VE THE FOREPERSON SIGN THE 

FINAL PAGE, AND RETURN YOUR VERDICT. 

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7. Has the Plaintiff proven that the Atlanticare defendants' conduct through Michael 

Senisch' s deviation from accepted standards of medical practice increased the risk of 

harm posed by Tracy Hottenstein's pre-existing condition? 

Yes No 

IF YOUR ANSWER IS "YES", PROCEED TO QUESTION NO. 8. 

IF YOUR ANSWER IS "NO", AND YOU ANSWERED "YES" TO EACH OF 

QUESTIONS NO. 1, NO. 2, AND NO. 3, PROCEED TO QUESTION NO. 9. 

IF YOUR ANSWER IS "NO", AND YOU ANSWERED "NO" TO ANY OF 

QUESTIONS NO. 1, NO. 2, OR NO. 3, HAVE THE FOREPERSON SIGN THE 

FINAL PAGE, AND RETURN YOUR VERDICT. 

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8. Was the Atlanticare defendants' conduct through Michael Senisch's deviation a 

substantial factor in causing the increased risk of death of Tracy Hottenstein? 

Yes No 

IF YOUR ANSWER IS "YES", PROCEED TO QUESTION NO. 9. 

IF YOUR ANSWER IS "NO", AND YOU ANSWERED "YES" TO EACH OF 

QUESTIONS NO. 1, NO. 2, AND NO. 3, PROCEED TO QUESTION NO. 9. 

IF YOUR ANSWER IS "NO", AND YOU ANSWERED "NO" TO ANY OF 

QUESTIONS NO. 1, NO. 2, OR NO. 3, HA VE THE FOREPERSON SIGN THE 

FINAL PAGE, AND RETURN YOUR VERDICT. 

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9. Have either of the defendants met their burden of proving by a preponderance of the 

evidence that some portion of the ultimate injury was a result of the pre-existing 

condition? 

Yes No 

PROCEED TO QUESTION NO. 10. 

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10. IF YOU ANSWERED "NO" TO QUESTION NO. 9, ENTER "O'' FOR PRE-EXISTING 

CONDITION. 

IF YOU ANSWERED "NO" TO ANY OF QUESTIONS NO. 1, NO. 2, OR NO. 3, 

ENTER "O" FOR DR. ZAKI KHEBZOU. 

IF YOU ANSWERED "NO" TO ANY OF QUESTIONS NO. 6, NO. 7, OR NO. 8, 

ENTER "O'' FOR MICHAEL SENISCH. 

State in percentages what portion of the ultimate injury is a result from: 

a. The pre-existing condition: ____ % 

b. Dr. Zaki Khebzou's deviation: ____ % 

c. The Atlanticare defendants' conduct 

through Michael Senisch's deviation: ____ % 

TOTAL 100 % ---=-"'-~-

PROCEED TO QUESTION NO. 11. 

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11. What sum of money will fairly and reasonably compensate plaintiffs Charles Hottenstein 

and Elizabeth Hottenstein for any damages? 

a. Past Loss $ _______ _ 

b. Future Loss $ --------

c. Funeral Expenses $ _______ _ 

TOTAL $ ______ _ 

REGARDLESS OF YOUR ANSWERS, THE FOREPERSON MUST SIGN AND DATE THIS 

VERDICT FORM. 

( I 

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