Bastidas v. Good Samaritan Hospital LP et al
Filing
258
VERDICT FORM (Illston, Susan) (Filed on 6/14/2017)
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UNITED STATES DISTRICT COURT
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NORTHERN DISTRICT OF CALIFORNIA
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J. AUGUSTO BASTIDAS,
Plaintiff,
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United States District Court
Northern District of California
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Case No. 13-cv-04388-SI
JURY VERDICT FORM
v.
GOOD SAMARITAN HOSPITAL LP and
GOOD SAMARITAN HOSPITAL
MEDICAL STAFF,
Defendants.
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PART I -- LIABILITY
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Re: Implementation of Proctoring Program
Question No. 1:
Did plaintiff, J. Augusto Bastidas, MD, prove, by a preponderance of the evidence, that
defendant Good Samaritan Hospital (“Hospital”) subjected him to an adverse employment action
by delaying implementation of his proctoring program?
Yes _____
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No _____
If your answer to Question No. 1 was “No,” please go to Question No. 3; otherwise, please answer
the next question.
United States District Court
Northern District of California
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Question No. 2:
Did plaintiff, J. Augusto Bastidas, MD, prove, by a preponderance of the evidence, that
this adverse employment action (delaying implementation of proctoring) was taken by Hospital
because Dr. Bastidas engaged in the protected activity of bringing and pursuing a civil rights
lawsuit?
Yes _____
No _____
Please answer the next question.
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Question No. 3:
Did plaintiff, J. Augusto Bastidas, MD, prove, by a preponderance of the evidence, that
defendant Good Samaritan Hospital Medical Staff (“Medical Staff”) subjected him to an adverse
employment action by delaying implementation of his proctoring program?
Yes _____
No _____
If your answer to Question No. 3 was “No,” please go to Question No. 5; otherwise, please answer
the next question.
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Question No. 4:
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Did plaintiff, J. Augusto Bastidas, MD, prove, by a preponderance of the evidence, that
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this adverse employment action (delaying implementation of proctoring) was taken by Medical
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Staff because Dr. Bastidas engaged in the protected activity of bringing and pursuing a civil rights
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lawsuit?
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Yes _____
No _____
Please answer the next question.
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Re: Update to Report on Dr. Bastidas in the National Practitioner Databank Report
Question No. 5:
United States District Court
Northern District of California
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Did plaintiff, J. Augusto Bastidas, MD, prove, by a preponderance of the evidence, that
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defendant Good Samaritan Hospital (“Hospital”) subjected him to an adverse employment action
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by delaying the filing of an update to the plaintiff’s National Practitioner Databank Report?
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Yes _____
No _____
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If your answer to Question No. 5 was “No,” please go to Question No. 7; otherwise, please answer
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the next question.
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Question No. 6:
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Did plaintiff, J. Augusto Bastidas, MD, prove, by a preponderance of the evidence, that
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this adverse employment action (delaying update to National Practitioner Databank Report) was
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taken by Hospital because Dr. Bastidas engaged in the protected activity of bringing and pursuing
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a civil rights lawsuit?
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Yes _____
No _____
Please answer the next question.
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Question No. 7:
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Did plaintiff, J. Augusto Bastidas, MD, prove, by a preponderance of the evidence, that
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defendant Good Samaritan Hospital Medical Staff (“Medical Staff”) subjected him to an adverse
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employment action by delaying the filing of an update to the plaintiff’s National Practitioner
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Databank Report?
Yes _____
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No _____
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If your answer to Question No. 7 was “No,” please go to part II. Otherwise, please answer the
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next question.
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Question No. 8:
United States District Court
Northern District of California
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Did plaintiff, J. Augusto Bastidas, MD, prove, by a preponderance of the evidence, that
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this adverse employment action (delaying update to National Practitioner Databank Report) was
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taken by Medical Staff because Dr. Bastidas engaged in the protected activity of bringing and
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pursuing a civil rights lawsuit?
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Yes _____
No _____
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Please go to Part II.
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PART II -- DAMAGES
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If your answer to each of Questions No. 2, 4, 6 and 8 was “No” or blank, do not answer
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any further questions; go to the end of this form and have your Foreperson date and sign the form,
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and return it. Otherwise, please answer the next question.
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Question No. 9:
As to the adverse employment action(s) which you have found were taken because Dr.
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Bastidas engaged in the protected activity of bringing and pursuing a civil rights lawsuit, did
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plaintiff prove, by a preponderance of the evidence, that such adverse employment action caused
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United States District Court
Northern District of California
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any damage to plaintiff?
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Yes _____
No _____
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If your answer to Question No. 9 was “No,” please go to Question No. 11. Otherwise, please
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answer the next question
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Question No. 10:
What is the amount of damage plaintiff has proved?
$_____________________________
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Please go to Question No. 12.
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Question No. 11:
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As to the adverse employment action(s) which you have found were taken because Dr.
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Bastidas engaged in the protected activity of bringing and pursuing a civil rights lawsuit, if you
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have found that plaintiff failed to prove any damages you must award nominal damages, which
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may not exceed one dollar ($1.00). Do you award nominal damages?
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If so, in the amount of ___________________________________
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Question No. 12:
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As to the adverse employment action(s) which you have found were taken because Dr.
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Bastidas engaged in the protected activity of bringing and pursuing a civil rights lawsuit, did
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plaintiff prove, by a preponderance of the evidence, that either defendant engaged in conduct
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which was malicious, oppressive or in reckless disregard of plaintiff’s rights?
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As to Good Samaritan Hospital?
Yes _____
No _____
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As to Good Samaritan Hospital Medical Staff?
Yes _____
No _____
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If you answered “Yes” to either part of Question No. 12, please answer the next question.
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United States District Court
Northern District of California
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Otherwise, do not answer any further questions; go to the end of this form and have your
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Foreperson date and sign the form.
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Question No. 13:
What is the amount of punitive damages which you award?
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$______________________
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Dated:
_____________________________
FOREPERSON
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