Preview
FILED: ERIE COUNTY CLERK 03/07/2019 03:33 PM INDEX NO. 819281/2018
NYSCEF DOC. NO. 22 RECEIVED NYSCEF: 03/07/2019
REQUEST FOR JUDICIAL INTERVENTION For Court Clerk Use Only:
UCS-840 (7/2012)
IAS Entry Date
Erie Supreme COURT, COUNTY OF Erie
Judge Assigned
Index No: 819281/2018 Date Index Issued: 12/10/2018
Enter the complete case caption. Do not use et al or et ano. If more space is required, RJI Date
CAPTION: attach a caption rider sheet.
Elizabeth M. Marino as Administratrix of the Estate of Phillip J. Marino, Jr.
Plaintiff(s)/Petitioner(s)
-against-
Mercy Hospital of Buffalo, Catholic Health System, Inc., Robert S. Armstrong, M.D., Kenneth H. Eckhert, III, M.D., Surgical Associates of
Western New York, P.C.
Defendant(s)/Respondent(s)
NATURE OF ACTION OR PROCEEDING: Check ONE box only and specify where indicated.
MATRIMONIAL COMMERCIAL
☐ Contested ☐ Business Entity (including corporations, partnerships, LLCs, etc.)
☐ Contract
NOTE: For all Matrimonial actions where the parties have children under the
age of 18, complete and attach the MATRIMONIAL RJI Addendum. For
Uncontested Matrimonial actions, use RJI form UD-13. ☐ Insurance (where insurer is a party, except arbitration)
☐ UCC (including sales, negotiable instruments)
TORTS
☐ Other Commercial:
☐ Asbestos
NOTE: For Commercial Division assignment requests [22 NYCRR § 202.70(D)],
complete and attach the COMMERCIAL DIV RJI Addendum.
☐ Breast Implant
REAL PROPERTY: How many properties does the application include?
☐ Environmental:
☐ Condemnation
☒ Medical, Dental, or Podiatric Malpractice
☐ Mortgage Foreclosure: ☐ Residential ☐ Commercial
☐ Motor Vehicle Property Address:
NOTE: For Mortgage Foreclosure actions involving a one- to four-family, owner-
☐ Products Liability:
occupied, residential property, or an owner-occupied condominium, complete and
attach the FORECLOSURE RJI Addendum.
☐ Other Negligence:
☐ Tax Certiorari - Section: Block: Lot:
☐ Other Professional Malpractice:
☐ Tax Foreclosure
☐ Other Tort:
☐ Other Real Property:
OTHER MATTERS SPECIAL PROCEEDINGS
☐ Certificate of Incorporation/Dissolution
[see NOTE under Commercial] ☐ CPLR Article 75 (Arbitration)
[see NOTE under Commercial]
☐ Emergency Medical Treatment ☐ CPLR Article 78 (Body or Officer)
☐ Habeas Corpus ☐ Election Law
☐ Local Court Appeal ☐ MHL Article 9.60 (Kendra's Law)
☐ Mechanic's Lien ☐ MHL Article 10 (Sex Offender Confinement-Initial)
☐ Name Change ☐ MHL Article 10 (Sex Offender Confinement-Review)
☐ Pistol Permit Revocation Hearing ☐ MHL Article 81 (Guardianship)
☐ Sale or Finance of Religious/Not-for-Profit Property ☐ Other Mental Hygiene:
☐ Other: ☐ Other Special Proceeding:
STATUS OF ACTION OR PROCEEDING: Answer YES or NO for EVERY question AND enter additional information where indicated.
YES NO
Has a summons and complaint or summons w/notice been filed? ☒ ☐ If yes, date filed:
12/10/2018
Has a summons and complaint or summons w/notice been served? ☒ ☐ If yes, date served:
12/13/2018
Is this action/proceeding being filed post-judgment? ☐ ☒ If yes, judgment date:
1 of 2
FILED: ERIE COUNTY CLERK 03/07/2019 03:33 PM INDEX NO. 819281/2018
NATURE
NYSCEF OF NO.
DOC. JUDICIAL
22 INTERVENTION: RECEIVED NYSCEF:
Check ONE box only AND enter additional information where indicated. 03/07/2019
☐ Infant's Compromise
☐ Note of Issue and/or Certificate of Readiness
☒ Notice of Medical, Dental, or Podiatric Malpractice
Date Issue Joined:
01/09/2019
☐ Notice of Motion Relief Sought: Return Date:
☐ Notice of Petition Relief Sought: Return Date:
☐ Order to Show Cause Relief Sought: Return Date:
☐ Other Ex Parte Application Relief Sought:
☐ Poor Person Application
☐ Request for Preliminary Conference
☐ Residential Mortgage Foreclosure Settlement Conference
☐ Writ of Habeas Corpus
☐ Other:
RELATED CASES: List any related actions. For Matrimonial actions, include any related criminal and/or Famiy Court cases. If
additional space is required, complete and attach the RJI Addendum. If none, leave blank.
Case Title Index/Case No. Court Judge (if assigned) Relationship to Instant Case
PARTIES: For parties without an attorney, check "Un-Rep" box AND enter party address, phone number and e-mail
address in space provided. If additional space is required, complete and attach the RJI Addendum.
Parties: Attorneys and/or Unrepresented Litigants:
List parties in caption order and indicate Issue
Provide attorney name, firm name, business address, phone number and e-
Un-
Rep
party role(s) (e.g., defendant; 3rd-party Joined
mail address of all attorneys that have appeared in the case. For Insurance Carrier(s):
plaintiff). unrepresented litigants, provide address, phone number and e-mail address.
(Y/N):
Name: Marino, Elizabeth M. MICHELE BRAUN, Brown Chiari LLP, 2470 Walden Ave , Buffalo, NY 14225,
mbraun@brownchiari.com
☐ Role(s): Plaintiff/Petitioner
YES
Name: Mercy Hospital of Buffalo JULIET BARGNESI, Bargnesi Britt PLLC, 350 Main St Ste 1105 , Buffalo, NY
14202, bargnesi@bargnesi.com
☐ Role(s): Defendant/Respondent
YES
Name: Catholic Health System, Inc. JULIET BARGNESI, Bargnesi Britt PLLC, 350 Main St Ste 1105 , Buffalo, NY
14202, bargnesi@bargnesi.com
☐ Role(s): Defendant/Respondent
YES
Name: Robert S. Armstrong, M.D. MICHAEL ROACH, CONNORS LLP, 1000 LIBERTY BUILDING , BUFFALO,
NY 14202, mjr@connorsllp.com
☐ Role(s): Defendant/Respondent
YES
Name: Kenneth H. Eckhert, III, M.D. MICHAEL ROACH, CONNORS LLP, 1000 LIBERTY BUILDING , BUFFALO,
NY 14202, mjr@connorsllp.com
☐ Role(s): Defendant/Respondent
YES
I AFFIRM UNDER THE PENALTY OF PERJURY THAT, TO MY KNOWLEDGE, OTHER THAN AS NOTED ABOVE, THERE
ARE AND HAVE BEEN NO RELATED ACTIONS OR PROCEEDINGS, NOR HAS A REQUEST FOR JUDICIAL
INTERVENTION PREVIOUSLY BEEN FILED IN THIS ACTION OR PROCEEDING.
Dated: 03/07/2019 MICHELE ANN BRAUN
SIGNATURE
2487486 MICHELE ANN BRAUN
ATTORNEY REGISTRATION NUMBER PRINT OR TYPE NAME
This form was generated by NYSCEF
2 of 2
Preview
FILED: ERIE COUNTY CLERK 03/07/2019 03:33 PM INDEX NO. 819281/2018 NYSCEF DOC. NO. 22 RECEIVED NYSCEF: 03/07/2019 REQUEST FOR JUDICIAL INTERVENTION For Court Clerk Use Only: UCS-840 (7/2012) IAS Entry Date Erie Supreme COURT, COUNTY OF Erie Judge Assigned Index No: 819281/2018 Date Index Issued: 12/10/2018 Enter the complete case caption. Do not use et al or et ano. If more space is required, RJI Date CAPTION: attach a caption rider sheet. Elizabeth M. Marino as Administratrix of the Estate of Phillip J. Marino, Jr. Plaintiff(s)/Petitioner(s) -against- Mercy Hospital of Buffalo, Catholic Health System, Inc., Robert S. Armstrong, M.D., Kenneth H. Eckhert, III, M.D., Surgical Associates of Western New York, P.C. Defendant(s)/Respondent(s) NATURE OF ACTION OR PROCEEDING: Check ONE box only and specify where indicated. MATRIMONIAL COMMERCIAL ☐ Contested ☐ Business Entity (including corporations, partnerships, LLCs, etc.) ☐ Contract NOTE: For all Matrimonial actions where the parties have children under the age of 18, complete and attach the MATRIMONIAL RJI Addendum. For Uncontested Matrimonial actions, use RJI form UD-13. ☐ Insurance (where insurer is a party, except arbitration) ☐ UCC (including sales, negotiable instruments) TORTS ☐ Other Commercial: ☐ Asbestos NOTE: For Commercial Division assignment requests [22 NYCRR § 202.70(D)], complete and attach the COMMERCIAL DIV RJI Addendum. ☐ Breast Implant REAL PROPERTY: How many properties does the application include? ☐ Environmental: ☐ Condemnation ☒ Medical, Dental, or Podiatric Malpractice ☐ Mortgage Foreclosure: ☐ Residential ☐ Commercial ☐ Motor Vehicle Property Address: NOTE: For Mortgage Foreclosure actions involving a one- to four-family, owner- ☐ Products Liability: occupied, residential property, or an owner-occupied condominium, complete and attach the FORECLOSURE RJI Addendum. ☐ Other Negligence: ☐ Tax Certiorari - Section: Block: Lot: ☐ Other Professional Malpractice: ☐ Tax Foreclosure ☐ Other Tort: ☐ Other Real Property: OTHER MATTERS SPECIAL PROCEEDINGS ☐ Certificate of Incorporation/Dissolution [see NOTE under Commercial] ☐ CPLR Article 75 (Arbitration) [see NOTE under Commercial] ☐ Emergency Medical Treatment ☐ CPLR Article 78 (Body or Officer) ☐ Habeas Corpus ☐ Election Law ☐ Local Court Appeal ☐ MHL Article 9.60 (Kendra's Law) ☐ Mechanic's Lien ☐ MHL Article 10 (Sex Offender Confinement-Initial) ☐ Name Change ☐ MHL Article 10 (Sex Offender Confinement-Review) ☐ Pistol Permit Revocation Hearing ☐ MHL Article 81 (Guardianship) ☐ Sale or Finance of Religious/Not-for-Profit Property ☐ Other Mental Hygiene: ☐ Other: ☐ Other Special Proceeding: STATUS OF ACTION OR PROCEEDING: Answer YES or NO for EVERY question AND enter additional information where indicated. YES NO Has a summons and complaint or summons w/notice been filed? ☒ ☐ If yes, date filed: 12/10/2018 Has a summons and complaint or summons w/notice been served? ☒ ☐ If yes, date served: 12/13/2018 Is this action/proceeding being filed post-judgment? ☐ ☒ If yes, judgment date: 1 of 2 FILED: ERIE COUNTY CLERK 03/07/2019 03:33 PM INDEX NO. 819281/2018 NATURE NYSCEF OF NO. DOC. JUDICIAL 22 INTERVENTION: RECEIVED NYSCEF: Check ONE box only AND enter additional information where indicated. 03/07/2019 ☐ Infant's Compromise ☐ Note of Issue and/or Certificate of Readiness ☒ Notice of Medical, Dental, or Podiatric Malpractice Date Issue Joined: 01/09/2019 ☐ Notice of Motion Relief Sought: Return Date: ☐ Notice of Petition Relief Sought: Return Date: ☐ Order to Show Cause Relief Sought: Return Date: ☐ Other Ex Parte Application Relief Sought: ☐ Poor Person Application ☐ Request for Preliminary Conference ☐ Residential Mortgage Foreclosure Settlement Conference ☐ Writ of Habeas Corpus ☐ Other: RELATED CASES: List any related actions. For Matrimonial actions, include any related criminal and/or Famiy Court cases. If additional space is required, complete and attach the RJI Addendum. If none, leave blank. Case Title Index/Case No. Court Judge (if assigned) Relationship to Instant Case PARTIES: For parties without an attorney, check "Un-Rep" box AND enter party address, phone number and e-mail address in space provided. If additional space is required, complete and attach the RJI Addendum. Parties: Attorneys and/or Unrepresented Litigants: List parties in caption order and indicate Issue Provide attorney name, firm name, business address, phone number and e- Un- Rep party role(s) (e.g., defendant; 3rd-party Joined mail address of all attorneys that have appeared in the case. For Insurance Carrier(s): plaintiff). unrepresented litigants, provide address, phone number and e-mail address. (Y/N): Name: Marino, Elizabeth M. MICHELE BRAUN, Brown Chiari LLP, 2470 Walden Ave , Buffalo, NY 14225, mbraun@brownchiari.com ☐ Role(s): Plaintiff/Petitioner YES Name: Mercy Hospital of Buffalo JULIET BARGNESI, Bargnesi Britt PLLC, 350 Main St Ste 1105 , Buffalo, NY 14202, bargnesi@bargnesi.com ☐ Role(s): Defendant/Respondent YES Name: Catholic Health System, Inc. JULIET BARGNESI, Bargnesi Britt PLLC, 350 Main St Ste 1105 , Buffalo, NY 14202, bargnesi@bargnesi.com ☐ Role(s): Defendant/Respondent YES Name: Robert S. Armstrong, M.D. MICHAEL ROACH, CONNORS LLP, 1000 LIBERTY BUILDING , BUFFALO, NY 14202, mjr@connorsllp.com ☐ Role(s): Defendant/Respondent YES Name: Kenneth H. Eckhert, III, M.D. MICHAEL ROACH, CONNORS LLP, 1000 LIBERTY BUILDING , BUFFALO, NY 14202, mjr@connorsllp.com ☐ Role(s): Defendant/Respondent YES I AFFIRM UNDER THE PENALTY OF PERJURY THAT, TO MY KNOWLEDGE, OTHER THAN AS NOTED ABOVE, THERE ARE AND HAVE BEEN NO RELATED ACTIONS OR PROCEEDINGS, NOR HAS A REQUEST FOR JUDICIAL INTERVENTION PREVIOUSLY BEEN FILED IN THIS ACTION OR PROCEEDING. Dated: 03/07/2019 MICHELE ANN BRAUN SIGNATURE 2487486 MICHELE ANN BRAUN ATTORNEY REGISTRATION NUMBER PRINT OR TYPE NAME This form was generated by NYSCEF 2 of 2