CACI No. VF-502. Medical Negligence - Informed Consent - Affirmative Defense - Emergency
Judicial Council of California Civil Jury Instructions (2023 edition)
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VF-502.Medical Negligence - Informed Consent - Affirmative
Defense - Emergency
We answer the questions submitted to us as follows:
1. Did [name of defendant] perform a [insert medical procedure] on
[name of plaintiff]?
1. Yes No
1. If your answer to question 1 is yes, then answer question 2. If you
answered no, stop here, answer no further questions, and have
the presiding juror sign and date this form.
2. Did [name of plaintiff] give [his/her/nonbinary pronoun] informed
consent to the [insert medical procedure]?
2. Yes No
2. If your answer to question 2 is no, then answer question 3. If you
answered yes, stop here, answer no further questions, and have
the presiding juror sign and date this form.
3. Would a reasonable person in [name of plaintiff]’s position have
refused the [insert medical procedure] if that person had been fully
informed of the possible results and risks of [and alternatives to]
the [insert medical procedure]?
3. Yes No
3. If your answer to question 3 is yes, then answer question 4. If you
answered no, stop here, answer no further questions, and have
the presiding juror sign and date this form.
4. Was [name of plaintiff] harmed as a consequence of a result or
risk that [name of defendant] should have explained before the
[insert medical procedure] was performed?
4. Yes No
4. If your answer to question 4 is yes, then answer question 5. If you
answered no, stop here, answer no further questions, and have
the presiding juror sign and date this form.
5. Did [name of defendant] reasonably believe the [insert medical
procedure] had to be done immediately in order to preserve the
life or health of [name of plaintiff]?
5. Yes No
5. If your answer to question 5 is no, then answer question 7. If you
answered yes to this question, answer question 6.
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6. Was [name of plaintiff] unconscious?
6. Yes No
6. If your answer to question 6 is no, then answer question 7. If you
answered yes, stop here, answer no further questions, and have
the presiding juror sign and date this form.
7. What are [name of plaintiff]’s damages?
[a. Past economic loss
[lost earnings $ ]
[lost profits $ ]
[medical expenses $ ]
[other past economic loss $ ]
[a. Total Past Economic Damages: $ ]
[b. Future economic loss
[lost earnings $ ]
[lost profits $ ]
[medical expenses $ ]
[other future economic loss $ ]
[b. Total Future Economic Damages: $ ]
[c. Past noneconomic loss, including [physical
pain/mental suffering:] $ ]
[d. Future noneconomic loss, including [physical
pain/mental suffering:] $ ]
[d. TOTAL $
Signed: Presiding Juror
Dated:
After [this verdict form has/all verdict forms have] been signed, notify
the [clerk/bailiff/court attendant] that you are ready to present your
verdict in the courtroom.
New September 2003; Revised April 2007, October 2008, December 2010,
December 2016, May 2020
VF-502 MEDICAL NEGLIGENCE
514
Directions for Use
This verdict form is based on CACI No. 533, Failure to Obtain Informed
Consent - Essential Factual Elements, and CACI No. 554, Affırmative
Defense - Emergency.
The special verdict forms in this section are intended only as models. They may
need to be modified depending on the facts of the case.
Depending on the facts, alternative language may be substituted for question 6 as in
item 2 of CACI No. 554. If specificity is not required, users do not have to itemize
all the damages listed in question 7. The breakdown is optional depending on the
circumstances.
If there are multiple causes of action, users may wish to combine the individual
forms into one form. If different damages are recoverable on different causes of
action, replace the damages tables in all of the verdict forms with CACI No. VF-
3920, Damages on Multiple Legal Theories.
If the affirmative defense, which is contained in questions 5 and 6, is not an issue in
the case, then questions 5 and 6 should be omitted and the remaining questions
renumbered accordingly.
If the jury is being given the discretion under Civil Code section 3288 to award
prejudgment interest (see Bullis v. Security Pac. Nat’l Bank (1978) 21 Cal.3d 801,
814 [148 Cal.Rptr. 22, 582 P.2d 109]), give CACI No. 3935, Prejudgment Interest.
This verdict form may need to be augmented for the jury to make any factual
findings that are required in order to calculate the amount of prejudgment interest.
VF-503-VF-599. Reserved for Future Use
MEDICAL NEGLIGENCE VF-502
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© Judicial Council of California.
