Arbitration Agreement

Liability Arbitration Agreement

1. Agreement to Arbitrate: I agree that any dispute as to medical malpractice, this is as to whether any medical services rendered under this contract were unnecessary or unauthorized or were improperly, negligently or incompetently rendered, will be determined by submission to arbitration as provided by California law, and not by a lawsuit or resort to court process except as California law provides for judicial review of arbitration proceedings.  I agree to give up my constitutional right to have any such dispute decided in a court of law before a jury, and instead are accepting the use of arbitration.
2. All Claims Must Be Arbitrated: I agree to bind all parties whose claims may arise out of or relate to treatment or service provided by Dr. Samuel Dismond III and his medical professional associates, these parties include any spouse or heirs of mine and any children, whether born or unborn, at the time of the occurrence giving rise to any claim.  In the case that I am a pregnant woman, my agreement binds both me and my expected child or children.
   
   I agree that any and all claims for monetary damages exceeding the jurisdictional limit of the small claims court against Dr. Samuel Dismond III and his partners, associates, association, employer, corporation or partnership, and the employees, agents and estates of any of them, must be arbitrated including, without limitation, claims for loss of consortium, wrongful death, emotional distress or punitive damages.
3. Procedures and Applicable Law: I agree that a demand for arbitration must be communicated in writing to all parties.  Each party shall select an arbitrator (party arbitrator) within thirty days and a third arbitrator (neutral arbitrator) shall be selected by the arbitrators appointed by either party.  Each party to the arbitration shall pay such party’s pro rata share of the expenses and fees of the neutral arbitrator, together with other expenses of the arbitration incurred or approved by the neutral arbitrator, not including counsel fees or witness fees, or other expenses incurred by a party for such party’s own benefit.  The parties agree that the arbitrators have the immunity of a judicial officer from civil liability when acting in the capacity of arbitrator under this Agreement. This immunity shall supplement, not supplant, any other applicable statutory or common law.
   
   Either party shall have the absolute right to arbitrate separately the issues of liability and damages upon written request to the neutral arbitrator.
   
   The parties consent to the intervention and joinder in this arbitration of any person or entity which would otherwise be a proper additional party in a court action, and upon such intervention and joinder any existing court action against such additional person or entity shall be stayed pending arbitration.
   
   The parties agree that provision of California law applicable to health care providers shall apply to disputes within this arbitration agreement, including, but not limited to, Code of Civil Procedure Sections 340.5 and 667.7 and Civil Code Sections 3333.1 and 3333.2.  Any party may bring before the arbitrators a motion for summary judgment or summary adjudication in accordance with the Code of Civil Procedure. Discovery shall be conducted pursuant to Code of Civil Procedure section 1283.05; however, depositions may be taken with prior approval of the neutral arbitrator.
4. General Provisions: All claims based upon the same incident, transaction or related circumstances shall be arbitrated in one proceeding.  A claim shall be waived and forever barred if (1) on the date notice thereof is received, the claim, if asserted in a civil action, would be barred by the applicable California statute of limitations, or (2) the claimant fails to pursue the arbitration claim in accordance with the procedures prescribed herein with reasonable diligence.  With respect to any matter not herein expressly provided for, the arbitrators shall be governed by the California Code of Civil Procedure provisions relating to arbitration.
   
   If any provision of this agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and shall not be affected by the invalidity of any other provision.

NOTICE:  BY SIGNING THIS AGREEMENT YOU ARE RELEASING DR. SAMUEL DISMOND III AND HIS MEDICAL PROFESSIONAL ASSOCIATES FROM LIABILITY RELATED TO MEDICAL CARE AND GIVING UP YOUR RIGHT TO A JURY OR COURT TRIAL RELATED TO MEDICAL MALPRACTICE.