Dr. Arnulfo Agbunag
3443 Dickerson Road
Nashville, TN 37207
Dr. Arnulfo Agbunag
610 West Due West Avenue
Madison, TN 37115
VIA CERTIFIED MAIL, RETURN RECEIPT REQUESTED
Re: Notice of Claim pursuant to TENN. CODE ANN. §29-26-122
Patient: Natasha Darna Williams (Deceased)
Claimant: Jacqueline Fisher (Her Mother)
Dear Dr. Agbunag,
Please read the following:
The full name and date of birth of the patient whose treatment is at issue:
Natasha Darna Williams
Date of birth: March 4, 1974
The name and address of the claimant authorizing this notice and the relationship to the patient is:
Mother of Natasha Darna Williams
508 Hatten Track Lane
Gallatin, TN 37066
The name and address of the attorney sending this Notice is:
Clinton L. Kelly, Esq.
Kelly, Kelly & Allman
629 East Main Street
Hendersonville, TN 37075
Doctor, I am the attorney representing Jacqueline Fisher, the claimant and mother of your deceased patient, Natasha Darna Williams. I am giving you notice pursuant to TENN. CODE ANN. §29-26-121 that a medical malpractice claim will be filed against you within the time period required by law. The claim arises out of Ms. Williams’ surgery you performed on 4/23/09 at Skyline Medical Center, including your post-surgical care of Ms. Williams though 5/3/09. Ms. Williams died from acute peritonitis according to the medical examiner.
The wrongful death / medical malpractice claim will be filed by Ms. Fisher on behalf of herself and her late daughter’s estate. A copy of Ms. Williams’ death certificate is included herein for your records. As required by TENN. CODE ANN. §29-26-122(a)(2)(E), Ms. Fisher has executed a HIPAA-compliant medical authorization [enclosed herein] that authorizes you to obtain complete medical records relating to Ms. Williams. If any health care provider does not accept this authorization for any reason, then please contact my office immediately. We will use our best efforts to execute a form acceptable to them that will permit you to obtain complete medical records concerning Ms. Williams from that provider. Please be advised that neither this Notice nor the medical authorization waives the common law physician-patient privilege concerning your care and treatment of Ms. Williams. We expect that in conformity with Givens v. Mullikin, 75 S.W.3d 383 (Tenn. 2002) you will not communicate with any of Ms. Williams’ health care providers about her any of care and treatment whatsoever.
My law firm and Attorney Joe Harsh will be representing Ms. Fisher and the Williams’ estate. If you wish to correspond or talk with this firm about this matter, then please direct your inquiry to me. Forward this Notice and the enclosures to your professional liability insurance carrier(s) and your legal counsel. Please ask your professional liability insurance carrier(s) or legal counsel to contact me. We believe that this letter complies with the letter and spirit of TENN. CODE ANN. §29-26-121. If you or your counsel believes it is deficient in any way, then please promptly let us know and any defect will be promptly cured. If we do not promptly hear from you, then we will assume that you and your legal counsel believe the letter complies with the law in all respects.
LIST OF NAME AND ADDRESS OF ALL HEALTH CARE PROVIDERS TO WHOM THIS NOTICE IS SENT PURSUANT TO TENN. CODE ANN. § 29-26-121(A) OF A POTENTIAL CLAIM FOR MEDICAL MALPRACTICE:
1. Dr. Arnulfo Agbunag, 456 State Avenue, Suite 100, Nashville, TN 37215.
Each provider above is being sent a HIPAA-compliant medical authorization permitting each to obtain complete medical records from each other.