FILED: ERIE COUNTY CLERK 11/20/2024 08:46 PM
`NYSCEF DOC. NO. 13
`
`REQUEST FOR JUDICIAL INTERVENTION
`
` _______________ COURT, COUNTY OF ___________________
`
`
`Index No: _______________
`Date Index Issued: _______________
`Enter the complete case caption. Do not use et al or et ano. If more space is needed, attach a caption rider sheet.
`
`INDEX NO. 811587/2024
`
`RECEIVED NYSCEF: 11/20/2024
`UCS-840
`
`(rev. 02/01/2024)
`
`For Court Use Only:
`IAS Entry Date
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`Plaintiff(s)/Petitioner(s)
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`Judge Assigned
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`RJI Filed Date
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`Defendant(s)/Respondent(s)
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`CAPTION
`
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`-against-
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`Q
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`QOOO
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`Q
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`OQ
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`Q
`Q
`Q
`O
`Q
`Q
`Q
`Q
`Q
`Q
`Q
`Q
`O
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`Initial Review
`
`@ Q
`@ Q
`@
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`
`
`Check only one box and specify where indicated.
`NATURE OF ACTION OR PROCEEDING
`MATRIMONIAL
`COMMERICIAL
` Contested
` Business Entity (includes corporations, partnerships, LLCs, LLPs, etc.)
`NOTE: If there are children under the age of 18, complete and attach the
` Contract
`MATRIMONIAL RJI ADDENDUM (UCS-840M).
` Insurance (where insurance company is a party, except arbitration)
`For Uncontested Matrimonial actions, use the Uncontested Divorce RJI (UD-13).
` UCC (includes sales and negotiable instruments)
` Other Commercial (specify): _______________________________________________ REAL PROPERTY
`Specify how many properties the application includes: _______
`NOTE: For Commercial Division assignment requests pursuant to 22 NYCRR 202.70(d),
` Condemnation
`complete and attach the COMMERCIAL DIVISION RJI ADDENDUM (UCS-840C).
` Mortgage Foreclosure (specify): Residential Commercial
`TORTS
`Property Address: ____________________________________________________
` Asbestos
`NOTE: For Mortgage Foreclosure actions involving a one to four-family,
` Environmental (specify): __________________________________________________
`owner-occupied residential property or owner-occupied condominium,
` Medical, Dental or Podiatric Malpractice
`complete and attach the FORECLOSURE RJI ADDENDUM (UCS-840F).
` Motor Vehicle
` Partition
` Products Liability (specify): ________________________________________________
`NOTE: Complete and attach the PARTITION RJI ADDENDUM (UCS-840P).
` Other Negligence (specify): ________________________________________________
` Tax Certiorari (specify):
`Section:________ Block:________ Lot:________
` Other Professional Malpractice (specify): _____________________________________
` Tax Foreclosure
` Other Tort (specify): ______________________________________________________
` Other Real Property (specify): __________________________________________
`SPECIAL PROCEEDINGS
`OTHER MATTERS
`Surrogacy Agreement
` Child-Parent Security Act (specify): Assisted Reproduction
` Certificate of Incorporation/Dissolution [see NOTE in COMMERCIAL section]
` CPLR Article 75 – Arbitration [see NOTE in COMMERCIAL section]
` Emergency Medical Treatment
` CPLR Article 78 – Proceeding against a Body or Officer
` Habeas Corpus
` Election Law
` Local Court Appeal
` Extreme Risk Protection Order
` Mechanic’s Lien
` MHL Article 9.60 – Kendra’s Law
` Name Change/Sex Designation Change
` MHL Article 10 – Sex Offender Confinement (specify):
` Pistol Permit Revocation Hearing
` MHL Article 81 (Guardianship)
` Sale or Finance of Religious/Not-for-Profit Property
` Other Mental Hygiene (specify): ____________________________________________
` Other (specify): ______________________________________________________
` Other Special Proceeding (specify): _________________________________________
`STATUS OF ACTION OR PROCEEDING
`Answer YES or NO for every question
`and enter additional information where indicated.
`
`NO
`
`YES
`___________________
`Has a summons and complaint or summons with notice been filed?
`
`
`If yes, date filed:
`___________________
`Has a summons and complaint or summons with notice been served?
`
`
`If yes, date served:
`Is this action/proceeding being filed post-judgment?
`
`
`If yes, judgment date: ___________________
`
`QQOO
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`QQ
`
`O
`O
`Q
`O
`O
`O
`O
`Q
`Q
`O
`O
`O
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`QOQQ@OQQOOOOOO
`
`Check one box only and enter additional information where indicated.
`
`Date Issue Joined: ___________________
`Relief Requested: ______________________________
`Relief Requested: ______________________________
`Relief Requested: ______________________________
`Relief Requested: ______________________________
`
`Return Date: ___________________
`Return Date: ___________________
`Return Date: ___________________
`
`
`NATURE OF JUDICIAL INTERVENTION
`
`Infant’s Compromise
` Extreme Risk Protection Order Application
` Note of Issue/Certificate of Readiness
` Notice of Medical, Dental or Podiatric Malpractice
` Notice of Motion
` Notice of Petition
` Order to Show Cause
` Other Ex Parte Application
` Partition Settlement Conference
` Poor Person Application
` Request for Preliminary Conference
` Residential Mortgage Foreclosure Settlement Conference
` Writ of Habeas Corpus
` Other (specify): ____________________________________________________________________________
`
`1 of 2
`
`SUPREME
`
`ERIE
`
`811587/2024
`
`08/07/2024
`
`Aaron B. Hoffman, M.D.,
`
`Kaleida Health, Steven Schwaitzberg, M.D., Michael Mineo, M.D., and State University
`of New York Jacobs School of Medicine,
`
`Whistleblower
`
`08/07/2024
`
`09/20/2024
`
`Dismissal per CPLR 3211
`
`12/13/2024
`
`
`

`

`FILED: ERIE COUNTY CLERK 11/20/2024 08:46 PM
`NYSCEF DOC. NO. 13
`RECEIVED NYSCEF: 11/20/2024
`RELATED CASES
`List any related actions. For Matrimonial cases, list any related criminal or Family Court cases. If none, leave blank.
`If additional space is required, complete and attach the RJI ADDENDUM (UCS-840A).
`Index/Case Number
`Court
`Judge (if assigned)
`
`INDEX NO. 811587/2024
`
`Relationship to instant case
`
`Case Title
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`PARTIES
`
`For parties without an attorney, check the “Un-Rep” box and enter the party’s address, phone number and email in the space provided.
`If additional space is required, complete and attach the RJI ADDENDUM (UCS-840A).
`Attorneys and Unrepresented Litigants
`For represented parties, provide attorney’s name, firm name, address, phone and
`email. For unrepresented parties, provide party’s address, phone and email.
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`Parties
`List parties in same order as listed in the
`caption and indicate roles (e.g., plaintiff,
`defendant, 3rd party plaintiff, etc.)
`Name:
`Role(s):
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`¼
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`Un-
`Rep
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`Role(s):
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`Name:
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`Name:
`Role(s):
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`Insurance Carriers
`For each defendant,
`indicate insurance
`carrier, if applicable.
`
`Issue Joined
`For each defendant,
`indicate if issue has
`been joined.
`
`Q O
`O
`O
`O
`O
`O O
`O O
`O
`O O
`O O
`O O
`O O
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` YES
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` NO
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` YES
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` NO
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` YES
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` NO
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` YES
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` NO
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` YES
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` NO
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` YES
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`Q
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` YES
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`O
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` NO
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` NO
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`Q
`Q
`O O
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` YES
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` NO
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`I AFFIRM UNDER THE PENALTY OF PERJURY THAT, UPON INFORMATION AND BELIEF, THERE ARE NO OTHER RELATED ACTIONS OR PROCEEDINGS,
`EXCEPT AS NOTED ABOVE, NOR HAS A REQUEST FOR JUDICIAL INTERVENTION BEEN PREVIOUSLY FILED IN THIS ACTION OR PROCEEDING.
`
`Dated: ___________________
`
`_______________________________________________________
`Signature
`
`________________________________________________________
`Attorney Registration Number
`
`_______________________________________________________
`Print Name
`
`2 of 2
`
`Aaron B. Hoffman, M.D.
`
`Plaintiff
`
`Gerald T. Walsh, Esq., Zdarsky, Sawicki & Agostinelli LLP, 1600 Main
`Place Tower, 350 Main Street, Buffalo, NY 14202, 716-855-3200,
`gtwalsh@zsalawfirm.com
`
`Kaleida Health
`
`Defendant
`
`Amy L. Hemenway, Esq., Harter Secrest & Emery LLP, 50 Fountain Plaza,
`Suite 1000, Buffalo, NY 14202, 716-844-3737, AHemenway@hselaw.com
`
`Steven Schwaitzberg, M.D.
`
`Defendant
`
`Jennifer J. Metzger and Soo-young Chang, Office of the Attorney General,
`Main Place Tower, Suite 300A, 350 Main Street, Buffalo, NY 14202,
`716-853-8477, Jennifer.Metzger@ag.ny.gov, Soo-young.Chang@ag.ny.gov
`
`Michael Mineo, M.D.
`
`Defendant
`
`Amy L. Hemenway, Esq., Harter Secrest & Emery LLP, 50 Fountain Plaza,
`Suite 1000, Buffalo, NY 14202, 716-844-3737, AHemenway@hselaw.com
`
`State University of New York Jacobs School of Medicine
`
`Defendant
`
`Jennifer J. Metzger and Soo-young Chang, Office of the Attorney General,
`Main Place Tower, Suite 300A, 350 Main Street, Buffalo, NY 14202,
`716-853-8477, Jennifer.Metzger@ag.ny.gov, Soo-young.Chang@ag.ny.gov
`
`11/20/2024
`
`4554333
`
`Jennifer J. Metzger
`
`