In June 2010, plaintiff Luke Romero, an anesthesiologist at Santa Clara Valley Medical Center, administered epidural anesthesia to three patients. Another anesthesiologist, Dr. Stephen King, took over the care the patients and administered general anesthesia to one of the patients because the patient required a Caesarean section and did not experience sufficient pain relief from the epidural anesthesia. Plaintiff Richard Hughes, the Certified Registered Nurse Anesthetist that assisted during the C-section, complained to the Chair of the Anesthesiology Department, Dr. Friedrich Moritz, that King had inappropriately criticized Romero’s skills, and Hughes characterized King’s behavior as harassing and bullying. Hughes also asserted that King could have adjusted the epidural anesthesia to provide sufficient pain relief. On Aug. 31, 2010, Romero sent an email to Moritz and various members of the medical center’s administration, alleging discrimination, harassment and retaliation by King. Romero also took issue with Moritz’s alleged tolerance of King’s behavior. The email reiterated Hughes’s concerns regarding King’s decision to administer general anesthesia to the obstetric patient more than two months before. In addition, Romero, who is a gay male, alleged that King made homophobic comments about him. Moritz submitted the matter involving King converting Romero’s epidural into a general anesthesia for peer review. A group of seven anesthesiologists, including the current and former Directors of Obstetric Anesthesia, unanimously determined that the clinical decision-making by both Romero and King was within the standard of care. Moritz also asked an outside anesthesiologist to review the matter, and the anesthesiologist concluded that there were no issues with the care provided by Romero and King. Moritz forwarded Romero’s discrimination, harassment, and retaliation allegations to the county’s Equal Opportunity Department, which investigated the allegations and informed Romero that the allegations could not be substantiated. Subsequently, Romero took a medical leave for stress, starting on Nov. 18, 2011. When his leave expired 13 months later, he failed to return to work, and the county separated him from employment on Dec. 3, 2012. Romero sued the operator of the Santa Clara Valley Medical Center, the county of Santa Clara; Moritz; the new Chair of the Anesthesiology Department, Dr. Bridget Philip; Dr. Alfonso Banuelos; Anna Hughes; Dr. Adella Garland; and Dr. Dolly Goel. Romero voluntarily dismissed Banuelos and Ms. Hughes, and the court dismissed Garland and Goel before trial. In addition, doctors Richard Hughes and Jana Dolnikova, who were both initially plaintiffs in this matter, voluntarily dismissed their claims before discovery began. However, both Mr. Hughes and Dolnikova testified at trial on behalf of Romero. Thus, the matter continued with Romero’s claims against the Santa Clara Valley Medical Center, Moritz and Philip. The district court ultimately granted in part the county’s motion for summary judgment regarding Romero’s claims for wrongful termination, discrimination and harassment, invasion of privacy, slander, and intentional infliction of emotional distress. However, the court denied summary judgment on Romero’s four retaliation claims brought under the Fair Employment and Housing Act, Health and Safety Code § 1278.5, Labor Code § 1102.5, and the First Amendment. Romero claimed that in retaliation for his August 2010 complaint, he was subjected to multiple “sham” peer reviews in order to build evidence against him for termination. Defense counsel argued that the increase in the number of Romero’s peer reviews had nothing to do with Romero’s complaint. Counsel contended that, instead, Santa Clara Valley Medical Center was required to implement a formal hospital-wide peer-review policy and that each department was required to establish a Quality Assurance Committee to oversee regular peer reviews of cases that met certain indicators. Counsel contended that as a result, all anesthesiologists were peer reviewed more frequently beginning in 2010, and into 2011, than they had been previously. Some anesthesiologists (including Romero) were opposed to the new structured practice, contending that it was punitive instead of educational. However, defense counsel contended that the Joint Commission, which accredits Santa Clara Valley Medical Center, required the transition to a more robust and formal Quality Assurance process. Counsel further contended that, in accordance with the implementation of a more formal peer-review process, the Anesthesia Department adopted objective indicators or triggers for peer review and that all of Romero’s peer-reviewed cases met that criteria. In addition, defense counsel contended that only one of Romero’s reviews, involving an elderly burn patient, resulted in a negative score. According to defense counsel, the burn patient case met the following indicators for peer review: low oxygen levels, post-surgery intubation, unexpected Intensive Care Unit admission, and a complaint submitted by a nurse on the hospital’s Patient Safety Network. The Quality Assurance Coordinator notified Romero that the case would be reviewed and asked Romero for a written response. However, Romero never prepared a response, and the case languished for seven months until the hospital’s Medical Director ordered the peer review to proceed without Romero’s input. Defense counsel contended that the peer review committee reviewed the case and concluded that the standard of care was not met. Moritz also sent the case for an independent review to the same reviewer used in the obstetric case, and the reviewer allegedly confirmed that Romero’s care had been “sub-optimal” and below the standard of care. Defense counsel noted that each month, the Anesthesiology Department presented one case for educational purposes during a staff meeting as part of the medical center’s Quality Assurance requirements and that the burn patient case was presented during one of the meetings. Counsel noted that Romero did not attend the meeting because he was working the night shift, but that Romero was not identified as the provider at the presentation. Counsel contended that others later told Romero that the presentation was negative (e.g., there was a quip by another physician that whoever had provided the care should be fired). Defense counsel noted that Romero subsequently requested that the Medical Director provide him the opportunity to present his side of the case and that the Medical Director agreed. However, over the next month, Romero accused the Quality Assurance Coordinator of denying him access to records and complained that he did not have sufficient administrative time to prepare a response. As a result, Romero later appeared before the Medical Executive Committee to complain about the unfairness of the Quality Assurance system and the “sham” peer review of the burn patient case. Defense counsel argued that, shortly after Romero filed this lawsuit, Romero requested the medical chart for one of Moritz’s patients, who Romero did not provide treatment. Romero testified at his deposition that he requested the chart because he was trying to determine–as the department’s Director of Billing and Coding–whether the county improperly billed for anesthesia services by coding that the assigned resident was supervised by an attending physician when she was not. However, defense counsel argued that Romero would not have been able to determine if the hospital improperly billed for anesthesia services because Romero admitted that he never saw the billing records for this patient or any other patient. Defense counsel contended that as a result, the medical center’s Compliance and Privacy Office investigated concerns raised by the individual who obtained the chart for Romero about whether Romero had a legitimate basis to obtain the chart. Counsel contended that the Compliance and Privacy Officer, Anna Hughes, attempted to schedule an investigative meeting with Romero, but that Romero began a stress leave and refused to be interviewed while on leave. As a result, Hughes proceeded with her investigation and interviewed other witnesses before concluding that Romero deliberately accessed and used the patient’s medical record without a work-related reason to do so in violation of federal and state laws and Santa Clara Valley Medical Center policies that protect patient confidentiality. Santa Clara Valley Medical Center subsequently reported the privacy breach, as legally required, to the California Department of Public Health and the Secretary of the Department of Health and Human Services. In addition, counsel contended that the day before Romero began his medical leave, one of his colleagues revealed that Romero had breached peer-review confidentiality by disclosing comments made during a confidential peer-review meeting to the provider whose care was being reviewed. The new Chair of the Anesthesiology Department, Dr. Bridget Philip, subsequently investigated the peer-review breach and concluded that Romero had breached peer-review confidentiality. Thus, defense counsel argued that Romero’s employment was appropriately separated based on Romero’s actions, specifically regarding the burn patient case and the breached peer-review confidentiality., Romero claimed that he remained on medical stress leave for 13 months, from Nov. 18, 2011 to Dec. 3, 2012, and that he treated with counseling. When his leave expired, he failed to return to work, and the county separated him from employment on Dec. 3, 2012. Thus, Romero sought recovery for emotional distress damages.