On Sept. 22, 2010, plaintiff Sherri Graham, a 66-year-old retired woman, presented to the office of Dr. Matthew Pautz, an orthopedic surgeon, for a follow-up exam after her ankle five days earlier. Graham previously fell down a short flight of stairs at her home in Red Bluff on Sept. 17, 2010. After several hours of pain and swelling, she was taken to the emergency room at St. Elizabeth Community Hospital in Red Bluff. A physical examination was performed by Nurse Practitioner Mary Whitmore, who detected swelling and ecchymosis of Graham’s entire right foot, and tenderness over the lateral aspect of Graham’s right foot in the area of the calcaneofibular ligament. X-rays were read by Dr. Frances Schlatter, an emergency room physician, as showing a possible avulsion fracture of the cuboid, but the X-rays were determined to be otherwise normal. The next day, Dr. Jack Kure, a radiologist, read the X-rays as normal. As a result, Graham was treated with a posterior splint and immobilization, and she was given instructions to non-weight bear and to follow up with Pautz. Graham was then seen in Pautz’s office on Sept. 22, 2010, at which time an exam revealed tenderness over the calcaneofibular ligament consistent with an ankle sprain. X-rays showed no fracture, and Graham was treated with a splint and told to weight bear as tolerated. She was also given a follow-up appointment in five weeks. However, there was a dispute as to the type of splint given to Graham. When Graham returned on Nov. 2, 2010, she was still swollen over her entire foot and unable to bear weight. A physical exam revealed exquisite tenderness over the entire foot and ankle. At that point, Pautz suspected reflex sympathetic dystrophy, also known as complex regional pain syndrome or causalgia, a chronic pain condition. As a result, Graham was referred to a neurologist. Graham was seen by Dr. Lee Vranna, a physiatrist, in December 2010, during which Graham underwent a repeat X-ray that clearly showed a fracture of the ankle’s navicular bone. Graham subsequently underwent a surgery and was released to normal activity in June 2011. Graham sued Pautz, Schlatter, Kure, and St. Elizabeth Community Health Center. Graham alleged that the defendants failed to timely diagnose her ankle fracture and that this failure constituted medical malpractice. Schlatter, Kure, and St. Elizabeth Community Health Center were ultimately dismissed from the case. Thus, the matter continued against Pautz only. Plaintiff’s counsel contended that Pautz was negligent for failing to diagnose the ankle fracture, for allowing weight bearing, and for not ordering a repeat X-ray after two weeks. Pautz claimed that he did not fail the standard of care and that he believed that Graham only had an ankle sprain because the X-ray appeared negative and Graham’s symptoms were consistent with an ankle sprain., Graham was diagnosed with a fracture of the ankle’s navicular bone in December 2011. She was subsequently referred to Dr. Robert Chase, an orthopedic surgeon, of Red Bluff, who ultimately performed ankle surgery in February 2011. The procedure consisted of open reduction and internal fixation with the placement of a screw in the navicular bone and the use of bone-grafting material. Graham was then released to normal activity in June 2011. Graham claimed that following the surgery, she had problems with gardening, exercising, walking, riding horseback, and other activities of daily living. She also claimed that the inserted screws were painful and needed to be removed. Graham further claimed that she would have made a better recovery, and could have been treated without surgery, if the navicular fracture had been diagnosed within the first two weeks. Medicare and Graham’s prior private health insurer paid approximately $7,500 in medical costs, and Graham made no income-loss claim. Thus, Graham only sought recovery of damages for her past and future pain and suffering. The defense’s orthopedic surgery expert testified that it was likely that Graham would have required surgery from the beginning due to the difficulty in healing a navicular fracture, particularly in an older person.