A 4-year-old child, who was born with Ebstein’s anomaly, a complex congenital abnormality of the cardiac anatomy in which the opening of the tricuspid valve is displaced towards the apex of the right ventricle of the heart, underwent an operative procedure to resect the hypertrophied muscle just below the child’s aorta and close the ventricular septal defect. Between birth and age 3, the child had undergone several successful partial repairs of the abnormal pericardial anatomic connections. At age 4, she appeared clinically healthy, with normal exercise tolerance, and was able to be a starter on her local soccer team. However, some further surgery was anticipated later in the child’s life. During routine screening tests, an obstruction to the outflow of blood from the child’s left ventricle was found at a level just below the aortic valve. Hypertrophied muscles in the heart’s septum and an unusually large right ventricle, the latter in turn caused in part by ventricular septal defects, were deemed to be the cause of this muscular hypertrophy, which created a significant pressure gradient between the child’s left ventricle and the aorta, the vessel into which the left ventricle pumped. The girl’s treating cardiac surgeon and invasive cardiologist conferred and determined that an operative procedure designed to resect the hypertrophied muscle just below the child’s aorta, and closure of the ventricular septal defect should be performed, notwithstanding the normal functional status of the child. They decided to try a combined procedure, on cardiac bypass, by which the cardiologist would attempt to close the ventricular septal defects by puncturing the heart during open heart surgery, and use an Amplatzer ventricular septal device to cross the defects and close them. After that the cardiac surgeon would attempt to resect hypertrophied cardiac muscle going through the aorta into the heart. During the surgery, the child was on prolonged cardiac bypass as it took multiple attempts for the cardiologist to effect what he believed was adequate closure of the ventricular septal defects. The cardiac surgeon ultimately believed he was able to resect the overgrown muscle, and both he and the invasive cardiologist believed the surgery was a success. However, the two doctors could not get the child off cardiac bypass over the next 24 hours. As a result, the girl was transferred to an extracorporeal membrane oxygenator on the ward and eventually transferred to a higher acuity medical center. At the new medical center, a surgeon’s attempts to revise this surgery failed, and the child could still not be taken off support. Within seven to 10 days, she suffered multi-organ failure and died. The child’s parents, acting individually and with the father as the executor of their daughter’s estate, sued the hospital where the surgery was performed, as well as five treating physicians, including the cardiologist and cardiac surgeon. They alleged that the defendants failed to properly perform the surgery, causing their daughter’s wrongful death, and that this failure constituted medical malpractice. Plaintiffs’ counsel contended that the chief of pediatric cardiac surgery at the higher acuity medical center noted that the device used to close the child’s ventricular septal defects not only did not close them fully, but was improperly placed. The chief surgeon also noted that the improper placement of the device caused cardiac damage and prevented any assessment of the remainder of the heart. In addition, plaintiffs’ counsel contended that the later surgeon found that there had been an inadequate removal of hypertrophied muscle, so that the blockage to outflow had not been relieved. Defense counsel contended that the hypertrophied muscle and blockage to outflow in the child’s heart would have caused heart failure at some time in the future. Counsel asserted that by removing the hypertrophied muscle and closing the ventricular septal defects, the blockage and cause of the blockage would be removed. Defense counsel further contended that the Amplatzer ventricular septal closer had been used in the Trans-cardiac method by others and that though it was an off-label use, according to the Food and Drug Administration, off-label uses of approved devices was not forbidden. In addition, defense counsel contended that the hope was that a single procedure, as planned, would avoid having to do two separate procedures on the child., The child, who was born with Ebstein’s anomaly, a complex congenital abnormality of the cardiac anatomy that required piecemeal and sequential repair of the abnormal pericardial anatomic connections, could not be removed from the cardiac bypass following surgery. After 24 hours, she was transferred to an extracorporeal membrane oxygenator and then transferred to a higher acuity medical center. There, a surgeon’s attempts to revise the prior surgery failed, and the child still could not be taken off support. Within seven to 10 days, she suffered multi-organ failure and died. She was 4 years old. The girl’s parents, a 40-year-old camera shop owner and his 41-year-old wife sought recovery of wrongful death damages for the loss of their daughter. It was recognized that pursuant to MICRA, in the absence of a potential claim for punitive damages or out of pocket medical expenses, the $250,000 available to the parents for non-economic damages would represent a ceiling and incidental medical costs would be waived by the defendants.