On Feb. 28, 2012, plaintiff James Murrin, 72, a real estate worker who had a 60-year history of smoking and a 10-year history of peripheral arterial vascular disease with numbness and tingling, presented to the Emergency Department at Los Alamitos Medical Center after suffering five hours of chest pain. He was diagnosed with an ST segment elevation myocardial infarction (STEMI). Dr. Omid Vahdat, a board certified cardiologist and interventional cardiologist, arrived at the hospital within 30 minutes of being notified of the STEMI. He then performed an emergent cardiac catheterization procedure, during which he identified multiple significant blockages in the right coronary artery, the immediate cause of the STEMI, and significant blockages in the left coronary artery and multiple branches. Significant findings included the left main artery with a 50 to 60 percent proximal lesion; the left anterior descending coronary artery with a 70 percent mid-lesion; the diagonal branch with an 80 percent ostial lesion; between 80 percent and 90 percent lesions in the circumflex and obtuse marginal; and a 99 percent ostial lesion with a Thrombolysis In Myocardial Infarction risk score of 2 flow in the right coronary artery. Vahdat, in his judgment, and consistent with the American College of Cardiology/American Heart Association (ACA/AHA) guidelines, opted not to stent the right coronary artery due to the size of the lesions in the left main branches and because such stent, which is not without risk, may delay Murrin’s needed coronary artery bypass graft surgery or increase the risks of surgery because anti-coagulants must accompany stent placement. Due to the STEMI, and significant right and left coronary artery blockages and risks associated therewith, Vahdat placed an intra-aortic balloon pump (IABP) to assist and support the heart function and to increase blood flow to the coronary arteries. Murrin also received nitroglycerine and Heparin, as well as Morphine for pain. Once the IABP pump was placed, there was no longer EKG evidence of a STEMI, meaning blood flow was improved and his chest pain resolved. Vahdat then contacted Dr. Robert Shuman, a cardiothoracic surgeon, at 10 p.m. on Feb. 28, 2012. Shuman agreed to see Murrin the following morning and arrange for his transfer to Long Beach Memorial Hospital, as Los Alamitos did not have the capability to perform bypass surgery. Murrin was stable at 11:30 p.m., when Vahdat left the hospital. At approximately 6 a.m. on Feb. 29, 2012, Murrin began complaining of severe right pain, distal from the IABP placement in the right femoral artery for which he was medicated by the nurse caring for him. Vahdat was subsequently notified of the pain at 6:45 a.m., and Shuman saw Murrin at 7 a.m. Murrin was then transferred to Long Beach Memorial and, in the operating room, within six to eight hours, Shuman performed an emergent three-vessel coronary artery bypass graft surgery, removing the IABP and performing an embolectomy before beginning the coronary artery bypass graft surgery. Shuman determined that there was good blood flow to the right leg after the embolectomy and then completed the bypass surgery. Following the surgery, Murrin was sent to the cardiac intensive care unit and did well until the following day, when Murrin had evidence of an ischemic right leg. A pre-op CT angiography on March 1, 2012, confirmed that he had thrombosed the entire iliac system on the right side. Murrin was also diagnosed with a platelet clumping disorder, although this disorder did not come into evidence. A fem-fem bypass by Shuman restored right leg blood flow, but the patient developed compartment syndrome the following day and underwent a fasciotomy. Murrin had a rocky hospital course due to his significant disease, but was ultimately discharged to rehabilitation after about two months. He was walking with a walker when he was last seen by Shuman in September 2012. At the time of trial, Murrin had a right leg wound that he contended was related to the IABP. Murrin sued Shuman; Vahdat; Vahdat’s medical office, Omid Vahdat, M.D., Inc.; and Los Alamitos Medical Center. Shuman and the hospital were let out of the case on summary judgment, and Vahdat’s corporation was also dismissed from the case. Thus, the matter continued only against Vahdat, as an individual. Plaintiff’s counsel contended that shortly after a balloon angioplasty was performed by Vahdat, Murrin complained of extreme pain in his lower leg and foot. The technician on duty notified Vahdat, who prescribed pain medication and went home for the evening after telling Shuman, the vascular surgeon, that he should come in the next morning to transfer Murrin for bypass surgery at another hospital. Counsel noted that Shuman opined that by the next morning, when he saw Murrin, irreparable damage had been done to the nerves and muscles of the lower leg, resulting in drop foot. Plaintiff’s counsel contended that the window of opportunity opened at 10 p.m. on Feb. 28, 2012, when Murrin had complaints of right foot pain. The plaintiff’s cardiology expert opined that the onset of pain following the balloon angioplasty is the hallmark of critical limb ischemia and that it requires immediate removal of the pump and referral for vascular surgery re-vascularization. The expert opined that the failure of Vahdat to recognize the condition and inform the vascular surgeon of the emergency was negligent, and was the cause of Murrin’s injury. The plaintiff’s cardiology expert contended that an IABP was contra-indicated, that a stent or balloon angioplasty were the only acceptable options in order to comply with the standard of care, and that Murrin could wait up to 30 days for coronary artery bypass graft surgery. Vascular surgery experts testified that there is a six to eight hour window of time to restore blood flow to the right leg, which may have been impaired due to Murrin’s vascular issue and the IABP. Defense counsel noted that the right leg wound was nearly four years after the surgery. Defense contended that no recent vascular studies had been done to ascertain the cause of the wound, which experts admitted could have been due to Murrin’s longstanding peripheral vascular arterial disease. The defense’s experts opined that the window opened at 6 a.m. with the acute limb ischemia (documented then and not before). Defense counsel contended that Vahdat had examined Murrin at 10 p.m. and found no evidence of acute limb ischemia, and that the foot pain resolved until 6 a.m. Counsel also contended that Shuman examined Murrin at 7 a.m. and determined that there was acute limb ischemia at that time, but that due to cardiac concerns, he did not remove the IABP until Murrin was in the operating room at Long Beach Memorial Hospital. In addition, counsel contended that Vahdat was notified of the foot pain at 6:45 a.m. and was then at Long Beach Memorial, awaiting Murrin’s arrival. The defense’s cardiology expert testified that all conduct by Vahdat was within the standard of care and in compliance with American College of Cardiology/American Heart Association guidelines. The expert also pointed out on the angiogram the improved blood flow after the IABP and the resolution of the STEMI EKG findings, a finding admitted by the plaintiff’s cardiology expert at trial. Both the defense’s and plaintiff’s vascular experts testified in depositions that the delays in the timing of the fem-fem bypass after the coronary artery bypass graft surgery, the development of compartment syndrome, and the timing of the fasciotomy were the cause of the foot drop, and not the IABP. Shuman also testified at deposition that the IABP was either not the cause of the vascular problems or had only contributed perhaps 1 percent to the outcome. Over objection and motion, the court excluded this testimony because Shuman’s expert (who was never deposed and was only presented during the motion for summary judgment) opined that the damage was done already by 6 a.m., Murrin had evidence of an ischemic right leg and a pre-op CT angiography on March 1, 2012, confirmed that the entire iliac system on the right side had been thrombosed. He was also diagnosed with a platelet clumping disorder, although this disorder did not come into evidence. A fem-fem bypass by Shuman restored right leg blood flow, but Murrin developed compartment syndrome the following day and underwent a fasciotomy. Murrin then had a rocky hospital course due to his significant disease, but was ultimately discharged to rehabilitation after about two months. Murrin claimed that all of his vascular injuries after seeing Vahdat were due to the delayed surgery, and no stent and/or intra-aortic balloon pump placement. He alleged that as a result, he has a residual foot drop in his right foot and a non-healing wound on his right leg. Murrin was walking with a walker when he was last seen by Shuman in September 2012. At the time of trial, Murrin had a right leg wound that he contended was related to the IABP. He also claimed his leg condition prevented him from driving or doing much of anything. Murrin also claimed that he could no longer sleep in his bed and could only sleep in a recliner. The plaintiff’s life care planning expert testified that Murrin could expect future medical costs to be in excess of $500,000 to nearly $2 million. Murrin’s wife, Sheila Yee-Murrin, initially sought recovery for loss of consortium, but later did not oppose a motion to dismiss her claim on procedural grounds. Defense counsel argued that all of Mr. Murrin’s residual complaints were due to his longstanding coronary artery disease and peripheral arterial vascular disease. Counsel also contended that Murrin has significant emphysema, which Mr. Murrin admitted was responsible for most of his sleep issues. The defense’s expert economist testified as to the present value of the alleged, and disputed, future damages.