On Aug. 4, 2009, plaintiffs’ decedent Michele Woo, 59, came under the care of a cardiologist, Dr. Peter Curran, for management of the blood thinner Coumadin, also known as warfarin sodium, following a prior heart surgery. Woo was previously diagnosed with atrial fibrillation and congestive heart failure in July 2009. She was subsequently assigned an “on-call” cardiologist, Curran, who placed her on Coumadin. However, within days of taking the blood thinner, Curran took Woo off of it. Woo then underwent heart surgery at Stanford University on July 24, 2009, and placed back on Coumadin to prevent clotting of her heart’s mechanical valve. While still at Stanford, Woo’s international normalized ratio, which measures the time it takes for blood to clot and compares it to an average, was tested daily with the Coumadin being stopped several times. When she was discharged, Woo’s INR level was 2.2, which was below the 2.5 to 3.5 therapeutic range for post-operative mitral valve patients. As a result, she was restarted on 2 milligrams of Coumadin. During the subsequent follow-up appointment on Aug. 4, 2009, Curran checked Woo’s INR level again, while the Coumadin was still reaching its cumulative effect, and determined that it was at 3.1. Curran then saw Woo in his office again on Aug. 12, 2009, and received a call of concern on Aug. 18, 2009, but no further blood tests were performed. On Aug. 26, 2009, Woo was found unresponsive and with evidence of gastrointestinal bleeding. One of Woo’s brothers subsequently took her to the emergency room at St. Mary’s Medical Center in San Francisco, where her INR level was at least 24.4, which was the highest the equipment could measure. Woo also had evidence of bleeding in her lungs, gastrointestinal system and other areas. She was admitted to the Intensive Care Unit and died in the early morning hours of Aug. 27, 2009. The decedent’s daughter, Jessica Chan, and son, John Woo, each acting individually and as successor in interest; as well as the decedent’s brothers Allen Woo and Ting Woo; sister-in-law, Wah Woo; and niece, Chia-Ming Woo, sued Stanford University Hospital & Clinics; Stanford University Medical Center; Falk Cardiovascular Research Center; Peter Curran, M.D.; Breall, O’Brien, Lee, Soto, Chun, Teng, Curran, M.D.’s; D. Craig Miller, M.D.; and Xin Ma, P.A. They alleged that the defendants failed to properly monitor the decedent’s blood thinner medication, resulting in her wrongful death, and that this failure constituted medical malpractice. At the time of trial, the suit was revised to the Estate of Michele Woo and Jessica Chan against Stanford Hospital and Clinics, Dr. Peter Curran and his medical group, Breall, O’Brien, Lee, Soto, Chung, Teng and Curran. The other plaintiffs and defendants had been dismissed from the case prior to trial. Also, by agreement, Stanford Hospital and Clinics was dismissed from the case and, upon the court granting the motion for nonsuit, Stanford Hospital and Clinics did not participate any further in the trial. Thus, the trial continued against Curran and his medical group only. The plaintiffs’ experts testified that a low INR level due to Coumadin can lead to blood clots, which can cause a stroke, but that if the INR level is too high, people can bleed to death. Thus, the experts opined that Woo’s internal bleeding caused a cardiac tamponade, which is an accumulation of fluid within the pericardium that prevents the heart from filling normally with blood. Plaintiffs’ counsel contended that Curran knew the importance of monitoring Michele Woo’s Coumadin since he had stopped the drug prior to the decedent’s heart surgery because he allegedly found it “difficult to manage” and felt Woo had an alleged “high risk of bleeding.” However, counsel argued that even though the decedent was prescribed Coumadin again a few days before her appointment with Curran, the cardiologist failed to monitor Woo’s INR level after the appointment on Aug. 4, 2009. Counsel further contended that despite seeing Woo again on Aug. 12, 2009, no further blood tests were performed. In addition, plaintiffs’ counsel contended that when the decedent’s daughter, Jennifer Chan, called Curran on Aug. 18, 2009, to inform him about her mother’s deteriorating condition, Curran did not check Woo’s INR level or seek to perform any other blood tests, nor did he warn her of potential Coumadin issues. The defense’s cardiology expert opined that Curran’s one measurement of Woo’s INR level was within the standard of care because the monitoring at Stanford could be considered when determining frequency of the monitoring post-discharge, even though the medication was started and stopped at the hospital and Woo was found to be both above and below the appropriate INR therapeutic range. In addition, Curran’s hematology expert opined that Woo’s death was caused by sepsis, not exsanguination. However, according to plaintiffs’ counsel, the defense’s expert could not identify what caused the sepsis or when it first started, nor could he rule out the claim that the infection was caused by the bleed., Michele Woo was admitted to the Intensive Care Unit at St. Mary’s Medical Center with evidence of bleeding in her lungs, gastrointestinal system and other areas. She ultimately suffered a cardiac tamponade and died in the early morning hours of Aug. 27, 2009, with her daughter at her bedside. Woo was 59 at the time of her death. She was survived by her adult daughter, adult son, two brothers, a sister-in-law and a niece. The decedent’s family sought recovery of wrongful death damages related to Woo’s death.