On Sept. 7, 2009, plaintiff James Chenoweth, 85, a retired man with Parkinson’s disease, fell getting out of the shower and struck the back of his head. He was subsequently evaluated by paramedics, who observed him bleeding from lacerations on the back of his head and left arm. Chenoweth was then transferred to Arcadia Methodist Hospital and evaluated in the emergency room by Dr. James Burke, who ordered a non-contrast CT study of the head. Dr. Tien Peng, the on-call radiologist read the CT results at his home by teleradiology and reported back, via fax, that the CT demonstrated “no acute disease” and that the only indication was “pain.” On Sept. 9, 2009, Dr. Wilson Wong “over-read” the CT to dictate the hospital report and read the study the same as Peng did. Chenoweth’s lacerations were ultimately repaired, and the discharge diagnose was “minor head trauma” and lacerations. Chenoweth was subsequently instructed to see his family doctor in a day or two, and return to the emergency room if he felt worse. During the next 17 days, Chenoweth saw his regular internist and neurologist. Both doctors claimed they received or detected complaints of severe neck pain, but that they assumed that the emergency room had ruled out a neck fracture and ordered physical therapy. On Sept. 24, 2009, Chenoweth suddenly became quadriplegic and was rushed to the emergency room at Huntington Memorial Hospital, where he was diagnosed with a Type III odontoid fracture at the C2 level and a comminuted fracture of the later process of the C2 vertebra. Chenoweth sued Burke; Burke’s office, James M. Burke Medical Corporation; Wong; Peng; Arcadia Methodist Hospital; the Arcadia Radiology Medical Group; Emergency Medical Management Associates; JJ&R Emergency Group; and Methodist Hospital Of Southern California. He alleged that the defendants failed to timely diagnose the cervical fractures and that this failure constituted medical malpractice. Arcadia Methodist Hospital, JJ&R Emergency Group; Methodist Hospital of Southern California, Arcadia Radiology Medical Group and Emergency Medical Management Associates were ultimately dismissed from the matter. Thus, the matter proceeded against Burkem, Burke’s office, Wong and Peng only. Chenoweth claimed that complained of neck pain in the emergency room and to Burke, but that his complaints were ignored by emergency room staff. Plaintiffs’ counsel argued that due to the nature of the fall, Chenoweth’s advanced age and the laceration to the back of the head, a CT scan of the spine should have been performed, instead of just a scan of the head. Counsel also argued that even if pain was not expressed by Chenoweth, the defendants should have followed the “Canadian Protocol” for the standard of care, in that a CT scan of the spine should have still been ordered based upon the frequency of fractures in the elderly. Thus, plaintiffs’ counsel contended that had a CT of the neck been ordered, it would have diagnosed the fracture and appropriate treatment could have instituted before the spinal cord was further injured. Plaintiffs’ counsel contended that the CT of the head showed the top of the cervical spine and that it clearly showed the odontoid fracture on the axial image. Thus, counsel argued that Peng and Wong should have reported this to the emergency room and recommended a CT of the cervical spine to confirm the perceived fracture. In addition, the plaintiffs’ radiology expert opined that no reasonable trained radiologist would have missed Chenoweth’s fracture on the CT scan. Burke contended that he did not recall Chenoweth ever expressing neck pain either subjectively or upon examination. His counsel also contended that no hospital staff ever heard Chenoweth claim that his neck was injured or in pain. Defense counsel contended that the “American Protocol” for ordering neck imaging under circumstances such as this case does not include age of the patient as an indication for ordering imaging studies. Counsel also contended that the “American Protocol” is what is commonly used in emergency rooms. Defense counsel argued that each indication for mandating a CT of the cervical spine was absent in this case, and that the CT of the head was only ordered to rule out a subdural hemorrhage or another acute injury. Counsel further contended that all of the indications for a CT of the head, such as subdural bleeding, were ruled out by the study. Wong and Peng claimed that they never saw Chenoweth and they only knew that a patient with “pain” was in the emergency room. Wong and Peng also claimed that based on their experience, training and guidelines issued by the American College of Radiology, “neck pain” is not an indication for a CT scan of the head, and that all indications for a CT of the head were ruled out by the study. They alleged that while the entire study is to be reviewed, the lowest part that showed an image suggestive of a fracture was not helpful to rule out any of the indications, and was likely marred due to movement of the patient during the scan. In addition, the defense’s expert in radiology opined that to miss the fracture on a “cold read” with limited information is not below the standard of care., Chenoweth was diagnosed with a Type III odontoid fracture at the C2 level and a comminuted fracture of the later process of the C2 vertebra. He subsequently underwent a closed reduction of the fracture fragments and placed in a halo. However, Chenoweth was rendered quadriplegic. Plaintiffs’ counsel contended that Chenoweth’s care averaged $82,000 per year and will live about 4.9 additional years. Thus, Chenoweth sought recovery of about $400,000 in economic damages and an unspecified amount of damages for his past and future pain and suffering. Chenoweth’s wife presented a derivative claim, seeking recovery of damages for loss of consortium based upon her husband’s . Defense counsel did not discuss any specific damages in their argument, but disputed Mr. Chenoweth’s almost 5-year life expectancy. Counsel also argued that Mr. Chenoweth would have required 12-hour care even without the fracture.