On the morning of Dec. 20, 2015, plaintiff Imelda Tovar, 47, woke up with severe pain and massive swelling of her left leg. Paramedics transported her to St. Jude Medical Center, in Fullerton. An ultrasound at 10:32 a.m. confirmed the presence of a very large deep vein thrombosis, and a CT scan of the chest at 1:15 p.m. demonstrated bilateral pulmonary emboli. Tovar had undergone a total abdominal hysterectomy at a Kaiser Permanente hospital four days earlier, and was discharged with no apparent complications on Dec. 19, 2015. St. Jude’s emergency room physician, Dr. Iksoo Kang, started Tovar on Heparin for anticoagulation, with that medication commencing at 12:15 p.m. via a bolus and an IV drip. In the interim, the emergency room physician assistant, Karen Delamora, approached Kang by 10:15 a.m. with her concern that the patient had developed compartment syndrome, which would be a surgical emergency. Neither Delamora nor Kang had ever heard of compartment syndrome developing as a result of a deep vein thrombosis, as the usual cause is trauma to the leg. Kang spoke by telephone with the on-call vascular surgery specialist, Dr. Steven Posner, at 2:13 p.m. on Dec. 20. Posner and Kang did not recall the details of that conversation, but Kang did document that Posner told him to elevate the leg "much higher than we have been," and that compartment syndrome was "very unlikely." Posner was not asked to come in to see the patient in person and did not choose to do so of his own accord. Tovar was admitted to the hospital that evening and, by the following day, had also developed numerous blisters on the skin of her left calf. She was transferred to Kaiser on Dec. 22. She was diagnosed with compartment syndrome the following day after elevated compartment pressures were detected with a Stryker test. Tovar underwent an emergency four-compartment fasciotomy on Dec. 23, 2015. Kaiser’s doctors said the fasciotomy revealed viable and healthy muscle in all four compartments, and that Tovar also demonstrated normal motor function and sensation of the left leg on Dec. 24. However, the muscles and nerves of the left lower leg proceeded to die over the next several days and Tovar eventually required an above-the-knee amputation on Jan. 8, 2016. Tovar sued Posner; Kang; St. Jude Medical Center; the operators of the Kaiser Permanente hospital, Kaiser Foundation Health Plan Inc., Kaiser Foundation Hospital, Kaiser Foundation Hospitals and Southern California Permanente Medical Group; and two other treating physicians, Dr. James Huang and Dr. Dennis Ross. Tovar alleged that the defendants failed to diagnose her condition, causing a delay in diagnosis. She also alleged that the defendants’ actions constituted medical malpractice. St. Jude Medical Center, Huang and Ross were ultimately dismissed from the case before trial, and Southern California Permanente Medical Group and the other Kaiser entities were let out of the case after a successful motion for summary judgment. The matter continued against Posner and Kang only. Tovar’s counsel contended that Tovar arrived in the emergency room at St. Joseph Hospital on Dec. 20 with compartment syndrome due to a deep vein thrombosis, which is a surgical emergency requiring intervention within 12 hours in order to save the leg. Tovar’s counsel agreed that compartment syndrome due to a deep vein thrombosis is extremely rare, but argued that the patient had all the signs and symptoms of compartment syndrome. Counsel further alleged that the emergency room physician, Kang, needed to either ask the on-call vascular surgeon, Posner, to come see the patient in person or needed to administer a Stryker test himself to check the compartment pressures. Counsel also contended that, as the consequences of a delayed diagnosis of compartment syndrome were so great, Posner was required to come to the emergency room to evaluate this patient in person as soon as he was asked about potential compartment syndrome. Given that the compartment syndrome was not diagnosed at St. Jude Medical Center on Dec. 20, Tovar’s experts testified that it was too late for the leg to be saved at any point thereafter. Per the experts, when the fasciotomy was performed at Kaiser on Dec. 23, the muscles and nerves appeared to be viable, but obviously were not as they proceeded to die over the following days. The physicians asserted that their care and treatment of Tovar complied with the standard of care in all respects. Kang indicated that he was mindful of the possibility of compartment syndrome and, while the patient had many of the symptoms of compartment syndrome, the quality of those symptoms argued against that diagnosis. For example, he stated that Tovar did have swelling of the left leg, but not hardness of the muscle compartments (as opposed to tightness), and while she did have paresthesias, there was no paresthesia on the top of the foot as one would expect with compartment syndrome. Kang explained that the Stryker test has risks, especially in a patient receiving anticoagulation, and he could not justify performing that test in the context of a low index of suspicion for compartment syndrome. Posner explained that his personal threshold to come in to see a patient when contacted by the emergency room is quite low. For that reason, he stated that the communications from Kang must have been quite reassuring to him that this was not compartment syndrome, otherwise he would have come to the hospital to see the patient in person. He said that his custom and practice under these circumstances would be to ask Kang a series of questions related to the patient’s symptoms, and to ask Kang to examine the compartment of the leg, as well as passive range of motion of the foot and ankle. He claimed that the results of this exam must have been reassuring to him that the patient did not have compartment syndrome, which is why it was not necessary for him to come to the hospital at that time. Posner asserted that Kang was equally qualified to perform this physical exam, and there would be no benefit for him to go to the hospital to repeat that exam personally. More importantly, the defense asserted, Tovar could not possibly have had compartment syndrome while in the emergency room at St. Jude Medical Center on Dec. 20. Per the defense, compartment syndrome is a surgical emergency with a window of 6 to 12 hours to save the leg from amputation with an emergency fasciotomy. The defense argued that, if compartment syndrome had been present and overlooked on Dec. 20, by the time the fasciotomy was performed on Dec. 23, the muscles and nerves of the leg would have been obviously dead and nonfunctioning. Instead, the defense maintained, the surgeons at Kaiser on Dec. 23 documented healthy and viable muscle tissue, with no necrosis, and that the muscles were contractile when tested with the Bovie. Moreover, the defense argued, the patient was found to have full motor function and sensation the following day, all of which would be impossible if compartment syndrome had been present on Dec. 20. The defense contended that Tovar came to St. Jude Medical Center on Dec. 20 with an extensive deep vein thrombosis, which was diagnosed and appropriately treated with anticoagulation (Heparin) and elevation of the leg. According to the defense, that treatment prevents the deep vein thrombosis from progressing and clotting off other veins in the leg in more than 99 percent of all patients. The defense claimed that, for reasons unknown, the treatment did not work for Tovar and she continued to form clots that obstructed all venous outflow from the left leg (a condition known as phlegmasia) in the hours following her admission to the hospital from the emergency room. The defense contended that, when the physicians at Kaiser identified elevated pressures in the compartment of the left leg, they diagnosed Tovar with compartment syndrome and performed a fasciotomy, but did nothing to address the underlying phlegmasia (deeming any such procedure too risky). The defense argued that, with venous outflow continuing to be obstructed, the muscles and nerves gradually died over the ensuing few days, ultimately forcing an above-the-knee amputation., Tovar underwent an above-the-knee amputation. She alleged that this led to her life being irretrievably altered for the worse and all activities made infinitely more difficult, which was undisputed by the defense. Her husband also asserted that the quality of their relationship as husband and wife was dramatically altered, which, again, was undisputed by the defense.  Tovar asked for an award of noneconomic damages of approximately $2.66 million to match any award of economic damages, with an award of $300,000 in noneconomic damages for her husband. Plaintiffs presented a claim for $17,700 in past loss of earnings, as well as a claim of approximately $440,000 for past loss of household services. A life care plan was also presented to the jury for Tovar’s future care needs, at a present value of approximately $2.2 million.