On Dec. 10, 2007, plaintiff Debra Votta, an unemployed 44 year old, underwent a pelvic organ prolapse surgery to repair sagging organs. The surgery included a transobturator urethral sling and prolapse repair, consisting of cystocele (bladder) repair, rectocele (rectum) repair, enterocele repair, sacrospinous ligament suspension, and a vaginoplasty, all performed with mesh. The surgery was performed by Dr. Red Alinsod at South Coast Medical Center in Mission Viejo. During the first part of the surgery, Alinsod placed a TS10 sling below Votta’s urethra. According to Alinsod’s medical records, a cystoscopy was performed after the placement of the TS10 sling. (It is necessary to perform cystoscopy during prolapse surgery to confirm an absence of injury to the bladder and urethra, and/or the misplacement of mesh.) Alinsod then placed one portion of the POP mesh near the rectum for the rectocele repair and another portion of the POP mesh at Votta’s bladder for the cystocele repair. Votta was released from the hospital three days later, on Dec. 13, 2007, and then began her recovery at home. However, Votta claimed she immediately began to experience constant pain in her pelvic area and a throbbing sensation when she urinated, causing her to immediately call Alinsod’s office. On Jan. 7, 2008, Votta presented to Alinsod with postoperative complaints of difficulty urinating and urethral pressure, but Alinsod considered the symptoms to be normal. On Jan. 17, 2008, Votta returned to Alinsod, this time with symptoms of a bladder infection. Alinsod subsequently prescribed various pain medications and antibiotics, but Votta claimed the pain in her pelvic area did not subside. Votta also had office visits on Jan. 24, 2008, and Feb. 18, 2008. On Feb. 26, 2008, a cystoscopy was performed in response to Votta’s continued complaints of urethral and bladder irritation, and the procedure yielded normal findings of the urethra and bladder. Thereafter, Votta made two more office visits to Alinsod, continued complaints of the same symptoms on both April 24, 2008, and May 9, 2008. On May 21, 2008, Votta again complained of continued pain and was referred to an urologist/stem cell specialist. Two days later, Votta’s CT scan indicated an obstruction of the left kidney and a calcified mass near the left ureter. On May 25, 2008, she underwent a renal ultrasound, which was remarkable for moderate left hydronephrosis, which is the backing up of the urine into the kidney usually because of blockage of the ureter. As a result, Votta underwent a cystoscopy, which revealed a large piece of graft and blue nylon suture protruding into the left side of the bladder trigone. She was ultimately admitted to Loma Linda University Hospital, where she underwent surgery to remove portions of the mesh. Intraoperative findings were remarkable for a 3×9-millimeter piece of graft and a 4-centimeter piece of Prolene suture in Votta’s left ureteral orifice. Votta sued Alinsod; Alinsod’s medical office, South Coast Urogynecology Inc.; South Coast Medical Center; and several other medical providers and hospital entities. Votta alleged that Alinsod failed to properly perform the pelvic organ prolapse surgery, and failed to timely diagnose the obstruction and her subsequently hydronephrosis. She also alleged that these failures constituted medical malpractice and that South Coast Urogynecology was vicariously liable for Alinsod’s actions. South Coast Urogynecology stipulated that Alinsod was an agent of the corporation and that Alinsod was acting within the course and scope of the agency. Prior to trial, South Coast Medical Center, and several other medical providers and hospital entities were all ultimately dismissed from the case. Thus, the matter proceeded to trial against Alinsod and South Coast Urogynecology only. Plaintiff’s counsel contended that Alinsod misplaced the bladder mesh during the surgery performed on Dec. 10, 2007, and, furthermore, that Alinsod failed to employ adequate visualization techniques when performing the procedure. Counsel also contended that Alinsod failed to perform a cystoscopy after the placement of the bladder mesh and that Alinsod also did not administer indigo carmine dye to better visualize urine flow through the ureters in order to confirm absence of a bladder injury. Thus, plaintiff’s counsel argued that Alinsod’s failure to timely diagnose the injury he caused, resulted in Votta losing 95 percent function of her left kidney. Counsel contended that during the five months that followed the surgery, Votta made over a dozen contacts (either telephonically or in person) with Alinsod office regarding her surgery. Counsel contended that on each visit, Votta would complain about pain and discomfort in her pelvic area and that each time Alinsod would run urine and blood tests, on Votta’s request, reassuring Votta that what she was experiencing was “normal” and “part of the healing process.” Alinsod claimed that he did not misplace the mesh during surgery and that he did not fail to timely diagnose Votta’s bladder injury. Alinsod’s counsel argued that there was a subclinical infection near the bladder and that the inflammation allowed a small portion of the mesh to erode into the bladder near the ureteral orifice. Counsel contended that this was evidenced by the fact that Alinsod performed a postoperative cystoscopy on Feb. 26, 2008, and found no foreign bodies in the bladder. Alinsod’s counsel further contended that the mesh erosion, which is a recognized complication, occurred after the Feb. 26, 2008 cystoscopy, and that Votta did not have any signs or symptoms of a bladder or kidney injury from the mesh erosion until May 22, 2008, when Votta, for the first time, complained of blood in her urine, at which time Alinsod immediately ordered imaging studies and found the mesh erosion., On May 25, 2008, Votta was diagnosed with moderate left hydronephrosis, which is the backing up of the urine into the kidney usually because of blockage of the ureter. As a result, Votta underwent a cystoscopy that same day and it was revealed that a large piece of graft and blue nylon suture was protruding into the left side of the bladder trigone. Also on March 25, 2008, Votta had a percutaneous nephrostomy placed in order to preserve kidney function. On June 4, 2008, Votta had a consultation with an urologist, who later performed a surgery on Votta at Loma Linda University Hospital on June 20, 2008. The surgery was to remove portions of the mesh, as well as perform a left ureteral reimplant, a psoas hitch procedure (or fixation of the bladder to the psoas muscle of the back), and an insertion of a ureteral stent. Intraoperative findings were remarkable for a 3×9-millimeter piece of graft and a 4-centimeter piece of Prolene suture in Votta’s left ureteral orifice. On June 26, 2008, Votta was released from the urologist’s care, and a follow up CT scan, performed on May 6, 2009, was remarkable for atrophy of the left kidney. Votta claimed she ultimately suffered a 95 percent loss of function of her left kidney. She claimed that as a result, she will require ongoing treatment. Thus, Votta sought recovery of $63,052 in past medical costs, $107,116 in future medical costs, and $250,000 in damages for her pain and suffering. Alinsod’s counsel contended that Votta had, and will continue to have, health insurance, such that the special damages for past and future medical costs had been, and will be, paid by her health insurance carriers. Counsel further contended that Votta was not going to require any ongoing treatment for the loss of one kidney and that Votta’s urinary status will not be affected due to the fact that she still has one functioning kidney, much like a healthy kidney donor.