On April 1, 2013, plaintiff Vimlaben Prajapati, 68, a disabled woman who had a history of hypertension and diabetes, was admitted to AHMC Anaheim Regional Medical Center, in Anaheim, with a seven to 10 day history of intermittent fevers and chest pain. She was subsequently assigned to a hospitalist, Dr. Kyoung Kim, who performed a cardiac work-up to rule out a cardiac cause for her complaints. The cardiologists ultimately cleared Prajapati to be discharged home. However, overnight on the evening of April 3, 2013, Prajapati developed a fever. As a result, Kim ordered blood cultures to be drawn prior to Prajapati’s discharge to determine the source of the fever. On April 25, 2013, Prajapati passed out in her home and was found with her head resting against the bathroom sink. She was subsequently taken to Kaiser Permanente Orange County – Anaheim Medical Center, in Anaheim, where it was discovered that she was in atrial fibrillation with a rapid ventricular response, she had positive blood cultures, and a CT scan of the head revealed blood in the right frontal subarachnoid space. The attending physician at Kaiser had intended to anticoagulate Prajapati with intravenous Heparin, an anticoagulant, and aspirin in response to the atrial fibrillation with a rapid ventricular response. However, when she learned about the blood in the right frontal subarachnoid space, the physician held anticoagulation and consulted with a neurosurgeon, Dr. Tina Lin, who recommended a CT scan be repeated to confirm the presence of the blood in the right frontal subarachnoid space. The repeat CT scan was performed on April 26, 2013, and the same finding was present. As a result, Prajapati was transferred to AHMC Anaheim Regional Medical Center the next day and went back under the care of Kim. Even though the records at Kaiser indicated that the information regarding blood being seen in the right, frontal subarachnoid space had accompanied Prajapati to AHMC Anaheim Regional Medical Center at the time of transfer, Kim placed Prajapati on Coumadin. Subsequent treaters requested for consultation by Kim diagnosed Prajapati with presumed endocarditis. However, Prajapati remained on Coumadin at the time of discharge, on May 3, 2013, even after the additional diagnosis of presumed endocarditis was reached. On May 6, 2013, Prajapati suffered a massive intracerebral hemorrhage and stroke. She was taken to St. Joseph’s Hospital of Orange for treatment following her severe hemorrhagic stroke. The treating neurologist at St. Joseph’s documented her suspicion that a ruptured mycotic aneurysm caused the stroke, given Prajapati’s history of bacteremia. Prajapati initially sued Kim and AHMC Anaheim Regional Medical Center. She then amended her complaint to include the operators of the Kaiser hospital in Anaheim, Kaiser Foundation Health Plan Inc., Kaiser Foundation Hospitals, and Southern California Permanente Medical. Prajapati then amended her complaint again to include Kim’s medical office, Chest and Critical Care Consultants, and five other individuals that had treated her. Prajapati alleged that the defendants failed to properly treat her and that this failure constituted medical malpractice. The Kaiser defendants, AHMC Anaheim Regional Medical Center, and several of the individual defendants were ultimately dismissed from the case. Thus, the matter continued against Kim and Chest and Critical Care Consultants only. Prajapati contended that she suffered a massive intracerebral hemorrhage and stroke as a consequence of being on Coumadin in the face of developed endocarditis, resulting in a brain bleed of unknown origin. Plaintiff’s counsel contended that Kim discharged Prajapati prior to obtaining the lab culture results and that Kim failed to document that lab culture results were pending on the discharge paperwork. Counsel noted that the blood cultures came back positive on April 4, 2013. Plaintiff’s counsel noted that the lab technician faxed the positive blood cultures to Kim’s employer and documented her actions in the medical record. The lab technician also testified that she would have notified Kim via telephone, but no documentation of a phone call was made. As a result, the positive blood cultures were never communicated to Prajapati, and no action or treatment was rendered in light of those positive blood cultures. Plaintiff’s counsel contended that after Prajapati was transferred to AHMC Anaheim Regional Medical Center on April 27, 2013, and came back under Kim’s care, Kim failed to check the results from the blood culture she had requested on April 3, 2013. Counsel also contended that Kim failed to review the entire discharge summary from Kaiser. In addition, plaintiff’s counsel contended that Kim did not make herself aware that blood had been seen in the right frontal subarachnoid space. Plaintiff’s counsel argued that if the defendants adequately secured the results of the April 3, 2013 blood cultures, and treated the bacteria in the blood, the entire sequence of events that followed would have been averted, including any need to place Prajapati on Coumadin. Counsel further argued that it was below the standard of care to have placed and maintained Prajapati on Coumadin when she was transferred back to AHMC Anaheim Regional Medical Center in the face of the known blood in the right subarachnoid space and in the presence of known endocarditis. Plaintiff’s counsel further argued that if Prajapati had not been placed on Coumadin, the massive intracerebral hemorrhage and stroke would not have occurred. Defense counsel argued that Prajapati’s positive blood cultures were never communicated to Kim, nor was any action or treatment rendered in light of those positive blood cultures. Counsel contended that when Prajapati was transferred to AHMC Anaheim Regional Medical Center on April 27, 2013 and came back under Kim’s care, Kim was not aware that blood had been seen in the right, frontal subarachnoid space, even though the records at Kaiser indicated that the information had accompanied Prajapati to AHMC Anaheim Regional Medical Center at the time of transfer. Defense counsel argued that AHMC Anaheim Regional Medical Center breached its obligations in terms of notifying Kim of the positive blood culture results and that this failure was the reason why no treatment or response to the positive blood cultures took place between April 4, 2013 and April 25, 2013. Moreover, counsel argued that treatment of the bacteremia would not have averted the atrial fibrillation and, therefore, would not have averted the need for Coumadin. Defense counsel further denied that Kaiser properly notified AHMC Anaheim Regional Medical Center of the subarachnoid bleed that was identified at that facility. Nevertheless, defense counsel argued that the decision to place Prajapati on Coumadin was the appropriate judgment call, and well within the standard of care, even in the face of that prior bleed and the subsequently identified endocarditis. The treating neurologist at Kaiser, Dr. Tina Lin, testified that there were three possible explanations for the finding of blood in the right, frontal subarachnoid space, including trauma, structural abnormalities (such as an aneurysm), or that it was spontaneous. Lin also testified that her clinical index of suspicion for an aneurysm was very low for three reasons: Specifically, the location, as a ruptured aneurysm would typically produce blood by the basal cistern, and not in the distribution seen on the CT scans; the history, as Prajapati reported a one month history intermittent, mild headaches, and no history of severe pain or sudden onset/”thunderclap” headache; and the amount of blood, as a ruptured aneurysm, even a ruptured mycotic aneurysm, would still be under arterial pressure and would be expected to produce more blood than was seen on the studies. Lin claimed that as a result, she recommended a CT angiogram to rule out any structural abnormalities, such as a ruptured aneurysm, a ruptured mycotic aneurysm, or an arteriovenous malformation. She further testified that she would not consider trauma or a spontaneous bleed in that setting to be a contraindication for anticoagulation and that she would only be concerned about anticoagulating Prajapati if the blood was due to a structural abnormality. The neurosurgeon testified that CT angiogram on April 25, 2013 at Kaiser revealed that there was no evidence of an aneurysm formation or significant stenosis; that there was no evidence of an aneurysm formation involving the distal internal carotid arteries, middle cerebral or pericallosal vessels; that there was no evidence of an aneurysm formation seen involving the communicating arteries; and that there was no evidence of an arteriovenous malformation identified. She explained that the impression was that it was a normal basilar system with no evidence of an aneurysm formation and that there was no evidence of an aneurysm formation or arteriovenous malformation involving the internal carotid arteries or the intracerebral carotid system. Thus, Kim opined that the CT angiogram dated April 25, 2013 conclusively ruled out the possibility that the blood seen at Kaiser was caused by a ruptured aneurysm or a ruptured mycotic aneurysm, as reflected in her consult note, which read, “. . . As there are no vascular anomalies, there is no risk of significant bleed, and thus anticoagulation for treatment of cardiac issues is not contraindicated.”, Prajapati contended that she suffered a massive stroke as a result of an intracerebral hemorrhage. She alleged that as a result, she is left completely disabled and that she will need attendant care services and other services for the remainder of her nine-year life expectancy. Thus, Prajapati sought recovery of approximately $980,000 in past medical expenses; approximately $5.8 million in future medical expenses, including attendant care services for the remainder of her life expectancy; and approximately $7.5 million in non-economic damages for her past and future pain and suffering. In addition, her husband, Babubhai Prajapati, sought recovery for his loss of consortium. Defense counsel did not disagree regarding the extent or expense of Ms. Prajapati’s damages, but argued that Ms. Prajapati’s life expectancy was quite limited and that she was unlikely to survive another six months.