On Aug. 26, 2010, plaintiffs’ decedent Martha Avendivar de Alvarez, 64, presented to the emergency room at Scripps Mercy Hospital, in Chula Vista, with a seven day history of malaise, cough, and expectoration of blood, as well as a blood stained sputum. She was also diaphoretic, making purulent sputum, and short of breath with coughing. Alvarez was subsequently diagnosed as having acute, right, lower lobe pneumonia, and admitted to the hospital. On the morning of Aug. 27, 2010, Alvarez received a chest X-ray, which was performed by Trevor Nelson, M.D. Alvarez also consulted with a pulmonologist and an infectious diseases specialist. The X-ray allegedly showed ongoing fluid collection in her right lung, with little change or improvement from an X-ray performed the night before in the emergency room. Later that day, a STAT ultrasound-guided thoracentesis was ordered by Alvarez’s admitting physician, to be performed by Nelson, and Nelson obtained Alvarez’s informed consent to perform the procedure. During the process of locating the plural effusion, Nelson noted it was smaller in size than anticipated and appeared loculated, which he understood would make the thoracentesis more difficult to perform. After multiple attempts to perform the thoracentesis, Alvarez developed hemoptysis, or bloody coughs, causing Nelson to abort the procedure. Over the course of the next six hours after the aborted procedure, Alvarez’s vital signs were checked frequently, which remained stable at her baseline. Alvarez did not have any further hemoptysis until six hours later, when a nurse was called to Alvarez’s room and noted that she was coughing up an excessive amount of blood. As a result, a response team was called and nurses began to suction off blood. However, within 40 minutes, Alvarez was noted to have no respirations and an extremely low heart rate. A Code Blue was called, and Alvarez was pronounced dead 34 minutes later. Following Alvarez’s passing, her family requested an autopsy, which was begun at Scripps Mercy Hospital. In the autopsy, it was noted that Alvarez’s right lung was atelectatic, or collapsed, and a blood clot was found in the right pleural space. The autopsy also found three to four puncture sites, as well as a subpleural hematoma. The autopsy, which was finished with the medical examiner’s office, concluded that the cause of Alvarez’s death was a pulmonary hemorrhage with hemoptysis and pneumothorax, allegedly due to the attempted thoracentesis. The decedent’s husband, Rodolfo Alvarez, and their two adult children, Marcela Alvarez and Carlos Alvarez, sued Nelson; Nelson’s medical group, La Jolla Radiology Medical Group – Diagnosis Inc. (which was erroneously sued as LJR Medical Group); and the hospital’s operators, Scripps Health and Scripps Chula Vista. The decedent’s family alleged that the defendants violated the standard of care by failing to properly treat the decedent, and that this failure constituted medical malpractice and caused the patient’s wrongful death. Scripps Health and Scripps Chula Vista were ultimately dismissed from the case prior to trial. Thus, the matter proceeded to trial against Nelson and La Jolla Radiology Medical Group – Diagnosis Inc. only. Plaintiffs’ counsel argued that Nelson failed to comply with the standard of care and failed to obtain adequate informed consent before performing the subject thoracentesis. Counsel contended that Nelson should have had the decedent undergo a CT scan so that Nelson could better delineate the fluid collection from the consolidated right lower lobe, which would have prompted him to not pursue the thoracentesis and instead pursue a bronchoscopy. Plaintiffs’ counsel also contended that due to the discovery of the small pleural effusion, it was below the standard of care to proceed with the thoracentesis. Thus, counsel contended that Nelson should have had a second informed consent discussion with the decedent, informing her that the situation had changed and that the risk of performing a thoracentesis had increased. Defense counsel contended that Nelson complied with the standard of care in his treatment of the patient. Counsel argued that any reasonable patient in the decedent’s situation would have consented to proceeding with the thoracentesis, even if the decedent had been told that the procedure would be more challenging than originally thought due to the fluid collection in her lungs being smaller than expected., Plaintiffs’ counsel contended that as a result of the thoracentesis, Martha Avendivar de Alvarez sustained bleeding in her lungs that continued for over six hours. The bleeding ultimately caused Alvarez to suffer massive hemoptysis and asphyxiation from the blood, as wells as clots in her trachea and upper bronchi. Thus, plaintiffs’ counsel contended that Alvarez died from a pulmonary hemorrhage with hemoptysis and pneumothorax. The decedent was 62. She is survived by her husband and two adult children. Thus, the decedent’s family sought recovery of wrongful death damages, as well as sought recovery of $2,457 in funeral and burial expenses. Defense counsel argued that, despite the conclusion of the autopsy, the decedent did not die from the thoracentesis procedure, but that, instead, she died due to her pneumonia, which led to an erosion of a bronchial artery under systemic pressure, just minutes before the massive hemoptysis. Thus, defense counsel argued that the decedent did not die as a result of the puncture wounds from the thoracentesis because the hemoptysis was not caused by the punctures.