On Oct. 29, 2012 plaintiff Tagui Kuzukyan, 55, a homemaker with a medical history of strokes, presented to the emergency room at Sherman Oaks Hospital with complaints of abdominal pain, nausea and vomiting. On assessment, Kuzukyan was found to have chronic kidney/renal failure disease, sepsis due to a urinary tract infection, hypertension, hypercholesterolemia, morbid obesity, diabetes, mitral regurgitation, hypoalbuminia, hyperglycemia, mitral regurgitation, pericardial effusion, ascites, anemia, and cardiomegaly hyponatremia. She was also noted to be a heavy smoker. Based on her symptoms, Kuzukyan underwent emergent abdominal surgery for an ischemic bowel. During the procedure, anesthesia was administered to Kuzukyan by Alia Shirzad, a certified registered nurse anesthetist. Shirzad inserted a central line with an 18-gauge needle with syringe, intending to place the line in either the internal jugular, external jugular or a collateral vein. After placing the central line, she confirmed that she had not hit an artery, as there was no high-pressure return and the blood was dark red, indicating that it was venous. However, Shirzad was unable to obtain a pressure reading, which would have assisted her in confirming the appropriate placement in the vein. As a result, the central line was not used, and was removed approximately eight hours after it was placed. Shortly thereafter, Kuzukyan began suffering symptoms consistent with a stroke. A neurology consult was requested, and the neurologist opined that the central line had been placed in the carotid artery, the removal of which, led to the stroke. This diagnosis was echoed/perpetuated throughout the medical records and by each of the Kuzukyan’s treating physicians prior to her discharge from the hospital. Kuzukyan sued Shirzad, Prime Healthcare Services, and Sherman Oaks Hospital, and Sherman Oak LLC (doing business as Sherman Oaks Hospital). The matter ultimately continued against Shirzad only. Plaintiff’s counsel contended that Shirzad improperly placed a central line into the carotid artery in an attempt to administer anesthesia during the surgery and that the improper placement subsequently led to Kuzukyan suffering a stroke. Counsel also contended that the failure of Shirzad to utilize an ultrasound to confirm and/or assist in the placement of the central line was a breach the standard of care. The plaintiff’s radiology expert opined that Shirzad breached the standard of care by not using an ultrasound to confirm proper placement of the catheter. He testified that based on photographs that Kuzukyan’s family had taken after the procedure, Shirzad exceeded the maximum number of attempts to establish the line with the locator needle, which was a maximum of two to three attempts/sticks. He further testified that based on medical records, all of Kuzukyan’s treating doctors concluded that the C-line placed by Shirzad was in the carotid artery and that this placement was the cause of the stroke. Shirzad’s counsel noted that the medical records clearly document the initial neurology opinion that the stroke had been caused by the placement of the C-line in the carotid artery. However, counsel contended that all subsequent charting of the cause of the stroke, care provided to Kuzukyan, and all subsequent treatment during the hospitalization were based upon the assumption that the carotid was perforated by the central line. Unfortunately, the treating neurologist passed away prior to his deposition occurring and, therefore, the defense could not establish the theory that the diagnosis of the cause of the stroke was an unfortunate charting error by another physician contemporaneous with the placement of the C-line. Shirzad’s counsel also noted that under cross, the plaintiff’s radiology expert admitted that a stroke is a known and a recognized risk of the procedure, that a single attempt/stick can cause a stroke, and that he could not testify as to a reasonable degree of medical probability which stick caused the stroke. The defense’s anesthesia expert testified that Shirzad conformed to the standard of care at all times and that her care was appropriate and did not cause the stroke. He also pointed out that a C-line is normally secured by two to three sutures and that the subject C-line was moved once, meaning that the multiple wounds in the photograph taken by the family were likely caused by the sutures, not the number of attempts by Shirzad. The defense’s radiology expert testified that the treating radiologist misread the initial films and that the central line was actually in the left internal mammary vein. The expert also testified that a Doppler ultrasound study of the carotid artery subsequent to the procedure conclusively established that the central line never entered the carotid artery. He further testified, with the use of an illustrative PowerPoint presentation, that the brain MRI showed bilateral strokes, which was totally inconsistent with the allegation of a left-sided carotid injury. In addition, the expert demonstrated that the stroke pattern was consistent with an ischemic stroke pattern, rather than an embolic stroke pattern., Kuzukyan suffered a stroke while undergoing abdominal surgery. She alleged that she was left with permanent, right-sided weakness in the arm and leg, which prevents her from accomplishing even the most mundane activities of daily living. Specifically, she claimed that she cannot cook, clean, dress, or accomplish basic personal hygiene without assistance. Kuzukyan claimed that as a result, her family members had to assist her for six to eight hours a day and were receiving compensation from the state to assist her with in-home care. The defense’s neurology/stroke expert testified that the MRI studies conclusively established that the stroke pattern demonstrated on the studies was consistent with an ischemic, rather than an embolic, stroke. The expert also testified that the MRI studies showed that Kuzukyan had prior history of micro strokes. He further opined that Kuzukyan’s stroke was not catastrophic, but mild to moderate, and that Kuzukyan had exhibited a very poor effort in rehabilitation. In addition, he testified that he treats stroke patients with much more significant strokes on a daily basis and whom easily adapt and accomplish all their activities of daily living. Defense counsel noted that plaintiff’s counsel initially suggested that the case presented near policy limits exposure based upon the alleged catastrophic and potential significant future life care plan for Kuzukyan. However, after pertinent depositions were taken, Kuzukyan’s settlement demand dropped.