On Sept. 4, 2012, plaintiff Brian Armstrong, 51, a waste water treatment plant operator, underwent a urethral dilation for a distal urethral stricture, penile degloving with adjacent tissue transfer, and a perineal skin resection at University of California San Francisco Medical Center. Armstrong claimed that due to the placement of a peripheral IV into his left wrist at the time of surgery, he subsequently suffered trauma to his left median nerve, resulting in left, upper extremity numbness. Armstrong sued the University of California San Francisco Medical Center; the hospital’s operator, Regents of the University of California; and doctors Benjamin Breyer and Scott Hansen. Breyer and Hansen were ultimately dismissed from the case. The UCSF Medical Center was also dismissed from the case once it was determined that the Regents of the University of California was the appropriate party and operator of the medical center. Thus, the matter continued against Regents only. Armstrong claimed that immediately after awakening from the surgery, he felt numbness in his left arm, which he did not have prior to the surgery. He alleged that he complained about his arm to the nurse who was caring for him in the Post-Anesthesia Care Unit and to every other nurse who cared for him while he was at UCSF Medical Center. However, he claimed that his complaint was not documented in his medical records by any of the nurses. Armstrong’s sister, who visited her brother on an almost daily basis while he was in the hospital from Sept. 4, 2012 through Sept. 10, 2012, claimed that Armstrong repeatedly complained to her about his left upper extremity numbness. She also claimed that her brother had complained about the numbness to the nursing staff on multiple occasions, but that the nurses ignored him. However, she acknowledged that she, personally, did not talk to any of the staff about her brother’s complaint. Armstrong claimed that the numbness in his arm was unabating from the time he left surgery until he followed up with other physicians following discharge. Plaintiff’s counsel noted that on Sept. 24, 2012, Armstrong’s left, upper extremity numbness was noted in his medical records during his follow-up visit with the urologist who performed the surgery. Counsel contended that the urologist felt that Armstrong’s condition was transient, but on Oct. 4, 2012, Armstrong presented to his local primary care physician with continued complaints of left, upper extremity numbness, tingling, and weakness since the time of surgery. Plaintiff’s counsel contended that Armstrong reported that his complaints had been unremitting since the time he woke up from surgery until the time he visited his primary care physician. Counsel contended that as a result, the physician referred Armstrong to a neurologist for further evaluation. The neurologist in the Santa Cruz area subsequently performed an EMG and opined that Armstrong had sustained a traumatic injury to his median nerve in the left, upper extremity, most likely from the placement of a peripheral IV at the time of surgery. Thus, plaintiff’s counsel argued that the IV was placed on the palmar side of Armstrong’s arm, causing an injury to the median nerve. The plaintiff’s medical experts testified that the precise mechanism of injury could not be determined, but that the severity of Armstrong’s permanent neurologic deficit and resultant left, upper extremity weakness would not have occurred in the absence of negligence. The experts opined that the three possible mechanisms of injury were direct injury to the nerve during the placement of the IV, injury to the median nerve from improper positioning, or injury to the nerve from an extravasation of IV fluid. However, there was a disagreement between the plaintiff’s experts as to which one was the most likely cause of injury. Defense counsel argued that Armstrong’s median nerve condition of his left arm was not related to the surgery or the placement of the IV. Counsel also disputed that Armstrong made any complaints to the nursing staff while he was at UCSF Medical Center and noted that Armstrong’s sister admitted that she, herself, didn’t mention her brother’s alleged condition to the hospital’s staff. Defense counsel contended that, at the time of discharge on Sept. 10, 2012, Armstrong was evaluated by the discharging physician and that there was no mention of left, upper extremity numbness in the discharge summary. Counsel also contended that Armstrong presented to a local urologist for his postoperative follow-up visit on Sept. 19, 2012, and that, again, there was no mention of any left, upper extremity numbness in the urologist’s notes. Counsel further contended that Armstrong later presented to the emergency room at his local hospital in Santa Cruz for treatment of complications associated with his surgery (bleeding at the surgical site), but that there was also no mention of any left, upper extremity numbness to the emergency room personnel or to the emergency medical technicians who transported Armstrong to the hospital. In addition, defense counsel maintained that although Armstrong did mention the left, upper extremity numbness on Sept. 24, 2012, during his follow-up visit with the urologist who performed his surgery, this was the first documented complaint of the condition in medical records following the surgery. However, counsel noted that the medical records did not state that Armstrong had this problem since the time of his surgery, and the urologist testified that he would have made such documentation in the records had Armstrong told him that he had been having this problem since that time. The urologist also testified that during that follow-up visit, he measured Armstrong’s grip strength and found it to be within normal limits, causing him to believe that the condition was probably transient. The urologist further testified that as a result, he advised Armstrong to return to the clinic if he continued to have problems with his left, upper extremity, but that Armstrong did not return following that visit. Defense counsel disputed the plaintiff’s claim as to where the IV was placed at the time of Armstrong’s surgery on Sept. 4, 2012. Counsel argued that the IV was actually placed on the dorsal side of Armstrong’s wrist and that given the anatomy of the wrist, it could not have caused an injury to the median nerve. Defense counsel noted that while there was documentation in the medical record about the IV being placed in the wrist, the actual side of the wrist that it was placed was not documented. However, counsel maintained that it was the usual customary practice to place an IV on the dorsal side of the wrist and that if it had been placed on the palmer aspect, it would have been specifically documented in the records. In response, plaintiff’s counsel called into question the alleged practice of placing an IV on the dorsal side. Counsel noted that in response to a Request for Production of Documents, which asked for any documentation by the person who had placed the IV in the wrist and for any references of previous placements of IVs on the palmer aspect of the wrist, the Regents claimed that no documents could be found because of changes in the computer system that had taken place during the requested time period. Thus, plaintiff’s counsel argued that the lack of documentation was inconsistent with this stated practice of the practitioner at the time of trial and that it should be held against the defendant as part of the jury’s deliberations., Armstrong claimed that immediately after his surgery on Sept. 4, 2012, he suffered from left, upper extremity numbness, tingling, and weakness. He claimed he suffered a permanent neurologic deficit as a result of the placement of the IV. Armstrong ultimately presented to a plastic surgeon for a consultation on his problem and was told that he may have experienced either a new injury or an exacerbation of an underlying carpel tunnel syndrome from improper positioning during surgery. Armstrong was then seen by an orthopedic hand surgeon who felt that the condition was permanent and that there were no medical or surgical options for further treatment. The plaintiff’s economic and vocational experts testified that due to the severity of the functional deficit of Armstrong’s left arm, Armstrong will be unable to continue to work as a waste water plant operator. The experts also opined that Armstrong would need vocational training to qualify for a new job that would be conducive to the limitations brought about by the limited use of the left, upper extremity. Thus, Armstrong sought recovery of $1.1 million in total damages. Defense counsel maintained that Armstrong’s median nerve condition and the worsening dysfunction of his left, upper arm was not related to the surgery, but was a normal progression of untreated carpel tunnel syndrome. Counsel contended that Armstrong had documented bilateral carpel tunnel syndrome prior to the surgery and that the IV placement or positioning of the body during surgery did not cause or aggravate Armstrong’s condition. In addition, the defense’s expert neurologist, who examined Armstrong as part of the pre-trial work-up, opined that Armstrong’s worsening carpel tunnel syndrome would likely resolve with further treatment, such as a carpel tunnel release or steroid injections, followed by physical therapy.