On Nov. 6, 2015, plaintiff Ayani Elizondo, an infant, was delivered via a Caesarean section at Riverside Community Hospital, in Riverside. Ayani’s mother, Janeka Elizondo, was considered to be a high-risk patient, based on her advanced maternal age, diabetes, obesity and history of having undergone three prior C-sections. Her prenatal care was managed by her primary obstetrician, Dr. Herman Carstens, and she was also seen weekly at the office of a perinatologist, Dr. Harbinder Brar. Leading up to the delivery, Elizondo presented twice to Riverside Community Hospital with labor-related complaints. She followed up with her perinatology appointment on Oct. 30, 2015, and she had a normal fetal non-stress test and biophysical profile. Elizondo presented to Carstens’ office the following week, on Nov. 5, 2015, and Carstens’ nurse practitioner found that there were no abnormalities. The next afternoon, on Nov. 6, 2015, at around 4:25 p.m., Elizondo presented to Brar’s office for her weekly scheduled non-stress test and biophysical profile. Brar’s nurse observed that the non-stress test was non-reactive and that the fetal tracings were tachycardic (with a baseline between 170 and 180) with minimal variability. A biophysical profile was performed, which was scored 8 out of 8. Brar was paged, and Brar ordered that Elizondo go to Riverside Community Hospital for monitoring. Brar’s nurse then alerted Carstens’ office and the hospital about the planned hospitalization, and verbally reported to the hospital the biophysical profile result. Elizondo presented to Riverside Community Hospital at 4:50 p.m. on Nov. 6th, 2015. She brought her records from Brar’s office, which showed the findings of the non-stress test from earlier that day but did not include results of the biophysical profile. Elizondo was placed on a fetal heart monitor, and the fetal heart tracing remained tachycardic and non-reactive with mostly minimal variability. About 1.5 hours after Elizondo’s arrival at the hospital, the nurses called the on-call physician covering for Carstens, who was out of town at the time, Dr. Sudha Moola. The nurses reported the tachycardia and non-reactivity, along with the findings from Brar’s records, but they did not report the prior biophysical profile score. Moola made telephone orders for continual fetal monitoring, a biophysical profile and a sterile vaginal examination. Fetal monitoring continued, showing no significant changes, while the biophysical profile (completed 3.5 hours later) no longer showed fetal breathing, resulting in a score of 6 out of 8. The nurses called Moola again with the results of the biophysical profile, and Moola went to the hospital, where Moola talked to Elizondo about her options to deliver then or wait to see whether the tachycardia resolved overnight. The decision was made to move forward with the delivery via C-section at around 10:45 p.m. At the time of the C-section, cord gases were determined to be within normal limits, but Ayani’s APGAR scores were 2, 6 and 8. Ayani was delivered by 11:46 p.m., but shortly after delivery, Ayani was intubated and sent to the neonatal intensive care unit at Riverside Community Hospital. She was then transferred to the NICU at Loma Linda University Medical Center, in Loma Linda, where she was diagnosed with severe hypoxic ischemic encephalopathy, a type of brain dysfunction that occurs when the brain doesn’t receive enough oxygen or blood flow for a period of time. Janeka Elizondo, acting as Ayani’s guardian ad litem, sued Riverside Community Hospital, Brar, Carstens and Moola. Elizondo alleged that the defendants were negligent in their care and treatment of her during her pregnancy, labor and delivery of Ayani. Plaintiff’s counsel contended that Carstens’ office negligently failed to provide the hospital with the complete and up-to-date prenatal chart for Elizondo, including the last several “normal” visits to his office prior to delivery. Counsel also contended that Brar’s office was negligent in failing to inform the hospital that a biophysical profile had been performed on Nov. 6, 2015, resulting in the unnecessary order of a second biophysical profile when Elizondo presented to the hospital shortly after she left Brar’s office. Counsel further contended that Riverside Community Hospital was negligent for its various delays, including delays in getting Elizondo into a room and placed on a monitor, delays in taking more than an hour to call Elizondo’s physician after her arrival at the hospital, delays in taking 3.5 hours to complete the biophysical profile, and delays in getting Elizondo into the operating room once the decision was made to deliver the baby. In addition, plaintiff’s counsel contended that Moola was negligent for failing to come directly to the hospital to assess Elizondo and deliver Elizondo’s baby immediately. Counsel argued that Moola should have done more to press the biophysical profile along when it took more than 1.5 hours to complete and that Moola should have delivered Ayani immediately after those results. Plaintiff’s counsel’s medical experts opined that the injury in this case was the result of a rare umbilical vein clot, which compromised the blood flow to Ayani for 20 minutes prior to delivery, while Elizondo was in the operating room and not on the monitor. The experts also opined that every minute counted and that if Ayani had been delivered even minutes earlier, she would have lived a perfectly normal and healthy life. Defense counsel argued that the defendants complied with the standard of care at all times and were not liable for Ayani’s injury. Counsel also argued that the injury in this case occurred prior to Elizondo’s presentation to Brar’s office on Nov. 6, 2015, as seen by the fetal tachycardia and non-reactivity, along with the normal blood gases at delivery. Counsel further argued that there was no reason to perform an emergency delivery on Nov. 6, 2015, since the fetal monitoring strips never showed any decelerations or deterioration. In addition, defense counsel argued that the injury in this case occurred up to five days prior to delivery, and was likely the result of an unpreventable and undetectable cord accident, as supported by findings in the placental pathology. The defense’s expert pathologist agreed that a clot was present within the umbilical vein but theorized that the clot did not significantly impact the blood flow to Ayani. Instead, the expert opined that the damage to the placenta dating back five days showed extensive interruption of blood flow., Ayani was diagnosed with severe hypoxic ischemic encephalopathy and spastic cerebral palsy, which has resulted in a severe case of kyphoscoliosis and chronic lung disease. After she was born, she was intubated and sent to the NICU at Riverside Community Hospital before being transferred to the NICU at Loma Linda University Medical Center. Ayani was eventually discharged home with a feeding tube, and she remains in the family home. Ayani still cannot swallow, so she requires regular suctioning from a manual suction machine to manage secretions and tube feeding, along with 24-hour care for all activities of daily living. She also has severe cognitive limitations. Ayani has had a number of lengthy hospitalizations to treat infections and related lung issues, and she is expected to have a severely limited life expectancy. Plaintiff’s counsel’s experts testified that Ayani is expected to survive to between the ages of 25 and 30 years old. Ayani was 4.5 years old at the time of trial. According to plaintiff’s counsel, Ayani’s projected future care and lost earnings were greater than $15 million (at present value). Ayani’s mother sought recovery of approximately $3.2 million in noneconomic damages and $18.3 million for Ayani’s losses. The defense’s experts opined that Ayani would not survive beyond the age of 10 and projected that Ayani’s future care needs would amount up to $10 million.