On Feb. 17, 2017, plaintiff Jamie Harper, 27, underwent a laparoscopic cholecystectomy at Modoc Medical Center, in Alturas. The surgery, which was performed by Dr. Dale Syverson, concluded uneventfully, and Harper was discharged from the hospital that same day. After several unremarkable post-operative visits, Harper’s liver function tests began to elevate on March 9, 2017. Due to the test results and continued post-operative pain to the right upper quadrant, Harper underwent an endoscopic retrograde cholangiopancreatography (ERCP), which was performed by a gastroenterologist in Reno, Nev., on March 15, 2017. The gastroenterologist opined that a clip from the gallbladder surgery was partially obstructing Harper’s common bile duct, causing an elevation of Harper’s liver function tests and jaundice. As a result, the gastroenterologist placed a 7 French pigtail stent in Harper’s common bile duct and performed a sphincterotomy, which allowed the bile ducts to drain in a normal manner. Harper claimed that the pain to her right upper quadrant improved substantially after the gastroenterologist placed the stent in her common bile duct, and her liver function tests returned to normal. However, the pain returned, and she underwent another ERCP at UC Davis Medical Center, in Sacramento, on June 15, 2017. The procedure was performed by another gastroenterologist, who removed the common bile duct stent, and noted that there were clips present around the common bile duct, but there was no evidence of a stricture or bile leak. Since the bile flow was normal, the stent was not replaced. When Harper’s abdominal pain to the right upper quadrant persisted, she underwent a third ERCP in Redding, on Sept. 10, 2018. Like the ERCP performed at UC Davis, the third study, which was performed a third gastroenterologist, showed a slight stricture at the point where the surgical clips overlaid the common bile duct, but demonstrated normal, unobstructed flow of bile through the common bile duct. Like other clinicians, the third gastroenterologist could not determine a cause for Harper’s continued right upper quadrant abdominal pain. Since no specific cause of the right upper quadrant pain could be delineated, Harper continued on opioid pain management. Harper sued Syverson and Modoc Medical Center. Harper alleged that the defendants were negligent in the performance of the initial surgery and that this negligence constituted medical malpractice. Modoc Medical Center’s demurrer was sustained, and the matter continued to trial against Syverson only. The plaintiff’s general surgery expert opined that the cholecystectomy clips were partially obstructing Harper’s common bile duct, which necessitated the placement of the stent by the first gastroenterologist in the first, post-operative ERCP. The expert also opined that Syverson must not have sufficiently visualized the relevant anatomy at the time of surgery, which fell below the standard of care, and that Syverson should have referred Harper to a larger facility for her gallbladder surgery given that Harper had an enlarged, fatty liver and was obese, both factors that made the surgery more challenging. Syverson claimed that if the surgical clips from the gallbladder surgery were indeed obstructing the common bile duct, he must not have sufficiently visualized the relevant biliary anatomy at the time of surgery. However, he questioned whether that was in fact the case, based on the post-operative ERCP imaging. The defense’s gastroenterology expert opined that there was no obstruction of Harper’s common bile duct by a cholecystectomy clip and that he has never seen a clip obstruction of the common bile duct that could be corrected by a 7 French stent. Given that the second and third ERCP’s did not show any obstruction of the flow of bile through Harper’s common bile duct, the expert opined that that the most likely cause of the post-operative obstruction was a microscopic bile leak from the cystic duct stump, leading to local inflammation and compression of the common bile duct. The defense’s general surgery expert opined that Syverson’s operative note demonstrated an appropriate operative technique. Like the defense’s gastroenterology expert, the general surgery expert opined that the clips that appeared over the common bile duct in the ERCP imaging were, in fact, likely on the cystic duct stump and were overlying the common bile duct, rather than across it. He added that had Harper’s common bile duct been occluded by clips during the gallbladder surgery, Harper would have been symptomatic immediately after the surgery, not three weeks later. In addition, defense counsel noted that the third treating gastroenterologist suspected that Harper’s abdominal pain to the right upper quadrant might be related to irritable bowel syndrome., Harper claimed that her persistent right upper quadrant pain was the result of Syverson placing a clip across her common bile duct. She sought recovery of $17,000 in past medical costs and $250,000 in general damages for her past and future pain and suffering. Defense counsel noted that at the conclusion of the plaintiff’s general surgery expert’s testimony, he looked directly at Harper and stated, “So stop crying over there, you’re going to get 100 percent back to normal at some point.”