At around 9 p.m. on July 3, 2014, plaintiff’s decedent Christopher Noteboom, 33, an insurance agent, presented with his mother to the Emergency Department at Hoag Memorial Hospital Presbyterian, in Newport Beach, with complaints of dental and head pain. However, prior to receiving any treatment, the two left the Emergency Department without notifying the emergency staff. Thereafter, Noteboom sought treatment with his dentist’s office, wherein Noteboom was administered an anesthetic to temporarily alleviate his pain. At 1:48 a.m. on July 4, 2014, Noteboom returned to Hoag’s Emergency Department with a compliant of severe tooth pain, and was subsequently triaged by a nurse. Noteboom was determined to have a dental abscess with eight out of 10 pain. His vital signs were also taken and it was determined to have blood pressure of 157/118, a respiratory rate of 18, a heart rate of 107, a temperature of 98.2 degrees, and a peripheral capillary oxygen saturation (SpO2), an estimate of the amount of oxygen in the blood, of 94 percent on room air. As a result, Noteboom was examined by an emergency medical physician, Dr. William Park, and at approximately 2:21 a.m., another nurse administered 2 milligrams of Dilaudid, intramuscularly, for pain, as ordered by Park. Approximately 10 minutes later, at around 2:30 a.m., a registered nurse noted that Noteboom was resting quietly with no sign of distress. His breathing was noted as even and unlabored, and his mother was at his bedside. He was also noted to have a respiratory rate of 18, a heart rate of 100, and a SpO2 of 93 percent on room air. At approximately 3 a.m., Noteboom’s vitals were noted as having a blood pressure rate of 168/91, a respiratory rate of 15, a heart rate of 87, and a SpO2 of 94 percent on a non-rebreather mask. At approximately 3:36 a.m., a nurse gave an additional 2 milligrams of Dilaudid for pain, as ordered by another emergency physician, Dr. Darrin Fryer. Noteboom’s pain level at that time was noted to be a six out of 10. Two minutes later, the nurse noted that Noteboom was re-medicated, as ordered. Noteboom was also educated regarding side effects and indications of adverse reactions. In addition, Noteboom was being monitored for adverse reactions and as he was noted to have sleep apnea, he was placed on a non-rebreather mask for comfort. Noteboom’s pain level was later noted to be a three out of 10 at around At 4 a.m. A nurse also measured Noteboom’s vital signs and found that his blood pressure was 160/96 and that he had a respiratory rate of 15, a heart rate of 88, a temperature of 98.4 degrees, and a SpO2 of 98 percent on a non-rebreather mask. The nurse checked the vitals again 13 minutes later and noted that they were the same. As a result, Noteboom signed the discharge instructions and was given printed instructions about the dental abscess. According to Noteboom’s mother, when they arrived home, Noteboom got out of the vehicle, walked into his home, and went directly into his room to lie down on his bed. He then asked her to stay with him and to scratch his back while he fell asleep. She claimed she scratched her son’s back for approximately 10 to 15 minutes as he fell asleep and then went to her own bedroom to go to sleep. According to Noteboom’s father, he went in to check on his son a couple of hours later, but when he touched his son’s leg, he felt that it was cold. He subsequently called 9-1-1 while Noteboom’s mother was administering CPR. Noteboom was ultimately taken to the Hoag emergency room, where he was pronounced deceased. According to the Orange County coroner’s report, the cause of Noteboom’s death was the result of dilated cardiomyopathy with coronary artery heart disease. According to the toxicology examination, levels of hydrocodone (Vicodin) were found in Noteboom’s post-mortem blood. The report did not note the levels of hydromorphone (Dilaudid) in the Noteboom’s blood. Although the toxicological examination reported no levels of hydromorphone (Dilaudid) in its findings, a review of the actual studies resulted in the presence of hydromorphone (Dilaudid) in Noteboom’s system. However, it did not meet the Orange County crime lab’s limit of detection. (In 2014, when the report was issued, the detection limit was .010 mg/L.) The dececent’s father, Spencer Noteboom, acting individually and as the administrator of his son’s estate, sued Fryer, Park, and Hoag Memorial Hospital Presbyterian. Fryer and Park’s medical office, Newport Emergency Medical Group Inc., was later added as a defendant. Park was ultimately dismissed from the case. Plaintiffs’ counsel argued that Hoag’s nursing staff fell below the standard of care because they failed to recognize that Christopher Noteboom was experiencing signs and symptoms of respiratory distress after the second dose of Dilaudid. Counsel also argued that the attending nurse failed to discuss the issues with the emergency room physician, Fryer, before discharging Noteboom. Counsel further argued that the cause of death was cardiac arrest as a result of respiratory failure brought on by the administration of too much opioid medication. In addition, plaintiffs’ counsel argued that the level of post-mortem hydromorphone (Dilaudid) was consistent with levels found in patients whose deaths were the result of opioid overdose. As to agency, Hoag’s counsel argued that Christopher Noteboom was alert and oriented when he read and signed the conditions of admission, had no interaction with Fryer, and, thus, had no expectation that Fryer was an employee of the hospital. Defense counsel argued that the administration of approximately 2 milligrams of Dilaudid on two separate occasions was appropriate and in compliance with the applicable standard of care, given Noteboom’s complaints of pain (eight out of 10) and in relation to the decedent’s body mass index (BMI) of 44.1. Counsel also noted that the medical records indicated that Noteboom was never experiencing respiratory distress and was placed on a non-rebreather mask for supplemental oxygen because he had sleep apnea and was unable to fall asleep. Thus, counsel argued that the mask was used for comfort, and was not used in response to oxygen desaturation. Defense counsel further argued that the nurse observed Noteboom’s vital signs, communicated with Noteboom to assess his pain and orientation, and ultimately exercised her clinical judgment that the slight drop in O2 was due to Noteboom’s physiology versus a side effect of the Dilaudid. Furthermore, defense counsel argued that if Noteboom was experiencing any respiratory issues due to the Dilaudid, the issues would have been evident within 10 to 20 minutes following the second administration. However, in this case, Noteboom was discharged approximately 35 minutes following the last administration of Dilaudid, when his vitals were normal and he showed no physical signs of distress, such as mottled appearance, being less responsive, and cyanosis., Noteboom died on July 4, 2014. He was 33 years old, and he was survived by his parents. Plaintiffs’ counsel contended that Noteboom’s cause of death was cardiac arrest as a result of respiratory failure brought on by the administration of too much opioid medication. Thus, Noteboom’s father sought recovery of $2.25 million in special and general damages as a result of his son’s wrongful death. With respect to causation, defense counsel argued that the cause of death was dilated cardiomyopathy with coronary artery disease, as stated by the Orange County coroner’s office. Defense counsel contended that the coroner’s autopsy finding confirmed that Noteboom died because he was not getting blood flow to his heart muscle, which set up a fatal arrhythmia. Counsel also contended that there were two significant occlusions, one to the right common artery of 75 to 90 percent and one to the left diagonal artery of 75 percent, which are sufficient to cause death from coronary artery disease. In addition, defense counsel argued that the physician who performed the autopsy specifically ruled out a drug overdose and that the physician testified that there was no physical sign of respiratory distress upon examination and, moreover, the levels of hydromorphone were subtherapeutic.