On June 12, 2010, plaintiff Vladimir Nakhabenko, 52, a laborer in the defense industry, presented to the Emergency Department at Mercy San Juan Medical Center, inCarmichael, with complaints of pain and swelling in the left testicle and scrotal area. An emergency room physician subsequently made a request for an evaluation of the testicle by a urologist due to potential torsion. As a result, Nakhabenko was evaluated in the emergency room by Dr. David Magnus. Prior to his presentation to Mercy San Juan Medical Center, Nakhabenko developed a large, left-sided scrotal mass while performing heavy lifting at work. He was subsequently seen at a Med7 Urgent Care Center in Sacramento on March 15, 2010, and was diagnosed with a large reducible hernia. Nakhabenko’s condition was then followed for approximately two months, but he was eventually referred to Dr. Eric Morse, a general surgeon, for possible surgical repair of the hernia. Nakhabenko first presented to Morse on May 3, 2010, during which Morse noted that Nakhabenko was a 52-year-old male with complaints of a bulge in his left groin that he first noticed in December 2009. Morse then scheduled Nakhabenko for an outpatient hernia repair, and the procedure, its risks, and its complications were explained to Nakhabenko, including the possibilities of recurrence of pain, infection, swelling, testicular atrophy, and hematoma/ecchymosis. On June 9, 2010, Nakhabenko underwent a left inguinal hernia repair with mesh, which was performed by Morse at Mercy San Juan Medical Center. During the procedure, an omental resection was performed, followed by the use of a 7.6-centimeter modified Kugel mesh to secure the repair. Post-operative instructions were then given, including the directive to return if Nakhabenko’s symptoms worsened. There was no dispute that Morse’s inguinal hernia repair was appropriate and in keeping with the standard of care. However, Nakhabenko’s claimed that Morse was unable to completely reduce the hernia contents because of its extremely large size. Three days later, on June 12, 2010, Nakhabenko presented to the Emergency Department at Mercy San Juan Medical Center with complaints of pain and swelling in the left testicle and scrotal area. The urologist, Magnus, noted that Nakhabenko presented with a swollen, uncomfortable, left testicle and, upon examination, noted, “no scrotal contents [were] discernible within the amount of swelling that [was] present.” Magnus also reviewed a Doppler study of the testicle, which he reported “showed no blood flow.” As a result, a repeat ultrasound of the left testicle was ordered, in which, according to Magnus, there was “no blood flow seen.” Magnus subsequently dictated an impression of “left testicular swelling, secondary to hernia surgery, with no clear evidence to suggest torsion.” Magnus then advised Nakhabenko that surgical intervention was unnecessary. Magnus noted in his consultation report that he also had a discussion with the on-call general surgeon, Dr. Joelle Jakobsen, who had completed the initial history and physical for Nakhabenko, and noted that urology had seen Nakhabenko and was following him. Per Magnus’ evaluation and Jakobsen’s additional advisement, conservative, nonsurgical measures were implemented with the thought that the testicle would remain viable. Nakhabenko remained hospitalized until June 17, 2010. During that time, he saw his original, treating general surgeon, Morse, on a daily basis. Morse considered, and ruled out, performing an exploratory surgery to assess the testicular condition. After being discharged from the hospital, Nakhabenko followed up with Morse in a clinical setting on July 2, 2010, Aug. 4, 2010, and Sept. 8, 2010, during which Nakhabenko reported that his testicular swelling and pain was improving. As a result, on Sept. 8, 2010, Morse determined that Nakhabenko was stable from a surgical standpoint and cleared him to return to work. However, Nakhabenko continued to experience a low-grade fever, so Morse suggested that Nakhabenko visit a medical provider. On Sept. 15, 2010, Nakhabenko presented to his primary care provider at Harbor Medical Clinic, in West Sacramento, and it was noted that Nakhabenko’s left testicle was tender and swollen. As a result, Nakhabenko was referred to a urologist at RAS Urology Associates of Northern California, in Sacramento. A scrotal ultrasound was performed on Sept. 21, 2010, and it demonstrated both decreased size of the left testicle and no obvious blood flow to the left testicle. As a result, Nakhabenko was diagnosed with testicular atrophy and advised he would lose the testicle. He ultimately underwent a left orchiectomy at a UC Davis Medical Center, in Sacramento on April 28, 2011. Nakhabenko sued Morse and the operator of Mercy San Juan Medical Center, Medical Clinic of Sacramento Inc. (doing business as Mercy Medical Group). Magnus was later added as a defendant. Nakhabenko alleged that Morse and Magnus failed to give him options in how to best treat his testicular condition and that their failure constituted medical malpractice. Magnus died prior to trial, and the complaint was amended to be against his estate. Ultimately, the matter proceeded to trial against Morse and the estate of Magnus only. Plaintiff’s counsel argued that Nakhabenko should have been given the option to undergo exploratory surgery both while he was an in-patient for five days at Mercy San Juan Medical Center and at all follow-up visits, when Nakhabenko was still symptomatic and in severe pain. Counsel contended that options for treatment should have been presented to Nakhabenko so as to permit him to determine whether he wanted to remain in pain on a theory that this testicle might resume blood flow or whether he preferred to have the pain cease by an orchiectomy. Counsel noted that once the orchiectomy was performed on April 28, 2011 — a little more than 10 months after Nakhabenko was first evaluated by Magnus at Mercy San Juan Medical Center — the pain, in fact, did cease. (The initial inguinal hernia repair procedure, which was performed by Morse on June 9, 2010, was not at issue, and all experts felt the procedure complied with the standard of care.) Defense counsel argued that the standard of care did not require any physician to perform an exploratory surgery or an orchiectomy when Nakhabenko first presented to Mercy San Juan Medical Center on June 12, 2010. Counsel contended that Nakhabenko was three days post-op from his inguinal hernia repair and that Nakhabenko was experiencing a recognized risk associated with the procedure. The defense’s urology and general surgery experts agreed that despite the venous duplex finding of no blood flow, there was a reasonable chance that there was still some blood flow to the testicle, allowing the testicle to remain viable. The experts also opined that operating on Nakhabenko in exploratory fashion with such a large amount of swelling would have been dangerous since the surgical structures would be obscured. Thus, the experts opined that an exploratory procedure could have potentially caused more harm under the circumstances and that it would have been inappropriate to expedite the removal of Nakhabenko’s testicle without giving it an opportunity to remain viable. In addition, the defense’s medical experts opined that there was no certainty that surgery at that point would have alleviated Nakhabenko’s pain., Nakhabenko claimed that he had pain and swelling in the left testicle and scrotal area from on June 12, 2010 until he underwent the left orchiectomy on April 28, 2011. He claimed that after he last saw Morse in September 2010, he presented to his primary care provider at Harbor Medical Clinic and was referred to a urologist at RAS Urology Associates of Northern California, who performed a scrotal ultrasound and diagnosed both decreased size of the left testicle and no obvious blood flow to the left testicle. As a result, Nakhabenko was diagnosed with testicular atrophy and advised he would lose the testicle. Nakhabenko claimed that once the orchiectomy was performed the pain, in fact, did cease. Thus, he sought recovery for his past pain and suffering, and did not make any claims for future pain and suffering. Defense counsel disputed the seriousness of Nakhabenko’s alleged pain during the time before the orchiectomy, contending that during the followed-up appointments with Morse on July 2, 2010, Aug. 4, 2010, and Sept. 8, 2010, Nakhabenko reported that his testicular swelling and pain was improving. Counsel further contended that although Nakhabenko was diagnosed with testicular atrophy on Sept. 21, 2010, and advised that he would lose the testicle, Nakhabenko did not return to the facility until Dec. 6, 2010. In addition, counsel contended that Nakhabenko did not actually undergo the orchiectomy until about seven months later, on April 28, 2011. In response, plaintiff’s counsel contended that Nakhabenko was initially scheduled to undergo an orchiectomy on Jan. 25, 2011, but four days before the procedure, Nakhabenko was advised that RAS Urology could not perform the procedure due to insurance issues. As a result, Nakhabenko was referred to the Sacramento-El Dorado Medical Society, in Sacramento, and then consented to the left orchiectomy on April 25, 2011. Thus, Nakhabenko ultimately underwent the procedure, which was performed by Dr. Paolo Andreassi at UC Davis Medical Center, three days later.