On March 30, 2010, plaintiff Julia Macias, 62, a clerical employee for the California Department of Transportation, presented to Dr. Mark Gabriel, a board certified gastroenterologist and partner with Beaver Medical Group, to undergo a dilation procedure. Over the eight years since 2001, Gabriel had performed dilation procedures on Macias as she had ingested lye at 3 years old and suffered dysphagia, secondary to a complex esophageal stricture. In March 2010, Gabriel performed the dilation procedure utilizing the Savary guide wire-assisted dilator, as he had done in the past. However, this time as he withdrew the dilator, he noticed Macias was becoming cyanotic and that her oxygen saturation levels were dropping, as was her blood pressure. After administering drugs to reverse the effects of sedative medications, Gabriel reinserted the endoscope and observed that the guide wire had coiled within Macias’ stomach. When attempts to remove the guide wire were unsuccessful, Gabriel called 911 and had Macias transported emergently to Redlands Community Hospital for further evaluation. Macias was later transported to Loma Linda University Medical Center and was seen in consultation by a cardiothoracic surgeon and a gastroenterologist. A joint decision was made for the gastroenterologist to try to remove the entangled guide wire the following morning. During the procedure, the gastroenterologist noted that the guide wire had actually perforated through Macias’ esophagus 3 centimeters below the distal end of the stricture. As a result, the gastroenterologist was ultimately successful in removing the guide wire. Macias sued Gabriel and Beaver Medical Group. She alleged that Gabriel failed to properly perform the dilation procedure on March 30, 2010, and that this failure constituted medical malpractice. She also alleged that the medical group was vicariously liable for Gabriel’s actions. The plaintiff’s gastroenterology expert opined that Gabriel was negligent in utilizing the Savary guide wire-assisted dilator without the benefit of fluoroscopy. The expert further testified that another available option was to perform the dilation procedure with a balloon dilator under direct endoscopic visualization. The defense’s expert gastroenterologist disputed the plaintiff’s stance and testified that the use of a Savary guide wire-assisted dilator without fluoroscopy was an approved method of treatment for complex esophageal strictures. The expert further testified that an esophageal perforation is a known complication of esophageal dilation from both known and unknown causes. Thus, defense counsel argued that, in this subject case, the specific cause of the perforation was unknown., At Redlands Community Hospital, Macias was intubated and placed on a respirator. Imaging studies showed massive amounts of air within the mediastinum and thoracic cavity. Chest tubes were then placed bilaterally to allow the accumulated air to dissipate. Macias was also placed on prophylactic antibiotics. She was later transferred to Loma Linda University Medical Center, where the esophageal perforation was discovered and the guide wire was removed. Following additional consultation with the cardiothoracic surgeon at Loma Linda University Medical Center, the gastroenterologist decided to place a stent through the stricture to cover the perforation and to allow it to heal by secondary intention. Macias also underwent the placement of a J-tube for feeding purposes. During the remainder of her hospitalization, Macias was eventually weaned from the respirator and the chest tubes were removed. Eventually Macias was discharged form Loma Linda University Medical Center on April 11, 2010. After her discharge, Macias continued to follow up with an outpatient gastroenterology service at Loma Linda University Medical Center for the next several months, during which multiple stents were removed and replaced to facilitate swallowing. The J-tube was eventually removed in October 2011. Macias claimed that she is left with abdominal scarring and recurrent dysphagia. She also claimed that she had a fear of undergoing any future esophageal dilation procedures as a result of the incident. However, Macias admitted that she was eventually able to return to work and continue working until she retired. According to defense counsel, Macias claimed $15,000 in damages for her past loss of earnings, and asked the jury to award $2.1 million in total damages.