On Sept. 17, 2015, plaintiff Marie Despres, 42, a flower shop’s owner, presented to the emergency department of Scripps Memorial Hospital La Jolla with complaints of severe abdominal pain and no bowel movement for two weeks. Dr. James Hwang, an emergency department physician, evaluated Despres. Imaging confirmed a distended bowel secondary to an obstruction in the sigmoid colon with significant dilation of the entire colon and small bowel with a finding of pneumatosis in the cecum. Dr. Keith Beiermeister, a colorectal surgeon, was consulted, and he had Hwang order a gastrografin enema to further clarify the nature of the obstruction. Despres was later taken to radiology, where the gastrografin study was performed by Dr. Kendall Martin, a radiologist. After administering approximately 500 cubic centimeters of contrast, the cecum perforated, resulting in a spillage of feces and contrast into the peritoneal cavity. Despres went into septic shock and was taken emergently to surgery. The right colon was ultimately removed. Despres sued Martin; Hwang; Beiermeister; an internist, Dr. Mihae Grace Joo; a gastroenterologist, Dr. Jurgen Lenz; and the operator of Scripps Memorial Hospital La Jolla, Scripps Health. Despres alleged that the defendants failed to timely treat her condition, and failed to properly order and perform the gastrografin procedure. Despres also alleged that the defendants’ failures constituted medical malpractice. Joo, Lenz and Scripps Health were dismissed from the case, and the matter only continued against Martin, Hwang and Beiermeister. Plaintiff’s counsel argued that Despres should have been emergently taken to surgery upon arrival at the emergency department. Counsel contended that Beiermeister violated the standard of care by delaying the emergent surgery and by ignoring his colleague’s concerns that the gastrografin enema procedure was contraindicated for Despres. Plaintiff’s counsel also argued that Martin was negligent for succumbing to pressure from Beiermeister and performing a procedure that Martin believed had risks that outweighed its benefits. Plaintiff’s counsel further argued that Hwang violated the standard of care by placing the wrong order and that Hwang negligently started the chain of events that led to the perforation of the cecum. Counsel contended that Beiermeister asked Hwang to order a limited gastrografin enema and to not exceed a few 100 cc of contrast. However, counsel contended that Hwang did not order a limited gastrografin enema and, instead, ordered a gastrografin enema without any specified limitation. Plaintiff’s counsel contended that as a result, Despres’ cecum perforated after the administration of 500 cc of contrast. Plaintiff’s counsel argued that each of the doctors’ violations proximately caused Despres’ bowel perforation. Defense counsel argued that the perforation could not have been anticipated or prevented. Counsel contended that Despres’ bowel was not maximally dilated, as reflected by measurements of the cecum on imaging, and that the gastrografin procedure was indicated both to further diagnose the nature of the obstruction and as a therapeutic measure to stimulate bowel movement to clean the bowels in the event surgery was indicated. However, defense counsel argued that the perforation occurred as the result of a necrotic bowel in the cecum, secondary to prolonged distension and compromise of the blood supply to the bowel wall., Despres suffered a rupture of the colon. As a result, she suffered from sepsis, septic shock and a shocked lung. She ultimately had to undergo a tracheotomy and multiple surgeries, including one in which her right colon was removed. After the bowel rupture, Despres was admitted to the intensive care unit for 40 days. She required ventilator support, and she nearly died. Surgery included an ileostomy and a mucous fistula, which is a type of colostomy that allows the release of colonic secretions, mucus and gas so that they do not build up over time. However, both were taken down one year later. Despres complained of an incisional hernia and constant bowel urgency, as well as continuing fatigue, as a result of her condition. Despres sought recovery of approximately $600,000 in past and future medical expenses, and an unspecified amount of damages for her past and future pain and suffering. Plaintiff’s counsel asked the jury to award Despres between $2 million and $5 million in total damages.