On May 4, 2015, plaintiff Brian Nall, 44, a contractor, underwent surgery on an L2 burst fracture (a compression fracture of the lumbar spine). The procedure was performed by Dr. Mukesh Misra, a neurosurgeon, at Antelope Valley Hospital, in Lancaster. Two days earlier, Nall was involved in a motor vehicle accident, during which he landed flat on his back after being separated from his motorcycle. As a result, he was transported via ambulance to Antelope Valley Hospital, were he was treated as a trauma patient. He was then worked up in the emergency room and diagnosed with an L2 burst fracture. Nall was fitted with a back brace and admitted to the hospital to be evaluated by Misra. Nall underwent a CT scan and MRI studies of the lumbar spine, which were interpreted by Misra as showing an unstable burst fracture that required surgery. At the recommendation of Misra, Nall consented to the surgery. Nall underwent the recommended surgery on May 4, 2015. Misra and the trauma team, which included Dr. Pavel Petrik, a trauma surgeon, then followed up with Nall on a daily basis until May 8, 2015, when Nall was discharged from the hospital. On the morning of May 10, 2015, Nall was transported by ambulance to the emergency room at Providence Little Company of Mary Medical Center, in Torrance, where he was diagnosed with a perforated bowel and a splenic injury as a result of a ruptured diverticulitis. Nall sued Antelope Valley Hospital, Misra, Petrik and two other doctors who were involved in Nall’s care at Antelope Valley Hospital, Dr. Walid Arnaout and Dr. Samir Fasheh. Nall alleged that the defendants negligently treated him and prematurely discharged him from the hospital. He also alleged that the defendants’ negligence constituted medical malpractice. Arnaout and Fasheh were let out of the case, and the matter continued against Misra, Petrik and the hospital only. Nall claimed that had he been kept in the hospital on May 8, 2015, the diagnosis of diverticulitis would have been made and successfully treated, thereby avoiding the rupture. The plaintiff’s expert neurosurgeon opined that the surgery performed by Misra on May 4, 2015 was not indicated and that, instead, Nall should have been treated conservatively with a back brace and then discharged to allow Nall to see his regular physician at another facility. The expert was also critical of Misra for authorizing the discharge of Nall on May 8, 2015, which the expert opined was when Nall was unstable and had developed clear signs of an infection that warranted continued admission and further work up. He also opined that Petrik violated the standard of care by prematurely discharging Nall on May 8, 2015. The plaintiff’s expert surgeon relied on abnormal vital signs on the day of discharge to opine that Nall was “very sick” and had developed diverticulitis. The expert also opined that had Nall been kept in the hospital for further work up, the team of physicians would have been able to definitively diagnose diverticulitis within a few hours of the time he was discharged and that, with appropriate treatment, the diverticulitis would not have ruptured. The neurosurgeon further testified that he believed that Nall did not have a bowel movement during his entire hospitalization, prior to discharge, and opined that the diverticulitis was caused by Nall’s severe constipation. The expert also highlighted a temperature spike of 102.4 on the morning of discharge to support his opinion that Nall was clearly sick and should not have been discharged. Defense counsel argued that the rupture of the diverticulitis was not caused by any omission on the part of the treating physicians, but, rather, was an unfortunate, rare, complication that occurred after Nall’s discharge. Counsel also argued that Nall was discharged from Antelope Valley Hospital in stable condition and that the rupture could not have been predicted or prevented. Both the plaintiff’s and defense’s neurosurgery experts relied on the Thoracolumbar Injury Classification and Severity Score scoring system, which assists surgeons in categorizing a patient’s condition to determine if surgery is indicated. However, the imaging studies and whether the films depicted a ligamentous injury were in dispute. The defense’s expert neurosurgeon opined that the surgery was indicated and necessary to stabilize Nall’s spine, which was unstable, as depicted on the pertinent imaging studies. (Defense counsel contended that the plaintiff’s neurosurgery expert never reviewed the imaging studies, and relied on the language used by the radiologist who interpreted the studies, and who did not mention any injury to the ligaments.) The defense’s expert reviewed the films, and opined that the films illustrated multiple images that showed clear evidence of a ligamentous injury. (According to defense counsel, the plaintiff’s neurosurgery expert conceded that if Nall did have evidence of even a possible ligamentous injury, surgery was indicated.) The defense’s expert trauma surgeon opined that it was entirely appropriate to discharge Nall on May 8, 2015. He also opined that Nall was not unstable and did not have diverticulitis at the time he was discharged. The expert testified that he relied on repeat abdominal exams, which were normal, to rule out an intra-abdominal process or complication following the surgery performed by Misra. He also addressed each of the isolated vital signs highlighted by the plaintiff’s cardiothoracic expert to explain why they were not of concern to a surgeon at the time of discharge. For example, the temperature spike to 102.4 degrees in the morning on May 8, 2015 came back down to within normal limits after a single Tylenol tablet. The defense’s expert trauma surgeon opined that if Nall was bacteremic, as alleged by the plaintiff’s cardiothoracic expert, Nall’s temperature would not have normalized after a single pill of Tylenol and Nall would have exhibited positive peritoneal signs on examination of his abdomen, such as guarding, rebound or tenderness. Defense counsel noted the normal abdominal examinations documented by every nurse and Petrik, who evaluated Nall on a daily basis post-operatively. Counsel also contended that Nall had two separate bowel movements post-operatively, prior to his discharge. The defense’s gastroenterology expert testified regarding the diagnosis and treatment of diverticulitis. She opined that constipation does not cause diverticulitis and that a patient cannot have diverticulitis without some positive peritoneal signs on abdominal examination. The expert opined that as a result, the repeat negative abdominal examinations ruled out diverticulitis at the time Nall was discharged and that the diverticulitis ruptured within 24 hours of Nall being discharged from Antelope Valley Hospital. The gastroenterologist further opined that even if Nall had theoretically been kept in the hospital on May 8, 2015, to a reasonable degree of medical probability, Nall would have suffered a ruptured diverticulitis because there would not have been sufficient time for the physicians to diagnose, treat and prevent the rupture., Nall suffered a ruptured diverticulitis, causing a perforated bowel and a splenic injury. He required the removal of his spleen and the placement of a colostomy. However, he developed multiple infections, which required additional hospitalizations, and two separate incisional hernias, which required surgical repair. As a result, Nall endured 1.5 years of protracted medical care related to the complications from the ruptured diverticulitis. Nall sought recovery of $260,000 in unpaid medical bills and an unspecified amount of damages for his pain and suffering. His wife, Erin Nall, brought a derivative claim seeking recovery for her loss of consortium, but she dismissed her claim a week before trial.