In 2012, plaintiff Walter O’Rourke, 53, a corporate consultant and the president and chief executive officer of a company, presented to Community Hospital Long Beach with complaints of pain to his left arm. He was evaluated in the emergency department by Dr. Charles O’Brien. O’Rourke complained of non-provoked pain to his left arm as well as dull, epigastric discomfort, which he claimed was waxing and waning, non-radiating, and rated as being a five out of 10. He underwent two EKGs, which O’Brien read as normal, and O’Rourke’s initial troponin levels, which were taken at approximately 4:30 a.m., were also read as normal. O’Rourke’s pain allegedly got better or resolved while in the emergency room, so O’Brien contacted a critical care specialist and hospitalist, Dr. Nayyer Ali, at approximately 7:15 a.m. to discuss admitting O’Rourke and performing a workup for potential cardiac problems, which Ali agreed to do. The floor nurse then contacted Ali for admission orders, and Ali returned a second call from the nurse. Later that day, while in the telemetry unit, O’Rourke began to complain of pain again. At approximately 1:20 p.m., Ali examined O’Rourke, and a third EKG was again interpreted as normal. Ali then ordered a second troponin test, which was drawn at approximately 2 p.m., and a cardiologist consult was requested. The results of the second troponin test showed that O’Rourke was having a non-ST-elevation myocardial infarction (NSTEMI), a less serious form of heart attack in which most of the coronary artery blockages are partial or temporary. However, a fourth EKG, which was performed at approximately 4 p.m., showed that O’Rourke was having an ST-elevation myocardial infarction (STEMI), a very serious type of heart attack during which one of the heart’s major arteries is blocked. A cardiologist, Dr. Emmanuel “Mike” Vasilomanolakis, had O’Rourke transferred via ambulance to Long Beach Medical Center, a bigger hospital that had a cardiac catheterization lab. O’Rourke coded as he arrived at Long Beach Medical Center and was resuscitated. Vasilomanolakis then did a catheterization on O’Rourke, but no stents could be placed in his artery, so O’Rourke underwent a four-vessel bypass surgery. O’Rourke stayed at the hospital for one month before going back to Canada, where he was initially from, to recover. He ultimately underwent a heart transplant in Canada in 2015. O’Rourke sued O’Brien; O’Brien’s medical corporation, CBO; Ali; Ali’s medical office, Nayyer Z. Ali Inc.; Vasilomanolakis; Vasilomanolakis’ medical corporation, E. Mike Vasilomanolakis M.D., a Professional Corp.; Community Hospital Long Beach; the medical group for emergency medical physicians, Emergency Physicians Medical Associates of Long Beach; the operator of Long Beach Medical Center, MemorialCare Health System; and MemorialCare’s parent company, Memorial Health Services. O’Rourke alleged that the defendants failed to timely treat his condition and that this failure constituted medical malpractice. Several defendants were let out of the case, and the matter only continued against O’Brien and Ali. Plaintiff’s counsel contended that O’Rourke’s heart attack was only discovered after a second test of his troponin levels showed that they were elevated. Thus, counsel argued that O’Brien should have recognized the matter as being a cardiac case and that O’Brien should have consulted with a cardiologist, not a hospitalist. Counsel also argued that Ali delayed in ordering the second test for troponin and if the test was done earlier, it would have shown elevated troponin levels at that time, which would have resulted in O’Rourke being transferred earlier and successfully catheterized. Plaintiff’s counsel argued that Ali also should have called for a cardiologist earlier and transferred O’Rourke to the intensive care unit sooner. According to defense counsel, that plaintiff’s cardiology and hospital medicine experts differed as to what time O’Rourke should have been transferred to Long Beach Medical Center. O’Brien claimed that he would have contacted the cardiologist, but that in O’Rourke’s case, it was unclear if O’Rourke was having a heart attack, so he contacted the hospitalist. Ali claimed that the first time he learned that O’Rourke had pain was when he examined O’Rourke at 1:20 p.m. He also claimed that the standard of care in 2012 allowed for the second troponin test to be done eight to 12 hours later, if the first test was drawn within six hours of the onset of symptoms, and that he ordered the test approximately 40 minutes after he examined O’Brien. Ali’s counsel contended that, in this case, the second troponin test was drawn eight to 12 hours after the first and thus, Ali complied with both the standard of care and the medical guidelines at the time. Counsel also contended that the American Heart Association last updated the standard in 2014 and that the update included a statement noting that a second test done eight to 12 hours later was okay, but that it should be done sooner if the patient’s symptoms come back., O’Rourke suffered a serious heart attack (a STEMI), coded and hade to be resuscitated. He then underwent a catheterization, but no stents could be placed in his artery. As a result, he underwent a four-vessel bypass surgery. O’Rourke remained hospitalized for one month. He ultimately underwent a heart transplant in 2015. O’Rourke claimed that he made six figures every year at his job, but that he lost his vitality for work after the events. He also claimed that he requires medical care related to the heart transplant and that he will eventually require in-home attendant care later in life, when he can no longer care for himself. In addition, O’Rourke claimed that he will eventually need an additional heart transplant. O’Rourke sought recovery of $10 million in future medical costs and $13 million in lost earnings. He also sought recovery of damages for his past and future pain and suffering. His wife, Wendy O’Rourke, presented a derivative claim seeking recovery for her loss of consortium.