On Dec. 23, 2010, plaintiff Ana Flores, an unemployed 38 year old, underwent gynecologic surgery by Dr. Daniel Lewis, an OB-GYN, at St. Helena Hospital Clearlake, in Clearlake. Lewis performed a hysteroscopy, dilation and curettage, a laparoscopy, an endometrial ablation, a cervical biopsy, and a loop electrosurgical excision procedure (LEEP). Flores tolerated the surgery well and was discharged the same day. The following day, on Dec. 24, 2010, a nurse from the hospital contacted Flores to see how she was feeling. Flores reported minimal vaginal bleeding and gas pains. The nurse encouraged Flores to use a heating pad and call the doctor if she had any other problems. However, just before midnight, Flores presented to the emergency department at Sutter Lakeside Hospital, inLakeport, with complaints of sharp lower abdominal pain and a bloated feeling. A CT scan revealed a large accumulation of intra-abdominal blood. As a result, Flores was admitted to the hospital, and seen by her treating general surgeon the following day. The treater subsequently performed an exploratory laparotomy and evacuated a large amount of blood from Flores’ abdominal cavity. He could not identify a definitive site for the intra-abdominal bleed, but felt that the most probable cause of the bleeding was from a blood vessel in the abdominal wall that had been damaged by a laparoscopic trocar from the prior surgery. Flores sued Lewis; Lewis’ medical office, the Kelseyville Family Health Center; and St. Helena Hospital Clearlake. Flores alleged that the defendants failed to detect the internal bleeding prior to completing the gynecologic surgery on Dec. 23, 2010, and that this failure constituted medical malpractice. The medical office and hospital were ultimately dismissed from the case, and the matter proceeded to trial against Lewis only. The plaintiff’s OB-GYN expert testified that a vascular injury occurred during Lewis’ surgery, during the placement of an accessory trocar port. He opined that, on conclusion of the laparoscopic portion of the surgery, Lewis failed to notice bleeding from the site of the accessory port upon withdrawal. The expert opined that because Lewis’ operative note failed to mention a deflation of the pneumoperitoneum and an observation of the accessory port upon termination of the laparoscopic procedure, it was never done. However, the expert conceded that the complication of a vascular injury in the course of a laparoscopic surgery does not, in itself, constitute a departure from the standard of care. Lewis testified that, although he did not specifically mention decompressing the abdomen (pneumoperitoneum) and observing removal of the accessory port trocar, it is his custom and practice to do this in every case. He added that he certainly would have noted bleeding from the accessory port at the conclusion of surgery and would have undertaken measures to address it at that time. The defense’s OB-GYN and urogynecology experts testified that Lewis met the standard of care in his laparoscopic surgery on Dec. 23, 2010. They agreed with the plaintiff’s expert OB-GYN that inadvertent injury to a blood vessel during a laparoscopic surgery does not automatically implicate substandard care. However, the defense’s expert opined that, based on all the facts in the case, if there had been a significant bleed present at the conclusion of Lewis’ procedure, it would have been recognized., Just before midnight on Dec. 24, 2010, Flores presented to the emergency department at Sutter Lakeside Hospital with complaints of sharp lower abdominal pain and a bloated feeling. A CT scan revealed a large accumulation of intra-abdominal blood. Flores’s treating general surgeon subsequently performed an exploratory laparotomy on Dec. 25, 2010, and evacuated a large amount of blood from Flores’ abdominal cavity. Flores then improved post-operatively, and was discharged from the hospital on Jan. 2, 2011. Flores had a Medi-Cal lien in the amount of approximately $65,000. She also sought recovery of $250,000 in non-economic damages associated with her physical pain and mental suffering.