On June 18, 2010, plaintiff James Van Valkenburg, 41, was incarcerated at the Bob Wiley Detention Facility, a pretrial jail operated by the county of Tulare, after being arrested for probation violations one day earlier by the Tulare Police Department. Van Valkenburg was an admitted intravenous drug user with multiple felony convictions over the previous 25 years for crimes involving property offenses, secondary to his drug habit. Additionally, he had sustained a head injury in the 1990’s that required the daily use of Dilantin, an anticonvulsant medication. He also required the daily use of insulin, as he had been diagnosed with diabetes many years earlier. While undergoing a medical screening exam on June 17, 2010, after his arrest by the Tulare Police Department, Van Valkenburg refused a blood draw in order to check his Dilantin and insulin levels. While undergoing the intake process the following day, on June 18, 2010, Van Valkenburg’s Dilantin dosage was determined to be 600-milligrams per day, with 300-milligrams administered in the morning and 300-milligrams administered in the evening. The nursing personnel indicated that they wished to obtain a Dilantin draw in order to check Van Valkenburg’s serum level upon confinement in the detention facility, but no screening draw was ever obtained. On June 27, 2010, Van Valkenburg submitted a “sick call note” to the infirmary, indicating that he was shaking so hard that he could not turn the page of a book and that he felt dizzy, fatigued and nauseous. When seen in the infirmary on July 5, 2010, a Licensed Vocational Nurse telephoned a county of Tulare physician, who was located off-site, and described the symptoms. The physician ordered a Dilantin screen to be drawn the following morning, and Van Valkenburg was returned to his cell. On July 6, 2010, a nurse practitioner, Hilda McAdams, saw Van Valkenburg and recognized him from prior stays at the Bob Wiley Detention Facility over the previous several years. She generally recalled that, on occasion, Van Valkenburg would appear to fake seizure activity. The same complaints were offered, and McAdams gave Van Valkenburg some Benadryl in order to see if he improved, since Benadryl would not affect symptoms associated with low blood sugar and/or cause a problem with Van Valkenburg’s Dilantin. It was then charted that Van Valkenburg had improved noticeably after some observation following the Benadryl. The results from the Dilantin screen drawn earlier that day were not yet available. The next day, Van Valkenburg was seen by a physician’s assistant, Hung Ngo, who observed that the Dilantin screen documented severe Dilantin toxicity with a value of 45.6. (The normal and expected range for Dilantin is 10 to 20.) Ngo elected not to contact a physician and, instead, decreased Van Valkenburg’s dosage to 200-milligrams once per day. At approximately 12:03 a.m. on July 8, 2010, Van Valkenburg was found seizing on his cell floor. The cellmate indicated that Van Valkenburg hit his head against the wall as his seizure commenced, prior to falling to the floor. Van Valkenburg’s blood sugar was abnormally low at 57, and an ambulance was summoned. Van Valkenburg was then admitted to Kaweah Delta Medical Center, part of the Kaweah Delta Health Care District in Visalia, from July 8, 2010 through July 13, 2010. He was diagnosed with Dilantin toxicity. Nursing notes indicated that Van Valkenburg was advised that he had been “unintentionally poisoned” with an overdose of Dilantin. Following his discharge from the hospital on July 13, 2010, Van Valkenburg was placed in the infirmary at Bob Wiley Detention Facility for approximately 10 days. However, Van Valkenburg claimed that he was without medical care over those 10 days. Van Valkenburg sued McAdams; Ngo; and the employer of McAdams and Ngo, the county of Tulare. Several other individual defendants were also originally named in the action, with other parties added later, but they were ultimately dismissed from the case. Van Valkenburg alleged that the defendants’ were negligent for failing to properly treat him and/or refer him to a neurologist and that their actions fell below the standard of care. He also alleged that his Section 1983 Constitutional rights to adequate medical care were violated. Van Valkenburg claimed that in addition to failing to properly manage his Dilantin intake, the defendants failed to treat him in any way after he was discharged from the hospital and was placed in the infirmary at Bob Wiley Detention Facility. He alleged that while he was in the infirmary, he was without medical care for over 10 days, during which he was unable to feel or move his lower extremities. He also alleged that he was incontinent of both bowel and bladder and that he made written complaints almost daily regarding the absence of medical care. Van Valkenburg even sent a letter to the Tulare County Grand Jury complaining of the care in the jail. He claimed that as a result of the lack of treatment, he was forced to lie in his own waste for approximately 10 days, without assistance or the provision of appropriate diapers. Defense counsel contended that the dosage of Dilantin given to Van Valkenburg was based on information directly obtained from Van Valkenburg. Counsel also contended that Van Valkenburg did not complain about being given too much Dilantin on a daily basis between June 18, 2010 and July 5, 2010, despite the fact that Van Valkenburg had been taking Dilantin, or was supposed to be taking Dilantin, going back many years, proving that the 600-milligram dosage most likely originated from information provided by Van Valkenburg himself. Defense counsel further contended that the defendants did not prescribe Dilantin, or any other medication, to Van Valkenburg, but simply continued what Van Valkenburg reported he was already taking during the intake process on June 18, 2010. Defense counsel argued that the standard of care permitted multiple approaches to management of Van Valkenburg on July 5, 2010 through July 7, 2010, since Van Valkenburg was not experiencing seizure activity nor did Van Valkenburg report breakthrough seizures during the previous days. Counsel contended that when a major seizure was seen in the early morning hours of July 8, 2010, Van Valkenburg’s needs were promptly met by immediate care and transfer, via ambulance, to the local hospital. Counsel also contended that the care and treatment rendered for Dilantin toxicity during the hospital stay was routine and that Van Valkenburg’s Dilantin levels fell back to normal by the time of discharge on July 13, 2010. Thus, defense counsel denied that Van Valkenburg’s claims had any merit as far as contentions that he went without medical care while confined in the infirmary for approximately 10 days, inasmuch as his vital signs were recorded daily and he was provided his normal medications, including a different anticonvulsant medicine in place of the Dilantin. Counsel also argued that it was not credible that multiple numbers of healthcare providers would allow Van Valkenburg to lie in his waste and refuse to provide medical care to him. Defense counsel noted that Van Valkenburg himself even testified that in multiple previous incarcerations at the detention facility, he was always treated in a reasonable fashion., Van Valkenburg suffered a major seizure at approximately 12:03 a.m. on July 8, 2010. His blood sugar was found to be abnormally low at 57, and an ambulance was summoned. He was then admitted to Kaweah Delta Medical Center, in Visalia, from July 8, 2010 through July 13, 2010, during which he was diagnosed with Dilantin toxicity. Following his discharge from the hospital on July 13, 2010, Van Valkenburg was placed in the infirmary at Bob Wiley Detention Facility for approximately 10 days. However, Van Valkenburg claimed that he was without medical care over those 10 days. Van Valkenburg claimed that he could not feel or move his lower extremities during that time and that he was forced to lie in his own waste during that time. On Nov.18, 2010, Van Valkenburg was transferred to the Kings County Jail, in Hanford, on different legal holds. Eventually, he served time in the Wasco State Prison-Reception Center, in Wasco, and in the California State Prison, Corcoran, before being released from custody in late July 2012. Van Valkenburg appeared at trial confined to a wheelchair, and he maintained that he had not walked since being hospitalized at the Kaweah Delta Medical Center following his Dilantin overdose in July 2010. Initially, Van Valkenburg claimed in the lawsuit that Dilantin toxicity caused him to become a true paraplegic. However, the plaintiff’s medical experts determined that there was no organic basis for his claim of paraplegia, since Dilantin toxicity is a temporary condition that does not cause permanent harm when treated appropriately. Thereafter, Van Valkenburg contended that he suffers a psychiatric conversion disorder, secondary to the trauma of being overdosed on Dilantin. He also contended that there was an organic basis to his urinary incontinence. Van Valkenburg, now 46 years old, sought recovery of $718,000 in future medical costs and recovery of reasonable general damages based on the alleged medical negligence and Section 1983 violations.