On Sept. 17, 2014, claimant Karla Bojorquez, 35, was at work when she began to feel ill. Her complaints were such that she began to worry about the health and safety of her baby. As a result, she decided to go to the emergency room at Kaiser Permanente Downey Medical Center, in Downey. Earlier that month, Ms. Bojorquez learned that she was pregnant with what would be her third child after her and her husband, claimant Edgar Bojorquez, had been attempting to conceive for nearly six months. However, when she began to experience abdominal pain in the mid-afternoon of Sept. 17, 2014, she decided to present to the emergency room. After being admitted to the emergency room, Ms. Bojorquez was evaluated by the emergency room physician, Dr. Scott Gwaltney, who noted that Ms. Bojorquez complained of sharp pain in her left, lower quadrant, which Ms. Bojorquez ranked as being a nine on a scale of one to 10. Thus, the examination was positive for abdominal pain, and Ms. Bojorquez reported to Gwaltney that she was pregnant. As a result, Gwaltney ordered, among other orders, HCG testing and an ultrasound. He also consulted with an OB-GYN, Dr. On Wing Lim. Following Gwaltney’s examination, but prior to Lim’s consultation, an ultrasound was performed to evaluate Ms. Bojorquez’s complaints and the status of the fetus. According to the ultrasound report prepared by Dr. Ramana Muthyala, the ultrasound revealed “an intrauterine sonolucent area present, which may represent a gestational sac or a collection of fluid. Neither a yolk sac nor a fetal pole is identified. Cannot rule out: an ectopic pregnancy.” The study also revealed the “right ovary demonstrates complex structure with peripheral increased vascularity.” Due to the inconclusive nature of the study, Muthyala recommended to “correlate with bhcg levels and [a follow-up] ultrasound.” Thereafter, Lim consulted and evaluated Ms. Bojorquez while she was in the emergency room. During Lim’s exam, he noted pelvic pain for two days with pain in Ms. Bojorquez’s right and left lower quadrants, and pain levels between five and eight out of 10. He also noted mild, general, lower abdominal pain 1+/4 without rebound. Lim also performed a pelvic examination, noting no bleeding, no lesions, normal fundus, and no masses, but bilateral tenderness. As a result, Lim noted that the ultrasound was “inconclusive for early gestational sac vs. small complex right adnexa.” His impression/diagnosis was “acute pelvic pain involving the right and left lower quadrants, unknown if ectopic or early intrauterine pregnancy.” Ms. Bojorquez claimed that dispute Lim noting that the exam was “inconclusive,” Lim told her that he found an ectopic pregnancy during the evaluation and then discussed with her the option of surgery versus methotrexate for the ectopic pregnancy, or expectant management. Shortly thereafter, Lim filed an addendum to his consultation note. According to that note, Lim discussed the case with both Mr. and Ms. Bojorquez, who both opted for methotrexate to terminate the pregnancy given the ectopic diagnosis. Lim further noted a history of a prior ectopic pregnancy that was similarly treated, but was not in Ms. Bojorquez’s records. Lim then proceeded with the termination of the pregnancy via methotrexate injection in the emergency room that same day. Following the injection of methotrexate, Ms. Bojorquez underwent blood draws to evaluate her HCG levels. Her HCG level was determined to be 3308 while in the emergency department on Sept. 17, 2014, but her HCG levels were later found to be 7029 and 6624, on Sept. 22, 2014, and Sept. 29, 2014, respectively. Given the inexplicable increase in HCG levels, which should not occur following termination of a suspected ectopic pregnancy via methotrexate, Ms. Bojorquez visited another OB-GYN, Dr. Jennifer Claman. Unfortunately, at that visit, Claman found, via a transvaginal ultrasound, “an intrauterine gestational sac,” a “fetal pole,” and “a yolk sac.” In other words, a normal intrauterine pregnancy. Despite the Claman’s findings, the fetus was unlikely to survive, given Lim’s recommendation to inject Ms. Bojorquez with methotrexate, and even if it did, it would likely be grossly deformed. As a result, Ms. Bojorquez underwent a dilation and curettage procedure to remove the fetus from her uterus on Oct. 2, 2014. Mr. and Ms. Bojorquez sued Lim and the believed operators of the Downey medical center, Kaiser Foundation Health Plan, Kaiser Foundation Hospitals, and Southern California Permanente Medical Group. The matter proceeded to arbitration. Mr. and Ms. Bojorquez claimed that Lim never told them that she may have a viable intrauterine pregnancy. They claimed that, instead, Lim immediately diagnosed Ms. Bojorquez with an ectopic pregnancy and recommended termination of the fetus without discussing any other options. Claimants’ counsel contended that there were multiple inaccuracies in the records and that Lim failed to review the ultrasound, which Lim claimed supported his recommendation despite the fact the radiologist recommended further HCG testing and a repeat ultrasound. At arbitration, the experts disagreed on whether it was reasonable to recommend termination of the pregnancy. The claimants’ OB-GYN expert testified that the ultrasound images clearly revealed an intrauterine pregnancy. The expert also testified that Lim breached the standard of care by failing to review the ultrasound, despite touting his own expertise at deposition and arbitration, and by failing to recommend that Ms. Bojorquez go home and have follow up testing. Thus, the claimants’ expert opined that there was simply no indication for the use of methotrexate to terminate a viable pregnancy. Lim contended that he was justified in recommending termination of an early pregnancy via the use of methotrexate. He claimed that the ultrasound was not only available for him to review, but he specialized in ultrasonography with respect to the evaluation of early pregnancies. Lim also claimed that he discussed multiple options with Ms. Bojorquez. However, claimants’ counsel contended that the medical records did not support that Lim told Ms. Bojorquez anything other than she had an ectopic pregnancy. In addition, Lim conceded that the risk of rupture of an ectopic pregnancy at four weeks was low and that he never told Ms. Bojorquez that she could have follow up testing to confirm the location of her pregnancy. The respondents’ OB-GYN expert testified that, based on Lim’s testimony, the recommendation to terminate the pregnancy was reasonable. However, at arbitration, he conceded that while he always reviews inconclusive ultrasound studies, Lim was not required to do so in this case. The expert also conceded that Lim’s examination of Ms. Bojorquez significantly lowered the suspicion for an ectopic pregnancy. In addition, the respondents’ expert testified that if he were to believe the testimony of Mr. and Ms. Bojorquez, then Lim breached the standard of care., On Oct. 2, 2014, Ms. Bojorquez underwent a dilation and curettage (D&C) procedure to remove the fetus from her uterus. Mr. and Ms. Bojorquez claimed that they were delighted by the news that they were pregnant with what would have been their third child. Thus, they claimed that they suffer from emotional distress as a result of the loss of their planned pregnancy. Specifically, Ms. Bojorquez claimed she suffers from emotional distress in connection with the termination of the pregnancy, which resulted in her need for therapy and psychiatric treatment. Mr. Bojorquez claimed he suffers from a loss of consortium as a result of his wife’s severe emotional distress.