On Aug. 3, 2010, plaintiffs’ decedent Albert Calvillo, 59, an employee of the city of Morro Bay’s Department of Waste Management, was scheduled to undergo a cervical discectomy with three-level fusion, including plating and screws, at Sierra View Regional Medical Center, in San Luis Obispo. The surgery was to be performed by Dr. Phillip Kissel, a neurosurgeon. Calvillo previously underwent a decompression surgery of the lumbar spine with Kissel in 2000, and the procedure was without complication or problem. Approximately 10 years later, in July 2010, Calvillo was working with a socket wrench on an overhead basis when he felt a sudden shock-like sensation go through his neck into both upper extremities. His treating family physician subsequently referred him back to Kissel for further evaluation, and an MRI of the cervical spine demonstrated severe canal stenosis and nerve compression. As a result, Calvillo was scheduled for the cervical discectomy with 3-level fusion on Aug. 3, 2010. However, during the surgery, Kissel encountered significant bleeding, which was controlled using multiple hemostatic agents and manual pressure, and Calvillo’s vital signs dropped transiently. Thus, in order to reduce anesthesia time and prevent a possible disruption of the packing efforts undertaken by Kissel to control the bleeding, the operation was terminated prematurely after two levels had been decompressed. As a precaution, Kissel left a drain in place and had Calvillo taken to the Intensive Care Unit for 24 hours, after leaving the post-anesthesia care unit with excellent vital signs. When no evidence of active bleeding was seen in the Intensive Care Unit, Calvillo was moved to a medical-surgical floor for an additional 24 hours. Prior to being discharged on Aug. 5, 2010, Kissel ordered a magnetic resonance angiogram (MRA) of the cervical vessels in order to rule out an arterial injury as an explanation for the intraoperative bleeding. A neuroradiologist, Dr. Arthur Duberg, interpreted the MRA as normal and the treating neurosurgeon, Kissel, reviewed the summary films of the MRA and felt they were normal as well. As a result, Calvillo was discharged home with instructions to immediately go to the emergency room if he noticed any abnormal swelling in his neck. At approximately 3 p.m. on Aug. 6, 2010, 24 hours after being discharged, Calvillo collapsed at home. Paramedics were summoned, and they found extreme swelling in Calvillo’s neck. CPR efforts were attempted, but found to be completely unsuccessful. As a result, Calvillo died in the ambulance at the emergency department. An autopsy determined that there was an extreme hemorrhage at or about the C5-6 level, immediately adjacent to the lower segment of the left vertebral artery, with bleeding throughout the neck, compressing the trachea and leading to Calvillo’s demise. The decedent’s wife, plaintiff Diane Calvillo, and his adult children, plaintiffs Shawna Calvillo, Evan Calvillo and Marci Calvillo, sued Kissel; Duberg; an assistant surgeon, Dr. Larry Herron; and Sierra Vista Regional Medical Center. The decedent’s family alleged that the defendants failed to timely diagnose and treat the ongoing hemorrhage, resulting in the decedent’s wrongful death, and that their failure constituted medical malpractice. Prior to trial, Herron and Sierra Vista Regional Medical Center were dismissed for cost waivers. Plaintiffs’ counsel noted that Kissel suspected that the bleeding he encountered was from the vertebral artery and that he controlled the bleeding using multiple hemostatic agents and manual pressure. However, counsel argued that Kissel knew, or should have known, that hemostatic agents were not a permanent repair for a large vessel injury and were not a substitute for surgical techniques, including ligation. Thus, plaintiffs’ counsel argued that Kissel’s decision to discharge Calvillo on Aug. 5, 2010, to his home in Morro Bay, located approximately 30 minutes from the nearest emergency room, fell below the standard of care since Kissel suspected arterial bleeding and knew that if Calvillo bled out, death could occur within a matter of minutes. In addition, plaintiffs’ counsel argued that Kissel failed to appropriately communicate with Duberg, insofar as the requisition form for the MRA order did not reflect intraoperative bleeding as a complication of the surgery, so Duberg had no information about Calvillo other than knowing, “status/post-anterior cervical discectomy.” Counsel contended that, in the absence of information from Kissel explaining why the study had been ordered, Duberg was obligated by the standard of care to contact Kissel to inquire as to why the study had been requested. Plaintiffs’ counsel argued that, instead, Duberg interpreted the MRA incorrectly. Counsel contended that the MRA was significantly abnormal, which should have resulted in Duberg reporting to Kissel that there was evidence of injury involving the left vertebral artery, such that a vascular surgeon and/or interventional radiologist should have been consulted, and Calvillo should have been kept in the hospital for further care. Duberg maintained that he read the study in a manner consistent with the standard of care and that what plaintiffs’ counsel called out as an abnormality in the study was nothing but a normal artifact. Kissel contended that the MRA was an excellent diagnostic modality for evaluation of the great vessels of the neck. He testified that he had practiced with Duberg for some 25 years and that an order for an MRA of the neck automatically communicated to the interpreting radiologist that the surgeon wanted information on the condition of the great vessels, including the left vertebral artery. Duberg also testified that he frequently receives no information at all as to why a study may be indicated and that he knew Kissel quite well, such that an order for the MRA automatically told him that Kissel was interested in any abnormalities found in the great vessels of the neck, including the left vertebral artery., Albert Calvillo suffered an extreme hemorrhage at or about the C5-6 level, immediately adjacent to the lower segment of the left vertebral artery, with bleeding throughout the neck, compressing the trachea. As a result, CPR efforts were completely unsuccessful, and he died in the ambulance at the emergency room. He was 59 years old. The decedent was survived by his wife, Diane Calvillo, who a 58-year-old civilian clerk for the San Luis Obispo County Sheriff’s Office at the time of her husband’s death. He was also survived by his adult daughters, Shawna Calvillo and Marci Calvillo; and his adult son, Evan Calvillo. The decedent’s family sought recovery of wrongful death damages. The parties stipulated that the past and future economic loss totaled $376,000.