On April 4, 2013, plaintiffs’ decedent Richard Humpal presented to the emergency room at Redlands Community Hospital, where he reported a sudden episode of chest pain with shortness of breath. Humpal originally underwent a quadruple coronary artery bypass surgery at Loma Linda University Medical Center in 2001. Thereafter, Humpal remained fairly stable from a cardiac standpoint until approximately Nov. 20, 2012, when he was admitted to Redlands Community Hospital for an evaluation of chest pain. In the emergency department, Humpal was found to have elevated cardiac enzymes and EKG changes. He was the transferred to St. Bernardine Medical Center, where he underwent a cardiac catheterization procedure performed by Dr. Thomas Makowski, who identified significant three-vessel coronary artery disease with at least two of the bypass grafts severely occluded. As a result, Makowski elected to stent the right coronary artery, where there were two lesions were noted. On Dec. 6, 2012, Humpal followed-up with Makowski on an outpatient basis. At that time, Humpal reported no further discomfort. However, one of his beta blocker medications was changed from Coreg to Metoprolol because he was complaining of an upset stomach. Humpal returned to Makowski’s office for a four-month check on March 19, 2013. This time, Humpal was evaluated by physician’s assistant Curtis Landreth, who noted that Humpal demonstrated no symptoms of a cardiac nature. While giving his history, Humpal reported a single episode of chest heaviness two weeks earlier, but then having no additional symptoms. On examination, he showed no signs or symptoms of heart failure, such as arrhythmias, passing out, or an irregular heartbeat. There was also no evidence of a pulmonary embolism. In fact, the primary reason for Humpal’s visit was his concern about joint and muscle pain in his hips and lower extremities. Landreth’s assessment was that Humpal’s musculoskeletal pain was related to his Lipitor therapy. In that regard, Humpal’s Lipitor was discontinued for the next six weeks, and Humpal was sent home with instructions to return in six weeks, at which time further recommendations would be made. On April 4, 2013, Humpal called Makowski’s office to report a sudden episode of chest pain. He was subsequently instructed to go immediately to the emergency room to be evaluated. As a result, Humpal presented to the emergency room at Redlands Community Hospital, where he reported that earlier in the day, he experienced a sudden onset of chest pain with shortness of breath. He also reported that he took a Nitroglycerin pill and his chest pain was relieved within 10 minutes, but that when he checked his blood pressure, it was noted to be 225/80. As a result, Humpal was evaluated by Dr. Barbara Nelson, a hospitalist, who performed a detailed evaluation of Humpal and documented her findings. Nelson noted that Humpal was pain free, with no complaints, at the time of admission. She then completed a 10-system review, which was noted to be negative, except for the history of present illness. A 12-lead EKG also revealed normal sinus rhythm with a rate of 77. As a result, Nelson’s assessment was of acute coronary syndrome (ACS) in a patient with known coronary artery disease, who reported that he had missed his dose of Metoprolol prior to the episode of chest pain. The first troponin level obtained in the emergency room was within normal limits, at 0.27, but Nelson admitted Humpal to the telemetry unit, per ACS protocol. Humpal was then started on Lovenox and he continued with his beta blockers and Ace Inhibitor. Nelson also added Nitroglycerin paste and aspirin, per ACS protocol. Nelson specifically noted that she would obtain three sets of cardiac enzymes and that if all the troponin levels were less than 0.5, she would order a stress echocardiogram. In contrast, if the troponin levels were positive, she would order a resting echocardiogram and cardiology consultation. A treadmill stress echocardiogram was performed by Dr. Steven Hildebrand, a cardiologist, on the morning on April 5, 2013. When Humpal complained of leg pain after approximately five minutes, the procedure was stopped. During the recovery phase, Humpal complained of severe shortness of breath. Thereafter, he became weak, short of breath, and hypotensive. A code was called, and after approximately 32 minutes of CPR without obtaining a pulse, respirations and bagging were discontinued. Humpal was pronounced dead. The decedent’s wife, plaintiff Bonnie Humpal, and his adult children, plaintiffs Troy Humpal and Tracy Humpal-Johnston, sued Nelson; Hildebrand; and their medical group, Beaver Medical Group. The Humpal family alleged that the defendants failed to properly treat the decedent’s condition, resulting in the decedent’s wrongful death. They also alleged that the defendants’ failure constituted medical malpractice. The decedent’s family also initially sued Makowski, Landreth, and Redlands Community Hospital, but they were ultimately dismissed from the case. Beaver Medical Group was also dismissed during trial. Thus, the matter continued against Makowski and Landreth only. Plaintiffs’ counsel argued that at the time the decedent presented to the emergency room at Redlands Community Hospital on April 4, 2013, he had a high-risk, unstable angina and that as a result, a treadmill test was absolutely contraindicated. Counsel also argued that Nelson was negligent for ordering a treadmill test and that Hildebrand was negligent for performing the treadmill test. Plaintiffs’ counsel contended that Humpal should have been referred to the catheterization laboratory for an angiogram, which would have revealed a critical lesion in the left anterior descending artery that could have been stented and that would have caused the patient to survive. The plaintiffs’ interventional cardiology expert testified that Hildebrand violated the standard of care by performing a treadmill test on the decedent. The expert further testified that all patients with unstable angina should be sent to the cath lab to undergo an angiogram. The plaintiffs’ expert hospitalist testified that the decedent’s presentation to the emergency room on April 4, 2013 was consistent with a high-risk, unstable angina. The expert also testified that a treadmill stress test is contraindicated in the face of a high-risk, unstable angina. Thus, the expert hospitalist opined that it was below the standard of care for Nelson to order a treadmill test. The defense’s expert cardiologist testified that the decedent did not have an unstable angina at the time of his presentation to the emergency room on April 4, 2013. The expert testified that the prior episode of chest pain was explained by a combination of factors, including missing a dose of his beta-blocker medication, Metoprolol, high blood pressure, and stress from his job. Accordingly, he opined that a treadmill stress test was absolutely appropriate and indicated under the circumstances. The defense’s internal medicine expert testified that the decedent did not have an unstable angina at the time he presented to the emergency room on April 4, 2013. Thus, the expert opined that Nelson complied with the standard of care by admitting the decedent to the hospital with a diagnosis of acute coronary syndrome. He further opined that in light of the negative serial troponin levels and negative serial EKGs, it was appropriate and within the standard of care for Nelson to order a treadmill stress test, pending an evaluation by a cardiologist., Richard Humpal went into cardiac arrest, resulting in leg pain and severe shortness of breath. He also became weak and hypotensive. However, after approximately 32 minutes of CPR, respirations and bagging, Humpal was pronounced dead on April 5, 2013. He was survived by his wife, Bonnie Humpal, and adult children, Troy Humpal and Tracy Humpal-Johnston. Mrs. Humpal claimed that she lost cash financial contributions totaling $20,000 per year. Humpal-Johnston claimed that she lost cash financial donations totaling $5,000 per year and Troy Humpal claimed he lost cash financial contributions of $9,000 per year. Overall, the decedent’s family sought recovery of $670,000 in lost financial contributions and household services, assuming a normal life expectancy. The defense’s expert cardiologist testified that the decedent’s life expectancy was no more than one to two years, based on the extensive nature of the decedent’s underlying coronary artery disease. The court also allowed defense counsel to introduce evidence that Mrs. Humpal had filed for legal separation in January 2008. In response, plaintiffs’ counsel introduced evidence through witnesses that established that Mrs. Humpal and the decedent never separated during their marriage. Mrs. Humpal justified filing a legal separation document as simply a tactic to separate and protect her personal assets. Accordingly, defense counsel was allowed to argue that Mrs. Humpal committed a fraud on the family court and, therefore, her testimony at the civil trial regarding damages should not be believed. Thus, the court’s ruling had a significant impact on the credibility of Mrs. Humpal, as well as the decedent’s family’s claim for loss of financial support.