In October 2014, plaintiffs’ decedent Ashley Picco, 30, a licensed vocational nurse, began experiencing episodes of severe shortness of breath, and chest tightness or discomfort. The symptoms occurred especially at night, when she would lay down in bed. As a result, it became necessary for her to prop herself up in bed with several pillows in order to relieve the shortness of breath so that she could sleep. Picco, who had been pregnant since June 2014, reported the symptoms of shortness of breath and chest tightness to Dr. Danielle Sawyer-Macknet, who was handling Picco’s prenatal care at Loma Linda Obstetrics & Gynecology. Sawyer-Macknet reassured her that the symptoms were likely common dyspnea of pregnancy. No further investigation, testing or referrals to outside consultants (such as a cardiologist) took place, and the complaints of shortness of breath were not recorded in the medical record. In the very early morning hours of Nov. 8, 2014, Picco’s husband found his wife to be unresponsive in bed, and called 9-1-1. Picco was subsequently rushed to Loma Linda University Medical Center, and her 24-week-old son was emergently delivered before she was pronounced dead. However, her son died just three days later due to complications of extreme prematurity. The subsequent autopsy revealed that Picco suffered from undiagnosed, idiopathic dilated and hypertrophic cardiomyopathy. As a result, her heart was found to be twice the size of normal at the time of the autopsy, and the coroner concluded that Picco’s death was caused by a sudden cardiac arrhythmia due to that undiagnosed, idiopathic dilated and hypertrophic cardiomyopathy. The decedent’s husband, Christopher Picco, and her mother, Elizabeth Wood, sued Sawyer-Macknet and Loma Linda Obstetrics & Gynecology. Plaintiffs’ counsel contended that the standard of care required Sawyer-Macknet to have investigated Ms. Picco’s complaints of shortness of breath, especially while in the prone position, with chest tightness and the need to be propped up with pillows in bed at night. Counsel argued that, instead, Sawyer-Macknet inappropriately assumed that Ms. Picco’s symptoms were due to dyspnea of pregnancy, thereby depriving Ms. Picco of the diagnosis and treatment that would have saved her life. One of the plaintiff’s OB-GYN experts, Dr. Laura Brodzinsky, opined that it was a breach of the standard of care to not refer Ms. Picco for a cardiology consult under the circumstances of the case. The plaintiff’s cardiology expert testified that a cardiology consultation would have resulted in an echocardiogram, which would have revealed the diagnosis of the idiopathic dilated and hypertrophic cardiomyopathy. The expert further testified that as a result of the diagnosis, treatment would have been initiated, possibly including a termination of the pregnancy, which would have saved the young woman’s life. Defense counsel argued that Sawyer-Macknet appropriately investigated and evaluated the complaints of shortness of breath, and that Sawyer-Macknet’s conclusion, under the facts of this case, that the condition was dyspnea of pregnancy was reasonable and within the standard of care. Counsel also argued that once the determination was made that Ms. Picco’s complaints were dyspnea of pregnancy, it was not necessary at that point to document in the medical record that the specific complaint had been evaluated. Defense counsel contended that it would have taken almost a month to reach the diagnosis of the idiopathic dilated and hypertrophic cardiomyopathy, if a referral had been made, at which time the initial step would have been to initiate a trial of diuretics and low-dose beta blockers. Counsel further contended that while that treatment would have minimized the risk of congestive heart failure from the idiopathic dilated and hypertrophic cardiomyopathy, to a reasonable medical probability, it would not have averted Ms. Picco’s fatal cardiac arrhythmia., Ms. Picco was found unresponsive in her bed, and she was subsequently rushed to Loma Linda University Medical Center, where she was pronounced dead on Nov. 8, 2014. An autopsy revealed that Ms. Picco died from a sudden cardiac arrhythmia caused by an undiagnosed, idiopathic dilated and hypertrophic cardiomyopathy. In addition, prior to Ms. Picco being pronounced dead, he 24-week-old son was emergently delivered at the hospital, but the baby died just three days later due to complications of extreme prematurity. Ms. Picco, 30, was employed as an LVN at Garden Pediatrics, in Redlands, but she allegedly had plans to return to school and obtain a registered nursing degree. She was survived by her husband, Christopher Picco, then a 35-year-old musician/music teacher, and her mother, Elizabeth Wood, then a 59-year-old ophthalmology office manager. Ms. Picco’s family sought recovery of $614,425 for their past and future loss of Ms. Picco’s household services and approximately $3,000 for funeral and burial expenses. They also sought recovery of past and future loss of financial support in the amount of either $1,337,861, based on Ms. Picco’s employment as an LVN, or $2,629,673, based on Ms. Picco’s possible future employment as an RN. Thus, they sought recovery of either the minimum amount of $1,955,286 in total economic damages (at present value) or the maximum amount of $3,247,098 in total economic damages (at present value), based on Ms. Picco’s employment status. In addition, Ms. Picco’s husband and mother sought recovery of noneconomic damages for the emotional loss of their wife/daughter.