On Feb. 1, 2017, claimant John Mitchell, 53, an electrical engineer, presented to a Kaiser workers’ compensation physician with complaints of back pain, numbness and weakness. He reported that he had injured his back during a work fall in early 2016 and that his symptoms grew progressively worse, starting in late 2016. The physician gave Mitchell steroids and a muscle relaxer, and then told Mitchell to return for a follow-up in one week. When Mitchell returned to the workers’ compensation doctor on Feb. 8, 2017, Mitchell reported increased numbness and weakness in his legs. The doctor suspected a possible herniated disc or spinal cord compression and sent Mitchell to a Kaiser emergency room for an MRI of his lumbar spine, which was performed several hours later and showed only mild degenerative changes. The treating emergency room physician then met with a physician’s assistant to decide whether Mitchell should be referred to a spinal surgeon, but they, instead, opted to recommend a physiatrist. Mitchell was released from the hospital that day and returned to the workers’ compensation doctor on Feb. 10, 2017. She noted that Mitchell’s symptoms were not consistent with the negative MRI findings and sent an emergency referral to Kaiser’s neurology department scheduled for seven days later. In the interim, Mitchell met with Kaiser’s physiatrist on Feb. 15, 2017. The physiatrist noted that Mitchell likely had thoracic spinal cord pathology that was causing his symptoms and ordered a “STAT” MRI, but Mitchell was not scheduled for the test until Feb. 19, 2017, which was the first available appointment date. Mitchell met with the referred Kaiser neurologist on Feb. 17, 2017, but the doctor decided to wait until the MRI results before determining the proper treatment. Two days later, Mitchell returned to Kaiser’s facility to undergo his thoracic MRI. However, by that time, his condition had deteriorated to the point where he could not get on the MRI table without assistance, and once the MRI was over, he was unable to walk and required a wheelchair to get off the table. The MRI confirmed a herniated thoracic disc at the T9-10 level with spinal cord compression. As a result of the MRI finding, Mitchell underwent an emergency decompression surgery and laminectomy. However, he had sustained permanent neurological damage, resulting in incomplete paraplegia. Mitchell brought claims against the employees of the treating Kaiser doctors, Kaiser Foundation Hospitals Inc. and Southern California Permanente Medical Group, and the administrator of his health insurance policy with Kaiser, Kaiser Foundation Health Plan Inc. Mitchell alleged that the respondents failed to timely diagnose and treat his spinal cord compression and that their failures constituted medical malpractice. The matter proceeded to arbitration, per the Kaiser Foundation Health Plan arbitration agreement, which states that claims must be arbitrated through the Kaiser system. The binding arbitration was conducted at the JAMS San Diego Dispute Resolution Center. Mitchell’s counsel presented medical experts who stated that the typical diagnostic process involves ruling out various possible causes of a patient’s symptoms. Counsel maintained that the respondents should have performed a thoracic MRI sooner in order to diagnose or rule out the possibility of a thoracic cord compression. Counsel also maintained that if the MRI had been performed earlier, Mitchell’s spinal condition could have been addressed before it got worse. Mitchell’s counsel argued that once the physiatrist noted a possible thoracic disc compression on Feb. 15, 2017, an expedited MRI should have been ordered and that Mitchell should have been sent right to the emergency room or to Kaiser’s radiology department. Counsel noted that, instead, Mitchell had to wait four additional days for the MRI, which counsel argued made Mitchell’s condition worse. Mitchell’s counsel also argued that any of the Kaiser doctors who saw Mitchell between Feb. 1, 2017 and Feb. 19, 2017 could have, and should have, ordered an expedited, thoracic MRI. Counsel further argued that Mitchell should have been referred to a spinal surgeon after his initial emergency room visit and that a spinal surgeon would have realized that immediate surgery was necessary. The respondents’ counsel maintained that Mitchell’s treatment was timely and appropriate and that all of the treating Kaiser doctors met the standard of care. Counsel also argued that there was no way of knowing that Mitchell’s condition would decline as quickly as it did and that thoracic disc compressions are rare, which is why the Kaiser doctors did not test for it immediately., After the Feb. 19, 2017 MRI confirmed the thoracic spine compression, Mitchell underwent an emergency decompression surgery and laminectomy. Immediately after the procedure, his condition temporarily got worse due to post-operative swelling. Once the swelling went down, Mitchell underwent a course of occupational and physical therapy, which he was still undergoing at the time of arbitration. Despite treatment, Mitchell was left with permanent neurological and mobility deficits. He has incomplete paraplegia that causes neuropathy, and continued pain, numbness, and spasms in the lower half of his body. He initially required the use of a wheelchair, but he was ultimately able to teach himself how to walk again. However, he still has an antalgic gait and requires the use of a cane. Mitchell also has to use a wheelchair to ambulance long distances. Mitchell only has limited control of the lower half of his body. As a result, he no longer has sexual function, and he has a neurogenic bladder and bowel. As a result, he is on a special program that helps him use the facilities. He also has to relieve himself at specific times each day, and he uses medication and physical stimulation to help with defecation. Mitchell claimed that his could lead to further kidney or bladder problems in the future. He also claimed that using his arms to maneuver his wheelchair could lead to future upper orthopedic issues. Mitchell returned to work within months of his surgery. However, his experts opined that Mitchell should only work six hours a day and that Mitchell should retire at age 60, instead of at age 67. In addition, Mitchell claimed that due to his , he can no longer run recreationally, as he had before, and that he can no longer perform maintenance work around his home. Mitchell sought recovery of $4,238,018 in total damages, which included $2,708,154 for a life care plan that featured future doctor and hospital visits, medical exams, physical therapy, pain management, acupuncture, wheelchair replacements, home modifications, and attendant care. The total damages sought also included $31,536 in past lost earnings, $199,629 in future lost earnings due to working only six hours a day, $1,048,699 in future lost earnings due to his earlier retirement, and $250,000 in general damages for his past and future pain and suffering. The respondents’ expert neurosurgeon, Dr. Howard Tung, disputed whether the delayed MRI caused Mitchell’s . The respondents’ counsel argued that Mitchell’s thoracic herniation was calcified, which meant that it had been present for a long time, and that even if the cord compression was diagnosed earlier in February 2017, Mitchell still would have had the same . Counsel further argued that the decompression surgery caused Mitchell’s paraplegia because Mitchell’s condition initially declined after the procedure. The respondents’ expert physiatrist opined that Mitchell could return to work full-time and retire at age 67. The expert also opined that Mitchell would not get any worse and that too much medical assistance would be detrimental. Specifically, the expert physiatrist opined that an attendant or medical device would cause Mitchell to lose some of his remaining function. In addition, the respondents’ expert life care planner presented a life care plan that was based on Mitchell seeking treatment with Kaiser’s doctors for the rest of his life. However, Mitchell’s counsel argued that Kaiser could not force Mitchell to continue seeing Kaiser’s doctors. Mitchell’s counsel contended that Mitchell would prefer to get his future treatment from non-Kaiser specialists, which would cost more money.