On Nov. 13, 2013, plaintiff Irma Perez-Castillo, a 30 year old who was 38 weeks pregnant, emailed her OB-GYN about how she was experiencing abdominal pain and a loss of appetite, as well as about how she was feeling less movement from her baby than normal. Perez-Castillo presented to her OB-GYN at Kaiser Permanente Hospital, in Woodland Hills, two days earlier for a routine follow-up appointment. During the appointment, she complained of abdominal pain and a loss of appetite. The OB-GYN physician told Perez-Castillo to go home and “eat whatever sounds good to you.” Two days later, Perez-Castillo, concerned her baby was moving less, emailed her OB-GYN about how she was still experiencing abdominal pain and a loss of appetite, but that she was now feeling less movement from her baby than normal. The OB-GYN emailed her back and told her to lie down and do kick counts. One hour later, Perez-Castillo emailed her OB-GYN again and stated that she was throwing up everything she eats. Perez-Castillo claimed that several back-and-forth emails between her and Kaiser staff went on throughout the day. By 5 p.m., Perez-Castillo and her husband presented to Kaiser Permanente’s Labor and Delivery Department, and were told that she suffered a fetal demise. Perez-Castillo sued Kaiser Foundation Health Plan Inc., Kaiser Foundation Hospital, and Southern California Permanente Medical Group, alleging medical malpractice. The matter ultimately proceeded to arbitration. Plaintiff’s counsel contended that Perez-Castillo’s OB-GYN failed to conduct an examination or order any blood work for her when she first presented to Kaiser Permanente Hospital with complaints of abdominal pain and a loss of appetite. The plaintiff’s OB-GYN expert opined that if an examination or blood work had been performed at the time of Perez-Castillo’s initial hospital presentation, the baby would have been saved. He also opined that if the OB-GYN had told Perez-Castillo to go into Labor and Delivery on the morning of her Kaiser Hospital presentation, the baby would have been born alive. He further that there was no standard of care issues during the pregnancy until Nov. 13, 2013, when Perez-Castillo should have been told to go to Labor and Delivery immediately. In addition, the plaintiff’s expert opined that during the follow-up visit on Nov. 11, 2013, the OB-GYN should have recognized the signs and symptoms of “acute fatty liver of pregnancy,” a rare disease that can cause stillbirths, and ran some blood tests that most likely would have led to additional blood work that might have diagnosed the acute fatty liver of pregnancy. However, on cross-examination, the expert admitted that acute fatty liver of pregnancy is a rare condition and that in all the years of practice, he only saw it a few times. He also admitted during cross-examination that there is no blood test that would diagnose this condition and that after the patient was hospitalized, she received great care and her life was saved. Defense counsel contended that on May 14, 2013, Perez-Castillo first presented to her OB-GYN for her pregnancy evaluation and that the estimated delivery date was Nov. 27, 2013. Thus, counsel argued that Perez-Castillo essentially had an uncomplicated pregnancy with expected progressive weight gain with no signs or symptoms of preeclampsia, which is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, often the kidneys. Defense counsel contended that Perez-Castillo experienced fetal movement during her pregnancy until she emailed her physician regarding decreased fetal movement on Nov. 13, 2013. Counsel also contended that when Perez-Castillo presented to her OB-GYN for a follow up visit on Nov. 11, 2013, her physician performed a vaginal examination and measured the fundus and that Perez-Castillo was found to have no signs or symptoms of preeclampsia, no signs of vaginal bleeding, no contractions or pressure, no leaking vaginal fluid or rupture of membranes, and no dysuria. Counsel further contended that there was fetal movement when Perez-Castillo reported some loss of appetite and some upper abdominal stomach pains (like a stomach ache). Thus, defense counsel argued that the assessment was that Perez-Castillo may be experiencing heartburn and that she was appropriately advised to take Tums, Pepcid and/or Tylenol, as needed, and to go to the hospital if her symptoms got worse, but that, instead, Perez-Castillo emailed the OB-GYN regarding decreased fetal movement at 6:10 a.m. on Nov. 13, 2013. Defense counsel noted that Perez-Castillo testified that the decreased fetal movement first started on Nov. 12, 2013, but that she did not discuss this with any physician until she emailed her OB-GYN the next day, at 6 a.m. Counsel argued that the OB-GYN, as well as a nurse, appropriately responded to Perez-Castillo’s emails and advised her to go to the Labor and Delivery Department to be evaluated, but that as of 5:10 p.m. on Nov. 13, 2013, Perez-Castillo had not gone. Counsel further argued that, instead, Perez-Castillo, called the Labor and Delivery Department at 5:10 p.m. and informed a nurse that her OB-GYN had told her to go to Labor and Delivery to be evaluated, but asked if she needed to go “now.” Defense counsel contended that Perez-Castillo was instructed to go to “Labor and Delivery for evaluation now,” and that Perez-Castillo arrived at Labor and Delivery and was admitted to the hospital at 5:53 p.m., when she was diagnosed with acute fatty liver of pregnancy and when the intrauterine fetal demise at 38 weeks was confirmed. The defense’s medical expert testified that Perez-Castillo’s complaint of stomach ache/pain on Nov. 11, 2013, was properly addressed and that there was no reason to run any blood work, as there was fetal movement during that visit. He also testified that acute fatty liver pregnancy is extremely rare and that it is a diagnosis of exclusion, so there was no test that would diagnose that condition. The expert admitted that Perez-Castillo was suffering from the rare condition of acute fatty liver of pregnancy on Nov. 13, 2013, but that the patient’s complaints could have been due to something benign or serious, so any physician would have instructed the patient to go for further evaluation, as occurred in the subject case. In addition, the expert testified that a physician would never alarm a patient by telling them to go to the Emergency Room or Labor and Delivery Department “right now” or “immediately” and that it was pure speculation to attempt to guess when the fetal death occurred., Perez-Castillo claimed she suffered emotional distress as a result of her unborn child’s death. Thus, she sought recovery of damages for her emotional pain and suffering, as well as sought recovery of special damages for her loss of earnings for the time she was recovering and for funeral and burial expenses. Perez-Castillo’s husband, plaintiff Jessie Perez, presented a derivative claim, seeking recovery of damages for his loss of consortium. Defense counsel contended that Perez-Castillo was properly instructed to go to the Labor and Delivery Department by the physician and nurse in the emails, but that Perez-Castillo did not arrive at Labor and Delivery until 5:53 p.m., when she was diagnosed with acute fatty liver of pregnancy and was informed of the intrauterine fetal demise at 38 weeks. Once admitted, Perez-Castillo was induced and the fetus was delivered on Nov. 14, 2013. Defense counsel contended that, thereafter, Perez-Castillo improved during the course of her hospitalization before being discharged on Nov. 18, 2013.