On May 21, 2011, claimant Raymond Palmer, 17, a student, suffered an anoxic brain injury while under the care of physicians and nurses at Kaiser Hospitals. Prior to sustaining the brain injury, Raymond was the victim of multiple stab wounds while at a trolley stop on May 12, 2011. He survived the attack and was taken to a hospital. Since he was a Kaiser member through his grandfather’s plan, Raymond was stabilized at University of California, San Diego Medical Center and was on his way to a full recovery. However, while at the hospital, surgery revealed evidence of hemopericardium, or blood in the pericardial sac of the heart. However, his heart was not injured or damaged. Raymond subsequently underwent the removal of one kidney, a left colon resection and had subsequent colostomy. Following the surgeries, Raymond had difficulty being weaned from the ventilator, and developed agitation when sedation was weaned. He also failed multiple continuous positive airway pressure trials. Raymond was ultimately extubated at UCSD on May 18, 2011. Raymond remained extubated for a few hours and was then able to speak with his mother, Andrea Palmer, to answer her questions and follow instructions. However, he then had to be reintubated as a result of increased work of breathing; tachypnea, or rapid breathing; and respiratory failure. After being reintubated, Raymond remained sedated on Propofol and showed signs of agitation when sedation was weaned. As a result, once he was stable, Kaiser insisted that Raymond be transferred to one of its facilities. On May 20, 2011, Raymond was transferred to San Diego Medical Center/Kaiser Foundation Hospital, located on Zion Avenue in San Diego. Upon arrival, Raymond’s wrist restraints, which were utilized because of his bouts of agitation while intubated, were maintained and he was kept on the Propofol drip for sedation. An intensivist then examined Raymond and was concerned about the patient’s persistent fever, which she thought might be a reaction to the Propofol. As a result, the intensivist wrote an order to wean Raymond off of the Propofol and start him on Versed. However, as the evening wore on, Raymond started to become more alert and agitated. Despite receiving Versed at the maximum drip and a Fentanyl drip, Raymond was still waking up intermittently and trying to pull out his endotracheal tube, resulting in several recorded episodes of agitation the night of May 20 and the early morning hours of May 21. At around 7 a.m. on the morning of May 21, 2011, a nurse reviewed the restraint orders and noted that they were warranted because Raymond was “pulling lines, pulling tubes, [removing] equipment, [and] climbing out of bed.” At 7:30 a.m. on May 21st, the nursing staff changed shift and another nurse was assigned as Raymond’s day nurse. According to the initial nurse, she was concerned Raymond’s tube was going to get removed or the ventilator would get disconnected, and expressed that concern to the second nurse. The second nurse testified that the initial nurse also told him that she called the medical officer on duty during the night to get orders for Versed. The episodes of agitation continued to worsen during the morning hours — there were a total of eight episodes, which were coming closer together and lasting longer. A cardiologist ultimately came to evaluate Raymond’s heart and pericardial condition shortly after 10:00 a.m. He did a bedside echo ultrasound, which confirmed that Raymond’s pericardial effusion was stable with no change and no tamponade. At one point, a general surgeon came in to also evaluate Raymond and was present during the bedside echo. While the Code sheet is allegedly vague, incomplete and unclear, it appears from piecing together testimony that somewhere between 10:41 a.m. and 10:45 a.m., the ventilator alarms sounded from Raymond’s ventilator, showing low tidal volume. Upon assessment of the tube, a respiratory therapist noted that the tube, itself, was leaking. He saw that the tube was no longer properly in place and was starting to fall out. A third nurse noted that Raymond’s oxygen stats were declining and that his color was not good. The cardiologist then entered the room and checked Raymond’s heart again with the portable ultrasound, and noted that the heart was barely moving and that Raymond had no pulse. Consequently, “Code Blue” was called, and another physician reintubated Raymond at 10:50 a.m. During the code, Raymond went between pulseless electrical activity and asystole, which is colloquially known as “flatline” and is a state of no cardiac electrical activity. As a result, Raymond had no pulse or blood pressure from the time of the initial ultrasound until his heart rate returned, and the first rhythm strip that showed a pulse at the conclusion of the code was at 11:03 a.m. Thus, Raymond suffered an anoxic brain injury during the code. Raymond’s mother, Andrea Palmer, acting as a conservator on behalf of her son, an incompetent adult, brought claims against Southern California Permanente Medical Group Inc., Kaiser Foundation Hospitals and Kaiser Health Plan Inc. Raymond’s mother alleged that the respondents failed to properly treat and monitor her son, and that their failures constituted medical malpractice. The matter proceeded to arbitration. Claimants’ counsel contended that while at UCSD, no one ever expressed any concerns to the family about Raymond’s neurological status and no neurology consultation was requested. Counsel also contended that the second nurse assigned to Raymond had no experience as an assigned nurse directly responsible for a patient exhibiting agitation such as Raymond was showing. Counsel noted that the first nurse denied telling the second nurse that she called the medical officer on duty that night to get orders for Versed and that although the general surgeon first testified he did not get the impression Raymond was pulling at his tubes, this was contradicted by his notes. Thus, claimants’ counsel contended that the events leading up to the disconnected endotracheal tube were predictable and preventable, that the extubation and subsequent cardiopulmonary arrest were poorly handled, and that Kaiser’s physicians and nurses were negligent in their care and treatment of Raymond, which ultimately resulted in his permanent brain injury. These claims were supported by the testimony of the claimants’ experts. Defense counsel contended that, prospectively, the outcome Raymond suffered was not foreseeable and therefore, the respondents were not negligent. Counsel also contended that in order to aid Raymond with coming off of the ventilator, the level of agitation he exhibited was expected and acceptable. Defense counsel further contended that Raymond “possibly” had sustained brain damage as a result of the underlying stabbing event, and suggested that Raymond was unusually susceptible because of his overall physical state and the pericardial effusion., Raymond suffered an anoxic brain injury. Claimants’ counsel contended that Raymond did not have the brain injury as a result of the initial altercation that landed him at UCSD and, ultimately, at Kaiser. Counsel asserted that this was shown by the fact that Raymond was able to speak with his mother, answer her questions and follow instructions, when he was initially extubated for a few hours on May 18, 2011. However, counsel contended that Raymond, now 19 years old, can only read at a second-grade level and is learning to walk with a walker. Raymond also requires assistance with his activities of daily living, and needs around-the-clock supervision and care to keep him safe. Claimants’ counsel further contended that Raymond will never be able to hold a job and will never be able to live independently. Thus, in closing argument, claimants’ counsel requested that Raymond be awarded $8,649,721 in total damages, including a $250,000 maximum award under California law for non-economic damages. Counsel also asked that that total award include $1,124,068 for Raymond’s loss of future earning capacity and $7,275,653 for the value of Raymond’s life care plan. Kaiser’s counsel contended that Kaiser was not negligent in the monitoring and treatment of Raymond. Counsel also contended that Raymond may have sustained his brain injury as a result of the underlying stabbing event, making Raymond unusually susceptible because of his overall physical state and the pericardial effusion. Thus, Kaiser’s counsel asked the arbitrator for a respondents’ award.