On Sept. 1, 2007, plaintiff Keyan Zameni, 16, a student, underwent the surgical removal of a spinal tumor at the T5 level, which had been previously identified by an MRI and CT scan after he had complaints of progressive back pain. The procedure was performed by Dr. Laurie Ackerman, a pediatric neurosurgeon, at Children’s Hospital Orange County. After surgery, pathology revealed that the tumor was an osteoblastoma,a rare, benign (noncancerous) bone tumor that often develops in the bones of the spine, and CT imaging studies showed a residual tumor. Keyan was ultimately discharged on Sept. 7, 2007, and during post-operative office visits, he reported resolution of his back pain and symptoms. On Nov. 7, 2007, a repeat full-body scan and CT scans showed recurrent growth of a tumor at the T5 level. Keyan was also experiencing recurrent back pain, although he did not have the physical symptoms of a spinal cord decompression. As a result, he consulted with Dr. William Loudon, a pediatric neurosurgeon, on Nov. 15, 2007, and a surgical excision of the osteoblastoma was recommended. Keyan’s family consulted with several other doctors, who all recommended a surgical excision. On Nov. 29, 2007, Keyan consulted with Dr. Afshin Aminian, a pediatric orthopedic surgeon, who recommended instrumentation and stabilization of the spine with fusion of the thoracic spine from T4 through T6. The plan was for Loudon and Aminian to participate in the operation as co-surgeons. Keyan and his parents met with Loudon and Aminian for pre-operative consultations to discuss the nature of the procedure, risks, benefits and alternatives. They ultimately agreed to go forward with the surgery, and signed consent forms. Loudon and Aminian then proceeded with the surgery on Dec. 18, 2007. During the operation, neuromonitoring was used to monitor Keyan’s sensory and motor functions in his extremities. Aminian was to place the pedicle screws to instrument the spine, followed by partial stabilization, excision of the tumor and decompression of the spinal cord by Loudon, as well as full stabilization and fusion by Aminian. However, during the placement of the pedicle screws, the neuromonitoring signals rapidly declined. Intraoperative investigation, including decompression and exploration of the spinal cord by Loudon, did not reveal any explanation for the signal loss and a wakeup test confirmed that Keyan was unable to use his lower extremities. As a result, the pedicle screws were removed, but with no improvement, and the surgery was completed. Keyan was then taken for an urgent MRI, which did not show any adequate explanation for the loss of function. After a consultation with Keyan’s parents, Loudon took Keyan for a second exploratory surgery; however, he did not find any hematoma, cord compression or other evidence explaining the loss of function. As a result, Keyan did not recover the functions of his lower extremities. After discharge from the hospital, Keyan was transferred to Craig Rehabilitation Hospital in Colorado, where he underwent several weeks of inpatient spinal cord injury rehabilitation. He subsequently underwent surgery at Cedars-Sinai Medical Center in West Hollywood, Calif., to stabilize his spine. Keyan sued Loudon, Aminian and Children’s Hospital Orange County. Keyan alleged that the defendants’ failed to obtain his informed consent, failed to properly perform the stabilization and fusion surgery, and failed to properly treat his condition. He alleged that these failures constituted medical malpractice. Keyan initially named St. Joseph Hospital, Dr. Gina Cruz and Ackerman, who performed the original tumor removal, as defendants as well. However, they were never served, and Children’s Hospital of Orange County was dismissed from the case very early on. Thus, the matter proceeded to trial against Loudon and Aminian only. Plaintiff’s counsel contended that Loudon and Aminian failed to obtain Keyan’s informed consent and that they proceeded with the surgery in an unsafe order. Counsel argued that Loudon should have removed the tumor and decompressed the spinal cord prior to the placement of the pedicle screws. Counsel also argued that the cord injury was caused by bruising of the cord, which would not have occurred had the decompression occurred first. Alternatively, plaintiff’s counsel argued that the misplacement of one of the pedicle screws by Aminian injured Keyan’s spinal cord. Counsel for Loudon and Aminian contended that the order of the surgery was an intraoperative decision within the judgment of the surgeons. Counsel also contended that in the absence of physical symptoms of cord compression, it is preferable to place the pedicle screws prior to removal of the tumor because that order provides the most stability for the cord, best visualization for placement of the screws and, overall, presents less risk than removing the tumor first. Defense counsel argued that the mechanism of injury was never identified by any of Keyan’s several treating physicians. Counsel also argued that the post-operative MRI studies did not reveal evidence of direct injury or compressive injury, as argued by plaintiff’s counsel., Keyan is now a paraplegic. He currently ambulates using a wheelchair and is semi-independent in his activities of daily life, although the nature of his loss of function has caused continued difficulty with matters such as housework, transfers, bathing and dressing. He claimed that he requires assistance from his father and that he has a neurogenic bowel and bladder, which require self-catheterizations and have led to numerous urinary tract infections. Keyan claimed he suffers ongoing neuropathic pains that require heavy use of narcotic medication, which he developed a dependency on. He further claimed ongoing issues with depression, which in combination with the effects of his medication use, has affected his ability to participate in school, leading him to drop out of college. Thus, Keyan sought recovery of $12.5 million in economic damages for his past and future medical costs and past and future loss of earnings. He also sought recovery of significant damages for his past and future pain and suffering, in which, if he prevailed, would be limited to $250,000 by MICRA. Defense counsel argued that, based on national studies and the testimony of defense experts, Keyan’s life care plan and economic analysis based thereon were significantly inflated and not representative of the true costs related to a spinal cord injury at the T5 level. The defense’s damages experts placed Keyan’s medical expenses in the range of $2.5 million, which was consistent with the national averages for spinal cord at the T5 level. Defense counsel further argued that Keyan would not suffer any significant loss of earning capacity, as Keyan was still capable of completing college and competing for the professional jobs that had interested him prior to his injury.