At around 11:15 p.m. on Aug. 31, 2014, plaintiff Francisco Guevara, 19, a surgical technician with the United States Air Force, presented to the emergency department of Mercy Southwest Hospital, in Bakersfield, with lacerations to his right hand and fingers. He reported that he was attacked with a knife by an unknown assailant at approximately 10:30 p.m. while he was sitting in the driver’s side of a vehicle with his girlfriend in the passenger seat. Guevara claimed they were in the vehicle with the windows down, waiting for a late-night screening of a movie at the movie theatre near Valley Plaza, in Bakersfield, when the assailant reached in and slashed him with a knife. He also claimed that he raised his right hand over his face to protect himself and ended up with lacerations to his pinky, ring, middle, and index fingers. The police were subsequently notified, and Guevara and his girlfriend were interviewed at the hospital. Photographs of Guevara were also taken of his hand post-attack in the early morning hours of Sept. 1, 2014. However, no arrests have ever been made. While in the emergency department, Guevara was examined and treated by Dr. Eural Gordon. At approximately 12:13 a.m. on Sept. 1, 2014, Guevara underwent an X-ray of his right hand. Gordon personally reviewed the X-ray that he ordered and saw no abnormalities. The X-ray was later interpreted by Dr. Jeffrey Child as exhibiting no significant arthropathy or acute abnormality of the bones. Child also interpreted the X-ray as exhibiting no visible soft tissue swelling, and no fracture or dislocation. Given the reviews of the X-ray and its lack of any positive pertinent findings, Gordon irrigated the wounds and applied 1 percent lidocaine to all affected fingers so that pain would not potentially mask physical examination findings. He also used single layer Vicryl 5-0 absorbable sutures to repair the injured digits. In addition, Gordon tested Guevara for both DIP and PIP flexion function, which Gordon claimed provided normal results. However, Guevara contended that he suffered an injury to the tendons of his right hand, which ultimately required a number of surgical procedures. Gordon discharged Guevara from the emergency department at 5:56 a.m. on Sept.1, 2014. Upon discharge, Guevara was instructed to follow up with his primary care provider within two to three days for a wound check. He was also prescribed Bacitracin to be applied three times a day, 500 milligrams of Keflex, 600 milligrams of ibuprofen, and Norco. Gordon provided no further care or treatment to Guevara following the visit to the Mercy Southwest’s emergency department. Guevara sued Mercy Southwest Hospital; Gordon; Gordon’s medical office, Pinnacle Emergency Physicians of Bakersfield; Gordon’s supervising physician, Dr. Ellen Crowe; and the physician who performed the later surgical procedures on Guevara, Dr. Gary Chen. Chen and Crowe were ultimately let out of the case by way of summary judgment motions. Mercy Southwest, which was named as a defendant under a respondeat superior theory, was also dismissed from the case when it became clear that Gordon was employed by Pinnacle Emergency Physicians of Bakersfield, and not employed by the hospital directly. Thus, Gordon stipulated that he was within his course and scope of employment with Pinnacle Emergency Physicians of Bakersfield at the time he treated Guevara. Plaintiff’s counsel contended that Gordon was negligent in his examination and evaluation of Guevara’s digit lacerations and that Gordon was negligent for failing to splint Guevara’s hand. Counsel also contended that Gordon was negligent for failing to refer Guevara to a hand surgeon (either directly or through Guevara’s primary care provider) and/or for failing to seek the assistance of his supervising physician, Crowe, who was on-site at Mercy Southwest’s emergency room and available for consultation, if deemed appropriate by Gordon. Defense counsel argued that Gordon met the applicable standard of care at all times, in all aspects of his visit with Guevara on the early morning hours of Sept. 1, 2014, and that there was nothing that Gordon either did or did not do that was a substantial factor in causing the Guevara’s alleged and damages. Gordon claimed that upon his arrival at the patient’s bedside, Guevara verbally indicated to him that he could move his fingers (extension and flexion). He also claimed that he visualized Guevara moving his fingers while they were wrapped in the dressing that Guevara had placed on himself after the injury-producing event. However, Guevara disputed Gordon’s claim and denied ever being asked to extend and flex his fingers. Guevara also claimed that he never was able to make a full fist with his fingers on the night in question while in the E.R., either by way of passive or active flexion. Defense counsel noted that Gordon’s dictated E.R. note stated that the range of motion of all Guevara’s phalanges were normal, with no deficits, at all times while in the E.R. In terms of testing for tendon function, Gordon testified about how he tested and evaluated Guevara’s distal interphalangeal (“DIP”) function. He also testified that he had Guevara lay his hand on the table, palm side up, and then laid his own hand across Guevara’s hand so as to isolate the DIP joint on each finger. He explained that he then had Guevara flex his fingers, which allowed him to determine whether or not there had been any kind of injury to the flexor digitorum profundus (“FDP”) tendon, as that tendon is responsible for DIP function in the hand. Gordon claimed that he did the test for all of the fingers that were lacerated and characterized them as active flexion, as opposed to passive flexion. Thus, he claimed that his physical examination findings were that Guevara had full range of motion intact following the DIP function testing, which helped him conclude that Guevara did not have completely lacerated tendons as of that visit. Gordon further explained that if the tendons were completely lacerated, Guevara would have had non-existent DIP functioning on examination. Gordon testified that if he suspected a tendon laceration for a patient like Guevara, his custom and practice would be to notify his supervising physician in the E.R., Crowe, and then either refer the patient out to a primary care provider for an orthopedic hand surgeon referral or directly refer the patient to an orthopedic hand surgeon himself. He claimed that he took no such actions because there was no indication, from his perspective, that Guevara had suffered any tendon damage based on his physical examination findings, Guevara’s ability to make a fist, and the X-ray results., Guevara claimed he suffered an injury to the tendons of his right hand. He ultimately underwent a number of surgical procedures to treat tendon problems in his right hand. Guevara presented to the emergency department of Kaiser Permanente Baldwin Park Medical Center, in Baldwin Park, on Sept. 3, 2014. He was seen by an emergency medicine physician, Dr. Craig Huber, who discharged Guevara with instructions to continue using Keflex, washing the wound once a day with soap and water, and to return to the emergency department as needed. Guevara returned to Kaiser Permanente Baldwin Park Medical Center’s emergency department on Sept. 17, 2014, and he was seen by another emergency medicine physician, Dr. Michael Guirguis, for suture removal. According to the records, Guevara indicated during the visit that his hand shook when he attempted to close it. In addition, Guirguis noted during his examination of Guevara that there was full extension of the fingers, but no flexion of the DIP joints on the second through fifth fingers. Thus, Guevara was diagnosed with multiple right finger flexor tendon lacerations and was discharged home with instructions to follow up with the Veteran’s Affairs orthopedics department that same day for surgical consultation. On Sept. 22, 2014, Guevara saw Dr. Allen Lu, an orthopedic surgeon, at SCOSI (Southern California Orthopedic Sports Institute) Orthopedics, in City of Industry. During that visit, Guevara reported numbness and tingling in his fingers. Lu noted that Guevara was unable to flex his fingers at the DIP joint or at the proximal interphalangeal (“PIP”) joints. Thus, Lu informed Guevara that the likely course of treatment would be surgery. Lu then referred Guevara to a hand surgery specialist. Guevara presented to a hand surgery expert on Sept. 24, 2014, and the examination revealed no active flexion at any of the DIP joints. Guevara did have intact function of the FDS tendons and could flex his digits to within 1 centimeter of his palm, flexing only at the metacarpophalangeal and PIP joints. As a result, the plaintiff’s expert hand surgeon recommended a two-stage reconstruction surgical procedure, including potentially the need for silicone rod placement. However, the expert did not believe there was enough palmaris longus tendon length in the wrist to be able to provide grafts for all four fingers. As a result, the expert did not perform the surgery or take Guevara immediately to an operating room. The treating hand surgery expert testified that he was operating under the assumption that Guevara’s tendons had been fully torn as of Sept. 1, 2014 and that Guevara was, therefore, outside of the critical window of time for a delayed primary repair. Guevara underwent a number of surgical procedures with Chen and another surgeon, Dr. Michael Rubinstein. Chen recommended the initial surgery and informed Guevara that there was going to be some residual dysfunction in the hand even after surgery. Chen performed the initial surgery on Dec. 22, 2014, at California Hospital Medical Center, in Los Angeles. It was a one-stage procedure that involved a right index, middle, ring, and pinky finger flexor tendon repair, reconstruction, and pulley reconstruction. Guevara then had four follow-up visits with Chen between December 2014 and February 2015. Chen also ordered Guevara to undergo formal rehabilitation therapy. Guevara returned to see his expert hand surgeon on March 27, 2015. The expert found Guevara to have severe stiffness of all four ulnar digits with severely limited DIP flexion. He also found, at that time, that Guevara had severe stiffness in all PIP joints. There were severe flexion contractures of the ring and small fingers, although Guevara could then touch his palm with the ring and small fingers. Guevara was also found to be unable to extend either digit more than 2.5 centimeters from his palm. Thus, the expert noted that Guevara had lost full extension of all four digits. As a result, the expert felt that additional physical therapy would not help Guevara’s condition, and he suggested that Guevara may need further surgical intervention. On April 28, 2015, Guevara was seen by Rubinstein, who recommended additional surgical procedures to repair the flexor tendons, the first of which was carried out on June 4, 2015. Guevara also underwent a subsequent surgical procedure (surgery number three) with Rubinstein on Jan. 13, 2016, for the insertion of silicone rods and pulley reconstruction of the right ring finger. Guevara claimed that he was scheduled to undergo a third surgical procedure with Rubinstein (surgery number four, in total), but that the procedure had not been performed or scheduled prior to trial. The plaintiff’s medical experts testified that it was expected that a fourth surgical procedure with Rubinstein (fifth surgery in total) would also be needed in the future. Guevara testified that he still has deficits in his fingers, although it has improved over time with usage and intensive post-operative physical therapy. He claimed that as a result, his fingers cause difficulties in performing his activities of daily living, including holding his newly born, 2-month-old daughter; changing her diapers; getting her dressed; etc. At the time of injury, Guevara was a reservist with the U.S. Air Force and had completed Phase II of his training to become an operating room/surgical technician with the military a few months before the incident. However, he claimed that since his injury, he has been placed on inactive status with the Air Force, but that he has been successful in the private world of insurance sales, earning multiple promotions and bonuses for his work. Guevara claimed that he tried to have his treatment transferred to the Armed Forces, but, for various reasons, it did not occur. He contended that the failure to refer resulted in a failure of treatment within the time frames required by the standard of care, thus complicating his course, prognosis and ability to continue his Air Force career as a surgical technician. The parties stipulated to a reasonable value of past medical expenses in the amount of $22,640.26 and stipulated to a reasonable value of future medical expenses in the same amount — $22,640.26 — for a total medical specials amount of $45,280.52. The plaintiff’s expert economist provided a present value calculation of Guevara’s alleged loss of future earnings, pension benefit package, housing allowance, etc. (all alleged to have been lost due to the asserted medical malpractice and inability to serve in the Air Force with his injury) in the amount of $554,776. (Guevara waived any claim for loss of past earnings.) Thus, Guevara sought recovery of $600,056.52 in total economic damages. He also sought recovery of damages for his past and future pain and suffering. During closing arguments, plaintiff’s counsel asked the jury to award approximately $1.4 million in total damages. Defense counsel noted that when Guevara presented to the emergency department of Kaiser Permanente Baldwin Park Medical Center on Sept. 3, 2014, two days after he was initially treated for the hand laceration, Huber documented in his visit note that Guevara exhibited normal range of motion, and no active bleeding, redness or discharge. Defense counsel noted that Huber explained in his deposition that he tests for range of motion in a patient with hand lacerations by assessing a patient’s ability to flex and extend their fingers. However, at trial, he claimed that the “range of motion” reference dealt with pronation and supination of the hand and wrist, as opposed to flexion ability of the digits. Thus, Huber agreed that he examined Guevara’s fingers, but he claimed he was looking for circulation distal to the laceration (which was located in the “No Man’s Land” of the border between Zone I and Zone II of the hand) as well as for sensation in each of the injured digits. Huber also testified that if Guevara complained of any tendon-related pathology during his visit on Sept. 3, 2014, his custom and practice would have been to examine Guevara further on those complaints and to document said complaints. As his record was silent as to any functional deficits in the fingers by Guevara, Huber testified that he would infer that no such complaints were made to him. Defense counsel contended that Guevara was only diagnosed with multiple right finger flexor tendon lacerations for the first time when he returned to Kaiser Permanente Baldwin Park Medical Center on Sept. 17, 2014. Counsel also contended that when Guevara was examined at SCOSI Orthopedics on Sept. 22, 2014, Lu assessed Guevara as having a “nontraumatic rupture of flexor tendons of hand and wrist.” The defense’s hand surgery expert conducted an independent medical evaluation of Guevara in Costa Mesa on Aug. 24, 2017. The expert opined that regardless of whether the tendon were traumatic or nontraumatic, Guevara had clear deficits in the involved four fingers of the right hand, with Guevara’s ring finger being in the worst condition. Although the defendants stipulated to the reasonable value of Guevara’s past and future medical expenses, defense counsel disputed the value of Guevara’s alleged loss of future earnings. Similar to the plaintiff’s economist, the defense’s expert economist provided a present value calculation of Guevara’s alleged loss of future earnings, pension benefit package, housing allowance, etc., but he opined that Guevara’s losses only totaled $101,970.