On Aug. 17, 2016, plaintiff Emma Enkhamgalan was born at Contra Costa Regional Medical Center, in Martinez, via a Caesarean section. Emma’s mother, plaintiff Dagiimaa Sungiidorj, 28, had been admitted to the teaching hospital on Aug. 16, 2016. Upon admission, the infant’s heart tones and reactivity demonstrated that she was neurologically intact, and the expectation was for a vaginal delivery of a healthy baby by a resident physician. However, early in the morning on Aug. 17, 2016, the infant was determined to be not tolerating the uterine environment, in distress and unlikely to be able to be delivered vaginally. As a result, by 9:30 a.m., there were considerations by a physician resident recommending a C-section. For the next 7.5 hours, Emma continued to demonstrate intolerance of labor, and decelerations or drops in heart rate persisted. There was also no meaningful advancement through the birth canal, and meconium, or an initial fetal bowel movement, went from thin to moderate to thick. The hospital had in-house anesthesiologists that should have been able to perform emergency C-sections in 15 minutes, but a physician failed to deliver for 33 minutes after the decision was made to perform a C-section. The infant ultimately suffered hypoxic ischemic encephalopathy. Sungiidorj, Emma and Emma’s father, Enkhamgalan Khatanbaatar, sued the operator of the hospital, Contra Costa County; the anesthesiologist, Dr. Peyman Keyashian; the county’s health maintenance organization, Contra Costa Health Plan; and several of the county physicians and nurses who treated Sungiidorj and Emma. The lawsuit alleged that the defendants failed to timely treat Emma, resulting in her birth injury, and that this failure constituted medical malpractice. Contra Costa Health Plan and the individual care providers employed by the county were let out of the case, and the matter continued against the county and Keyashian (who was not a county employee). Plaintiffs’ counsel contended that a C-section should have been recommended as early as 9 a.m. on Aug. 17, 2016, and that each time there was additional evidence of continued or more severe fetal distress thereafter, a C-section should have been recommended. Counsel asserted that when the C-section was called for, it had to be performed within 15 minutes, not the 33 minutes the county’s medical staff took to deliver Emma. Plaintiffs’ counsel contended that it was noted that Emma began to suffer repeat decelerations, tachycardia and meconium beginning many hours before delivery and that when meconium is found in utero, it is an indication of fetal distress. Counsel also contended that when the fetus is in distress, it is then at risk of aspiration, which can be fatal, or otherwise have respiratory problems and even hearing loss. Plaintiffs’ counsel noted that nursing interventions for Emma’s decelerations were implemented, but that the decelerations continued and Emma’s fetal distress persisted. Plaintiffs’ counsel asserted that Sungiidorj’s labor, as a new mother, should have progressed in an expected fashion, generally dilating 1.2 centimeters per hour after 4 centimeters, and that a failure to progress as such posed a risk to the fetus and suggested cephalopelvic disproportion. Counsel also asserted that there was early, extensive and continued evidence of cephalopelvic disproportion and that Emma could not be delivered vaginally, as there was clear evidence of arrest of descent/labor. Plaintiff’s counsel contended that Sungiidorj never progressed further despite laboring and, later, pushing for more than 6.5 hours. Throughout that entire time, there was a category-II strip for variable and late decelerations. Counsel also contended that, during that entire time, meconium worsened, Sungiidorj was tachysystolic, and Emma showed ongoing signs of fetal distress and intolerance of labor. Thus, plaintiffs’ counsel asserted that there was no benefit for Emma to remain in utero and that the longer labor progresses, the riskier any C-section, whether emergent or not, increases. Plaintiff’s counsel further asserted that there were failures at the hospital before and during Sungiidorj’s labor. Counsel contended that the records did not reflect an estimated fetal weight for Emma, despite the performance of ultrasonographies, including during labor and delivery. Counsel asserted that the estimated weight for Emma should have been done, as Sungiidorj had an "untested pelvis," since this was her first pregnancy and she had a small frame with a height of 5 feet, 2 inches and a weight of 118 pounds pre-pregnancy. Plaintiffs’ counsel contended that Emma’s birth weight was eventually noted to be 7 pounds, 11.5 ounces, which was a relatively large baby for such a small mother, and that if it had been known earlier, the prospect of a vaginal delivery would have been exceedingly remote. Thus, counsel asserted that the expected length of time for delivery, given a sterile vaginal examination coupled with fetal distress, dictated that a C-section should have been performed. In addition, plaintiffs’ counsel asserted that Sungiidorj’s labor was negligently augmented with Pitocin, despite Emma’s fetal heart tracing being at category II, which indicated that Pitocin should not be started when the fetus already showed evidence of hypoxemia. Counsel contended that Pitocin also leads to a risk of tachysystole, or frequent contractions, more than five in a 10-minute period, which deprive a fetus of an opportunity to recover between contractions. Those frequent contractions also decrease fetal perfusion. Plaintiffs’ counsel asserted that, consequently, Sungiidorj had tachysystole for nearly 12 hours prior to delivery. Defense counsel asserted that the treating medical staff complied with the standard of care and that no act or failure to act caused Emma harm., Emma suffers from hypoxic ischemic encephalopathy, a brain injury caused by oxygen deprivation to the brain, also commonly known as intrapartum asphyxia, which resulted in impaired neuropsychological test scores. She also suffers from bilateral sensorineural hearing impairment, which happens after inner ear damage. At birth, Emma had no heartbeat, and was limp, apneic and blue with thick meconium. She was ultimately intubated and suctioned. She intermittently took a few breaths, and passive cooling was started at about 10 minutes. Emma was then transferred to the nursery for ongoing stabilization. She had Apgar scores of 1, 4 and 5 at one, five and 10 minutes. She had moulding (an abnormal head shape that results from pressure on the baby’s head during childbirth), cephalohematoma (a collection of blood between a baby’s scalp and the skull), a subdural hemorrhage, and a 5 to 6 centimeter caput (swelling) on left occipital parietal scalp. Plaintiff’s counsel contended Emma’s condition after birth was evidence of CPD, as the moulding is due to head compression moving through the birth canal, and that the evidence establishes a lack of true descent with fetal head position assessment. After intubation, it was determined that Emma needed a higher level of care. As a result, she was transferred to UCSF Benioff Children’s Hospital, in Oaklandm where she was treated at the hospital’s high-risk pediatric neurology department for the first couple of years of her life. According to plaintiff’s counsel, since the matter was a government code claim and the statute requires that the case be tried within five years of filing, counsel was hampered in the ability to marshal evidence of future earnings impairment. Specifically, plaintiffs’ counsel contended that "super cooling," as Emma was cooled after birth, can "mask" an injury that does not manifest for many years into development. Emma and her parents, Sungidorj and Khahanbaatar, sought recovery of Emma’s past and future medical costs, and damages for Emma’s past and future pain and suffering. Defense counsel contended that after only a few weeks of life, Emma’s neuromotor physical exams were all within normal limits and that despite an inauspicious start to life, Emma has done fairly well. Counsel also contended that there are multiple causes of sensorineural hearing loss, including Cytomegalovirus (a virus found around the world and related to the viruses that cause chickenpox and infectious mononucleosis), which Sungiidorj had and that as a result, Emma’s presentation was not consistent with hypoxic ischemic insult. In addition, defense counsel asserted that Emma’s parents were partially responsible for Emma’s impaired language development because they failed to require Emma to wear her hearing aids, as repeatedly instructed by healthcare providers. Defense counsel asserted that Emma’s neuropsychological evaluation in the academic setting did not identify deficits and that Emma has been thriving in school. Thus, defense counsel asserted that any future earnings loss was highly speculative.