On March 28, 2011, plaintiff Jamie Costa, 21, a grocery checker who was previously diagnosed with endometriosis, presented to the emergency room of Mercy Hospitals of Bakersfield with pelvic pain. A pregnancy test was positive and an ultrasound did not demonstrate the presence of a gestational sac. As a result, the E.R. physician suspected a tubal pregnancy and Costa was directed to follow up with her OB-GYN group. On March 30, 2011, Costa presented to San Dimas Medical Group in Bakersfield and met with Dr. Tillai Kannappan, who was not her usual physician. Kannappan got a repeat human chorionic gonadotropin (hCG) test, as well as a repeat ultrasound, which was interpreted as showing a suspicious area of the right adnexa. As a result, Kannappan suspected an ectopic pregnancy, as the area is highly suspicious for it. Costa claimed that she was then only given the options of surgery to end the pregnancy or, alternatively, to take methotrexate to conclude the pregnancy. Thus, Costa opted for the methotrexate injection. On April 1, 2011, Costa returned to her regular OB-GYN at San Dimas Medical Group with severe pelvic pain. This physician did a laparoscopy to find out more information and then performed surgery to remove what he thought to be a ruptured ectopic pregnancy. However, he found no evidence of a rupture or of a tubal pregnancy. Approximately one week to 10 days after she got the injections, Costa experienced bleeding and passed the products of conception, ending her pregnancy. Costa sued San Dimas Medical Group Inc.; Kannappan; the operator of Mercy Hospitals of Bakersfield, Dignity Health; and another OB-GYN physician, Dr. Gregory Klis. Costa alleged that Kannappan and San Dimas Medical Group failed to properly diagnose and treat her pregnancy, and failed to obtain her informed consent. Thus, she alleged that their failure constituted medical malpractice. Costa also alleged that that when she awoke from the laparoscopic surgery on April 1, 2011, a jeweled piercing on her left cheek had been disrupted, resulting in a scar, and that Dignity Health was liable for this injury. Prior to trial, Costa settled the scarring injury case against Dignity Health for $5,000. Klis was also dismissed for the case. Thus, the matter proceeded to trial against Kannappan and San Dimas Medical Group only. Costa claimed she had been told that, due to her endometriosis and prior surgeries for that condition, it was unlikely she would ever become pregnant. Plaintiff’s counsel contended that the hCG test was consistent with a normally developing early pregnancy, but that Kannappan told Costa that she had an ectopic pregnancy that could be life-threatening. Counsel also contended that Costa’s pelvic pain was consistent with her pre-existing diagnosis of endometriosis. The plaintiff’s OB-GYN expert testified that it would be expected that Costa would have pelvic pain from her endometriosis condition until the pregnancy was more advanced. Thus, plaintiff’s counsel argued that Kannappan was negligent in failing to order a progesterone test to determine if she had a non-viable pregnancy, which would have been consistent with a tubal pregnancy, before recommending a course of treatment. Costa testified that Kannappan gave her only two options, surgery or medication, both of which would terminate her pregnancy. Plaintiff’s counsel noted that Kannappan’s office note also reflected that only two options were discussed with Kannappan. The plaintiff’s OB-GYN expert testified that the standard of care required that Costa be provided with a third option — to monitor the pregnancy with serial hCG testing for 48 to 72 hours, at which time Costa’s pregnancy should be sufficiently advanced that a fetal sac would be visible on an ultrasound. Costa testified that Kannappan never told her that she might be too early in her pregnancy for an ultrasound to pick it up and that had she been told this, she would have waited the 48 to 72 hours so that a diagnosis of tubal vs. intrauterine pregnancy could be confirmed. Thus, Costa claimed that because she had not been provided with all of the information necessary to make an informed decision about whether to terminate the pregnancy, Kannappan had not obtained her informed consent to terminate the pregnancy. Kannappan denied the standard of care had been breached and maintained that it was reasonable, both at the time and in the present time frame, to suspect an ectopic pregnancy. She also maintained that there was absolutely no evidence to prove that Costa ever had a normal intrauterine pregnancy. In addition, Kannappan maintained that she gave Costa three different options, and not just the two that Costa alleged had been given to her. She claimed that she told Costa that she had a third option, which was to go home and simply return in a few days for further workup., Costa had a severe reaction to the methotrexate, which caused nausea, vomiting, and open sores in her mouth and genital area. She claimed the injection also terminated her normally developing early pregnancy. Costa claimed she suffered emotional distress as a result of the termination of her pregnancy and missed time from work. The experts for both sides agreed that it may be very difficult for Costa to become pregnant in the future. Thus, plaintiff’s counsel asked the jury to award Costa $250,000 in damages, including approximately $3,500 in lost earnings.