On Jan. 22, 2013, plaintiff Steven Pawling, 61, presented to Dr. Ravi Patel, a board certified medical oncologist, for treatment of skin cancer that was detected in a major salivary gland on his left side. He underwent a staging workup, during which multiple imaging studies, including a PET scan, were performed. The imaging studies revealed significant radiographic abnormalities in the chest and lungs. Pawling previously had a lengthy history for skin cancers in the nature of squamous cell carcinoma and/or basal cell cancer. In late December 2012, he noticed a lump in the left side of his cheek. As a result, Pawling went to his family physician of approximately 20 years, and the physician ordered an ultrasound and biopsy of the left parotid gland. The ultrasound showed a mass and the biopsy, which was performed on Jan. 16, 2013, documented squamous cell carcinoma in the parotid gland. Pawling learned of the biopsy results of the biopsy on Jan. 22, 2013, and was referred to Patel, who saw Pawling that same day. Patel subsequently commenced a staging workup of Pawling, and the multiple imaging studies were read by four different board certified radiologists, who concluded that the significant radiographic abnormalities seen in Pawling’s chest and lungs were consistent with metastatic disease. Patel also had Pawling see another oncologic surgeon on Jan. 23, 2013, and again on Jan. 29, 2013. When the imaging studies came back, it appeared that Pawling had either metastatic cancer to the chest and lungs, or, alternatively, a different primary cancer in the same anatomical region. As a result, Patel informed Pawling and his wife that he believed that the scans proved that Pawling had Stage IV lung cancer. Patel then ordered a biopsy of the lungs, which was carried out on Feb. 4, 2013, but the biopsy results were found to be inconclusive. Patel subsequently informed Pawling and his wife that there was no histologic confirmation that the cancer had spread to Pawling’s lungs, but that Pawling could either start chemotherapy at that point and reevaluate the circumstances in three months, or, alternatively, undergo a repeat biopsy effort. Pawling elected to undergo chemotherapy. After approximately three chemotherapy sessions, restaging was carried out, including new imaging studies, in April 2013. Multiple radiologists concluded that the parotid gland tumor was shrinking in size, but that the radiographic abnormalities in the chest and lungs were basically unchanged. As a result, Pawling continued with the chemotherapy treatments and was restaged, including additional scans, in late May/early June 2013. This time, a radiologist reported that, in addition to the previously reported cancer, the radiology studies suggested a possible infectious etiology and/or inflammatory disease, such as sarcoidosis. Given the changed radiology differential, Patel referred Pawling to a pulmonologist for a further biopsy, which was attempted on July 23, 2013. The results were once again nondiagnostic. After Pawling completed his 10th and final chemotherapy session in early August 2013, additional imaging studies were carried out. The tumor in the parotid gland appeared to be growing, rather than shrinking in size, and Patel referred Pawling to a radiation oncologist for consultation as to whether or not radiation therapy should be given to the parotid gland and/or the chest and lungs. However, Pawling and his wife decided to get a second opinion and on Aug. 30, 2013, Pawling was evaluated by a medical oncologist at the University of Southern California. In her differential, the physician considered a new primary cancer and/or metastatic cancer, as well as a possible infection or inflammatory disease. The USC Tumor Board then met, and sarcoids in the chest and lung were suspected and favored as a diagnosis, over cancer. As a result, a bronchoscopy was performed on Sept. 16, 2013, and the pathological confirmation for sarcoidosis was obtained with no malignant cells identified. Pawling sued Patel and Patel’s medical office, Ravi Patel M.D. Inc., doing business as Comprehensive Blood & Cancer Center. Pawling alleged that he underwent unnecessary chemotherapy and aftereffects due to Patel’s negligence. He also alleged that Patel’s negligence constituted medical malpractice and that the medical office was liable for Patel’s actions. Additional parties were originally named in the suit, but the matter ultimately proceeded to trial as to Patel and his medical office only. Plaintiff’s counsel argued that Patel committed fraud in regard to the care and treatment rendered to Pawling. Specifically, counsel argued that Patel knew that without a histologic confirmation of cancer in the chest and/or lungs, there was no basis to tell Pawling that he had Stage IV cancer. Counsel also argued that Patel knew that Pawling would rely on his statement that Pawling had lung cancer based on the imaging studies, such that Pawling would likely follow Patel’s recommendations for chemotherapy, which would then result in substantial billings in Patel’s oncology practice. Counsel contended that Patel operated a very large cancer practice that employed numerous other oncologists and physicians in different specialties, including in-house imaging studies, labs and chemotherapy infusion centers, all of which were money-makers for Patel. Plaintiff’s counsel argued that Pawling’s first chemotherapy session, on Feb. 6, 2013, occurred before Patel knew about the failed biopsy effort. Counsel contended that the biopsy specimen was first sent, in a highly unusual way, to Patel before it was sent on to the pathology group that looked at the tissue under a microscope and that Patel had compromised the biopsy specimen, such that the pathologist received no lung tissue and, thus, concluded that the biopsy effort was nondiagnostic. Plaintiff’s counsel suggested that this was part of the overall fraud pattern that Patel allegedly engaged in for the purpose of insurance billing. Defense counsel denied that Pawling and his wife were ever defrauded by Patel. Counsel noted that Pawling’s wife testified that, at all times, Patel seemed to be polite, professional and caring with reference to her husband’s needs. Counsel also noted that Pawling’s family physician for over 20 years testified that he often referred patients in need of cancer treatment to Patel and Patel’s group, Comprehensive Blood & Cancer Center, because Patel was responsive to patient needs and that patients had reported back a high level of satisfaction relative to the care provided by Patel. Defense counsel argued that Patel met the standard of care in all material respects. Counsel contended that Pawling was staged promptly, beginning with the initial referral on Jan. 22, 2013, including all appropriate imaging studies and referral to an oncologic surgeon. Counsel also contended that, thereafter, Patel did not steer Pawling to chemotherapy based on the imaging studies, but, rather, obtained a biopsy of the lung tissue in an effort to confirm, under a microscope, that Pawling had cancer in his lung and chest, but that the biopsy effort was nondiagnostic. In addition, defense counsel contended that Pawling and his wife agreed that they were told that the tests could not confirm the presence of cancer and that Pawling and his wife agreed that the option of a rebiopsy was discussed with Patel. Thus, counsel argued that Patel’s actions were reasonable at all times and that when the imaging studies changed, for the first time in mid-May 2013, Pawling was immediately referred for an additional biopsy effort. Defense counsel further contended that Patel was supportive of the second opinion at USC., Pawling claimed that he underwent 10 unnecessary chemotherapy cycles, including the placement of a Port-a-Cath. He claimed that as a result, he suffered complications in the nature of a line infection and severe side-effects of the chemotherapy, including hair loss, chemo brain, peripheral neuropathy, severe fatigue, constipation, and a belief that although treatment was being provided, he had been given a death sentence in the nature of metastatic lung cancer, such that severe emotional distress occurred. Pawling alleged that he has never been the same since undergoing chemotherapy and that he continues to experience memory loss problems, peripheral neuropathy and fatigue. Pawling did not pursue recovery of economic damages and only sought recovery of non-economic damages for his past and future pain and suffering. His wife, plaintiff Melanie Pawling, sought recovery for her loss of consortium. Thus, plaintiffs’ counsel asked the jury to award the Pawlings $37 million in total damages.