On Aug. 31, 2010, plaintiff John Herger, a retired 66 year old, first presented to Dr. Carmine Cammarosano, an ophthalmologist, and was diagnosed with keratoconjunctivitis sicca, or dry eye syndrome, which is an eye disease caused by eye dryness due to either decreased tear production or increased tear film evaporation. He then returned to Cammarosano with complaints of double vision and blurry vision on Sept. 21, 2010, and was subsequently diagnosed with sixth cranial nerve palsy, a disorder associated with dysfunction of the abducens nerve, which is responsible for causing contraction of the lateral rectus muscle to turn out the eye. (The inability of an eye to turn outward results in double vision or diplopia.) Based on Herger’s long-term history of hypertension, Cammarosano’s assessment was a vasculopathic sixth cranial nerve palsy, a condition that tends to resolve on its own within three to four months. As a result, Herger was to follow up within that time. In early October 2010, Herger sought a second opinion from Dr. Jonathan Perlman, who recommended an MRI. However, Cammarosano did not feel an MRI was indicated at that time. On Oct. 17, 2010, Herger suffered an acute neurological decline. It was determined that Herger had a chondroid chordoma, a rare skull-based tumor, which allegedly was the cause of his sixth cranial nerve palsy. It was also determined that Herger’s neurological decline was caused by bleeding around the chondroid chordoma. Herger sued Cammarosano, alleging medical malpractice. Plaintiff’s counsel argued that Cammarosano was negligent for failing to order an MRI, and for failing to suspect or diagnose a brain lesion. Specifically, counsel argued that Cammarosano was negligent for failing to order a more complete workup on Sept. 21, 2010, when Cammarosano first diagnosed the sixth cranial nerve palsy. In addition, counsel argued that Cammarosano should have ordered an MRI on either, or both, of the presentations — as Herger claimed he had first complained of double vision and blurry vision during the presentation on Aug. 31, 2010 — and that Cammarosano’s failure to do so resulted in a delay in diagnosing the chondroid chordoma. Plaintiff’s counsel contended that the delay in the diagnosis resulted in a bleed in or around the tumor that could have been prevented if an earlier diagnosis had been made and surgical intervention had been completed, all of which could have been completed between Aug. 31, 2010, and Oct. 17, 2010, or between Sept. 21, 2010, and Oct. 17, 2010. Cammarosano claimed that his care and treatment of Herger was at all times appropriate. Defense counsel contended that Herger did not report double vision to Cammarosano on Aug. 31, 2010, and that Cammarosano did not appreciate double vision or the sixth cranial nerve palsy during his examination of Herger on that date. Thus, counsel contended that Cammarosano appropriately diagnosed the sixth cranial nerve palsy on Sept. 21, 2010, and appropriately believed the cause to be vasculopathic, based on Herger’s significant history of hypertension. Defense counsel contended that because a vasculopathic sixth cranial nerve palsy will resolve on its own, it was appropriate for Cammarosano to have Herger return for a follow-up appointment within the next two months, at which time further testing would have been completed., Herger suffered an acute neurological decline as a result of bleeding around the chondroid chordoma, a rare skull-based tumor. He subsequently suffered a brain injury/cognitive loss, resulting in partial paralysis and decreased ambulation. Herger claimed that he now requires 24-hour care due to his current condition. Thus, he sought recovery of $56,078 for past household services, $179,786 for future household services, $2,428,596 for future medical care and services (life care plan), and $250,000 in general damages. Defense counsel contended that even if Cammarosano had ordered an MRI on Aug. 31, 2010, or on Sept. 21, 2010, treatment of a chondroid chordoma, a historically slow growing tumor, would have been nonemergent and, therefore, unlikely to have prevented the bleed on Oct. 17, 2010. Thus, defense counsel contended that Herger’s acute neurological decline and corresponding deficits were inevitable. The defense’s economics and life care planning experts opined that shorter respite care was appropriate.