On Oct. 3, 2014, plaintiff Ryan Nguyen, 10, a student, underwent a second surgical resection of a craniopharyngioma, a type of benign brain tumor that occurs most commonly in children. The procedure was performed by a neurosurgeon at UCLA Medical Center, in Los Angeles. Ryan was first diagnosed with the craniopharyngioma in 2013, when he 9 years old. He was subsequently taken by his parents to UCLA Medical Center, where they met with a neurosurgeon who specialized in adult patients because the pediatric neurosurgeon was on medical leave. The neurosurgeon attempted a total resection in an attempt to remove the tumor endoscopically in June 2013. Following the resection, Ryan recovered, and in five weeks, was back in school and participating in all of his extracurricular activities. However, because of the size of the tumor and the unlikelihood of a complete removal because the tumor’s size, doctors advised Ryan and his family that Ryan would have to return to continually return to UCLA Medical Center and undergo MRIs to determine whether or not the tumor had returned. In June 2014, the MRI allegedly showed that there was a small 4 millimeter recurrence of the tumor. However, the recurrence was allegedly missed because of the small size. As a result, during a repeat MRI in September 2014, the recurrent tumor was detected and determined to be pressing against the optic chiasm. However, Ryan was completely asymptomatic at the time. The neurosurgeon who operated on Ryan in June 2013 ultimately felt that Ryan needed to be taken emergently back for further surgery. During the surgical resection that was performed on Oct. 3, 2014, Ryan suffered a massive cerebral hemorrhage and was subsequently given nicardipine, an antihypertensive drug, to treat the bleeding. After later being taken off of the medication, Ryan suffered a second stroke, resulting in additional brain damage on Oct. 14, 2014. Ryan’s father, Jonathan Nguyen, acting individually and as Ryan’s natural guardian, and Ryan’s mother, Mary Nguyen, sued the operator of UCLA Medical Center, the Regents of the University of California, as well as his treating doctors. Ryan’s parents alleged that the defendants’ negligent treatment and failure to timely diagnose Ryan Nguyen’s condition caused his strokes. Plaintiffs’ counsel contended that the hospital made multiple errors in the months before Ryan’s strokes. Counsel asserted that even though the neurosurgeon who performed the procedures specialized in adults, not children, the surgeon failed to inform Ryan or his parents that he wasn’t trained in pediatrics and failed to refer Ryan to a pediatric neurosurgeon at another facility, despite the fact that several world-renowned pediatric neurosurgeons allegedly practice in the Southern California area. Counsel also asserted that an adult neurosurgeon should not operate on a pediatric patient due to the significant differences in pediatric anatomy. Plaintiff’s counsel further asserted that evidence of the recurrence was missed on the June 2014 MRI and that if the tumor had been detected then, Ryan would have been a candidate for radiation therapy and could have avoided any further surgical procedures. Counsel contended that, instead, by the time the recurrence was discovered in September 2014, the tumor had doubled in size. Based on expert review, plaintiff’s counsel disputed the need for Ryan’s second surgery. Counsel asserted that there was no emergent need to proceed with a second surgery and that it was prudent to actually monitor the tumor over the course of several months before having to decide to go forward with surgery, especially since Ryan was still asymptomatic. Counsel contended that while the tumor was being monitored, Ryan’s case could have been presented to UCLA’s Tumor Board, a panel of specialists who give treatment advice to patients, to determine the best way to proceed with his case, but that at no time did the doctor tell the Nguyens about the existence and purpose of the Tumor Board. Plaintiffs’ counsel also asserted that the standard of care for treating recurrent pediatric craniopharyngiomas was to treat the tumor with radiation (with fractionated stereotactic proton radiotherapy being the most effective), and not surgery, but that the treating neurosurgeon told the family that a second surgery was their only option. In addition, counsel asserted that the neurosurgeon failed to ever advise the Nguyen family that they could have sought a second opinion before agreeing to any of the surgeries. The Nguyens claimed that if the neurosurgeon had told them their other options, they would not have consented to the second surgery. Plaintiffs’ counsel also questioned how the neurosurgeon decided to perform the second surgical resection. Counsel contended, based on expert report, that re-operating through the same approach meant that there were increased risks due to changes in anatomic location due to scar tissue. Counsel asserted that despite the risks, the neurosurgeon decided to perform the second procedure by going through the nose again, even though he knew there were significant risks of bleeding and complications due to the scar tissue from the first surgery. Plaintiffs’ counsel also asserted that the neurosurgeon performed the procedure endoscopically even though the standard of care for resection of pediatric craniopharyngiomas is to not use an endoscopic approach due to the smaller operative and visual fields and, thus, the greater risk of major complications, including stroke, and a significantly diminished ability to deal with the emergent complications. In addition, counsel noted that the neurosurgeon admitted that he was unable to distinguish between Ryan’s normal tissue and scar tissue during the second procedure and that as a result, instead of abandoning the surgery as the standard of care required, the neurosurgeon continued to dissect through areas of brain tissue he could not see. In doing so, the neurosurgeon transected Ryan’s anterior cerebral artery, causing a massive, life-altering cerebral hemorrhage. Plaintiffs’ counsel noted that as a result of the hemorrhage and damage to the artery, Ryan’s cerebral circulation went into periodic vasospasm, which had to be treated him with nicardipine, a drug designed to reduce/prevent vasospasms, which can increase the risk of further strokes. Counsel also noted that nicardipine, per the protocols of the manufacturer, should be given for a minimum of 21 days. However, plaintiff’s counsel asserted that the staff neurosurgeons and residents in neurosurgery discontinued the nicardipine on day 14, even though Ryan continued to have vasospasms, and that as a result, Ryan had a subsequent stroke within 24 hours. Defense counsel asserted that the neurosurgeon’s decisions in the lead-up to the surgery were at the doctor’s discretion. Counsel also asserted that the cerebral hemorrhage was a known side effect of the procedure and, thus, not a sign that the surgeon deviated from the proper standard of care., Ryan’s anterior cerebral artery was transected, resulting in a massive cerebral hemorrhage. As a result, his cerebral circulation went into periodic vasospasm. He was subsequently treated with nicardipine to reduce/prevent vasospasms, but that when the medication was discontinued, Ryan had a second stroke, resulting in additional brain damage. Ryan’s emotions and intellect remained intact, and he can speak intermittently, saying a few words here and there. However, he is now legally blind and can no longer walk, as movement in all of his extremities was significantly limited. He also needs a feeding tube to help him eat. Ryan continues to undergo occupational, physical, and cognitive therapy following the strokes. He also continues to require around-the-clock care from a nurse and/or his parents. The plaintiffs’ experts opined that Ryan’s earning potential was significant because he was an honors student both before and after the stroke, played multiple musical instruments, and excelled at computer coding. Ryan was also able to continue schooling after his stroke. However, the plaintiffs’ experts opined that Ryan’s physical limitations will prevent him from getting a job in the future. Plaintiffs’ counsel noted that Ryan recently had radiation surgery to destroy the remaining tumor and, thus, could live and work until at least his late 50s. Counsel also noted that Ryan is determined to walk again. Thus, the Nguyens sought recovery of damages in excess of $50,000 for past out-of-pocket medical expenses, in excess of $100,000 for past modifications to their home and a purchase of a modified vehicle, and in excess of $19 million for future medical expenses. They also sought recovery for Ryan’s past and future loss of earnings, and non-economic damages for his past and future pain and suffering. In addition, Ryan’s parents sought recovery due the alleged negligent infliction of emotional distress. Defense counsel maintained that Ryan’s life expectancy is only around 35 years, so his loss of earnings would not be as high as his parents alleged.