In March 2010, the plaintiff, a 63-year-old retired woman, developed pain with numbness in her left leg and presented to Inland Valley Medical Center in Wildomar. The plaintiff previously underwent an aortoiliac bypass with placement of an artificial graft in 2008. After developing new pain in 2010, she was admitted to Inland Valley Medical Center for evaluation of her symptoms and a Doppler ultrasound showed monophasic flow in left leg, below the iliac artery. Two days later, the plaintiff had the beginnings of an ischemic ulcer, measuring approximately 2 centimeters by 3 centimeters. The attending physician claimed he palpated normal tibial and pedal pulses. However, blood tests showed creatine phosphokinase levels in excess of 37,500 microliters, above the normal levels of between 26 and 140 microliters. A CPK level above 37,500 meant the plaintiff’s leg muscles were being starved of oxygen and muscle cell death was occurring. Despite this, the plaintiff was sent home with a diagnosis of low potassium and muscle pain possibly due to statins. Two subsequent visits, about three weeks apart, to the same emergency room document that the ulcer had progressed from 2 centimeters by 3 centimeters on the shin to extending from the knee all the way to ankle. The plaintiff was subsequently given IV antibiotics at the E.R., but she was not admitted for treatment of an infection or for a diagnostic workup to determine the cause of her ischemia. The plaintiff finally presented to Scripps Hospital in San Diego and was immediately diagnosed by angiogram with a thrombosed graft, which, by then, could no longer be declotted. The plaintiff sued her attending physician at Inland Valley Medical Center. She alleged that the physician failed to diagnose her condition and that this failure constituted medical malpractice. Counsel for the plaintiff and her husband contended that the attending physician failed to appreciate the importance of the Doppler results, and that the differential diagnosis did not include the occluded aortoiliac bypass and graft. Counsel noted that the attending physician, at his deposition, stated that he did not understand the differences between mono-, bi-, and triphasic flow patterns on the Doppler exam he ordered. Counsel further contended that the attending physician did not ask the radiologist for an explanation of the Doppler findings or even bring in a vascular consult., The plaintiff’s ischemic ulcer progressed to stage IV, with tracking along the tibia. She was ultimately diagnosed with a thrombosed graft, which could no longer be declotted. As a result, she required an extra-anatomic axillobifemoral bypass from her axillary artery near her shoulder across the flank, down to her femoral arteries, on April 16, 2010. Plaintiff’s counsel noted that this was a much less efficient graft, which is more prone to occlusions and has a five-year patency rate significantly below that of her original bypass. The plaintiff’s ischemic ulcer remained open over the next two years, despite seven hospital admissions, 55 physician visits and four surgical procedures. She also underwent extensive physical therapy for neurological and soft-tissue damage, which resulted in a permanent foot drop to her left foot. The plaintiff sought recovery of damages for her medical costs and pain and suffering. Her husband sought recovery of damages for his loss of consortium. At mediation, defense counsel disputed the plaintiffs’ damages, asserting that once the patient’s original graft became occluded, the axillobifemoral bypass was inevitable. Counsel also asserted that in the early stages of the plaintiff’s illness, neither a thrombolysis nor a thrombectomy would have worked and should not have been attempted.