On Sept. 1, 2010, plaintiff Charles Blevins, 64, a banker underwent a right knee arthroscopy at Coastal Surgical Institute, an ambulatory surgical center that offers general and specialized surgical procedures for patients who do not require admission to a hospital. Subsequently, on Sept. 4, 2010, Blevins contacted his physician to report severe pain and a fever. He then went to the emergency room at Sierra Vista Regional Medical Center and underwent additional surgery and antibiotic therapy for pseudomonas aeruginosa bacterial infection. Blevins sued Coastal Surgical Institute and The Ruhof Corp., which provided sponges that were used to clean surgical instruments. Blevins alleged that the defendants were negligent in his treatment due to the use of unclean surgical instruments and that this negligence constituted medical malpractice. The Ruhof Corp. filed a cross-complaint against Coastal Surgical Institute. The Ruhof Corp. ultimately settled with Blevins prior to trial, and the matter proceeded to trial against Coastal Surgical Institute only. Blevins claimed that he contracted an infection via unclean surgical instruments, specifically, an improperly sterilized arthroscope. He also claimed that at least three other patients who had arthroscopies at Coastal Surgical Institute during the same time period also contracted the same infection. The plaintiff’s infectious diseases expert testified that outbreaks do not occur in the absence of negligence. The plaintiff’s orthopedic expert testified that any surgeon performing a surgery has the right to presume that the instruments are sterilized, just as the patient would. In addition, the plaintiff’s nursing expert testified that Coastal Surgical Institute violated the standard of care by having inadequate procedures for sterilization of instruments and for failing to train and supervise the personnel performing the sterilizations of the instruments. Coastal Surgical Institute denied liability and contended that the sponges from The Ruhof Corp. must have been contaminated. Its counsel noted that Coastal Surgical Institute immediately ceased performing all further arthroscopic surgeries and called in an infectious disease epidemiology team of experts to investigate the source of the bacteria. Counsel contended that as a result, all of the surgical instruments, the products used to clean the instruments and all surface cultures were sent to a lab. Counsel further contended that the manufacturers of all the sterilization equipment were called in and inspected their equipment, which all checked out as normal and are all still in use today. In addition, counsel contended that when the results of the cultures were obtained, they indicated that the source of the bacteria was the Endozime sponges, which are used to clean the surgical scopes and instruments following surgery and before sterilization. Counsel for Coastal Surgical Institute noted the sponges were manufactured and supplied by The Ruhof Corp. in sealed packages for one time use and are then discarded. Counsel further contended that when DNA confirmed that the bacteria from these sponges was the same strain of bacteria that caused Blevins’ infection, the sponges were immediately removed from Coastal Surgical Institute’s facility and the surgical arthroscopes were replaced. There have been no further infections. Thus, counsel for Coastal Surgical Institute contended that The Ruhof Corp. was solely responsible for Blevins’ infection and that once the sponges were removed and the arthroscopes replaced, there were no further infections at the surgical center. Counsel asserted that Coastal Surgical Institute’s sterilization policies and procedures have not been changed since Blevins’ surgery and that if a breakdown in those policies and procedures had been the cause of Blevins’ infection, one would expect other infections to have occurred, the situation to be ongoing, and the incidents to involve additional bacteria. The defense’s experts testified about a peer reviewed article published in 2011, which addressed a similarly extremely rare outbreak of pseudomonas at a hospital in Texas involving seven patients. The article concluded that the bacteria was able to get past their sterilization process, even though the instruments and scopes had been cleaned according to the manufacturer’s specifications. The article attributed this to biofilm, which can form around bacteria and cannot be detected by visual inspection. The article further explained that biofilm covers the bacteria and prevents it from being eliminated by proper sterilization procedures. Coastal Surgical Institute’s counsel contended that the Endozime sponges manufactured and supplied by The Ruhof Corp. had been contaminated when bacteria entered the packaging and used up all of the preservative, which was intended to prevent contamination. According to Coastal Surgical Institute’s counsel, The Ruhof Corp. has since doubled the amount of preservative used in its sponges, and there have been no further contamination incidents., After complaining of severe pain and a fever, Blevins went to the emergency room at Sierra Vista Regional Medical Center and was diagnosed with pseudomonas aeruginosa bacterial infection. As a result, he was hospitalized while he underwent intravenous antibiotic therapy. After one month, Blevins was released home with IV antibiotics. However, six months later, in May 2012, he underwent a complete knee replacement and one year later, he had a knee revision and hardware was replaced. The plaintiff’s orthopedic expert opined that the infection completely destroyed the tissue in Blevins’ right knee, causing Blevins to require the total knee replacement. The expert also opined that Blevins will require at least one additional replacement surgery in his lifetime. In addition, Blevins claimed that he cannot longer walk long distances without a cane and that he cannot walk more than four blocks. Coastal Surgical Institute reimbursed the out of pocket costs for medical treatment/consultation relating to the infections sustained by Blevins and the other three patients who were infected.