On Sunday, Aug. 17, 2008, Jacob Janz, 18, was driving a dune buggy at the family ranch outside Atwater when the vehicle rolled and crushed his right, dominant hand under the roll bar of the vehicle. As a result, he suffered a dislocation fracture of the right index finger, as well as large, deep lacerations to the palm of the hand and a deep laceration to the base of the right index finger. Jacob arrived at Emanuel Medical Center in Turlock at 6:45 p.m., and capillary refill of the right index finger was noted to be normal at less than two seconds. Emergency Room Physician Kuljit Hundal, M.D., ordered an X-ray, Dilaudid for pain, and antibiotics. When the X-ray revealed a fracture of the right index finger, Hundal consulted with Richard Slovek, M.D., an orthopedic surgeon who Hundal considered to be the “hand expert” in the area. The decision was then made for Hundal to attempt to reduce the fracture in the emergency department and for Slovek to see Jacob the next day. As a result, Hundal discussed with Jacob’s parents the plan to perform the reduction of the fracture under conscious sedation in the Emergency Department. Prior to the reduction, Alexander Chan, M.D., a hospitalist, reviewed Jacob’s admitting history and performed a physical on Jacob at around 8:45 p.m. Chan testified that he could not recall checking the capillary refill of the right index finger at the time, noting that he only checked the pulses in the right wrist. At 9 p.m., Hundal performed the reduction procedure, resulting in improved, but not complete, reduction (alignment) of the fracture. Hundal then reported that there was good capillary refill at the right index finger, but that Jacob had no sensation at the tip of the finger was unable to move it. As a result, Jacob was admitted to the floor at around 10 p.m., and Hundal stopped by Jacob’s room at the end of his shift at around 2:15 a.m. to check on him. The nurse noted that Hundal instructed her to cut back the dressing on Jacob’s finger to better monitor the finger’s condition. The nurse note indicated that Jacob’s finger appeared grey/blue, as it had upon admission to the floor. Overnight, the condition of the finger appeared to worsen and Chan assessed the finger at around 5:25 a.m. He reported that the finger was purple and turned outward, noting that Jacob claimed he hit it in bed during his sleep, but that there still appeared to be vascular return. Slovek arrived at 7:15 a.m. and performed surgery on Jacob at around 10 a.m. He determined that the two arteries leading to the finger had been crushed and that repair was beyond his expertise. Slovek then spent the day, without success, trying to find a microvascular surgeon to accept the patient. At around 6 p.m. on Aug. 18, 2008, Jacob’s mother, frustrated by Slovek’s inability to locate an accepting microvascular surgeon, spoke to Charles Lee, M.D., at St. Mary Hospital in San Francisco, and Lee agreed to accept Jacob. Surgery was then performed in the early morning hours of Sept. 19, 2008, with a second surgery two days later. Despite these efforts, Jacob’s finger could not be rescued, and it was amputated on Sept. 11, 2008. Jacob initially sued only Slovek, Chan and Emanuel Medical Center. Jacob alleged the defendants failed to recognize his digit was suffering from vascular compromise and that the defendants were negligent in their efforts to get him to a qualified vascular surgeon, causing the loss of his finger. Chan and Emanuel Medical Center were ultimately dismissed from the medical malpractice action. After the statute of limitations expired, Lee was deposed and plaintiff’s counsel decided to name Hundal as a “Doe” defendant. In opposition to Hundal’s motion for summary judgment, plaintiff’s counsel argued that Jacob did not know Hundal’s identity or fault prior to his being named. Hundal’s motion was denied, but the court later granted a motion for a bifurcated trial on the statute of limitations issue. At trial for the statute of limitations issue, the jury was asked to decide if Jacob had enough information at the time the complaint was originally filed to name Hundal as a defendant. If he did, then the “Doe” amendment did not relate back to the original complaint and the amendment was void as being outside the statute of limitations. Defense counsel contended that prior to Jacob filing suit, Lee allegedly told both Jacob and his mother that he thought there had been an improper delay in getting Jacob to a qualified microvascular surgeon. Plaintiff’s counsel contended that it was not until Lee’s deposition that Lee made it clear that he was referring to Hundal’s delay in referring Jacob out, and that no mention was ever made about a vascular surgeon being needed immediately. Hundal claimed, by way of his hired experts, that he did nothing below the standard of care and that if he did, the finger could not have been saved anyway., Jacob was transferred to St. Mary Hospital in San Francisco and, in the early morning hours of Sept. 19, 2008, underwent surgery on the index finger of his right, dominant hand. He then underwent a second surgery two days later. However, despite the surgical efforts, Jacob’s finger could not be saved, and it was amputated on Sept. 11, 2008. Thus, Jacob sought recovery of general damages and damages for his future income loss.