On Jan. 8, 2011, plaintiff Martha Martinez, 55, underwent a bilateral salpingo-oophorectomy by Eduardo Guzman, M.D., an obstetrician/gynecologist. Martinez originally presented to Guzman in 2009 for a regular gynecological checkup. Martinez was post-menopausal and had a history of three Cesarean sections, a total abdominal hysterectomy, and a laparoscopy for an ovarian cyst that Guzman was aware of when Martinez told him. During the 2009 visit, Martinez reported occasional right, lower quadrant discomfort. Guzman subsequently ordered an ultrasound, which revealed no abnormalities. On Dec. 8, 2010, Martinez again presented to Guzman for another gynecological checkup, during which Guzman wrote in his notes that Martinez reported right lower quadrant pain that was intermittent, progressive and radiating down her right leg. His notes also indicated urine loss with coughing or sneezing, and slight pain on intercourse. Martinez returned to Guzman again on Dec. 29, 2010, during which it was noted that Martinez had bilateral lower quadrant pain, but that there was some improvement on urine loss with Ditropan. Martinez claimed that Guzman told her the pain was caused by her ovaries and that she needed to have a bilateral salpingo-oophorectomy, which is the removal of both ovaries and both fallopian tubes. Guzman performed the surgery on Jan. 8, 2011, which Martinez noted took 3.5 hours, instead of the 1.5 hours Guzman estimated. Guzman allegedly said the surgery took longer because he had to perform extensive lysis of adhesions. Martinez claimed that when she went home after the surgery, she did not feel right. On Jan. 9, 2011, she attributed the pain she felt to the surgery and on Jan. 10, 2011, she tried to eat, but vomited. As a result, she asked her daughter to contact Guzman. Martinez claimed that after several attempts, Guzman came to the phone and told her that the pain was due to gas. She also claimed that Martinez told her that she should use a suppository and that it would make her feel better. However, when her pain continued and got worse into the morning of Jan. 11, 2011, she was taken to an emergency room. Martinez was then seen by a surgeon, who found a perforation of Martinez’s colon. Martinez sued Guzman, alleging the doctor was negligent in diagnosing her condition, in the performance of the bilateral salpingo-oophorectomy, and in her post-operative treatment. Martinez also alleged that this negligence constituted medical malpractice. Martinez also sued Guzman’s medical clinic, but it was ultimately let out of the case prior to trial. Plaintiff’s counsel contended that the bilateral salpingo-oophorectomy was unnecessary and led to further complications for Martinez. Counsel asserted that Guzman did not properly do a workup of Martinez’s complaints and that simply due to Martinez’s history of being post-menopausal, Guzman should have seen that Martinez’s prior pain was not caused by her ovaries. Counsel contended that Martinez’s pain could have been due to other causes, including those of a musculoskeletal or neurological origin. Plaintiff’s counsel also asserted that Guzman failed to timely and properly respond to Martinez’s phone calls on Jan. 10, 2011. In addition, counsel asserted that Guzman did not write the surgical report within 24 hours after the surgery, as he was required to do, but instead, he wrote it after Jan. 11, 2011, after he knew of Martinez’s complications. Guzman’s counsel noted that the plaintiff’s medical experts agreed that Guzman was not medically negligent for perforating the colon, in that such an event can occur in the absence of negligence. Thus, Martinez’s only contention was that Guzman failed to adequately workup Martinez to reach the conclusion that the pelvic pain was caused by the ovaries. Defense counsel contended that there was enough evidence that would warrant Martinez’s surgery, which included examinations on May 29, 2009, Dec. 8, 2010, and Dec. 29, 2010. Guzman claimed that the pelvic pain that was found to be bilateral, as of the exam of Dec. 8, 2010, was caused by adhesions involving the ovaries. The defense’s experts testified that the ultrasound ordered by Guzman on May 26, 2009, was inconclusive because adhesions cannot be seen on ultrasound. Plaintiff’s counsel responded that Guzman never mentioned the adhesions in his notes before the surgery, but that Guzman only said that he had encountered extensive adhesions and had to lysis them during the surgery., On the morning of Jan. 11, 2011, Martinez was taken to an emergency room and a perforation of her colon was discovered. She subsequently required a colostomy and a colostomy bag. Several months later, there was an attempt to take down the colostomy, but it was unsuccessful, and Martinez required another colostomy. Martinez underwent several surgeries and she spent 20 months with a colostomy bag. A year and half after the second colostomy, Martinez had a successful colostomy takedown and she no longer requires the colostomy bag. Martinez’s husband, Enrique Martinez, presented a derivative claim, seeking recovery for his loss of consortium. Defense counsel noted that because the health coverage was based on the Employee Retirement Income Security Act (ERISA), the Medical Injury Compensation Reform Act (MICRA) was preempted on the collateral source rule.