On Aug. 31, 2009, the plaintiff, a heavy equipment operator in his 50s who worked for the county of Orange and was previously diagnosed with Type II diabetes, awoke with a swollen left foot and presented to an urgent care facility, where he was seen by a physician’s assistant. A 3+ edema of the left foot was noted, and a Doppler ultrasound and Lasix was prescribed, as it was thought that the swelling was caused by a vascular problem. However, the ultrasound showed a normal vasculature. As a result, the plaintiff continued to go to work. On Sept. 8, 2009, the plaintiff returned to the facility and was seen by a different physician’s assistant. Significant swelling of the left foot was noted, along with serosanguinous fluid draining from a large bullae at the left instep. The physician’s assistant also noted that the arch of the plaintiff’s left foot was completely flattened and noted to “R/O Charcot foot.” An X-ray was subsequently taken that day and it was noted that the patient had a complete dislocation at the second through fifth metatarsal joints along with linear lucencies transversing the bases of the second through fifth metatarsals. The X-ray report was prepared that day, but was not signed off by the physician’s assistant until Sept. 18, 2009. On Sept. 11, 2009, the plaintiff returned to the facility and saw the same physician’s assistant. He was told to return to the clinic in one week, but no mention was made of the X-ray report from Sept. 8, 2009, nor of a draining diabetic ulcer. As a result, non-urgent referral to an orthopedist was attempted. On Sept. 18, 2009, the plaintiff returned to see the physician’s assistant and by that time, he was feverish and his left foot was gangrenous. As a result, the plaintiff was transferred that day to Corona Regional Medical Center and, on Sept. 20, 2009, he underwent a below-the-knee amputation. The plaintiff sued the facility for failing to timely diagnose his foot injury, failing to consult with a specialist, and failing to properly treat his condition. The patient further alleged that the facility’s failures constituted medical malpractice. The plaintiff claimed that each time he presented to the facility, he was seen by physician’s assistants, but not by a physician. He contended that the accepted standards of care required that he be seen by a physician and not a physician’s assistant on all the occasions. The plaintiff further argued that a physician would have appreciated a Stage 1 Charcot foot on Aug. 31, 2009, would have immobilized him and would have arranged for him to see an orthopedic surgeon without delay. Defense counsel noted that the plaintiff’s diabetes was not well controlled prior to first presenting to the facility and that there was patient compliance issues. However, counsel argued that despite these conditions, the patient’s care and treatment were within accepted standards of care. In addition, defense counsel argued that it was reasonable and within the accepted standards of care for the plaintiff to be seen by a physician’s assistant, who each treated the patient appropriately., The plaintiff underwent a below-the-knee amputation of his left leg on Sept. 20, 2009. The plaintiff contended that prolonged immobilization or, if unsuccessful, a midtarsal arthrodesis would have provided an adequate osseous union, such that he probably would have been able to return to work in six months’ time. However, he claimed that as a result of the amputation, he was off from work from Sept. 18, 2009, until Jan. 13, 2011. Although he has continued to work on a full-time basis since June 13, 2011, he alleged that he had to return in a different capacity and it is unlikely that he will be able to work after the age of 55, whereas it was his intention to work until he was 65. Thus, the plaintiff, who was 53 at the time of settlement, claimed that his past loss of earnings totaled $45,000, allowing for an offset for disability insurance received, and that his future care costs and future earnings lost, reduced to their present value, totaled $700,000. The plaintiff’s wife presented a derivative claim, seeking recovery for her loss of consortium. Defense counsel argued that the findings on X-rays from the Sept. 8, 2009, demonstrated a problem that had been in existence for many months. Counsel contended that even if the plaintiff had been hospitalized as of Aug. 31, 2009, and treated accordingly, it was extremely unlikely that he would ever have been able to return to work as a heavy equipment operator, and it was probable that he still would have undergone a below-the-knee amputation, as his Charcot foot had existed for weeks, if not months. Defense counsel further argued that the plaintiff’s health plan with the county will provide full coverage to him in the future, by virtue of his 25 years of employment with the county.