On May 11, 2011, plaintiff Lupe Ramirez, 50, sought advanced breast reconstruction involving a Deep Inferior Epigastric Artery Perforator (DIEP) flap technique from microvascular plastic surgeons Charles Lee, M.D., and Scott Hansen, M.D., in San Francisco. Ramirez was previously diagnosed with advanced breast cancer and subsequently underwent bilateral mastectomies in Sacramento. She then underwent breast reconstruction with tissue expanders and implants, but the reconstruction failed due to multiple infections. As a result, she presented to Lee and Hansen, seeking to undergo advanced breast reconstruction. The surgeons agreed to perform the surgery together, and Ramirez signed a consent form for the DIEP flap procedure. During the surgery on May 11, 2011, Lee and Hansen were unable to perform the DIEP flap technique on the right side because of inadequate vessels. As a result, they decided to perform a Transverse Rectus Abdominus Myocutaneous (TRAM) flap technique on the right side. Hansen then had no further involvement after the surgery, making Lee solely responsible for Ramirez’s after-care. During the postoperative period, tissue monitors signaled poor tissue oxygen saturation of the TRAM flap, causing the flap to become discolored. However, the monitors were ignored and by the time Ramirez was discharged from the hospital on May 18, 2011, the TRAM flap had become partially necrotic from the lack of blood supply. As a result, Lee performed staged debridement surgeries on Ramirez to remove necrotic tissue until all of the remaining right flap tissue was removed. Ramirez sued Lee; Hansen; two other treating physicians, Dr. Gene Kim and Dr. Benjamin Maeck; the hospital where the surgery was performed, St. Mary’s Medical Center; and the operator of the hospital, Catholic Healthcare West (also known as Dignity Health). Ramirez alleged that defendants failed to obtain her informed consent, failed to properly perform the advanced breast reconstruction surgery and failed to properly monitor her postoperatively. She also alleged that the defendants’ actions constituted medical malpractice. Prior to trial, Hansen, Kim, Maeck, St. Mary’s Medical Center and Catholic Healthcare West were all dismissed from the case. Thus, the matter proceeded to trial against Lee only. Ramirez claimed she only consented to the DIEP flap procedures and not to the TRAM flap procedure. She also claimed that Lee inappropriately allowed podiatry residents to monitor her and that Lee did not see her postoperatively while she was in the hospital. In addition, Ramirez claimed Lee ignored the signs and symptoms of poor circulation and dying tissue to the right flap, failed to take her back to surgery in the days following the surgery to enhance vascular supply, delayed in debriding the dead tissue, and caused the entire flap to fail. Lee claimed that before the surgery, he advised Ramirez that if the DIEP flap could not be done, a TRAM flap would be performed. He also claimed that he provided appropriate monitoring and postoperative care. However, Lee contended that the right TRAM flap failed due to inherently poor quality/caliber blood vessels supplying it and because there were no alternative blood vessels that were adequate to enhance the blood supply. He further contended that there was no delay and that the staged debridements that Ramirez received were done within the appropriate time frame., Following the advanced breast reconstruction surgery, Ramirez’s TRAM flap had become partially necrotic from the lack of blood supply. As a result, she had to undergo staged debridement surgeries, commencing one month after the reconstructive surgery, to remove the necrotic tissue. Ultimately, all of the remaining right flap tissue was removed by surgeons in Sacramento. Ramirez claimed she suffered pain, suffering and humiliation due to the infected, necrotic tissue and due to the multiple surgeries she underwent to remove the dead and infected tissue from her right breast.