On Feb. 23, 2010, plaintiffs’ decedent Kathryn Trump, 52, a bookkeeper suffering from irreversible end-stage cardiomyopathy and a candidate for a heart transplant, presented to the Emergency Department of Providence Holy Cross Medical Center, in Mission Hills, with complaints of chest pain, severe shortness of breath, and palpitations. She was subsequently admitted to the Intensive Care Unit and came under the care of a cardiologist, Dr. Adel El-Bialy. At the age of 18, Trump was diagnosed with hypertrophic cardiomyopathy, a disease in which the heart muscle becomes abnormally thick. She had a significant family history of cardiac disease and sudden death at young ages, including her father, who died suddenly at age 49 of a myocardial infarction after heart valve repair, and her sister, who was diagnosed with cardiac disease and died suddenly due to hypertrophic cardiomyopathy at age 36 while on a heart transplant list in Michigan. Trump also had a 30-year history of arrhythmias. She eventually had a dual chamber implantable cardioverter defibrillator (AICD) implanted in 2005. However, after undergoing nine electrical cardioversions to restore her heart rhythm, and following numerous emergency visits and admissions to hospitals for treatment of congestive heart failure, Trump was evaluated for a heart transplant at Ronald Reagan UCLA Medical Center, in Los Angeles, in 2009. By that time, Trump was experiencing atrial fibrillation and atrial flutter with worsening left ventricular function as well as congestive heart failure with no signs of clinical improvement. She also reported that she no longer had an adequate quality of life. As a result, UCLA physicians determined that Trump was an appropriate candidate for a heart transplant. In November 2009, Trump’s health insurance carrier advised her that it would no longer cover treatment with her doctors at UCLA. As a result, Trump’s medical records were transferred to USC University Hospital for transplant evaluation. However, on Feb. 16, 2010, she was denied entry to the Heart Transplant Program at USC because she was misclassified as a “post-heart transplant” patient. Two days after receiving the letter from USC, Trump presented to the Emergency Department at Providence Holy Cross. She was admitted to the ICU for treatment of her renal failure, a low ejection fraction of 20 percent, and end-stage cardiomyopathy. The following day, on the morning of Feb. 24, 2010, El-Bialy ordered Digoxin to enhance cardiac function. At 10:10 a.m., Trump went into cardiac arrest. El-Bialy ran the code for 35 minutes, and advanced cardiac life support measures were initiated. Trump was intubated, and El-Bialy placed a temporary pacer. As a result, an eventual return in pulse was obtained. However, an EEG, taken on Feb. 25, 2010, revealed anoxic encephalopathy, or brain damage due to a lack of oxygen to the brain. As a result, Trump’s family ultimately made the decision to withdraw her care on March 2, 2010. Due to being misclassified as a “post-heart transplant” patient, Trump passed away before she was placed on a transplant list. An autopsy by the Los Angeles County coroner reported that Trump died of natural causes resulting from a dilated cardiomyopathy of years in duration. The decedent’s husband, William Trump Jr.; her adult son, Charles Trump; her adult daughter, Sarah Trump, sued El-Bialy, Lakeside Medical Group Inc., Lakeside Systems Inc., Lakeside Community Healthcare Inc., David Geffen School of Medicine at UCLA, Heritage Provider Network Inc., Regents of the University of California, Ronald Reagan UCLA Medical Center, UCLA Health System, UHC of California (formally known as Pacificare of California, and doing business as Pacificare and United Healthcare of California), University of Southern California (doing business as USC University Hospital), and USC Care Medical Group Inc. (doing business as The Doctors of USC). The decedent’s family alleged that the defendants failed to appropriately manage the decedent’s congestive heart failure and that the defendants’ failure constituted medical malpractice that caused the decedent’s wrongful death. Several of the defendants were either voluntarily dismissed or prevailed on motions for summary judgment. Thus, the matter continued against El-Bialy only. Plaintiffs’ counsel contended that El-Bialy deviated from the standard of care in prescribing Digoxin in the setting of an abnormally low potassium level, leading to Digoxin toxicity and the decedent’s subsequently cardiac arrest and brain damage. The plaintiffs’ cardiology expert opined that the failure to determine the decedent’s potassium levels prior to El-Bialy prescribing Digoxin was a violation of the standard of care because there was no way to know if the potassium had returned to normal levels. Thus, plaintiffs’ counsel argued that had the decedent’s congestive heart failure been managed appropriately, she would have survived and received a heart transplant within 90 to 100 days. El-Bialy’s counsel maintained that even though El-Bialy did not order a specific potassium blood level before Digoxin was administered, El-Bialy’s practice of ordering Digoxin one hour after oral and IV potassium was started was within the standard of care. The defense’s cardiology expert opined that the decedent’s potassium levels were adequately restored by the time Digoxin was administered, that there was no Digoxin toxicity, and that the decedent’s cardiac arrest was due to a weakened heart., Kathryn Trump suffered a cardiac arrest and advanced cardiac life support measures were initiated. However, after she was intubated, a temporary pacer was placed, and her pulse returned, an EEG revealed that Mrs. Trump had suffered anoxic encephalopathy, or brain damage due to a lack of oxygen to the brain. As a result, her family made the decision to withdraw her care on March 2, 2010, and she died a short time later. Mrs. Trump was 52 years old. She was survived by her husband, a 52-year-old pastor, William Trump Jr.; her 25-year-old son, Charles Trump, and her 28-year-old daughter, Sarah Trump. The decedent’s family claimed that the decedent died from cardiac arrest and brain damage due to Digoxin toxicity. Thus, the decedent’s family sought recovery of damages for their loss of the decedent’s love, companionship, comfort, care, assistance, protection, affection, society, and moral support. They also sought recovery of $275,012 in economic damages, including the present value of the decedent’s total loss of earnings as a bookkeeper at $116,017 and the present value of the loss of the decedent’s household services at $158,995. Defense counsel disputed the cause of the decedent’s death. Although defense counsel agreed that the decedent suffered cardiac arrest and anoxic encephalopathy, they denied that Digoxin was the cause. Counsel also noted that the Los Angeles County coroner’s autopsy report stated that the decedent died of natural causes resulting from a dilated cardiomyopathy of years in duration.