On Sept. 2, 2007, plaintiff German Velasquez, 56, an optical clerical worker, was involved in a motor vehicle accident in Rancho Cucamonga in which he experienced a hypoglycemic event and crashed into a fire hydrant. He was subsequently airlifted to Loma Linda University Medical Center and diagnosed with scapula and left femur fractures, and an open trimalleolar fracture/dislocation of the left ankle. After an initial reduction of his left ankle with a splint on the date of the accident, Velasquez underwent open reduction surgery by Dr. Wesley Phipatanakul, an orthopedic surgeon. Velasquez, who suffers from uncontrolled diabetes, followed up with Phipatanakul for post-operative care, as well as with Dr. Suzy Sedrak, his family practitioner, for general medical care. While the condition of his ankle and surgical wound improved initially, the wound became necrotic and he developed gangrene, causing Velasquez to undergo a below-the-knee amputation of his left leg on Oct. 20, 2007. Velasquez sued Phipatanakul, Loma Linda University Medical Center, Sedrak and West Covina Medical Group. He alleged that the defendants failed to refer him to a vascular surgeon during their care of him as a patient and that this failure constituted medical malpractice. West Covina and Loma Linda were ultimately dismissed from the case via a motion for summary judgment. Sedrak was also let out of the case. Thus, the matter proceeded to trial against Phipatanakul only. Plaintiff’s counsel argued that Phipatanakul should have referred Velasquez to a vascular surgeon immediately on the date of the accident and at subsequent post-operative visits at Loma Linda. Counsel contended that a vascular surgeon would have evaluated Velasquez’s prior Femoropopliteal (fem-pop) bypass, which was performed years before to bypass blocked blood vessels and redirect blood through a graft, and decided to perform a new bypass to unblock the restricted blood flow to his lower left leg. Counsel further noted that a successful fem-bop bypass would have saved Velasquez’s leg from necrosis and subsequent amputation. Phipatanakul contended that he met the standard of care on the date of the accident/surgery. He claimed that he warned Velasquez that due his uncontrolled diabetic condition, there was a high probability that he would lose his leg to necrosis following the open reduction surgery. However, Phipatanakul claimed that clinical data never suggested or required that he refer Velasquez to a vascular surgeon since the patient exhibited good blood profusion. In addition, the defense’s orthopedic and vascular surgery experts testified that Velasquez suffered from microvessel disease, or heart disease that affects tiny coronary arteries, and that a new fem-pop surgery would not have increased blood flow to the patient’s lower left leg even if a vascular surgeon opted for the procedure., Velasquez developed necrosis and gangrene to his left ankle, ultimately requiring a below-the-knee amputation of his left leg on Oct. 20, 2007. He was later fitted with a prosthetic leg. Velasquez claimed that he is now restricted in all activities due to the loss of his left leg, including standing, walking and dancing with his wife. However, he was limited to general damages at trial, and sought approximately $2 million. Defense counsel did not dispute Velasquez’s or residual symptoms.