On July 22, 2016, plaintiffs’ decedent David Domingo, 51, a soft-water specialist, presented by ambulance to the emergency room of Sierra View Medical Center, in Porterville, with complaints of lower back pain. Domingo’s medical history included congestive heart failure, diabetes and high blood pressure. In addition, he had a long-standing problem with chronic lower back pain. During the ambulance trip, Domingo was given 50 micrograms of fentanyl, as he described his back pain as being a 10 out of 10. While in the emergency room, Domingo was seen by a certified physician’s assistant, Lamin Seisay, who ordered an X-ray of the lumbar spine and administered Valium, a drug used to treat anxiety or muscle spasms, and Toradol, an anti-inflammatory drug, by intravenous push. Shortly thereafter, Domingo became abnormally drowsy, weak and unable to stand. He was also described as sweating heavily. Seisay requested that the on-duty emergency room doctor, Dr. William Franklin, evaluate Domingo. Franklin did so and suspected a reaction to the medication. Out of an abundance of caution, Domingo was transferred to the main portion of the emergency department for a cardiac workup. An EKG was found to be significantly abnormal, consistent with Domingo’s history for congestive heart failure, with no acute changes on the EKG noted by Franklin. While various labs were pending, including a cardiac troponin study, Domingo allegedly informed Franklin that he wished to leave without completing the test. Franklin claimed that he attempted to persuade Domingo to stay and complete the cardiac workup, but Domingo allegedly refused and left the department after being picked up by his wife at approximately 3:30 p.m. Vital signs between the time the ambulance arrived at noon and the time when Domingo departed the emergency room were within normal limits at all times. The following evening, Saturday, July 23, 2016, Domingo’s wife and daughter went to a family party, where a relative informed Domingo’s wife that her husband “seemed to have died” at their residence. Domingo’s wife immediately returned to the family residence, where she found Domingo nonresponsive on the bed. She called 9-1-1, and the ambulance crew found Domingo in asystole (having a cardiac arrest rhythm with no discernible electrical activity on the EKG monitor), which is the most serious form of cardiac arrest. Domingo was taken to the emergency room, where Franklin happened to be on duty again. Despite resuscitation efforts, Domingo could not be revived, and Franklin pronounced him dead at approximately 11:30 p.m. The decedent’s wife, Ginaline Domingo, acting individually and on behalf of her minor daughter, Dana Domingo, sued Franklin; California Emergency Physicians Medical Group, APC (later renamed CEP America); Seisay; and Sierra View Medical Center (which was erroneously sued as “Sierra View District Hospital”). Several other Domingo family members were also listed as indispensable parties. The Domingo family alleged that the main defendants failed to diagnose and properly treat the decedent, resulting in his wrongful death. Seisay was ultimately dismissed in exchange for a waiver of costs prior to the start of trial. California Emergency Physicians Medical Group (CEP America) was also let out of the case. Plaintiffs’ counsel contended that the decedent was having acute coronary syndrome and/or an actual heart attack while in the emergency room for approximately three hours on July 22, 2016, but that Franklin failed to diagnose the condition. Counsel also contended that Franklin was obligated by the standard of care to aggressively persuade the decedent to remain for the completion of his cardiac workup. In addition, plaintiffs’ counsel contended that because Franklin did not chart that the decedent left against medical advice, there was no corroborating evidence that the decedent was not willing to complete his cardiac workup, such that Franklin, who had canceled the cardiac workup orders, was responsible for not completing the cardiac workup, rather than Domingo. The estate’s nursing expert was prevented from testifying regarding an alleged violation of the Emergency Medical Treatment and Labor Act, as a non-retained defense expert was precluded from testifying, consistent with his deposition, concerning the Emergency Medical Treatment and Labor Act. Defense counsel contended that lumbar pain is not associated with any type of acute cardiac event and that Franklin’s judgment was correct, in that the decedent likely had a reaction to the Valium and Toradol that had been given to him after the administration of fentanyl in the ambulance. Counsel also argued that the decedent’s health care decision to leave the department was his to make and that Franklin was required to respect the decedent’s health care decision. Counsel further argued that the standard of care did not require the decedent to be “scared” into changing his decision to leave. In addition, defense counsel argued that the decedent, who was hospitalized for three days because of an acute episode of congestive heart failure one month earlier, clearly knew that he was at risk for sudden cardiac death, at all times, simply by virtue of his history. Counsel noted that the decedent’s ejection fraction, one month earlier, was in the low 20 percent, representing severe, acute decompensated heart failure. In response, plaintiffs’ counsel contended that, while in the emergency room on July 22, 2016, the decedent exhibited no signs or symptoms consistent with an acute episode of congestive heart failure or any other cardiac problem., David Domingo was found to be nonresponsive, and an ambulance crew determined that he was in asystole, which is the most serious form of cardiac arrest. As a result, Domingo was taken to the emergency room at Sierra View Medical Center. Despite resuscitation efforts, Domingo could not be revived and he was pronounced dead at approximately 11:30 p.m. on Saturday, July 23, 2016. He was 51 years old. He was survived by his wife, Ginaline Domingo, who was 47 years old at the time, and a daughter, Dana Domingo, who was 15 years old at the time of her father’s death. The decedent’s wife and daughter sought recovery of wrongful death damages. They also sought recovery of $585,000 for their past and future loss of the decedent’s earnings, and approximately $225,000 for their loss of the decedent’s household services. Plaintiffs’ counsel also asked the jury to award $1 million for each component of the wrongful death jury instruction given to the jury.