On Oct. 23, 2018, plaintiff Matthew Farmer, 58, a chef, had an office visit with Dr. Jeffrey Rice, an internist, a few days after being discharged from a hospital. Farmer previous presented to Rice on Aug. 28, 2017, during which time Farmer underwent an EKG that showed "some left ventricular hypertrophy" ("LVH"). As a result, Rice suggested blood pressure checks and a possible stress test, but Farmer did not come back to follow-up. On Oct. 18, 2018, Farmer presented to Community Hospital of the Monterey Peninsula, in Monterey, with complaints of gasping for air with wheezing and profuse sweating. He was found to have low oxygen saturation and was determined to be "on the brink of indecemtubation." Farmer underwent an EKG, which was determined to be abnormal, showing LVH, and an X-ray, which showed cardiomegaly (an enlarged heart). He was subsequently treated for chronic obstructive pulmonary disease, and he got better with treatment. A family medicine specialist, Dr. Ellen McEwen, ultimately discharged Farmer from Community Hospital the next day, on Oct. 19, 2018. Five days later, on Oct. 23, 2018, Farmer presented to Rice’s office, where he told Rice that he had been hospitalized overnight at Community Hospital and was diagnosed with an exacerbation of COPD. Rice recommended a pulmonary function test for Farmer and scheduled it for Nov. 27, 2018, but Farmer did not keep that appointment. Farmer allegedly felt worse through Thanksgiving, when he had "complete exhaustion" and "couldn’t walk or breathe." His Albuterol inhaler was also no longer working at that time. His condition progressively worsened, and he had swelling in his knees and toes by mid-December 2018. Farmer eventually returned to Rice on Dec. 26, 2018. Rice noted that "the big issue" was that Farmer had no insurance and that after a lengthy explanation, he decided to prescribe Inderal (a beta-blocker) and Bumex (a diuretic used to reduce extra fluid in the body). The next day, Farmer presented to an emergency room emergency department, where he was determined to be suffering from congestive heart failure. Farmer sued Rice, McEwen and Community Hospital of the Monterey Peninsula. Farmer alleged that the defendants failed to consult with another specialist about his condition, which caused a delay in treatment. Farmer also alleged that the defendant’s actions constituted medical malpractice. Community Hospital and McEwen settled out of the case. Another family medicine specialist, Dr. Nathaniel Lepp; an emergency medicine specialist, Dr. Robert Collins; a radiologist, Dr. Robert Gardner; and the physicians’ medical group, Montage Medical Group, were initially also named as defendants, but they were all dismissed from the case prior to trial. Thus, the matter proceeded to trial against Rice only. Plaintiff’s counsel contended that Rice failed to refer Farmer to a cardiologist during either of the office visits, which were on Oct. 23, 2018 and Dec. 26, 2018. Counsel also contended that Rice’s negligence caused a delay in treatment, which caused his condition to worsen and result in congestive heart failure. Rice claimed that Farmer had no shortness of breath and "felt perfectly fine" during the office visit on Oct. 23, 2018. He also claimed that he reasonably relied upon the diagnosis of the discharging physician at Community Hospital, McEwen, as she was the one who worked Farmer up at the hospital with the full array of diagnostic tests available and discharged Farmer. Moreover, Rice claimed that Farmer got better with COPD treatment at Community Hospital and that because the COPD treatment worked, there was no reasonable explanation for why it worked if Farmer did indeed have symptomatic congestive heart failure at the hospital. Defense counsel contended that Rice had access to 13 pages of medical records from Community Hospital when he saw Farmer on Oct. 23, 2018, and that those records contained the discharge summary from McEwen, which did not say anything about an abnormal EKG or cardiomegaly on an X-ray. Counsel further contended that Rice did not have access to the EKG strip or the X-ray image in his office, so he would not have known about those results. In addition, defense counsel contended that there was no evidence Famer would have presented to a cardiologist or a hospital, if it had been recommended at that time. Defense counsel noted that Farmer was medically considered morbidly obese, had smoked since childhood, and had a past medical history that included hypertension and erectile dysfunction. Counsel also noted that during the eight-year period between his initial visit with Rice on June 3, 2010, and when he first presented to Rice’s office after being treated for COPD at the hospital, Farmer only went to see Rice twice — once on Feb. 2, 2015, and once on Aug. 28, 2017. Counsel further noted that Farmer did not return for the recommended blood pressure checks and possible stress test after an EKG showed signs of LVH during the office visit on Aug. 28, 2017, and that Farmer again did not keep his scheduled follow-up appointment after Rice recommended a pulmonary function test during the office visit on Oct. 23, 2018, after Farmer was treated for COPD at the hospital. Defense counsel contended that despite feeling worse through Thanksgiving and the Albuterol inhaler no longer working, Farmer still chose not to see a doctor or go the emergency department, as he had done in October 2018, and that even though Farmer’s condition became progressively worse in mid-December 2018, Farmer still did not seek medical help. Defense counsel argued that Farmer likely skipped the appointment for the pulmonary function test, and avoided seeing a doctor or going back to the emergency department because he did not have insurance. Counsel also argued that while Farmer denied that Rice ever told him to go to the emergency department on Dec. 26, 2018, Rice’s records and testimony showed that Rice did in fact tell Farmer to go to the hospital. In addition, defense counsel argued that Farmer’s refusal to go to the emergency department was supported by his own hesitancy to seek medical care over the prior month despite feeling so much worse with new symptoms. The defense’s internal medicine expert opined that the standard of care did not require referral to a cardiologist and that the LVH was reasonably explained by Farmer’s longstanding hypertension. The defense’s cardiology and pulmonology experts both opined that although Community Hospital’s tests found an abnormal EKG, which showed LVH, and an X-ray showing cardiomegaly, neither of those findings were specific to a heart condition and, instead, were consistent with COPD and hypertension. The experts testified that there was no way Farmer would have made such an incredible recovery and been discharged from the hospital on Oct. 19, 2018, if Farmer had congestive heart failure and was only treated with Albuterol and steroids. Indeed, they opined that treatment would have more than likely increased the fluid in Farmer’s lungs and made his condition worse. Defense counsel argued that Farmer likely had a genetic heart condition called hypertrophic cardiomyopathy, which is not curable or reversible with earlier treatment. The defense’s cardiology expert further opined that Farmer’s current ejection fraction and functional status would have been the same regardless of the treatment he received between October 2018 and December 2018., Farmer claimed that the delay in treatment caused an exacerbation of a heart condition, which caused him unnecessary pain and suffering. He also claimed that the delay in treatment resulted in additional medical costs and lost wages, since he was unable to return to work in his chosen profession as a chef. Farmer sought recovery of future medical costs, past and future loss of earnings, and damages for his past and future pain and suffering. During closing arguments, plaintiff’s counsel asked the jury to award Farmer $900,000 in total damages. Defense counsel argued that Farmer failed to mitigate his own damages numerous times, noting the several instances where Farmer chose not to go the tests that were recommended and the follow-up appointments that were made. Counsel also argued that Farmer failed to mitigate his own damages by refusing to seek health care when he was symptomatic in November 2018 and December 2018. The defense’s expert cardiologist opined that it would not have mattered, from a causation standpoint, whether Farmer went to the emergency department on Dec. 26, 2018, rather than Dec. 27, 2018, as Farmer’s outcome would have been the same. (According to defense counsel, the plaintiff’s cardiology expert was unable to quantify the difference in outcome had Farmer been seen in the emergency department on Dec. 26, 2018.) The defense’s expert cardiologist further opined that it did not matter when Farmer went to the emergency department because Farmer has made a full recovery. Defense counsel added that Farmer’s own treating cardiologist, Dr. Masataka Kawana, opined that Farmer was cleared to work full time, without restrictions, as a chef as of Nov. 16, 2019. Defense counsel also noted that Kawana has not placed any restrictions on Farmer’s recreational activities and that he would only limit them if Farmer had severe heart dysfunction, but that Kawana characterized Farmer’s congestive heart failure as being in the "moderate" range. Thus, defense counsel argued that Farmer chose to work as a chef and failed to mitigate his own alleged economic damages.