On Jan. 6, 2014, plaintiffs’ decedent Darion Brewer, a 7-month-old boy, was seen by his primary care pediatrician, Dr. Cheryl Emoto, after being sick for several days. Over the course of a prior nine-day period, Darion was seen in a hospital emergency room, at an urgent-care facility and at another medical facility. The hospital performed a chest X-ray on Dec. 28, 2013, and it placed Darion on a course of antibiotics (Zithromax, a brand name for azithromycin). The chest X-ray came back positive for pneumonia, and all of the medical providers referred Darion to his primary care pediatrician, Emoto. During the office visit on Jan. 6, 2014, Emoto noted in Darion’s chart that Darion was not getting better after nine days and three sick visits, after being placed on an antibiotic in the emergency room, and that Darion was experiencing respiratory distress, including coughing, wheezing and an abnormal breathing pattern. Emoto also noted that Darion had lost more than 6 percent of his body weight and that Darion had an elevated respiratory rate. She concluded that Darion was “at risk for hospitalization.” Emoto ultimately diagnosed Darion with bronchiolitis and prescribed him an albuterol breathing treatment. She then discharged Darion home and advised the family to follow up in a week if Darion did not improve. Darion died four days later. During an autopsy, Darion’s lungs were noted to be in an advanced state of destruction with acute pneumonia in all sections, primarily in the lower lobes. Even though common viral tests were negative, bacterial blood cultures came back positive for two uncommon bacteria, enterococcus and Enterobacter. The pathology report indicated that the cause of Darion’s death was acute pneumonia. Darion’s mother, Velanta Babbitt, and aunt, Nikithea Fleming Johnson, sued Emoto and Emoto’s medical group, La Salle Medical Associates. The lawsuit alleged that Emoto was negligent in the treatment of Darion and misdiagnosed Darion’s condition and that Emoto’s negligence constituted medical malpractice. They also alleged that La Salle Medical Associates was liable for Emoto’s actions. Prime Healthcare Services Inc., Desert Valley Hospital Inc., nurse practitioner Seleaina Thomas, Dr. Geetha Kunkala Reddy, Meridian Urgent Care and Occupational Health Center P.C., and physician’s assistant Yohannes Debebe were also all named as defendants, but they ultimately settled out of the case for undisclosed amounts. In addition, Darion’s aunt, Johnson, was removed as a plaintiff. Thus, the matter continued with Babbitt’s claims against Emoto and La Salle Medical Associates only. Plaintiffs’ counsel contended that Emoto misdiagnosed Darion and that despite Darion’s signs and symptoms, Emoto failed to obtain Darion’s prior medical and radiology records, failed to obtain an oxygen saturation or a heart rate, failed to perform a chest X-ray, failed to re-evaluate the viability of the antibiotic, failed to evaluate Darion for dehydration, and failed to hospitalize Darion or otherwise escalate care. Babbitt’s expert pediatrician testified that Darion was partially, but ineffectively, treated with the antibiotic and that Darion died of untreated bacterial pneumonia. The expert opined that Emoto violated the standard of care. Defense counsel argued that Emoto did not violate the standard of care and that Darion died of aspiration pneumonia caused by vomiting and inhaling the contents of his stomach shortly before his death. Counsel noted that Darion was taken to a hospital in Texas on Jan. 11, 2014, where it was noted that Darion had vomitus (emesis) around the mouth and nose and that it was suctioned. Defense counsel also argued that the condition of Darion’s lungs were consistent with the destructive gastric and bowel enzymes aspirated by Darion prior to his death. Defense counsel contended that the chest X-ray, taken at the hospital on Dec. 28, 2013, was read by a nurse practitioner who initially diagnosed bronchiolitis, but that a radiologist read the report the next day and opined that the findings were consistent with right, upper lobe pneumonia. However, counsel contended that on Jan. 2, 2014, during the nine-day period where Darion allegedly had pneumonia, Darion was seen at a Loma Linda pediatric cardiology clinic for a scheduled, routine evaluation of a congenital cardiac condition and was not seen for symptoms related to pneumonia. The cardiologist who evaluated Darion during that visit scheduled a return visit in six months. Darion’s exam noted rales (small clicking, bubbling or rattling sounds in the lungs), but indicated that Darion’s oxygen saturation was 97 percent. Counsel also noted that the cardiologist did not send Darion to an emergency room for pneumonia. Emoto noted in her chart that Darion’s aunt, Johnson, reported that Darion was seen in the emergency room on Dec. 28, 2013, and later at an urgent-care facility, and that Darion was placed on an antibiotic in the emergency room. Emoto claimed that Johnson informed her that Darion was not getting better, but that the records showed that Darion had improved since his emergency room visit. Emoto testified that as a result, she wanted to see Darion in two to three days, if Darion did not improve. Defense counsel noted that Johnson testified that she asked to take Darion out of town, but Emoto claimed that she had no recollection of being asked about that, and stated that she would have wanted to see Darion before he left, if that was the case. However, Emoto claimed that Johnson did not bring Darion back to see her or any other provider after Jan. 6, 2014, and that Darion was next seen at the hospital on Jan. 11, 2014, which was five days after she saw Darion. (Defense counsel noted that plaintiff’s counsel contended that it was four days later, but hospital records showed the admission date as being 10 p.m. on Saturday, Jan. 11, 2014, and Johnson testified that Darion died on Saturday with the death certificate containing the incorrect date of Jan. 10, 2014.) Defense counsel contended that Emoto and his office were not told about the X-ray being done and that Darion’s lungs cleared after the office treatment, which would not have happened if Darion had pneumonia. Defense counsel argued that Darion had a resolving viral pneumonia that was improving until he aspirated due to the effects of cough and sleep medication containing Doxylamine, an antihistamine, which were in Darion’s system at near toxic levels. Counsel contended that the medication is contraindicated in children under the age of 4 and should not have been given to the 7.5-month-old child, but that Darion was sedated in preparation for a 14- to 15-hour car ride back from Texas, where his aunt had taken him for a funeral. Defense counsel also noted that Johnson testified that Darion was not ill on Jan. 8, 2014, and that Darion had no fever, otherwise she would not have taken him on the 14- to 15-hour car trip to Texas. Defense counsel argued that the advanced state of destruction of Darion’s lungs, as noted in the autopsy, was due to gastric enzymes and that the fact that the autopsy was done four days after Darion’s death allowed the enzymatic destruction to continue. Counsel contended that the two uncommon bacteria, enterococcus and Enterobacter, found in Darion’s blood did not cause community-acquired pneumonia, as Darion would have been gravely ill and died within days of the emergency room visit on Dec. 28, 2013, because the antibiotic azithromycin does not cover those virulent bacteria, which are commonly found in the gastrointestinal tract and which got into Darion’s lungs by aspiration and then into his blood. The defense’s experts opined that the antibiotic would have had no effect on the organisms found during the autopsy and that Darion would have been gravely ill long before he died on Jan. 11, 2014, as he would have had those infections on Dec. 28, 2013. The defense’s infectious-diseases expert testified that the virulent bacteria enterococcus and Enterobacter are not covered by azithromycin, and contended that the U.S. Food and Drug Administration has not approved it to treat those organisms because it will not work. The expert also opined that a person infected with those bacteria will be gravely ill and septic and that the person will die without intravenous antibiotics, which is what happened when Darion later aspirated and died. The defense’s pharmacology expert opined that Darion should never have been given Doxylamine because it causes nausea, vomiting and anti-cholinergic effects of gastric slowing. The expert also opined that Doxylamine causes the loss of the protective reflexes, which leads to aspiration from the loss of tracheal protective reflexes and the loss of gastric valve reflexes, allowing stomach and bowel contents to be vomited and aspirated. Defense counsel noted that Johnson testified that Darion had no fever from Jan. 6, 2014, until Darion’s death on Jan. 11, 2014, that Darion’s breathing was better and that Darion was receiving treatments ordered by Emoto. Counsel contended that the antibiotic was prescribed for five days and that the aunt, Johnson, testified that she went to urgent care, not because Darion was worse, but because she wanted more antibiotics, as the antibiotics were finished by Dec. 31, 2013, or Jan. 1, 2014. In addition, counsel contended that Darion’s lungs were clear at the urgent care facility. On rebuttal, the Babbitt’s expert pediatrician testified that the antibiotic Zithromax (azithromycin) has been found to be effective against some bacterial strains, such as the strains found in Darion’s lungs (enterococcus and Enterobacter), and that those bacteria are an uncommon, but documented, cause of community-acquired pneumonia. Ultimately, Babbitt’s expert opined that, given the original hospital radiology report, the continuing clinical symptomology and the findings of the final pathology report, untreated bacterial pneumonia was the cause of Darion’s death., Darion died on Jan. 11, 2015. He was 7.5 months old. His mother claimed that acute bacterial pneumonia was the cause of Darion’s death. Darion’s mother, Babbitt, sought recovery of wrongful-death damages for the loss of her son. Defense counsel disputed Darion’s cause of death, arguing that Darion died of aspiration pneumonia caused by vomiting and inhaling the contents of his stomach shortly before his death.