On Feb. 13, 2013, plaintiff Breanna Minton, a 13-year-old girl who suffered Down syndrome, was admitted to Miller Children’s & Women’s Hospital, in the city of Long Beach. She presented symptoms that included fatigue, a persistent cough, profound anemia, intermittent fevers, hair loss, and diminished appetite and weight. Earlier in her childhood she had undergone surgical repair of a cardiac defect, but she remained susceptible to bacteremia-induced endocarditis. Breanna’s longtime pediatrician, Dr. Louis Theriot, who was an attending physician at Miller Children’s & Women’s Hospital, oversaw the first three days of Breanna’s treatment. During the evening of Feb. 13, an X-ray suggested that Breanna may have developed pneumonia. A blood culture was obtained, and broad-spectrum antibiotics were administered. The culture’s result was obtained the following day, after a transfusion had been administered to address Breanna’s anemia. The culture was preliminarily positive for streptococci. A repeat culture was performed during the morning of Feb. 15, 2013, a Friday, but it did not grow an organism. Theriot was therefore provided the results of the preliminary culture. Soon thereafter, he departed for the weekend. During the following morning, Feb. 16, the culture was found positive for alpha-hemolytic streptococcus. A day later, the culture was also found positive for viridans group streptococci, which is known to be particularly associated with the development of endocarditis, especially in a patient with a congenital heart defect and a history of cardiac surgery. Later that day, Feb. 17, Breanna was discharged by another doctor. She was prescribed a course of antibiotics. On May 14, 2013, an outpatient echocardiography revealed large, mobile vegetation on Breanna’s mitral valve and chordal apparatus, consistent with endocarditis and associated destruction of the mitral valve. Breanna was admitted to UCLA Medical Center, in Los Angeles. Medication was administered, but she suffered a hemorrhagic stroke of the frontal lobe of her brain. She required mitral valve replacement and permanent implantation of a pacemaker. Blood cultures obtained at UCLA Medical Center did not identify an organism responsible for endocarditis, but Breanna’s mother, Michelle Spigner, claimed that Breanna’s stroke was a result of endocarditis caused by viridans group streptococci. Spigner, acting individually and as Breanna’s guardian, sued Theriot; Miller Children’s & Women’s Hospital; UCLA Medical Center’s operator, the Regents of the University of California; several pediatricians and family physicians who were believed to have treated Breanna, Dr. Shanna Cox, Dr. Tranh Ha, Dr. Gregory Kimura, Dr. Talia Shorr, Dr. Hung Tran and Dr. Peter Welty; and their practices, Centers of Family Medicine and Pediatric Medical Centers. The lawsuit alleged that Cox, Ha, Kimura, Shorr, Theriot, Tran, Welty and UCLA Medical Center’s staff failed to properly treat Breanna, that the failures constituted malpractice, that Miller Children’s & Women’s Hospital was vicariously liable for Theriot’s actions, that the Regents of the University of California was vicariously liable for the actions of UCLA Medical Center’s staff, and that Centers of Family Medicine and Pediatric Medical Centers were vicariously liable for the actions of their doctors. Cox, Kimura, the Centers for Family Medicine and the Regents of the University of California were dismissed via summary judgment, and plaintiffs’ counsel negotiated settlements of the claims against, Ha, Shorr, Tran, Welty, Miller Children’s & Women’s Hospital, and Pediatric Medical Center. The settlements’ terms were not disclosed. The matter proceeded to a trial against Theriot. Plaintiffs’ counsel contended that Theriot, upon being notified that Breanna’s culture indicated streptococci, and knowing Breanna’s susceptibility to endocarditis, should have investigated the possibility of endocarditis, either by performing an echocardiography or by consulting a cardiologist or an infectious-diseases specialist. Plaintiffs’ counsel claimed that an audit of Miller Children’s & Women’s Hospital’s computer records indicated that Theriot had accessed Breanna’s electronic medical record 21 times during the five-day period beginning Feb. 17., including three entries into the final blood culture results identifying viridans group streptococci. Defense counsel contended that the standard of care did not mandate an investigation for endocarditis on Feb. 15, when Theriot learned of the streptococci, and that it was acceptable for Theriot to await more specific isolation of the organism involved on the blood culture. Defense counsel contended that the more specific information did not become available until Feb. 16 or Feb. 17, while Breanna was under the care of other physicians, who chose to discharge Breanna on Feb. 17. Theriot claimed that he had no recollection of entering Breanna’s electronic medical record on 21 occasions between Feb. 17 and Feb. 21, or of learning that the final blood culture results were viridans group streptococci. He contended that access to Breanna’s electronic medical record must have occurred while he was clearing incomplete charts from his computer, moving in and out of documents for only seconds at a time, to see if his signature was required. He claimed that, even if he had seen that the final blood culture results were viridans group streptococci, he would have trusted that the physicians caring for Breanna during the weekend would have reacted appropriately to those results. Theriot further claimed that it simply never would have occurred to him to go into Brenna’s chart to verify that the other physicians had done their job properly., Breanna suffered a hemorrhagic stroke of the frontal lobe of her brain. She required mitral valve replacement and permanent implantation of a pacemaker. Plaintiff’s counsel claimed that Breanna’s stroke was a result of endocarditis caused by viridans group streptococci and that if Breanna had been diagnosed and treated at that time for endocarditis, she would have avoided the stroke, the need for heparin therapy, the mitral valve surgery and the need for a permanent pacemaker. Plaintiff’s counsel acknowledged that Breanna never could have lived independently, given her Down syndrome, but argued that Breanna’s stroke and residual effects increased Breanna’s need for attendant care. Spigner sought recovery of more than $16 million for Breanna’s future medical and life-care expenses, and she sought recovery of unspecified damages for Breanna’s past and future pain and suffering. She also presented a derivative claim. Defense counsel argued that Breanna did not have endocarditis in February 2013 and that the positive blood culture for viridans group streptococci was only a contaminant, as reflected by the negative result of the second blood culture that month and subsequent negative blood cultures at the UCLA Medical Center. Defense counsel also argued that if endocarditis was present in February 2013 and had been discovered, Breanna still would have been admitted to the UCLA Medical Center and placed on heparin. Defense counsel further claimed that Breanna would have had the same risk for a hemorrhagic stroke, the same need for mitral valve surgery and the same risk for requiring a permanent pacemaker. Defense counsel also contended that Breanna returned to baseline from a cognitive standpoint following the stroke and that Breanna merely had modest residual motor deficits involving one hand that could be ameliorated with five to seven years of intensive occupational therapy and physical therapy.