On Nov. 20, 2009, plaintiff Kurt Deshayes, 52, a senior project manager for Lawrence Laboratory in Berkeley, presented to the emergency department at Alta Bates Summit Medical Center in Berkeley. His chief complaint was of chest pain from an episodic cough that he had for three weeks. Concurrently, Deshayes complained of having an upper respiratory infection with a runny nose, cough, fever and sore throat. The chest pain was described as tightness, aching and localized in the central chest area. It was not induced or exacerbated by activity. The night before his presentation at the hospital, Deshayes returned from a business trip to the East Coast. The next day, at around 6 a.m., he experienced an episode of chest pain that lasted 15 minutes. As a result, he went to the E.R. during his first opportunity to see a physician, but at the hospital, his chest pain had abated. Deshayes then came under the care of Emergency Room Physician Teri Chew, M.D. An EKG was subsequently ordered, which was read as normal, and a D-Dimer test was performed to rule out a pulmonary embolism, but it came back negative. Chew also ordered cardiac enzyme testing to check for evidence of a cardiac infarction. However, only the myoglobin test was elevated, which is a non-specific marker of muscle damage, and all other cardiac testing was normal. In addition, the EKG, compared with one from a year prior, showed no changes. Thus, after being observed in the E.R. and being found that there was no recurrence of his symptoms, Deshayes was discharged by Chew. On the morning of Nov. 22, 2009, at about 10 a.m., Deshayes began to experience a recurrence of his chest pain, this time stronger and continuous. He waited until 8:30 p.m., when he could stand it no more, and returned to the emergency department of Alta Bates. This time, Deshayes’ EKG and enzyme testing were abnormal. As a result, Deshayes was advised that he was having a heart attack and that an artery on the left side of his heart (the left anterior descending artery) was 98 percent blocked. He subsequently underwent emergency angioplasty and stenting, and was then discharged on Nov. 27, 2009. Deshayes sued Chew for medical malpractice, as well as Alta Bates Summit Medical Center. Alta Bates was ultimately dismissed prior to the commencement of trial. Deshayes contended that Chew was negligent in diagnosing and treating him. Plaintiff’s counsel contended that Deshayes’ symptoms at the time when Chew saw him were classic for unstable angina, and that Chew failed to recognize this and perform a proper evaluation. Counsel contended that had Chew done so, Deshayes’ coronary artery disease would have been diagnosed and the heart attack would have been avoided. Specifically, plaintiff’s counsel argued that Chew failed to order a second set of cardiac enzyme studies and a second EKG, and failed to either order a stress test or consult with a cardiologist on the case. Chew claimed that Deshayes was discharged based upon all the negative testing and her opinion that Deshayes was stable and his condition had improved, as well as based upon findings that Deshayes was able to walk, was active, was drinking fluids and had no pain. Additionally, Chew claimed that many of Deshayes’ symptoms, including the chest pain, could be attributable to the upper respiratory tract infection that he had for three weeks. Thus, she claimed that based on her clinical impression of chest wall pain and upper respiratory tract infection, she told Deshayes to take it easy, to not work that day, to return or contact his physician immediately if his condition worsened or changed, and to follow up with his primary care physician within four days, even if he was well. Chew contended that her care was at all times appropriate and that her conduct did not result in injury to Deshayes. While it was admitted that a second set of cardiac testing was not ordered, Chew maintained that this was not necessary under the circumstances, since Deshayes reported having had his worst episode of chest pain two or three days before coming to Alta Bates. Thus, she claimed that if the source of the complaint was cardiac in etiology, the initial cardiac studies should have been abnormal and the specific cardiac enzymes should have been elevated, but they were not. In addition, defense counsel contended that there was a more obvious and reasonable explanation for the chest pain; Deshayes had been having problems with an upper respiratory infection during the three weeks he had been having chest pain, and he reported to Chew that his chest pain was associated with a cough that he had been having. Despite the fact that there was no physical evidence for an upper respiratory infection at the time Deshayes was seen in the E.R., the defense’s experts explained that oftentimes there will be no findings on physical examination, so the absence of physical findings did not mean the patient did not have an upper respiratory infection, as Deshayes contended. Defense counsel also pointed to the lengthy delay on Deshayes’ part in returning to Alta Bates on Nov. 22 (i.e. approximately 10 hours) as an indication that Deshayes was either entirely, or to a significant degree, responsible for the cardiac injury he experienced. The experts for both sides testified that Deshayes had six hours from the onset of chest pain to get to the hospital and undergo surgery in order to avoid or minimize the cardiac damage. They opined that because of his delay, Deshayes had experienced permanent and irreversible injury. However, Deshayes claimed that he delayed in returning to the hospital because Chew had assured him that he was not having a heart problem, so he could not be faulted for waiting to see if the problem would resolve itself., Deshayes suffered a heart attack and it was determined that the anterior, descending artery on the left side of his heart was 98 percent blocked. He subsequently underwent an emergency coronary angioplasty and stenting, and was then discharged on Nov. 27, 2009. All of Deshayes’ medical costs were covered by private insurance. However, Deshayes claimed that he suffered permanent coronary damage, which precludes him from working and has resulted in past and future lost wages. He alleged that he planned on working until he was 70, but due to an early retirement, he suffered a deduction in the value of his pension. Thus, Deshayes receives short- and long-term disability at 70 percent of his salary, most of which is tax free. He will continue to receive disability at that rate until he is 65. Deshayes’ wife, Yvonne, dismissed her derivative claim prior to trial.