On Nov. 18, 2016, plaintiff David Collins, 30, a welder who had been sick with a pulmonary infection for several weeks, was found stumbling on Gardena Road, in Encinitas, less than 100 yards from his home. Collins previously called 911 to report homeless people sleeping in his bed. Three San Diego County Sheriff’s deputies, including Matthew Chavez and David Sanchez, arrived at the scene and searched Collins’ home. They also spoke to Collins before leaving. Approximately three hours later, two Good Samaritans found Collins stumbling on Gardena Road and called 911. They told the operator that Collins had requested paramedics. As a result, Encinitas City firefighter paramedics and several deputies, including Chavez and Sanchez, arrived at the scene. Collins was then arrested and transported to Vista Detention Facility, in Vista. Once there, he received a medical assessment from an intake nurse, Jonathan Symmonds, who concluded that Collins was medically fit to be placed in jail. As a result, Collins remained in jail for 13 hours. Medical records confirmed that Collins fell twice in his cell during that time. After the first fall, Collins was examined by another county nurse, Roela Carolino, who then examined Collins two more times. However, during those 13 hours, no medical personnel were called to the jail. Shortly after the second fall, Collins was released from jail, and staff members called a courtesy ambulance to transport Collins to Palomar Medical Center in Escondido. Collins was then seen by Doctors Shannon Rose, Ian Butler and Asaf Presente. He was ultimately diagnosed with a subarachnoid hemorrhage and hyponatremia — a condition that occurs when the level of sodium in blood is abnormally low, causing the body’s water levels to rise, and cells to swell. Collins also developed a brain stem injury. Collins sued Chavez; Sanchez; Symmonds; Carolino; and their employer, the county of San Diego. Collins also sued Rose, Butler, Presente and the operator of Palomar Medical Center, Palomar Health. In addition, Collins sued other individuals and companies that were believed to have had contact with him during the time in question, including ambulance services American Medical Response Inc. and American Medical Response of Southern California; Doctors John Anshus and Andrew Nguyen; the doctors’ medical group, The Regents of The University of California; and the employer of the responding firefighter paramedics, the city of Encinitas. Collins alleged that the deputies had falsely arrested him and that both the deputies and the prison nurses were negligent in their failure to obtain medical assistance for him and that the county was vicariously liable for their actions. Collins also alleged that Rose, Butler, Presente, hospital nurses and a hospital pharmacist were negligent in their treatment of him at Palomar Medical Center and that this negligence constituted medical malpractice. He further alleged that Palomar Health was vicariously liable for the actions of the nurses and pharmacist. (Collins specifically claimed that Rose, Butler, Presente, the nurses and the pharmacist caused his sodium level to rise too quickly at the hospital, leading to the injury to his brain stem.) In addition, Collins alleged that the city was liable for the actions of its firefighter paramedics and that the Regents was responsible for the actions of its employee, Nguyen. Rose, Butler, Presente and Palomar Health settled out prior to trial. In addition, Anshus, Nguyen, the American Medical Response defendants, the city of Encinitas, and the Regents of the University of California were dismissed prior to trial. The matter continued against the deputies, Chavez and Sanchez; the jail’s nurses, Symmonds and Carolino; and the employer of the deputies and nurses, the county of San Diego. Plaintiff’s counsel contended that during the first 911 call, which Collins made earlier that evening, Collins told the phone operator that he was not intoxicated and that Collins also later told the Good Samaritans who found him that he was not drunk. Counsel noted that the Good Samaritans also told the 911 operator during the second call that they didn’t believe Collins was drunk and that Collins’ toxicology screen at the hospital came back clean. Counsel further contended that neither Collins’ roommate nor the two visitors who came to the home earlier that evening had seen Collins drinking. As a result, plaintiff’s counsel maintained that Collins was not under the influence of drugs or alcohol at the time of his arrest. The plaintiff’s expert neurologist opined that Collins was suffering from a low sodium level due to a combination of his infection and over-the-counter medications. Plaintiff’s counsel argued that the deputies, specifically Chavez and Sanchez, should have known from their prior interaction with Collins that Collins was hallucinating and required immediate medical attention, but that, instead, the officers interrupted the paramedics’ medical assessment and took Collins to jail. Counsel also argued that the deputies should have let the paramedics take Collins to the hospital for appropriate treatment and that the officers’ actions were in violation of the county’s emergency medical services policy, which states that paramedics, the base hospital and the emergency medical subject must all agree to no hospital transport when an ambulance is requested for medical assistance. In addition, plaintiff’s counsel contended that once Collins arrived at the jail, Symmonds should have realized Collins was in medical distress and had him taken to a hospital and that Carolino should have called for medical attention soon after Collins’ first fall in his cell. Defense counsel maintained that the deputies’ actions were justified. Specifically, the defense argued that Collins was drunk on the night in question, contending that Collins was drinking heavily prior to his arrest and that Collins smelled of alcohol when the deputies arrested him. Defense counsel noted that Collins’ roommate got worried and called Collins’ parents on the evening in question when Collins could not be found, and contended that Collins’ parents immediately came to the house and found numerous empty beer cans in Collins’ room, along with large bottles full of his urine. Collins’ dad called 911 and told police that he thought his son was missing and had been binge drinking. According to defense counsel, Collins also told his doctor that he had not eaten anything over the past few weeks, but that he had continued to drink alcohol, which counsel argued was additional evidence that Collins’ excessive drinking had set off the entire chain of events. Defense counsel contended that the deputies had probable cause to arrest Collins for public intoxication and that Penal Code 647(f) calls for individuals to be arrested if they seem to be under the influence of drugs or alcohol, are in public, and appear unable to care for their own safety. Counsel argued that the penal code applied to Collins because he was staggering and falling in the street prior to his arrest. Counsel also pointed to the testimony of Collins’ roommate’s houseguests, who claimed that they thought Collins was intoxicated on the night in question and that they believed it was unsafe for Collins to be walking on the street alone at that time. Defense counsel contended that the deputies arrested Collins after the paramedics had finished their medical assessment, and pointed to the testimony of a paramedic who was at the scene, who stated that no deputy took Collins away while paramedics were assessing Collins. Both the paramedic and a fire engineer further testified that Encinitas law enforcement officers had never taken a person away while a medical assessment was being performed. In addition, a fire captain testified that the paramedics had sufficient time to determine whether Collins was a patient before the officers arrested Collins. Defense counsel further maintained that while Collins was in jail, there was no reason for Symmonds or Carolino to contact an ambulance earlier, as Collins did not appear to need immediate medical attention either when he arrived at the jail or during the 13 hours Collins was in his cell., Collins was diagnosed with a subarachnoid hemorrhage and a critically low sodium level while at Palomar Medical Center in Escondido. He claimed that his frontal lobe brain injury was caused by one of the falls in jail. Collins also developed a brain stem injury, called osmotic demyelination syndrome, during his hospital stay. Plaintiff’s counsel contended that the brain stem injury was a result of the doctors raising Collins’ sodium level too rapidly. Collins was then monitored at the hospital for the next month and on Dec. 18, 2016, he was sent to rehabilitation. At that time, Collins was not communicative or mobile. At the rehabilitation facility, Collins received an experimental treatment, called intravenous immune globulin, and underwent physical and occupational therapy. He made a steady recovery, and was soon able to walk and talk. He was ultimately discharged from the rehabilitation facility on Jan. 31, 2017. Collins then underwent several more months of outpatient physical therapy and followed up with a neurologist. Collins claimed that he still has trouble talking and that he walks with an unsteady gait. He also has poor fine motor skills, and has difficulty with judgment, insight and processing. As a result, he continues to receive occasional follow-up treatment with a neurologist. After leaving the rehabilitation facility, Collins had to move back in with his parents. He claimed that he is no longer able to work or drive and that his parents have to cook and clean for him. He also claimed that he is able to bathe and dress himself, but those activities take longer than they should. Collins further claimed that he is less social than he was before the incident and that he mostly just stays home. He alleged that he used to go hiking frequently, but that he now goes less often and has to bring somebody with him. Plaintiff’s counsel argued that Collins requires full-time attendant care and that Collins should either have an attendant live with him or move to a group home for patients with brain injuries. Collins sought recovery of past and future medical expenses, past and future lost earnings, and damages for his past and future pain and suffering. Several of the defense’s medical experts disputed whether over-the-counter medications could have caused a low sodium level, as the plaintiff’s expert neurologist opined. The defense’s critical care expert also opined that Collins’ low sodium level was likely caused by Collins drinking alcohol excessively and not eating over the past few weeks. Defense counsel noted that the Good Samaritans who found Collins suggested that Collins had fallen in the street. As a result, counsel argued that the alleged fall in the street, and not the falls in the jail, may have caused Collins’ hematoma. Counsel also argued that Collins’ brain stem injury did not result from the actions of the deputies or prison nurses, and contended that the brain stem injury was due to a combination of Collins’ critically low sodium level, which existed for a day and a half before the arrest, and Collins’ sodium level rising too quickly at the hospital after Collins had already left the jail. In regard to Collins’ current condition, defense counsel contended that Collins can live alone and doesn’t need full-time attendant care. Counsel also argued that the lost earnings award should be limited and based on the part-time salary Collins was receiving at the time of the incident.