On Oct. 2, 2014, plaintiff’s decedent Mansoor Lahiji, 73, a retiree, was having his feeding tube replaced at Providence Little Company of Mary Medical Center-Torrance, in Torrance, when he suffered a cardiopulmonary arrest and died at 9:40 p.m. Prior to his death, Lahiji suffered a subdural hematoma, which was surgically evacuated on Sept. 24, 2014. He was on the road to recovery, but had an impaired swallow function. As a result, he was placed on a Dobhoff tube (a small-bore feeding tube) on Sept. 27, 2014. However, a registered nurse, John Flynn, inadvertently inserted the feeding tube into Lahiji’s right lung while trying to replace it. The tube was then removed, but it was reinserted into Lahiji’s left lung. As a result, Lahiji’s lungs were injured, resulting in bilateral pneumothoraces. He subsequently went into cardiopulmonary arrest and died at 9:40 p.m. on Oct. 2, 2014. The decedent’s wife, Nahid Lahiji, sued Flynn; Flynn’s employer, the operator of Providence Little Company of Mary Medical Center-Torrance, Providence Health System-Southern California; a hospitalist, Dr. Roman Culjat; and a specialist in diagnostic radiology, Dr. Randall Sutherland. Ms. Lahiji alleged that defendants were negligent in the treatment of her husband, causing her husband’s wrongful death. She also alleged that the defendants’ negligence constituted medical malpractice. Sutherland’s counsel moved summary judgment, asserting that there was no liability against Sutherland, as Sutherland had immediately contacted a nurse with the critical X-ray results. The motion was granted, and Sutherland was dismissed from the case. Plaintiff’s counsel argued that Flynn inserted the feeding tube improperly and caused the lung to develop, which led to Mr. Lahiji’s cardiopulmonary arrest and death. Counsel contended that although Lahiji had an impaired swallow function and was placed on a feeding tube, the plan was that Lahiji would either regain his swallow function with rehabilitation therapy, or, if unsuccessful, Lahiji would be placed on a gastrostomy tube (a G-tube) within a few days and discharged into an acute rehabilitation program. Counsel further contended that none of Lahiji’s treating doctors expected him to die. The plaintiff’s critical care expert opined that Lahiji died as a direct result of the bilateral pneumothoraces caused by the negligent placement of feeding tubes first through the right lung and then through the left lung. The expert also opined that Lahiji would have survived either lung injury with timely intervention and placement of chest tubes, but that the delay in response directly resulted in the cardiopulmonary arrest and death. Plaintiff’s counsel argued that Flynn was negligent in the insertion of the feeding tube, which caused the pneumothoraces. Counsel also argued that the hospitalist, Culjat, was negligent for failing to supervise Flynn, for failing to sign out to another hospitalist and for providing vague orders to the nursing staff. Counsel further argued that the hospital was negligent for failing to properly supervise Flynn, for allowing Flynn to insert feeding tubes when he lacked competency to do so, and for having policies and procedures that were vague and ambiguous as to the scope of nursing decisions and when a doctor should be notified. Plaintiff’s counsel maintained that there was inconsistency and ambiguity between the orders of Culjat and the hospital’s policies and procedures. Counsel contended that the hospital’s written policy stated that a medical order was required before the insertion of any feeding tube, but Culjat’s order did not specify whether it was a standing order that allowed nurses to remove and replace the feeding tube as needed or whether it was a one-time order, requiring a renewal from the doctor each time. Plaintiff’s counsel argued that the hospital’s written policies and procedures were vague and ambiguous, and gave the nurses far too much leeway in making clinical decisions without requiring them to ask the doctor. Counsel also argued that the hospital is responsible for the actions of its nurses under the doctrine of respondeat superior and that Culjat’s orders were unclear, noting that Culjat gave inconsistent testimony as to whether he expected the nurses to call him if the tubes had been placed in the lung. Plaintiff’s counsel further argued that Culjat was acting as a hospitalist and was on call after hours, but that Culjat did not respond to his answering service pages for 31 minutes while Lahiji continued to deteriorate. The plaintiff’s nursing expert opined that the nurses at Providence Little Company of Mary Medical Center-Torrance were negligent in placing the tubes into Lahiji’s lungs and failed to recognize red flag warning signs that Lahiji lacked cough/gag reflex, which would have signaled the tube going down the trachea. The expert also opined that the nurses were negligent for removing and reinserting the tubes without a doctor’s order, that the nurses failed to seek immediate medical intervention when Lahiji’s vital signs began to deteriorate and that the nurses exercised clinical judgment beyond the scope of nursing. The expert further opined that the hospital’s own staff competency checklist showed that Flynn lacked competency to place small bore feeding tubes, yet the hospital had negligently authorized Flynn to do so. In addition, the nursing expert opined that Flynn negligently proceeded to place the feeding tube despite the fact that he lacked experience in placing that type of feeding tube and despite knowing that he lacked competence. The plaintiff’s expert in hospital medicine opined that Culjat breached the standard of care by issuing vague and ambiguous orders, and by failing to hand off Lahiji to another hospitalist once Culjat left the hospital. The expert testified that hospital medicine requires a hospitalist to be on the premises at all times and not to be on-call after leaving the hospital. He further opined that the hospital’s policies were vague as to the required communications between nurses and doctors. The pulmonology expert for the hospital and Flynn opined that the nursing standards of care were met and that Lahiji died because of an unfortunate complication, as Lahiji allegedly had multiple comorbidities that severely limited his life expectancy. Culjat and his expert in hospital medicine contended that Culjat was not required, as a hospitalist, to be on the premises or to hand off a patient to an incoming hospitalist. The expert also opined that it was within the standard of care for Culjat to be on-call after hours and that any delay in responding to an answering service’s pages did not result in harm to Lahiji. Culjat’s counsel contended that Culjat timely responded to his pages. Counsel also noted that the plaintiff’s expert in hospital medicine worked in a group of hospitalists whose policy was to have one member of the group present in the hospital at all times, whereas Culjat’s expert in hospital medicine, who works at Cedars-Sinai, opined that a hospitalist’s role is akin to that of a physician caring for a hospitalized patient, like any internist would., Lahiji sustained to his lungs, resulting in bilateral pneumothoraces. He subsequently went into cardiopulmonary arrest and died at 9:40 p.m. on Oct. 2, 2014. He was 73. The plaintiff’s critical care expert opined that Lahiji died as a direct result of the bilateral pneumothoraces and that Lahiji would have survived either lung injury with timely intervention and placement of chest tubes The expert also opined that the delay in response directly resulted in the cardiopulmonary arrest and death. While the expert had no opinion about Lahiji’s life expectancy, he opined that Lahiji would have survived the hospitalization but for the bilateral pneumothoraces, that Lahiji would have gotten through an acute rehabilitation program, and that Lahiji’s comorbidities were all stable and well controlled. The decedent’s wife, Nahid Lahiji, sought recovery of wrongful death damages for the loss of her husband. The pulmonology expert for the hospital and Flynn opined that because of Mr. Lahiji’s comorbidities due to a prior stroke, atrial fibrillation and diabetes, Mr. Lahiji’s life expectancy, but for the bilateral pneumothoraces, was only weeks.