On the evening of July 31, 2010, plaintiff Kody Myrick, 19, a recent high school graduate, was with his father herding cattle on a ranch in Bakersfield, when he suddenly slumped over and had difficulty speaking. Myrick’s father immediately drove him to the emergency room at Bakersfield Memorial Hospital, a community hospital and primary stroke center. Myrick was triaged in the emergency room approximately one hour after the onset of his symptoms, and the E.R. nurse noted a primary complaint of “possible stroke.” Myrick was examined by the emergency room physician, Caroline Han, M.D., who noted that Myrick was flaccid in all four extremities and unable to talk. Han subsequently ordered a non-contrast CT scan of the brain, which was read by a radiologist as showing a small infarct of indeterminate age in the left thalamus. Blood tests for infection (complete blood count with differential) were performed, and Myrick’s electrolyte and glucose levels were checked, all of which proved normal. A toxicology screen was also negative. Han later telephoned Sahaphun Hansa, M.D., to transfer responsibility for Myrick at midnight. Hansa, a hospitalist and pulmonologist, was at home while he was covering the night shift as the on-call hospitalist for Bakersfield Memorial Hospital. Hansa admitted that his telephone conversation with Han lasted between one and five minutes, that he understood no neurology consultation had been obtained yet, and that although he lived near the hospital, he decided not to go in to evaluate Myrick. There was conflicting testimony at trial between Hansa and Han as to what Hansa was told during the phone call about Myrick’s physical examination and the C.T. scan findings, but Hansa admitted that he did not ask any questions about the findings either. Following the phone conversation, Hansa decided to admit Myrick to the hospital without evaluating him in person and without requesting an emergency neurology consultation. Hansa gave admission orders over the telephone to admit Myrick to the neurology floor with the diagnosis of “possible stroke.” Pursuant to Hansa’s orders, Myrick was transferred from the emergency department to the hospital floor, and Myrick was not seen by Hansa or any other physician for the rest of the night. During the night the stroke symptoms waxed and waned such that Myrick regained a normal Glascow Coma Scale and the ability to move one side of his body. However, the next morning, at approximately 8:00 a.m., Myrick’s neurologic condition deteriorated, and he became obtunded and aspirated. An angiography was obtained and revealed that the basilar artery was occluded. By the time the stroke was properly diagnosed, Myrick had suffered significant permanent damage to his brain stem. Myrick sued Hansa; Han; the emergency room physician’s medical group, Pinnacle Emergency Physicians of Bakersfield; Bakersfield Memorial Hospital; Catholic Healthcare West; an internist, Gary Hensley, M.D.; and a neurologist who was the director of the hospital’s stroke program, Stephen Helvie, M.D. Myrick alleged that the defendants failed timely treat his condition and that this failure constituted medical malpractice. Prior to trial, Hensley was dismissed from the case, and Han, Helvie, Bakersfield Memorial Hospital, Catholic Healthcare West and Pinnacle Emergency Physicians of Bakersfield all settled with Myrick. Thus, the matter proceeded to trial against Hansa only. Plaintiff’s counsel contended that Myrick’s stroke should have been at the top of the differential diagnosis for a patient with an acute onset of profound neurologic abnormalities and a C.T. scan that showed a small stroke. Counsel also contended that the standard of care required emergency neurology consultation and that a C.T. angiogram should have been performed on an emergency basis. At trial, plaintiff’s counsel presented evidence that both Han and Hansa failed to follow Bakersfield Memorial Hospital’s protocols for the rapid evaluation of a potential acute stroke. The plaintiff’s emergency room expert testified that Han should have ordered intravenous tissue plasminogen activator (tPA), a protein involved in the breakdown of blood clots, and obtained an emergency neurology consultation. The plaintiff’s internal medicine expert testified that Hansa breached the standard of care by failing to perform an emergency workup to determine if Myrick was having an acute stroke, by ordering a drug that was not the standard of care for acute stroke, and by failing to obtain an emergency neurology consult, which was available at the hospital through a teleneurology system that had neurologists on-call 24 hours a day. The plaintiff’s neurology expert testified that had a competent neurologist been called, the neurologist would have recognized that Myrick’s symptoms were indicative of a posterior circulation stroke, ordered an immediate C.T. angiography, and arranged for emergency transfer to a comprehensive stroke center that had stroke neurologists and interventional radiologists — services that were not available at Bakersfield Memorial Hospital. The expert also testified that a C.T. angiography would have demonstrated the basilar artery was occluded by thrombus, which required an urgent thrombectomy by an interventional radiologist. The plaintiff’s interventional neuroradiology and neurology experts testified that Myrick had a stroke in evolution, with a waxing and waning course, and that had Myrick undergone a thrombectomy to remove the blood clot prior to 8:00 a.m., much of the permanent ischemic injury to the brain stem would have been prevented, such that he could have lived and worked independently. Hansa’s counsel contended that Han had tried to call a neurologist, but that no hospital neurologist would return her call. Counsel also contended that Han believed that the teleneurologist, who had only started the month before, was only for the potential use of tPA, which Han had ruled out. Counsel further contended that this was discussed with Hansa and that Hansa was told that there was no neurologist available. Hansa’s counsel argued that under these circumstances, Hansa admitted Myrick for observation, consisting of 2-hour neurology checks, and put Myrick on stroke prophylaxis, including anticoagulation, pending further evaluation, if necessary, in the morning. Hansa testified that he did not know Myrick was undergoing a stroke, and that because Myrick’s vital signs were stable, there was no need for an emergency neurology consultation. Hansa’s counsel argued that Helvie failed to detect an occlusion of the basilar artery on Myrick’s non-contrast C.T. scan, thereby misleading both Han and Hansa. Counsel also disputed causation, arguing that by the time Hansa accepted transfer from Han, Myrick’s stroke was already completed. Thus, counsel contended that Myrick suffered no further brain injury while under Hansa’s care. In addition, Hansa’s counsel argued that it would have been impossible to transfer Myrick to a tertiary care center for the thrombectomy procedure. The defense’s stroke neurology expert, who was the director of the University of California, San Francisco Medical Center, testified that he would not have accepted Myrick for transfer, as Myrick would not have met the criteria for a mechanical thrombectomy. He also testified that mechanical thrombectomy was still an “experimental” procedure and that even in San Francisco, had this occurred in San Francisco and not Bakersfield, it was almost impossible to arrange an inner city transfer in under six hours., Myrick was originally diagnosed with “locked in” syndrome, consisting of paralysis and the inability to speak, but with normal cognitive function. However, he ultimately suffered a catastrophic brain stem injury. Myrick subsequently spent three weeks at Bakersfield Memorial Hospital, paralyzed in all four limbs and unable to talk, before being transferred to Santa Clara Valley Medical Center, where he spent three months undergoing intensive rehabilitation with speech, occupational and physical therapy. Over the next year, he regained partial use of one hand. Myrick claimed that his permanent injuries include spastic quadriparesis, loss of balance, and profound speech impairment. He claimed that as a result, he requires 24-hour attendant care and is restricted to a wheelchair. In addition, plaintiff’s counsel contended that an implanted baclofen pump would be warranted to treat Myrick’s spasticity problems. The parties stipulated that Myrick’s past medical costs paid by Medi-Cal amounted to $370,587. Thus, plaintiff’s counsel asked the jury to award Myrick economic damages consisting of $116,419 for his past wage loss, $3,247,980 for his future wage loss, $230,655 for his past attendant care, and $33,111,900 for his future life care costs. Plaintiff’s counsel did not ask for an explicit amount of non-economic damages, but advised the jurors to use their common sense and experience in reaching a fair amount. Hansa’s counsel did not dispute the reasonableness and necessity of Myrick’s past medical care, but presented a different life care plan to the jury. Counsel conceded the necessity of most items in Myrick’s plan, but disputed the plaintiff’s pricing of certain items, including the cost of future attendant care, arguing that Myrick could be cared for at a group home. Hansa’s counsel also disagreed with Myrick’s alleged future necessity for an intrathecal baclofen pump, arguing that treating Myrick with doses of oral baclofen was sufficient. Thus, Hansa’s counsel suggested that if the jury did not return a defense verdict and reached the question of damages, it should award Myrick $3 million in total damages.