On June 11, 2012, plaintiff Alfonso Castro, 63, was presented to the emergency room of Providence Holy Cross Medical Center in Mission Hills. He was admitted with a bilateral jaw fracture following an assault. Castro underwent a six-hour, surgical procedure with open reduction and internal fixation performed by plastic surgeon Zareh Vartivarian. Vartivarian was assisted in the surgery by otolaryngologist Rafael Quinonez, who attempted to manipulate the right jaw fracture from the outside. The procedure was unsuccessful and Castro was transferred into the intensive care unit while still intubated. Castro remained there for four days and was discharged four days later. Castro claimed a right side facial droop, due to a nerve injury. Castro sued Vartivarian, alleging that they had departed from the standard of care. Castro’s counsel specifically alleged that Vartivarian caused Castro’s facial nerve avulsion by using excessive force and traction during the procedure. In addition, Castro’s counsel alleged that Castro did not give informed consent to the procedure and that Vartivarian should have treated the fracture by wiring Castro’s jaw closed. Further, plaintiff’s counsel alleged that Vartivarian was negligent in choosing to inject him with the anesthetic Lidocaine and in failing to use nerve monitoring during surgery. Defense counsel denied liability, arguing that no departure occurred. The defense argued that Vartivarian’s actions, such as bringing in the assistance of Quinonez and transferring Castro into the ICU, were reasonable and done out of concern for Castro’s health. Defense counsel maintained that Castro’s facial avulsion was due to an unknown and incredibly rare complication, and that it would require a tremendous amount of force to avulse the main trunk of the facial nerve. Quinonez was initially named as a defendant but was dismissed prior to trial., Castro was subsequently admitted to Olive View UCLA Medical Center. He underwent exploratory nerve surgery and was diagnosed with a complete avulsion to the main trunk of his right facial nerve as it exited the skull. Castro has not received further surgical treatment for his nerve injury. Castro suffers from right side facial paralysis and is unable to close his right eye. He complained of depression and emotional distress. Castro sought damages for past medical expenses of $368,000, future medical expenses of $81,000, and general damages of $250,000. Defense counsel disputed the damages, arguing that past medical expenses had been written-off or covered by MediCAL.