On Feb. 9, 2014, plaintiff John Selindh, 54, a marketing/sales executive who was between jobs, presented to the emergency room at Mission Hospital, in Mission Viejo, with complaints of chest pressure, chest pain, and shortness of breath. As a result, a CT angiogram was performed to rule out a pulmonary embolism. Although the study was negative for a pulmonary embolism, it did identify a small amount of fluid and air in the mediastinum within the chest. Selindh had previously undergone an atrial ablation procedure at Anaheim Regional Medical Center, in Anaheim, on Jan. 15, 2014. The procedure was performed to address paroxysmal atrial fibrillation, and was accomplished without apparent complication. However, when he presented to Mission Hospital with chest and breathing complaints nearly four weeks later, on Feb. 9, 2014, the emergency room physician at Mission Hospital recognized that air and fluid in the mediastinum, as shown by the CT angiogram, was an abnormal finding. The physician specifically commented that the finding was concerning since it suggested there was an atrial-esophageal fistula, which is a rare, but well-recognized, potential complication of atrial ablation surgery. The complication is so rare that very few physicians encounter it even once in their career, and it is typically fatal when it does occur. Recognizing the potential dire emergency, the emergency room physician arranged for Selindh to be admitted to Mission Hospital and requested consultations from a thoracic surgeon, Dr. Shigeru Chino, and a pulmonologist, Dr. Raul Marquez. Chino promptly ordered an esophagram to evaluate the patient for an esophageal perforation. Chino acknowledged that a negative esophagram would not definitively rule out an esophageal perforation or reveal a recent perforation that was now in the process of attempting to heal. Nevertheless, once the esophagram was interpreted to be negative, Chino documented definitively that Selindh did not have an esophageal perforation and that the likely source of the mediastinal air was the lungs. (However, Chino agreed that there was no evidence to support the conclusion that the air that was seen was coming from the lungs.) As a result, Chino elected to follow the mediastinal air with repeat AP and lateral chest X-rays, even though the mediastinal air was too small to be detected on plain film X-rays. The next day, after the esophageal perforation was ruled out, Dr. Milan Patel, a cardiologist, was consulted. He diagnosed and treated Selindh for pericarditis. Selindh was later discharge from the hospital on Feb. 12, 2014. On Feb. 20, 2014, Selindh saw his primary cardiologist, Dr. John Baker, and allegedly reported that he was improving. However, Selindh continued to be symptomatic over the next two weeks, and ultimately suffered stroke-like symptoms and collapsed at home on Feb. 25, 2014. As a result, Selindh returned to Mission Hospital, where he was ultimately diagnosed with an atrial-esophageal fistula, which had resulted in air emboli being transmitted to the brain through the heart, which was now communicating with the esophagus. Selindh sued Chino; Marquez; Patel; Baker; the electrophysiologist who performed the ablation on Jan. 15, 2014, Dr. Timothy Yeh; the operator of Mission Hospital, Mission Hospital Regional Medical Center; and multiple other defendants. Selindh alleged that the defendants failed to timely diagnose and treat his condition and that their failure constituted medical malpractice. Marquez, Mission Hospital Regional Medical Center, and several other defendants were dismissed via summary judgment prior to trial. Thus, the matter continued against Chino, Baker and Patel only. Plaintiff’s counsel contended that Chino, Baker and Patel all failed to diagnose the perforated esophagus, which is a precursor to an atrio-esophageal fistula, and that if it was treated correctly, the development of the atrioesophageal fistula would have been prevented. Counsel also contended that Chino did not choose to order a repeat CT scan of the chest at any time prior to Selindh’s discharge from the hospital on Feb. 12, 2014 and that doing so could have detected perforated esophagus. The plaintiff’s thoracic surgery expert opined that Chino absolutely should have recognized that Selindh had suffered an esophageal perforation as soon as Chino learned that Selindh had undergone a cardiac ablation 25 days earlier and had presented to Mission Hospital with air and fluid in the mediastinum. The expert also opined that Chino should have recognized that the esophagram was failing to detect a very small perforation of the esophagus, or a perforation that was now attempting to heal, and that the logic of that conclusion should have been reinforced by the fact that the alternative-proposed source for the air in the mediastinum, the lungs, was not consistent with the facts of the case. The plaintiff’s cardiology/electrophysiology expert opined that the two cardiology consultants should have been acutely aware of the rare, potential, cardiac complication and should have reinforced that reality to Chino and/or called Yeh, the electrophysiologist who performed the ablation. The plaintiff’s experts both claimed that if the esophageal perforation had been recognized and treated sooner, the atrioesophageal fistula would have never developed. Defense counsel for the two cardiologists, Patel and Baker, contended that the two cardiology consultants were acutely aware of the rare, potential, cardiac complication. However, counsel contended that Patel’s only involvement was during the Feb. 9, 2014 hospitalization, where Patel was consulted the day after admission, which was after the esophageal perforation was ruled out, and that Patel diagnosed and treated Selindh for pericarditis, which the plaintiff’s cardiology expert agreed was present and properly treated. Counsel further contended that Baker only saw Selindh on Feb. 20, 2014, between the two Mission Hospital admissions, and that Selindh reported that he was improving at that time. Chino’s counsel contended that Chino ordered the correct study and relied upon the results of that study in concluding that the esophagus was unlikely to have been the source for the mediastinal air and fluid. Counsel also insisted that both the esophagus and the back wall of the left atrium had suffered significant damage during the atrial ablation procedure and that both of those structures would need to be repaired whenever the diagnosis was reached. In addition, defense counsel argued that Selindh’s condition was simply too subtle of a diagnosis to reach at an earlier point in time and that it was further challenging given the rarity of the particular complication., Selindh was ultimately diagnosed with an atrial-esophageal fistula, which had resulted in air emboli being transmitted to the brain through the heart, which was now communicating with the esophagus. As a result, he was air-lifted to UCLA Medical Center, in Los Angeles, on the night of Feb. 26, 2012, despite inclement weather. He then underwent surgery by a cardiothoracic surgeon to repair the back wall of the heart, as the entire posterior wall was necrotic and had to be replaced with a graft. Another cardiothoracic surgeon repaired the esophagus. Selindh is one of the few patients to ever survive after developing an atrial-esophageal fistula. Selindh claimed that his physicians missed the opportunity to heal the esophagus without any damage to the heart and that if it was timely healed, it would have prevented the stroke and surgery that followed. Moreover, he claimed that he had just completed one job, earning approximately $300,000, but that his job search was truncated by his medical complication. He alleged that as a result, by the time he was ready to re-enter the workforce, his marketability had dropped to $150,000 per year. Thus, Selindh sought recovery of $25,000 in out-of-pocket medical expenses, $710,000 in past loss of earnings, $1.5 million for future loss of earnings, and $250,000 in general damages for his pain and suffering. His wife, Tammy Selindh, sought recovery of $250,000 in general damages for her loss of consortium. Defense counsel denied that any earlier diagnosis would have prevented the damage to the heart or need for surgery, arguing that both the esophagus and the back wall of the heart had suffered significant damage during the atrial ablation procedure and that both of those structures would have needed to be repaired whenever the diagnosis was reached.