On March 8, 2009, plaintiff’s decedent Selena Carroll, 31, presented to the emergency room at Antelope Valley Hospital complaining that she was retaining water and had pain with walking. She also requested the hypertension medicine Lasix. Carroll was subsequently admitted for management of congestive heart failure, increased Troponin levels and renal failure. As a result, cardiology and renal consults were requested. The next day, Carroll was seen by Dr. Richard Lee, a nephrologist. Lee’s assessment of Carroll included acute renal failure and fluid overload. As a result, he started Carroll on high-dose Lasix, ordered a renal ultrasound to rule out an obstruction, and noted to watch Carroll’s creatinine. The renal ultrasound noted the right kidney unremarkable with normal echogenicity and without hydronephrosis. However, due to Carroll’s large body habitus, visualization of the left kidney was limited. Lee saw Carroll again on March 10, 2009, and March 11, 2009, during which Lee assumed Carroll’s acute renal failure was from fluid overload. As a result, Lee thought Carroll might need hemodialysis, but he wanted to rule out nephritic syndrome. On March 12, 2009, Carroll was first seen by nephrologist Dr. Bassel Hadaya. During that time, Carroll’s creatinine level was 5.9 and her blood urea nitrogen was 40, which were significantly elevated, indicating Carroll was experiencing kidney failure. As a result, Hadaya ordered a 24-hour urine protein. The next day, Hadaya noted that Carroll’s 24-hour protein was in excess of 39 grams, the maximum value that can be recorded. He subsequently ordered a biopsy of the kidney to help determine the etiology and treatability of Carroll’s kidney failure. Hadaya discussed the risks and benefits of the renal biopsy, and informed consent was obtained. Later that day, a renal ultrasound was performed that revealed positive flow within the bilateral renal arteries, as well as revealed a complex cystic mass on the left kidney upper pole. On March 14, 2009, Carroll began hemodialysis and was seen by Lee, who noted a biopsy was ordered. Lee then saw Carroll again on March 15, 2009, and noted that Carroll had undergone dialysis and again noted that she was to undergo a biopsy. On March 16, 2009, and March 17, 2009, Carroll was seen by Hadaya while the kidney biopsy was still pending. Carroll continued to receive dialysis and she signed a second consent form for a renal biopsy that day. She was then placed on a gurney for the CT-guided renal biopsy, but the procedure did not go forward for unknown reasons and she was returned to her room. Hadaya did not see Carroll again before the biopsy. On March 18, 2009, Carroll was seen by Lee, who wrote a progress note indicating “bx asap,” meaning the biopsy should be done as soon as possible, because Carroll had been waiting for the biopsy since March 13, 2009. As a result, Dr. Kevin Rice started a biopsy of Carroll’s left kidney at approximately 12:54 p.m. and completed the procedure at approximately 1:06 p.m. Rice’s progress note indicated that there were no complications. In addition, Rice’s radiology report documents that the procedure, risks, complications and alternatives were discussed with Carroll. The procedure report specifically documents bleeding as one of the risks and also documents informed consent was obtained. The specimen obtained during the biopsy was submitted to pathology, and it was reported as revealing “sclerosing/proliferative glomerulopathy with features of dual glomerulopathy, possibly underlying diffuse diabetic glomerulopathy and concomitant collapsing variant of focal glomerulosclerosis.” Also noted was a “detached fragment of renal artery.” At approximately 2 p.m., Carroll was back on the floor. Shortly thereafter, a nurse noted profuse bleeding from around the foley catheter site. At 2:30 p.m. Rice, hospitalist Dr. Pradeep Singh, and urologist Dr. Steve Koh were noted to be at Carroll’s bedside. By 3:30 p.m., it was noted that Carroll’s blood pressure had dropped precipitously and that there was copious amounts of blood from the bladder. An ultrasound showed a probable hematoma around the left kidney. At approximately 3:50 p.m., and again at 4:50 p.m., Carroll arrested and was resuscitated. At approximately 5 p.m., a surgeon performed an emergency left nephrectomy in an attempt to stop the hemorrhage. Thereafter, Carroll was comatose and intubated. Hadaya was not on call to hospital patients on the day of the biopsy and was not involved in diagnosing and/or treating the hemorrhage. Carroll had two further arrests on March 19, 2009, at approximately 8:30 p.m. and again at midnight. After the final arrest, Carroll could not be resuscitated and was pronounced dead at 12:15 a.m. on March 20, 2009. The decedent’s son, Lawrence Williams, a minor, through his guardian ad litem, Monica Isabell, sued Rice, Singh, Lee, Koh, Hadaya, and the operator of Antelope Valley Hospital, Antelope Valley Healthcare District. Singh, Koh and Lee prevailed on summary judgment, and Antelope Valley Healthcare District agreed to settle. During jury selection, Rice also settled. Thus, the matter proceeded to trial against Hadaya only. On the first day of trial, plaintiff’s counsel changed Lawrence’s guardian ad litem to the child’s uncle, Sanifu Carroll. A mistrial was then declared on Jan. 27, 2014, as the trial judge sustained an injury. Thus, the matter was to be retried. During the retrial, plaintiff’s counsel argued that there was no reason for Hadaya to order the biopsy. Counsel contended that the decedent had end stage renal failure as a result of her poorly treated diabetes and hypertension and that the only treatment available was hemodialysis. The plaintiff’s nephrology expert testified that the decedent’s elevated creatinine and “torrential” proteinuria, as measured by the 24-hour urine protein, could only be attributable to five conditions: focal segmental glomerulosclerosis (FSGS), diabetic kidney disease, membranous glomerulotherapy, amyloidosis, and minimal change disease. The expert opined that irrespective of the cause, none of the five conditions was treatable in the decedent’s case. Thus, the expert testified that the biopsy was not medically necessary, as the procedure only exposed the decedent to risk with no benefit. Hadaya claimed that the order for the renal biopsy was reasonable under the circumstances. He alleged the decedent was relatively young and had significant findings, which were suddenly apparent and not consistent with a simple diagnosis of “end stage renal disease.” Hadaya claimed that there were two types of FSGS, collapsing and non-collapsing, and that non-collapsing FSGS is potentially treatable, while the collapsing variant cannot be treated. However, he claimed there is no way to determine the FSGS variant without a renal biopsy. The defense’s expert nephrologist testified that clearly “something else was going on,” and that Hadaya acted “over and beyond” the standard of practice in trying to determine the cause of the torrential proteinuria. Defense counsel noted that no expert or treating physician had ever experienced a situation involving a fatal hemorrhage following a renal biopsy, nor had they personally known of such an occurrence in their practice. Counsel contended that literature suggests that there is a 1-in-10,000 risk of a patient bleeding to death following a renal biopsy. Thus, defense counsel argued that the risk of such an outcome was exceedingly small and that finding a potentially treatable explanation for the decedent’s condition was worth that small risk., Selena Carroll lost copious amounts of blood from the bladder following the renal biopsy. An ultrasound showed a probable hematoma around the left kidney. As a result, she arrested and was resuscitated twice. Carroll then underwent an emergency left nephrectomy in an attempt to stop the hemorrhage, but was left comatose and intubated. The next day, Carroll had two further arrests. After the final arrest, Carroll could not be resuscitated and passed away at 12:15 a.m. on March 20, 2009. She was 31. Carroll is survived by her son, Lawrence Williams, who was 9-years-old at the time of her death. Plaintiff’s counsel contended that the decedent would have lived until Lawrence was 18. Thus, counsel requested that Lawrence be awarded $133,000 for his loss of household services. In addition, prior to trial, plaintiff’s counsel sought to have Lawrence recover $503,000 in economic damages for his “loss of supervision,” arguing that the 17-hours-a-day not consumed as part of the household services was an item of economic damages because compensation for supervising the child should have an economic value. However, after briefing by the parties, and before the jury was selected, the court ruled that damages for “loss of supervision” were included in non-economic damages as described in California Civil Jury Instruction 3921. As a result, the plaintiff’s expert economist was not permitted to testify that such damages were “economic” in nature. Thus, plaintiff’s counsel asked the jury to award Lawrence a minimum of $250,000 in non-economic damages and about $133,000 in economic damages (for loss of household services), plus funeral and burial expenses.