On July 29, 2016, plaintiff James Luzzi, 64, who worked in technology sales, underwent knee-replacement surgery at Saddleback Memorial Medical Center, in Laguna Hills. Approximately six weeks after the surgery, Luzzi complained of back pain. Thereafter, a fractured needle was discovered in his lower spine. A scan about two months post-surgery identified the metal artifact, which was initially identified as a needle, and since Luzzi denied having any other back procedures, the only suspect procedure left was the spinal anesthesia that was performed by Dr. Kathleen Sullivan, an anesthesiologist, during the knee-replacement surgery. Luzzi sued Saddleback Memorial Medical Center; two anesthesiologists, Dr. Kathleen Sullivan and Dr. Stephen Garber; and the anesthesiologists’ medical group, California Anesthesia Associates Medical Group. Luzzi alleged that the defendants negligently performed the administration of the spinal anesthesia and that their negligence constituted medical malpractice. Saddleback Memorial Medical Center, California Anesthesia Associates Medical Group and Garber were also dismissed from the case before trial, and the matter ultimately continued against Sullivan only. Plaintiff’s counsel contended that Sullivan was negligent in her performance of the attempted spinal anesthesia procedure, which resulted in the fractured needle. Specifically, counsel argued that the object found in Luzzi’s spine was part of a needle that Sullivan mistakenly used as an introducer and that Sullivan pushed into the spinal canal with her spinal needle. Luzzi’s expert anesthesiologist identified the metal cannula as a blunt-tipped introducer needle. The expert opined that Sullivan mistakenly picked up the introducer needle and pushed it off the hub into the spinal canal. Plaintiff’s counsel noted that Sullivan testified that she had to make multiple attempts to achieve the spinal anesthetic, and argued that even though Sullivan claimed that the subject blunt-tipped introducer needle was not in the anesthesia kit she used, Sullivan was rushed and simply mistakenly used a needle from her anesthesia cart, and not from the specific anesthesia kit. Sullivan claimed that she attempted spinal anesthesia in a manner consistent with the standard of care and that when she could not complete the procedure, she was assisted by another anesthesiologist, Garber, who placed the spinal anesthesia. She also noted that there were no immediate complaints of back pain after the procedure. In addition, Sullivan claimed that the subject object was not something that came from her kit nor would she have used such an item in attempting to perform spinal anesthesia. Sullivan’s counsel contended that once the metal cannula was examined by engineers, it was found to be a blunt-tipped cannula and not a fractured needle, as alleged. Counsel also contended that the cannula could not be matched to anything in the anesthesia kit and that it did not match the gauge or size of any hospital blunt needles available to Sullivan. Sullivan’s counsel noted that Luzzi’s expert engineer could not find a match to any U.S. needle and that the expert’s opinion was that it was closest to an industrial needle. However, defense counsel argued that none of the medical experts, anesthesiologists or orthopedic surgeons could not identify the object as a U.S. needle or a U.S. cannula and that none of the 14 experts who evaluated the case, including the engineers, could identify the object at all. The defense’s biomedical engineering expert opined that the subject object was not a medical needle, as it was tooled to be blunt-tipped and never had a hub on it, so it could not have been a broken blunt-tipped needle, as alleged by Luzzi’s expert. The defense’s experts also opined that the spinal needle used by Sullivan did not fit inside the subject cannula and could not have been mistaken for an introducer, as alleged by plaintiff’s counsel. The defense’s engineering expert further opined that since Sullivan’s spinal needle would not fit inside the cannula, the plaintiffs’ theory that Sullivan somehow pushed the blunt-tipped cannula through muscle and into the tough ligament was impossible. Sullivan’s counsel presented a cannula ordered from India and contended that it was the exact same type of cannula that was found in Luzzi’s back. Counsel argued that, based on the cannula found, Luzzi must have undergone a secret spinal procedure of some sort in India or somewhere in the United States, which Luzzi either did not recall or intentionally concealed. Counsel noted that three years before the subject incident, Luzzi suffered a severe episode of lumbar pain in 2013, which caused him to fall and require a wheelchair. Luzzi consulted a neurosurgeon, and surgery was scheduled to correct his significant degenerative condition. However, Luzzi produced evidence that he was searching for alternatives to surgery, including laser spine surgery, acupuncture or other therapies. He ultimately canceled his surgery, and he testified that his debilitating back pain, which required a wheelchair and crutches, spontaneously resolved. Defense counsel noted that Luzzi travelled to India for his work on at least two occasions after his 2013 back pain event as well as traveled to other parts of the United States. Counsel contended that while there were no insurance records in the United States that documented a surgery from 2013 to 2016, Luzzi was uninsured for some periods of time during a job loss, and records from India could not be obtained. Defense counsel noted that Luzzi continued to deny that he underwent any other surgical procedure, injection or acupuncture. However, defense counsel argued that there was no other explanation for an unidentifiable blunt-ended metal cannula being found in the Luzzi’s spine at L2-3, especially since the subject object could not be found on the hospital’s inventory and, according to the defense’s experts, was not consistent with a needle, as it was not beveled on either side and was not ever been attached to a hub., Luzzi was taken to surgery by his treating orthopedic surgeon on Nov. 14, 2016. The surgeon documented degenerative spondylolisthesis, severe spinal stenosis and bilateral radiculopathy at L2-3. The surgical findings included severe facet overgrowth and severe facet arthrosis. He completed a posterior lateral fusion; a posterior osteotomy; a partial posterior reduction/decompression of the spondylolisthesis; a partial laminectomy and bilateral foraminotomy with nerve root decompression; a segmented pedicle screw fixation; a placement of bilateral longitudinal rods and a local bone graft; a removal of the needle from the spinal canal; and a repair of the dura due to needle placement, all at the L2-3 level. Surgical pathology found the metal remnant to be blunt tipped on both ends and measured 2.1 centimeters with 1 centimeter imbedded in the ligamentum flavum. Once engineers examined the metal cannula, it was found to be a blunt-tipped cannula. Luzzi claimed that he suffers from adjacent level disease as a result of needing to undergo the surgery by the orthopedic surgeon. He also claimed that he will need addition surgery to treat his condition. Luzzi sought recovery of either $1,019,496 in total economic damages, which included his alleged loss of earnings without a bonus, or $1,385,496 in total economic damages, which included his alleged loss of earnings with a bonus. Also included in the amounts sought for total economic damages was $269,675.56 in total past medical expenses, of which $103,200.93 was paid by insurance and $8,338.66 was paid out of pocket. In addition, Luzzi sought recovery of $500,000 in non-economic damages. He also had multiple claims for special damages for house maintenance, a new mattress, painting, etc., but he withdrew those claims during trial. His wife, Jane Luzzi, presented a derivative claim seeking recovery of damages for her loss of consortium. The defense’s orthopedic expert testified that Mr. Luzzi underwent the same surgery he needed in 2013, which also included the removal of the cannula. The expert opined that if only the cannula needed to be removed, it could have been done alone, but that he agreed with Luzzi’s treating orthopedic surgeon that Luzzi needed the other procedures done by the treating surgeon due to his pre-existing condition. The defense’s orthopedic surgery and neurology experts agreed with a prior treating physician, that the cannula was not the cause of Luzzi’s pain in 2016, as Luzzi’s symptoms did not correlate to the location of the object, which could have been there for three years, and was placed sometime after his last available imaging from 2013. The experts also opined that Luzzi’s back pain, which began six weeks post-knee surgery, was more likely caused by Luzzi aggravating his pre-existing condition during therapy for his knee. The defense’s orthopedic surgery expert also testified about his published study that reported that adjacent level disease happens in patients because they are genetically predisposed to spinal degeneration and not due to other surgery, which Luzzi claimed was due to the cannula. The expert opined that young persons who have an injury that is repaired in the same fashion do not develop adjacent level disease because such degeneration is not due to the surgery, but the patient’s own condition. The defense’s expert neurologist opined that Luzzi recovered by the time of the independent medical exam that he performed and that any later degeneration was not due to the surgery or the cannula. The expert also opined that there were no neurological findings on Luzzi’s independent medical exam, which was done within one month of the defense’s exam, but that Luzzi still claimed that the later, more current complaints, were from the cannula. Defense counsel contended that Luzzi was impeached on his work history, income and other issues. Counsel noted that Luzzi had recommendations for back surgery in 2013, that Luzzi was told that he would need a knee replacement in 2012, and that Luzzi was being scheduled for total knee replacement in January 2016. Counsel also noted that Luzzi fell on a golf course at a company function in March 2016 and that Luzzi filed a workers’ compensation claim, contending that the fall was the reason he needed the subject surgery in July 2016. Defense counsel contended that Luzzi then claimed that the knee surgery caused the need for the subsequent back surgery to correct his pre-existing problems and to remove the “cannula” and that Luzzi was still collecting workers’ compensation benefits at the time of trial. Thus, defense counsel argued that Luzzi’s total economic damages ranged from $137,386 to a net benefit of $27,754, given Luzzi’s disability and workers’ compensation benefits. Specifically, counsel argued that if Luzzi recovered from his injuries by Nov. 14, 2018, then Luzzi’s net past lost earnings would be $137,386; if Luzzi recovered at the termination of his disability insurance on March 9, 2018, then Luzzi’s net past lost earnings would be $52,143; if Luzzi’s lumbar recovered eight weeks post-operation on Dec. 12, 2017, then Luzzi’s net past lost earnings would be $32,275; and if Luzzi recovered by the time of his first job search on March 19,2017, then Luzzi’s net past lost earnings would be $27,754.