On Sept. 19, 2015, plaintiffs’ decedent Liem Tran, 45, a store’s owner, was driving home from a party with his wife when he complained of chest pain. His wife called 9-1-1 at 10:41 p.m. Paramedics arrived at Tran’s vehicle four minutes later and obtained three EKGs, two of which were interpreted as demonstrating an ST-elevation myocardial infarction (STEMI) and/or a suspected myocardial infarction. Tran was transported to the emergency department at St. Joseph’s Medical Center, in Stockton, between 10:50 p.m. and 11 p.m. The last EKG obtained two minutes before his arrival in the emergency department demonstrated sinus tachycardia and was abnormal, showing a bundle branch block, but it no longer demonstrated a STEMI. Upon arrival at the emergency department, Dr. Soliman Sparta Atai, a family physician and emergency medicine specialist, immediately obtained an EKG, and it did not demonstrate a STEMI. Atai requested that the EKG be transmitted to the on-call cardiologist, Dr. Abbas Chothia, who reviewed the EKG remotely and agreed it did not show a STEMI. Chothia also agreed that the cardiac catheterization laboratory did not need to be activated. A second EKG was performed at 11:17 p.m., and it also did not show a STEMI. It was estimated that Chothia would have reported that information to the emergency department at 11:20 p.m., at the earliest. Tran developed symptoms of agitation and nausea at 11:30 p.m. and he sustained a cardiac arrest at 11:42 p.m. The administration of CPR was not successful, and Tran was pronounced dead at 12:02 a.m. The decedent’s wife, Diem Ho, acting individually and as guardian ad litem for her minor sons, Alex Tran and Quoc Tran, and minor daughter, Sabella Tran, sued Atai; the operator of St. Joseph’s Medical Center, Dignity Health; Chothia; and the medical groups of Stockton Cardiology Medical Group Complete Heat Care Inc., San Francisco Physicians International Medical Group Inc. and Team Physicians of California Medical Group Inc. Ho alleged that the defendants were negligent in their treatment of her husband, causing his wrongful death, and that the defendants’ actions constituted medical malpractice. Dignity Health, Chothia and Stockton Cardiology settled for confidential amounts, and San Francisco Physicians and Team Physicians were dismissed from the case. The matter continued to a trial against Atai. Plaintiffs’ counsel called to testify one of the paramedics that transported Mr. Ho to the hospital. The paramedic testified that although she did not document it, she called the emergency department to report a STEMI and that she expected that the emergency department would activate a STEMI alert and have a cardiac catheterization team present to perform percutaneous intervention upon Ho’s arrival at the hospital. The treating emergency medical technician also claimed that a STEMI alert was called into the hospital. However, a STEMI alert was not activated at the hospital. The plaintiffs’ emergency medicine expert testified that the standard of care and the hospital’s policy required that Atai activate the catheterization laboratory upon receipt of the field report of a STEMI or a suspected myocardial infarction. The plaintiffs’ cardiology expert testified that the consulting cardiologist was required by the standard of care to request more clinical information regarding Tran’s presentation and to come to the hospital to evaluate the patient given the abnormal EKG. Based upon the testimony of both the plaintiffs’ emergency medicine and cardiology experts, plaintiffs’ counsel asserted that had the catheterization laboratory been opened between 10:50 p.m. and 10:55 p.m., a cardiac catheterization could have been performed prior to Ho’s cardiac arrest at 11:42 p.m. The plaintiffs’ forensic pathology expert testified that he performed an autopsy of Ho, during which he identified severe atherosclerosis of the left, main, anterior descending artery, and left marginal and right coronary arteries. He did not find thrombus in any coronary artery. However, the pathologist opined that because the troponin was normal, Ho’s “heart cells” were still viable and Ho’s condition was “survivable.” The expert concluded that the administration of anticoagulants would have changed the outcome of the case. Atai’s counsel noted that while the treating paramedic and EMT testified that a STEMI alert was called into the hospital, the telephone call was not documented and neither the paramedic nor the EMT had a recollection as to who actually made the call to the hospital. The paramedic also agreed that the field EKGs could not be transmitted to the emergency department during the transport to the hospital. In addition, the emergency room nurse testified that she did not recall hearing a STEMI alert called by the paramedic, but she recalled that Ho was coming in with chest pain and, therefore, she would “expect a possible STEMI patient.” However, the nurse testified that she “did not tell Dr. Atai that a STEMI alert patient was arriving.” As a result, defense counsel argued that plaintiffs’ counsel failed to establish that Atai was informed of a STEMI alert by the nursing staff while Ho was being transported to the hospital by paramedics. Counsel also contended that there was no evidence that Atai heard the radio call of the STEMI alert. Defense counsel argued that while Atai had documented that he was aware that a patient was coming in with a “possible STEMI,” because there was no evidence that Atai was advised of a confirmed diagnosis of STEMI during the transport, Atai was not required by the standard of care to activate the cardiac catheterization laboratory prior to the patient’s arrival in the emergency room. The director of the emergency department testified that while the national standard for the door to balloon time is within 90 minutes, the average door to balloon time at St. Joseph’s Medical Center is approximately 60 minutes. The defense’s emergency medicine expert testified that he did not believe any of the EKGs were diagnostic of a STEMI and he opined that Atai’s care and treatment of the patient met the standard of care. The expert opined that the standard of care allowed Atai to follow the advice of the consulting cardiologist and not activate the catheterization laboratory and to work up a metabolic disorder. The expert also opined that standard of care did not require the administration of additional anticoagulants and that it was reasonable to delay treatment pending the opinion of the cardiologist regarding the EKGs. The defense’s cardiology expert opined that the activation of the catheterization laboratory at 11 p.m. would not have prevented Ho’s death, as Ho had severe occlusion of all four coronary arteries. The expert further opined that Ho would have required a coronary artery bypass graft surgery and that percutaneous coronary intervention would have offered no benefit. He further opined that there was no thrombus or blood clot in any coronary artery on autopsy and that, as such, the administration of Heparin or Plavix would have had no effect in preventing the cardiac arrest. In addition, the defense’s cardiology expert opined that placement of an intra-aortic balloon pump would not have decreased the risk of mortality. Defense counsel noted that, on cross-examination, the plaintiffs’ emergency medicine expert agreed that it was reasonable for Atai to obtain an immediate EKG at 11:02 p.m. and to have that EKG interpreted by a cardiologist. The plaintiffs’ expert also agreed that it was reasonable to rely upon the cardiologist regarding whether to activate the catheterization laboratory and agreed that the presence of a left bundle branch block obscured the diagnosis of a STEMI. The plaintiffs’ expert further agreed that the 11:02 p.m. EKG and the follow-up EKG at 11:17 p.m. did not demonstrate a STEMI and that because of the ambiguous EKG results, it was acceptable for Atai to delay treatment of an acute myocardial infarction pending consultation with a cardiologist. Defense counsel also noted that, during cross-examination, the plaintiffs’ cardiology expert agreed that if the conversation between Chothia and the emergency room physician occurred after 11:15 p.m., it was probably too late to perform percutaneous coronary intervention and save Ho. The plaintiffs’ expert also agreed that the autopsy report demonstrated moderate to severe four coronary artery vessel disease and that there was no evidence of a blood clot found in the left anterior descending artery, which would have been amenable to cardiac catheterization. Although the plaintiffs’ forensic pathology expert performed a “limited” autopsy, which defense counsel noted was 20 minutes in duration, and suggested that the administration of anticoagulants would have changed the outcome of the case, defense counsel noted that the expert’s testimony was contrary to the testimony of the plaintiffs’ own cardiology and emergency medicine experts, both of whom testified that neither Heparin nor Plavix would have changed the outcome. (Defense counsel noted that Ho did receive aspirin.) Defense counsel also noted that the plaintiffs’ forensic pathologist expert admitted on cross-examination that it takes two or more hours for troponin to register as positive following the death of heart tissue. Defense counsel further noted that the plaintiffs’ expert did not express an opinion regarding when sort of different treatment would have been required to have altered the outcome and admitted that he “does not treat patients” and “[could not] testify regarding what medications should have been given.”, Tran suffered a cardiac arrest and died at 11:42 p.m. on Sept. 19, 2015. He was 45 years old. He was survived his wife, Diem Ho, a nail salon owner and operator who was 42 years old by the time of trial. Mr. Ho was also survived by his minor children, which included his two sons, Alex Tran, who was 20 years old by the time of trial, and Quoc Tran, who was 22 by the time of trial, and which included his minor daughter, Sabella Tran, who was 8 years old by the time of trial. The plaintiffs’ expert economist testified that Mr. Ho would have earned more than $1 million dollars during the remainder of his life. During closing arguments, plaintiffs’ counsel asked the jury to award the decedent’s family more than $1 million in economic damages, and between $400,000 and $500,000 in noneconomic damages. The defense’s expert economist opined that based upon the decedent’s actual average income over the four years prior to his death, which was approximately $12,000 per year, there was no loss of financial support to the heirs, as the Social Security death benefits exceeded the amount of the decedent’s net earnings. Defense counsel did not submit a damages number to the jury, and reminded the jury that plaintiffs’ counsel had agreed during trial that the data upon which the plaintiffs’ economist relied constituted “inadmissible hearsay.”