On July 30, 2015, at approximately 4:20 a.m., plaintiff Manuel Ortega, a 78-year-old dementia patient in a skilled nursing facility, fell while he was alone walking the hallway of San Marino Manor, a nursing home located in San Gabriel. Ortega sustained of his hip and leg. Ortega’s sister, Enedina Gutierrez, acting as the guardian ad litem of her brother, sued the operator of San Marino Manor, 3GenCare Inc., alleging theories of medical negligence, elder abuse, fraud, and violations of the patient’s bill of rights. Plaintiff’s counsel argued that Ortega’s fall constituted elder abuse and stemmed from the nursing staff’s lack of proper training and/or supervision. Counsel contended that 3GenCare negligently allowed Ortega to walk around the facility for more approximately 2.5 hours without one-on-one assistance, which was required by the nursing care plan. Counsel also contended that it was known that dementia patients like to walk around the hallways late at night and that the hallway/station nurses on staff saw Ortega walking alone that night. Counsel further contended that Ortega had a history of falls, which were previously documented, and that one of the station nurses who observed Ortega walking the hallways alone on the night in question should have provided standby assistance or forced him to go back to bed with medication or restraints. Thus, plaintiff’s counsel argued that 3GenCare’s individual care plan for Ortega was inadequate based on his past behavior and safety needs. Counsel also argued that 3GenCare violated the state’s patient’s bill of rights, as outlined in the state’s Health and Safety Code § 1430. Specifically, Ortega’s counsel asserted that 3GenCare failed to have an ongoing, educational in-service training program to teach the staff or personnel about accident prevention and safety measures, and failed to ensure that Ortega received adequate supervision and assistance devices, such as a wheelchair or a walker, to prevent the falls. Thus, plaintiff’s counsel contended that 3GenCare failed to implement Ortega’s care plan according to the methods indicated by his care plan, failed to administer treatments and medication to Ortega as necessary, and failed to employ an adequate number of qualified personnel to carry out all of the functions of the facility. Counsel also contended that the skilled nursing facility had an inadequate personnel-to-patient ratio of 14:1 or 15:1, indicating that it was understaffed, and thus, could not provide adequate assistance to its patients. In addition, plaintiff’s counsel argued that 3GenCare’s receipt of daily, $266 Medicaid reimbursements for Ortega’s one-patient assistance program over a period of a five-week rehabilitation training program comprised Medicaid fraud. Counsel contended that for the days the facility was reimbursed by Medicaid, Ortega only received one hour of one-on-one assistance, during the hour the program was held, and did not receive one-on-one assistance during the remaining 23 hours of the day. Thus, plaintiff’s counsel argued that San Marino Manor was improperly and illegally reimbursed and that 3GenCare was not entitled to the majority of Medicaid’s reimbursement. The plaintiff’s expert in nursing standard of care opined that the nurses employed at 3GenCare’s San Marino Manor were negligent in allowing Ortega to walk alone at night, and in failing to administer a shot of Ativan and put Ortega back to bed, which violated the standard of care. She further opined that the facility departed from the standard of care by failing to implement a staff training program and failing to implement the patient’s personalized critical care plan. Defense counsel denied plaintiff’s counsel’s allegations of billing fraud, and denied there were any violations of the patient’s bill of rights. Counsel asserted that Ortega was rendered adequate care, that Ortega’s care plan was followed, and that the proper training programs were implemented. Counsel also asserted that Ortega’s care plan only required one-to-one assistance care during the duration of the hour-long training program. Thus, defense counsel argued that the facility followed the care plan that was provided by Ortega’s family medicine physician, that the care plan said that Ortega could ambulate on his own and did not require an escort, and that the facility implemented Ortega’s care plan according to the methods indicated. Specifically, defense counsel contended that during the night shift, 3GenCare had one licensed practical nurse and four certified nursing assistants on staff, that Ortega had a known tendency to roam the hallways at night, and that employees would try to return Ortega to bed in half-hour increments. Counsel also contended that at the time of the incident, Ortega had been a resident of the facility for nearly three years, that its staff knew he frequently walked the halls at night, and that it was appropriate to allow the end stage dementia patient to walk on his own. Thus, counsel for 3GenCare maintained that the facility was adequately staffed, that the nurse-to-patient ratio was 10:8:1, and that the facility required its staff to participate in an annual safety and accident prevention course held each January. Counsel further maintained that the facility did not try to misrepresent the level or nature of care provided to Ortega for the one-to-one patient-assistance program and that it provided the level of care that was required by Ortega’s personalized care plan. The defense’s expert in the nursing standard of care testified that San Marino Manor was adequately staffed, provided the appropriate staff training, and properly implemented Ortega’s personal critical care plan during the course of his treatment and on the night of the incident. The defense’s expert in nursing standards further opined that 3GenCare acted appropriately in allowing Ortega to continue to walk the halls alone after he was spotted by a nurse and that it would have been improper to retrain Ortega or administer sleep-inducing chemicals to force him to return to bed., Ortega sustained a comminuted fracture of his right hip’s intra-articular supracondylar femur and a fracture of his right hip. He was subsequently taken by ambulance to the emergency room at Garfield Medical Center, in Monterey Park, where he underwent X-rays and was admitted for treatment. On Aug. 3, 2015, Ortega underwent a surgery that addressed his leg injury. As a result, he was admitted to the hospital for a total of 12 days before being transferred to Glendora Grand, a skilled nursing facility in Glendora. Over the course of approximately four months, Ortega underwent conservative treatment and rehabilitation at the Glendora Grand facility. On Dec. 18, 2015, he was transported, at his family’s request, to another in-patient nursing facility, where he was treated for a period of five months. Ortega was then admitted to Inter-Community Hospital, in Covina, in June 2016, for treatment of a number of medical issues, including renal failure, and to undergo surgery to have a gastric tube inserted into his abdomen. After the procedure, Ortega was admitted to a Kindred Healthcare skilled nursing facility for in-patient treatments. The plaintiff’s orthopedic surgery expert opined that the comminuted fracture of Ortega’s right femur and hip resulted in the surgical placement of a rod in his thigh, which compromised his ability to walk independently, and respond to conservative treatments and rehabilitation exercises. The parties stipulated that Ortega’s amounted to $13,790. Thus, Ortega sought recovery of $13,790 in stipulated past, paid medical costs and $2.2 million in non-economic damages for his pain and suffering. He also sought recovery of damages for the violations of the patients’ bill of rights, and punitive damages. Defense counsel contended that Ortega made a good recovery after the surgery and that his condition improved. The defense’s geriatric expert testified that end-stage dementia patients have a high risk of falling without an external trigger, that femur fractures are a common injury among end-stage dementia patients, and that the surgical repair of the fracture was successful. She also opined that Ortega’s course of post-operative rehabilitation was successful, but that Ortega’s attitude and will to live deteriorated in or around December 2015, when he was transported to a new skilled nursing facility. In addition, the defense’s geriatric expert opined that Ortega suffered from pre-existing and debilitating medical conditions of renal failure and dementia, that Ortega’s life expectancy at the time of his dementia diagnosis in 2011 was five years, and that Ortega’s life expectancy was less than one year and could terminate as early as the end of 2016.