On Nov. 18, 2013, plaintiffs’ decedent Deborah Larkin, 42, underwent a second laparoscopic hiatal hernia repair at Ronald Regan UCLA Medical Center, in Los Angeles. Her previous repair was performed in 2011, but her symptoms eventually returned. As a result, she had to undergo a redo repair in 2013, this time performed by Dr. Oscar Hines, the chief of surgery at the hospital, with the assistance of a fourth-year resident, Dr. Chow. However, during the surgery a gastrotomy (a hole in the stomach) occurred, which had to be repaired by Hines. On the first day after surgery, Larkin complained of severe pain that was not responding to Dilaudid. This was attributed to Larkin’s addiction to pain medication. As a result, a pain-management consult was obtained. Throughout the day there were occasions where Larkin showed signs of tachycardia (a rapid heart rate) and her condition worsened considerably the following morning, on Nov. 20, 2013. In addition to ongoing abdominal pain, Larkin became persistently tachycardic, her sodium level dropped to an abnormal 120 (with the normal level being between 135 and 145), her white blood count was abnormally high, and she had become hypotensive, with her blood pressure down to 81/50 at 7:44 a.m. As the day went on, her creatinine level rose from a normal 0.8 on admission to 1.8 by 11:40 a.m. Due to the hyponatremia, or low sodium, a renal consult was obtained, and the nephrologist’s assessment was sepsis. At 1:11 p.m., Chow sent an e-mail to Hines, who told Chow to have a gastrografin swallow study done, which did not show a leak. After the study was done, Larkin returned to the medical-surgical floor. Laboratory results performed that afternoon showed a declining CO2 level and an increased lactate level, which indicated that Larkin was in metabolic acidosis. Despite Larkin’s worsening condition, she remained on the medical-surgical floor for the next 14 hours without any further attempt to identify the source of her infection or sepsis. At about 4:30 a.m. on Nov. 21, 2013, Larkin’s systolic blood pressure dropped into the 80s, for the first time since about 21 hours earlier, as it had mostly been in the 90s during those 21 hours. Larkin was then taken to the Intensive Care Unit with an altered mental status, in respiratory distress, and in kidney failure. She subsequently required intubation in the ICU and at about noon on Nov. 21, 2013, Hines performed an exploratory laparotomy, which revealed a 4-millimeter gastric leak to be the source of the infection and septic shock. Copious amounts of bile were found in all four quadrants of the abdomen, and she was in critical condition going in and out of surgery. After the surgery, Larkin remained in the ICU, never being able to go off a ventilator or pressors, and with continuing leakage for 36 days, until she was disconnected from life support and died on Dec. 27, 2013. The decedent’s children, plaintiffs Ryan Larkin and Jessica Larkin, sued Hines; the operator of the hospital, Regents of the University of California; and Dr. Barbara Kadell, a radiologist who correctly interpreted the study that was performed. The individual doctors were ultimately dismissed from the case early on, and the matter continued to trial against Regents only. The plaintiffs’ general surgery expert opined that when the decedent went into shock on the morning of Nov. 20, 2013, the standard of care required an immediate transfer of the patient to the ICU for resuscitation and proper monitoring with a central venous line, source identification and source treatment. He also opined that Hines acted below the standard of care by not performing a CT scan right after the swallow study failed to show a leak, since the source of the infection and sepsis had not been identified and time was very much of the essence in identifying and treating the source. The expert further opined that Hines acted below the standard of care by not seeing Larkin during the time between the first and second surgeries. Plaintiffs’ counsel noted that although Hines claimed that he did see the decedent every day, there was no documentation from either of Hines or a nurse, or orders made directly by Hines, indicating that Hines saw the decedent during the time between the surgeries. The defense’s infectious disease expert opined that the decedent suffered from urosepsis from a proven urinary tract infection and did not start to leak on the morning of Nov. 20, 2013. He also opined that, based on the autopsy, the decedent’s organs were not damaged, except for her lungs, which showed acute respiratory distress syndrome, and that there was no treatment for the ARDS once it occurred. However, the expert admitted that the ARDS was caused by sepsis. The defense’s general surgery expert opined that it was within the standard of care to rely on the swallow study and to not do anything else that day to identify the source of the leak, other than observe the decedent, and that if the decedent was not better the next morning, then a CT scan should be performed. In response, plaintiffs’ counsel argued that the defense’s infectious disease expert’s opinion — that the decedent had urosepsis — was not a diagnosis made by any of the medical providers or treaters in the hospital, including the nephrologist. Counsel further argued that the opinion of the defense’s infectious disease expert as to when the leak occurred was contradicted by both general surgery experts and by Hines. In addition, plaintiffs’ counsel contended that the defense’s infectious disease expert also claimed that the leak occurred sometime on the night of Nov. 20, 2013, and not on the morning of Nov. 20, 2013, but that this was also contradicted by both general surgery experts and Hines., On Nov. 21, 2013, Deborah Larkin was diagnosed with a 4-millimeter gastric leak, causing an infection and septic shock. Copious amounts of bile were found in all four quadrants of the abdomen, and she was in critical condition going in and out of surgery. After the surgery, she remained in the Intensive Care Unit, never being able to go off a ventilator or pressors, and with continuing leakage for 36 days. Larkin was ultimately disconnected from life support and died on Dec. 27, 2013. Larkin was 42 years old., and she was survived by her 18-year-old son (who turned 19 the day after she passed away), Ryan Larkin, and her 17-year-old daughter, Jessica Larkin. The decedent’s children claimed that their mother was extremely caring and loving. They also presented photographs of the family and beautiful notes that the decedent wrote to her children. Since the decedent’s children did not live with her, and were not economically dependent on her at all, they only sought recovery of non-economic damages.