On Jan. 13, 2014, claimant Veronica Bland, 41, a real estate broker, underwent an arthroscopic debridement of the left, dominant shoulder. The procedure was performed by Dr. Najeeb Khan at Kaiser Permanente San Diego Medical Center, in San Diego. Bland initially presented to Khan with complaints of pain in her left shoulder on Nov. 15, 2013. After an MRI, Khan recommended an arthroscopic debridement with a tenotomy, a procedure where the bicep is detached, followed by an open tenodesis, a procedure where the bicep would be reattached at the correct length. The surgery was subsequently scheduled for Jan. 13, 2014. On the day of the surgery, Bland was taken to the operating room and positioned with her arm placed in a Shoulder Traction and Rotation (STaR) sleeve, which was then connected to a three-point shoulder traction tower. Khan first performed the arthroscopy on the left shoulder, during which he detached the bicep muscle and then proceeded to the open procedure. However, prior to commencing the tenodesis, Bland’s arm was removed from the STaR sling and repositioned. Bland’s left arm was then held by the nurse during the open tenodesis procedure. Khan made one 4-inch longitudinal incision at the anterior part of the proximal arm, just lateral to the axilla, or armpit, and with a gloved finger, he performed a blunt dissection. However, Khan noted bleeding, which was unusual for the procedure, so he placed a Hohmann’s retractor just lateral to the humerus to assist with visualization. Khan noted significant bleeding, and he recalled it took a while to stop the “robust, non-pulsatile bleeding.” Once the bleeding was controlled, Khan decided to forego the tenodesis and closed the surgical site. Following the surgery, Khan evaluated Bland, and he found that Bland had decreased sharp sensation in her hand, and no wrist or finger function. Khan also noted that Bland could not flex, extend, abduct or adduct. Bland brought claims against Kaiser Foundation Health Plan, Southern California Permanente Medical Group, and Kaiser Foundation Hospitals Inc. Bland alleged that her shoulder was injured during the procedure and that the Kaiser entities were liable its employees’ actions during the procedure. She also alleged that this failure constituted medical malpractice. The matter proceeded to arbitration. Claimant’s counsel contended that Bland suffered a severe brachial plexus injury as a result of traction while Khan was dealing with the bleeding. A traction injury occurs when a structure is pulled beyond its normal limits. Claimant’s counsel noted that Kaiser’s orthopedic surgery expert agreed that Bland likely suffered a traction injury, and agreed with Khan’s testimony that additional pressure was placed on the nerve, either by traction, stretching or direct pressure, causing the nerve to be traumatized. Counsel also noted that Kaiser’s expert also agreed with the claimant’s experts, that this type of injury from this type of procedure is essentially unheard of. Khan admitted that Bland’s injury to the brachial plexus was caused by a traction injury during the tenodesis surgery. However, he claimed that he does approximately five arthroscopies with tenodesis per year and has never before had a case with a patient suffering a severe brachial plexopathy. Kaiser’s counsel asserted that as a result of prior and surgeries, Bland had aberrant anatomy in the area and that no excessive traction/retraction was applied. Counsel also asserted that Khan, at all times, complied with the standard and care., Bland claimed she suffered a traction injury to her brachial plexus, resulting in brachial plexopathy, also known as brachial plexus dysfunction, a form of peripheral neuropathy. She also claimed she suffered damage to her radial, median, and ulnar nerves. Bland alleged that as a result, she suffers pain, loss of sensation, muscle weakness, and paralysis of some or all of the muscles in her left, dominant arm, wrist, and hand. She also alleged that she developed complex regional pain syndrome, also known as reflex sympathetic dystrophy or causalgia, a chronic pain condition that typically affects the sympathetic nervous system and causes pain out of proportion to the inciting injury. Bland contended that while sales of properties were part of her employment picture, rehabbing homes for profit was an important contributor to her income. However, she claimed that as a result of her , she can no longer perform many of the physical jobs involved in improving a piece of property for profit from its re-sale and that she can now only work as a realtor and property investor on a limited basis. She also claimed that she is in constant pain and that she will require extensive physical and occupational therapy, pain management, and nerve blocks for the rest of her life. In addition, Bland claimed that she may also require several surgeries to optimize the function of her hand. Thus, Bland sought recovery for her past and future medical expenses, and past and future lost earnings. She also sought recovery of damages for her past and future pain and suffering. Kaiser’s counsel asserted that Bland’s alleged were not severe enough to prevent her from working full-time as a real estate agent.