On Feb. 4, 2011, claimant Jesus Maldonado, 14, a student, was taken to the Minor Injury Clinic at Kaiser Hospital Walnut Creek after his left wrist playing soccer the previous day. A scaphoid fracture was subsequently diagnosed, a splint was applied and he was discharged from the hospital. Over the next several hours, while at home, Jesus experienced discomfort and pain about his left forearm, where the splint had been applied. His parents ultimately took him back to Kaiser Hospital later that day and in the Emergency Department, the splint was replaced. An intramuscular injection of Dilaudid (for pain control) was also administered into Jesus’ right buttock and an injection of Phenergan, an anti-nausea medication, was administered intramuscularly into the left buttock. While at home over the next 36 hours, Jesus developed pain and redness at the injection site in his right buttock, as well as pain in his right foot. He also developed a fever, tachycardia, and became septic. On Feb. 6, 2011, Jesus returned to the Emergency Department at Kaiser Hospital Walnut Creek, where he was found to be in septic shock with an area of cellulitis on his right buttock, where the prior Dilaudid injection was administered. Blood cultures were drawn and came back positive for Group A Beta Hemolytic Streptococcus (Group A Strep). A pediatric infectious disease consult at Oakland Medical Center – Kaiser Permanente later assessed that given the time course and the surrounding appearance of erythema, the likely site for the introduction of the Group A Strep bacteria was at the Dilaudid injection site. Jesus brought a claim against the operators of Kaiser Hospital Walnut Creek, Kaiser Foundation Hospitals, Kaiser Foundation Health Plan and The Permanente Medical Group. Jesus alleged that the respondents failed to properly inject the Dilaudid and that their failure constituted medical malpractice. The matter ultimately proceeded to a binding arbitration, as required per the Kaiser Health Plan. Claimant’s counsel asserted that it was more likely than not that something tainted was introduced into the right buttock at the time of the intra-muscular injection of Dilaudid on Feb. 4, 2011. Counsel contended that the relative immediacy of the local reaction at the injection site pointed to the injection as the origin. Counsel also contended that the introduction of the bacteria through the right buttock injection site resulted first in the cellulitis, then probably seeded an osteomyelitis in Jesus’ right foot, and then seeded an osteomyelitis in Jesus’ left wrist, requiring hospitalization, antibiotic treatment and multiple surgical interventions. Respondents’ counsel contended that the licensed vocational nurse who administered the buttock injections complied with all standard sterile techniques and protocols and that there was no evidence to the contrary. Counsel also contended that Jesus was an asymptomatic carrier of Group A Strep, either in his pharynx or on his skin, as is the case with approximately 20 percent of school-age children. Respondents’ counsel noted that claimant’s counsel relied on a conditional res ipsa loquitur theory of negligence and that one of the claimant’s experts testified that he could not identify any act of negligence, but that Jesus’ condition ordinarily would not occur in the absence of negligence. Counsel also noted that the claimant’s other expert testified that he could not identify an act of negligence and that the likely cause of Jesus’ condition was a tainted needle or tainted injectate. Thus, respondent’s counsel asserted that in either case presented by the claimant’s experts, the nurse administering the injection was likely not negligent., Jesus was taken to the Emergency Department at Kaiser Hospital Walnut Creek, where he was determined to have an obvious area of cellulitis on his right buttock and to be suffering from septic shock. He was determined to be positive for Group A Beta Hemolytic Streptococcus (Group A Strep) and was subsequently transferred by ambulance to Oakland Medical Center – Kaiser Permanente, where it was suspected that Jesus had hematogenous osteomyelitis in his right foot, which was the site of an old fracture sustained some four or five years prior. As a result, Jesus remained critically ill with sepsis, cellulitis and bacteremia. His left wrist fracture subsequently developed osteomyelitis, requiring multiple orthopedic interventions for incision and drainage, followed by open reduction and internal fixation. After one month of hospitalization, Jesus continued treatment at home by undergoing IV antibiotic therapy. Jesus sought recovery of damages for his pain and suffering. He made no claim for economic damages.