On Sept. 12, 2008, plaintiffs’ decedent Joan Boice, 81, a retired schoolteacher and community volunteer, and her husband moved from another assisted living facility to Emeritus at Emerald Hills in Auburn so that they could be closer to their children and grandchildren. Boice was ultimately admitted to the facility’s Memory Care Unit. Unbeknownst to her family or physician, Boice began developing bedsores, which are alternately termed “decubitus ulcers” or “pressure sores,” within the first month of her admission. On Dec. 1, 2008, Boice’s family and outside health care providers learned that she had developed more than what had been previously described as a bunion on her foot. As a result, she was moved to a nursing home on Dec. 4, 2008, and diagnosed with multiple deep, necrotic pressure ulcers on her ischium and feet, as well as other wounds. It was also discovered that Boice had had developed severe contractures and lost 20 pounds in less than three months at Emeritus. Boice ultimately died on Feb. 14, 2009. Pressure ulcers were listed as a significant contributing factor on her death certificate. The decedent’s children, Eric Boice, Nancee Boice and Mark Boice, and the decedent’s husband, Myron Boice, sued the operator of Emeritus at Emerald Hills, Emeritus Corp., and Emeritus’ Regional Director of Operations, Rhonda Castleberg. The decedent’s family alleged that the defendants’ actions constituted elder abuse, causing the decedent’s wrongful death. Emeritus subsequently filed third-party claims against Tayyiba Awan, M.D., Kaiser Foundation Health Plan Inc., Kaiser Foundation Hospitals, Kaiser Permanente, Kaiser Permanente Medical Group, The Permanente Medical Group and The Permanente Medical Group Inc. Prior to trial, Castleberg was dismissed as a defendant and plaintiff Myron Boice passed away, so he was also dismissed from the case. In addition, Emeritus’ cross-complaint was dismissed. The matter then proceeded to a bifurcated trial. Plaintiffs’ counsel offered evidence from Emeritus’ former and current employees, from facility level to the top of the corporation, as well as from third-party health care providers and a medical expert. Counsel contended that the evidence showed that the decedent’s neglect, physical and death were the result of Emeritus’ corporate policies of understaffing its facilities, while also accepting and retaining high acuity residents. Plaintiffs’ counsel also presented evidence that Emeritus had notice, a year before the decedent was there, that there were serious problems with staffing and training in its 58-facility California division, including the decedent’s facility at Emerald Hills. Counsel also presented evidence that Emeritus’ corporate mandate was to fill its buildings at any cost. The terms, “No Barriers to Sales,” “Heads in the Beds,” and “Close the Back Door,” were defined by the plaintiffs’ witnesses as Emeritus’ corporate slogans that meant that it was permissible to sign up and admit elders whose care needs exceeded Emeritus’ capacity and regulatory limitations, and that the only acceptable move-out was death. Emerald Hills’ employees and directors that were called by plaintiffs’ counsel testified that Emeritus’ Emerald Hills facility, and others in the region, were routinely understaffed, particularly on the evening and overnight shifts. They also testified that throughout Boice’s admission, the Memory Care Unit had only one staff member working overnight to care for 17 demented residents and that several nights, there were no staff members assigned to the Memory Care Unit overnight. Emerald Hills’ staff further testified that frequently there were only two or three staff members working in the entire three-story building, serving nearly 80 frail elders. One Emerald Hills’ caregiver testified that the facility nurse had told her to treat the decedent’s wounds, but to not to let anyone know. Thus, plaintiffs’ counsel argued that Emeritus’ policies resulted from a focus on revenue and cash flow, instead of the residents’ care. The head nurse for the company and the regional nurse for northern California both testified that Emeritus had notice, based on its own internal audits and its Ethics’ First hotline complaints from employees, residents and families of residents, that there were serious problems with staffing and training at Emerald Hills, as well as at other facilities in the same region and throughout California. In addition, a former facility employee testified that the facility’s Executive Director and nurse were hiding from the Boice family and telling staff to say they were unavailable when the family was looking for answers to their mother’s decline. Emeritus was steadfast in its position that it did nothing wrong and its counsel presented testimony from Emerald Hills’ caregivers, three medical experts, the Chairman of the Board of a competitor, and Emeritus’ own Chief Financial Officer. They testified that the decedent had a series of undetected strokes while in the facility, which caused the decedent’s rapid functional decline, and that the bedsores, weight loss and contractures were all unavoidable. They also claimed that the bedsores were not life threatening. Emeritus’ counsel argued that the decedent could not have been neglected at Emerald Hills because many third-party healthcare providers treated her at the end of her stay at Emeritus, as well as at the nursing home where she died two months later, and no one reported neglect to the authorities. Counsel also argued that the Emerald Hills’ Executive Director could have used more guidance, but that all of the staff were caring people. In addition, counsel argued that Emeritus had no liability for the decedent’s or death., Joan Boice died on Feb. 14, 2009. Pressure ulcers were ultimately determined to be a significant contributing factor to her death. The decedent was 81. She is survived by two sons and a daughter, as well as by grandchildren. During the second phase of the bifurcated trial, plaintiffs’ counsel presented evidence from 10-K reports that Emeritus had earned $1.57 billion in 2012 and paid its Co-CEOs more than $22.8 million dollars in 2011, the last year proxy statements were available. In addition, the plaintiffs’ expert economist testified that Emeritus’ average daily revenue was $4.3 million in 2012. Thus, the decedent’s three children, Eric Boice, Nancee Boice and Mark Boice, sought recovery of wrongful death damages for their mother’s death. They also sought recovery of punitive damages. Defense counsel presented evidence through its industries and markets expert about the state of Emeritus. In addition, Emeritus’ CFO testified that the company was highly leveraged and had a growth strategy. Defense counsel argued that the CFO’s testimony meant that if the jury gave a large punitive damages award, Emeritus might have to raise its rates or lose its ability to continue buying more facilities.