Facts

On Feb. 22, 2019, in the late morning, plaintiff Matthew Beaver, 23, developed sudden onset right side weakness, difficulty walking, vomiting, and the inability to speak. After stumbling into the bathroom to rinse off in the shower, he collapsed. A family member found him in the bathtub and called 9-1-1. On scene, the paramedics determined he was last seen normal thirty minutes prior to their arrival and attempted to perform a stroke assessment but were unable due to Mr. Beaver's inability to speak or follow commands. Paramedics took Mr. Beaver to UC Davis Medical Center (UCDMC), an advanced primary stroke center. The Regents of the University of California operated UCDMC.

As an advanced comprehensive stroke center, UCDMC has a set of policies and procedures outlining how a patient with an acute stroke should be treated. In the setting of an acute stroke, time lost is brain lost. When a Stroke alert is activated, an entire team of stroke specialists are mobilized. The care and treatment are guided by evidence-based standards to afford stroke patients the best possible outcomes.

Upon arrival, two Emergency Medicine physicians (an attending and a resident) evaluated Mr. Beaver and decided that his presentation was atypical for a stroke so they did not activate a stroke alert. Instead, the providers ordered various tests and consults looking for other causes of Mr. Beaver's altered mental status and inability to speak. In the Emergency Department, Mr. Beaver developed seizure-like activity. Providers admitted him to the ICU without getting further imaging to evaluate for a stroke. Approximately 26 hours later, an MRI with angiography showed a blood clot in his middle cerebral artery (MCA) and large stroke in the left MCA territory. By that time, there was extensive left-sided brain damage that was irreversible and could not be treated.

PLAINTIFF'S CONTENTIONS: Plaintiff's Emergency Medicine expert, Dr. David Pregerson, opined that Mr. Beaver's presentation was not atypical and was most consistent with an acute stroke. UCDMC Emergency Medicine physician should have activated the Stroke Alert. The standard of care also required that a CT angiogram be performed to identity a blood clot in brain's blood supply.

Plaintiff's expert stroke neurologist, Dr. Nerses Sansossian testified that had the Stroke Alert been activated: 1) A CT angiogram would have been obtained; 2) the brain imaging would have diagnosed the left middle cerebral artery clot within one hour of presentation; and 3) Mr. Beaver would have been given intravenous tPA and would have received a mechanical thrombectomy which would have improved his outcome.

Plaintiff's comprehensive life care plan included 24/7 supervision for safety and quality of life. Mr. Beaver also claimed a loss of earning capacity and inability to finish college.

DEFENDANT'S CONTENTIONS: Defendant contended that the emergency medicine doctors acted within the standard of care at all times in evaluating plaintiff and maintaining a broad differential diagnosis for plaintiff's critical illness, including brain infection, seizure, toxic ingestion and cerebrovascular accident. Defendant contended that plaintiff had a very rare presentation for an ischemic stroke as he was barely responsive and moving all extremities when he arrived in the emergency department. Although stroke was on the differential diagnosis list, it was low as his symptoms were much more likely to be present with other equally life threatening conditions, such as brain infection.

Defendant also opined that there was no reliable time when plaintiff was last seen well and it was unclear if he was even seen well the morning in question. No witness was called at trial who saw plaintiff well the morning of his stroke. Although a stroke alert was not activated, the Neurology providers who would have been involved had a stroke alert been activated, did not diagnose a stroke when they evaluated plaintiff that same afternoon. Defendant also contended that, based on review of the initial head imaging, plaintiff's stroke started more than six hours earlier. Therefore, even if the stroke had been diagnosed shortly after plaintiff arrived, he would not have been a candidate for acute stroke treatment and acute stroke treatment would not have changed the outcome. Plaintiff's experts conceded that plaintiff would not have made a full recovery had he been diagnosed earlier with a stroke; he already had ischemic changes present on the non-contrast CT scan, meaning he had already suffered at least some irreversible brain damage before arrival.

Last, defendant's damage experts opined plaintiff required some assistance, approximately 15 hours per week. Ultimately, the jury awarded plaintiff 22 hours per week of attendant care, not the 24 hour attendant care sought by plaintiff.

Result

The jury found for plaintiff and awarded: Past Wage Loss: $25,000; Future Wage Loss; $2,384,200; Future Care and Medical Expenses: $4,899,404; Past Non-economics: $2 million; Future Non-economics: $6 million. Award in PCV and pre-MICRA reduction, which limits non-economic damages to $250,000.