In June of 2005, DENISE X developed pneumonia, for which she was initially treated with antibiotics that provided some improvement. When her condition worsened in early July, she presented to the Sonora Regional Medical Center (not a party to this action) and was diagnosed with right mid-lobe pneumonia. A stronger antibiotic was prescribed, and she was instructed to follow up with her own primary care physician through KAISER if she did not improve.

When seen on July 21, 2005, in the Emergency Department of the local KAISER hospital, Ms. X had developed a productive green cough, fever and right-sided rib pain. The ER doctor was planning to discharge her, but her symptoms became worse while she was in the ER and the nurse there did not let her go immediately. At that point, her pain had gone from a 3 out of 10 to 10 out of 10; x-rays indicated she had an infiltrate over the right midlung zone which was suspicious for an effusion; she had diminished lung sounds on the right, was breathing shallowly and had increased respirations, along with a fever and elevated white blood cell count – classic symptoms of pleuritis. However, instead of admitting her per their own protocol and despite pleading from BERNICE X to do so, KAISER’s physicians sent her home, without antibiotics, but with a rib belt - which made it even more difficult for her to breathe - and a prescription for Tylenol with codeine.

Over the course of the next two days, BERNICE X repeatedly contacted KAISER’s Nurse Advice Line reporting that her sister’s condition was worsening. She was told that the pain and breathing difficulties were to be expected because of the suspected rib fracture. Finally, on July 23rd, BERNICE X took DENISE to an emergency room in a facility which was not part of the KAISER system, where x-rays showed a complete collapse of her right lung, and ER personnel drained over 1200cc’s of fluid from that lung. She underwent a thoracotomy and decortication, and remained intubated and sedated until August 2nd. The following day, Ms. X reluctantly agreed to transfer to a KAISER facility after being told that KAISER would no longer pay for her care at the independent hospital, and that she in fact could lose her home if she refused the transfer.