Darryl McGinnes, a 38 year old man, was admitted to Wesley Medical Center, a tertiary care center with severe right sided abdominal pain, nausea, vomiting and diarrhea. He weighed 420 pounds and had been suffering from these symptoms for over two months. These symptoms were similar to a gallstone attack which he had suffered eight years earlier, which ultimately required his gallbladder to be removed. Defendant Estephan Zayat, a gastroenteroligst, ordered a full lab work up with upper and lower endoscopies. None of the tests were conclusive, and when McGinnis continued to have pain, defendant suggested an endoscopic procedure called an ERCP, to see if he suffered from a gallstone that was obstructing the common bile duct. Defendant advised McGinnis that if he did have a gallstone, it could cause infection and death however he did not advisee that the ERCP is one of the most technically difficult endoscopic procedures and carries the highest risk of death. It is well known in the medical community that ERCP should be avoided if there is a low chance the patient has a stone or there is a high risk of complications from the procedure. While performing the procedure, defendant encountered difficulties due to McGinnis’ size and weight and was unable to visualize the common bile duct on fluoroscopy. Immediately following the procedure, McGinnis developed extreme abdominal pain and acute pancreatitis. Five days later, McGinnis died of cardiomyopathy, pulmonary embolus and acute necrotizing pancreatitis. Plaintiffs alleged that the ERCP was not necessary, that defendant operated below the standard of care, and argued that alternative procedures were not discussed, such as referral to a teaching institution like University of Missouri at Columbia, Missouri in Boone County. Defendant argued his conduct was proper and that McGinnis died from causes unrelated to the procedure.