This case takes place in North Dakota and involves a male patient who presented to Emergency Room with gout in his left foot. He was given the appropriate medication and discharged. Four days later he presented to another ER with worsening symptoms. He was again diagnosed with a flare up of his gout and no workup was ordered. The defendant doctor allowed the patient to leave and he later presented to a third hospital, where he was found to have sepsis. As a result, the patient required amputation of his left leg.