A hospitalist expert witness discusses the treatment given to a patient who died from pneumonia prior to being transferred to a tertiary care center. This case involves a thirty-seven-year-old male patient with no significant past medical history. The patient developed flu like symptoms. His condition progressively worsened over the course of the day and his wife called for an ambulance when he developed trouble breathing with minimal exertion. He was admitted to the emergency room of a local hospital for complaining of cough, fever, chest pain and shortness of breath. On physical examination the patient was tachypneic and appeared constitutionally unwell. The initial chest x-ray performed on admission showed clear lung fields while a chest x-ray performed one hour after his presentation showed bilateral pulmonary pneumonia and superimposed congestive changes. The dramatic change in findings on the chest x-rays was indicative of the patient’s rapidly declining condition. A CT scan was ordered which demonstrated a consolidation on the left lower lobe with pleural fluid and air bronchograms. The decision was made to transfer the patient to a tertiary care center, given the severity of his condition. The patient was to be intubated prior to transportation to stabilize. During the intubation procedure the patient’s condition deteriorated further. The patient died within a few hours of his presentation to the hospital. The postmortem examination documented extensive and severe bronchopneumonia involving all lung lobes as the cause of death.