This case takes place in Iowa and involves a male patient with an extensive medical history of multiple chronic conditions. The patient went to a nephrology appointment, while just prior to the appointment, he had dry heaves and was suctioned for foul smelling, loose red secretions. The patient presented to the nephrologist with complaints of severe pain in his sides, shortness of breath, and nausea. The defending nephrologist made note of his symptoms and lab work, addressing the fact that his Bun levels were elevated and his Creatinine had also risen sharply. The defendant recommended hospitalization if his nausea and vomiting persisted, or if the patients’s creatinine continued to climb. Later that night, the patient was found in a stuporous state, with bloody sputum and an elevated body temperature. The patient was transferred via ambulance to the hospital. There, it was discovered that the patient was suffering from Legionella pneumonia, septic shock, and urinary tract infection, along with several other serious medical problems. He was placed in triage where he passed away, with immediate causes of death being sepsis and pneumonia.