$49.8 Million Verdict for Brain-Injured Kingsburg Man After Paramedic Removed Breathing Tube During Transport

In March 2018, Nicholas Merlo, a 39-year-old mortgage broker and expectant father from Kingsburg, California, underwent a routine endoscopy at a local surgery center. The procedure itself went without incident. The crisis began during the ambulance ride afterward, when an American Ambulance paramedic dislodged Merlo's endotracheal tube and failed to reinsert it. Without a secure airway, Merlo suffered oxygen deprivation, went into cardiac arrest, and sustained catastrophic hypoxic brain damage. He entered a persistent vegetative state from which doctors expected he would never recover.

The incident, dated March 14, 2018, left Merlo's wife, Kaci K. Merlo, caring for a husband who no longer recognized her and a newborn child he would never know. She brought suit both in her own name and on her husband's behalf, seeking to hold American Ambulance and its paramedics accountable.

At trial, the plaintiff's legal team presented evidence of two compounding failures: the improper removal of the breathing tube and the paramedics' failure to use end-tidal carbon dioxide monitoring, a standard tool for confirming ventilation status during transport. Rather than following protocols to contact the receiving hospital when reintubation proved difficult, the crew made repeated unsuccessful attempts on their own. The defense tried to shift blame to Clovis Community Hospital, but the jury rejected that argument entirely, placing full liability on American Ambulance and the three paramedics involved.

In October 2021, after roughly three and a half years of litigation, the Fresno County jury returned a verdict of $49.8 million. The award included $39.8 million to Nicholas Merlo covering past and future economic losses, medical expenses, and pain and suffering, and $10 million to Kaci Merlo for loss of companionship. It was among the largest medical malpractice verdicts in the Central Valley's history.

California's Medical Injury Compensation Reform Act, enacted in 1975, caps non-economic damages in medical malpractice cases at $250,000. The statutory limit forced a reduction that brought the collectible judgment down to approximately $17.3 million, stripping the Merlos of more than $29 million in compensation the jury had found appropriate. American Ambulance subsequently pursued an appeal, and reports emerged that the company's insurer disputed coverage, creating additional uncertainty about collection. The case drew statewide attention to MICRA's human cost and to gaps in ambulance provider oversight.