Drunk driver guy needs surgery and Sam seems to notice something on the guy’s electronic heart readout. But he’s not the one doing the surgery, so it’s not his problem. Right? In fact, no one will be operating since the patient is refusing treatment. He feels he deserves to die because of what he did. Not many people around Oceanside disagree.
We flashback to Sam’s surgery on the pedophile teacher. Complications arise during the operation. Those assisting wonder why Sam isn’t taking more aggressive action to save the guy. Later, Sam tells Addison he made a choice. In other words, he chose to let that pedophile die.