Ismael Castellanos v. Jihad E. Bacha, aka Jihad Eddine M. Al-Basha, aka Office of Jihad Al-Basha
Published: Apr. 29, 2000 | Result Date: Mar. 23, 2000 | Filing Date: Jan. 1, 1900 |Case number: 301041 Verdict – $180,000
Judge
Court
San Francisco Superior
Attorneys
Plaintiff
Defendant
Experts
Plaintiff
Stephen R. Cohen
(medical)
Michael E. Barkin
(medical)
Richard Cohan
(medical)
Defendant
Nestor Karas
(medical)
Frederick Finzen
(medical)
Harold E. Goodis
(medical)
Facts
In November 1997, plaintiff, a 48-year-old cook, had defendant general dentist perform a root canal procedure on his lower third molar (tooth number 17), an anchor abutment tooth, for his lower partial denture. One week post-operatively, plaintiff complained of a continuing feeling of local anesthesia in his left lip and chin.
Defendant explained to plaintiff that he had over-extended the root canal packing material of gutta percha, which impinged upon his inferior alveolar nerve, but that it would soon return to normal sensation.
Eleven days post-operatively, plaintiff reported improvement from anesthesia (total sensory loss) to paresthesia (partial sensory loss), which encouraged defendant, who prognosticated all feeling would shortly return to normal. Subsequently, plaintiff had no further improvement in his paresthesia loss of feeling in his left lip and chin.
Also, plaintiff feels electric shock symptoms of dysesthesia when his lip and extraction site are touched. Defendant continued to treat plaintiff for partial denture repairs and cleanings through July 1998, and continually assured plaintiff of a return to normal sensation in a few more months. He also represented to plaintiff that no permanent nerve injury would occur.
The lawsuit was filed three days before expiration of C.C.P. Section 364 Ninety Day Notice of Intent to Commerce Litigation and one day before plaintiff obtained a second opinion. The prior attorney did not obtain X-rays, which would have showed over-extension of root canal filling material.
Settlement Discussions
At a subsequent settlement conference, 11 days before trial, defendant offered $75,000. The next day, defendant submitted a C.C.P. Section 998 offer of $99,999, which plaintiff rejected, since the previous drop dead mediation and C.C.P. Section 998 offers for $100,000 had expired.
Specials in Evidence
$15,000 $10,000 (future decompression surgery)
Injuries
Permanent parasthesia and dysesthesia of lower left lip and chin.
Other Information
<m>A mediation was held before Steve Harper at which the defendant offered $65,000. The plaintiff countered at $100,000 as his ôdrop deadö offer, and subsequently served his C.C.P. Section 998 for $100,000 four months before trial.</m> <e>PlaintiffÆs expert, Stephen Cohen, D.D.S., endodontist, testified that defendant should have referred plaintiff to an endodontist since the underlying inferior alveolar sensory nerve, which supplies sensation to the lip and chin, was close to the number 17 root apex. Also, upon completion of the root canal procedure, when over-extension of the gutta percha root canal filling material was X-ray evident, defendant should have telephoned plaintiff that evening and the following morning, after the effects of local anesthesia wore off, to determine if persistent anesthesia was present. This would verify endodontic packing material was inside the inferior alveolar nerve canal and mechanically compressing the inferior alveolar nerve, as well as chemically destroying nerve. If an endodontist proved unsuccessful in retrieving over-extended gutta percha non-surgically, the patient should have been referred to an oral surgeon within the first 48 hours, or no later than the first six months thereafter. Michael Barkin, D.D.S., testified that tooth number 17 was non-restorable after consultation with restorative general dentist Richard Cohan. Dr. Barkin extracted tooth number 17, which removed virtually all of the over-extended gutta percha. However, irreversible nerve damage had already occurred, resulting in permanent paresthesia and dysesthesia of the inferior alveolar nerve and its branches to the lip and chin. At 14 months, when Dr. Barkin first examined the plaintiff, he had suffered permanent, irreversible inferior alveolar nerve injury. No surgical treatment was recommended by Dr. Barkin, since surgical decompression is only effective within the first six months and too risky thereafter. Richard Cohan, D.D.S., testified that the gum area of tooth number 17 was no longer suitable to be covered with a removable partial denture, due to dysesthesia in the gum area overlying the socket of number 17. Instead, plaintiff required implants in the 19 and 19 area to replace pre-existing loss of teeth numbers 18 and 19, which the partial denture would have covered. Also, several fillings were defective due to defendantÆs amalgam overhangs and required replacement with crowns. DefendantÆs expert, Harold Goodis, D.D.S., testified that early referral to a specialist is best when over-extension occurs, but was uncertain it would have made any difference. Also, over-extensions occurred inadvertently. Nestor Karas, D.D.S., testified that subsequent treating dentist Dr. Barkin should have performed immediate decompression surgery and that, following his extraction of number 17, residual gutta percha still remained inside the inferior alveolar nerve canal. BAJI number 14.66 was given, to the effect that defendant was responsible for subsequent negligent dental care. Dr. Karas also testified that he could not elicit dysesthesia when he examined plaintiffÆs lip. He also testified that paresthesia was probably permanent. Also, Dr. Karas recommended surgical decompression, which would not likely change the loss of feeling, but may improve the painful dysesthesia when chewing, with 50 to 75 percent likelihood of surgical success. Frederick Finzen, D.D.S., testified that two of defendantÆs three fillings met the standard of care, but on cross-examination admitted that the third filling had a severe overhang. Dr. Finzen also testified that the implants already placed may be short and unstable and implant crowns last for 20 years, rather than Dr. CohanÆs estimate of 10 years.</e>
Deliberation
1+ days
Poll
11-1
Length
eight days
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