Knutson v. Sand

282 A.D.2d 42, 725 N.Y.S.2d 350, 2001 N.Y. App. Div. LEXIS 5322
CourtAppellate Division of the Supreme Court of the State of New York
DecidedMay 21, 2001
StatusPublished
Cited by13 cases

This text of 282 A.D.2d 42 (Knutson v. Sand) is published on Counsel Stack Legal Research, covering Appellate Division of the Supreme Court of the State of New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Knutson v. Sand, 282 A.D.2d 42, 725 N.Y.S.2d 350, 2001 N.Y. App. Div. LEXIS 5322 (N.Y. Ct. App. 2001).

Opinion

OPINION OF THE COURT

Luciano, J.

The question presented for review appears to be one of first impression, to wit: whether a plaintiff is required to present expert dental testimony expressly stating that the conduct of the defendant oral surgeon was a “departure from the requisite standard of care,” notwithstanding the fact that during the plaintiffs case-in-chief, the defendant oral surgeon testified that the conduct forming the basis of the alleged dental malpractice was to be avoided during implantation of titanium fixtures.

In October 1994, the defendant Richard H. Sand, M.D., D.D.S., performed tooth implant surgery on the plaintiff Robert A. Knutson (hereinafter the plaintiff). Subsequent thereto, the plaintiff complained of pain, numbness, drooling, and swelling in his lower jaw. This action for dental malpractice thereafter ensued. The plaintiffs’ theory of the dental malpractice was that the defendant oral surgeon improperly implanted two of the three titanium fixtures into the inferior alveolar nerve canal of the right mandibular bone, one of which extended into the alveolar nerve, and one of which obliterated the alveolar nerve.

There is no argument that in order to prove a prima facie case of dental malpractice, a plaintiff must show that (1) there was a deviation or departure from the requisite standard of dental practice, and (2) the departure from the requisite standard of practice was a proximate cause of the complained of injury (see, Prete v Rafla-Demetrious, 224 AD2d 674).

The plaintiffs called two expert witnesses to testify as to the standard of care required in the implantation of titanium fixtures. Each of these expert witnesses testified that a primary concern in planning a case for dental implants was that care should be taken to avoid intrusion of the titanium fixtures into the inferior alveolar nerve canal of the mandibular bone. Additionally, these experts testified that it is necessary to avoid an intrusion of a foreign body, to wit the titanium fixtures, into [44]*44the inferior alveolar nerve canal in order to prevent damage to the nerves therein. A third expert, a neuroradiologist, testifying on behalf of the plaintiffs, confirmed that one of the implants passed through the canal and that one intruded into the inferior alveolar canal of the right mandibular bone. Finally, all of the plaintiffs’ experts testified that the placement of two of the titanium implants into the inferior alveolar canal was a competent producing cause of the plaintiff’s injuries.

Radiographic evidence supported the plaintiffs’ contention that the distal titanium implant was in the middle of the inferior alveolar canal and completely obliterated the inferior alveolar nerve. A second titanium implant was partially into the alveolar canal and the third titanium implant was behind the foramen. None of the plaintiffs’ experts, however, stated in specific words or phrases that the defendant oral surgeon’s act of placing the titanium fixtures into the inferior alveolar nerve canal of the mandibular bone constituted a departure from the requisite standard of oral surgery.

Noteworthy is the fact that in this action, the plaintiffs called the defendant oral surgeon to testify during their case-in-chief. During that testimony, the plaintiffs’ counsel inquired of the defendant oral surgeon what was the accepted protocol of performing dental implant surgery. At several instances during the defendant oral surgeon’s testimony, he testified that it is vital to the success of dental implant surgery that an oral surgeon avoid going below the bone ridge and intruding into the inferior alveolar canal of the mandibular bone or impinging on the inferior alveolar nerve. In fact, the defendant oral surgeon agreed with a statement, read into the record from written authority, that the inferior alveolar nerve must be avoided during dental implant surgery. The defendant oral surgeon further conceded that prior to the surgery he told the plaintiff that he was not supposed to place the titanium fixture into the inferior alveolar canal, but that there was a risk that this could occur. The question, therefore, whether the implantation of titanium fixtures into the inferior alveolar canal of the mandibular bone, although concededly an act to be avoided, was merely a risk of the implantation procedure as opposed to a departure from the requisite standard of care, was never given to the jury to answer.

This raises an even more exquisite question: whether and when does a risk of a procedure become a departure from the requisite standard of care.

[45]*45The testimony of these experts that it was imperative to avoid violation by the titanium implants of the inferior alveolar canal should be accorded great probative force in determining whether the defendant oral surgeon’s conduct was a departure from the requisite standard of oral surgery. A determination that the defendant oral surgeon’s conduct was a departure from the requisite standard of oral surgery is not contrary to reason, common conclusion, or natural and physical cause. So long as the inference of departure from the requisite standard of care is fairly supported by the evidence and consistent with a party’s argument or theory of the case, it may be drawn.

While there was no allegation by the plaintiffs of lack of informed consent, curiously, the defendant oral surgeon contended that it was a disclosed risk of the procedure that the titanium implants could intrude into the inferior alveolar canal, but in any event denied that this occurred. These all constitute questions of fact for the jury.

Posited against the background of plaintiffs’ experts’ testimony, it is pivotal to our determination that during the plaintiffs’ case-in-chief the defendant oral surgeon, testifying as an expert, admitted that he was to avoid placing a titanium fixture into the inferior alveolar nerve canal of the mandibular bone.

It is well settled that a plaintiff in a medical/dental malpractice action may call as a witness the doctor, dentist, or other health care provider against whom the action is brought in order to elicit testimony both as to fact and opinion (see, McDermott v Manhattan Eye, Ear & Throat Hosp., 15 NY2d 20, 27).

Since all the experts agreed that intrusion into the inferior alveolar canal of the mandibular bone must be avoided, the occurrence of that act compels the inference that the intrusion was a departure from the requisite standard of dental practice.

Curiously, the defendant oral surgeon’s defense is predicated on the position that intruding into the alveolar canal of the mandibular bone is a risk of the implant procedure, but that in any event he did not do it. This alternative theory of the defense was supported by the defendant oral surgeon’s expert dental witness. It is submitted that these theories are inapposite and would cause the jury to speculate.

The circumstances herein are unique in that the defendant oral surgeon, testifying as an expert, admitted that he was not supposed to place a titanium fixture into the inferior alveolar [46]*46canal. It cannot be questioned that the defendant oral surgeon’s admission under oath was not made in ignorance of the facts, or in an abnormal state of mind, or made casually, thoughtlessly, or insincerely (see, Gangi v Fradus, 227 NY 452, 457).

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Cite This Page — Counsel Stack

Bluebook (online)
282 A.D.2d 42, 725 N.Y.S.2d 350, 2001 N.Y. App. Div. LEXIS 5322, Counsel Stack Legal Research, https://law.counselstack.com/opinion/knutson-v-sand-nyappdiv-2001.