Koslowski v. Sanchez

563 So. 2d 937, 1990 WL 75372
CourtLouisiana Court of Appeal
DecidedMay 30, 1990
DocketCA 89 0582
StatusPublished
Cited by5 cases

This text of 563 So. 2d 937 (Koslowski v. Sanchez) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Koslowski v. Sanchez, 563 So. 2d 937, 1990 WL 75372 (La. Ct. App. 1990).

Opinion

563 So.2d 937 (1990)

Donna KOSLOWSKI and Wally Koslowski
v.
Dr. Gayle M. SANCHEZ, D.D.S., Shenandoah Dental Clinic, Inc., and CNA Insurance Company.

No. CA 89 0582.

Court of Appeal of Louisiana, First Circuit.

May 30, 1990.

*938 Ralph L. Fletcher, Baton Rouge, for plaintiff-appellee Donna Koslowski, et al.

Stephen R. Wilson, Baton Rouge, for defendant-appellant Dr. Gayle Sanchez, D.D.S., Shenandoah Dental Clinic, Inc., and CNA Ins. Co.

S. Alfred Adams, William Carruth, Baton Rouge, for Com'r of Ins.

Before LOTTINGER, CRAIN and LEBLANC, JJ.

LOTTINGER, Judge.

This is an appeal by the State of Louisiana's Commissioner of Insurance and the Louisiana Patient's Compensation Fund (collectively referred to hereafter as the "Fund"), from an excess judgment in favor of Ms. Donna Koslowski pursuant to her malpractice action against a qualified dental health care provider and his insurer. Ms. Koslowski alleges that the dental health care provider's use of a filler called N-2 in her root canal has damaged her mandibular nerve and caused permanent *939 partial parathesia (numbness) of her lower left lip and face. Ms. Koslowski alleges that N-2 is inappropriate as a root canal filler because it contains 6.5 percent paraformaldehyde, and that therefore it constituted malpractice to have used it.

The jury in the trial below rendered a verdict of $250,000.00 in general damages against Dr. Gayle Sanchez, D.D.S., and his insurer in favor of Ms. Koslowski. The jury found in favor of Dr. Sanchez and his insurer on Mr. Koslowski's loss of consortium claim, and he has not appealed.

Dr. Sanchez's insurer, Continental Casualty Company, paid its policy limits of $100,000.00, was released by plaintiffs, and has not appealed. The Fund intervened and has suspensively appealed the award in excess of $100,000.00, contesting liability, damages, and whether certain of the plaintiff's expert witnesses should have been allowed to testify.

Ms. Koslowski contends in her reply brief that since the insurer "settled" for its statutory limit of $100,000.00, that the Fund cannot appeal the liability issue, but can only appeal the amount of the award.

FACTS

On September 6, 1984, Ms. Donna Koslowski went to the office of Dr. Gayle Sanchez, D.D.S., a general dentist practicing in Baton Rouge, Louisiana, with complaints of pain in her lower left molar area. This was the first time that Ms. Koslowski had been to see Dr. Sanchez. After examining Ms. Koslowski and taking X-rays, Dr. Sanchez performed a root canal on her lower left second molar.

This was not Ms. Koslowski's first root canal. She had several root canals done on various other teeth in the past. Basically, a root canal is the removal of the diseased or infected pulp and root of a tooth, after which the empty area, or canal, is filled in with some type of filler material. There are dozens of different filler materials available.

Dr. Sanchez used a filler called N-2, or Sargenti paste, to fill Ms. Koslowski's root canal. This paste was being used by about half of the dentists practicing in Baton Rouge at that time. N-2 is 6.5 percent paraformaldehyde and is designed to disinfect and render harmless any pulp left inside the canal, while at the same time acting as a filler. This allows a root canal to be done in one visit and makes it less imperative to remove all of the pulp material.

Most endodontists (dentists who limit their practice to root canals), use an inert filler material called gutta-percha. It is more important to remove all of the pulp material when using this filler so that infection does not occur. If infection is already present, the canal is usually first packed with an antiseptic material to get rid of the infection. Later, the antiseptic material is removed and replaced with the gutta-percha.

The antiseptic material used by most endodontists and dentists, is called formacreasol and contains 19 percent formaldehyde and 35 percent creasol. This material is widely used and accepted in the endodontic and dental communities even though it contains a higher level of formaldehyde than N-2.

Dr. Sanchez testified that he also uses formacreasol to disinfect a canal if an infection is present, but that he prefers to use N-2 instead of gutta-percha as a filler because it provides a better seal. In Ms. Koslowski's case, there was no infection present after the pulp was removed, so Dr. Sanchez filled the canal with the N-2 paste from the beginning and did not use formacreasol.

The tooth that Dr. Sanchez did a root canal on for Ms. Koslowski had what is called a blunderbuss canal. This is a single large canal that doesn't taper to a point at the end. This canal extended down and ended either in, or very near, Ms. Koslowski's mandibular canal. The mandibular canal is the canal in the jawbone that contains the nerves which innervate the lips and lower facial area.

When Dr. Sanchez filled Ms. Koslowski's canal, some of the N-2 paste, which goes in as a semi-liquid then later hardens, leaked out of the bottom of the root canal into the *940 mandibular canal. When filler material leaks out of the bottom of a root canal, it is said that an overfill has occurred. Overfills are not uncommon and there was uncontradicted expert testimony that an overfill is not in itself considered to be malpractice, and that an overfill is more likely when a blunderbuss canal is being filled.

After completing Ms. Koslowski's root canal, Dr. Sanchez again took X-rays. This set of X-rays showed that an overfill had occurred. Dr. Sanchez informed Ms. Koslowski of the overfill and told her it might cause problems. He prescribed antibiotics and pain killers and told her to call if she had any trouble with the tooth.

After unsuccessfully trying to see Dr. Sanchez on September 11, 1984, Ms. Koslowski returned to Dr. Sanchez's office on Friday, September 14, 1984. She was complaining of pain in the tooth and numbness of the lower left face and lip.

After examining and consulting with Ms. Koslowski, Dr. Sanchez extracted the tooth, took another set of X-rays, and tried to remove the overfill of N-2 from Ms. Koslowski's mandibular canal. His efforts to remove the overfill were unsuccessful, and Dr. Sanchez suggested at that point that Ms. Koslowski see an oral surgeon.

The feeling never returned to Ms. Koslowski's lower face and lip, nevertheless, Ms. Koslowski did not see the oral surgeon she was referred to nor did she return to see Dr. Sanchez. Approximately one year later Ms. Koslowski retained an attorney who filed this dental malpractice suit against Dr. Sanchez following review by a medical review panel pursuant to La.R.S. 40:1299.41, et seq.

On the advise of her attorney, Ms. Koslowski saw Dr. William Chisholm, Jr., D.M.D., a Baton Rouge endodontist in September of 1985; and Dr. Paul Rosenberg D.D.S., a New York endodontist, in January of 1986. Both Drs. Chisholm and Rosenberg concluded that Ms. Koslowski suffers from permanent partial paresthesia of the lower left lip and facial area. In their opinion, this condition more likely than not resulted from the overfill of N-2 paste damaging the mandibular or inferior alveolar nerve.

The medical review panel found that the evidence failed to support the conclusion that Dr. Sanchez did not meet the applicable standard of care as alleged in the complaint. The panel was unable to determine whether Dr. Sanchez's conduct was or was not a factor in causing Ms. Koslowski's paresthesia.

At trial, plaintiff's counsel repeatedly asserted that the only negligence committed by Dr.

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Bluebook (online)
563 So. 2d 937, 1990 WL 75372, Counsel Stack Legal Research, https://law.counselstack.com/opinion/koslowski-v-sanchez-lactapp-1990.