Jerry’s Little Shop of Horrors and Linda’s Full Mouth Reconstruction – Part 2 the Trial

In the last article we found Jerry, the general practitioner, and Linda his failed full mouth reconstruction patient at the eve of trial.

You will recall that in the summer of 1988 Jerry recommended to Linda, his long time patient, that it was time to replace her bridge and partial removable denture. He also suggested for aesthetic reasons that he place new facings on the crowns of the three upper anterior teeth. The treatment fee estimate Jerry quoted was $6000. He told Linda he would complete the work in 6 weeks. He started work in right away, however despite four attempts to fit the new bridge and the removal of each temporary bridge and crowns without local anesthetic, by Christmas the bridge and partial still did not fit. The teeth were too long, painful, had a hairline crack when returned from the lab, caused serious injury and pain to Linda’s gums. She could not eat even the softest of foods.

This was a difficult case, but Jerry was not a quitter! He would not give up. He did not even consider referring Linda to a specialist or another practitioner, who might have more advanced reconstructive skills and experience. He forged ahead. He took new impressions. And started over again. So around April 1989 the new bridge was installed. Unfortunately once cemented into Linda’s mouth, Jerry’s new bridge, obliterated Linda’s anterior interproximal spacing. Flossing and home care were now impossible! Jerry had promised the pain would end once the treatment was completed. However by November 1989, her pain was unbearable. Linda gave up on Jerry and found the assistance of a team of specialists.

Over the next 2 years Linda was told she must have all of Jerry’s work removed and redone. She visited a new general practitioner, a periodontist, Dr.Spittle who carried out gingival reduction and root lengthening and installed six implants, Dr. Bore who carried out root canals, and Dr. Michael, a prosthodontist who designed the new bridges, overdenture and crowns. The team worked together to restore Linda’s dental health and confidence.

At the trial the learned judge heard from Linda about Jerry’s multiple attempts to prepare a bridge and partial. She told of the pain caused by Jerry when he performed each procedure without anesthetic. The pain which continued to intensify with each treatment. She spoke of her excruciatingly painful attempts to insert floss between the front crowned teeth that Jerry restored and the embarrassment of developing periodontal disease. She said she complained on an on-going basis to Jerry and that he assured her the pain would disappear when he had completed the treatments. It did not!

Linda then recounted the new phase of treatment which began in August 1990. Her new dentist worked up her case. After a thorough examination and consultations between her specialists using advanced diagnostic techniques, the usual x-rays, photographs and impressions were taken. A treatment plan and options were presented to Linda. Linda’s treatment was to be carried out in stages. Tissue healing time was allowed between procedures to ensure a positive outcome.

Linda was a very credible witness. She testified that she was now 57 years old and had been an administrative assistant. She was missing ten lower teeth and six upper teeth She said she was an innocent victim of Jerry’s careless incompetence. She cried when she described the chain of events that followed her relentless painful dental experience. She spoke of the breakdown of her long term relationship with her best friend, her fiancé, her inability to carry out the job which she loved and the ultimate loss of that job. She described her psychological losses including fear for her long term health after having taken copious prescriptions and exposures to countless x-rays. She reported that she now suffered from anxiety and had a phobia of medical and dental professionals. The trial judge found Linda’s testimony sympathetic and her reaction to Dr. Jerry’s incompetent dental care justified.

The judge accepted Linda’s expert on the standard of care. Dr. Pro, a prosthodontist prepared his report. He described what the average, prudent diligent professional’s requirements should be when providing full mouth reconstruction. He outlined Linda’s condition and listed the deficiencies and inadequacies in Linda’s care. Then he told the judge of the subsequent treatments Linda underwent which were remained partially completed at the time of trial. He clinically demonstrated and charted the following.

1. The margins of all the crowns are deficient, over-contoured and rough. There is no semblance of proper adaptation anywhere.
2. The form and contour of the crowns are improper.
3. The interproximal spaces between the teeth are still closed particularly from the lingual aspect thus preventing proper home care.
4. The porcelain has been ground in many places (incisal edges, interproximals) and is thus non-glazed and rough.
5. Teeth no. 31 and no. 41 have temporary filling material in the openings created during endodontic treatment by Dr. Michael.
6. Generalized chronic marginal gingivitis is present. The tissues are very hyperaemic and edematous.
7. Generalized mobility is present in both the mandibular and maxillary teeth.
8. There is no evidence of any tissue irritation being caused by the partial denture.
9. The margins of the maxillary laminates are rough and poorly adapted and thus causing gingival irritation".

Dr. Pro concluded that Jerry failed to meet the required standard of care in the circumstances in the preparation of Linda’s fixed bridge and removal partial. He also indicated that Jerry’s record keeping was very poor. He further confirmed that Linda’s was a difficult and advanced total reconstruction case clearly beyond the abilities of Jerry, a general practitioner. He said he was troubled that Jerry worked as a sole practitioner without the collaborative support, input or consultation with his professional peers.

In addition when asked to address the treatment provided by Linda’s subsequent dentist. Dr. Pro testified:

... Now what Dr. Robby, Linda’s new general practitioner did was a definite attempt to correct temporarily the underlying situation, relieve the pain and suffering of the patient and attempt to get the patient to some form of tolerable dental health. The question that you should consider is: did he, worsen or make the situation better?

In my view nothing could have make the situation worse, anything he did positively would help. Any attempt to open those (interproximal) spaces would definitely help. Those spaces were totally closed.

He withstood vigorous cross-examination from able counsel for Dr. Jerry.

The judge found that Dr. Jerry was not held to an ideal or perfect standard of care when evaluating his professional work, nor was Dr. Jerry’s work assessed or compared to the standard of a specialist. The Judge found Jerry to be negligent in all circumstances when the standard of care and competence applicable to a general practitioner was applied to the work undertaken for Linda.

He addressed the issue of contributory negligence or Linda’s role in her advancing periodontal deterioration. The learned judge found that Linda was incapable of keeping her mouth clean due to the faults described by Dr. Pro. He found Linda’s mouth was already inflamed and her gums irritated before Dr. Michael redid her restorative work. He found Jerry responsible as a result.

The judge concluded that Linda was entitled to receive competent care. If Jerry did not have the training and skill to provide it because of the particular difficulties of her case, he should have referred her to a specialist or, at the very least, consulted someone who had that training.

The judge awarded the following damages to Linda:

*Linda recovered within this amount the cost of surgery and implants and the initial cost of treatment by Jerry.

So it appears that Linda was wise not to accept Jerry’s trivial $1000 offer in full settlement.

The trial judge asked counsel to provide written submissions on costs. Jerry’s counsel hinted it was not over and sought instructions to Appeal.

Tune into the brief Appeal results and our next article from the scintillating files of Joyce R. Weinman, LLB.

JW