Dental Malpractice Case in Bridgeport, CT
MARVALYN FOSTER V. DARREN K. MARTINEZ, DDS
DOCKET NUMBER: CV-06-5005673S
PLAINTIFF’S VERDICT: $196,880.50
DATE OF VERDICT : DECMEBER 22, 2008
ECONOMIC LOSS: $46,880.50
NON-ECONOMIC LOSS: $150,000.00
The plaintiff, Marvalyn Foster, was 42 years old when she consulted with the defendant, Dr. Darren Martinez, a general dentist with offices in Stamford. Ms. Foster had lost a central incisor, tooth number 9 in her upper jaw, approximately 18 years prior. For that period of time, she was wearing a removable partial denture with a false tooth known as a flipper. The false tooth or pontic had discolored over time and shortened and she was interested in replacing it with a permanent fixed crown or bridge. Marvalyn had just completed training to obtain her real estate license and was concerned about her appearance.
She consulted Dr. Martinez on February 7, 2006, who informed her that he could provide her a fixed bridge, “from canine to canine” and give her a “beautiful Hollywood celebrity smile.” Ms. Foster returned to his office two days later and after being anesthetized heard the doctor remark that she had very strong teeth and felt tapping on the teeth. She assumed that her teeth were being prepared for what would be a six unit bridge from canine to canine or eye tooth to eye tooth. Instead, Dr. Martinez extracted her 3 remaining upper incisors. He did not obtain written informed consent from the plaintiff prior to extracting the teeth. Ms. Foster and her husband both testified that Dr. Martinez never informed them that he intended to extract the teeth or that the teeth were hopeless. Dr. Martinez did not consider referring her to either a periodontist or a prosthodontist to attempt to determine if the teeth were salvageable. After a period of time her husband walked into the operatory to find out what was taking so long and observed three bloody teeth on a tray next to his wife. It was at this time that Ms. Foster sat up in the chair and realized for the first time that Dr. Martinez had extracted her two lateral incisors and remaining central incisors thus leaving her missing four front teeth in her upper jaw. Dr. Martinez claimed that these teeth were periodontally hopeless and had been traumatized by the manner in which her upper jaw occluded with her lower jaw.
Prior to commencing treatment, Dr. Martinez did not take pre-treatment x-rays or photographs. Although he claimed that the patient had significant periodontal disease affecting the three extracted teeth, he did not record any periodontal probings in his chart. Dr. Martinez then had his assistant add three false teeth to the patient’s existing flipper and sent her out with that. In the space of several months, Dr. Martinez replaced the flipper on two occasions. He also ordered a temporary six unit bridge constructed by a laboratory in California. When the bridge arrived the teeth were large and unsightly, and Dr. Martinez referred to them as “horse teeth”. He indicated to the plaintiff that he would not cement the temporary bridge in because the teeth were unacceptable.
Dr. Martinez then determined that the plaintiff’s teeth in her lower jaw, which were angled and had some periodontal compromise, needed to be straightened by the application of orthodontic braces. He attempted to place brackets on all of her lower teeth when he claims that one of her lower incisors, tooth number 23, was significantly loose. An x-ray taken demonstrated a large radiolucency around the apex of the root of that tooth. Dr. Martinez recommended the extraction of that tooth. Based on his treatment recommendation Ms. Martinez agreed that he could extract tooth number 23. At this time she had also received further assurance from the doctor that he could provide her “a nice bridge”. After several successive appointments, Dr. Martinez finally met with the plaintiff and her husband on Saturday, April 1st at his office. At that time he had a bank check made payable to her for money that she had paid as a deposit on the six-unit bridge. The plaintiff testified that Dr. Martinez informed her that he could not provide her the bridge and that no one in the world could ever provide her this bridge. The plaintiff refused the check and requested that he attempt to complete the bridge. Arrangements were made for the last flipper to be provided to her on a temporary basis. She obtained that from the doctor two weeks later and left his care.
Thereafter, Ms. Foster consulted with Dr. Carol Felder, the dental director of Optimus Health Center, formerly the Bridgeport Community Health Center in Bridgeport, and with Dr. Gary Horblitt, a prosthodontist in Fairfield. Dr. Horblitt was disclosed by plaintiff as both a standard of care expert and a treating expert. In addition to his private practice Dr. Horblitt is the chair of the Department of Prosthetics at Yale New Haven Hospital and an Assistant Clinical Professor of Surgery at Yale Medical School.
Dr. Horblitt referred the plaintiff to Dr. Terrence Jackson, a periodontist, who evaluated her periodontal health and also determined that she was a candidate for placement of titanium implants in the upper jaw to replace the four missing teeth. It would be Dr. Horblitt’s intention to provide crowns or a bridge affixed to implants in the upper jaw. Dr. Jackson saw the plaintiff and ordered a CT Scan. He determined that she could be a candidate for the placement of implants, but also recommended that she be evaluated by an endodontist (a specialist in root canal therapy) and an orthodontist to address the skeletal discrepancy issues in her upper and lower jaw. Dr. Jackson thereafter withdrew from her care when he learned that Dr. Martinez was being sued, as he was a personal friend of the defendant.
Dr. Horblitt then referred the plaintiff to another periodontist, Dr. Barry Weiss in Hamden. Dr. Weiss testified that the plaintiff was a candidate for the placement of implants both in the upper jaw and the lower jaw to replace the teeth the defendant had extracted. The number of implants would be determined jointly by Dr. Weiss together with Dr. Horblitt. Because of bone loss in the upper jaw, the plaintiff would require some type of bone grafting. It would either be simultaneous grafting where bone chips are placed around the implants at the time of the installation of the implants; or, it would be staged bone grafting. With staged bone grafting, bone would be harvested from another portion of the plaintiff’s body or cadaver bone would be utilized. A period of approximately six months would be needed for that bone to integrate. Thereafter implants could be placed.
Dr. Horblitt determined that the plaintiff needed to be evaluated by an orthodontist in order to complete any reconstruction of her upper jaw. She was not presently a candidate for an implant supported restoration because of the occlusal issues that she had. Dr. Horblitt testified that the plaintiff would require either orthodontia to straighten the teeth, or she would require oral surgery to remove a section of bone below the lower incisors, and drop the teeth lower thus creating a better plane of occlusion.
The defendant disclosed Dr. Adina Carrel, a cosmetic dentist from New York City to testify as to causation and damages. Shortly before commencement of the jury trial, the defendant conceded liability and elected to defend the case on the issue of causation and damages only.
Dr. Martinez conceded that he did not take pre-treatment x-rays, keep adequate records, or obtain written informed consent from the plaintiff prior to extracting her teeth. He did contend before the jury, however, that he had informed her that he was going to extract the teeth in advance of the extraction. This fact was disputed by both Mrs. Foster and her husband, Andrew Foster.
Plaintiff offered expert testimony from Dr. Carol Felder, a general dentist, and director of the Dental Clinic at Optimus Health Center in Bridgeport, formerly the Bridgeport Community Health Center. Dr. Felder examined Mrs. Foster within several weeks of her last visit with Dr. Martinez. At that time she was wearing the last of the flippers that Dr. Martinez had constructed and delivered to her. The teeth on this flipper were protruding and did not follow the curvature of her smile line. The plaintiff had referred to these as “cat teeth” because the four incisors were shorter than her canines on either side, giving her a fang like appearance.
Dr. Felder testified that based on her evaluation Mrs. Foster was not a candidate for a six unit fixed bridge. The span was too large which would cause the bridge to fracture. In addition Dr. Felder described Mrs. Foster as having a deep bite because of the extensive over-bite that she had.
Dr. Horblitt testified to a number of standard of care violations by Dr. Martinez including his failure to do an appropriate pre-treatment evaluation which would have included x-rays, a periodontal evaluation, retaining pre-treatment models to identify what her occlusion had been, and maintaining appropriate records. Dr. Horblitt also testified that the plaintiff was not a candidate for the bridgework that Dr. Martinez intended without first addressing the issues of the hyper-eruption of her lower incisors as well as the occlusal discrepancy between her two jaws.
Dr. Horblitt prepared a replacement removable partial denture for her. Instead of utilizing four large pontics, he filled the space with six pontics. In addition, he created an appropriate smile line that followed the natural curvature of her lips when she smiled. He also prepared a lower flipper to replace the lower incisor that Dr. Martinez had extracted.
Dr. Horblitt testified that although Mrs. Foster suffered from traumatic occlusion, which may have periodontally compromised her upper teeth to some extent, a referral to a periodontist could have given her the opportunity for those teeth to be treated and saved. They were not hopeless simply because of the traumatic occlusion.
Dr. Horblitt testified that the cost of future care in his office at present day prices was approximately $24,000. He also testified that the cost of orthodontia for her in the future would be $8,000.
Plaintiff’s medical specials to date for treatment rendered by Drs. Felder, Jackson, Weiss, and Horblitt total $10,033.
Dr. Adina Carrel, the defense expert, testified that she had reviewed photos of the various later models taken by Dr. Martinez as well as reproductions of x-rays. She had not examined the plaintiff and had not been shown original x-rays or original models. She provided an opinion that the plaintiff presented with compromised upper incisors because of traumatic occlusion. Dr. Carrel testified that because of traumatic occlusion and periodontal compromise of those teeth, she left the defendant’s office with what she came in with. She did not agree with the proposals for treatment by Dr. Horblitt and offered an opinion that none of the treatment needs of the plaintiff were causally related to the negligence of Dr. Martinez.
The case was tried before Judge Richard Gilardi. The jury deliberated for approximately one hour and 45 minutes before delivering the verdict for the plaintiff. Mrs. Foster was awarded past and future economic damages in the amount of $46,880.50. She was awarded past and future non-economic damages in the amount of $150,000 for a total award of $196,880.50.