Holiday greetings to one and all. And a shout out to my new urban legend, that rascal Gary Baker. Do y'all remember my post of 7/22/09? Titled "Gone to the Dogs....", it was a little ditty about course and scope and the idiopathic fall defense involving veterinary surgeon Dr. Laci Nash (now Laci Nash Schaible). Benefits were awarded and as I recall, it was ruled that Dr. Nash collapsed due to the heat in the OR, or the smell of the anesthetic, or some such thing. Thus, the event was not deemed an idiopathic fall, sad to say for the defense.
Okay, so Gary Baker didn't win the first round on compensability. And that's the thing about Gary.....as defense lawyers go, Gary walks softly and carries a big stick. So when Dr. Nash came back on a DACD petition seeking authorization of crowns for teeth six through eleven, Gary was ready for her. I should mention that when Dr. Nash collapsed in the OR, she fell onto her face and broke her right jaw. She reportedly cracked teeth six and seven (and appropriately, the one tooth is known as the "canine"). Treatment was rendered by Dr. George Carr, specialist in prosthodontics, who testified for the claimant.
So what was the dispute?
Dr. Carr proposed to place crowns on teeth six through eleven. Crowns on teeth six and seven would reinforce two endodontically treated teeth and crowns for teeth eight and nine would remediate a hole between the two front teeth occasioned by gum loss. Crowns on teeth ten and eleven would reportedly create symmetry across the tooth line from six to eleven. I, for one, am a huge fan of "symmetry". I share that quality with my husband, an engineer, and together we make a splendid anal-retentive pair. But back to our story.
The proposed crowns for teeth six and seven were not disputed by the carrier. There was an issue of "craze lines", or cracks, on teeth six through eleven. These were visible with magnification. Dr. Carr was less than certain on the issue of whether the craze lines were the result of the work-related trauma. He had not examined the claimant prior to the work event, and he admitted that treatment to date rendered by himself, Dr. Cohen and Dr. Popowich was limited to teeth six and seven.
Enter Dr. Stephen Niemoeller as the defense dental expert and a general dentist with a focus on crown and bridge work. Dr. Niemoeller was aware of the root canals to teeth six and seven, the treatment of the jaw fracture, and the final office note of Dr. Popowich commenting that the results of treatment were "clinically excellent." Pursuant to his evaluation of the claimant's mouth, Dr. Niemoeller testified that the vertical craze lines did not necessarily result from trauma, nor are they indicative of any instability. To the contrary, a horizontal craze line would be more highly suggestive of a tooth having the potential to fracture. He would agree that removal of composite resin on teeth eight and nine would be appropriate. He did not, however, believe that crowns on teeth eight through eleven was necessary from a structural standpoint-"The only reason for crowning those teeth would be for aesthetic reasons to make the teeth match crowns six and seven."
The Board deemed Dr. Niemoeller more persuasive than Dr. Carr. Greatly impacting the result was the fact that all of the initial and acute treatment was directed to teeth six and seven. No injury or problems were ever identified relating to teeth eight through eleven. Moreover, teeth eight through eleven were "healthy" and healthy tooth material would need to be removed to place the crowns. The was also scrutiny of the respective expertise of the two testifying doctors and while great weight was assigned to the fact that Dr. Carr was the treating, and also a specialist in prosthodontics, the Board was also impressed with Dr. Niemoeller's credentials. Of further concern to the Board was the fact that Dr. Carr's justification for crowns eight to eleven "appears to have changed over time and is less convincing as a result."
So much for aesthetics, so much for symmetry. I find the result slightly surprising. But no doubt an excellent outcome for Gary's client. And as for opposing counsel, I guess one could say that this time it is his case that has gone to the dogs.
Laci Nash Schaible v. Medical Management International, IAB# 1320555 (12/1/11).
Irreverently yours,Cassandra Roberts
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