Bloxham v. Jeffrey V. Anzalone, D.D.S., L.L.C.

Citations: 134 So. 3d 1216; 2014 WL 631577; 2014 La. App. LEXIS 428Docket: No. 48,690-CA

Court: Louisiana Court of Appeal; February 18, 2014; Louisiana; State Appellate Court

SummaryOriginalCytator Case TreatmentBackward CitatorAnalysis

EnglishEspañolSimplified EnglishEspañol Fácil

Gerald M. Bloxham, as substituted plaintiff for the deceased Laura O. Bloxham, appeals the trial court's judgment favoring Dr. Jeffrey Anzalone and his dental practice, as well as Louisiana Medical Mutual Insurance Company (LAMMICO), in a dental malpractice case. 

Mrs. Bloxham had a dental implant placed in 1986 and reported gum soreness to Dr. Eric Geist in 2005. Following an evaluation, Dr. Geist referred her to Dr. Anzalone in 2006 due to ongoing tissue issues around the implant. Dr. Anzalone diagnosed her with peri-implantitis, noted significant bone loss, and recommended a bone graft. He performed the procedure on August 4, 2006, during which he observed that the implant was integrated into the jawbone but also noted bone loss.

Post-operatively, Mrs. Bloxham experienced numbness and burning sensations in her lip and tongue, which she reported during subsequent visits. Dr. Anzalone attributed these symptoms to bruising and swelling but later sought additional consultations with Dr. Geist and Dr. Roger Meyer, a neurosurgeon, and referred her to neurologist Dr. Vipul Shelat. Four months post-surgery, Dr. John Zuniga examined Mrs. Bloxham, confirming her symptoms and opting for conservative management before deciding that surgery was necessary due to her intolerance to medications. 

The trial court's ruling in favor of the defendants is affirmed.

Mrs. Bloxham’s mental nerve was compressed by an old implant during a surgical procedure, which did not alleviate her pain and numbness. Following this, she underwent extensive treatment from various specialists, culminating in the severing of her mental nerve by Dr. Ghali on January 22, 2010, resulting in permanent numbness. A medical malpractice complaint was filed against Dr. Anzalone, leading to a medical review panel that found the placement of the bone graft deviated from the standard of care but could not determine whether Dr. Anzalone's actions caused the nerve compression. The panel noted that Dr. Zuniga’s records indicated the implant caused the nerve compression and lacked sufficient information to link Dr. Anzalone's procedure to Mrs. Bloxham's injuries. The plaintiff alleged improper surgical techniques and invoked res ipsa loquitur to shift the burden of proof to Dr. Anzalone. Subsequent motions were filed concerning the applicability of legal doctrines and the exclusion of certain defenses and testimonies. At trial, the court ruled in favor of the defendants, stating the plaintiff did not prove that the bone graft caused her injuries, without addressing whether Dr. Anzalone breached the standard of care. The court also did not rule on the motions related to res ipsa loquitur and the Housley presumption. The plaintiff appealed, arguing the trial court erred in its finding and that symptoms arose only after the procedure, with testimony suggesting the procedure could have caused the issues. Dr. Anzalone acknowledged multiple potential causes for Mrs. Bloxham’s problems.

To establish a medical malpractice claim, a plaintiff must demonstrate three elements: (1) the applicable standard of care for the defendant, (2) a breach of that standard, and (3) a causal link between the breach and the injury incurred. The manifest error standard governs appellate review of these claims, meaning that an appellate court cannot overturn a trial court's factual findings unless clearly erroneous. When conflicting expert opinions exist, appellate courts defer to the fact finder's conclusions. 

In the case concerning Mrs. Bloxham, she reported experiencing symptoms of numbness, burning, and pain after surgery, which she did not have prior. Testimony from her husband corroborated her account of symptom progression. Dr. Zuniga, who performed a corrective surgery, observed that the mental nerve was compressed by an implant, suggesting that the impingement could have developed over time. He stated there was no clear relationship between the prior procedure and Mrs. Bloxham’s symptoms, attributing the nerve compression to the implant's presence rather than the earlier surgical intervention. Dr. Geist indicated that the longevity of the implant likely contributed to nerve compression and offered a more definitive view on the cause of the symptoms. Both experts contributed to the understanding of the causal relationship between the surgical procedure and the resultant symptoms, highlighting the complexity of establishing liability in this case.

Dr. Geist indicated that while it is possible to infer a connection between Dr. Anzalone's procedure and Mrs. Bloxham's symptoms based on timing, he emphasized that such conclusions are speculative and could result from various factors, not solely compression. He ultimately stated uncertainty regarding whether the symptoms stemmed from the implant or the procedure itself. Dr. Thomas McNeely, a periodontist, acknowledged that Mrs. Bloxham's symptoms might relate to nerve trauma, potentially influenced by the implant or inflammation. He speculated that the inflammatory process during recovery might have contributed to her condition. Dr. David Kim, an oral and maxillofacial surgeon, asserted that while there was no prior evidence of nerve compression, the onset of symptoms two weeks post-surgery suggested a causal link between the procedure and the nerve injury. He noted the significance of the surgery's location in relation to the nerve. However, he remained uncertain whether the injury was due to the bone graft or surgical instruments. Dr. Ghali Ghali also noted the temporal relationship of the symptoms to the surgery. Ultimately, the trial court ruled in favor of Dr. Anzalone, concluding that the evidence did not convincingly link the bone graft to Mrs. Bloxham's injury, despite Dr. Kim's opinion suggesting a connection. Other experts attributed the nerve impingement to an older dental implant.

Great deference is given to the trial court's decision to accept the expert testimony of Drs. Geist, Zuniga, and McNeely over that of a contradictory expert, leading to the conclusion that the plaintiff, Mrs. Bloxham, did not meet her burden of proof regarding causation of her injury by the bone graft procedure. The plaintiff's argument that the trial court erred in not applying the doctrine of res ipsa loquitur is addressed; this doctrine requires three conditions to be met: unusual circumstances suggesting negligence, exclusive control by the defendant over the injury-causing object, and a reasonable conclusion that the defendant's breach caused the accident. The court noted that while Mrs. Bloxham experienced symptoms post-procedure, the expert testimonies provided multiple potential explanations for her nerve impingement, which could include prior dental work, thus negating a presumption of causation from Dr. Anzalone’s actions. Therefore, the trial court's findings were not clearly wrong, and the plaintiff's assignment of error was deemed meritless. The judgment of the trial court is affirmed, with costs of the appeal assigned to the plaintiff. Mrs. Bloxham passed away from unrelated causes shortly after the trial. Notably, the dental implant in question was placed on top of the jawbone rather than inserted into it, and Dr. Anzalone consulted her on several dates in September and October 2006.