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Naderi v. Ratnarajah

Court of Appeals of Texas, Fourteenth District

April 2, 2019

SANJAR NADERI, D.D.S. AND ANTOINE DENTAL CENTER, LLC, Appellants
v.
KANGASABAPATHY "RIKKI" RATNARAJAH, Appellee

          On Appeal from the 164th District Court Harris County, Texas Trial Court Cause No. 2017-83384

          Panel consists of Justices Wise, Zimmerer, and Spain.

          OPINION

          KEN WISE JUSTICE

         Appellee Kangasabapathy "Rikki" Ratnarajah brings a health care liability claim against appellants Sanjar Naderi, D.D.S. and Antoine Dental Center, LLC. The trial court denied appellants' Chapter 74 motion to dismiss based on alleged deficiencies in Ratnarajah's expert report. See Tex. Civ. Prac. & Rem. Code § 74.351. We affirm.

          I. Factual and Procedural Background [1]

         A. Factual Background

         On July 25, 2016, Ratnarajah went to the Antoine Dental Center seeking treatment for an upper left wisdom tooth abscess. Dr. Naderi or his staff recorded Ratnarajah's medical history, blood pressure, pulse, and weight. They also took several types of X-rays of Ratnarajah's teeth. Dr. Naderi charted various operative and restorative dental procedures Ratnarajah needed. Dr. Naderi's charting showed that teeth numbers 1, 16, 17, and 32 were circled and labeled "SE," presumably indicating surgical extraction. Dr. Naderi extracted tooth #16 that day without complications. Although an abscess on tooth #17 was clearly visible on a panoramic X-ray, Dr. Naderi did not extract tooth #17 or prescribe any antibiotics for Ratnarajah.

         Ratnarajah returned to Antoine Dental Center for his post-operative follow-up visit on August 1, 2016. Dr. Naderi determined that Ratnarajah was healing well and advised him to resume his regular activities. Dr. Naderi did not diagnose the abscess on tooth #17 or prescribe antibiotics for Ratnarajah at that time, and there is no evidence that Dr. Naderi suggested to Ratnarajah that tooth #17 be removed.

         Ratnarajah returned to Antoine Dental Center and Dr. Naderi on November 9, 2016, complaining of "left sided tenderness." Dr. Naderi's notes reflect "no signs of abscess or inflammation" and "to consult OMFS if problem persists, "[2]even though no new X-rays were taken and there was evidence of an abscess around tooth #17 on the X-rays taken forty-five days earlier. Despite recording that there were no signs of an abscess or inflammation, Dr. Naderi prescribed

          Amoxicillin 500 mg without explanation or recording a diagnosis.

         Ratnarajah returned to Antoine Dental Center and Dr. Naderi on November 30, 2016, still in pain. The only documentation of this visit is a note that "Pt left office without being seen by a doctor."

         Ratnarajah again returned to Antoine Dental Center and Dr. Naderi on February 28, 2017, still complaining of pain and discomfort on the left side. Dr. Naderi's notes reflect that Ratnarajah had "left sided discomfort and swelling, [and] intraoral left sided swelling in lower left area." Dr. Naderi referred Ratnarajah to an oral surgeon for "further evaluation and possible systemic issues contributory to swelling and inflammation" rather than for extraction of a wisdom tooth he was unable or unwilling to perform. No more X-rays were taken, and no antibiotics were prescribed despite the diagnosis of swelling and inflammation. There is no documentation that Dr. Naderi or anyone at Antoine Dental Center had a conversation with Ratnarajah to discuss his issues and possible treatment options. Dr. Naderi did not record anywhere that tooth #17 needed to be extracted.

         Ratnarajah saw a medical provider on April 26, 2017, when he had an extraction of tooth #17 and incision and drainage of a large infection that Dr. Naderi failed to identify. Ratnarajah went on to develop osteomyelitis and other large infections that eventually required a resection of his lower left mandible.

         B. Procedural Background

         Ratnarajah sued Dr. Naderi and Antoine Dental Center (collectively, Appellants) in late 2017. Ratnarajah alleged that Appellants' negligent evaluation, treatment, and management of his care resulted in permanent, disabling injuries, including the development of osteomyelitis and other severe infections; the compete loss of his lower left mandible; permanent facial disfigurement and loss of function; permanent loss of many teeth in his lower jaw; and at least three subsequent surgical procedures that would not have been necessary but for Appellants' negligence. Ratnarajah alleged that Antoine Dental Center was liable for Dr. Naderi's actions based on vicarious liability theories.

         Because Ratnarajah alleged health care liability claims against Appellants, he timely served Appellants with a Chapter 74 expert report and curriculum vitae of Andrew Hood, D.D.S. See Tex. Prac. & Rem. Code § 74.351(a); see also id. § 74.001(13) (defining "health care liability claim"). Antoine Dental Center filed objections to Dr. Hood's qualifications. Ratnarajah responded by filing an amended expert report of Dr. Hood. In the meantime, Dr. Naderi had filed objections to Dr. Hood's original expert report. Shortly thereafter, Dr. Naderi filed objections to Dr. Hood's amended expert report that were substantively similar to the objections previously filed in response to Dr. Hood's original expert report. On the same day, Ratnarajah filed a second amended expert report of Dr. Hood, which is the subject of this appeal.

         In his report, Dr. Hood set out the following opinions on the applicable standard of care and Dr. Naderi's breach of those standards:

         1. Making the right diagnosis based on the oral and radiographic examination

a. Dr. Naderi failed to make a proper diagnosis of a dental infection on tooth #17 that was clearly visible on the panoramic radiograph o[n] his initial examination on July 25, 2016, therefore breaching the standard of care.
i. Dr. Naderi failed to make this diagnosis on several occasions. Specifically, when the initial examination was done on July 25, 2016 as well as on September 9, 2016 when Mr. ...

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