Idlibi v. Conn. State Dental Comm'n

212 Conn.App. 501

275 A.3d 1214

Ammar A. IDLIBI

v.CONNECTICUT STATE DENTAL COMMISSION

AC 44331

Appellate Court of Connecticut.

Argued January 12, 2022

Officially released May 17, 2022

Ammar A. Idlibi, self-represented, the appellant (plaintiff).

Shawn L. Rutchick, assistant attorney general, with whom, on the brief, were William Tong, attorney general, and Clare Kindall, solicitor general, for the appellee (defendant).

Prescott, Alexander and Harper, Js.

HARPER, J.

The self-represented plaintiff, Ammar A. Idlibi, appeals from the judgment of the Superior Court dismissing his administrative appeal from the decision of the defendant, the Connecticut State Dental Commission (commission), finding that the plaintiff had failed to meet the applicable standard of care while treating a three year old patient and ordering disciplinary sanctions with respect to the plaintiff's dental license. On appeal, the plaintiff claims that the court improperly dismissed his administrative appeal. Specifically, the plaintiff claims that the court improperly (1) determined that it was proper for the commission to rely on its own expertise in reaching its conclusion that he had breached the applicable standard of care by failing to obtain adequate informed consent; (2) concluded that the commission properly permitted certain expert testimony from a witness who was not board-certified and, as such, lacked knowledge as to the prevailing standard of care; (3) rejected his challenge to the commission's finding that he breached the standard of care by failing to obtain informed consent to place more than one stainless steel crown in the patient's mouth because (a) he did obtain informed consent and (b) the commission, in finding a deviation from the standard of care, acted in excess of its statutory authority; (4) determined that the evidence in the record supports the commission's finding that he failed to chart caries¹ and decalcifications adequately in violation of the standard of care; (5) left unresolved inconsistences in the commission's decision; and (6) violated his right to fundamental fairness.² The commission contends that the court lacked subject matter jurisdiction because the plaintiff served his administrative appeal on the Department of Public Health (department) rather than on the commission.³ We affirm the judgment of the Superior Court dismissing the plaintiff's appeal.

The following facts and procedural history are relevant to this appeal. The plaintiff is a licensed, board-certified pediatric dentist and has been a member of the American Academy of Pediatric Dentistry (AAPD) since 1990. The plaintiff provides specialized care for children under general anesthesia at the Connecticut Children's Medical Center (hospital), where he has had privileges since 2004.

After the patient was referred to the plaintiff's office by a general dentist, an associate dentist at the office, Joseph Guzzardi, first attempted to treat the patient on January 11, 2016. At that appointment, Guzzardi was not able to take X-rays of the patient but was able to observe the patient's teeth. On the basis of his observations, he indicated to the patient's mother that the patient would require one crown on tooth S and that two more teeth may need fillings. The mother signed multiple consent forms authorizing "treatment of diseased or injured teeth with dental restoration (filling or caps) ... treatment as may be advisable to preserve health and life," and treatment of unforeseen conditions. She also signed a form consenting to the use of stainless steel crowns.

On January 21, 2016, the patient's mother called Guzzardi to express concern with the idea of placing a stainless steel crown on her child's tooth. Guzzardi testified that, during this phone call, he explained to her that tooth S absolutely needed a crown and that the patient may need multiple crowns. At an appointment on April 8, 2016, the mother again signed a consent form consenting to the treatment of unforeseen conditions. At that appointment, Guzzardi attempted to treat the patient in his office with the use of general anesthesia but was unsuccessful because the attending anesthesiologist was not comfortable going forward with the procedure given the patient's negative reaction to the general anesthesia.

The patient subsequently was placed on the plaintiff's schedule for treatment at the hospital. The day of the procedure was the first time that the patient and her mother had ever met the plaintiff, as they previously had communicated with, and the patient received treatment from, Guzzardi. On April 26, 2016, the plaintiff provided care to the three year old patient under general anesthesia. During the course of the procedure, the plaintiff placed eight stainless steel crowns in the patient's mouth.

The patient's mother subsequently filed a complaint with the department.⁴

On September 7, 2017, the department presented the commission,⁵ as the relevant governing board, with a statement of charges against the plaintiff. The charges alleged that the plaintiff's license was subject to disciplinary action pursuant to General Statutes § 20-114 (a)⁶ on the ground that the care provided to the three year old patient failed to meet the standard of care. Specifically, the department alleged that the plaintiff (1) failed to obtain adequate informed consent for placing eight stainless steel crowns in the patient's mouth, (2) placed one or more crowns without adequate justification, or without adequate documentation of such, (3) failed to make adequate attempts at treatment without general anesthesia or failed to document those attempts adequately, (4) failed to chart findings of cervical decalcification⁷ adequately, (5) failed to attempt treatment of cervical decalcification other than by placement of crowns, and (6) failed to adequately chart caries or other dental disease for one or more of the teeth that he crowned.

The parties were notified that hearings would be held before a duly authorized panel of commissioners (panel) comprised of Steven G. Reiss, a doctor of dental surgery; Deborah Dodenhoff, a registered nurse; and Anatoliy Ravin, also a doctor of dental surgery. The hearings took place on January 11 and 16, 2018.⁸ Both the plaintiff and the department presented evidence, conducted cross-examination of witnesses, and provided argument. At the hearing, the department called Jenny Federman, a pediatric dentist, to testify as an expert. After extensive direct and cross-examination, the panel qualified Federman to testify as an expert. During the hearing, Federman testified extensively about her opinion concerning the X-rays of the patient. She stated that "[the patient] had one cavity on X-ray and came out with eight crowns." She testified that the informed consent in this case was not adequate because the patient's mother "made it very clear she didn't want eight stainless steel [crowns]. She didn't even want one, and she asked [the plaintiff] to come out after he took the X-rays. ... It's ultimately the parent's decision." When asked whether the consent form or the conversations between the dentist and the patient to which the witness testified governed informed consent, she stated: "In my opinion, it would be the conversations."

The plaintiff called Donald Kohn, a board-certified pediatric dentist, to testify as an expert witness. Kohn testified that informed consent should be understood "[f]rom the patient's point of view." He also testified that communicating from the operating room to a patient's parent is a practice he does "frequently" to "reassure [the parent] ... [and] when there's really been a dramatic change ... in the treatment plan ...." Kohn also testified that "the standard is, what does mom understand? And we have to start to think about what is the consent giver's appreciation of what I'm going to do? And again, we really have to stress, when you go to the operating room the conundrum is you don't know what you're going to find there and so when you get something that's so drastically different from what you initially did, at what point do you do it?" He further testified: "I would say that anything that you can do to make sure that the parent knows the range of—and appreciates the range of outcomes is going to strengthen your informed consent." In response to a question regarding possible preventative measures, Kohn testified that if "all you're seeing is decalcification ... there are some things you can do. ... [W]e have ... some other approaches that we didn't have even a few years ago."

In addition to those expert witnesses, the patient's mother, Guzzardi, and the plaintiff testified. The patient's mother testified emphatically that she had discussed and agreed to placing a crown on only one tooth, tooth S, and that "[n]ever, ever was there any other discussion about [any] other tooth or [other] stainless steel crowns ...." She also testified that she and the plaintiff had agreed that, before he did anything to the patient, he would come out of the operating room and let her know what the X-rays and the examination showed. She stated: "From my understanding, I couldn't agree or say anything until [the plaintiff] came out and let me know what my child needed."

Guzzardi testified that "[t]he last agreement that I had with [the patient's] mom when we walked into the room for using general anesthesia was that ... tooth S definitely needs a crown. There may be further cavities. I will do my best capabilities in invasive procedure, such as a filling, but there may need to be more crowns. I will not know until I have X-rays." When asked by the department's counsel what his understanding was at the appointment that occurred on April 8, 2018, of what the patient's mother had consented to, he stated that "[she] consented to definitely needing a crown on [tooth] S and having the potential to need crowns on other teeth, based on the X-rays and what they reveal[ed]." When asked if, at...