Was an oral surgeon at fault for the massive stroke his patient suffered after an 8-tooth extraction under local anesthesia? A federal court will take up that question now that a judge has dismissed the U.S. government's motions to exclude the plaintiff's expert witnesses from testifying in the malpractice case.

Christopher Ellison, a 49-year-old man with a history of hypertension, hyperlipidemia, smoking, diabetes and obesity, presented to the Philadelphia Veterans' Administration Medical Center in September 2007 to have 8 teeth extracted "as part of a treatment plan for periodontal disease," according to court documents. An oral and maxillofacial surgeon from the VA performed the procedure with the assistance of a dental student.

Two VA surgeons testified that Mr. Ellison appeared anxious at the start of the procedure, which began around 9 a.m. As one doctor administered the first few shots of local anesthesia, the patient said that he felt nauseous and had a low blood pressure reading. The oral surgeon stopped, reclined the patient's chair and got his blood pressure back up to normal. He waited about 10 minutes and until Mr. Ellison said he was OK before continuing, according to court documents.

The patient's blood pressure dropped again 3 times during the procedure: once again during anesthetic injections and twice during the tooth extractions. Each time, a doctor testified that he reclined Mr. Ellison's chair, waited for his blood pressure to rise and had the patient consent before he continued.

The surgeon discharged Mr. Ellison around 10:30 a.m., after keeping him in the reclined chair for about 10 to 15 minutes after the last extraction and going over his post-operative instructions. The oral surgeon testified that he observed Mr. Ellison for about 15 to 20 minutes total and that he "was moving his arms and legs and looked fine" when he left. He believed the patient's hypotensive episodes to be symptoms of vasovagal syncope, or anxiety.

Mr. Ellison attempted to drive himself home after visiting the pharmacy at the VA Medical Center, but his car was later found a short distance from the facility, with the patient unconscious inside. He was later diagnosed as having suffered a left middle cerebral artery stroke, which required a left hemicraniectomy, "a protacted hospitalization" and "many months" rehabilitation, according to court documents.

Mr. Ellison's wife and guardian, Cheryl Ellison, filed a malpractice complaint in December 2008 against the University of Pennsylvania Health System, the surgeon and other defendants, who were later replaced with the U.S. government, since the incident took place at a VA facility.

The government filed motions to exclude the testimony of Ms. Ellison's expert witnesses, including the neurologist who cared for her husband after the stroke and testified that he believed "the episodes of hypotension [Mr. Ellison] experienced in the dental chair contributed to his stroke." Arguing that the plantiff's expert opinions were "unreliable," the government also moved for summary judgment. However, District Judge William Yohn denied the defendants' motions on Nov. 10, allowing the malpractice suit to proceed with the testimony from the plaintiff's expert witnesses.

Irene Tsikitas

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