Coquitlam pharmacist loses malpractice lawsuit over sleep apnea jaw surgery

A Coquitlam pharmacist has lost a medical malpractice lawsuit alleging a surgeon performed a different jaw procedure for sleep apnea than the one he had agreed to.

In a Sept. 9 decision, BC Supreme Court Justice Eric Gottardi dismissed Jeremy Lorne Antepyan-Ruckenstein’s claims against Dr. Fahad Cadili and his corporation.

“I have significant concerns about the reliability of the plaintiff’s testimony,” Gottardi said, adding there were times when he “would clearly resist making admissions that might paint him in a slightly negative light.”

Antepyan-Ruckenstein, who lives in Coquitlam, underwent jaw surgery at UBC Hospital in June 2022 after being diagnosed with obstructive sleep apnea, a condition he said had caused fatigue and other symptoms since adolescence.

The Coquitlam resident alleged Cadili, an oral and maxillofacial surgeon, failed to perform the agreed upon surgery and instead carried out a procedure that included a genial tubercle advancement (GTA) without his informed consent.

Antepyan-Ruckenstein maintained the agreed plan called for advancement of both jaws by more than one centimetre, counterclockwise rotation and genioplasty. He alleged the surgery he actually received failed to adequately alleviate his sleep apnea and left him unable to return to work, eventually prompting him to undergo further procedures. 

The lawsuit included claims of negligence, lack of informed consent, breach of contract, battery and negligent misrepresentation.

Cadili denied the allegations, maintaining the surgery was consistent with the treatment plan discussed during consultations and on the day of the procedure.

Gottardi sided with the surgeon, finding the agreed plan was for a straight advancement of the jaws of at least one centimetre, with Cadili to move them as far as the patient’s soft tissues would allow.

The judge found Antepyan-Ruckenstein’s own contemporaneous video recordings contradicted parts of his testimony at trial, including his assertion that Cadili had agreed to perform a counterclockwise rotation.

Gottardi also concluded the GTA was within the scope of what had been discussed and that Antepyan-Ruckenstein consented to the procedure.

The court found the surgery successfully advanced the upper and lower jaws and improved his airway. An expert called by the defence pointed to an August 2022 sleep study showing Antepyan-Ruckenstein’s apnea-hypopnea index had fallen to 8.4 events per hour, which was consistent with mild obstructive sleep apnea.

Gottardi found Cadili’s treatment met the standard expected of a reasonably skilled maxillofacial surgeon and rejected the claim that the surgeon was required to use virtual 3D modelling when planning or performing the operation. Expert evidence at trial indicated that surgical splints, cephalometric imaging and trace modelling also met the applicable standard of care.

The court also examined Antepyan-Ruckenstein’s claim that his health and ability to function deteriorated following the operation.

Gottardi found he had not established that deterioration was caused by the surgery. The ruling noted that sleep interruptions, fatigue, headaches and slight cognitive impairment had existed before the procedure and had not been shown to have been worsened by it.

The judge also found there was insufficient evidence connecting the 2022 surgery to any new or aggravated sleep apnea symptoms.

Antepyan-Ruckenstein subsequently underwent several other procedures, including a second jaw advancement surgery in Brazil in November 2024.

Gottardi ultimately found Antepyan-Ruckenstein had failed to prove Cadili breached the standard of care or failed to obtain informed consent.