FILED: NEW YORK COUNTY CLERK 12/28/ :37 PM INDEX NO /2012 NYSCEF DOC. NO. 361 RECEIVED NYSCEF: 12/28/2017

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1 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF NEW YORK EDWARD SCARANO and SUSAN SCARANO, Index No.: /2012 -against- Plaintiffs, PLAINTIFFS' AMENDED SECOND RESPONSE TO DEMAND FOR EXPERT INFORMATION AS TO MAXILLOFACIAL SURGERY SERVICES, L.L.C. and GEORGE ANASTOSSOV, D.D.S. MAXILLOFACIAL SURGERY SERVICES, L.L.C. and GEORGE ANASTRASSOV, M.D., D.D.S., Defendants X â â â â â --- â â Plaintiffs, EDWARD SCARANO and SUSAN SCARANO, by their undersigned attorneys, hereby provide expert witness information, pursuant to CPLR 3101(d), in the following: L Qualifications of Expert: This expert obtained a Bachelor's degree from Provident College in 1987 and a DMD at the Tufts University School of Dental Medicine in This expert completed a four-year residency in Oral and Maxillofacial Surgery at the University of Texas in Houston Texas in He/she served as a staff Oral and Maxillofacial Surgeon at Winn Army Community Hospital, Fort Stewart Georgia. As of 2002, he/she is a Diplomate of the American Board of Oral and Maxillofacial Surgery and a Fellow of the American Association of Oral and Maxillofacial Surgeons. In 2003, he/she became Board Certified in Dental Anesthesia and General Anesthesia /Deep Sedation for the State of Rhode Island. This expert is a Clinical Assistant Professor of Oral and Maxillofacial Surgery at Alpert Medical School, Brown University. 1 1 of 7

2 IL Subject matter on which expert is to testify: This expert will offer opinions at trial as to his/her review of the medical, dental, and hospital records and reports and diagnostic studies of plaintiff, photographs of plaintiff, pleadings, discovery responses, deposition transcripts, motion papers and will base his/her testimony upon the foregoing as well as his/her knowledge, expertise and experience in the fields of dentistry and oral and maxillofacial surgery. It is anticipated at trial that this expert will offer opinions relating to the defendants' departures from accepted standards of dental and oral surgical care and treatment and that said departures were a substantial factor in causing serious injuries to EDWARD SCARANO. IIL Substance of the facts and opinions on which this expert is expected to testify: This expert is expected to offer opinions at trial as to the care and treatment of plaintiff by defendants, and more particularly, by defendants MAXILLOFACIAL ORAL SURGERY SERVICES, L.L.C. and GEORGE ANASTOSSOV, D.D.S. (collectively referred to as "Anastossov") in that defendant Anastosso departed from good and accepted dental and oral surgical procedures in the following, thereby proximately causing permanent injuries sustained by the plaintiff, as set forth in the bills of particulars and the hospital, medical, and dental records and reports; in failing to properly assess the plaintiff's condition such as failing to take or order adequate and proper diagnostic studies and tests to determine the nature and condition of plaintiff's mouth, facial structure, gums, prior medical/dental condition and lifestyle prior to and during treatment, past medical and dental history; failed to consider risks of failure, infections, and other risks; in failing to perform an appropriate and adequate pre-treatment evaluation from all reasonable perspectives with other dental and medical practitioners in a team approach; failed to maintain adequate records; failed to recognize that EDWARD SCARANO was not a candidate for this type of extensive full mouth restoration aft( 2 2 of 7

3 having the remaining 15 teeth in his mouth removed and after having undergone a prior attempt at a full moutl restoration, which had substantially failed and based on other risk factors regarding EDWARD SCARANO; failed to consider and discuss, with the plaintiff, the percentage of risk of failure in attempting to perform such extensive surgeries and in attempting to replace virtually all of the plaintiff's dentistry in a very short time period; in failing to consider all reasonable ramifications regarding the patient's malocclusion of approximatel mm, history of bruxism, clenching, past history of smoking, past history of poor dental hygiene, past history of failed implants, past history of infections, and failure to have a full team approach and complete treatment plan with periodontists, prosthodontists, and other dental specialists; failed to consider the two prior failed attempts and disregarded the unsuccessful outcomes by subjecting the plaintiff to three additional risky, invasive, and extensive surgeries whereby mesh, plates, and screws were placed, and then removed and replaced; disregarded improperly placed implants on a patient with a Class III occlusion and engaged in invasive, and expensive surgeries with no reasonable assurance that the patient's mouth could be reasonably restored prior to addressing the malocclusion and its inherent stresses including bruxism, grinding and clenching and the patient's prior lifestyle and habits; failed to consider the risk of failure and failed to discuss the aforesaid risks of failure with the plaintiff; failed to adequately communicate with plaintiff's other providers; failed to properly consider the diagnostic findings during all phases of treatment, and failed to consider the risks to this particular patient of failure of treatment; provided inadequate dental and oral surgical care; failed to properly plan a full mouth restoration on this patient with a known malocclusion of mm; failed to take and use adequate pre- and post-operative x-rays, diagnostic studies, surgical guides, computer generated guides, and other available and state of the art diagnostic tools for such a difficult and challenging case; failed to consider the risks associated with these extensive and invasive surgical procedures on a patient with significant bone loss, poor dental hygiene, malocclusion, and other risk factors; failed to treat plaintiff in skillful and proper manner; failed to properly formulate an appropriate treatment plan; failed to properly 3 3 of 7

4 execute an appropriate treatment plan; failed to consult with competent specialists such as orthodontists, prosthodontists, the plaintiff's primary medical physician, an infectious disease doctor, and plaintiff's prior treating dentists, oral surgeons, and other specialists of adequate skill, experience and training to participate in the treatment planning and treatment of the plaintiff; failed to have skills appropriate for an oral surgeon in treating plaintiff; failed to use reasonable skill, care, and diligence in the exercise of professional knowledge t( accomplish the purpose for which defendants were retained; failed to take any and all effective measures or means to prevent further harm and injury to the plaintiff; failed to properly plan and administer treatment to th plaintiff; failed to take proper and reasonable precautions for the safety and health of the plaintiff and failed to treat and prepare for his condition; failed to take, record, and appreciate the plaintiff's history and prior failed dental treatment; failed to order or take proper and comprehensive diagnostic studies such as x-rays and CT scans; failed to call in proper consultants; failed to keep proper records; failed to read and respond to defendants' own records; failed to obtain, read and respond to records of other dental and healthcare providers failed to ensure that the prescribed treatments were properly and adequately administered; failed to fully and fairly disclose to the plaintiff the nature of treatment to be rendered to plaintiff; failed to consult with prior ora surgeons and dentists, who treated the plaintiff; failed to disclose alternatives to treatment rendered; failed to disclose alternative treatment of the dental problems; failed to disclose all reasonable risks of the procedures; failed to properly appreciate plaintiff's complaints, which were overlooked during the course of treatment; failed to properly assess the risks of the procedures and more particularly, regarding the plaintiff's prior medic history, conditions, and prior dental and oral surgical treatment; failed to heed the plaintiff's requests not to tal heroic measures and to remove but not replace the infected mesh, plates, and screws; failed to appropriately treat the plaintiff, and more particularly, as set forth above and in failing to evaluate properly the plaintiff's existing occlusion, facial structure, occlusal status, and the plaintiff's particular dental and medical needs; performed dental and oral surgical procedures on plaintiff in a manner contrary to accepted standards of denta 4 4 of 7

5 and/or oral surgical practice and further, performed dental procedures on plaintiff which were not indicated, bi rather, were contra-indicated; caused massive bone loss, infections, and further, rendered the plaintiff's mouth virtually unrestorable; performed procedures which were contra-indicated as to this patient; failed to take adequate, timely and proper measurements and precautions necessary and calculated to avoid the occurrence and conditions complained of herein; failed to perform proper restorations such that the plaintiff has no teeth and has bone loss, gum atrophy, Class III occlusion, and was caused to suffer infections including osteomyelitis; caused failure of all dental and oral surgical procedures, which further resulted in significant bone loss, holes in the sinuses, infections with resultant difficulty eating and drinking; failed to ensure that plaintiff would have any chewing efficiency; performed aggressive and costly dental procedures on a patient when this defendant knew or should have known that such procedures were doomed to fail; caused and/or created infections, bone loss, and gum atrophy throughout plaintiff's mouth; failed to perform dental procedur in a slow and and/or moderate manner considering the risks of the procedures to the plaintiff; failed to heed plaintiff's complaints and symptoms in a timely manner; failed to provide proper post-surgical treatment; faile to timely refer plaintiff to a proper dental specialists; failed to follow-up with other treating practitioners; faile to consider all reasonable risks and to take all reasonable steps to prevent those risks including but not limited bone failure, implant failure, nerve injury, infection, and the loss of the hope of having a full mouth restoratio1 all of which resulted in causing plaintiff's injuries, which are permanent in nature. This expert will also testify that the above-stated departures were all substantial factors in causing the injuries as set forth in the Verified Bill of Particulars and as set forth in the dental records, medical records, hospital records, x-rays, and reports. It is also expected that this expert will discuss, possibly using demonstrative devices, the principles of x-ray and physical examination; the principles of bone grafting, craniotomy, iliac crest grafting, implant placement surgery and the planning process therefor, as well as defining all terms 5 5 of 7

6 needed for an understanding of the issues at hand; the anatomic and functional considerations in planning for and doing such surgeries; the concepts of anatomy, the sinuses and sinus lifts as they relate herein; the permanence of plaintiff's injuries; the obligations of dentists with regard to the standard of care; the concepts of bone grafting from the skull and iliac crest, risks of infection, osteomyelitis, sinus fistulas, and failure, osseointegration and protection of the bone, nerve structures, and branches. This expert is also expected to comment on facts, testimony, records in evidence, and subsequent treatment and surgery, providing explanations of same. This expert is also expected to address issues raised at the trial prior to his/her testimony. This expert will explain past and anticipated treatments. IV. Summary of the grounds for this expert's opinion: This expert relies upon the dental records, medical records, and dental/specialists' reports, dental x-rays, pleadings in this action, deposition transcripts, this expert's professional experience and expertise, as well as the trial testimony of the various witnesses. Plaintiff may also call as trial witnesses any of his treating dentists and physicians, whose records have been provided to defense counsel, directly and/or through authorizations. Same are expected to testify in conformity with those records and diagnostic studies, explain the treatment, discuss how the treatment was causally related to the negligence, and discuss the injury permanence, as well as all other entries in the records. One or more of these treating and/or consulting dentists/doctors/therapists will testify regarding his/her examinations and treatment of the plaintiff, his/her findings, his/her care and treatment rendered to the plaintiff, issues of causation, diagnoses, prognoses, and the past and future costs incurred by plaintiff for the dental, medical, and therapeutic services provided as well as the anticipated necessary medical, dental, and therapeutic treatment to be done in the future and reasonably anticipated costs of same as a result of the care and treatment of Anastossov, and the extent of the injuries Anastossov 6 6 of 7

7 substantially caused plaintiff. Plaintiffs reserve the right to supplement this response up to and including the time of trial. Dated: New City, New York December 28, 2017 Yours, etc. VALERIE J. CROWN, ATTORNEY AT LAW, P.C. By: VALERI. CROWN, ESQ. Attorney r Plaintiffs 151 North Main Street, 4th Floor New City, NY TO: RAWLE & HENDERSON, LLP Attorneys for Defendants GEORGE ANASTRASSOV, MD, DDS & Maxillofacial Surgery Services, LLC 170 Old Country Road - Suite 502 Mineola, New York of 7