Coquitlam pharmacist loses malpractice suit over sleep apnea jaw surgery

B.C. Supreme Court Justice Eric Gottardi dismissed a Coquitlam pharmacist’s medical malpractice claims against Dr. Fahad Cadili and his corporation in a Sept. 9 decision. Jeremy Lorne Antepyan-Ruckenstein alleged Cadili performed a different jaw procedure for obstructive sleep apnea than the one agreed upon and included a genial tubercle advancement (GTA) without informed consent.

Antepyan-Ruckenstein underwent surgery at UBC Hospital in June 2022 after being diagnosed with obstructive sleep apnea, which he said had caused fatigue and other symptoms since adolescence. He maintained that the agreed plan involved advancing both jaws by more than one centimetre, counterclockwise rotation and genioplasty. He alleged the procedure he received did not adequately relieve his sleep apnea, left him unable to return to work and led to further procedures. His lawsuit alleged negligence, lack of informed consent, breach of contract, battery and negligent misrepresentation.

Cadili denied the allegations, saying the surgery was consistent with the treatment plan discussed during consultations and on the day of the procedure. Gottardi found the agreed plan was a straight advancement of the jaws of at least one centimetre, with Cadili to move them as far as the patient’s soft tissues allowed. The judge found Antepyan-Ruckenstein’s contemporaneous video recordings contradicted parts of his trial testimony, including his assertion that Cadili had agreed to counterclockwise rotation. Gottardi also found the GTA fell within what had been discussed and that Antepyan-Ruckenstein consented to it.

The court found the surgery successfully advanced the upper and lower jaws and improved Antepyan-Ruckenstein’s airway. A defence expert cited an August 2022 sleep study showing his apnea-hypopnea index had fallen to 8.4 events an hour, consistent with mild obstructive sleep apnea. Gottardi found Cadili met the standard expected of a reasonably skilled maxillofacial surgeon and rejected the claim that virtual 3D modelling was required for planning or performing the operation. Expert evidence indicated surgical splints, cephalometric imaging and trace modelling also met the applicable standard of care.

Gottardi found Antepyan-Ruckenstein had not established that deterioration in his health or ability to function was caused by the surgery. Sleep interruptions, fatigue, headaches and slight cognitive impairment existed before the operation and had not been shown to have worsened because of it, the ruling said. The judge also found insufficient evidence connecting the 2022 surgery to new or aggravated sleep apnea symptoms. Antepyan-Ruckenstein later underwent several additional procedures, including a second jaw-advancement surgery in Brazil in November 2024.