Lawyers clash over testimony from patients

The question of whether more former patients of a Spokane oral surgeon should be allowed to testify in a malpractice trial about bad outcomes from jaw surgery erupted in Spokane Superior Court on Thursday.

Mary Schultz, lawyer for plaintiff Kimberly Kallestad, 29, asked defense psychotherapist Dr. Paul J. Domitor how many patients other than Kallestad had been referred to him by defendant Dr. Patrick Collins for evaluation prior to total jaw replacement surgery – a controversial operation Collins proposed for Kallestad in 2001 after four other flawed operations on her jaw joints. Kallestad, who declined the artificial jaw, is disabled and reports unrelenting pain, her doctors say.

The court never heard an answer, because Superior Court Judge Michael P. Price excused the jury to discuss a number of recent phone calls and e-mails to The Spokesman-Review and to Schultz from people claiming that Collins also injured them.

“We’ve had individuals who have approached us. They say Collins starts surgeries, pain follows, they are told it’s ‘all in their head’ – and they come out with metal joints,” Schultz said. She said she wants to use some of the new information in rebuttal testimony so she can try to establish that Collins has a “pattern of conduct” and a “business plan” to steer people toward total joint replacement.

Collins’ attorney, John Versnel III, strenuously objected, saying Schultz’s attempts this week before the jury to introduce evidence of more suffering patients “draws attention that other patients are waiting in the wings.”

It would be “inappropriate and highly prejudicial” to let others testify, Versnel said.

That rebuttal is proper because Kallestad has already testified that Collins told her he had a near-perfect success rate in his surgeries and she was the only patient who’d ever complained of severe pain afterward, Schultz said.

In addition, Domitor – who said he’s done psychological screenings for Collins for 20 years – testified that some of Collins’ patients describe Collins as “the best” dental surgeon in town when they come in for their pre-surgical psychological tests.

“I’m entitled to impeach” Collins by referencing patients with bad outcomes, Schultz argued.

Price ruled before the trial began July 14 that information on a limited number of ex-patients of Collins suffering pain from his procedures who sought help from Spokane dentists Dr. John Ames and Dr. James Howard could be presented. They were deposed by defense attorneys.

Price, in a ruling from the bench, said he isn’t inclined to let more people testify, saying the new information is “incredibly inflammatory.”

“There’s a mountain of evidence in support of the plaintiff’s theory of this case without going down this road,” he added.

But Price, saying a trial is supposed to be “dynamic,” left the door open to revisit the issue later, when Schultz seeks to call rebuttal witnesses.

The defense’s theory of the case – that Kallestad is unique – makes the rebuttal testimony essential, Schultz noted.

Collins’ defense team is attempting to portray Kallestad as a young woman with psychological stresses unrelated to the surgeries who was struggling in college and was already feeling severe jaw pain from a sledding accident when she came to Collins.

But not all of the defense testimony has been favorable.

In testimony Wednesday, a psychologist hired by the defense said Collins should never have promised to be a “hero” to Kallestad before operating on her jaw.

“I’d take that surgeon behind the woodshed and paddle his butt,” Spokane psychologist Robert Klein said under cross-examination.

Kallestad testified last week that Collins promised to fix her painful jaw in 2000 and said, “I’m going to be your hero.”

Price asked Klein to explain his “woodshed” remark.

Any talk of being a “hero” is inappropriate for a surgeon, Klein replied. “It raises expectations beyond what is reasonable. There are risks versus benefits in surgery,” Klein said.

Under questioning by Versnel, Klein said Kallestad felt “betrayed” by Collins when the surgeries didn’t go well and the tendency to “idealize” him was part of her psychological makeup.

“Psychological issues” are complicating Kallestad’s reports of severe, disabling pain following the surgeries, Klein said.“She perceives the pain as real. There’s a significant psychological component…. Nothing about Kimberly Kallestad is simple,” the psychologist said.

He recommended that Kallestad, who takes powerful pain medications and tranquilizers and stays in bed about 20 hours a day in her South Hill home where she’s cared for by her parents, be sent to an in-patient rehabilitation unit where therapists could help her “rejoin life.”

Under cross-examination by Schultz, Klein said he hadn’t consulted with any of Kallestad’s treating physicians before making that recommendation. His suggested course of treatment cost significantly less than the “life care plan” proposed by plaintiff’s experts. Schultz also pressed Klein to say that Kallestad has actual nerve injuries in her face that he didn’t mention in his psychological report.

When asked what physical damage Collins’ surgeries had caused, Klein replied “I don’t know the answer … My role was not to respond to questions of surgical competence.”

Schultz asked how many college-age girls Klein had examined with Kallestad’s range of symptoms, which include serial surgeries, growth of body hair and loss of breast tissue from steroid injections, a fused jaw and facial nerve damage.

“None, other than Kimberly. Her history is unique,” Klein replied.