Oral surgeon testifies in malpractice trial

A Spokane oral surgeon accused of malpractice for a series of jaw operations on a young woman took the stand Thursday in his own defense, saying although he doesn’t remember the specifics of his initial conversations, he never promised to be Kimberly Kallestad’s “hero.”

“I think I said, ‘I’d like to make you better,’ ” Dr. Patrick Collins told a Spokane County Superior Court jury.

In a 2007 study within his oral surgery practice of 117 responding patients who’d agreed to have open jaw surgery in his South Hill office, Collins said 86 percent replied they were pleased with the results. A total of 202 patients were contacted for the study, but some didn’t respond, he said.

“We know of 31 patients who didn’t do well” who had recurring pain or fused jaws, Collins added.

Collins is accused of leaving 29-year-old Kallestad, a former Lewis and Clark High School cheerleader, permanently disabled after a series of jaw surgeries triggered by a January 2000 sledding accident at Washington State University, where she was a student.

The trial started July 14. Kallestad’s attorney, Mary Schultz, has presented a series of expert witnesses who’ve testified that a conservative treatment that included physical therapy was working when Kallestad was referred to Collins for a second opinion by a former neighbor, ear, nose and throat specialist Dr. Edward Treyve.

Kallestad has testified that Collins immediately reassured her he could fix her jaw, saying, “I’m going to be your hero.” He embarked on a series of procedures over a year that included steroid injections, two open-jaw surgeries and two arthroscopic surgeries. He also tried to schedule her for total joint replacement, an experimental and controversial procedure, but she refused.

Defense lawyer John Versnel III, of Seattle, has brought in a series of defense witnesses this week who have said Collins’ surgeries were within the standard of care for patients suffering severe jaw pain.

Dr. Robert Walker, a Dallas oral surgeon and University of Texas professor who taught Collins his own “Walker procedure” for open-jaw surgery when Collins was a dentistry resident, testified that Collins’ surgeries on Kallestad were reasonable for a patient suffering jaw pain, though they differed in several important aspects from what he’d taught him – including the use of steroids injected into the jaw. Under cross-examination by Schultz, Walker said Kallestad’s post-operative physical therapy differed markedly from the “aggressive” therapy he used in his practice to ensure that the jaw joint didn’t fuse shut after surgery. He described the therapy as a painful but essential process that patients don’t like.

Walker said it’s his “standard of care” to do his own physical therapy starting immediately after jaw surgery to get patients to open their jaws to a normal 40 millimeters within one week. Collins didn’t refer Kallestad for physical therapy for a month after surgery, according to the testimony.

In his testimony, Collins said he refers his patients to local physical therapists who do less aggressive treatment than Walker because “I don’t want to hurt anybody” – a response that caused Kallestad’s younger sister Lisa Kallestad, a Helena lawyer, to react angrily as she sat in court.

Kallestad’s jaw closed from a normal opening before surgery to 11 millimeters afterward. She cannot eat solid food or brush her teeth and survives on smoothies. She takes powerful pain medication and stays in bed up to 20 hours a day.

Walker also testified that an alternative to surgery for Kallestad would have been to “do nothing,” managing her pain with drugs and physical therapy. But he said surgery was appropriate because Kallestad had already spent nine months in physical therapy and had had a “high level of discomfort over a long period.”

Of the 150 cases he’s treated, only “one or two” were as severe as Kallestad’s, and “very few” of his patients ever needed the Walker procedure on both sides of their jaw, Walker said in response to jurors’ questions.

In other testimony this week, Treyve , the doctor and former neighbor who referred Kallestad to Collins, testified from his new practice in Longview.

Treyve said he sent her to Collins in the summer of 2000 for a consultation after he’d heard she was still having jaw problems from her accident.

Treyve said he’d had a “business relationship” with Collins, referring patients with jaw joint problems.

In cross-examination, Schultz pressed Treyve on whether he knew that Collins, who’d been asked to give Kallestad a second opinion, immediately began treating her.

“Did you know at the first session with Dr. Collins, he injected steroids into her face?” Schultz asked.

“I can’t give you the name of anybody in the country” who does that, Treyve replied.

After Kallestad had multiple surgeries and her condition was deteriorating, Collins called Treyve in August 2001.

“I recall he said, ‘What’s going on with this girl? She’s acting kind of strange,’ ” Treyve testified. “I said, ‘I don’t know what you’re talking about,’ ” he said.

In his testimony Thursday, Collins said he immediately injected Kallestad with steroids on her first visit because of the discomfort she reported to him.

“I was trying to alleviate her pain,” he said.