BC court rejects medical malpractice claim over sleep apnea surgery

A pharmacist who sued his oral surgeon after a jaw surgery failed to cure his sleep apnea has lost his medical malpractice case in the BC Supreme Court. In Antepyan-Ruckenstein v. Cadili, 2026 BCSC 1715, the court dismissed all four of the plaintiff’s claims after finding that the surgeon performed exactly the procedure that was discussed and agreed upon, and that the surgery was, by objective measures, a success.

What the medical malpractice claims alleged

Jeremy Lorne Antepyan-Ruckenstein, a Coquitlam pharmacist, brought his case against Dr. Fahad Cadili and Dr. Fahad Cadili OMFS Corp. over a jaw advancement surgery performed on June 27, 2022, at UBC Hospital in Vancouver. The surgery was meant to treat his obstructive sleep apnea (OSA).

Antepyan-Ruckenstein, who represented himself at trial, advanced four claims:

• medical negligence: that Dr. Cadili failed to perform the surgery as agreed
• lack of informed consent: that he was not properly told about a specific chin procedure added on the day of surgery, known as a genial tubercle advancement (GTA)
• battery: that a different procedure was performed than the one he had consented to
• negligent misrepresentation: that Dr. Cadili falsely claimed to have performed “thousands” of such surgeries, which led him to choose the surgeon

On the misrepresentation claim, the court found that Dr. Cadili’s surgical experience was not overstated. Dr. Cadili testified he had performed 284 orthognathic surgeries in his first year of residency alone and had continued at a rate of three to five surgeries at least once a week since 2015, putting his total well above 2,000.

The court also found that cost and wait time, not the surgeon’s claimed experience, were the real reasons Antepyan-Ruckenstein chose Dr. Cadili.

Whether the surgeon met the standard of care

The standard of care for a specialist like Dr. Cadili is measured against what a reasonably skilled practitioner in the same field would do in the same circumstances, as set out by the Supreme Court of Canada in Sylvester v. Crits, [1956] SCR 991.

The defence called Dr. Richard Bell, a Canadian oral and maxillofacial surgeon and the only Canadian specialist to testify at trial. His findings:

• post-operative cone beam CT scans showed the plaintiff’s airway had improved
• the plaintiff’s apnea-hypopnea index (AHI) dropped from 21.9 before surgery to 8.4 by August 2022, consistent with mild OSA
• a subsequent sleep study showed the plaintiff’s AHI within the normal range
• the surgical approach, including the GTA, was consistent with the agreed plan and met the applicable standard of care in BC

The court preferred Dr. Bell’s evidence over that of the plaintiff’s expert, the semi-retired American surgeon Dr. Michael Lee, who admitted he had not reviewed the Canadian guidelines and could not identify the Royal College of Dentists of Canada.

Why the plaintiff’s own words undermined his case

Credibility was central to the outcome. Antepyan-Ruckenstein kept a seven-hour video blog documenting his experience before and after surgery, which became a significant liability at trial.

The court identified the following contradictions:

• He said the agreed plan included counterclockwise jaw rotation. In his video blog, he said his surgeon “is doing the straight one.”
• He said Dr. Cadili agreed to use 3D surgical planning. In the same blog, he called Dr. Cadili “an analog guy” who used 2D methods.
• He said the GTA was never discussed. A June 5, 2022 email he sent to family members showed he had researched GTA himself and was weighing whether to request it before surgery.

Two months after the procedure, Antepyan-Ruckenstein posted a five-star online review of Dr. Cadili, writing that the surgery “went perfectly” and that he was “more functional and healthier now.” The court found that the plaintiff’s severe somatic symptom disorder, which predated the surgery, drove his later belief that the procedure had failed.

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