7-2 Final Project I Submission Malpractice
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7-2 Final Project I Submission: Malpractice
Ashlie Bell
Southern New Hampshire University
IHP 420: Ethical and Legal Considerations
In the case of Iturralde vs. the Hilo Medical Center, Arturo Iturralde sued Dr. Robert
Ricketson and the Hilo Medical Center for medical malpractice that put Iturralde’s health at risk.
Arturo Iturralde needed a spinal fusion surgery that was to be performed by Dr. Ricketson at Hilo
Medical Center USA. He was scheduled for surgery on January 29, 2001. During the surgery, Dr.
Ricketson discovered that the titanium implant rods were missing from the hardware kit that was
ordered from Medtronic. Dr. Ricketson decided to make a makeshift rod when he was told by a
Medtronic sales representative that it would take about 90 minutes to deliver the rods personally.
The makeshift rod was implanted into Iturralde without informing him or his family. Iturralde
sustained many falls which caused the makeshift shaft to shatter. He underwent additional
surgery to remove the shattered pieces and implant the proper titanium rod. During the initial
operation, the nurse reported the incident to her supervisors, who informed her that it was the
surgeon’s responsibility to address the incident with the patient. However, Dr. Ricketson did not
communicate this to Iturralde or his family. The nurse contacted Arturo and presented the
shattered shaft to an attorney after his death due to malpractice. After Arturo Iturralde was
discharged from Hilo Medical Center, his condition began to deteriorate. He required two
additional surgeries because the titanium rod had dislodged. He also required permanent
catheterization and passed away due to a urinary tract infection after multiple stays at the
hospital and ER visits.
The Intermediate Court of Appeal of Hawaii ruled in favor of the plaintiff, Arturo
Iturralde’s family, in the medical malpractice case against Dr. Ricketson and the Hilo Medical
Center USA on March 30, 2012, 1. Arturo Iturralde was diagnosed with degenerative
spondylolisthesis L4-5 with stenosis, which exerts pressure on the nerves and requires spinal
fusion surgery. During the surgery, Dr. Ricketson discovered that the titanium rods ordered were
not present. He decided to implant the shaft of a surgical stainless-steel screwdriver into Iturralde
instead of the titanium rods ordered before surgery 2. The makeshift shaft snapped a few days
later, requiring Iturralde to undergo several more surgeries 12. Arturo Iturralde passed away a
few years later due to complications.
An injury to the patient caused by a breach of the standard of care during treatment is
called medical malpractice. Iturralde vs. Hilo Medical Center USA was a case that happened in
Hawaii, where the following laws apply to medical malpractice claims: The maximum amount
for pain and suffering damages is $375,000. The time limit to file a claim is two years from when
the injury was discovered, but no more than six years from when the incident occurred (for
minors, the time limit is six years from the incident, or until they turn 10 years old, whichever is
longer). The defendants are jointly and severally liable for economic damages, but only severally
liable for noneconomic damages (if a defendant's negligence is less than 25%, they only pay
noneconomic damages according to their degree of fault). The court must approve and ensure the
reasonableness of the attorney fees for both parties. The claimant cannot receive periodic
payments. A medical claim conciliation panel must review the claim and give an advisory
opinion on liability and damages, which cannot be used as evidence if the claim goes to trial. The
claimant does not need to submit an affidavit or certificate of merit to support their claim" (MML
Holdings, n.d.).
Arturo Iturralde underwent a spinal fusion surgery performed by Dr. Robert Ricketson, an
orthopedic surgeon who testified in court. Dr. Ricketson claimed that he acted reasonably when
he discovered that the titanium rods were missing during the surgery. He denied that he violated
the standard of care by using the screwdriver shaft, which was the same size, as a substitute for
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the rods. He said that he did not want to expose the patient for another two hours while waiting
for the rods to arrive, as Iturralde had already lost a lot of blood.
The medical standard of care is the level and type of care that a qualified and skilled
health care professional with a similar background and in the same medical community would
provide in the same situation that led to the alleged malpractice" (Goguen, n.d.). Dr. Ricketson
breached the standard of care when he intentionally used a makeshift rod instead of the titanium
rod from Medtronic, which endangered Iturralde's life by using an unapproved object. This was
shown negligence by Dr. Ricketson, which proves that he did not act according to his standard of
care.
To provide safe and quality healthcare to their patients, physicians need to be aware of
their patients' socioeconomic backgrounds and how they influence their health beliefs and
behaviors. The outcome of this case would have changed significantly if the defendant had a
different cultural background. This is because their culture might affect their knowledge of the
laws or regulations that were relevant to this case. For example, language is an important factor.
If the patient or their family did not speak English, the healthcare provider could have claimed
that the patient did not understand the instructions properly.
The court found Dr. Robert Ricketson, the defendant, responsible for his actions and the
choices he made while treating Arturo Iturralde. The Hilo Medical Center had to pay $2.2 million
to Iturralde's family and $3.4 million in punitive damages, a total of $5.6 million, after the five-
week trial. The case involved negligence by the physician, who caused Iturralde's death by
implanting a makeshift screwdriver shaft. The Hilo Medical Center USA and Dr. Ricketson were
liable for 35% and 65% respectively. Dr. Robert Ricketson claimed he acted reasonably during
the surgery and did not admit any wrongdoing.
The malpractice case of Iturralde and the Hilo Medical Center USA involved many
ethical issues. One of them was that Dr. Ricketson operated on Iturralde without checking the kit
that he ordered from Medtronic. This was an ethical violation by Dr. Ricketson, who should have
verified the kit before the surgery. The hospital staff also had the duty to check the inventory. Dr.
Ricketson's operation harmed the patient and eventually led to his death due to complications
from the surgery. Another ethical issue was related to the informed consent of the patient. The
patient should have been educated about the surgery and its possible risks and complications.
The patient should have also been given the opportunity to ask any questions or concerns before
signing and documenting the consent. Without a signature and proper documentation, it could be
argued that the patient did not understand the procedure and its outcomes.
The ethical theory of utilitarianism could help solve the problem and provide a safe and
quality healthcare experience for the patient. "Utilitarianism is a philosophical perspective or
theory that guides us to evaluate a variety of things that involve choices that people face. It can
be applied to actions, laws, policies, character traits, and moral codes. Utilitarianism is a type of
consequentialism because it is based on the idea that the consequences or outcomes of actions,
laws, policies, etc. are what determine their goodness or badness, rightness, or wrongness"
(Nathanson, n.d.). Dr. Ricketson should have followed this ethical theory and realized that it was
wrong to operate on the patient without making him understand the benefits and risks of the
surgery. The patient could have chosen to reject the surgery if he knew the risks. The outcome of
the surgery would also have been different because Dr. Ricketson would not have done the
procedure without checking the kit. If he had checked the kit, he would have noticed that a piece
was missing and that it could have negative consequences. Instead, Dr. Ricketson did not inform
the patient about the missing piece and used a makeshift rod from a screwdriver to perform the
surgery. Dr. Ricketson should have used utilitarianism and told the patient about this and advised
him to stay on bed rest until another surgery could be done to fix the mistake with the correct
piece. This way, the patient would have had the best results and the quality of care at the hospital
would have been improved.
A shared decision-making model enables the patient and the physician to collaborate to
provide a safe healthcare experience. They can agree on tests, make plans based on the clinical
information, and balance the risks and outcomes of their plan according to the patient's values.
Dr. Ricketson and Arturo Iturralde could have used this model. If they had, the patient would
have received information about his procedure, along with its benefits and risks. The patient
would have had the opportunity to ask questions about his diagnosis and the risky procedure.
They would have also discussed post-operation care with the patient. In the end, the patient
would have decided whether he wanted the procedure or not. This would have resulted in safer
and better healthcare provided by the physician and the hospital.
The Hilo Medical Center USA should have followed clear ethical guidelines when caring
for a patient. The guideline could have prevented the errors and avoided repeating them in the
future. One of the key guidelines is to obtain informed consent and decision-making from the
patient. This ensures that the care plan promotes patient-centered outcomes. It is also essential to
get informed consent to prevent any legal issues, like the ones that arose in the Iturralde and Hilo
Medical Center case. Another important guideline is to evaluate the staff members of the hospital
regularly to ensure that they provide adequate and appropriate care to the patient.
Before starting the care plan agreed by the patient and the physician, the healthcare
provider must obtain informed consent and decision-making from the patient. The provider must
explain the care plan verbally and in writing and get the patient's signature. This will help the
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patient to remember and understand the care plan better. This will also protect the provider's
professional medical license. Another important factor for the quality of care is to evaluate all the
staff members. The evaluations will make the staff members responsible for ensuring a safer
patient outcome.
To avoid liability in the future, the healthcare provider could implement some preventive
strategies. One of them is to be clear and consistent. Communication is important because most
patients may not understand the medical technology that is used, so the provider should explain it
in simple ways that the patient can understand. Another preventive strategy is to maintain
accurate and complete documentation of the patient's visit. This strategy could make or break a
malpractice lawsuit. It is essential to have proper documentation and good communication. This
can help the healthcare provider to avoid liability in the future.
References
Hawaii Medical Malpractice Laws | MML Holdings (n.d.). Retrieved from
https://www.medicalmalpracticelawyers.com/hawaii-medical-malpractice-laws/
Gorguen, D. (n.d.). What is the "medical standard of care" in a malpractice case?
Retrieved from
https://www.nolo.com/legal-encyclopedia/what-the-medical-standard-care-malpractice-
case.html
Leonard, J. (n.d.). ITURRALDE v. HILO MEDICAL CENTER USA. Retrieved from
https://caselaw.findlaw.com/hi-intermediate-court-of-appeals/1597588.html
Nathanson, S. (n.d.).
Utilitarianism, Act, and Rule | Internet Encyclopedia of Philosophy.
Retrieved from:
https://www.iep.utm.edu/util-a-r/
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