3-2 Milestone One

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Southern New Hampshire University *

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IHP 420

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Health Science

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Dec 6, 2023

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1 Christine Davis Southern New Hampshire University Milestone One: Malpractice Case IHP 420: Ethical & Legal Considerations Professor Darnell Burgess September 17, 2023

2 Milestone One: Malpractice Case Introduction: Summarize This case involves Mr. Arturo Iturralde and his subsequent surgeries at Hilo Medical Center (HMC). Mr. Iturralde was admitted to HMC in January 2001 for weakness in his legs that caused multiple falls. Dr. Robert Ricketson—an Orthopedic Surgeon credentialed by HMC— assessed the patient and recommended spinal fusion surgery due to the diagnosis of Degenerative Spondylolisthesis L4-5 with stenosis—causing pressure on the nerves. Surgery was then scheduled for January 29, 2001, and would implant two titanium rods into the spine forming a bilateral fixation. A Medtronic M8 Titanium CD Horizon kit was ordered and received in two separate packages from two different warehouses—Memphis, TN and Tulane, LA. Per hospital policy the kit(s) should have been inventoried before being sent for sterilization. On the day of the scheduled surgery, Nurse Vicki Barry informed Dr. Ricketson that the inventory had not been completed but Dr. Ricketson decided to move forward with surgery. Approximately two hours into the surgery Dr. Ricketson discovered that there were no Titanium Rods, after searching the hospital, a HCM staff member called Eric Hanson—the Medtronic rep—but he was not able to confirm if the rods had been shipped but stated that he could deliver the rods to the hospital in about 90 minutes. Dr. Ricketson decided that further delay would be unsafe for the patient and improvised by cutting down a surgical stainless-steel screwdriver to replace the missing Titanium rods— creating a unilateral rod. Dr. Ricketson then implanted this improvised rod into the patient—Mr. Iturralde. However, the surgical stainless-steel screwdriver is not approved for human implantation. Dr. Ricketson also failed to inform the patient or his family of his improvised

3 implantation of the screwdriver. The patient was discharged home and instructed to begin physical therapy. Again, the patient has multiple falls causing the improvised screwdriver rod to shatter in his spine. The patient required additional surgery on February 5, 2001, to remove the shattered screwdriver and to implant the correct Titanium rods. Nurse Janelle Feldmeyer was present during both surgeries—she collected the pieces of the shattered screwdriver—and had reported the improvised screwdriver to the administration but was told it was Dr. Ricketson’s responsibility to share this information with the patient. Nurse Feldmeyer attempted to inform the patient but wasn’t able to due to language barriers and the fact that a security guard had been stationed outside of the patient’s room. Nurse Feldmeyer took the pieces of the shattered screwdriver to an attorney and contacted the patient’s sister—Rosalinda Iturralde—informing her of the details of the improvised screwdriver implantation. The patient’s condition worsened to the point where he had to be catharized to empty his bladder—which caused tremendous pain and caused several occurrences of urosepsis. The Titanium rods became dislodged and required additional surgery. After many complications the patient—Mr. Arturo Iturralde—passed away on June 18, 2003. Medical Malpractice Component: Legal Components Medical Law and Ethics, Chapter 6, the Four D’s of negligence are: Duty (obligation), Dereliction (breach of duty), Direct (proximate cause), and Damages (award). Dr. Ricketson had an obligation to his patient—Mr. Iturralde—to perform a surgery that would make his life better, Dr. Ricketson was derelict in this by performing a surgery after being informed that there was no inventory performed on the surgical kit, Dr. Ricketson was the direct cause of harm to his patient

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