IHP-420 final milestone WORD

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Southern New Hampshire University *

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420

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Medicine

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Dec 6, 2023

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Meg Combatti 4/14/2022 IHP-420 Final Submission I This case occurred in January 2001 when the plaintiff, Arturo Iturralde was admitted to Hilo Medical Center, a state owned hospital in Hawaii. The reason for Arturo Iturralde being admitted included weakness to bilateral extremities which required surgical intervention. While under the care of the defendant Doctor Robert Ricketson, Mr. Iturralde acquired severe complications due to both negligence and medical malpractice, which resulted in death . Arturo Iturralde required a surgical procedure to address his stenosis as well as degenerative spondylolithesis of the L4 and L5 vertebrae. The procedure was a spinal fusion in which Dr. Robert Ricketson performed. Dr. Ricketson did not have the necessary medical equipment to properly perform this surgery and intentionally implanted a screwdriver shaft into Mr. Iturralde’s spine in place of the missing rods from the M8 Titanium CD Horizon Kit he had ordered from the company Medtronic. Although Dr. Ricketson was aware that a representative from Medtronic would be able to bring the missing parts to the operating room with a 90-minute timeframe, he felt the wait time was too long and decided to go outside the standard of care. Due to Dr. Ricketson’s negligence, Mr. Iturralde required more surgeries as a result . The jury found that Dr. Ricketson and Hilo Medical Center acted negligently in the care of Arturo Iturralde ’s health resulting in his death. The Intermediate Court of Appeals of the State of Hawaii found Dr. Ricketson 65% at fault and HMC to be 35% at fault. As a result, the court

awarded nearly $5.6 million dollars to Arturo Iturralde’s estate as well as his personal representative, Rosalinda Iturralde for general damages . Dr. Ricketson ordered HMC to order an M8 Titanium CD Horizon Kit from the company Medtronic which was to include all tools necessary to do the surgery. Medtronic did not have the complete kit needed to do the surgery so the remaining parts were shipped from two other facilities, one in Memphis and the other from Tulane. Hilo Medical Center did not perform an inventory check and sent the instruments to the operating room to be sterilized. Dr. Ricketson was advised by the nurse that the inventory had not been checked. However, Dr. Ricketson proceeded with the surgery anyways. This occurred on January 29th, 2001. During the surgery, titanium rods were to be placed in Arturo’s spine. Dr. Ricketson informed staff that the rods were not included and maybe misplaced. Staff searched for the missing rods and placed a call to Medtronic. Medtronics said they could have a representative deliver a new set of rods in 90- minutes but Dr. Ricketson’s testimony was, “that he believed that the delay would be too risky for the patient. He proceeded with the surgery, absent the titanium rods” (Intermediate Court of Appeals of the State of Hawaii, 2012). Instead, Dr. Ricketson used a the shaft of a surgical screwdriver which was not approved for human use nor was authorized to use and implant into Arturo Iturralde. These actions of Dr. Ricketson, although were not intentionally malicious nor planned when scheduling this surgery, his actions were unethical and stepped outside the medical scope of practice and the Hippocratic Oath doctors must take, with one of the promises within the oath being “first, do no harm” (Shmerling, 2020 .( According to the case study, “HMC extends hospital privileges to healthcare professional who, through a credentialing process, document their “current professional competence, good

judgement, and adequate physical and mental health, and who adhere to the ethics of their respective professions.” At the time Dr. Ricketson applied for hospital privileges at HMC, he had a history of serious professional problems. He was subject to professional disciplinary orders in Oklahoma, Texas and Hawaii had placed Dr. Ricketson on probation for failing to disclose prior disciplinary actions. Despite these serious lapses, HMC granted Dr. Ricketson hospital credentials.” HMC was aware of Dr. Ricketson’s negligent behavior yet still granted him privileges. Dr. Ricketson also did not post-operatively inform Mr. Iturralde of the negligence that occurred during his surgery; his Nurse, Janelle Feldmeyer did. But because of the language barrier, the hospital reportedly had posted a security guard at his room . This case demonstrated that Dr. Ricketson ’s actions did not meet the standard of care when handling this patient case. Fremgen refers to standard of care being that, “ordinary skill and care that all medical practitioners” would use in similar circumstances. There were a variety of instances where Dr. Ricketson did not hold up to the professional standard of care. He did not confirm all surgical equipment that was necessary to do this procedure successfully was present, he consciously made the decision to use the shaft of a medical screwdriver in place the steel rods to implant in Mr. Iturralde’s spine and lastly Dr. Ricketson did not communicate the situation of what happened during the surgery post-operatively. Although Dr. Ricketson played the largest role of being at fault during this case, HMC was also a key player in the fault of medical malpractice and negligence as they hired Dr. Ricketson knowingly of previous accusations towards him . Cultural barriers played a role in this case as there was a language barrier between Mr. Iturralde and the medical staff. Because of this language barrier, it can leave some actions to

uncertainty for how communication could have been overlooked. There were a few situations that did not help ease the opportunity for communication at HMC; they did not appoint a translator for the staff and patient to communicate effectively, HMC placed a security guard outside of Mr. Iturralde’s room which made it difficult for healthcare staff to communicate with him, especially Nurse Feldmeyer to speak with him regarding the situation that occurred, and because communication was difficult, who is to say that Dr. Ricketson took advantage of feeling like he did not need to make any extra effort to explain all the details of the surgery, pre or post operatively. It’s situations like this where it only makes individuals with differing cultural backgrounds, beliefs and/or language barriers feel unsafe when seeking medical treatment . In the resulting accountability of this case, The Circuit Court concluded that, “HMC and Dr. Ricketson were jointly and severally liable and adopted the jury’s apportionment of fault. However, the court found that 75% of the damages were attributable to Arturo’s pre-existing medical conditions. Accordingly, the Circuit Court concluded that HMC was only jointly and severally liable for 25% of the total damage found by the court.” Even though Mr. Iturralde’s pre existing may have played a factor in his health condition, the negligence and malpractice of Dr. Ricketson definitely lead to the rapid decline in his health and ultimately played a large role in his untimely death . When individuals decide to become healthcare professionals, there is an oath they take which sets a precedence in how they will choose to act when providing patient care. For Nurses, they take the Florence Nightingale Pledge, also known as the Hippocratic oath. This oath is the same for physicians. It is one of the “oldest binding documents in history”. (Marks, 2021) In the case of Iturralde vs. Hilo Medical Center, there are many ethical issues involved in the care and

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