FINAL PROJECT MALPRACTICE CASE 2

Final Project Malpractice Case
Case Summary : Iturralde V. Hilo Medical Center

Arturo Iturralde was admitted at Hilo Medical Center in January 2001 as a result of
weaknesses that were developing in is legs. On assessment, Dr. Ricketson determined that the
condition could be treated by fixing two implanting two titanium rods in his spine. The rods were
not available at the facility at this time and, therefore, were ordered (“FindLaw’s Intermediate
Court of Appeals of Hawaii case and opinions.”, 2020). After the package was received, Dr.
Ricketson started operating confirming whether the required rods were in the package only to
realize later that they were not. The doctor improvised by cutting the rods from two
screwdrivers. The operation later led to medical complications that resulted in the death of
Iturralde, and his family sued Dr. Ricketson for negligence.
Medical Malpractice Component

Legal components
The jury, in this case, will base on the facts and evidence presented by the family and
consider the standard of care before coming up with a ruling. That is, they will compare the
behavior of the accused against what a professional doctor could do in the same case to
determine whether there is any violation. Therefore, the court is dealing with a question of fact.
Malpractice policies
Doctors and other healthcare professionals have a duty of care to their patients. They are
thus required to provide treatment that meets the medical standard of care. If a doctor or any
other healthcare provider offers the medical services in a way that is different from the medical
standard care, they are said to have breached medical conduct and thus charged with negligence

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(Goguen, 2020). The judgment is based on the deviation of the doctor from the standard of care
and the harm that the deviation caused to the patient.
Standard of care
Standard care is defined as the level of care that a competent medical profession with a
similar background would provide to a patient in similar circumstances that led to the
malpractice in question (Goguen, 2020). When making a judgment about the standard of care,
the jury compares the practice of the provider against what another competent provider could do
in a similar case. In the case discussed in this paper, a qualified professional could first check to
ensure that the rods were received before beginning the operation. Therefore, due to the failure
of Dr. Ricketson to check, it is concluded that he breached the standard of care.
Cultural backgrounds
The malpractice would have an effect on the perception of the consumer on the quality of
services offered by healthcare facilities. For instance, a consumer would conclude that
contemporary healthcare facilities lead to complications instead of providing a solution to the
problem of the patient. The impact would vary with variation in cultures. Some cultures would
encourage consumers to seek assistance from traditional healers instead of modern facilities.
Accountability
There is a lack of accountability in this case where Dr. Ricketson failed to confirm
whether the rods were received before commencing operation. Lack of accountability is also
presented when the provider who was working with Dr. Ricketson failed to raise a complaint
earlier on but waited until the matters were out of hand. Healthcare providers are advised to be
accountable and provide medical services with care to avoid such cases (James, 2019). A high

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level of accountability will build trust towards services offered by healthcare facilities among the
consumers.

Ethical Component

Medical ethics and physician-patient shared decision-making model
The case of Iturralde V. Hilo Medical Center involves a patient, Iturralde, who was
presented at Hilo Medical Center complaining of weaknesses developing in his legs. The
diagnosis by Dr. Ricketson indicated that a spinal operation to fix titanium rods in his spine
could solve the issue. However, there were no rods to attach in the patient’s spine at the moment
(“FindLaw’s Intermediate Court of Appeals of Hawaii case and opinions.”, 2020). The hospital
ordered the rods, which was supposed to be delivered within four days. On arrival of the
package, Dr. Ricketson began operating on the patient before confirming whether the rods had
arrived. The second opinion physician asked him to confirm the availability of the rods first, but
he ignored it. After beginning the operation, it was discovered that the rods were not in the
package. The doctor made a decision to cut the rods from two screwdrivers and fix them in the
patient’s spine. After being discharged, the patient developed complications and died. Dr.
Ricketson and Hilo Medical Center were held liable for causing the patient’s death.
Ethical issues
Physicians are expected to act in the best interest of the patients by saving lives and
avoiding any harm to the patient as much as possible. As such, every decision and action of a
physician should be aimed at improving the wellbeing of the patient and, at the same time,
avoiding harm. In the case of Iturralde V. Hilo Medical Center, there is negligence where the
doctor refuses to confirm whether the rods were available before commencing the operation
process. Any medical officer could have known that performing the operation without having the

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rods could endanger the life of the patient. It was, therefore, unethical for the doctor to start the
process before confirming the availability of the rods. Secondly, the second opinion physician
failed to raise the alarm but waited until the issue was out of hand before coming forward with
the matter. The two incidences were not in the best interest of the patient, thus raising ethical
questions.
Ethical theory and guidelines
The issues witnessed in the Iturralde V. Hilo Medical Center case could be resolved by
beneficence and non-maleficence principles. Beneficence is concerned with ensuring that any
decision and action was taken by a physician concerning is more of benefiting the patient than
causing harm (Alzheimer, 2009). That is, even if the treatment could cause some harm to the
patient, the benefits associated with it should outweigh the harm. Non-maleficence states that the
physician should avoid harming the patient as much as possible (Alzheimer, 2009). The facility
should ensure that their employees adhere to medical ethics of autonomy, justice, beneficence,
and non-maleficence are followed to later to avoid such cases in the future. If the doctors
respected the two principles, they could have ensured that all the necessary actions that could
protect the patient from harm were undertaken.
Physician-patient shared decision-making model
A shared decision model based on choice, option, and decision talk could have provided
the best possible care for the patient. There are three steps in this model; first, the doctor
introduces a choice; second, he or she described the viable options to the patient, and finally,
they help the patient in exploring preferred alternatives (Elwyn et al., 2012). In this model,
deliberation is prioritized, and the decisions are influenced by what matters most to patients as

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individuals based on informed preferences. As such, the patients could make choices based on
what could benefit them most.

Recommendations

To avoid future liabilities, there are a number of strategies that the facility could use.
One of them is changing its recruitment policies so that they focus on acquiring talented,
competent, and skilled medical staff for the facility. Additionally, the recruitment policies
should prioritize extensive performance of background checks of candidates before employing
them. Had rigorous background checks on Dr. Ricketson been conducted before employing
him, the facility would have discovered that he had previously committed medical
malpractices. With such information, it is unlikely that the facility would have hired him.
Apart from changing its recruitment policies, Hilo Medical Center should also
establish a rigorous and continuous employee training program. In addition to improving the
skills and competencies of the medical staff, the training should also be on a code of conduct
that the facility expects its employees to adhere to. With such kind of training, especially for
the medical staff, liability resulting from negligence or other misconduct will fall on the
medical staff that would have committed the negligent act instead of the facility. In addition to
transferring liability to staff, the training will improve staff skills and commitment to delivery
of safe healthcare experience to patients thus significantly reducing cases of medical and
ethical malpractices.
Equally important, the hospital should create a system that facilitates efficient
communication among medical personnel at the facility. A close examination of the case
reveals that poor communication contributed to the outcome of the case. The recommended
titanium rods were available at the hospital. However, due to poor communication between

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Dr. Ricketson and nurses as well as personnel at the medical equipment store, the doctor could
not receive them on time thus forcing him to improvise by implanting screwdriver shafts into
the patient’s spine thus resulting in his eventual death. As the case reveals, proper and efficient
communication should not just be between the doctor and other personnel at the facility but
also between the medical staff and patients or their representatives. For instance, Dr.
Ricketson would have informed the patient or their representative about his decision to
improvise, his reasons for improvising, and any possible side effects to the procedure before
going forward with the operation.

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References

Alzheimer. (2009). Alzheimer Europe – Ethics – Definitions and approaches – The four common
bioethical principles – Beneficence and non-maleficence. Retrieved April 2, 2020, from
https://www.alzheimer-europe.org/Ethics/Definitions-and-approaches/The-four-common-
bioethical-principles/Beneficence-and-non-maleficence
Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., Cording,
E., Tomson, D., Dodd, C., Rollnick, S., Edwards, A., & Barry, M. (2012). Shared
decision making: a model for clinical practice. Journal of general internal medicine,
27(10), 1361–1367. https://doi.org/10.1007/s11606-012-2077-6
FindLaw’s Intermediate Court of Appeals of Hawaii case and opinions. Findlaw. (2020).
Retrieved March 8, 2020, from https://caselaw.findlaw.com/hi-intermediate-court-of-
appeals/1597588.html.
Goguen, D. (2020). Medical Negligence. www.alllaw.com. Retrieved 16 March 2020, from
https://www.alllaw.com/articles/nolo/medical-malpractice/negligence.html.
James, T. (2019). How Leaders Create a Culture of Accountability in Health Care. Lean
Forward. Retrieved 16 March 2020, from
https://leanforward.hms.harvard.edu/2019/08/15/how-leaders-create-a-culture-of-
accountability-in-health-care/.