IHP 420 Milestone 4 - Coursework up to standards for an A grade. Be sure to read through it thoroughly. PDF

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Coursework up to standards for an A grade. Be sure to read through it thoroughly....

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Sarah Powell 08-15-2021 IHP - 420 Milestone Four Malpractice Case The plaintiff Rosalinda Iturralde is a personal representative of the Estate of Arturo Iturralde. The defendant is Dr. Robert Ricketson and Hilo Medical Center, Hawaii Health Systems Corporation, State of Hawaii. Arturo Iturralde sued Dr. Robert Ricketson and Hilo Medical Center claiming the doctor acted below the standard of care when he implanted a screwdriver shaft into his spine after the two titanium rods that he had intended to use were missing. On January 29th, 2001 a spinal fusion surgery to correct a diagnosis of Spondylothisthesis, which is a condition that puts pressure on the spinal nerves, was performed. This is where two of the roads were supposedly not present but Dr. Ricketson continued to perform the surgery anyways. The court was deciding a law issue, in which the Hawaii Health Systems Corporation and Dr. Robert Ricketson weren’t careful enough and caused the death of Arturo Iturralde on June 18th. There was a present medical attendant who was there for the entire procedure and didn’t report anything before Iturralde started complaining of the pain he was still experiencing. Little did he know a screwdriver was used for this procedure at the time. Dr. Ricketson had three other disciplinary orders against him from other existing states before he even joined the Hilo Medical Center. Rather than accepting the two rods that were delivered specifically for this procedure by Medtronic supplies during the surgery, he turned them down and continued his work. Iturralde had many other surgeries done and falls that he experienced before his death, but these all led to the screwdriver bar breaking.

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As stated by Fremgen, “malpractice is professional misconduct or demonstration of unreasonable lack of skill that results in injury farmer last, or damage to the patient (2021). Negligence happens when someone performs or fails to perform in the same situation. If the surgeon would have waited for the correct rods, or cancelled the procedure all together, none of this negligence would have happened. Duty, neglect of duty, direct cause, and damages are what make up negligence. Dr. ricketson and Mr. Iturralde discussed the surgery, and the patient gave consent, therefore this component was met properly. When it comes to neglect of duty, Dr. Ricketson did not meet this standard because if any of his fellow surgeons came across this problem, the action would not have been performed. The direct cause was from the screwdriver, which is obvious that it is not meant for human procedures, with proof of that with the following events that happened to Mr. Iturralde after the surgery was finished. It is important to understand that the defendant had direct control over the cause of the injury, and the patient couldn’t have contributed to the cause of his injury (Fremgen, 2021). “Medical malpractice insurance is a specialized type of professional liability insurance that covers physician liability arising from disputed services that result in a patient's injury or death. Medical liability insurance is required in almost all states and most medical systems as a requirement to practice” (Stewart, 2021). Hilo Medical Center has a policy which correlates to this exact idea. They are to verify all equipment and instruments that will be used during the time of surgery, before the procedure even begins, and this includes all staff who are performing and taking part of the procedure. This is to reduce malpractice claims through insurance, which results in legal actions. Mr. Iturralde’s death could have been avoided if this policy was followed correctly. Standard of care is an entitlement for every patient, which is the ordinary skill that all

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medical practitioners must use (Fremgen, 2021). In this case, Dr. Ricketson did begin the procedure by creating a relationship with his patient Mr. Iturralde, where he then felt comfortable enough to consent to the operation. By installing the screwdriver that was most certainly not approved or even the right device, and not notifying Mr. Iturralde of the outcome after the surgery with no follow up solution, Dr. Ricketson violated the standard of care when he did so. It is in the Hilo Medical Center policy along with laws and regulations that if any given procedure does not go as planned, the physician must tell their patients exactly what went wrong, with a way to fix it. Dr. Ricketson implanted a screwdriver not intended for surgical use, and gave instructions to Iturralde to begin physical therapy, knowing the surgery went unplanned. This results in violation of non malfeasance. Mr. Iturralde does not speak english. A translator was provided for the beginning of his procedure processes. As Fremgen states “In the U.S. there has been a dumping crisis of indigent patients that have resulted in patient deaths because of the shuffle between private hospitals and public hospitals” (2021). It is recommended that the organization has a process to make sure that communications with the patient in any language is effective and is fully understandable for the patient. A translator was not provided to Mr. Iturralde to discuss the end results of the procedure. This is a violation of the Joint commission for health providers. It is clear the using a screwdriver to perform a medical surgery procedure on a patient is in-humane. Mr. Iturralde was not informed of any of these wrong doings throughout any point of this procedure, which leaves Dr. Ricketson accountable along with HMC. Dr. Ricketson was held 65% accountable as his actions were negligent and were essential factors leading to Mr. Iturralde’s death. The HMC was held 35% accountable for not having to proper tools for their patients. It is also known that when Dr. Ricketson applied for employment at HMC, he had other

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disciplinary actions being held against him, but was still hired. An ethical issue is defined as “an issue that accrues when choices need to be made, the answers may not be clear, and the options are not ideal. The result could be declined in the quality of patient care, problematic clinical relationships, and moral distress which is defined as knowing you think the right thing to do but not being allowed or able to do it” (Hayward, 2021). To evaluate ethical problems, you must consider the action and the impact the action will have on everyone involved. It is important to have critical thinking skills as a healthcare professional. In the case of Iturralde v. Hilo Medical Center, Dr. Ricketson was hired and given the job to properly tend to his patients, and was privileged to do so by the HMC. Although we know Dr. Ricketson had a prior past of lapses in the medical field, HMC either disregarded these red flags, or hired him and ignored these red flags from three other states. According to Fremgen, “three months prior to performing Mr. Iturralde’s surgery, the state of Hawaii put Dr. Ricketson on probation” (Fremgen, 2021). With the choice that this hospital chose to make disregarding all other problems in the past, Dr. Ricketson is most definitely linked to the cause of the malpractice case and the all of the events that led up to the death of the patient. This is said because during the surgery of Mr. Iturralde, Dr. Ricketson made the decision to use a screwdriver that was not intended or approved for any human interaction to fix a surgical issue. Fremgen goes to say that there are teleological and deontological theories. Teleological theories are “concerned with the consequences of actions which means the basic standards for our actions being morally right or wrong” and deontological theories determine how we act regardless of the consequences (Fremgen, 2021). This would mean that the same standards for the decisions, and actions remained the same when the same circumstances, knowledge, and the appropriate decision for the patient are made. The screwdriver would have never been implanted

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if Dr. Ricketson was performing within his knowledgeable duty. The decision making model that provides a safe, quality healthcare experience for the patient would be Dr. Bernard Lo’s clinical model. “This model not only allows and encourages the providers to ensure the patient has a voice in their health care decisions, and it also encourages all providers who have direct care to be involved in the decision as well” (Fremgen, 2021). This requires the patient and all of the healthcare staff involved in the procedures to discuss their expectations. Since Mr. Iturralde was unable to understand and speak fluent English, he should have been provided by the hospital, in an interpreter to explain the proprocedures and relay the outcome of the post-procedures. By law someone with the ability to make the decision in regards to Mr. Iturralde of the implant, should have been identified before the surgery was started. The guidelines that would work hand in hand with Dr. Bernard Lo’s decision making process would be autonomy, non malfeasance, and justice. Autonomy is expressed as the right for adults to make informed decisions about their own medical care. This would result in the patient being aware of the consequences of deciding against the procedure. Non malfeasance is expressed as not to inflict any harm on others. This means the patient would not have received a screwdriver in place of a medical graded device to finish his procedure. Lastly, justice is expressed as fairness to individuals in certain populations. Quality healthcare does not depend on the patients education, abilities, impairment, or socio-economic status. Communication is extremely important when trying to create and maintain a physician patient relationship before constructing surgery. By creating this professional bond, this will assure that healthcare providers will give patients the best chance at maintaining good health. A professional relationship between the medical specialist and a patient is significantly important.

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This creates non malfeasance by opening communication between the primary care physician, the patient, and the surgeon before treatments. Hilo Medical Center failed their patient by not performing their standardized inventory of the Medtronic kit. Performing inventory before they sterilize or even before the incision process would have resulted in finding the defective kit. In result of finding the titanium rod missing would humanely be to reschedule the operation completely. Another failure that the HMC made, was completing a proper background check on Dr. Ricketson. These steps that should have been taken prior to any surgery done on any patient, would have protected the medical facility, the staff, as well as the patient who was allowing this doctor to provide them with care. Preventative recommendations are to ensure misconduct and safety violations which are not tolerated and are clearly outlined to all staff, along with policies that are enforced by healthcare organizations. Informed consent is proof the provider discussed risks, options, and outcomes with the patient prior to a procedure and confirming the patient agrees with the treatment. Last, collaborating with all of the staff involved prior to the procedure, during and after the procedure, and even a “time-out” session to discuss what options are available if something like this case occurs.

References:

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Ballista, S. (2009, February). An introduction to medical malpractice in the United States. Clinical orthopaedics and related research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628513/. Fremgen, B. F. (2021). Medical law and ethics (5th ed. ). Upper Saddle River: Pearson. Retrieved from https://mbsdirect.vitalsource.com/#/books/9780134092683/cfi/179@/4/[email protected]:14.9. Hayward, N. (2020, June 5). Ethical issues in nursing: Explanations & solutions. Duquesne University School of Nursing. https://onlinenursing.duq.edu/blog/ethical-issues-innursing/. Stewart, J. (2020). Medical Malpractice Insurance. ACP. https://www.acponline.org/about-acp/about-internal-medicine/career-paths/residency-careercounseling/guidance/medical-malpractice-insurance....