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Prompt: In this project, you will analyze a court case involving medical malpractice. For this milestone, you will use the facts from the original case to identify an ethics issue, determine an ethical theory that would help provide a safe and quality healthcare experience for the patient, and apply a clinician–patient shared decision-making model. III. Ethical Component: In this section, you will evaluate the case to identify the specific ethical issues and determine ethical theories and shared decision- making models that would help resolve the issue and provide a safe, quality healthcare experience. Then, you will propose and defend ethical guidelines for healthcare providers to follow in order to avoid future incidents. A. Describe the ethical issues that led to the malpractice case and explain why the issues are credited with causing the incident. Support your response with research and relevant examples from the case. B. Describe an ethical theory that would help resolve the issue and provide a safe, quality healthcare experience for the patient. Support your response with research and relevant examples from the case. C. Select a physician–patient shared decision-making model and explain how it would provide a safe, quality healthcare experience for the patient D. Propose ethical guidelines that would have helped prevent the incident and would help the organization prevent future incidents. E. Defend how your proposed ethical guidelines will hold healthcare providers accountable to themselves, their profession, their patients, and the public. Rubric Guidelines for Submission: Your paper should be a 2- to 3-page Microsoft Word document with double spacing, one-inch margins, and at least three sources cited in the most recent APA format. All references should be formatted according to the most recent APA guidelines Hawaiian jury finds doctor liable for inserting screwdriver in patients spine Authors: Natalie White Source: Lawyers Weekly USA. 04/10/2006. Regional Business News Translate Full Text: Hawaiian jury finds doctor liable for inserting screwdriver in patient’s spine Full Text Listen Story Type: News
A Hawaiian jury awarded $5.6 million to the family of an elderly minister whose doctor improvised by implanting the shaft of a screwdriver into his spine during surgery.
"This was the most egregious case of malpractice I've ever seen in my career, and it started a cascade of events that ultimately ended in death," said Mark Davis, who represented the family of Arturo Iturralde.
But Dr. Robert Ricketson, an orthopedic surgeon who represented himself at trial, said he acted reasonably when he discovered halfway through the surgery that two titanium rods needed to fix Iturralde's spine were missing.
Iturralde had lost a lot of blood already and he didn't want to leave the patient exposed for two hours while waiting for the medical supply company to deliver the rods. He noticed the shaft to the screwdriver was about the same diameter as what he needed so he decided to use it instead. He cut it to size with a surgical hacksaw and went on with the operation.
A few days later, the stainless steel shaft of the screwdriver snapped in the back of the 73-year-old patient, requiring him to undergo several more surgeries. He died two years later of related complications, Davis said.
The jury found Ricketson 65 percent liable and Hilo Medical Center 35 percent liable for credentialing him despite a questionable history. Davis said the doctor's medical license had been suspended in Oklahoma and Texas before he came to Hawaii.
The medical supply company, Medtronic, was also sued but the jury did not apportion any blame.
After a five-week trial, the jury awarded the plaintiffs $2.2 million in compensatory damages and $3.4 million in punitive damages.
George W. Playdon, attorney for the state of Hawaii, which runs Hilo Medical Center, said in an e-mail that judgment had not been entered regarding the state.
"There has been no judgment as to my clients," he said. "The court has not ruled on our case and has asked for supplemental briefings."
Blowing The Whistle
Based on the testimony of a "whistleblower nurse," several nurses tried to dissuade Ricketson from using the stainless steel screwdriver shaft as a replacement for the titanium rods, Davis said. One nurse argued that the family needed to know about the substitution but testified that she was told not to tell relatives.
The rods were to be used to brace Iturralde's back to take pressure off some nerves.
After the shaft snapped and had to be removed, the nurse retrieved the screwdriver part and took it to a lawyer, who sent it on to the family.
The nurse's testimony was powerful, Davis said.
"She was outraged by what happened. She had the courage to defy what she knew was not right," he said.
Deflecting Blame
Each of the parties involved in the crisis contended that they were not to blame.
The hospital said that the medical supply company must have forgotten to send the rods, but the medical supply company claimed it did send them and that the surgical team should have checked their inventory before moving forward with the operation. Company officials also testified that they offered to rush replacement rods to the hospital.
Hospital officials said they were not responsible for the doctor's unorthodox surgical swap because it was not a foreseeable action.
But Davis argued that the hospital never should have permitted Ricketson to do surgery.
"There had been a host of disciplinary problems and disciplinary actions against him arising out of his addiction to narcotics," Davis said. "My pitch to the jury in closing argument was: Here is a guy who keeps hopping from jurisdiction to jurisdiction, and the jury has to send a message to him and the hospital that the community feels betrayed."
The defendants also argued at trial that Iturralde was not seriously injured by the surgical incident and that the patient's medical complications and subsequent death were the result of other serious health problems, including heart disease and diabetes.
As for Ricketson, he told the jury it was not his job to inventory the items needed for the operation, and that the nursing team should have done that.
But a medical ethicist testified that Ricketson never should have implanted the stainless steel shaft into a person, Davis said. While titanium has been approved for implanting in a human body, stainless steel has not. The ethicist, also a surgeon, said the doctor should have stopped the operation.
"He said the doctor is responsible for making sure all the appropriate equipment and devices are there. In this case when it was apparent he didn't, then he should have closed and taken the patient back into the operating room the following morning," Davis said.
Ricketson is solely responsible for the punitive portion of the verdict since Hawaiian law prevents punitive damages from being awarded against hospitals. Recovering the award may be difficult, since Ricketson had no malpractice insurance, Davis said.
Plaintiff's Attorney: Mark S. Davis of Davis, Levin, Livingston Grande in Honolulu, Hawaii.
Defense Attorneys: Robert Ricketson represented himself; George W. Playdon of Reinwald O'Connor & Playdon in Honolulu, Hawaii for Hawaii Health Systems; Murray Levin of Pepper Hamilton in Philadelphia for Medtronic.
The Case: Iturralde v. Ricketson; March 13, 2006; Circuit Court, Hawaii County, Hawaii; Judge Glenn Hara.
Choose Language ITURRALDE v. HILO MEDICAL CENTER USA Intermediate Court of Appeals of Hawai‘i. Rosalinda ITURRALDE, Individually and in her Capacity as Personal Representative of the Estate of Arturo Iturralde, Plaintiff–Appellant, Cross–Appellee, v. HILO MEDICAL CENTER, a Hawai‘i Non–Profit Corporation, Hawai‘i Health Systems Corporation, a Public Benefit Corporation, State of Hawai‘i, Defendants–Appellees, Cross–Appellants and Medtronic Sofamor Danek, USA, a Tennessee Corporation Licensed to do Business in Hawai‘i, and Robert Ricketson, M.D., Defendants–Appellees. No. 28792. Decided: March 30, 2012 NAKAMURA, Chief Judge, FUJISE and LEONARD, JJ. Mark S. Davis, Anne L. Williams, and Robert P. Marx (Davis Levin Livingston), on the briefs, for Plaintiffs–Appellants/Cross–Appellees. George W. Playdon, Jr., Kelvin H. Kaneshiro, R. Aaron Creps (Reinwald O'Connor & Playdon LLP), on the briefs, for Defendants–Appellees/Cross–Appellants. Edmund Burke, David Y. Suzuki, Patricia Aburano (Burke McPheeters Bordner & Estes), and Murray S. Levin (Pepper Hamilton LLP), on the briefs, for Defendant–Appellee Medtronic Sofamor Danek USA. Robert Ricketson, M.D., Defendant–Appellee. Plaintiff–Appellant/Cross–Appellee Rosalinda Iturralde (Appellant or, in reference to her individual capacity, Rosalinda), individually and in her capacity as personal representative of the Estate of Arturo Iturralde (Arturo's Estate), and Defendants–Appellees/Cross–Appellants Hilo Medical Center, Hawai‘i Health Systems Corporation, State of Hawai‘i (collectively, HMC), appeal from the Amended Final Judgment (Judgment) of the Circuit Court of the Third Circuit (Circuit Court).1 The Judgment, entered September 10, 2007, awarded various damages against HMC and Defendant–Appellee Robert Ricketson, M.D. (Dr.Ricketson). It awarded judgment in favor of Defendant–Appellee Medtronic Sofamor Danek USA, Inc. (Medtronic) on all claims. On appeal, Appellant asserts that the Circuit Court erred in: (1) awarding joint and several damages against HMC in an amount different from the amount awarded by jury against Dr. Ricketson; (2) adopting Medtronic's proposed jury instruction on the substantial change doctrine of products liability; (3) adopting Medtronic's proposed jury instructions and special verdict interrogatory on foreseeability and superseding cause; and (4) failing to hold HMC jointly liable for damages awarded to Rosalinda for negligent infliction of emotional distress (NIED). On cross-appeal, HMC asserts that the Circuit Court erred in: (1) failing to apply Hawaii Revised Statutes (HRS) § 663–10.5 (Supp.2006), as amended, to preclude HMC from being held jointly and severally liable in tort; and (2) failing to offset the judgment against HMC by the good-faith settlement of non-party Hawaii Orthopaedics, Inc. I. BACKGROUND A. Arturo Iturralde's Medical Care Decedent Arturo Iturralde (Arturo) was admitted to HMC, a state-owned hospital in Hilo, in January of 2001, for an assessment of increasing weakness in his legs that had resulted in several falls. Dr. Ricketson, an orthopedic surgeon with credentials at HMC, examined Arturo on January 24, 2001. He diagnosed Arturo with degenerative spondylolisthesis L4–5 with stenosis, a condition that exerted pressure on the nerves. This condition could potentially be relieved through spinal fusion surgery, which involved implanting two rods into the spine to form a bilateral fixation. Dr. Ricketson scheduled Arturo for the surgery the following Monday, January 29, 2001. Dr. Ricketson directed HMC to order an M8 Titanium CD Horizon Kit (Kit) from Medtronic, which would contain all the necessary instrumentation and tools, including the two titanium implant rods crucial for the surgery. Because Medtronic did not have the instrumentation portion of the Kit in stock at its Memphis facility, it sent the order in two shipments: one from Memphis and one from Tulane. HMC received both shipments on Saturday, January 27, 2001, at approximately 7:30 pm. The contents