Introduction
The case of medical malpractice under examination describes the inappropriate actions of health care professionals that resulted in the patient’s death. In 2001, Arturo Iturralde went to HMC, a Hawaiian state-owned hospital. He was diagnosed with degenerative spondylolisthesis and scheduled for surgery after several days. The surgery went wrong due to the absence of a previous inventory of essential materials received from Medtronic, and Dr. Ricketson, a surgeon, decided to temporally replace absent titanium rods with a screwdriver shaft (“Iturralde V. Hilo Med. Ctr.,” n.d.). Despite subsequent surgeries and the implantation of titanium rods, the patient’s condition declined, he suffered from depression and urosepsis, became bedridden, and died in 2003. In the court, Arturo’s interests were represented by his sister and caretaker, Rosalinda Iturralde.
Medical Malpractice
In general, the case’s major legal components include negligence, negligent credentialing, strict liability against multiple defendants, and breach of warranty (“Iturralde V. Hilo Med. Ctr.,” n.d.). Although the parties of the process have stipulated to asserted facts, the application of particular rules was disputable. The jury of the Circuit Court initially apportioned 35% of the fault to HMC and 65% to Dr. Ricketson as their negligence was regarded as the main factor in causing the patient’s harm (“Iturralde V. Hilo Med. Ctr.,” n.d.). However, the court subsequently declined to follow the determination of damages provided by the jury and concluded that Dr. Ricketson and HMC were jointly and severally liable as the patient suffered from pre-existing severe medical conditions. Total judgments were awarded in accordance with Counts I, II, and VIII of the First Amendment Complaint.
Malpractice may be regarded as professional misconduct that results in the patient’s damage, injury, or loss. According to well-accepted fundamental principles of the United States’ tort law, a plaintiff should establish the following legal components “in order to prevail in a medical malpractice suit” (Heller, 2017, p. 141):
- A legal duty was owed to the plaintiff by a professional or a medical facility;
- This duty’s breach had occurred;
- The breach presumably resulted in the plaintiff harm;
- The plaintiff subsequently sustained damages.
The case under analysis has all components of the medical malpractice or negligence. First of all, neither Dr. Ricketson nor health care personnel completed an inventory before the surgery as required by a well-established policy of HMC (“Iturralde V. Hilo Med. Ctr.,” n.d.). Furthermore, the surgeon ignored the message of his nurse concerning the absence of check of necessary equipment’s availability and proceeded with the surgery. Later, he made an intentional medical mistake by implanting a steel screwdriver shaft in the patient’s spine. Although Dr. Ricketson believed that the delay connected with the titanium rods’ delivery could be risky for Arturo Iturralde, he knew that the screwdriver shaft is not approved and intended for human transplantation.
According to Fremgen (2012), the standard of care may be defined as “the ordinary skill and care that all medical practitioners such as physicians, nurses, physician assistants, medical assistants, and phlebotomists must use, as determined by their state license or certification and that a “reasonable” person
would use in a similar circumstance” (p. 61). Dr. Ricketson had breached the standard of care through negligence that resulted in the patient’s loss. Moreover, HMC breached the standard of care as well as the medical center granted Dr. Ricketson hospital credentials regardless of his previous negative experience while no surgeon is allowed to practice in the same situation.
From a personal perspective, concerning this case, the patient’s cultural background did not play a significant role in the outcome. Although Arturo Iturralde and his family trusted the center and Dr. Ricketson, their trust was probably connected with these people’s personal characteristics, and another person from different culture could trust a doctor in a respectable medical facility as well. Nurse Janelle Feldmeyer could not inform Arturo about the result of his surgery as he did not speak English, however, there is no evidence that her information could contribute to the improvement of the patient’s condition. In general, HMC and Dr. Ricketson are fully responsible for the patient’s loss in front of his family. The highest level of accountability is determined by credentials to a non-professional surgeon from the medical center, the violation of HMC’s guidelines, the absence of an inventory, intentional mistake during the surgery, and time-insensitive reaction of the medical facility that led to the patient’s death.
Ethical Component
Regardless of the exceptional role of medical ethics in the health care system, the principles of ethics may confront appropriate decision-making and lead to negative consequences. While the fundamental goal of a health care professional is nonmaleficence and the minimization of a patient’s pain and sufferings, he or she may face a serious ethical dilemma and choose between several options (Laurie, Harmon, & Dove, 2019). In the case of Dr. Ricketson, the surgeon was conducted by the belief that waiting would be dangerous for the patient and decided to replace titanium rods with a screwdriver shaft to save Arturo’s life and alleviate his suffering. However, as a result, this ethically correct decision led to the man’s death.
One more principle of medical ethics was seriously violated – Dr. Ricketson did not inform Arturo Iturralde about the problem and result of the surgery, despite the fact that a patient has a right to receive full information concerning his or her health condition (Laurie, Harmon, & Dove, 2019).
If Iturralde had been informed, he probably would have been more accurate in the period before a new correct surgery. The patient’s falls and attempts to walk may be regarded as the reason for the shaft’s shattering that led to multiple complications and death. By his incompetent actions, Dr. Ricketson excluded the patient from the physician-patient shared decision-making model that presupposes mutual contribution to decision-making concerning the treatment process and agreement on previously discussed decisions. Arturo had a right to be informed about his health after the surgery and involved in discussion and decision-making concerning an appropriate therapy. Moreover, the patient could feel more relaxed and confident seeing that Dr. Ricketson support him and respect his opinion.
From a personal perspective, communication with the patient, information transfer, and shared decision-making are advisable ethical guidelines related to Iturralde’s case. Although the most severe damage was caused by the surgeon’s mistake, subsequent negative consequences could be minimized through the consideration of the patient’s demands and mutual trust and respect. In addition, even ethically-correct decisions should be thoroughly evaluated and discussed to avoid negative outcomes and provide high-quality health care and treatment.
Recommendations
On the basis of malpractice and ethical analyses of the provided case, the following strategies may be recommended in order to avoid malpractice and improve health care delivery:
- Medical facilities should pay particular attention to the health care professionals’ previous experience;
- Supervisors should consider the reports and comments of their subordinates as they may prevent malpractice;
- Patients should be definitely involved in the decision-making process concerning their treatment;
- Health care professionals should be guided by the principles of medical ethics, however, under specific conditions, all options should be thoroughly evaluated.
References
Fremgen, B. F. (2012). Medical law and ethics (4th ed.). Upper Saddle River, NJ: Pearson.
Heller, T. A. (2017). An overview of medical malpractice law in the United States including legislative and the health care industry’s responses to increased claims. Medicine, Law & Society, 10(2), 139-163. Web.
Iturralde V. Hilo Med. Ctr. (n.d.). Web.
Laurie, G. T., Harmon, S. H. E., & Dove, E. S. (2019). Mason and McCall Smith’s law & medical ethics (11th ed.). Oxford, UK: Oxford University Press.