Medicine: On Medical Malpractice

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Milestone One

Introduction

Medical malpractice has always been one of the most complicated investigation subjects due to a variety of pitfalls when resolving a court case. As a result, a single case can be addressed in court for several years, followed by several appeals. A prime example of such a sophisticated medical malpractice case is the case of R. Iturralde v. Hilo Medical Center USA. The case considered surgeon’s malpractice (in this specific case, the medical worker implemented a foreign body into the patient’s spinal cord), along with a series of appeals presented by the defendant aimed at justifying illegal actions.

The stakeholders of the case included the plaintiff – Rosalinda Iturralde, the patient’s younger sister, and caretaker, and the defendant – Hilo Medical Center in Honolulu that employed the surgeon responsible for the malpractice (Iturralde v. Hilo Medical Center USA, 2012). The incident itself took place in 2001, followed by a series of events ever since (e.g., the patient’s death in 2003, and the final court decision issued in 2012). The primary aim of the following paper is to define the major legal components and policies related to the case that would potentially influence the events’ outcome.

Medical Malpractice Component

In terms of the medical law system, the very notion of law consists of a variety of semantic paradigms that define the idea of securing one’s right to access proper healthcare. Law, being a framework of rules and responsibilities that later form a foundation for ethical behavioral patterns, is a ground terminal for further defining the malpractice case components (Phahlamohlaka & Coetzee, 2018). Speaking of the following malpractice case, some of the major components of the case should be outlined to conduct further analysis:

Case parties. The case’s plaintiff party is represented by the victim’s caretaker and relative – Rosalinda Iturralde. The defendant party is represented in court by the Hilo Medical Center USA – Dr. Robert Ricketson’s employer.
Facts and circumstances. Speaking of the facts and circumstances that led the parties to the court, the following precedents might be outlined: (a) malpractice case demonstration, which involved former surgeon implementing a piece of a screwdriver into the patient’s spine; (b) steady worsening of the patient’s condition after the surgery; (c) doctor’s attempt to hide the surgery details from the hospital and caretakers; (d) nurse’s statement on the committed malpractice that eventually led the case to the state court.
Question of fact decision. The following malpractice case’s central issue is related to the extent to which the defendant party should be held responsible for the incident’s outcome. When it comes to the rule of law applicable to the situation, there were no questions, as the issue was regarded through the prism of Chapter 662 of Hawaii Revised Statutes (HRS).

When dealing with malpractice management in terms of local healthcare, it is important to outline all the policies present in the legal system that could potentially be applied to the case. First, the vast majority of the legislative foundation for medical malpractice cases is described in the HRS document that encompasses the scope of legal communication between the parties. Moreover, Hawaiian federal law presupposes a series of policies accountable for the malpractice incidence. The variety of these policies sometimes formulates a major dissonance when discussed in court. For example, Hawaiian medical workers are inclined to apologize for the damages provided without acknowledging one’s fault as evidence (Medical Malpractice Center, n.d.). Hence, it might be concluded that the following malpractice case, while justified by several policies aimed at defending the consumers’ rights, could still become a subject of controversy due to the same procedures.

The worldwide process of healthcare policy development is followed by a variety of standards that encourage the best possible experience for the patients. In the context of the following malpractice case, one of the major worldwide care standards was breached. When asking for the professional help from medical facilities, people expect the procedures to be legally approved by federal institutions (Frakes & Jena, 2016). In the Iturralde case, the patient was intentionally cured in ways unapproved by the medical policies, putting one’s life in danger even because the doctor was to act fast in the setting.

Almost everyone would agree upon the statement that any violation of medical competency has no ethnic affiliation whatsoever, making it inappropriate for any culture. However, the cultural background of the defendant might influence how the breach could be handled. To begin with, the overall American sense of individualism has always been a driving force for the court proceedings and a continuous appealing process. Thus, people with different cultural backgrounds might not make much effort to resolve the case with the best possible profit from the decision.

Speaking of the case accountability, the Hawaiian law presupposes the responsibility division between the healthcare facility and the employee to the extent which would correspond to the level of the damage caused for the patient. In the following case, HMC was entitled to cover 25% of the damages, leaving the rest for Dr. Ricketson to pay. However, the decision was appealed in several ways for the doctor to cover the whole amount of damage fee without being divided between defendants. Hence, considering everything, it might be concluded that the following malpractice case is quite exhaustive in terms of guilt definition, while the question of responsibility division was unclear and required a series of appeals to define the extent to which defendants were to be held responsible.

Milestone Two

The notion of ethics has always been inseparable from the healthcare segment, as medical practice is aimed at helping people regardless of external factors. However, today’s world is impossible to imagine without flaws that undermine the overall dignity and reputation of its fellow residents. As a result, the presence of major ethical issues in society has influenced the patterns of healthcare. Some of the most widespread ethical issues in the healthcare segment concern equal access to the services, humanly doctor-patient communication, and medical employees’ competence in the field.

When deciding on pursuing a medical career, an individual is to take full responsibility for one’s actions due to their major and direct impact on other people’s life expectancies and health. Thus, medical employees are to preserve some moral obligations when dealing with the treatment process (Maher et al., 2019). In the following case, the defendant failed to provide the patient with the expected quality medical help, eventually contributing to his sudden death. Hence, the ethical issue of professional competency was breached to find the simplest solution for the problem that emerged in the course of treatment.

Any ethical issue that emerges during the treatment process is inevitably correlated with the process of decision-making. To resolve the issue, the employee is to know how to operate some of the basic patterns of reaching a consensus in terms of the setting. To help medical workers find the most appropriate decision, some basic ethical theories should be introduced:

Utilitarianism;
Rights-based ethics;
Duty-based ethics;
Justice-based ethics;
Virtue-based ethics.

All of the aforementioned theories usually result in reaching a decision based on various approaches to the same issue. The perception of these decisions is often modified when experienced in terms of some stressful situations that require immediate action (O’Mathúna et al., 2018). Hence, while some of the theories are used in favor of the ones who bring the most benefit to society in general, others are based upon the fact that every human being was born as an individual with exclusive rights to live a long and happy life. Whereas all of the theories might contradict each other at some point of discussion, all of them help practitioners justify their decisions through the prism of causal connection.

However, when any of the theories are applied to the Iturralde v. HMC case, it becomes clear that all of the basic human rights were neglected by the healthcare practitioner. The patient, as a human being in the first place, was entitled to receive proper medical aid regardless of his virtue or social benefit. According to the primary sociology patterns, such behavior would only be appropriate in cases when many lives are simultaneously at stake, making it mandatory to choose the ones who deserve to be saved more than others, still regarding this behavioral pattern as dehumanizing.

Hence, when there is no major need to choose people according to their theoretical efficiency in society, the rights-based theory is the most suitable foundation to resolve the situation. The surgery held by the practitioner was primarily aimed at preserving one’s health, making it a major goal to justify the fundamental human privilege to live. In terms of the rights-based theory, hence, it was the surgeon’s task to ensure one’s life duration instead of searching for an immediate situation outcome.

Over the past years, the issue of interpersonal communication in terms of the treatment process has become a subject for continuous discussion due to the dissonance in the process of patients advising on their treatment. Whereas many practitioners still tend not to discuss the details of the treatment plan with individuals, researchers have been actively trying to define the most beneficial model of shared decision-making to involve patients in the process to an extent safe for their physical and mental health. Nowadays, the two models of shared decision-making might be outlined in the healthcare context:

Interventions targeting patients, i.e., the process of the issue discussion with patients or their caretakers;
Interventions targeting healthcare professionals, i.e., the consultancy process in terms of reaching an agreement in terms of further treatment plan agenda (Légaré et al., 2018).

When dealing with the following case study, one should emphasize the fact that the doctor was obliged to have his colleagues advise him on the decision made during such a serious operation. Hence, it was of crucial importance to implement an intervention targeting healthcare professionals as a shared decision-making model. Moreover, Dr. Ricketdon had a full-scale opportunity to discuss all the possible operation outcomes with the patient’s caretaker, implying intervention targeting patients. In case the following decision-making models were executed, the following course of the events would have been avoided, and another efficient solution would have been found.

Since ethical competence is one of the most crucial factors in terms of efficient medical practice, it goes without saying that practitioners have to follow certain guidelines that form an ethical environment within the unit (Koskenvuori et al., 2019). Thus, the question of ethical guidelines in the following case should, by all means, concern the practitioner’s willingness to save patients’ lives in the first place. Hence, one of the most significant guidelines provided in the medical facility should concern some fundamentals of communication within both medical employees and patients to provide the best service possible. Taking everything into consideration, it might be concluded that the very process of decision-making in terms of medical practice is highly correlated with one’s personal qualities and perception of professional competence. The following information leads to a conclusion that all of the future ethical considerations and guidelines are to be compatible with the practitioner’s outlook to achieve satisfying results.

Milestone Three

Medical practice as a process is replete with various ethical contradictions that potentially aggravate the struggle of decision-making when it comes to one’s treatment. Thus, one of the major issues in terms of ethical policy adherence is the notion of euthanasia and its execution prerequisites. The problem is especially contradictory when it comes to patients who are not able to express their own will due to severe health conditions, leaving the right to choose to the patient’s guardian. One of the most notorious cases concerning the issue is Terri Schiavo’s case dealing with one’s end-of-life wishes and basic human right to live. The primary goal of this paper is to identify the case’s bioethical issue and reflect upon its role in the trial process.

As a result of an unprecedented event of 1990, the life of Terri Schiavo was divided into the “before” and “after” parts, as she was no longer available to live a life without medical assistance due to the persistent vegetative state (PVS) emergence (Caudell, 2016). After years of attempts to bring Terri back to life, her husband and legal guardian, Michael Schiavo, issued a petition to remove his wife’s feeding tube. The other case stakeholders, Robert and Mary Schindler (Terri’s parents), immediately objected to the following request, assuming that their daughter would have never intentionally ended her own life.

Michael, however, argued that a few years before PVS, Terri said that she would not want artificial feeding to support her life in case she struggled with some health issues. In terms of the following situation, one might conclude that the major issue of the case deals with the dissonance between medical practitioners’ intention to save one’s life at all costs and the human right to express end-of-life wishes. Hence, the bioethical issue of the case relates to the “end-of-life” policy, which encompasses practitioners’ duty to respect the wishes of their patients, along to do everything in their power to save their lives.

Taking into consideration the aforementioned case details and the overall concept of human rights to live and receive a proper reaction to their wishes, it might be concluded that both legal ad moral values can reach a consensus exclusively in the case of one’s self-determination. That is, any medical intervention, guardian’s appeals, or external circumstances would never be exhaustive in terms of the decision-making process (Joshua et al., 2005). When faced with a similar situation, the medical employee’s primary goal is to make sure that the full-scale medical service is provided to the patient before the final decision is made. Once this ethical milestone is completed, the legal concerns would be tackled in terms of further investigation. In this particular case, a major legal issue concerned a conflict between the patient’s parents and her legal guardian on the subject of euthanasia appropriateness given the situation. On the one hand, the parents’ concern might be understood from the moral point of view, whereas the legal segment implies prioritizing the guardian’s decision in terms of the patient’s intentional life termination.

Considering both ethical and legal obligations that determine the process of one’s decision to terminate medical treatment, it might be concluded that there would never be an appropriate answer to the question of preserving human life. However, the least that could be done in a situation like this is to make sure that medical assistance is provided to such an extent that a decision would be made considering all the attempts to save one’s life. The legal case of Terri Schiavo’s life termination serves as a landmark for further policy development in terms of respecting one’s will and following legal guidelines in reaching an agreement.

Final Project I

Medical practice is a sophisticated mechanism, which encompasses both legal prerequisites of healthcare and ethical consideration in terms of doctor-patient communication patterns. Thus, some healthcare cases frequently deal with medical malpractice due to the lack of professional competence or the absence of substantial proof of one’s actions. As a result, a single case can be addressed in court for several years, followed by several appeals. A prime example of such a sophisticated medical malpractice case is the case of R. Iturralde v. Hilo Medical Center USA. The case considered surgeon’s malpractice (in this specific case, the medical worker implemented a foreign body into the patient’s spinal cord), along with a series of appeals presented by the defendant aimed at justifying illegal actions.

The stakeholders of the case included the plaintiff – Rosalinda Iturralde, the patient’s younger sister, and caretaker, and the defendant – Hilo Medical Center in Honolulu that employed the surgeon responsible for the malpractice (Iturralde v. Hilo Medical Center USA, 2012). The very incident took place in 2001, followed by a series of events ever since (e.g., the patient’s death in 2003, and the final court decision issued in 2012). The primary aim of the following paper is to define the major legal components and policies related to the case that would potentially influence the events’ outcome.

Speaking of the following malpractice case, some of the major components of the case should be outlined to conduct further analysis:

Case parties. The case’s plaintiff party is represented by the victim’s caretaker and relative – Rosalinda Iturralde. The defendant party is represented in court by the Hilo Medical Center USA – Dr. Robert Ricketson’s employer.
Facts and circumstances. Speaking of the facts and circumstances that led the parties to the court, the following precedents might be outlined: (a) malpractice case demonstration, which involved former surgeon implementing a piece of the screwdriver into the patient’s spine; (b) steady worsening of the patient’s condition after the surgery; (c) doctor’s attempt to hide the surgery details from the hospital and caretakers; (d) nurse’s statement on the committed malpractice that eventually led the case to the state court.
Question of fact decision. The central issue of the following malpractice case is related to the extent to which the defendant party should be held responsible for the incident’s outcome. When it comes to the rule of law applicable to the situation, there were no questions, as the issue was regarded through the prism of Chapter 662 of Hawaii Revised Statutes (HRS).
Case legal foundation. To operate the case’s primary allegations, it is of crucial importance to define which legislative policies are relevant in terms of the given location. When speaking of the following case, specific attention should be paid to the fact that events took place at the Hawaiian hospital, addressing the issue through the prism of the local legislative system. Hawaii Revised Statutes (HRS) is a major legal document relevant in the area, with several chapters of the book being dedicated specifically to the issue of healthcare and medical policy. In the case of this particular malpractice, the case was managed through the ideas outlined in Chapter 662 HRS.

When it comes to making decisions that might considerably affect the patient’s life, it is of crucial importance for the administration to estimate the basic standards of care that would potentially advise practitioners on how to act in a specific setting. In terms of the Hawaiian malpractice policy, the major care merit presupposes ensuring proper communication with the patients, caregivers, and/or guardians on the matter of treatment plan and further actions in terms of diagnostics. Hence, these quality variables are of crucial importance when justifying the instance of malpractice, as the action committed should contradict the care fundamentals outlined in the legislative sources. The following outcome has fully demonstrated the fact that the standards of care were breached by the practitioner, as he failed to maintain a professional relationship with the guardian.

Almost everyone would agree upon the statement that any violation of medical competency has no ethnic affiliation whatsoever, making it inappropriate for any culture. However, the cultural background of the defendant might influence how the breach could be handled. To begin with, the overall American sense of individualism has always been a driving force for the court proceedings and a continuous appealing process. Thus, people with different cultural backgrounds might not put so much effort to resolve the case with the best possible profit from the decision.

Utilitarianism;
Rights-based ethics;
Duty-based ethics;
Justice-based ethics;
Virtue-based ethics.

While all of the aforementioned theories have a full-scale right to exist within the healthcare ethics paradigm, rights-based ethics is the most appropriate tool in terms of managing malpractice. If the practitioner took into account the fact of human life superiority, there would be a higher chance of him giving his intentions a second thought to make sure it would work in the long run.

To prevent such errors in medical practice in general, medical employees must acknowledge the importance of one’s ability to reach a consensus in terms of decision-making. For this reason, both professional and patient-targeted shared decision-making models would be quite efficient in the following case, as they would let the defendant obtain various perspectives on the accident. Moreover, caretakers’ integration in the treatment process would prevent breaching the standard of care defined for the state.

Since ethical competence is one of the most crucial factors in terms of efficient medical practice, it goes without saying that practitioners have to follow certain guidelines that form an ethical environment within the unit (Koskenvuori et al., 2019). Thus, the question of ethical guidelines in the following case should, by all means, concern the practitioner’s willingness to save patients’ lives in the first place. Hence, it is the administration’s responsibility to define legally verified preventative strategies on how to avoid such malpractice cases in the future. One of the most efficient policies to be introduced is providing mandatory professional training on the most common malpractice cases to define action strategies in collaboration with practitioners. In such a way, they would be able to become a part of the process and, hence, know what to do in such situations based on the empirical data. Thus, as a result of the learning process, community residents would feel more secure about healthcare facilities in the area given if practitioners in the hospitals were aware of the majority of contradictory situations in the process of treatment.

Taking everything into consideration, it might be concluded that the notions of healthcare and legacy are interrelated to such an extent that they cause various controversies in terms of the healthcare’s major task – help and serve the community. Nowadays, to become a full-scale qualified practitioner, one is to take into account profound specialized knowledge, ethical concerns of the occupation, and legislative peculiarities of the treatment process and communication with patients. However, in a variety of cases, despite the developed healthcare policies foundation, it is the medical employee’s negligence that creates issues for the whole unit. Hence, the future implications of healthcare policy research should concern the peculiarities of human resources management within medical facilities.

References

Caudell, M. (2016). The process model and the stagnation of new public policy: an analysis of the Terri Schiavo case.

Frakes, M., & Jena, A. B. (2016). Does medical malpractice law improve health care quality? Journal of public economics, 143, 142-158. Iturralde v. Hilo Medical Center USA. [2012]. No. 28792.

Joshua, P., Churchill, L., & Kirshner, H. (2005). The Terri Schiavo case: legal, ethical, and medical perspectives. In Annals of Internal Medicine (10th ed., Vol. 143). Vanderbilt University.

Koskenvuori, J., Stolt, M., Suhonen, R., & Leino‐Kilpi, H. (2019). Healthcare professionals’ ethical competence: A scoping review. Nursing Open, 6(1), 5-17.

Légaré, F., Adekpedjou, R., Stacey, D., Turcotte, S., Kryworuchko, J., Graham, I. D., Lyddiatt, A., Politi, M. C., Thomson, R., Elwyn, G., & Donner‐Banzhoff, N. (2018). Interventions for increasing the use of shared decision-making by healthcare professionals. Cochrane Database of Systematic Reviews, 7.

Maher, N. A., Senders, J. T., Hulsbergen, A. F., Lamba, N., Parker, M., Onnela, J. P., Bredenoord, A. L., Smith, T. R., & Broekman, M. L. (2019). Passive data collection and use in healthcare: A systematic review of ethical issues. International journal of medical informatics, 129, 242-247.

Medical Malpractice Center. (n.d.). Hawaii medical malpractice laws.

O’Mathúna, D. P., Dranseika, V., & Gordijn, B. (2018). Disasters: core concepts and ethical theories. Springer Nature.

Phahlamohlaka, M. C., & Coetzee, M. (2018). CaseRank: Ranking case law using precedent and principal component analysis. In 2018 Conference on Information Communications Technology and Society (ICTAS) (pp. 1-6). IEEE.