Summarize the case Surgery: Iturralde v. Hilo Medical Center USA , including inf

Question

Summarize the case Surgery: Iturralde v. Hilo Medical Center USA , including information on the stakeholders involved, the problem, and the time period the incident occurred.

Explain the key legal components of the case, including the nature of the issue and the rules that applied. Determine relevant malpractice policies in place for addressing the issues within the case. Analyze the malpractice case for the standard of care provided to the victim. Be sure to apply what the law states about standard of care to support whether or not it was breached in the case. Analyze how the malpractice case would impact healthcare consumers from different cultural backgrounds. For example, would this case have a similar impact on a person from a culture different from the one in the case? How could this incident change the views of these healthcare consumers toward the healthcare system? Assess the malpractice case for accountability based on its severity. To what extent was the healthcare provider held accountable?

Explanation / Answer

Iturralde v. Hilo Medical Center USA

Case Summary

            Iturralde v. Hilo Medical Center, USA is a case that was decided on March 30, 2012 by the Intermediate Court of Appeals of Hawaii. The plaintiff, in the case, Iturralde, sued Dr. Robert Ricketson and Hilo Medical Center due to a medical malpractice that exposed the patient to health risks. According to Iturralde, the doctor acted below the standard of due care when he knowingly implanted a shaft of a screwdriver into his spine. Iturralde was diagnosed with degenerative spondylolisthesis L4-5 with stenosis, a condition which required a spinal fusion surgery. The doctor decided to use the shaft after he realized that the two titanium rods meant to be used for the operation were missing from the operating room at Hilo Medical Center. Later, the stainless steel screwdriver shafts snapped after being placed in the patient’s back, which led to further surgeries. Eventually, Iturralde died two years after the surgery in 2001. In the court, Dr. Ricketson denied that the level of care he had provided was below standard. The court ordered the hospital to pay $5.6 million to the family of the plaintiff and $3.4 million in punitive damages. This case was categorized as a case of negligence where the doctor was held liable or the death of Iturralde three years after the implantation.

Medical Malpractice Component

            Based on the case of Iturralde v. Hilo Medical Center USA, Dr. Ricketson was required to exercise a legal duty by performing in conformance to the set professional standards. By acting professionally, the doctor was not supposed to implement any decision that could cause arm to the health of the patient. However, Dr. Ricketson failed to confirm whether all the necessary equipment for the surgery were available in the operation room. This is regarded as one of the legal duties of a surgeon before conducting any form of surgery. Additionally, the doctor’ conduct reveals a high level of negligence upon a patient since he acted in a manner that deviate from the standards of care as recognized by the medical community. Dr. Ricketson resolved to the use of non-recommended equipment rather than the recommended titanium rods that were available in the hospital. The doctor’s malpractice and level of negligence is believed to have been the eventual cause of death of the patient who died three years after the surgery.

            Furthermore, due to Dr. Ricketson’s negligence, the non-party Hawaii Orthopedics Inc. was accused of negligence as a result of hiring Ricketson who a had a well-known past history. Dr. Ricketson had been dismissed from two health facilities due to malpractices. The death of Arturo Iturralde could not have occurred if Feldmeyer had alerted Hilo Medical Center administration about Dr. Ricketson’s poor code of conduct. According to Moore, Adler, and Robertson (2000), the malpractice policies propose that physicians have the ethical obligation of whistleblowing in case they feel that medial standards have been reached by medical practitioners. Feldmeyer was present during the start of the first surgery where Dr. Ricketson committed a major medical mistake. However, she decided to keep quiet and only spoke out when things had already gone bad. Also, health care facilities are required to take surgeons through a credentialing process and documenting their level of professional competence before employing them. The main reason for undertaking surgeons and physicians through the process is to ensure that they are mentally and physically healthy to offer their various services to the patients. In this case, Hilo Medical Center failed to put this into consideration and employed an unqualified surgeon in their facility.

            In addition, when Dr. Ricketson agreed to undertake a surgical operation on Iturralde, a legal duty of care was established between the two people. Every physician possess a duty of professional care to the patient in the process of providing their services. Dr. Ricketson was expected to use the right equipment rather than using the improvised screwdriver shafts that had not been recommended for human implantation. Therefore, by implanting the screwdriver shafts into Iturralde’s spine, the doctor breached his professional duty of providing quality service to the patient. The implantation of screwdriver shafts rather than titanium rods was an obvious breach of duty under the recommended standard of care. The incidence of negligence by Dr. Ricketson directly linked health care consumer’s state’s facilities with incapability and inefficiencies in addressing the needs of the patients. Thus, this contributed to a worse health outcome for the patient rather than improving his condition. This aligns to the notion that state-run health institutions are poorly managed and incompetent in their operations. Although Hilo Medical Center was partly responsible for the malpractice, Dr. Ricketson was more responsible for the wrong surgery.

            Healthcare consumers from different cultural backgrounds would be impacted differently with the malpractice evident in the case. For example, the consumers might lose trust in state-run healthcare facilities since they believe that such institutions are the source of problems rather than healing. Additionally, terminally ill patients and people suffering from chronic diseases may opt for the services of traditional healers. In this case, the patients believe that traditional treatment methods are safer and more reliable compared to those sought in modern healthcare facilities. Therefore, it is evident that malpractices in healthcare have different impacts to consumers from diverse backgrounds. As a result, it is imperative for all care providers and health institutions to maintain professionalism and adhere to professional standards. The malpractice case of accountability was evident when Dr. Ricketson failed to wait for the recommended titanium rods for implants. The staff working together with Dr. Ricketson could also be held liable for lack of accountability because she waited for things to go wrong in order to report the incident. As a result, it is the duty of healthcare professionals to remain accountable for their practices.

Ethical Component

            According to Barry et al (2004), surgeons are required by their professional code of conduct to look after the patient’s welfare by minimizing pain and suffering through all means possible. However, Moore, Pichert, Hickson and Federspiel (2006) assert that physicians are not always sure of what is deemed correct and right action to be undertaken in diverse situations. In many cases, physicians are faced with complicated ethical dilemmas particularly when it comes to choosing between two or more options. In reference to the current case, Dr. Ricketson thought that waiting for the nurse to bring the titanium rods for more than one and half hours would expose the patient to greater risk. Using his personal knowledge, the doctor decided to alleviate the suffering experienced by Iturralde who was fighting for his life. Ricketson resolved to the use of screwdriver shafts which he implanted into the spine of the patient. Ultimately, it is believed that the screwdriver shafts worsened the condition of the patient leading to death three years after the operation.

            Ethical theories are meant to guide the professional conduct of health practitioners in their respective fields. The ethical theories help in resolving issues and provision of quality, safe healthcare experience for the patients. In the case of Iturralde v. Hilo Medical Center, deontological ethics are applicable as they are based of justice, autonomy and beneficence to the patient. Therefore, the duties and obligations of the surgical doctor are of prime importance. Based on the case, Dr. Ricketson failed to adhere to the deontology ethics while attending to Iturralde. For example, Dr. Ricketson should have realized the fact that harm is unacceptable irrespective of the consequences. Therefore, resolving to use improvised screwdriver shafts instead of the recommended titanium rods was a poor decision which is discouraged in the healthcare sector. Breaching the deontological practice also put Hilo Medical Center in danger because families would not trust them with the lives of their loved ones. The traditions of deontological ethics require health practitioners to do good to their patients and strengthen the doctor-patient relationship. Additionally, the physician was required to show empathy, religiosity and perspective-taking in relation to the case of the patient. Therefore, balancing the key principles of deontological ethics would help healthcare practitioners to overcome most ethical and moral dilemmas.

            Physician-patient shared decision making models help healthcare practitioners to deliver quality health services to the patients. The physician should ensure that the model applied help in the provision of safe, quality healthcare experience for the patients. In this case, the most appropriate model is the Shared Decision Making Model (SDM Model) which involve a four-step decision making process (Elwyn et al 2012). Accountable health practitioners should often use this model when communicating with their patients and when deciding on the treatment plans to be used. The first step involves a brief background of the patient’s situation. The background knowledge is essential because the physicians will have a more accurate understanding of the harms, risks and benefits involved while following a specific decision. The less passive and undecided patients should be accompanied by representatives who are preferably family members to explain the condition of the patient.

            Next, the SDM model tests how well the structured decision making process can result to the best outcomes. Inadequate time and lack of resources may be a key barrier to understanding the requirements of the customer, which may ultimately lead to wrong medical decisions. Evidence-based practice is important at this stage for the physician to isolate the best treatment option available. In the case of Iturralde, the doctor failed to make an informed decisions which led him to choose a non-recommended treatment method that cost the life of the patient. Lastly, the physician should identify a suitable procedure to communicate the decision agreed to the eligible beneficiaries of the patient. In reference to the duty of care, the physician can be sued on negligence for failure to infirm the family about the alternative treatment plan agreed on in the healthcare facility. In the case, Dr. Ricketson did not explain that the recommended titanium rods for implantation were missing which violates the code of conduct. Therefore, it is evident that an effective physician-patient shred decisions making model can help in reducing medical malpractices.

            Ethical guidelines established by a healthcare facility can help in avoiding liability and preventing future incidents which put the lives of patients at stake. The implementation of these guidelines and policies will help in improving the health outcomes of patients and the professionalism of the medical staff as well as physicians. For example, the institution could employ a larger number of physical and specialists so that thy work collaboratively in treating patients. Most of the physicians who engage in malpractices do so because they lack consultation and colleagues who can easily clarify misunderstandings. Additionally, a larger number of health practitioners will help in whistleblowing in case one of them end up engaging in unethical practices. In the modern healthcare environment, the number of patients continue to increase, and hence the need to increase the number of practitioners in a health facility. Also, the institution could increase the specialty services to address the ever increasing needs of the society. For instance, Dr. Ricketson decided to risk the life of Arturo Iturralde because there number of waiting patients was large. By increasing specialty services as well as the number of staff providing such services would reduce malpractices in healthcare.

            Hilo Medical Center should also work in collaboration with the physicians to start an Integrated Provider Association (IPA) so as to align the staff and the medical center to the assumption of financial risk and health care delivery improvement. In this case, the interests of the patients should always come first where any unethical conducts lead to litigation. Provision of guidelines and policies in the healthcare facility would hold the providers accountable to themselves, the patients, their profession and the general public. In reference to the case, Dr. Ricketson could be held liable for the eventual death of the patient as he engaged in malpractices that contributed to it. Ethical guidelines could therefore, be implemented to avoid liability and provide a safe, quality healthcare environment.

Recommendations

            There are numerous strategies that could be implemented to help in improving medical practices and consequently avoid future liabilities. In order to avoid future liabilities, Hilo Medical Center could focus on hanging the existing recruitment policies and guidelines to make sure that doctors and other medical staff employed in the facility are competent and skilled accordingly. Employing individuals who are licensed to handle cases involving treatment should be a key consideration. Despite the belief that health care providers are trained in accordance with the requirements of medical practice and ethical guidelines, it would be advisable for the healthcare facility to conduct continuous training to its employees. Training the medical staff and the physicians in relation to the expected code of conduct would transfer all the liabilities to the practitioner rather than the institution. Based on the case of Iturralde v. Hilo Medical Center, Dr. Ricketson could be wholly liable for the malpractice litigation.

            Furthermore, employing eligible staff in the healthcare facility would ensure that all the individuals employed are competent and adequately skilled to handle diversified patient cases. The healthcare facility management should make sure that all the practitioners are aware of their practice and that they are dedicated towards the delivery of quality and safe healthcare experience. Adherence to an agreed code of conduct would see the hospital reduce malpractices because the health practitioners are conversant with the needs of the patients.

            The hospital should also introduce new programs that facilitate efficient and flawless communication within the work environment. The establishment of an effective communication program between nurses, technicians and the medical equipment store would ensure limited cases of malpractices. Based on the case, proper communication between the practitioners on duty could have enabled Dr. Ricketson to receive the recommended titanium rods for the implant. However, poor communication meant that it could take a minimum of one and half hours to assemble the right equipment into the operation room. Since the doctor feared worsening the condition of the patient, he ended up improvising the screwdriver shafts and implanted them in the spine of Mr. Iturralde, which caused his eventual death three years later. Also, proper communication program enhance decision making process in the healthcare facility and this helps the practitioners to uphold ethical standards. Hilo Medical Center as well as other healthcare facilities should ensure that their staff are well trained. Communication between the doctor and patient or his representative would ensure that they effectively understand everything about the intended treatment plans.

            Additionally, the institution should focus on establishing a superior cultural humanity where health practitioners have the ability to maintain interpersonal attitudes and the cultural identity of the patients. The course on cultural humanity should be refreshed on an annual basis to ensure advancement of knowledge and development of competent skills to handle people from diverse cultural backgrounds. To conclude, the recommended preventative strategies would help healthcare providers to avoid liability and provide a safe and quality healthcare experience to the patients. Also, this will help the institution to maintain a positive image in the face of consumers.

References

Barry, L., Blair, P. G., Cosgrove, E. M., Cruess, R. L., Cruess, S. R., Eastman, A. B., ... & Sachdeva, A. K. (2004). One year, and counting, after publication of our ACS “Code of Professional Conduct”. Journal of the American College of Surgeons, 199(5), 736-740.

Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., ... & Edwards, A. (2012). Shared decision making: a model for clinical practice. Journal of general internal medicine, 27(10), 1361-1367.

Moore, I. N., Pichert, J. W., Hickson, G. B., & Federspiel, C. (2006). Rethinking peer review: detecting and addressing medical malpractice claims risk. Vand. L. Rev., 59, 1175.

Moore, P. J., Adler, N. E., & Robertson, P. A. (2000). Medical malpractice: the effect of doctor-patient relations on medical patient perceptions and malpractice intentions. Western Journal of Medicine, 173(4), 244.

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