Introduction
The Iturralde v. Hilo Medical Center USA (2012) case can be summarized as follows. The incident is the death of Arturo Iturralde, who was admitted to the Hilo Medical Center (HMC) in January 2001 for increasing weakness in his legs (FindLaw, n.d., para. 4). After examining him, orthopedic physician Dr. Robert Ricketson scheduled him for spinal fusion surgery, which required inserting two rods into his spine (FindLaw, n.d.).
Dr. Ricketson directed HMC to order two titanium implant rods that were crucial for the surgery. However, the implant rods were not in stock, leading to a delay in the surgery. While waiting, Dr. Ricketson continued the surgery, opting for a screwdriver instead of the titanium rods.
Unfortunately, the screwdriver broke inside Arturo’s spine, causing severe injury, and Arturo died as a result of an infection. The main stakeholders of the case are Rosalinda Iturralde, who filed a lawsuit alleging wrongful death and negligent infliction of emotional distress, and the defendants: HMC, Dr. Ricketson, and the State of Hawaii (FindLaw, n.d.). These are the main facts that constitute the reviewed case.
Medical Malpractice
The nature of the case is a medical malpractice and product liability suit brought by Rosalinda Iturralde. Iturralde argues that Dr. Robert Ricketson deviated from the accepted standard of care by proceeding with the surgery using a screwdriver instead of the titanium rods, which caused injury and death of Arturo (FindLaw, n.d.). The case falls under the jurisdiction of the state of Hawaii. The court must consider the laws and regulations, such as the Hawaii Revised Statutes (HRS), to determine foreseeability and superseding cause (FindLaw, n.d.). These are the key legal components of the case.
The issues within the case can be addressed using the following relevant malpractice policies. Firstly, HRS § 663-10.5 (Supp . 2006) pertains to joint and several liabilities in tort cases (FindLaw, n.d.). Secondly, HRS § 663–15.5 (Supp . 2003) set a rule for reasonable faith settlement that bars a defendant from offsetting damages by an amount paid by a settling tortfeasor (FindLaw, n.d.). These policies can be considered the most relevant among those regulating the case.
Dr. Ricketson and HMC breached the standard of care provided to the victim. The standard of care is “the duty… to have the knowledge and skill ordinarily possessed, and to exercise the care and skill ordinarily used, by a [physician/nurse/specialty] practicing in the same field under similar circumstances” (Hawaiʻi Civil Jury Instructions, 2021). The jury determined that Dr. Ricketson and HMC shared blame for Arturo’s injuries and that their negligence played a significant role in those injuries (FindLaw, n.d.). Thus, both were negligent in their care of Arturo Iturralde.
The incident could create mistrust and skepticism towards the healthcare system among consumers from different cultural backgrounds, specifically non-English speaking patients and their families. As Iturralde did not speak English, his being an English speaker could have changed the nature of the case (FindLaw, n.d.). Therefore, non-English speaking patients may feel that their cultural and linguistic needs were not adequately addressed by the healthcare providers, making them less likely to seek medical attention when needed.To improve the quality of care for non-English speaking patients, healthcare providers should have robust policies to ensure that they provide appropriate language interpretation services.
Dr. Robert Ricketson and HMC were held accountable to a significant degree for the malpractice incident. The jury apportioned 65% of the fault to Dr. Ricketson and 35% to HMC. The Circuit Court adopted the jury’s apportionment of fault. It concluded that HMC and Dr. Ricketson were jointly and severally liable (FindLaw, n.d., para. 15). Furthermore, the jury awarded $307,000 in special damages to Arturo’s Estate, $1.7 million in general damages to the Estate, $170,000 in general damages to Rosalinda, and $3.4 million in punitive damages against Dr. Ricketson individually (FindLaw, n.d., para. 15). This underlines that the court and the jury viewed the incident seriously and attributed accountability to the defendants.
Ethics
Ethical Issues
The malpractice case raises several ethical issues that led to the incident. One of the key ethical issues in this case is the issue of informed consent. The patient, Arturo Iturralde, was not informed that Dr. Ricketson did not have the necessary implant rods in stock and that a screwdriver was used instead of the rods during the surgery. The ethical concept of autonomy, which states that patients possess the right to make educated decisions regarding their medical care, is violated by a lack of informed consent (Rus & Groselj, 2021). The ethical issues in this case ultimately led to the malpractice incident, as the healthcare provider’s failure to adhere to ethical principles resulted in harm and injury to the patient.
Bioethics Principles
One ethical theory that would help resolve the issues in this malpractice case is the principle-based ethical theory of bioethics. It is based on four fundamental principles, autonomy, beneficence, non-maleficence, and justice, which are the foundation for ethical healthcare decision-making (Rus & Groselj, 2021). The principle of autonomy in bioethics would ensure that the patient is informed of the risks and benefits of the proposed treatment (Rus & Groselj, 2021). In this case, if Dr. Ricketson had obtained informed consent from Arturo Iturralde before proceeding with the surgery, it would have ensured that the patient was fully aware of using a screwdriver instead of implant rods and the associated risks.
The principle of beneficence stipulates that healthcare professionals act in the patient’s best interests (Rus & Groselj, 2021).In addition, the principle of non-maleficence states that healthcare professionals take all necessary precautions to prevent harm (Rus & Groselj, 2021). If Dr. Ricketson had chosen not to proceed with the surgery when he did not have the necessary implant rods in stock, it would have prevented harm to the patient.
Finally, the principle of justice is similarly applicable to the case. Its essence is that healthcare needs to be distributed fairly among the patient population (Rus & Groselj, 2021). In this case, if HMC had proper systems in place to ensure that necessary equipment was available for surgeries, it would have prevented the harm caused by the unavailability of implant rods. These principles would serve as a framework for resolving ethical issues in healthcare and help ensure that incidents like this do not occur in the future.
Shared Decision-Making Model
One commonly used physician-patient shared decision-making model is the SHARE approach. This model focuses on the patient being informed and involved in the decision-making process by presenting them with a range of options and the potential risks and benefits of each option (Hargraves et al., 2020).In the malpractice case presented before, Dr. Ricketson could have implemented this shared decision-making model by, for example, discussing all the options available with Arturo and his family and the potential risks and benefits of each.
Preventive Ethical Guidelines
Specific ethical guidelines can be proposed to help the organization prevent future incidents. Implementing a straightforward informed consent process could help prevent incidents where patients are unaware of the risks associated with their treatment (Chenneville & Schwartz-Mette, 2020). Furthermore, implementing systems to ensure the equipment is maintained correctly could help prevent incidents where necessary equipment is unavailable, as seen in this case.
The proposed ethical guidelines would help to hold healthcare providers accountable to themselves, their profession, their patients, and the public in several ways. Healthcare providers would be held accountable to the patient by ensuring that they are educated about the risks and benefits of the proposed treatment and make an informed decision about their care (Chan et al., 2018). In this case, taking all necessary precautions to prevent harm would become necessary for healthcare providers, aiding their accountability (Vaismoradi et al., 2020). Therefore, healthcare providers must act in the patient’s best interests and do everything possible to prevent harm and promote well-being.
Recommendations
To avoid liability in the future, the healthcare provider could implement several preventative strategies, such as establishing and implementing clear policies and procedures that align with the principles of bioethics. These policies and procedures would ensure that healthcare professionals act in the patient’s best interests (Vaismoradi et al., 2020). For instance, Dr. Ricketson could have clearly explained the risks associated with using a screwdriver instead of the titanium rods and obtained written consent from the patient. Dr. Ricketson would no longer be liable for medical malpractice in this hypothetical scenario.
Conclusion
In summary, specific strategies can help the healthcare provider avoid liability and provide a safe, quality healthcare experience for the patient.Procedures for obtaining informed consent, double-checking equipment availability, seeking the help of a senior colleague or supervisor, and seeking out continuing education opportunities can be implemented (van Dijk et al., 2021).These strategies will ensure that the healthcare provider is operating at the highest standard of care, following best practices, and minimizing the potential for harm to the patient.
References
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Hawaiʻi Civil Jury Instructions. (2021). Hawaii State Judiciary. Web.
FindLaw. (n.d.). FindLaw’s Intermediate Court of Appeals of Hawaii case and opinions. Findlaw. Web.
Rus, M., & Groselj, U. (2021). Ethics of vaccination in childhood—a framework based on the four principles of biomedical ethics. Vaccines, 9(2), 113. Web.
Vaismoradi, M., Tella, S., A. Logan, P., Khakurel, J., & Vizcaya-Moreno, F. (2020). Nurses’ Adherence to patient safety principles: a systematic review. International Journal of Environmental Research and Public Health, 17(6), 2028. Web.