Introduction
Surgery requires high skills and well-coordinated work, but mistakes and violations of practice standards occur. In the Iturralde v. Hilo Medical Center USA (2012), plaintiff Rosalinda Iturralde represents her brother’s interests, Arturo Iturralde. She opposes the Hilo Medical Center (HMC) and its surgeon, Robert Ricketson. Arturo Iturralde became an HMC patient due to spondylolisthesis with stenosis in 2001. Dr. Ricketson scheduled surgery and ordered the necessary tools, including titanium implantation rods.
The instruments came in two parcels and were not thoroughly checked. During the surgery, specialists noticed an absence of the necessary rods. Dr. Ricketson decided not to wait for the new titanium rods the supplier proposed to deliver and made ones from stainless steel screwdrivers. Such actions led to the rods’ breakdown, additional intervention to replace them, health problems, and Iturralde’s death in 2003. The specialists’ actions violate the legal and ethical standards of practice, so HMC needs to change its work.
Medical Malpractice Component
Key Legal Components
Determining the nature of the problem in the presented case requires an analysis of its legal components. The judgment will be built on “duty, dereliction or breach of duty, direct or proximate cause, and damages or injuries” (Fremgen, 2019, p. 125). The duty component suggests using reasonable measures from specialists that other professionals would apply in similar circumstances (Fremgen, 2019).
In the considered case, such actions include inventorying tools before the operation and waiting for approved titanium rods. The dereliction component suggests that the specialist did not perform the duty or act reasonably (Fremgen, 2019). Dr. Ricketson decided to improvise and apply an unapproved method instead of checking the tools and waiting for the necessary ones, which indicates a breach.
The remaining two components analyze the causal relationships in the case. In assessing a direct cause, it is essential to consider whether the specialist’s actions led to the problem. Although some of Iturralde’s health outcomes were due to his previous conditions, Ricketson’s actions worsened the patient’s health. The res ipsa loquitur rule applies, and there would be no such problems without the specialist’s wrong actions (Fremgen, 2019).
The surgeon’s actions led to harm, for which the surgeon had to pay compensation (White, 2006). This fact means the presence of the last of the components – damage. Consequently, the four described components establish that the nature of the problem is negligence.
Relevant Malpractice Policies
Since neglect and the need for compensation were proven, malpractice policy application is possible. It implies insurance, which is owned by specialists and can cover the cost of compensation for damage in the case of a malpractice claim (Fremgen, 2019). While such insurance can be expensive, especially for specialists in surgery, it is required in many states and can facilitate compensation payments. The court ordered Dr. Ricketson to pay compensation, and due to a lack of insurance, the amount is significant (White, 2006). He was disadvantaged, neglecting his duties and being inattentive to malpractice policies.
Breach of Standard of Care
Hospital patients expect a certain standard of care, which was not provided in the considered case. As a legal concept, the standard of care defines the actions of a specialist (Vanderpool, 2021). Each jurisdiction can set its standards, but the majority follow national ones, setting measures that can be “recognized as acceptable and appropriate by reasonably prudent similar health care providers” (Vanderpool, 2021, p. 50).
The laws also establish that standard violation occurs when negligence is proven (Vanderpool, 2021). Dr. Ricketson violated the standard by failing to prepare for surgery, using disapproved methods, and failing to report problems. Moreover, the surgeon did not receive the patient’s consent to changes in treatment. The established nature of negligence by evaluating legal components also confirms the breach.
Impact on Healthcare Consumers from Different Cultural Backgrounds
Medical professionals encounter patients from multiple cultures, and their differences can significantly affect outcomes, even in cases like Iturralde v. Hilo Medical Center USA. For example, neglecting patients from minorities and other countries would demonstrate the staff’s cultural incompetence and bias. Such aspects of culture as language can cause misunderstandings and difficulties in communication between providers and patients.
Moreover, patients’ cultural and religious views influence their perception of the situation. Some cultures do not allow specific surgical interventions or may consider the outcome in terms of fate or divine influence rather than specialist action. Therefore, medical staff must understand how to approach patients of diverse cultural backgrounds.
Accountability
After considering the case, the jury and court distributed responsibility and payments. Following the jury, HMC’s liability was 35%, and the surgeon’s responsibility was 65% (Iturralde v. Hilo Medical Center USA, 2012). The center is liable since the administration did not check Ricketson’s reliability and competence, ignored the ban on practice for this specialist in several states, and could not maintain safety and accountability.
The surgeon violated his duties and legal and ethical requirements for the practice, which imposes responsibility on him. The defendants had to pay $5.6 million, of which $2.2 million was compensation and $3.4 million was punitive damages (White, 2006). The court changed the distribution of liability by assigning 75% to the patient’s preexisting conditions and 25% to HMC and Dr. Ricketson, and their joint damage liability reached $500,000 (Iturralde v. Hilo Medical Center USA, 2012). Such decisions required a thorough investigation, attention to detail, and expert opinion.
Ethical Component
Ethical Issues
In addition to the standards of practice, ethical norms support the relationship between patients and providers. The fundamental ethical principles in healthcare are nonmaleficence, autonomy, justice, and beneficence (Varkey, 2021). Understanding ethics makes practice more honest and compassionate, but Dr. Ricketson has failed to follow its norms. His actions violated the principles of beneficence and nonmaleficence since the non-approved rods led to harm and negative consequences for the patient.
Standard of practice breach also indicates a violation of justice since the attitude towards Iturralde was not as it should be for all patients. Finally, there were autonomy violations, not allowing Itturalde to decide about his treatment. Dr. Ricketson did not report changes in surgery before and after using stainless steel rods and did not involve the patient in the decision-making.
Ethical Theory
Adherence to standards and ethical principles of practice would help to solve the identified issues and provide safe, quality services. This approach is consistent with the application of duty-based ethical theory, also called deontology, which implies the need for specialists to focus on duties and principles in their actions (Hindocha & Badea, 2022). For example, following his duties, the surgeon would check for the necessary tools and not use risky rod replacements. Adhering to ethical principles, he would also apply measures to prevent harm, obtain consent for changes in treatment, and provide the patient with all information related to surgery.
Shared Decision-Making Model
HMC needs a physician-patient shared decision-making model to maintain service quality. Joint decision-making supports the ethics of practice, especially the principle of autonomy. An effective model is the interprofessional shared decision-making model, which involves several specialists, the patient’s family, and the provider and patient (Waldron et al., 2020). Following the model’s steps, it is necessary to determine the decision to make, discuss available information and patient preferences, assess and select preferred options, and implement treatment (Waldron et al., 2020). Such a model is flexible and patient-centered and significantly informs and involves patients, contributing to the safety and ethics of treatment.
Ethical Guidelines
Given the identified problems and the possibility of preventing their recurrence, one may propose an ethical guide for HMC. The hiring supports the practice’s ethics, so the center needs to check candidates’ competencies and professional backgrounds. Following ethical and professional standards, employees should check surgery tools, avoid disapproved methods, and apply shared decision-making and informed consent in patient care. Such actions correspond to duty-based ethics and maintain ethical principles of practice.
Defending Accountability
Compliance with ethical guidance will also support providers’ accountability. Having ensured its employees’ professionalism, the center will be ready to confirm their reliability and confidence in their actions. Following ethical principles and standards, the surgeon and care team would be able to ensure the transparency of their actions and confirm that they have taken the necessary measures to prevent harm. Consequently, employees would show patients and society that they are dedicated to their profession and willing to take responsibility.
Recommendations on Preventive Strategies
Several strategies could help HMC avoid liability in the future. Implementing recruitment and selection strategies to hire the best candidates is essential. All employees must understand the standards and ethical principles of practice and the specifics of their application, which can be implemented through training and reporting. Center specialists also need to develop team communication skills and patient interaction. The center can also change existing policies and implement additional protocols to support employees’ duties to follow ethical principles and standards.
These strategies will contribute to the safety of practice and thereby deter liability. For example, knowledge and reminders of standards and principles will guide employee actions. Improved communication within the team and with patients will make care more effective. Surgery protocols will help the team ensure they have all the necessary tools and reduce risks. Therefore, the center needs to analyze its errors and implement problem-solving strategies.
References
Fremgen, B. F. (2019). Medical law and ethics (6th ed.). Pearson.
Hindocha, S., & Badea, C. (2022). Moral exemplars for the virtuous machine: The clinician’s role in ethical artificial intelligence for healthcare. AI and Ethics, 2(1), 167-175. Web.
Iturralde v. Hilo Medical Center USA, No. 28792 (3rd Cir. 2012). Web.
Vanderpool, D. (2021). The standard of care. Innovations in Clinical Neuroscience, 18(7-9), 50–51. Web.
Waldron, T., Carr, T., McMullen, L., Westhorp, G., Duncan, V., Neufeld, S. M., Bandura, L. A., & Groot, G. (2020). Development of a program theory for shared decision-making: A realist synthesis. BMC Health Services Research, 20(1), 1-17. Web.
White, N. (2006). Hawaiian jury finds doctor liable for inserting screwdriver in patient’s spine. Lawyers Weekly USA. Web.