IHP-420 - Week 7 - Final Project 1 Submission.docx - Final...

Final Project: Final Project 1 Submission
Jennifer D Coleman
Southern New Hampshire University
IHP-420 Ethical & Legal Considerations
June 21, 2019

Introduction
The case study presented is ITURRALDE v. HILO MEDICAL CENTER USA. In this
case, the plaintiff is Rosalinda Iturralde, the sister of the deceased patient, is representing the
Estate of Arturo Iturralde. The defendants are the Hilo Medical Center (HMC), Dr. Robert
Ricketson, and Medtronic Sofamor Danek USA, Inc. The plaintiff, Rosalinda Iturralde is suing
Hilo Medical Center, Hawaii Orthopaedics, Inc., Dr. Ricketson, and Medtronic Sofamor Danek
USA, Inc. for medical malpractice and negligence that led to the death of her brother Arturo
Iturralde. Arturo Iturralde reported to HMC in January of 2001 for an assessment following
several falls due to increasing weakness in his legs. Dr. Ricketson, an orthopedic surgeon,
assessed Arturo on January 24, 2001 and diagnosed him with degenerative spondylolisthesis L4-
5 with stenosis. This condition was exerting pressure on his nerves and could potentially be
relieved with a spinal fusion surgery. Under the direction of Dr. Ricketson, the surgery was
scheduled for Monday January 29, 2001. The HMC ordered an M8 Titanium CD Horizon Kit
from Medtronic which included all the necessary tools for the surgery including two titanium
implant rods that were vital for the surgery. Medtronic sent the kits in two shipments, one from
Memphis and the other came from Tulane. The shipments arrived to HMC on Saturday, January
27, 2001. The HMC staff didn’t complete an inventory of the contents of the package as they are
supposed to do in accordance with their policy. Knowing that the Kit hadn’t been inventoried, an
operating room was booked, and the available contents were prepped for surgery. Prior to the
surgery, nurse Vicky Barry, informed Dr. Ricketson that an inventory of the Kit was not
completed. Dr. Ricketson chose to proceed with the surgery, which is baffling. Over two hours
into the surgery, when it became time to implant the titanium rods, the staff notified Dr.
Ricketson that they could not locate the rods. The staff searched the hospital for the rods and

were unsuccessful in locating them. The staff then contacted a Medtronic sales representative,
Eric Hanson and he offered to bring the implant rods to the hospital within 90 minutes. Dr.
Ricketson states that he believed that the delay was too risky for the patient and proceeded to
improvise the surgery and use a 3-4 cm piece of a surgical stainless-steel screwdriver in place of
the titanium rods. He implanted the improvised section of the screwdriver into patient’s spine.
Dr. Ricketson and the HMC staff failed to notify Arturo or his family that a screwdriver shaft
was implanted in his spine rather than the titanium rods that he was told he would receive. Post-
operative instructions were given by Dr. Ricketson that Mr. Arturo should be walking and
undergoing physical therapy. The following day, Arturo sustained multiple falls, and this caused
the screwdriver shaft to shatter. Dr. Ricketson preformed another surgery on Arturo on February