IHP 420 3-2 Final Project Milestone One Malpractice Case.docx - 1 Milestone One Malpractice Case Summary Medical malpractice case No 28792 involved

IHP 420 3-2 Final Project Milestone One Malpractice Case.docx

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Milestone One: Malpractice Case Summary Medical malpractice case No. 28792 involved Rosalinda Iturralde as the plaintiff, representing the estate of the late Arturo Iturralde. The defendants are identified as Hilo Medical Center, Medtronic Sofamor Danek, USA, and Robert Ricketson, M.D. Arturo Iturralde was admitted to Hilo Medical Center, USA in January of 2001 for assessment of increasing leg weakness that resulted in several falls. He was assessed by Dr. Robert Ricketson, an orthopedic surgeon that diagnosed Arturo with degenerative spondylolisthesis L4-5 with stenosis. Dr. Ricketson recommended spinal fusion surgery which involved the implantation of two rods into the spine. Arturo consented to surgery on 1/29/2001. Dr. Ricketson directed HMC staff to order an M8 Titanium CD Horizon Kit for surgery; which should have contained all necessary instruments and tools. But the company which fulfills orders, Medtronic, did not have the instrument portion of the kit in stock and therefore sent the order in two shipments. Both shipments arrived on 1/27/2001. Although the contents were sterilized and sent to the operating room, no staff completed an inventory of contents of the two shipments as required by HMC policy. Prior to surgery initiation, nurse Vicki Barry advised Dr. Ricketson that an inventory had not be completed. He decided to procced. Portions of Arturo’s vertebrae were removed in preparation for rod implantation. When Dr. Ricketson was ready to implant two the titanium rods, surgical staff informed him that the rods could not be located. Several staff testified that an extensive searched was conducted throughout the hospital but did not produce the rods. A Medtronic sales representative names Eric Hanson was contacted but he could not definitively confirm the rods were shipped. Eric offered to personally deliver the rods which he had 1
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available, to HMC within ninety minutes. Dr. Ricketson testified that he believed a ninety-minute delay was too risky and instead proceeded with the procedure without the titanium rods. Instead Dr. Ricketson cut a three to four centimeter section from the shaft of a surgical, stainless steel screwdriver that was included in the kid, and implanted the shaft into Arturo’s spine; creating an improvised unilateral rod. This screwdriver shaft was not intended or approved for human implantation.
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