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Final Project I: Malpractice Case
William J Pesillo III
Nursing, Southern New Hampshire University
IHP-420 – Ethical and Legal Considerations
John Rhodes
April 19, 2020
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Final Project I: Malpractice Case
Introduction
Summary
Rosalinda Iturralde, Arturo’s younger sister and caretaker, is representing the Estate of
Arturo Iturralde in the case of Iturralde v. Hilo Medical Center USA. Rosalinda is suing
Medtronic supplies, Robert Ricketson, M.D., and Hilo Medical Center USA (HMC) for the death
of her brother Arturo Iturralde. In January of 2001 Arturo Iturralde was admitted to HMC to be
seen for increasing weakness in both of his legs which had caused multiple falls. He was seen by
Robert Ricketson, M.D., an orthopedic surgeon at HMC, who diagnosed Arturo with
degenerative spondylolisthesis L4-L5 with stenosis. This condition required a spinal fusion to
release pressure off the nerves to alleviate the symptoms. This procedure includes implanting
two titanium rods into the spine to form a bilateral fixation. The rods come in a kit called the M8
Titanium CD Horizon Kit that Dr. Ricketson ordered to be available for the procedure the
following Monday, January 29
th
. Medtronic was the company Dr. Ricketson ordered the kit from
but, they didn’t have the instrument portion of the kit in stock at their Memphis location, so they
sent two separate orders from two different facilities, one from Memphis and one from Tulane.
Both shipments were received the same day, on Saturday, January 27
th
. Both kits were then
sterilized and sent to the operating room without being inventoried by HMC staff, which was
against HMC policy. Before the surgery, Nurse Vicky Barry advised Dr. Ricketson that the kits
have not been inventoried, but Dr. Ricketson proceeded with the surgery anyways. After Dr.
Ricketson removed portions of Arturo’s vertebrae in preparation for the rod implantation. Over
two hours into the surgery Dr. Ricketson was ready to implant the two titanium rods into Arturo’s
spine but, surgical staff informed Dr. Ricketson that they couldn’t locate the rods. Staff engaged
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in an extensive search throughout the hospital and could not find any available. Eric Hanson, a
Medtronic sales representative in Honolulu was contacted by HMC staff to confirm whether the
rods have been shipped in the kits. Eric Hanson couldn’t immediately confirm if the rods have
been shipped but offered to personally deliver them to HMC within ninety minutes. Dr.
Ricketson believed that the delay was too risky for Arturo, so he proceeded with the surgery
without the rods. Dr Ricketson cut a three to four-centimeter section from the shaft of a surgical,
stainless steel screwdriver that was included in the kit. Dr. Ricketson implanted the cut section
into Arturo’s spine creating an improvised unilateral rod. The screwdriver shaft was not intended
or approved for human implantation. HMC didn’t inform Arturo of the screwdriver shaft that
implanted into his spine and post-operative orders were ordered from Dr. Ricketson to start
physical therapy and begin walking. During the next day Arturo sustained multiple falls that
