Ethical issue


Case summary
The case Surgery: Iturralde v. Hilo Medical Center, USA describes a situation where Decedent Arturo Iturralde was admitted to Hilo Medical Center (HMC), a health facility owned and operated by the
state in Hilo, following a problem with her legs that were continually becoming weak. This was in January 2001 when Arturo was examined by Dr. Ricketson, a credentialized orthopedic surgeon after
which the patient was diagnosed with degenerative spondylolisthesis L4–5 with stenosis. The condition required a spinal fusion surgery to be performed by implanting two rods into the patient’s
spine which was available at the hospital.
Feeling that waiting for that long would be risky for the patient, he improvised the two rods by cutting a steel screwdriver into two pieces which implanted into Arturo’s spine. During the next
day, Arturo fell once or twice, leading to shattering of the screw shafts. On February 5, 2001, he returned for three additional surgeries in order to replace the screwdriver with the expected
titanium rods. After he was discharged from the hospital, Arturo died on June 18, 2003, as a result of urosepsis complications. Consequently, the family was awarded $5.6 million following a jury
that accused both the Hilo medical center and Dr. Ricketson of being negligent.
Medical malpractice component
In the case of Iturralde v. Hilo Medical Center, USA, Dr. Ricketson had a legal duty to operate Arturo in a professional manner and in a way that may not cause any harm to his health. He never
first confirmed whether the surgery equipment was available before commencing the surgery, which in one or another was in contrary to the legal duties of surgeons. In addition, Dr. Ricketson’s
conduct reveals negligence upon the patient by acting in a manner that “deviates from the standards of care in the medical community” (Calisi, 2017; par 2). The surgeon resolved to use of
improvised screwdriver strands rather than the recommended titanium rods. It is believed that the negligence of Dr. Ricketson is responsible for the death of his patient three years after the
surgery. In addition to Dr. Ricketson’s negligence, the non-Party Hawaii Orthopaedics, Inc was also accused of negligence because of hiring Dr. Ricketson who they knew was not fit for the job
having been chased in two health facilities.
Such a case could not have occurred if Feldmeyer had alerted the hospital administration about Dr. Ricketson’s code of conduct. This is in accordance with one of the various malpractice policies
that second-opinion physicians possess an ethical obligation to whistle blow if he/she feels that the standard of treatment has been breached by a medical practitioner (Moore, 2017). Despite the
fact that Feldmeyer was present during the start of the initial surgery, she just decided to keep quiet only to speak out when things had already gone bad. In addition, it is a requirement before
any health care facility employing a surgeon to take him/her through a credentialing process, document his professional competence and ensure he is physically and mentally healthy to offer services
to patients. Nevertheless, did not Hilo Medical Center put this into consideration and it could have saved the situation by not having unqualified surgeons in the facility.
When Dr. Ricketson agreed to operate Arturo, a legal duty was established between him and the patient, and in the provision of services, a physician possesses a duty of professional care to the
patient. In this respect, Dr. Ricketson was expected to use the right titanium rods rather than the improvised screwdriver rods that were not recommendable for human implantation. By implanting
screwdriver rods into Arturo’s spine, Dr. Ricketson breached the professional duty to provide care to his patient since he never delivered the standard of care which although can be defined
differently in various jurisdictions is what any other surgeon would have executed his/her duties in performing the surgery to Arturo (Bal, 2009). Therefore, implanting screwdriver rods rather than
titanium rods is an obvious breach of duty that is self-spoken.
Dr. Ricketson’s case of negligence would lead to health care consumers associating state’s facilities with inefficiency and in-capabilities to an extent to making a patient’s condition worse rather
than helping them recover. This is in line with the notion that state-run institutions are poorly run and inefficient in their operations. While people from different cultures may have a different
translation of the case above, some other people would even resolve traditional treatment methods which they believe could be more careful and true in their service. An incidence such as the one
discussed in Iturralde v. Hilo Medical Center, USA can result in the public losing trust in state-run health care facilities which they believe can be a source of problems rather than healing.
Although HMC was to some extent accountable of the surgery gone bad, it was Dr. Ricketson’s big mistake not to adhere what was to be done in the practice. That could the reason why the jury
allocated 65% of the fault to Dr. Ricketson and 35% proportion to HMC (, 2012).
Ethical component
According to Torjuul, Nordam & Sorlie (2005), physicians are never sure of what is deemed as correct and right actions to be taken upon patients in different situations. While surgeons are expected
to look for patients’ welfare and minimize pain and suffering as much as possible (Pandit & Pandit, 2009), they are faced with difficult ethical dilemmas as well as decision making because they
have to choose between two or more options Torjuul, Nordam & Sorlie (2005). In the case at hand, Dr. Ricketson thought waiting for the titanium rods for one and half hours was risky for the
patient. Much concerned to alleviate suffering and fighting to save Arturo life, Dr. Ricketson resolved to improvise a screwdriver to come up with the rods to be implanted into Arturo’s spine,
which is believed to have worsened the patient’s condition and subsequent death three years down the line.
In order to prevent liability issues in the future, HMC could change its employment policies to ensure that physicians and health care providers employed in the facility are competent and skilled
enough to handle all cases involving treatment. Although it is believed that health care providers and staff are well trained to the standard of care and also ethical guidelines, it would be good
to conduct continuous training on the expected code of conduct and state clearly in the code of conduct that every practitioner is held wholly liable for all malpractice litigations. Employing
eligible employees would ensure that people employed in the health care facility are competent enough and skilled to handle patient cases. In addition, with the practitioners being aware that they
are responsible for their own actions, they will be much more careful in their practice and ensure that they provide a safe, quality healthcare experience to their patients.


In this project, you will analyze a court case involving medical malpractice (Please see attachment for case). You will use the facts from the original case to identify an ethics issue, determine
an ethical theory that would help provide a safe and quality healthcare experience for the patient, and apply a clinician–patient shared decision-making model.

Ethical Component: In this section, you will evaluate the case to identify the specific ethical issues and determine ethical theories and shared decisionmaking models that would help resolve the
issue and provide a safe, quality healthcare experience. Then, you will propose and defend ethical guidelines for healthcare providers to follow in order to avoid future incidents.

A.Describe the ethical issues that led to the malpractice case and explain why the issues are credited with causing the incident. Support your response with research and relevant examples from the
B. Describe an ethical theory that would help resolve the issue and provide a safe, quality healthcare experience for the patient. Support your response with research and relevant examples from the
C. Select a physician–patient shared decision-making model and explain how it would provide a safe, quality healthcare experience for the patient
D. Propose ethical guidelines that would have helped prevent the incident and would help the organization prevent future incidents.
E. Defend how your proposed ethical guidelines will hold healthcare providers accountable to themselves, their profession, their patients, and the public.


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