Iturralde V. Hilo Medical Center Summary

Iturralde v. Hilo Medical Center (HMC) is a medical malpractice case brought about by a representative for the Estate of Arturo Iturralde. The plaintiff, Rosalind Iturralde, is suing both HMC and Dr. Ricketson individually and as a representative for Arturo Iturralde’s Estate. The Defendants are HMC, Medtronic Sofamor Danek and Robert Ricketson, M.D. This case was brought about as a result of gross negligence and malpractice on the parts of HMC and Dr. Ricketson. During spinal surgery on January 29, 2001, Dr. Ricketson implanted a portion of a stainless steel, surgical screwdriver shaft into the spine of Aurturo Iturralde. This screwdriver shaft was not intended or approved for human implantation. HMC staff failed to inventory the surgical

kit prior to surgery and it was missing the appropriate titanium rods. Additionally, Dr. Ricketson, nor HMC staff notified the patient of the screwdriver shaft being implanted. The following day, during physical therapy, Aurturo fell causing the screwdriver shaft to shatter. On February 5, 2001, Aurturo was operated on again by Dr. Ricketson to remove the shaft and implant the proper titanium rods. After being discharged from the hospital, Aurturo’s health declined and he was no longer able to function independently, requiring catheterization. Furthermore, he needed two additional revision surgeries to repair the rods. After suffering multiple catheter infections, he passed away on June 18, 2003 from complications of urosepsis. (Iturralde, 2013)
Medical Malpractice Component
Legal Components
The key legal components of this case are the issue, rule(s), application and conclusion. The issues pertaining to the case are is the Circuit Court erred in:
• Awarding joint and several damages against HMC in the amount different from the amount awarded by the jury against Dr. Ricketson.
• Adopting Medtronic’s proposed jury instructions and special verdict interrogatory on foreseeability and suspending cause.
• Failing to hold HMC jointly liable for damages awarded to Rosalinda for negligent infliction of emotional distress (NIED)
• Failing to apply Hawaii Revised Statute HRS § 663-10.5 as amended, to preclude HMC from being held jointly and severally liable in tort.
• Failing to offset the judgement against HMC by the good-faith settlement of non-party Hawaii Orthopaedic, INC. (Iturralde, 2013)
The rules that applied to this case were that (4) the Circuit court did not error in holding HMC jointly and severally liable and the Estate of Aurturo was entitled to recover damages. (5) The Circuit Court did however, error in deciding HMC was not entitled to offset its damages. HMC cannot be a joint tortfeasors with Hawaii Orthopsedics because employer and employee are joint tortfeasors with each other, they cannot also be joint tortfeasors with anyone else. (1) Since HMC is part of a State agency and the State waived its Sovereign Immunity, it limited it’s liability to an amount determined by a judge and not a jury. (2) The wording used in the Circuit Court's instruction states:
“If the act was a normal consequence of the situation created by defendant's conduct, then said act is not a superseding cause.

Without clarifying the instruction, it was suggested that if the behavior is not what a reasonable person would consider to be a “normal consequence” of the situation created by defendant's conduct, then said intervening act is a superseding cause. Consequently, it does not convey the relevant standard—whether the probability of harm is “sufficiently serious that a reasonable and prudent person would take precautions to avoid it.” (Iturralde, 2013)
This language made is favorable for the jury to consider Dr. Ricketson’s negligence as not foreseeable. The rule for the NIED claim relates to “the alleged actual injury is for psychological distress alone,” and NIED claim achieves compensation for “persons who have sustained emotional injuries attributable to the wrongful conduct of others.” (Iturralde, 2013) Which would apply to Rosalinda because she was Aurturo’s caregiver.
Malpractice Policies
In the State of Hawaii, there exists a Medical Liability/Malpractice Joint and Several Liabilities Statute. This allows people to pursue a civil lawsuit against a physician(s) or other health care providers. It allows people to sue for damages in the event of an injury or death as a result of negligent behavior. In order to recover damages, a person must establish the following:
1. The physician owed a duty to the patient
2. The standard of care and the breach of

that standard
3. A compensable injury
4. The violation of the standard of care resulted in harm to the patient. (Morton, 2014)
Under this statue in these types of malpractice cases, the plaintiff may recover damages from all of the defendants in proportion to the amount awarded by the court.
Standard of Care
There was undoubtedly a breach in standard of care in this case. Dr. Ricketson failed to act in the same manner as a similarly trained physician when he implanted the screwdriver shaft, which was not intended or approved for human implantation. Additionally, he failed to notify the patient of this which is also substandard care.
Hawaii’s General Negligence Law states that a plaintiff must meet specific criteria in order to have a negligence case.
1. Duty: The doctor/hospital owed the patient a duty of care
2.

Breach of Duty: The doctor/hospital failed to meet that duty
3. Cause in Fact: As a result of the doctor’s/hospital’s failure, the patient would not have been injured
4. Proximate Cause: The doctor’s/hospital’s failure (and not something else) caused the patient’s injury and
5. Damages: The patient has actually been injured and suffered some loss.
Hawaiian Laws also contain a doctrine known as contributory negligence. This means a plaintiff cannot recover damages if he or she is more at fault that the defendant. Furthermore, any possible monetary recovery will be decreased in proportion to the plaintiff’s proved fault. (FindLaw, n.d.)
Cultural Backgrounds
Racial and ethnic inequalities in healthcare results in non-white patients receiving lower quality care that White patients. Additionally, people who speak limited English encounter more communication issues with doctors and nurses that people whose primary language is English. (AHRQ, 2011). Consequently, as people with chronic conditions utilize more healthcare services, they are more likely to complain of issues with the doctor-patient relationship. They feel as though they are not able to participate in their care, their doctors do not allow them to contribute to their medical decisions and they feel like doctors are not disclosing all information related to care. People who encounter this type of cultural ignorance become dissatisfied with their treatment and overall healthcare experience and are at high risk for negative

health outcomes. (Georgetown, 2004)
Of the three defendants in this case, two were found to be liable. Dr. Ricketson and Hilo Medical Center were both guilty of negligence and their negligence was a contributing factor in the harm that was done to Aurturo. Dr Ricketson was assigned the highest percentage of blame at 65% because he was directly involved with behavior that resulted in malpractice. HMC was assigned a smaller percentage of blame because given the disciplinary actions against Dr Ricketson’s license and HMC’s inadequate credentialing procedures he was still hired.