Ethics of Iturralde v. Hilo Medical Center Case

Topic: Medical Ethics
Words: 921 Pages: 3


This paper analyzes a court case involving medical malpractice in terms of ethics. The sides of the case include the patient, the doctor, and the governmental medical center. Arturo Iturralde went to Hilo Medical Center because of increasing weakness in his leg and was diagnosed on January 24, 2001. The diagnosis was given by Dr. Ricketson, an orthopedic surgeon, with degenerative spondylolisthesis, L4-L5 with stenosis. Arturo Iturralde required a spinal fusion surgery that involved implanting two rods into the spine to form a bilateral fixation. A special kit containing tools and the two titanium rods implants were ordered by HMC from Medtronic for the surgery per Dr. Ricketson’s request. The kit was shipped in two parcels and was received by HCM on January 27, but no inventory was conducted by the staff to verify the content of the kit.

Dr. Ricketson proceeded to the surgery although he was informed by a nurse that the inventory of the kit was not completed. During the operation, he realized the titanium rods, necessary for the operation, were missing from the kit. Thus, he forged rods with a stainless screwdriver and fused them into Iturralde’s back. The screwdriver shaft was not intended or approved for human implantation. After the surgery, HMC personnel did not inform Arturo that a screwdriver shaft had been implanted in his spine. The day after the surgery, Iturralde fell at least once, breaking the screwdriver shaft segment in his back.

In a week, on February 5, 2001, Dr. Ricketson operated Arturo for the second time to remove screwdriver pieces and implant proper titanium rods. The assisting nurse obtained the shaft and delivered it to the attorney’s office. The titanium rods eventually became dislodged, the patient had two more operations and died in June 2003 from the consequences of urosepsis. The patient’s sister started a lawsuit against the hospital, Dr. Ricketson, and other personnel that was aware of the case.

Ethical Issues

In this case, the patient-physician relationship shows several ethical issues such as patient rights and patient safety. According to Bookman and Zane (2020), this relationship requires professionalism, ethical conduct, extensive skill and training, and confidentiality. The rights any patient owns are the right to receive a good-quality treatment, to agree and disagree on any intervention in the body, to refuse treatment despite any medical advice, to know the information about his disease, and the process of treatment. Patient Iturralde did not receive the information about the implant or the doctor’s decision during the operation. The other ethical issue is the safety of the patient. As the material was not approved in terms of medical usage, it could never have been used by a doctor. Any patient has a right to be treated with high-quality tools and medications. However, in this case, both ethical issues were not achieved.

Ethical Theory

To provide a safe, quality healthcare experience for the patient, any physician should follow the deontology principles. Aiming to the interest of the patient, and his or her benefit, making morally correct actions can lead to resolving the issue. If Dr. Ricketson had been following deontological ethics, he would have never decided on continuing the operation after finding the lack of the necessary equipment. The physician was more likely following consequentialism rules, according to which human practices that produce good eventually are morally right. Dr. Ricketson did not seem to have good intentions as a result of the operation. On the opposite, he wanted to reach a good outcome and use creativity and flexibility. Even if sometimes it can be hard for a practitioner to ascertain which principles should take priority, deontology’s preference for generalizable rules is a helpful way to determine which principles are most fundamental (Goldsmith & Burton, 2017). Still, a doctor’s degree obliges Ricketson to focus on the patient’s good and safety, and the decision made cannot be justified.

Physician-Patient Shared Decision-Making

Good communication between a patient and a doctor is also good medical ethics. For good communication, a relationship of trust should be performed because the physician can be engaged in the patient’s problems faster and deeper. For a patient, it is important to feel that his or her autonomy is guaranteed. Protection of rights, freedom, and safety plays an essential role in a patient’s faith. The Decision-making process should include both the physician and the patient while the first one provides relevant information about the disease and the other one is actively involved in the discussion. According to Bae (2017), the higher the level of patient participation, the stronger the patient self-monitoring and the higher the treatment safety is. The choice made by a doctor and a patient should be patient-centered and focus on the characteristics of the last one.

Ethical Guidelines

To provide a safe high-quality treatment experience, the doctor should never risk the patient’s health. The Nonmaleficence principle is essential in everyday physician practice because the final aim of any doctor is to improve the health, not to harm it. In this case, Dr. Ricketson took a risk during the operation, improvising by making a rod from a material that was not approved for the interstation in a human body. As a result, the outcome of these manipulations harmed patients’ health. Along with avoiding risk, the strategy of a doctor should be focusing on the patient and his character, building a faith relationship, and sharing information about his status, disease, and possible ways of treatment. Showing professionalism, and providing relevant knowledge can form trust with the patient and lead to a better outcome.


Bae, J. M. (2017). Shared decision making: Relevant concepts and facilitating strategies. Epidemiology and Health, 39, e2017048.

Bookman, K., & Zane, R. D. (2020). Surviving a medical malpractice lawsuit. Emergency Medicine Clinics of North America, 38(2), 539-548.

Goldsmith, L., & Burton, E. (2017). Why teaching ethics to AI practitioners is important. Proceedings of the AAAI Conference on Artificial Intelligence, 31(1), 4836-4840. Web.

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