course material

1. 7-2 Final Project I Submission: Malpractice
IHP 420 Milestone One Denise Vazquez Southern New Hampshire University I.
Introduction: A. Summarize. Iturralde v. Hilo Medical Center USA was a lawsuit filed on
January 24, 2001, against Hilo Medical Center (HMC), Medtronic Sofamor Danek, and Dr.
Robert Ricketson, M.D as the defendants, by the plaintiff, Ms. Rosalinda Iturralde
(Rosalinda) who appeared both personally and on behalf of the estate of Mr. Arturo
Iturralde (Arturo). Prior to the case, Arturo was admitted to HMC after several occasions of
falls, resulting primarily from his bilateral lower extremity weakness. Dr. Ricketson
diagnosed him with degenerative spondylolisthesis of his L4-L5 vertebrae. He advised
Arturo that the best intervention would be a spinal fusion surgery in which titanium rods
are placed into the patient’s spine. Arturo agreed. Dr. Ricketson ordered an M8 Titanium CD
Horizon Kit from HMC. However, on the material day, Dr. Ricketson placed a stainlesssteel
surgical screwdriver into Arturo’s spine instead of the appropriate and approved titanium
rods. The patient later suffered health complications and lost his life two years after the
malpractice. II. Medical Malpractice Component: A. Legal components. The plaintiff argued
that Dr, Ricketson’s negligence had a direct cause to the demise of Arturo. Negligence is a
tort law that requires that the plaintiff prove that the defendant had a duty to care,
breached that duty, direct or proximate cause of injury, and the plaintiff suffered injuries
(Dahlawi et al., 2021). As a licensed orthopedic surgeon, Dr. Ricketson had the legal
obligation to provide safe and high-quality care for Arturo. However, his actions indicated a
breach of that duty. He did not use the appropriate titanium rods for the surgery. Thus,
Arturo suffered medical damages that had a proximate/direct relationship with Dr.
Ricketson’s breach of duty to care. B. Malpractice policies Dr. Ricketson violated several
malpractice policies in place for addressing the issues within the case. The defendant failed
to obtain Arturo’s informed consent before using the screwdriver instead of the approved
titanium rods. Patients have a right to safety and health (Dahlawi et al., 2021). Thus, using
unsanctioned material that placed the patient’s life at risk implied that he violated this
malpractice policy. At the time of the incident, HMC had policies in place to prevent such
malpractices from occurring. For instance, it had a policy that all instruments must be
inventoried before use. This policy was violated at first when the shipment arrived at the
hospital, and when brought to Dr. Ricketson’s attention by nurse Feldmeyer immediately
after the operation (Findlaw for Legal Professionals, 2018). C. Standard of care Standards of
care establish a foundation for which healthcare professionals should deliver safe,
accountable, and high-quality care (Fremgen, 2020). Failure to meet these standards

2. compromises the overall dependence on the nursing profession and the safety of patients
(Fremgen, 2020). In this case, the care Arturo received was devoid of the standard of care
guidelines. For instance, when Dr. Ricketson chose not to wait for the approved titanium
rods to arrive and subsequently failed to consult Arturo on the same and obtain his consent
on the proposed alternative, he violated the standards of safe and patient-oriented care
delivery. HMC also breached standards of employment by extending privileges to perform
orthopedic surgeries to Dr. Ricketson despite the past disciplinary and unsafe patient care
behaviors he had (Findlaw for Legal Professionals, 2018). D. Cultural backgrounds The
malpractice, in this case, can harm any patient regardless of their cultural background. The
foundation for the malpractice was not culture-mediated. The effects also had no cultural
underpinning. Hence, any patient can experience the negative effects of Dr. Ricketson’s
negligence. E. Accountability Both Dr. Ricketson and HMC were held liable. In the initial
ruling, the plaintiff was awarded $5.6 million and determined that Dr. Ricketson was liable
for 65% of Arturo’s damages and HMC was responsible for 35% of the damages (Findlaw
for Legal Professionals, 2018). The Appellate Court determined that 75% of the patient’s
damages had a direct relationship with his medical conditions (Findlaw for Legal
Professionals, 2018). References Dahlawi, S., Menezes, R., Khan, M., Waris, A., Saifullah, -., &
Naseer, M. (2021). Medical negligence in healthcare organizations and its impact on patient
safety and public health: a bibliometric study. F1000research, 10, 174.
https://doi.org/10.12688/f1000research.37448.1 Findlaw for Legal Professionals. (2018).
Findlaw’s Intermediate Court of Appeals of Hawaii Case and Opinions. Findlaw. Retrieved
September 21, 2022, from https://caselaw.findlaw.com/hi-intermediate-court-of-
appeals/1597588.html# Fremgen, B. F. (2020). Medical Law and Ethics. (6th ed.). Pearson
Running Head: IHP 420 MILESTONE 2 IHP 420 Milestone 2 Denise Vazquez Southern New
Hampshire University 1 IHP 420 MILESTONE 2 2 Ethical Component A. Ethical Issues The
malpractice suit’s ethical issues started when Hilo Medical Center gave Dr. Ricketson the
green light to perform surgeries although they were aware that he had been reprimanded
for professional misconduct in three different states, they nonetheless accepted his
credentials. The problem persisted when Dr. Ricketson started the procedure before
doublechecking that all equipment was present and accounted for after being notified that
an inventory of the Kits had not been completed. Then, without informing the patient, he
implanted an improvised unilateral rod into the body. Furthermore, the patient is never told
what is being transplanted into his body. Last, Dr. Ricketson abandoned his patient without
ever checking in with them again. The incident is blamed on the issues because the patient
required three additional procedures to fix the initial one, all of which were necessary
because of the unsuitable material inserted. As a result, his health deteriorated, he needed a
catheter for the rest of his life, he suffered from episodes of urosepsis, and he was
eventually rendered bedridden to his demise on June 18, 2003. B. Ethical Theory Mr.
Iturralde’s problems could be alleviated by applying the ethical theory of duty. As far as Dr.
Ricketson was concerned, he was not behaving in accordance with the ethical theory of
theory when he decided to use the stainless steel screw driver instead of waiting for the
arrival of permanent ones (Fremgen, 2020). His duty as a doctor was to ensure that he
provide quality, safe, evidence-based, and patient-oriented care. Therefore, Dr. Ricketson’s

3. conduct was unethical to his patient and exacerbated his injuries by violating the non-
maleficence standard. a. IHP 420 MILESTONE 2 3 It only takes a little deliberation to
develop a model of shared decision-making between doctors and patients that guarantees
the patient will receive the highest standard of care (Elwyn et al., 2022). If Dr. Ricketson had
taken the time to sit down with Arturo and have a simple deliberation about his options,
risks, and impacts, Arturo might have made an informed decision about what was best for
him. This would have allowed for a more secure operation, eliminated the need for
additional procedures, and maybe saved Arturo’s life. C. Shared Decision-Making Model
Professionals in the medical field utilize ethical criteria, which are based on fundamental
values and concepts, to decide what is in the best interest of their patients (Pozgar, 2019).
Given that Dr. Ricketson could have avoided Arturo’s fall and subsequent hospitalization
had he allowed Arturo to make his own healthcare decisions, some simple ethical guidelines
would have prevented this and would enable the organization to avoid such problems in the
future. (Horowicz & Williams, 2022). In addition to his altruism, Dr. Ricketson knew that the
unilateral rod was not designed for human implantation before he implanted it. He should
have helped his patient, but he persisted with the lecture. Finally, for non-malfeasance, Dr.
Ricketson did not check in with Arturo after the operation to ensure he was doing okay. D.
Ethical Guidelines and Rationale The stainless-steel screwdriver shaft’s unsuitability
presents professional, ethical, and judgmental challenges for human medical implantation.
Issues of Ethics: A surgeon’s or healthcare provider’s duty, in accordance with the specialist
code of conduct, is to ensure the patient’s well-being and safety by alleviating pain and
anguish as much as possible (Elwyn et al., 2022). However, there are certain situations in
which a surgeon or doctor may be unable to determine what is true or proper. When there
are several potential courses of action and IHP 420 MILESTONE 2 4 outcomes, healthcare
professionals are frequently put in an ethical bind (Pozgar, 2019). . Dr. Robert Ricketson
believed that waiting an extra hour and a half for the right titanium rods would expose a
greater risk to the patient than operating immediately. Dr. Ricketson wanted to help those
afflicted by Iturralde, so he developed his treatment. Dr. Ricketson implanted the shaft of a
screwdriver into Iturralde’s spine. The conclusion is that the insertion of the screwdriver
shaft worsened Iturralde’s condition, which led to further complications and, ultimately, his
death. IHP 420 MILESTONE 2 5 References Dahlawi, S., Menezes, R., Khan, M., Waris, A.,
Saifullah, -., & Naseer, M. (2021). Medical negligence in healthcare organizations and its
impact on patient safety and public health: a bibliometric study. F1000research, 10, 174,
https://doi.org/10.12688/f1000research.37448.1 Elwyn, G., Frosch, D., Thomson, R.,
Joseph-Williams, N., Lloyd, A., Kinnersley, P. . . . Barry, M. (2022). Shared decision making: A
model for clinical practice. Retrieved October 02, 2022, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445676/ Fremgen, B. F. (2020). Medical
Law and Ethics. (6th ed.). Pearson Horowicz, E., & Williams, A. (2022). Healthcare Ethics
and Professional Operating Department Regulation Practice in. Fundamentals of Operating
Department Practice, 15. Pozgar, G. D. (2019). Legal and ethical issues for health
professionals. Jones & Bartlett Learning. Final Project I Guidelines and Rubric Overview
Healthcare professionals must have a strong working knowledge of ethics and law to be
competent and successful. A qualified professional knows how to provide safe, quality

4. healthcare to a population of culturally diverse consumers. To address the needs of all
patients, you can apply models such as shared decision making, where patients are
encouraged to share their preferences and needs. The application of this model requires
that healthcare professionals know how to apply ethical theories such as patient autonomy,
beneficence, nonmaleficence, justice, and fidelity when caring for patients. On a daily basis,
healthcare professionals face ethical dilemmas involving patients and colleagues.
Understanding how to effectively apply the code of ethics in your field, and various other
codes of professional conduct, is an important skill required of all healthcare professionals.
By applying ethical decision making, you positively impact the delivery of safe, quality
healthcare. Under certain circumstances, healthcare professionals can be sued by patients
for malpractice; it is more common for physicians to be sued when patients are injured or
die as a result of their medical care. Healthcare professionals need a clear understanding of
the elements of medical malpractice (standard of care, breach, causation, and damages) and
how they are applied by a judge in a court of law. Healthcare professionals play a critical
role due to the nature of their relationship with both patients and physicians. To remain
competent and grow in the field, healthcare professionals are expected to understand how
their professional responsibility includes a wide-ranging accountability to self, their
profession, their patients, and the public. Your final case study for this course will require
you to analyze a court decision in which a physician was found liable for medical
malpractice. You will focus on facts pertaining to the medical standard of care, breach of
care, and causation, and explain how they were applied to law. You will then use the facts of
the case to identify an ethics issue and determine an ethical theory that would help provide
a safe, quality healthcare experience for the patient. Next, you will apply a clinician–patient
shared decision-making model to describe how the ethics issue could be resolved. You will
also include a discussion about possible violations of the code of ethics in your given field.
Lastly, you will augment or vary the facts of the case to create a hypothetical scenario that
changes the outcome so that the physician is no longer liable for medical malpractice. Final
Project I is divided into two milestones, which will be submitted at various points
throughout the course to scaffold learning and ensure quality final submissions. These
milestones will be submitted in Modules Three and Five. The final product will be submitted
in Module Seven. In this assignment, you will demonstrate your mastery of the following
-related policy and legislature with
theories and decision-making models appropriate for healthcare providers to use for
providing a safe, quality healthcare experience for the patient Analyze the role of
professional regulation, the standard of care, and codes of ethics in determining healthcare
providers’ wide-ranging accountability to self, their profession, their patients, and the
public Prompt In this project, you will analyze a court case involving medical malpractice.
Using your analysis of the case, you will address the facts pertaining to the medical standard
of care, breach of care, and causation. Further, 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, apply a clinician–patient shared decision-
making model, and augment or vary the facts of the case to change the outcome. You will

5. Center USA • Hawaiian jury finds doctor liable for inserting screwdriver in patient’s spine
(Supplemental article) Specifically, your case study must address the following critical
elements: I. Introduction: A. Summarize the selected case, including information on the
stakeholders involved, the problem, and the time period the incidentoccurred. II. Medical
Malpractice Component: In this section, you will evaluate the case to address the legal
components, the malpractice policies similar to this case, and the standard of care given to
the patient and how it was breached. Then, you will draw connections to how this
malpractice case impacted stakeholders and healthcare consumers outside of the case. A.
Explain the key legal components of the case, including the nature of the issue and the rules
that applied. B. Determine relevant malpractice policies in place for addressing the issues
within the case. C. Analyze the malpractice case for the standard of care provided to the
victim. Be sure to apply what the law states about standard of care to support whether or
not it was breached in the case. D. Analyze how the malpractice case would impact
healthcare consumers from different cultural backgrounds. For example, would this case
have a similar impact on a person from a culture different from the one in the case? How
could this incident change the views of these healthcare consumers toward the healthcare
system? E. Assess the malpractice case for accountability based on its severity. To what
extent was the healthcare provider held accountable? 2 III. 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 case. 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 case. 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 futureincidents. E. Defend how your proposed ethical guidelines
will hold healthcare providers accountable to themselves, their profession, their patients,
and the public. II. Recommendations: In this section, you will utilize the knowledge you
gained from your malpractice and ethical analyses to recommend and defend strategies that
would help improve medical practices and avoid future liability. A. Recommend
preventative strategies the healthcare provider could implement to avoid liability in the
future. B. Defend how your recommended preventative strategies would assist the
healthcare provider in avoiding liability and provide a safe, quality healthcare experience
for the patient. Milestones Milestone One: Malpractice Case In Module Three, you will
submit a 2- to 3-page paper. You will complete part of your analysis of the malpractice case.
Using this analysis of the case, you will address the facts pertaining to the medical standard
of care, breach of care, and causation. This milestone will be graded with the Milestone One
Rubric. Milestone Two: Ethical Components of the Malpractice Case In Module Five, you will

6. submit 2- to 3-page paper. 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, apply a clinician–patient shared decision-making model, and
augment or vary the facts of the case to change the outcome This milestone will be graded
with the Milestone Two Rubric Final Submission: Malpractice Case Analysis In Module
Seven, you will submit your final project. It should be a complete, polished artifact
containing all of the critical elements of the final product. It should reflect the incorporation
of feedback gained throughout the course. This submission will be graded with the Final
Project I Rubric. 3 Final Project I Rubric Guidelines for Submission: Your case study should
be a 4- to 6-page Microsoft Word document with 12-point Times New Roman font and one-
inch margins. All citations and references should be formatted according to the most recent
APA guidelines. Critical Elements Introduction: Summarize Exemplary Proficient Needs
Improvement Not Evident Summarizes the case, including Summarizes the case, but Does
not summarize the case (0%) information on the stakeholders summary is cursory or
illogical, involved, the problem, and the time contains inaccuracies, or does not period of the
incident that occurred include information on (100%) stakeholders, the problem, or the
time period of the incident (55%) Medical Meets “Proficient” criteria, Explains the key legal
components Explains the key legal Does not explain the key legal Malpractice and
explanation demonstrates of the case, including the nature of components of the case, but
components of the case (0%) Component: Legal sophisticated understanding the issue and
the rules that applied analysis is illogical, contains Components of the key legal components
of (85%) inaccuracies, or does not include the case (100%) the nature of the issue or the
rules that applied (55%) Value 2.24 10.61 Medical Malpractice Component: Malpractice
Policies Meets “Proficient” criteria and Determines relevant malpractice demonstrates a
sophisticated policies in place for a ddressing the awareness of which policies issues within
the case (85%) address the issues within the case (100%) Determines malpractice policies,
but response lacks detail, or the chosen policies are irrelevant or do not address the issues
of the case (55%) Does not determine relevant malpractice policies in place for addressing
the issues within the case (0%) 10.61 Medical Malpractice Component: Standard of Care
Meets “Proficient” criteria and Analyzes the malpractice case for demonstrates astute ability
in the standard of care provided to applying what the law states the victim, and applies
what the about standard of care to law states about standard of care determine whether or
not it to support whether or not it was was breached in the case breached in the case (85%)
(100%) Analyzes the malpractice case for Does not analyze the malpractice the standard of
care provided to case for the standard of care the victim, but does not apply provided to the
victim (0%) what the law states about standard of care (55%) 6.37 4 Medical Malpractice
Component: Cultural Backgrounds Meets “Proficient” criteria, Analyzes how the malpractice
case and analysis makes cogent would impact healthcare connections between the
consumers from different cultural incident and its impact on backgrounds (85%) healthcare
consumers from different cultural backgrounds (100%) Analyzes how the malpractice Does
not analyze how the case would impact healthcare malpractice case would impact
consumers from different cultural healthcare consumers from backgrounds, but analysis is
different cultural backgrounds cursory or c ontains inaccuracies (0%) (55%) 10.61 Medical

7. Malpractice Component: Accountability Meets “Proficient” criteria, Assesses the malpractice
case for Assesses the malpractice case for Does not assess the malpractice and assessment
makes a accountability based on its severity accountability based on its case for
accountability based on cogent connection to the level and explains the level of severity and
explains the level of its severity (0%) of accountability held against accountability the
healthcare accountability the healthcare the healthcare provider based provider was held to
(85%) provider was held to, but on the severity of the case explanation lacks detail or is
(100%) illogical (55%) 6.37 Ethical Component: Meets “Proficient” criteria, Ethical Issues
and research and examples provided demonstrate a complex grasp of how the ethical issues
led to the malpractice case (100%) Describes the ethical issues that led Describe the ethical
issues that to the malpractice case and led to the malpractice case and explains why the
issues arecredited explains why the issues are with causing the incident, and credited with
causing the supports with research and incident, but description lacks relevant examples
(85%) details or does not support with research and relevant examples (55%) Ethical
Component: Meets “Proficient” criteria, Ethical Theory and research and examples provided
demonstrate a complex grasp of how the ethical theory would help resolve the issue and
provide a safe, quality healthcare experience for the patient (100%) Describes an ethical
theory that would help resolve the issue and provide a safe, quality healthcare experience
for the patient, and supports with research and relevant examples from the case (85%) 5
Does not describe the ethical issues that led to the malpractice case and does not explain
why the issues are credited with causing the incident (0%) 7.96 Describes an ethical theory
that Does not describe an ethical would help resolve the issue and theory that would help
resolve the provide a safe, quality healthcare issue and provide a safe, quality experience for
the patient, but healthcare experience for the description lacks detail, is patient (0%)
illogical, or does not support with research or r elevant examples (55%) 7.96 Ethical
Component: Meets “Proficient” criteria and Selects a physician–patient shared Shared
Decision- demonstrates a nuanced decision-making model and Making Model
understanding of appropriate explains how it would provide a physician–patient shared
safe, quality healthcare experience decision-making models that for the patient (85%)
would provide a safe, quality healthcare experience for the patient (100%) Selects a
physician–patient Does not select a physician– shared decision-making model patient
shared decision-making and explains how it would model and does not explain how it
provide a safe, quality healthcare would provide a safe, quality experience for the patient,
but healthcare experience for the explanation lacks detail (55%) patient (0%) 7.96 Ethical
Component: Meets “Proficient” criteria and Proposes ethical guidelines that Ethical
Guidelines makes a cogent connection would have helped prevent the between the
proposed ethical incident and would help the guidelines and how they organization prevent
future would prevent the current and incidents (85%) future incidents (100%) Proposes
ethical guidelines that Does not propose ethical would have helped prevent the guidelines
that would have helped incident and would help the prevent the current and future
organization prevent future incidents (0%) incidents, but proposal is cursory (55%) 7.96
Ethical Component: Meets “Proficient” criteria and Defends how the proposed ethical
Defend makes cogent connections guidelines will hold healthcare among the proposed

8. ethical providers accountable to guidelines and how to hold themselves, their profession,
their healthcare providers patients, and the public (85%) accountable to themselves, their
profession, their patients, and the public (100%) Defends how the proposed Does not
defend how the ethical guidelines will hold proposed ethical guidelines will healthcare
providers accountable hold healthcare providers to themselves, their profession,
accountable to themselves, their their patients, and the public, but profession, their patients,
and the defense lacks detail or is illogical public (0%) (55%) 6.37 Recommends
preventative Recommends preventative Does not recommend strategies the healthcare
provider strategies the healthcare provider preventative strategies the could implement to
avoid liability in could implement to avoid liability healthcare provider could the future
(85%) in the future, but implement to avoid liability in the recommendations are cursory or
future (0%) illogical (55%) 6.37 Recommendations: Meets “Proficient” criteria,
Preventative and recommendations Strategies masterfully demonstrate how the healthcare
provider can avoid liability in the future (100%) 6 Recommendations: Meets “Proficient”
criteria and Defends how the recommended Defends how the recommended Defend makes
cogent connections preventative strategies would assist preventative strategies would
among the recommended the healthcare provider in avoiding assist the healthcare provider
in preventative strategies and liability and provide a safe, quality avoiding liability and
provide a how they would assist in healthcare experience for the safe, quality healthcare
avoiding liability and provide a patient (85%) experience for the patient, but safe, quality
healthcare defense is cursory or illogical experience for the patient (55%) (100%)
Articulation of Response Submission is free of errors Submission has no major errors
related to citations, grammar, related to citations, grammar, spelling, syntax, and spelling,
syntax, or organization organization and is presented (85%) in a professional and easy-
toread format (100%) Does not defend how the recommended preventative strategies
would assist the healthcare provider in avoiding liability and provide a safe, quality
healthcare experience for the patient (0%) Submission has major errors Submission has
critical errors related to citations, grammar, related to citations, grammar, spelling, syntax,
or organization spelling, syntax, or organization that negatively impact readability that
prevent understanding of and articulation of main ideas ideas (0%) (55%) Total 7 6.37 2.24
100%