Doctor Admits Implanting Screwdriver In Patient

[sasha031]

A family in Hilo, Hawaii, has sued a doctor after the man admitted he implanted a screwdriver into the neck of a patient, instead of titanium rods, according to a Local 6 News report.Local 6 News showed an X-ray of Arturo Iturralde's neck with a vertical screwdriver shaft inside.Doctor Robert Ricketson said that during a surgery on Iturralde, a nurse told him there were no more titanium rods for his neckRicketson said he did not feel he could risk keeping the man under anesthetic with an unstable spine for any longer so he made the decision to substitute the rods with a screwdriver, according to the report.

An attending nurse, Janelle Feldmeyer, said she was kicked out of the operating by Ricketson and later found out from a co-worker at Hilo Medical Center how the surgery ended."She said Dr. Ricketson used a screwdriver that he cut apart from the instrumentation tray," Feldmeyer said. "And I said to Theresa at that time, 'He can not do that.'"Feldmeyer said she complained to superiors at the hospital on different occasions but was told to keep quiet, according to the report.

Iturralde's family is now suing the Ricketson and the medical center.


It's those Damn Trial Lawyers that are raising medical cost, that's why we are canceling all health insurance,setting up personal accounts and eliminating frivolous lawsuits!

http://www.local6.com/news/7078103/detail.html

[atommom]

1. Unbelievable. Any word on what the screwdriver was made of?

Because you can't implant just any old piece of metal in the human body and hope for the best...

[Kingshakabobo]

2. Did it work? I woulda used a 16 penny nail. n/t

[bleedingheart]

16. no it fractured and it caused more problems....

[Burried News]

3. Surgical screwdriver would be my guess, which may be titanium.

Story may not be as crazy as it sounds. I wouldn't want it to happen to me but if the operation is in progress and he has to stabilize the neck ...

What was the outcome? Is the patient paralyzed? Will they be going back in? Lots of questions.

[Tace]

4. Sounds Like The Doctor Was Trying To Save This Fellow's Life

This is bizarre, but I admire the doctor's spontaneous improvisation.

[berni_mccoy]

6. Even though the doc did the right thing IMHO,

He should have had plenty of supplies in stock before opening the guy up. That's where the malpractice is.

[Tace]

7. Good Point

[txindy]

9. Yep, he showed ingenuity, but only had to do so because he lacked planning

Then he tried to cover it all up. Where have we seen this before?! :eyes:

[Beausoir]

8. Absolutely..he should have been prepared.

[SharonAnn]

11. Actually, the hospital is probably more responsible

[Bake]

24. Both the doc and hospital.

I'd sue both entities.

Bake

[panzerfaust]

26. Lets see

“The Hospital” is represented in this case by a surgical scrub tech who probably makes 24-35k per year, and a circulating RN who likely makes 40-55k a year.

For this particular type of operation, I would hazard a guess that the surgical fee would be 12-24k. I know it is a wide range, but I do not know the usual charges in Hawaii.

So tell me again who's responsibility it is? Who is making a handsome fee, potentially equally to someone else's entire annual income? Who is in charge of the operation? What are they being paid for?

Given the long years of training to acquire the surgical skills, the risk of the surgery, and its technical complexity it is not an unreasonable fee. Not unreasonable if the surgeon accepts the responsibilities implied by his fee.

I have actually been in an operating room when a planned and needed implant was not there at the time it was to be implanted. The assistant surgeon started blaming the OR crew. The attending surgeon stopped him. He said “it was my responsibility. I did not specifically look to see if this prosthesis was there”.

As this particular surgeon was not a “close enough is good enough” sort of person, and as the patient was stable with an epidural anesthetic (so only lightly dozing, not under the more depressing effect of general anesthesia) his decision was to check with nearby hospitals and, when they did not have the required implant, to call the company who made it to fly one out in a medivac plane. He would have paid for the flight himself, but the company did, as he was a good customer.

Whilst it was enroute, the surgeon went out and told the family what had happened. The ambulance met the plane, brought the implant to the OR and all went well.

The surgeon never ever again started an implant case without holding the planned implant in his hand prior to setting up the OR.

And THAT is how it should be done.

[Yupster]

31. Agree Sharon

I'm sure the ER has a stocking system for its inventory and I'm sure it's not each doctor who does the checking. That would be a waste of a doctor's time.

In a similar vein, in an operation there is a nurse who is responsible for counting the sponges at the end of an operation. Before the doctor sews up the patient, he will call for a sponge count. The nurse will then count the sponges and tell the doctor he can close.

A surgeon friend has told me that twice he's had to go back in and retrieve a sponge even though the nurse had approved the sponge count. He said you can't leave them in.

I'm sure it will be the doctor who gets sued, but if he's operating, he shouldn't be the one counting sponges. And according to him, it's very easy to leave one in when a body is opened up and things are moved around.

[bleedingheart]

15. No it is profound incompetence

I did some engineering studies in the OR area of a hospital and I have to say that the people I observed were very competent and NO surgeries were ever done without the proper tools, and the required number of personnel. (in fact we were there to study how to schedule the OR better to insure that they didn't have to keep hiring nurses from agencies to fill shifts...a cost issue)

In the surgeries I observed there was always a recording nurse present who kept a count of what tools had been used, how many sponges...etc. If something was not present in the room, she/he was the one who would leave the room or call out to ask for the supplies to be directed there immediately....

The man could have clearly been stabilized until the proper device was available.

[rwork]

5. They look like

lag bolts.Not screwdrivers.

[Strawman]

10. The guy ordered a Tom Collins

[panzerfaust]

12. A few facts ...

1) The screw driver blade is the vertical object seen on the left-hand side of the x-ray. It is the metallic density without threads on it. As one can see, it is completely fractured.

2) It is the responsibility of the surgeon to determine that critical needed equipment and implants are available prior to starting an operation. Indeed the surgeon should insure that instrumentation is available for any reasonably foreseeable alternative operation.

3) Far from being a brilliant improvisation in an attempt to save the patients life, it was a criminal act undertaken in an attempt to cover up the initial failure to insure the equipment was ready for the proposed operation

4) Mr Iturralde's neck could have been stabilized by other means (Philadelphia collar, tongs and traction) and he could have been then either transported to another hospital, or could have been cared for in the ICU until suitable implants were obtained in the original hospital. He could have then been returned to the OR for fixation with something that was likely to actually work.

5) The fact that the surgeon did not inform the family of his “brilliant improvisation”, and that an operating room nurse who reported what had happened to the hospital administration was told to say nothing speaks volumes about the character of the surgeon, of the rest of the operating-room team, and of the institution.

6) How is Mr Itrurralde doing? “... after three more surgeries, Iturralde was left a bedridden, incontinent paraplegic. He died from complications from the surgeries last month.”

7) Many surgeons still feel that they are beyond reproach and above the law. In one of the more telling looks into the surgical mind, one part of a study of aviation and of operating-room accidents (which have many similarities) involved asking senior pilots and senior surgeons if another person present in the cockpit/operating-room who noticed that the pilot/surgeon was making a serious mistake should speak up? 100 percent of the pilots said that they would want to be told, but just under 50 percent of the surgeons wanted their error to be pointed out.

Could this be because the pilot would likely die as a result of his or her error, but, for a surgeon, it is the patient who takes the risk? As surgeons create revenue for hospitals - the administrators, in my experience, virtually always try to shield surgical incompetence.

In my opinion, this was not only malpractice: but a criminal act and, if guilty, the surgeon should loose his license and go to jail for involuntary manslaughter.

But that's just me.

[muriel_volestrangler]

13. No, I don't think it is just you

I'd certainly agree that losing his licence looks like the right thing to do, to protect others from this guy; I don't know the exact legal definition of involuntary manslaughter, but I could see it's the kind of thing to be considered as a charge.

At the time of the operation, the lawsuit alleges, Ricketson suffered from drug addiction and incompetence, had his medical license suspended in Oklahoma and revoked in Texas, and was on probation in Hawaii for improper conduct.

"Despite this rather extraordinary record of incompetence, dishonesty and criminal behavior, he was granted privileges at the Hilo Hospital, hired by a Big Island orthopedic group. He was unleashed on the public," Davis said.

Hawaii Orthopedics and Hilo Hospital are also accused of negligence in the suit.

If that's correct, I can see them sharing the blame too.

[bleedingheart]

14. you know what is bizarre....here is a hospital in Hawaii...Paradise

and you would think they would not have a huge problem attracting competent people...but instead they hire a complete and utter moron with a record to prove it...

[dysfunctional press]

17. Hilo isn't the best part of paradise-

once the sun goes over the mountain, you're in the shade.

don't get me wrong- mornings are great...
but the afternoons can be a lot like oak st. beach in chicago.

[knitter4democracy]

19. They're having a hard time getting docs, from what I hear.

They're always sending stuff out to residents and attendings. We get notices from Hawaii at least once a month. The living's expensive, but the pay is about the same. It's also far from family and expensive for them to visit. We thought about interviewing but gave it up when we added up how much it would cost.

Btw, that doc needs his license yanked. That screwdriver was the totally wrong thing to use, and there were ways to stabilize the patient until the right medical item was found. I don't know any doc around here who'd think that was okay unless it was in a third world hospital with no SICU, no rods, and nothing else to keep the patient alive and well with until the right rods came.

[bleedingheart]

20. that explains it to some degree...

if the cost of living is high and they aren't making enough to compensate...

License yanked and perhaps some time in prison...

[knitter4democracy]

28. Prison sounds a bit much.

Trust me, he'll have a hard enough time with losing his livelihood and all of his money. He won't be able to work in medicine again for any money at all (maybe as a lab tech, but probably not with that background). He'll be ruined.

If he gets off of the civil case, then yeah, they should go after criminal charges . . .

[panzerfaust]

30. Willful, reckless, wanton action which results in death?

I believe the actions, which had the foreseeable result of paraplegia, quadriplegia, or death (which did, in fact, result) is nothing less than criminal conduct, criminal negligence, and that it should be handled as both a civil (malpractice) and a criminal case.

This was not a simple medical error. It was a deliberate and gross violaton of the standard of care, of medical ethics and of simple human compassion which resulted in needless suffering and death. With memories which will torment Mr Iturralede's family for the rest of their lives.

Surgeons are not above the law: Neither above the laws of the land, nor above those of common human decency.

If guilty, he belongs in jail.

[panzerfaust]

21. Hawaii's medical care is also racially divided - even for the Yuppies

An orthopedic surgeon acquaintance of mine was hired out of residency at a handsome salary by a group in Hawaii.

They made no bones about (sorry) the reason for the good salary being that besides having good references from his training program that it was because of his Japanese ancestry. It turned out that people of Japanese descent in Hawaii tend to only see Japanese descent doctors, the group hoped to cut into the heavily Japanese referral base of a competing group.

I myself once looked at a practice opportunity on one of the islands (have forgotten which) but did not pursue it for two reasons. First I happened to meet two physicians who had just left the hospital I was interested in. It was clear the hospital and many on the medical staff had issues with quality medical care. Second, I have lived on a semi-remote island in the past, and the reality is that Hawaii is a very long way from anywhere else. At that point in my life, the disadvantages of the remoteness outweighed the advantages.

All that aside. I cannot begin to comprehend how the family of Mr Iturrald must feel. His surgeon violated the most basic values of medical practice and responsibility. The hospital utterly failed in its duty of 'due diligence' to the community.

Shameful.

[knitter4democracy]

27. Well, he is an orthopod.

:) They make good money. So, what was his sport? All of the ones my hubby trained with in med school and residency (as internal med) were former and current jocks. Every one. At least they were nicer in the OR . . .

If that were my family member, I'd be going postal right now. I always warn hospital staff that I'm a b****y doc's wife and that I will ask tons of questions and have my hubby on speed dial. I figure they need the warning. The one time I didn't warn the radiology tech, I was assaulted, and I did everything I could to get her yanked out (apparently, she was in training and just got busted back a couple of levels). I filed a police report, contacted the state, argued with the head of the practice, called our lawyer . . . and that was the best outcome I could get.

Frankly, I cannot even begin to imagine what the heck he was thinking or what the hospital was thinking in silencing the nurse. Once, when Hubby was in residency, one of the surgeons left a sponge in a patient, and when it was caught by an intern when the patient came back in complaining of pain, the hospital paid for everything, forced the surgical team to apologize in writing, and treated him like a king (and paid more to the family, from what we heard). It saved them a lot of money later.

[panzerfaust]

29. Even so ...

... he is able to notice :) things like that they would not have hired him had he not been of Japanese ancestry.

Actually, they wanted Nisei, but had to settle for Sansei.

Skiing and tennis. Never into team sports – which does make him an anomaly.

[Yupster]

32. Agree knitter

I'd think this doctor should lose his license, at elast temporarily.

I still think the hospital is also at fault, maybe even more so for not having its inventory for its upcoming operations.

[Taxloss]

18. In the UK there was an alarming case similar to this.

A surgeon lacked an important piece of equipment called a "sharp spoon". Furious, he stormed to the canteen and confronted administration officials with the fact that their penny pinching was denying him vital equipment. They suggested he use a dessert spoon. When he refused, he was dismissed.

He won his case for unfair dismissal.

[yellowcanine]

22. Obvious question: Why wouldn't one make sure you had all of the materials

you needed BEFORE placing the guy under anasthesia?

[Mayberry Machiavelli]

23. It stinks. There might conceivably be some rationale for doing something

like this if the patient came in emergently with a broken neck and risked paralysis within hours, gear or not, but usually the neck can be stabilized with a traction device or "halo" pending getting the right gear for surgery.

It doesn't say if the doctor was honest with the patient and their family about the improvisation, and I wonder if the his report of the operation in the patient's chart makes any mention of it. If he didn't tell them or document, and it only came out when the piece broke, he's toast.

[panzerfaust]

25. No, there is not.

There is no conceivable “justification” for such an unconscionable act. Unstable necks were externally stablized long before the development of internal fixation devices.

It was reported when the “brilliant improvisation” was discovered: 'Iturralede's family didn't find out about the screwdriver until a week after it broke in half in his back'

The screwdriver is also reported to have broken within 48 hours of surgery. I do not know when the x-rays shown in the various articles were taken. But all show a significant forward slipping of his vertebrae which should have been held in alignment by the rod.

From plain x-rays one cannot say for certain that the spinal cord is being crushed – but the degree of slipping shown (and the subsequent paralysis) makes it highly likely.

Sadly, the surgeon is not toast, the patient is. I wonder if the hospital billed for the (not implanted) titanium rod?

My guess would be “Yes.”

[Norwood]

33. His excuse isnt valid

Making sure he had everything he needed to successfully complete the surgury should have been done before he even put the patient under.