COURTESY IMAGE
An X-ray of Arturo Iturralde's spine shows the vertical shattered screwdriver piece that was used as a surgical pin.
Medical mayhem
Malpractice complaints dog
a former Big Island surgeon
A former Hilo surgeon had already opened the back of Arturo Iturralde during spine surgery when he discovered the titanium rod he planned to insert was missing from his surgical kit.
According to a lawsuit filed yesterday in Circuit Court on the Big Island, operating room nurses at Hilo Medical Center immediately called their Honolulu medical supplier for the right-size rod. The supplier said he could be in Hilo with the rod in 90 minutes.
Instead, Dr. Robert Ricketson allegedly grabbed a stainless-steel screwdriver and used a hacksaw to cut off the handle and a piece of the blade. He then inserted the screwdriver piece into Iturralde's spine and tightened it into place with screws designed for the titanium rod, the lawsuit alleges.
Days after the Jan. 29, 2001, surgery, the screwdriver snapped in half.
Iturralde suffered three more corrective surgeries before becoming an incontinent, bedridden paraplegic who was dependent on the care of his sister. Iturralde, an ordained Baptist minister who mostly spoke Spanish, died June 18 at the age of 76.
Ricketson, 48, could not be located for comment. The 1987 graduate from the medical school at the University of Oklahoma practiced in San Antonio and Edmond, Okla., before moving to Hilo in July 1998, according to Texas State Board of Medical Examiners files.
GEORGE F. LEE / GLEE@STARBULLETIN.COM
Yesterday, attorney Mark Davis held up the screwdriver piece that was used in the botched spinal operation.
Ricketson left Hawaii sometime in late 2001 or 2002 and applied for a medical license in Kansas in late 2002. The Kansas State Board of Healing Arts reviewed his record and on Dec. 14, 2002, recommended he withdraw his application, according to Kansas board documents. Ricketson withdrew.
Iturralde's sister, Rosalinda, filed the lawsuit yesterday that alleges that after Ricketson's surgery her brother became bedridden, prone to infections that caused him to deteriorate and that he died from "complications associated with the surgery."
Her suit alleges Ricketson never told the patient or his family of the screwdriver substitution. The suit also alleges that Ricketson was addicted to painkillers and even stole them from his patients.
Before Iturralde was ever wheeled into Ricketson's operating room, the surgeon had had at least seven medical malpractice suits filed against him, and his medical license had already been suspended in Oklahoma, revoked in Texas and was being reviewed in Hawaii, according to medical board documents from three states.
In one of the malpractice suits, an Oklahoma woman was awarded $1.3 million after she went to Ricketson for a ruptured disc in her back. Her lawsuit alleges he was under the influence of narcotics during her operation.
Ricketson admitted in court documents for the case that he "had severed eight or nine nerves and that he could not adequately express how sorry he was." The woman now wears a diaper and walks only with a walker.
Documents from medical boards in Oklahoma and Texas say Ricketson had become addicted to narcotics because he was self-treating chronic back pain. The documents said he wrote fake prescriptions for the drugs and even stole them from his patients.
Ricketson voluntarily entered treatment programs twice, according to files from the Oklahoma Board of Medical Licensure and Supervision.
In 1998 an Atlanta rehabilitation center recommended treatment for narcotics addiction, but instead of undergoing the treatment, Ricketson "returned to his medical practice in Hawaii," according to the Oklahoma files.
Iturralde's attorney, Mark Davis, said yesterday, "This doctor had shown previous evidence of drug abuse and incompetence in other states and should never have been allowed to step foot into an operating room."
Davis said that despite the evidence documented in medical board files in Oklahoma and Texas, Ricketson was allowed to practice surgery at Hilo Medical Center and with Hawaii Orthopaedics Inc.
A statement from Hawaii Orthopaedics said, "Due to privacy/confidentiality issues, we are unable to discuss anything about a patient."
Miles Takaaze, public affairs director for Hawaii Health Systems Corp., the state-run parent of Hilo Medical, said, "Our legal department is not aware of any formal claim associated with this case, and consequently, any comment or response at this time would be inappropriate."
Five days before Iturralde died, the Hawaii Medical Claims Conciliation Panel found in an administrative proceeding that Ricketson, Hawaii Orthopaedics and Hilo Medical "were actionably negligent in the care and treatment of Arturo Iturralde."
Iturralde, in the fog of heavy painkillers, never learned of the decision.
Davis said the only reason the screwdriver story ever surfaced was because of the efforts of one operating room nurse.
The nurse spoke to the Star-Bulletin on the condition of anonymity.
During Iturralde's first surgery, the nurse had played a supporting role to the operating room and Ricketson. When the patient was under general anesthetic with his back open and the rods were found missing, the operating room staff told her about it, she said.
The nurse said the medical supplier in Honolulu promised to be in Hilo with the rod in 90 minutes. Instead of waiting for the rod, she said, Ricketson grabbed a screwdriver from a surgical kit and cut it with a hacksaw.
"We all watched in horror and didn't know what to do," said the nurse. "I kept saying, 'Who is going to tell him (Iturralde)? Who is going to tell him?' And the physician then dismissed me from the room. I was told several times that it wasn't our business and that it was up to the physician to communicate with the family."
The suit says, "Ricketson guessed that the stainless-steel screwdriver was either of the same material as a titanium rod or comparable material."
On Feb. 5, 2001, days after the screwdriver broke, Ricketson again operated on Iturralde's back.
The nurse said, "I just knew they were going to take the screwdriver out and put the right rod in and never tell anyone."
After the surgery, the nurse retrieved the metal pieces from the trash and took them to an attorney. Iturralde learned about the screwdriver after the second surgery.
