Jury Awards Family of Hilo Patient Over $5 Million After Surgeon Implants Cut Screwdriver in Spine

A Hawaii County jury in March 2006 awarded the family of Arturo Iturralde about $5.6 million after a surgeon at Hilo Medical Center implanted a section of a stainless steel screwdriver shaft in his spine. The jury found the surgeon, Dr. Robert Ricketson, 65 percent at fault and the hospital 35 percent at fault for giving him staff privileges despite his record. Mark S. Davis of Davis Levin Livingston represented the family.

Iturralde, then 73, was admitted in January 2001 with leg weakness and diagnosed with degenerative spondylolisthesis. Ricketson scheduled a spinal fusion for January 29, 2001. The titanium rods he had ordered from Medtronic had arrived at the hospital two days earlier, but nobody had inventoried them as hospital policy required, and they could not be found once the operation was under way. A Medtronic representative offered to bring replacements within 90 minutes. Ricketson instead cut a 3 to 4 centimeter piece from a screwdriver in the instrument kit and implanted it as a rod. Nothing about the shaft was approved for use in a person, and the family was not told.

Iturralde fell the next day and the shaft shattered. Ricketson operated again on February 5 to remove the fragments and install proper rods. A nurse who had been in the first operating room reported what happened, and she passed the broken shaft and the account to Iturralde's sister, Rosalinda, who cared for him. The rods later shifted, and he needed two more surgeries in Honolulu. He lost the ability to live independently, required permanent catheterization, suffered repeated urinary infections and hospital stays, became bedridden, and died of urosepsis on June 18, 2003.

The trial ran from February 6 to March 13, 2006, before Judge Glenn Hara. Evidence showed that Ricketson had been disciplined in Oklahoma, Texas and Hawaii, including for falsifying records and drug violations, and that Hawaii had placed him on probation in October 2000 for failing to disclose that history. The hospital credentialed him anyway. Jurors cleared Medtronic. They awarded $307,000 in special damages and $1.7 million in general damages to Iturralde's estate, $170,000 in general damages to his sister, and $3.4 million in punitive damages against Ricketson alone.

Because the hospital is a state entity, the judge treated the jury as advisory on the claims against it and set those damages himself. He attributed most of the harm to Iturralde's pre-existing spinal condition and entered a $629,250 judgment against the hospital. The judgment against Ricketson was $5,517,500, including the full punitive award.

In March 2012 the Hawaii Intermediate Court of Appeals, with Davis, Anne L. Williams and Robert P. Marx representing the family, held that the hospital stayed jointly and severally liable under the law in force in 2001. It also held that the sister's emotional distress claim carried joint liability, and it ordered a new trial against Medtronic because of flawed jury instructions. The court largely left the hospital's reduced liability in place, and the state was expected to pay just under $600,000 after a credit for an earlier settlement with another defendant. Ricketson, who represented himself at trial, carried no malpractice insurance, and his lawyers said he was last known to be in Kansas.