When incomplete medical records had an adverse impact…

19 05 2010

Robert Ricketson was a spinal surgeon, but after a multitude of errors, one of which being his failure to properly document a conversation with a patient and their family, he has been divorced by his wife, had his medical license revoked, turned to cocaine, and his background check is rife with negativity (Ricketson).  He adds, “I became so depressed at one point I attempted suicide.” (Ricketson)  While the lack of proper documentation wasn’t solely to blame for his sufferings, it served as a critical aspect of his downfall.  This former surgeon from Hawaii now works on creating Power Point presentations, earning $25 – $50 a presentation (Seaspine Edu).

Arturo Iturralde was born in Mexico and worked as a Spanish speaking Baptist minister in Hawaii (Apgar).  At 73 years of age he was suffering from diabetes, bladder problems, had underwent heart surgery and suffered from strokes and broken bones (Thompson).  He underwent surgery for a lumbar laminectomy and spinal fusion to alleviate problems that resulted from spondylolisthesis and spinal stenosis (Ricketson).  During the surgery, titanium rods necessary for the surgery were missing; the surgeon improvised with stainless steel rods which later broke (Thompson).  Despite having another corrective surgery to implant the titanium rods, the patient later became paralyzed and died within three years (Apgar).

The surgeon, Dr. Ricketson, claimed that after the initial surgery he explained how he had used the makeshift stainless steel rods due to the fact the titanium rods were missing, yet he failed to document this conversation in the patient’s records (Ricketson).  In his words, Dr. Ricketson explains:

“Did it really matter if it was titanium or stainless steel? No. I clearly informed everyone this was done in the patient’s best interest given the unfortunate situation and accepted full responsibility.  The family was clearly informed that evening, although this was denied at trial. My error was in failing to fully document the conversation.” (Ricketson)

By not having documented proof of the conversation with the patient and his family, Dr. Ricketson could not prove that the family was made aware of his actions and this helped to further the negative image of the doctor for the jury.  Janelle Feldmeyer, a nurse who attended the second surgery, obtained the remains of the makeshift stainless steel rods and took them to an attorney and alerted the family, saying that she felt she “had to make sure the patient knows what happened to him.” (Good Morning America)  Even then though, no lawsuit was filed by the family until two years later when the patient passed away.  When Dr. Ricketson was asked what he would have done differently, if given the opportunity, he responded by stating, “Document the opinions and any remedial action before it becomes a serious problem. That way it’s done before the patient leaves the hospital.” (Ricketson)  By failing to do this, this surgeon allowed for an opportunity to face a lawsuit that stemmed from his failure to document his surgical actions and the acceptance of those actions by the family.

As explained in the situation above, by failing to fully document what transpires in a medical facility, we as medical staff must live by the saying “if it’s not documented, it didn’t happen.”  We cannot expect staff or patients to recall or accurately retell a situation days, months or even years after it occurs.  “You must rely on your ability as a witness to convince a judge or jury that you gave appropriate care despite your failure to document the care you provided,” explains Maureen Habel (Habel).

Work Cited

Apgar, Sally. “Malpractice Complaints Dog a Former Big Island Surgeon.” Honolulu Star-Bulletin. 15 July 2003. Mon. 10 May 2010. <http://archives.starbulletin.com/2003/07/15/news/index.html&gt;.

Dayton, Kevin. “Surgeon Improvised with Screwdriver, Jury Told.” Honolulu Advertiser. 10 Feb. 2006. Mon. 10 May 2010. <http://the.honoluluadvertiser.com/article/2006/Feb/10/ln/FP602100372.html&gt;.

“Doctor Sued for Inserting Screwdriver Into Patient’s Back.” Good Morning America. ABC. 17 Feb. 2006. Tue. 11 May 2010. <http://abcnews.go.com/GMA/story?id=1630844&gt;.

Habel, Maureen. “Document It Right: Would Your Charting Stand Up to Scrutiny?” Stat Staff Pro. Sun. 09 May 2010. <http://statstaffpro.com/document.htm&gt;.

Ricketson, Robert. “Robert Ricketson and the Surgical Screwdriver Medical Malpractice Case: The Medical Records Revisited.” Web log post. KevinMD. 12 Aug. 2009. Mon. 10 May 2010. <http://www.kevinmd.com/blog/2009/08/robert-ricketson-and-the-surgical-screwdriver-medical-malpractice-case-the-medical-records-revisited.html&gt;.

Ricketson, Robert. SeaspineEdu. Tue. 11 May 2010. <http://seaspineedu.web.officelive.com/default.aspx&gt;.

Roach, William H. Medical Records and the Law. Gaithersburg, Md: Aspen, 1998. Sat. 8 May 2010. <http://books.google.com/books?id=iHMg2AGzaH8C&gt;.

Thompson, Rod. “Hospital, Doctor Charged $5.6M for Screwdriver Implant.” Honolulu Star-Bulletin. 14 Mar. 2006. Mon. 10 May 2010. <http://archives.starbulletin.com/2006/03/14/news/story03.html&gt;.

Walter, Laura. “9/11 Workers Refute NYCs Claim of Incomplete Medical Records.” EHS Today – The Magazine for Environment, Health, and Safety Leaders | OSHA. 9 July 2008. Sat. 08 May 2010. <http://ehstoday.com/fire_emergencyresponse/ehs_imp_81215/&gt;.

“Obituaries – Arturo Iturralde.” West Hawaii TodayWest Hawaii Today. 19 Mar. 2008. Mon. 10 May 2010. <http://www.westhawaiitoday.com/articles/2008/03/19/obituaries/obits03.txt&gt;.




24 responses

19 05 2010
3 Basics of Insurance Coverage

[…] When incomplete medical records had an adverse impact… « Mundane … […]

19 05 2010

[…] When incomplete medical records had an adverse impact… « Mundane … […]

Good post

19 05 2010
Bill signed involving incomplete medical records

[…] When incomplete medical records had an adverse impact… « Mundane … […]

19 05 2010

Wow sucks to be that surgeon

20 05 2010

Yes, but also what a pity for the patient and his family too.

20 05 2010
You missed the point

Your trying to paint this surgeon as well meaning, but you forgot to mention that those makeshift stainless steel rods were made from screwdrivers. You also forgot to explain how he failed to make certain that he had everything necessary before beginning the surgery. Ricketson had titantium rods on order, didn’t verify they were there, cut the patient open, let him lose massive amounts of blood before noticing the rods weren’t there. The nurse called the company that they’d ordered the rods from to deliver another set and they said they would be there within an hour and a half. This is Hawaii okay, this was on the big island where the surgery was, the manufacturer was on another island. So this wonderful doctor Ricketson decided instead of waiting and cauterizing the incision to take a hacksaw to a screwdriver he found in the surgery room! Did you read that – hacksaw to a screwdriver. Then he cut it to the lengths of the rods and went on about the surgery like nothing happened.
Yeah so he says he told the family, they say he didn’t. That part doesn’t matter because he didnt go to Arturo’s sister before he decided to use a screwdriver and say do you want to wait or should I take a hacksaw to a screwdriver, he did what he wanted and that was it.
You also forgot to mention that his surgeons license was suspended in several other states when he did this surgery but he forgot to mention that too when he went to work at Hilo.
Boohoo he wanted to kill himself, what he did killed a good Christian man for no reason and then Ricketson wanted to blame it on Arturo being fat.

20 05 2010

I did research and read a good deal of what you shared and I’ll tell you why I omitted it from my paper – it was not relevant to the topic at hand. This paper was about incomplete medical records and their impact and Dr. Ricketson (is he still referred to as Dr. without a license?) claimed that the lack of documentation was to blame for some of the legal issues in this case.
I appreciate your expounding though.

26 05 2010

Theres always going to be 2 sides to every story. I think you presented both well

9 06 2010

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18 06 2010


15 07 2010

It is quite outrageous and sad isn’t it?

23 06 2010
Jessica Bill

I turn up this article from google,it’s extraordinarily useful for me,I honest collect these infomation.If I subscribe the newsletter,do these articles entertain copyright limit? can I brief them in my blog?

15 07 2010

You may brief them yes, there is no copyright limit that I am aware of, you would however need to seek out permission specifically from the sources as listed.

5 08 2010
Allie Foxe

What ever happened to the surgeon in Honolulu that operated on Mr. Iturralde 3 months after and left him with an epidural hematoma for 5 days? Did he ever get sued for causing the paralysis? As for the comment on the “hacksaw”-that’s what the plaintiff’s attorney called it. Actually it was the rod cutter in the spine tray-Medtronic doesn’t make “hacksaws”.

6 08 2010

To my knowledge, it was never addressed because the family, I believe it was the sister of the patient, only sued Dr. Ricketson. Finding information on her further actions was very difficult for me when I was writing this, but as best I could locate in searching records, there were no further law suits. I’ll admit, perhaps I don’t have the full story, as I only had what I could find online, but it seems a lot to me as though an ambulance chaser smelled a gold mine, reeled in the sister of the patient and Dr. Ricketson paid the price for making mistakes that weren’t the actual cause of death. Again, that’s my opinion alone.
As for the hacksaw, I found it comical that anyone would think a well trained surgeon would have a hacksaw lying about in an operating room.

13 02 2012
Allie Foxe

What happened to my last post?

1 11 2010

This is the kind of thing I try to teach people. Can we expect a sequel?

7 02 2012
Allie Foxe

See my post from today. I talked to him. The Internet is making it almost impossible for him to get in the door. All anyone sees are the distorted misinformation. Anyone have any ideas how to help him? Clear this up so he can do what he does best! Why people like to attack good physicians who are honest about their mistakes I don’t understand. There are so many unpunished providers out there who hold themselves blameless for their mistakes, or who won’t rally behind an unjustly accused physician is unconscionable. How about the times you (other unnamed surgeons and physicians) called in Dr. Ricketson to bail you out? Did he castrate you or throw you to the dogs when he could easily have done? No. Why? Patient first, physician second. Always was. To his detriment. Aloha.

2 11 2010


25 11 2010
Ward Ashmead

I could be here all day

30 11 2010
Valentine Laa

I strongly recommend you website out as is really brilliant

9 01 2011
Marcos Chioma

Can I just say what a relief to find someone who basically knows what they’re talking about on the internet. You absolutely know how to bring an issue to light and make it accepted. More people need to read this and understand this side of the story. I cant believe youre not more popular because you definitely have the gift.

7 02 2012
Allie Foxe

After many years of reading the internet and other media accounts of this case, the discussions here are the closest to the actual facts in the case. I can say that because I was in the operating room and also know Dr. Ricketson on a personal and professional basis. Actually for 2 years before and many years since that first operation on Mr. Iturralde. Before the case started, both Dr. Ricketson and Ms. Feldemeyer asked Vikki Barry, Dr. Ricketson’s usual scrub tech and assistant, if all the instruments were present. She pointed to the set and said yes. Dr. Ricketson clearly told everyone that because the patient had significant medical problems keeping the total operating time down to less than 3 hours was critical for the patients safety. Mr. Iturralde had been cleared medically by his internist, Dr. Thomas Green, prior to surgery. There was no reason to expect the bleeding disorder that resulted. It was well known that Dr. Ricketson was meticulous in both surgical and medical management in the most complicated cases. When other surgeons had problems or complications, Dr. Ricketson was always the one called in. Any time of day or night. Needless to say, he calmly corrected the bleeding problem over an hour and a half with the anesthesiologist (platelet issue from an over the counter medication not previously identified). When he asked Vikki for the rods, she told him she couldn’t find them, “I thought they were there.” Dr. Ricketson and Ms. Feldemeyer both said you said you had every thing. I told you before the case started we can’t have any delays. Get Eric on the phone now and start looking. We all looked-everywhere. Not there. They were supposed to be inventoried by the receiving nurse the night before. When Eric called back he said he could PROBABLY be in Hilo in an hour and a half. In reality, it was more like 2 1/2 hours since the flight from Honolulu wouldn’t leave for at least an hour. Eric still had to see if he had a back up set (the original set was shipped in from Memphis). An hour later, Eric called back and said he found a titanium set and that the one we had was the stainless steel set. They make two types. Dr. Ricketson told him that we couldn’t wait another hour and a half (speaker phone) that it wasn’t safe. Vikki then showed him the stainless steel screwdriver and asked if we we cut the shaft it might work. The only needed one inch of stainless steel. They took the rod cutter (no hacksaw by the way-that was the attorneys word for it) cut it and on the side table attached it to the screws where it fit perfectly. Same diameter of the stainless steel rods that were supposed to be in the kit anyway. This is all in the operating note by the way. Ms. Feldemeyer, well known to be openly critical of every surgeon in the hospital, then told Dr. Ricketson repeatedly he couldn’t do that he had to wait for Eric. He told her to go look at the patients medical history and that he couldn’t wait and that if it worked it would save the patient another operation. It made sense if you understand Dr. Ricketson was considering the patients safety first. Ms. Feldemeyer continued her ranting, that she would report it. Dr. Ricketson had her get the supervisor. Ms. Feldemeyer was well known to write up everyone she didn’t agree with or who didn’t do something “they way we did it in San Diego”. He closed and left to talk to the family. They weren’t there.
When we had to replace the rod after the patient fell in his room, Dr. Ricketson told Ms. Feldemeyer to send the rod from the first operation to the pathologist. She hid them-not retrieved them from the trash can. She took them to an attorney instead. The second operation only took one hour. No complications. Mr. Iturralde walked out of the hospital 5 days later, no complications. Yes, Dr. Ricketson talked to the family. Through an interpreter as they spoke Spanish. At trial, that nurse could not be located to verify the conversation.
Ms. Feldemeyer, being the vindictive person she is, secretly contacted family outside the hospital, told them which attorney to go to. 4 months later, Mr. Iturralde fell while walking at home. Because of Ms. Feldemeyer’s intervention, they decided to go go to Honolulu and have Dr. Terry Smith operate on him. Dr. Smith failed to read Dr. Ricketson’s operating note about Mr. Iturralde’s bleeding problem. In the recovery room at Queen’s Hospital, the drain came out and was never replaced. After 5 days of the nurses telling Dr. Smith Mr. Iturralde couldn’t move his legs, Dr. Smith found a large epidural hematoma and took hem back to the OR in Honolulu. Too late as the patient was already paralyzed. That was Dr. Smith’s error and the reason Mr. Iturralde became paralyzed, not Dr. Ricketson’s fault. If Dr. Smith had read Dr. Ricketson’s note, replaced the pulled out drain immediately, or had thought it important enough to find out early enough why Mr. Iturrade couldn’t move his legs, none of this would have happened.
So why was Dr. Ricketson sued and not Dr. Smith? Keep in mind, Mr. Iturralde had passed away from complications due to the paralysis from Dr. Smith’ s surgery. When the family initiated the suit, the decision was to tie Medtronic’s failed rod delivery as the proximate cause using the rationale that Dr. Smith wouldn’t have had to operate had we used titanium rods in the first place. Really? Remember Mr. Iturrade had titanium rods placed at the second operation in Hilo. They failed too. By tying in Medtronic, the payday to plaintiff might be as high as $45 million dollars. The deep pocket. If they sued Dr. Smith, much easier and would have been settled out of court, they might get $3 million. Ramp up the publicity (Good Morning America, etc), show the world a trumped up mental image of a drug-crazed, deranged, malpractice ridden surgeon with a “hacksaw”-why not? This was not the Dr. Ricketson we all knew. He admitted he had a problem before he came to Hawaii. The hospital knew that. He stayed clean-the hospital knew that, too. He became severely depressed after his family left him-his wife hated being in Hawaii, the place Dr. Ricketson and his children called Home. One night, someone offered him cocaine, he took it and started to run “to have a heart attack, I can’t take it anymore”. The next day, he went to Honolulu for treatment, and never came back. We found out later he went back to the mainland for treatment and to be closer to his kids. That’s the Dr. Ricketson we knew, not the one made out to be in the media.
I found him on LinkedIn the other night and contacted him. Hawaii revoked his license after the heavily published trial. They said he “broke his contract” with Physician’s Health when he took the cocaine. He had Kansas monitor him for four years and he has been clean now for ten years. “My anniversary this month! Ten years”, he said this week. I asked him if he missed medicine. “Everyday. I still volunteer at a local free health clinic. I’ve taught medical assistants. My interests won’t ever go back to surgery after all the grief and distorted information. My purpose now is to give all I can in research. If I can somehow make my contribution to medicine there, change something for the better, I can live with the past.”
Are you coming back to Hawaii? “My kids are with me now-I have custody since last July-and we’re talking about it. A dream, maybe, but we’re talking. We miss you all and Hawaii is still home in our hearts and Ohana.” When I saw this site and read what is written here, hopefully someone will read this and know Dr. Ricketson for who he really was and is from someone who knows the truth. We love you and hope you will come back to Hawaii. Aloha. Write to me on Facebook-Allie Foxe.

24 01 2014

WOW!! Allie Foxe,
Truly, I love and am inspired by your innocence and your trust and your desire to see the good in people. I do my best to live my life with the same priorities. It is not always possible, because sometimes, there are people who will not– or choose not–to abide in truth. They cover their flaws and their failings, and call them something else, hoping that the hurt and spoil that they smear across the face of the earth will somehow, go unnoticed by the rest of us.

Rick Ricketson was a man who refused to confront and deal with his personal issues, and many of his patients, in his care and under his knife, suffered because of it. He was at the time, a drug addict, a Doctor with access to–and a problem with–drugs. What he did to Mr. Arturro Iturralde was criminal and Ricketson knew that then, and knows that today. Ricketson’s choices and treatment of his patients are not accurately depicted in your writing, Allie.
Other things that you write are close, but inaccurate, as well.
Who are you Allie Foxe?? Because I do not remember you ever being present at Hilo Medical Center as an employee. You were never a member of the surgical staff at Hilo Medical Center. You never participated in the surgical care of Mr. Iturralde. You were never on staff at HMC, nor were you a member of either of the teams —in any way–that dealt with the surgeries cited here. Yet you write about everything as if you were there and personally…living through it. Hmmmmmmm.

Your opinions about Ms Feldmeyer are kinda mean-spirited, and are really quite pointed, if not just blatantly ugly. Maybe you are a person with a reason to spew some hatred and malcontent about Ms. Feldmeyer…
Maybe you are someone really close to the doctor….

I am the nurse that reported Dr. Ricketson, Me, I Am Ms. Feldmeyer. Friends call me Janelle.
“People” do not like to attack good physicians who are honest about their mistakes. There was no attack laid on Dr. Ricketson’s life or his medical practice. Truth was told.

What you have written, and the story that you so artfully weave, is a joyless misrepresentation of the truth, pointed at elevating the Doctor who willfully chose to actively do harm, into the role of victim. You see the poor Ricketson as a Doc scammed and hated by me, and somehow manipulated into a pitiful position of defenseless attack by me. You are dead wrong, Allie. What was covered and revealed in the media was not 1/100 of the facts surrounding this case. You can “pundit” the rest of your lives, and position yourselves around any belief you want, you can write and toss words to array a story that you find appealing–one that suits your tastes and your hearts desires—but you cannot re-invent truth.
What happened in the case of Arturro Iturralde as a crying shame. And a preventable error. For that, Dr. Ricketson was responsible, and so was Hilo Medical Center. Period.

Again, who are you Allie Foxe?? And why does your quill spill so much ink to elevate this doctor ??

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