Helling v. Carey, 519 P.2d 981 (Was. 1974)

1. Procedural History:

1.1. Plaintiff sued Defendant, Ophthalmologists, for medical malpractice alleging that severe and permanent injuries resulted from substandard care. Trial Court entered Judgment for the Defendants based on a jury verdict.

1.1.1. Plaintiff appealed and the intermediate appellate court affirmed. Plaintiff then appealed to the highest court in Washington State which is the State Supreme Court.

1.1.1.1. The Issue on appeal was whether the intermediate appellate court erred in affirming the trial court's failure to give the Plaintiff's jury instructions which defined the standard of care as being that which the law imposes upon an ophthalmologist.

2. Facts:

2.1. The Plaintiff first consulted the Defendants for nearsightedness in 1959 when she was fitted for contact lens. No test for glaucoma was ever performed. She then proceeded to be treated by the physicians and saw them several times over the course of the next nine years all for symptoms and conditions being considered by the physicians for contact related issues. No glaucoma tests were performed on any of the visits except for the last one in October of 1968.

2.1.1. On the last exam, a glaucoma test was performed and returned a positive test result for glaucoma. By that time, the Plaintiff lost her periphery vision and her central vision was reduced.

2.2. "During trial, the testimony of the medical experts for both the plaintiff and the defendants established that the standards of the profession for that specialty in the same or similar circumstances do not require routine pressure tests for glaucoma upon patients under 40 years of age." Carey, supra. at p. 982.

2.2.1. Experts for both the defendants and the plaintiff agree that the incidence of glaucoma in people under 40 are very low.

3. Rule:

3.1. The standard of medical care and how it is defined is a matter of law to be given by the courts, not necessarily by members of the same or similar medical profession as the Defendant physicians.

3.2. Rationale for the Rule: "Courts must in the end say what is required." Id. at P. 983. Evidence of the standard of care is what a physician ought to do and certainly evidence of what is usually done is persuasive, but the medical professions can never be the sole arbiter of what the standard is for the case.

4. Reasoning:

4.1. In the case at bar, the court reasoned that everyone, even those under 40, should routinely be given the test for glaucoma even though the incidence of glaucoma is minimal. The court added that every person should be afforded the same protections as those over 40 to avoid the consequences of this disease. Essentially, the court relied on the testimony that the test is harmless and is such a minimally invasive and inexpensive test that everyone should get it. Apparently, the court felt that the professional standard was inadequate to protect the public.

5. Holding:

5.1. The Supreme Court held that, as a matter of law, the professional standard was inadequate, and judicially constructed its own standard of care which requires that every patient be given a glaucoma test regardless of whether there is only a minimal chance of a person under 40 having the disease.

5.2. The Supreme Court found no need to review the appropriateness of the plaintiff's jury instruction because by ruling that as a matter of law the defendants breached the standard of care, the only issue for the jury to decide was damages.

5.3. On that basis, the Supreme Court reversed the appellate court decision and vacated the judgment at the trial court level ordering a new trial on the issue of damages only.

6. Impact:

6.1. In Barton V. Owen, 71 Cal App. 3rd 484 (1977), the California court disagreed with the Helling decision noting that the standard of care and whether a health care provider acted reasonably is always a question of fact for the jury to decide and never a legal question as a matter of law. It may be that a custom is not the standard, but its not a matter of law for the court to decide as it always is a jury question.

6.2. In Gates v. Jensen, 579 P. 2d 374 (Wash App 1979), the appellate court distinguished Helling noting that the decision was superseded by a new statute which expressly required that negligence be determined in accordance with a professional standard and hence not one manufactured by the court.

7. Importance:

7.1. With Helling standing for the proposition that the medical profession does not necessarily set the standard of care, rather the courts do, physicians need to be aware of what those standards are and document their SOAP notes accordingly. If Helling were still applicable, and its not in a majority of states, plaintiff verdicts would be on the rise due to court's forcing their own judicially created standards onto the medical profession. In some other industries, judicial navigating is sometimes mandated, but not in the medical profession because of its uniqueness.

8. Influence:

8.1. Gratefully for defense lawyers and the medical profession, the proposition in Helling is no longer extant because its been supplanted by Statutes making the standard purely a professional one.

8.2. As a consequence of this movement towards a purely professional standard, defense lawyers are calling on academics in the various medical collegium to write articles clearly outlining the standards in the circumstances as needed. Now I am not suggesting that these standards are manufactured to fit, but rather the standards or usual practices need to be codified by certifying entities. Likewise, public education needs to expanded to help educate the public on what the standards are for the most treatable diseases. Cancer Treatment falls neatly into that latter category as there is an exact written protocol for each type of cancer and its all available on the internet.