Helling v. Carey

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Helling v. Carey by Mind Map: Helling v. Carey

1. Issue

1.1. Should adherence to standard of care absolve claims of negligence when reasonable prudence may prevent severe damages.

2. Facts

2.1. Parties

2.1.1. Barbara Helling (Plaintiff): patient who experienced progressive eye pain and visual loss during her 20s while a patient of Dr Carey's ophthalmology practice

2.1.2. Dr Thomas Carey (Defendant): practicing opthamologist who cared for the plaintiff for 10+ years

2.2. Events

2.2.1. Disease Course: Plaintiff began experiencing nearsightedness in 1959 and was prescribed contacts. 4 years later, she experienced progressive irritation of her eyes and consulted the defendant several times over the following years. Her pain was attributed to the contact lenses

2.2.2. Her visual changes progressed to near blindness when the defendant conducted a manometry exam to test for open angle glaucoma, a condition rarely seen in the plaintiffs age demographic

2.3. Procedural History

2.3.1. WIth a positive manometry test confirming glaucoma, the plaintiff files a claim of negligence of the defendants which resulted in severe and permanent damage to her vision.

2.3.2. Trial and Appellate Courts: Favor for the defence. Expert testimony and adherence to the ophthalmology standard of care which stated that it is not routine to perform glaucoma testing in patients younger than 40 years of age.

2.3.3. Washington Superior Court: States that despite the accepted standard of care and unlikely occurrence of glaucoma in patients below 40, reasonable prudence was not delivered to the patient and not conducting manometry earlier was proximate cause resulting in permanent blindness. Court decision was reversed in favor for the plaintiff for files of negligence as a quick, cheap and minimally invasive exam may have preserved her vision.

3. Analysis/Application

3.1. Perpective

3.1.1. Plaintiff: Ms. Helling asserts that despite the standard of care not recommending testing for glaucoma, and quick simple and cheap manometry study could have prevented severe and permanent damage (visual loss). Throughout the span of her care with the defendant and the potential for the damages mentioned above, a greater level of prudence was warranted despite only 1 in 25,000 patients in her age group developing this disease. As that 1, she deserves the same standard of care as the target demographic at risk.

3.1.2. Defense: Dr Carey and associates maintained that it was not routine standard of care practice to conduct manometry testing in patients under the age of 40. This was widely accepted by the ophthalmology community and supported by expert witnesses

3.2. Court Reasoning:

3.2.1. Trial Court: in favor for the defense who upheld the standard of care confirmed by expert testimony

3.2.2. Court of Appeals: in favor of the defense

3.2.3. Washington State Supreme Court: reversal in favor of the plaintiff on claims of negligence against the defense - state reasonable prudence may require a standard of care higher than that actually practiced by the profession

3.2.3.1. Defendants breach of duty by not practicing the appropriate level of prudence and care of Ms. Helling led to severe damages. Failure to conduct manometry testing was proximate cause to her visual loss. Irrespective of the standards of care, the court's duty is to protect patients under the age of 40 regardless of the incidence.

4. Impact

4.1. Response from the community: the Helling case was met with shock as it implied that the courts did not value the standard of care in cases of medical negligence. This essential made expert testimony inconsequential in such cases.

4.2. Statute: "after being overturned, the Helling Rule influenced Washington legislature to release a statute stating that if a plaintiff were to bring a civil suit for damages against a healthcare practitioner, they must prove by preponderance of evidence that the defendant(s) failed to exercise the degree of skill, care and learning possessed at that time by others in the same profession and that this was a proximate cause to the damages suffered by the plaintiff.

4.3. Emphasized the value of reasonable prudence in cases where the standard of care is insufficient to prevent proximate cause and inso doing result in harm

4.4. Case reference: Pederson v. Dumouchel, 72 Wn.2d 73, 431 P.2d 973 (1967) - plaintiff was in a car accident and seen by the physician for minor injuries. A jaw fracture was discovered and the patient to undergo surgery with no gross or minor brain injury identified by the MD. Patient later develops seizures and is found to have anoxic brain injury which would have been prevented if a prudent work up and exam were performed earlier.

4.5. Case reference: Gates v Jensen: Applied the Helling Rule: States the "standard was not limited to what members of the [healing arts] actually did but what they ought to have done"

5. Conclusion

5.1. The Helling Rule: statute passed in response to Helling v. Carey which states that in any civil action for damages based on professional negligence, the plaintiff must prove by a preponderance of evidence that the defendant(s) failed to exercise reasonable skill, care and learning possessed at that time by others in the same profession and as proximate cause, led to the plaintiff suffering damages

5.1.1. This rule applies to this case by stating that defendants in the healing arts are held accountable by the standards of care established by others in their field at their time and are liable for damages their actions (or lack thereof) directly cause

5.2. Washington Legislature: overturned the Helling Rule after claims of impertinence from the medical community.

6. Rule of Law

6.1. Standard of Care: caution and prudence a reasonable person would exercise under similar circumstances

6.1.1. Expert testimony: It was indisputable that the defense held up to the ophthalmology standards of care as the patient was below the suggested age of glaucoma testing and the incidence of occurrence would be less than 1 in 25,000

6.1.2. The reasonable physician: the defence is liable to provide "reasonable and ordinary" treatment and are not typically judged against the most knowledgeable or highly skilled colleagues but rather those of of average knowledge and skill.

6.2. Negligence: Unintentional failure to live up to the accepted standards of behavior for a reasonably prudent person established by a (1) duty of care, (2) breach of said duty, (3) injury and (4) causation.

6.2.1. Reasonable Prudence: a hypothetical legal standard to which practitioners are held to when practicing caution in their duty of care

6.3. Proximate Cause: the act or omission of one from which a direct injury results and without which the injury would not have occured

7. Importance/Influence

7.1. The Helling v Carey case made practitioners more liable for using their judgment and reasonable prudence regarding a patient rather than soley the standard of care. This meant that no matter how unlikely a diagnosis may be, it is their responsibility to approach the care of a patient cautiously despite disease prevalence. Specifically, this case referred to the plaintiff being 1 in 25,000. THe question that arises now is: what if the next patient is that 1.

7.2. This raises the standard for medical practices, hospitals and other healthcare institutions to hire reasonable prudent staff as vicarious liability can make even them responsible for the failure of diagnosis in cases that result in severe damages, no matter how unlikely the diagnosis may be.

7.3. Real world impact: Physcians who no longer feel protected by following the standard of care may order extensive and unwarranted testing in patients where history and physical would still lead to a reasonable differential diagnosis. This promotes the practice of defensive medicine and consequently sky rocketing medical expenses.

7.4. The physician-patient relationship: Trust and mutual respect promote a stronger professional relationship. If the standard of care is deemed insufficient, both patients and physicians can become frustrated with excessive testing in the name of reasonable prudence. This breeds feelings of doubt and faith in the caregivers knowledge.