Helling v. Carey No. 42775

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Helling v. Carey No. 42775 by Mind Map: Helling v. Carey No. 42775

1. Facts

1.1. Barbara Helling suffers from primary open angle glaucoma.

1.1.1. Condition of rising pressure inside the eye that results in damage to the optic nerve and ultimately vision loss

1.2. Dr. Thomas Carey and Robert Laughlin (Defendants) are Ophthalmologists.

1.3. Plaintiff was seen by Defendants for myopia (nearsightedness) in 1959.

1.3.1. Fitted with contact lenses

1.4. September 1963, seen again for contact lens discomfort.

1.5. Additionally seen by defendants multiple times in 1963, 1967, 1968.

1.6. October 1968, Defendant performed ocular pressure ad field of vision test for the first time.

1.6.1. She was 32 at this encounter.

1.6.2. Peripheral vision gone, Central vision significantly diminished.

1.7. August 1969, Plaintiff consulted multiple physicians.

1.7.1. Filed suit against Defendants for negligence resulting in severe damage to vision.

1.8. Court ruled in favor for defendants.

1.8.1. Care rendered was determined to be in keeping with the standards of practice for the Ophthalmological profession.

1.9. The Hellings appealed

2. Issue

2.1. Did the court justly rule in favor of the Defendants.

2.1.1. Was the appropriate standard of care followed.

2.1.2. Did the delay in pressure testing of the Plaintiff's eyes cause significant damage to her vision.

3. Rule of Law

3.1. Negligence- deviation from normally accepted standards of care through error or omission.

3.1.1. Ophthalmological standards of care do not include the administration of a pressure test prior to 40 years old.

3.1.2. Physicians must use reasonable prudence in the prolonged care of their patients.

3.1.2.1. Court determined that reasonable prudence pertaining to this patient included the timely giving of an ocular pressure test.

3.2. Liability-legal responsibility for actions or outcomes.

3.2.1. In this case, the concept of Strict Liability is applied.

3.2.2. Liability without fault.

3.2.2.1. Found responsible but not at fault.

3.2.2.2. Everything expected by standard was done,

3.2.2.2.1. Role of court-

3.2.2.2.2. Determine if following standard of care precludes the Defendants from liability for damages entirely, or to what extent.

4. Analysis

4.1. Defendants argued that they could not be held to any other standard of practice than is reasonable expected.

4.1.1. Damages resulted from a test reasonably considered as not essential in the treatment of individuals under age 40.

4.1.2. The likelihood of glaucoma in a patient under 40 is roughly 1 in 25,000

4.1.3. The likelihood of glaucoma in a patient under 40

4.2. Plaintiff argued that continued discomfort throughout the substantial period of time in this case warranted additional testing.

4.2.1. Question raised that rare occurrence or not, should the patient be afforded all possible protections.

4.2.2. Test done earlier would have made a definitive diagnosis of glaucoma.

4.2.2.1. Upon examination defendant identified the glaucoma as having been present approx. 10 years

4.2.2.2. Earlier diagnosis would have led to significant reduction in damages that occurred over time.

4.2.3. Test was inexpensive, caused no harm to the patient or risk to the provider, no judgement required regarding risk/benefit.

4.2.3.1. Court determined that

4.3. Court's determination

4.3.1. The test for a patient under 40 was not a part of the standard of ophthalmological care.

4.3.1.1. The test, however universally disregarded, is so imperative in the diagnosis of glaucoma that it is a crucial part of the patient's treatment.

4.3.1.1.1. Thus, a physician exercising reasonable prudence would include an ocular pressure test for the patients prescribed complaints.

4.3.2. Reasonable prudence is required by physicians in all cases.

4.3.2.1. Reasonable prudence for this condition was determined to include an ocular pressure test.

4.3.2.1.1. Defendants care by this standard, did not meet the standard of reasonable prudence.

5. Conclusion

5.1. Court determined that the Defendants were in fact, responsible without fault.

5.2. previous court's rulings were overturned.

5.3. Court weighed the cost effectiveness of the treatment in its decision.

6. Impact

6.1. Chester v. Deeproots Alderwood LLC

6.1.1. Individual sued tattoo shop for severe infection caused by ink contaminated during manufacture.

6.1.1.1. Standard of practice was to use sterile EQUIPMENT and aseptic technique.

6.1.1.2. Patron referenced Helling in the aspect that since all equipment was to be sterile, the ink being injected could reasonably be assumed as requiring sterility.

6.1.1.2.1. Plaintiff lost both trial and appeal.

6.1.1.2.2. Court ruled that although sterile ink was "available" it was not within the tattoo parlor's scope to perform bacteriological testing.

6.2. Gates v. Jensen

6.2.1. Ophthalmologists failed to act beyond standard of care, although patients individual symptoms and condition could warrant such care.

6.2.1.1. Plaintiff argued that reasonable prudence for providers would have included additional cost-effective testing above the normal standard of care for patients condition.

7. Importance

7.1. Standards of practice are not the only requirement to meet.

7.2. Negligence can be found due to error or omission without deviation from standards of practice.

7.2.1. Leads to physicians erring on the side of excess with procedures.

7.2.1.1. Often comes into direct contention with managed care goals of cost reduction

7.2.2. Potentially increases the overall cost of healthcare

8. Influence

8.1. The lack of insulating protection from standards of practice has led to many adjustments in current medicinal practices.

8.1.1. Defensive medicine-providing excess medical treatment as to prevent negligence claims.

8.1.2. Courts now contemplate the reasonable prudent physician standard on a more regular basis, with Helling v. Carey referenced over 500 times rather than simply whether the standard of care was met (save Washington State).

8.2. The State of Washington actually implemented a revised code in order to prevent future rulings using the Helling v Carey case analysis

8.2.1. West's RCWA 4.24.290