1. Importance
1.1. Health care professionals have a moral obligation to use available technology, when safe, to protect patients from disease and disease progression
1.2. Health care professionals should use diagnostic measures when appropriate as precautions against detectable and preventable disease
1.3. Health care professionals may consider using the common standard of practice for their field as a baseline minimum and adjust accordingly on a per patient basis
2. Facts
2.1. Parties
2.1.1. Barbara Helling, 32 year old sufferer of "primary open angle glaucoma"
2.1.1.1. Helling v. Carey, 83 Wash. 2d 514, 519 P.2d 981 (1974)
2.1.2. Drs. Thomas F. Carey and Robert C. Laughlin, opthamology practice partners
2.2. What happened
2.2.1. 1959 Helling began seeing defendants for treatment of nearsightedness and was given contact lenses for correction
2.2.2. 09/1963 Helling returned to the defendants due to eye irritation presumably caused by the contacts
2.2.3. Helling consulted with the defendants nine additional times for eye issues throughout 1963, 1967, and 1968
2.2.3.1. again presumably though to be due to the contact lenses
2.2.4. 10/1968 Carey used a pressure test for glaucoma as well as a peripheral vision test for the first time
2.2.5. Helling was 32 at the time and tested positive for glaucoma
2.2.5.1. it was determined that Helling had "essentially lost her peripheral vision and her central vision was reduced to approximately 5 degrees vertical by 10 degrees horizontal"
2.2.5.1.1. Helling v. Carey, 83 Wash. 2d 514, 519 P.2d 981 (1974)
2.2.5.2. glaucoma generally presents with little to no symptoms until the eyes and vision are damaged
2.3. Procedural history
2.3.1. 08/1969 Helling filed suit against Carey and Laughlin for negligence after discussing her condition with other physicians
3. Issue
3.1. Whether the defendants committed a breach of duty and are therefore liable for the plaintiff's blindness as a result of detecting her glaucoma at a later stage
4. Rule of Law
4.1. Standard of care
4.1.1. What a reasonable person would do in a similar situation
4.1.1.1. In this case, what a reasonable ophthalmologist would do
4.1.2. During this era it was not standard practice for opthamologists to administer glaucoma testing on patients under 40 years of age due to the very rare incidence rate
4.2. Strict Liability
4.2.1. Liability without being negligent
4.3. Proximate cause
4.3.1. Action directly proceeding the injury
4.4. Prior cases discussing reasonable prudence vs standard practice
4.4.1. Texas & P. Ry. Co. v. Behymer, 189 U.S. 468, 470, 23 S. Ct. 622, 623, 47 L. Ed. 905 (1903)
4.4.1.1. personal injury case brought against the Texas and Pacific Railway company by and injured worker
4.4.1.1.1. the worked refused surgery to his injured leg thereby allowing for exacerbation of his injury
4.4.1.2. the judge determined that "...what ought to be done is fixed by a standard of reasonable prudence, whether it usually is complied with or not"
4.4.2. The T.J. Hooper, 60 F.2d 737, 737–38 (2d Cir. 1932)
4.4.2.1. case where tug boats were caught in a storm regardless of the availability of radios and storm reports on board
4.4.2.2. the judge determined that "there are precautions so imperative that even their universal disregard will not excuse their omission"
4.4.2.2.1. i.e. if there exists a preventative measure that would help avoid a negative consequence, it is reasonable to use it
5. Analysis
5.1. Plaintiff
5.1.1. Alleged that the defendants were negligent in their care and treatment of her, ultimately leading to her irreversible eye damage
5.1.1.1. i.e. that the defendants were not 'timely' in their administration of the pressure test given her continued eye irritations and complaints
5.2. Defendants
5.2.1. Alleged that they were not negligent as the standard practice for ophthalmologists at the time was to not administer the pressure test to patients under 40
5.2.1.1. i.e. they met the standard of care that was common at the time
5.3. Factual considerations
5.3.1. The incidence rate for glaucoma in persons under 40 years of age is roughly 1 in 25,000
5.3.2. The standard practice for ophthalmologists at the time was to test for glaucoma over 40 years of age
5.3.3. The test given for glaucoma, an eye pressure test, is a relatively inexpensive, simple, and safe test to give
6. Conclusion
6.1. The Court ruled in favor of Helling
6.1.1. The Court decided that persons under 40 are due the same protections and precautionary procedures as those over 40
6.1.2. Decided that the defendants were negligent and that, in referencing precedents, reasonable prudence would have been to administer the pressure test in a more timely manner
6.2. Concurring Justices
6.2.1. concluded that the defendants followed the normal standard of care for their profession at the time
6.2.1.1. not negligent by breach of duty
6.2.2. concluded that the defendants were liable via strict liability
6.2.2.1. the defendants could have administered the inexpensive and safe pressure test earlier than they did
6.2.2.2. failure to do so led to continued diagnosed and untreated glaucoma for the plaintiff which led to permanent eye damage
7. Impact
7.1. Chester v. Deep Roots Alderwood, LLC, 193 Wash. App. 147, 371 P.3d 113, review denied sub nom. Chester v. Deep Roots Tattoo & Body Modification, 186 Wash. 2d 1011, 380 P.3d 500 (2016)
7.1.1. Negative use
7.1.2. Plaintiff received a tattoo from the defendant and had an adverse reaction from the ink commonly used by the tattoo parlor
7.1.2.1. the ink was not sterile though the availability of sterile ink existed
7.1.3. The Court concluded that since neither common practice nor the FDA required the use of sterile ink, there was no breach of duty on the defendants part
7.1.3.1. the court concluded that while the use of a glaucoma test in Helling's case would have been simple and inexpensive, obtaining the sterile ink was a more complicated process
7.2. Gates v. Jensen, 92 Wash. 2d 246, 595 P.2d 919 (1979)
7.2.1. Positive use
7.2.2. Plaintiff was given an eye pressure test by the defendant and while the results showed early signs of glaucoma, the defendants did not use any other available diagnostic tool to confirm the high pressure reading and incorrectly diagnosed the plaintiff as having contact lens trouble
7.2.2.1. the plaintiff became functionally blind as a result of the missed diagnosis
7.2.3. The court referenced the Helling case, taking into account other available diagnostic tools for glaucoma, and concluded that the defendants were negligent in not using them to confirm the pressure reading or possible presence of glaucoma
8. Influence
8.1. It is now common practice for ophthalmologists to administer eye pressure tests during annual eye exams on patients under 40 years of age
8.2. Most insurance companies cover yearly preventative examinations, easing the financial burden on patients
8.3. Wash. Rev. Code Ann. § 4.24.290 (West)
8.3.1. civil code stating that plaintiffs must prove by the preponderance of the evidence that a health care professional has not performed the standard of care and that their negligence cause the plaintiff's injury