1. FACTS
1.1. Parties
1.1.1. Plaintiff/Petitioners: Morrison P. Helling and Barbara Helling
1.1.1.1. Husband and wife but Barbara Helling was the actual patient in this case.
1.1.2. Defendant/Respondents: Thomas F. Carey and Robert C. Laughlin
1.1.2.1. Partners in Ophthalmology
1.2. What Happened
1.2.1. 1959- Barbara Helling first meets and is treated by defendants
1.2.1.1. Experienced nearsightedness and myopia
1.2.1.2. Helling was given contact lenses
1.2.2. 1963-Four years later Helling consulted with defendants again due to contact irritation
1.2.3. Over the course of 5 years, Helling consulted with Dr. Carey and Dr. Laughlin 8 addtional times.
1.2.3.1. Consultation Dates Include: October 1963; February 1967; September 1967; October 1967; May 1968; July 1968; August 1968; September 1968; October 1968
1.2.3.2. Helling was treated for complications with contact lenses prior to final visit.
1.2.4. Helling's final visit was October 1968, Dr. Carey tested Ms. Hellings eye pressure and field of vision.
1.2.4.1. This is the first time either defendant conducted this test.
1.2.4.2. Results of test indicated Ms. Helling had glaucoma
1.2.4.3. 1 out of 25,000 people under 40 get glaucoma and Ms. Hellings at 32 years of age was 1 out of 25,000.
1.2.5. Ms. Helling's vision was reduced to 5 degrees vertical by 10 degrees horizontal.
1.2.6. Ms. Helling filed complaint against defendants in August 1969
1.2.6.1. Prior to doing this, Helling sought consultations from other physicians.
1.3. Procedural History
1.3.1. Ms. Helling filed negligence complaint against defendants in August 1969
1.3.1.1. Helling alleged the damage to her eye and loss of vision is the result of the defendant's negligence.
1.3.2. Trial Court returned a verdict in favor of defense
1.3.2.1. Medical experts on both sides asserted the defendants followed standards of care.
1.3.3. Appellate court returned a verdict in favor of defense
1.3.4. Supreme Court of Washington State reversed verdict from Trial Court and Appellate Court
2. ISSUE
2.1. Does following the standard of the profession for ophthalmology absolve the defendants of negligence?
3. RULE of LAW
3.1. In order to prove negligence in this case, one must prove that there was a breach of duty or a breach in reasonable standards of care.
3.1.1. Reasonable standards of care are established by medical experts.
3.1.1.1. The "School Rule" must be followed meaning medical experts must be included and the standards of care must be established by physicians in the same specialty.
3.1.2. Reasonable standards of care indicate what a reasonable/average physician would do.
3.1.2.1. This does not include risky treatments or experimental procedures.
3.2. Strict liability is also a consideration in this case.
3.2.1. Poses automatic responsibility
3.2.2. Strict Liability involves a harmful act that imposes high risk of harm to others.
3.2.3. Done unintentionally and not out of negligence.
4. ANALYSIS
4.1. The facts in this case are not disputed in terms of what actually occurred. The interpretation is different.
4.2. Defense Position
4.2.1. Defendants did what any reasonable physician would and upheld the standards of the profession.
4.2.2. 1 out of 25,000 people under 40 get glaucoma.
4.2.2.1. Due to this rare occurrence, it is not common practice to test for glaucoma in patients under 40.
4.2.3. There was no breach of duty since they upheld the standard for their profession as testified by medical experts from both the defense and prosecution.
4.2.4. The standard profession should be enough to protect defendants from any negligent liability.
4.3. Plaintiff Position
4.3.1. Ms. Helling had glaucoma for an estimated 10 years while under the care of the defendants.
4.3.2. The standards of the profession require pressure tests if a patient is experiencing symptoms of glaucoma, regardless of age.
4.3.3. Pressure test is inexpensive and should have been given to the plaintiff.
4.4. Supreme Court of Washington
4.4.1. The defendants carried out common practice. There is no clear fault.
4.4.1.1. No clear fault does not mean that there isn't liability.
4.4.1.2. In this case, strict liability against the defendants would apply.
4.4.1.2.1. By following the common practice of their profession they did what any medical professional would do.
4.4.1.2.2. The defendants could have prevented the loss of the plaintiff's eye sight.
4.4.1.2.3. Following common practice does not absolve the defendants from liability for the plaintiff's loss of sight.
4.4.1.2.4. The plaintiff's loss of sight is the proximate cause of the defendants' negligence.
4.4.2. Common standard vs. Reasonable Standard
4.4.2.1. The "Common" standard of care is not always the "Reasonable" standard of care.
4.4.2.2. Though it was "common" practice for the defendant's not to conduct pressure tests for patients under 40, it was not "reasonable" for them not to test.
4.4.2.3. Patient's under 40 deserve to be protected as those over 40.
4.4.3. The courts decided that common prudence does not protect from reasonable prudence.
4.4.3.1. Reinterpreted the sufficiency of medical practice standards protecting against negligence.
4.4.3.1.1. With this analysis, just because a physician follows the common practice standard, does not mean it will be considered "reasonable"
4.4.3.2. The standard of the profession should have been higher.
4.4.4. Pressure tests should be common practice
4.4.4.1. The determination of who is entitled to early detection was also a key factor.
4.4.4.2. The ease of administration, the cost and the accuracy of the pressure test weighed in on the court's decision.
4.4.5. The courts have a responsibility to decide how to best protect patients under 40 in this case.
4.4.5.1. Justice Holmes in Texas & Pac. Ry. v. Behymer influenced this case.
5. CONCLUSION
5.1. The judgement of trial court and the Court of Appeals were reversed.
5.2. Supreme Court of Washington found the defendants liable for negligence.
6. IMPACT
6.1. Gates vs. Jensen
6.1.1. In this case, the physician followed standard professional practices, but in following those standards the plaintiff's disease was not detected early.
6.1.1.1. Courts decided that with additional reasonable testing the defendant could have detected the plaintiff's disease early.
6.1.1.2. Supreme court decided the standards of the profession were too low, and cited Helling vs. Carey as a reference.
6.2. Christensen v. Munsen
6.2.1. Case is similar in that the plaintiff claimed that the physicians negligence called her to go blind.
6.2.1.1. Courts did not rule in plaintiff's favor.
7. IMPORTANCE
7.1. Helling vs. Carey supports that if the standards of a profession are too low, physicians will not be protected against negligence.
7.1.1. This case illustrates the difference between what should be done and what ought to be done and holds physicians accountable for that
7.1.2. Determinations about what is considered "reasonable" may vary case by case if standards of the profession are insufficient