1. IMPACT OF DECISION
1.1. Harris v Groth, 99 Wn.2d 438, 663 P.2d 113 (1983)
1.1.1. The Court summarized the state of jurisprudence with regards to conformity as follows: “The standard of care against which a healthcare provider’s conduct is to be measured is that of a reasonably prudent practitioner, possessing the degree of skill, care, and learning possessed by other members of the same profession in the state of Washington. The degree of care actually practiced by members of the profession is only some evidence of what is reasonably prudent—it is not dispositive
1.1.1.1. Absent exceptional circumstances such as were present in Helling, expert testimony will be necessary to show whether or not a particular practice is reasonably prudent. It will also usually be necessary to prove causation.
1.2. Christensen v. Munsen123 Wash. 2d 234, 867 P.2d 626 (1994)
1.2.1. Patient filed medical malpractice suit against ophthalmologist alleging that she was legally blind as result of his failure to follow required standard of care in treating her underlying eye disease, pars planitis. The Superior Court, King County, Marsha J. Pechman, J., entered judgment on jury verdict for defendant. Patient appealed. The Court of Appeals certified the appeal to Supreme Court. The Supreme Court, Madsen, J., held that: (1) trial court properly allowed one of plaintiff's treating physicians to testify as defense witness, and (2) trial court properly refused patient's proposed instructions regarding standard of care and informed consent.
1.2.1.1. The Plaintiff argued for instructions to the jury that referenced the Helling case. Specifically, "The fact that a possible risk associated with care and treatment of [a] patient [is small] does not excuse an ophthalmologist from his obligation to inform the patient of that risk and to obtain the informed consent of a patient before providing treatment to that patient.... [T]he fact that a possible risk associated with the care and treatment of a patient is small, does not excuse an ophthalmologist from his obligation to exercise reasonable prudence in the care and treatment of his patient."
2. CHANGE TO BUSINESS OPERATIONS
2.1. Standard Practice of Ophthalmology
2.1.1. This case changed the standard of medical practice in ophthalmology and is the reason why a glaucoma test is done with every eye exam.
3. INFLUENCE
3.1. Malpractice Law
3.1.1. Following standard practices/guidelines will not necessarily get doctors off the medical malpractice hook.
3.1.1.1. What has evolved is the legal principle that conforming to norms may be one measure of medical prudence, but it is never the only measure of such.
3.1.2. Even a small probability of risk may be too great, especially when you could incorporate practices whereby you could check for the risk at low cost.
3.1.3. It is the court system that ultimately makes the call about whether physicians should be engaging in a practice or not, by weighing costs against risk to the patient.
3.2. Judicial Activism
3.2.1. Helling is a notorious decision as it rejects the notion of a traditional professional standard of care
3.2.2. Example of "judge made law"
4. FACTS
4.1. Parties
4.1.1. Plaintiff: Barbara Helling (32 years old)
4.1.2. Defendants: Drs. Thomas Carey & Robert Laughlin (ophthalmologists)
4.2. What Happened?
4.2.1. The plaintiff filed a complaint against the defendants alleging, among other things, that she sustained severe and permanent damage to her eyes (glaucoma) as a proximate result of the defendants' negligence in failing to diagnose.
4.2.1.1. A 32-year-old woman complained of nearsightedness, which her eye doctors treated by prescribing contact lenses. After complaining over the course of five years, she was diagnosed with glaucoma.
4.2.1.2. Her doctors responded that they had followed medical guidelines in not screening her, because the probability of someone that young having glaucoma was low.
4.3. Procedural History
4.3.1. The trial court entered judgment for the defendants following a defense verdict. .
4.3.2. The case was appealed and the Court of Appeals reversed the decision and the case was remanded for a new trial on the issue of damages only.
5. ISSUES BEFORE COURT
5.1. Were the defendants negligent for not performing a glaucoma test on the plaintiff though it was not the standard of care for ophthalmology for a patient her age?
5.2. Whether the eye doctors’ compliance with the standard of the profession of ophthalmology insulated them from liability?
5.3. Does compliance with the professional standards of a specialty satisfy the appropriate duty of care?
6. RULE OF LAW
6.1. Standard of Care
6.1.1. 1. Reasonable and ordinary treatment
6.1.2. 2. Locality rule - is the care comparable "in the same neighborhood"
6.1.3. 3. In the same line of practice (school rule)
6.1.3.1. Legitimacy depends on whether rules and principles of practice have been set to guide the practice; for instance clinical practice guidelines
6.2. Breach of Duty
6.2.1. Once standard of care established, must show by presenting facts of the case and expert testimony that standard of care was or was not met
6.3. Injury and Causation
6.3.1. 1. Injury would not have occurred but for the defendant's actions OR
6.3.2. 2. It was a forseeable result of the negligent conduct
7. APPLICATION/ANALYSIS
7.1. Plaintiff Argument
7.1.1. Helling argued her eye doctors despite continued complaints over 5 years ignored these and did not screen her timely for glaucoma and thus had not caught it in time.
7.2. Defendant Argument
7.2.1. Doctors responded that they had followed medical guidelines in not screening her, because the probability of someone that young having glaucoma was low.
7.2.2. The medically accepted standard at the time was that giving a routine glaucoma pressure test to people under 40 years old was not required. The rationale was that the probability of someone under 40 having glaucoma was very low, such that the expense of the test was not justified.
7.3. Court Overview
7.3.1. Professionals whose actions conform to the standards of their given specialty may, nevertheless, commit malpractice if such conduct is not reasonably prudent.
7.3.1.1. The Court’s position was that the legal field involves determining acceptable versus unacceptable risks, and involves trials where expert testimony can inform the jury.
7.3.1.2. Courts ultimately make the call as to whether a standard of care is reasonable and prudent, and courts must in the end say what is required. Indeed, the Court found that there are precautions so imperative that even their universal disregard will not excuse their omission (quoting The T.J. Hooper, 60 F.2d 737).
8. CONCLUSION
8.1. The Court held that under the facts of this case, reasonable prudence required the timely administration of the pressure test to the patient. In failing to do so, the Court found that the ophthalmologists were negligent, which proximately resulted in the blindness of the patient.
8.1.1. The Court responded by stating that a 1 in 25,000 chance was not that low, especially when considering that the risk was blindness. The Court found that it is the job of the courts to decide the acceptable risk.