1. Application
1.1. In analyzing the case, one can deduce that there is a possible claim for medical negligence by the plaintiff
1.1.1. If there was such a case, the plaintiff must prove that there was a violation of any parts of a negligence claim (Standards of Care)
1.1.1.1. Plaintiff Arguments
1.1.1.1.1. In analyzing the case, there was a definite physician-patient relationship between the defendants and Helling.
1.1.1.2. Defendant Defenses
1.1.1.2.1. The defense can argue that it was not "customary" to screen patients under age 40 with glaucoma and it goes against evidence-based practice and the nationally guidelines accepted by the community of ophthalmologists
1.1.2. Was there causation?
1.1.2.1. The plaintiff may argue that there was a proximate cause that linked her developing glaucoma and permanent vision loss with the doctor's negligence to look further into it. Them failing to diagnose her, substantially contributed to permanent damage
1.1.2.1.1. The plaintiff may also argue that she could have been referred to by another opthalmologist for a second opinion
1.1.2.2. The defense can also argue that the plaintiff had the free will to seek the opinion of another eye doctor if she was truly concerned about it
1.1.2.2.1. This is a weak argument, however. Why?
1.1.3. Claim / Damage?
1.1.3.1. The defendant cannot claim an assumption of risk or duty to mitigate defense because they failed to investigate and diagnose the pain early on
1.1.3.1.1. However, we cannot be too sure if the early diagnosis can change the prognosis of permanent damage. In this case, there could potentially be a reduction in liability and monetary compensation
2. Impact of Decision
2.1. The Washington legislature passed a statute that would attempt to overturn the Helling rule
2.1.1. Cautionary tale of what can occur if medical professionals only go by science alone. Medical professionals must rely on instinct on top of science
2.2. Gates v Jensen
2.2.1. Held that the Helling's rule was still in effect and that the "standard was not limited to what the members of the profession did, but what they ought to have done"
3. Facts
3.1. Background: Barbara Helling (P) suffered from open angle glaucoma resulting in a rise in ocular pressure, which consequently led to optic nerve damage and eventually a loss of vision. Drs. Thomas Carey and Robert Laughlin (D) were co-defendants and Helling's ophthalmologists. For a few years, Helling thought that her vision issue was related to irritation from contact lenses. Dr. Carey, a few years later, performed an eye and field of vision test
3.1.1. Glaucoma is primarily detected by performing an ocular pressure test (tonometry) on the affected eye and is relatively inexpensive
3.1.2. The eye test revealed that Helling had developed glaucoma, which contributed to some vision loss. Helling soon filed a malpractice lawsuit stating that the Co-defendant's negligence contributed to the vision loss
3.1.2.1. The Defense: Both the plaintiff and defendant's expert witness attested that the standards of practice did not require persons under 40 years of age to undergo a pressure test due to the rare nature in this particular age group
3.1.2.1.1. The jury was in favor of Carey and Laughlin, Helling filed for an appeal, however, the court of appeals affirmed the judgement
3.1.2.2. The Plaintiff's Argument: the defendant's negligence in failing to timely perform the pressure test was the proximate cause of her permanent vision loss
4. Conclusion
4.1. The supreme court reversed the judgement for the defendants, Carey and Laughlin due to reasonable prudence standards - which required the doctors to perform that test even though the standards of practice does not call for it
5. Issue
5.1. The issue stems from whether or not the defendants, Carey and Laughlin, comply with the standards of practice in their field
5.1.1. Standard practice does not call for a routine ocular pressure tests for persons under 40 years of age
5.2. What is an acceptable and appropriate practice to a reasonably prudent ophthalmologist?
6. Rule of Law
6.1. Elements of Medical Negligence
6.1.1. Duty
6.1.1.1. A physician-patient relationship must exist
6.1.2. Breach
6.1.2.1. A breach of duty occurs when the defendant fails to exercise reasonable care for a specified duty - which is determined by the jury through a question of facts
6.1.2.1.1. The plaintiff must show that the standard of care was breached by presenting evidence of facts and expert testimony that would attest to this standard of care
6.1.3. Causation
6.1.3.1. Actual Cause and the but for test - would the plaintiff's injury occur if it were not for the defendant's actions or for the lack there of? In other words, the plaintiff must prove that the defendant's action caused the injury in question
6.1.3.1.1. 1. The injury would not have occurred but for the defendant's acts 2. it was a foreseeable result of the negligent act
6.1.3.2. Proximate Cause: were the injuries foreseeable and were the actions by the defendant directly contributory to the plaintiff's injury?
6.1.4. Damages
6.1.4.1. Was there a legally recognized harm due to the negligence by the defendant?
6.2. Reasonable Prudence
6.2.1. may require a standard of care higher than the ones customarily and locally accepted by the ophthalmologist community regarding glaucoma screening
6.3. Strict Liability Standard
6.3.1. Plaintiff would only need to prove that the defendant was responsible for the plaintiff's injuries, even if the defendant acted in good faith or took all possible precautions
7. Impact on Health Care Operations
7.1. Rulings such as the one by Helling will profoundly impact on how a hospital treats diseases, especially treatment algorithms
7.1.1. Differential diagnoses may include additional diagnosis that would not otherwise be developed based on presenting symptoms.
7.1.1.1. Additional tests and procedures may be ordered to avoid lawsuits to show that "everything is being done."
7.2. Ruling may give rise to new guidelines set forth by another reputable institution, which may further complicate standards of care practices
7.2.1. Washington v. Washington Hospital Center
7.2.1.1. Conflicting sets of medical guidelines were reviewed in a medical practice case. In this case, which guideline would a reasonably prudent practitioner choose to follow?
8. Two Health Care Practices Influenced by Holding
8.1. 1. Medical Malpractice Lawsuits
8.1.1. Due to potential lawsuits, practitioners may order additional tests that may otherwise deviate from the normal standard of care for a particular condition. For example, cardiac enzymes for a suspected myocardial infarction by a 25 year old
8.2. 2. Ophthalmologists deviating from normal practice patterns as a result of the Helling ruling.
8.2.1. This would also likely increase in overall cost, but would probably not see a reduction in overall morbidity