1. Issue: Did defendants comply with standards of care and, if so, does compliance with standards of profession insulate defendants from liability?
2. Impact:
2.1. In general, Helling v. Carey is a controversial case. It is often referred to as an exception to malpractice rulings because of the courts decision that it could rule on what ought to have been done even when physicians acted within standards of care. There have been statues that followed the Helling case that attempted to overturn the ruling, but this has not always been followed. There are many examples of cases that have both followed and not followed the Helling ruling. Two are cited here.
2.1.1. Barton v. Owen 1977: COurt ruled that Helling v. Carey did not hold and did not accept argument in similar case of negligence against physicians for diagnosis of glaucoma.
2.1.2. Gates v. Jensen 1979: upheld Helling v. Carey
2.2. Insurance companies less willing to insure against malpractice, greater chance of loss.
2.3. Standard of Care in Opthamalogy changed. glaucoma testing is part of routine care (http://www.allaboutvision.com/eye-exam/expect.htm)
3. Importance
3.1. This ruling is significant to physicians because the court can decide the standards of care. It is concerning for physicians to have to consider that a failure to do something, even outside standards of care could get them into trouble is stressful. Often what one "ought" to have done is only apparent once the opportunity to act has past, therefore the ruling places physicians in a unique position of having to be particularly prudent when they may in fact think they are being overly cautious.
4. Influence
4.1. One business factor that has been influenced by this decision is that agencies must have malpractice insurance and a legal team in order to manage malpractice claims. This places a greater cost burden on business, who must then find ways to generate profits to cover such expenses.
4.2. Related to the example above, there is a greater need to include legal language in patient contracts and interactions in order to protect against malpractice suits. This creates more paperwork and therefore a greater burden on administrative staff and the patient.
4.3. Another result is that physicians may order additional tests in order to exercise prudent care for a patient. This means higher costs to insurers and patients, as well as the hospital. This also means a higher possibility for false positives which may result in additional and unnecessary interventions with higher costs.
5. Rule of Law
5.1. Negligence
5.1.1. Negligence - the unintentional failure to live up to accepted standards of behavior.
5.1.1.1. To claim negligence, these four elements must be proven:
5.1.1.1.1. The duty of care: refers to a legal obligation the defendant owes to the plaintiff. It is expressed as the caution and prudence that a reasonable person would exercise under the circumstances or that are required by appropriate authority for such situations.
5.1.1.1.2. Breach of that duty: Once the standard of care (duty) has been established, the plaintiff must show that it was breached by presenting evidence of the facts of the case and testimony from expert witnesses regarding whether the standard was met.
5.1.1.1.3. Injury/ Damages:The law considers an injury to be the proximate result of a negligence act if: the injury would not have occurred but for the defendant’s act, or it was a foreseeable result of the negligent conduct.
5.1.1.1.4. Causation: The plaintiff must show that the injury was the proximate cause of the negligence. Proximate cause is the act or omission from which an injury results as a natural direct, uninterrupted consequence and without which the injury would not have occurred; the legal cause of the damages to the plaintiff; the cause that immediately precedes and produces the effect (as contrasted with a remote or intermediate cause).
5.2. locality rule; (School Rule)
5.2.1. The principle that healthcare practitioners are judged by the standards of their own branch of medicine
5.3. strict liability (Tort law): law considered but not strictly applied
5.3.1. liability that does not depend on actual negligence or intent to harm
5.3.1.1. although referenced in the case, but not the rule of law ultimately applied since court found negligence
6. Analysis/Application
6.1. Plaintiff's side
6.1.1. Existence of patient/physician contract: patient (plaintiff) had consulted and paid for and received services from defendant on multiple occasions.
6.1.2. The plaintiff's side argued that the defendants were negligent and this resulted in her permanent loss of vision.
6.1.2.1. 1. The duty of care: Plaintiff argued that reasonable prudence was not used by defendants, since a low cost, simple test could have been performed in response to repeated complaints by plaintiff regarding her discomfort.
6.1.2.1.1. Even though defendants were acting in accordance of standard of care, it was argued that reasonable prudence should have compelled them to offer this simple test
6.1.2.2. 2. Breach of that duty: As explained in duty of care, the plaintiff side argued that the duty above was breached by failure to perform the test.
6.1.2.2.1. Evidence to support the breach of duty was supported by testimony "that the standards of the profession do require pressure tests if the patient's complaints and symptoms reveal to the physician that glaucoma should be suspected. Plaintiff had complained and consulted physicians on numerous occasions.
6.1.2.3. 3. Injury/damages: patient suffered glaucoma and permanent loss of vision as proximate result of defendants failure to provide pressure test
6.1.2.3.1. late detection of glaucoma causes permanent damage, defendants had multiple opportunities to perform pressure test.
6.1.2.4. 4. Causation: Had the defendants applied the pressure test earlier, they could have detected, treated, and prevented permanent damage from the glaucoma
6.1.2.4.1. Testimony supported that glaucoma, with early detection can be treated.
6.2. Defendant's side
6.2.1. This side argued that defedant's had performed within standards of the profession and therefore they did not commit a breach of duty or were liable for resulting permanent loss of vision.
6.2.1.1. Locality rule/School rule
6.2.1.1.1. Standards of the profession do not require providing pressure test to patients under 40 years of age, particularly because the rate of glaucoma is so low.
6.2.1.2. Negligence: based on information and evidence that they had performed within standards of care, defendants argued that the four elements of negligence had not been met.
6.2.1.2.1. If duty of care has not been violated, plaintiff could not not prove causation
6.3. Supreme Court's decision
6.3.1. Court ruled that reasonable prudence had not been met and the defendant's should have performed the pressure test. The court also ruled that this was negligence by the defendants and the proximate results was permanent blindness to the plaintiff
6.3.1.1. The court considered this a unique case because the defendants had not acted outside of their standard of care. Rather, the court argued, the defendant's had not displayed reasonable prudence because the test that could have prevented damages was so simple to perform and that considering the many visits from the plaintiff to the defendants, it was not outside prudent responsibility to use some extra caution and test for glaucoma, despite the rare occurrence in women of plaintiff's age. Additionally, testimony revealed that a pressure test should be given if patient complaints and symptoms might suggest glaucoma.
6.3.1.1.1. Essentially, the court ruled that it could judge such cases by what a physician should have done.
6.3.1.1.2. plaintiff should have received the same protections given to women over 40 because plaintiff should also be protected from disease. Additionally, even though occurrence of glaucoma is low, the risk is high enough to warrant use of test.
6.3.1.2. The court decided that even though standards of care were followed, this did not protect the defendants from being liable for negligence.
6.3.1.2.1. Texas & Pacific Ry. Co. v. Behymer (1903)
6.3.1.2.2. T.J. Hooper (2 Cir. 1932)
6.3.1.3. Concurring opinion: Additional justices concurred that reasonable prudence was not adhered to and that the defendants had a greater responsibility to the plaintiff than they performed.
6.3.2. In this case, the court is expanding the law regarding liability. Physicians could not expect operating within standards of care to protect them from being liable for negligence.
6.3.3. Supporting arguments to Court's decision:
6.3.3.1. Commenting on Tort law, court discussed that decision considers the "logic of maxmizing service and minimizing diservice." This implies that
6.4. Public Policy
6.4.1. The court ruled that as "a matter of law" operating within standards of care did not insulate from liability. This meant the court could judge if the standards of care practiced by a profession were adequate.
6.4.1.1. The implications of this ruling complicated physician practice who relied on their own field and colleagues to dictate standards of care and not those outside the profession. As a result, physicians more vulnerable to liability.
7. Conclusion
7.1. The court overturned lower court's ruling and found in favor of the plaintiff that the defendants were liable for negligence.
8. Facts
8.1. Parties
8.1.1. Plaintiff: Morrison P. Helling and wife Barbara Helling (wife patient)
8.1.1.1. patient: wife, suffering glaucoma with permanent eye damage
8.1.1.2. version of events:
8.1.1.2.1. 1959: Plaintiff consulted physicians for nearsightedness in and received contact lenses
8.1.1.2.2. September 1963:Plaintiff consulted defendants for irritation caused by her contact lenses.
8.1.1.2.3. Additional consultations with defendants occurred in the following years: Oct. 1963; Feb 1967; Sept. 1967; Oct. 1967; May 1968; July 1968; Aug. 1968; Sept. 1968; Oct. 1968
8.1.1.2.4. Oct. 1968: Plaintiff, age 32, has eye pressure and field of vision test for first time. Test indicates glaucoma.
8.1.2. Defendent: Thomas F. Carey MD and Robert C. Loughlin MD (Opthamalogists)
8.1.2.1. version of events:
8.1.2.1.1. Defendants claimed they practiced according to standards of the profession and that routine pressure tests for glaucoma are not required for patients under 40 years of age.
8.1.2.1.2. Experts establish and support claim that this what defendants claim above is standard practice.
8.1.3. Procedural History
8.1.3.1. August 1969: Plaintiff filed malpractice suit alleging negligence which caused the permanent damage from glaucoma. She claimed she "sustained severe and permanent damage to her eyes as proximate result of the defendants negligence"
8.1.3.1.1. Court ruled in favor of defendants
8.1.3.2. court of appeals upholds judgement
8.1.3.3. Plaintiff appealed to supreme court
8.1.3.4. Supreme court rules in Plaintiff favor and moves case to proceed for damages