1. Facts
1.1. Parties
1.1.1. Plaintiff - Barbara Helling
1.1.2. Defendants- Dr. Thomas Carey and Dr. Robert Laughlin
1.2. What Happened?
1.2.1. Ms Helling first consulted Dr Carey and Dr. Laughlin's practice in 1959 for myopia, (nearsightedness)
1.2.1.1. She was given contact lenses to improve her vision
1.2.2. She again consulted the practice in 1963 concerning irritation caused by contact lenses
1.2.2.1. She had 9 other encounters with the defendants over 5 years, regarding the same concern and Dr Carey kept telling her that her problems were due to the irritation caused by contact lenses.
1.2.2.1.1. On her 9th encounter in 1968 Dr Carey checked for her eye pressure and field of vision when he diagnosed that she suffered from Open angle glaucoma
1.2.3. In August 1969, after consulting with multiple other physicians Ms. helling filed a suit against Dr Carey
1.2.3.1. She alleged that her vision was damaged due the medical negligence of the defendants
1.2.3.2. Medical experts from both the plaintiff and defendants side claimed that in similar circumstances, for a patient under 40 years of age checking ocular pressure was not the standard of care as this disease occurs in older population.
2. Impact
2.1. Defensive practice of medicine and unnecessary testing
2.1.1. In this case the doctors stuck to the standard of care and yet they missed the diagnosis, as a result of which the patient lost her vision. To avoid such malpractice law suits doctors may go on a defense and order more testing. Thus increasing the cost of healthcare.
2.1.1.1. Would this strategy improve health of the patients or just further burden patients who are already burdened by the high costs of healthcare? Unnecessary testing has not shown to improve health.
2.2. Healthcare systems need to come up with better differential diagnosis algorithms
2.2.1. Doctors would be able to consider and test multiple diseases presenting with similar symptom profile.
2.2.1.1. This might increase examination times and physician may be able to see fewer patients further leading to physician shortage and decreased access.
2.3. Increase in practice of Evidence based medicine
2.3.1. This would allow doctors to to definitively show the probability of a particular outcome based on research that has been already done.
2.3.1.1. Doctors will be able to argue their standard of care based on clinical evidence.
3. Influence
3.1. Barton v. Owen Most negative 139 Cal.Rptr. 494, Cal.App. 2 Dist.
3.1.1. Plaintiff alleges that due to the negligent actions of the defendants he suffered brain abcess. The only point of contact was when the plaintiffs wife called the doctor and doctors suggested he may be suffering from sinusitis but he would need to come in so that he can check it up.
3.1.1.1. The court of appeals held the judgement that doctors can't be held liable if they had limited conversation on the phone. The patient negligently did not follow all the instructions so these actions were intact the proximal cause for the injury.
3.2. Gates v. Jensens 579 P.2d 374, Wash.App. Div. 1
3.2.1. In this case Ms. Gates went to eye clinic with complains of failing vision. They checked her intraoccqular pressure which was borderline high and they did ophthalmoscopic exam but did not dilate the eyes. Also vision testing was not done.
3.2.1.1. The court affirmed that testing for ocular pressure does not require vision testing
4. Issue before the Court
4.1. Did Dr. Carey and Dr. Laughlin act according to standard of care?
4.1.1. Although they adhered to the standard of care prevalent at the time, were they liable for the damages in this case due to strict liability?
4.2. Were the defendants negligent?
4.2.1. What would a prudent Ophthalmologist do in a similar situation?
4.2.1.1. Diid the defendants show reasonable prudence in the situation they were presented ?
5. Rule of the Law
5.1. Medical Negligence
5.1.1. There are four factors to be considered when proving Medical negligence
5.1.1.1. Duty
5.1.1.1.1. There must be a physician doctor relationship ( an expressed or an implied contract)
5.1.1.2. Breach of duty
5.1.1.2.1. Doctor must fail to provide treatment based on the reasonable standard of care based on specialty, qualification, location
5.1.1.2.2. The petitioner must provide evidence and expert testimonies, that the doctor failed to provide the reasonable care.
5.1.1.3. Causation
5.1.1.3.1. The petitioner needs to provide evidence that but for the doctors actions or inaction the injury would not have occurred.
5.1.1.3.2. Showing the proximate cause- The damage is the direct result of the negligent actions of the physician
5.1.1.4. Damage
5.1.1.4.1. How much worth are these injuries?
5.2. Strict Liabilty
5.2.1. Imposes liability without having to prove negligence
5.2.1.1. It is closely related to the concept of Res Ispa Loquitur and reasonable prudence
5.3. Reasonable prudence
5.3.1. What a reasonably prudent physician may do in the given scenario may be a standard that is higher than the standard of care set at that time for a particular condition.
6. Application of the Law
6.1. The Plaintiff argued that the defendants were negligent. They did not check intraoccular pressure (tonometry) for the 9 years that the plaintiff was consulting with them. Her reason for eye discomfort was not her contact lenses but it was infact a open angle glaucoma. Due to this delay in diagnosis she had lost her vision in her eye. To help prove malpractice claim the defendant had to prove the following-
6.1.1. Did defendants have a duty towards the plaintiff? Was there a doctor patient relationship?
6.1.1.1. The plaintiff was seeking the defendants' dare for almost 10 years for the discomfort in her eyes. Thus, there was a physician patient relationship so the defendants had a duty towards the plaintiff.
6.1.2. Was there a breach of duty?
6.1.2.1. Plaintiff argued that her condition demanded that the defendants do tonometry to diagnose open eye glaucoma. But they failed to do that and she lost her vision.
6.1.3. Was there a proximate cause?
6.1.3.1. Loss of vision was due to the glaucoma which if diagnosed correctly in a timely fashion could have been treated. And her vision would have remained intact. Thus there was a proximate cause.
6.1.4. Damages.
6.1.4.1. Ms Helling was a young woman and she had permanent loss of vision which would affect her day to day life.
6.2. The defendants argued that the standard of care did not expect the defendants to check intra ocular pressure of a patient under 40 years of age and which is why they did not check Ms. helpings intraoccqular pressure.
6.2.1. They also argued that the plaintiff should have seeked other physicians opinion and thus has contributory negligence.
6.2.1.1. But the discomfort in plaintiff;s eyes was since almost 10 years and she had 9 encounters with the defendants. They had changed the contact lenses without really solving the problem. This must have forced them to doubt if really they had done the correct diagnosis. Also this should have prompted them to do more testing. there was no need to wait for 10 years to do a simple pressure test.
6.2.1.2. Plaintiff could have seemed a different opinion but she already had a relationship and trusted the physicians judgement. And it was their duty to give her the best treatment.
6.3. The standard of care did not specify a pressure test under the age of 40 but in this case doctors were treating the patient for almost 10 years without second thoughts or tests without being able to relive her of the eye discomfort. What would a prudent physician do in this situation?
6.3.1. It is expected that a prudent physician would have gone a step further and done all the testing in order to go in details of the case and try to relieve the symptoms
6.3.1.1. Thus under the rule of reasonable prudence doctors should be expected to go above and beyond the standard of care in order to treat the patient.
6.3.1.1.1. Ultimately the court felt that defendants were liable for the damages based on reasonable prudence standards.