Helling v. Carey (1974)

1. Facts

1.1. Parties Involved

1.1.1. Plaintiff(s) (Petitioners): Morrison P. HELLING and Barbara Helling

1.1.1.1. Helling, M. "suffers from primary open angle glaucoma" (Helling v. Carey, 1974).

1.1.2. Defendant(s) (Respondents): Thomas F. CAREY and Robert C. Laughlin

1.1.2.1. Partners at an ophthalmology practice (Helling v. Carey, 1974).

1.2. Historical Proceeding

1.2.1. In September of 1963, the plaintiff consulted the defendants about irritation caused by contact lenses (Helling v. Carey, 1974).

1.2.2. Until October of 1968, the "defendants considered the plaintiff's visual problems to be related solely to complications associated with her contact lenses" until Dr. Carey examined the "plaintiff's eye pressure and field of vision for the first time" (Helling v. Carey, 1974).

1.2.3. The plaintiff was 32 when she lost her peripheral and central vision (Helling v. Carey, 1974).

1.2.4. Nearly one year later, in August of 1969, "after consulting other physicians, the plaintiff filed a complaint against the defendants alleging, among other things, that she sustained severe and permanent damage to her eyes as a proximate result of the defendants' negligence" (Helling v. Carey, 1974).

2. Rule of Law

2.1. Negligence

2.1.1. For a plaintiff to recover damages from medical malpractice alleging a negligence tort, it must be proven that: (1) the duty of care was substandard, (2) there was a breach of duty, (3) injury resulted, and (4) actions taken or not taken resulted in causation (Showalter, 2017).

3. Analysis

3.1. Negligence (Medical Malpractice)

3.1.1. Testimony

3.1.1.1. "Q. Now, when was it, actually, the first time any complaint was made to you by her of any field or visual field *518 problem?" (Helling v. Carey, 1974).

3.1.1.1.1. "A. Really, the first time that she really complained of a visual field problem was the August 30th date. (1968)" (Helling v. Carey, 1974).

3.1.1.2. "Q. And in your opinion, how long, as you **983 nor have the whole history and analysis and the diagnosis, how long had she had this glaucoma?" (Helling v. Carey, 1974).

3.1.1.2.1. "A. I would think she probably had it ten years or longer" (Helling v. Carey, 1974).

3.1.1.3. "Q. How about the incidence of glaucoma in people over 40?" (Helling v. Carey, 1974).

3.1.1.3.1. "A. Incidence of glaucoma over 40 gets into the two to three per cent category, and hence, that's where there is this great big difference and that's why the standards around the world has been to check pressures from 40 on" (Helling v. Carey, 1974).

3.1.2. The court examined prudence of a reasonable physician. The leading argument being, a reasonable physician is not likely to test for glaucoma for someone under 40, given the standard of care is not to test for glaucoma unless presenting symptoms.

3.1.3. Moreover, "there are no disputed facts to submit to the jury on the issue of the defendants' liability. Hence, a discussion of the plaintiff's proposed instructions would be inconsequential in view of our disposition of the case" (Helming v. Carey, 1974).

3.1.4. "Given the inaccuracy of tonometry tests, the relatively low incidence of the disease in younger persons, and some disagreement about the effectiveness of existing treatment options, there is an issue as to whether universal glaucoma screening makes good sense as public policy" (Showalter, 2017).

4. Issue

4.1. Simply, "the issue is whether the defendants' compliance with the standard of the profession of ophthalmology, which does not require the giving of a routine pressure test to persons under 40 years of age, should insulate them from liability under the facts in this case where the plaintiff has lost a substantial amount of her vision due to the failure of the defendants to timely give the pressure test to the plaintiff" (Helling v. Carey,1974).

5. Conclusion

5.1. In conclusion, "the judgment of the trial court and the decision of the Court of Appeals is reversed, and the case is remanded for a new trial on the issue of damages only" (Helling v. Carey, 1974). Furthermore, "imposing liability, because, in choosing between an innocent plaintiff and a doctor, who acted reasonably according to his specialty but who could have prevented the full effects of this disease by administering a simple, harmless test and treatment, the plaintiff should not have to bear the risk of loss" (Helling v. Carey, 1974).

5.2. Overall, "If the standard of a reasonably prudent specialist is, in fact, inadequate to offer reasonable protection to the plaintiff, then liability can be imposed without fault. Where its presence can be detected by a simple, wellknown harmless test, where the results of the test are definitive, where the disease can be successfully arrested by early detection and where its effects are irreversible if undetected over a substantial period of time, liability should be imposed upon defendants even though they did not violate the standard existing within the profession of ophthal- mology. . ." (Helling v. Carey, 1974).

6. Impact

6.1. In the case of "Justice Holmes stated in Texas & Pac. Ry. v. Behymer, 189 U.S. 468, 470, 23 S.Ct. 622, 623, 47 L.Ed. 905 (1903): What usually is done may be evidence of what ought to be done, but what ought to be done is fixed by a standard *519 of reasonable prudence" (Helling v. Carey, 1974).

6.2. In The T. J. Hooper, 60 F.2d 737, on page 740 (2d Cir. 1932), Justice Hand stated: "Under the facts of this case reasonable prudence required the timely giving of the pressure test to this plaintiff...The precaution of giving this test to detect the incidence of glaucoma to patients under 40 years of age is so imperative that irrespective of its disregard by the standards of the opthalmology profession, it is the duty of the courts to say what is required to protect patients under 40 from the damaging results of glaucoma" (Helling v. Carey, 1974).

7. Importance

7.1. A health care professional would care about the ruling because, though "standard of the profession, which does not require the giving of a routine pressure test to persons under the age of 40" it does not negate the capability or agreement to perform screenings for glaucoma as early as age 30 (Helling v. Carey, 2017).

8. Influences

8.1. For glaucoma screenings, "If you are younger than 40 and have no known risk factors for glaucoma, the American Academy of Ophthalmology (AAO) recommends that you have a complete eye exam every 5 to 10 years. This includes tests that check for glaucoma. The AAO suggests more frequent routine eye exams as you age" (Hsuney et al, 2017).

9. “There are many situations in which a careful person is held liable for an entirely reasonable mistake. . . . in some cases the defendant may be held liable, although he is not only charged with no moral wrongdoing, but has not even departed in any way from a reasonable standard of intent or care. . . . There is ‘a strong and growing tendency, where there is blame on neither side, to ask, in view of the exigencies of social justice, who can best bear the loss and hence to shift the loss by creating liability where there has been no fault” (Helling v. Carey, 1974).

10. References

10.1. 1. Supreme Court of Washington, Helling v. Carey (1974)

10.2. 2. Showalter, S. J. (2017). The law of healthcare administration (8th ed.). Chicago, IL: Health Administration Press. ISBN 1567938760.

10.3. 3. Hsuney, A. and Rudnisky, C.J. (2017). Glaucoma Screening - Topic Overview. Glaucoma Screening-Topic Overview