1. Importance
1.1. The case redefined how the courts can "define" standard of care--they indicated that the practice of the ophthalmologists fell below the standard of care that SHOULD apply to the specialty, and determined it was the court's responsibility to evaluate the standard of care to protect patients
2. Influence
2.1. Washington legislature passed a statute to try and overturn the ruling: "In any civil action for damages based on professional negligence against a hospital…or against a member of the healing arts…the plaintiff in order to prevail shall be required to prove by a preponderance of the evidence that the defendant or defendants failed to exercise that degree of skill, care, and learning possessed at that time by other persons in the same profession, and that as a proximate result of such failure the plaintiff suffered damages"
2.2. Courts now rely heavily on clinical practice guidelines (CPGs) to help make decisions regarding standard of care in malpractice cases
3. Impact
3.1. Fullerton v. Sacred Heart Med. Ctr., 2003 Wash. App. LEXIS 984 (Wash. Ct. App. May 20, 2003)
3.1.1. The plaintiff complained of complications after a tube was inserted into her throat during a test, and claimed her providers were negligent in not conducting an exam of her throat.
3.1.2. The plaintiff sited Helling v. Carey that reasonable prudence may require a standard of practice higher than that exercised by the relevant professional community.
3.1.3. The court determined that the patient failed to prove that the healthcare providers did not follow the acceptable standard of care of reasonable prudence. The jury was instructed that poor medical result did not constitute negligence or that the healthcare providers were not necessarily liable for an error of judgment.
3.2. Keogan v. Holy Family Hospital, 24 Wn. App. 583, 601 P.2d 1303, 1979 Wash. App. LEXIS 2757 (Nov. 1, 1979)
3.2.1. The defendant (family doctor) misdiagnosed decedent's angina and did not tell him about alternate diagnostic tests or treatments. When the plaintiff came to the hospital's emergency room, the emergency room doctor misdiagnosed the condition and did not order an electrocardiogram (EKG), resulting in death from lack of appropriate care.
3.2.2. The court cited Helling v Carey in the conclusion that the defendant was negligent in failing to exercise "reasonable prudence."
3.2.3. The appeal court found that the trial court erred in not finding the ER doctor negligent as a matter of law in not ordering an EKG.
4. Facts
4.1. Parties
4.1.1. Plaintiff(s): Morrison Helling and Barbara Helling
4.1.2. Defendant(s): Dr Thomas Carey and Dr Robert Laughlin
4.2. What Happened
4.2.1. 1959-1968: Barbara Helling, plaintiff, was treated by Dr Thomas Carey and Dr Robert Laughling, ophthalmologists, for myopia
4.2.2. 1963: plaintiff consulted with defendants regarding difficulties with her contact lenses
4.2.3. 1968: Dr Carey tested plaintiff's eye pressure and field of vision for the first time
4.2.4. 1968: Helling was diagnosed with glaucoma from test conducted by Dr Carey
4.2.5. Helling sued Carey and Laughlin
4.2.6. Helling claimed her vision was permanently damaged because they did not conduct a simple test nine years earlier during the time of treatment
4.3. Procedural History
4.3.1. • 1969: plaintiff filed complaint that she sustained severe and permanent damage to her eyes as the result of defendants' negligence
4.3.2. Trial court entered judgment for defendants
4.3.3. Supreme court reversed decision of the trial court and court of appeals
4.3.4. Case remanded for new trial on issues of damages
5. Issue
5.1. Should the defendant's compliance with standards of the profession of ophthalmology protect the doctors from liability and claim of negligence?
6. Rule of Law
6.1. Negligence
6.1.1. The unintentional failure to live up to accepted standards of behavior.
6.1.1.1. 1) the duty of care (2) breach of that duty (3) injury (4) causation
6.1.1.1.1. Duty of Care
6.1.1.1.2. Reasonable Prudence
7. Analysis
7.1. Plaintiff's Take
7.1.1. Helling claimed her vision was permanently damaged because they did not conduct a simple glaucoma test nine years earlier during the time of treatment
7.2. Defendant's Take
7.2.1. Argue the standard of the profession doesn't require giving routing pressure test to those under age of 40 due to rarity of disease in age group and therefore should not be found negligent
7.3. Court's Take
7.3.1. Reasonable Prudence
7.3.1.1. Court argued that the plaintiff was entitled to the same timely detection of glaucoma despite rarity of disease in age group
7.3.1.1.1. Test is simple and inexpensive, no judgement required, detection is likely, test is harmless
7.3.1.1.2. No evidence that they test could not have been given in a timely fashion during course of care
7.3.1.2. T.J. Hooper: "reasonable prudence" does not take into account that a common course of care may not have adopted new and available devices
7.3.1.2.1. Courts must say what is required
7.3.1.3. “reasonable” physician needs to provide“reasonable and ordinary” treatment.
7.3.1.3.1. The courts usually hold that the physician is not liable if the chosen treatment would be recognized by a “respectable minority” of the medical profession
7.3.2. Duty of Care
7.3.2.1. Expert witness for defense: stated standard of practice at the time did not require routine testing for glaucoma in patients younger than age 40.
7.3.2.1.1. Medical expert witnesses established standards of profession for ophthalmology in same/ similar circumstances do NOT require routine pressure tests for glaucoma
7.3.2.2. Court's opinion that a greater duty of care should be imposed on defendants than of the standard profession
7.3.2.2.1. Imposition of liability aligns with strict liability, or liability without fault
7.3.2.3. Strict liability: compensatory function since the defendant is more financially responsible
7.3.2.3.1. If standard of reasonably prudent specialist cannot protect the plaintiff from harm, liability can be imposed without fault
8. Conclusion
8.1. Reasonable Prudence
8.1.1. Reasonable prudence required giving the pressure test to the plaintiff
8.1.2. Court deems it is their duty to determine the important of the test in the standards of the ophthalmology profession to protect patients
8.2. Duty of Care
8.2.1. Reasonable standard of care should have included timely administration of glaucoma test
8.2.2. Defendants are negligent in failing to administer the test
8.2.2.1. Defendants are liable for the proximate result in blindness in plaintiff
8.3. Supreme court reversed decision of the trial court and court of appeals
8.3.1. Case remanded for new trial on issues of damages