Helling v. Carey
83 Wn.2d 514, 519 P.2d 981 (1974)
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Rule of Law:
A physician's compliance with the customary standard of care of their profession is not a conclusive defense in a negligence action when a court determines that the standard itself is not reasonably prudent under the circumstances.
Facts:
- Barbara Helling first consulted ophthalmologists Dr. Thomas F. Carey and Dr. Robert C. Laughlin in 1959 for nearsightedness.
- Between 1963 and October 1968, Helling had multiple consultations with the defendants concerning irritation she experienced with her contact lenses.
- The defendants considered Helling's visual problems to be related solely to her contact lenses and did not test her for glaucoma.
- In October 1968, at age 32, Helling's intraocular pressure was tested for the first time, revealing that she had advanced primary open angle glaucoma.
- By the time of her diagnosis, Helling had already suffered permanent eye damage, including the essential loss of her peripheral vision and significantly reduced central vision.
- The established standard of care for ophthalmologists at the time did not require routine glaucoma pressure tests for patients under the age of 40.
- The pressure test for glaucoma is simple, relatively inexpensive, and harmless to the patient.
- The incidence of glaucoma in patients under 40 is rare, estimated to be around one in 25,000 people.
Procedural Posture:
- Barbara Helling filed a medical malpractice complaint against Dr. Carey and Dr. Laughlin in a Washington state trial court.
- Following a trial, the jury rendered a verdict for the defendants, and the trial court entered a judgment in their favor.
- Helling, as appellant, appealed the judgment to the Washington Court of Appeals.
- The Court of Appeals affirmed the judgment of the trial court.
- Helling, as petitioner, petitioned the Supreme Court of Washington for review, which was granted.
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Issue:
Does a physician's compliance with the accepted professional standard of care for their specialty insulate them from liability for negligence if that standard does not require performing a simple, harmless, and inexpensive diagnostic test that could prevent severe, irreversible harm to a patient?
Opinions:
Majority - Hunter, J.
No. A physician's compliance with the professional standard of care does not insulate them from liability if that standard itself falls below the level of reasonable prudence. Although the professional standard for ophthalmologists did not require routine glaucoma tests for patients under 40, the court has the ultimate authority to determine what is required by a standard of reasonable care. Citing Justice Hand's opinion in The T.J. Hooper, the court reasoned that 'a whole calling may have unduly lagged' and that courts 'must in the end say what is required.' Given that the test is simple, inexpensive, and harmless, while the potential harm of undetected glaucoma is devastating and irreversible, reasonable prudence required the doctors to administer the test. The defendants' failure to do so constituted negligence as a matter of law.
Concurring - Utter, J.
No, but the imposition of liability in this case is better understood through the lens of strict liability rather than negligence. It is illogical for judges, who lack medical training, to declare that doctors following their professional standards failed to exercise reasonable care. Instead, the court is effectively making a policy decision about risk allocation. In choosing between an innocent plaintiff who suffered a catastrophic loss and doctors who could have prevented it with a simple, harmless test, the doctors (who can insure against such risks) are in the better position to bear the loss. This approach imposes liability without finding moral fault, which is more appropriate given the facts of the case where the defendants acted in accordance with the standards of their specialty.
Analysis:
This case is a landmark decision in medical malpractice law, establishing that professional custom is not an absolute shield against liability. The court asserted its authority to scrutinize and reject an entire profession's standard of care if it deems the standard unreasonable. This holding, often called the 'Helling rule,' significantly impacts medical practice by requiring physicians to consider not just what is customarily done, but what is reasonably prudent to protect a patient from foreseeable harm, especially when a low-cost, low-risk preventative measure can avert a devastating outcome. It signals a shift from a purely professional standard to a standard that incorporates a judicial cost-benefit analysis of medical procedures.
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