Helling v. Carey

Supreme Court of Washington, En Banc · 1974 · Torts

negligencecustommedical malpracticeglaucoma testmedical malpracticeophthalmologyprofessional standard of carecustom

Facts

The plaintiff was treated by defendant ophthalmologists from 1959 through multiple visits ending in October 1968, primarily for problems associated with contact lenses. At the October 1968 visit, defendants tested her eye pressure and field of vision for the first time, revealing glaucoma after she had already essentially lost her peripheral vision and had only a very narrow area of central vision remaining. Expert testimony from both sides established that the professional standard in ophthalmology did not require routine pressure tests for glaucoma in patients under age 40, unless complaints or symptoms suggested glaucoma. The disease was rare in that age group, but the pressure test was simple, relatively inexpensive, harmless if the eye condition permitted, involved no judgment factor, and would detect glaucoma.

Issue

Whether ophthalmologists who complied with the profession's custom of not routinely giving pressure tests to patients under 40 were nevertheless negligent for failing to timely administer that test to this plaintiff. More specifically, the question was whether professional custom conclusively insulated defendants from liability under these facts.

Rule

What is usually done in a profession is evidence of what ought to be done, but the legal standard is reasonable prudence, not custom itself. Under the facts of this case, reasonable prudence required the timely administration of a simple, harmless pressure test to detect glaucoma, even though the professional standard did not require routine testing of patients under 40.

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One of 10 multiple-choice questions for this case. Pick an answer to see why.

In Portland, Oregon, Dr. Nina Patel, a pulmonary specialist, sees Evan Brooks several times over six years for recurring breathing irritation she attributes to seasonal allergies. The undisputed expert testimony is that specialists in her field do not routinely use a quick, inexpensive, noninvasive oxygen-saturation screen on patients under 35 absent alarming symptoms, even though the screen would reliably reveal a rare lung disorder whose untreated progression causes permanent injury.

If Evan proves the screen could have been given during prior visits and would have revealed the disorder in time to prevent the permanent injury, what is the strongest argument that Dr. Patel was negligent despite compliance with professional custom?

Explanation. The majority held that customary professional practice is relevant evidence, but the legal standard remains reasonable prudence. Where a precaution is simple, relatively inexpensive, harmless, and capable of detecting a serious condition in time to avoid grave harm, a court may require it even if the profession generally does not. The other choices overstate the rule or incorrectly make custom conclusive.