HA 625 Unit 3 liability case brief example

When the Whole Profession Is Wrong: A Case Brief of Helling v. Carey and What It Means for a Clinic That Relies on Custom

Student Name

Health Care Administration, Herzing University

HA 625: Healthcare Law and Ethics

Instructor Name

January 29, 2026

When the Whole Profession Is Wrong: A Case Brief of Helling v. Carey and What It Means for a Clinic That Relies on Custom

Citation

Helling v. Carey, 83 Wash. 2d 514, 519 P.2d 981 (1974). Supreme Court of Washington, decided March 14, 1974. Opinion by Justice Hunter; concurring opinion by Justice Utter.

Facts

Barbara Helling first consulted the defendant ophthalmologists in 1959 for nearsightedness and was fitted with contact lenses. Over the following years she returned for examination and for complications the physicians attributed to her lenses, with visits in 1963, 1967 and repeatedly in 1968. Until October 1968, the physicians treated her visual complaints as problems caused by the lenses. At that visit they measured her eye pressure and tested her field of vision for the first time and found primary open-angle glaucoma. She was 32. By then she had lost her peripheral vision, and her central vision was reduced to a narrow field of about 5 degrees vertically by 10 degrees horizontally (Helling v. Carey, 1974).

Open-angle glaucoma raises pressure inside the eye gradually and damages the optic nerve. It usually produces few symptoms until the damage is extensive, and the damage cannot be reversed. The pressure test that detects it is simple, relatively inexpensive, and involves no judgment in its reading.

Procedural History

Helling sued for malpractice. Expert witnesses on both sides testified that the standard of the profession did not require routine pressure tests for patients under 40, because the disease is rare in that age group; the court noted an incidence of about one in 25,000 people under 40. The jury returned a verdict for the defendants, the trial court entered judgment on it, and the Court of Appeals affirmed. The Supreme Court of Washington granted review.

Issue

Can a court hold physicians negligent as a matter of law for failing to give a simple, inexpensive diagnostic test, even though the uncontradicted expert testimony established that the standard of their profession did not require the test for a patient of the plaintiff's age?

Holding

Yes. The court held that reasonable prudence required the timely giving of the pressure test to this patient, and that the defendants' failure to give it was negligence as a matter of law. The judgment was reversed and the case remanded for a new trial on the issue of damages only.

Reasoning Through the Four Elements

Duty. The physician-patient relationship was not disputed. The defendants had treated Helling for nearly a decade, and a physician who undertakes to examine a patient's eyes owes that patient a duty of reasonable care in doing so. The dispute was about the content of the duty, not its existence.

Breach. This is where the court departed from the usual rule. Ordinarily, a physician's conduct is measured against the standard of the profession, proved by expert testimony, and conduct that matches the profession's standard is not a breach. The court accepted that the defendants had met the professional standard but held that the standard itself fell short. It relied on the principle, stated by the United States Supreme Court in a railroad case decades earlier, that what is usually done may be evidence of what ought to be done, but what ought to be done is fixed by a standard of reasonable prudence, whether or not it is usually complied with. Because the test was simple, inexpensive, harmless and conclusive, and because the harm it would prevent was blindness, reasonable prudence required it even for a patient under 40, and failing to give it was a breach.

Causation. The court treated the connection between the missing test and the harm as established by the nature of the disease: glaucoma progresses silently, the test detects it, and early treatment can halt progression. Had the test been given at one of the earlier visits, the disease would have been found before so much vision was lost.

Damages. Helling's loss of peripheral vision and narrowing of central vision were permanent and not disputed. Because the court found negligence as a matter of law, the only question left for a new jury was how much she should recover, which is why the remand was limited to damages.

The Concurrence

Justice Utter agreed with the result but not with calling it negligence. The defendants, he reasoned, had done what their profession required and could not fairly be called careless. He would have imposed liability without fault, treating it as more just that the physicians, rather than an innocent patient, bear the loss when a simple, harmless and definitive test could have prevented an irreversible injury. His view shows the tension in the majority's approach: it found fault in physicians who had followed accepted practice.

What Happened Next

The Washington legislature responded in 1975 with a statute requiring a plaintiff in a professional negligence action against a health care provider to prove that the defendant failed to exercise the skill, care and learning possessed by others in the same profession (Wash. Rev. Code § 4.24.290). The legislature's aim was to restore the pre-Helling standard. The case is still taught because it states, more clearly than most, the idea that a profession's custom is evidence of reasonable care rather than the definition of it, a point legal texts continue to discuss when explaining how the standard of care is proved (Showalter, 2020).

The medical question has also moved on. Current evidence reviews find limited direct evidence that screening adults without symptoms for glaucoma improves vision outcomes, even though treatment slows progression once the disease is found (Chou et al., 2022). The case is about a patient already under a specialist's care for eye complaints, which is a different setting from population screening.

Significance for a Health Care Organization

For an administrator, the lesson is not that every test should be given to every patient. It is that a protocol defended only by "this is what everyone does" is weaker than one defended by a reasoned comparison of cost, risk and harm prevented. Consider a composite multispecialty clinic whose protocols for low-cost screening measures, such as a foot examination for patients with diabetes, were adopted years ago from peer practice. The clinic's quality committee can apply the Helling reasoning directly: for each measure it does not perform routinely, it can ask whether the test is simple and inexpensive, whether it carries risk, whether it detects a condition whose harm is serious and irreversible, and whether early detection changes the outcome. Where all four answers point toward testing, following peer practice is a thin defense.

The analysis also belongs in the record. A committee that documents why it chose a protocol, citing current evidence, is in a far stronger position than one that can say only that others do the same. The case brief method used here, stating the facts, the question, the answer and the reasons, is also a useful template for those committee minutes.

References

Chou, R., Selph, S., Blazina, I., Bougatsos, C., Jungbauer, R., Fu, R., Grusing, S., Jonas, D. E., & Tehrani, S. (2022). Screening for glaucoma in adults: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA, 327(20), 1998-2012. https://doi.org/10.1001/jama.2022.6290

Helling v. Carey, 83 Wash. 2d 514, 519 P.2d 981 (1974).

Showalter, J. S. (2020). The law of healthcare administration (9th ed.). Health Administration Press.

Wash. Rev. Code § 4.24.290 (2025).