Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-24T02:18:34.609Z Has data issue: false hasContentIssue false

The Application of Reasonable Prudence to Medical Malpractice Litigation: The Precursor to Strict Liability?

Published online by Cambridge University Press:  27 April 2021

Extract

Recently, the California Supreme Court found an established medical standard of care to be inadequate and replaced it with a judicially constructed medical standard of practice premised on the rule of reasonable prudence. California thus joined the State of Washington and became the second state to sanction the invocation of reasonable prudence in the fashioning of judicially formulated medical standards of care.

As this article will illustrate, the Supreme Courts of California and Washington are, in a narrow class of cases, imposing a greater duty of care on physicians than previously mandated by the medical profession. These courts are impliedly stating that although the physicians complied with the particular standard of care within their profession, they could have better protected their patients had they pursued a more prudent course of conduct. Moreover, in choosing between the innocent and damaged plaintiff and the equally innocent and compliant physician, the courts have reasoned that the plaintiff should not have to bear the risk of loss and, consequently, have imposed liability on the physician.

Type
Article
Copyright
Copyright © American Society of Law, Medicine and Ethics 1981

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Truman v. Thomas, 611 P.2d 902 (Cal. 1980) [hereinafter cited as Truman].Google Scholar
Gates v. Jensen, 595 P.2d 919 (Wash. 1979) and accompanying text [hereinafter cited as Gates].Google Scholar
Helling v. Carey, 519 P.2d 981 (Wash. 1974) [hereinafter cited as Helling].Google Scholar
The Helling court supported its rejection of the established professional standard of care and its adoption of the rule of reasonable prudence by relying upon two cases, Texas & Pacific Ry. v. Behymer, 189 U.S. 468(1903), and The T. J. Hooper, 60 F.2d 737 (2d Cir. 1932). Factually, both decisions speak to industry-wide disregard of necessary safety precautions by commercial cargo carriers — tugboats and railroads.Google ScholarGoogle ScholarGoogle ScholarGoogle Scholar
Myopia, (nearsightedness) “is the condition in which uncorrected distance vision is more or less blurry and near vision without correction is clear.” Gray, Attorneys' Textbook of Medicine §55A. 40 (3d ed. 1981).Google Scholar
Suit was brought against Carey, Thomas F. M.D. Laughlin, Robert C. M.D., partners in ophthalmology. Plaintiffs physician was Dr.Carey, . For the purpose of this article, the defendants will be referred to in the singular.Google Scholar
Intraocular pressure may be defined as: “The pressure of the fluids within the eye against the tunics, or coverings. This pressure is altered in certain diseases; an increase suggests the onset of glaucoma…. [An] accurate measurement is obtained with a tonometer, an instrument that indents the cornea by a plunger and … through the use of tiny weights, indicates the pressure on a scale.” 6 Lawyers' Medical Cyclopedia §39.8b (1977) (revised volume).Google Scholar
Open angle glaucoma represents an extreme in the polymorphic (having more than one form) clinical pictures produced by glaucoma. Without any discomfort, ache, congestion, or other form of warning a gradual, but characteristic loss of peripheral vision occurs, with one eye usually a little ahead of the other. The rise in intraocular pressure occurs so gradually that the blood circulation of the eye can adapt itself to the new pressure level. Under these conditions only the structures directly concerned with vision, the retina (the light-sensitive membrane of the back of the eye) and the optic nerve (the nerve carrying visual impulses from the eye to the brain) deteriorate while the other structures of the eye continue a fairly normal existence. Gray, supra note 5, at §55B.32(3).Google Scholar
Helling, supra note 3 at 983. The plaintiff, who was 32 years old when her condition was diagnosed, had essentially lost her peripheral vision and her central vision was reduced to a field approximately 5 degrees vertical by 10 degrees horizontal.Google Scholar
Id. The reason the pressure test was not administered as a regular practice to patients under the age of 40 was that the disease rarely occurs in this age group. Specifically, it afflicts one out of every 25,000 people below the age of 40.Google Scholar
Id. at 982. The Supreme Court of Washington heard the case subsequent to two lower court decisions. The trial court entered judgment for the defendant based on the jury's verdict. The plaintiff appealed to the Court of Appeals, which affirmed the judgment of the trial court.Google Scholar
Id. at 983.Google Scholar
Gates, supra note 2.Google Scholar
Id. at 921. The first test was to apply the standard eye drops for dilating the pupils to obtain a good view of the optic nerve discs. The second was to have the plaintiff take a visual field examination to determine whether she had suffered any loss in her field of vision.Google Scholar
Id. at 922.Google Scholar
Id. at 923, n.3. Plaintiffs proposed instruction read:Google ScholarGoogle Scholar
Id. at 924. On appeal before the Supreme Court of Washington the defendant argued that the Helling rule of reasonable prudence had been abrogated by legislative enactment, Wash. Rev. Code §4.24.290. The statute provides in pertinent part:Google ScholarGoogle ScholarGoogle Scholar
Truman, , supra note 1.Google Scholar
The Pap smear is: [A] simple, painless test used most commonly to detect cancer of the uterus and cervix…. The test can be performed on any body excretion (urine, feces), secretion (sputum, prostatic fluid, vaginal fluid), or tissue scraping (as from the uterus or the stomach). The sample is removed from the area being examined, placed on a glass slide, stained, and then studied under a microscope for evidence of abnormal, or cancerous, cells. In five minutes, the Pap test can reveal uterine or cervical cancer at a stage in which it produces no visible symptoms, has done no damage and, usually, can be completely cured. Encyclopedia and Dictionary of Medicine. Nursing, and Allied Health at 745-46 (2d ed. 1978).Google Scholar
Truman, , supra note 1, at 904. At trial, “[t]here was disputed expert testimony that the standard of medical practice required a physician to explain to women patients that it is important to have a Pap smear each year to pick up early lesions that are treatable, rather than have to deal with [more developed] tumor[s] that very often aren't treatable.”Google Scholar
Id. While it might be difficult to accept that Mrs. Truman might not have died in 1970 if she had undergone a Pap smear in 1969, expert testimony given at trial indicated that had she “undergone a Pap smear anytime between 1964 and 1969, the cervical tumor probably would have been discovered in time to save her life.”Google Scholar
Id. at 904-05.Google Scholar
Id. at 905.Google Scholar
Id. at 907, quoting Cobbs v. Grant, 502 P.2d 1,11 (Cal. 1972).Google Scholar
Gates, , supra note 2, at 925. See Prosser, W., Law of Torts §3233 (4th ed. 1971).Google Scholar
Prosser, , supra note 27.Google Scholar
Id. at §75.Google Scholar
Id. Indeed, in Helling v. Carey, the imposition of strict liability was the basis for a concurring opinion. 519 P.2d at 985.Google Scholar
Prosser, , supra note 27, at §75.Google Scholar
Id. at §81.Google Scholar