Nerve Monitoring and Medical Malpractice

Medical malpractice occurs when a physician causes harm to a patient due to an action or omission of action that is outside the standard of practice. There are four elements the plaintiff must prove in a medical malpractice case: the physician’s legal duty to provide treatment, occurrence of a breach of that duty, occurrence of patient injury resulting in damages, and causation between the breach of duty and injury. Medicolegally, a breach of duty is synonymous with substandard medical care. The “medical standard of care” is what another similarly trained physician would have done in the situation in question. In malpractice claims in the arena of thyroid surgery, recurrent laryngeal nerve (RLN) injury is the most cited harm to the patient. Intraoperative neuromonitoring (IONM) is an adjunct to thyroid surgery to assist with RLN identification and assessment of functionality. While IONM has been shown to be beneficial in certain patient situations, it has not been proven to decrease the risk of RLN injury and has not been adopted as the standard of care. From a medicolegal perspective, IONM can be an advantage or disadvantage to the surgeon as arguments can be made for and against its use.