NMT will provide distinguished expert witnesses who are nationally recognized as subject matter experts in the medical sub-specialty of Intra-operative Neurophysiologic Monitoring (IONM), also referred to as Neuromonitoring.  Our expert witnesses will conduct an intrusive review of the monitoring data, patient history, chart notes, and all related elements that are exclusive to the surgery.  

Upon completion of the review, our expert witnesses will create a disposition of the events that transpired and identify any inconsistencies, lack of communication, and form an expert opinion based upon the information provided. Additionally, our expert witnesses will testify on your behalf.

The purpose of providing our expert witness and case review service is to assist attorneys in understanding the intrinsic details of a highly specialized complex medical sub-specialty.  There are many key concerns and critical steps that must be considered when determining whether or not negligent practices were performed during IONM.  

Patient care and safety are of paramount interest during all surgeries.  When patients undergo IONM during their surgery, it is critical to establish if clinicians followed their department/company polices and procedures, established appropriate professional oversight in a timely manner, and notified the surgeon of changes in monitoring data.     

We know from reviewing numerous closed case reviews that IONM teams have been found negligent for failure to notify the surgeon when critical changes occur during surgery.  Often times the technical staff did not establish a connection with their oversight physician in a timely manner.  The oversight physician should be connected to the technical staff's case before the patient is in the operating room suite using a HIPAA compliant secured connection.  The qualifications and certifications of the monitoring team are necessary to display competence among the team. When unqualified individuals perform monitoring without professional oversight, this creates a liability to the team.  The surgeon may not be aware that the monitoring was performed without appropriate oversight.

One of the key points of conducting an extensive case review is to evaluate whether or not the IONM practices performed meet the current industry standards, guidelines, position statements, and accepted medical community practices.  NMT's team of expert witnesses consists of dozens of neurologists who are familiar and fluent with the ACNS Guidelines and ASNM position statements. It is important to note that in the absence of a formal policy and procedures manual, the guidelines and position statements are often used as a mode of comparison in a medical-legal review. 

This expert witness and IONM case review service is geared toward medical malpractice attorneys who have clients that suffered a neurologic compromise or injury during surgery that involved Intra-operative Neurophysiologic Monitoring. Our services are also geared toward health insurance companies.

Several of the most commonly discovered issues that arise during a case review include:

• Failure to connect with oversight physician
• Gaps in connectivity and communication with oversight
• Failure to notify the surgeon when changes occur in the neuromonitoring data
• Technologists performing an interpretation outside of the scope of their credentials
• Independently and improper interpretation of the data
• Failure to document
• Breaching the standard of care 
• Failure to discuss test modalities specific to the surgical procedure