Duty of care is the watchfulness, attention, caution, and prudence that a reasonable person in the circumstances would exercise. A breach of duty is when the care given is below the standard the patient had a right to expect and injury occurs.

Causation is the establishment of a link between the breach of duty and the injuries complained of.

What Information Is Available with Regard to the Frequency of Litigation After Thyroid Surgery?

From the USA it is reported that the rate of post-thyroidectomy malpractice claims is 5.9 per 10,000 cases (Singer et al. 2012). Eighty-nine percent of cases occur after routine thyroid surgery, deficient informed consent is the issue in 11 % (Lydiatt 2003), and 46 % of cases involve injury to the recurrent laryngeal nerve (Abadin et al. 2010). A review of claims specifically related to iatrogenic vocal cord palsy reported that 30 % occurred after thyroid/parathyroid surgery, in 36 % there was a failure to recognize the complication, and 19 % were consent issues (Shaw and Pierce 2009).

Claims following surgical injury to accessory nerve injury result from cervical lymph node biopsies (68 %) and neck dissections (5 %). Claim allegations include negligent surgical technique (98 %), lack of informed consent (21 %), and failure to diagnose the injury (20 %) (Morris et al. 2008).

In the UK there is little specific information on post-thyroidectomy litigation, but the National Health Service Litigation Authority recorded 17 claims involving thyroid surgery and damage to the vocal cords between 1995 and 2005 (Mihai and Randolph 2009).

Factors reported to increase the likelihood of a successful litigation claim after thyroid surgery include the need for a second operation, if the primary goal of an operation had been missed, and a complication is followed by a fault in postoperative care (Schulte and Roher 1999).

Before you take on the role of an expert witness, you should be familiar with the relevant GMC guidance on your role and duties including knowledge of Civil Procedure rule 35.3.

Key issues that you must consider include the remit that the expert:

Remember that the expert witness is no longer immune from actions of breach of duty that includes preparation of reports for service on the opposition, legal conferences, and oral evidence impartially.