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What Are the 4 Ds of Medical Negligence?

Medical negligence is a serious tort, but a complex one to prove. It can refer to medication mistakes, surgical slip-ups, misdiagnoses and other types of preventable errors in a health care setting that ultimately harm or kill a patient.

Learning whether you have grounds for a medical malpractice claim in Virginia may need the help from an attorney. In general, you will need evidence of the four Ds of medical negligence to bring a successful claim.

Proving Medical Negligence

In any personal injury case, negligence is the key idea for finding fault. We have to prove that someone’s poor decisions or actions directly caused your injury. This is much trickier in medical cases than in something more straightforward, like a car accident.

Medicine is a practice and there are no guarantees of a cure, or even survival, if you go to see a doctor. Yet the law does lay out guidelines to prove whether a doctor was negligent or just unfortunate with a particular patient.

The four Ds of medical negligence are a rubric for proving medical negligence. If we can prove these four things in your case, you can win and receive compensation for the injuries you’ve suffered at the hands of the medical profession.

Duty of Care

The first D is duty of care. The person or party you believe is responsible for causing your injuries will serve as the defendant during your medical negligence case. Common defendants are doctors, surgeons, nurses, pharmacies, hospitals and health care centers. There could even be more than one defendant in your case.

To bring a medical negligence claim against a defendant, the party must have owed you a professional duty of care at the time of the alleged wrongdoing. A duty of care is something the medical industry places upon any physician or facility that accepts a patient.

Once you have established a physician-patient relationship with the practitioner, he or she will owe you certain duties of care according to the standards of the medical industry. These duties include properly diagnosing, treating and following up with you. Proving a defendant owed you a duty of care may require evidence, such as your patient records.

Dereliction of Duty

The second D of medical negligence is dereliction of duty. Dereliction refers to a failure to fulfill one’s obligations or duties of care. A dereliction of duty by a physician, nurse or someone else in the healthcare field could describe any act or omission a reasonable and prudent professional would not have made in similar circumstances.

Prior cases have noted a wide range of acts that constitute dereliction of duty by a doctor to their patients. Some of these include:

  • Misdiagnosis
  • Failure to diagnose
  • Failure to treat
  • Prescription errors
  • Failure to warn of risks
  • Surgical errors
  • Wrong patient, site, or surgery
  • Foreign object left behind
  • Medical device defects
  • Birth injury
  • Emergency room errors

Any failure to meet the expectations of patient care, such as a physician’s incompetence or a hospital’s dangerous premises, could constitute a dereliction of duty. Your lawyer may be able to prove this element using evidence such as medical records, eyewitness testimony and statements from medical experts in comparable fields.

Direct Causation

The third D is direct causation. Your medical malpractice lawyer must be able to prove a direct causal connection between the defendant’s dereliction of duty and your injury, illness or a loved one’s wrongful death.

The physician or hospital must have directly caused the damages in question by breaching a duty of care owed to you as a patient. Without proximate cause, the defendant may not be liable for your damages.

For instance, if you had a terminal illness, for example, and would have experienced a decline of health even with a timely diagnosis, a physician might not be liable for a delayed diagnosis. The defendant’s mistake must be the main cause of your damages.

Another example where direct cause would fail is if you didn’t follow your doctor’s instructions. If a doctor gives you medicine and you refuse to take it, you can’t say that their advice caused any consequence for not taking the medicine.


The final D of a medical negligence claim in Virginia is damages. A defendant may not owe you compensation, even if he or she was negligent, if the breach of duty did not give you any compensable losses.

Your lawyer must show proof of specific, quantifiable damages related to the defendant’s negligence, recklessness or default. Common damages in a medical malpractice claim include hospital bills, pain and suffering, lost wages, lost earning capacity, legal fees, lost quality of life, and punitive damages.

Damages are often the easiest part to prove. You normally wouldn’t approach a medical negligence lawyer without something bothering you. However, your total possible damages may be far more than you know, especially for ongoing care or being forced onto disability.

How the Opposing Side Will Fight Back

Naturally, the lawyers on the opposing side will work to prove that one or more of these four Ds of medical negligence aren’t valid in your case. All four must be present for you to win a lawsuit. Without a lawyer, this is very hard to do on your own.

Medical malpractice insurers often have their own doctors come forward to dispute that your doctor or hospital did nothing wrong, and it’s very hard for a layperson to counter those claims. We have access to our own independent doctors who will give an unbiased opinion about your case.

You do not have to file or prove your medical negligence claim alone in Virginia. A medical malpractice attorney in Virginia could help you fulfill your burden of proof by obtaining and presenting evidence of all four Ds to bring a successful medical negligence claim.

The personal injury lawyers at Christina Pendleton & Associates can take care of complicated legal requirements—including the burden of proof—on your behalf while you focus on healing from your malpractice-related injuries.