What Are the “4 Ds” of Medical Negligence Lawsuits?

Medical Malpractice | March 28, 2023

Medical negligence occurs when a health care practitioner falls short of the required standards of care for his or her profession, such as by misdiagnosing a patient or carelessly causing a birth injury. In Kentucky, a patient who is injured or harmed by medical negligence can file a lawsuit in pursuit of financial compensation. Medical negligence claims are founded on four key elements, also known as the “4 Ds.”


The first D of a medical negligence lawsuit stands for duty, otherwise known as the duty of care. In a tort claim, the duty of care refers to the legal or ethical obligation that a defendant (the allegedly at-fault party) had to prevent injury to the plaintiff (the filing party). In a medical malpractice case, it means the standard of care that a health care provider owes his or her patients.

The medical industry has strict standards of care for health care providers, including doctors, surgeons, nurses and hospitals as a whole. If a physician carelessly or knowingly falls short of these standards when treating a patient, it is medical negligence. To establish that the defendant owed a duty of care, the plaintiff must show that a doctor-patient relationship existed at the time of the act of malpractice.


Dereliction of duty is the second D of medical negligence. Dereliction means to stray from the required standards of care. A dereliction of duty describes a doctor’s failure to fulfill his or her obligation to properly care for and treat a patient. It can refer to many different mistakes and errors made in the medical profession, such as:

  • Misdiagnosing a patient or failing to make a diagnosis
  • Prescribing the wrong medication or dosage
  • Mixing up two patients’ medical records
  • Making a careless surgical error
  • Injuring an infant or mother with improper birth techniques

A departure from the standard of care can refer to an act or the failure to act by the defendant. If a reasonable and prudent physician would not have done the same thing under the same or similar circumstances, this can be proof of the defendant’s dereliction of duty. Proving this element often requires bringing in a medical expert to explain the standards of care and demonstrate how the defendant fell short.

Direct Causation

A defendant will only be held liable for medical negligence if a direct connection can be established between his or her act or omission and the plaintiff’s harm. The defendant’s dereliction of duty must be the actual or proximate cause of the injury or damages being claimed by the plaintiff. A common test used to prove direct causation is the “but for” test: if the plaintiff would not be injured but for the defendant’s negligence, the defendant will be held responsible.


Damages is a legal term that has a dual meaning. It refers to a plaintiff’s injuries or losses as well as the financial compensation available in a lawsuit. As the last of the four Ds, it refers to the losses the plaintiff suffered due to the defendant’s negligence, such as physical harm, emotional damage, medical expenses and lost wages. The plaintiff must show proof of measurable, specific damages that were caused by the medical malpractice to seek financial compensation for them.

Proving Medical Negligence

The burden of proof in a medical negligence lawsuit is a preponderance of the evidence. This is also known as the “more likely than not” standard of evidence. It requires enough proof to show that the defendant committed medical negligence with at least a 51 percent certainty. To meet your burden of proof and establish the 4 Ds of medical negligence, you may need to hire an attorney. An experienced medical malpractice attorney can help you collect evidence and seek the compensation that you deserve.

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