How the Four D’s of Medical Negligence Can Impact Your Case?

July 31, 2020 Medical Malpractice

According to a medical study performed in 2016 by Johns Hopkins patient safety experts, medical errors fall among the leading causes of death in the United States. You can read more about this study by visiting the Johns Hopkins Medicine website.

What are some examples of medical errors? Medical errors can include anything from surgeons performing surgery on a patient’s wrong body part to performing them on the wrong patient. A medical error can also be used to describe the situation where a physician prescribes medication to a patient that can cause him or her allergic reaction, resulting in severe injuries or death. Since no law requires physicians or healthcare providers to publicly admit their mistakes, the decision to report these doctors to medical boards for causes of medical malpractice falls on the patient or the patient’s family.

When a doctor commits a medical error resulting in immediate death, it’s easier for the victim’s family to flag it. However, sometimes victims of medical negligence go years without releasing the medical error. Aside from reporting the physicians or healthcare providers to the medical board, the victims or their loved ones have a right to seek compensation against the physician, hospital, and other medical personnel whose negligence created the injuries or death, even in cases of unexpected and unusual accidental death. To bring suit against the responsible parties, the victim or victim’s family bringing the action against the medical provider must prove the four D’s.

If you or a loved one believes that you are a victim of medical negligence, or had a family member die from the same due to a potential medical malpractice case, talk to one of our attorneys at the accident and injury law office of Terry Bryant to learn more about your legal options. For a free consultation, call us at 713-973-8888 or toll-free 1 (800) 444-5000. We look forward to assisting you.

What Are the Four D’s of Medical Negligence?

The four D’s of medical negligence stand for “Duty,” “Deviation,” “Damages,” and “Direct Cause.”


The first requirement that a victim of medical malpractice must prove is that there must have been a patient-physician or patient-healthcare provider relationship established and that the provider owed the patient a duty of care. To establish this duty, the victim can provide copies of medical records showing that a particular physician or healthcare provider was the party overseeing the victim’s treatment.

Once the patient-physician or patient-healthcare provider relationship is established, the medical provider must exercise the degree of care that a reasonably careful provider would use to avoid harm or injury to his or her patients. In a medical setting, there is generally a set of medical protocols the provider has to follow when caring for patients. For example, they are required to listen to their patients and their concerns. If the provider assigned to a particular patient feels that they no longer have the credentials to care for the patient properly, then the provider must refer the patient to another provider who does.

If the victim cannot establish the first D, he or she does not have a case for medical negligence.


If the victim establishes the first D, the next element that the victim must prove is that the physician deviated from the expected standard of care or industry of care. As mentioned, this could include when a surgeon performs surgery on the patient’s wrong body part or, even more egregious, on the wrong patient. Another example of deviation could be seen when a physician carries out unnecessary procedures or additional procedures to hide the mistake from the first procedure. Prescribing the wrong medication that could create allergic reactions in a patient, misdiagnosing a patient, or diagnosing a patient too late are other examples of deviation.


After meeting the first two D’s, the victim will then have to prove by a preponderance of the evidence that the physician’s deviation caused damages to the victim. At this stage, the victim will need to put forth evidence of medical records that show the improper procedures that were undertaken by physician or prescription records, such as in those cases where the physician prescribed the wrong medication. Billing records that detail the cost of corrective treatment can also be used to prove the third D.

Direct Cause:

With proper evidence, the victim must show that the provider’s deviation from the standard was the direct cause of the victim’s injuries. Take the following example. Let’s say that a baseball player injures his arm and shoulder during a pitch. If the physician does not provide the baseball player with treatment per the industry standard resulting in his injury’s not healing correctly, the patient could prove that there was a direct link between deviation and the cause of the damages suffered.

Let’s switch the facts. The physician tells the baseball player that he cannot play baseball until he comes to his next follow-up visit. However, the player does so anyway and gets injured, causing an additional injury; the player will not be able to prove the fourth D as to the injury suffered. Here, the victim failed to follow the protocol that was recommended to him by his physician.

Disclaimer: This information is for general information only. Nothing on this site should be taken as legal or medical advice.

How Can the Four D’s of Medical Negligence Impact My Case?

A victim must prove the four D’s to be successful in a medical negligence case. Not having the proper evidence can diminish a victim’s ability to prove their case.

Do I Need an Attorney to Assist Me with Bringing a Medical Negligence Suit?

Bringing a medical malpractice case is not an easy feat. You should contact an experienced Texas medical malpractice (or “med mal”) attorney to discuss your options because of the complexity surrounding these medical negligence cases. Medical malpractice suits in Texas have become the center of a controversial discussion due to the 2003 tort reform act introduced by the Texas Legislature, which restricted victims’ ability to obtain full compensation for their injuries or losses. In part, the Texas Medical Malpractice and Tort Reform Act limited the amount of damages that victims can receive for pain and suffering. You will need an attorney to help you navigate through these hurdles.

If You’ve Been Injured Due to a Provider’s Medical Negligence, Contact Our Med Mal Lawyers at the Terry Bryant Law Firm

If you or a loved one has suffered severe injuries, or are suffering the wrongful death of a loved one caused by medical malpractice, talk to one of our attorneys at the accident and injury law office of Terry Bryant to learn more about your legal options. Call our Houston attorneys now at 713-973-8888 or toll-free 1 (800) 444-5000 for a free, no-obligation consultation.

Attorney Terry Bryant

Attorney Terry BryantTerry Bryant is Board Certified in personal injury trial law, which means his extensive knowledge of the law has been recognized by the Texas Board of Legal Specialization, setting him apart from many other injury attorneys. The 22 years he spent as a Municipal Judge, Spring Valley Village, TX also provides him keen insight into the Texas court system. That experience also helps shape his perspective on personal injury cases and how they might resolve. This unique insight benefits his clients. [ Attorney Bio ]

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