Medical malpractice claims live or die on four elements: duty, breach, causation, and damages. Every successful case proves all four. Every failed case stumbles on at least one. Understanding these elements helps patients evaluate whether they have viable claims and what proving them requires.
Duty of Care
The first element is usually the simplest. A healthcare provider owes a duty of care to patients they have agreed to treat. When you see a doctor, when a hospital admits you, when a surgeon operates on you, a professional relationship forms that creates legal obligations.
Duty questions occasionally become complicated. A physician who provides curbside advice to a colleague may not owe a duty to the patient being discussed. A doctor who sees you socially and offers informal medical opinions may or may not have established a treatment relationship. But in most malpractice cases, duty is straightforward: you were the provider's patient, so they owed you competent care.
Breach of Standard of Care
Breach is where most malpractice cases are won or lost. The question is whether the provider's care met the standard of care—the level of skill, attention, and treatment that a reasonably competent provider in the same specialty would deliver under similar circumstances.
The standard of care isn't perfection. Medicine involves uncertainty, and competent physicians can make judgment calls that turn out wrong. The standard is reasonableness: what would a competent peer have done facing the same situation with the same information? If the defendant's actions fall within the range of reasonable professional judgment, there's no breach even if the outcome was poor.
Proving breach requires expert testimony. A physician in the same specialty as the defendant reviews the care, compares it to professional standards, and explains where and how it fell short. Without this expert testimony, juries cannot evaluate whether care was substandard—they lack the medical knowledge to make that judgment independently.
Causation
Proving the provider was negligent isn't enough. You must also prove their negligence caused your injury. This causation element has two components, often described as "cause in fact" and "proximate cause."
Cause in fact asks whether your injury would have occurred but for the defendant's negligence. If you would have suffered the same harm regardless—if your condition would have progressed identically even with proper care—then the negligence didn't actually cause your injury. The care was substandard, but the substandard care isn't what hurt you.
Proximate cause asks whether the injury was a foreseeable consequence of the negligence. Bizarre chains of causation that no one could have anticipated may break the connection between breach and harm. In practice, proximate cause is rarely the central issue in malpractice cases—the more common fight is over whether the negligence actually caused the injury at all.
Causation often requires expert testimony just as breach does. Medical experts explain how the specific act of negligence led to the specific harm the patient suffered, drawing the causal connection that makes the provider responsible for the outcome.
Damages
Finally, you must have suffered actual harm. The harm can be physical (injury, illness, disability), financial (medical bills, lost income), or non-economic (pain, suffering, emotional distress), but it must be real and demonstrable.
Without damages, there's no malpractice case regardless of how negligent the care was. A surgical error that's caught and corrected before causing any harm isn't malpractice in the legal sense—it's negligence without injury. A diagnostic delay that doesn't change the ultimate outcome isn't compensable. Damages aren't just a measure of what you might recover; they're an element of the claim itself.
How the Elements Connect
Each element depends on the others. Duty sets the stage by establishing the provider's legal obligation. Breach establishes that the obligation wasn't met. Causation connects the breach to specific harm. Damages quantify that harm for compensation purposes.
Defense strategies target whichever element is weakest. If duty is questionable, defendants argue no treatment relationship existed. If breach is debatable, they present experts testifying the care was appropriate. If causation is unclear, they argue the injury would have happened anyway. If damages are limited, they minimize the compensation owed.
Evaluating a potential malpractice case means honestly assessing each element. Where is the evidence strong? Where is it weak? What would proving each element require? Experienced malpractice attorneys perform this analysis when deciding whether to accept cases, and patients benefit from understanding the framework themselves.