"No one really talks about it," he told me. "Doctors and nurses are not publicizing the fact, the patients are either dead or in the middle of a nasty legal battle, and the families are just too grief-stricken to do anything about it."

I hung up the phone that day and began searching the Internet for more information. The more I read, the more I was beginning to realize the magnitude of the problem.

A 2000 report by the Institute of Medicine, called To Err Is Human, found that between forty-four thousand and ninety-eight thousand people a year die from medical errors, the equivalent of a jumbo jet crashing every day. Deaths from medical errors, it concluded, was one of our country's top killers, along with cancer, AIDS, diabetes, and heart disease. The Joint Commission—the nation's premier heath care safety and quality accreditation organization—reported that over 70 percent of all sentinel events, unexpected medical events that result in death or serious injury, occur because of a breakdown in communications—just like what happened to Josie.

Every night when Tony came home from work, I told him everything I was learning about medical errors and patient safety.

We decided we'd start a foundation. Its mission would be to prevent patients from being harmed or killed by medical errors. We would name it after Josie, and we would begin with Johns Hopkins.

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