In reply
Dr Grossbart's critique of our article “Patient Characteristics and the Occurrence of Never Events” is based largely on fundamental misinterpretations of the study and its results. He asserts that “the premise of the article is that patient characteristics . . . rather than provider error, explain variation in never events.” As clearly indicated in the article's abstract and conclusion, the study found that patient characteristics as well as provider error explain variation. Contrary to Grossbart's closing statement, our conclusions do support a focus by health care providers on “implementing changes . . . that clearly improve the reliability and safety of care.”