Milestones

Betsy Lehman, a 39-year-old journalist and mother of two who had been undergoing breast cancer treatment, dies from a massive chemotherapy overdose at a leading Boston hospital. It was several months before the hospital realized that her death was the result of an error. Learn more

The Institute of Medicine releases its seminal report To Err is Human, which estimates that medical error causes as many as 98,000 preventable deaths each year in U.S. hospitals alone. The report highlights Betsy’s story.

The Massachusetts legislature first establishes the Betsy Lehman Center to address the need for better coordination of efforts by health care providers and other state agencies to reduce medical error and keep patients safe.

The Center is reestablished under the cost, quality, and transparency provisions of health reform legislation known as Chapter 224, and relaunched as an affiliate of the state’s Center for Health Information and Analysis.

The Betsy Lehman Center works with multiple state agencies to research, map, and design a system called the Patient Safety Navigator that would help guide health care providers in Massachusetts on how to report key patient safety events.

The first issue of Patient Safety Beat is published. The Center's email newsletter provides important and lively stories about patient safety news and progress in Massachusetts.

Non-profit organization Medically Induced Trauma Support Services (MITSS) becomes part of the Betsy Lehman Center, expanding peer support opportunities for those affected by medical harm.

Research is released on the state of patient safety in Massachusetts and cost of medical error — what has changed since Betsy’s death, current challenges, and what we can do to improve safety here.

The Massachusetts Health Care Safety and Quality Consortium develops the initial Roadmap to Health Care Safety. Four task forces begin work on proposed goals and strategies to drive investment, action and transformative change on safety across the Commonwealth’s health care continuum.

The Center assumes responsibility for building on the success of the Communication, Apology and Resolution (CARe) model, previously managed by the Massachusetts Alliance for Communication and Resolution following Medical Injury (MACRMI).

The Consortium publishes the Roadmap to Health Care Safety for Massachusetts. The statewide strategic plan sets five goals that will be reached through a sustained, collective statewide effort among provider organizations, patients, payers, policymakers, regulators, and others.