Why Seth Died
                                                                                     Laurel Mayer, M.D.  and the I.C.U. 

                                                                                     Robert R. Goodman, M.D.  
                                                                                     Terminal Condition 

                                                                                     Moral Justice    
                                                                                     Crimes and Misdemeanors 
                                                                                     What Killed Libby Zion? 


                                                       A Death in the Hospital
      After 6 days being unwillingly made a 
human model for training purposes, our 
son Seth Speken died on August 27, 1993.
His death was at the premier Ivy League
teaching hospital, Columbia Presbyterian
Hospital in the City of New York.
     This Web Site is dedicated to Seth. It
is also dedicated to the other 133 people
who died that week directly as a result of
medical negligence in hospitals in New 
York State. The Harvard Medical 
Practice Study, documented in The New
England Journal of Medicine, (February
7, 1991), found strong evidence of 
6895 deaths during the year 1984 in New
York hospitals due to negligent medical
care alone. One can only imagine what the
statistics are now.
     On a national basis the Harvard 
numbers work out to approximately 
100,000 people dying each year from 
medical negligence. To make this figure
understandable, it is roughly equivalent
to one 747 jetliner, filled with passengers,
crashing every day of the week.
     Yet, as frightening as these numbers 
are, they may be vastly understated. As
reported in Lancet (1997:349:309-313), 
the actual rate of medical negligence in
hospitals could be at least 17.7% and 
probably higher. People in hospitals run
an almost 1 in 5 risk of suffering medical
negligence. In many case, as happened to
Seth, this will result in death.
     To put this figure in perspective, your
risk of dying in a plane crash is around 1
in 9,000,000.
    The Harvard Medical Practice Study
identifies "Physician inexperience" as
being probably the largest single cause of
medical negligence. In The Girl Who Died
Twice (Delcort Press, 1995), Natalie
Robbins describes a common  practice
in teaching hospitals called the Closed 
Order Book. 
It is the blatant permission
to leave health care decisions involving 
human life in the hands of green students
who receive minimal supervision and 
monitoring if they receive any at all.
     In the Law, a Fiduciary is the person 
you place your trust in to handle
important issues you are incapable of 
handling yourself. A physician is a 
Fiduciary whom you entrust with your life.
Not knowing of the Closed Order Book,
we entrusted the care of our son's life to 
inexperienced trainees. The system of 
medical education typified by the Closed
Order Book meant that Seth's body was 
in the Allen Pavilion principally to serve 
the training needs of the students. These
trainees were to learn by their mistakes.
This was vastly different from the 
medical education I had received a 
generation earlier when experienced 
physicians closely monitored all my 
     As pointed out by Robbins, medical
educators and State Medical Board
regulatory agencies are well aware of this
practice of giving patient care 
responsibilities to untrained students. 
This is called the 'dirty little secret' of 
Medicine. In the case of Seth Speken the
Closed Order Book, that is, the turning
over life and death decisions to the 
youngest and least experienced, led to 
its ugliest but predictable conclusion.
      The American health care delivery 
system may be the world's finest but there
is a monstrous level of 'acceptable'
death. This is a national shame.
Ralph H. Speken, M.D.
Stephanie Z. Speken, M.S.
Click for Preface