This article is part of a broader series examining every New York City hospital rated by the Hospital Safety Grade program of The Leapfrog Group—not only top-rated institutions, but also those receiving failing grades. Drawing on the experience of our NYC medical malpractice lawyers, the goal is to help patients and families understand what these grades mean in real-world terms and how hospital safety data can affect clinical outcomes.
While St. John’s performs well in several important areas, the Leapfrog data reveals systemic safety gaps that likely contributed to its low overall grade. For patients and families, understanding these risks is critical.
What a Leapfrog “D” Rating Actually Means
Leapfrog safety grades are heavily weighted toward metrics most closely linked to serious injury and death, including:
- Hospital-acquired infections
- Nurse staffing and skill mix
- Surgical volume and outcomes
- Maternity and procedural safety
- Error prevention systems
A hospital can “meet standards” in administrative or policy-based categories yet still receive a low grade if outcomes show elevated risk.
Key Safety Concerns Identified at St. John’s Episcopal Hospital
Elevated Bloodstream and Urinary Tract Infections
Leapfrog data shows significantly higher-than-expected infection rates:
- Central line–associated bloodstream infections:
Standardized Infection Ratio (SIR) 1.443—approximately 44% more infections than expected - Catheter-associated urinary tract infections:
SIR 1.641—more than 60% above expected levels
These infections are widely recognized as largely preventable and are often linked to hospital negligence, frequently resulting in severe complications, sepsis, prolonged hospitalization, and wrongful death claims.
Nurse Skill Mix Below Optimal Levels
Although overall nursing hours meet Leapfrog standards, only 55.62% of nursing care is delivered by registered nurses, a level Leapfrog classifies as only “some achievement.”
Extensive research has shown that lower RN-to-patient ratios and heavier reliance on less-trained staff increase the risk of medication errors, delayed intervention, and missed signs of patient deterioration.
Low Surgical Volumes for High-Risk Procedures
St. John’s fails to meet Leapfrog’s minimum volume standards for several complex surgeries, including:
- Carotid endarterectomy (1 procedure annually vs. 20 recommended)
- Total hip replacement (19 vs. 50)
- Total knee replacement (40 vs. 50)
Low procedural volume is strongly associated with higher complication rates, poorer outcomes, and increased likelihood of revision surgery, particularly in orthopedic and vascular cases.
Elevated Cesarean Section Rate
The hospital reports a 31.9% Cesarean section rate, significantly exceeding Leapfrog’s recommended maximum of 23.6% for low-risk, first-time births.
High C-section rates raise concerns about unnecessary surgical intervention, which can increase the risk of infection, hemorrhage, and long-term maternal complications.
Patient Experience Signals in Outpatient Surgery
While patient experience is not the primary driver of a “D” grade, Leapfrog survey data shows:
- Only 74% of patients would recommend the facility
- Lower performance in communication and overall satisfaction
These indicators often correlate with breakdowns in care coordination, discharge planning, and follow-up.
Where the Hospital Performs Well—and Why That Was Not Enough
St. John’s Episcopal Hospital meets or exceeds Leapfrog standards in several important areas, including:
- Medication ordering and barcode scanning
- Hand hygiene monitoring and compliance
- Leadership accountability for safety initiatives
- Informed consent procedures
- Formal response protocols for “never events”
However, Leapfrog grades emphasize patient outcomes over written policies. Strong administrative safeguards cannot fully offset elevated infection rates, low surgical volumes, and staffing composition concerns.
What Patients Can Do to Protect Themselves
Patients and families receiving care at hospitals with low safety grades should consider taking proactive steps:
- Ask questions about experience and volume before surgery
- Confirm who is supervising care, especially overnight or in critical units
- Watch closely for signs of infection or deterioration
- Bring a family member or advocate to help monitor care and communicate concerns
- Keep detailed records of symptoms, medications, and test results
When Safety Failures Become Medical Malpractice
Not every adverse outcome constitutes malpractice. But preventable infections, surgical complications tied to low procedure volume, delayed diagnosis, and inadequate staffing can cross the line into negligence—particularly when safety data already shows elevated risk.
If you or a loved one were harmed while receiving care at St. John’s Episcopal Hospital or another New York facility, prompt legal review is critical. Medical records can be altered or lost, and strict filing deadlines apply under New York law.
Our team of Brooklyn medical malpractice attorneys can evaluate whether hospital safety failures contributed to the injury and determine whether a claim may be warranted.