Dallas’ Parkland Memorial Hospital is known nationally as the place where President John F. Kennedy was pronounced dead. To Texans, it has been a beloved public resource that has trained
generations of doctors while caring for the region’s poor and uninsured.

But a multi-year investigation by The Dallas Morning News revealed a different story – a hospital run by resident doctors, working with little or no supervision, where patients suffered the consequences of on-the-job training.

Residents had so much autonomy that they sometimes operated on patients without telling the doctors who were supposed to supervise them – faculty members from Parkland’s medical school affiliate, the University of Texas Southwestern Medical Center. Patients suffered permanent mutilation or even death from improper care.

In addition, some units of the hospital were severely understaffed, and others had staff who were poorly trained and supervised. Employees failed to follow practices as basic as proper hand- washing. Parkland was not delivering the superior health care it had claimed for years. Indeed, patient
safety statistics analyzed by the newspaper showed that the hospital was among the worst in Texas for several years running.

In fall 2011, federal health care inspectors moved in and confirmed problems uncovered by the newspaper. The federal government then put Parkland under a rare form of oversight. The state of Texas, in August 2012, fined Parkland $1 million for patient safety violations – a penalty 20 times greater than that of any other hospital in Texas history. By April 2013, Parkland must meet the government’s demands for systemic change or risk losing hundreds of millions of dollars in Medicare-Medicaid financing.

This book compiles The News’ complete coverage of Parkland and its patient safety crisis throughout 2010 and 2011. It tells the stories of patients who lost their lives or were forever altered by their treatment at the hospital. It chronicles the buildup to the breakdown, including red flags about bad care, lack of informed patient consent, poor faculty supervision of residents and the use of medical students as paid clinicians in the psychiatric emergency room.

It also tells some of the story behind the story, through Ask-The-Editor columns, which discuss how the reporting was conducted and address reader questions and criticism. Also included are editorials demanding better care for North Texas residents and DMN Investigates blog posts that cover incremental story developments. You’ll also find links to our photo gallery, Emmy award-winning patient documentary and online database of hospital patient safety in Texas.

First, Do No Harm is the story of a patient safety crisis at one of America’s landmark public hospitals. But it also illustrates some of the choices and trade-offs of modern health care at big teaching hospitals, along with the life-and-death consequences of those decisions.