RE: Focus on personnel, not system

["John Constantine" <thesfg1@home.com>]

>If we look at each unnecessary death as a sentinel event, can we expect
>5 of every 100 to be attributable to the individual and not the system?
>And given the finality of the indicator, shouldn't we put someone to the
>task of truth and consequences at the personal level?>

Bob Clements asks a good question. Unfortunately, we don't know what
constitutes an "unnecessary death".

Please define, Bob. Then we can point fingers at someone, maybe.
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John Constantine
thesfg1@home.com
Phoenix, AZ