A hospital is expected, although not required, to report what is known as a sentinel event. This is an event that produces an unexpected occurrence involving death or serious physical or physiological injury or the risk thereof.  These events suggest a need for proper investigation and response. If a hospital is accredited, they are strongly encouraged to report these events to the accrediting body (JCAHO). If JCAHO is either told of a sentinel event or discovers such an event through other sources, it will require the hospital to determine the root cause of the event and establish a plan of action to avoid further such events. There are time limits within which the plan must be implemented. This process is intended to avoid further incidents of the same kind. Maryland Malpractice Lawyer