ou would think that Mike Hurewitz could have expected the best possible medical care in January when he donated more than half of his liver to save his brother's life. The operation was performed at one of New York City's best hospitals, Mount Sinai, which is a world leader in using live donors for liver transplants. There was risk, of course. Some experts say the odds of death for a liver donor can be as high as 1 in 100. But Mr. Hurewitz was healthy, and he was in the hands of a renowned liver transplant program that had never experienced a donor fatality.

Three days after the operation, Mr. Hurewitz's good deed ended in tragedy. He became progressively sicker, vomited blood and died from inhaling it, leaving his family and friends in shock. The precise chain of causation remains murky. But a critical report issued this week by the state health commissioner faulted Mount Sinai for lapses that can only be described as frightening. This is a death that might have been prevented if the hospital had been better staffed and its doctors more attentive.

The report lays bare a pattern of "woefully inadequate" postsurgical care. The doctor who performed the operation never checked up on Mr. Hurewitz afterward, and while a senior member of the surgical team may have checked twice without documenting the visits, the state says postoperative care was left primarily to doctors in training who did not monitor or evaluate the patient's condition appropriately.

The transplant unit in which Mr. Hurewitz was recuperating was staffed, during three critical hours, by too few nurses and by a single first-year resident who felt overwhelmed by caring for 34 patients alone. The rest of the medical staff failed to respond appropriately when the patient developed an abnormally rapid heartbeat, hiccups and nausea. One doctor who was called at a bookstore and told of Mr. Hurewitz's difficulties did not examine him upon returning to the hospital but dealt with another patient instead.

This was all happening at a major teaching hospital, where patients are supposed to benefit, the mantra goes, from the combined wisdom and care of a top-flight medical team. They should expect, if anything, to receive too much attention, with waves of doctors and residents prodding and questioning to make sure that nothing is overlooked.

It is also disturbing that, according to Mr. Hurewitz's wife, Victoria, Mount Sinai pressured her to let the hospital conduct an autopsy rather than leave that task to the city's medical examiner. Surely, it would best have been done by an independent authority. As it turned out, the hospital's autopsy found an unusual bacterial infection in Mr. Hurewitz's stomach that may have played a role in contributing to his death.

A century or so ago hospitals were often feared as places that might do more harm than good for the average patient. With the advent of modern medicine, the major teaching hospitals have come to be seen as places that could perform medical miracles. But as the case of Mr. Hurewitz demonstrates, a patient's fate, even in the most advanced medical centers, often rests on longstanding basics — the quality, training and diligence of the medical and nursing staff.