Because of repeated problems, Down East Community Hospital in Machias could be barred from participation in the Medicare system. The Centers for Medicare and Medicaid Services have given the hospital until April 15 to come into compliance with federal standards. The threatened sanction comes on the heels of a recent investigation that revealed numerous failures in emergency room procedures at the Machias hospital after an incident last fall. It was the third federal survey in about 15 months that found DECH out of compliance and required drastic changes in various procedures at the hospital. Is the threatened loss of federal money enough to prompt changes? In light of ongoing problems, should the hospital’s administration be changed? Is investigating hospitals after patient deaths too little, too late? How can problems be identified and fixed before there are tragic consequences?