Accountability is a concept that many wrestle with as they steer their organizations and patients toward understanding and accepting the idea of a blameless culture within the context of medical injury. Marx presents the concept from the legal perspective but does so for the non-barrister. Written prior to the acceptance of open disclosure or general policy support of it, the primer thoughtfully outlines the complex nature of deciding how best to hold individuals accountable for mistakes. Four key behavior concepts serve as the structure for the paper: human error, negligence, reckless conduct, and knowing violations. How they are applied to various situations in health care and how the individuals involved should be disciplined provide thoughtful reading.