This case study discusses the ongoing challenges in balancing patient safety with the system of tort liability for medical malpractice. A defendant-physician and her attorney share their perspectives through the presentation of a specific case, revealing the tension between malpractice claims and patient safety initiatives. The authors propose targeted reforms that may create a more effective system, while suggesting incentives to improve safety and quality. This article is part of a special collection entitled “Quality Grand Rounds,” a series of articles published in the Annals of Internal Medicine that explores a range of quality issues and medical errors.