Associated Press

BOSTON — When their children are critically ill, parents from New England and beyond come to Children’s Hospital of Boston, a place where cutting-edge medicine and even apparent miracles are a near-daily occurrence.

But Children’s, a Harvard-affiliated teaching hospital considered among the finest in its field, is suffering through one of the lowest moments in its history after a state review sharply criticized its handling of four cases in the past 13 months.

Three people died, including a 5-year-old boy having an epileptic seizure. All of the doctors treating him believed someone else was in charge.

The hospital, now facing a license review for Medicare treatment, has apologized, saying in a statement it was “profoundly saddened that we did not provide the high level of care to these patients.” It has promised changes to make sure the same problems are never repeated.

Experts say these incidents, along with others recently, point to a problem afflicting even the best institutions: Providing exceptional treatment to a few patients is often easier than guaranteeing adequate routine care for each of the thousands they treat every year.

“Being at a place like Emory or Harvard, we often look at quality and safety in terms of the brilliant things we do,” said William Bornstein, chief quality officer at Atlanta’s Emory Healthcare, which includes Emory University Hospital. “That’s very important, but an equally important part is the routine stuff, the communications, the systems we put in place to ensure safety.”

The review of Boston’s Children’s Hospital came two years after the hospital was faulted for “systems problems” that contributed to the death of a toddler who suffered fatal brain damage while waiting overnight for surgery.

Children’s isn’t the only prominent hospital to find itself at the center of a harsh scrutiny. The Duke University Medical Center in North Carolina is also under investigation by the federal Medicare agency.

In February, 17-year-old Jesica Santillan died after a transplant operation there in which she was given organs that did not match her blood type.

Just four months later in Duke University Hospital, a flash fire burned a 2-day-old baby. And in August, an infant suffered burns from overheated air in an incubator.

And last year in New York, Mount Sinai Hospital suspended its liver transplant program using living donors when a donor died from an infection due in part to inadequate supervision. The program was allowed to resume this year.

Those were just cases that grabbed headlines; the Institute of Medicine has estimated up to 98,000 people die each year from preventable medical errors.

Of course, nobody tracks how many lives are saved at top teaching hospitals, and experts point out risks are inevitable with extremely sick patients.

But they also say teaching hospitals can be more vulnerable to breakdowns, given two aggravating factors. First, their expertise attracts particularly complex medical problems requiring specialists in different fields to communicate. Secondly, their teaching mission requires them to involve medical students and young doctors as part of their training.