The Joint Commission has conducted numerous studies regarding the effect that a hostile environment (including one in which nurses, technicians, orderlies, other staff members and even patients feel bullied or intimidated) can have on the quality of medical care provided. It has resoundingly been shown that, when this sort of culture exists - one in which some staffers feel empowered to bully or demean others - patient care inevitably suffers. Patients subjected to these behaviors have less confidence in their care and may be more likely to bring medical malpractice claims when mistakes occur during the course of their treatment. Furthermore, when nurses feel uncomfortable stepping forward regarding errors made by physicians who have in the past bullied or demeaned them, those errors are much more likely to become systemic in nature and affect a greater number of patients. Preventable medical errors constitute a huge portion of care-related fatalities each year, with estimates ranging from between 98,000 and 440,000 deaths annually attributable to mistakes. When a bullying culture is allowed to persist at a care facility, mistakes are even more likely, and so are patient injuries or fatalities.