In this research letter, the authors report their analysis of fatal medication errors as reported on United States death certificates from 1983 through 1993. They find a 2.57-fold increase in the incidence of medication errors as the reported cause of death, in the face of an only 1.39-fold increase in prescriptions written over the same period. The authors suggest that the shift from inpatient to outpatient care, which transfers responsibility for medication administration from health professionals to patients, and decreased continuity of care in the outpatient setting may explain the apparent increase in fatal errors.