Much of the attention following the reversal of a defendant’s wrongful conviction focuses on the role the police or the prosecutor played in perpetuating the injustice. To the extent that the public defender institution’s role is considered, it is often limited to its failure to provide effective assistance of counsel. This Article challenges the conventional wisdom that the public defender institution’s role in addressing a wrongful conviction is limited to ineffective assistance of counsel claims and ends once a wrongful conviction is reversed. At minimum, the legal profession’s mandate for competent representation requires public defenders, and the institutions that house them, to learn from any performance that permitted a wrongful result so that it can limit the possibility that such an error would occur again.

The medical, military, and aviation sectors have adopted sentinel event reviews to broadly examine the behaviors and actions that lead to loss of life or physical harm. Perhaps due to its adversarial underpinnings, the criminal justice system has yet to adopt similar large-scale reviews. In the absence of a similarly expansive review of how each component of the criminal process failed to uphold systemic integrity for any client found to be wrongfully convicted, the public defender institution should engage in its own comprehensive learning process. Such a process should include more direct involvement by trial attorneys in appellate work, greater action by public defender institutional leadership to address the official misconduct of other government actors, and a more formalized review by independent evaluators to unearth any failure to abide by professional licensing standards. By adopting such review methods, the public defender institution would more clearly mirror other entities tasked with protecting the public from significant harm and reduce the systemic brittleness that permits repeat failures in the criminal justice system.

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