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The below two sentences are from GMAT sentence correction. I have two questions.

Incorrect: Hospitals are increasing the hours of doctors, significantly affecting the frequency of surgical errors, which already are a cost to hospitals of millions of dollars in malpractice lawsuits.

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Correct: Hospitals are increasing the hours of doctors, significantly affecting the frequency of surgical errors, which already cost hospitals millions of dollars in malpractice lawsuits.

1) I feel both are correct. The corrected sentence (I think) is a concise version, which made noun [(are) a cost)] to verb (cost) and deleted the word "of". Is there any other reason for changing this sentence?

2) The word "already" is a signal word for "Present Perfect" (for reference click here). So can I rephrase the sentence to

Hospitals are increasing the hours of doctors, significantly affecting the frequency of surgical errors, which have already cost hospitals millions of dollars in malpractice lawsuits.

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  • The subject of to "cost" is the frequency, not surgical errors and if you want to use the present perfect, you should use has instead of have. Also, what makes you think already requires the use of the present perfect tense?
    – user24743
    May 2, 2016 at 5:41
  • @ Rathony I think the word "cost" modifies the noun "the hours of doctors" not "the frequency of surgical errors" (which is an appositive). so the word "cost" is plural verb as it modifies plural noun.
    – ARYF
    May 2, 2016 at 5:55
  • @Rathony As for the question "already", I am not good at using tense. the website "englisch-hilfen.de/en/grammar/present_perfect_signal_words.htm" made me confuse.
    – ARYF
    May 2, 2016 at 5:59
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    It is correct to say already goes well with the present perfect tense, but it is absolutely wrong to say already always calls for the tense. You need to find more example sentences using already and get yourself familiarized with them.
    – user24743
    May 2, 2016 at 6:01
  • I have changed my comment to an answer. The sentence is not easy to understand.
    – user24743
    May 2, 2016 at 6:22

3 Answers 3

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Hospitals are increasing the hours of doctors, significantly affecting the frequency of surgical errors, which already was or has been a cost to hospitals of millions of dollars in malpractice lawsuits.

  1. You have to note that the subject of the verb "cost" in the correct (second) example is the frequency of surgical errors which (in the past) cost (past tense) hospitals millions of dollars in malpractice lawsuits.

  2. The only thing that need to be changed grammatically seems to be are. It should be in the past tense that agrees with the third party singular frequency and it should be changed to was or has been.

Now, the above example (after changing "are" to "was" or "has been") sounds far less idiomatic as the subject complement in the relative clause is too long. "a cost of millions of dollars in malpractice lawsuits to a hospital" is the subject complement. If you use the verb "cost", it sounds more idiomatic and natural.

If you contrast "The book cost me 10 dollars to buy" with "The book was a cost of 10 dollars to me to buy", you will notice that the former is far more natural than the latter. The latter is not used in English.

If you divide the sentence into three sentences, it would be easier to understand.

  1. Hospitals are increasing (present continuous) the hours of doctors,

  2. It (increasing the hours of doctors) significantly affects (present tense) the frequency of surgical errors.

  3. The frequency of surgical errors already cost (past tense) hospitals millions of dollars in malpractice lawsuits.

You should understand the sentence as follows:

  1. The frequency of surgical errors were there in hospitals which cost (past tense) them millions of dollars already.

  2. Hospitals are increasing the hours of doctors (probably they don't have enough doctors as in the U.S. or they have to save the salary expenses).

  3. Increasing the hours affects the frequency of surgical errors as it makes doctors more tired and increase the chances of surgical errors.

Conclusion: The first sentence is wrong not only because it uses the wrong verb are, but also it is not idiomatic.

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  • Does this sentence make you any sense " Hospitals are increasing the hours of doctors, which already cost hospitals millions of dollars in malpractice lawsuits"? To my assumption, increasing hours of working will cost them high (I mean the hospital has to pay the doctors more money for their overtime work). In this case, "hours" (plural noun) will be the subject, and "cost" (plural verb) will be the verb of the subject.
    – ARYF
    May 2, 2016 at 6:49
  • I agree with with your answer for my question "of". But I disagree with the subject/verb agreement.
    – ARYF
    May 3, 2016 at 4:51
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as a native English speaker, here's what I can tell you about the structure of these sentences:

First Question:

First of all, your first example of the sentence is incorrect because of the way it is structured. To make that senstence more correct, I would say

Hospitals are increasing the hours of doctors, significantly affecting the frequency of surgical errors, which are already a cost of millions of dollars in malpractice lawsuits to hospitals.

However, this is still not great because as the reader is reading, they will have lost track of what you are writing once they get to "to hospitals".

This means that it is better to keep things concise when possible, so readers can always follow the subject of your sentences. Essentially, the answer to your question is that the correct option is concise and easy to follow, while the second leaves the readers lost as they are reading the sentence.

Second Question

Your example sentence is not correct, but it is very close to being so.

Option 1:

Hospitals are increasing the hours of doctors, significantly affecting the frequency of surgical errors, which already cost hospitals millions of dollars in malpractice lawsuits.

Admittedly, this answer is kind of obvious, since it is what the test says, but I would say it is the best way to write out this sentence. However, you can also say (option 2):

Hospitals are increasing the hours of doctors, significantly affecting the frequency of surgical errors, which have already costed hospitals millions of dollars in malpractice lawsuits.

That 'ed' is extremely important in this case because the word 'have' implies that this happened in the past, which means that 'cost' needs to be modified to past tense.

I hope this helps! Let me know if you have any other questions :)

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  • Brother, please refer this link (englisch-hilfen.de/en/grammar/unreg_verben1.htm) in which past participle word for "cost" is "cost" then how can I use "costed"?
    – ARYF
    May 2, 2016 at 5:48
  • @ARYF I could be wrong; native speakers often do not learn all the rules necessary to speak correctly 100% of the time. However, my gut feeling says that something 'has costed' money, not something 'has cost' money. Try typing 'define costed' into google. It tells me this: verb past tense: costed; past participle: costed
    – Alex
    May 2, 2016 at 6:00
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    The standard form is cost. Don't use costed on a test! It's non-standard.
    – user230
    May 2, 2016 at 7:29
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Hospitals are increasing the hours of doctors, significantly affecting the frequency of surgical errors, which already are a cost to hospitals of millions of dollars in malpractice lawsuits.

Football stadiums are lowering the price of beer, significantly increasing the number of messy spills, which already cost them gazillions of dollars in mops.

People drink beer at football games. People spill their paper cups from time to time. The stadium must mop these spills up, and bear that cost. With the lower price of beer, there will be greater beer consumption, and an even greater number of beer spills—and the number of spills is already quite high at current rates of consumption.

Note the present tense is in that final phrase: the number of spills is already quite high. The already does not trigger a present perfect, but refers to a current situation in light of an anticipated one.

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