Earlier quoted context omitted.
If it's important to the analogy then lets say we caught him driving super drunk but he hadn't hurt anyone yet. Should we let him off the hook?
That's a poor analogy, because people driving super drunk have the potential to cause very great harm. If we're sticking to car analogies he wrote his name in the dirt on the back of a truck, but the dirt was abrasive and so he also scratched his initials into the paint.
That is, a patient who gets signed upon and one who doesn't following the exact same procedure for the rest are at an identical risk?