A new report card from the Leapfrog Group, a healthcare watchdog, paints an unflattering picture of safety in New York’s hospitals.

Only 14 of its 139 rated hospitals, or 10 percent, received an “A,” ranking New York 43rd among the 50 states and the District of Columbia.

Twenty hospitals scored “B,” 80 scored “C,” 23 scored “D,” and there were two “Fs” – for the state-operated SUNY Downstate Medical Center in Brooklyn, and for the city-owned Flushing Hospital Medical Center in Queens.

The statewide average, which was just above “C,” was virtually unchanged from last spring’s report, with 30 hospitals receiving higher grades, and 29 scoring lower.

Leapfrog is a coalition of major employers and other healthcare payers focused on reducing medical mistakes, which are estimated to kill hundreds of thousands of patients each year, making them a leading cause of death in the United States.

The grades in the group’s semiannual reports on hospital safety are based on 30 measures, including the rates of preventable infections, bedsores, and surgery errors, surveys of patients, and analysis of procedures and policies.

The Healthcare Association of New York State, which represents hospitals statewide, has faulted Leapfrog’s grading system for relying on measures that are not widely accepted as medically valid, and for using some survey results that are not evidence-based or risk-adjusted. In HANYS’ 2013 report card on hospital report cards, Leapfrog received the lowest score of one star.

In a statement, HANYS spokesman Darren Dopp said some of Leapfrog’s measures “skew toward positive self-report and bear little association with required Medicare outcome measures and associated payment penalties.”

“Use of valid, reliable, and evidence-based measures that are aligned with national efforts will enable patients and families to make better decisions about their care,” Dopp said.

In a federal report card on overall quality, released last summer, New York’s hospitals collectively rated 50th.