NEW YORK: State Launches Probe Of Residency Overwork
In "surprise raids on a slew of top academic medical centers" in New York, "state health authorities launched a sweeping probe to stop hospitals from overworking young doctors," the Wall Street Journal reports. Beginning last Thursday morning, "squads of state inspectors descended unannounced into some of the nation's most prestigious hospitals," kicking off a broad investigation that may last for months. The raids were prompted by "criticism that hospitals, squeezed by managed care and cutbacks in funding, have been flouting New York's pacesetting rules aimed at reducing the workload of young residents, who are the staffing backbone of many hospitals."
Endangering Patient Lives
The rules, designed to "prevent medical residents from working without adequate supervision and going without sleep for days on end," were enacted a decade ago. They were prompted by the highly publicized case of Libby Zion, who died at New York Hospital "after being treated by what her father, journalist Sidney Zion, charged were overworked, untrained residents." Since that time, the state has been paying hospitals millions of dollars for the extra help needed to maintain reasonable schedules for young doctors. However, Albert Einstein College of Medicine's Bertrand Bell, author of the residency regulations, said hospitals "took the money and ran."
The New York Public Health Law regulations require that emergency room residents not work more than 12 straight hours and that medical ward residents not work more than 24 straight hours. Surgery residents can work more than 24 hours when "on call," but must receive a 16-hour break afterward, and may not repeat the long rotation more than every third night. The Journal reports that most of the resistance to the laws stems from surgeons. According to Ray Sweeney of the Healthcare Association of New York, "Surgery is the one area where you have the macho or bravado approach -- and people are expected to work hundreds of hours." Sweeney said doctors in other departments, particularly internal medicine, were more inclined to follow the guidelines. Dr. William Speck, president and COO of New York and Presbyterian Hospital, denounced the rules as "ridiculous, very arbitrary and very capricious." He said that for residents, more important than sleep is "the proper amount of instruction."
Health Department spokesperson Robert Hinckley said the current investigation "took months in planning" and will probe "hospitals across the state to look at the way in which they were complying" with the rules. He said the agency will "follow up with 'increased training, surveillance, revisits and new visits to be followed up by enforcement.'" The state will continue its surprise visits, which include review of schedules, rosters and call rotations, extended interviews and sustained surveillance. An alert sent to all New York teaching hospitals by the Healthcare Association of New York State on Thursday morning warned that "the 12 facilities hit in the first round of inspections are the 'first phase' of a new surveillance process." According to the memo, the visits will not lead to "deficiency citations or other enforcement actions," but rather will be used to provide "a snapshot" of compliance with the protective rules. They will be followed by a period of follow-up and education (Lagnado, 3/11).