PUBLIC CITIZEN HEALTH RESEARCH GROUP SIDNEY M. WOLFE, M.D., EDITOR JUNE 2001 + VOL. 17, NO. 6 Public Citizen Petitions OSHA to Limit Residents' Working Hours icture this: It's 6 a.m. and you resident who had been working for 23 driving limits. In one study, residents are in the obstetrics ward of a (or often as many as 36) hours straight, reported that 41 percent of their mis­ P hospital, expecting to give birth and who had most likely gotten little or takes were due to fatigue and 31 per­ to your first child at any moment. It no sleep during that time? Second, cent of residents reporting mistakes has been a busy night, and there are would you want your physician to be said that their errors had resulted in the several other expectant mothers also possibly harming herself in order to be death of a patient. needing care. The resident (a young helping you? During their residency training after doctor just out of medical school and In recent years, many studies have medical school, residents can regularly undergoing further training) who has supported the common sense notion work 100-hour weeks-2-1/2 times the been taking care of you rushes by. that it is unsafe to subject patients to normal work week in the U.S. In New She looks exhausted, as if she had sleep-deprived and exhausted resi­ York, the only state so far to have been in the hospital since early yester­ dents. Sleep-deprived residents have attempted regulating resident work day morning-which, in fact, she had. been shown to perform worse than hours (a limit of 80 hours per week), On closer look you notice that she's rested colleagues on tests of memory, the state health department found that got an IV stuck in her arm. concentration, and problem-solving in New York City 94 percent of resi­ It turns out that your resident is 26 skills. Also, their ability to carry out dents were working more than 85 weeks pregnant herself, and-just like certain medical procedures is dimin­ hours per week, and 77 percent of you-is expecting her first child. It ished. A recent study demonstrated surgical residents were working more turns out that tonight she is the only that staying up for 24 hours straight has than 95. One resident worked a man­ doctor caring for the group of patients an effect on cognitive performance killing 136 hours in a single week. on your ward. In fact, she's started equal to having a 0.1 percent blood This archaic system of training comes having contractions herself, but rather alcohol level, a value above many U.S. from a time at the turn of the previous than seeking treatment, as any expect­ ant mother would do, she has hooked <: () N T E N T S herself up to an IV so that she can keep working. When she calls her senior physician to tell him what has hap­ Preventing Heat-Induced Death and Illness pened, his response is "Will you be As summer starts, find out how to protect yourself from the hot weather back... tomorrow?" and what drugs can make the situation worse ......................................... 3 Seem impossible? Not according to Product Safety Recalls a colleague of that resident, Sonya April 11-May 11, 2001 Rasminsky. Dr. Rasminsky is a second­ More Chinese herbs, acetaminophen and car seats are on our list this year resident at Cambridge Hospital, month . .......................................... ........................................................ 5 and co-chair of the residents' union known as the Committee of Interns Outrage of the Month and Residents (CIR). l..otronex and the FDA: A Fatal Erosion of Integrity A prominent medical journal denounces the FDA for its actions on this This story raises at least two ques­ drug including the possibility it may allow it back on the market. ....... 12 tions: First, would you trust your care or the care of your unborn infant to a VISIT HEALTH RESEARCH GROUP'S WEB SITE AT WWW.CITIZEN.ORG/HRG/ century when physicians literally lived sider that residents work hours much dents. Thirty-two percent of residents in the hospital and hence were literally longer than workers in the transporta­ in one hospital reported depressed "residents." But medicine has changed tion industries-but understandable, scores while working in the intensive dramatically in the last 100-odd years. perhaps, when you consider the power care unit, a hospital rotation requiring Patients are now more acutely ill, and of the medical lobby in Washington. over 100 hours of work per week. their turnover rate in hospitals is higher. Airline pilots are allowed to fly no Residents working on rotations with Yet long, exhausting hours for the longer than 30 hours per week, and fewer hours had lower rates of de­ doctors-in-training still remain as a truck drivers are limited to 60 hours pressed scores. vestige of the old system. per week. Lastly, female residents were found The medical profession has made On April 30, Public Citizen jumped to experience twice the rate of preterm some feeble attempts to regulate itself. into the fray. Along with CIR and the labor requiring serious hospitalization, The Accreditation Council on Graduate American Medical Student Association, and twice the rate of preeclampsia or Medical Education (ACGME), the orga­ we filed a petition with the Occupa­ eclampsia (types of pregnancy-induced nization representing residency pro­ tional Safety and Health Administration hypertension which can be fatal if not grams, has some work-hour guidelines (OSHA), the government body respon­ controlled), compared to the wives of for residents in place. These guidelines, sible for ensuring workplace safety, to male residents. Moreover, female resi­ however, are weak, voluntary, and dif­ put forth regulations limiting the num­ dents working greater than 100 hours fer for each medical specialty. Many ber of hours that medical residents per week during their third trimester of programs have no limit on the length of work (http://www.citizen.org/hrglpub­ pregnancy were twice as likely to have a shift, and residency directors in gen­ lications/1570.htm). Together with our premature babies as residents working eral surgery, for example, decide how cosigners, we asked for the following fewer than 100 hours per week. many hours per week are "appropriate" limits on residents' work hours: (1) a Anandev Gurjala, a second-year for their residents. Talk about letting the limit of 80 hours of work per week; (2) medical student from Northwestern fox watch the henhouse! a limit of 24 consecutive hours per shift; University working with Public Citi­ Inspections by the ACGME have (3) scheduling of on-call shifts only zen, commented, "The medical profes­ found that-just as in New York State­ once every three days; (4) 10 hours of sion has proved unable to police itself. hospitals across the country are in poor rest away from the hospital for residents Instead, residents are taught to subju­ compliance with even these weak stan­ between shifts; and (5) at least one day gate their own health to their work dards. Although hospitals potentially off in seven from the hospital. requirements. No physician would of­ face the penalty of having their ac­ Whereas previous attempts at resi­ fer such advice to his or her own creditation withdrawn by the ACGME dent work-hour reform have focused patients." for violating the guidelines, none so far on harm to patients, we examined Congress has charged OSHA with has ever lost accreditation solely for effects on the health of residents them­ the responsibility "to send every worker this reason. Furthermore, residents are selves as a result of their long work home whole and healthy every day." unlikely to report work-hour violations hours. From the medical literature, we Based on the latest scientific literature, to the ACGME, as withdrawal of ac­ found that residents experience harm resident work-hour reform is needed creditation is hardly an outcome de­ in three areas: automobile accident now, for both the safety of patients and sired by residents who depend on risk; mental health; and complications the safety of the residents who are those hospitals for their training. during pregnancy. treating them. Most other industrialized nations A study comparing motor vehicle have already taken active steps to limit crash rates in residents before and What You Can Do residents' work hours, either through during residency found that residents Send a letter to OSHA supporting national legislation, ministerial direc­ had almost seven times the likelihood Public Citizen's petition for regulation tives, or other agreements. Provinces of having an accident due to falling of resident work hours (send a copy of in Australia limit their residents to 75 asleep at the wheel compared to the your letter to us too). If you have been hours of work per week. The Euro­ period before their residencies. Three the victim of a fatigue-caused medical pean Union recently voted to phase in out of five residents had a near-miss error, or know of a resident who has a 48-hour work week for residents by accident due to falling asleep. A sec­ experienced any of the harms described the year 2003. The United Kingdom ond study found that 90 percent of the above, please tell OSHA your story. limits its residents to 56 hours per occasions when a resident fell asleep OS_f!A_can be reached at: Acting Assis­ week, and Denmark limits its residents while driving were after an on-call shift tant Secretary for Occupational Safety to 45 hours per week. lasting at least 24 continuous hours. and Health, U.S.