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Medical Whistleblower Advocacy Network

Human Rights Defenders

“All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.”

 Universal Declaration of Human Rights

Article 1

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Audio by Public Citizen on the Overworked and Exhausted Medical Residents

On-call duty scheduling abusive of human rights of residents and interns

Resident doctors are those who are still in training.  They are still formally students and are completing the last part of their training to become fully qualified doctors.  They are dependent on the medical training institution to provide them with their credentials to be an independent fully qualified physician.  They have invested a large amount of their time and their money into becoming a doctor and are close enough to graduation to see the end in sight.  But during this last year of training they become vulnerable to the greed and uncaring of those that supervise their residency or internship and use them as cheap labor without concern to their human rights.   Theses doctors still in training can and do (by law) routinely work 24-30 hour shifts, several days a week, for years.

These overworked, exhausted residents/interns perform many functions within the busy hospital,  they may and will be treating you or your loved one,  with thirty or forty other patients on their minds and having had no sleep for hours, they will be making life or death decisions.  

In light of patient safety and human rights concerns for the residents/doctors Medical Whistleblower joins patient advocates in  launching a campaign to change the requirements of the number of hours that medical residents can work. 

Resident physicians' marathon shifts, lasting as long as 30 hours as often as 10 times a month, leave them fatigued and prone to errors--which could be fatal for the patients at the whim of their judgment.

Making a Doctor - Exhaustion

Qur’ān. V49:11–13: "come to know each other, the noblest of you, in the sight of God, are the ones possessing taqwá".

Medical Error

Your risk of dying in a plane crash is estimated to be 1 in 9,000,000 but your risk of suffering medical negligence or medical error is about 1 in 5.  The Harvard Medical Practice Study, documented in The New England Journal of Medicine, (February 7, 1991), found strong evidence of  6895 deaths during the year 1984 in New York hospitals due to negligent medical care alone. On a national basis the Harvard numbers work out to approximately  100,000 people dying each year from medical negligence. To make this figure understandable, it is roughly equivalent to one 747 jetliner, filled with passengers, crashing every day of the week.      Yet, as frightening as these numbers  are, they may be vastly understated. As reported in Lancet (1997:349:309-313), the actual rate of medical negligence in hospitals could be at least 17.7% and probably higher. People in hospitals run an almost 1 in 5 risk of suffering medical negligence.

Patient Safety Organizations

Congress passed The Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act). To read the Patient Safety Act, go to http://www.pso.ahrq.gov/statute/pl109-41.htm.

To implement the Patient Safety Act, the Department of Health and Human Services issued the Patient Safety and Quality Improvement final rule (Patient Safety Rule, PDF file, 760 KB. PDF Help). The Patient Safety Act and the Patient Safety Rule authorize the creation of PSOs to improve quality and safety through the collection and analysis of data on patient events.

PSOs are organizations that share the goal of improving the quality and safety of health care delivery. Organizations that are eligible to become PSOs include: public or private entities, profit or not-for-profit entities, provider entities such as hospital chains, and other entities that establish special components to serve as PSOs.

By providing both privilege and confidentiality, PSOs create a secure environment where clinicians and health care organizations can collect, aggregate, and analyze data, thereby improving quality by identifying and reducing the risks and hazards associated with patient care.

 

Listed Patient Safety Organizations

 

http://www.pso.ahrq.gov/listing/psolist.htm

"He who passively accepts evil is as much involved in it as he who helps to perpetrate it. He who accepts evil without protesting against it is really cooperating with it."

Martin Luther King, Jr.

Medical Residency - Poorly Paid and Overworked

The Effect of Health Care Working Conditions on Patient Safety, Structured Abstract. March 2003. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/worktp.htm

 

Libby Zion - Death by Serotonin Syndrome

New York State Department of Health Code, Section 405, also known as the Libby Zion law, is a regulation that limits the amount of  time resident physicians' work in New York State hospitals to roughly 80 hours per week. The law was named after Libby Zion who died at the age of 18 under the care of what her father believed to be overworked resident physicians and intern physicians. In July 2003 the Accreditation Council for Graduate Medical Education (ACGME) adopted similar regulations for all accredited medical training institutions in the United States.

Libby Zion had been ill with a "flu-like ailment" when admitted to New York Hospital, she died of cardiac arrest. Zion was assigned to two medical residents who both evaluated her but were unable to determine the cause of Zion's illness. They prescribed Demerol to control the "strange jerking motions" that Zion had been exhibiting when she was admitted.  The two medical residents were both responsible for covering dozens of other patients. After evaluating Zion, they left. Weinstein went to cover other patients, and Stone went to sleep in an on-call room in an adjacent building. Zion, however, did not improve, and continued to become more agitated. After being contacted by nurses by phone, Weinstein ordered physical restraints be placed on Zion. She also prescribed haloperidol by phone to control the agitation. Zion finally managed to fall asleep, but by 6:30, her temperature was 107 °F (42 °C). Weinstein was once again called, and measures were quickly taken to try to reduce her temperature. However, before this could be done, Zion suffered a heart attack and could not be resuscitated.  It was later determined that Libby Zion was suffering from Serotonin Syndrome.  Zion had been taking a prescribed antidepressant, phenelzine, before she was admitted to the hospital. The combination of that and the meperidine given to her by Dr.  Stone and Dr. Weinstein contributed to the development of "serotonin syndrome", a condition which led to increased agitation which lead to increased drug dosing ultimately leading to her death.

Although regulatory and civil proceedings found conflicting evidence about Zion's death, today her death is widely believed to have been caused by serotonin syndrome from the drug interaction between the phenelzine she was taking prior to her hospital visit, and the Demerol administered by a resident physician. The lawsuits and regulatory investigations following her death, and their implications for working conditions and supervision of interns and residents were highly publicized in both lay media and medical journals.

 

Serotonin or 5-hydroxytryptamine (5-HT) which is a neurotransmitter.  Serotonin is a neurotransmitter that affects the brain and plays a role in aggression, memory, learning,  pain, sleep, appetite, anxiety, depression, migraine, and vomiting.   Several different classes of psychiatric drugs like anti-depressants, anti-psychotics, anti-anxiety drugs, anti- migraine drugs and psychedelic drugs affect the level of this neurotransmitter inside the neuro-synapses of the brain.   

Some drugs such as tricyclic antidepressants (TCA’s) and selective serotonin reuptake inhibitors (SSRIs) inhibit the reuptake of serotonin, making it stay in the synapse longer.  Serotonin syndrome which can also be called serotonin toxicity is really a poisoning and is the predictable consequence of excess serotonin activity in the brain and elsewhere in the body which can be caused by therapeutic use of these medications.  No laboratory tests can currently confirm the diagnosis and it is usually diagnosed base on the patient’s symptoms and clinical history.  Serotonin syndrome may be mistaken for a viral illness, anxiety, neurological disorder, various kinds of poisonings, or a worsening psychiatric condition.    

The symptoms of Serotonin Syndrome are:

Cognitive effects: headache, agitation, hypomania, mental confusion, hallucinations, coma

Autonomic effects: shivering, sweating, hyperthermia (temperature as high as 104o F and even go as high as 106oF, hypertension (high blood pressure), tachycardia, nausea, diarrhea.

Somatic effects: myoclonus (muscle twitching), hyperreflexia (manifested by clonus), tremor.

 

 

References:

 

"Libby Zion". New York Times. March 6, 1984.

Philibert I.; Friedmann P.; Williams W. T.; for the members of the ACGME Work Group on Resident Duty Hours (2002). "New Requirements for Resident Duty Hours". Journal of the American Medical Association 288 (9): 1112–1114. doi:10.1001/jama.288.9.1112. PMID 12204081

 

Zion, Sidney (December 18, 1997). "Hospitals Flout My Daughter's Law". New York Daily News. "After it became clear to everybody, including a New York County grand jury, that Libby's death was caused by overworked and unsupervised interns and residents, the Libby Zion law was passed: No more 36-hour shifts for interns and residents; from now on, attending physicians would be at the ready to supervise the young, inexperienced student-doctors."

 

Fox, Margalit (March 5, 2005). "Elsa Zion, 70. Helped Cut Doctor Workloads.". New York Times.

 

Jane Ellen Brody (February 27, 2007). "A Mix of Medicines That Can Be Lethal". New York Times.

 

Spritz, N. (August 1991). "Oversight of physicians' conduct by state licensing agencies. Lessons from New York's Libby Zion case". Annals of Internal Medicine 115 (3): 219–22. PMID 2058876.

"The great and invigorating influences in American life have been the unorthodox: the people who challenge an existing institution or way of life, or say and do things that make people think."

William O. Douglas

(1898-1980), U. S. Supreme Court Justice

Source: Interview, 1958

References on ACGME Duty Hours

Duty Hour Recommendations and Implications for Meeting the ACGME Core Competencies: Views of Residency Directors Mayo Clin Proc.. 2011;86(3):185-191.

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Persistent Noncompliance With the Work-Hour Regulation Arch Surg. 2011;146(2):175-178.

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Interns Overestimate the Effectiveness of Their Hand-off Communication Pediatrics. 2010;125(3):491-496.

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Association of Resident Fatigue and Distress With Perceived Medical Errors JAMA. 2009;302(12):1294-1300.

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Association of Workload of On-Call Medical Interns With On-Call Sleep Duration, Shift Duration, and Participation in Educational Activities JAMA. 2008;300(10):1146-1153.

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The Accreditation Council for Graduate Medical Education's Limits on Residents' Work Hours and Patient Safety: A Study of Resident Experiences and Perceptions Before and After Hours Reductions Arch Intern Med. 2008;168(5):493-500.

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The U.S. Presidential Election and Health Care Workforce Policy Policy Politics Nursing Practice. 2008;9(1):6-14.

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Work patterns and fatigue-related risk among junior doctors Occup. Environ. Med.. 2007;64(11):733-738.

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Effect of Residency Duty-Hour Limits: Views of Key Clinical Faculty Arch Intern Med. 2007;167(14):1487-1492.

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Tough Times for Teaching Faculty Arch Intern Med. 2007;167(14):1453-1455.

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Hippocrates Affirmed? Limiting Residents' Work Hours Does No Harm to Patients ANN INTERN MED. 2007;147(2):143-144.

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Changes in Hospital Mortality Associated with Residency Work-Hour Regulations ANN INTERN MED. 2007;147(2):73-80.

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House Staff Team Workload and Organization Effects on Patient Outcomes in an Academic General Internal Medicine Inpatient Service Arch Intern Med. 2007;167(1):47-52.

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Pediatric Residency Duty Hours Before and After Limitations Pediatrics. 2006;118(6):e1805-e1811.

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High-quality learning for high-quality health care: getting it right. JAMA. 2006;296(9):1132-1134.

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Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. JAMA. 2006;296(9):1071-1078.

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Residents Report on Adverse Events and Their Causes Arch Intern Med. 2005;165(22):2607-2613.

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Near-miss errors in laboratory blood test requests by interns QJM. 2005;98(10):753-756.

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Work Hours and Reducing Fatigue-Related Risk: Good Research vs Good Policy JAMA. 2005;294(9):1104-1106.

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Effects of Work Hour Reduction on Residents' Lives: A Systematic Review JAMA. 2005;294(9):1088-1100.

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Resident Attitudes Regarding the Impact of the 80-Duty-Hours Work Standards J Am Osteopath Assoc. 2005;105(7):307-313.

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Adoption of duty-hour standards in a pharmacy residency program Am J Health Syst Pharm. 2005;62(8):800-803.

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Impact of the ACGME Work Hour Requirements: A neurology resident and program director survey Neurology. 2005;64(2):E11-E15.

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Systematic Review: Effects of Resident Work Hours on Patient Safety ANN INTERN MED. 2004;141(11):851-857.

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The Hospital Mortality of Patients Admitted to the ICU on Weekends Chest. 2004;126(4):1292-1298.

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Introduction: the origins and implications of a growing shortage of cardiologists J Am Coll Cardiol. 2004;44(2):221-232.

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Reducing Resident Work Hours: Unproven Assumptions and Unforeseen Outcomes ANN INTERN MED. 2004;140(10):814-815.

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Fellowship training, workload, fatigue and physical stress: a prospective observational study CMAJ. 2004;170(6):965-970.

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The Relationship Between Pediatric Residency Program Size and Inpatient Illness Severity and Diversity Arch Pediatr Adolesc Med. 2003;157(7):676-680.

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Don't Believe Everything You Read in the Patient's Chart Pediatrics. 2003;111(5):1108-1109.

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Limiting Residents' Work Hours JAMA. 2002;288(23):2973-2975.

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Filing a Discrimination Complaint at the Dept of Education

How to File a Discrimination Complaint With the Office for Civil Rights
September 2010


Introduction The Office for Civil Rights (OCR) enforces five federal civil rights laws that prohibit discrimination on the basis of race, color, national origin, sex, disability and age in programs or activities that receive federal financial assistance from the Department of Education (ED). Discrimination on the bases of race, color and national origin is prohibited by Title VI of the Civil Rights Act of 1964; sex discrimination is prohibited by Title IX of the Education Amendments of 1972; discrimination on the basis of disability is prohibited by Section 504 of the Rehabilitation Act of 1973 and Title II of the Americans with Disabilities Act of 1990 (Title II prohibits discrimination on the basis of disability by public entities, whether or not they receive federal financial assistance); and age discrimination is prohibited by the Age Discrimination Act of 1975.These civil rights laws extend to all state education agencies, elementary and secondary school systems, colleges and universities, vocational schools, proprietary schools, state vocational rehabilitation agencies, libraries and museums that receive federal financial assistance from ED. Programs or activities that receive ED funds must provide aids, benefits or services in a nondiscriminatory manner. Such aids, benefits or services may include, but are not limited to, admissions, recruitment, financial aid, academic programs, student treatment and services, counseling and guidance, discipline, classroom assignment, grading, vocational education, recreation, physical education, athletics, housing and employment.OCR also enforces the Boy Scouts of America Equal Access Act, part of the Elementary and Secondary Education Act. Under this act, OCR can investigate complaints involving the denial of equal access or a fair opportunity to meet to, or discrimination against, any group officially affiliated with the Boy Scouts or affiliated with any other youth group listed in Title 36 of the United States Code, by a public elementary school, a public secondary school, or a state or local education agency that receives funds from ED.


Who Can File a Discrimination Complaint


Anyone who believes that an education institution that receives federal financial assistance has discriminated against someone on the basis of race, color, national origin, sex, disability or age, or who believes that a public elementary or secondary school, or state or local education agency has violated the Boy Scouts of America Equal Access Act, may file a complaint. The person or organization filing the complaint need not be a victim of the alleged discrimination but may complain on behalf of another person or group.


Timeliness
A complaint must be filed within 180 calendar days of the date of the alleged discrimination, unless the time for filing is extended by OCR for good cause shown under certain circumstances.


Institutional Grievance Procedures
Prior to filing a complaint with OCR against an institution, a potential complainant may want to find out about the institution’s grievance process and use that process to have the complaint resolved. However, a complainant is not required by law to use the institutional grievance process before filing a complaint with OCR. If a complainant uses an institutional grievance process and also chooses to file the complaint with OCR, the complaint must be filed with OCR within 60 days after completion of the institutional grievance process.

How to File an Online Complaint

Complainants wishing to file a complaint may do so by:

Mail or Facsimile: Complainants may mail or send by facsimile a letter or use the OCR’s Discrimination Complaint Form available from one of OCR’s enforcement offices (see the list of OCR’s offices in this brochure). In your correspondence, please include:

  • The complainant’s name, address and, if possible (although not required), a telephone number where the complainant may be reached during business hours;
  • Information about the person(s) or class of persons injured by the alleged discriminatory act(s) (names of the injured person(s) are not required);
  • The name and location of the institution that committed the alleged discriminatory act(s); and
  • A description of the alleged discriminatory act(s) in sufficient detail to enable OCR to understand what occurred, when it occurred, and the basis for the alleged discrimination (race, color, national origin, sex, disability, age or the Boy Scouts of America Equal Access Act).

E-mail: Complainants may file a complaint, using the following e-mail address: ocr@ed.gov. Use the same procedures as above.

Online: Complainants may file a complaint with OCR using OCR’s electronic complaint form at the following website: http://www.ed.gov/about/offices/list/ocr/complaintintro.html.

For those without current e-mail accounts, Internet access may be freely available from your local public library, and free e-mail accounts are available from several large providers.

Note: A recipient of federal financial assistance may not retaliate against any person who has made a complaint, testified, assisted or participated in any manner in an investigation or proceeding under the laws listed on the first page of this brochure. If you believe that you have been retaliated against for any of these reasons, you may file a complaint with OCR.

U.S. Department of Education
Arne Duncan
Secretary
September 2010

Where to Write

See Addresses
Also see OCR "Contact Us" page

 

Links for additional Information http://www2.ed.gov/about/offices/list/ocr/index.html

How to File a Discrimination Complaint with the Office for Civil Rights

Downloadable File PDF (228 KB)


“Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around.”
 
― Leo Buscaglia

Medical Whistleblower Advocacy Network

MEDICAL WHISTLEBLOWER ADVOCACY NETWORK

P.O. 42700 

Washington, DC 20015

MedicalWhistleblowers (at) gmail.com

CONTACT

"Never impose on others what you would not choose for yourself."  Confucius

"It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat."

Theodore Roosevelt- Excerpt from the speech "Citizenship In A Republic", delivered at the Sorbonne, in Paris, France on 23 April, 1910