February, 04 2010, 01:45pm EDT
Patient Safety Advocates Launch Campaign to Reduce Resident Physician Fatigue, Boost Patient Safety
Groups Call for Shorter Shifts and More Supervision, Create Web Site to Solicit Public’s Involvement
WASHINGTON
A coalition of public interest and patient safety groups launched a
campaign today to increase public awareness and gather stories about
patients who have received inferior medical care from fatigued
physicians.
At www.WakeUpDoctor.org,
which went live today, the public can get background information about
the correlation between physician sleep deprivation and patient safety,
share stories and sign on to a letter expressing support for
commonsense regulations to reduce the number of work hours and enhance
supervision of resident physicians.
Public Citizen, Mothers Against Medical Errors and other patient
advocates also sent a letter to the Accreditation Council on Graduate
Medical Education (ACGME), the group that oversees the training of
physicians in the U.S., calling for shorter shifts and more supervision
of resident physicians (also known as medical residents) in an effort
to boost patient safety. More than 40 health care, patient safety and
other public interest advocates have signed the letter.
In a telephone news conference today, residents and experts spoke
about the dangers posed by medical residents working shifts as long as
30 hours, frequently with limited support or supervision, leaving them
exhausted and prone to mistakes. Residents may work as many as 10 of
these 30-hour shifts a month.
"Few, if any, people would fly on a plane whose pilot had been awake
and working for 25 to 30 hours. Federal regulations prohibit pilots
from flying more than 30 to 35 hours a week," said Dr. Sidney Wolfe,
director of Public Citizen's Health Research Group. "But because
medical residents work on shifts lasting as long as 30 hours straight,
they become fatigued, making them more susceptible to making errors
that greatly harm patients. It is likely that there are more deaths in
U.S. hospitals each year caused by sleep-deprived doctors than the
total annual deaths from plane crashes and train accidents."
The scientific evidence linking acute and chronic sleep deprivation
with preventable medical errors has mounted steadily over the years,
Wolfe said. "Reducing the length of their shifts is the commonsense
approach that both the medical field and consumers need."
The Institute of Medicine (IOM) in December 2008 issued a landmark
report, "Resident Duty Hours: Enhancing Sleep, Supervision and Safety."
The comprehensive review listed 10 recommendations for change,
including an increase in supervision of junior residents and a
significant reduction in work hours - from 30-hour shifts to shifts no
longer than 16 hours. The ACGME board of directors will meet Feb. 7-9
to discuss changing its policy on work hours in light of this report.
Ample evidence has shown that marathon shifts in excess of 16 hours
can have a detrimental effect on a physician's abilities and judgment.
"After 24 hours without sleep, attentional failures at night double
and impairment of reaction time is comparable to the impairment induced
by drinking alcohol," said Dr. Chuck Czeisler, a professor and director
of sleep medicine divisions at Harvard Medical School and Brigham and
Women's Hospital. "The clinical performance of physicians - who are
used to being at the top of the class - drops to the seventh percentile
of their rested performance. Yet, as with alcohol, those affected by
sleep loss often do not recognize their impairment."
In 2006, the Harvard Work Hours, Health and Safety Group at Brigham
and Women's Hospital in Boston reported that one in five first-year
resident physicians admitted making a fatigue-related mistake that
injured a patient. One in 20 admitted a fatigue-related mistake that
resulted in a patient's death.
"Considerable scientific evidence backs up what common sense tells
me: that life and death decisions should not be made by someone who is
sleep-deprived," said Dr. John Ingle, fourth-year ear, nose and throat
resident at the University of New Mexico and regional vice president of
the Committee of Interns and Residents/SEIU Healthcare. "My patients
are consistently horrified when they learn that I haven't gone to sleep
since they saw me the previous day."
Many suspect that a major factor leading to these exorbitantly long
shifts is tradition in the medical field; because seasoned doctors had
to endure long hours when they were training, they believe incoming
physicians should be subject to the same conditions.
Helen Haskell, the founder and president of Mothers Against Medical
Error, became involved in patients' rights after her 15-year-old son
died from a preventable medical error. When her son went to the
hospital for an elective procedure in 2000, he died from "failure to
rescue," or failure to recognize and act upon the signs of serious
decline in a patient.
"I know that fatigue must have played a role in my son Lewis's
intern's judgment and in her inability to buck the system for the sake
of a patient," said Haskell. "There is no way I can ever know how large
a role it played, but I do know that in those hours of crisis, the last
thing we needed was to have an exhausted, unsupervised young trainee as
my dying child's only lifeline."
Another well-known case of a fatal medical error was that of Libby
Zion, an 18-year-old whose 1984 death in a New York City hospital
spurred new limits for resident work hours. After Zion's death, her
father, journalist Sidney Zion, brought charges against the hospital
and the physicians, indicting the medical training system for excessive
work hours and poor supervision that, he argued, contributed to poor
judgment and medical negligence. As a result of Zion's crusade, New
York state has stronger work hours rules than the rest of the country.
For current and future resident doctors, these are cautionary tales.
"Medical training must promote supportive teamwork, not rugged
individualism," said Daniel Henderson, health justice fellow at the
American Medical Student Association. "Try as we might to ignore our
own limits, all doctors are humans, and we all need sleep."
Other industries impose limits on the hours employees work in a
given shift to prevent fatigue-related accidents. It's time for the
medical field to follow suit.
"Federal regulators and the airline industry long ago recognized
that pilots and crews should not have unlimited duty hours. As a
result, flight crews' duty time is closely regulated so as to minimize
the potential for crew fatigue and its potential lethal consequences,"
said Art Levin, director of the Center for Medical Consumers and a
reviewer of the IOM report. "Patients and medical residents deserve the
same protection."
To learn more, to share stories and to sign the letter to the ACGME, visit www.WakeUpDoctor.org.
Public Citizen is a nonprofit consumer advocacy organization that champions the public interest in the halls of power. We defend democracy, resist corporate power and work to ensure that government works for the people - not for big corporations. Founded in 1971, we now have 500,000 members and supporters throughout the country.
(202) 588-1000LATEST NEWS
Critics Blast 'Reckless and Impossible' Bid to Start Operating Mountain Valley Pipeline
"The time to build more dirty and dangerous pipelines is over," said one environmental campaigner.
Apr 23, 2024
Environmental defenders on Tuesday ripped the company behind the Mountain Valley Pipeline for asking the federal government—on Earth Day—for permission to start sending methane gas through the 303-mile conduit despite a worsening climate emergency caused largely by burning fossil fuels.
Mountain Valley Pipeline LLC sent a letter Monday to Federal Energy Regulatory Commission (FERC) Acting Secretary Debbie-Anne Reese seeking final permission to begin operation on the MVP next month, even while acknowledging that much of the Virginia portion of the pipeline route remains unfinished and developers have yet to fully comply with safety requirements.
"In a manner typical of its ongoing disrespect for the environment, Mountain Valley Pipeline marked Earth Day by asking FERC for authorization to place its dangerous, unnecessary pipeline into service in late May," said Jessica Sims, the Virginia field coordinator for Appalachian Voices.
"MVP brazenly asks for this authorization while simultaneously notifying FERC that the company has completed less than two-thirds of the project to final restoration and with the mere promise that it will notify the commission when it fully complies with the requirements of a consent decree it entered into with the Pipeline and Hazardous Materials Safety Administration last fall," she continued.
"Requesting an in-service decision by May 23 leaves the company very little time to implement the safety measures required by its agreement with PHMSA," Sims added. "There is no rush, other than to satisfy MVP's capacity customers' contracts—a situation of the company's own making. We remain deeply concerned about the construction methods and the safety of communities along the route of MVP."
Russell Chisholm, co-director of the Protect Our Water, Heritage, Rights (POWHR) Coalition—which called MVP's request "reckless and impossible"—said in a statement that "we are watching our worst nightmare unfold in real-time: The reckless MVP is barreling towards completion."
"During construction, MVP has contaminated our water sources, destroyed our streams, and split the earth beneath our homes. Now they want to run methane gas through their degraded pipes and shoddy work," Chisholm added. "The MVP is a glaring human rights violation that is indicative of the widespread failures of our government to act on the climate crisis in service of the fossil fuel industry."
POWHR and activists representing frontline communities affected by the pipeline are set to take part in a May 8 demonstration outside project financier Bank of America's headquarters in Charlotte, North Carolina.
Appalachian Voices noted that MVP's request comes days before pipeline developer Equitrans Midstream is set to release its 2024 first-quarter earnings information on April 30.
MVP is set to traverse much of Virginia and West Virginia, with the Southgate extension running into North Carolina. Outgoing U.S. Sen. Joe Manchin (D-W.Va.) and other pipeline proponents fought to include expedited construction of the project in the debt ceiling deal negotiated between President Joe Biden and congressional Republicans last year.
On Monday, climate and environmental defenders also petitioned the U.S. Court of Appeals for the D.C. Circuit, challenging FERC's approval of the MVP's planned Southgate extension, contending that the project is so different from original plans that the government's previous assent is now irrelevant.
"Federal, state, and local elected officials have spoken out against this unneeded proposal to ship more methane gas into North Carolina," said Sierra Club senior field organizer Caroline Hansley. "The time to build more dirty and dangerous pipelines is over. After MVP Southgate requested a time extension for a project that it no longer plans to construct, it should be sent back to the drawing board for this newly proposed project."
David Sligh, conservation director at Wild Virginia, said: "Approving the Southgate project is irresponsible. This project will pose the same kinds of threats of damage to the environment and the people along its path as we have seen caused by the Mountain Valley Pipeline during the last six years."
"FERC has again failed to protect the public interest, instead favoring a profit-making corporation," Sligh added.
Others renewed warnings about the dangers MVP poses to wildlife.
"The endangered bats, fish, mussels, and plants in this boondoggle's path of destruction deserve to be protected from killing and habitat destruction by a project that never received proper approvals in the first place," Center for Biological Diversity attorney Perrin de Jong said. "Our organization will continue fighting this terrible idea to the bitter end."
Keep ReadingShow Less
'Seismic Win for Workers': FTC Bans Noncompete Clauses
Advocates praised the FTC "for taking a strong stance against this egregious use of corporate power, thereby empowering workers to switch jobs and launch new ventures, and unlocking billions of dollars in worker earnings."
Apr 23, 2024
U.S. workers' rights advocates and groups celebrated on Tuesday after the Federal Trade Commission voted 3-2 along party lines to approve a ban on most noncompete clauses, which Democratic FTC Chair Lina Khansaid "keep wages low, suppress new ideas, and rob the American economy of dynamism."
"The FTC's final rule to ban noncompetes will ensure Americans have the freedom to pursue a new job, start a new business, or bring a new idea to market," Khan added, pointing to the commission's estimates that the policy could mean another $524 for the average worker, over 8,500 new startups, and 17,000 to 29,000 more patents each year.
As Economic Policy Institute (EPI) president Heidi Shierholz explained, "Noncompete agreements are employment provisions that ban workers at one company from working for, or starting, a competing business within a certain period of time after leaving a job."
"These agreements are ubiquitous," she noted, applauding the ban. "EPI research finds that more than 1 out of every 4 private-sector workers—including low-wage workers—are required to enter noncompete agreements as a condition of employment."
The U.S. Chamber of Commerce has suggested it plans to file a lawsuit that, as The American Prospectdetailed, "could more broadly threaten the rulemaking authority the FTC cited when proposing to ban noncompetes."
Already, the tax services and software provider Ryan has filed a legal challenge in federal court in Texas, arguing that the FTC is unconstitutionally structured.
Still, the Democratic commissioners' vote was still heralded as a "seismic win for workers." Echoing Khan's critiques of such noncompetes, Public Citizen executive vice president Lisa Gilbert declared that such clauses "inflict devastating harms on tens of millions of workers across the economy."
"The pervasive use of noncompete clauses limits worker mobility, drives down wages, keeps Americans from pursuing entrepreneurial dreams and creating new businesses, causes more concentrated markets, and keeps workers stuck in unsafe or hostile workplaces," she said. "Noncompete clauses are both an unfair method of competition and aggressively harmful to regular people. The FTC was right to tackle this issue and to finalize this strong rule."
Morgan Harper, director of policy and advocacy at the American Economic Liberties Project, praised the FTC for "listening to the comments of thousands of entrepreneurs and workers of all income levels across industries" and finalizing a rule that "is a clear-cut win."
Demand Progress' Emily Peterson-Cassin similarly commended the commission "for taking a strong stance against this egregious use of corporate power, thereby empowering workers to switch jobs and launch new ventures, and unlocking billions of dollars in worker earnings."
While such agreements are common across various industries, Teófilo Reyes, chief of staff at the Restaurant Opportunities Centers United, said that "many restaurant workers have been stuck at their job, earning as low as $2.13 per hour, because of the noncompete clause that they agreed to have in their contract."
"They didn't know that it would affect their wages and livelihood," Reyes stressed. "Most workers cannot negotiate their way out of a noncompete clause because noncompetes are buried in the fine print of employment contracts. A full third of noncompete clauses are presented after a worker has accepted a job."
Student Borrower Protection Center (SBPC) executive director Mike Pierce pointed out that the FTC on Tuesday "recognized the harmful role debt plays in the workplace, including the growing use of training repayment agreement provisions, or TRAPs, and took action to outlaw TRAPs and all other employer-driven debt that serve the same functions as noncompete agreements."
Sandeep Vaheesan, legal director at Open Markets Institute, highlighted that the addition came after his group, SBPC, and others submitted comments on the "significant gap" in the commission's initial January 2023 proposal, and also welcomed that "the final rule prohibits both conventional noncompete clauses and newfangled versions like TRAPs."
Jonathan Harris, a Loyola Marymount University law professor and SBPC senior fellow, said that "by also banning functional noncompetes, the rule stays one step ahead of employers who use 'stay-or-pay' contracts as workarounds to existing restrictions on traditional noncompetes. The FTC has decided to try to avoid a game of whack-a-mole with employers and their creative attorneys, which worker advocates will applaud."
Among those applauding was Jean Ross, president of National Nurses United, who said that "the new FTC rule will limit the ability of employers to use debt to lock nurses into unsafe jobs and will protect their role as patient advocates."
Angela Huffman, president of Farm Action, also cheered the effort to stop corporations from holding employees "hostage," saying that "this rule is a critical step for protecting our nation's workers and making labor markets fairer and more competitive."
Keep ReadingShow Less
'Discriminatory' North Carolina Law Criminalizing Felon Voting Struck Down
One plaintiffs' attorney said the ruling "makes our democracy better and ensures that North Carolina is not able to unjustly criminalize innocent individuals with felony convictions who are valued members of our society."
Apr 23, 2024
Democracy defenders on Tuesday hailed a ruling from a U.S. federal judge striking down a 19th-century North Carolina law criminalizing people who vote while on parole, probation, or post-release supervision due to a felony conviction.
In Monday's decision, U.S. District Judge Loretta C. Biggs—an appointee of former Democratic President Barack Obama—sided with the North Carolina A. Philip Randolph Institute and Action NC, who argued that the 1877 law discriminated against Black people.
"The challenged statute was enacted with discriminatory intent, has not been cleansed of its discriminatory taint, and continues to disproportionately impact Black voters," Biggs wrote in her 25-page ruling.
Therefore, according to the judge, the 1877 law violates the U.S. Constitution's equal protection clause.
"We are ecstatic that the court found in our favor and struck down this racially discriminatory law that has been arbitrarily enforced over time," Action NC executive director Pat McCoy said in a statement. "We will now be able to help more people become civically engaged without fear of prosecution for innocent mistakes. Democracy truly won today!"
Voting rights tracker Democracy Docket noted that Monday's ruling "does not have any bearing on North Carolina's strict felony disenfranchisement law, which denies the right to vote for those with felony convictions who remain on probation, parole, or a suspended sentence—often leaving individuals without voting rights for many years after release from incarceration."
However, Mitchell Brown, an attorney for one of the plaintiffs, said that "Judge Biggs' decision will help ensure that voters who mistakenly think they are eligible to cast a ballot will not be criminalized for simply trying to reengage in the political process and perform their civic duty."
"It also makes our democracy better and ensures that North Carolina is not able to unjustly criminalize innocent individuals with felony convictions who are valued members of our society, specifically Black voters who were the target of this law," Brown added.
North Carolina officials have not said whether they will appeal Biggs' ruling. The state Department of Justice said it was reviewing the decision.
According to Forward Justice—a nonpartisan law, policy, and strategy center dedicated to advancing racial, social, and economic justice in the U.S. South, "Although Black people constitute 21% of the voting-age population in North Carolina, they represent 42% of the people disenfranchised while on probation, parole, or post-release supervision."
The group notes that in 44 North Carolina counties, "the disenfranchisement rate for Black people is more than three times the rate of the white population."
"Judge Biggs' decision will help ensure that voters who mistakenly think they are eligible to cast a ballot will not be criminalized for simply trying to re-engage in the political process and perform their civic duty."
In what one civil rights leader called "the largest expansion of voting rights in this state since the 1965 Voting Rights Act," a three-judge state court panel voted 2-1 in 2021 to restore voting rights to approximately 55,000 formerly incarcerated felons. The decision made North Carolina the only Southern state to automatically restore former felons' voting rights.
Republican state legislators appealed that ruling to the North Carolina Court of Appeals, which in 2022 granted their request for a stay—but only temporarily, as the court allowed a previous injunction against any felony disenfranchisement based on fees or fines to stand.
However, last April the North Carolina Supreme Court reversed the three-judge panel decision, stripping voting rights from thousands of North Carolinians previously convicted of felonies. Dissenting Justice Anita Earls opined that "the majority's decision in this case will one day be repudiated on two grounds."
"First, because it seeks to justify the denial of a basic human right to citizens and thereby perpetuates a vestige of slavery, and second, because the majority violates a basic tenant of appellate review by ignoring the facts as found by the trial court and substituting its own," she wrote.
As similar battles play out in other states, Democratic U.S. lawmakers led by Rep. Ayanna Pressley of Massachusetts and Sen. Peter Welch of Vermont in December introduced legislation to end former felon disenfranchisement in federal elections and guarantee incarcerated people the right to vote.
Currently, only Maine, Vermont, and the District of Columbia allow all incarcerated people to vote behind bars.
Keep ReadingShow Less
Most Popular