Federal Regulation of Hospital Resident Work Hours: Enforcement with Real Teeth

In recent years, there has been an increase in the public’s awareness of medical errors committed by sleep-deprived and overworked hospital residents. This awareness has resulted in increased public concern regarding patient safety in teaching hospitals across the United States, as well as increased concerns regarding the safety and education of hospital residents themselves. To address these concerns, the Accreditation Council for Graduate Medical Education (ACGME) appointed the Work Group on Resident Duty Hours and the Learning Environment in September 2001 to establish guidelines for appropriate resident work hours. At about the same time, bills establishing federal statutory restrictions on resident work hours were introduced in Congress, and a Public Citizen petition requesting the promulgation of federal regulations restricting resident work hours was submitted to the Occupational Safety and Health Agency (OSHA). When the ACGME adopted its guidelines for resident work hours in 2003, Congress and OSHA deferred to the ACGME’s “expertise” and tabled the proposals for federal regulation of resident work hours that were before them. Since 2003, however, questions remain as to whether the federal government should regulate resident work hours despite the existence of the ACGME guidelines. In this Comment, Clark J. Lee argues that this question should be answered in the affirmative. Part I presents a general background on the issue of restricting hospital resident work hours in the United States, including the attitudes of the medical establishment, medical educators, and hospital residents toward the issue. Some of the published scientific research on the effects of long work hours and sleep deprivation among residents is also reviewed. Part II reviews in detail the history behind the only state-level regulations of resident work hours currently in existence, i.e., the New York regulations promulgated in 1989 in the aftermath of the Libby Zion case. The impact of these regulations on the medical community, political community, and general public in New York State and nationwide are also considered. Part III reviews the immediate legacy of the Libby Zion case, including compliance issues with the New York State regulations that have arisen since their promulgation. Part IV examines recent proposals for federal regulation of resident work hours. Part V examines the ACGME accreditation standards implemented in July 2003 and the reaction of the medical and graduate medical education communities to this attempt at self-regulation. Part VI reviews the findings of various studies on compliance with and attitudes toward the ACGME and New York State resident work hour restrictions in recent years. Part VII advances the argument that the federal government should regulate resident work hours rather than the states or the graduate medical education community because the federal government is better suited to implementing and enforcing such regulations successfully. Some suggestions for future federal legislation are also presented in this part. In conclusion, Part VIII gives some consideration to the likelihood of federal regulation of resident work hours in the near future