An Anniversary To Remember

John Fisher
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Stopping Medical Injustice

A few weeks ago, I wrote a blog about how medical residents are forced to work long hours with little sleep under their belts. Up until 2003, medical school graduates performing their hospital residencies were forced to work more than 100 hours a week with hardly any time off to sleep. It wasn't uncommon for a resident to stay up for over 36 hours without getting any rest.

Fortunately, in 2003, the Accreditation Council for Graduate Medical Education adopted guidelines to limit the amount of hours that residents could be required to work. The guidelines stated that residents could work no more than 80 hours a week with no more than 30 hours of consecutive work. In addition, the Institute of Medicine (IOM) has recently moved to further alter these guidelines and asserts that while the 80 hour limit should be maintained, residents should be provided with at least 5 hours of uninterrupted sleep per every 16 hour shift.

I thought that as a follow up to this piece, I would tell you a little bit about how these changes came to be. They happened mainly due to the advocacy efforts of one man, Sidney Zion, whose daughter died in a New York hospital almost 29 years ago. On the evening of March 4, 1984, Libby Zion, an 18-year-old college freshman at the time, was admitted to what is now New York Presbyterian Hospitals due to a high fever, agitation, and jerking movements. Thinking that she had a virus, she was given liquids and Meperidine, an opiate drug, to stop the jerking movements. She was only evaluated by medical residents. However, they did consult with Libby's primary care physician and the attending physician.

Libby quickly grew more restless. A first-year resident, Dr. Luise L. Weinstein, without visually evaluating Libby. ordered that she be placed in physical restraints and given a shot of another sedating medication. The second-year resident who had originally evaluated Libby, Dr. Gregg Stone, had left to try to get a few hours of sleep. Libby was not evaluated again until many hours later. When she was, the nurses were alarmed to find that her fever was a disturbing 107 degrees. Although they tried to cool her down, she suffered from a heart attack and died soon after.

Following Libby's death, Sidney Zion hired an attorney to investigate. He soon learned the tragic details of how his daughter had been tied down and not re-evaluated, that she had only been seen by doctors who were in training and who had been working for 36 straight hours, and that the attending physician had never actually gone into the hospital Furious and hoping for reform, Sidney, a former lawyer, and journalist for The New York Times, recruited journalists around the country to report on his daughter's death. He also persuaded the Manhattan District Attorney to convene a grand jury to consider murder charges against the physicians involved. He then brought a malpractice case against the hospital and doctors involved.

Although the grand jury did not indict the physicians, it did serve as a catalyst for change. The grand jury issued a scathing report highly criticizing the hospital. In response, a state commission was formed. In 1987, it recommended that doctors in training work no more than 80 hours a week and no more than 24 hours in a row and receive significantly more on-site supervision from senior physicians. As I stated earlier, in 2003, the Accreditation Council for Graduate Medical Education made the recommendation mandatory.

Libby Zion's story and the courageous work of her father should not soon be forgotten. Although we are coming up on the 29th anniversary of Libby's death, despite the new guidelines, residents continue to be overworked to save hospitals money. With Libby in mind, the IOM's new recommendations should be carefully considered and reforms should continue to be passed that make the practice of medicine safer. Although the anniversary of Libby's death is still a few months away, I think we should all bow our heads in remembrance today and thank her and her father for helping to bring change to where it is desperately needed.

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