[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1228 Introduced in House (IH)]







108th CONGRESS
  1st Session
                                H. R. 1228

  To amend title XVIII of the Social Security Act to reduce the work 
hours and increase the supervision of resident-physicians to ensure the 
         safety of patients and resident-physicians themselves.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 12, 2003

 Mr. Conyers introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
  To amend title XVIII of the Social Security Act to reduce the work 
hours and increase the supervision of resident-physicians to ensure the 
         safety of patients and resident-physicians themselves.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Patient and Physician Safety and 
Protection Act of 2003''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) The Federal government, through its medicare program, 
        pays approximately $8 billion per year solely to train 
        resident-physicians in the United States, and as a result, has 
        an interest in assuring the safety of patients treated by 
        resident-physicians and the safety of resident-physicians 
        themselves.
            (2) Resident-physicians spend a significant amount of their 
        time performing activities not related to the educational 
        mission of training competent physicians.
            (3) The excessive numbers of hours worked by resident-
        physicians is inherently dangerous for patient care and for the 
        lives of resident-physicians.
            (4) The scientific literature has consistently demonstrated 
        that the sleep deprivation of the magnitude seen in residency 
        training programs leads to cognitive impairment.
            (5) A substantial body of research indicates that excessive 
        hours worked by resident-physicians lead to higher rates of 
        medical error, motor vehicle accidents, depression and 
        pregnancy complications.
            (6) The medical community has not adequately addressed the 
        issue of excessive resident-physician work hours.
            (7) Different medical specialty training programs have 
        different patient care considerations but the effects of sleep 
        deprivation on resident-physicians does not change between 
        specialties.
            (8) The Federal government has regulated the work hours of 
        other industries when the safety of employees or the public is 
        at risk.

SEC. 3. REVISION OF MEDICARE HOSPITAL CONDITIONS OF PARTICIPATION 
              REGARDING WORKING HOURS OF RESIDENTS.

    (a) In General.--Section 1866 of the Social Security Act (42 U.S.C. 
1395cc) is amended--
            (1) in subsection (a)(1)--
                    (A) by striking ``and'' at the end of subparagraph 
                (R);
                    (B) by striking the period at the end of 
                subparagraph (S) and inserting ``; and''; and
                    (C) by inserting after subparagraph (S) the 
                following new subparagraph:
            ``(T) in the case of a hospital that uses the services of 
        physician residents or postgraduate trainees, to meet the 
        requirements of subsection (j).''; and
            (2) by adding at the end the following new subsection:
    ``(j)(1)(A) In order that the working conditions and working hours 
of physicians and postgraduate trainees promote the provision of 
quality medical care in hospitals, as a condition of participation 
under this title each hospital shall establish the following limits on 
working hours for certain members of the medical staff and postgraduate 
trainees:
            ``(i) Subject to subparagraph (C), postgraduate trainees 
        may work no more than a total of 80 hours per week and 24 hours 
        per shift.
            ``(ii) Subject to subparagraph (C), postgraduate trainees--
                    ``(I) shall have at least 10 hours between 
                scheduled shifts;
                    ``(II) shall have at least 1 full day out of every 
                7 days off and one full weekend off per month;
                    ``(III) who are assigned to patient care 
                responsibilities in an emergency department shall work 
                no more than 12 continuous hours in that department; 
                and
                    ``(IV) shall not be scheduled to be on call in the 
                hospital more often than every third night.
    ``(B) The Secretary shall promulgate such regulations as may be 
necessary to ensure quality of care is maintained during the transfer 
of direct patient care from one postgraduate trainee to another at the 
end of each such 24 hour period referred to in subparagraph (A) and 
shall take into account cases of individual patient emergencies.
    ``(C) The work hour limitations under subparagraph (A) and 
requirements of subparagraph (B) shall not apply to a hospital during a 
state of emergency declared by the Secretary that applies with respect 
to that hospital.
    ``(2) The Secretary shall promulgate such regulations as may be 
necessary to monitor and supervise postgraduate trainees assigned 
patient care responsibilities as part of an approved medical training 
program, as well as to assure quality patient care.
    ``(3) Each hospital shall inform postgraduate trainees of--
            ``(A) their rights under this subsection, including methods 
        to enforce such rights (including so-called whistle-blower 
        protections); and
            ``(B) the effects of their acute and chronic sleep 
        deprivation both on themselves and on their patients.
    ``(4) For purposes of this subsection, the term `postgraduate 
trainee' includes a postgraduate intern, resident, or fellow.''.
    (b) Designation.--
            (1) In general.--The Secretary of Health and Human Services 
        shall designate an individual within the Department of Health 
        and Human Services to handle all complaints of violations that 
        arise from residents who report that their programs are in 
        violation of the requirements of section 1866(j) of the Social 
        Security Act (as added by subsection (a)).
            (2) Grievance rights.--A post graduate trainee or physician 
        resident may file a complaint with the Secretary of Health and 
        Human Services concerning a violation of such requirements. 
        Such a complaint may be filed anonymously. The Secretary may 
        conduct an investigation and take such corrective action with 
        respect to such a violation.
            (3) Civil money penalty enforcement.--Any hospital that 
        violates such requirement is subject to a civil money penalty 
        not to exceed $100,000 for each resident training program in 
        any 6-month period. The provisions of section 1128A of the 
        Social Security Act (other than subsections (a) and (b)) shall 
        apply to civil money penalties under this paragraph in the same 
        manner as they apply to a penalty or proceeding under section 
        1128A(a) of such Act.
            (4) Disclosure of violations and annual reports.--The 
        individual designated under paragraph (1) shall--
                    (A) provide for annual anonymous surveys of 
                postgraduate trainees to determine compliance with such 
                requirements and for the disclosure of the results of 
                such surveys to the public on a residency-program 
                specific basis;
                    (B) based on such surveys, conduct appropriate on-
                site investigations;
                    (C) provide for disclosure to the public of 
                violations and compliance, on a hospital and residence-
                program specific basis, of such requirements; and
                    (D) make an annual report to Congress on the 
                compliance of hospitals with such requirements, 
                including providing a list of hospitals found to be in 
                violation of such requirements.
    (c) Whistleblower Protections.--
            (1) In general.--A hospital covered by the requirements of 
        section 1866(j)(1) of the Social Security Act (as inserted by 
        subsection (a)) shall not penalize, discriminate, or retaliate 
        in any manner against an employee with respect to compensation, 
        terms, conditions or privileges of employment, who in good 
        faith (as defined in paragraph (2)), individually or in 
        conjunction with another person or persons--
                    (A) reports a violation or suspected violation of 
                such requirements to a public regulatory agency, a 
                private accreditation body, or management personnel of 
                the hospital;
                    (B) initiates, cooperates or otherwise participates 
                in an investigation or proceeding brought by a 
                regulatory agency or private accreditation body 
                concerning matters covered by such requirements;
                    (C) informs or discusses with other employees, with 
                a representative of the employees, with patients or 
                patient representatives, or with the public, violations 
                or suspected violations of such requirements; or
                    (D) otherwise avails himself or herself of the 
                rights set forth in such section or this subsection.
            (2) Good faith defined.--For purposes of this subsection, 
        an employee is deemed to act ``in good faith'' if the employee 
        reasonably believes--
                    (A) that the information reported or disclosed is 
                true; and
                    (B) that a violation has occurred or may occur.
    (d) Effective Date.--The amendments made by subsection (a) shall 
take effect on the first July 1 that begins at least 1 year after the 
date of the enactment of this Act.

SEC. 4. ADDITIONAL FUNDING FOR HOSPITAL COSTS.

    There are hereby appropriated to the Secretary of Health and Human 
Services such amounts as may be required to provide for additional 
payments to hospitals for their reasonable additional, incremental 
costs incurred in order to comply with the requirements imposed by this 
Act (and the amendments made by this Act).
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