[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 952 Introduced in Senate (IS)]






108th CONGRESS
  1st Session
                                 S. 952

  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 SENATE OF THE UNITED STATES

                             April 30, 2003

  Mr. Corzine introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 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 the medicare program, 
        pays approximately $8,000,000,000 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 as much as 30 to 40 percent 
        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) The Federal Government has regulated the work hours of 
        other industries when the safety of employees or the public is 
        at risk.
            (8) The Institute of Medicine has found that as many as 
        98,000 deaths occur annually due to medical errors and has 
        suggested that 1 necessary approach to reducing errors in 
        hospitals is reducing the fatigue of resident-physicians.

SEC. 3. REVISION OF MEDICARE HOSPITAL CONDITIONS OF PARTICIPATION 
              REGARDING WORKING HOURS OF MEDICAL RESIDENTS, INTERNS, 
              AND FELLOWS.

    (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 
        postgraduate trainees (as defined in subsection (j)(4)), 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 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 
postgraduate trainees:
            ``(i) Subject to subparagraphs (B) and (C), postgraduate 
        trainees may work no more than a total of 24 hours per shift.
            ``(ii) Subject to subparagraph (C), postgraduate trainees 
        may work no more than a total of 80 hours per week.
            ``(iii) 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 1 full weekend off per month;
                    ``(III) subject to subparagraph (B), who are 
                assigned to patient care responsibilities in an 
                emergency department shall work no more than 12 
                continuous hours in that department;
                    ``(IV) shall not be scheduled to be on call in the 
                hospital more often than every third night; and
                    ``(V) shall not engage in work outside of the 
                educational program that interferes with the ability of 
                the postgraduate trainee to achieve the goals and 
                objectives of the program or that, in combination with 
                the program working hours, exceeds 80 hours per week.
    ``(B)(i) Subject to clause (ii), 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 1 
postgraduate trainee to another at the end of each shift.
    ``(ii) Such regulations shall ensure that, except in the case of 
individual patient emergencies, the period in which a postgraduate 
trainee is providing for the transfer of direct patient care (as 
referred to in clause (i)) does not extend such trainee's shift by more 
than 3 hours beyond the 24-hour period referred to in subparagraph 
(A)(i) or the 12-hour period referred to in subparagraph (A)(iii)(III), 
as the case may be.
    ``(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' means a postgraduate medical resident, intern, or fellow.''.
    (b) Designation.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this subsection referred to as the ``Secretary'') shall 
        designate an individual within the Department of Health and 
        Human Services to handle all complaints of violations that 
        arise from a postgraduate trainee (as defined in paragraph (4) 
        of section 1886(j) of the Social Security Act, as added by 
        subsection (a)) who reports that the hospital operating the 
        medical residency training program for which the trainee is 
        enrolled is in violation of the requirements of such section.
            (2) Grievance rights.--A postgraduate trainee may file a 
        complaint with the Secretary concerning a violation of the 
        requirements under such section 1886(j). 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) Enforcement.--
                    (A) Civil money penalty enforcement.--Subject to 
                subparagraph (B), any hospital that violates the 
                requirements under such section 1886(j) is subject to a 
                civil money penalty not to exceed $100,000 for each 
                medical residency training program operated by the 
                hospital 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.
                    (B) Corrective action plan.--The Secretary shall 
                establish procedures for providing a hospital that is 
                subject to a civil monetary penalty under subparagraph 
                (A) with an opportunity to avoid such penalty by 
                submitting an appropriate corrective action plan to the 
                Secretary.
            (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 the 
                requirements under such section 1886(j) and for the 
                disclosure of the results of such surveys to the public 
                on a medical residency training program specific basis;
                    (B) based on such surveys, conduct appropriate on-
                site investigations;
                    (C) provide for disclosure to the public of 
                violations of and compliance with, on a hospital and 
                medical residency training program specific basis, 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) of the Social Security Act, as added 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 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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