[Congressional Record Volume 148, Number 77 (Wednesday, June 12, 2002)]
[Senate]
[Pages S5456-S5457]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CORZINE:
  S. 2614. 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; to the Committee on Finance.
  Mr. CORZINE. Mr. President, I rise today to introduce legislation, 
the Patient and Physician Safety and Protection Act of 2002, to limit 
medical resident work hours to 80 hours a week and to provide real 
protections for patients and resident physicians who are negatively 
affected by excessive work hours. This is a companion bill to 
legislation introduced in the House of Representatives by 
Representative John Conyers.
  It is very troubling that hospitals across the Nation are requiring 
young doctors to work 36 hour shifts and as many as 120 hours a week in 
order to complete their residency programs. These long hours lead to a 
deterioration of cognitive function similar to the effects of blood 
alcohol levels of 0.1 percent. This is a level of cognitive impairment 
that would make these doctors unsafe to drive, yet these physicians are 
not only allowed but in fact are required to care for patients and 
perform procedures on patients under these conditions.
  While the medical community has been aware of this problem for many 
years, the issue has largely been pushed under the rug. Only recently 
has the medical community taken a more serious look at the problem. In 
the last couple of months, my office has worked with the Association of 
American Medical Colleges and teaching hospitals in New Jersey and New 
York to address this problem and to try to find a workable solution.
  As a result of these efforts and increased public pressure on the 
medical community to address this quality of care and labor issue, the 
Accreditation Council for Graduate Medical Education, ACGME, announced 
today new work hour recommendations. This is an important first step. 
But while some of their recommendations are commendable, they would 
still require residents to work in excess of 80 hours a week and 30-
hour shifts. I look forward to working with the Council to adapt strong 
standards that are not only recommendations, but are enforceable 
requirements that truly protect patients and residents.
  Today, I am introducing legislation that not only recognizes the 
problem of excessive work hours, but also creates strong enforcement 
mechanisms. The bill also provides funding support to teaching 
hospitals to implement new work hour standards. Without enforcement and 
financial support, efforts to reduce work hours are not likely to be 
successful.
  Let me again emphasize that the Patient and Physician Safety and 
Protection Act of 2002 will limit medical resident work hours to 80 
hours a week. Not 40 hours or 60 hours. 80 hours a week. It is hard to 
argue that this standard is excessively strict. In fact, it is 
unconscionable that we now have resident physicians, or any physicians 
for that matter, caring for very sick patients 120 hours a week and 36 
hours straight with fewer than 10 hours between shifts. This is an 
outrageous violation of a patient's right to quality care. And, for 
many patients, it is literally a matter of life and death.
  In addition to limiting work hours to 80 hours week, my bill limits 
the length of any one shift to 24 consecutive hours and limits the 
length of an emergency room shift to 12 hours. The bill also ensures 
that residents have at least one out of seven days off and ``on-call'' 
shifts no more often than every third night.
  Finally, my legislation provides meaningful enforcement mechanisms 
that will protect the identity of resident physicians who file 
complaints about work hour violations. The guidelines that the ACGME 
released today do not contain any whistleblower protections for 
residents that seek to report program violations. Without this 
important protection, residents will be reluctant to report these 
violations, which in turn will weaken enforcement.
  My legislation also makes compliance with these work hour 
requirements a condition of Medicare participation. Each year, Congress 
provides $8 billion to teaching hospitals to train new physicians. 
While Congress must continue to vigorously support adequate funding so 
that teaching hospitals are able to carryout this important public 
service, these hospitals must also make a commitment to ensuring safe 
work conditions for these physicians and providing the highest quality 
of care to the patients they treat.
  In closing I would like to read a quote from an Orthopedic Surgery

[[Page S5457]]

Resident from Northern California, which I think illustrates why we 
need this legislation:

       I was operating post-call after being up for over 36 hours 
     and was holding retractors. I literally fell asleep standing 
     up and nearly face-planted into the wound. My upper arm hit 
     the side of the gurney, and I caught myself before I fell to 
     the floor. I nearly put my face in the open wound, which 
     would have contaminated the entire field and could have 
     resulted in an infection for the patient.

  This is a very serious problem that must be addressed before medical 
errors like this occur. I hope every member of the Senate will consider 
this legislation and the potential it has to reduce medical errors, 
improve patient care, and create a safer working environment for the 
backbone of our Nation's healthcare system.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2614

       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 2002''.

     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 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 1 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 1 
     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 postgraduate 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 of 
     and compliance with, on a hospital and residence-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)(1) 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).
                                 ______