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November 8, 2006... “If the medical profession can’t regulate itself, and it seems that they can’t, government will have to step in to protect patients and the health professionals themselves,” a key Massachusetts state legislator told participants attending the 134th Annual Conference of the American Public Health Association (APHA) meeting at the Massachusetts Convention Center in Boston this week. 

Senator Richard T. Moore, the Senate Chairman of the Massachusetts Legislature’s Committee on Health Care Financing and a recognized legislative expert in patient safety, made the comment following presentations by fellow panelists who explained that despite national standards for physician work hours, few physicians in training or supervising hospitals followed recommended limits on work schedules. Senator Moore was a speaker on a panel presentation entitled: “Re-evaluating Current Hospital Work Hour Limits: What are Safe Hours for Physicians, Nurses – and the Public?”

Senator Moore’s call for increased regulation followed a presentation about a recently published study in the Journal of the American Medical Association (September 6, 2006) by Landrigan, Barger, Cade and Ayas. The study demonstrated that 84% of interns reported work hours in violation of the standards established by the Accreditation Council for Graduate Medical Education. Those standards set limits for residents at 80 hours per week.

“The study,” Senator Moore explained, “demonstrates that pressures from employers, supervising physicians, and the health care system make it unlikely that voluntary compliance with even these most generous standards can be achieved without the force of law or regulation.” “I am convinced,” Moore explained, “that physicians, nurses and direct care health workers must conform to limits of hours worked and time off, just as we expect airline pilots, truck drivers and others to do to avoid sleep impairment.”

According to Dr. Christopher Landrigan of Brigham and Women’s Hospital and Harvard Medical School, research indicates that the current long hours required for physicians in training here, and throughout the United States, result in twice the likelihood of causing medical mistakes injuring patients and nearly twice the likelihood that the physician, himself, will be in an auto accident at the end of the shift.

The presentations during the panel discussion included: the science of circadian rhythms and sleep deprivation and their effects on human performance; current evidence regarding the adverse effects of 24-hour work shifts on provider and patient safety; research that registered nurse shifts of 12 hours or longer nearly triple the risk of making errors and create difficulties remaining alert on duty and driving home; a resident's perspective on making medical assessments and decisions, dealing with patients, families, and co-workers, learning, studying, doing sign-outs and handovers, and then driving home – all while acutely and chronically sleep deprived; and fatigue as a significant public health hazard and describes his proposed state legislation to regulate resident work hours. Errors and fatigue-related accidents are a problem commonly identified in other industries, and the panel asked the question: “Are doctors and nurses and their work so different?”

Joining Senator Moore on the panel were: Dr. Landrigan, lead author of the study on physician work hours; Dr. Charles Czeisler, Professor in the Division of Sleep Medicine at Harvard Medical School, Dr. Ann Rogers, Ph.D., RN, Associate Professor of Nursing at the University of Pennsylvania an expert on nursing work hours; Dr. Simon Ahtaridis, a resident at Cambridge Health Alliance and President of the Resident Physicians Association.

Senator Moore’s legislation to develop limits on physician work hours was recently approved in the Massachusetts Senate and, currently, is under review by the House Committee on Ways and Means. His bill, Senate Bill No. 1263 would establish an advisory committee in the Massachusetts Department of Public Health to develop work hour limits for physicians training in Massachusetts hospitals. Although the legislative session is winding down, Senator Moore is hopeful that the House of Representatives might act favorably on this important bill.

The APHA Annual Meeting is the premier national platform for health care leaders and professionals to share successes and failures, discover exceptional best practices and learn from expert colleagues and the latest research in the field. 

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