MA State Work Hours Bill Clears First Hurdle In The Legislature

MA State Work Hours Bill Clears First Hurdle In The Legislature

December 2007

CIR leaders Mike Mazzini, MD, of Boston Medical Center and Erica Wilson, MD of Cambridge Hospital give testimony at the Massachusetts State Capitol.

Safe Work Hours for Physicians in Training and Protection of Patients (S.1247) jumped its first hurdle in the Massachusetts legislature when it was voted out of the Joint Committee on Public Health in late October.

At a hearing on October 10, 2007, Dr. Christopher Landrigan, Director of Sleep and Patient Safety at Brigham & Women’s Hospital declared the Accreditation Council on Graduate Medical Education’s current hours limits “unsafe,” pointing out that “24-30 hour shifts exceed those established in other safety sensitive industries on the basis of the best available scientific evidence.”

The ACGME’s enforcement mechanisms were also criticized. “The only penalties…are to put a residency program on probation--or worse, take away accreditation,” testified Dr. Erica Wilson, CIR member from Cambridge Hospital. “That penalty only hurts residents – there is simply no advantage to reporting violations – in fact, it’s quite the opposite.”

Hospital opposition came from the Council of Boston Teaching Hospitals and the Partners Healthcare VP for Graduate Medical Education, who told the committee that the ACGME was the proper venue for hours reform. But their arguments appeared to have little traction with the committee.

“We’ve heard data today that medical errors are increased with these long hours,” said Rep. Alice Wolf. “We’ve also heard today that there is a conflict between truthful reporting when the punitive action seems to be in conflict. These young people are at risk when they drive home and patients are at risk. This is a system that could use more oversight.”

S.1247 authorizes the Department of Public Health to begin the process of regulating work hours for the Commonwealth’s 4,000 resident physicians by forming an advisory committee to represent the stakeholders. Committee recommendations will assist DPH in establishing an evidence-based standard for resident work hours that promotes patient and resident physician safety.

CIR is confident that the bill, now before the Health Care Finance Committee, will be amended to remove language which labeled residents who work in violation of work hours as “mistreatment of patients.” In his testimony on October 10, CIR’s BMC Co-Pres. Mike Mazzini, MD, Cardiology Fellow, told the Committee that, “We do believe there should be some teeth in S. 1247, but the penalty should be placed directly on the hospitals which schedule the hours, not the residents who are scheduled to work them.”