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Nov. 3, 2011  

OSHA Should Use Its Existing Authority to Enforce Work Hours for Doctors-in-Training, Public Citizen Tells Agency

Agency Must Inspect Hospitals to Protect Physicians and Patients

WASHINGTON, D.C. – Although it has now rejected two requests to regulate the number of hours that medical residents work, the Occupational Safety and Health Administration (OSHA) should use its existing authority to limit resident hours, thereby better protecting patients and doctors, Public Citizen told the agency today.

OSHA is tasked with enforcing safety and health legislation. Under a “general duty clause” of the law that created the agency, employers are required to provide a workplace that is free from hazards that are likely to harm to employees. This language gives OSHA the authority to limit the number of hours that medical residents work to prevent physician fatigue and medical errors, Public Citizen said in a letter to the agency.

Public Citizen and other groups have petitioned OSHA twice to create a standard to regulate medical resident hours – in 2001 and 2010 – but recently learned that the Obama administration rejected last year’s petition. Now, Public Citizen is calling on OSHA not only to enforce existing work-hour limits through the agency’s general duty clause but also to protect medical residents who blow the whistle on work-hour abuses.

“It’s regrettable that the Obama administration has decided to follow the lead of the Bush administration, refusing to enact a standard that would protect 110,000 resident physicians,” said Dr. Sammy Almashat, researcher with Public Citizen’s Health Research Group and co-author of the letter.“In the absence of a standard, which it has now twice refused to enact, OSHA must exercise its existing authority under the general duty clause to hold accountable teaching hospitals that violate the health and safety of their residents.”

In justifying its denial of the petition, the Obama administration reproduced the same discredited arguments that the Bush administration used nine years ago in rejecting the first petition, Public Citizen observed. In his Sept. 14 denial letter, OSHA chief David Michaels admitted that fatigue due to extended work hours can harm the health of employees in a wide range of fields, including medical interns and residents. But because medical residents also are considered students, OSHA declined to take them under its purview, leaving regulation of their hours to the Accreditation Council for Graduate Medical Education (ACGME), a private organization that oversees training programs for resident physicians. Compliance with the ACGME’s standards historically has been poor.

Under pressure to update its rules, the ACGME released new guidelines in June 2010 to regulate the number of hours that medical residents work. These guidelines limit the number of hours for medical interns – first-year residents – to 16 continuous hours, but inexplicably allow upper-level residents to work up to 28 hours straight. The guidelines also continue to allow residents to average 80-hour workweeks over the course of a month, which would enable physicians-in-training to work as many as 100 hours in one week and place both patients and themselves in harm’s way.

In its letter, Public Citizen pointed out that the new guidelines are inconsistent with years of evidence on the dangers of resident fatigue, and that the ACGME has been consistently ineffective in enforcing its own standards.

“It is unacceptable that the Obama administration has opted out of its legal obligation to protect residents from excessive work hours, deferring instead to a largely unaccountable private entity, the ACGME,” said Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group. “The OSH Act never mentions excluding from its jurisdiction workers who receive some sort of educational benefit in the course of their work. Additionally, the National Labor Relations Board has asserted that resident physicians are primarily employees, not students. As such, they should be protected by OSHA.”

To read all relevant documents, visit: http://www.citizen.org/response-to-osha-denial-of-resident-work-hours-petition-110311.

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