[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 2614 Introduced in Senate (IS)]
107th CONGRESS
2d Session
S. 2614
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
June 12, 2002
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 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).
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