by Terry O'Neal-Cox MD

Created on: March 31, 2009   Last Updated: April 03, 2009

What Happens after 80 Hours?

There has been significant debate about the number of hours a doctor in training (Resident) should be allowed to work without a period of rest. The debate started after the unfortunate death Libby Zion which, after legal battles, resulted in the passage of the Libby Zion law. The law states that Residents cannot work more than 80 hours per week or more than 24 continuous hours without a mandatory rest period. The law was first applicable to New York (NY) State, and subsequently adopted by the Accreditation Council on Graduate Medical Education (ACGME) and applied throughout the Country.

Libby Zion was the 18 year-old daughter of a NY couple (the father was a lawyer and a New York journalist) who died less than 24 hours after being admitted to a NYC hospital, through the ER. Respectfully and sympathetically the death of this young lady should not be, and will not be, dissected here, but the circumstances surrounding her death warrants mentioning. Ms. Zion, reportedly, had a pre-admission history of a medical condition that resulted in the need for a prescribed drug. She presented to the ER with symptoms that included fever and agitation; symptoms of the prescribed drug if taken in overdose. She was admitted to the hospital for observation and treatment. Without a definitive diagnosis, she was treated with drugs that potentiated reactions that may have contributed to her death. In the trial that followed, it was discovered that the residents involved had been on duty for hours considered to be too long. The residents were found guilty of negligence, but subsequently cleared of the responsibility after disagreements by several investigating bodies. MS. Zion, herself, was also blamed for taking prescription and other drugs, with potentiating effects, that were not reported to the doctors during evaluation and management. The attending physician did not see the patient. It is obvious that there is enough blame to go around here. Extended hours, while a possible contributing factor at worst, in my opinion, is the least likely cause.

New doctors are trained in hospitals in a setting that is designed to minimize unfavorable events. There are directors, chiefs of departments, attending (licensed practicing) physicians, chief residents, senior and junior residents, and finally interns. The capability, experience, and proficiency of every doctor in training is (should be) known by his/her superior in all well run programs, and even the not so

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