St. Vincent's Hospital and Medical Center Fined for Violating Resident Work Hours
Albany, December 30, 1998 – The State Health Department today announced that it has fined St. Vincent's Hospital and Medical Center, in Manhattan, $20,000 –– the maximum amount authorized by law –– for allowing physicians in residency training to work hours that far exceed the limits set by the State Health Department as a protection for patients.
To protect patients from medical errors due to sleep–deprived and overworked physicians, the New York State Hospital Code limits the working hours of physicians in hospital residency training programs to no more than 80 hours per week over a four week period and no more than 24 consecutive hours. Close supervision of medical residents by attending physicians also is mandated. Hospitals in New York State have been put on notice that full–compliance with these important quality of care standards is required and that sanctions will be imposed for violations.
St. Vincent's has taken action to address a number of deficiencies cited by the Department of Health and has expressed a commitment to fully resolve any outstanding concerns. The Medical Center must submit a Plan of Correction to the Department that incorporates previous corrective actions and identifies additional steps that will be taken to prevent a recurrence of the violations cited.
Working hour violations identified at St. Vincent's by Health Department inspectors during a Sept. 27, 1998 survey, include the following:
- All of the hospitals 20 surgical residents were working in excess of 85 hours per week;
- All 20 surgical residents worked 30 to 36 hours straight in violation of the 24–hour maximum shift rule;
- Residents "on call" during night shift hours are not generally resting due to frequent interruptions for patient care responsibilities;
- Continuous assignments for residents that include night shift "on call" duty are not followed by a required non–working period;
- In 12 of the 25 medical records reviewed, documentation of oversight of residents by the senior resident or supervising attending physician was not evident;
- The hospital failed to appropriately limit the duties of medical students –– medical record entries were not countersigned within 24 hours and medical students were permitted to write medical orders, including orders for controlled substances;
- Seven of nine medical records reviewed did not contain documentation to indicate that telephone orders for the administration of drugs were personally authenticated by the prescribing doctor.
Earlier this year the State Health Department issued a report, based on a survey of 12 teaching hospitals, showing widespread abuse of resident working hour limits, particularly among surgical residents in New York City. This report represents a continuation of unannounced inspections of all teaching hospitals to improve compliance with the residency regulations.