Local Hospitals Respond
In a story that was reported on earlier, 54 "teaching hospitals" have been inspected by the New York State Department of Health since November of 2001, and all (which include two local hospitals - St. John's Episcopal Hospital South Shore and Peninsula Hospital Center) have been cited for violations related to resident working hours. Teaching hospitals are licensed by the state and allow residents and interns to participate in the learning process of becoming a doctor.
"New York is the only State in the nation that limits resident work hours and ensures that residents have adequate rest. The Governor has made it clear that hospitals need to comply with resident working hours, and he has provided us with the resources to inspect and the tools to fine hospitals that are not complying with regulations," said Antonia C. Novello, New York State Health Commissioner.
To ensure that resident working hour regulations were being followed at State teaching hospitals, the Governor included funding in the Health Care Reform Act of 2000 (HCRA 2000) to support inspections that focus on resident working hours. The Island Peer Review Organization (IPRO), in conjunction with the Department of Health, conducted the current surveillance initiative.
As part of their surveillance, IPRO inspectors conducted interviews with residents and other appropriate hospital staff; observed resident working conditions; and reviewed both medical records and operating room logs to determine if each of the hospitals were complying. IPRO also investigates complaints regarding resident working hours; conducts revisits where appropriate; and is continuing its efforts to conduct annual focus surveys at New York's 115 teaching hospitals. IPRO is under contract with New York State through September 2004.
St. John's Episcopal Hospital South Shore was cited for allowing residents to work their regular tour, and then allowing them to work a second unscheduled tour. In addition, the hospital was charged with violating the guideline that allowed trainees to have a 24-hour off period following their tour.
Peninsula Hospital Center was cited for allowing 6 of 18 trainees in Surgery, including surgical rotations by general surgery, orthopedic surgery, and dental residents to work over 24 consecutive hours.
In letters sent to the President and CEO of St. John's Episcopal Hospital (Luis Hernandez) and Peninsula Hospital Center (Robert Levine), Frederick J. Heigel (Director of the Bureau of Hospital & Primary Care Services) stated the following.
"A Hospital Compliance Review of Working Hours and Working Conditions of Post Graduate Trainees was conducted in your hospital on the above referenced dates (2/20-2/21/02). The reviews consisted of interviews with all post-graduate trainees in family practice/medicine, and surgery."
The letter goes on to say, "The findings and documentation obtained were reviewed by the Department of Health Bureau of Hospital and Primary Care Services. The results of this review are non-compliant with regulations, which restrict the working hours of residents, as noted on the enclosed Statement of Deficiencies. A plan of correction addressing these deficiencies must be submitted to this office within 30 working days, no later than May 7, 2002."
In their defense, SJEH issued the following statement.
"St. John's Episcopal Hospital underwent an annual compliance review from the State Health Department regarding compliance with the residency working hours. The hospital was cited in two areas. The citation required corrective action regarding the restriction on dual employment in order to limit or prohibit moonlighting. Moreover, the hospital's policy was revised to include the requirement that all trainees have a 24-hour off period following a call of duty. It is noteworthy that there were no violations for the 80-hour work week limit for residents, nor for requiring hours off between scheduled work assignments."
The hospital continued by saying that a plan of correction was submitted to the Department of Health and has been accepted.
"St. John's found the experience to be quite educational and productive and will be beneficial in helping us to further our goal of achieving excellence in patient care and the post-graduate training of physicians," the letter concluded.
Peninsula Hospital Center responded to the charges by issuing a statement as well. According to hospital administrators, The Department of Health found the Peninsula Hospital Center Plan of Correction to be acceptable in response to the IPRO Survey Non-Compliance Notice.
"As reported in the Wave's July 6 edition â018Local Hospitals Cited for Violations', the IPRO survey team found a small, minor violation: a chief resident adjusted the schedule of a junior resident causing him to work on-call within 48 hours, rather than the regulation 72 hours. All facilities, regardless of the number of infractions or severity (type) of findings receive the same notice from the DOH indicating non-compliance with regulations," noted Stuart B. Almer, Vice President, Operations at PHC.
"Peninsula Hospital Center was commended by the IPRO survey team for meeting all of the standards of the New York Department of Health in the area of regulating resident working hours, and indicated that it would be highly unlikely that any findings would result in a violation, in light of a positive review over a six month period," added Almer.
Gerald Teplitz, D.O., Director of Medical Education, stated that "they (the IPRO inspection team) were so impressed by this institution, the surveyors even requested one of our documents to present to all other institutions in the state as a standard. Their statement to us was that â018this was one of the finest examinations of all institutions this team had surveyed'"
The Department of Health may impose a maximum fine of $6,000 per violation against hospitals cited for resident working hour violations.