Gov. Cuomo’s budget plan scraps rigorous state audits of hospitals that help make sure resident doctor-interns aren’t severely overworked and exhausted on the job — and critics worry that could imperil patient safety.
The audits — conducted by an independent contractor hired by the state — enforce the Libby Zion Law, named after the 18-year-old daughter of the late New York Times writer Sydney Zion, who died from botched care at a Manhattan hospital in 1984.
The law requires that doctor-interns at 100 teaching hospitals work no more than 80 hours per week, or 24 consecutive hours — and facilities hit with violations get slapped with financial penalties.
But Cuomo’s $68 billion spending plan would eliminate the audits — considered the nation’s most stringent because the law allows for surprise inspections and reviews of payroll data.
Hospital officials instead would be allowed to make an “attestation” — to self-certify that they are abiding by the working hour requirements, a budget memo explaining the change says.
Elimination of the audits “does not prohibit” the state from performing “targeted investigations” of hospitals if needed, officials said. But the head-scratching move set off alarm bells among patient safety advocates.
One lawmaker said the proposal — which would save $1.1 million — is a gift to the politically influential hospital industry, plain and simple.
“The hospital industry has never liked the Health Department looking over their shoulder,” said Assembly Health Committee Chairman Richard Gottfried, who is fighting to get the audit funds restored.
“You wouldn’t want doctors working on patients who can’t stand up and think, let alone perform medical tasks,” he said.
The Committee of Interns and Residents, the union representing the doctor-trainees, also opposed the move as anti-worker and anti-patient safety.“Neither patients nor physicians benefit from having residents work over 80 hours per week, or more than 24 consecutive hours,” said CIR president Eve Kellner. “Representatives should fully enforce our state’s accountability structures to make sure that there are no more violations of these common sense regulations that protect both physicians and patients.”
The most recent report of audits found the rate of violations of the working rules at New York’s medical teaching hospitals ranged from 13 percent to 25 percent, with the largest hospitals with the most medical interns having the highest rate violations, according to analysis of data by CIR. A breakdown by hospital was not immediately available.
The Cuomo administration defended the proposal.
“The audit requirement is duplicative to the process already in place nation-wide, including in New York, which ensures hospitals comply with mandatory limitations on residents’ work hours. The proposal would not change those limits on working hours,” said Health Department spokesman Jonah Bruno.
He repeated that department reserves the right to launched targeted inspections “if necessary.”
As expected, the lobbying group representing New York City’s hospitals applauded the change.
“New York’s hospitals are deeply committed to complying with resident work hour rules, but the State’s on-site oversight program is disruptive to teaching hospital staff and accomplishes no useful purpose,” said Brian Conway, spokesman for Greater New York Hospital Association.
He, too, said that several independent organizations “already closely monitor” resident work hour, including the Accreditation Council for Graduate Medical Education (ACGME).
But Kellner of ICR said ACGME relies largely on a “voluntary enforcement” program of pre-announced visits and surveys, not sweeping audits or inspections
The state auditing program is far more extensive and effective, she said.
