For more than four decades, Ebola virus had only been diagnosed in central or eastern Africa.
Then late this past March, the first cases of Ebola began appearing in a surprising part of the continent. The Ministry of Health in Guinea notified WHO of a rapidly evolving outbreak of Ebola virus disease. The outbreak in Guinea was the first sign the virus had made the jump across the continent.
Ebola then spread quickly to Sierra Leone and Liberia, and then to Nigeria.
As the world learned of the cases, CDC began receiving questions from American hospital labs. They were looking for guidance on how to handle testing for patients who had recently returned to the U.S. from West Africa with potential Ebola symptoms.
If U.S. hospitals were to run laboratory tests on these patients, how could they be sure their staff could safely handle materials that might contain this dangerous virus? Did they need the kind of personal protective equipment they saw CDC scientists using when they were testing for Ebola?
Last year, Public Citizen and other groups filed a petition – the second in 10 years – calling on the Occupational Safety and Health Administration (OSHA) to take over responsibility for enforcing medical resident work hours from the Accreditation Council for Graduate Medical Education (ACGME). This past September, the Obama administration denied our groups’ petition on the grounds that the ACGME is the appropriate entity to handle the issue, an identical argument to one put forward by the Bush administration nine years earlier to justify the denial of our first petition.
Both petitions were filed as a result of the long-standing failure of the ACGME to adequately protect residents from the proven deleterious effects of long work hours. Six years after the ACGME implemented the first limits on resident work hours in 2003, the Institute of Medicine (IOM) concluded an exhaustive 12-month review examining the existing system of medical training and the evidence regarding fatigue, resident physicians, and patient safety. The IOM concluded that the 2003 ACGME rules were not adequately protective and that major changes were needed, including a limit of 16 hours in a row for all resident work shifts.
In response, the ACGME updated its guidelines in 2010, but unfortunately, the new rules failed to incorporate the majority of the IOM’s recommendations. The rules limited medical interns ― first-year residents ― to 16-hour shifts but inexplicably allowed all other residents to continue to work up to 28 hours straight. There is no biological rationale to support the notion that residents suddenly become able to withstand the adverse effects of extended shifts upon completing their first year of residency. In addition, the new rules, in permitting averaging over several weeks to achieve the 80-hour weekly limit, continued the practice of allowing residents to work 100 or more hours in certain weeks.
On September 2, Assistant Secretary David Michaels for Occupational Safety and Health received a petition requesting that OSHA regulateresidentphysician and subspecialty resident physicians. “Depending on the type of residency, physicians-in-training can work anywhere from 60 to 100 or more hours a week, sometimes without a day off for two weeks or more.” The petition requests that OSHA exercise the authority granted under §3(8) of the Occupational Safety and Health Act to implement the following federal work-hour standard:
(1) A limit of 80 hours of work in each and every week, without averaging;
(2) A limit of 16 consecutive hours worked in one shift for all resident physicians and subspecialty resident physicians;
(3) At least one 24-hour period of time off work per week and one 48-hour period of time off work per month for a total of five days off work per month, without averaging;
(4) In-hospital on-call frequency no more than once every three nights, no averaging;
(5) A minimum of at least 10 hours off work after a day shift, and a minimum of 12 hours off after a night shift;
(6) A maximum of four consecutive night shifts with a minimum of 48 hours off after a sequence of three or four night shifts.