II 

109TH CONGRESS 

1ST SESSION S. 1297 

To amend title XVIII of the Social Security Act to reduce the work hours 

and increase the supervision of resident-physicians to ensure the safety 

of patients and resident-physicians themselves. 

IN THE SENATE OF THE UNITED STATES 

JUNE 23, 2005 

Mr. CORZINE (for himself, Mr. BINGAMAN, and Ms. LANDRIEU) introduced 

the following bill; which was read twice and referred to the Committee 

on Finance 

A BILL

To amend title XVIII of the Social Security Act to reduce 

the work hours and increase the supervision of residentphysicians to ensure the safety of patients and residentphysicians themselves.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Patient and Physician 

5 Safety and Protection Act of 2005’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 
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1 (1) The Federal Government, through the medi2 care program, pays approximately $8,000,000,000 

3 per year solely to train resident-physicians in the 

4 United States, and as a result, has an interest in as5 suring the safety of patients treated by resident-phy6 sicians and the safety of resident-physicians them7 selves. 

8 (2) Resident-physicians spend as much as 30 to 

9 40 percent of their time performing activities not re10 lated to the educational mission of training com11 petent physicians. 

12 (3) The excessive numbers of hours worked by 

13 resident-physicians is inherently dangerous for pa14 tient care and for the lives of resident-physicians. 

15 (4) The scientific literature has consistently 

16 demonstrated that the sleep deprivation of the mag17 nitude seen in residency training programs leads to 

18 cognitive impairment. 

19 (5) A substantial body of research indicates 

20 that excessive hours worked by resident-physicians 

21 lead to higher rates of medical error, motor vehicle 

22 accidents, depression, and pregnancy complications. 

23 (6) The medical community has not adequately 

24 addressed the issue of excessive resident-physician 

25 work hours. 
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1 (7) The Federal Government has regulated the 

2 work hours of other industries when the safety of 

3 employees or the public is at risk. 

4 (8) The Institute of Medicine has found that as 

5 many as 98,000 deaths occur annually due to med6 ical errors and has suggested that 1 necessary ap7 proach to reducing errors in hospitals is reducing 

8 the fatigue of resident-physicians. 

9 SEC. 3. REVISION OF MEDICARE HOSPITAL CONDITIONS OF 

10 PARTICIPATION REGARDING WORKING 

11 HOURS OF MEDICAL RESIDENTS, INTERNS, 

12 AND FELLOWS. 

13 (a) IN GENERAL.—Section 1866 of the Social Secu14 rity Act (42 U.S.C. 1395cc) is amended— 

15 (1) in subsection (a)(1)— 

16 (A) by striking ‘‘and’’ at the end of sub17 paragraph (U); 

18 (B) by striking the period at the end of 

19 subparagraph (V) and inserting ‘‘, and’’; and 

20 (C) by inserting after subparagraph (V) 

21 the following new subparagraph: 

22 ‘‘(W) in the case of a hospital that uses the 

23 services of postgraduate trainees (as defined in sub24 section (k)(4)), to meet the requirements of sub25 section (k).’’; and 
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1 (2) by adding at the end the following new sub2 section: 

3 ‘‘(k)(1)(A) In order that the working conditions and 

4 working hours of postgraduate trainees promote the provi5 sion of quality medical care in hospitals, as a condition 

6 of participation under this title, each hospital shall estab7 lish the following limits on working hours for postgraduate 

8 trainees: 

9 ‘‘(i) Subject to subparagraphs (B) and (C), 

10 postgraduate trainees may work no more than a 

11 total of 24 hours per shift. 

12 ‘‘(ii) Subject to subparagraph (C), postgraduate 

13 trainees may work no more than a total of 80 hours 

14 per week. 

15 ‘‘(iii) Subject to subparagraph (C), post16 graduate trainees— 

17 ‘‘(I) shall have at least 10 hours between 

18 scheduled shifts; 

19 ‘‘(II) shall have at least 1 full day out of 

20 every 7 days off and 1 full weekend off per 

21 month; 

22 ‘‘(III) subject to subparagraph (B), who 

23 are assigned to patient care responsibilities in 

24 an emergency department shall work no more 

25 than 12 continuous hours in that department; 
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1 ‘‘(IV) shall not be scheduled to be on call 

2 in the hospital more often than every third 

3 night; and 

4 ‘‘(V) shall not engage in work outside of 

5 the educational program that interferes with 

6 the ability of the postgraduate trainee to 

7 achieve the goals and objectives of the program 

8 or that, in combination with the program work9 ing hours, exceeds 80 hours per week. 

10 ‘‘(B)(i) Subject to clause (ii), the Secretary shall pro11 mulgate such regulations as may be necessary to ensure 

12 quality of care is maintained during the transfer of direct 

13 patient care from 1 postgraduate trainee to another at the 

14 end of each shift. 

15 ‘‘(ii) Such regulations shall ensure that, except in the 

16 case of individual patient emergencies, the period in which 

17 a postgraduate trainee is providing for the transfer of di18 rect patient care (as referred to in clause (i)) does not 

19 extend such trainee’s shift by more than 3 hours beyond 

20 the 24-hour period referred to in subparagraph (A)(i) or 

21 the 12-hour period referred to in subparagraph 

22 (A)(iii)(III), as the case may be. 

23 ‘‘(C) The work hour limitations under subparagraph 

24 (A) and requirements of subparagraph (B) shall not apply 
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1 to a hospital during a state of emergency declared by the 

2 Secretary that applies with respect to that hospital. 

3 ‘‘(2) The Secretary shall promulgate such regulations 

4 as may be necessary to monitor and supervise post5 graduate trainees assigned patient care responsibilities as 

6 part of an approved medical training program, as well as 

7 to assure quality patient care. 

8 ‘‘(3) Each hospital shall inform postgraduate trainees 

9 of— 

10 ‘‘(A) their rights under this subsection, includ11 ing methods to enforce such rights (including so12 called whistle-blower protections); and 

13 ‘‘(B) the effects of their acute and chronic sleep 

14 deprivation both on themselves and on their pa15 tients. 

16 ‘‘(4) For purposes of this subsection, the term ‘post17 graduate trainee’ means a postgraduate medical resident, 

18 intern, or fellow.’’. 

19 (b) DESIGNATION.— 

20 (1) IN GENERAL.—The Secretary of Health and 

21 Human Services (in this subsection referred to as 

22 the ‘‘Secretary’’) shall designate an individual within 

23 the Department of Health and Human Services to 

24 handle all complaints of violations that arise from a 

25 postgraduate trainee (as defined in paragraph (4) of 
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1 section 1886(k) of the Social Security Act, as added 

2 by subsection (a), who reports that the hospital op3 erating the medical residency training program for 

4 which the trainee is enrolled is in violation of the re5 quirements of such section. 

6 (2) GRIEVANCE RIGHTS.—A postgraduate train7 ee may file a complaint with the Secretary con8 cerning a violation of the requirements under such 

9 section 1886(k). Such a complaint may be filed 

10 anonymously. The Secretary may conduct an inves11 tigation and take corrective action with respect to 

12 such a violation. 

13 (3) ENFORCEMENT.— 

14 (A) CIVIL MONEY PENALTY ENFORCE15 MENT.—Subject to subparagraph (B), any hos16 pital that violates the requirements under such 

17 section 1886(k) is subject to a civil money pen18 alty not to exceed $100,000 for each medical 

19 residency training program operated by the hos20 pital in any 6-month period. The provisions of 

21 section 1128A of the Social Security Act (other 

22 than subsections (a) and (b)) shall apply to civil 

23 money penalties under this paragraph in the 

24 same manner as they apply to a penalty or pro25 ceeding under section 1128A(a) of such Act. 
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1 (B) CORRECTIVE ACTION PLAN.—The Sec2 retary shall establish procedures for providing a 

3 hospital that is subject to a civil monetary pen4 alty under subparagraph (A) with an oppor5 tunity to avoid such penalty by submitting an 

6 appropriate corrective action plan to the Sec7 retary. 

8 (4) DISCLOSURE OF VIOLATIONS AND ANNUAL

9 REPORTS.—The individual designated under para10 graph (1) shall— 

11 (A) provide for annual anonymous surveys 

12 of postgraduate trainees to determine compli13 ance with the requirements under such section 

14 1886(k) and for the disclosure of the results of 

15 such surveys to the public on a medical resi16 dency training program specific basis; 

17 (B) based on such surveys, conduct appro18 priate on-site investigations; 

19 (C) provide for disclosure to the public of 

20 violations of and compliance with, on a hospital 

21 and medical residency training program specific 

22 basis, such requirements; and 

23 (D) make an annual report to Congress on 

24 the compliance of hospitals with such require-
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1 ments, including providing a list of hospitals 

2 found to be in violation of such requirements. 

3 (c) WHISTLEBLOWER PROTECTIONS.— 

4 (1) IN GENERAL.—A hospital covered by the re5 quirements of section 1866(k) of the Social Security 

6 Act, as added by subsection (a), shall not penalize, 

7 discriminate, or retaliate in any manner against an 

8 employee with respect to compensation, terms, con9 ditions, or privileges of employment, who in good 

10 faith (as defined in paragraph (2)), individually or 

11 in conjunction with another person or persons— 

12 (A) reports a violation or suspected viola13 tion of such requirements to a public regulatory 

14 agency, a private accreditation body, or man15 agement personnel of the hospital; 

16 (B) initiates, cooperates, or otherwise par17 ticipates in an investigation or proceeding 

18 brought by a regulatory agency or private ac19 creditation body concerning matters covered by 

20 such requirements; 

21 (C) informs or discusses with other em22 ployees, with a representative of the employees, 

23 with patients or patient representatives, or with 

24 the public, violations or suspected violations of 

25 such requirements; or 
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1 (D) otherwise avails himself or herself of 

2 the rights set forth in such section or this sub3 section. 

4 (2) GOOD FAITH DEFINED.—For purposes of 

5 this subsection, an employee is deemed to act ‘‘in 

6 good faith’’ if the employee reasonably believes— 

7 (A) that the information reported or dis8 closed is true; and 

9 (B) that a violation has occurred or may 

10 occur. 

11 (d) EFFECTIVE DATE.—The amendments made by 

12 subsection (a) shall take effect on the first July 1 that 

13 begins at least 1 year after the date of enactment of this 

14 Act. 

15 SEC. 4. ADDITIONAL FUNDING FOR HOSPITAL COSTS. 

16 There are hereby appropriated to the Secretary of 

17 Health and Human Services such amounts as may be re18 quired to provide for additional payments to hospitals for 

19 their reasonable additional, incremental costs incurred in 

20 order to comply with the requirements imposed by this Act 

21 (and the amendments made by this Act).

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