I 

109TH CONGRESS 

1ST SESSION H. R. 1228 

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 HOUSE OF REPRESENTATIVES 

MARCH 10, 2005 

Mr. CONYERS introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Ways and Means, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

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 its medi2 care program, pays approximately $8 billion per year 

3 solely to train resident-physicians in the United 

4 States, and as a result, has an interest in assuring 

5 the safety of patients treated by resident-physicians 

6 and the safety of resident-physicians themselves. 

7 (2) Resident-physicians spend a significant 

8 amount of their time performing activities not re9 lated to the educational mission of training com10 petent physicians. 

11 (3) The excessive numbers of hours worked by 

12 resident-physicians is inherently dangerous for pa13 tient care and for the lives of resident-physicians. 

14 (4) The scientific literature has consistently 

15 demonstrated that the sleep deprivation of the mag16 nitude seen in residency training programs leads to 

17 cognitive impairment. 

18 (5) A substantial body of research indicates 

19 that excessive hours worked by resident-physicians 

20 lead to higher rates of medical error, motor vehicle 

21 accidents, depression and pregnancy complications. 

22 (6) The medical community has not adequately 

23 addressed the issue of excessive resident-physician 

24 work hours. 
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1 (7) Different medical specialty training pro2 grams have different patient care considerations but 

3 the effects of sleep deprivation on resident-physi4 cians does not change between specialties. 

5 (8) The Federal government has regulated the 

6 work hours of other industries when the safety of 

7 employees or the public is at risk. 

8 SEC. 3. REVISION OF MEDICARE HOSPITAL CONDITIONS OF 

9 PARTICIPATION REGARDING WORKING 

10 HOURS OF RESIDENTS. 

11 (a) IN GENERAL.—Section 1866 of the Social Secu12 rity Act (42 U.S.C. 1395cc) is amended— 

13 (1) in subsection (a)(1)— 

14 (A) by striking ‘‘and’’ at the end of sub15 paragraph (U); 

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

17 subparagraph (V) and inserting ‘‘; and’’; and 

18 (C) by inserting after subparagraph (V) 

19 the following new subparagraph: 

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

21 services of physician residents or postgraduate train22 ees, to meet the requirements of subsection (k).’’; 

23 and 

24 (2) by adding at the end the following new sub25 section: 
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1 ‘‘(k)(1)(A) In order that the working conditions and 

2 working hours of physicians and postgraduate trainees 

3 promote the provision of quality medical care in hospitals, 

4 as a condition of participation under this title each hos5 pital shall establish the following limits on working hours 

6 for certain members of the medical staff and postgraduate 

7 trainees: 

8 ‘‘(i) Subject to subparagraph (C), postgraduate 

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

10 per week and 24 hours per shift. 

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

12 trainees— 

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

14 scheduled shifts; 

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

16 every 7 days off and one full weekend off per 

17 month; 

18 ‘‘(III) who are assigned to patient care re19 sponsibilities in an emergency department shall 

20 work no more than 12 continuous hours in that 

21 department; and 

22 ‘‘(IV) shall not be scheduled to be on call 

23 in the hospital more often than every third 

24 night. 
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1 ‘‘(B) The Secretary shall promulgate such regulations 

2 as may be necessary to ensure quality of care is main3 tained during the transfer of direct patient care from one 

4 postgraduate trainee to another at the end of each such 

5 24 hour period referred to in subparagraph (A) and shall 

6 take into account cases of individual patient emergencies. 

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

8 (A) and requirements of subparagraph (B) shall not apply 

9 to a hospital during a state of emergency declared by the 

10 Secretary that applies with respect to that hospital. 

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

12 as may be necessary to monitor and supervise post13 graduate trainees assigned patient care responsibilities as 

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

15 to assure quality patient care. 

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

17 of— 

18 ‘‘(A) their rights under this subsection, includ19 ing methods to enforce such rights (including so20 called whistle-blower protections); and 

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

22 deprivation both on themselves and on their pa23 tients. 
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1 ‘‘(4) For purposes of this subsection, the term ‘post2 graduate trainee’ includes a postgraduate intern, resident, 

3 or fellow.’’. 

4 (b) DESIGNATION.— 

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

6 Human Services shall designate an individual within 

7 the Department of Health and Human Services to 

8 handle all complaints of violations that arise from 

9 residents who report that their programs are in vio10 lation of the requirements of section 1866(k) of the 

11 Social Security Act (as added by subsection (a)). 

12 (2) GRIEVANCE RIGHTS.—A post graduate 

13 trainee or physician resident may file a complaint 

14 with the Secretary of Health and Human Services 

15 concerning a violation of such requirements. Such a 

16 complaint may be filed anonymously. The Secretary 

17 may conduct an investigation and take such correc18 tive action with respect to such a violation. 

19 (3) CIVIL MONEY PENALTY ENFORCEMENT.— 

20 Any hospital that violates such requirement is sub21 ject to a civil money penalty not to exceed $100,000 

22 for each resident training program in any 6-month 

23 period. The provisions of section 1128A of the Social 

24 Security Act (other than subsections (a) and (b)) 

25 shall apply to civil money penalties under this para-
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1 graph in the same manner as they apply to a pen2 alty or proceeding under section 1128A(a) of such 

3 Act. 

4 (4) DISCLOSURE OF VIOLATIONS AND ANNUAL

5 REPORTS.—The individual designated under para6 graph (1) shall— 

7 (A) provide for annual anonymous surveys 

8 of postgraduate trainees to determine compli9 ance with such requirements and for the disclo10 sure of the results of such surveys to the public 

11 on a residency-program specific basis; 

12 (B) based on such surveys, conduct appro13 priate on-site investigations; 

14 (C) provide for disclosure to the public of 

15 violations and compliance, on a hospital and 

16 residence-program specific basis, of such re17 quirements; and 

18 (D) make an annual report to Congress on 

19 the compliance of hospitals with such require20 ments, including providing a list of hospitals 

21 found to be in violation of such requirements. 

22 (c) WHISTLEBLOWER PROTECTIONS.— 

23 (1) IN GENERAL.—A hospital covered by the re24 quirements of section 1866(k)(1) of the Social Secu25 rity Act (as inserted by subsection (a)) shall not pe-
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1 nalize, discriminate, or retaliate in any manner 

2 against an employee with respect to compensation, 

3 terms, conditions or privileges of employment, who 

4 in good faith (as defined in paragraph (2)), individ5 ually or in conjunction with another person or per6 sons— 

7 (A) reports a violation or suspected viola8 tion of such requirements to a public regulatory 

9 agency, a private accreditation body, or man10 agement personnel of the hospital; 

11 (B) initiates, cooperates or otherwise par12 ticipates in an investigation or proceeding 

13 brought by a regulatory agency or private ac14 creditation body concerning matters covered by 

15 such requirements; 

16 (C) informs or discusses with other em17 ployees, with a representative of the employees, 

18 with patients or patient representatives, or with 

19 the public, violations or suspected violations of 

20 such requirements; or 

21 (D) otherwise avails himself or herself of 

22 the rights set forth in such section or this sub23 section. 
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1 (2) GOOD FAITH DEFINED.—For purposes of 

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

3 good faith’’ if the employee reasonably believes— 

4 (A) that the information reported or dis5 closed is true; and 

6 (B) that a violation has occurred or may 

7 occur. 

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

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

10 begins at least 1 year after the date of the enactment of 

11 this Act. 

12 SEC. 4. ADDITIONAL FUNDING FOR HOSPITAL COSTS. 

13 There are hereby appropriated to the Secretary of 

14 Health and Human Services such amounts as may be re15 quired to provide for additional payments to hospitals for 

16 their reasonable additional, incremental costs incurred in 

17 order to comply with the requirements imposed by this Act 

18 (and the amendments made by this Act). 

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