I 
108TH 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 12, 2003
Mr. CONYERS introduced the following bill; which was referred to the Com-
mittee 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 resident-
physicians to ensure the safety of patients and resident-
physicians themselves.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Patient and Physician 
Safety and Protection Act of 2003’’. 
SEC. 2. FINDINGS. 
Congress finds the following:
(1) The Federal government, through its medi-
care program, pays approximately $8 billion per year 
solely to train resident-physicians in the United 
States, and as a result, has an interest in assuring 
the safety of patients treated by resident-physicians 
and the safety of resident-physicians themselves. 
(2) Resident-physicians spend a significant 
amount of their time performing activities not re-
lated to the educational mission of training com-
petent physicians. 
(3) The excessive numbers of hours worked by 
resident-physicians is inherently dangerous for pa-
tient care and for the lives of resident-physicians. 
(4) The scientific literature has consistently 
demonstrated that the sleep deprivation of the mag-
nitude seen in residency training programs leads to 
cognitive impairment. 
(5) A substantial body of research indicates 
that excessive hours worked by resident-physicians 
lead to higher rates of medical error, motor vehicle 
accidents, depression and pregnancy complications. 
(6) The medical community has not adequately 
addressed the issue of excessive resident-physician 
work hours.
(7) Different medical specialty training pro-
grams have different patient care considerations but 
the effects of sleep deprivation on resident-physi-
cians does not change between specialties. 
(8) The Federal government has regulated the 
work hours of other industries when the safety of 
employees or the public is at risk. 
SEC. 3. REVISION OF MEDICARE HOSPITAL CONDITIONS OF 
PARTICIPATION 
REGARDING 
WORKING 
HOURS OF RESIDENTS. 
(a) IN GENERAL.—Section 1866 of the Social Secu-
rity Act (42 U.S.C. 1395cc) is amended—
(1) in subsection (a)(1)—
(A) by striking ‘‘and’’ at the end of sub-
paragraph (R); 
(B) by striking the period at the end of 
subparagraph (S) and inserting ‘‘; and’’; and 
(C) by inserting after subparagraph (S) 
the following new subparagraph: 
‘‘(T) in the case of a hospital that uses the 
services of physician residents or postgraduate train-
ees, to meet the requirements of subsection (j).’’; 
and 
(2) by adding at the end the following new sub-
section: