Libby Zion

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Yes to cocaine use though it didn't say if she had used prior to  
admission. Lack of hands on re-evaluation and not consulting with more  
senior doc for acute management (unclear from today's article what  
level the resident was and I forget) obviously a problem. I thought  
the lack of any surgeons or other "in the trenches" kind of docs on  
the committee was kind of telling. I would think most of America would  
fit their criteria for dangerous "fatigue". I'd say lol but it's not  
really very funny.

Rob
On Mar 3, 2009, at 4:55 PM, nappio at aol.com wrote:

> Did they mention her friends confirmed she was a drug user and that  
> cocaine plyed more a role in her death then any resident?dn
> Sent from my Verizon Wireless BlackBerry
>
> -----Original Message-----
> From: Robert Smith <rfsmithmd at comcast.net>
>
> Date: Tue, 3 Mar 2009 12:26:06
> To: Trauma-List at Trauma. Org<trauma-list at trauma.org>
> Subject: Libby Zion
>
>
> Today apparently marks the 25th anniversary of the death of Libby
> Zion. There was an article in the NYTimes today about the subsequent
> changes in residents work weeks by: Barron H. Lerner, a professor of
> medicine and public health at Columbia University Medical Center, is
> the author of “When Illness Goes Public: Celebrity Patients and How We
> Look at Medicine." The Libby Zion case was included in his book. Her
> father was described as a "former lawyer and powerful journalist" who
> made his daughters death into a crusade to change the working hours of
> residents. Dr. Lerner cited the report by the Institute of Medicine
> requested by Congress in 2007 and released in December of 2008:  http://www 
> ..iom.edu/CMS/3809/48553/60449/60469.aspx
> .. The report defines factors that increase fatigue as " being up for
> 16 hrs, disturbed sleep, shift work, and intensity of work"  and calls
> for reducing resident's hours to no more than 16 consecutive hours,
> with a mandatory 5 hr sleep break in a 30 hour shift. They note that
> some medical educators worry that doctors will not be able to learn
> about the progression of acute illnesses especially in the crucial
> first 24 - 36 hrs. It estimates the cost of implementing these changes
> would be at least $1.7 billion.
>
> I was wondering what type of physicians would propose such
> recommendations so I thought the make up of the committee might be
> instructive.
>
>
> COMMITTEE ON Optimizinggraduatemedicaltrainee(resident) hoursandwork
> schedulestoimprovepatientsafety
> MICHAEL M.E. JOHNS (Chair), Chancellor, Emory University, Atlanta, GA;
> JAMES BAGIAN, Chief Patient Safety Officer, Director, VA National
> Center for Patient Safety, Department of Veterans Affairs, Ann Arbor,
> MI; JAYANTA BHATTACHARYA, Assistant Professor, Center for Primary Care
> and Outcomes Research, Stanford University, CA; MAUREEN BISOGNANO,
> Executive Vice President and Chief Operating Officer (COO), Institute
> for Healthcare Improvement, Cambridge, MA; PASCALECARAYON, Procter &
> Gamble Bascom Professor in Total Quality, Department of Industrial and
> Systems Engineering and Director, Center for Quality and Productivity
> Improvement, University of Wisconsin-Madison; JORDAN J. COHEN,
> Professor, Medicine and Public Health, George Washington University,
> Washington, D.C.; DAVID F. DINGES, Professor and Chief, Division of
> Sleep and Chronobiology, Department of Psychiatry, University of
> Pennsylvania School of Medicine, Philadelphia; JAVIER A. GONZALEZ DEL
> REY, Professor of Pediatrics and Director, Pediatric Residency
> Programs, Cincinnati Children’s Hospital Medical Center; PETER J.
> KOLESAR, Professor Emeritus and Research Director, Deming Center for
> Quality, Productivity and Competitiveness, Columbia University, NY;
> BRIAN W. LINDBERG, Executive Director, Consumer Coalition for Quality
> Health Care, Washington, D.C.; KENNETH M. LUDMERER, Professor of
> Medicine and Professor of History, Washington University, St. Louis,
> MO; DANIEL MUNOZ, Fellow, Division of Cardiology, Johns Hopkins
> University School of Medicine, Baltimore, MD; CHRISTOPHER S.
> PARSHURAM, Director, Center for Safety Research, Assistant Professor,
> Department of Critical Care Medicine, Hospital for Sick Children, and
> Departments of Pediatrics, Health Policy Management and Evaluation,
> University of Toronto, ON; ANN E. ROGERS,Associate Professor,
> University of Pennsylvania School of Nursing, Philadelphia; DENISE
> M.ROUSSEAU, H.J. Heinz II Professor of Organizational Behavior and
> Public Policy and Director, Project of Evidence-based Organizational
> Practices, Carnegie Mellon University, Pittsburgh, PA; EDUARDOSALAS,
> Pegasus Professor and University Trustee Chair, Department of
> Psychology and Institute for Simulation and Training, University of
> Central Florida, Orlando, FL; BRUCE SIEGEL, Director, Center for
> Health Care Quality, George Washington University School of Public
> Health and Health Services, Washington, D.C.
>
> Rob Smith
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