List Archives

Wed Mar 4 15:26:44 GMT 2009

Date: 3/4/09
From: Patricia Levy (plevy at fhsu.edu)
Subject: Libby Zion 
To: "Trauma-List at Trauma. Org" <trauma-list at trauma.or

I worked for years in a hospital in Israel where residents worked three 
consecutive shifts. They could lay down to sleep during the night shift in 
a room connected to the floor. However, needless to say, they were very 
tired. Under socialized medicine however, the doctors' primary place of 
work was the hospital and if they had private outpatient clinics outside 
of the hospital, often it was only for a few hours a week on their own 
time. 

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Today's Topics:

   1. Libby Zion (Robert Smith)
   2. Re: Libby Zion (nappio at aol.com)
   3. Re: Libby Zion (Robert Smith)
   4. Re: Libby Zion (Krin135 at aol.com)

----------------------------------------------------------------------

Message: 1
Date: Tue, 3 Mar 2009 12:26:06 -0500
From: Robert Smith <rfsmithmd at comcast.net>
Subject: Libby Zion
To: "Trauma-List at Trauma. Org" <trauma-list at trauma.org>
Message-ID: <215B18E3-F616-4F6D-A3A7-746A30A54D87 at comcast.net>
Content-Type: text/plain;                charset=WINDOWS-1252; 
format=flowed;
                 delsp=yes

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

------------------------------

Message: 2
Date: Tue, 3 Mar 2009 21:55:33 +0000
From: nappio at aol.com
Subject: Re: Libby Zion
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID:

<1405169352-1236117322-cardhu_decombobulator_blackberry.rim.net-788444770- at bxe1299.bisx.prod.on.blackberry>

Content-Type: text/plain; charset="Windows-1252"

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
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

------------------------------

Message: 3
Date: Tue, 3 Mar 2009 17:10:05 -0500
From: Robert Smith <rfsmithmd at comcast.net>
Subject: Re: Libby Zion
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Message-ID: <8982D42C-65EB-4E55-97F0-B18203400A7C at comcast.net>
Content-Type: text/plain; charset=WINDOWS-1252; format=flowed;
                 delsp=yes

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
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/

------------------------------

Message: 4
Date: Tue, 3 Mar 2009 17:44:42 EST
From: Krin135 at aol.com
Subject: Re: Libby Zion
To: trauma-list at trauma.org
Message-ID: <c53.459815a4.36df0cda at aol.com>
Content-Type: text/plain; charset="US-ASCII"

from Wiki:

<block quote>
Although regulatory and civil proceedings found conflicting evidence about 

Libby's death,_[3]_ (
http://en.wikipedia.org/wiki/Libby_Zion#cite_note-nyt05-2) 
  today her death is widely believed to have been caused by _serotonin 
syndrome_ (http://en.wikipedia.org/wiki/Serotonin_syndrome)   from the 
_drug 
interaction_ (http://en.wikipedia.org/wiki/Drug_interaction)   between the 

_phenelzine_ (http://en.wikipedia.org/wiki/Phenelzine)  [Nardil (r) ck] 
she was taking 
prior to her hospital visit, and the _meperidine_ 
(http://en.wikipedia.org/wiki/Meperidine)   administered by a _resident 
physician_ 
(http://en.wikipedia.org/wiki/Resident_physician) ._[4]_ 
(http://en.wikipedia.org/wiki/Libby_Zion#cite_note-brody-3)   The lawsuits 
and regulatory investigations following her 
death, and their  implications for working conditions and supervision of 
interns 
and residents  were highly publicized in both lay media and medical 
journals._[5]_ (
http://en.wikipedia.org/wiki/Libby_Zion#cite_note-annim91-4) 
</block quote>

the intern and resident were eventually cleared of all criminal charges, 
and 
only $375K was paid out in malpractice fees, as Ms. Zion was found to have 

contributed to her own death by not letting medical personnel know about 
her 
poly pharmacy abuse.

ck
Charles S. Krin, DO 

In a message dated 3/3/2009 16:11:09 Central Standard Time, 
rfsmithmd at comcast.net writes:

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

**************Need a job? Find employment help in your area. 
(
http://yellowpages.aol.com/search?query=employment_agencies&ncid=emlcntusyelp00000005
)

------------------------------

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