trauma-list Digest, Vol 69, Issue 6

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Interesting topic...
I am a resident (my last 4 months-voila!) in Gen Surgery. Have to say that yes, it is flattering to have people defend our rights which isnot about our safety but patient safety and proper pt care. Agree that after having been on call for 3 days in a row and having run between the OR, ER, floors and ICU during these 3 days, I felt like a zombie on day 4. The truth is, I still loved it. The bottomline is that I would not be able to work the 48-hr/week schedule that Europe established (correct me if am wrong) for their residents-I believe taht for a surgery resident, 48 hrs are not sufficient to absorb everything we need to absorb. The 
80-hr/wk schedule we have here is just right. Sometimes we work more, but this is life. No one staff chains us to the hospital or tells us what a weak resident we are if we tell them we need to take a break (doesnt happen often simply because of the workload). 
Who said medicine was an easy profession? My understanding is that when someone picks medicine (and specifically surgery) for profession, they realize that most of their time they will be spending in the hospital, that the other parts of their life is going to be haphazard and disorganized during the residency. Yes, if we are rotating in a big trauma center where we are responsible for every surgical case taht come thru the door, it is insane to take a 3-day call in a row and we need a formal day off in between (that's how it is here now). 
I understand there will be a lot of residents (or maybe staff too?) who will disagree. This is only my opinion. 
Cheerz
Kh.
 


--- On Thu, 3/5/09, trauma-list-request at trauma.org <trauma-list-request at trauma.org> wrote:

From: trauma-list-request at trauma.org <trauma-list-request at trauma.org>
Subject: trauma-list Digest, Vol 69, Issue 6
To: trauma-list at trauma.org
Received: Thursday, March 5, 2009, 7:00 AM

Send trauma-list mailing list submissions to
	trauma-list at trauma.org

To subscribe or unsubscribe via the World Wide Web, visit
	http://list.mistral.net/mailman/listinfo/trauma-list
or, via email, send a message with subject or body 'help' to
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When replying, please edit your Subject line so it is more specific
than "Re: Contents of trauma-list digest..."


Today's Topics:

   1. Re: Libby Zion (nappio at aol.com)
   2. Re: Libby Zion (Robert Smith)
   3. Re: trauma-list Digest, Vol 69, Issue 5 (plevy at fhsu.edu)
   4. Resident Work Hours (was RE: trauma-list Digest, Vol 69,
      Issue 5) (Bjorn, Pret)
   5. FW: trauma course (gamal ejaimi)
   6. Re: FW: trauma course (KMATTOX at aol.com)


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

Message: 1
Date: Wed, 4 Mar 2009 12:08:07 +0000
From: nappio at aol.com
Subject: Re: Libby Zion
To: "Trauma &amp; Critical Care mailing list"
<trauma-list at trauma.org>
Message-ID:
	<2011206334-1236168476-cardhu_decombobulator_blackberry.rim.net-1445580044- at bxe1109.bisx.prod.on.blackberry>
	
Content-Type: text/plain; charset="Windows-1252"

Where are the surgeons???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: 2
Date: Wed, 4 Mar 2009 07:27:38 -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: <81C1CA82-B68D-4B78-9AF4-68D4068F7F96 at comcast.net>
Content-Type: text/plain; charset=WINDOWS-1252; format=flowed;
	delsp=yes

Yes. Exactly.

It's mostly sleep specialists and psychologists. One Cardiology Fellow  
and no one else who seems to be actually doing stuff. Like actually  
training the residents.

Rob
On Mar 4, 2009, at 7:08 AM, nappio at aol.com wrote:

> Where are the surgeons???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: 3
Date: Wed, 4 Mar 2009 09:26:44 -0600
From: plevy at fhsu.edu
Subject: Re: trauma-list Digest, Vol 69, Issue 5
To: trauma-list at trauma.org
Message-ID:
	<OF4985D9F5.0101735F-ON8625756F.00543CB8-8625756F.0054DCA7 at tiger.fhsu.edu>
	
Content-Type: text/plain; charset="US-ASCII"

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. 



trauma-list-request at trauma.org 
Sent by: trauma-list-bounces at trauma.org
03/04/2009 06:00 AM
Please respond to
trauma-list at trauma.org


To
trauma-list at trauma.org
cc

Subject
trauma-list Digest, Vol 69, Issue 5






Send trauma-list mailing list submissions to
                 trauma-list at trauma.org

To subscribe or unsubscribe via the World Wide Web, visit
                 http://list.mistral.net/mailman/listinfo/trauma-list
or, via email, send a message with subject or body 'help' to
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You can reach the person managing the list at
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When replying, please edit your Subject line so it is more specific
than "Re: Contents of trauma-list digest..."


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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To change your settings or unsubscribe visit:
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End of trauma-list Digest, Vol 69, Issue 5
******************************************



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

Message: 4
Date: Wed, 4 Mar 2009 15:35:19 -0500
From: "Bjorn, Pret" <pbjorn at emh.org>
Subject: Resident Work Hours (was RE: trauma-list Digest, Vol 69,
	Issue 5)
To: "Trauma &amp; Critical Care mailing list"
<trauma-list at trauma.org>
Message-ID:
	<9CCE32ECAAFDEB4DA01EC771B6AD951B036A7CFE at VALIER.me.emh.org>
Content-Type: text/plain;	charset="us-ascii"

I have nothing special to add.  

Never stopped me before:

1: Such stories as this comprise #62 of the One Hundred Good Reasons
Pret Never Became a Doctor.

(Before anybody asks, it's a tedious and wholly predictable list, mostly
preoccupied with my shortcomings in the scruples and brainpower
departments.  But there are also several references to how not being a
doctor is really quite a lot of fun.)

2: In the US, pretty much ALL of our rooms are attached to the floor.
Do you have pictures?

Pret Bjorn, RN
Bangor, ME USA



-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of plevy at fhsu.edu
Sent: Wednesday, March 04, 2009 10:27 AM
To: trauma-list at trauma.org
Subject: Re: trauma-list Digest, Vol 69, Issue 5


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. 



trauma-list-request at trauma.org 
Sent by: trauma-list-bounces at trauma.org
03/04/2009 06:00 AM
Please respond to
trauma-list at trauma.org


To
trauma-list at trauma.org
cc

Subject
trauma-list Digest, Vol 69, Issue 5






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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-78844477
0- 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=emlcntu
syelp00000005
)


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

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

End of trauma-list Digest, Vol 69, Issue 5
******************************************

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

Message: 5
Date: Wed, 4 Mar 2009 23:23:08 +0200
From: gamal ejaimi <gamalejaimi at hotmail.com>
Subject: FW: trauma course
To: "Trauma &amp; Critical Care mailing list"
<trauma-list at trauma.org>
Message-ID: <SNT102-W76587186CB51B7FB6E5DD9AAA70 at phx.gbl>
Content-Type: text/plain; charset="Windows-1252"







 


From: gamalejaimi at hotmail.com
To: trauma-list-request at trauma.org
Subject: trauma course
Date: Wed, 4 Mar 2009 23:17:44 +0200





Dear all i work on a proposal of trauma course and medicine to be applied as
aseperate course for both medical stuidents and recentlly graduated doctors to
motivate this a very serious medicine. please if possible i aske from members to
give me more informations and suggestions.
 
with thanks
 
Dr. Gamal
MD Anesthesia and ICU





check out the rest of the Windows Live?. More than mail?Windows Live? goes way
beyond your inbox. More than messages
_________________________________________________________________
See all the ways you can stay connected to friends and family
http://www.microsoft.com/windows/windowslive/default.aspx

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

Message: 6
Date: Wed, 4 Mar 2009 17:10:56 EST
From: KMATTOX at aol.com
Subject: Re: FW: trauma course
To: gamalejaimi at hotmail.com, trauma-list at trauma.org
Message-ID: <c38.4cb8ea14.36e05670 at aol.com>
Content-Type: text/plain; charset="UTF-8"

_www.trauma-criticalcare.com_ (http://www.trauma-criticalcare.com) 
 
Great outline for a course.   You should come to it if for no  other reason 
than to help you plan your own conference.   Registration  is not yet closed, 
although it may be within the next two weeks.   
 
you can also contact _redstart at aol.com_ (mailto:redstart at aol.com) 
 
k
 
 
 
 
In a message dated 3/4/2009 3:24:03 P.M. Central Standard Time,  
gamalejaimi at hotmail.com writes:










From:  gamalejaimi at hotmail.com
To: trauma-list-request at trauma.org
Subject:  trauma course
Date: Wed, 4 Mar 2009 23:17:44  +0200





Dear all i work on a proposal of trauma course  and medicine to be applied as 
aseperate course for both medical stuidents and  recentlly graduated doctors 
to motivate this a very serious medicine. please  if possible i aske from 
members to give me more informations and  suggestions.

with thanks

Dr. Gamal
MD Anesthesia and  ICU





check out the rest of the Windows Live?. More than  mail?Windows Live? goes 
way beyond your inbox. More than  messages
_________________________________________________________________
See  all the ways you can stay connected to friends and  family
http://www.microsoft.com/windows/windowslive/default.aspx
--
trauma-list  : TRAUMA.ORG
To change your settings or unsubscribe  visit:
http://www.trauma.org/index.php?/community/

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


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

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

End of trauma-list Digest, Vol 69, Issue 6
******************************************



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