Limit the work hours of physicians

By Chien Jien-wen 錢建文  / 

Fri, Sep 08, 2017 - Page 8

A young woman named Libby Zion on Mar. 4, 1984, was admitted to New York Hospital. She was given the wrong medicine by a resident physician who was, at the time, dealing with 40 other patients and was exhausted from having worked too many hours without a break. Zion died about eight hours later in the hospital.

Her enraged parents sued the hospital, and the case led to the Libby Zion Law being passed in New York State in 1989. The law limits the number of hours that resident physicians are allowed to work without a break.

On Oct. 16, 2009, a sleep-deprived long-distance bus driver traveling along the Sun Yat-sen Freeway (Freeway No. 1) near Yuanlin Township (員林) in Changhua County failed to brake in time and plowed into 13 stationary cars in front of him, killing four people and injuring six.

This was not the first time that a fatal accident occurred due to a lack of limits on driving hours for mass transport drivers.

In response to an incensed public, the Control Yuan on Jan. 14, 2010, admonished Council of Labor Affairs and the Ministry of Transportation and Communications.

On Feb. 3 that year, the ministry implemented a regulation stating that long-distance transportation drivers could not drive more than four hours without a break of 30 minutes.

The bus company involved in the accident in question had actually introduced its own regulation before the ministry’s was legislated, to the effect that there must be a change of drivers at the halfway point, in central Taiwan.

Human factors theory provides the academic basis for limiting work hours. In certain situations, humans cannot but commit errors. These circumstances include being overtired, emergency situations and overwork.

For this reason, the aviation industry has long maintained restrictions on pilots’ flight hours. Aviation accident reports always include an investigation into whether the pilot was overworked.

In announcing the findings of the TransAsia Airways Flight GE222 that crashed on July 23, 2014, the Aviation Safety Council said that the pilots being overtired was to a small degree one of the factors contributing to the crash.

Medical research into sleep has also shown that a person’s ability to perform tasks that require thinking and making decisions is distinctly reduced when that person is sleep-deprived.

The nature of the medical profession is such that all three of these circumstances — being overtired, emergency situations and overwork — are involved.

To this cocktail is added the need for accurate cognition and inference in making correct diagnoses, providing the perfect recipe for medical professionals making mistakes when tired.

Research worldwide has confirmed that medical mistakes happen everywhere, leading to considerable loss of human life.

In December 1992, the US Institute of Medicine — now the US National Academy of Medicine — published a report estimating that as many as 44,000 to 98,000 fatalities were caused every year by avoidable medical negligence, making it No. 8 of the top 10 causes of death in the US.

Academics have estimated that, in Taiwan, medical negligence is responsible for 6,000 to 20,000 deaths a year, and for harming as many as 80,000 patients.

Consequently, the most important reason for restricting doctors’ work hours is to avoid causing harm to the patients.

Not only are limits warranted but, due to the nature of the medical industry, these limits must be more stringent than those for other industries and at the very least cannot be more relaxed than the standards stipulated in the Labor Standards Act (勞動基準法).

Taiwan already trails other nations by 30 years in terms of legislation that limits the working hours of medical personnel. This is why President Tsai Ing-wen (蔡英文) should fulfill her campaign promises and include doctors in the labor act.

We would be lucky to see Tsai go in this direction.

Unfortunately, Minister of Health and Welfare Chen Shih-chung (陳時中), who is drawing up a white paper, has already signaled to the media that this campaign promise is dead in the water.

How can Taiwanese needing medical treatment not be angry?

Twenty-eight years ago, an angry father in the US pushed for legislation limiting doctors’ work hours and, in so doing, saved countless lives.

Seven years ago, in response to an irate public, the transportation ministry introduced legislation restricting work hours for long-distance bus drivers, and there has not been a major fatal accident on the freeway by a transport company since.

So why is it that the government is dragging its feet on introducing reform to the medical profession?

The reason is likely that patients in Taiwan, when medical treatment goes wrong, have no way of going after the big fish, but have to satisfy themselves instead with individual minnows.

When an incident occurs, medical institutions always shirk the responsibility and instead simply offer up their individual doctors.

The government is willing to face the situation to avoid the unsustainable situation of hospitals relying on less severe cases to reduce their potential liabilities and keep themselves afloat.

Citing the difficulties in running hospitals as one of the reasons for opposing the government from including physicians in the labor act, many medical professionals, who should be advocating for solutions to social issues, are siding with the hospital operators, whose main objective is turning a profit.

When those who should represent a social conscience abdicate their responsibilities, the rest of us have to rely on ourselves.

This nation needs angry people.

When you or a family member receives inadequate medical treatment, have a judge request that physician’s shift schedule for the previous year. Look into whether the hospital operator is legally liable, due to not keeping the staff from working too many hours.

You should also seek compensation from the present government, which continues to put off including doctors in the Labor Standards Act — let it go down in history how certain politicians have reneged on their campaign promises.

Of course, the best method would be to completely replace government officials who have given up on fulfilling their promises and to instead have more competent ones implement Tsai’s campaign promises.

Chien Jien-wen is a pediatrician and a board member of the Changhua Medical Alliance for Public Affairs.

Translated by Paul Cooper