Public Citizen, the American Medical Student Association (AMSA) and other worker advocates petitioned the Occupational Safety and Health Administration (OSHA) to issue a regulation limiting the number of hours worked by medical residents. The petitioners argue that the excessive hours expected by the employers (hospitals) of these physicians-in-training cause chronic sleep deprivation and stress, which contributes to motor vehicle crashes, depression and mood disorders, needlestick injuries and other health problems. Among the compelling evidence provided are studies demonstrating significantly diminished mental acuity for sleep-deprived medical residents at levels comparable to 0.05% blood alcohol levels. One cited study indicated:
“Reaction times were 7% slower (p<.001), commission of errors was 40% higher (p< 0.001), speed variability was 71% greater (p<0.001) in heavy-call residents compared to light-call resident physicians."*
The petitioners use anecdotes to illustrate how a working condition—in this case excessive hours on-the-job—has a latent effect on the worker once they’ve left the workplace.
“Almost every resident I know in that program [surgery] has fallen asleep at the wheel driving home from work. And many of them have been in car accidents.”
Were injuries sustained in these car accident work-related? I would say so. I doubt though that many employers (including the administrators of these hospitals) label them work-related. [Current OSHA regulations also exempt them.**]
As Sid Wolfe, MD of Public Citizen’s Health Research Group notes:
“The dangerously excessive number of hours resident physicians are currently allowed to work is a similarly toxic exposure that OSHA has the authority to regulate and reduce in order to protect these physicians from harm.”
The link between work hours and safety is well recognized by other regulatory agencies, such as the FAA for airline pilots and DOT for commercial drivers. They’ve had regulations on the books for decades to limit work hours and mandate rest breaks. The justification for these rules is likely public safety, not protection per se of the drivers or pilots, but common sense (and our own experience) tells us that working too many hours and/or too many days in the row takes it toll on the body and mind. Our colleagues at Hazards magazine offer a compilation of research on work hours and health. It reveals a litany of adverse consequences of shiftwork, from increased risk of cancers, accidents, heart disease and pregnancy problems.
OSHA’s assistant secretary David Michaels responded immediately to the petition through a written statement. Dr. Michaels said the agency would “review and consider the petition” and acknowledged the relationship between worker fatigue and safety beyond the experience of medical residents. He said:
“It is clear that long work hours can lead to tragic mistakes, endangering workers, patients and the public. All employers must recognize and prevent workplace hazards. That is the law.”
The OSHA chief suggests that long work hours are an occupational exposure that employers are required to “recognize and prevent.” What’s less clear is whether OSHA will use its enforcement authority to compel employers to eliminate or control this hazard. Without a regulation on the books, the agency (or its legal advisors in the Solicitor’s Office) are reluctant to use the OSH Act’s general duty clause. This is likely the reason Public Citizen and the other petitioners are urging OSHA to put the following rules in place:
*A limit of 80 hours of work in each and every week;
*A limit of 16 consecutive hours worked in one shift for all resident physicians;
*At least one 24-hour period of time off work per week and one 48-hour period off of work per month;
*In-hospital on-call frequency no more than once per every three nights, no averaging;
*A minimum of at least 10 hours off work after a day shift, and a minimum of 12 hours off work after a night shift;
*A maximum of four consecutive night shifts with a minimum of 48 hours off after a sequence of three or four night shifts.
As I noted in a post earlier this week, worker fatigue was identified in the Kleen Energy explosion by family members and others as a contributor to the disaster. The Hartford Courant’s Josh Kovner reported that some of the laborers were working 84 or more hours per week, for weeks on end, to meet production deadlines.
Whether its working 80 hours in a hospital, laboring at a construction site, or toiling in a field, 80 hours of work is not sustainable or healthy for the vast majority of us. Economists may call U.S. workers the most productive in the world, but there’s a cost for that skewed measure of performance. Mr. Robert Owen (1771-1858) was on the right track with his slogan: 8 hours work, 8 hours recreation, 8 hours rest.
*Note: As I was hitting the “publish” button for this post, I received an email from Dr. Tony Carter, an occupational health researcher in Queensland Australia. He sent me a copy of his research on safety risk factors associated with fatigue among mine workers. As he explains: “Following 8 consecutive 12 hour day shifts cognitive processing deteriorated beyond what you would expect to see for a blood alcohol concentration of 0.05%. The mind boggles at the deterioration following 29 consecutive 12 hour shifts.”
**Note: I read a couple of provisions in OSHA’s regulations that lead me to say these work-related sleep deprivation motor vehicle incidents are exempt from OSHA’s current injury recording regulations. First, OSHA defines the work environment as a location where employees are working. If the injury didn’t occur in or was not exacerbated by the “work environment,” it is not an “OSHA recordable injury.” Second, an injury sustained in a motor vehicle accident in the worksite’s parking lot or on an access road is not recordable, let alone one occurring while a worker is driving from work after a 30-hour shift.