New York State Department of Health Code, Section 405,
also known as the Libby Zion law, is a regulation that limits the amount of time resident physicians' work in New York State hospitals to roughly 80 hours per
week. The law was named after Libby Zion who died at the age of 18 under the
care of what her father believed to be overworked resident physicians and
intern physicians. In July 2003 the Accreditation Council for Graduate Medical
Education (ACGME) adopted similar regulations for all accredited medical
training institutions in the United States.
Libby Zion had been ill with a "flu-like
ailment" when admitted to New York Hospital, she died of cardiac arrest.
Zion was assigned to two medical residents who both evaluated her but were
unable to determine the cause of Zion's illness. They prescribed Demerol to
control the "strange jerking motions" that Zion had been exhibiting
when she was admitted. The two medical
residents were both responsible for covering dozens of other patients. After
evaluating Zion, they left. Weinstein went to cover other patients, and Stone
went to sleep in an on-call room in an adjacent building. Zion, however, did
not improve, and continued to become more agitated. After being contacted by
nurses by phone, Weinstein ordered physical restraints be placed on Zion. She
also prescribed haloperidol by phone to control the agitation. Zion finally
managed to fall asleep, but by 6:30, her temperature was 107 °F (42 °C).
Weinstein was once again called, and measures were quickly taken to try to
reduce her temperature. However, before this could be done, Zion suffered a
heart attack and could not be resuscitated.
It was later determined that Libby Zion was suffering from Serotonin
Syndrome. Zion had been taking a
prescribed antidepressant, phenelzine, before she was admitted to the hospital.
The combination of that and the meperidine given to her by Dr. Stone and Dr. Weinstein
contributed to the development of "serotonin syndrome", a condition
which led to increased agitation which lead to increased drug dosing ultimately
leading to her death.
Although regulatory and civil proceedings found
conflicting evidence about Zion's death, today her death is widely believed to
have been caused by serotonin syndrome from the drug interaction between the
phenelzine she was taking prior to her hospital visit, and the Demerol
administered by a resident physician. 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.
Serotonin or 5-hydroxytryptamine (5-HT) which is a neurotransmitter.
Serotonin is a neurotransmitter that
affects the brain and plays a role in aggression, memory, learning, pain, sleep, appetite, anxiety, depression,
migraine, and vomiting. Several different classes of psychiatric drugs
like anti-depressants, anti-psychotics, anti-anxiety drugs, anti- migraine
drugs and psychedelic drugs affect the level of this neurotransmitter inside
the neuro-synapses of the brain.
Some drugs such as tricyclic antidepressants (TCA’s) and selective
serotonin reuptake inhibitors (SSRIs) inhibit the reuptake of serotonin, making
it stay in the synapse longer. Serotonin
syndrome which can also be called serotonin toxicity is really a poisoning and
is the predictable consequence of excess serotonin activity in the brain and
elsewhere in the body which can be caused by therapeutic use of these
medications. No laboratory tests can currently
confirm the diagnosis and it is usually diagnosed base on the patient’s
symptoms and clinical history. Serotonin
syndrome may be mistaken for a viral illness, anxiety, neurological disorder, various
kinds of poisonings, or a worsening psychiatric condition.
The symptoms of Serotonin Syndrome are:
Cognitive effects: headache, agitation, hypomania, mental
confusion, hallucinations, coma
Autonomic effects: shivering, sweating, hyperthermia
(temperature as high as 104o F and even go as high as 106oF,
hypertension (high blood pressure), tachycardia, nausea, diarrhea.
Somatic effects: myoclonus (muscle twitching), hyperreflexia
(manifested by clonus), tremor.
References:
"Libby Zion". New York Times. March 6, 1984.
Philibert
I.; Friedmann P.; Williams W. T.; for the members of the ACGME Work Group on
Resident Duty Hours (2002). "New Requirements for Resident Duty
Hours". Journal of the American Medical Association 288 (9):
1112–1114. doi:10.1001/jama.288.9.1112.
PMID 12204081.
Zion, Sidney (December 18, 1997).
"Hospitals Flout My Daughter's Law". New York Daily News. "After it became clear
to everybody, including a New York County grand jury, that Libby's death was
caused by overworked and unsupervised interns and residents, the Libby Zion law
was passed: No more 36-hour shifts for interns and residents; from now on,
attending physicians would be at the ready to supervise the young,
inexperienced student-doctors."
Fox,
Margalit (March 5, 2005). "Elsa Zion, 70. Helped Cut Doctor Workloads.".
New York Times.
Jane Ellen Brody (February 27, 2007).
"A Mix of Medicines That Can Be Lethal".
New York Times.
Spritz,
N. (August 1991). "Oversight of physicians' conduct by state licensing
agencies. Lessons from New York's Libby Zion case". Annals of Internal
Medicine 115 (3): 219–22. PMID 2058876.
Resident doctors are those who are still in training. They are still formally students and are completing the last part of their training to become fully qualified doctors. They are dependent on the medical training institution to provide them with their credentials to be an independent fully qualified physician. They have invested a large amount of their time and their money into becoming a doctor and are close enough to graduation to see the end in sight. But during this last year of training they become vulnerable to the greed and uncaring of those that supervise their residency or internship and use them as cheap labor without concern to their human rights. Theses doctors still in training can and do (by law) routinely work 24-30
hour shifts, several days a week, for years. 
Your risk of dying in a plane crash is estimated to be 1
in 9,000,000 but your risk of suffering medical negligence or medical error is
about 1 in 5. The Harvard Medical Practice
Study, documented in The New England Journal of Medicine, (February 7, 1991),
found strong evidence of 6895 deaths
during the year 1984 in New York hospitals due to negligent medical care alone.
On a national basis the Harvard numbers work out to approximately 100,000 people dying each year from medical
negligence. To make this figure understandable, it is roughly equivalent to one
747 jetliner, filled with passengers, crashing every day of the week. Yet, as frightening as these numbers are, they may be vastly understated. As reported
in Lancet (1997:349:309-313), the actual rate of medical negligence in hospitals
could be at least 17.7% and probably higher. People in hospitals run an almost
1 in 5 risk of suffering medical negligence. 
