Well-rested residents make fewer mistakes

“Recreating the Residency” by Peter Farley [Fall/Winter 2004] contains a large amount of palaver garnered from secondary sources. The grand jury found insufficient evidence to return an indictment of murder against the attending physician. Instead they indicted the system of graduate medical education.

Ms. Zion did not die from an overdose of cocaine. She died from hyperpyrexia—her last recorded temperature was 108 degrees.

The Accreditation Council for Graduate Medical Education rules governing residents’ work hours are based on New York state regulations enacted in 1989. Yale will find, as have many programs in New York state, that eliminating sleep deprivation and chronic fatigue will improve the physical and mental health of young doctors and reduce medical errors in patient care.

Bertrand M. Bell, M.D., Distinguished University Professor, Professor of Medicine, Albert Einstein College of Medicine of Yeshiva University

The writer was chair of the commission now known as the Bell Commission, formed by New York state health commissioner David Axelrod, M.D., after Libby Zion’s death to investigate issues surrounding patient care and the training of physicians in New York hospitals.

The cause of Libby Zion’s death remains a subject of debate, and indeed, no consensus emerged among investigating agencies as to what went wrong. A jury in a civil trial split the blame for her death between Cornell Medical Center’s New York Hospital and Zion herself. An autopsy found traces of cocaine in her nasal passages, but subsequent tests turned out negative. A grand jury blamed the death on inadequate care and numerous mistakes, including a mishandled diagnosis, made by unsupervised interns and residents. —Eds.