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In 1989, New York State adopts recommendations put forth by the Bell Commission to limit the number of hours physicians can work to 80 hours per week, in shifts no longer than 24 hours.

Libby Zion (November 30, 1965 - March 5, 1984)

March 5, 1984, 6:30 AM

Why did this happen?

March 4, 1984

March 5, 1984, 3:00 AM

Bell Commission 1989

Libby Zion, an 18 year old freshman at Bennington College, is admitted to New York Hospital by emergency room physicians due to exhibiting “flu-like symptoms.”

The intern and resident are having difficulty determining the cause of Zion’s illness. They prescribe meperidine (Demerol) to control the patient’s “strange jerking motions,” which have been present since Zion’s admission to the hospital.

Zion’s parents question the decisions made by the attending intern and resident in the hours before, what her mother refers to as, their daughter’s “murder.” They also questions the residents’ ability to adequately care for patients when working extremely long shifts.

Zion falls asleep, but by 6:30, her fever is 107 ° F (42 °C). Weinstein is called again and measures are quickly taken to reduce her temperature. Unfortunately, before this can be done, the patient suffers from cardiac arrest and cannot be resuscitated. Libby Zion dies.

Court Hearings 1987

ACGME 2003

What Happened

Medical Decisions

Residents Assigned to Zion

ACGME makes similar regulations standard for all accredited medical training institutions in the country.

An intern and resident are assigned to evaluate and treat Zion: Luise Weinstein (PGY-1) & Gregg Stone (PGY-2). They consult with her primary physician and agree to hydrate and observe her. Meanwhile, Weinstein and Stone are responsible for covering dozens of other patients at the same time.

In 1987, the intern and resident are charged with 38 counts of gross negligence and/or gross incompetence.

Weinstein leaves to attend to other patients while Stone goes to sleep in an on-call room located in an adjacent building. Weinstein is contacted by nurses when Zion’s symptoms worsen, causing severe agitation, which leads to Zion pulling on her intravenous tubes. Without visually evaluating Zion, Weinstein orders she be placed under physical restraints and prescribes haloperidol to control her agitation.

Several years pass before the agreed cause of Zion’s death was determined: She had been taking a prescribed antidepressant, phenelizine, before being admitted to the hospital. Meperidine, prescribed by Weinstein and Stone, combined with her current medication, contributed to the development of “Serotonin Syndrome,” which led to increased agitation.

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