Chicago hospital wins lawsuit over resident crash

Teaching hospitals exhaled in relief after a court decision declared them not responsible for crashes caused by post-call medical residents falling asleep while driving.

Ted Nodzenski, the Illinois Hospital Assn.'s associate general counsel, said a ruling in favor of the plaintiff would have had tremendous ramifications for hospitals.

"Every time a resident, nurse or a tired CEO leaves the hospital and has an accident of some sort that causes injuries, the hospital could have been held responsible," he said. "This stopped us in our tracks. We're pleased that the court went unanimously with what traditional law has always been: When employees go off duty, their behavior is their responsibility."

A spokesman for Chicago's Rush University Medical Center, the hospital named in the suit, said the decision "is in the best interest of Rush and all other employers."

But this sense of relief could be short-lived, as the plaintiff prepares to appeal the decision of the 1st District Appellate Court of Illinois to the state Supreme Court. The appellate decision was issued in September and upheld a lower court ruling that excluded Rush from a lawsuit seeking to hold it responsible for a medical resident who fell asleep while driving, leading to a crash that injured another driver.

In July 1997, a first-year internal medicine resident driving home from Rush after 36 hours on call collided with a car driven by Heather Brewster, then 23. Brewster's head injury left her permanently disabled.

Brewster's attorney, Kevin Conway, and the Committee for Interns and Residents say there's now solid scientific evidence showing the negative effect of sleep deprivation on medical residents. For example, researchers in the Harvard Work Hours, Health and Safety Study found that first-year residents were twice as likely to have a car crash and almost six times as likely to have a near miss after working 24 or more hours.

Conway is optimistic that this evidence will move the Illinois Supreme Court to overturn the decision, if it decides to hear the appeal. He is adamant that hospitals requiring long hours from residents be held accountable.

"The question is whether or not the courts will blame the hospital, which actually caused the occurrence, or will limit the responsibility to the fatigued resident," Conway said.

He said the hospital's argument that a victory for Brewster would leave all hospitals vulnerable to a raft of similar lawsuits was misleading.

As far as he is aware, this is the only such case, Conway said. He said the argument citing the threat of future litigation implies that there are a string of people injured in car crashes caused by sleepy residents. If that's the case, Conway said, then it would behoove hospitals to address this safety issue by giving residents taxi coupons to get home or to work on it in another way.

But Rush's general counsel, George Galland, has argued in the past that if employers are held liable for employees' behavior after work, a jury would determine if an employee's hours were excessive. He said it wouldn't matter if a hospital followed the Accreditation Council for Graduate Medical Education's weekly 80-hour resident limit. All it would take to hold the employer responsible is a jury decision that the employer demanded too many hours from a worker.

Harry Franklin, general counsel for the Committee for Interns and Residents, said the decision from the 1st District Appellate Court did not dispute the scientific evidence but stated that it was not within the scope of current Illinois law to allow the hospital to be held liable.

The court chose not to expand the scope of Illinois law, he said, indicating such a decision should be made at a higher level, a challenge he hopes the state's Supreme Court will tackle.

"This is the first court to look at all the solid, scientific evidence that connects the hospitals to the injuries caused by residents who have to drive home after working 24 to 36 hours," Franklin said. "Now it's up to the Supreme Court to have the law catch up with this new knowledge and put liability where it belongs."