Libby Zion Law

Libby Zion (November 1965 – March 5, 1984) was a freshman at Bennington College in Bennington, Vermont. She took a prescribed MAOI antidepressant, phenelzine, daily. A hospital autopsy revealed traces of cocaine, but other later tests showed no traces. She was the daughter of Sidney Zion, a lawyer who had been a writer for The New York Times. Her obituary in The New York Times, written the day after her death, stated that she had been ill with a "flu-like ailment" for the past several days. The article stated that after being admitted to New York Hospital, she died of cardiac arrest, the cause of which was not known. Libby Zion had been admitted to the hospital through the emergency room by the resident physician assigned to the ER on the night of March 4. Raymond Sherman, the Zion family physician, agreed with their plan to hydrate and observe her. Zion was assigned to two residents, Luise Weinstein and Gregg Stone, who both evaluated her. Weinstein, a first-year resident physician (also referred to as intern or PGY-1), and Stone, a PGY-2 resident, were unable to determine the cause of Zion's illness, though Stone tentatively suggested that her condition might be a simple overreaction to a normal illness. After consulting with Dr. Sherman, the two prescribed pethidine (meperidine) to control the "strange jerking motions" that Zion had been exhibiting when she was admitted. Weinstein and Stone were both responsible for covering dozens of other patients. After evaluating Zion, they left. Luise 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 medical 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 had soared to . Weinstein was once again called, and measures were quickly taken to try to reduce her temperature, but Zion had a cardiac arrest and could not be resuscitated. Several years later, physicians concluded the combination of phenelzine and the pethidine given to her by Stone and Weinstein contributed to the development of serotonin syndrome, which led to increased agitation. This led Zion to pull on her intravenous catheter, causing Weinstein to order physical restraints, which Zion also fought against. By the time she finally fell asleep, her fever had already reached dangerous levels, and she died soon after of cardiac arrest. ==Publicity and trials==

Zion's parents became convinced their daughter's death was due to inadequate hospital staffing. Although the jury declined to indict for murder, in 1987 the intern and resident were charged with 38 counts of gross negligence and/or gross incompetence. The grand jury considered that a series of mistakes contributed to Zion's death, including the improper prescription of drugs and the failure to perform adequate diagnostic tests. The civil trial came to a close in 1995 when a Manhattan jury found that the two residents and Libby Zion's primary care doctor contributed to her death by prescribing the wrong drug, and ordered them to pay a total of $375,000 to Zion's family for her pain and suffering. The jury also found that Raymond Sherman, the primary care physician, had lied on the witness stand in denying he knew that Libby Zion was to be given pethidine. Although the jury found the three doctors negligent, none of them was found guilty of "wanton" negligence, i.e., demonstrating utter disregard for the patient, as opposed to a simple mistake. Payouts for wanton negligence would not have been covered by the doctors' malpractice insurance. == Law and regulations ==

After the grand jury's indictment of the two residents, Axelrod decided to address the systemic problems in residency by establishing a blue-ribbon panel of experts headed by Bertrand M. Bell, a primary care physician at the Albert Einstein College of Medicine in the Bronx. Bell was well known for his critical stance regarding the lack of supervision of physicians-in-training. Formally known as the Ad Hoc Advisory Committee on Emergency Services, and more commonly known as the Bell Commission, the committee evaluated the training and supervision of doctors in the state, and developed a series of recommendations that addressed several patient-care issues, including restraint usage, medication systems, and resident work hours. The Bell Commission recommendations that attending physicians should be present at all times and limiting residents to 80 hours a week and 24 hours at a time were adopted by New York in 1989. Implementation of the recommendations caused some hospitals to introduce doctors who worked overnight to spell their colleagues. Periodic follow-up audits have prompted the New York State Department of Health to crack down on violating hospitals. Similar limits have since been adopted in numerous other states. In July 2003, the Accreditation Council for Graduate Medical Education (ACGME) adopted similar regulations for all accredited medical training institutions in the United States. == See also ==