Health Brooklyn Boro

Overwhelmed Public Hospital Doctor Trainees Detail Grueling Pandemic Work Conditions

September 28, 2021 By Claudia Irizzary Aponte, THE CITY
Dr. Omar Fattal, Behavioral Health at NYC Health and Hospitals and Clinical Associate Professor at NYU Grossman School of Medicine, testifies during the City Council Committee on Hospitals meeting on NYC interns and residents’ health. Screengrab/New York City Council
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Logo for THE CITYThis article was originally published on by THE CITY.

Public hospital officials acknowledged Friday that the system is ill-equipped to respond to staff suicides following at least two incidents in which medical residents took their own lives during the pandemic.

The admission came at a hearing Councilmember Carlina Rivera (D-Manhattan) called  following three deaths since last summer among medical residents in training at Lincoln Hospital in The Bronx, after reports by THE CITY and the Daily News in July.

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The speakers, who work at Kings County, Coney Island Hospital, Bellevue, Metropolitan and other public hospitals, implored city officials and lawmakers to increase funding for the H+H system. They cited critical staff and equipment shortages and major factors contributing to their stress and mental health struggles — often at the expense of the patients in their care.

At the hearing, a Kings County resident, testifying anonymously, said shortages are so drastic at the facility that clinicians created a WhatsApp group called “Where is the ultrasound?,” to track the whereabouts of the lone imaging tool that services three entire floors of the hospital’s internal medicine wards.

Rivera grilled Health + Hospitals Corporation executives about a statement H+H Chief Equality Officer Dr. Eric Wei made to THE CITY in July, in which he declared that an existing mental health and wellness program called Helping Healers Heal is “not meant to address suicide.”

Dr. Omar Fattal, H+H’s deputy medical director at the Office of Behavioral Health, affirmed that the program “in and of itself doesn’t address suicide,” noting the peer-support model “is not a clinical encounter.”

The agency is in the process of hiring “a crisis response education lead” who can be deployed “if and when a tragedy occurs,” testified Jeremy Segall, the assistant vice president and chief wellness officer at H+H.

Two dozen residents and interns then testified at the oversight hearing, which focused on the mental health struggles of medical trainees at the city’s public hospitals as well as allegations of harassment against them.

“It’s sad to see my patients are not satisfied with the care they receive and that their concerns are valid,” said a resident who testified anonymously. “When my patient tells me she refused her water pill since there is no nurse to help her with urination, and she has to be in her urine for hours, it makes me sad and it feels like I have failed my patients.”

‘Ill-Equipped and Poorly Staffed’

Hospital residency programs, where medical school graduates receive training and prepare for specialties, are notoriously tough, with trainees working long hours.

Working conditions for residents have long been targets for reform. Thanks to past changes, residents may work no more than 80 hours a week, averaged over four weeks, and no more than 24 hours on duty at a time, with certain exceptions.

The Committee for Interns and Residents, a union representing the state’s medical trainees, is pushing for a strict 80-hour work week limit, “not as an average and including non-clinical tasks.”

Dr. Ernesto Blanco, a former resident at Coney Island Hospital, testified Friday that his program was “very unsympathetic” when he requested time off to deal with the crisis his family faced in 2019 when his home country of Venezuela collapsed.

“I had to fight to get time off and I eventually was told I could take four days off. On the second day, I started getting called and asked when I was coming back,” he said. “My program director said to me, ‘You need to come back, this is not the way to deal with things.’”

“When we do dare speak about the struggles that we’re facing, it seems that we are not being listened to,” he said.

Coney Island Hospital on Ocean Parkway in southern Brooklyn.
Photo courtesy of NYC Health and Hospitals

Double Duty

Dr. Dina Jarber, an internal medicine resident at Kings County, testified that due to staff shortages, residents often have to perform phlebotomy tasks usually reserved for nurses, taking time away from their treatment of patients.

“I feel like the nurses and the techs are totally understaffed,” she said.

The mixing of duties “doesn’t create a good culture between the nurses and the residents, which is a further stressor for us, for the nurses, and clearly is not good for our patients,” Jarber added.

At the hearing, Rivera implored city hospital officials to ensure that “wellness programs are accessible to residents, and that they are safe spaces.”

Even with existing wellness programs, many residents say they are afraid to speak up after seeing or experiencing what they saw as bullying behavior. That includes one former Lincoln trainee who told THE CITY in July that program leaders and even some fellow residents scolded her as too soft for the job after she said she was struggling emotionally.

Residents alleged harassment and retaliation from management at Lincoln Hospital, with current and former trainees at the hospital claiming a harsh culture took toll before three residents died in a span of eight months, two of them by suicide. In an op-ed, Lincoln medical director Dr. Vihren Dimitrov and director of internal medicine Dr. Nehad Shabarek emphatically denied claims of a “toxic” work culture.

Rivera said at the hearing that “all residents should feel safe, providing feedback about their programs without fear of retaliation.”

A spokesperson for Health + Hospitals, Stephanie Guzman, provided a statement to THE CITY in response to Friday’s testimony.

“NYC Health + Hospitals’ interns and residents are essential members of our health care teams and have heroically served New Yorkers though the COVID-19 pandemic. We are proud of their contributions and recognize the challenges they have faced during this devastating pandemic,” she wrote.

“All claims of unhealthy, unsafe, or unfair work conditions are taken seriously and reviewed by the system. We respect and welcome our residents to be a part of the public process and we’re committed to work with them on addressing these claims appropriately.”

THE CITY is an independent, nonprofit news outlet dedicated to hard-hitting reporting that serves the people of New York.


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