MAXIMUM DUTY HOURS

16.1

(a) Unless agreed otherwise by the affected residents, their Program Director and PAIRO, a resident shall not be scheduled or required to work two (2) or more consecutive periods of call. It is understood that the terms, "day of call", "night of call", "duty period", "call period" and other similar terms used in this Agreement, refer to a period of time which is twenty-four (24) hours or less in duration. It is understood and agreed that the twenty-four (24) hour limitation does not encompass a crossover period which ensures adequate handover of patient care responsibilities.

(b) No hospital department, division or service shall schedule residents for in-hospital call more than seven (7) nights in twenty-eight (28), including two (2) weekend days in eight (8) weekend days over that twenty-eight (28) day period. A weekend day is defined as a Saturday or a Sunday.

(c)

(i) As an exception to Articles 16.1(b) and 16.9, residents in a hospital department, division or service may be required to work up to an additional three (3) call periods over a six month block period (July 1 to December 31 and January 1 to June 30), but only if needed to replace a resident who is forced to miss scheduled call days due to unexpected, short-term sickness, being on a vacation for a period of two (2) consecutive weeks or more, or being absent in other circumstances beyond his/her control or due to emergency.

(ii) In selecting a resident to provide additional call coverage under this exception, the hospital department, division or service will first ask for volunteers. For clarity, this additional volunteered call shall not count as a "required" call pursuant to this provision.

(iii) Where no resident volunteers for additional call coverage under this exception, the hospital department, division or service may require a resident to provide such coverage but only provided there is no breach of other call provisions (with the exception of the two week notice requirement in Article 16.2) and provided that the resident is not subject to exceptional personal or family hardship. The hospital shall use its best efforts to minimize such required increased call responsibilities. For clarity, it is agreed that where a resident has been required to work three call periods under this provision, the resident cannot be required to work any additional call periods beyond those scheduled in accordance with Article 16.1(b) and (d).

(iv) Upon the hospital's designate being informed that a resident was required to provide call coverage under this provision, the hospital will advise both PAIRO and the resident's Program Director of such occurrence within two weeks of notification by the resident. The hospital shall identify a single individual to serve as the hospital designate.

(d) Schedules for out-of-hospital call shall be, on average, one (1) night in three (3). For greater clarity, no resident shall be required to do more than ten (10) nights of out of hospital call in thirty (30).

16.2 Duty schedules shall be published on a monthly basis at least two weeks prior to their effective date and copies shall be made available to residents and to PAIRO.

PAIRO, individual residents, and the hospitals all have an interest in certain information related to duty schedules that may not be immediately apparent from the centralized hospital call schedule prepared for or used by hospital locating.

Individuals responsible for preparing the call schedule on behalf of the hospital, including the Chief or Senior Resident where the hospital has delegated such responsibility to him or her, will forward the following information to PAIRO pursuant to this provision.

• hospital name
• service
• call period
• resident names
• type of call (in or out)
• resident vacation and other scheduled leaves
• weekends clearly identified
• a contact name and telephone/pager number
• the date and time the schedule is made

This information may be provided on a separate document from the schedule given to hospital locating, so as to ensure that the utility of the hospital locating call schedule is not diminished. Where the Chief or Senior Resident is responsible for preparing a call schedule which does not contain the information required in this Article, PAIRO agrees that it will not seek damages against the hospital for non-compliance with the information requirements of this Article.

16.3 Should a resident be away from the hospital, department, division or service for any reason whatsoever for any part of the calculation period referred to in 16.1, the maximum number of duty periods during such calculation period shall be based on the pro-rated number of working days present.

16.4

(a) After being available for service in-hospital for twenty-four (24) consecutive hours, a resident working on the service of anaesthesia or obstetrics/ gynaecology shall be relieved of all service and educational duties until the commencement of the next working day, after ensuring adequate handover of patient care responsibilities. Such handover shall not exceed one (1) hour.

After being available for service in-hospital for twenty-four (24) consecutive hours, a resident working on the service of ICU or CCU shall be relieved of all service and educational duties until the commencement of the next working day, after ensuring adequate handover of patient care responsibilities. Such handover shall not exceed one and one-half (1 1/2) hours.

For the purposes of this Article, the commencement of the next working day will be the normally established start time for the entire service.

(b) Until June 30, 2009, 16.4(b.1) applies:

(b.1) Residents working on services other than anaesthesia, obstetrics/ gynaecology, ICU or CCU, shall be relieved of their duties by 1200 hours on the day following their in-hospital call. As of July 1, 2009, 16.4 (b.1) is replaced by the following new 16.4 (b):

(b) For services other than anaesthesia, obstetrics/gynaecology, ICU or CCU the following applies:

(i) Where a service provides PAIRO with advance notice that the service cannot relieve residents of their responsibilities within the time set out in Article 16.4(b)(ii) below, residents working on that service shall be relieved of their responsibilities by no later than 1200 hours on the day following their in-hospital call, and Article 16.4(b)(ii) does not apply. A service's decision that Article 16.4(b)(ii) does not apply cannot be the subject of a grievance or arbitration, but will be addressed through the committee process set out in Article 16.4(b)(iii) below.

(ii) After being available for in-hospital call for twenty-four consecutive hours, residents shall be relieved of their duties after ensuring adequate handover of patient care responsibilities, and no new patient responsibilities will be assigned, except for responsibilities which are reasonably necessary to ensure appropriate clinical handover (including completion of sign-out notes, follow up on ordered investigations, and/or review/rounding with incoming team members to ensure appropriate transfer of care). The handover period will not exceed two hours following the end of the 24 hour in hospital call period. This provision does not apply, however, where at any time a service has provided notice under Article 16.4(b)(i) above.

(iii) The parties will establish a joint committee with the objective of jointly working on the issue of home after call for those programs which provide notice under 16.4(b)(i), and attempting to identify solutions which are mutually satisfactory, taking into account the respective interests of relieving residents of responsibilities after being on call for a 24 hour period, optimal patient care, and excellence in education. This committee will begin meeting within 30 days following ratification. The parties agree to use William Kaplan as a facilitator to the committee, in order to assist them in their desire for a satisfactory solution.

(c) For clarity, the right to be relieved of duties by 1200 hours in 16.4(b.1) applies to a resident on out-of-hospital call in either of the following two circumstances:

i) a resident who commences work in the hospital after midnight but before 6 a.m.; and,

ii) a resident who works for at least four (4) consecutive hours at least one hour of which extends beyond midnight.

Note: Effective July 1, 2009, if Home call is converted to in Hospital Call pursuant to 16.4(c)(i) or (ii) above, the call will be deemed to be In Hospital Call for the purposes of 16.4(b)(i) and (ii).

16.5 In those services/departments where a resident is required to do in-hospital shift work (e.g. emergency department, intensive care), the guidelines for determining Maximum Duty Hours of work will be a sixty (60) hour week or five (5) shifts of twelve (12) hours each. Housestaff working in these departments will receive at least two (2) complete weekends off per month and (except where the resident arranges or PAIRO agrees otherwise) shall between shifts be free of all scheduled clinical activities for a period of at least twelve hours. All scheduled activities, including shift work and educational rounds/seminars, will contribute towards calculating Maximum Duty Hours. Should a resident be away from the hospital, department, division or service for any reason for part of a week during which they are required to do shift work, the Maximum Duty Hours during the week shall be reduced on a pro rata basis.

16.6 Any difference concerning educational exceptions to the maximum call provisions in this Article shall be processed through the procedure outlined in Attachment 2 of this Agreement entitled "Memorandum Re: Maximum Duty Hours" rather than through the grievance procedure in Article 8.

16.7 It is agreed that no change in the Maximum Duty Hours under this Article will be made without the agreement of the parties and COFM.

16.8 A resident shall not be required to be on call at home two (2) consecutive weekends.

16.9 For the purpose of determining the maximum "blended" in-hospital or out-of-hospital call permitted under this Article, the total number of out-of-hospital call assignments multiplied by three (3) plus the total number of in-hospital call assignments multiplied by four (4) shall not exceed thirty (30) over a twenty-eight (28) day period.

16.10 Notwithstanding 16.1(b), PAIRO agrees that when a resident is scheduled on Friday night/Saturday morning call in conjunction with a Sunday call, only the Sunday call will be deemed to be a weekend call day. In turn, CAHO agrees that residents shall be free of all patient care duties, including scheduled weekend call, on at least two weekends (including Friday night/Saturday morning and the rest of Saturday and Sunday) over a 28-day or monthly call period. The parties understand and agree that the restrictions noted above do not apply when residents switch their weekend call schedules with another resident.