Emergency Care in Critical Condition: Study

Published February 1, 2006

The American College of Emergency Physicians (ACEP) has unveiled the first comprehensive, state-by-state report card on the status of emergency medicine in the United States. The January study found most states’ emergency programs are in critical condition.

An ACEP task force collected data from all 50 states and the District of Columbia in the categories of access to care, quality and patient safety, measures to prevent injuries or public health crises, and medical liability issues.

Announcing the results January 10 at the National Press Club, Angela Gardner, M.D., an emergency room physician and chairman of the report card task force, revealed the national overall grade of “C-” and cited overcrowding, declining access to care, soaring liability costs, and a poor capacity to deal with natural and manmade disasters as major reasons for the poor rating.

ACEP is the national medical specialty society representing emergency medicine, with more than 23,000 members. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, Puerto Rico, the District of Columbia, and the military.

California Leads

California led the country with the best average grade, a “B,” followed by Massachusetts, Connecticut, and the District of Columbia. (See table.)

According to ACEP data, California did well in the public health and injury prevention category because, relative to other states, there were fewer automobile fatalities in which the person killed was not wearing a seat belt. It also ranked well against other states in having fewer alcohol-related fatalities. California also received high marks for its vaccination record, measured as the percent of adults 65 and older who have ever received a pneumococcal vaccine and the percent of adults 65 and older who received a flu vaccine in the past year.

California also scored well in the medical liability environment category because of its model $250,000 cap on noneconomic damages. The cap helped the state achieve lower increases in physicians’ and specialists’ medical liability insurance rates.

Although it leads the nation overall, California scored last among all states and the District of Columbia for its number of emergency departments per one million people. The state also has fewer registered nurses and hospital beds than appropriate for its population and needs to immunize more children, the study noted.

Arkansas Lags

Arkansas was “dead last,” with a grade of “D,” Gardner noted. According to the study, the state’s “low annual state contributions to the State Children’s Health Insurance Program (SCHIP) per 100 children younger than age 18,” along with an insufficient number of trauma centers, a high number of annual emergency visits per board-certified emergency physician, and too few board-certified emergency physicians per 100,000 people contributed to the near-failing grade.

On the positive side, Arkansas ranked 9th in the country in the number of emergency departments per one million people and 7th overall for the number of hospital-staffed beds per one thousand people.

More than 80 percent of the states earned poor or near-failing overall grades (C+ to D).

Neglect, Unfunded Mandate Cited

Georges C. Benjamin, M.D., executive director of the American Public Health Association, speaking at the January 10 National Press Club event, called the report card “a wake up call” to a system that is “crumbling before our eyes.” In the event of a pandemic flu or bioterrorist attack, Benjamin said, the nation’s emergency departments’ “capacity to handle a disaster is questionable.

“We should all be concerned,” said Benjamin, former director of emergency medicine for Walter Reed Hospital and of the ambulance unit for the D.C. fire department.

ACEP President Frederick C. Blum echoed his colleagues’ concerns, pointing out emergency doctors “treat everyone regardless of their ability to pay, an ‘unfunded mandate’ that has become a ‘huge problem.'” He urged press and policymakers to begin a national dialogue based on the report card findings.

Liability Crisis Stifling Care

Emergency medicine should be “treated as the public service that it is,” said Blum. With medical liability at a crisis point, where neurosurgeons will not practice in emergency rooms and obstetricians do not want to deliver babies there, “it’s not a sustainable way to do business,” Blum said. And yet patients with neurological illnesses and injuries, and women in labor, continue to come to emergency rooms.

The task force analyzed data from a wide range of sources, including the American Medical Association, American Nurses Association, Henry J. Kaiser Family Foundation, and U.S. Department of Health and Human Services. A group of emergency physicians assigned the grades by considering 50 measurements common to all states. A “curved” grading system was used, assigning grades by comparing each state with the highest ranked state in each category.

Susan Konig ([email protected]) is managing editor of Health Care News.

For more information …

Policymakers and the public can visit the ACEP Web site at http://www.acep.org and view individual state report cards. The 129-page ACEP National Report Card is available online at http://my.acep.org/site/DocServer/2006-NationalReportCard.pdf?docID=221.