Alabama continues to support Disaster Preparedness systems and has worked to maintain an adequate Quality and Patient Safety Environment. However, the state continues to struggle with workforce shortages related to Access to Emergency Care and high rates of preventable injury and chronic disease.
Alabama has a relatively strong Disaster Preparedness system with several provisions in place to protect its citizens in the event of a disaster. For instance, the state addresses special needs patients, patients dependent on medication for chronic conditions, patients dependent on dialysis, mental health patients, and patients on psychotropic medications in its medical response plans. Furthermore, Alabama has made great improvements since the last Report Card in hospital capacity to respond to a disaster or mass casualty event, ranking among the top states for its bed surge capacity (1,634.0 beds per 1 million people), burn unit beds (11.0 per 1 million), and intensive care unit beds (350.1 per 1 million). The state also has strong liability protections in place for health care workers responding to a disaster, which will encourage a timely and effective medical response.
Alabama has been working to maintain its Quality and Patient Safety Environment by continuing to fund a state emergency medical services (EMS) medical director as well as quality improvement initiatives within the EMS system. The state has or is working on a stroke system of care, and it has destination policies in place that allow EMS to bypass local hospitals to take stroke patients to a hospital specialty center. In addition, 95% of patients with acute myocardial infarction are given percutaneous coronary intervention within 90 minutes, and the median time to transfer to another facility for chest pain patients is well below the average across the states (60 versus 72 minutes).
Alabama has failed to address its health care workforce shortage since the last Report Card, severely affecting overall Access to Emergency Care. Despite a slight increase in the number of emergency physicians, the state ranks 50th for having only 7.5 emergency physicians per 100,000 people. Alabama has low rates of specialists, including neurosurgeons, orthopedists, and plastic surgeons, as well as physicians accepting Medicare (2.0 per 100 beneficiaries) and mental health providers, with an additional 1.7 full-time providers needed per 100,000 people. While the state has lower-than-average rates of adults (14.9%) and children (7.3%) with no health insurance, a relatively large proportion of adults are underinsured (9.7%), which may further impede access to care.
Contributing to Alabama’s workforce shortage is an unfavorable Medical Liability Environment, which has not improved since the previous Report Card. The state continues to lack reforms that would require clear and convincing evidence of wrongdoing in medical liability cases involving Emergency Medical Treatment and Labor Act (EMTALA)-mandated care and medical liability caps on non-economic damages. Alabama has also failed to abolish joint and several liability or pass legislation that would prevent apologies made by health care providers from being used as evidence of wrongdoing. Finally, the average malpractice award payment is $330,942, representing a 12.5% increase since 2009.
Alabama’s workforce shortage is a critical challenge in light of the high rates of fatal injuries in several categories. Alabama has some of the nation’s highest rates of traffic fatalities (16.6 per 100,000 people), bicyclist fatalities (10.9 per 100,000 cyclists), pedestrian fatalities (11.0 per 100,000 pedestrians), homicides and suicides (22.5 per 100,000 people), and unintentional fire- or burn-related deaths (2.0 per 100,000 people). Alabama’s inhabitants also suffer disproportionately from chronic disease risk factors with high rates of adult and child obesity (32.0 and 18.6%, respectively) and a high percentage of adults who currently smoke (24.3%).
In the area of Public Health and Injury Prevention, there are several steps that Alabama could take to advance the health and safety of its citizens. With high rates of traffic fatalities, Alabama should consider strengthening its safety belt and child safety seat legislation. The state may consider expanding primary enforcement of its current adult seat belt law to cover all vehicle seats. Similarly, child safety restraint laws may be expanded to require that children through age 8 use booster seats, as opposed to current requirements that cover children through age 5. The state also lacks smoke-free legislation that targets worksites, restaurants, and bars, despite the high rates of adults who currently smoke and the known poor chronic health outcomes associated with tobacco use.
Alabama must work diligently to increase its health care workforce and implement measures to attract and retain emergency physicians, specialists, and primary care providers. Supporting a more favorable Medical Liability Environment would help address this issue. As such, the state should consider instituting additional liability protections for EMTALA-mandated care, requiring pretrial screening panels to determine whether a medical liability case has merit, and placing a $250,000 medical liability cap on non-economic damages.