Category Grades
45D+ 31D+
Access to Emergency Care:
48F 48F
Quality/Patient Safety:
29C 14B-
Medical Liability:
48F 29C-
Public Health/ Injury Prevention:
40D- 26D+
Disaster Preparedness:
9A- 24C-

Since the last Report Card, Arizona has made significant improvements to its Medical Liability Environment and addressed some challenges in Public Health and Injury Prevention. However, the state continues to struggle with health care workforce shortages and overall Access to Emergency Care.

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Arizona has made great strides in improving its Medical Liability Environment, having instituted several reforms that help protect practitioners and reduce frivolous lawsuits. It provides additional liability protections for Emergency Medical Treatment and Labor Act (EMTALA)-mandated emergency care that require clear and convincing evidence of negligence. It has also mandated expert witness rules that require that the witness be of the same specialty as the defendant. While the state still has relatively high average medical liability insurance premiums for primary care physicians ($17,883) and specialists ($65,100), these rates are considerably lower than reported in 2009.

Arizona continues to improve its Quality and Patient Safety Environment with strong and effective policies, including destination policies in place for both stroke and ST-elevation myocardial infarction patients, as well as funding for quality improvement of the EMS system. The state ranks among the top 10 for indicators related to quality of care for patients suffering cardiac events, including the proportion of patients with acute myocardial infarction given percutaneous coronary intervention within 90 minutes of arrival (91%) and the median time to transfer to another facility for chest pain patients (54 minutes). Arizona also has a unique sudden cardiac arrest reporting and education network called SHARE (Save Hearts in Arizona Research and Education), which includes the majority of people living in Arizona.


Arizona continues to struggle with Access to Emergency Care and ranks close to last in the nation in this category. The state ranks among the bottom 10 for access to several essential medical professionals, including registered nurses; ear, nose, and throat specialists; and orthopedists and hand surgeons. Arizona also has a great need for primary care and mental health care providers (4.3 and 2.1 fulltime providers needed per 100,000 people, respectively). There is a glaring need for better access to mental health care and substance abuse treatment in Arizona; the state has one of the lowest rates of psychiatric care beds available (11.6 per 100,000 people) and one of the highest levels of unmet need for substance abuse treatment (10.1%). Emergency physicians in the state report that psychiatric patients often spend days in the emergency department (ED) waiting for admission to inpatient behavioral health treatment beds.

Despite improvements in Public Health and Injury Prevention, Arizona still lags in the area of early childhood immunizations: only 68.1% of children received recommended immunizations. Although it has a relatively low obesity rate among adults (24.7%), the very high rate among children (19.8%) is a growing public health emergency. The state also has some of the highest rates of pedestrian fatalities (9.1 per 100,000 pedestrians), fall-related deaths (12.2 per 100,000), and unintentional poisoning-related deaths, which include drug overdoses (14.7 per 100,000).

While Arizona has maintained its strong Disaster Preparedness policies and procedures, it has lagged behind other states in the number of physicians, nurses, and behavioral health providers registered in the Emergency System for Advance Registration of Volunteer Health Professionals. The state also falls below average for bed surge capacity and intensive care unit beds per 1 million, which could impede timely, safe, and effective emergency care response during a major disaster or mass casualty event.


Arizona desperately needs to improve Access to Emergency Care by both growing the state's health care workforce and increasing hospital capacity to reduce ED boarding and crowding. Additional graduate medical education funding for more residency positions could be one strategy to help address the workforce shortage issue. The state needs to cultivate an environment that attracts and retains specialists, particularly for mental health care and substance abuse care, as well as on-call specialty care. The low numbers of psychiatric care beds, staffed inpatient beds, and number of EDs overall likely contribute to boarding and crowding, as evidenced in higher-than-average ED wait times (292 minutes from ED arrival to departure for admitted patients).

Arizona must continue to improve its Medical Liability Environment. While the state has taken major steps forward, more attention is needed to help further reduce physician liability insurance premiums to ensure that high insurance costs do not inhibit efforts to address physician workforce shortages. Adoption of pretrial screening panels could help further weed out frivolous lawsuits and reduce unnecessary liability-related costs.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 8.6 9.8
Emergency physicians per 100,000 pop 11.0 13.5
Neurosurgeons per 100,000 pop 1.6 1.7
Orthopedists and hand surgeon specialists per 100,000 pop 7.1 7.4
Plastic surgeons per 100,000 pop 2.2 2.2
ENT specialists per 100,000 pop 2.2 2.3
Registered nurses per 100,000 pop 560.8 691.3
Percent of children able to see provider 94.6
Level I or II trauma centers per 1M pop 1.1 1.1
Percent of population within 60 minutes of Level I or II trauma center 87.6 89.7
Accredited chest pain centers per 1M pop 1.4 4.6
Percent of population with an unmet need for substance abuse treatment 8.9 10.1
Pediatric specialty centers per 1M pop 1.8 1.8
Medicaid fee levels for office visits as a percent of the national average 140.4 104.0
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 16 -8.9
Percent of adults with no health insurance 22.3 18.6
Percent of adults underinsured 10.0
Percent of children with no health insurance 17.0 13.5
Percent of children underinsured 18.3
Percent of adults with Medicaid 10.4 11.8
Hospital closures in 2006/2011 0 1
Staffed inpatient beds per 100,000 pop 225.2 238.0
Hospital occupancy rate per 100 staffed beds 69.2 62.6
Psychiatric care beds per 100,000 pop 14.8 11.6
Median time from ED arrival to ED departure for admitted ED patients 292
State collects data on diversion YES YES

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $9.51 $5.08
State budget line item health care surge NO
ESF-8 plan is shared with all EMS and essential hospital personnel YES YES
Emergency physician input into the state planning process YES, NO YES
Public health and emergency physician input during an ESF-8 response NR
Drills, exercises conducted involving hospital personnel, equipment, or facilities per hospital
Accredited by the Emergency Management Accreditation Program (EMAP) YES, ACCREDITED YES
Special needs patients included in medical response plan YES YES
Patients dependent on medication for chronic conditions in medical response plan NO YES
Medical response plan for supplying dialysis NO YES
Mental health patients included in medical response plan YES
Medical response plan for supplying psychotropic medications NO
Mutual aid agreements in place with behavioral health providers STATE LEVEL
State requires long-term care and nursing home facilities to have a written disaster plan YES
State able to report number of exercises involving long-term care facilities or nursing YES
Just-in-time training systems in place STATEWIDE STATEWIDE
Statewide medical communication system with one layer of redundancy YES YES
Statewide patient tracking system YES YES
Statewide real-time or near real-time syndromic surveillance system YES YES
Real-time surveillance system in place for common ED presentations YES YES, STATEWIDE
Bed surge capacity per 1M pop 304.9 750.3
ICU beds per 1M pop 256.7 285.4
Burn unit beds per 1M pop 7.9 8.1
Verified burn centers per 1M pop 0.157759686 0.2
Physicians registered in ESAR-VHP per 1M pop 28.6 19.2
Nurses registered in ESAR-VHP per 1M pop 139.9 69.1
Behavioral health professionals registered in ESAR-VHP per 1M pop 5.6
Strike teams or medical assistance teams YES YES
Disaster training required for essential hospital/EMS personnel YES, YES NR
Percent of RNs that received emergency training 40.4 37.0

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 12.7 14.1
Lawyers per physician 0.5 0.6
Lawyers per emergency physician 11.2 10.5
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) -2 1
Malpractice award payments per 100,000 pop 1.2 2.7
Average malpractice award payments $275,771 $315.364
National Practitioner Databank reports per 1,000 physicians 27.1 39.2
Apology laws: Apology is inadmissible as evidence in a court of law YES
State has implemented a patient compensation fund NO NO
Number of insurers writing medical liability policies per 1,000 physicians 5.2 6
Average medical liability insurance premiums for primary care physicians $22,799 $17,883
Average medical liability insurance premiums for specialists $87,175 $65,100
Presence of pretrial screening panels NONE NO
Pretrial screening panel's findings admissible as evidence N/A N/A
Periodic payments are: required, granted upon request, at court's discretion NO NO
Medical liability cap on non-economic damages NONE NONE
Additional liability protection for EMTALA-mandated emergency care NO YES
Joint and several liability abolished YES YES
Collateral Source Rule/Provides for Awards to be Offset YES, NO OFFSET
State provides for case certification YES YES
Expert witness required to be of the same specialty as the defendant NO YES
Expert witness must be licensed to practice medicine in the state NO NO

Public Health & Injury Prevention

Title 2009
Report Card
Report Card
Bicyclist fatalities per 100,000 cyclists 3.9
Pedestrian fatalities per 100,000 pedestrians 9.1
Percent of traffic fatalities alcohol-related 45.0 32.0
Percent of front occupants using restraints 80.9 82.9
Child safety seat/seat belt legislation - score out of a possible 10 points 1 4
Helmet use required for all motorcylce riders NO NO
Distracted driving legislation score - out of a possible 4 points 0
Graduated drivers' licenses legislation score -out of a possible 5 points 0
Percentage of children aged 19-35 months who are immunized 74.8 68.1
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 65.4 57.9
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 66.5 71.3
Fatal occupational injuries per 1M workers 38.3 23.4
Homicides and suicides (non-motor vehicle)(per 100,000) 24.8 23.2
Unintentional fall-related fatal injuries (per 100,000) 11.8 12.2
Fire/burn related fatal injuries (per 100,000) 0.9 0.6
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.3 0.2
Rate of unintentional poisoning-related deaths (per 100,000) 14.7
Total injury prevention funds per 1,000 persons $18.42 $68.71
Dedicated child injury prevention funding YES
Dedicate elderly injury prevention funding NO
Dedicated occupational injury prevention funding NO
Anti-smoking legislation score - score out of a possible 3 points 3
Infant mortality rate per 1,000 live births 6.9 6.0
Percentage of adults who binge drink 15.2 18.0
Percentage of adults who currently smoke 18.2 19.2
Percentage of adult population who are obese (BMI > 30.0) 22.9 24.7
Percentage of children who are obese 19.8
Cardiovascular disease disparity ratio 1.5
HIV diagnosis disparity ratio 5.0
Infant mortality disparity ratio 2.5

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system YES YES
Funded state EMS medical director YES YES
Emergency medicine residents per 1M pop 10.6 18.9
Adverse event reporting required NO NO
% of counties with Enhanced 911 capability 93.3 100.0
State has a uniform system for providing pre-arrival instructions NO NO
State uses CDC guidelines for state field triage protocols YES (2011)
State has or is working on a stroke system of care YES YES
State has triage and destination policy in place for stroke patients YES
State has or is working on a PCI network or a STEMI system of care YES YES
State has triage and destination policy in place for STEMI patients YES
State maintains statewide trauma registry YES YES
State has triage and destination policy in place for trauma patients YES
Prescription drug monitoring program score (range 0-4) 2
% of hospitals with computerized practitioner order entry 28.4 88.6
% of hospitals with electronic medical records 40.3 92.0
% of patients with AMI given PCI within 90 minutes of arrival 44 91
Median time to transfer to another facility for acute coronary intervention 54
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 51.5
% of hospitals with or planning to develop a diversity strategy or plan 30.3

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