Category Grades
51D- 50D-
Access to Emergency Care:
35D- 39F
Quality/Patient Safety:
50F 41D
Medical Liability:
12C+ 37D-
Public Health/ Injury Prevention:
47F 48F
Disaster Preparedness:
48F 36D-

Arkansas continues to struggle with its emergency care environment but has made laudable improvements in Quality and Patient Safety and Disaster Preparedness over the past 5 years. Reversing the trend in its Medical Liability Environment, strengthening current systems for ensuring quality health care and patient safety, and improving Access to Emergency Care will help the state face its formidable public health and injury problems.

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Arkansas moved up 12 places in Disaster Preparedness, largely due to its enhanced hospital capacity for responding to a disaster. The state has one of the highest per capita number of ICU beds (396.0 per 1 million people), as well as a high bed surge capacity (1,332.6 per 1 million). Since the previous Report Card, Arkansas has been accredited by the Emergency Management Accreditation Program and implemented liability protections for health care workers during a declared disaster.

Arkansas has also made improvements to its Quality and Patient Safety Environment. The state has or is working on a stroke system of care, as well as a percutaneous coronary intervention (PCI) network or ST-elevation myocardial infarction (STEMI) system of care, and has implemented destination policies to allow EMS to bypass local hospitals to take STEMI and stroke patients to hospital specialty centers. The state ranks fifth in the nation in the time that it takes to transfer a chest pain patient to another facility (50 minutes). Arkansas hospitals have demonstrated a commitment to quality improvement, with 77.7% collecting data on race/ethnicity and primary language and 51.5% having or planning to develop a diversity strategy.

While Arkansas received poor marks in Access to Emergency Care overall, it has seen a number of improvements related to its hospital capacity. In 2009, Arkansas was the only state in the nation with no Level I or II trauma centers; now the state has four certified trauma centers, greatly improving access to life-saving emergency care. The state has the third highest number of psychiatric care beds per capita (50.0 per 100,000 people), as well as a relatively high rate of staffed inpatient beds (377.9 per 100,000 people) and low hospital occupancy rate (57.9 per 100 staffed beds). As such, the state enjoys the 13th lowest emergency department (ED) wait time (223 minutes from ED arrival to ED departure for admitted patients).


Arkansas faces significant challenges in several areas. It continues to be one of the last states in terms of Public Health and Injury Prevention, with poor ratings on a wide range of indicators. Arkansas has one of the highest rates of traffic fatalities for drivers and passengers (17.9 per 100,000 people), as well as notably high rates of bicyclist fatalities (11.3 per 100,000 cyclists) and pedestrian fatalities (8.1 per 100,000 pedestrians). Arkansas fares poorly in indicators of chronic disease burden and risk. The state has one of the highest adult smoking rates (27.0%) and very high rates of obesity among adults (30.9%) and children (20.0%).

Arkansas suffers several notable workforce shortages, which greatly impede Access to Emergency Care. The state ranks among the bottom five for emergency physicians, orthopedists and hand surgery specialists, and plastic surgeons. The state also has the lowest per capita rate of physicians accepting Medicare (1.7 per 100 beneficiaries), and its Medicaid fee levels have remained stagnant since 2007.

Arkansas's Medical Liability Environment is mixed. On the positive side, the state has one of the lowest average medical liability insurance premiums for primary care physicians ($7,119) and specialists ($31,602). On the negative side, it has seen an increase in the average medical malpractice award payment; had its provisions for case certification declared unconstitutional; and has failed to enact many important liability reforms.


Arkansas's high rate of traffic-related fatalities points to a need for education and legislation related to traffic safety. The state should consider passing legislation to require motorcycle riders to wear a helmet and require that all car occupants use seat belts in all seats. Additionally, given the third highest rate of adults who currently smoke in the nation, public health officials in Arkansas should focus on passing smoke-free legislation for bars, restaurants, and worksites.

To help combat its workforce shortages and improve overall Access to Emergency Care, Arkansas should enact such medical liability reforms as a medical liability cap on non-economic damages, additional liability protections for care mandated by the Emergency Medical Treatment and Labor Act (EMTALA), pretrial screening panels, and a complete repeal of joint and several liability. Improving the Medical Liability Environment will help to ensure that the state can recruit and retain a health care workforce that matches the gains made in hospital capacity and specialty facilities.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 4.0 4.6
Emergency physicians per 100,000 pop 6.9 8.3
Neurosurgeons per 100,000 pop 1.8 2.1
Orthopedists and hand surgeon specialists per 100,000 pop 6.7 6.9
Plastic surgeons per 100,000 pop 1.1 1.2
ENT specialists per 100,000 pop 3.0 3.2
Registered nurses per 100,000 pop 780.3 801.4
Percent of children able to see provider 95.0
Level I or II trauma centers per 1M pop 0.0 1.4
Percent of population within 60 minutes of Level I or II trauma center 12.6 17.9
Accredited chest pain centers per 1M pop 0.4 2.4
Percent of population with an unmet need for substance abuse treatment 7.4 8.0
Pediatric specialty centers per 1M pop 3.9 3.7
Medicaid fee levels for office visits as a percent of the national average 103.0 83.8
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 10 0.0
Percent of adults with no health insurance 22.1 20.4
Percent of adults underinsured 9.8
Percent of children with no health insurance 9.3 8.1
Percent of children underinsured 15.0
Percent of adults with Medicaid 6.3 8.9
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 392.2 377.9
Hospital occupancy rate per 100 staffed beds 60.4 57.9
Psychiatric care beds per 100,000 pop 45.3 50.0
Median time from ED arrival to ED departure for admitted ED patients 223
State collects data on diversion NR NO

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $7.34 $5.93
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, YES NO
Public health and emergency physician input during an ESF-8 response YES, NO
Drills, exercises conducted involving hospital personnel, equipment, or facilities per hospital
Accredited by the Emergency Management Accreditation Program (EMAP) NO YES
Special needs patients included in medical response plan NR NR
Patients dependent on medication for chronic conditions in medical response plan NR NR
Medical response plan for supplying dialysis NR NR
Mental health patients included in medical response plan NR
Medical response plan for supplying psychotropic medications NR
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 NO
State able to report number of exercises involving long-term care facilities or nursing NO
Just-in-time training systems in place STATEWIDE COUNTY or CITYWIDE
Statewide medical communication system with one layer of redundancy NO YES
Statewide patient tracking system NO NO
Statewide real-time or near real-time syndromic surveillance system NO NO
Real-time surveillance system in place for common ED presentations NR NO
Bed surge capacity per 1M pop NR 1332.6
ICU beds per 1M pop 427.5 396.0
Burn unit beds per 1M pop 3.5 3.4
Verified burn centers per 1M pop 0.352758945 0.3
Physicians registered in ESAR-VHP per 1M pop 17.6 19.3
Nurses registered in ESAR-VHP per 1M pop 70.6 108.5
Behavioral health professionals registered in ESAR-VHP per 1M pop 9.2
Strike teams or medical assistance teams YES YES
Disaster training required for essential hospital/EMS personnel YES, NO YES
Percent of RNs that received emergency training 33.9 36.3

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 10.5 11.7
Lawyers per physician 0.5 0.6
Lawyers per emergency physician 15.1 14.1
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 0
Malpractice award payments per 100,000 pop 2.0 2.0
Average malpractice award payments $239,128 $286,534
National Practitioner Databank reports per 1,000 physicians 16.8 25.5
Apology laws: Apology is inadmissible as evidence in a court of law NO
State has implemented a patient compensation fund NO NO
Number of insurers writing medical liability policies per 1,000 physicians 9.8 11.8
Average medical liability insurance premiums for primary care physicians $7,633 $7,119
Average medical liability insurance premiums for specialists $32,638 $31,602
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 UPON REQUEST OR AGREEMENT OF PARTY(IES) UPON REQUEST
Medical liability cap on non-economic damages NONE NONE
Additional liability protection for EMTALA-mandated emergency care NO NO
Joint and several liability abolished YES NO
Collateral Source Rule/Provides for Awards to be Offset NO
State provides for case certification YES NO
Expert witness required to be of the same specialty as the defendant YES 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 11.3
Pedestrian fatalities per 100,000 pedestrians 8.1
Percent of traffic fatalities alcohol-related 38.0 35.0
Percent of front occupants using restraints 69.9 78.4
Child safety seat/seat belt legislation - score out of a possible 10 points 2 5
Helmet use required for all motorcylce riders NO NO
Distracted driving legislation score - out of a possible 4 points 2
Graduated drivers' licenses legislation score -out of a possible 5 points 0
Percentage of children aged 19-35 months who are immunized 74.9 79.1
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 68.6 57.3
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 64.4 68.5
Fatal occupational injuries per 1M workers 60.6 66.9
Homicides and suicides (non-motor vehicle)(per 100,000) 22.3 22.3
Unintentional fall-related fatal injuries (per 100,000) 4.9 7.8
Fire/burn related fatal injuries (per 100,000) 2.7 2.0
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.7 0.6
Rate of unintentional poisoning-related deaths (per 100,000) 8.8
Total injury prevention funds per 1,000 persons $125.82 $1,199.77
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 1
Infant mortality rate per 1,000 live births 7.9 7.3
Percentage of adults who binge drink 12.4 14.1
Percentage of adults who currently smoke 23.7 27.0
Percentage of adult population who are obese (BMI > 30.0) 26.9 30.9
Percentage of children who are obese 20.0
Cardiovascular disease disparity ratio 2.5
HIV diagnosis disparity ratio 5.8
Infant mortality disparity ratio 2.5

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system NR NO
Funded state EMS medical director YES NO
Emergency medicine residents per 1M pop 8.8 8.1
Adverse event reporting required NO NO
% of counties with Enhanced 911 capability 94.7 94.7
State has a uniform system for providing pre-arrival instructions NR NO
State uses CDC guidelines for state field triage protocols YES (2011)
State has or is working on a stroke system of care NR 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 NR 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 4.0 68.5
% of hospitals with electronic medical records 23.3 85.4
% of patients with AMI given PCI within 90 minutes of arrival 49 93
Median time to transfer to another facility for acute coronary intervention 50
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 77.7
% of hospitals with or planning to develop a diversity strategy or plan 51.5

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