Colorado ranked 1st in the nation with regard to the Medical Liability Environment, and placed 13th for its overall emergency care environment, but some serious concerns remain including high percentages of uninsured residents.
Strengths. Colorado leads the nation with regard to the Medical Liability Environment because it has implemented numerous reforms, including case certification by expert witnesses, requiring expert witnesses to be of the same specialty as the defendant, and ensuring that expert witnesses are licensed in the state. Colorado has also implemented and maintained a $300,000 cap on non-economic damages.
Regarding public health indicators, Colorado is among the best-performing states with regard to vaccination rates for adults aged 65 years and older and has the lowest percentage of obese adults of any state (18.2 percent). In addition, Colorado has a relatively low rate of smokers (17.9 percent of adults).
Colorado also has some noteworthy successes in Disaster Preparedness. It is one of only two states to offer civil and criminal liability protections to health care workers during a disaster. Colorado also ranks fifth among the states reporting bed surge capacity, with 1,337 beds per 1 million people.
Challenges. Access to Emergency Care is a critical issue in Colorado. The state has a high percentage of uninsured residents, ranking 9th worst in the nation for the percentage of children who are uninsured (14.6 percent) and 16th worst for its rate of uninsured adults (18.1 percent).
Emergency physicians in the state are also reporting increasing problems with crowding and boarding, a serious issue that is potentially exacerbated by low rates of staffed inpatient beds (237.3 per 100,000 people) and psychiatric care beds (11.8 per 100,000), for which the state ranks 47th and 50th, respectively.
Colorado is lacking with regard to the Quality and Patient Safety Environment. The state does not provide funding for quality improvement of the Emergency Medical Services system or have a uniform system for providing pre-arrival instructions. In addition, the state does not have a stroke system of care or a PCI network or STEMI system of care. The state also fares poorly with regard to the use of information technology in hospitals: 25.7 percent of hospitals have electronic medical records, while only 15.8 percent have computerized practitioner order entry, both of which are intended to reduce medication and treatment errors when used properly.
Recommendations. Colorado should take immediate steps to improve access to care by increasing the number of children and adults who have adequate health insurance coverage. To further enhance access and help alleviate hospital crowding and emergency department patient boarding, Colorado should work to establish an adequate supply of hospital inpatient beds and psychiatric care beds. Disaster Preparedness efforts could also be strengthened by increasing the state’s below-average number of burn beds and ICU beds (5.6 and 271.1 per 1 million people, respectively).
Colorado could improve Public Health and Injury Prevention in a number of ways, including instituting a universal motorcycle helmet requirement and a primary seat belt law. The state would also benefit from addressing the relatively high rate of binge drinkers (16.4 percent of adults).
While Colorado enjoys the best Medical Liability Environment in the United States, the state should act to maintain the current reforms and not increase the medical liability cap as has been proposed in the past. In addition, the state may consider additional liability protections for EMTALA-mandated emergency care as another means of improving the Medical Liability Environment and drawing physicians and specialists to the state.