The relatively healthy lifestyles of Connecticut residents place the state among the best in the nation for Public Health and Injury Prevention, but a lack of liability reforms and a shortage of facilities for treating disaster victims leaves the state vulnerable in key areas.
Strengths. Connecticut has numerous strengths with regard to Public Health and Injury Prevention. More than 86 percent of children aged 19–35 months are immunized, for which the state ranks third in the country. Connecticut has the fourth lowest rates of obesity and smoking among adults (20.6 and 17.0 percent, respectively). The state also has relatively low rates of both fatal occupational injuries (23.8 per 1 million workers) and traffic fatalities (8.6 per 100,000 people).
There are a number of indicators that positively contribute to Connecticut’s grade in Access to Emergency Care. Among those are the state’s relatively high rates of health care professionals per capita. Connecticut falls among the top 10 states with regard to neurosurgeons; orthopedists and hand surgeon specialists; plastic surgeons; and ear, nose, and throat specialists. In addition, Connecticut has 3.1 Level I or II trauma centers for every million residents, and every resident is within 60 minutes of a Level I or II trauma center. The state also boasts the sixth lowest percentage of uninsured adults (10.5 percent) and the fifth lowest percentage of uninsured children (6.0 percent).
Challenges. Connecticut’s most serious problems with regard to the Medical Liability Environment stem directly from high malpractice award payments and liability insurance premiums. The average award payment in Connecticut is $418,457, well above the average across the states of $285,218. Concurrently, the average medical liability insurance premiums for primary care physicians and specialists ($27,929 and $121,912, respectively) are significantly higher than the averages across the states ($16,042 and $65,489, respectively). Despite these high awards and premiums, Connecticut has not instituted a medical liability cap on non-economic damages or additional liability protections for EMTALA-mandated emergency care.
Emergency physicians in Connecticut have reported that boarding of patients in the emergency department and hospital crowding have become major concerns confronting the state’s health care system.
Connecticut’s grade for the Quality and Patient Safety Environment reflects the state’s lack of a uniform system for providing pre-arrival instructions, a stroke system of care, and a PCI network or STEMI system of care. In addition, the state does not provide funding for quality improvement within the EMS system.
The state received a below average score in Disaster Preparedness, due primarily to a relatively low capacity for handling disaster patients. The state has below-average rates of burn unit and ICU beds (4.3 and 255.5 per 1 million people, respectively). Connecticut’s bed surge capacity (356.9 beds per 1 million) is also significantly lower than the average among the states (673.4 beds per 1 million).
Recommendations. State policymakers should take steps to address boarding of admitted patients in the emergency department, as well as other issues related to hospital crowding, in order to ensure timely and quality care to patients. A system for collecting and reviewing data on ambulance diversions should be implemented and efforts should be made to address the low rate of staffed inpatient beds and the high hospital occupancy rate (80.4 per 100 staffed inpatient beds).
Connecticut should take immediate steps to implement major medical liability reforms. The state could benefit significantly from instituting a $250,000 medical liability cap on non-economic damages. Providing additional liability protections for EMTALA-mandated emergency care might encourage more specialists to provide on-call services for emergency patients. Connecticut could also benefit from a requirement that expert witnesses be licensed to practice medicine in the state.