Hurricane Katrina and its aftermath still play a significant role in Louisiana’s emergency care environment. While the state now ranks among the best in Disaster Preparedness, Katrina’s impact has also left Louisiana in dire need of more providers to care for a population that has large numbers of uninsured and a higher than average risk of suffering from preventable illnesses and injuries.
Strengths. Louisiana has made great strides in Disaster Preparedness, as reflected in high marks for nearly every disaster planning, training, and communication systems indicator in this Report Card. The state also ranks among the top in the country regarding the numbers of physicians and nurses registered in the state-based Emergency System for Advance Registration of Volunteer Health Professionals program.
Louisiana has in place a number of medical liability reform measures, including a medical liability cap on damages, mandatory pretrial screening panels, and the elimination of joint and several liability. The state has also implemented a patient compensation fund that covers damages totaling more than $100,000 for physicians participating in the program.
Challenges. Access to Emergency Care and crowding are major concerns in Louisiana, which is feeling the effects of attrition, hospital closures, and the loss of qualified emergency medical staff following Hurricane Katrina. Louisiana has severe shortages of primary care physicians (ranked 47th) and mental health professionals (ranked 48th). These significant shortages are likely contributors to growing problems with hospital crowding and emergency department boarding, as reported by emergency physicians in the state. Contributing to access issues, Louisiana has some of the highest rates of uninsured adults and children, for which it ranks 49th and 45th in the nation, respectively.
The lack of Level I or II trauma centers (0.2 per 1 million people) also poses a challenge. Fewer than twelve percent of Louisiana residents are within 60 minutes of a Level I or II trauma center, compared to an average of 76.0 percent across the states, resulting in the need to transfer patients over long distances or to neighboring states.
Louisiana’s failing grade in Public Health and Injury Prevention reflects a multitude of problems. The state has the second lowest rate of childhood immunizations and ranks 45th for influenza vaccination among older adults. Louisiana also has the third highest infant mortality rate (10.1 infant deaths per 1,000 live births), which is significantly higher than the nation as a whole (6.9 per 1,000). The state has among the highest percentages of adults who are obese (27.1 percent) and who smoke cigarettes (23.4 percent). The rates of unintentional fatalities from firearms or fires and burns are also among the worst in the country.
The Quality and Patient Safety Environment in Louisiana ranks among the lowest in the nation. There is no statewide trauma registry, uniform system for providing pre-arrival instructions, or funding for quality improvement within the EMS system. The state also lacks a hospital-based infections reporting requirement. The percentage of patients receiving PCI within 90 minutes of arrival with acute myocardial infarction is the second worst in the nation (34 percent).
Medical liability concerns have also surfaced as recent court action has placed the future of the state’s damage cap in serious doubt. Additionally, while emergency physicians in the state report shortages of specialists willing to provide on-call services for emergency patients, the state lacks any special liability protection for providers of EMTALA-mandated care.
Recommendations. Louisiana’s low grade in Public Health and Injury Prevention points to a critical need for greater investment in and application of targeted, effective, and culturally competent strategies to address preventable health risks, injuries, and mortality. In addition, the state could greatly improve the Quality and Patient Safety Environment by implementing a statewide trauma registry and providing funding for EMS quality improvement.
Louisiana also needs to improve Access to Emergency Care in the state by addressing current shortages of primary care and mental health providers. The state must also ensure that existing medical liability reforms are protected and expanded in order to attract more physicians to the state and encourage more specialists to provide on-call services.