Nevada’s poor showing not only includes failing grades in Access to Emergency Care and Disaster Preparedness, but also last place rankings for indicators in other categories as well.
Strengths. Nevada ranks 11th in the nation with regard to its Medical Liability Environment. This is reflective of the state’s success in passing numerous liability reforms. These include a $350,000 medical liability cap on non-economic damages and expert witness rules providing for case certification.
While Nevada’s Public Health and Injury Prevention grade leaves much room for improvement, the state demonstrates a few successes with regard to traffic safety indicators. The state has a universal helmet law requiring all riders to wear a helmet regardless of their position on all motorized cycles. The state also has a high rate of seat belt use, with 92.2 percent of front seat occupants using seat belts.
Challenges. The Quality and Patient Safety Environment in Nevada faces numerous challenges. Nevada ranks last in the nation for the percentage of patients with acute myocardial infarction receiving PCI within 90 minutes of arrival. There is no funding for a state EMS medical director position or quality improvement within the EMS system. The state’s lack of funding may be reflected in the low percentage of counties with Enhanced 911 capability (52.9 percent), for which the state ranks 50th.
Overall, Nevada fares poorly with regard to Public Health and Injury Prevention. The state has the nation’s lowest percentages of both childhood immunizations and annual influenza vaccinations among older adults. The state also has the second highest rate of homicides and suicides, at 27.8 per 100,000 people. The rate of traffic fatalities is higher than in most states (17.3 per 100,000), as is the percentage of traffic fatalities that are alcohol-related (43.0 percent).
Regarding Access to Emergency Care, Nevada faces severe shortages of medical specialists; the state ranks last or near last with regard to the rate of neurosurgeons; orthopedists and hand surgeons; ear, nose, and throat specialists; and registered nurses. The state fares only slightly better regarding the supply of emergency physicians and plastic surgeons. The state is ranked 48th for the proportion of uninsured children (18.8 versus 11.7 percent nationally) and 42nd for the percentage of uninsured adults (19.8 versus 17.2 percent nationally). The state also ranks among the bottom 10 for its low rates of emergency departments, staffed inpatient beds, and psychiatric care beds per capita, as well as for its high daily hospital occupancy rate.
Nevada receives a poor grade in Disaster Preparedness, as well. It lacks a statewide medical communication system with one layer of redundancy, patient and victim tracking systems, and medical assistance teams. The state also lacks the ability to verify credentials of volunteer health professionals and assign them to one of four levels within a state-based Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) program.
Recommendations. Access to Emergency Care in Nevada is in crisis. The state must employ strategies to increase the recruitment and retention of providers, including specialists, registered nurses, and emergency medicine residents. There is also an urgent need to address the high rates of uninsured children and adults, increase immunization rates, and expand patient bed capacity. Nevada needs to build on or expand systems to ensure high standards, coordination, and quality for both emergency and disaster situations (e.g., by developing a state-based ESAR-VHP system or implementing a PCI network or STEMI system of care).
While Nevada fares well in comparison to other states with regard to the Medical Liability Environment, average medical liability insurance premiums and malpractice awards are higher than the averages across the states. The state could further alleviate the medical liability burden on physicians by providing additional liability protections for EMTALA-mandated emergency care, requiring pretrial screening panels, and requiring or providing for expert witnesses to be licensed to practice in the state.