New York scored among the best states in the nation for its Disaster Preparedness efforts but among the worst for its Medical Liability Environment. Access to Emergency Care suffers from some disconcerting factors including low numbers of emergency departments, primary care providers, and mental health professionals.
Strengths. New York has in place multiple systems to promote the Quality and Patient Safety Environment, including required adverse event reporting and reporting of hospital-based infections, as well as a statewide trauma registry. New York also ranked fourth for its high rate of emergency medicine residents (38.1 per 1 million people).
New York received a high score in Disaster Preparedness due to a wide array of planning activities and capacity. In addition to an all-hazards medical response plan that is shared with EMS and essential hospital personnel, the state has a written plan for special needs patients. The state requires disaster management training for EMS and essential hospital personnel and provides additional liability protections to health care workers during a disaster. There is a real-time or near real-time syndromic surveillance system, as well as a real-time surveillance system for common emergency department presentations. New York ranks 2nd and 14th, respectively, for the per capita rates of physicians and nurses enrolled in the state-based Emergency System for Advance Registration of Volunteer Health Professionals program.
Regarding Public Health and Injury Prevention, New York ranked among the top eight states for its low rates of traffic fatalities, homicides and suicides, fatal occupational injuries, and unintentional firearm-related fatal injuries. The infant mortality rate is 5.8 deaths per 1,000 live births compared with 6.9 per 1,000 nationally. The state also has below average rates of obese adults (22.9 percent) and adult smokers (18.2 percent).
Challenges. New York’s poor showing regarding Access to Emergency Care reflects a myriad of problems. While New York has average rates of medical specialists overall, the state ranks 46th and 49th for access to primary care and mental health providers, respectively. The state has the third lowest rate of emergency departments (7.1 per 1 million people) and the second highest daily hospital occupancy rate (80.6 per 100 staffed beds). New York also ranks 46th for the low rate of pediatric specialty centers (2.2 per 1 million people). Finally, Medicaid fee levels for office visits are only 59.3 percent of the national average.
The Medical Liability Environment in New York is among the worst in the nation. The state’s average malpractice award payment is significantly higher than the average across the states ($356,003 versus $285,218, respectively), while average medical liability insurance premiums for specialists are 46 percent higher than the average across the states ($95,567 versus $65,489, respectively). New York has failed to enact reforms such as pretrial screening panels, a medical liability cap on non-economic damages, and expert witness rules that require the witness to be of the same specialty as the defendant, among others.
Recommendations. As reflected in the state’s grade for the Medical Liability Environment, New York policymakers must work to institute comprehensive medical liability reform. The already high and escalating insurance premiums for primary care physicians and specialists must be addressed to help attract and retain physicians. The state should consider enacting special liability protections for EMTALA-mandated emergency care to help encourage more specialists to provide needed on-call services for emergency patients. A shortage of on-call specialists has been reported by emergency physicians in the state as a significant problem.
Emergency physicians also report serious problems with hospital crowding and boarding of patients in emergency departments. As first steps toward addressing these problems, the state could work toward increasing the number of staffed and available inpatient and psychiatric care beds. The state might also institute a mechanism to track the time spent in the emergency department for admitted and discharged patients to identify areas for improvement.
Finally, the state must address the dearth of primary care and mental health providers and reduce barriers for accessing those services.