North Carolina has made excellent progress in improving its Medical Liability Environment since 2009, which is reflected in its overall performance. However, critical issues hindering Access to Emergency Care have not been adequately addressed and continue to burden the entire emergency care system.
North Carolina should be applauded for passing legislation to improve the Medical Liability Environment, including a requirement that clear and convincing evidence be provided as proof of medical negligence in suits related to the provision of care mandated by the Emergency Medical Treatment and Labor Act (EMTALA), adding one additional layer of liability protection for physicians who provide emergency care. The state also instituted a $500,000 medical liability cap on non-economic damages in 2011. Since 2009, North Carolina has seen average medical liability insurance premiums decrease by more than 25% for both primary care physicians and specialists. Average medical malpractice award payments decreased as well.
North Carolina received high marks in Quality and Patient Safety for having implemented a prescription drug monitoring program that monitors drug schedules II to V; putting in place stroke and ST-elevation myocardial infarction (STEMI) systems of care, including destination policies that allow emergency medical services to bypass local hospitals to take patients to hospital specialty centers; and ranking third in the nation for fewest minutes before outpatients with chest pain were transferred to an appropriate hospital (47 minutes). Nearly 97% of the state's hospitals have electronic medical records, and 58.3% have or are planning to develop a diversity strategy or plan. In addition, 97% of patients with acute myocardial infarction were given percutaneous coronary intervention within 90 minutes of arrival, up from 70% in 2009, ranking second in the nation.
North Carolina made limited progress regarding Access to Emergency Care since the 2009 Report Card. While increasing the proportion of the population within 60 minutes of a level I or II trauma center (94.1%) and the number of accredited chest pain centers per capita (3.5 per 1 million people), the state lost ground in the number of staffed inpatient beds and emergency departments (ED) per capita (289.6 per 100,000 and 11.2 per 1 million people, respectively). North Carolina also continues to have a high hospital occupancy rate (70.7 per 100 staffed inpatient beds) and a low rate of psychiatric care beds (21.9 per 100,000 people).
North Carolina's Public Health and Injury Prevention grade reflects a mix of adequate and poor performance. For instance, while the state has relatively high rates of vaccination among the elderly, only 75.3% of children receive the full schedule of immunizations, down from 84.3% in 2009. North Carolina also has higher-than-average obesity rates among adults and children, contributing to an overburdened medical system.
North Carolina's performance in Disaster Preparedness fell slightly since 2009, resulting in an average grade. Only about a third of registered nurses in North Carolina report receiving training in emergency preparedness, compared to about 40% nationally.
While North Carolina has made great progress in improving its Medical Liability Environment, the state must be vigilant in maintaining recent reforms, such as additional liability protections for EMTALA-mandated care and medical liability caps on non-economic damages. Additional reforms should be considered, including abolishing joint and several liability and providing for malpractice award payments to be offset by collateral sources.
North Carolina must act immediately to address its many issues related to Access to Emergency Care. The number of physicians accepting Medicare has dropped to only 2.5 per 100 Medicare beneficiaries, an access problem likely to be exacerbated by an aging population. With regard specifically to emergency care, the state must work with hospitals and mental health providers to increase the availability of psychiatric care beds and access to community mental health services in order to prevent boarding of mental health patients in the ED. The state needs to work to reduce ED wait times, which average 312 minutes from ED arrival to ED departure for admitted patients.