Troubling issues related to the Medical Liability Environment and Access to Emergency Care overshadowed North Carolina’s strong performance in the Quality and Patient Safety Environment, as well as its Disaster Preparedness efforts.
Strengths. North Carolina’s grade for the Quality and Patient Safety Environment reflects the state’s commitment to improving and maintaining statewide systems of care. The state has demonstrated this commitment by funding quality improvement of its EMS system, as well as an EMS medical director position, and maintaining a uniform system for providing pre-arrival instructions. Hospitals within the state have also demonstrated a commitment to quality improvement through the use of electronic medical records (56.9 percent) and computerized practitioner order entry (21.6 percent).
North Carolina ranked 20th in the nation in the Disaster Preparedness category. The state has made noteworthy strides in preparing for disasters and emergency events. North Carolina has an all-hazards medical response plan or ESF-8 plan that is shared with all EMS and essential hospital personnel and a written plan for the coordination of the State Emergency Operations Center or local emergency management agencies to provide security to hospitals during a disaster event. The state also requires training in disaster management and response to bio- and chemical terrorism for all EMS and essential hospital personnel. North Carolina has statewide patient and victim tracking systems and a medical communication system with one layer of redundancy.
Challenges. North Carolina’s Medical Liability Environment could benefit substantially from instituting liability reforms. The state lacks a medical liability cap on non-economic damages, as well as additional liability protections for EMTALA-mandated emergency care. While the state requires expert witnesses to be of the same specialty as the defendant, it lacks requirements for case certification by an expert witness and for the witness to be licensed to practice in the state.
North Carolina falls well below most states with regard to Access to Emergency Care. The state has relatively few facilities compared to the nation as a whole with 1.0 Level I or II trauma centers and 11.7 emergency departments per 1 million people, compared with an average across the states of 1.8 and 19.9 per 1 million, respectively. The lack of insurance among adults and children is also a concern in North Carolina: 19.2 percent of adults and 14.0 percent of children lack health insurance, compared to nationwide averages of 17.2 and 11.7 percent, respectively.
North Carolina received an average grade in Public Health and Injury Prevention. Despite a number of high points, such as traffic safety, the state could still make substantial improvements in this category. North Carolina has a high infant mortality rate (8.8 deaths per 1,000 live births) compared to the nation as a whole (6.9 per 1,000). The state also suffers from a relatively high percentage of adults who are obese (26.6 percent) and who are current smokers (22.1 percent).
Recommendations. Policymakers in North Carolina should focus on improving Access to Emergency Care for everyone, regardless of their insurance status. The state needs to address the relatively high rates of uninsured, as well as the deficit in available facilities to provide adequate access to care for all residents. The state should also work with the medical community to increase the number of providers accepting Medicare, currently 2.7 per 100 beneficiaries. The state must also address the lack of mental health providers, needing an additional 42.9 full-time equivalent providers to serve its population, and the low rate of psychiatric care beds (19.5 per 100,000 people).
North Carolina could also benefit from a more favorable Medical Liability Environment. Policymakers should act to implement a cap on non-economic damages and to abolish joint and several liability, which may help attract and retain more physicians. Additional liability protections for EMTALA-mandated emergency care could help encourage more specialists to provide on-call services to emergency patients.