Rhode Island's overall decline from 2nd to 18th is a result of its failure to improve the Medical Liability Environment and to keep pace with other states improving upon their Quality and Patient Safety Environment and Public Health and Injury Prevention scores.
Rhode Island continues to support strong Disaster Preparedness policies and procedures, which includes getting public health and emergency physician input during an Emergency Support Function 8 response and requiring all emergency medical services (EMS) personnel to be trained in disaster management and response. Rhode Island's burn center capacity, 1.0 burn centers per 1 million people, ranks second in the nation. The state also ranks in the top 10 for physicians, nurses, and behavioral health professionals registered in the Emergency System for Advanced Registration of Volunteer Health Professionals.
While Rhode Island's grade in Public Health and Injury Prevention worsened somewhat, the state continues to benefit from low rates of traffic fatalities, fatal occupational injuries, homicides, and suicides. The proportion of traffic fatalities due to alcohol has fallen significantly in the past 5 years. The state also has banned smoking in restaurants, bars, and worksites. Rhode Island has strengthened its adult seatbelt laws to include primary enforcement of the law.
While the Quality and Patient Safety Environment fell in comparison to other states, Rhode Island has a few noteworthy accomplishments in this arena. The state supports the second largest emergency medicine resident population, with 70.5 per 1 million people, and ranks first with regard to the proportion of hospitals developing a diversity strategy or plan (62.5%) and the proportion of patients with acute myocardial infarction given percutaneous coronary intervention within 90 minutes of arrival (98%).
Rhode Island's Medical Liability Environment continues to be among the worst in the nation due to its inability to pass any meaningful liability reform and its increasing average malpractice award payments. The state lacks pretrial screening panels; apology inadmissibility laws, which permit physicians to apologize to patients without fear of that apology being used as evidence against them in a malpractice suit; and case certification by an expert witness to confirm that medical liability cases have merit. Average medical liability insurance premiums for primary care physicians and specialists are well above the average across the states. Insurance premiums for specialists ($82,426) are a particular concern at more than 43% above the national average ($57,459). At the same time, the average malpractice award payment has increased markedly from $260,388 in the 2009 Report Card to $355,199.
The Quality and Patient Safety Environment grade has suffered for Rhode Island, because of new indicators included in this Report Card and the state not keeping pace with improvements and processes implemented in other states. For instance, it does not have funding for quality improvement of the EMS system and no longer has a funded state EMS medical director. The state also lacks a uniform system for providing pre-arrival instructions, field trauma triage protocols or guidelines, and a statewide trauma registry.
Access to Emergency Care in Rhode Island shows a mixture of results, with high rates of emergency physicians and specialists coupled with limited treatment centers and hospital resources. Rhode Island has a low rate of emergency departments (ED) per capita (9.5 per 1 million people) and a high hospital occupancy rate (72.5 per 100 staffed beds). Combined with a severe decrease in the availability of psychiatric care beds since 2009 (from 37.2 to 25.9 per 100,000), these factors all likely contribute to the seventh longest ED wait times in the nation (343 minutes from ED arrival to ED departure for admitted patients).
Rhode Island must take action to improve its failing Medical Liability Environment. While the state is home to many specialists, on-call specialist support is still at a critical juncture, and liability protections should be put in place to ensure a fair environment for providing care in emergency situations often involving high-risk patients. Such protections would help to encourage specialists to provide on-call services in the state. Rhode Island should also consider strengthening its expert witness rules to include case certification and require that expert witnesses be licensed to practice medicine in the state.
Rhode Island must also work to improve Access to Emergency Care by increasing the availability and accessibility of inpatient and psychiatric care beds and working with EDs to achieve shorter wait times in the ED. Increasing access to substance abuse treatment and outpatient mental health care might decrease the burden on an already overwhelmed emergency care system in this state with the seventh highest rate of poisoning-related deaths, which includes drug overdoses, and second highest rate of adults with an unmet need for substance abuse treatment. Financial barriers to care also persist in Rhode Island despite lower-than-average rates of uninsured adults and children, including Medicaid fee levels for office visits that are only 39.9% of the national average.