South Carolina

Category Grades
26C 33D+
Access to Emergency Care:
45F 45F
Quality/Patient Safety:
16B+ 13B-
Medical Liability:
5A 7B+
Public Health/ Injury Prevention:
50F 51F
Disaster Preparedness:
34C 46F

South Carolina has worsened with regard to its overall emergency care environment, largely due to failing grades in Access to Emergency Care, Public Health and Injury Prevention, and Disaster Preparedness.

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South Carolina continues to support one of the best Medical Liability Environments in the nation. The state has liability protections for the provision of care mandated by the Emergency Medical Treatment and Labor Act (EMTALA), a medical liability cap on non-economic damages, and expert witness rules requiring case certification. South Carolina has also seen a dramatic decrease in the average malpractice award since the 2009 Report Card, from $218,482 to $176,366, the 10th lowest in the nation.

While South Carolina's overall grade dropped slightly from 2009, its Quality and Patient Safety rank improved, owing in part to having a funded state emergency medical services (EMS) medical director and implementing destination policies for ST-elevation myocardial infarction (STEMI) and trauma patients that allow EMS providers to bypass local hospitals to bring patients to specialty centers. Additionally, the proportion of patients with acute myocardial infarction given percutaneous coronary intervention within 90 minutes of arrival increased from 55% to 97%. South Carolina's hospitals are also among the most likely to collect data on patients' race and ethnicity and primary language (76.1%) and to be developing a diversity strategy or plan (58%).


South Carolina fell one place to rank last in the nation in Public Health and Injury Prevention. This is due to a combination of poor public health outcomes and the failure of the state to pass key legislation to improve upon those measures. For instance, while the state has some of the highest rates of traffic fatalities (15.2 per 100,000 people), bicyclist fatalities (13.5 per 100,000 bicyclists), and pedestrian fatalities (11.7 per 100,000 pedestrians), it has not passed legislation banning texting or handheld cellphone use for all drivers. The state is also one of only seven to have failed to pass any antismoking legislation to discourage smoking and reduce secondhand smoke exposure in restaurants, bars, and worksites. South Carolina has some of the highest rates of adult and child obesity (30.8% and 21.5%, respectively).

Access to Emergency Care in South Carolina is impeded by growing financial barriers to care. Rates of uninsurance have increased dramatically for both adults and children since the last Report Card, resulting in South Carolina ranking 43rd and 48th on these measures, respectively. Uninsured rates for children have increased from 10.7% to 13.3%, and even those children with insurance face financial barriers to care, with 18.8% considered underinsured. Similarly, nearly one in five adults lack health insurance, with 9.2% of those who have insurance delaying or forgoing care due to cost. South Carolina's aging population also faces challenges in accessing care, with only 2.1 physicians accepting Medicare per 100 beneficiaries, the fifth lowest rate in the nation.

South Carolina faces challenges in Disaster Preparedness with regard to a lack of key policies and limited resources and hospital capacity for responding to a disaster or mass casualty event. The state has one of the lowest bed surge capacities (310.8 per 1 million people) and per capita rates of burn unit beds (2.1 per 1 million) in the nation. South Carolina does not require training in disaster management and response for hospital and EMS personnel, and only 31.9% of registered nurses reported receiving training related to disaster response. The state also lacks a Uniform Emergency Volunteer Health Practitioners Act or similar legislation that would provide appropriate protections for health care workers and the entities that sponsor them when responding to a disaster.


South Carolina must improve Access to Emergency Care for all by reducing financial barriers and increasing hospital and workforce capacity across the board. The state has a shortage of health care workers with below average rates of emergency physicians; neurosurgeons; orthopedists and hand surgeons; plastic surgeons; ear, nose, and throat specialists; and registered nurses. A concerted effort is needed to ensure that the people of South Carolina have access to the primary and specialty care that they need, especially with the expected increase in insured patients that will likely result from full implementation of the Patient Protection and Affordable Care Act.

While improving access to care, South Carolina must take immediate steps to address the poor public health outcomes of its population, specifically the high rates of traffic fatalities, infant mortality, and obesity. The state must work toward reducing these and other types of preventable deaths and chronic conditions that threaten to overburden the entire medical system.

South Carolina must work to maintain existing medical liability reforms. While its medical liability insurance premiums are below the national average for the states, they are slightly higher than in 2009. If this trend continues, insurance premiums may pose challenges to recruiting and retaining an adequate supply of on-call specialists and emergency physicians.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 8.7 9.1
Emergency physicians per 100,000 pop 11.8 12.9
Neurosurgeons per 100,000 pop 1.4 1.5
Orthopedists and hand surgeon specialists per 100,000 pop 8.8 8.7
Plastic surgeons per 100,000 pop 1.8 1.8
ENT specialists per 100,000 pop 3.1 3
Registered nurses per 100,000 pop 809.2 912.6
Percent of children able to see provider 95.5
Level I or II trauma centers per 1M pop 1.1 1.1
Percent of population within 60 minutes of Level I or II trauma center 79.2 88.4
Accredited chest pain centers per 1M pop 1.6 3.4
Percent of population with an unmet need for substance abuse treatment 8.2 9.4
Pediatric specialty centers per 1M pop 2.1 1.9
Medicaid fee levels for office visits as a percent of the national average 111.8 NR
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) -21 NR
Percent of adults with no health insurance 17.6 20.7
Percent of adults underinsured 9.2
Percent of children with no health insurance 10.7 13.3
Percent of children underinsured 18.8
Percent of adults with Medicaid 8.7 11.4
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 311.8 293.9
Hospital occupancy rate per 100 staffed beds 71.1 65.5
Psychiatric care beds per 100,000 pop 25.7 23
Median time from ED arrival to ED departure for admitted ED patients 272
State collects data on diversion NO NO

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $6.91 $4.95
State budget line item health care surge NO
ESF-8 plan is shared with all EMS and essential hospital personnel YES YES
Emergency physician input into the state planning process YES, NO YES
Public health and emergency physician input during an ESF-8 response YES
Drills, exercises conducted involving hospital personnel, equipment, or facilities per hospital
Accredited by the Emergency Management Accreditation Program (EMAP) CONDITIONALLY YES
Special needs patients included in medical response plan YES YES
Patients dependent on medication for chronic conditions in medical response plan NO NO
Medical response plan for supplying dialysis YES YES
Mental health patients included in medical response plan YES
Medical response plan for supplying psychotropic medications NO
Mutual aid agreements in place with behavioral health providers LOCAL LEVEL
State requires long-term care and nursing home facilities to have a written disaster plan YES
State able to report number of exercises involving long-term care facilities or nursing NR
Just-in-time training systems in place STATEWIDE COUNTY OR CITYWIDE
Statewide medical communication system with one layer of redundancy NO YES
Statewide patient tracking system YES NO
Statewide real-time or near real-time syndromic surveillance system YES YES
Real-time surveillance system in place for common ED presentations YES YES, STATEWIDE
Bed surge capacity per 1M pop 791.6 310.8
ICU beds per 1M pop 316.2 276.3
Burn unit beds per 1M pop 1.6 2.1
Verified burn centers per 1M pop 0 0
Physicians registered in ESAR-VHP per 1M pop 12.9 9.5
Nurses registered in ESAR-VHP per 1M pop 73.3 116.6
Behavioral health professionals registered in ESAR-VHP per 1M pop 29
Strike teams or medical assistance teams YES YES
Disaster training required for essential hospital/EMS personnel YES, YES NO
Percent of RNs that received emergency training 38.2 31.9

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 11.9 11.2
Lawyers per physician 0.5 0.5
Lawyers per emergency physician 9.9 8.7
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 0
Malpractice award payments per 100,000 pop 1.2 2.1
Average malpractice award payments $218,482 $176,366
National Practitioner Databank reports per 1,000 physicians 23.6 27.7
Apology laws: Apology is inadmissible as evidence in a court of law YES
State has implemented a patient compensation fund YES YES
Number of insurers writing medical liability policies per 1,000 physicians 5 7.1
Average medical liability insurance premiums for primary care physicians $9,788 $10,268
Average medical liability insurance premiums for specialists $40,937 $43,743
Presence of pretrial screening panels NONE NO
Pretrial screening panel's findings admissible as evidence N/A N/A
Periodic payments are: required, granted upon request, at court's discretion NO NO
Medical liability cap on non-economic damages $350,001-500,000 $350,001-500,000
Additional liability protection for EMTALA-mandated emergency care YES YES
Joint and several liability abolished PARTIALLY PARTIALLY
Collateral Source Rule/Provides for Awards to be Offset NO
State provides for case certification YES YES
Expert witness required to be of the same specialty as the defendant YES YES
Expert witness must be licensed to practice medicine in the state YES NO

Public Health & Injury Prevention

Title 2009
Report Card
Report Card
Bicyclist fatalities per 100,000 cyclists 13.5
Pedestrian fatalities per 100,000 pedestrians 11.7
Percent of traffic fatalities alcohol-related 50 46
Percent of front occupants using restraints 74.5 86
Child safety seat/seat belt legislation - score out of a possible 10 points 6 6
Helmet use required for all motorcylce riders NO NO
Distracted driving legislation score - out of a possible 4 points 0
Graduated drivers' licenses legislation score -out of a possible 5 points 1
Percentage of children aged 19-35 months who are immunized 83.2 74.1
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 62.9 65.2
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 61.5 70.1
Fatal occupational injuries per 1M workers 58.9 35.3
Homicides and suicides (non-motor vehicle)(per 100,000) 19.9 20.7
Unintentional fall-related fatal injuries (per 100,000) 4.9 6.4
Fire/burn related fatal injuries (per 100,000) 2.2 1.6
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.6 0.4
Rate of unintentional poisoning-related deaths (per 100,000) 13.3
Total injury prevention funds per 1,000 persons $186.97 $171.42
Dedicated child injury prevention funding YES
Dedicate elderly injury prevention funding NO
Dedicated occupational injury prevention funding NO
Anti-smoking legislation score - score out of a possible 3 points 0
Infant mortality rate per 1,000 live births 9.4 7.4
Percentage of adults who binge drink 13.5 15.4
Percentage of adults who currently smoke 22.3 23.1
Percentage of adult population who are obese (BMI > 30.0) 29.4 30.8
Percentage of children who are obese 21.5
Cardiovascular disease disparity ratio 2
HIV diagnosis disparity ratio 7.4
Infant mortality disparity ratio 2.2

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system YES YES
Funded state EMS medical director NO YES
Emergency medicine residents per 1M pop 6.6 10.2
Adverse event reporting required YES YES
% of counties with Enhanced 911 capability 100 100
State has a uniform system for providing pre-arrival instructions NO NO
State uses CDC guidelines for state field triage protocols NR
State has or is working on a stroke system of care YES YES
State has triage and destination policy in place for stroke patients NO
State has or is working on a PCI network or a STEMI system of care YES YES
State has triage and destination policy in place for STEMI patients YES
State maintains statewide trauma registry YES YES
State has triage and destination policy in place for trauma patients YES
Prescription drug monitoring program score (range 0-4) 2
% of hospitals with computerized practitioner order entry 21.9 60
% of hospitals with electronic medical records 63.5 93.3
% of patients with AMI given PCI within 90 minutes of arrival 55 97
Median time to transfer to another facility for acute coronary intervention 59
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 76.1
% of hospitals with or planning to develop a diversity strategy or plan 58

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