Despite receiving solid marks for its Quality and Patient Safety Environment and having one of the best Medical Liability Environments in the country, Texas continues to face significant problems, particularly in the area of Access to Emergency Care.
Strengths. Texas has the third lowest average malpractice award payment in the nation ($148,495), reflecting the multitude of medical liability reforms that have been enacted. The state has a $250,000 medical liability cap on non-economic damages and additional liability protections for EMTALA-mandated emergency care. The state also has expert witness rules requiring witnesses to be of the same specialty as the defendant and provides for case certification by an expert witness. Periodic payments of malpractice awards also are required by the state to alleviate the financial burden on physicians.
Texas has made numerous efforts to improve the Quality and Patient Safety Environment by maintaining a statewide trauma registry and providing funding for quality improvement within the EMS system. In addition, the state has or is working on a PCI network or STEMI system of care, as well as a stroke system of care.
Challenges. Access to Emergency Care in Texas is in crisis. The state has the highest rates of uninsured children and adults (21.2 and 25.8 percent, respectively), and ranks among the lowest states regarding access to all types of providers. Texas needs an additional 664.4 primary care providers and 139.4 mental health providers (full time equivalents) to serve the state’s growing population. In addition, the state ranks among the worst 10 with regard to rates of orthopedists and hand surgeon specialists (7.3 per 100,000 people), emergency physicians (8.2 per 100,000), and registered nurses (674.4 per 100,000). Texas also faces a serious lack of physicians accepting Medicare (2.5 per 100 beneficiaries).
The state’s grade in Public Health and Injury Prevention also indicates significant challenges for Texas. The state lacks adequate funding for injury prevention programs with total allocations of $14.96 per 1,000 people, the fourth lowest in the country. Texas also lacks a law requiring all riders on all motorized cycles to wear a helmet. The percentage of traffic fatalities that are alcohol-related (48.0 percent) is the fifth highest among the states. In addition, the state ranks among the worst 10 with regard to immunizations among children aged 19–35 months (76.7 percent).
Disaster Preparedness in Texas suffers from the state’s limited capacity to deploy health care workers during a disaster event. The state lacks medical assistance teams or strike teams, and has no nurses or physicians registered in a state-based Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) program. Texas also lacks a statewide real-time or near real-time syndromic surveillance system. In addition, the state receives the lowest level of federal funding for disaster preparedness ($6.24 per capita).
Recommendations. High rates of uninsured residents, combined with a shortage of providers, present a serious problem for Texas. The state needs to address the severe lack of physicians, registered nurses, and other providers in order to enhance access to medical care throughout its population. The state’s comprehensive medical liability reforms are reportedly improving this situation, as the state has reported a significant influx of new physicians since those reforms were enacted. Additional efforts are needed to increase the percentage of the population with health insurance in order to increase overall access to care and reduce the number of patients who delay care until they require emergency treatment.
Texas could improve its status with regard to the Quality and Patient Safety Environment by providing funding for a state EMS medical director position, and implementing a uniform system for providing pre-arrival instructions. The state could also benefit from increasing the number of emergency medicine residents (8.2 per 1 million people).
At the time the data were collected, Texas was in the process of implementing a state-based ESAR-VHP program. The state can expect its disaster preparedness score to improve significantly by making a strong effort to register volunteer nurses and physicians into the newly developed ESAR-VHP program. The state could take additional steps to provide specific liability protections to health care workers during a disaster event, and prepare for deployment during a disaster by developing regional strike teams or medical assistance teams.