Virginia has made notable improvements in the Quality and Patient Safety Environment and in supporting medical liability reforms. However, there are signs that Virginia's emergency care infrastructure is under strain and in need of investment.
Virginia continues to support a strong Quality and Patient Safety Environment. The state is making significant progress in promoting and protecting the interests of emergency patients and physicians. The state continues to fund quality improvement efforts within the emergency medical services (EMS) system, as well as an EMS medical director. The state's destination policies allow EMS providers to bypass local hospitals to take stroke, ST-elevation myocardial infarction (STEMI), and trauma patients to appropriate facilities. In 2013, Virginia provided additional funds for the purchase of 12-lead electrocardiograms in ambulances for early detection of cardiac events. This allows EMS providers to better determine where patients need to be transported and has been shown to markedly decrease the time that it takes for patients to receive a potentially life-saving percutaneous coronary intervention.
Virginia has updated its Medical Liability Environment to better protect its health care workforce from unfounded lawsuits and excessive malpractice awards. Virginia provides for case certification and voluntary pretrial screening panels and has apology inadmissibility laws in place. In 2011, Virginia passed a comprehensive 20-year agreement on the medical malpractice cap on total damages that will result in the cap gradually increasing from $2 million to $3 million by the year 2032. Virginia recently passed tort reforms on where a lawsuit may be filed, recovery of expert witness fees and costs in certain situations, and clarification of the use of medical records to corroborate testimony in wrongful death cases.
While declining somewhat overall in Public Health and Injury Prevention, Virginia has implemented legislation to reduce traffic fatalities and improve traffic safety. In 2013, the state passed a new law to address texting while driving, making it a primary offense, with a $125 fine for the first offense and $250 for the second offense. The state also supports solid funding levels for injury prevention ($547.98 per 1,000 people) and dedicates funds specifically for child and elderly injury prevention efforts.
Virginia faces challenges in ensuring continued statewide Access to Emergency Care. The Department of Medical Assistance's PEND program treats emergency physicians differently from all other physicians taking care of Medicaid patients, retroactively reducing payments to slightly more than $22.06 for approximately 45,000 claims a year. Federal law requires emergency physicians to see Medicaid patients, but Virginia's PEND process means the state refuses to compensate physicians appropriately for the services that they provide.
Virginia faces shortages in hospital capacity, with a relatively high hospital occupancy rate (70.5 per 100 staffed beds) and below-average per capita rates of emergency departments (ED), staffed inpatient beds, and psychiatric care beds. Virginia EDs also struggle with relatively high ED wait times (286 minutes from ED arrival to ED departure). However, Virginia's health department and collaborators developed and adopted guidelines to help hospitals better manage emergency patients when inpatient beds are not available, with the ultimate goal of reducing ED wait times.
While Virginia has many important Disaster Preparedness practices and policies in place, it still faces some challenges. The state has a very low rate of intensive care unit beds (223.8 per 1 million) despite an above-average bed surge capacity. Virginia also lacks solid liability protections for volunteers and health care workers during a disaster and has roughly average rates of health professionals registered in the Emergency System for Advance Registration of Volunteer Health Professionals.
Emergency doctors are required to treat Medicaid patients by federal law, yet Virginia's PEND program retroactively reduces payments without disputing that the services were provided. Elimination of the PEND program will help ensure that Virginia's emergency physicians are fairly compensated and that Access to Emergency Care will not be unnecessarily threatened.
There are strong signs that Virginia's emergency care system is under strain. Virginia faces shortages in nurses, hospital capacity, and Access to Emergency Care. Investments that bolster hospital capacity and the availability of frontline care providers like nurses will improve access to care both in a large disaster situation and for everyday trauma patients.
Emergency care is an essential public service that involves unique challenges and circumstances that lawmakers should recognize and address by strengthening medical liability protections for health care workers. Joint and several liability reform can limit the scope of medical liability cases to only those parties responsible, and collateral source rule reform can reduce duplicative damage payments, both of which may help to bring down Virginia's high malpractice award payments.