Washington has made a strong commitment to the Quality and Patient Safety Environment and Public Health and Injury Prevention. However, the state lacks coordination for Disaster Preparedness and faces a challenging Medical Liability Environment.
Washington earns an A- in Public Health and Injury Prevention, the fifth highest score in the nation. The state boasts low rates of fatal injuries and generally low levels of chronic disease risk factors. Traffic fatality rates in Washington are particularly low, thanks in part to its strong child safety seat and adult seatbelt legislation and strict laws against distracted driving. The state is first in the nation for seatbelt use, with 97.5% of vehicle front-seat occupants using seatbelts. The infant mortality rate (4.5 deaths per 1,000 live births) is the 6th lowest in the nation. Only 17.5% of the state's adults are current smokers and strong anti-smoking legislation keeps secondhand smoke out of bars, restaurants, and workplaces.
Washington continues to be a leader in the Quality and Patient Safety Environment, with patient care procedures, protocols, and triage guidelines in place for ST-elevation myocardial infarction (STEMI), trauma, and stroke patients. The state has a uniform system for providing pre-arrival instructions. Washington has a strong prescription drug monitoring program, which has been implemented statewide and monitors drug schedules II to V. While the state continues to fund quality improvement efforts within the emergency medical services (EMS) system, it does not have a funded state EMS medical director.
Washington has worked to improve some aspects of Access to Emergency Care. It has improved its Medicaid fee levels, with a 61.2% increase between 2007 and 2012 that has lifted the state's fees to 125.1% of the national average. A recent collaboration between state officials and the medical community resulted in implementation of best practices that protect Medicaid patients' Access to Emergency Care while better ensuring that Medicaid patients seek and receive treatment in appropriate care settings.
Washington's Disaster Preparedness rank fell, largely because the state did not implement improvements made in other states. Per capita federal Disaster Preparedness funds have dropped from $7.09 in the 2009 Report Card to $5.31, and the state does not have a budget line item for Disaster Preparedness funding specific for health care surge. Washington lacks many policies and procedures that ensure that medically vulnerable patients receive care in a disaster and that help coordinate responses between different responders. However, the state is conducting a pilot project for statewide electronic patient tracking software, which is a step in the right direction.
Washington has a challenging Medical Liability Environment, with few protections in place for the state's medical practitioners. Although the state maintains below-average medical liability insurance premiums for both primary care physicians ($11,128) and specialists ($52,935), practitioners are vulnerable to unfounded lawsuits. Washington does not provide for case certification or for pretrial screening panels, both of which can weed out frivolous or unsubstantiated lawsuits. It remains in the minority of states without any cap on non-economic damages in medical liability cases, which can lead to exorbitant malpractice award payments.
Despite some improvements noted above, Washington continues to receive a failing grade for Access to Emergency Care. One major area of concern is the lack of resources and inpatient capacity for mental health patients. The state ranks third worst in the nation for the number of psychiatric care beds (8.3 per 100,000 people).
Washington is a home rule state with authority for local response held by local health officers. While this is a logical setup for disaster response in a large and rural state, Washington could benefit from more attention to statewide planning and processes. A statewide medical communication system with redundancy would help ensure that different authorities can coordinate their response to an unfolding disaster. Washington also has some of the lowest rates of physicians, nurses, and behavioral health professionals registered in the Emergency System for Advance Registration of Volunteer Health Professionals and should focus on recruiting these professionals in advance of a disaster event.
Washington should work to reform its Medical Liability Environment by passing a medical liability cap on non-economic damages to ensure that award payments do not rise uncontrollably. Another vital reform is special liability protection for care mandated by the Emergency Medical Treatment and Labor Act, which would protect emergency care workers who provide care in life-threatening situations, often to high-risk patients, without knowledge of their medical histories.
Washington needs greater investments in its hospital infrastructure. In addition to the paucity of psychiatric care beds, the state has some of the lowest levels of staffed inpatient and intensive care unit beds. There is also very low access to level I or II trauma centers, with only 83.2% of the population within 60 minutes of one.