West Virginia

Category Grades
25C 24C-
Access to Emergency Care:
5B 11C
Quality/Patient Safety:
30C- 30C-
Medical Liability:
20C 16C+
Public Health/ Injury Prevention:
43D- 42F
Disaster Preparedness:
38D+ 35D

West Virginia has strong liability protections in place for health care providers, admirable access to medical facilities, and adequate hospital capacity overall. However, the state faces challenges with high rates of chronic disease risk factors and fatal injuries, as well as weak Disaster Preparedness plans.

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West Virginia has a strong Medical Liability Environment, with the nation's eighth lowest average malpractice award payment ($170,416). West Virginia is one of only 8 states that has enacted special liability protections for Emergency Medical Treatment and Labor Act-mandated care. The medical liability cap on non-economic damages, abolishment of joint and several liability, and collateral source rule reform work to hold down excessive judgments. Case certification by expert witnesses helps ensure that only cases with merit are advanced. These and other reforms help West Virginia maintain a fair legal atmosphere that promotes good practice and protects patient access to care.

Despite its rural and mountainous geography, West Virginia fares well in certain aspects of Access to Emergency Care. It has the fifth highest per capita rates of staffed inpatient beds (455.3 per 100,000 people) and psychiatric care beds (47.5 per 100,000 people). West Virginians also have above-average access to emergency departments and level I or II trauma centers. The state ranks fifth in the nation for the low proportion of people needing but not receiving substance abuse treatment (7.0%).

West Virginia has bright spots in its Quality and Patient Safety Environment, despite a subpar showing in the category. The state has dedicated funding for both quality improvement and a state emergency medical services director. West Virginia developed systems of care for stroke and ST-elevation myocardial infarction (STEMI) patients and has triage and destination policies for trauma patients. These policies help ensure that patients in West Virginia receive prompt and appropriate medical attention.


West Virginia ranks poorly in Public Health and Injury Prevention, largely due to risk factors for chronic disease. It has the second highest rate of adults who smoke (28.6%), the third highest rate of adult obesity (32.4%), and a childhood obesity rate higher than the national average (18.5%). West Virginia's children face other risks as well: The state has one of the lowest rates of childhood immunizations in the nation (69.3%). In terms of injury, West Virginia has some of the highest rates of motor vehicle-related deaths, fatal occupational injuries, and accidental firearm-related deaths and the highest rate of accidental poisoning deaths, which include overdoses (25.4 deaths per 100,000 people).

West Virginia lacks many important statewide Disaster Preparedness policies and plans, leaving the state potentially vulnerable to emergency situations. The state's medical response plan does not address patients dependent on medications, and it has one of the lowest rates of behavioral health professionals registered in the Emergency System for Advance Registration of Volunteer Health Professionals. West Virginia also lacks systems that help state officials track and respond to emerging disasters, such as a patient-tracking system, a syndromic surveillance system, or a surveillance system for common emergency department presentations.


West Virginia must undertake a concentrated public health response to combat numerous health risk behaviors. It has the second highest rate of tobacco use but weak anti-smoking legislation. Prohibiting smoking in bars, restaurants, and workplaces would not only discourage smoking but protect workers and other patrons from secondhand smoke exposure. The state's dangerously high obesity rates for adults and worrisome health markers for children also require a public health strategy. West Virginia is making strides to address these issues: In recognition of the public health disparities facing West Virginians and in concert with its land grant mission, West Virginia University has established the state's only School of Public Health. This new school now has nearly 50 faculty members dedicated to improving public health indicators over time; the dean of the new school is an emergency medicine physician.

West Virginia is also acting to address the state's high injury rates. The West Virginia Department of Health and Human Resources has established a new Violence and Injury Prevention Program (VIPP) within the Bureau for Maternal and Child Health. The VIPP has a full-time coordinator and has initiated a series of statewide planning efforts designed to address the notable injury disparities in the state with the engagement of the emergency medicine community. In addition, West Virginia University has received an additional 5 years of funding from the Centers for Disease Control and Prevention (CDC) for its CDC-designated Injury Control Research Center and is supporting the efforts of the VIPP.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 8.2 8.6
Emergency physicians per 100,000 pop 12.3 12.4
Neurosurgeons per 100,000 pop 1.9 2.4
Orthopedists and hand surgeon specialists per 100,000 pop 7.8 8.4
Plastic surgeons per 100,000 pop 1.5 1.6
ENT specialists per 100,000 pop 3.5 3.7
Registered nurses per 100,000 pop 938.2 985.5
Percent of children able to see provider 95.8
Level I or II trauma centers per 1M pop 3.3 3.2
Percent of population within 60 minutes of Level I or II trauma center 71 91.4
Accredited chest pain centers per 1M pop 0 1.6
Percent of population with an unmet need for substance abuse treatment 7.9 7.0
Pediatric specialty centers per 1M pop 2.8 2.2
Medicaid fee levels for office visits as a percent of the national average 108.4 99.6
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 7 12.9
Percent of adults with no health insurance 14.9 16.3
Percent of adults underinsured 9.1
Percent of children with no health insurance 8.5 9.7
Percent of children underinsured 17.6
Percent of adults with Medicaid 11.1 11.2
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 490.8 455.3
Hospital occupancy rate per 100 staffed beds 63.6 62.7
Psychiatric care beds per 100,000 pop 44.5 47.5
Median time from ED arrival to ED departure for admitted ED patients 268
State collects data on diversion YES YES

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $9.41 $7.75
State budget line item health care surge NO
ESF-8 plan is shared with all EMS and essential hospital personnel NR YES
Emergency physician input into the state planning process YES, YES 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) NO NO
Special needs patients included in medical response plan NO YES
Patients dependent on medication for chronic conditions in medical response plan NO NO
Medical response plan for supplying dialysis NO NO
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 STATE 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 YES
Just-in-time training systems in place STATEWIDE STATEWIDE
Statewide medical communication system with one layer of redundancy YES YES
Statewide patient tracking system YES NO
Statewide real-time or near real-time syndromic surveillance system NO NO
Real-time surveillance system in place for common ED presentations NR NO
Bed surge capacity per 1M pop 612.6 887.1
ICU beds per 1M pop 384.3 364.3
Burn unit beds per 1M pop 2.2 2.2
Verified burn centers per 1M pop 0 0
Physicians registered in ESAR-VHP per 1M pop NR 34
Nurses registered in ESAR-VHP per 1M pop NR 434.9
Behavioral health professionals registered in ESAR-VHP per 1M pop 2.7
Strike teams or medical assistance teams YES NO
Disaster training required for essential hospital/EMS personnel NO, YES NO
Percent of RNs that received emergency training 39.3 39.7

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 11.2 12.1
Lawyers per physician 0.4 0.4
Lawyers per emergency physician 9.1 9.7
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) -2 -3
Malpractice award payments per 100,000 pop 3.5 6.1
Average malpractice award payments $209,565 $170,416
National Practitioner Databank reports per 1,000 physicians 30.1 57.8
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 13.1 15.5
Average medical liability insurance premiums for primary care physicians $23,599 $19,369
Average medical liability insurance premiums for specialists $93,828 $72,606
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 >$500,000 >$500,000
Additional liability protection for EMTALA-mandated emergency care YES YES
Joint and several liability abolished YES YES
Collateral Source Rule/Provides for Awards to be Offset YES
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 NO NO

Public Health & Injury Prevention

Title 2009
Report Card
Report Card
Bicyclist fatalities per 100,000 cyclists 3.3
Pedestrian fatalities per 100,000 pedestrians 3.9
Percent of traffic fatalities alcohol-related 39 32
Percent of front occupants using restraints 89.6 84.9
Child safety seat/seat belt legislation - score out of a possible 10 points 4 7
Helmet use required for all motorcylce riders YES YES
Distracted driving legislation score - out of a possible 4 points 4
Graduated drivers' licenses legislation score -out of a possible 5 points 0
Percentage of children aged 19-35 months who are immunized 77.7 69.3
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 66.4 68.5
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 65.4 64.4
Fatal occupational injuries per 1M workers 81.6 86.5
Homicides and suicides (non-motor vehicle)(per 100,000) 19.2 18.8
Unintentional fall-related fatal injuries (per 100,000) 7.6 10.7
Fire/burn related fatal injuries (per 100,000) 1.7 1.4
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.6 0.7
Rate of unintentional poisoning-related deaths (per 100,000) 25.4
Total injury prevention funds per 1,000 persons $212.47 $758.28
Dedicated child injury prevention funding NO
Dedicate elderly injury prevention funding YES
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 8.1 7.3
Percentage of adults who binge drink 11.2 10.1
Percentage of adults who currently smoke 25.7 28.6
Percentage of adult population who are obese (BMI > 30.0) 31.0 32.4
Percentage of children who are obese 18.5
Cardiovascular disease disparity ratio 2
HIV diagnosis disparity ratio 8.6
Infant mortality disparity ratio 1.6

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system YES YES
Funded state EMS medical director YES YES
Emergency medicine residents per 1M pop 9.9 30.7
Adverse event reporting required NO NO
% of counties with Enhanced 911 capability 98.2 100
State has a uniform system for providing pre-arrival instructions NO YES
State uses CDC guidelines for state field triage protocols NO
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 NO
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 13.5 63
% of hospitals with electronic medical records 34.7 87
% of patients with AMI given PCI within 90 minutes of arrival 61 91
Median time to transfer to another facility for acute coronary intervention 104
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 72.3
% of hospitals with or planning to develop a diversity strategy or plan 43.1

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