Wyoming has robust hospital capacity and some liability protections for health care providers. However, financial barriers to care, health care work force shortages, and a lack of statewide policies and practices for its Quality and Patient Safety Environment and Disaster Preparedness lands the state at the bottom of this year's rankings.
Wyoming has some strong elements facilitating Access to Emergency Care with robust access to important medical facilities. The state is fourth in the nation for access to emergency departments (ED) and fifth for its high per capita rate of level I or II trauma centers; however, because of its geography, only 33% of the population is within 60 minutes of a trauma center. Wyoming has the second lowest hospital occupancy rate in the nation and ranks among the top 10 for per capita rates of psychiatric care beds and staffed inpatient beds. The state's median time from ED arrival to departure for admitted patients is only 216 minutes, well below the national average.
Wyoming has instituted some protections for practitioners in its Medical Liability Environment. Mandatory pretrial screening panels help discourage lawsuits that lack merit, and physician apologies are not admissible as evidence in court. Wyoming has abolished joint and several liability, reducing unfair liability payments. While its average malpractice award payments are among the highest in the nation ($545,729), the state does have one of the lowest rates of malpractice payments.
Finally, Wyoming has very low obesity rates, with a low proportion of children who are obese (10.7%) and a below-average proportion of adults who are obese (25.0%).
Wyoming has the lowest ranked Quality and Patient Safety Environment in the country, largely due to a lack of state-level investment in this area. Wyoming provides no funding for quality improvement within the emergency medical services (EMS) system or a state EMS medical director. Wyoming also lacks a uniform system for providing pre-arrival instructions and triage and destination policies for stroke, ST-elevation myocardial infarction (STEMI), and trauma patients.
Although Wyoming fares well in overall hospital capacity, lack of health insurance and a health care workforce shortage are troubling barriers to care. The state has high proportions of adults and children with no health insurance (20.3% and 10.0%, respectively) and the second highest proportion of children who are underinsured (22.5%). The state also has low per capita rates of emergency physicians; neurosurgeons; plastic surgeons; and ear, nose, and throat specialists which can affect the availability of on-call specialty care in the ED.
These numbers are troubling in light of Wyoming's challenges in Public Health and Injury Prevention. Wyoming has the highest rate of traffic fatalities in the country (26.9 per 100,000 people) and the second highest rate of fatal occupational injuries (99.0 per 1 million workers). The state also has high rates of homicide and suicide; firearm-related deaths; and poisoning-related deaths, which include drug overdoses. Wyoming also has extremely low rates of vaccination among children and older adults.
Wyoming has the second highest per capita federal investment in Disaster Preparedness at $18.84 but lags behind most other states, largely due to a lack of important statewide policies and plans. The state has no redundant medical communication system in place, which would be an asset in a large and rural state, and no statewide patient-tracking system. Wyoming's medical response plan does not include patients dependent on medications or dialysis to ensure these patients receive needed care.
Wyoming needs to invest in quality improvement in the emergency care system and in patient safety. In addition to developing state-level protocols for stroke, STEMI, and trauma patients, Wyoming should encourage more of its hospitals to adopt technological advances, such as computerized practitioner order entry and electronic medical records, which help reduce errors and improve the ability of doctors and hospitals to provide timely and appropriate care.
While many of Wyoming's challenges in Access to Emergency Care are due to being a large, rural state, Wyoming can and must take action to improve immunization rates and reduce traffic fatalities. The state should invest in outreach and education aimed at increasing seatbelt use and pass legislation to require helmets for all motorcycle riders. The state could also explore innovative approaches to increasing immunization rates among children and the elderly.
Wyoming can strengthen its Medical Liability Environment to help lower the average malpractice award payment and to aid in recruiting a skilled workforce. The state should explore a medical liability cap on non-economic damages and require periodic payments of malpractice awards. Wyoming should consider providing special liability protections for care mandated by the Emergency Medical Treatment and Labor Act to further alleviate the burden on physicians who are willing to provide emergent, life-saving care to patients.