New York Earns a C and Ranks 21st in the Nation, for Its Support of
Emergency Patients in National Report Card
 

State Fails Category of Medical Liability Environment

Rochester, NY —While New York received A-‘s in the categories of Quality & Patient Safety Environment and Disaster Preparedness on the American College of Emergency Physicians’ (ACEP) National Report Card on the State of Emergency Medicine, the state received a failing grade and ranked 43rd in the nation for its Medical Liability Environment and received an overall grade of C.  The Report Card comes at the time when the national picture looks bleak: job and insurance losses, a rapidly growing senior population and a recent survey forecasting critical shortages of primary care doctors all point to escalating emergency patient populations.
 
New York’s F in the category of Medical Liability Environment is due primarily to the high malpractice award amounts and insurance premiums for practicing physicians in the state. New York’s average malpractice payment of $356,003 is significantly higher than the national average of $285,218 and medical liability insurance premiums for specialists of $95,567 are more than 46 percent higher than the national average. Policymakers have failed to enact reforms such as pre-trial screening panels for liability cases, medical liability caps on non-economic damages and the adoption of expert witness rules requiring witnesses to be of the same specialty as the defendant.

“New York policymakers must work to institute comprehensive medical liability reform in order to help attract and retain physicians,” said Gerard Xavier Brogan, Jr., MD, president of the New York Chapter of ACEP. “The state should enact special liability protections for federally mandated emergency care to help encourage more specialists to provide on-call services for emergency patients.  Shortages of on-call specialists are a significant and dangerous problem in our state’s emergency departments.”

In the category of Access to Emergency Care, New York narrowly avoided its second failing grade, receiving a D- and a national ranking of 36th. The state’s poor showing in this category is due to a number of problems. For instance, though New York has a number of medical specialists on par with the nation average, the state ranks 46th for its access to primary care and 49th for access to mental health providers. The state has the third lowest rate of emergency departments (7.1 per 1 million people) and the second highest daily hospital occupancy rate (80.6 per 100 staffed beds). In addition, New York has only 7.1 emergency departments per one million people, vs. the national average of 19.9.

“As first steps toward addressing the overcrowding and high occupancy rates, New York must increase the number of staffed and available inpatient and psychiatric care beds,” says Dr. Brogan. “New York should also institute a mechanism to track the time spent in the emergency department for admitted and discharged patients to identify areas for improvement.”

New York fared better in the category Public Health & Injury Prevention, receiving a grade of B- and a national ranking of 18th. Contributing factors included rankings in the top eight states for its low rates of traffic deaths, homicides and suicides, fatal occupational injuries, and unintentional firearm-related fatal injuries. New York’s infant mortality rate of 5.8 per 1,000 is lower than the nation average of 6.9 per 1,000, and the state has a lower than average number of obese adults and smokers (22.9 percent and 18.2 percent respectively).

ACEP awarded New York an A- with a national ranking of 12th for the category Quality & Safety Environment. The state has in place multiple systems to promote quality and patient safety in their emergency facilities such as required reporting of adverse events in hospitals and hospital-based infection, as well as a statewide trauma registry. New York’s rate of 38.1 emergency medicine residents per one million people was the fourth highest in the nation.

New York's level of Disaster Preparedness ranked it sixth in the nation with a grade of A-. The state’s high scores in this category can be traced directly to a wide array of planning activities and surge capacity in the event of a man-made or natural disaster event. New York employs an all-hazard medical response plan that is shared with EMS and essential hospital personnel and has a written plan for special needs patients including those requiring dialysis or individual monitoring. Disaster management has become an essential component of the training for all EMS and essential hospital personnel and the state provides additional liability protection to those workers during a disaster. The state also has a real-time or near real-time syndromic surveillance system, a real-time surveillance system for common emergency department presentations and is ranked second and 14th, respectively, for the per capita rates of physicians and nurses enrolled in the state-based Emergency System for Advance Registration of Volunteer Health Professionals program.

“The weakened economy combined with a failing health care system mean that growing numbers of people will need emergency care,” said Dr. Nick Jouriles, president of ACEP.  “In fact, the role of emergency care has never been more critical to this nation, which is why emergency patients must become a top priority for health care reform.  We are urging President-elect Obama and the new Congress to strengthen emergency departments, because they are the health care safety net for us all.”

The nation’s failure to support emergency patients resulted in a C- for the country overall.  Massachusetts earned the highest overall grade of a B and Arkansas ranked last (51st) in the nation with a D-.  The national grade was calculated using the same methodology used for the overall state grades and is a weighted average of the nation’s category grades.

The grades are from ACEP’s National Report Card on the State of Emergency Medicine, a comprehensive analysis of the support that states provide for emergency patients. The new Report Card contains more than  twice the measures of ACEP’s first Report Card in 2006, as well as a new category for disaster preparedness, which makes it more comprehensive, although not directly comparable to the previous Report Card. 

The five Report Card categories (and weightings) are:  Access to Emergency Care (30 percent), Quality and Patient Safety Environment (20 percent), Medical Liability Environment (20 percent), Public Health and Injury Prevention (15 percent) and Disaster Preparedness (15 percent).

The National Report Card on the State of Emergency Medicine was made possible, in part, by funding from the Emergency Medicine Foundation, which gratefully acknowledges the support of The WellPoint Foundation and the Robert Wood Johnson Foundation.

The New York Chapter of ACEP is a state chapter of the American College of Emergency Physicians, a national medical specialty society representing emergency medicine with more than 27,000 members. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

# # #