Category Grades
38D+ 44D
Access to Emergency Care:
30D- 41F
Quality/Patient Safety:
18B- 28C
Medical Liability:
31D 31D
Public Health/ Injury Prevention:
44F 43F
Disaster Preparedness:
21B- 15C+

Alabama continues to support Disaster Preparedness systems and has worked to maintain an adequate Quality and Patient Safety Environment. However, the state continues to struggle with workforce shortages related to Access to Emergency Care and high rates of preventable injury and chronic disease.

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Alabama has a relatively strong Disaster Preparedness system with several provisions in place to protect its citizens in the event of a disaster. For instance, the state addresses special needs patients, patients dependent on medication for chronic conditions, patients dependent on dialysis, mental health patients, and patients on psychotropic medications in its medical response plans. Furthermore, Alabama has made great improvements since the last Report Card in hospital capacity to respond to a disaster or mass casualty event, ranking among the top states for its bed surge capacity (1,634.0 beds per 1 million people), burn unit beds (11.0 per 1 million), and intensive care unit beds (350.1 per 1 million). The state also has strong liability protections in place for health care workers responding to a disaster, which will encourage a timely and effective medical response.

Alabama has been working to maintain its Quality and Patient Safety Environment by continuing to fund a state emergency medical services (EMS) medical director as well as quality improvement initiatives within the EMS system. The state has or is working on a stroke system of care, and it has destination policies in place that allow EMS to bypass local hospitals to take stroke patients to a hospital specialty center. In addition, 95% of patients with acute myocardial infarction are given percutaneous coronary intervention within 90 minutes, and the median time to transfer to another facility for chest pain patients is well below the average across the states (60 versus 72 minutes).


Alabama has failed to address its health care workforce shortage since the last Report Card, severely affecting overall Access to Emergency Care. Despite a slight increase in the number of emergency physicians, the state ranks 50th for having only 7.5 emergency physicians per 100,000 people. Alabama has low rates of specialists, including neurosurgeons, orthopedists, and plastic surgeons, as well as physicians accepting Medicare (2.0 per 100 beneficiaries) and mental health providers, with an additional 1.7 full-time providers needed per 100,000 people. While the state has lower-than-average rates of adults (14.9%) and children (7.3%) with no health insurance, a relatively large proportion of adults are underinsured (9.7%), which may further impede access to care.

Contributing to Alabama’s workforce shortage is an unfavorable Medical Liability Environment, which has not improved since the previous Report Card. The state continues to lack reforms that would require clear and convincing evidence of wrongdoing in medical liability cases involving Emergency Medical Treatment and Labor Act (EMTALA)-mandated care and medical liability caps on non-economic damages. Alabama has also failed to abolish joint and several liability or pass legislation that would prevent apologies made by health care providers from being used as evidence of wrongdoing. Finally, the average malpractice award payment is $330,942, representing a 12.5% increase since 2009.

Alabama’s workforce shortage is a critical challenge in light of the high rates of fatal injuries in several categories. Alabama has some of the nation’s highest rates of traffic fatalities (16.6 per 100,000 people), bicyclist fatalities (10.9 per 100,000 cyclists), pedestrian fatalities (11.0 per 100,000 pedestrians), homicides and suicides (22.5 per 100,000 people), and unintentional fire- or burn-related deaths (2.0 per 100,000 people). Alabama’s inhabitants also suffer disproportionately from chronic disease risk factors with high rates of adult and child obesity (32.0 and 18.6%, respectively) and a high percentage of adults who currently smoke (24.3%).


In the area of Public Health and Injury Prevention, there are several steps that Alabama could take to advance the health and safety of its citizens. With high rates of traffic fatalities, Alabama should consider strengthening its safety belt and child safety seat legislation. The state may consider expanding primary enforcement of its current adult seat belt law to cover all vehicle seats. Similarly, child safety restraint laws may be expanded to require that children through age 8 use booster seats, as opposed to current requirements that cover children through age 5. The state also lacks smoke-free legislation that targets worksites, restaurants, and bars, despite the high rates of adults who currently smoke and the known poor chronic health outcomes associated with tobacco use.

Alabama must work diligently to increase its health care workforce and implement measures to attract and retain emergency physicians, specialists, and primary care providers. Supporting a more favorable Medical Liability Environment would help address this issue. As such, the state should consider instituting additional liability protections for EMTALA-mandated care, requiring pretrial screening panels to determine whether a medical liability case has merit, and placing a $250,000 medical liability cap on non-economic damages.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 3.9 4.5
Emergency physicians per 100,000 pop 6.7 7.5
Neurosurgeons per 100,000 pop 1.6 1.7
Orthopedists and hand surgeon specialists per 100,000 pop 8.8 8.8
Plastic surgeons per 100,000 pop 1.7 1.7
ENT specialists per 100,000 pop 4.1 3.9
Registered nurses per 100,000 pop 918.9 945.1
Percent of children able to see provider 95.4
Level I or II trauma centers per 1M pop 0.2 1.0
Percent of population within 60 minutes of Level I or II trauma center 48.3 75.2
Accredited chest pain centers per 1M pop 0.4 3.1
Percent of population with an unmet need for substance abuse treatment 7.1 6.7
Pediatric specialty centers per 1M pop 3.3 3.5
Medicaid fee levels for office visits as a percent of the national average 113.1 92
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 7 0
Percent of adults with no health insurance 17.8 14.9
Percent of adults underinsured 9.7
Percent of children with no health insurance 7.4 7.3
Percent of children underinsured 15.2
Percent of adults with Medicaid 8.5 9.4
Hospital closures in 2006/2011 0 3
Staffed inpatient beds per 100,000 pop 394.0 384.3
Hospital occupancy rate per 100 staffed beds 64.3 62.1
Psychiatric care beds per 100,000 pop 18.3 24.5
Median time from ED arrival to ED departure for admitted ED patients 240
State collects data on diversion YES YES

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds 6.9 4.84
State budget line item health care surge NO
ESF-8 plan is shared with all EMS and essential hospital personnel YES 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 129 0.2
Accredited by the Emergency Management Accreditation Program (EMAP) YES YES
Special needs patients included in medical response plan YES YES
Patients dependent on medication for chronic conditions in medical response plan YES
Medical response plan for supplying dialysis NO YES
Mental health patients included in medical response plan YES
Medical response plan for supplying psychotropic medications YES
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 NO YES
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 263.8 1634
ICU beds per 1M pop 306.5 350.1
Burn unit beds per 1M pop 11.2 11
Verified burn centers per 1M pop 0 0
Physicians registered in ESAR-VHP per 1M pop 37.6 6.2
Nurses registered in ESAR-VHP per 1M pop 107.8 333.3
Behavioral health professionals registered in ESAR-VHP per 1M pop 14.7
Strike teams or medical assistance teams YES NO
Disaster training required for essential hospital/EMS personnel NO, NO YES
Percent of RNs that received emergency training 43.3 40.8

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 12.3 10.6
Lawyers per physician 0.6 0.5
Lawyers per emergency physician 18.3 14.1
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 1
Malpractice award payments per 100,000 pop 1.3 0.8
Average malpractice award payments 294148 330942
National Practitioner Databank reports per 1,000 physicians 12.4 13.1
Apology laws: Apology is inadmissible as evidence in a court of law NO
State has implemented a patient compensation fund NO NO
Number of insurers writing medical liability policies per 1,000 physicians 5.5 7.8
Average medical liability insurance premiums for primary care physicians 7484 7484
Average medical liability insurance premiums for specialists 36126 36126
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 At judge's or court's discretion At court's discretion
Medical liability cap on non-economic damages NONE NONE
Additional liability protection for EMTALA-mandated emergency care NO NO
Joint and several liability abolished NO NO
Collateral Source Rule/Provides for Awards to be Offset YES, NO OFFSET
State provides for case certification NO NO
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 10.9
Pedestrian fatalities per 100,000 pedestrians 11.0
Percent of traffic fatalities alcohol-related 39 35
Percent of front occupants using restraints 82.3 88
Child safety seat/seat belt legislation - score out of a possible 10 points 5 5
Helmet use required for all motorcylce riders YES YES
Distracted driving legislation score - out of a possible 4 points 2
Graduated drivers' licenses legislation score -out of a possible 5 points 0
Percentage of children aged 19-35 months who are immunized 80.7 79.2
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 62 62.6
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 59.7 68.3
Fatal occupational injuries per 1M workers 55.6 37.8
Homicides and suicides (non-motor vehicle)(per 100,000) 21.3 22.5
Unintentional fall-related fatal injuries (per 100,000) 3.4 4.5
Fire/burn related fatal injuries (per 100,000) 2.4 2.0
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.9 0.7
Rate of unintentional poisoning-related deaths (per 100,000) 10.7
Total injury prevention funds per 1,000 persons 201.39 286.61
Dedicated child injury prevention funding YES
Dedicate elderly injury prevention funding NO
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 9.4 8.7
Percentage of adults who binge drink 11.2 13.7
Percentage of adults who currently smoke 23.2 24.3
Percentage of adult population who are obese (BMI > 30.0) 30.5 32.0
Percentage of children who are obese 18.6
Cardiovascular disease disparity ratio 2.7
HIV diagnosis disparity ratio 7.5
Infant mortality disparity ratio 1.8

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 4.8 6.2
Adverse event reporting required NO NO
% of counties with Enhanced 911 capability 97 100
State has a uniform system for providing pre-arrival instructions YES NO
State uses CDC guidelines for state field triage protocols YES
State has or is working on a stroke system of care YES YES
State has triage and destination policy in place for stroke patients YES
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 YES
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) 3
% of hospitals with computerized practitioner order entry 17.2 68.3
% of hospitals with electronic medical records 34.7 89.4
% of patients with AMI given PCI within 90 minutes of arrival 56 95
Median time to transfer to another facility for acute coronary intervention 60
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 40
% of hospitals with or planning to develop a diversity strategy or plan 34.4

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