Since the last Report Card, Arizona has made significant improvements to its Medical Liability Environment and addressed some challenges in Public Health and Injury Prevention. However, the state continues to struggle with health care workforce shortages and overall Access to Emergency Care.
Arizona has made great strides in improving its Medical Liability Environment, having instituted several reforms that help protect practitioners and reduce frivolous lawsuits. It provides additional liability protections for Emergency Medical Treatment and Labor Act (EMTALA)-mandated emergency care that require clear and convincing evidence of negligence. It has also mandated expert witness rules that require that the witness be of the same specialty as the defendant. While the state still has relatively high average medical liability insurance premiums for primary care physicians ($17,883) and specialists ($65,100), these rates are considerably lower than reported in 2009.
Arizona continues to improve its Quality and Patient Safety Environment with strong and effective policies, including destination policies in place for both stroke and ST-elevation myocardial infarction patients, as well as funding for quality improvement of the EMS system. The state ranks among the top 10 for indicators related to quality of care for patients suffering cardiac events, including the proportion of patients with acute myocardial infarction given percutaneous coronary intervention within 90 minutes of arrival (91%) and the median time to transfer to another facility for chest pain patients (54 minutes). Arizona also has a unique sudden cardiac arrest reporting and education network called SHARE (Save Hearts in Arizona Research and Education), which includes the majority of people living in Arizona.
Arizona continues to struggle with Access to Emergency Care and ranks close to last in the nation in this category. The state ranks among the bottom 10 for access to several essential medical professionals, including registered nurses; ear, nose, and throat specialists; and orthopedists and hand surgeons. Arizona also has a great need for primary care and mental health care providers (4.3 and 2.1 fulltime providers needed per 100,000 people, respectively). There is a glaring need for better access to mental health care and substance abuse treatment in Arizona; the state has one of the lowest rates of psychiatric care beds available (11.6 per 100,000 people) and one of the highest levels of unmet need for substance abuse treatment (10.1%). Emergency physicians in the state report that psychiatric patients often spend days in the emergency department (ED) waiting for admission to inpatient behavioral health treatment beds.
Despite improvements in Public Health and Injury Prevention, Arizona still lags in the area of early childhood immunizations: only 68.1% of children received recommended immunizations. Although it has a relatively low obesity rate among adults (24.7%), the very high rate among children (19.8%) is a growing public health emergency. The state also has some of the highest rates of pedestrian fatalities (9.1 per 100,000 pedestrians), fall-related deaths (12.2 per 100,000), and unintentional poisoning-related deaths, which include drug overdoses (14.7 per 100,000).
While Arizona has maintained its strong Disaster Preparedness policies and procedures, it has lagged behind other states in the number of physicians, nurses, and behavioral health providers registered in the Emergency System for Advance Registration of Volunteer Health Professionals. The state also falls below average for bed surge capacity and intensive care unit beds per 1 million, which could impede timely, safe, and effective emergency care response during a major disaster or mass casualty event.
Arizona desperately needs to improve Access to Emergency Care by both growing the state's health care workforce and increasing hospital capacity to reduce ED boarding and crowding. Additional graduate medical education funding for more residency positions could be one strategy to help address the workforce shortage issue. The state needs to cultivate an environment that attracts and retains specialists, particularly for mental health care and substance abuse care, as well as on-call specialty care. The low numbers of psychiatric care beds, staffed inpatient beds, and number of EDs overall likely contribute to boarding and crowding, as evidenced in higher-than-average ED wait times (292 minutes from ED arrival to departure for admitted patients).
Arizona must continue to improve its Medical Liability Environment. While the state has taken major steps forward, more attention is needed to help further reduce physician liability insurance premiums to ensure that high insurance costs do not inhibit efforts to address physician workforce shortages. Adoption of pretrial screening panels could help further weed out frivolous lawsuits and reduce unnecessary liability-related costs.