Category Grades
13C+ 5C+
Access to Emergency Care:
31D- 22D+
Quality/Patient Safety:
25C 11B-
Medical Liability:
1A 1A
Public Health/ Injury Prevention:
15B- 17B-
Disaster Preparedness:
14B+ 22C

Colorado continues to rank first in the nation for its Medical Liability Environment and has improved from 13th to 5th for its overall emergency care environment since 2009. However, some serious concerns remain with regard to Access to Emergency Care, including high rates of uninsured and underinsured adults and children and the need for greater access to behavioral health care.

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Colorado continues to lead the nation in its Medical Liability Environment, having implemented and maintained legislation that allows health care providers to issue apologies to patients without those statements being admissible as evidence of wrongdoing; maintaining expert witness rules that provide for case certification and require expert witnesses to be of the same specialty as the defendant and licensed to practice medicine in the state; and allowing malpractice awards to be offset by collateral sources. The state has maintained its $300,000 cap on non-economic damages despite continuous efforts to increase it.

In Public Health and Injury Prevention, Colorado has some of the lowest obesity rates for adults and children (20.7 and 10.9%, respectively) and relatively high rates of influenza and pneumococcal vaccinations among older adults (65.9 and 75.8%, respectively). The state also has low rates of adult cigarette smoking (18.3%), supported by legislation that prohibits smoking in restaurants, bars, and private worksites.

While dropping eight places since 2009, Colorado maintains some noteworthy practices in Disaster Preparedness. Its medical response plan specifically addresses patients with special needs, patients dependent on medication for chronic conditions, and mental health patients. Colorado is one of only five states to require training in disaster management and response to biological and chemical terrorism for essential hospital and emergency medical services personnel. Since the previous Report Card, Colorado has become accredited by the Emergency Management Accreditation Program.


Colorado continues to face critical issues in Access to Emergency Care, especially related to financial barriers to care and behavioral health capacity. Colorado continues to have one of the highest rates of uninsured people, and even those who have health insurance face financial barriers to receiving care: 17.4% of adults and 10.4% of children in Colorado lack health insurance, while an additional 8.4% of adults and 19.7% of children are underinsured.

Access to behavioral health care is a major barrier in Colorado, which has the second highest proportion of adults reporting an unmet need for substance abuse treatment (10.7%) and the lowest rate of psychiatric care beds (5.5 per 100,000 people) in the nation. Adding to this the sixth lowest rate of staffed inpatient beds (226.7 per 100,000 people), the state faces challenges in addressing emergency department boarding and crowding.

While Colorado has improved slightly in the Quality and Patient Safety Environment, the state is still lacking in many respects. It does not have a uniform system for providing prearrival instructions and scored below average in the percentage of hospitals with electronic medical records (89.7%). Additionally, while Colorado has triage and destination policies in place for trauma patients, it lacks similar policies to enhance the timeliness and quality of care for stroke and ST-elevation myocardial infarction (STEMI) patients.


Financial barriers to care continue to be a major burden on Colorado's people and weaken the state's overall system of emergency care. Colorado must take steps to ensure that all people not only have health insurance but the capability to obtain the care that they need when they need it. The state also should improve access to substance abuse treatment and work with hospitals to increase capacity related to psychiatric care beds and staffed inpatient beds. Financial barriers to care continue to burden Colorado's people and the overall system of care.

To improve Colorado's Quality and Patient Safety Environment, efforts should be made to implement triage and destination policies for STEMI and stroke patients; however, the stroke and STEMI system effort is concentrated outside of state government and statewide regulatory functions, which may pose challenges to improving the overall system of emergency care. The state also should work with and encourage hospitals to collect data on race, ethnicity and primary language and to develop a diversity strategy or plan, as these are the first steps in being able to examine and address health inequities.

Despite overall high performance in Public Health and Injury Prevention, Colorado must work to reduce racial and ethnic disparities in cardiovascular disease and infant mortality rates in its population. The state should address the high rate of binge drinking reported among adults (20.1%), a proportion that has increased considerably since 2009. Colorado could further improve traffic safety in the state by instituting more rigorous graduated driver's license laws, requiring all motorcycle riders to use helmets, and passing a ban on all cellphone use while driving.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 13.5 14.6
Emergency physicians per 100,000 pop 14.6 16.9
Neurosurgeons per 100,000 pop 1.7 2.1
Orthopedists and hand surgeon specialists per 100,000 pop 10.2 10.2
Plastic surgeons per 100,000 pop 2.2 2.1
ENT specialists per 100,000 pop 3.5 3.5
Registered nurses per 100,000 pop 773.1 830.9
Percent of children able to see provider 95.5
Level I or II trauma centers per 1M pop 2.7 1.9
Percent of population within 60 minutes of Level I or II trauma center 87.5 89.9
Accredited chest pain centers per 1M pop 0.8 2.9
Percent of population with an unmet need for substance abuse treatment 9.7 10.7
Pediatric specialty centers per 1M pop 4.4 5.0
Medicaid fee levels for office visits as a percent of the national average 120.1 106.2
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 21 8.7
Percent of adults with no health insurance 18.1 17.4
Percent of adults underinsured 8.4
Percent of children with no health insurance 14.6 10.4
Percent of children underinsured 19.7
Percent of adults with Medicaid 6.4 8.1
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 237.3 226.7
Hospital occupancy rate per 100 staffed beds 65.3 61.0
Psychiatric care beds per 100,000 pop 11.8 5.5
Median time from ED arrival to ED departure for admitted ED patients 244
State collects data on diversion YES YES

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds $8.61 $5.19
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
Accredited by the Emergency Management Accreditation Program (EMAP) NO YES
Special needs patients included in medical response plan NR YES
Patients dependent on medication for chronic conditions in medical response plan NR YES
Medical response plan for supplying dialysis NR 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 NO
Just-in-time training systems in place STATEWIDE COUNTY OR CITYWIDE
Statewide medical communication system with one layer of redundancy YES YES
Statewide patient tracking system YES YES
Statewide real-time or near real-time syndromic surveillance system YES NR
Real-time surveillance system in place for common ED presentations YES YES, STATEWIDE
Bed surge capacity per 1M pop 1,337.0 1,089.3
ICU beds per 1M pop 271.1 298.6
Burn unit beds per 1M pop 5.6 6.2
Verified burn centers per 1M pop 0.205697195 0.2
Physicians registered in ESAR-VHP per 1M pop 15.4 6.6
Nurses registered in ESAR-VHP per 1M pop 93.2 78.5
Behavioral health professionals registered in ESAR-VHP per 1M pop 43.0
Strike teams or medical assistance teams YES YES
Disaster training required for essential hospital/EMS personnel YES, YES YES
Percent of RNs that received emergency training 34.7 35.2

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 20.8 21.8
Lawyers per physician 0.8 0.8
Lawyers per emergency physician 13.9 12.9
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 0
Malpractice award payments per 100,000 pop 1.3 1.8
Average malpractice award payments $275,788 $246,660
National Practitioner Databank reports per 1,000 physicians 21.8 15.9
Apology laws: Apology is inadmissible as evidence in a court of law YES
State has implemented a patient compensation fund NO NO
Number of insurers writing medical liability policies per 1,000 physicians 4.6 5.9
Average medical liability insurance premiums for primary care physicians $12,541 $12,275
Average medical liability insurance premiums for specialists $52,281 $53,023
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 REQUIRED BY STATE REQUIRED
Medical liability cap on non-economic damages $250,001-350,000 $250,001-350,000
Additional liability protection for EMTALA-mandated emergency care NO NO
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 YES YES

Public Health & Injury Prevention

Title 2009
Report Card
Report Card
Bicyclist fatalities per 100,000 cyclists 1.7
Pedestrian fatalities per 100,000 pedestrians 3.3
Percent of traffic fatalities alcohol-related 42.0 39.0
Percent of front occupants using restraints 81.1 82.1
Child safety seat/seat belt legislation - score out of a possible 10 points 2 4
Helmet use required for all motorcylce riders NO NO
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 80.0 75.8
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 75.9 65.9
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 72.9 75.8
Fatal occupational injuries per 1M workers 54.8 32.0
Homicides and suicides (non-motor vehicle)(per 100,000) 21.1 21.3
Unintentional fall-related fatal injuries (per 100,000) 8.4 12.9
Fire/burn related fatal injuries (per 100,000) 0.4 0.6
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.2 0.1
Rate of unintentional poisoning-related deaths (per 100,000) 11.0
Total injury prevention funds per 1,000 persons $732.43 $687.33
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 3
Infant mortality rate per 1,000 live births 6.4 5.9
Percentage of adults who binge drink 16.4 20.1
Percentage of adults who currently smoke 17.9 18.3
Percentage of adult population who are obese (BMI > 30.0) 18.2 20.7
Percentage of children who are obese 10.9
Cardiovascular disease disparity ratio 2.8
HIV diagnosis disparity ratio 5.9
Infant mortality disparity ratio 2.9

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system NO YES
Funded state EMS medical director YES YES
Emergency medicine residents per 1M pop 11.7 11.6
Adverse event reporting required YES YES
% of counties with Enhanced 911 capability 100.0 100.0
State has a uniform system for providing pre-arrival instructions NO NO
State uses CDC guidelines for state field triage protocols YES (2006)
State has or is working on a stroke system of care NO 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 NO 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) 3
% of hospitals with computerized practitioner order entry 15.8 80.5
% of hospitals with electronic medical records 25.7 89.7
% of patients with AMI given PCI within 90 minutes of arrival 67 93
Median time to transfer to another facility for acute coronary intervention 52
% of patients with AMI who received aspirin within 24 hours 100
% of hospitals collecting data on race/ethnicity and primary language 54.5
% of hospitals with or planning to develop a diversity strategy or plan 42.1

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